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ANNUAL REPORT 



lURGEON-GENER; 



I'LHLIC HEALTH AND MARINEHOSPITA 
'^KRVia- OF THE UNITI-I) STATES. 



nSCAL YEAR 19(». 



WASHTNGTOH: 



ANNUAL REPORT 



OP THE 



SURGEON-GENERAL 



OP THE 



PUBLIC HEALTH AND MARINE-HOSPITAL 
SERVICE OF THE UNJtEfi/StAtES.- 



-. •- :.' 



•■ • 



POR THE 



FISCAL YEAR 1903. 



WASHINGTON: 
GOVERNMENT PRINTII^G OFFICE. 



«. 






■• "J 






I 



Trkasury Dkpartmekt, 

tService. 



':']*: . ' / • : /'DcAjBiiientNo. 2354. 

• *" 'piil^r'lh'nHh'nM Marine-H(»ipit<il i'!fenn( 



• •' • • • 



. • 



' ••-• 



• «■ 



.• • » • . 



• • :" • •« 



• • • 



• '• 






OPERATIONS 



OP THS 



UNITED STATES PUBLIC HEALTH AND 
MARINE-HOSPITAL SERVICE. 



1903. 



CONTENTS. 



Pace. 

Secretaiy' 8 letter of transmittal to Congress 13 

RepMort to theSecretary — summary of operations 16 

Division of personnel and accounts 23 

Personnel : 

(Jommissioned officers — promotions, appointments, resignations, and 

casualties 25 

Advisory board for Hyeienic Laboratory 26 

Chief 01 division of zoology, Hyf^enic Laboratory 26 

Noncommissioned officers — samtary inspectors, acting assistant sur- 
geons, medical inspectors, internes, pharmacists, pilots, and marine 

engineers 26 

Hospital attendants 1 27 

Special details of commissioned officers: 

For domestic duty 27 

For foreign duty 28 

Domestic and foreign duty in connection with outbreak of bubonic 

plague in Mexico 29 

Inve&g|ation of reported prevalence ot smallpox 30 

Special details of noncommissioned officers: 

For duty in connection with prev^iting the spread of epidemic 

diseases in the United States 30 

For foreign duty 31 

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

public-health associations 31 

Boards convened 32 

Accounts : 

Vouchers passed for pa3rment and settlement 34 

Financial statement 34 

Administrative details— circular letters 36 

Division of marine hospitals and relief 39 

Belief of seamen -.... 41 

Belief stations 41 

Inspection of stations 41 

Aid to other branches of the Government: Revenue-Cutter Service, Steam- 
boat-Inspection Service^ life^Saving Service^ Coast and Geodetic Survey, 
Light-House Service, Civil Service Commission, Post-Office Department, 

United States Customs Service 42 

Physical examinations of merchant seamen 42 

Phvsical examinations of officers of the Revenue-Cutter Service 42 

Bention of medical officers to local courts (opinion of the Acting Solicitor 

of the Treasury) •. 44 

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

medical officer in command) 45 

Purveying depot at New York (report of medical purveyor) 50 

Advisory Doard of purveying depot. 51 

New hospitals: New York, N. Y.; Buffalo, N. Y.; Pittsburg, Pa.; Savan- 
nah, Ga.; ftin Juan, P. R 52 

Report on oil-burning plant at San Francisco marine-hospital 53 

BepoirB and improvements made to buildings and grounds, including 
woric nnder contract, and repairs to heating apparatus of marine hospi- 
tal..... •.•-...-.. 53 

1 



8 coNTEirrs. 



Divifiion of sanitary reports and statistics 59 

Cholera 61 

Yellow fever 65 

Plague 67 

United States (San Francisco) 67 

Foreign and insular 67 

Smallpox 72 

United States 72 

Foreign and insular 05 

General mortality statistics in the United States 99 

Division of foreign and insular quarantine (embracing medical inspection of 

immigrant) 101 

Cuba 108 

Chanee in details of officers 103 

No yellow fever 103 

Passengers from infected Mexican ports to Florida via Habana 103 

Cuban quarantine methods 104 

Disinfection at Habana of vessels leaving for United States ports 106 

Reports of transactions: 

Habana 107 

Matanzas Ill 

Nuevitas 112 

Santiago 114 

Cienfuegoe 118 

Porto Rico 119 

Title to Mirafiores Island 120 

Stegomyia mosquitoes in San Juan 121 

Reports of transactions: 

San Juan and subports 122 

Ponce 126 

Mexico 126 

Plague in Ensenada and MazaUan 126 

Detail of medical officers to Vera Cruz, Tampico, and Progreso, on 

account of prevalence of yellow fever 128 

Letter of instructions 128 

Issue of certificates of immunity forbidden 129 

Investigation as to mosquitoes earned bv ships 129 

Disinfection at Mexican ports of vessels Dound for the United States. . 130 
Reports of transactions: 

Vera Cruz ^ 131 

Tampico 132 

Progreso 133 

Central and South America ( f niit jiort inspection service) 133 

Season of 1902— July 1 to October 31 133 

Reporta of transactions: 

Port Limon 133 

Puerto Cortes 134 

BocasdelToro 135 

Ceiba 135 

Bluefields 135 

Belize 136 

Season of 1903— April. May, June 137 

Additional precautions on account of yellow fever at Port Limon . . 138 
Officer at Livingston authorized to issue certificates to vessels sail- 
ing from Puerto Barrios 138 

Reports of transactions: 

Port Limon 139 

Puerto Cortes 140 

Livingston 142 

Bocas del Toro 143 

Ceiba 144 

Bluefields 145 

BeUze 146 

Hawaii 147 

Title to quarantine island at Honolulu confirmed 147 

Report of transactions at Honolulu and subports 147 



CONTENTS. 9 

Diyiaon of fore^ and infiular quarantine — Continned. "P^ge. 

Philippine filandfl 150 

Assistant Sorgeon Heiser detailed as chief quarantine officer 150 

Work of Passed Assistant 8ar(;;eon Perry commended hy PhiUppine 

government 150 

Manila, and suhports: 

Report of transactions Jnly 1 to September 15, 1902 151 

Floating disinfecting plants (baizes) at lloilo and Cebu 156 

Report of transactions to June 30, 1903 157 

Cholera 157 

Pla§rue 158 

Station at Jolo established 159 

Examination for cholera infection in Pasig River 162 

Financial statement 175 

Japan 179 

Destruction of rats on vessels leaving plague-infected ports 179 

Reports of transactions: 

Yokohama 180 

Nagasaki 181 

Kobe 181 

China 183 

Destruction of rats on vessels leaving plague-infected ports 183 

Reports of transactions: 

Hongkong 183 

Shai^hai 186 

India 189 

Calcutta — detail of medical officer to Uniteil States consulate on 

account of prevalence of plague 189 

Efeypt 190 

Alexandria and Cairo — inspection of disinfection of rags prior to their 

shipment to the United States 190 

England 192 

Liverpool — report of transactions 192 

Medical inspection of immi^nts 193 

Detail of officers to United States ports and Quebec, Canada 193 

Book of instructions prepared by the Bureau 194 

Certificates of insanity 194 

Boards of medical officers to consider special cases 195 

Ni^ht inspection at Quebec, Canada 195 

Ships' manifests not to be signed by service officers 196 

Inspection of immigrants on harkentine Vera CniZy wrecked near New- 

bem, N. C 197 

Report» of transactions: 

United States 198 

Porto Rico 209 

Hawaii 210 

Canada 211 

Italy (emigrants from Naples, Genoa, Palermo) 212 

IHviflion of domestic quarantine 215 

Plague in San Francisco 217 

Plaffue on United States-Mexican border 268 

Yellow fever 275 

None in the United States 275 

Modification of (][uarantine regulations 275 

Patrol of Mississippi Gulf coast 275 

Smallpox in the United States 279 

Assistance rendered State health authorities 279 

Aid rendered postal service 285 

Leprosy 285 

Revision of the United States quarantine regulations 285 

National quarantine stations, reports from 285 

Portland, Me 286 

Eastport, Me 286 

Reeay Island, Delaware 287 

Delaware Br^sJrwater 287 

Alexandria, Va 289 

OapeGharlee 289 



10 CONTENTS. 

Division of domestic quarantine — Continued. 

National quarantine stations, reporta from — Ck)ntinued. Face. 

Cape Fear 290 

Savannah, Ga 290 

South Atlantic 292 

Brunswick, Gra 293 

Tampa Bay, Florida 294 

Cumberland Sound, Femandina, Fla 296 

St Johns river inspection station, Mayport, Fla 296 

Key West 297 

Boca Grande 298 

Cedar Keys 299 

St. George Sound 299 

Santa Rosa quarantine, Pensacola, Fla 299 

Biscayne Bay quarantine, Miami, Fla 300 

PuntaRassa 301 

Fascagoula, Miss : 302 

Gulf 302 

San Diego, Cal 303 

Los Angeles and Santa Barbara 304 

San Francisco 305 

Eureka : 306 

Columbia River 307 

Hoquiam, Wash 307 

Port Townsend (Seattle, Tacoma, South Bend, Port Angeles.) 307 

Nome, Alaska 310 

Texas-Mexican border inspection senice 310 

Reports of transactions: 

Laredo, Tex i 310 

El Paso, Tex 311 

Eagle Pass, Tex 311 

Police power of national quarantine officers 311 

Treatment of "via" vessels at Southern stations 313 

Division of scientific research 315 

Transactions of the division 317 

Yellow-fever institute 317 

Spotted fever 318 

first General International Sanitary Convention of American Republics. . 318 

Plague Conference 320 

First annual conference of State health authorities with the Public Health 

and Marine-Hospital Service 321 

Hvgienic laboratory — report of the director 322 

Personnel 322 

Studentofficers 324 

Bulletins 324 

Standard antitoxin 325 

Plague 326 

Weekly inspections 326 

Pathological report 326 

Report of a case of lipoma arborescens 327 

Micro-photography 328 

Disinfectants 328 

Plague vaccines 328 

New laboratory building 329 

Division of Zoology, report of the chief of 330 

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

and public health associations 335 

Association of Military Sui]^ns, Boston, Mass., May 19-21, 1903, by 

Asst. Sui^. Gen. G. T. A^ughan 335 

American Public Health Association, New Orleans, Ia. , December 8-13, 

1902, by Sui^. H. R. Carter 336 

Meeting of special committee with committee on revision of the Phai^ 

macopceia of the United States, by Passed Asst. Surg. M. J. Rosenau. 338 
First Egyptian Mediod Congress, Cairo, Egypt, December 19-24, 1902, 

by Asst Surg. V. G. Heiser 338 

American Public Health Association, New Orleans, La., by Asst Surg. 

Claude C. Pierce 341 



CONTENTS, 11 

iflion of scientific research— Continued. 

Beports of officers detailed to represent the Service at meetings of medical 
iad pablic health associations-— CSontinued. PB«re. 

Florida State Medical Association, St Augustine, Fla., April 8, 1903, 

by Aast Surg. Claude C. Pierce 343 

Alabama State Medical Association, Talladega, Ala., April 21-24, 

1903, by Ch. Warden Stiles-.... 344 

Texas State Medical Association, San Antonio, Tex., April 2&-May 1, 

1903, by Ch. Warden Stiles 346 

American Pharmaceutical Association, Philadelphia, Pa., September 

8-16, 1902, by Senior Pharmacist S. W. Richardson 346 

American Pharmaceutical Association, Philadelphia, Pa., September 

&-16. 1902, by Senior Pharmacist A. M. Roehrig 347 

cellaneous division (including contributed articles and necropsy reports) . . 349 

Transactions of the division 361 

Contributed articles: 

Dislocation first metatarsal bone downward and outward into plantar 
arch — ^Direct reduction through opening made by incision— -Kecov- 

ery. By Suig. H. W. Sawtelle 362 

A case of acute yeUow atrophy of the liver compared with two cases 

of Weil's disease. By Suig. Eusene Wasdin 364 

The epidemic of cholera in the Aiilippine Islands during the year 

1902. By Passed Asst Surg. J. C. Perry 357 

Trachoma as an epidemic and maritime disease. By Passed Asst 

Suig. J. M. Eager 376 

Value of the prompt recognition of the underlying causes of coma, 
with report of a case of pernicious malarial fever of the comatose 

type. By Asst Sui^. A. J. McLaughlin 379 

A case of osteomyehtis of the ulna K>llowing typhoid fever, due to 
the streptococcus pyogenes — Early operation — Kecoverv. By Asst. 

Sure. A. J. McLaughlm .' 383 

Reports of fata] cases, with necropsies 386 

istics of United States marine hospitals and relief stations 473 

ex 636 



LETTER OF TRANSMITTAL 



Treasury Department, 

Washington^ December Z3^ 1903. 

Sib: In accordance with section 9 of the act of Congress approved 
July 1, 1902, entitled ^^An act to increase the efficiency and change the 
name of the Marine-Hospital Service," I have the honor to ti*ansmit 
herewith the annual repK)rt of the Surgeon-General of the Public 
Health and Marine-Hospital Service for tne fiscal year 1903. 
Respectfully, 

Leslie M. Shaw, Secretary. 

To the Speaker of the House of Representatives. 

13 



r 



ANNUAL REPORT 



OF THE 



SURGEON-GENERAL PUBLIC HEALTH AND 

MARINE-HOSPITAL SERVICE. 



REPORT TO THE SECRETARY. 



Treasury Department, 
Bureau of Public Health and 

Marine-Hospital Service, 
Washingto7i^ D, 6'., December 11^ 1903, 
Hon. Leslie M. Shaw, 

Secretary of the Treasury, 

Sir: I have the honor to submit, for transmission to Congress, in 
compliance 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, 1903, the same being the thirty- 
second annual report of the Service, in the one hundred and fifth year 
of its existence, and the second annual report under its new name. 

I beg leave to invite attention to the fact that this report differs 
from previous annual reports in that no transactions are included 
beyond the end of the fiscal year. Heretofore it has been customary to 
include later transactions, particularly those relating to quarantine and 
epidemic work, but it is proposed to hereafter confine the annual report 
to the fiscal year. It will be noted also that much of the matter here- 
tofore published in the annual report is now published in the several 
bulletins of the Service, making the annual report smaller in volume. 

The operations of the Service have been conducted under the act of 
Congress to "increase the efficiency and change the name of the 
Marme-Hospital Service," approved July 1, 1902, and new regulations 
in accordance therewith promulgated November 29, 1902. 

sanitary convention of AMERICAN REPUBLICS. 

In accordance with resolutions passed by the Second International 
Conference of the Pan-American States, Held in the City of Mexico, 
October, 1901, to January, 1902, the first general international sani- 
tary convention of the American Republics was held at Washington, 
D. C, December 2-5, 1902. Eight Central and South American 
Republics, Mexico, and the United States were represented in the con- 
vention, which passed resolutions relating to ganitary and qufi^T^w\]\\i^ 



16 PUBLIC HEALTH AND MABINE-H08PITAL 8EBVICE. 

measures and effected the formation of an International Sanitary 
Bureau to aid and be aided by the several republics and to be perma- 
nently located in Washington. The transactions of this convention 
have been published in full as Senate document No. 169, Fifty-seventh 
Congress, second session. A summarized account will be found in the 
report of the Division of Scientific Kesearch. 

PLAGUE CONFERENCE. 

Under section 7, act of July 1,1902, 22 States and Territories hav- 
ing joined in a request, representatives of the boards of health of said 
States and Territories were convened in Washington January 19, 1903, 
to consider the plague situation in California. H^solutions were passed 
which have materially aided the Service in the prosecution of its work 
in Chinatown, San Francisco. The transactions <Jf this conference 
have been published in full in the Public Health Reports of January 
23 and February 6, 1903, and a summary of the same will be found in 
the report of the Division of Domestic Quarantine. 

ANNUAL OONFEHENCE WTTH STATE AND TERBITORIAL HEALTH 

AUTHOHITIES. 

The first annual conference of State and Territorial health authori- 
ties with the Public Health and Marine-Hospital Service, under sec- 
tion 7, act of July 1, 1902, was held in Washington June 3, 1903. 
Twenty-two States and Territories were represented. The delegates, 
in turn, gave synopses ot the laws under which their respective boards 
operate, and a resolution was adopted favoring the formation of com- 
mittees on special diseases and special sanitary subjects for the consid- 
eration of such questions relating to the same as might be referred to 
them by the Surgeon-General. The transactions will be published in 
full in the near future. An interesting account of this conference 
will be found in the report of the Division of Scientific Kesearch. 

The two conferences above mentioned have developed a spirit of 
harmony and cooperation between the State and National governments 
in matters of public health, which is of great present value and in the 
future there will doubtless be demonstrated in still greater degree the 
benefits of this provision of the law. 

THE NATIONAL QUARANTINE SERVICE. 

Maritime quarantine has been conducted at 37 national quarantine 
disinfection and inspection stations in the United States proper, 5,922 
vessels being inspected before entry and 352 vessels disinfected. 

In October, 1902, by request of the State health authorities of Maine, 
inspectors were stationed, and are still maintained, on the noilhern 
border of that Stat<3 to prevent the introduction of smallpox from the 
province of New Brunswick. 

The inspection service on the Mexican border has been continued 
against the introduction of smallpox, yellow fever, and later the plague, 
which last disease made its appearance in Ensenada, Lower California, 
and Mazatlan, upon the west coast of Mexico. At the close of the fiscal 
year special attention is directed to the Texas-Mexican border against 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 17 

the entrance of yellow fever, now prevailinir at some ports in Mexico, 
inspectors being on duty at El Paso, Eagle rass, and Laredo, in aid of 
the Texas State quarantines at the same ports of entry. 

National quarantine has been conducted through officers of the serv- 
ice in all the principal ports of Porto Rico, Hawaii, and the Philippines. 
In Porto Rico and Hawaii the expenses are paid out of the annual 
Congressional appropriation for quarantine maintenance. In the Phil- 
ippines the quarantine expenses are paid from the funds of the islands 
under Executive Order or January 3, 1900. The recrudescence of the 
cholera epidemic in the Philippines has necessitated the maintenance 
of a stringent outgoing quarantine upon all vessels from Manila to the 
uninfect^ ports in the islands as well as to ports in the United States 
and its other insular possessions. A quarantine of five days is imposed 
on army transports before allowing them to sail for the United States. 
In addition to the chief quarantine ofii(*er in the Philippines and his 
assistants stationed at Manila, assistant surgeons have been on duty at 
Iloilo and Cebu. During the latter part of the fisail year an assistant 
surgeon was stationed at Jolo. An examination bv an officer of the 
Service showed that the Pavsig River is contaminated with cholera. 

The last Congress appropriated $80,000 for improvements to the 
station on Quarantine island, in Honolulu Harbor, and measures are 
under way for effecting the required improvements. 

Service officers are stationed in the United States consulates of five 

?3rts in Cuba: Habana, Matanzas, Nuevitas, Santiago, and Cienfuegos. 
hese officers exercise supervision over all outgoing vessels bound for 
the United States or its msular possessions. The disinfecting barge 
SanatoTy owned by the Service, has been continued at anchor in Habana 
Harbor and used for any required disinfection of vessels bound for 
the United States. 

Service officers are stationed at seven fruit ports in Central and 
South America to inspect fruit vessels departing for our southern 
ports and to enforce special regulations under which said vessels may 
avoid quarantine detention at the port of arrival and consequent ruin 
of their cargoes. 

On account of the prevalence of plague in China and Japan medical 
officers have been detailed for duty in the offices of the United States 
consuls at Yokohama, Nagasaki, and Kobe, Japan, and Hongkong and 
Shanghai in China. 

On account of yellow fever in Mexico officers have also been detailed 
for duty in the consular offices at Vera Cruz, Progreso, and Tampico. 

New regulations for maritime quarantine and for the Mexican and 
Canadian borders have been prepared, and were promulgated by the 
Secretaiy of the Treasury April 1, 1903, in which practical recognition 
is given to recent advances made in the study of the origin and propa- 
gation of epidemic disease. 

SMALLPOX. 

Reports published weekly in the Public Health Reports show the 
continued prevalence of this disease in a mild form in nearly every 
State of the Union. During the fiscal year 1908 in 44 States there 
were reported 42,590 cases with 1,642 deaths, a mortality of 3.86 per 
cent. The distribution of literature on the prevention and suppression 
of smallpox has been continued. 

a Doc. 338 2 



18 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

PLAGUE. 

Cases of this disease have continued to appear in the Chinese dis- 
trict of San Francisco, 38 aises being reported during the fiscal year. 
The aid afforded the municipal authorities has been continued, ana this 
joint work has no doubt served to confine the disease to its original 
limits. Owing to the fact that the efforts of the health officials of San 
Francisco had been carried on under unusual difficulty and that an 
increase in cases was reported in the latter part of the summer of 1902, 
with the approval of tne Department a oeryice officer was specially 
detailed to the State of California to ascertain conditions, particularly 
in the Chinese settlements outside of San Francisco. Sanitary inspec- 
tions during November and December by this officer, in conjuntion 
with a representative of the governor, developed the fact that no 
centers of infection existed in these outside districts. In December 
last the Surgeon-Geneml visited the State to confer with the State 
and local health officers. A cordial understanding was I'eached and 
the way prepared for future coopemtive action more decisive in char- 
acter. After the inauguration of the new State officials last Januar}' 
the special representative of the governor, the sanitary officials of San 
Francisco, and the Service's representative effected a gratifying coop- 
emtive plan of campaign for the destruction of plague infection m 
the Chinese district. The work has l>een and is being prosecuted satis- 
factorily, and is expected to be continued for a considerable time 
before complete surpression is attained. 

YELLOW FEVER. 

Fortunately no cases of this still dreaded disease have been reported 
in the United States during the fiscal year, although it is now prevailing 
in some of the ports of our southern neighbors. Cuba has continu^ 
to be free from this disease. 

The work of the Yellow Fever Institute, mentioned in the last two 
annual reports, has been continued, and five bulletins, Nos. 9 to 13, 
have been issued. Bulletin No. 13 is of special importance and is a 
study of the etiology of yellow fever, the report of a working party 
of medical officers stationed at Vera Cruz, Mexico, from May to Octo- 
ber, 1902, and whose labors were afterwards continued in the United 
States until March, 1903. At the present time a second working party 
is continuing the investigation at Vera Cruz to repeat and confirm (or 
otherwise) the findings of the first party and make such additional 
experiments as may be prompted in tne course of their investigations. 

MARINE HOSPITALS AND RELIEF. 

The relief statistics for the year are as follows: 

Total numl)er of patients 58, 573 

Number of patients treated in hospital 13, 567 

Number of patients treated in dispensary 45, 0(^ 

Total number of days* relief in hospital 383, 389 

Excess in number of patients over previous year 2, 263 

Excess in number of days' relief over previous year 26, 620 

ITie Service controls and operates 23 hospitals, 22 of these being 
owned by the Government. The hospital building at Dutch Harbor, 
Alaska, is leased, but the lease will not be renewed for the ensuing 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 19 

as the amount of relief work at Dutch Harbor does not warrant 
urther maintenance of a relief station at that port. In addition 
e marine hospitals there are 121 relief stations where seamen 
ve hospital and dispensary treatment. A relief station was estab- 
1 during the year at Nome, Alaska, where two buildings on the 
lilitary reservation have been assigned for the use of the Service. 

NEW HOSPITALS. 

w Torl\ N. Y. — ^The purchase of the Seaman's Retreat, Staten 
d, New York, heretofore leased and operated as a marine hospital, 
[consummated during the year. The price paid was $250,000, 
Dpriated by Congress for this purpose. 

ttsburg^ Pa. — The commission appointed by Department order of 
ber 15, 1902, after examining all property offered, recommended 
a part of the United States arsenal reservation be obtained if 
;icable for a hospital site. Act of Congress approved March 3, 
(sundry civil act), authorized the transfer to the Department of 
ores of this reservation at the discretion of the Secretary of War. 
iffalo^ N, Y, — A commission appointed by Department order of 
uary 17, 1903, after examination of the property offered, recom- 
led purchase of a site, approximately five acres in extent, situated 
ain street about two and one-half miles from th^ city hall. 
vannah^ Ga. — Building plans for this hospital are now being pre- 
1 by the Supervising Architect. The hospital will be erected on 
owned by the Government. 

SANATORIUM FOR CONSUMPTIVES, FORT STANTON, N. MKX. 

JO hundred and seventy-four patients have been treated during 
ear, an excess of 62 over the previous year. There were 12 dis- 
ced, recovered; 54 discharged, improved; 10 discharged, not 
oved; 150 remained under treatment at the close of the year, 
nsive repairs have been made during the year, special attention 
ig been given to increase of ward space and to the fitting out of 
Qodious and well-equipped kitchen and dining-room. I have to 
N my recommendation of last year relative to the good results 
h would surely follow the reception and treatment at this sana- 
m of patients from the several States, to be charged a per diem 
based upon cost of maintenance. 

PURVEYING DEPOT, NEW YORK. 

iring the year 726 requisitions were filled and supplies furnished 
e marine hospitals, quarantine stations in the United States, and 
ependencies, to the Immigration Service, and to vessels of the 
nue-Cutter Service, and the Coast and Geodetic Survey. 

AID TO OTHER SERVICES. 

d was given to other services as follows: To the Revenue-Cutter 
ice, in physical examination of 884 applicants for enlistment, of 
Q 121 were rejected; to the Steamboat Inspection Service, by the 
dnation of 1^525 pilots as to visual capacity, of whom 80 were 
ted; to the Life-Saving Service, by physical exaixmiaWotLoi\3»i^ 



20 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

surfmen, 51 of whom were rejected; to the Coast and Geodetic Survey, 
by physical examination of 63 applicants, with 12 rejections; to the 
Liglit-House Service, by physical examination of 3 applicants for 
enlistment; to the Customs Service, by physical examination of 115 
employees and 5 rejections. Twenty -one employees of other services 
were also examined physically, as were also 426 American merchant 
seamen, of whom 44 were rejected. 

MEDICAL INSPECTION OF IMMIGRANTS. 

During the fiscal year 857,046 immigrants were inspected by the 
officers of the Service as to their physical fitness for admission, as pre- 
scribed by the immigration laws. One officer has been stationed at 
Naples, Italy, and another at Quebec, Canada, in the interest of the 
medical inspection service. Examinations are conducted at 32 ports 
in the United States, and on account of the large number of immi- 

grants entering at New York, Boston, Baltimore, Philadelphia, New 
Orleans, and San Fi-ancisco medical officers have been assigned to duty 
at these ports exclusively for the examination of arriving aliens. 
Under the law the expense of these insi)ections is met by the immi- 
gration fund. The relation of the Bureau and of the medical officers 
engaged in this work to the Immigration Service is defined in the reg- 
ulations of the Public Health and Marine-Hospital Service, approve 
by the Secretary of the Treasury and the President, and during the 
year a book of instructions for tne guidance of medical officei's in the 
inspection of immigrants has been prepared with great care in | 
the Bureau and issued with the approval of the Department. 

PERSONNEL. 
COMMISSIONED CORPS. 

At the close of the fiscal year the commissioned corps of the Service i 
consisted of 109 officers, as follows: The Surgeon-General, 6 assistant r 
surgeons-general, 24 surgeons, 27 passed assistant surgeons, and 51 1 
assistant surgeons. Eight candidates passed a successful examination 
for admission to the corps and were commissioned assistant surgeons. 



ACTING ASSISTANT SI RGEON8. 



At the close of the fiscal year there were 179 acting assistant sur- 

§eons, including 7 appointed for duty at fruit ports of CSentral and 
outh America whose services will be terminatea at the close of the 
quarantine season. 



PHARMACISTS. 



At the close of the fiscal year there were 46 pharmacists, as follows: 
Phanuacists of the first class, 16; of the second class, 23; of the third 
class, 7. 



ATTENDANTS. 



At the beginning of the fiscal year there were 630 hospital attendants 
at the marine hospitals. Quarantine stations, and on epidenodc duty. 
The number at the close oi the fiscal year was 577. 



. 



\ 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 21 



BOARDS. 



iring the fiscal year 40 boards of medical officers were convened 
be pnysical examination of officers of and applicants for entrance 
the Kevenue-Cutter Service. A board was convened June 15, 
, for the examination of candidates for appointment as assistant 
»ons in the Service. Twenty-four applicants presented themselves 
he board was still in session at the close of tne fiscal year. 

EXPENDITURES, 
8ERVICE FUND. 

e balance of the appropriation for the maintenance of the Public 
bh and Marine-Hospital Service at the beginning of the fiscal year 
^35,831.51; the receipts from all sources, tonnage tax, repay- 
Sj care of foreign seamen, and reimbursements from the Immi- 
on Service, etc.^ were ^947,240. 98. The expenditures for the 
period were $1,096,434.49, leaving a balance on hand at the end 
e fiscal year of $486,638. These expenditures included improve- 
8 and repairs to marine hospitals, heating apparatus, furniture, 
fuel, light, and water, these items being no longer included by 
;ress in annual appropriations. 

EPIDEMIC FUND. 

e amount available of the appropriation- for preventing the spread 
ddemic disease at the beginning of the fiscal year was ^54,090.10; 
expenditure was $165,038.11, leaving a balance July 1, 1903, of 
051.99. 

QUARANTINE FUND. 

e amount of the appropriation was $325,000. There were repay- 
8 for the care of foreign seamen, etc., of $2,621.83. The expend- 
s were $322,712.02, leaving a balance at the close of the fiscal 
of $4,909.81. 

HYGIENIC LABORATORY. 

iring the fiscal year the scope of the laboi-atory has been increased 
the additional features contemplated by the act of July 1, 1902. 
Division of Zoology has been organized and the organization of 
Hvision of Pharmacology is in progress. The Division of Chem- 
will be organized at a later date. 

e laboratory building, for which $35,000 was appropriated in the 
ry civil act of March 1, 1901, has recently been completed and 
^e furnished and equipped during the present fiscal year. Atten- 
is invited to the fact that this building was provided for prior to 
eorganization of the laboratory above mentioned, and was origi- 
intended for the Division of Pathology and Bacteriology alone. 
i space will be required for the new divisions, and I have there- 
to recommend that an appropriation for one additional building 
ade. 

6 work of the laboratory has been along lines pertaining to the 
c health, examination of water supplies, a study of the action of 
us disinfectants and germicidal agents, the investigation of dis- 
and conditions of sanitary and economic importance. 



22 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

INSPECTION OF VACCINE VIRUS, SERUMS, TOXINS, ETC. 

Under the regulations prepared in accordance with act of Congress 
approved July 1, 1902, armngements have been completed to inspect 
all establishments manufacturing vaccine virus, serums, toxins, and 
analogous products, preliminary to the issue of licenses for the sale of, 
bai'ter, or traffic in such products. 

PUBLICATIONS OF THE SERVICE. 

The following are the regular publications of the Service, namely, 
annual report, weekly public health reports, precis on various topics 
connected witn the public health, laboratory bulletins, bulletins of the 
yellow-fever institute. 

Attention is invited to the necessity of legislation authorizing a 
larger issue of these publications than is now permitted by law. 

Following are the reports prepared by the assistant surgeons- 
general in charge of the several divisions of the Bureau, whicli give 
m detail all the transactions of the Service during the fiscal year. 
Kespectfully, 

Walter Wyman, 

Surgeon- General, 



DIVISION OF PERSONNEL AND ACCOUNTS. 



23 



REPOET OF THE DIVISIOH OF PERSONNEL AND ACCOXTNTS. 

By George Pitrviance, 
Astigtant Surgeon- General^ IL S. Public Health and Mar ine- Hospital Sen^icfj in charge. 

Sir: I have the honor to transmit herewith the following report of 
the division of personnel and accounts for the fiscal year ended June 
30, 1903: 

PERSONNEL. 

COMMISSIONED OFFICERS. 

At the beginning of the fiscal year, July Ij 1902, the commisiSioned 
corps, including the Surgeon-General, consisted of 105 officers, as 
folfows: 

Saigeon-General 1 

Surgeons 29 

Famed aasistaDt eorgeons 27 

AsaLstant surgeons 48 

During the year one surgeon died, one surgeon resigned, and two 
passed assistant surgeons were promoted to fill the vacancies thus 
created; two passed assistant surgeons resigned and five assistant 
surgeons were pronoioted to the grade of passed assistant surgeon. 

As a result of the examination held by a board of commissioned officers 
convened to meet in Washington, D. C., June 16, 1902, eight candidates 
passed a successful examination and were commissioned assistant sur- 
geons in this service. 

In accordance with the provisions of act of Congress approved July 
1, 1902, entitled "An act to increase the efficiency and change the 
name of the United States Marine-Hospital Service," the commissioned 
officers detailed for duty in the Bureau in charge of Bureau divisions 
(under paragraph 12 of the regulations) were given the i*ank of assist- 
ant surgeons-general while so serving, as follows: 

Division of personnel and accounts, Asst. Surg. Gen. George Purvi- 
ance in charge; domestic quarantine division, Asst. Surg. Gen. A. H. 
Glennan in charge; division of marine hospitals and relief, Asst. Surg. 
Gen. L. L. Williams in charge; division of foreign and insular quar- 
antine, Asst. Surg. Gen. W. J. Pettus in charge; division of sanitary 
reports and statistics, Asst. Surg. Gen* G. T. Vaughan in charge; 
division of scientific research, Asst. Surg. Gen. H. D. Geddings in 
charge. 

The corps at the close of the fiscal year June 30, 1903, consisted of 
109 officers, as follows: 

SuTj^eon-Greneral 1 

Assistant suigeons-general 6 

Suigeons 24 

Paceed assistant suigeons 27 

surgeons ^\ 



26 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

ADVISORY BOARD FOR HYGIENIC LABORATORY. 

An advisory board for the Hygienic Laboratory was also provided 
for in the act above referred to, to consist of three experts to be 
detailed from the Army, the Navy, and the Bureau of Animal Indus- 
try, Department of Agriculture; the director of the Hygienic Labora- 
tory, Public Health and Marine-Hospital Service, and five other mem- 
bers who were to be appointed by the Surgeon-General with the approval 
of the Secretary of the Treasury. In accordance therewith, on June 
26, 1903, the Surgeon-General of the Army detailed Maj. Walter D. 
McCaw, of the U. S. Army, on November 28, 1902, the Surgeon-Gen- 
eral of the Nayy detailed Surg. George F. tJrie, of the U. S. Navy, 
and on November 24, 1902, the Secretary of Agriculture detailed Dr. 
D. E. Salmon. 

Under approval of the Secretary of the Treasury, dated October 23, 
1902, the Surgeon-General, on February 19, 1903, appointed the fol- 
lowing persons: Prof. Frank F. Wesbrook, of the Universitv of Min- 
nesota, for a period of one 3''ear from July 1, 1902; Prof. William T. 
Sedgwick, of the Massachusetts Institute of Technology, for a period 
of two years from July 1, 1902; Prof. Victor C. Vaugnan, of the Uni- 
versity of Michigan, for a period of three years from July 1, 1902; 
Prof. Simon Flexner, of the University of Pennsylvania, for a period 
of four years from July 1, 1902; Prof. William H. Welch, of the 
Johns Hopkins University, for a period of five years from July 1, 1902. 

CHIEF OP DIVISION OF ZOOLOGY. 

In accordance with the provisions of the same act, Dr. Ch. Wardell 
Stiles was, by Depailment letter of August 16, 1902, transferred from 
the Department of Agriculture to the position of chief of the division 
of zoology in the Hygienic Laboratory. 

NONCOMMISSIONED OFFICERS. 

Sanitary inspectors. — Two sanitary inspectors served during the 
entire fiscal year, namely, J. Y. Porter, at Key West, Fla., and K. I. 
Bowie, at Nagasaki, Japan. 

Acting (isswtant surgeons, — At the beginning of the fiscal year there 
were 181 acting assistant surgeons; 39 were appointed, 38 were sepa- 
rated from the Service by limitation of appomtment, and 3 died, 
leaving on dutj^ at the close of the fiscal year 179 such officers. 

For further information in regard to the appointment and assign- 
ment of certain acting assistant surgeons, rererence is made to tbat 
portion of this report which refers to acting assistant surgeons under 
foreign detail and acting assistant surgeons for domestic auty in con- 
nection with the prevention of the spread of epidemic diseases. 

Medical iiispectors. — One medical inspector, E. F. Smith, served 
during the entire year at Honolulu, Hawaii, and one, J. McDonald, 
was appointed for duty at San Francisco quarantine station. 

Litemes, — At the beginning of the fiscal year there were 10 internes 
on duty at the various marme-hospital stations; 11 were appointed 
and 11 separated from the Service by reason of resignation, leaving 
at the close of the fiscal year 10 internes on duty. 

PharnuwlHts, — At the beginning of the fiscal year there were on duty 
1 senior pharmacist and cnemist, 1 senior pharmacist and assistant 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



27 



chemist, 1 junior pharmacist, chemist and special disbursing agent, 
25 senior pharmacists, and 17 junior pharmacists, aggregating 45 
pharmacists. 

In accordance with the provisions of the regulations of the Service, 
approved November 21, 1902, the above titles were abolished and the 
title of pharmacists of the first, second, and third class created. The 
number of pharmacists of the first class was limited to 16, and all 
pharmacists who have served a period of three yeara and passed a sat- 
isfactory examination are entitled to promotion to the second class. 

Two pharmacists were reinstated during the year and 1 resigned, 
leaving the number at the close of the year 46, divided as follows: 

Pharmacists of the first class 16 

Pharmacists of the second class 23 

Pharmacists of the third class 7 

Pilots and marine engineer's. — Under the provisions of paragraph 
63 of the regulations of this Service, approved November 21, 1902, 
pilots and marine engineers were given tlie title of noncommissioned 
officers, and on June 30, 1903, there were 11 pilots and 21 marine 
engineers on duty. 

HOSPITAL ATTENDANTS. 

At the beginning of the fiscal year there were 630 hospital attendants 
employed in the various marine hospitals, quarantine stations, and on 
epidemic duty. Six hundred and nineteen were appointed and 672 
were separated from the service, leaving at the close of the year 577, 
as shown by the following table: 



BraDch of Service in which employeii. 



Marine-Hospital Seryice. 

Quarantine 

Epidemic 



Total 

Philippine Islands 



In Service 
July 1, 1902. 



371 

220 

39 



630 



&4 



Appointed 

during 

year. 



365 

211 

43 



619 



28 



Separated 

irom 
Service. 



23 



In Service 
June 30» 1903. 



3»4 


842 


232 


199 


46 


86 


672 


677 



69 



The quarantine table includes 34 attendants employed in the Terri- 
tory of Hawaii and 26 in the island of Porto Rico. 

The epidemic table includes 1 attendant at Matanzas and 13 employed 
on the disinfecting steamer SanaU/i' at Habana. 

SPECIAL DETAILS OF COMMISSIONED OFFICERS. 



FOR DOMESTIC DITTY. 



October i^ 190S, — Surg. A. H. Glennan was relieved from duty at 
Habana^ Cuba, and from special temporary duty in the Bureau, and 
assigned to duty on the Pacific coast in charge of the plague labora- 
tory, San Francisco, Cal. 

June 10, 1903, — Surg. A. H. Glennan was relieved from duty in 
San Francisco, Cal., and detailed as assistant surgeon-general, in 
f^harge of the domestic quamntine division in the Bureau. 

Jwu 17^ 1902.Svxv^, W. J. Pcttus wiis relieved from duty at 
Cleveland, Ohio, and detailed as assistant surgeon-general, in charge 
of insular and foreign quamntine division in the Bureau. 



20 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

surf men, 51 of whom were rejected; to the Coast and Geodetic Survey, 
by ph3'sical examination of 63 applicants, with 12 rejections; to the 
Liglit-Housc SinTice, by physical examination of 3 applicants for 
enlistment; to the Customs Service, by physical examination of 115 
employees and 5 rejections. Twenty -one employees of other services 
were also examined physicallj, as were also 426 American merchant 
seamen, of whom 44 were rejected. 

MEDICAL INSPECTION OF IMMIGRANTS. 

During the fiscal year 857,046 immigrants were ins{)ected by the 
oflScers of the Service as to their physical fitness for admission, as pre- 
scribed by the immigration laws. One oflScer has been station^ at 
Naples, Italy, and another at Quebec, Canada, in the interest of the 
medical inspection service. Examinations are conducted at 32 ports 
in the United States, and on account of the large number of imini- 

grants entering at New York, Boston, Baltimore, Philadelphia, New 
►rleans, and San Fi-ancisco medical officers have been assigned to duty 
at these ports exclusively for the examination of amving aliens. 
Under the law the expense of these insi)ections is met by the immi- 
gration fund. The relation of the Bureau and of the medical officers 
engaged in this work to the Immigration Service is defined in the r^- 
ulations of the Public Health and Marine-Hospital Service, approve 
by the Secretary of the Treasuiy and the President, and during the 
year a book of instructions for the guidance of medical officers m the 
inspection of immigrants has been prepared with great care in 
the Bureau and issued with the approval oi the Depailment. 

PERSONNEL. 

COMMISSIONED CORPS. 

At the close of the fiscal year the commissioned corps of the Service r 
consisted of 109 officers, as follows: The Surgeon-General, 6 assistant I 
surgeons-general, 24 surgeons, 27 passed assistant surgeons, and 51 1 
assistant surgeons. Eight candidates passed a successful examination 
for admission to the corps and were commissioned assistant surgeons. 

ACTING ASSISTANT SURGEONS. 

At the close of the fiscal ye^r there were 179 acting assistant sor- 

§eons, including 7 a])p()inted for duty at fruit ports of Central and 
outh America \vhose services will be terminated at the close of the 
quarantine season. 

PHARMACISTS. 

At the close of the fiscal year there were 46 pharmacists, as follows: 
Pharmacists of the first class, 16; of the second class, 23; of the third 
class, 7. 

ATTENDANTS. 

At the beginning of the fiscal year there were 630 hospital attendants 
at the marine hospitals, quarantine stations, and on epidemic daty. |^ 
The number at the close of the fiscal year was 677. 



i 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 21 



BOARDB. 



During the fiscal year 40 boards of medical officers were convened 
or the pnysical examination of officers of and applicants for entrance 
nto the Revenue-Cutter Service. A board was convened June 15, 
903, for the examination of candidates for appointment as assistant 
urgeons in the Service. Twenty -four applicants presented themselves 
nd the board was still in session at the close of tne fiscal year. 



EXPENDITURES. 



8BRVICB FUND. 



The balance of the appropriation for the maintenance of the Public 
lealth and Marine-Hospital Service at the beginning of the fiscal year 
^as $635,831.61; the receipts from all sources, tonnage tax, repay- 
lents, care of foreign seamen, and reimbursements from the Immi- 
ration Service, etc., were $947,240.98. The expenditures for the 
une period were $1,096,434.49, leaving a balance on hand at the end 
f the fiscal year of $486,638. These expenditures included improve- 
lents and repairs to marine hospitals, heating apparatus, furniture, 
ad fuel, light, and water, these items being no longer included by 
'ongress in annual appropriations. 



EPIDEMIC FUND. 



The amount available of the appropriation for preventing the spread 
f epidemic disease at the beginmngof the fiscal year was $i554,090.10; 
be expenditure was $165,038.11, leaving a balance July 1, 1903, of 
489,051.99. 

QUARANTINE FUND. 

The amount of the appropriation was $325,000. There were repay- 
lents for the care of foreign seamen, etc., of $2,621.83. The expend- 
bures were $322,712.02, leaving a balance at the close of the fiscal 
ear of $4,909.81. 

HYGIENIC LABORATORY. 

During the fiscal year the scope of the laboi-atory has been increased 
rith the additional features contemplated by the act of July 1, 1902. 
The Division of Zoology has been organized and the organization of 
he Division of Pharmacology is in progress. The Division of Chem- 
stry will be organized at a later date. 

Trtie laboratory building, for which $35,000 was appropriated in the 
undry civil act of March 1, 1901, has recently been completed and 
rill be furnished and equipped during the present fiscal year. Atten- 
jon is invited to the fact that this bunding was pro v idea for prior to 
he reorganization of the laboratory above mentioned, and was origi- 
lally intended for the Division of Pathology and Bacteriology alone. 
Here space will be required for the new divisions, and I have there- 
'ore to recommend that an appropriation for one additional building 
ye made. 

The work of the laboratory has been along lines pertaining to the 
mblic health, examination of water supplies, a study of the action of 
various disiniectants and germicidal agents, the investigation of dis- 
lases and conditions of sanitary and economic importance. 



22 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

INSPECTION OF V^ACCINE VIRUS, SERUMS, TOXINS, ETC. 

Under the regulations prepared in accordance with act of Congress 
approved July 1, 1902, arrangements have been completed to inspect 
all establishments manufacturing vaccine virus, serums, toxins, and 
analogous products, preliminary to the issue of licenses for the sale of, 
barter, or traffic in such products. 

PUBLICATIONS OF THE SERVICE. 

The following arc the regular publications of the Service, namely, 
annual report, weekly public health reports, precis on various topics 
connectecl with the public health, laboratory bulletins, bulletins of the 
yellow-fever institute. 

Attention is invited to the necessity of legislation authorizing a 
lai'ger issue of these publications than is now permitted by law. 

Following are the reports prepared by the assistant surgeons- 
general in charge of the several divisions of the Bureau, which give 
in detail all the tmnsactions of the Service during the fiscal year. 
Kespectfully, 

Walter Wyman, 

Surgeoii' General. 



DIVISION OF PERSONNEL AND ACCOUNTS. 



23 



REPOET OF THE DIYISIOH OF PERSONNEL AND ACCOUNTS. 

By Georob Purvianck, 
^•imstant Surgeon-Generdly U. *Sf. Public Health and Marine- Hospital Service^ in charge. 

Sir: I have the honor to transmit herewith the following report of 
the division of personnel and accounts for the fiscal year ended June 
30, 1903: 

PERSONNEL. 

COMMISSIONED OFFICERS. 

At the beginning of the fiscal year, July 1, 1902, the commisiSioned 
corps, including the Surgeon-General, consisted of 105 oflScers, as 
folu)ws: 

Surgeon-General 1 

Soiigeons 29 

Piimed assistant surgeons 27 

Assistant surgeons 48 

During the year one surgeon died, one surgeon resigned, and two 
passed assistant surgeons were promoted to fill the vacancies thus 
created; two passed assistant surgeons resigned and five assistant 
surgeons were promoted to the grade of passed assistant surgeon. 

As a result of the examination held by a board of commissioned officers 
convened to meet in Washington, D. C., June 16, 1902, eight candidates 
passed a successful examination and were commissioned assistant sur- 
geons in this service. 

In accordance with the provisions of act of Congress approved July 
1, 1902, entitled "An act to increase the efficiency and change the 
name of the United States Marine-Hospital Service,' the commissioned 
officers detailed for duty in the Bureau in charge of Bureau divisions 
(ander paragraph 12 of the regulations) were given the rank of assist- 
ant surgeons-general while so serving, as follows: 

Division of personnel and accounts, Asst. Surg. Gen. George Purvi- 
ance in char^; domestic quarantine division, Asst. Surg. Gen. A. H. 
Glennan in cnarge; division of marine hospitals and relief, Asst. Surg. 
Gen. L. L. Wilfiams in charge; division of foreign and insular quar- 
antine, Asst. Sur^. Gen. W. J. Pettus in charge; division of sanitary 
reports and statistics, Asst. Surg. Gen* G. T. Vaughan in charge; 
division of scientific research, Asst. Surg. Gen. H. D. Geddings in 
charge. 

The corps at the close of the fiscal j^ear June 30, 1903, consisted of 
109 officers, as follows: 

Sui)^eon-GeneTal 1 

Assistant suiKOons-general 6 

Surgeons 24 

Paused assistant surgeons 27 

AsHwtant surgeons ^\ 



26 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

ADVISORY BOARD FOR HYGIENIC LABORATORY. 

An advisory board for the Hygienic Laboratoiy was also provided 
for in the act above referred to, to consist of three experts to be 
detailed from the Array ^ the Navy, and the Bureau of Animal Indus- 
try, Department of Agriculture; the director of the Hygienic Labora- 
tory, Public Health and Marine-Hospital Service, and five other mem- 
bers who were to be appointed by the Surgeon-General with the approval 
of the Secretary of the Treasury. In accordance therewith, on June 
26, 1903, the Surgeon-General of the Army detailed Mai. Walter D. 
McCaw, of the U. S. Army, on November 28, 1902, the ourgeon-Gen- 
eral of the Nayy detailed Surg. George F. Urie, of the U. S. Navy, 
and on November 24, 1902, the Secretary of Agriculture detailed Dr. 
D. E. Salmon. 

Under approval of the Secretary of the Treasury, dated October 23, 
1902, the Surgeon-General, on February 19, 1903, appointed the fol- 
lowing persons: Prof. Frank F. Wesbrook, of the Universitv of Min- 
nesota, for a period of one 3'ear from July 1, 1902; Prof. William T. 
Sedgwick, of the Massachusetts Institute of Technology, for a period 
of two years from July 1, 1902; Prof. Victor C. Vaughan, of the Uni- 
versity of Michigan, for a period of three years from July 1, 1902; 
Prof. Simon Flexner, of the University of Pennsylvania, for a period 
of four years from July 1, 1902; Prof. William H. Welch, of the 
Johns Hopkins University, for a period of five years from July 1, 1902. 

CHIEF OF DIVISION OF ZOOLOGY. 

In accordance with the provisions of the same act, Dr. Ch. Wardell 
Stiles was, by Department letter of August 16, 1902, transferred from 
the Department of Agriculture to the position of chief of the division 
of zoology in the Hygienic Laboratory. 

NONCOMMISSIONED OFFICERS. 

Sanitary inspectors. — Two sanitary inspectors served during the 
entire fiscal year, namely, J. Y. Porter, at Key West, Fla., and K. I. 
Bowie, at Nagasaki, Japan. 

Acting assistant surgeons. — At the beginning of the fiscal year there 
were 181 acting assistant surgeons; 39 were appointed, 38 were sepa- 
rated from the Service by luuitation of appointment, and 3 died, 
leaving on duty at the close of the fiscal year 179 such officers. 

For further information in regard to the appointment and assign- 
ment of certain acting assistant surgeons, reference is made to that 
portion of this report which refers to acting assistant surgeons under 
foreign detail ancl acting assistant surgeons for domestic auty in con- 
nection with the prevention of the spread of epidemic diseases. 

Medii'al inspeetors. — One medical inspector, E. F. Smith, served 
during the entire A^ear at Honolulu, Hawaii, and one, J. McDonald, 
was appointed for duty at San Francisco quarantine station. 

Internes. — At the beginning of the fiscal year there were 10 internes 
on duty at the various marme-hospital stations; 11 were appointed 
and 11 separated from the Service b}^ reason of resignation, leaving 
at the close of the fiscal year 10 internes on duty. 

Pharmacists. — At the beginning of the fiscal year there were on duty 
1 senior pharmacist and chemist, 1 senior pharmacist and assistant 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



27 



hemist, 1 junior pharmacist, chemist and special disbursing agent, 
5 senior pharmacists, and 17 junior pharmacists, aggregating 45 
»hamiacist8. 

In accordance with the provisions of the regulations of the Service, 
pproved November 21, 1902, the above titles were abolished and the 
itle of pharmacists of the first, second, and third class created. The 
lumber of pharmacists of the first class was limited to 16, and all 
pharmacists who have served a period of three yeai's and passed a sat- 
rfactory examination are entitled to promotion to the second class. 

Two pharmacists were reinstated during the year and 1 resigned, 
eaving the number at the close of the year 46, divided as follows: 

'harmacists of the first class 16 

'harmacists of the second class 23 

'hannacists of the third class 7 

Pilot4$ and marine en<f infers. — Under the provisions of paragraph 
3 of the regulations of this Service, approved November 21, 1902, 
>ilot« and marine engineers were given tne title of noncommissioned 
fficers, and on June 30, 1903, there were 11 pilots and 21 marine 
ngineers on duty. 

HOSPITAL ATTENDANTS. 

At the beginning of the fiscal year there were 630 hospital attendants 
mployed in the various marine hospitals, quarantine stations, and on 
pidemic duty. Six hundred and nineteen were appointed and 672 
rere separated from the service, leaving at the close of the year 577, 
s shown by the following table: 



Branch of Service in which employed. 



larine-Hoepital Service. 

tuirantine 

pidemic 



Total 

hilippine Inlands 



In Service 
July 1, 1902. 



871 

220 

89 



630 



&4 



Appointed 

during 

year. 



865 

211 

43 



619 



28 



Separated 

irom 
Service. 



394 

232 

46 



672 



23 



In Service 
June 30, 1903. 



842 

199 

86 



577 



69 



The quarantine table includes 34 attendants employed in the Terri- 
ory of Hawaii and 26 in the island of Porto Rico. 

The epidemic table includes 1 attendant at Matanzas and 13 employed 
n the disinfecting steamer Sanatoi* at Habana. 

SPECIAL DETAILS OP COMMISSIONED OFFICERS. 



FOR DOMESTIC DUTY. 



October ^, 1902. — Surg. A. H. Glennan was relieved from duty at 
labana, Cuba, and from special temporary duty in the Bureau, and 
ssigned to duty on the Pacific coast in charge of the plague labora- 
ory, San Francisco, Cal. 

June 10^ 1903. — Surg. A. H. Glennan was relieved from duty in 
»an Francisco, Cal., and detailed as assistant surgeon-general, in 
barge of the domestic quaiuntine division in the Bureau. 

jQ/u 17^ 1902.—Sur^. W. J. Pettus was relieved from duty at 
!!leyefBknd, Ohio, and detailed as assistant surgeon-general, in charge 
f insular and foreign quamntine division in the Bureau. 



28 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

May 11^ 190S. — Asst. Surg. -Gen. H. D. Geddings, upon a request 
from the State board of health of West Virginia, was directed to visit 
the town of Elkins, W. Va., and make an examination of the water 
supply of that town, and determine by analysis made in the Hygienic 
Laboratory, from samples taken, if the condition of the water is 
responsible for the outbreak of typhoid fever at that place. 

May 26^ 1903, — Passed Asst. burg. Rupert Blue was directed to 
assume command of plague laboratory, San Francisco, Cal., relieving 
Surg. A. H. Glennan. 

October 21, 1902. — Asst. Surg. J. F. Anderson was detailed as assist- 
ant director of the Hygienic Laboratory. 

April 23, 1903, — Asst. Surg. J. F. Anderson was directed to proceed 
to Great Falls, Mont., and vicinity, for the purpose of making a thor- 
ough investigation as to the recrudescence of an epidemic of so-called 
*' spotted fever," and to make recommendation as to measures to be 
taken looking to the eradication of the disease. 

March 17, 1903. — Asst. Surg. W. A. Korn was assigned to duty at 
Philadelphia, Pa., for exclusive duty in connection with examination 
of immigrants. 

June i<9, 1903. — Asst. Surg. C. E. D. Lord was assi^ed to duty at 
San Francisco, Cal., for exclusive duty in connection with examination 
of immigrants. 

July 19, 1902. — Asst. Surg. A. J. McLaughlin was directed to pro- 
ceed to Ocean City, Chincoteague, and Watchapreague, Md., for the 
purpose of making physical examination of keepers and surfmen of 
the Lif e-Saving Service. 

March 17, 1903. — Asst. Surg. M. W. Glover was assigned to duty 
at Baltimore, Md., for exclusive duty in connection with examination 
of immigrants. 

/September 11, 1902. — Asst. Surg. B. J. Lloyd was relieved from 
duty at Nome, Alaska, on close of navigation (he having been assigned 
to special temporaiy duty at that port by Bureau order of May 3, 
1902) and directed to return to San Francisco quarantine, Angel Island, 
Cal., and report to medical officer in command for duty and assignment 
to quarters. 

Decemher 23, 1902. — Asst. Surg. B. J. Lloyd was assigned to duty 
at the plague laboratory, San Francisco, Cal. 

July 17^ 1902. — Asst. Surg. Edward Francis was directed to proceed 
to Point Pleasant, N. J., for the purpose of making physical examina- 
tion of keepers and surfmen of the Life-Saving Service. 

July 17, 1902. — Asst. Surg. B. S. Warren was directed to proceed 
to Atlantic City, N. J., for the purpose of making physical examina- 
tion of keepers and surfmen of tne Life-Saving Service. 

March 17, 1903. — Asst. Surg. A. M. Stimson was assigned to duty 
at New Orleans, La., for exclusive duty in connection with examination 
of immigrants. 

FOR FOREIGN DITY. 

June 25, 1903. — Passed Asst. Surg. E. K. Sprague was detailed for 
duty in the office of the United States consul-general at Calcutta, 
India. 

August 23, 1902. — Passed Asst. Surg. M. J. Rosenau was directed 
to proceed to Vera Cruz, Progreso, Jalapa, CoatzaCoalcos, Orizaba, 
ana Tampico, Mexico, for duty in connection with working party 
No. 1 of Yellow Fever Institute. 

BepldTnbe?' 15^ 1902. — Asst. Surg. John McMuUeu was relieved from 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 29 

duty in the United States consulate-general, London, England, and 
directed to proceed to Hongkong, China, for duty in the office of the 
United States consul-general, and relieve Asst. Surg. J. W. Kerr. 

April ^7, 190S, — Asst. Surg. H. B. Parker was directed to proceed 
to Vera Cruz, Mexico, as chairman of working party No. 2 of Yellow 
Fever Institute. 

May 26^ 1903. — Asst. Surg. L. L. Lumsden was assigned to tem- 
porary duty at San Juan, Porto Rico, during absence of Asst. Surg. 
W. W. King, chief quarantine officer, who was granted two months' 
leave of absence from June 2, 1903. 

Jidy 17^ 1902. — Asst. Surg. V. G. Heiser was directed to proceed 
to Manila, P. I., and report to Passed Asst. Surg. J. C. Perry for 
temporary duty and instructions for a period of one month, familiar- 
izing himself with the duties of the station, after which he was to 
relieve Passed Assistant Surgeon Perry and assume duties of chief 
quarantine officer of said islands. 

July 17^ 1902. — Asst. Surg. W. C. Billings was directed to proceed 
to Quebec, Canada, for duty in office of United States Commissioner 
of Immigration at that port. Upon closing of the port at Quebec he 
was, on December 21, 1902, directed to accompany the Commissioner 
of Immigration to St. John, New Brunswick, for duty, and on April 16, 
1903, he was directed to accompany the Commissioner of Immigration 
to Quebec for duty in connection with the examination of aliens enter- 
ing the United States. 

September 20^ 1902. — Asst. Surg. J. W. Kerr was relieved from duty 
at Hongkong, China, by Passed Asst. Surg. John McMullen and 
directea to return to the United States. 

October 22 J 1902. — Asst. Surg. W. W. King was directed to proceed 
to San Juan, P. R., relieving Passed Asst. Surg. H. S. Mathewson 
and assuming the duties of chief quarantine officer. 

Septemhei* 15^ 1902. — Asst. Surg. Carroll Fox was relieved from 
duty in the office of the United States consul at Liverpool, England, and 
directed to proceed to Manila, P. 1., and report to the chief quarantine 
officer for assignment to duty. 

October 22^ 1902. — Asst. Surg. Joseph Goldberger was relieved from 
duty in the office of the United States consul at Tampico, Mexico, and 
directed to proceed to Ponce, P. R., for duty. 

April 27^ 1903. — Asst. Surg. Edward Francis was directed to pro- 
ceeci to Jalapa, Mexico, and report to Passed Asst. Surg. H. B. Par- 
ker for special temporary duty as a member of working party No. 2, 
of Yellow Fever Institute. 

July 19^ 1902.— Asst Surg. G. W. McCoy was relieved from duty 
at San Francisco, Cal., and directed to proceed to Manila, P. I., and 
report to the chief quarantine officer for duty. 

DOMBSmC AND FOREIGN DUTY IN CONNECTION WITH THE OUTBREAK OF BUBONIC 

PLAQUE IN MEXICO. 

March 2^ 1903. — Passed Asst. Surg. G. M. Guiteras was directed 
to proceed to Eagle Pass and other points in Texas and Mexico for 
special duty in connection with measures to prevent the spread of 
reported cases of plague in Mexico. 

F^^mary 28^ 1903. — Passed Asst. Surg. C. P. Wertenbaker was 
directed to proceed to El Paso, Tex., and confer with the acting assist- 
ant surgeon at that place with reference to protection iioixv wvbcyoia 
plague, particularly if Francis wires Torreon infected. 



80 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

December 12^ 1902. — Passed Asst. Surg. S. B. Grubbs was directed 
to proceed to Ensenada, Mexico, for the purpose of making an inves- 
tigation relative to the presence of bubonic plague in that vicinity, 
and to take such action as may be necessary to prevent the spread to 
the United States by land or sea. 

December SO., 1902. — Passed Asst. Surg. S. B. Grubbs was directed 
to proceed to Mazatlan, Mexico, and confer with Mexican officials and 
mase all possible effort toward definite determination of character of 
existing aisease. 

January ^, 190S. — Passed Asst. Surg. S. B. Grubbs was directed to 
proceed to Guaymas and advise Bureau fully as to condition relative 
to bubonic plague, and to make such recommendation as to measures 
to be adopted as may be necessary. 

February 28., 1903. — Passed Asst. Surg. L. L. Lumsden was directed 
to proceed to Los Angeles, Cal., Phoenix, Ariz., and other points in 
the southwestern portion of the United States and make investigation 
relative to reported cases of bubonic plague, and make such recom- 
mendation to the Bureau as the facts warrant, nominating and placinjg 
on duty temporarv acting assistant surgeons at such places as in his 
judgment required the services of such officers. 

rdynuiry 13, 1903. — Asst. Surg. Edward Francis was directed to 
proceed to Durango and other points in Mexico and make investigation 
relative to reported cases of bubonic plague, keeping Bureau advised 
as to situation. 

INVESTIGATION OP REPORTED PREVALENCE OK 8MALLPOX. 

March 3^ 1903. — Surg. H. R. Carter was directed to proceed to Mor- 
gan town, W. Va., and make investigation as to whetner diagnosis of 
smallpox among students at university was correct. 

April 5, 1903. — Surg. W. P. Mcintosh was directed to proceed to 
Lumpkin, Ga., for the purpose of making diagnosis of suspected case 
of smallpox. 

SPECIAL DETAILS OF NONCOMMISSIONED OFFICERS. 

ACTINQ ASSISTANT 8URGEON8 APPOINTED ¥X)R DUTY IN CONNECTTION WITH PREVENTING 

THE SPREAD OP EPIDEMIC DISEASES. 

By Department letter of May 6, 1903, the following-named physi- 
cians were appointed acting assistant surgeons for aiity along the 
Gulf coast for the pui'pose of keeping the Bureau thoroughly advised 
as to the health of individuals in these localities, and for the further 
purpose of examining into health of all deck hands and employees on 
vessels and schooners touching at their respective ports : R. J. Turner, 
Bay St. Louis; J. J. Harr}% Handsboro; O. L. Bailey, Ocean Springs; 
W. T. Bolton, Biloxi; W. K. Kell, Scranton; J. J. Washington, Pass 
Christian; A. R. Robertson, Long Beach; C. A. Sheely, GuTfport; E. 
M. Fahnestock, DeLisle. 

Dr. J. M. Boothby was appointed acting assistant surgeon, effective 
January 16, 1903, for duty at Lowelton, Sle., in connection with out- 
break of smallpox, which was reported to have assumed epidemic 
form. His services were discontinued May 31, 1903. 

Dr. Estes Nichols was appointed acting assistant surgeon, effective 
April 16, 1903, Sandy Bay Plantation, Me., in connection with out- 
break of smallpox. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 31 

Dr. A. L. Gustetter was appointed acting assistant surgeon for duty 
at Nogales, Ariz., in connection with other acting assistant surgeons, 
for prevention of spread of plague. 

The following-named physicians were appointed acting assistant 
surgeons for similar duty at the ports set opposite their names: D. T. 
Wright, Douglas, Ariz.; E. F. Burton, Tucson, Ariz.; D. W. Bran- 
don, Naco, Ariz. 

ACTING ASSISTANT SURGEONS UNDEK FOREIGN DETAII^. 

On October 20, 1902, the following acting assistant surgeons were 
relieved from duty in the office of the United States consuls in Central 
and South American fruit ports, viz: S. H. Backus, Puerto (;!ortcz, 
Honduras; W. H. Carson, roi-t Limon, Costa Kica; D. W. Goodman, 
Bluefields, Nicaragua; Paul Osterhout, Bocas del Toro, Colombia; 
R. H. Peters, Belize, British Honduras; W. B. Robertson, Ceiba, 
Honduras. 

The services of Acting Asst. Surgs. G. E. Beyer and O. L. Pothier, 
who were appointed for dutv at Vera Cruz, Mexico, effective May 6, 
1902, under the direction of Asst. Surg. H. B. Parker, in connection 
with working party No. 1 of the Yellow Fever Institute, were discon- 
tinued without prejudice, to take effect October 31 and August 15, 

1902, respectively. Prof. G. E. Beyer was appointed acting assistant 
surgeon again, to date from May" 8, 1903, for duty at Vera Cruz, 
Mexico, and directed to report to P. A. Surg. H. B. Parker for 
duty in connection with working party No. 2 of the Yellow Fever 
Institute during the summer of 1903. 

Acting assistant surgeons were appointed for foreign duty as follows: 
S. A. Ransom, Shanghai, China, eflfective July 15, 1902; K. I. Bowie, 
Nagasaki, Japan, effective July 29, 1902; S. H. Hodgson, Vera Cruz, 
Mexico, effective May 1, 1903; J. F. Harrison, Progreso, Mexico, 
effective April 16, 1903. 

Drs. E. B. Alexander and C. H. Power were appointed acting 
assistant surgeons for duty at Ensenada, Mexico, effective January 7 and 
16, 1903, their services being discontinued April 30 and January 24, 

1903, respectively. 

Dr. Luther Mason was appointed acting assistant surgeon for duty 
at Glasier Lake Camp, New Brunswick, effective March 2, 1903, in 
connection with the outbreak and prevalence of smallpox reported in 
that locality. 

The following-named physicians were appointed March 13, 1903, 
for duty at the fruit ports of Central and South America, as follows: 
Paul Osterhout, Bocas del Toro, Colombia; W. H. Carson, Belize, 
British Honduras; D. W. Goodman, Bluefields, Nicaragua; W. B. 
Robertson, Ceiba, Honduras; R. H. Peters, Livingston, Guatemala; 
Fleetwood Gruver, Port Limon, Costa Rica; C. §. Carson, Puerto 
Cortez, Honduras. 

Acting Asst. Surg. John Frick was, by Department letter of April 
24, 1903, transferred from Habana, Cuba, to Tampico, Mexico, for 
iuty in the office of the United States consul at that port. 

DETAILS OP OFFICERS TO REPRESENT THE SERVICE AT MEETINGS OP 

MEDICAL AND PUBLIC HEALTH ASSOCIATIONS. 

[Reports of Uiese officera appear under DivLsion of Scientific Research.] 

Asst. Surg. Gen. G. T. Vaug^han: Meeting of Med\ca\ S^ocXefc^ <A 
Virginia at Newport News, Fa., September 23-26, 190^', m^ei^^Iwi^ o\ 



32 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

the Association of Military Surj^eons at Boston, Mass., May 20-21, 
1903. 

Asst. Surij. Gon. H. D. Geddings: Meeting of Association of State J 
and Provincial Health Officers at New Haven, Conn., October 28-29, 
1902; meeting of Ohio health officers at Columbus, Ohio, June 29-31, 
1903; meeting of school of health officers of Indiana at Indianapoltt, 
Ind., June 24-20, 1903; meeting of South Carolina Sanitary Asaocii- 
tion at Colum))ia, S. C, May 28-29, 1903. 

Surg. H. K. Cartel-: Meeting of American Public Health Associa- 
tion at New Orleans, La., December 8-13, 1902. 

Passed Asst. Surg. C. P. Wertenbaker: Meeting of American Pub- 
lic Health Association at New Orleans, Ija., December 8-13, 1902. 

Passed Asst. Surg. M. J. Rosenau: Meeting of International Sani- 
tary Conference at Washington, D. C, October 15, 1902; meeting of 
special committee on diphtheria antitoxins at Philadelphia, Rl, 
March 7, 1903. 

Passed Asst. Surg. J. M. Eager: Meeting of International Confer- 
ence on Tuberculosis at Berlin, Gemiany, October 22-26, 1903. 

Passed Asst. Surg. S. B. Grubbs: Meeting of American Public 
Health Association at New Orleans, La., December 8-13, 1902. 

Asst. Surg. C. C. Pierce: Meeting of American Public Health Asso- 
ciation at New Orleans, I^a., December, 8-13, 1902; meeting of Florida 
Medical Association at St. Augustine, Fla., April 8-10, 1903. 

Pharmacist A. M. Koohrig: Meeting of American Pharmaceutical 
Association at Philadelphia, Pa., September 2, 1902. 

Pharmacist S. W. Richardson: Meeting of American Pharmaceu- 
tical Association at Phihideiphia, Pa., September 2, 1902. 

Dr. Ch. Wardell Stiles: Meeting of btate Medical Association at 
Talladega, Ala., April 21-24, 1903; meeting of State Medical Associa- 
tion at San Antonio, Tex., April 28-May 1, 1903; meeting of Ameri- 
can Medical Association at New Orleans, La., Mav5-8, 1903; meeting 
of North Carolina Medical Society at Hot Springs, N. C, June % 
1903. 

BOARDS CONVENED. 

For physical examination of Surg. John Vansant, as a result of 
which examination he was placed on waiting orders from August 20, 
1902. (August 19, 1902.) 

Two boards were convened, September 29, 1902, and January 5, 19CS, 
for examination of Passed Asst. Surgs. J. B. Stoner and G. M. Quit- 
eras, respectively, to determine their fitness for promotion to the 
grade of surgeon. Both officers passed a satisfactory examination and 
were accordingly promoted, as jDreviously stated in this report. 

Five boards were convened, November 18, 1902; January 12, 1903; 
February 10, 1903; June 15 and June 18, 1903, for the examination of 
assistant surgeons to determine their fitness for promotion to the gradeof 
passed assistant surgeon, as follows: At Washmgton, D. C, November 
18, 1902, V. G. Heiser; Washington, D. C, January 12, 1903, H. B. 
Parker, R. H. Von Ezdorf, and 3ohn F. Anderson; at San Francisco, 
Cal., Februarv 10, 1903, M. H. Foster and L. L. Lumsden; June 18, 
M. K. Gwyn and W. C. Hobdy; June 15, 1903, at Washington, D. Cr 
for examination of candidates for admission as assistant surgeon, 28 
applicants appeared before the board, and 9 were successful m attain- 
ing the required average; during the month of July, 6 of the success- 
ful candidates were commissioned as assistant surgeons. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 33 

Thirteen boards were conveued at different stations for the physical 
examination of pharmacists of the second class to determine their fit- 
ness for promotion to the grade of pharmacist of the first class; with 
the exception of one all applicants passed a satisfactory examination 
tnd were promoted to be pharmacists of the first class. 

Six boards were convened for examination of pharmacists of the 
third class to determine their fitness for promotion to the grade of 
pharmacist of the second class. All applicants, having passed satis- 
mctory examination, were promoted to be pharmacists of the second 
class. " 

Fortv boards were convened at different times and at various stations 
throughout the United States for the physical examination of officers 
yt the Revenue-Cutter Service and application for entrance thereto. 

One board convened to meet at Washington, D. C, July 11, 1902, 
for the physical examination of applicants for positions in the Coast 
ftnd Geodetic Survey. 

Jane 25, 1903, board convened to meet at Bureau for consideration 
of sketch plans and memoranda relative to hospital building to be 
erected at Ellis Island, N. Y. 

February 9, 1903, board convened to meet at Washington, D. C, to 
ooDsider an outline plan for marine-hospital building to be erected at 
Savannah, Ga. 

Aa^st 7, 1902, board convened to meet at Washington, D. C., for 
the purpose of preparing regulations relative to securiiiuf uniformity 
of action as to the duties of medical officers in connection with the 
examination of aliens of the Immigration Service. 

Au^st 20, 1902, board convened to meet at Washington. D. C, to 
investigate conduct of Passed Asst. Surg. A. R. Thomas while en route 
from London, England, to Manila, P. I., and by approval of the find- 
ings of the board he was reduced 11 files in rank and placed at the foot 
of passed assistant surgeons and placed on three-quarters pay for six 
months from September 3, 1902. 

August 26, 1902, board convened to meet at New York to investigate 
(conduct of Surg. T. B. Perry while on duty at immigration depot. 

August 27, 1902, board convened to meet at Washington, D. C, to 
revise the regulations governing the Service. 

November 10, 1902, board convened to meet at Washington, D. C. 
for consideration of act of Congress approved July 1, 1902, entitled 
'^'An act to regulate the sale of viruses, serums, toxins, and analogous 
products in the District of Columbia, to regulate interstate tmrnc in 
aaid articles, and for other purposes.-' 

December 4, 1902, board convened to meet at Washington, D. C, to 
revise uniform regulations of the Service. 

February 25, 1903, board convened to meet at Siin Francisco, Cal., 
to investigate conduct of Passed Asst. Surg. A. R. Thomas, from Decem- 
ber 15 to 80, 1902. 

March 16, 1903, board convened to meet at Honolulu, H. I., to make 
investigation relative to conduct of Asst. Surg. F. J. Thorn bury. 

June 10, 1903, board convened to meet at Washington, D. C, to 
review testimony taken before board in Honolulu, convened Febru- 
try 26, and make recommendation in case of Asst. Surg. F. J. Thorn- 
bury, and by approval of the findings of the lioard, he was, by Depart- 
ment letter of June 16, 1903, dismissed from the Service to take effect 
from date of the receipt by him of said letter. This leUj^Y vj«L^\j«t- 

a Doc. 838 8 



34 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

sonally delivered to Asst. Surg. Thornbury on July 1, 1903, by Passed 
As8t. Surg. L. E. Cofer, the medical oflScer in command at Honolulu. 
June 18, 1903, board convened to meet in Washington, D. C, to 
ascertain whether any irregularities in regard to preparing for publi- 
cation and presentation the findings of working paily No. 1, organized 
by Department letter of March 6, 1902, had occurred. 



ACCOUNTS. 

VOUCHERS PASSED FOR PAYMENT AND SETTLEMENT. 

The records of the Bureau show that 18,824 vouchers were passed 
during the year. Of this number 16,978 were sent to the disbursing 
clerk for payment, 570 were transmitted to the Auditor for theTreasui; 
Department for examination and settlement, and 1,276 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, 1903. 

The balance of the Marine-Hospital fund available at the commeDce- 
mcnt of the fiscal year was $635,831.51, and the receipts from all 
sources $947,240.98. The expenditures were $1,096,434.49. 

Su mmanjj Marine^ HoRpiUd fuml. 

Balance, July 1, 1902 $635,83L5l 

Receipts, tonnage tax 907, 316. 44 

Repayment, care foreign seamen, medical and hospital supplies, etc .. 39,924.54 

Total 1,583,072.49 

Ea'pendUnrea. 

Maintenance of stations 1756, 553. 44 

Salaries, Surgeon-Generars Office 39, 040. 00 

Fuel, lights, and water 61, 191. 25 

Repairs to public buildings 101, 204. 75 

Furniture and repairs 3, 820. 44 

Heating apparatus 4, 569. 28 

Purveying depot 131 , 055. 33 

Total 1,096,434.49 

Balance July 1, 1903 486,638.00 

Statement of AppropriatUm.^ Quarantine Sen-ice j 190S, 

Amount of appropriation i $325, 000. 00 

Repayment, care foreign seamen, etc 2, 621. 83 

Total available 327,621.83 

Expenditures July 1, 1902, to June 30, 1903 319, 469. 42 

Balance July 1, 1903 8,152.41 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



35 



Name of station. 



Maintenance 
o£ stations, 
salaries, sub- 
sistence sup- 
plies and mis- 
cellaneous 



eedj Island, Del 

•elaware Breakwater, Del 

ape Charles. Va 

ape Fear, N. C 

outh Atlantic 

nmswick, Ga 

all. Hiss 

ey West, Fla 

ampaBaj, Fla 

&n Diegro, Cal 

Ko Francisco, Cal 

ort Townsend, Wash 

olombia River, Oreg 

RYAmuth, Ga 

mnberiand Soond, Fla 

L Johns Riyer 

IscaTneBay 

oea Grande 

edarKeys. Fla 

L Geoives Sound 

«ii8BCoIa, Fla 

'^eRftorr of Hawaii 

^ortoRico 

UBoellaneotu 



123,279.66 

5,493.74 

16,180.65 

6,942.65 

11,370.85 

5,885.61 

22,174.80 

5.690.66 

7,834.29 

7,888.90 

43,462.97 

17,454.12 

12,961.19 

17,882.61 

4,697.19 

1,940.20 

2,024.79 

8,523.50 

635.78 

3,378.77 

10,670.62 

40.808.53 

29,708.55 

1,900.09 



Medical 
and bospi- 
talsupplies. 



Total 303,290.72 



92,939.28 

718.03 

682.91 

308.24 

414. 74 

892.75 

1,185.01 

63.22 

234.33 

691. 45 

685.68 

691.43 

257.97 

1,361.99 



Total. 



101.47 
179.38 



236.66 
2,037.04 
1,098.76 
1,222.80 

227.56 



16,178.70 



126,218.94 

6,206.77 

16,863.56 

7,250.89 

11,785.59 

6,778.86 

23,309.81 

5,753.88 

8.068.62 

8,083.&') 

44,148.65 

18,145.55 

13,219.16 

19,244.60 

4,697.19 

1,940.29 

2,126.26 

8,702.88 

635.78 

8, 615; 43 

12,707.66 

41,907.29 

30,931.85 

2,127.65 



319,469.42 



Preventing the spread of epidemic diseases, 

balance July 1, 1902 $654,090.10 

bcpenditures July 1, 1902, to June 30, 1903, viz: 

Foreign medical service, salaries and miscellaneous, viz, 
Chma, England, France, Germany, Japan, and Cen- 
tral America $:^9,918.63 

Habana, Cuba (including outlying districts), salaries, 
subsistence supplies, and miscellaneous 35, 359. 54 

Sanitary inspection in the United States, salaries, travel- 
ing expenses, and miscellaneous 45, 809. 59 

Yellow fever, maintenance of detention camps, pre- 
caution against outbreak of yellow fever, salaries. 
medical and hospital supplies, disinfectants, etc 13, 710. 59 

Vera Cruz, Mexico: Salaries, supplies, laboratory ex- 
penses, etc., special investigation of yellow fever 7, 623. 28 

Nome and Sitka, Alaska: Medical supplies, ^laccine, sal- 
aries, etc. , account smallpox inspection 12, 51 1 . 37 

Texas bonier inspection, account smallpox: Salaries 
and miscellaneous 10, 025. 11 

Philippine Islands, traveling expenses 80. 00 

165,038.11 

Balance July 1, 1903 489,051.99 

Appropriations for qaaraniine stations, 

Ihe8ax)eake Bay Quarantine Station, act March 3, 1893: 

Balance July 1, 1902 $6,935.00 

Balance July 1, 1903 6,935.00 

rulf Quarantine Station, act March 3, 1899: 

Balance July 1, 1902 824.56 

Balance July 1, 1903 824.56 

oath Atlantic Quarantine Station, act June 4, 1897: 

Balance July 1, 1902 453.02 

Balance July 1, 1903 453.02 

teedy Island Quarantine Station, act March 3, 1901 : 

Balance July 1, 1902 1,307.95 

Expended July 1, 1902, to July 1, 1903 440.00 



Balance JtzJr h 1903. 



^1,^ 



36 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Port Townsend Quarantine Station, act March 3, 1901: 

Balance July 1, 1902 $39,800.00 

Expenditures previously authorized but not used 176. 30 

Total available 39,976.30 

Balance July 1, 1903 39,976.30 

South Atlantic Quarantine, act June 28, 1902: 

Amount of appropriation 3, 500. 00 

Expenditures July 1, 1902, to June 30, 1903 170.40 

Balance July 1, 1903 3,329.60 

Femandina, Fla., act June 28, 1902: 

Amount of appropriation 6, 000. 00 

Expenditures July 1, 1902, to June 30, 1903 6,000.00 

Mayport, Fla., act June 28, 1902: 

Amount of appropriation 2, 350. 00 

Expenditures July 1, 1902, to June 30, 1903 860.00 

Balance July 1, 1903 1,600.00 

Miami, Fla., act June 28, 1902: 

Amount of appropriation 23, 600. 00 

Expenditures July 1, 1902, to June 30, 1903 16,852.24 

Balance July 1, 1903 6,747.76 

Boca Grande, Florida, act June 28, 1902: 

Amount of appropriation 3, 500. 00 

Expenditures July 1, 1902, to June 30, 1903 3,000.00 

Balance July 1, 1903 600.00 

Pensacola, Fla., act June 28, 1902: 

Amount of appropriation 30, 000. 00 

Expenditures July 1, 1902, to June 30, 1903 26,469.39 

Balance July 1, 1903 4,630.61 

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

Amount of appropriation 7, 600. 00 

Expenditures July 1, 1902, to June 30, 1903 7,48L45 

Balance July 1, 1903 18.55 

Appropriations transferred to Superinnng Architect, 
Pittsburg, Pa., act March 31, 1902 160,000.00 

ADMINISTRATIVE DETAILS— CIRCULAR LETTERS. 

Circular Letter Relative to Appointment of Hospital Attbndantb. 

Treasury Dspabtmbmt, 
Bureau or Public Health and Marine-Hospital Sesticb, 

Wddhingtonj November 29, 1909, 

To commissioned officers^ acting assistant surgeons^ and others concerned: 

It is observed that at some of the stations in this Service appointments are recom- 
mended for the position of hospital attendants without regara to the standing of the 
person on the ehgible list. 



PUBLIC HEALTH AND liARINE-HOSPITAL SERVICE. 37 

In order that the requirements of the eivilHservice law, rules, and regulations may 
at all times be strictly observed, officers of the Service are directed to state in the let- 
ter of nomination (if the party nominated has previously qualified^, or in the letter 
recommending a probationary appointment, that the selection of tne party in ques- 
tion was made from the highest three eligibles on the list who possess the requisite 
qualifications for the puticular duties to be required of the appointee. If there are 
eligibles on the list whose standing is higher than the party nominated who have 
declined the position or whose addresses are not known at the time of recommend- 
ing the eU^bie with a lower average, this fact should be reported either in the let- 
ter of nonunation or in the letter recommending a probationary appointment. 

In this connection attention is called to the f£;t that when the transcript of regis- 
ter of eligibles forwarded to the Bureau prior to the nomination of an attendant does 
not contain the name of the party nominated, the appointment can not be made for 
a period to exceed thirty days. Before the temporary appointment has expired the 
par^ should be required to qualify and a letter forwarded to the Department, through 
the Bureau, recommending the probationary appointment for a period of six months 
from date of expiration of the temporary appointment. If the temporary appointee 
fails to attain an average of 70 per cent, this fact should be reported m ample time for 
the Bureau to receive the letter prior to the expiration of the temporary appointment, 
and the services of the attendant should be promptly dispensed with at the expira- 
tion of the thirty-day appointment. 

Bespectfolly, Walter Wyman, 

Surgeon- Oeneral, 



CracuLAB Lbtter RsLATrvB TO Pebsonal-Rbcord Index Cards. 

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

Washinffton^ March 21, 1903, 

Sir: I have to inclose herewith a personal-record index card, together w^ith the 
accompanying circular of instructions, issued by the Assistant Secretary of the Treas- 
nry under date of March 25, 1903. 

You are directed to fill out the card in typewriting, in accordance with instruc- 
tions, and transmit the same to the Bureau at as early a date as possible. 
Respectfully, 

Walter Wyman, Surgeon-General 



Cibculab Letteb Rklattvb to Pebsonal-Rbcord Index Cards. 

Trbasuby Department, 
Bureau op Pubuc Health and Marine-Hospital Service, 

Washington, March 27, 1903, 

Sib: There is transmitted to you herewith a sufficient number of personal-record 
index cards and circular letters signed bv the Assistant Secretary ot the Treasury, 
under date of March 25, 1903, to supply the medical officers and pharmacists at your 
station. 

You are hereby directed to have one of these cards filled out in typewriting by 
yooTBelf and each of the said medical officers and pharmacists, and transmit the 
same, with as little delay as possible, to the Bureau. 

Respectfully, yours, Walter Wyman, 

Surgeon- QeneraL 

In addition to the foregoing circular letters, two Department circu- 
lars were issued during the year, as follows: 

Department circular No. 22, dated February 27, 1903, entitled 
"Information for candidates for appointment as pharmacist in the 
Public Health and Marine- Hospital Service of the United States." 

Department circular No. 24, dated March 4, 1903, entitled '^Infor- 
mation for persons desirous of entering the medical corps of the Pub- 
lic Health and Marine-Hospital Service." 



88 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

The above circulars were rendered necessar}' by reason of the issue 
of new service regulations, based on the act of Congress of July 1, 
1902, ''To increase the efficiency and change the name of the Marine- 
Hospital Service." 

Respectfully, George Purviance, 

Assistant Surgeon- GeneraL 
Surgeon-General Public Health 

AND Marine-Hospital Service. 



DIVISION OF MARINE HOSPITALS AND RELIEr 



39 



BEPOET OF DIYISIOH OF MABIHE HOSPITALS AKD BELIEF. 

By L. L. Williams, 
AstiMarU Surgeon-General, Public Health and Marine- Hospiial Service, in Charge, 

Sra: 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, 1903: 

BELIEF OF SEAMEN. 

During the year 58,573 seamen were treated at the various relief 
stations of the Service. Of these 13,567 were treated in hospital 
and 45,006 were treated as out-patient9. Three hundred and eighty- 
three thousand three hundred and eighty-nine days' relief in hospi^l 
were furnished. 

Excess in number of patients over previous year 2, 263 

Excess in number of days' relief over previous year 26, 620 

RELIEF STATIONS. 

During the year the Service controlled and operated 23 hospitals. 
The Government owns 22 of these hospitals. The hospital building at 
Dutch Harbor, Alaska, was leased until the close of the fiscal 3''ear 
ending June 30, 1903. As the amount of relief work at Dutch Harbor 
does not warrant the further maintenance of a hospital at that port 
the lease will not be renewed. The hospital equipment, etc., is being 
removed to Nome, Alaska, where two buildings on the reservation 
formerly occupied by the Army, but now controlled by the Treasury 
Department, have been assigned for the use of the Service by Depart- 
ment order of June 4, 1903. As a measure of economy the mainte- 
nance of a marine hospital at Delaware Breakwater, Del., was discon- 
tinued at the close of the fiscal year. A station of the second class 
will continue the relief work at that port. 

In addition to the marine hospitals there are 121 relief stations where 
seamen receive hospital and dispensary treatment. A relief station 
has been established during the year at Nome, Alaska. 

INSPECTION OF STATIONS. 

The following^ relief stations were inspected during the year, and 
appropriate action on the inspection reports taken by the Bureau: 
I\>rtland and &ngor, Me.: Portsmouth, N. H.; Boston, Gloucester, 
and New Bedford, Mass.; New Haven and New London, Conn.; New- 
port and Providence, R. I.; New York, N. Y.; Philadelphia, Pa.; 
Chicago and Cairo^ 111.; Cleveland and Cincinnati, Ohio; Evansville, 
Ind. ; Louisville, Ky.; St. Louis, Mo.; Memphis, Tenn. ; Port Town- 
send, Sc»tUe, Tacoma, and Hoquiam, Wash.; Portland, Astoria, and 
Marshfield, Oreg. ; Los Angeles, £ureka, and San Diego, Cal. 



42 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

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. 

AID TO OTHER BRANCHES OF THE GOVERNMENT. 

Revenue- Cutter Service. — Eight hundred and eighty-four applicants 
for enlistment were examined^ of whom 121 were rejected. 

Steamboat- Inspection Service. — One thousand five hundred and 
twenty-five pilots were examined as to visual capacity, and 80 were 
rejected. One inspector of hulls physically examined and rejected. 

Life-Saving Se)*vice. — One thousand two hundred and twenty-six 
surfmen were examined and 51 rejected. 

Coast and Geodetic Survey. — Sixty-three applicants for enlistment 
were examined and 12 rejected. 

Light- House Service. — ^Three applicants for enlistment were exam- 
ined and none rejected. 

Civil Service Commission. — Three applicants physically examined 
and passed. 

Post- Office Department. — Eighteen employees examined and 1 
rejected. 

United States customs service. — One hundred and fifteen employees 
examined and 5 rejected. 

PHYSICAL EXAMINATIONS OF MERCHANT SEAMEN. 

Ph^^sical examinations were made of 426 American merchant sea- 
men, of whom 44 were rejected, and of 69 foreign seamen, of whom 6 
were rejected. 

PHYSICAL EXAMINATIONS OF OFFICERS OP THE REVENUE-CUTTER 

SERVICE. 

The following orders have been issued during the year: 

Treasury Department, Office of the Secretary, 

Washingiony July £6, J90£. 

The following physical standard for appointments to the Revenue-Cutter Service, 
to the grade of cadet and second assistant engineer (original appointments) is hereby 
promuTi^ated: 

Candidates will be examined physically by a board composed of medical officers 
of the Public Health and Marine-Hospital Service. Any one of the following con- 
ditions will be sufficient to cause the rejection of a candidate: Feeble constitution, 
inherited or acquired; retarded development; impaired general health; decided 
cachexia, diathesis, or predisposition. 

Any disease, deformity, or result of injury that would impair efficiency, such as 
weak or disordered intellect; cutaneous or communicable disease; unnatural cun'a- 
ture of spine, torticollis, or other deformity; inefficiency of either of the extremities 
or large articulations from any cause; epilepsy or other convulsions within five years; 
impaired vision, disease of the organs of vision, imperfect color sense; visual acute- 
ness must be normal in both eyes; impaired hearing or disease of the ear; chronic 
nasal catarrh, ozoena, polypi, or great enlargement of the tonsils; impediment of 
speech to such an extent as to impair efficiency in the performance of duty; disease 
or heart or lungs or decided indications of liability tocaixliacor pulmonary affections; 
hernia, complete or incomplete, or undescended testis, varicocele, sarcocele, hydro- 
cele, stricture, fistula, hemorrhoids, or varicose veins of lower limkNs; disease of the 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 43 

genito-urinary organs; chronic ulcers, ingrowing nails, large bunions or other deform- 
ity of the feet; loss of many teeth, or teeth generally unsound. 

Attention will also be paid to the stature of the candidate, and no one manifestly 
under size for his age will be appointed. In case of doubt about the physical condi- 
tion of the candidate, any marked deviation from the usual standard of height or 
weight will add materially to the consideration for rejection. Fiye feet three inches 
will be the minimum height for the candidate. 

O. L. Spauldinq, 

Acting Secretary, 

Imperfect color sense will not necessarily reject a candidate for the position of 
second assistant engineer. 



[Circular letter.] 

Treasury Dbpartmbnt, 
Bureau op Public Health and Marine-Hospital SsRyiCB, 

Washington, April j?i, 190S, 
To Commissioned Medical OfficerSy 

Public Health and Marine-Hospital Service: 

The accompanying blank form is hereby adopted as the form of medical certificate 
to be used by medical officers serving on boards for the physical examination of 
ofiBcers of and candidates for appointment in the Revenue-Cutter Service. 

Thia form, after being filled out and signed by the members of the board, will be 
forwarded to the Surgeon-General in duplicate, except in the case of an officer appear- 
ing before a retiring board, when one copy should be submitted to the boara and 
the duplicate transmitted to the Surgeon-General for the files of the Bureau. 

It is contemplated that, from the files of the Bureau, there will be furnished all 
previous certificates bearing upon the medical or surgical history of any officer of the 
Revenue-Cutter Service who may be before a board for examination. 

When boards are convened outside of the Bureau, the necessary information will be 
supplied to the chairman of the board, and when boards are convened by telegraph, 
a synopsis of the findings of previous medical examining boards will be lumishecf in 
the telegraphic order convening the board, if practicable. 

When an officer is found to be physically incapacitated for service, the medical 
certificate should contain a statement under the head of " Remarks" as to the cause 
which, in the judgment of the medical examiners, has produced his disability, and 
whether such disability was acquired in the line of duty. The final lines above sig- 
natures are left for insertion of statements in reply to special inquiries embodied m 
the letters of the Secretary of the Treasury requesting the convening of the board. 
Respectfully, 

Walter Wyman, Surgeon-General. 

Approved: 

R. B. Armstrong, Assistant Secretary. 

[Inclosure.] 
Medical certificate. 

PhjTsieal examination of for (appointment, promotion, sick 

leave, retirement, fitness for duty «). (Designate cause for examination.) 
Applicant's statement of previous illness or injury: 



(To be signed by the officer or candidate undeiT^ing examination. ) 

General appearance, ; age, ; weight, ; height, ; vision 

(including color sense) ; hearing, ; cheat, ; mobility, ; 

expiration, inches; inspiration, inches; lungs, ; 

aBy ''fitness for duty" in the Revenue-Cutter Service is meant physical and men- 
tal ability to serve on any station or any vessel of the Service, including prolonged 
cruise at sea. 



44 PrBLlO HEALTH AND MABINE-H08PITAL 8EBVICE. 
heart, ; abdominal organs, 



jjfenito-urinary apparatus, ; urine, specific gravity, ; reac- 
tion, ; albumen, ; sugar, ; casts, ^if microeoooical exami- 
nation deemed necessary). 

Extremities, ; mouth, ; throat and noee, 

Remarks : ( Cause of disability, whether in line of duty, etc. ) 

We certify that we have carefully examined the above-named and 

find that he is of sound mind and is physically qualified for duty in the 

U. S. Revenue-Cutter Service, as defined in footnote ., 



Respectfully submitted. 



RELATION OF MEDICAL OFFICERS TO LOCAL CODRT8. — OPINION OF 

ACTING SOLICITOR. 

Dbpabtmsnt of JusncB, 
Oppice op the Solicitor op the Trsasuby, 

Washington D. C, March 7, 190S, 

Sir: By reference of Assistant Secretary Armstrong I am in receipt of a letta 
addressed to the Surgeon-General of the Public Health and Marine-Hoepital Service 
by Charles £. Banks, surgeon in charge of the marine hospital at Chicago, 111., stat- 
ing that he has been serv^ with a subpoena duces tecum, issued by the superior court 
of Cook County, commanding him to appear, with ''all books, papers, documents, and 
history sheets and records pertaining to the treatment of said William Larsen while 
a patient in the United States marine hospital.'' It is stated that the individual 
named is a plaintiff in a damage suit, and that the process was issued at the request 
of the defendant, a corporation. 

Section 2 of the act of the legislature of Illinois, approved January 11, 1867, ceding 
jurisdiction over the cite where the marine hospital has been erected, provides that 
*' All civil and criminal process issued under the authority of this State or byanr 
of its ofheers in pursuance of law may be executed on said real estate as if sdcd 
jurisdiction had not been ceded." 

My opinion is requested as to whether the surgeon should obey said smnmons. 

It does not appear, nor is it suggested, that compliance with the said process would 
be contrary to public policy, and unless the production of the books, papers, etc., 
called for would be prejudicial to the interests of the Government I can see no 
objection to compliance with the summons. 

A somewhat similar question was raised in re Hirsch (74 Fed. Kep., p. 928). In 
that case it was held that an internal-revenue collector was not justined in refusing 
to produce, in obedience to a subpoena duces tecum issued by a stote court the appb- 
cation or return made by a person who desired to pay the tax imposed by the statatee 
of the United States upon persons engaged in the retail liquor business, either bv the 
nature of such documents or by alleged instructions from the Commissioner of lnte^ 
nal Revenue. On appeal the ruling of the circuit court judge was affirmed by the 
circuit court of appeals (87 Fed. Rep., p. 1005). 

The letter submitted is herewith returned. 

Very respectfully, F. A. Reeve, 

Acting SoticUor, 

The Secretary of the Treasury. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 45 

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

{Report of medical officer hi catnmand,) 

United States Public Health and Marine- Hospital Service, 

Office of Medical Officer in Command, 

Fort SUiiUon, N. Mex,, September i, 1903, 

Sir: In accordance with Bureau order of July 2, 1903, I have the honor to submit 
le following report of transactions of this sanatorium during the fisod year ended 
une 30, 19(3: 

StatMcs, 

atients under treatment July 1, 1902 ^ 105 

atients admitted during the year 169 

atlentA under treatment June 30, 1903 150 

atient8 dii«charged during the year 124 

.ges of patients admitted during the year: 

Under 25 years 19 

From 25 to 34 years 67 

From 35 to 44 years 47 

From 45 to 54 years 29 

Over 55 years 7 

169 

feredity in patients admitted during the year: 

History of tuberculosis in parente 34 

No history of tuberculosis in parents 135 

169 

kage of disease (first stage meaning where no consolidation nor excavation 

can be discovered) : 

First stage 22 

Second and third stages 147 

169 

rea of involvement as shown by physical examination : 

Bight lung only 8 

Left lung only 7 

Both lungs. .1 154 

169 

reneral condition at arrival (good, meaning well nourished and without 

jeiave complications; bad, meaning rather poorly nourished or with com- 
plications not necessarily fatal ; very bad, meaning much emaciated or with 
grave complications, such as organic heart disease, chronic nephritis, or 
advanced laryngeal involvement) : 

Good 49 

Bad 60 

Very bad 60 

169 

^ibercle-tecilli: 

Were not present in the sputum of 28 

Were present in the sputum of 141 

169 

Hher oiigans were involved with tuberculosis as follows: 

Lanaix '. 16 

Intestines 3 

Testicles 2 

Vertebrae 2 

Ribs 1 

L3rmph glands 4 

Infenor maxilla 1 

Rectam (fistula in ano) 4 

Complications occurred as follows: 

Syphilis 19 

Hemorrhoids 8 

Hernia 7 

Varicose veins of Im; 6 

Valvular disease of heart 6 

Varioocele ^ 



46 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Complications occurred as follows — Continne<K 

Paraplegia (cerebral hemorrhage) 1 

Epilepsy 2 

Fissure in ano 1 

Nephritis 1 

Trachoma 2 

Chronic pleurisy with effusion 1 

Record of patients who had pulmonary hemorrhap:e: 

Before arrival only 51 

After arrival only 3 

Both before and after arrival 5 

59 

Duration of residence of discharged patients: 

Over 2 years 6 

Between 1 and 2 years 23 

Between 6 and 12 months 35 

Betweien 3 and 6 months 31 

Under 3 months 29 

124 

Condition of the 124 patients at time of discharge: 

Apparently cured 12 

Improved 54 

Not improved 10 

Died 48 

124 

During the year we have had under treatment, in addition to the above, con- 
sumptive officers and employees as follows: 

Those here July 1, 1902 11 

Admitted during the year 8 

19 

Still under treatment June 30, 1903 12 

Left during the year 7 

19 

Condition of those leaving at time of discharge: 

Apparently cured 2 

Improved 3 

Not improved «2 

Several of those still here are cured. 

The large number of cases leaving before there has been time to complete their 
cure lowers very considerably the percentage of cured cases discharged, and has 
caused me to thmk very mucn of the possibility of securing greater control over the 
patients in this regard. In sending a patient to this sanitarium the Service invests 
a considerable sum of money, and it would seem but fair that there should be some 
obligation on the part of the patient to remain for a sufficient length of time to be 
cur^ or to demonstrate the fact of his incurability; but under existing conditions 
there is no such control, although there seems to be a moral obligation on the part 
of the patient to remain long enough to justify the expense of sending him here. 

The case charted on the inclosed statistical sheet illustrates most excellenUy this 
phase of the situation. It will be noted that this man, although only here two 
months, had made a gain of 15 pounds in weight and was, when he left, somewhat 
above his normal weight. The chart also shows that both lungs had cleared up 
remarkably for so short a period of treatment. This patient went to El Paso, but 
had scarcely l^en there a week when he wrote me that he was having hemorrha^ 
and was otherwise doing badly, and asked permission to return. Fortunately for him 
I was able to take him back at once before verv serious rt^trogression had taken place, 
and having learned his lesson he will doubtless remain until completely cured. 
Unfortunately for our statistics, it continues to be true that the most promising of 
our cases are the ones who leave prematurely; very few of the hopeless or less prom- 
ising cases leave. It is doubtful whether, without s})e('ial Congressional enactment, 
we could make a binding agreement with patients prior to tlieir transfer here which 
would enable me to control their movements. It is therefore suggested that Con- 
gress be asked to pass a law which will enable us to enlist these patients for, say, a 
period of one year, or make other written agreement with them, with appropriate 
penalty for breach of contract on the part of the patient, granting authority to the 



o Here but a short time. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 47 

commanding officer to arrest or otherwise restrain those desiring to leave without his 
consent prior to the termination of their enlistment or contract. 

The treatment pursueti has been as heretofore hygienic, dietetic, and symptomatic. 
All |>atients, whose condition warrants it, have taken daily breathing exercises dur- 
ing the year. This, I think, is of undoubted value, and has resulted in an average 
increase of 2 cm. in chest mobility. 

A large proportion of our patients require treatment on account of nose and 
throat troubles. 1 have therefore established a nose and throat clinic, the average 
daily attendance being 12, and an additional number take self-treatment in the form 
of sprays under medi^ advice. 

RSPAIBS TO KUILDINQS, ETC. 

A 8j>ecial report of repairs and alterations has been made, but it is believed that 
the accompanying photographs will be of interest here as illustrating the value of 
the improvements made. 

WATER dUPPLV. 

The water supply, being derived chiefly from the Rio Bonito, is very uncertain. 
It will be remembered that a reservoir was constructed by my predecessor and sup- 
plied by a ditch 3 miles long, leading from the Bonito to the reservoir. This ditch 
has insufficient fall, and is only kept in repair by the expenditure of considerable 
labor. A separate report regarding the water supply has been submitted and, in 
addition to tne recommendation contained in that report, it is intended, with the 
labor of hospital attendants, to greatly enlarge the present reservoir and perhaps 
excavate an additional one, in the hox)e that we may be able during the time when 
water is plentiful in the river to store sufficient water to carry us over periods of 
drought. This work is now in progress. Pumping water from the old army well is not 
only expensive and, with the present gasoline engine, uncertain, but the wells do not 
supply more than one-third the requisite amount of water. 

MILK SUPPLY. 

The present source of milk supply is inadequate, the number of patients having 
increased much more rapidly than our ability to produce milk; but this difficulty is 
g^udually adjusting itself, as we are making material additions to the herd of milk 
cattle by natural increase. Many of the cows purchased were of inferior quality as 
milk producers, which has added to the average cost per gallon of the milk produced, 
since a p>oor cow eats as much as a good one. It is oelieved, however, by selecting 
the best cows of our own raising and discarding the poor ones, we will soon have a 
sufficient number to supply all the milk we ne«d at a moderate cost. The following 
is a statement showing tne present condition of the Jersey herd. It has occurred to 
me that w^e might increase our milk supply and, at the same time, add to the meat 
supply and furnish occupation to some of our patients by acquiring a small herd of 
native goats, place one or two in charge of such patients as would be willing to 
nnderttULe their care, and permitting patients to drink the milk of the goats in their 
immediate care. This matter will l^ brought more particularly to your attention in 
a separate communication. 

Nineteen thousand one hundred and twenty gallons of milk have been produced 
and used during the year. 

The numl)er of Jersey cows and bulls purchased was 44. We now have — 

Cows 56 

Bulla 3 

Yearling heifers 10 

Yearling steers 4 

Calves: 

Heifers 26 

Steers 26 

Total 124 

RANGE OR BEEP CATTLE. 

The increase of our herd of range cattle has been very satisfactorv, as shown by 
the subjoined table, and during the present calendar year has furnished our supply 
of beef for about two and a half montns. It is believed that within two years, with- 
out further purchase, except perhaps a few bulls, we will be ab\^ \tt ipto^\w» wa 
entire supply of beef. 



48 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVI0B. 



The original purchase of Herefords, or beef cattle, was 206, of which 140 
cows. The present condition of the herd is as follows: ' 

CJows ,, 

Steers i 

Heifers 

Calves of this year: 

Heifers 

Steers 

Calves, unclassified 

Bulls purchased •, 

Bulls raised at station 

Steers killed for beef *.^ 

Total 

HORSES. 

We raised last year six colt8, and this year seven. The station will be abblfti 
to raise all the horses needed as saddle and work horses. 

FARM AND GARDEN. 

The present year has been a most unsatisfactory one for agricultural 
Two late freezes and a subsequent hailstorm of ^reat severity amiost ruin< 
den three times, necessitatinc: rei)lanting, and m consequence all garden pi4 
have been very late. It is impossible at this time to give a complete statwB 
the farm and garden products of the year. 

We have about 63 acres in alfalfa, which yielded at the first cutting 91 to 
hay. The second crop was harvested during July, 34 tons were bedled, mC 
greater portion of it is still stacked in the field. The yield of the second <S0[ 

Srobably not fall much short of 100 tons. The third harvest will begin witbini 
ays, and will probably weigh in 60 tons. In addition to this we have harydb 
tons of oat hay, and have alx)ut 20 acres of corn which promises to vield faMj 
About 20 acr^ each of corn and oats were almost a total loss for lack of railL 
portion of the crop which succeeded had partial irrigation. 

Respectfully, • P. M. Carrinqtos^ 

Surgeon in CammiM 
Surqbon-General, Public-Health and Marine-Hospital Service. 



Statistical hifitory sheet — Tuberculosis. 

U. 8. Public Health aio) Marine>Ho6Pital Sbryick Sanatobiui; 

Fort Stanton, N. 

Name, E. C; rating, fireman; nativity, California; age, 23; date of examination, June2, IWS. 
i\y history (tubercular): M., no; F., yes; B., no; S., no; W., single; child. Personal history: I 
favoring tuberculosis, dissipation; consumptive roommate, about one year ago; normal weig) 
weight now. 127; well or badly nourished, only fairly well; condition of teeth, ftdrly good; i 
tions per minute, 22; pulse, 106. 



Symptoms. 



Cough (how long) , 



Sputnm (how long) 

Tubercle bacilli (how long) . . . 
Mixed infection (character, 

and how long). 
Fever (how long) 



Night sweats (how long) 



Dvspnoea ( how long) 

Pleurodynia (how long) 
Pleurisy (how long) 



Hemorrhages (number). 
Tuberculin test (result) , 



Early — before entrance to 
sanatorium. 



Present trouble, March, 
1903; has had slight 
cough since November. 

Yes; since March, 1903... 

Yes 

Yes 



None, to his knowledge; 

redded in boHpital. 
Yes: since Marcn, 1903... 



Slight 



Pleuritic pain, in March, 
1903. 

No 

No 



During stay at 
sanatorium. 



At the time c 
charge, July] 



Present, June 2. 



Present, first two 
nights after ar- 
rival. 



None since arrival . 



No cough. 
Very scant 

None. 
None since Ji 

Very slight 
None. 



k 



l 






■.'I i 



^' YOilK! 






:~» 



I 

I 

\ 



. V. 



■".' . * 



-V . «^ 



PUBLIC HEALTH AND MARINP>n08PITAL 8ERVICK. 49 

tStntuUical hijiton/ nfu't't — Tubcrraiottix — ContiniUHl. 



^ f ^in • Early— Jn'forc entrance to Durinfr stay at 

.^>iiipioui.v. sanatorium. sanatorium. 



<r»MI*LI('ATIONH. 



l2&.<tro intestinal (diafniOKi8)a. No 

Cenito-urinary (diagnosis) ft... (ionorrha*a, stricture, 

ehancre. in 1900. 
BUmmI diseajiCJ* (diagnotdm) c .,. No 



Hemoglobin. 50 per 
cent, June 2, 1903. 



At the time of din- 
chargc. July :il, lUOtJ. 



Hemoglobin, 70 per 
cent. 



Bone diivasos (diagnosis) No 

Kenous diiieanes (diagnosis) . . No 

Heart disea-Hw (diagnosis) No 

Koseand throat diseases (diag- No Slight, naso-pharyn- 

nosis). j { geal catarrh. 

GLandnlair diseases (diagiio- Enlargement of cervical.. : Enlargement of 

sis).*! I I rightcervical lym- 

phatic glands. 



• Diarrhren. indigestion, etc. <• Anemia, malaria, etc. 

* Syphilis, Bright's diKe«»c, etc. fi Orchitis and hepatic conditions can b*.' put under this head. 

Stage of phthisis. se<*ond: result of treatment, much improve<l; length of stay, two months; weight, 
142| p<^>undi(; gaine<l 151 iHMinds in weight. 

NoTB. — It i'i niv opinion that softening and excavation has begun, which would make this a third 
Instead of secona, but there are no {Kisitive signs of a cavity. 

DI8INFKCTION OF WARI)K AT FORT STANTON HANATORIITM. 

U. S. Public IIkai.tii and Marine-Hospital Service, 

Office of Medical Officer in Com.viand, 

Fort iSUintoiiy N. Mex.^ May 6, 190S. 

8ib: I have the honor to transmit herewith report of exi>erimenta conducte<i by 
fttet Asst. Siirjr. K. K. Snrague, which shows that the building, No. 14, known as the 
bompital, and occupied by our worst cases of tuberculosis, is absohitely uninfected 
with tuberculosis. These experiments, of course, do not prove tliat the buildings 
do not bei'onie temporarily infec^ted, but they at least prove that they were not 
infected at the time of the experiment, and that the method of disinfection practiced, 
namely, monthly sponging with bichloride of mercurv, is effective. 

Other experiments relating to the effectiveness of formaldehyde gas, as generated 
imia wood alcohol by means of the Kuhn lamps, are in progress and the results 
obtaine<l will be reported within a few days. 

Respectfully, P. M. Carrington, 

Surgemi in Command. 
Smci eon-General, Public Health 

and Marine-Hospital Service. 

[Inclosure.] 

U. S. Public Health and Makine-Hospital Service, 

Office of Medical Officer in Command, 

Fort Stanton f N, Mex.^ May 5, 190S, 

Sir: I have the honor to make the following report of investigations into the sani- 
lar>' conditions of the wards of the building now useii as a hospital for our most seri- 
ous cases of pulmonary tuberculosis. It is in these wards tnat are finally placed 
pnicticall}^ all of our fatal cases, the sputa of each one of which are known by repeated 
microscopical examinations to contain myriads of tubercle l)acilli. They were selected 
as the ones most liable to infection among some 50 rooms occupied by patients at this 
eanitarium. 

February 12, 1903, dust was collected from each of the seven wards on sterile cotton 
Bwabs from the walls, from the floor before the daily cleansing, from ol)6cure corners, 
and from every point considered most liable to furnish tubercle germs. The pwal)8 
were then returned to their sterile glass receptacles and at once saturated with sterile 
distilled water. After a thorough shaking the tubes were allowed to stand for a few 
hours aiid later giiinea pigs were inoculated intra-abdominally with about 5 c. c. of 
the Be<iiment obtained from the swal)s. One of the pigs sickened and died February 
25, 1903, from a demonstrated pus infection; the others remaining in good health 
wer»? killed May 1, 1903, after a lai)8e t>f more than twelve weeks, and a c^ireful 

H. Doc. 338 4 



50 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

macroscopit-al and iuii'n>scopical exauiination failed to rc»veal any indication of the 
presence of tulKjrcle bacilli. 

Respectfully, E. <i. Spracue, 

Passed AwiMarU Surgerm. 

Surg. P. M. (-ARRIXfJTON, 

l*uhlic Health and Marine-lltrntiUd Service^ 

Fort Statitoti, X. Mex. 

PURVEYING DEl*OT AT NEW YORK. 

( Report of mcdiad puriTyor, ) 

U. 8. Pi^BLic Hkaltii and Marine- Hospital Skrvice, 

Office of Medical Ptrvbyor, 
378 Waithington street, Netv York, N. 1'., Jxdy SS, Itm. 

Sir: I have the honor to submit herewith report of the operations of this station 
for the fiscal year ended June J^), 1903. 

The i)erson*nel of the station as to number is the same as state<l in the previous 
annual report. Two resignations have taken place within the year. The work of 
purchasing and issuing of supplies has been carried on as on previous lines, but the 
system of ac(*ounting for same has been materially changed. The system in foree 
when I assumed conmiand of the depot was the card system, which has been replaced 
by books specially printed for the purpose of keeping a concise yet more oonaenseil 
reconi of all transactions pertaining to the issue of and receipt of supplies. 

In addition to the regular stations of the Service to which supplies have been \xa- 
nished through this depot, I may mention that of the Immigration Service, CoKt 
and Geodetic Survey, Revenut^Cutter Service, Storekeeper, Treasury Depaitment, 
as well as the Quarantine and Epidemic services, which are under the immeditte 
8ui)ervision of the Bureau, for which requisitions to the number of 726 have been 
filled. 

The financial statement follows: 

Total cost of orders placed during the year, inclusive of fuel and packing 
material (f?9:^.87), which are not accounted for under the hea<l of 

operating expenses of the depot $105, 472.00 

Dry gooils, etc $19, 057. 17 

Medical supplies 16,788.20 

Hospital stores 14, 310. 17 

Surgical dressings, instruments, appliances, and hospital fur- 
niture 11,329.07 

Station equipment 11, 006. 80 

Microscopic, bacteriological, and optical apj>aratus 6, 271. 32 

Disinfecting apparatus and disinfectants 4, 441. 15 

Kitchen and household utensils 4, 159. 65 

Beds and bedding 3,186.02 

Medical books and journals 3, 055. 55 

Carpets 2, 1 04. 19 

Wines and liquors 1, 663. 58 

Pharmaceutical implements, etc 1, 527. 29 

Rubber goods 1, 255. 56 

Paints and brushes 

Vials 

Toilet and wrapping paper 

Flags 

Photographic and X-ray apparatus 

Packing material 

Refrigerators 

Fuel 

Chemical glassware, etc 

Lumber 

Fiquipment purveying depot 

Rubber stamps and seal press*»s 

105,472.00 

Operating exptMises 8, 653. 31 

Street spfinklintr 35. 00 

Repairs 38.25 

Gross expeiulitur(*s 114, 198. 56 



974. 32 


864.58 


810. 50 


801.82 


595. 49 


535. 87 


480. 55 


400.00 


231.89 


231. 15 


219. 76 


171.35 



PUBLIC HEALTH AND MARINE- HOSPITAL SERVICE. 51 

Cr. 

By amoants included in above, specially authorized by the Department, 
paynients beins made from the several appropriations other than that 
of Public HealUi and Marine-Hospital Service $3,796.43 

110, 402. 13 
Cr. 

By amoants due for reimbursement for supplies issued during 
the year to other services: 

Quarantine Service |16, 224. 89 

Immigration Service II, 341 . 41 

Epidemic Service 3, 865. 73 

Appropriation enforcement Chinese-exclusion act 2, 181 . 87 

Coast and Geodetic Survey 731 . 18 

Barge Oeanser 178.25 

Storekeeper, Treasury Department 81. 03 

Revenue-Cutter Service 79. 09 

34, 683. 45 

Net expenditures chaigeable to Public Health and Marine-Hospital 

Service 75, 718. 68 

Salaries 16,530,98 

Commutation 600. 00 

Total net expense 92, 849. 66 

Beqoisitions filled 726 

Number of packages 10, 549 

Weight l)ound8.. 772,174 

In addition to work performed by this depot not enumerate<l in the above state- 
ment may be mentioned services rendered to the Immigration Service as purchasing 
agent, for which that service made pa^rment from its fund for the supplies furnished! 
Previous to October 21, 1902, such service was rendered without charge to the service 
affected. Department approval of the date mentioned provided authority for a charge 
of 10 i>er cent of the am^gate cost of such supplies as should be purchaseil under 
SQch dicumstances to oTefray the expenses of tiiis depot attendant on such work, 
namely, labor, carta^, packing material, etc. 

By a comparison with the previous annual statement it will be observed that the 
oofltof orders for the fiscal year just ended is in excess, whereas the total net expense 
is nearlv $4,000 less. 

Respectfully, Henry W, Sawtelle, 

Surgeon and Medical Purveyor. 

Subobon-Gbnbral, Pubuc Health and Marine-Hospital Service. 

ADVISORY BOARD OF PURVEYING DEPOT. 

A board to be known as the advisory board of the purveying depot 
was constituted by Bureau order of October 22, 1902. 

This board consists of the medical officer in command of the marine 
hospital, port of New York, the medical purveyor and the medical 
officer in charge of the medical inspection of immigrants at Ellis 
Island, N. Y., who are ex officio members of the board. The senior 
member is chairman and the junior member recorder of the board. 
The medical purveyor is executive officer of the board, conducts the 
necessary correspondence with the Bureau, has custody of all corre- 
spondence, samples, etc., and presents the same to the board for con- 
sideration. The board meets regularly once in three months at the 
purveying depot, on the first Monday in July, October, January, and 
April, or oftener upon the call of the chairman. The board examines 
the schedules of the supply table (except schedules 1 , 2, 3, 4, and 5), 
and makes recommendation for removal therefrom of such articles as 
appear to be unnecessary or undesirable. It also couaideYft saOci <j«vx\' 
municatioii^ relative to new remedies, new books, new \ti^\.r\\me;tvV& ox 



52 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

• 

other supplies or appliances as may l)e forwarded to it from the 
Bureau, and recommends to the Bureau such of these articles as, io 
the judgment of the board, are necessary for the use of the Service. 

NEW HOSPITALS. 

New York^ N. Y. — The Seamen's Retreat, which has been leased 
and operated as a marine hospital since 1883, was purchased during 
the year for $250,000, Congress having appropriatea that amount for 
the purpose. The property consists of approximately 10 acres of land 
in Stapleton, Staten Island, fronting on Bay street and commanding a 
view of New York Harbor. The buildings are described elsewhere. 
The purchase of this property had been recommended in the anniol 
reports of the Service for the past twenty years. 

Buffalo^ JV. Y. — Acting under Department order of February 17, 
1903, a commission consisting of Asst. Surg. Gen. L. L. Williams, of 
this Service, and Mr. Francis B. Wheaton^ of the oflSce of tiie Super- 
vising Architect, Treasury Department, visited Buffalo and made ao 
inspection of the various properties onered as sites for the marine 
hospital to be erected under act of Congress, March 24, 1902. After 
careful consideration of the 47 proposals received and inspection of all 
available sites, the commission recommended the puixmase of the 
property offered by Mr. H. H. McPherson at a cost of $22,000. This 
property is situated in the highest part of the city. It contains about 
3 acres fronting on Main street, and located between two existing 
hospitals. Sewer, water, and gas pipes are contiguous, and the street- 
car service is of the best. The site is about 3i miles from the city 
hall. It is understood that negotiations are in progress for the par- 
chase of this land through the office of the Supervising Architect. 

JPittshmv/, Pa. — Department order of October 16, 1902, appointeda 
commission composed of Mn M. H. Garland, collector of customs at 
Pittsburg; Asst. Surg. Gen. L. L. Williams, of this Service; and ib, 
Francis B. Wheaton, Supervising Architect's office, to examine the 
various sites offered for a marine hosjmtal at Pittsburg, authorised by 
act of Congress, March 31, 1902. ISie 44 proposals received were 
duly considered and all available sites examined. The commission 
also examined, through the coui*tesy of the officer in conmfiand, the 
land now belonging to the United States and formerly used as an 
arsenal. The commission unanimously recommended that a portion 
of the arsenal reservation, approximately 5 acres in extent, be secured 
as a site for the hospital, provided a transfer of the property from the 
War Department to the Treasury Department could be arrange. 

Act of Congress approved March 3, 1903, sundry civil bill, provides 
as follows: 

United States marine hospital, Pittsburg, Pa. : That the Secretary of War be, and 
he is hereby, authorizecl in his discretion, upon the application of the Secretary of 
the Treasury, to transfer to the custody ana control of the Treasuir Department u 
a marine-hospital site so much of the iJnited States arsenal grounds in the dty of 
Pittsburg, Pa., as may be require<i for that purpose, not exceeding 6 acres in extent, 
fronting on Pennsylvania avenue. Thirty-ninth and Fortieth streets. 

It is understood that negotiations for the transfer of this land to the 
Treasury Departinent are in progress. 

Sarammh^ Ga, — Act of Congress, March 21, 1902, having author- 
ized purchase of a site and erection of buildings at a cost of $150,0(K), 
or the erection of hospital buildings at a cost of $126,000 on a site 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 58 

owned l>y the Govornnient, it has been doeiiiod exixidient to adopt the 
latter alternative and build ujwn the site formerly- purchased as a site 
for a post-office at Savannah. This site is a strip of land 90 feet by 
245 feet, fronting on AI)ereom and York streets. Before all the 
proiec*tea buildings can be erected it will be necessary to obtain the 
authority of the Congress for the purchase of an adjoining strip of 
land, 60 bv 90 feet, fronting on York and Drayton streets. 

A board of medical officers was convened by Bureau order of Febru- 
ary 17, 1903, to consider and prejjare an outline plan for the proposed 
hospital. A plan of a block hospital of 40 beds was prepared and sub- 
mitted to the Bui*eau and subsequently forwarded to tlie Supervising 
Architect of the Treasury Department for consideration. The essen- 
tial features of this plan are embodied in the building plans now being 
prepared in the Supervising Architect's office. 

San Juayi^ Porto Rico, — An Executive order dated June 30, 1903, 
reserves the following-described land for a hospital site: 

For the use of the Marine-Hospital Service, a parcel of land at San Juan lying 
next west of the north-and-south line of the eastern boundary line of the military 
reservation west of the first line of defenses, near San Antonio brid£re» running 300 
feet front east and west along the so-called military road and extending toward the 
north to the old stone ditch defense. 



KEPOBT ON OIL-BURNING PLANT AT MARINE HOSPITAL, SAN FRANCISCO, 

CAL. 

Office of Medical Officer in Ck)MMAND, 

Fori of S(in Frmicisco^ (Vr/., Jul;/ i, lffO:i, 

Sir: As directed in Bureau letter, April 9, 1903, I have the honor to make the fol- 
lowing report on the operation of the oil-huming plant an follows, viz, from the time 
Uuitthe plant was set in operation, about March 1, 1903, to June 30, 1903, the boil- 
era have been in service on an avera^ of al)out fourteen hours daily. During this 
time two burners were usuallv kept m operation, as it has been my experience that 
two bamers under medium draft will consume very little, if any more oil than one 
bamer under forced draft, and the steam pressure is more easily maintained. 

The amount of oil consumed during this period, March 1 to June 30, 1903, was 
834 ^Ar barrels, costing $501.94, as compared to 164 J J|j^ tons of coal used during the 
sune period last year, costing $1,020.34, causing a'net saving of over 50 i)er (^nt. 
Aboot 3.9 barrels, costing $3.04, is equal to one ton of coal at $6.20. 

There has been no expense connected w^ith the |)lant for repairs, adjustments, 
cleaning, etc., as all of this work was done by the engineer and fireman. 

The working of the plant has been very satisfactory, and besides the great saving 
in cost of fuel consumeil is also very much cleaner, doing away with the smoke nui- 
aance, and saving much labor in keeping the outsides of the various buildings in 
good appearance. 

Respectfully, W. G. Stimpson, 

Passed Assistant Surgeon. 

Scrobon-Gknebal Public Health and Marine-Hospital Service. 

REPAIRS AMD IMPBOYEMENTS MADE TO BUILDINGS AND GROUNDS, 
INCLUDING WORK UNDER CONTRACT, AND REPAIRS TO HEATING 
APPARATUS OF MARINE HOSPITALS. 

Marine Hospital at Baltimore^ Md, {erected 1887). — Surg. H. R. 
Carter, in command, reports the following repairs and improvements: 

The gallery floor to westwanl was repaire<i at a cost of $27.25; repairs to roadwa^rs 
of r^wrvation, t76.60; i)ointing mortar joints of stone retaining wall, $298.4Q\ rev^\t 
of roof gatters, $67; oonstriM^tio/i o/ twn nforerooinH under wesl >Na,T\\, ^^\\ wv''^ 



54 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE, 

wood fences on three sides of reservation, |252; painting exterior of surgeon's quar- 
ters, $155; laying tile drains around buildings, $135.71, and miscellaneous minor 
repairs. 

A contract has been awanled for an adition to the executive building for space for 
an operating room for $3,232, and the work is to be completed in October, 1903. 

Mmor repairs were made to the heating apparatus, at a cost of $53. 

Hospital at Boston^ Mass. {erected 1860), — Surg. R. M. Woodward, 
in command, reports the following repairs and improvements: 

The plumbing system of hospital was renovated, new piping and fixtures supplied, 
and toilet rooms repaired and ])ainted, at a cost of $8,813.75. 

A complete system of electric light wiring and fixtures was installed in all the 
buildings, at a cost of $1,973.50; the electric elevator repaired, at a cost of $366.60; 
new iron gate placed at High fetreet entrance, $250; 50 lockers for patients' clothing 
construct^ in outbuilding, at a cost of $239.85; flagstaff repaired and painted, 
$135.25; artificial stone floors laid in portions of basement of hospital building and in 
rooms in outbuilding, $390, and miscellaneous repairs, lumber, and painting material, 
$1,256.27. 

Repairs were made to heating apparatus, including new smokestack for boilere, at 
a cost of $2,569. 

Hospital at Cairo^ lU. {ere^cted 1885). — Surg. G. M. Guiteras, in 
command, reports the following repairs and improvements: 

General painting of exterior of buildings, repairs to porches, steps, down spouta, 
and gutters, and miscellaneous repairs and improvements, at a cost of $1,973.74. 
Repairs to heating apparatus were made at a cost of $11.93 for material. 

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

Solaria were constructed in north and south balcx)nie8, at a cost of $300; repairs in 
surj^cal operating room, removal of benches, etc., $187.50; 9 new doors and repairs, 
$225; 3 kitchen sinks supplied for surgeon's, ()aj38ed assistant surgeon's, and pharma- 
cist's quarters, $260; crushed stone laid on driveways, $222.^; cleaning interior 
painting of hospital, $100; repair of stone steps, front entrance, $325; batn tub for 
attendants in laundry building, $39.30; repair and painting of flagpole, $60; and mis- 
cellaneous reoairs and repair material, $650. 

Repairs to neating apparatus, $90. 

Hospital at Cincinnati^ Ohio {erected 1884). — Acting Asst. Surg. 
J. W. Stevenson reports the following repairs and improvements: 

Inclosing area way and repairs to floors, $555.40; installation of an electric-bell- 
and-call system, $168; and miscellaneous repairs to buildings, plumbing, laundry 
machinery and ranges, at a cost of $242.58. Door and window screens were supplied 
at a cost of $403. 

Repairs to heating apparatus, $125.90. 

Hospital at Cleveland^ Ohio {effected 1852). — Passed Asst, Surg. 
Joseph B. Greene, in command, reports the following repairs and 
improvements: 

Grading, soiling, and seeding reservation, at a cost of $4,477.50; new water heater 
installed, $537; inclosure from first story rear porch, $676; and miscellaneous repaint 
and painting, at a cost of $1,248.68. Two new boilers were placed in new boiler 
house, at a cost of $6,649.60. Special appropriation. 

Repairs to heating apparatus were made at a cost of $62.08. 

Hospital at Detroit., Mich, {erected 1857). — Surg. H. W. Austin, in 
command, reports the following repairs and improvements: 

Cement concrete walk on Wight street, $200; repairs to hospital building under 
contract, $3,046.90; and minor repairs to buildings, plumbing, and ranges, $542.46. 
Repairs to heating apparatus, $959.71. 

Hospital at Delaware Breakwater^ Del. {established 1894). — ^Passed 
Asst. Surg. C. H. Lavinder, in command, reports the following repairs: 

Material for repair of coal bin and walks and general repair, $135.70. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 55 

Hospital at EvansviUe. Ind. (erected 1891). — Passed Asst. Sur|(. 

B. W. Brown, in command, reports the following repairs and improve- 
ments: 

General painting of baildings, $837.41; tile floor and wainscot in operating room, 
1370; second story to porch of executive building, $149; repairs to plumbing, $251; 
new wagon scale installed for $241; and miscellaneous repairs to buildings, $665.17. 

Repairs to heating apparatus, including repairs to boiler walls, rebuilding chinmey 
tops, and repair of boiler stack, $629.62. 

MaTine- Hospital Sanatorium^ Fort Stantmi^ N, Mex, {estahlisJted 
1900), — Surg. P. M. Carrington, in command, reports the following: 

The general repairs and improvements to buildings Nos. 4, 6, 10, and 11, wards and 
dining room for patients, begun during the fiscal year 1902, were completed under 
contract for $34,475. 

Contracts have been entered into for the repair and improvement of 
buildings Nos. 1, 2, 3, 9, and 13, and the corrals, for $33,830, and for 
the installation of an electric-lighting system and fire-alarm sj^stem 
for $8,440. 

Miscellaneous repairs and improvments have been made to buildings, 
and the plumbing system, including new shingles on roof of building 
No. 5 and the hay barii and installing fire hydrants, $5,191.33. 

Door and window screens supplied for wards and dining-room build- 
ings; $436.91. 

Kepairs to heating apparatus, $372.97. 

Hospital at Key West^ Fla. {erected ISlfi). — Surg. R. D. Murray, in 
command, reports the following repairs and improvements: 

New concrete water-supply cistern built at north end of hospital building, at a cost 
of $S49; 101 new piles placed under wharf, l)oathouse, insolation ward, etc., $275; 
and general repairs and painting, at a cost of $169.30. 

Hospitod at Louisville^ Ky, {erected 1852), — Passed Asst. Surg. G. B. 
Young, in command, reports the following repairs and improvements: 

General repairs to hospital building and stable, under contract, $2,830; painting 
walls and ceuings in hospital building, cost of material, $3:^.83; new gas fixtures, 
$223; change of system ot water supply pipes in basement, $220; door and window 
screens, $170, and miscellaneous repairs, $602.65. 

Hospital at Memphis^ Tenn, {erected 1885). — Surg. G. M. Magruder, 
in command, reports the following repairs and improvements: 

The roofe of ward buildings and stable were reshingled, at a cost of $1,089.99; 
door and window screens were supplied for wards and executive building, at a cost 
of $160.88; trees, 34 in number, were planted, cost $11.90, and miscellaneous repairs, 
coet $145.80. New tubes were supplied for laundry boiler, at a oast of $67.50. 

Hospital at Mobile. Ala. {erected 18Ii3). — Surg. »T. H. White, in com- 
mand, reports the following repairs and improvements: 

Miscellaneous repairs to buildings and improvements were ma<le, at a cost of $873.76; 
new wagon scales installed, at a cost of $150. 

Hospital at New Orleans^ La. {erected 1885). — Passed Asst. Surg. 

C. P. >Vertenbaker, in command, reports the following repairs and 
improvements: 

Roofe and gntters of buildings were repaired and new tin roofs to porches and gal- 
leries and hanging gutters and down spouts placed, at a cost of $2,700; door and 
window screens supj^ied for wards (2^ and operating-room building, at a cost of $409; 
new range for hoepital kitchen, $373; three kitchen ranges for quarters, $147; tele- 
phone system installed, at a cost of $1^, and miscellaneous repairs to engines, pumps, 
electric-light plant were made, at a cost of $912.74. 

Repairs to heating apparatus and re{>air material for same, $260.41. 



5fi PUBLIC HEALTH AND MARINK-H08PITAL SERVICE. 

Hospital lit Xefr Vorh\ y, V, {i-rcffrif ISo-).— Sur^. P. H. Bail- 
hache in coinniand. 

This stiitlou was occupic»d under lease until zVpril 15, 1903, when 
check for $250,000, in payment for site and buildings, wa« delivered 
to the lessoi*s. Act of Congress approved June C, 1902, appropriated 
$250,000 for purchase of site and buildings. The sit^ comprises 9.7o5 
acres, fronting 488 feet on Bay street, Stapletoii, Staten Island, N. Y. 

The hospital building is 300 feet long, has basement and three stories, 
and an average width, including porc»hes, of 50 feet; is built of stone 
with brick and wood entablature, heated by eight furnaces, numerous 
fireplaces, and steam radiators. Surgeon's house is a stone structure 
28 by 41 feet — subba^seiuent, basement, two stories, and attic. Laun- 
dry building is a two-story frame structure 41 by 26 feet. The morgue 
is a one-story frame building 15 by 25 feet, and the building called 
white house is a three-story dilapidated brick structure built (accord- 
ing to statement of residents) a})out one hundred years ago. 

The small house at entrance is a one-story brick, 11 feet square. 

During the year 1902-3 miscellaneous repairs were made to build- 
ings* and heating apparatus, at a cost of $1,722.15. 

Kepairs, i. e., new floor, etc., were made in out-patient oflSce, in 
second stoiT of building adjoining the barge office in New York City, 
at a cost of $214. 

Marine- Hoi^pital offi<ie and out-patient bmhfin// at Philadelphia^ Piu 
(erected 1877). — Extension, 1901 — Surg. Fairfax Irwin, in command, 
reports that repairs were made to the radiators in building, at a cost 
of *38.25. 

IIoHpyltal at Portland^ Me. (erected 1859). — Surg. W. P. Mcintosh, 
in command, reports the following repairs and improvements: 

Repairs to electric-liglit plant, iucluding auxiliary dynamo, $496; new system of 
hot-water supply, including tank and fittings, $.'{t)5; new pipe sewer, $1,449; repairs 
to roadways, $7S1; concrete walks around hospital, $240, and niisi^ellaneous repairs 
to buildings and plumbing, at a cost of $796.92. 

Repairs to heating ap[)aratus, $77.07. 

IIoHpital at Part Tinonnend^ Wan]i. (erected 1895). — Passed Asst. 
Surg. M. H. Foster, in command, reports the following repairs and 
improvements: 

Wood and iron fences repainted, at a cost of $290; new vestibule door at main 
entrance, $83.85; repairs to plumbing and mis(^llaneous rejjairs, $265.70; new lu>8- 
pital kitchen range installed, cost $295. 

ITospltal at iSan Francisco.^ Cal. (erected 1875). — Passed Asst. Surg. 
W. G. Stimpson, in command, reports the following repairs and 
improvements: 

New pumping engine for water supply^ $250. A 10-inch diameter pipe well wa.«» 
driven 42 feet de(»p near the lake for additional water supply to station, at a cost of 
$175: tile floor and lavatory for o|)erating room, $450, and miscellaneous repairs to 
buildings and plumbing, $1,478.48. 

Fuel oil-buniing plant installed for boilers of heating apparatus, at a cost of $600, 
an<l piping fittings, valves, etc., supplied for repairs, at a cost of $624.05. 

Hoapltal at St. Louls^ Mo. (erected 1885). — Surg. James M. Gas- 
saway, in command, reports the following repairs and improvements: 

Miscellaneous repairs in executive building, under contract, $1,525; new flag- 
staff, 82 feet, $578; painting material, lumber, and tools for miscellaneous re|)air8 to 
buildings were purchased and minor repairs made, at a cost of $1,414.24; new door 
and window screens, $131.30. 



PUBLIC HEALTH AND MARINK-HOSPITAL SERVICE. 57 

In>n fence on Marine avenue, and jM»Ht an<l wire fence on other sides of reserva- 
tion, under contract, for 13,981. 

Repairs to heating apparatus, including snioke-consuiuing device for two l>oiIers, 
$1^.69. 

Hospital at Vineyard Haven ^ Mam. (erected 1895), — Sur^. D. A. 
CarmichaeU in command, reports the following repairs and improve- 
ments: 

Misi^llaneous repairs to buildings and plumbing, $402.14. Repairs to heating 
apparatus, $11. 

Hospital at Wilmington^ N. C. (erected 1859), — Surg. John Godfrey, 
in command, repoiis the following repairs and improvements: 

New board fence built on three sides of portion of reservation to he retained; lum- 
ber for plank sidewalk on Eighth street, at a cost of $1,021.04 for material; laying 
water main with fire plug on reservation, cost $337. A bath tub, water-closet, and 
lavatory were placed in basement of executive building, at a cost of $200 for the 
fixtures, piping, and connections; window and door screens were supplied for the 
wards, at a cost of $193.66; post and plank bulkhead built on Eighth street, at a cost 
of $128; an artificial stone walk laid in front of executive, at a cost of $62.50; and 
miflcellaneoos repairs to buildings, tools, and material, $672.88. 

Respectfully submitted. 

L. L. Williams, 
Assistant Surgefm- GetieraL 
Surgeon-General Pubuc Health 

and Marine-Hospital Service. 

[Note. — The statistical tables which form a part of the report of 
the division of marine hospitals and relief will be found at the end of 
this volume.] 



DIVISION OF SANITARY RETORTS AND 

STATISTICS. 



59 



i 



DIYI8I0V OF 8AHITART REPORTS AND STATISTICS. 

By (t. T. Vaicjhan, 
AftnMant Surgeon-General, Ftiblic Health and Marine- Hottjnial Senirf, in charge. 

Sir: I have the honor to submit the following report of the opcm- 
tions of the Division of Sanitary Reports and Statistics for the fiscal 
year ended June 80, 1903: 

CHOLERA. 

This disease has probably been more widespread during the year 
ended June 30, 1903, than at any other period durinp the world's his- 
tory, having been reported in twelve countries, all in the Eastern 
Hemisphere (omitting isolated cases resulting from transportation by 
ships), as follows: 

ARABIA. 

In September, 1902, 9 cases and 9 deaths from cholera were reported 
as having occurred at Hodeidah. 

BORNEO. 

From May 23 to June 5, 1902, there were repoi-ted at Bandjermas- 
sin 78 cases of cholera, with 72 deaths. 

BRAZIL. 

During the week ended January 23, 1903, 1 death from cholem was 
reportea at Rio de Janeiro. 

CEYLON. 

One fatal case of cholera was reported from Ceylon during the week 
ended August 9, 1902. 

CHINA. 

The reports from China give imperfect statistics, but enough to 
show wide dissemination of the disease with many deaths, far exceed- 
ing in number the deaths from this disease in India during the same 
period. During the year it is roughly estimated that in round num- 
bers 55,000 deatns occurred — an estimate short of the actual number. 
The places most seriously aflfeeted were Amoy, Hongkong, Kweiiam, 
Macao, Nankin, Niuchwang, Pinglo, Port Arthur, Shanghai, Shou- 
yanghsien, and Tientsin. 

According to Commercial Agent R. T. Greener, cholera was 
announced July 4, 1902, as present at Tientsin, Inkou, Tiehliu, and 
along the Liao Kiver, having been brought to Tientsin by an English 
vessel. The disease spread northward along the Chinese fcastern Kail- 
road and into Manchuria, affecting many places, but seems to have 
expended its force within the space of two months and a half, as no 
cases were reported after Septeml^er 14, 1902. During this i^riod 
there were reportwl 090 deaths — undoubtedly a very conservative 



62 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

estimate, an reports from other sources give nearly twice this number 
of deaths. 

DITTCH INDIA. 

From May 26, 1902, to Deceml)er 13, 1902, 1,191 deaths from cholera 
were repoiiied from the following places: Batisivia, Pasoervean, Peka- 
longan, Probolingo, Samarang, ana Soerabaya. 

E(iYPT. 

July 21, 1902. Consul-Gencral John G. Long at Cairo repoiled the 
outbreak of cholera July 15 at Moucha, near Assiout, in Assiout Prov- 
ince. The disease was next reported at Cairo, and later at Alexandria, 
Damietta, El Ariche, Ismailia, Port Said, Suez, and in the pro\H[nces 
of Assouan, Behcra, Beni Souef, Charkieh, Dakahlieh, Cruirgueh, 
Guizeh, Keneh, Menoufieh, Minieh, and Sudan. From July 15, 1902, 
to January 20, 1903, 31,012 deaths were reported as having l>een caused 
by cholem throughout all Egypt. 

GREAT BRITAIN — MALTA. 

January 15, 1903. the steamship Boyal arrived at Valletta, Malta, 
from Alexandria, with 5 cases of c*nolera on board. These were landed 
on the island of Comino and 2 more cases from the same ship were soon 
added, making 7 cases in all. Of this number 1 died. 



INDIA. 



It is no loujger correct to say as in my report of 1900, ''As usual, 
the great majority of cases of cholera Kave been reported from the 
cities of India," for at least four countries, China, Philippine Islands, 
Egypt, and Japan, report more deaths from this disease than India. 

From May 27, 1902, to Mav 16, 1903, there have been reported 
2,355 deaths in the following places: Bombay, Calcutta, Karachi, and 
Madras. 

JAPAN. 

From June 1, 1902, to October 29, 1902, a space ot aDout nve 
months, there were reported 4,742 deaths from 19 places in Japan. 
Besides, cholera was reported present at 11 other places, but the num- 
ber of deaths was not given. From November 1, 1902, to June 26, 
1903, only 8 deaths were reported from Japan. The above statistics 
include the island of Fonnosa. 

KOREA. 

During August and September, 1902, and for some time previous, 
cholera was reported in Korea at the following places: Chenampo, 
Seoul, Syen Chun, Wang Hai, and Woonan. At l^oul in September 
it was estimated that from 50 to 250 deaths occurred daily. 

PHILIPPINE ISLANDS. 

Since the introduction of cholera into Manila, probably through the 
medium of vegetables from Canton in March, 1902, this disease has 
spread over the greater part of the archipelago. 

From July 9, 1902, to November 1, li>02,most of the cases occurrea, 
there having been reported for this period of four months 95,531 
cases, with 63.500 deaths, throughout the islands, including Manila, 
Cebu, and the provinces. From November 2, 1902, to May 2, 1903, 
there were reported only 5,351 cases, with 3,271 deaths. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



63 



HTRAITK SETTLKMKNTS. 



From April 20, 1902, to May 2, 1903, there were reported from 
Siii^pore 895 deaths from cholera. 



TIRKKY. 



October 18, 1902, Consul Merrill at Jerusalem reported the occur- 
rence of cholera at Gaza and Lydda — probably having spread from the 
i-oast town El Ariche. From October 18 to November 18, 1902, an 
incomplete report ^ve 1,108 deaths, distributed as follows: Endor, 
Gaza, Jaffa and vicniity, Lydda, Shefamier, and Tiberias. 

It was reported present at Dalaiky, Haifa, Lubeih, and Nazareth, 
but the number of cases or deaths was not given. 

In January the disease reached Damascus, and from January 1 to 
March 11, 1903, there were reported in this city 314 deaths. 

Below is a tal)le of cholera in two sections, (1) from June 28 to 
December 26, 1902, and (2) from December 27, 1902, to June 26, 1903: 



ChyiA-TUy an reported to the Surgemi-deiiernl l\M\c Health and Marine'IIottpital Service, 

JUNE 28 TO DECEMBER 2rt, 1902. 

[RfrR>rtj< rtTcivwi fnuu United States eonwils throuRh the Department of State and from other 

Nources.] 



Place. 



Arabia: 

Hodeidah 

Borneo: 

BandJermaMsin 

l>yIon 

China: 

Amoy 

Canton 

Chenglohien . . 

Chinkiang 

Choanchow ... 

Fatahan 

Foochow 

Hangchowr 

Hongkonfs 

Hsinchou 

Kianfryin 

Kweilam 

Macao 

Nanking 

Niuchwang 

Peking 

Pinglo 

Port Arthur ... 

Shanghai 



Date. 



Sept. 10-8ept. 12 

May 23-June 5 i 
Aug a- Aug. 9 



('41868. 



31-Aug. 16 

9 

6 

24 

6 

9-July 6 
6 

24-Sept. 6 



May 

May 

Sept. 

June 

June 

May 

Sept. 

June 

To Oct. 25 

Sept. 6 

do 

To June 12 

To May 31 

To Sept 6 

June 5-Sept. 22 

June 7 

To June 12 

Sept. 14 

May 1-Sept. 1 



Shihlich 

Sbeoyang 

Shoayanghsicn . . 

Sooehow 

Tai}'uanfu 

Tangku 

Tientsin 

Wujdeh 

Hunan Province. 

.Shanfli Province . 
Dutch India: 

Batavia 

Samarang 

Pekalongan 

Soerabaya 

Pafloervean 

Probolingo 

Egypt: 

Alexandria 

Cairo 

Df'mietta 

EI Ariche 



Sept. 

do 

do 

do 

do 

June 

June 7-8ept. 6 

June 24 

Sept. 6 

do 



6. 



June 
May 
May 
June 
June 
June 

Aug. 
July 
Aug. 
Sept. 



a-Oct. 25 
2»->June 24 
26-June 24 
1-June 28 
2-June 29 
9- June 29 I 



5-Nov. 1\ 
22-Nov. 24 
26-Nov. 24 
16-Nov. 21 



I 



78 
1 

flO 



Deaths. 



Remarks. 



483 



1,170 



592 



914 



43 
256 
165 
150 

36 



9 

72 
1 



423 



10,000 



40,000 

1,018 

1 

3,000 

285 

493 



Estimated. 
Abating. 
Epidemic. 
Present. 

Do. 
Epidemic. 

Do. 
Present. 

Epidemic 
Do. 

Do. 



Imported. 



569 



607 

38 

219 

117 

74 

88 

1,072 

1,424 

609 



One case on rs. County 
of Roxbury bound for 
United States. 
Epidemic. 

Do. 
3,000 cases a day 
Imported. 
Epidemic. 
Do. 

Present. 
Reported. 
Do. 



64 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Cholera as rqtorted U) the Surgeou-deiwral Pnhlic Hettlth and Marine-JIospital Sfrnr^ 

ContinucMl. 



JUNE 2X TO DECKMBKR '2Ct, 1902— ConUnucd. 



Pla«M'. 



Dah- 



(!«Hes. 



Egypt — CoiitiiUKHi. 

Ismailia 

rortSaid 



Suex 

Aasiout Province 

AsBOuan Province . . . 

Behera Province 

Benl 8ouef Province. 

C'harkieh Province . . 

Dakahlieh Province . 

Favoum Province . . . 

Galioubieh Province. 

Uharbieh Province . . 

Guirgueh Province . . 

Guizeh Province 

Keneh Province 

Menoufieh Province . 

Minieh Province 

Sudan Province 

India: 

Bombay 

Calcutta 

Karachi 

Madras 

Japan: 

Chiaka and Iliogo 

Yokohama 

Ehime Ken 

Formosa 



Aug. 

Sept. 

Sept. 

Aug. 

Oct. 

Aug. 

Aug. 

Aug. 

Aug. 

do 

Aug. 
Aug. 
Aug. 
July 
Sept. 
Aug. 
Aug. 
Oct. 



26-Nov. 

1-Nov. 

«^-Nov. 

2-Nov. 
28-Nov. 
12-Nov. 
11-Nov. 
19-Nov. 
26-Nov. 



21 
21 
24 
24 
2i 
24 
24 
24 
24 



4-Nov. 
18-Nov. 
26-Nov. 
25-Nov. 

1-Nov. 

^Nov. 
19-Nov. 
20-Nov. 



May 27-Nov. 

May 24-Nov. 

May 2&-Aug. 

July 5-Oct. 



Fukuoka Ken 

Uiogo Ken ( Kobe included) . 

Hiroshima Ken 

Kagashima Ken 

Kanagawa Ken 

KochfKen 

Kumamoto Ken 

Kyoto Ken 

Myazakl Ken 

Nagasaki Ken 

Nara Ken 

Oita Ken 

Okayama Ken 

Okinawa Ken 

Osaka Fu 

Shiga Ken 

Shimane Ken 

Shlzuoka Ken 

Tokyo Fu 

Tokushima Ken , 

Tottori Ken 

Wakayama Ken 

Yamaguchi Ken , 

Korea: 

Chenampo 

Seoul 



Sept 

To Oct 

June 

July 

Jan. 

June 

June 

June 

do 

June 
June 

do 

do 

do 

June 
June 

do 

June 

do 

June 
June 

do 

July 

do 

do 

do 

do 

do 



6-Sept. 

.29 

1-Aug. 

3-Oct. 

1-July 

l-8ept. 

1-Oct. 

l-8ept. 



24 
24 
24 
24 
24 
24 
24 
24 

4 

15 

24 

3 

27 



13 
29 
3 
22 
18 
22 



1-Oct. 
1-Aug. 



16 
31 



1-Oct. 
l-8ept. 



20 
10 



l-8ept. 22 



1-Sept. 
1-Aug. 



6 
81 



To Aug. 21. 
Sept. 27.... 



Syen Chun l To Aug. 17. 

Wang Hal , Aug.l7 .... 

Woonan ' Aug. 9 

Philippine Island.^: I 



Cebu 

Manila 

Provinces 

Russia: 
Amur District— 
Blagoweschtchen.*.k 

Chaoarowsk 

Charbin 

Dalnij 

Olrin 

Inkou 

Mukden 

Manchuria 

Nikolajewsk 

NikolHk 

Odessa 

Olowiannaja 

Vladivostock 

Zizikur 



July 9-Oct. 14 
Oct. 18-Nov. 1 
do 



14 
14 
20 
14 
20 
17 
16 



July 16-Sept. 
July 2S-8ept. 
June 14-June 
Aug. 2&-8ept. 
July 14-Juiy 
July 6-July 
July 12-July 
To July 19 . . . 
Aug. 25-Sept. 

do 

Aug. 24-Sept. 10 

To Aug. 8 

Aug. ]4-Sei)t. 14 
July 11-July la 



14 



438 



6 

84 

655 

1,987 

1,042 

294 

706 

8 

2,350 

8 

82 

58 

16 

828 

2 

143 

2,140 

8 

293 

1 

7 

1 

6 

1 

9 

3 

171 

92 



l>eathK. 



20 



1,271 

4,173 

90,087 



156 
147 
112 
143 



128 
87 
54 
25 
12 
IH 
8 

111 



2^ 

29 

108 

3.?22 

2 

2,261 

350 

1,367 

2,233 

848 

1,731 

5,519 

2,563 

1,812 

1,134 

2,744 

1,152 

7 

46 

605 

355 

9 

65 
4 

82 

485 

1,516 

646 

60 



2 
48 
36 

1 
207 



39 

1,455 
3 

74 



1 
•V5 



11 
50 



713 

3,141 

59,646 



98 

8 

44 



175 

106 

78 

24 



6 



l."»7 



Remarks. 



Epidemic. From 50 to 
deaths daily. 



Present. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



65 



Cholera as teporUd to ifie Surgeon- General PtMie Heallh and Marine-HoiqntaL Service- 

Continueii. 

JUNE 28 TO DKCEMBER 26, 1902— Continued. 



Place. 



Date. 



CaflCH. 



Straits Settlements: 

Singapore 

Turkey: 

Dalaiky 

Endor 

Gaza 

Haifa 

Jaffa and vicinity 

Lubeih 

Lydda 

Nazareth 

Shefamir 

Tiberias 



Apr. 26-Nov. 1 



Nov. 8 

To Nov. 2 

Oct. 25-Nov. 

Nov. 8 

Oct. 25-Nov. 

Nov. 8 

do 

Oct. — 

To Oct 80 

ToNov.18.... 



Deaths. 



RemarkN. 



716 



18 



12 



2 
449 



IfiO 



75 



12 
420 



DECEMBER 27, 1902, TO JUNE 26, 1903. 



Brazil: 

Rio dc Janeiro Jan. 

China: 



n-Jan. 23 



Canton 

Hongkong 

Dutch India: 
Jav&, Batavia. 



To May 2.... 
Apr. 26-May 

Oct. 26-Dec. 



^; 



2 
13 
20 



lexandria ! Nov. 25-Jan. 

Damietta do 

Behera Province do 

Gharbieh Province i Dec. 2-Jan. 

Guiigueh Province j Dec. 25-Jan. 

Keneh Province ' Nov. 25-Jan. 

Great Britain: 

Malta quarantine island To Jan. 17 

India: ; 

Bombay Nov. 19-May 12 

Galcutta Nov. 16-May 16 

Madras i Apr. 25-May 1 

Japan: i 

Hiogo Nov. 9-Nov. 23 

Jan. 13-Jan. 16 

Nov. 2-May 2 
do 



Karatsu 

Philippine Islands: 

Manila 

Provinces 

Straits Settlements: 

Singapore 

Turkey: 

Damascus 



2 
2 

l.vS 




I 



Nov. 1-May 
Jan. 1-Mar. 



•> 



11 



4'2Q 
4.922 



103 

96 

10 

5 

2 

29 

< 

1 

10 

1,329 

1 

2 
6 

324 
2,9^17 

149 

314 



Reporte<i. 

Reported. 
Reported. 
Reported. 



On S8. Royal, from Alex- 
andria. 



YELLOW FEVEE. 



UNITED STATES. 



During the year ended June 30, 1903, no case of yellow fever was 
reporteain the United States with the exception of one case, June 3, 
at Mississippi River Quarantine Station, on the S. S. Westhall^ from 
Tampico, Mexico. 



FOREIGN AND INSULAR. 



During the same time no case was reported from Cuba as havinj^ 
originated there. There were seven cases reported, but all were im- 
ported from Mexican ports. 

The largest number of deaths from yellow fever occurred in Bi-azil ; 
second, in Mexico (chiefly in Vera Cruz) ; and, third, in Ecuador. Other 
countries reporting a number of cases are Colombia and Costa Rica. 

See the taole of yellow fever below, in two sections, (1) June 28 to 
December 26, 1902; and (2) Pecem ber 27 to June 26, IWS. 

H. Doc 838 5 



6r> 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



YeWftr fcccr (n* rejtortfd to the Stirf/fon-Generalj I\iWr Health aiui Marinr Ha<jiihi 

^ien'ice. 

JUNE 2K T() DECEMBER '26, 1902. 

[Reports receivejl from T'nited States constiH thmtifrh the Department of State and fri>m (»iIiit 

Hourees.] 



Place. 



Brazil: 

Bahia 

ManaoH 

Pemambuco 

Rio de Janeiro 

(Colombia: 

Panama 

(^sta Rica: 

Port Llmon 

Cuba: 

Gibara 

Habana | Aug. 

Sept. lU 
Sept. l(» 



Date. 



Cases. . Deaths. 



RemarkH. 



June 7-Junc 14 

July 23 

June 16-June ^) 

Sept. 21-Nov. 1« 



Present. 



July 
July 
July 



1-Dec. 
4-Dec. 






•27 



1 I 
10 1 

16, 
14' 



Ki. 



Nov. IS. 



Dutch Guiann : 



Paramaribo ; July 



1-July 31 
lo 



9 

H 



Dutch West Indies: i 

Buen Ayrc i Nov. 

Ecuador: 

Guayaquil Aug. 10-Nov. '22 

Mexico: 

Alvarado July 7 

City of Mexico June 1-Nov. 

Coatzaconlcos June 14-Nov. 

Cordoba July 7 

Jaltipan July 19 i . 

Mcrida ' To Oct. 3 ; 

I*rogreRO •'"^^^ 15-Oct. 24; 

Tampico ' To Dec. 7 

Tuxpan 'Oct. 14-Oct. 21 I 

Vera Cruz Juno 7-Dec. 13' 

Porto Rico: i ' 

San Juan Oct. 29 ' 

Venezuela: i 

Valencia Aug. 25 



1 

1 

19 



From S8. Vigilanciti fmm 

Vera Cniz. 
From »'<. Monten'V fn»ra 

Vera (.'niz. 
On SH. Havana from Mtxi 

can i)ort*». 
From «s. E.Mporanza Cn>m 

Vera Cruz. 



On Dutch Hchooner Tnni- 
er. 



74 



G ! 

21 



19 
13 



431 



K • 
10 ' 
67 
1 
174 

1 



Epidemic. 



Present. 

Reported epidemic. 



One CIU5C on >*. Moiit- 

gomerj'. 
Repo^t<^a. 



DECEMBER 27. 1902, TO JUNE 26. 190U. 



Brazil- 

Rio do Janeiro Dec. 2H-May 17 

(Colombia: 

BarranquiUa Mar. 

Cartagena Jan. 

Panama Dec. 

Costa Rica: 

Limon Nov. 

Cuba: 



»-Mar. ir> 
20-Mar. 15 
16-June 1 

l^une 11 



Habana 



Feb. 14-June 16 



Ecuador: ' 

Guayaquil ' Dec. 1-Apr. 18 | . 

Mexico: i 

Coatzacofllco-^ i Dec. 7-June 6 

Mexico ' Apr. 2«-May 3 

Merlda ' May 30 i 

Progrej*o i June 3 

Tampi(?o I Dec. 7-June 13 i 

Tuxpan i Dec. 24-Dec. 80 i 



Vara Cruz 
Nicaragua: 
Bluefleld'* 



Dec. 14-June 13 
May 8 



Venezuela: 

Caracas , Jhu. 



1-Feb. 28 



2 
73 

50 



5 



1 



172 
1 



748 

2 

2 

26 

21 

2 



239 



2 , 
1 I 



?2 I 
1 I 
69 



One death on rs. Esper- 
anza, from Progreso; 1 
death on le. Niagara, 
from Tampico. 



One caKe Imported. 

Present. 

Eleven new cases. 



On achr. Sunbeam, from 
Limon. 

Present. 



PUBLIC HEALTB AND MARINE -HOSPITAL SEBVIC£. 67 

H disease is still widely prevaleot, 

UNITED STATES. 

C8 of plague, which has existed iu San Francisco since March 6, 
continue to be reported at intervals. 

ow two tablea are given. No. i includes the calendar year IW2, 
il cases and 41 deaths, and No. 3 the six months ended June 
■03, with 3 cases and 3 deaths. 



JANITARY 1 TO DECEMBER M. 1«K. 


Place. > Dmte. 


Cam. 


Deallu. 


Remarkx. 


ia- 


Hay "a 

Jut is 

Ju r ao 

All|:t> 

Aug- 30 

Sepl.% 
Bept.« 

11 

Hot. U 
5oT. »7 




J 


ODecawInimOikUiid. 





DBCEtlBER 27. 1102, TO JUNE 2S. 190). 



FOBEIQN AND INSULAB. 



juiffi 28, 1902, TO JPNB 28, 1903. 



^fo1lowiDg countries and places were reported affected: Africa — 
Peninsula, Mossel Bay, Natal, and Port Elizabeth. Australia— 
ue, Newcastle, Perth, Rockbamton, Sydney, and Townsville. 



68 



PUBLIC HEALTH AND MA BINE-HOSPITAL 8EBVICE. 



Brazil — Pernambuco, Port Victx)ria, and Rio de Janeiro. Chile— 
Iquique (in May, 1903). China — Amov, Canton, Chiangchow, Choan- 
chow, Honam, Hongkong, Phautai, and Swatow. Egypt — Alexandria, 
Menoufieh, Minieh, Samalut, Tukh, and the provinces of Assiout, 
Dakahlieh, Gralioubieh, Garbieh, ana Keneh. France — At Dunkirk, 
June 11-13, there were 2 deaths on the steamship City of Perth^ from 
Calcutta, and at -Marseille, July 3, 1 case on steamship ^Eitpagne^ from 
Buenos Ayres. Germany — Berlin, in June, 1903, tnere was 1 case 
contracted in laboratory work. Hawaiian Islands — Hilo and Hono- 
lulu. India — As usual, the great majority of eases and deaths occurred 
in this country, many times more than in all the rest of the world 
taken together. The disease was especially prevalent in Bombay 
Presidency and Sind, Bengal Presidency, the upper provinces of Agra 
and Oudh, the Punjab, andthe central provinces. From April 26, 1902, 
to May 2, 1903, more than 643,000 deaths were reported. Japan — ^A 
few cases occured at Yokohama, 1 at Tokyo, and 700 cases, with 555 
deaths, on the Island of Formosa, during May, 1902. Madagascar— 
Majunga and Tamatave. Mauritius — From December 6, 1902, to May 
21, 1903, 122 cases, with 89 deaths. Mexico — Cases occurred at 
Ensenada, Mazatlan, Oso, Siqueros, Villanoir, and Villa Union 
during the time from December 25, 1902, to May 19, 1903. Peru— 
In the spring of 1903, 10 cases, with 4 deaths, were reported at Callao. 
Philippine islands — In June, 1902, there was 1 dieath, and from 
December 28, 1902, to April 4, 1903, 44 deaths at Manila. Russia- 
July 10, 1902, Consul Heenan cabled from Odessa the existence of 
plague in that city. The disease seems to have started about the middle 
of the preceding month (June), probably a recrudescence of the disease 
of 1901, as ever since that time the examination of rats at intervals had 
shown infection with plague. By November 8, 1902, there occured 49 
cases, with 17 deaths. Spain— t)ne case occured Julv 16, 1902, at 
Barcelona, on the steamship Ihica de GaUiera^ from Buenos Ayres. 
Straits Settlements — Two deaths were reported from Singapore. 
Turkey — A few isolated cases were reportea in this country at Con- 
stantinople, Pera, and Smyrna. 

Plag\jie as rejxrrUd to the Surgeon- Generalf Ptiblic Health and Marine-HoBpital Service, 

JUNE 28 TO DECEMBER 26, 1902, 

[Reports received from United States consuls through the Department of State, and from other 

sources.] 



riace. 



Africa: 

Cape Peninsula. 

Port Elizabeth.. 

Moesel Bay 

All other places 
Australia: 

Brisbane 

Newcastle 

Sydney 

Townsville 

Brazil: 

Pernambuco 

Port Victoria . . . 

Rio de Janeiro.. 
China: 

Canton 

Chiangchow 

Choanchow 

Honam 

Hongkong 



Date. 



To Aug. 9. 

do — 

do.... 

do.... 



Feb. l-July 81 

Aug. 24-Aug. 31 

June 12 

Aug. 21 , 



Apr. 15-Oct. 15 

Oct, 2 

Aug. Ift-Oct. 16 



Cases. 



745 

135 

13 

14 

74 
1 
1 



30 



Deaths. 



.__ 



862 

66 

4 



26 
1 



109 
"29' 



Remarks. 



May 10 ' Decreasing: 

June 5 ' Present 

do I Do. 

do I ' : Epidemic. 

May 10-Nov, 8 434 



IBLIC HEALTH AND MARtNE-HOSPtTAl SERVICE. 09 

orled to the Surgeim-Gfnerul, I^btic Heidlli atid MaTine-Hotpitat Serria — 

t'lmtinueil. 

JDNE IS TO DECEMBER X. ISOl— Cotitlnucd. 









pTorluee. . . 



14-NOY. 16 

. June 18... 

: & " ' 



a-Ang. 

. Mar llAiiine'a 

"— TJuiiB a. 

le-June % 

. Juou ll-Juae 1 

July » 



. TwodsthionM.CICrot 

Penh, (ram Calcn It*. i>IG. 

One vuK on m. bpagne. 

rrom BiKDM Afiea. 



. Apr, 36-Nov. 8 . 

. Apr. aa-NoT. 

. Aag. 30-NoT. 

. June T-Ndt. 

. Apr. at-Nor. » 



idMilGt 

tlrt 

jMet and rlty . . 



district and ;>' 



mj l^eddencr *i 



'. M^ji 



! May 



RtTlDoeand Oudh— 



Inpludlng 1» Imported 
cues unA H IratOTMA 
dnt,lu. 



70 



PUBLIC HEALTH AND BCARINE-HOSPITAL SERVICE. 



FUufue as reported to tfw SurgfX)ii-Genernlf Jhiblic IleoHh and Mariue-HotpUal Scrric 

Continued. 

JUNE 28 TO SEPTEMBER 26, 1902-Coiitinued. 



Place. 




India— Continued. 
Bombay Presidency and Bind— 

Continued. 
Northwest Provinces 
Oudh— Continued. 

Benares 

Pyzabad 

Oorakpur 

Lucknow , 

Meerut 

Punjab- 
Delhi division 

Jind 

Jullunder 

Lahore 

MalerKotla 

Patiala state 

Burma- 
Rangoon 

Rawalpindi division , 

Mysore state — 

Bangalore city, district, and 
military station. 

Chitaldrug district 

Hassan district 

Kadur district 

Kolar district and gold fields. . 

Mysore citv and district 

Shimoga district 

Tumkur district 

Hyderabad state 

Berar state 

Ralpunta state 

Beluchistan 

Kashmir— 

Jammu Province 

Poonch district 

Japan: 

Formosa 

Yokohama 

Madagascar: 

M^unga 

Tamatave 

Philippine Islands: 

Manila 

Russia: 

Odessa 

Spain: 

Barcelona 

Straits Settlements: 

Singapore 

Turkey: 

Constantinople 

Pera 

Smyrna 



Remarks. 



Apr. aft-Nov. 8 

June 21-Nov. 8 

May 24-Nov. 8 

Sept. 13-Nov. 8 

May 24-Nov. 8 

Apr. 26-Nov. 8 

June 21-Nov. 8 , 

Apr. 26-Nov. 8 ' 

do 

June 21-Nov. 8 

July 5-Nov. 8 

Oct. 4-Nov. 8 

Apr. 26-Nov. 8 

do 



21 

11,349 

22 

9,841 

16,540 

42 



do 

do 

do 

do 

do 

do 

do 

do 

do 

June 7-Nov. 8 
July 5-Nov. 8 

Apr. 26-Nov. 8 
Oct. 4-Nov. 8 

May 1-May 31 
Oct. 6-Nov. 2 

May 2&^une 22 
July 1-July 22 

June 8-June 21 

To Nov. 8 

July 16 

Oct. 25-Nov. 1 



10.784 

4,646 

213 

597 

1,684 

821 

6.269 

1,851 



2,313 

2,057 

4 

13 

490 
38 

700 
7 



18 

1 

49 



Oct. 30 

Julys 

Sept. 29-Oct. 5 



1 I 



16 



I ncIudi]ig6importedci 
and 6 deaths. 

Three cases imported. 



7,680 I 

6 

6,565 

9,347 

29 

20 



8,580 
3,327 

147 

399 
1,244 

611 
4,5P6 
1,167 

136 

1,841 

1.475 

4 

11 

373 
31 

555 
4 

41 
14 

1 

17 



1 
1 



One caae imported. 



One case on ss. Duca 
Galliera from Bnei 
Ayres. 



Declared. 
Do. 



DECEMBER 27. 1902. TO JUNE 26. 1908. 



Africa: 

Cape of Good Hope (East Lon- 
don. Port Elizabeth,and King 
Williams Town included). 
Natal (Durban and Fieterma- 
ritzburg included). 
Australia: 

Queensland, Brisbane 

Rockhamnton 

Townsville 

Western Australia. Perth 

Braxil: 

Rio de Janeiro 

Chile, Iquique , 

China: 

Amoy ■ 

Canton 

Hongkong 

Phauthai 

Swatow 



Mar. 29-May 2 



To Apr. 18 



July 31-May 

To May 9 

do 

To Mar. 23.... 



9 



Dec. 28-May 17 
May27 



May9 

May4 

Jan. 1-May 
To Mar. 21.... 
To Apr. 3 



36 



145 



17 
2 
3 

16 



499 



81 



8 



8 
20 



410 
100 
100 



Present 

Plague present 
Plague sporadic. 



tUC HEALTH AND HAKINE-R08PITAL 8EBVICE. 



ice. 


KI7. 1902.TO JL'SE 
Hay 1«-May 22 


1 


iwallii 


■d. 

Kemarks. 




3 


















Jan. 1-«M. SI 


63,623 

»:>»& 

6.M7 

3W 
&,22fi 

«,W2 

1 

?:| 

17, mS 

!.^ 
61470 

220 






Contracted in laboiulory 




To Mar. IT 

Not. S-Hay 2 


ency and Elnd- 


W.015 
79,706 

7.099 

6.S80 
















get 

"■^y 










a, .ag ? 

' Dec. 27-Uay 2 










Def. 27- ay 2 
Dec. &- ay 2 
Mar. 1- ay 2 

Nov. 8-May 2 




ri-VABraimi 


W.7B 
llluGB 

a.e»ii 

b:679 

Ji.as3 






































Feb. I4-May i 
Apr. 11-May 2 

Nov. 8-May a 
















Nar- 2i-May 2 

Not. 8-May 2 

Mar. 1-Uay 2 
Apr. as-May 2 

Nov. »-May 2 
Iler. 1»-May 2 

Nov*. »-May 2 








n— 


b:285 
19,1106 

ilooo 
'me 








■■■ 










Not. 1-S-May 2 
Aprj^_^ll-May 2 








fPr.nrln.H- 






ToJan.H 










Dec. 2A^an. » 

?r*S.1;'.":::: 


Kt«ulilnia Maru. 








2 






SJa,':""...!. 

|tuM«>-1J 

i E: S:!i;;: ! 






^ 




,": 




^Slwpon..... 











72 



PUBLIC HEALTH AND MARINE-HOSPITAL RElfcVlOl?. 



SMALLPOX. 



UNITED OTATE8. 



During the six months ended December 31, 1902, smallpox was 
reportea from 44 States and Territories, with a total of 15,658 cases 
and 806 deaths. 

During the six months ended June 30, 1903, smallpox was reported 
from 43 States and Territories, with a total of 26,937 cases and 842 
deaths. Total for the year, 42,590 cases and 1,642 deaths — a mortal- 
ity of 3.86 per cent. 

Comparing these statistics with those of last year, we find reason, 
on accoimt of the decrease in the number of cases and deaths, to believe 
that the disease has spent its force and will now continue to de<*rease 
until it practically disappears. If we compare the statistics ye^r by 
year, beginning with 1898, as it was during the winter of 1898-99 that 
the disease began to assume great proportions, although it had been 
slowly increasing since 1897, we find a tremendous increase each year 
over its predecessor up to the year ended June 30, 1902, when" the 
high-water mark was reached, with 55,857 cases and 1,852 deaths. 
During the live years from July 1, 1898, to June 30, 1903, there were 
reported 164,283 cases of smallpox, with 5,627 deaths — a mortality of 
3.42 per cent. 

Below is given a short table showing the cases and deaths, by years, 
during this period: 



Ciifle^. I Deaths. 



July 1, 1898-Juije 30, 1899 ., 
July 1, 1899-June 30, 1900 . . 
July 1, 1900-June 30, 1901 .. 
July 1, 1901-June 30. 1902 .. 
July 1, 1902-June 30, 1903 . . 

Total 





12,277 
15,058 
88,506 
65,857 
42,590 


70» 
73S 




99 




1,8K 
1.6£! 








ir>4.2K3 


5 &.1 







Below is given the table in two sections for the fiscal year ended 
June 30, 1903, showing the occurrence of the disease b}' States, coun- 
ties, etc. : 



SmaUpox in the Jh\iUd States as reported to the Surgeon- (ieneral Ptiblic Health and 

Marine-Hospital Service, 

JUNE 28 TO DECEMBER 26, 1902. 



Plaoo. 



Date. 



Alabama; I 

Mobile , Aug.2 



Total for State. 



Alaska: 

Juneau ; June 16. 

Total for Territory i 



Arizona: ' 

Nograles ! Nov. 29 

Total for Territory i 



1 

1 Ca.ses. 

1 


DcathH. 

1 




1 








1 



RemarkR. 



1 I ! Imi)orted from a mining 

camp. 



6 



6 



PCBLIC HBALTH AND MABINE-BOSPITAL SBKVICS. 



JUNE X TO DECEMBER 3S, 1 



Plwc. 


Duu. 


QWM. 


DwUu. 


Remark., 


fXlilo»I.: 




a 


































use l-Nov. la 


K 














1TB 








June 1-Dee. 13 
July 1-JQlT a 

DM I-OCL 81 






Colomdo: 

Arspfthoe Counlr (Dcavvr In- 
ciuded). 


3* 








Qiildde o( Denver. 














































ir IS. 

sr IS 

Jnae 1-Oct. 






































JSiT liSSf- S! 


































■Jniie^Wbiy -si 














Jane l-Auc. SI 














m 








Aug^l-A«. 81 








s 














Not. 1-Kov. ig 
Joly l-Ao». SI 
Not. 1-Not. ao 


























Juljr 1-JuIy Bl 
Jnly l-NoT. 30 






















Aug. 1-Aw. 81 


» 














S3 








8.pt. l-eepl.26 






Dcl.*>»: 


T 












T 






July a7-Aug. n 




DWrtctotColoraW*: 


» 
















June 14-Dec. 18 






"^Si^flU. 














Efnunbla Connly (Peiuacoln 

Inpludedl. 
Jcllenon dounlr (lamont 1n- 

cltided). 


Aug. 10-Dec, 
Ott. 4-Nov. 1 















74 



PUBLIC HK*LTH AND MA BIKE- HOSPITAL SERVinE. 



Bnuutfxi.. 



Blackbird Cminr 
BobleOmntj.... 
Boone CooDtt... 

OBrrol Ooimq' . . . 




idlenaa County 

KdoiCdddI; 

l:oM^l<uko Coamtjr |Wumw li 

LacrBUgeCounl 



Id in- 



tk-pt. l-Ovt SI 
'JiilV i-OM. " 
l-Oct. 



t*porle Connly 

lawrente Count; _ 

H»rlon CouDtjr (lortUiupnll' 

Included). 

lIiullDtToIlnCy.. 

HUml CouDtr Sept. 1-SepI. 30 

Monroe Coant; do 

Noble CounljT I sept, 1-Ocl, 

NobleConnl; <Wt. l-Ont. 

OnuweCouQty Ocl. 1-Oot. 

Bana^b Coantr Repi- i-Oci. 

Bt. Jowpb Cotintj (South Benil Sept. VO-Ocl. 

and Htihawalcalnrloded). 

BpeiuctCountr H«pl- 1-Sept. SO 

lUrkeOouniy... " -• ' "— "' 



Vandertmrg Counly (Rvniii- i Jim 
TUIelueluded), 

Vormfllon Connljr Bepi 

Vim Comity (Tene Haute iu- ; Jim 

Total (or SlHlL' 






BLIC HEAITH AND MA BIKE- HOSPITAL SEBVICE. 



JCNB 2« TO RECEMBKK IBi. IWi— Com 



,«e. 


Rule. 
June l-Jnne SO 

i:s Kffi, £ 

Oct 1-Oct. SI 


CiuHfl. IXath-. 


Rcnurlf. 








wuniy 








1 

1). 

m 

Ik 
im 




junly 






















iV"" "■■-■■ -■" 








Oct. iloii. si 

s' Si 

June -July SI 

»■ :ftS 

June -July SI 




























sv:;::;:;;;;:;;: 










































la 








Vn.''''-v:Ai«:-si' 
































I'-J'uiy 31 

Jii»f l-Juiiu 30 


































Aug. l-Oi!t, SI 
July July 31 

Oct. -Oet SI 
June -Nov. M 






























o^'^gj; j -- 








■a 












fciv:::::::::;:: 














S'.::: :::;:::: : 














ninty 


■"""do ^"^""^ " 


























S7 








July l-July 10 








y 




















































DoimlV (Wichiu 


Jul)' Wiity m 






1 










«o 


1 






Sl!li!:!!:::S 






so 




















ITS 








June H-NoT. 2» 
Aug. 17-Sepl. M 








; 




















7 































V6 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Smallpox in the United Stales as reporUd to the Sargeon^Getieral Public Health o 

Marine- Hoipilal Service — Continued. 

JUNE 28 TO DECEMBER 26, 19Q2— Continued. 



Place. 



Maine — Continued. 
Macliias 



Montage 
Portland . 



Waterville. 
Winalow... 



Total for State. 

Maryland: 

Baltimore 

Cumberland 



Total for State. 



Massachusetts: 

Boston 

Brockton 

Cambridge.., 

Chelsea 

Chicopee 

Clinton , 

Everett 

Fall River... 
Fitchburg.... 

Lawrence 

Lowell 

Maiden 

Manchester .. 

Marlboro 

Medford 

Melrose 

New Bedford 

Newton 

Quincy 

Somerville . . . 

Taunton 

Weymouth . . 
Worcester . . . . 



Total for State. 



Michigan: 

Alpena County 

Antrim County 

Arenac County 

Baraga County 

Bay County 

Benzie County 

Berrien County 

Branch County 

Calhoun County 

Cass County 

Charlevoix County 

Cheboygan County 

Clare County 

Clinton County 

Delta County 

Eaton County 

Emmet County 

Qenesee County 

Gladwin County 

Gogebic County 

Grand Traverse County 

Gratiot County 

Houghton County 

Huron County 

Ingham County 

Ionia County 

Iosco County 

Iron County 

Isabella County 

Jackson County 

Kalamazoo County 

Kalkaska County 

Kent County (Grand Rapids 
included). 



Date. 



June 26 



Oct. 10 

Aug. 3-Dec. 13 



Nov. 4 
Sept. 18 



July 27-Oct. 4 
June 1-Nov. 80 



June 

Aug. 

June 

July 

De<*. 

Nov. 

June 

July 

Aug. 

Aug. 

June 

June 

Nov. 

Oct. 

July 

June 

July 

June 

Aug. 

June 

June 

Nov. 

June 



21-Dec. 
lO-Aug. 
21-Nov. 
27-Dec. 

1-Dec. 
16-Nov. 
21-Dec. 
27-Oct. 
10-Sept. 
17-Dec. 
21-Aug. 
14-Dec. 

9-Nov. 
la-Nov. 
13-Nov. 
21-July 
80-Aug. 
21-Dec. 
31-Nov. 
21-Aug. 
21-Dec. 

»-Nov. 
13-Nov. 



13 
30 
29 
13 

6 
22 

6 

4 

6 
13 

9 
13 
15 
29 

8 
12 

2 
13 
29 
30 
13 
22 
14 



June 14-Dec. 13 
July 12-Aug. 9 
June 14-Dec. 13 
Sept. 6-Sept. 20 
July 14-Dec. 13 
June 14-July 5 
July 12-Dec. 13 
Nov. 29-Dec. 13 
June 14-Nov. 16 
June 14-8ept. 20 
July I'J-Dec. 13 
June 14-Dec. 13 
Sept. 20-Oct. 11 
Aug. 9-Oct. 4 
June 14-Oct. 11 
June 14-Oct. 4 
June 14-JuIy 5 
June 14-Oct. 4 
Aug. 2-Oct. 25 
Nov. 22-Dec. 13 
June 21-Nov. 1 
June 21-Dec. 6 
June 14-Dec. 13 
June 21-Aug. 23 
June 14-Nov. 1 
June 14-Dec. 13 
June 14-Sept. 13 
Aug. 2-Sept. 6 
June 14-Nov. 22 
June 14-Nov. 1 
June 14-July 6 

do 

Jiuie 7-Dec. 13 



Cases. 



1 
4 

1 
2 



45 



3 
3 



6 



300 
4 

58 
5 
1 
1 

23 
4 
2 
6 

22 
7 
2 

10 
5 
2 
1 

10 
2 

33 

12 
2 
4 



516 



Deaths. 



1 



56 
'24' 



2 



1 
"2 



92 



55 



Remarks. 



Imported from a lun 
camp a few milen fi 
Machii 



One seaman from scbc 
er Charles Jeffrey. 

Imported from Oanad 



Stopped at quarantlDc 



Present. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 



IC HEALTH AND HABINE- HOSPITAL 8BRVI0E. 



JUNE 3S TO DECEMBER 28, istri— (^mliuual. 



- 


Dale. 


Cua. 


DeMha. 


R^markiL 


ti. 


Jmw l4Jnlr G 
Aiv- 2-Aii|. 90 

June IWni?' G 
Oct ll-D«o. IS 

Oct. *-o«. as 

June 7-^)01. 18 

June t^-Aug. 18 
June IV-Dec. 13 
June l*-NoT. a 

SitSg.lS 

Oct. 1-Dce. 8 

§r ST'! 




































' 












* 










Do 




















































































£ ,S ■ 












.m\ |J««'«„i*-^' " 












Jnne 4-Do-. 12 

SIS 'J 






















Do. 






















fDelmll In- 


:»l i 




PUBLIC HEALTH AND MABINE-HOBPITAL SERVICE. 



JUNE 28 TO l)E(TKMBKR 26. leCB-CoIttlnudl. 



PI*™. D«tc. 


Cmw. 


I>atl«. 


Ronukx 




ir^SiS^- S 


i 

3 




























OttS'TilVSSSi jSnl ti^ ^ 












Nm*^ 'SIn™' 5 












PoTkaiiiiilv Jiirtas-Aiig. 4 

Pol>cL-..l.]H^ Juntia-Nov. M 
























Juneao-Dec. « 






■ 










S::,tss- ,! 














Swift Cnmity ; Jane»july J8 












































WlnonaCouDtr l Jul/ 14^uly 3B 

WrGchtCoaDtt Jiini; »-Nov. 24 

YelTt«f Medicine Ccunli- Juno »-Dec. s 




















1,W7 


T 








£'ia::::;:::::::::::::::::IS:;iSS. 1! 

St. LoQU 1 June S-Dvc. U 


3D 






a 






m 










llontinat 


Jniie l-8epl, RD 


10 




















20 








June 14-Dec. 13 






Npbntka: 


HI 




















lOB 
















Ju'^e ZiIdSJ,' 18 










2SS 


2 










IK 


■J 






June 7»-Km. a 
June 16-Dw, T 

a: iS'' 1! 




Camden Counl; (Cumden in- 
cluded). 
^x Counlf (Ncvtirk Includ- 

Hudion Counly I JerwyClty In- 
cluded). 


M 


I 




"s.sfijjsar"'' 


se 


58 


One cAH Imported « 
ft BtdoUtd tKcpltal. 

One CMC iiDKinod It 


Kew York: ' j m 




S.,S:te:l! ,5 




llSfiSr"".::::::::::::::::::: 





UBLIG BKALTH AND HAKINE-HUSPITAL SERVICE. 



iVm W TO DECEHBER ■», ItWi— Conl: 



Place. l>aii.-. 


r«,» 


,W,h. 


RenurlK 


mUniid. 


July 2X-Au)[. -i 
Mi'pl. 1-Sept. W 

luly IS«epi. ZH 
Oct. l-0«. SI 


1 














M 










1 












248 n 






An*. l-Not. 1 

St' ISli 




SJ":::::::::;::: 
ffl,w::::;::::::;:: 


J? 


















Vranly 






1 




"■'a..'.:?!'':.." 

iVij. ilBepi.'so' 
Oct. 1-Ocl. SI 

SI' laS! 

June l-B«pl. SD 
May I-NOT, m 

Aug. l-Auj. 31 




-only 


I 


Olio law tmponed 


S'.::::::.::::::::: 


::::;■;!:: 
















Stf::.::;::::;::: 










■ffite:;::::::::::: 

TT County 










IS 








SrSS?::::::;:; 

CoDDly 


Sep). I-Hrpl. 80 

"■',„'■*■-" 


47 
























OM. 1-OM. SI 
May 1-Orl. 31 
Hay l-laae SO 
May 1-Ocl, 31 






inly 

ii 1= 
































IHN 


w 






SS^^IS'S 






1 
1! 






SSSy::::::::::::::: 

intjr 

niy 

yniMi'.'.'.'.'."'.'.'.'.'.'.'. 
lonty 










Uay 1-Nuv. ID 
Mity I-KOY. 1.1 














I 




k; 1:S^..?. 






»uiiiv 
























121 


1 






June 1-S..V. >. 




igr 


1 










g= 






rto 




M 




S^-"--"- 




2 




£S-(BiiJiiiii ii- 


Junt I-Sov. W 
June 1-Nov. <t 




ra.nv::"::::": 









80 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



finuiUpox in the Untied States as reported to the Surgeon- General Public Health 

Marine- Hospital Service — Continued. 

JUNE 28 TO DECEMBER 'J6. I902-<:outinued. 



Place. 



Date. 



Ohio— Continued. ; 

Clermont County June 1-Nov. 8 

Clinton County do 

Columbiana County do 

Crawford County i do 

Cuyahoea County (Cleveland , June 
included). 

Darke County , J une 

Delaware County do 

Erie County do 

Fayette County ' do 

Franklin County (Columbus ' do 

included). > 
Gallia County ' do 




1-Dec. 13 
1-Nov. 8 



do 
do 
June 



June 
....do 



Oeauga County 

Greene County 

Hamilton County (Cincinnati 
included). 

Hancock County 

Harriwn County 

Highland County > do 

Holmes County , do 

Huron County , do 

Jefferson County , do 

Knox County do 

Lake County do 

Lawrence County do 

Licking County ' do 

Logan County ' do 

Lorain County do 



1-Dec. 12 
1-Nov. 8 



Lucas County fToledo included ) J une 

Madison County June 

Mahoning County (Youngs- do 

town included). 

Marion County ' do 

Medina County ' do 



1-Dec. 6 I 
1-Nov. 8 ' 



(Zanes- 



June 



Meigs County do 

Mercer County June 

Monroe County do 

Montgomery County (Dayton June 

included). 
Muskingum County 

ville included). 

Ottawa (bounty , do 

Paulding County , do 

Perry County do 

Portage County do 

Preble County do 

Putnam County i do 

Richland County i do 

Rom Coun ty i do 

Scioto County ! do 

Seneca County ! do 

Shelby County do 

Stark County do 

Summit County do 

Trumbull County (Warren in- June 

eluded). 

Tuscarawas County 

Union County , 

Van Wert County , 

Warren County 

Williams County 

Wood County 



1-Nov. 8 



1-Nov. 22 
1-Nov. 80 



Total for State. 



Oklahoma: 

Oklahoma County. 



Total for Territory 

Oregon: 

Portland 

Total for State 



1-Dec. 6 



do 
do 
do 
do 
do 
do 



June 16-July 9 



June 1-Sept. 80 



43 

4 

9 

8 

44 

22 

17 

2 

19 

1 

6 

5 

100 

10 

16 

86 

24 

10 

3 

20 

80 

6 
3 
1 
6 
6 
7 



2,687 



6 



Deaths. 



6 



2U) 



2 
1 



'7'l 



I I 



1 
2 

1 
1 



1 
2 



2.59 




Remarks. 



UC HEALTH AND MABINE-H03FITAL 8EBVICE. 



JCNE 'a TO DECEMBER 26, 1^ 



tr (Mniibnil, . 
d MDR«apori 



unlj (rord City Sept, 1-Op1. 



?(Ri^QRin-' 


Seri. 


1-Ocl. 


?J 


lAlU™. !D- 


Jun,- 


il-Dec. 


18 


mlr (Sayre In- 


Oct. 


1-Oct 


« 


T (Bdstol In- 


Sept. 


l-8«frt 


30 


ly (Buller m- 


July 


la-Aug 


■a 


Idincluded). 


tepl. 


ai-Dec 
l-Scpl 


Z 




8epl, 




iX 


f.i,ri."^'« 

inty (Dabota In- 
nly (ChcMw In- 
Eriu and Delhll 










June 


as-Dee 


u 


H?id Hlgl^Sw 


Hepl. 


I -Sepl 


* 


uuatyfScnnton 


June 


\%tc 


1! 


IWJCI. 


XI 


atih^ (Wblttker 


Pcpl. 


1-Oci. 


31 


Lilly (Hiuol IK-Il 
r (Alli-nlowi. Ili- 








July 


6-Jiily 


VI 


ad County IHiiii- 
iinty (Krtbnrliie' 


^T.. 


1-S«pl 


30 


jS!", 


3S-Dec. 
I -July 


W 




K.V. 


11-Dcc. 


li 


ly (Warren In- 


'ountj- (Mid way 


Sepl. 


l-Oel. 


31 


y iGarlBDd and 


July 


1-JtJly 


■H 


County (GreenH- 


Bepl. 


l-Ool. 


31 












IM: 


2-Deo.' 












inly |Chsrl«Blon 


Aug, 


10-Dcfl. 


13 




Ott. 


1-Ocl. 


31 


jnty ( Green vlllK 







. Elglit cBKi impon«xl. 



'- Pour cMca Imported from 
Mtlsbutv. Two CMCT In 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



JUNE ai TO DECEUBER 16, 19(U— CoQtliiued. 



Pl««. 


Dah?. 


2B 


Deatb. 


..■^»> 


Boil I h C*rolln»— ConUnued. 

Spuunbuis Oiuntr [Spuun- 

Unlon Included). 


Oct. i-Oci. ai 




































2 




eaulh Dakota: 














11 




T^anr^: 


Feb. le-Sept. Ifl 


























c«t*^S? 

Crockett CoiimV 

?e^ES"SSm^:::::::;::::::: 






















1 














■FVb.''i»^8^'a6' 






IS 
111 

11 

ss 

Ti 
S 

i 

i 

I 
11 

8 
S 

2 






« 




Feb IWepL 20 












1 










nooga iDcloded). 


Feb, 19-NoT. 30 
Feb. l^^ept. 20 




































i 




















































• 














3 






































1 






















i 




"js^l '™-"- '"■ 










"SKaaS""" '"-"^ 










s 










Plckew County 

PolkCmintT 

Putnam County 










































SheJbr CoQtit)' lUemphli ia- 
cludcd). 


Feb. l»-Ocl. I 


21 


One csK on n. llBt 






i 


















do 





ILIC HEALTH AND MAEINB-H08FITAL SERVICE. 



JUNE IS TO DECEMBER a 



^. 


».,.. 


C^e.. 


»„,,„, 


Remarlu. 


lDU3d. 


Feb. l»^t. 4 


S 








T 




















2,228 


M 






June l-»ov. SO 






a 














s 








is .tffl: S 








30 








1 


yiVBCa^itaportod. 






M 


I 






juir K-Ai.g. a 






, 














I 








isi Ba'.s 








3 








1 










s 


1 






Jul. l-June 80 






66 

8 

1 

J 

SB 

j 

7 
26 




































































ISeiitleinciiidVa). 


its: JS^S 


1 




















Jul. l-June SO 


























nil- (B^kiiioin- 


























































1,278 


1 






June 1-AuE. 38 






1 

■j 

1 
J 






























J^e^ l-A^-» 






















































1 


















































is;:::::::;:::;:: 









84 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Smallpox in the Vnili'd States as reported to the Surgeon-General Public HeaWi 

Afarine-Hosjntal Serrirf — Continued. 

JUNE 28 TO DECEMBER 26. 1902— Continued. 

Cai<e.s. 



Place. 



Date. 



Wisconsin— Continued. 

KemiBha County ' June 

Kewaunee County ' do 

La Crosse County do 

Lafayette County do 

Langlade County do 

Lincoln County do 

Manitowoc County do 

Marathon County do 

Marinette County , do 

Marquette County do 

Milwaukee County (Mllwau- June 

kce included). 

Monroe County June 

Oconto County do 

Oneida County do 

OutaRamlo County do 

Ozaukee County do 

Pepin County do 

Pierce County do 

Polk County do 

Portage County ' do 

Price County do 

Racine County , 

Rock County (Janesville In 

eluded). 

Sauk County , 

Sawyer County 

Shawano County 

Sheboygan County 

Trempealeau County 

Vernon County 

Vilas County 

Walworth County 

Washburn County 

Washington County 

Waupaca County 

Waushara County 

Winnebago County 

Wood County 



Total for State. 
Grand total 



....do 
June 

June 

....do 

....do 

....do 

....do 

....do 

....do 

....do 

....do 

do 

....do 

do 

....do 
....do 



1-Aug. 28 



1-Dec. 6 
1-Aug. 28 



1-Aug. 30 
1-Aug. 28 



1 
23 

9 

3 
10 
83 
22 

1 

56 

18 

169 

20 

20 
2 

14 
5 
9 
1 
2 

17 
4 
8 
9 

4 
1 

17 
7 
11 
8 
2 
1 

10 
4 
34 
26 
29 
4 



Death.H. 



Remarks. 



849 



I 15,658 



1 
2 



6 



806 



DECEMBER 27, 1902. TO JUNE 26, 1908. 



Alabama: 
Mobile 



Total for State 



Alaska: 
Sitka 




Total for Territory 



California: 

Berkeley 

Fresno 

Los Angeles . . 

Oakland 

Sacramento . . 
San Francisco 
Stockton 



Total for State. 



Colorado: 

Arapahoe County (Denver in- 
cluded) . 

Boulder County 

Chaffee County 

Clear Creek County 

ConeJoe County 

Coatilla County 



Jan. 
Feb. 
Jan. 
Feb. 



1-Feb. 
1-Feb. 
1-Feb. 
1-Feb. 



28 
28 
28 
28 



I 

1 

77' 


1 


77 1 


" 1 


1 




1 1 





Feb. 19-Mar. 11 ! 

Dec. 1-May 81 

Dec. 8-June 6 

Dec. 1-Dec. 81 

Dec. 7-Mar. 28 

Dec. 8-June 14 

Dec. 1-May 1 



Dec. 7-May 28 i 



.do 



342 



881 

11 
2 

19 
2 
1 



2 , 

79 i 1 
52 , 

6 

16 ' 

159 i 2 
28 1 



3 



Two 



imported. 



On Br. achr. TriampI 



PUBIJO HEALTH AND MARIKE-HOSPITAI. SEBVIOE. 



85 



In the United States as reported to the Surgeon-General Ptiblic Health and 

Marine- Hoiqntal Service — Continued. 

DECEMBER 27. 1902, TO JUNE 26, 1908-<}ontinued. 



Place. 




iontinued. 

>anty 

'ounty 

County (Colorado 
^ included). 

County 

/Ounty 

aCounty 

'County 

nma County 

»anty 

>unty 

County 

County 

nco County 

Dunty 

County 

ounty 

!ounty 



for State. 



t: 

il ... 
y... 
Itain 

1 

Id .. 



Feb. 

do 

do 



1-Feb. 28 



A^ec. 
Feb. 
Jan. 
Dec. 



1-Feb. 28 
1-Feb. 28 
1-Feb. 28 
1-Feb. 28 



.do 



Dec. 
Dec. 
Jan. 
Dec. 
Dec. 



.do 



l^an. 81 
1-Feb. 28 
l-Feb. 28 
1-Feb. 28 
l^an. 81 



Feb. 
Jan. 



1-Feb. 28 
1-Feb. 28 
1-Feb. 28 



Dec. 1-Dec. 31 



d... 
•on., 
in tic 



for State. 



gton 

for State. 



^lumbia: 
gton 



for District . 



till 



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



May 

Jan. 
Dec. 



10. 



1-May 81 



1-Dec. 81 



Mar. 1&-Mar. 21 



Jan. 11-May 9 



County (Sanderson in- 

d). 

»ia County (Lake City 

lenton Included). 

ounty 

I (Nocatee included) 

/Ounty (Jacksonville in- 

d). 

lia County (Pensacola 

ded). 

n (>ounty (Quincy in- 

I County (Weiityille in- 
d). 

tteCkiunty 

ounty (Otter Creek in- 
d). 

County (Orlando in- 
d). 

low County (Milton in- 
d). 

ACoonty (Sopchoppy in- 
d). 

County (Florala in- 

•d). 

igton County (Cbipley 
luded). 
for State 



Feb. 1-Feb. 14 
May 17^une 13 

Jan. 25-June 13 



Feb. 
Apr. 



1-Feb. 14 
5-May 9 



Jan. 25-June 13 
Dec. 7-June 13 
Jan. 25-Feb. 14 

do 

I 

' Jan. lO^an. 24 
May 17-June 13 

Jan. 25-Feb. 14 

....do 

....do 

Jan. 10-Jan. 81 

May 2-May 23 



4 

1 
9 

4 

1 

9 

8 

1 

2 

129 

4 

15 

65 

2 

4 

6 

42 



717 



1 
8 
1 
6 
4 
1 
6 
15 
1 
1 
1 



40 



15 



15 



8 
2 



5 

29 
61 

180 

7 

2 

8 
20 

4 

4 

2 

6 

16 



855 



Deaths. 



Remarks. 



Imported. 



PUBLIC HEALTH AMD MARIME-H08PITAL 8GRVI0E. 



DECEMBER -a. IDOS. TO JUNE 3b. igOS-~CoDtlliued. 



Place. 


Da.t«. 


Caws. 1 Dealba. 


lUOTarfa, 


Geo 
Illln 

Indl 


S'^u 


Dee. IWune IT 


mj . 








TM^forBtaW 




133 1 » 




OiK 


Mar. 1-Apr. t 
Fell. l-June 13 

Si -tir,!! 

Jan. l^ao. 31 
Jan. IB-Ma; 23 

Apr. 1-Apr. 30 




>i 






a" IB 


























*^| * 




















330| ^ 






Kov. -J&n. SI 
Nov. -Apr. X 

Nov! -Apr.' 30 

d™' ^a''?' £ 

Not. -Apr! 30 
Dn. -Apr. 30 

Nov. 1-Apr. 30 




«l 






















Boone County 


















'm " 




JbtIe Coaniy (JeiiL'nunviile 

iTSSi 
















Dee. I-Dk. 31 
Nov. 1-Apr. 30 
Jan. Wan. 31 
Nov. 1-Apr. 30 






'11 ^ 
























1^ :;;:::;.:: 




ffiSfoSr: 


Ok. 1-Apr. 30 
Nov. 1-Apr. BO 




















Nov. 1-Kar. 31 
Mar. 1-Apr. 30 
Nov.^l-Afr. 30 


























gl ^■ 












Jan. -Apr. 80 

till 

Mar! l-A'pr. 30 


















^dJJS)?™'"^ iKok-™. in- 






aeVnon Counly 






















eftetBon (fcnniy 

enninuB ConDl/ 

Saffi-Siii;-;:::::::::::; 














gS. !:K: !8 
SS; IS. i! 

Nov. I-Apr. 30 


































[*noneCoiinl)r(KBnk«l«Hii- 
[^^^.l-Co«n,r 












hIsItt/'""""'""' 


Nov. l-Mw M 
Nov. IJune 13 


665 1 100 






Mar. -Apr 


30 
90 
30 
30 
30 
31 

30 
























Onnge CouDix 

SiSSiiS::::;:::::::::::: 



















PUBLIC HEALTH AND MAKINB-HOSPTTAL SEBVIOE. 



DBCEUBER 27. 1302, TO JUNE 2S, ie03--<::on 



Pla«. 


«.,.. 


C^- 


Death. 


Remark. 


cttouetf. 


Apr. l-ipi. 
'■"do""' 


s 


i 

10 

ifl 

63 

12 

_1 




















Dec. 1-Uar. 
Jan. l-ICar. 

E; Si 

Kov. Wan. 

Dec! I-Jan! 
Dec. 1-Dec. 

No': ti^: 


s 

81 

w 

i 

ao 














T 








b CouDIT (Houlb Bund 


' 
















^'V 


1 






i 








SS''..'-''"" 


Nuv. 1-June 

Mar. -Mar. 

Dec! -Dec! 

£; :€; 

S(«r. -Apr. 


13 

90 
SO 

1! 

SO 

80 

31 

30 


^ 


Three caseB imported. 






























































3.5M 


IM 






Feb. 1-Feb. 
Nov. l-Mar. 
Jan. Wuno 
Mar. I»-May 


SI 






1 
































M 








Jan. ll-May 


e 








13 








1 










16 


1 






SS: .tK 

Jan. 1. ivfo 

Apr. ao. 1«U 

Jan. 4-MBy 


11 
as 








2 










« 
















BB1 


8 






Dec. 14^unc 
May l-Mar 


13 




Countv (NfW OrleaHH 


« 


" 


""»"—'-»"-■ 


























tess,;'. 


s 








IM 
315 




























Jan. IWan. 


17 






































^. a:F;b:'"7" 


' 










SS' i""'" ! 




'XS^'"""""™^' 






BT State 










1 





PUBLIO HEALTH AND HA RING- HOSPITAL BEBTIOB. 



DKCEMBER 'S, iVK, TO JUNE '16. 



PUw. 




l)«i*. 




y-iaer. 


,>..,i» 




r™.,.. 


""e,'^oro 


Del 


■«?.' 


i 


si 


, 


Four 


»K« Impriftfrt. 



















PallKiTer.. 

BftTlThtU .. 

Hoiyoke... 



tSeti'Biiii'it^V.'.'.'.'.'.'.V. 




Dec. 

Fub". 
Apr- 


14-Jnn. S 
KMiin. IT 


KSsr.":::::::::: 




*-Apr. 11 


hlgan: 
Bniu;hCouDt)-(Harl»> 

Genwe County (FU 


,rt 


, Jan. 


i-Jhii. ;;i 

Sl-June 13 



eluded). 

Ronghlfln Counly FoL. l-Feb. 

Hurnn Coumr Jim. l-Jun. 

EeuC Coontr (Ontad l4<i[i<da , Due. 14-June 

Included). 
Uuiiuctle Counlf (Muiinettu Feb. T-Mar, 

Included). 

MMibmlneeConnl;- Fuh. T-Feh. 

OtMvaCountytGniud Baveii). Kch. l-Ft'b. 
St. CUlr County (Port Humn Feb. I5-Jiiii( 

Incladed). 
Waahteoa* County (Ann Ai- Msr. l-Aiir. 

bor iDclud«d). 
Wnyne County (Dctmil Hurl Dw. 14-~]uni 

Wyutdottolocludrd). 











































■jt?lsV 11 


























Dec. 


H-ilay 11 




::::.-^Sl: 


































gfise-.Psn^j: 


Is 


iwimi- i 
















































ao-Mnr. -1 




PITBUO RKALTH AND HARTNE-HOSPITAL SERVICE. 



DECKUBKR ZT, 1M2, TO JHNE X, IMS— Conllnued. 



lUee. 


Dkle. 


c^. 


DcsU». 


R™ar^ 


CmanmA. 


1 SI 

Dec! S-Mar! ao 

Feb, 3-^Illne 1 
Mar. 33- Apr. IT 

Dec' S-JuD^ » 
Dec. B^unc « 


28 
S 

BS 
11 

21 
49 

SS5 
BO 

IS 

BS 

n 
s 

10 

10 
77 

as 

IS 

10 

3U 
























1 














































Dee. IWnno e 
Dec. l&^unc 1 
Maj' ll-May IB 

{2: Kr.! 

Mar. S-Har. » 

E- si ! 

Feb. I3-M«r. M 

K IE""? 

Dec. 30-Apr. < 
Dec. Sl^uno S 

a s:ss ; 

Dec. iS^une ■'> 

E Hi ! 

Jan. n-^Iunc n 
Dec, IS-June A 
Dec. g-Juno N 
Dec, 3Z-Apr. 30 
Jan. la^une I 
Mar. 1»-Mar. £3 
Dec. 80-Mar 18 
Mar. IfrJune 8 
Dec. 8-May as 
Dee. BO^Une 1 




















I 















Ss;::::;;:;-:;:;: 


1. 




















' 






















' 






































J 




















8.976 








ffi SiiS i! 








Jfi 














m 








Mar. Is-Apr. 12 
Mar. Sl-Apr. « 
Dec. ISJonc IS 






g»:::::::::::::::::::: 


! 


















3H 1 5 






SS: t-BSS 






li 




















M 








iS: -ttr^ 


==" 


















W 















90 



PUBLIC HEALTH AND MABlNE-HOSPITAL SEBVICE. 



Smailpox in the United States as reported to the Surgeon- General Public HeaUh a 

Marine- Hospital Service — Ck>ntinued. 

DECEMBER 27, 1902, TO JUNE 26, 1903-Continaed. 



Place. 



New Hampshire: 

Concord 

Manehefltor . 
Nashua 



Total for State. 



New Jersey: 

Camden County (Camdon in- 
cluded). 

Essex County (Newark in- 
cluded). 

Hudflon County (Jersey City 
included). 

Mercer County (Trenton In- 
cluded). 

Union County (Plainfield in- 
cluded). 

Total for State 



New York: 

Binghamton 

Buffalo 

Elmira 

New York . . . 
Rochester . . . 
Yonkere 



Total for State. 



Date. 



Jan. 1-Mar. 31 
Dec. 1-May 23 
Dec. 14-June 13 



Dec. 14-May 23 
Dec. 14-Apr. 11 
Doc. 22-Apr. 6 

June 0-13 

Jan. 10-Feb. 14 






2 

133 

88 



Dec. 21-Apr. 4 

Dec. 14-May 9 

Apr. 26-May 23 

Dec. 14-June 6 

Apr. 1-June 7 

Feb, 2a-Feb. 27 



North Carolina: 

Anson County Jan. 

Buncombe County Nov. 

Burke County Nov. 

Cabarrus County do 

Caldwell County do 

Camden County Feb. 

Catawba County Jan. 

Chatham County Mar. 

Cherokee County Nov. 

Cleveland County Nov. 

Craven County Nov. 

Cumberland County Nov. 

Currituck County Jan. 

Davidson C-ounty Feb. 

Davie County Dec. 

Durham County Jan. 

Forsyth County Nov. 

Qaston County do 

Graham County do 

Granville County^ Jan. 

Greene County do 

Guilford County Nov. 

Haywood County Feb. 

Henderson County Dec. 

Iredell County Nov. 

Jones County do 

Lincoln County Dec. 

McDowell County Nov. 

Macon County Mar. 

Madison County Jan. 

Mecklenburg County (Char- Nov. 
lotte included). 

New Hanover County Feb. 

Onslow County Nov. 

Orange County Mar. 

PolkCounty Dec. 

Randolph County Nov. 

Richmond County Feb. 

Rockingham County Dec. 

Rowan (>)unty do 

Rutherford County do 

Bampson County Jan. 

Stanly County I do 



1-Jan. 31 
1-Jan. 31 
1-Mar. 81 



I 



1-Feb. 28 
1-Mar. 31 



1-Mar. 
1-Dec. 
1-Mar. 
1-Feb. 
1-Dec. 
1-Feb. 
1-Mar. 31 
1-Mar. 31 
1-Mar. 31 
1-Mar. 81 



31 

31 , 
31 
28 
31 ! 
28 



1-Feb. 28 



1-Mar. 81 
1-Mar. 81 
1-Mar. 31 
1-Mar. 31 



1-Mar. 31 
1-Mar. 81 
1-Mar. 31 
1-Mar. 31 
1-Mar. 31 



Stokes County. 

8urr;ir County 

Swam County 

Transylvania County. 
Union County 



.do 
Nov. 

do 

Dec. 
Nov. 



1-Feb. 


28 


1-Feb. 


28 


1-Mar. 


31 


1-Mar. 


31 


1-Dec. 


31 


1-Feb. 


28 


1-Mar. 


31 


::"::::::: 


1-Mar. 


81 




1-Mar. 


31 


1-Dec. 


31 


1-Mar. 


31 



Deaths. | 



Remarks. 



223 j. 



39 

34 

25 

1 

3 



102 



2 
26 

6 
33 
31 



98 



3 

297 

216 

10 

30 

1 

36 

1 

7 

25 

136 

1 

7 

30 

8 

33 

175 



13 

78 

2 

102 
18 
42 
30 
20 
52 

122 

9 

33 

808 

1 
76 

6 
63 

6 

1 

52 
32 
38 
64 
27 
45 
128 
67 

4 
71 



4 

1 



5 1 



. .. One case imported fr 
3 Pennsylvania. 



3 
5 
1 



12 



21 



2 



One case importe<l. 



.^»veral. 



ILIO HEALTH AND MA BINE-HOSPITAL 8EBVICB. 



DBCEMBER 27, IWl, TO JtrNE K, igOJ-Coutinued. 



l-Mnr. S 



Jen. 1-M«r 

"(AViiabiiiii'i'MHy i(^M«j-"; 



Mint)- (CleTuUnil J«n, 1-Ji 



l-May B 



ly'tToiKJo' in-TJwi. 



Coonljr (Dajioti Jan. 



92 



PUBLIC HEALTBt AND ifABINE-HOSPlTAL 8EfiVtOK« 



SmaUpox in the United Stales as reported to the Surgeon-General Public Health 

Marine- Hoi^tal Serxnce — Continued. 

DECEMBER 27. 1902, TO JUNE 26, 19(»-Continued. 



Place. 



(Zanes- 



Date. 



Jan. 
Jan. 



Ohio— Continued. 

Morrow County , 

Musklnsrum County 
Yille include ). 

Noble County do 

Ottawa County do 

Perry County do 

Pike County do 

Portage County do 

Preble County do 

Putnam County do 

Richland County do 

RoflH County (Chillicothe in- 
cluded). 

Sandusky County 

Scioto County 

Seneca County 

Stark County (MasMillon in- 
cluded). 
Summit County (Akron in- 
cluded). 
Trumbull County (Warren in- Jan. 
eluded). 

TuBcarawas County 

Van Wert County I do 

Vinton County I do^ 

Wa«hinffton County (Marietta 
included). 

Wavne County i do 

Williams County I do 

Wood County do 

Wyandot County ' do 



Total for State. 



1-May 9 
1-May 31 



Jan. 1-May 23 
Jan. 1-May 9 



.do 
.do 
.do 

.do 



1-June 20 



.do 




Cases. ' Deaths. 



Oregon: 
Portland 



Total for State. 



Apr. 1. 



in- 
in- 



in- 



Pennsvlvania: 

Adams County 

Allegheny County (Pittsburg 
and McKeesport included). 

Armstrong County (Freeport 
includea). 

Beaver County 

Berks County (Reading in- 
cluded). 

Blair County (Altoona 
eluded). 

Bucks County (Bristol 
eluded). 

Butler County (Butler 
eluded). 

Cambria County (Johnstown 
included). 

Carbon County 

Chester County (Spring City 
included). 

Clarion County 

Clearfield County 

Crawford County 

Cumberland County 

Dauphin County 

Delaware Ck)unty 

Elk County 

Erie County (Erie included) .. 

Fayette County 

Forrest County 

Greene County 

Huntingdon County (Hunt- 
ingdon included). 

Indiana County 

Jefferson County 

Lackawanna County (Scran- 
ton. Dunmore, and Carbon- 
dale included). 

Lawrence County (Newcastle 
Included). 



Mar. 
Jan. 



1-Apr. 80 
1-June 13 



Jan. 1-Apr. 30 



Mar. 
Jan. 

Dec. 

Jan. 

Jan. 

De<!. 

Mar. 
Jan. 



Jan. 
Jan. 



.do 



Mar. 
Jan. 



.do 
.do 



1-Apr. 30 
6-May 25 

21-June 6 

1-Apr. 30 

18-Apr. 30 

14-June 6 

1-Apr. 30 
1-Apr. 30 

l^an. 31 
1-Apr. 80 

i-Apr 30 
1-Apr. 30 



Dec. 
Feb. 
Mar. 
Jan. 
Jan. 



14-June 6 
1-Apr. 30 
1-Apr. 80 
1-Jan. 31 
1-Apr. 30 



.do 
.do 



Feb. 1-May 1 



Jan. 1, 1902-Apr. 
80,1903. 



2 




74 


.......... 


3 


.......... 


61 




36 




36 
8 


3 


45 




23 




41 
18 


4 


2 




82 
11 


13 


48 




169 
18 


5 


12 
28 


2 


23 
54 

1 


8 
6 


57 




'? 


1 






4,422 


247 


1 









1 








1 




591 
10 


90 


6 




4 





35 

50 

56 

242 



6 

8 

2 

24 



6 
4 


2 


189 




169 
1 


5 


7 




95 

231' 

71 

13 


2 


8 




ft 




10 
13 


1 


119 
27 

52 


5 



Remarks. 



Thirty-one cases 
ported. 



Seven cases importei 



Two caAen imported. 



ILIO HEALTH AKD UABIKE*HOSPITAL SERVICE. 



98 



e UnUed States as reported to the Surgeon-Geiieral Public Health and 
Marine-HogpiJtal Service — Continued. 

DECEMBER 27, 1902, TO JUNE 26, igoS-Continaed. 



kce. 



Date. 



)ntinaed. 

mnty (WilliamB- 

8d), 



County (Norrla- 
led). 
ind County 



County 

junty (Potteville 



nty 

County 

nty 

ly 

^unty 

i County 

( York included) . 



ate. 



ate. 



id EdiBto islands, 
ate 



Dec. 28-Apr. 80 



Jan. 
Feb. 

Dec. 
Mar. 
Dec. 
Mar. 
Dec. 

Jan. 
Mar. 
Feb. 
Jan. 
Feb. 
Jan. 
Jan. 



l-Apr. 80 
22-Apr. 30 

1-Apr. 80 
1-Apr. 30 
14-June 20 
l-Apr. 30 
1-Apr. 80 



1-Apr. 80 
1-Apr. 30 
1-Apr 
1-Apr 



30 
80 



1-Apr. 30 



1-Apr. 
1-Jan. 



30 
31 



Dec. 28-Jan. 3 
Dec. 25-June 15 



Dec. 21-June 13 

Nov. 

Jan. 

Jan. 

Nov. 

do 

do 

do 

do 



1-Nov. 
23-May 
l^Apr. 

1-Nov. 



30 
20 
11 
30 



ate. 



inty. 
inty. 



ty... 
jnty 



»mity (Naahvlllc 



ity 



ty 

inty 

y 

^y 

mty 

inty 

)unty 

ty 

nty 

inty 

3tinty 

7 

aty 

k>anty 

nty 

f (Knoxvllle in- 



loiinty 

Cllltj.. 

ity.... 



Dec. 21-Dec. 27 



Sept. 15-Mar. 15 
do 



do 

do 

do 

do 

do 

Sept. 15-June 20 

Sept. 15-Mar. 15 
do 



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

.do 
.do 
.do 
.do 



Cases. 



161 

19 
8 

24 
32 
685 
18 
66 

21 
31 
29 
82 
10 
35 
1 



3,175 



9 



100 

32 

3 

7 

4 

4 

50 

7 

49 



256 



Death H. 



10 

46 

10 

1 

2 

4 

28 

34 

28 

42 

56 

5 

78 

13 

26 

31 

545 

1 

1 

5 

13 

5 

169 

17 

9 

9 

6 

35 

10 

15 

5 



1 
70 



Remarks. 



218 



3 

*i 



10 



1 
3 



2 
1 

2 
1 
6 



94 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Smallpox in the United SUitett as reported to the Surgeon-General Public HeaUl 

Marine- Hospital »Senice — Continued. 

DECEMBER 27, 1902, TO JUNE 26, 1908— Continued. 



Place. 


Date. ! Camw. 

1 


Deaths. 


Remarks. 


Tennessee— Contlnaed . 

McMinn OonPtv .,..,,.,» ^ r 


1 

Sept. 15-Mar. 15 
do 


23 
3 


1 




McNairv County 




Madison County 


do 


20 
16 
19 

7 


1 




Marion County 


do 




Maury County 


do 1 


1 




Montgomery County 


do i 




Obion County 


do 


112 

2 

2 

7 

12 


1 




Perry County 


do 




Rhea County 


do 






Roane County 


do 






Robertson County 


do 






Rutherford County 


do 1 


4 

1 

18 
99 

7 
1 
1 






Sequatchie County 


do 1 






Sevier County 


::.:.do ' 






Shelbv County (Memphis in- 
cluded). 
Smith County 


Sept. 15-rune20 

Sept. 15-Mar. 16 ; 
do 


1 




Sullivan County 






Sumner County , 


do 1 






Tipton County : do 


RO 












Williamson County i do 35 






Total for State 








1,833 


32 








Texas: 

Galveston 


Mar. 27 


1 






San Antonio 


Dec. 1-May 31 1 i^ 










1 






Total for State 


1 13 

- 






1 




Tun cajK8 imported 


Utah: 

Ogden City 


Jan. 1-Jan. 81 


' „ 




Salt Lake City 


Doc. 1-June 6 '< 5*-*^ 


2 








Total for State 


1 367 


2 








Virginia: 

Danville 


Jan. 10-Jan. 17 


9 1 




Richmond 


Jan. 1-Jan. 31 


1 ' 1 




Total for State i 


> 9 
1 ^ 


2 




1 




Washington: 

Adams County (Ritzville in- 


Mar. 1-Muy 31 


3 






cluded). 
Chelan County 


Apr. 1-Apr, 80 
Apr. 1-May 31 


1 
4'i 






Clarke County 




Cowlitz County (Kelso in- 


Mar. 1-Mar. 31 I 6 

1 

Mar. 1-May 31 i '24 






cluded). 
KingCounty (Seattleincluded) . 
Lewis County 






May 1-May 31 
Apr. 1-Apr. 30 
Apr. 1-May 31 

Doc. &-June 1 

May 1-May 31 
Apr. 1-Apr. 80 

Mar. 1-May 31 

do 

do 


2 

2 

14 

16 

11 

7 

181 
13 
17 






Lincoln County 






Okanogan County (Chesaw in- 
cluded). 
Pierce County (Tacoma in- 


8 




cluded). 
Snohomish County 






Spokane County (Spokane in- 






cluded). 
Wallawalla County (Walla 






Walla included). 
Whatcom County (Blaine and 

Laurel included). 
Whitman County (Colfax in- 


1 




cluded). 






Total for State 








339 


4 




Wist Virginia: 1 

Moigantown Mar. 6 

Total for State ' 




9 










9 












Wisconsin: 

Eighteen counties, 25 places . . . 
Twenty-three counties, 84 
places 


Sept. 1-Sept. 80 
Oct 1-Oct 81 


62 
184 


1 





PUBTJO HEALTH AND HARINE-H08PITAL SEBVICE. 



95 



in the United States as reported to the Surgeon-General Public Health and 

Marine-Hospital Servirt — Continued. 

DECEMBER 27, 1902, TO JUNE 26, 1903— Continued. 



Place. 


Date. 


Cases. 


Deaths. 


Remarks. 


— Contiiiued, 
ty-elght counties, 46 
» 


Nov. 
Dec. 
Jan. 
Feb. 


1-Nov. 
1-Dec. 
1-Jan. 
16-May 
1-June 


30 
31 
31 
3 
20 


278 

317 

410 

14 

84 


1 
1 
3 




-nine oountiefi, 65 places. 
>ne counties, 74 places. . . 
>ay 




ikee 


Feb. 












1 for State 




1,339 


6 






Feb. 


23 






prings 


1 


% 














1 for State 


1 














d total 


26,937 


842 




1 





FOREIGN AND INSULAR. 



ig the year ended June 30, 1903, smallpox was reported in 43 
and countries outside of the United States, as may be seen in 
tables ffiven below — one for each half year. It will be seen 
lese tables, judging by the number of deaths, that the disease 
)st prevalent in India; then Russia, Great Britain, France, 
Belgium, and Mexico. It is instructive, a^in, to invite atten- 
the small number of deaths reported from tne (jerman Empire, 
vaccination is thoroughly enforced, as compared with other 
Bs where vaccination is not enforced. For example, there 
ily 7 deaths in the German Empire^ while there were 162 in 
Q, 321 in France, 376 in Great Britain, and so on. 



as rejwrted to the Surgeon-Oeneral, Public Health and Marine- Hospital Service, 

JUNE 28 TO DECEMBER 26, 1902. 
ceived from United States consuls through the Department of State and from other sources.] 



Place. 



Ayres 

ngary: 

•P 

s 

ibuco 

Taneiro , 

itbuig , 

(Megantic District in 
d^. 
rille (New Brunswick) . 

1 , 

▼er , 

eg 

yym 

o 



May 1-June 30 



May 
Aug. 
July 

May 
Aug. 
Aug. 

Sept. 

May 

Sept. 

Sept. 
June 

Nov. 
July 
July 
June 

Nov. 

June 



26-Nov. 22 

10-Aug. 16 

1-Nov. 29 

26-Nov. 22 
17-Sept. 27 
81-Nov. 8 



28-Nov. 

17-Oct. 

21-Nov. 



1 

81 
16 



2a-Nov. 8 
7-Dec. 13 



27 

13-July 26 
1-July 81 
7-June 28 



19 

14-June 21 



Cases. 


DeathN. 
13 




132 

1 
1,368 

32 




117 

12 

7 

14 




9 


106 
32 




9 

18 

8 
2 
2 
8 

42 


1 










1 



Remarks. 



One case Imported. 



96 



PUBLIC HEALTH AND MARINE-HOSPITAL HERVICE, 



SmalliH)x as reported to the Surgemt-Genercdy Public HeaUh and Marine-HospUal Sen 

Continued. 

JUNE 28 TO DECEMBER 26, 1902— Continued. 



Place. 



Chile: 

Pisagua 

China: 

Hongkong. 

Shanghai . . 
Colombia: 

Cartagena . 

Panama . . . 
Cuba: 

Habana ... 



Dutch Wcj)t Indies: 

Curasao 

Ecuador: 

Guayaquil 

Egypt: 

Cairo 

England: 

Birmingham 

Bradford 

Bristol 

Leedfl 

Liverpool 

London 

Manchester 

Newca«tle-on-Ty ne . 

ShelHeld 

South Shields 

Sunderland 

Swansea 

Warrington 

France: 

LaRochelle 

Marseille 

Paris 

Rhcims 

Roubaix 

Gibraltar 

Greece: 

Athens 

India: 

Bombay 

Calcutta 

Karachi 

Madras 

Ireland: 

Belfast 

Dublin 

Italy: 

Milan 

Naples 

Palermo 

Japan: 

Formosa 

Yokohama 

Malta: 

Valletta , 

Mexico: 

City of Mexico 

Nogales 

Vera Cruz , 

Netherlands: 

Rotterdam 

Philippine Islands: 

Manila 

Porto Rico: 

Arecibo 

Bayamon 

Caguas 

Camuy 

Cialcs , 

Corosal 

Fajardo , 

Hatlllo , 

Humacao 

Isabela 

Lares , 

Ponce 

San Juan 

Utoado 



Date. 



Cases. 



Oct. 13. 



Apr. 25-8ept. 13 

Aug. 24-^pt. 6 

June 1-July IS 

June 1-July 21 

Sept. 80 



Aug. 3-Aug. 9 
Aug. 23-Nov. 15 
June 26-July 1 



May 31-Aug. 

To Nov. 29 

Oct. 
Oct. 
May 
May 
Sept. 



9 



4-Oct. 18 
4-Nov. 22 
81-Nov. 22 
31-Nov. 29 
27-Nov. 29 
May Sl-Sept. 20 
Nov. 2-Nov. 29 
May Sl-Sept. 20 
June 7-8ept. 27 
Sept. 20-Sept. 27 
do 



Oct. 

June 

June 

Oct. 

Oct. 

Aug. 



2(K)ct. 26 
1-Sept. 80 
7-Nov. 22 
6-Nov. 80 
1-Oct 81 

11-Nov. 80 



June 29-Nov. 22 

May 13-Nov. 18 

May 10-Oct 25 

May 25-July 27 

May 10-Oct 10 



June 
Aug. 



7-June 14 
8-Aug. 23 



May l-8ept 80 

June 21-Dec. 1 

May 24-Nov. 22 

May 1-May 31 

May 31-June 7 

June 22-June 28 



June 
Nov. 
June 



1-Nov. 80 
9-Nov. 29 
7->July 12 



June 14-Aug. 23 
Apr. 26-Junc 21 
Feb. 1-June 16 



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



6 
13 



12 
1 

1 



35 

38 

1 

18 
185 
779 
6 
3 
9 
6 
8 



13 



46 

28 

187 

73 
1 



15 
8 

3 



381 

8 

71 

121 
6 
2 
1 
5 
1 
9 
8 

128 

110 
79 



Deaths. 



10 
8 

8 



Remarks. 



31 
1 



1 

1 

8 

154 



1 
1 
1 
1 

1 

85 

11 

4 

1 

10 



110 

25 

6 

18 



5 

2 

21 

8 



15 



8 



On Spanish ss. Ontoii 
Hamburg and Bill 



TBLIC HEALTH AND MARINE-HOSPITAL 9EEVI0E. 



JUNE M TO DECEMBER ■X. 1902— Contlnueil. 
ViiW. nises. Deaths. 



:4S 



. Aug. S-Aug,' 9 i 

. Sept. l-8epl. SO . 

1-JuTy 31 . 
1-June IS . 

\ May 3-Nov. 1 :. 

. May 31-Oct. IK '. 



; June 5-Oc(. 

I Aug. ■» 

DECEMBER 17, i9H, 





Ncn-. 23-Mar. 31 

Ocl. 1-May SO 
July l-Feb. 27 

Nov. W-M«y 80 
Dec. 1-M«y 30 
Nov. 23-May 16 
Feb. l-Feb. 7 

Nov. 16-May 30 

Feb. 10-May 16 

Due. 14-May 16 
Jan. H-June 12 

Dw. M-jHne 12 

Jan. l-Jan, 31 

Feb. l-Feb, 28 
Mar. I-Mar. 31 

Mar. Ift-May 80 




22 




)■: 


74 


















ti 
























ii 










One cite Imported Irom 








on «i. (^rinthlan. 










i 






IS 






12 
















Sf. 






Apr. B-A|ir. 12 






< 






Nov. St-Feb. 14 

Nov. 1-Apr. 80 
Mar. l-MBT. 31 


J 


7.TiS"g.rS 




31 































98 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Smallpox as reported to the Surgeon-General^ Public Health and Marine-Hospital Sen 

Continued. 

DECEMBER 27, 1902, TO JUNE 26, 19(»-Continned 



Place. 



France— Continued. 

Rheims 

Roubaix 

Rouen 

Germany: 

Altona 

Hamburg 

Leipzig 

Gibraltar 

Great Britain: 

Birmingham 

Bradford 

Bristol 

Cardiff 

Dublin 

Dundee 

Edinburgh 

Glaw:ow 

Hebbum 

Leeds 

Leith 

Liverpool 

London 

Manchester 

Newcastle-on-Tyne 

Nottingham 

Shelfield 

South Shields 

Sunderland 

Walker-on-Tyne 

Wallsend 

West Hartlepool.... 
Hawaiian Islands: 

Honolulu 

India: 

Bombay 

Calcutta 

Karachi 

Madras 

Italy: 

Milan 

Palermo 

Jamaica: 

Duan Vale 

Japan: 

Kobe 

Yokohama 



Korea, Seoul 

Malta 

Mexico: 

City of Mexico 

Nuevo Lareoo 

Tamplco 

Vera Cru« 

Netherlands: 

Amsterdam 

Flushing 

Rotterdam 

Newfoundland: 

St. Johns 

Philippine Islands: 

Manila 

Porto Rico: 

Ponce 

Rio Piedras 

San Juan 

Russia: 

Moscow 

Odesm 

Riga 

St. Petersburg 

Warsaw , 

Spain: 

Canary Islands, Las Palmas 

Corunna , 

Santander 

Tenerifle , 

Straits Settlements: 

Singapore 



Date. 



Jan. 19-Apr. 12 
Dec. 1-Mar. 31 
Apr. 1-Apr. 90 



To Jan. 22 

Jan. 25-May 16 

Jan. 18-Jan. 24 

Nov. 24-Mar. 1 

Dec. 1-June 6 

Dec. 1-May 30 

Mar. 29-June 6 

Dec. 2a-May 2 

Dec. 20-June 6 

Dec. 1-June 6 

Dec. 1-Apr. 4 

Jan. 9-May 15 

Mar. 15-May 21 

Dec. 1-May 80 

Apr. 5- Apr. 11 

To June 6 

Dec. 1-June 6 

do 

Mar. 1&-June 6 

Jan. 4-May 23 

Dec. 1-May 30 

Mar. 22-May 16 

Mar. 1-June 6 

Mar. 8-Mar. 14 

Mar. 1&-Mar 21 

May 17-May 23 

Dec. 1-June 1 

Nov. 19-May 19 

Nov. 16-May 16 

Nov. 24-Mar. 22 

Nov. 16-Apr. 24 

Nov. 1-Mar. 81 

Nov. 23-Apr. 26 



Cases. 



Feb. 1. 



Mar. 80-May 16 
Mar. 7-May 23 



Apr. 
Nov. 

Dec. 
Mar. 
Apr. 
Feb. 

Mar. 
Mar. 
Apr. 

Apr. 

Feb. 

Mar. 
Apr. 
Mar. 

Nov. 
Nov. 
Jan. 
Nov. 
Jan. 

Dec. 
Jan. 
Mar. 
May 



18 

24-Feb. 



28 



19 



1-June 7 



1-Apr. 30 
1-Feb. 7 

16-Apr. 25 

8-Mar. 18 

12-Apr. 18 

7-Apr. 13 

1-Apr. 4 

23-Apr. 6 

1-Apr. 30 

17-May 31 

16-May 23 

23-May 23 

1-Mar. 31 

23-May 31 

3-May 16 



7-May 
81-Feb. 
81-Apr. 
10-May 



9 

7 

6 

16 



Nov. 1-May 2 



11 

7 



241 

143 

23 

36 

183 

22 

6 

3 

1 

290 

1 

1,106 

166 

313 

20 

84 

62 

7 

14 
1 
2 
2 



Deaths. 



2 



6 
106 



11 
3 



203 



1 

41 

1 

1 
6 
1 
1 

7 
6 
3 
2 
22 



Remarks. 



1 

"i9 



118 
4 
20 
1 
1 
3 



1,046 

36 

1 

7 

1 
6 



2 
116 



4 




1 




2 
2 


1 


1 




2 




23 
12 


2 




1 


11 




84 
53 


35 
14 
68 


1,097 


160 
62 


422 


8 
1 






2 






51 



One ca<«e imported. 



One on ss. Solace. 1 
Gaelic, 1 on 
Navy collier S 
and 1 on SB. Kore 



Present. 



One on ss. Gaelic 

Hongkong. 
Present. 



Threeon ss. Alliano 
Port of Spain. 



Present. 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



99 



\Upox <u reported to the Surgeon-General^ Public HeaUh and Marine-Hospital Service- 

Continued. 

DECEMBER 27, 1902, TO JUNE 26. 1908— ConUnued. 



Place. 



zerland: 

iiarich 

ley: 

VlexAndretta. . 
>>ii8tantinople 

tmyma 

ruay: 

if on te video . . . 
: Indies: 
intigrua 



Date. 




Cases. 


Deaths. 


Feb. 8-Feb. 


14 

4 

22 
26 

12 


1 
15 




Feb. 22-Apr. 
Nov. 24-Mar. 


1 
9 
4 

8 


Jan. 26-Apr. 
Nov. 2-Apr. 
Mar. 26 




41 
1 







Remarks. 



On Br. m. Solent from 
England. 



GENERAL MORTALITY STATISTICS FOR THE UNITED STATES. 

'hese statistics are for the calendar year 1902, and are compiled from 
53 replies received in response to 3,780 letters, one to every city 
own having, according to the United States census of 1900, a popu- 
on of 1,000 or more. The complete table is published in Public 
dth Reports No. 32, August 7, 1903. The total number of deaths 
m all causes is given, namely, 378,394 in a population of 22,469,816 
the cities and towns reporting; also the deaths from the common 
actions diseases, namely, tuberculosis, smallpox, enteric fever, 
isles, scarlet fever, diphtneria and membranous croup, and whoop- 
cough, according to cities and towns in every State, 
.^he annual mortality per thousand is given on the United States 
sus of 1900 and also on the estimated census reported by the cities 
[ towns. 

lie mortality per thousand for 1902 on the United States census is 
84, while that for 1901 was 17.12, showing a decrease in death rate 
).28 per thousand. It is interesting also to see a marked decrease 
;he aeaths from tuberculosis — 41,404 in a total of 378,313 deaths, 
x>mpared with 41,938 deaths from tuberculosis in a total of 365,216 
.ths for the year 1901, a decrease of 0.64 per cent. There was an 
rease in the number of deaths from enteric fever, measles, and 
oopine cough, a decrease in diphtheria and membmnous croup, and 
kcticalTy no change in the number of deaths from scarlet fever. 
Jo far as these statistics, which are entirelj^ urban and somewhat 
omplete, indicate the health of the States, it would seem that the 
ith rate was lowest in Nebraska, 10.03 per thousand, with Montana 
lose second, with 10.62 per thousand, and Minnesota, with 10.89, 
rd, and highest in Wyoming, with 26.96 per thousand, Florida being 
ond, with 24.32. 
Respectfully submitted. 

George T. Vaughan, 

Assistant Surgeon- General. 

Juroeon-General, Public Health 

AND Marine-Hospital Service. 



1 ^. -//)r^^^ . 



DIVISION OF FOREIGN AND INSULAR 

QUARANTINE. 

(EMBRACING MEDICAL INSPECTION OF IMMIGRANTS.) 



101 



REPOBT OF THE DIYISIOH OF FOBEIOH AHD IH8TJLAB QITABAH- 
TINE (EMBBACnrO MEDICAL IH8PECTI0H OF IMMI0BANT8). 

By W. J. Pettus, 
Assistant Surgeon-General^ Public Heulih and Marine-Hospital Service, in charge. 

Sir: I have the honor to submit the following report of the trans- 
actions of the division of foreign and insular quarantine and immi- 
gration for the fiscal year ended June 30, 1903: 

Cuba. 

chai^ges in detail of officeks. 

When Surg. A. H. Glennan was relieved from duty at Habana, 
August 23, 1903, Asst. Surg. F. E. Trotter was placed m temporary 
charge. Passed Asst. Surg. R. H. von Ezdorf was stationed in charge 
at Matanzas, Acting Asst. Surg. U. L. McMahon at Cienfuegos, and 
Acting Asst. Surg. K. Wilson at Santiago. 

NO YELLOW FEVER REPOBTED. 

During the fiscal year just ended not a single case of yellow fever 
has l>een reported as originating on the island. Eight cases have been 
taken from vessels arriving at Habana from Mexican ports. They 
were promptly removed to Las Animas hospital, where they were 
carefully screened to prevent mosquitoes having access to them. The 
8uc<?e«s*of this treatment is shown by the fact that not a single case of 
infection arose from any of these patients. 

PASSENGERS FROM INFECTED MEXICAN PORTS TO FLORIDA VIA IIAIiANA. 

On account of a rumor that nonimmunes from infect-ed Mexican 
ports could arrive at Habana and, by changing steamers there, land in 
Florida in less than five days from the Mexican port, the following 
telegram was sent to the medical oflBcer in charge of the service at 
Habana : 

[Telegram.] 

Washington, June 18, 190S, 
EcHEMENDiA, Public Health and Marine-Hospital Service, Habana, Cuba: 

Reliably informed that Mr. Montes, nonimmune from Merida, via Progreeo and 
Habana, changed steamers at Habana and landed in Florida less than five days from 
Progreso. Investigate and wire if this is possible. 
By direction Suigeon-General: 

Pettus, 
Assistant Surgeon-General. 



104 PUBLIC HEALTH AND MARIKE-H08P1TAL 8EBVI0E. 

[Telegram in reply to above.] 

Habana, Juiie 19f 190S, 
Wyman, Washington: 

Invei^tigation shows that Mr. Avelino Mont<i8 arrived at Habana on May 26, thirty- 
two hours out from Progreso; was accepted as immune by Cuban authonties on cer- 
tificate issued by Dr. Pla, ('uban medical officer at Prc^greeo, bafied on ten years' 
residence. He was not <letained at Triscornia for this reason. Mr. Montes sailed 
from Habana to Tampa on May 28. It is ix>ssible for an immune to reach Florida 
from Progreso within five days, but not possible with nonimmunes, as they are 
detaine<l five days at Triscornia. 

ECHEMENDIA, 

In temporary charge. 
CUBAN QUARANTINE METHODS. 

On account of the importance in quarantine matters that Habana 
occupies as a stopping pomt between infected ports in Mexico and the 
United Stiites, it was thought l>est to institute an inquiry into the 
method of handling vessels in vogue at Habana. The following tele- 
gram was sent to Assistant Surgeon Trotter. His reply by telegram, 
followed bv a letter, is given below. 

[('HblograniH.] 

Washington, April 7, 1903, 
Trotter, Jlalxina: 

Wire Bureau the intention of the Culmn authorities w^ith regard to vessels from 
infected Mexican ports. Will they disinfect for mosquitoes? 

Wyman. 



Habana, April 9, 1903, 
Wyman, Washington: 

Vessels from infected Mexican ports at present are treated under orders contained 
in Presidential decree transmitted to Bureau in my letter dated December 11. Doc- 
tor Finlay states that more stringent measures and disinfection for moequitoee will 
be enforced after May 1. 

Tbottbb. 



[Letter.] 



Public IIealtpi and Marins-Horpital Ssbvicb, - 

Offick of Medical Officer in Commakd, 

Habana, Cuba, April 11, 1903, 

Sir: Relative to my cablegram of the 9th instant in regard to the treatment of veB- 
sels from infected ports on arrival at Cuba, I have the honor to report that I discoflBed 
the matter with Dr. Carlos J. Finlay, chief (juarantine officer for Cuba, who stated 
that the disinfection of vessels, after May 1, would ))e done on arrival, provided the 
vessel had not been disinfected at port of departure. Doctor Finlay proposes to use 
formaldehyde in the cabins and pyrethrum powder in other parts oi the vesBel. 
During the past winter vessels on arrival from infected Mexican ports were placed in 
quarantine, and remained so until their departure, all nonimmune passengers beinff 
sent to quarantine to complete five days from port of departure, provided the vessei 
had not been at the dcx'k at that port. If the vessel had touched at the dock the 
passengers were held to complete rive days from arrival at the Cuban port Sanitary 
guards were placted on all ve85»els in quarantine, and no communication was allowed, 
except by permission of the chief quarantine officer. Stevedores working on these 
vessels were required to be immune to yellow fever. 

Doctor Finlay has paid i>articular attention to the quarantine service since taking 
charge, and evidently intends to take all measures to prevent the introduction of 
yellow fever into Cuba. The quarantine work at the port of Habana is in my opinion 
well performed, and the CuVwm authorities have always rendered me full reports of 
any sickness oc^curring aboard of vessels in the bay. Doctor Menocal, in charge of 



PUBLIC HEALTH AND MARIKE-HOSPITAL SERVICE. 105 

detention camp for nonimmunes, is engaged in remodeling the quarters of that 
p, in order to render them mosquito proof and thus prevent any possible 
;tion. 

1 stated in my weekly report transmitted on April 8, 1903, the President has 
ted sufficient rands for the construction of a ward at Las Animas Hospital, to 
sed for the isolation of contagious diseases. I have again to add that every pre- 
lon is being taken to prevent the introduction of yellow fever, and the measures 
»rce are being rigidly carried out. 

RespectfuUy, F. E. Trotter, 

A8»Utant Surgeoriy in temporary charge, 

•rgbon-Gknkral, Pubuc Health and Marine-Hospital Service. 

n this connection it is interesting to note the very excellent qnar- 
ine methods adopted by the quarantine authorities of Cuba given 

TBS OBTAINED FROM DOCTOR GIRALT, CHIEF QUARANTINE PHYSICIAN OF HABANA. 

he Cuban Government has resident medical inspectors at Progreso, Vera Cruz, 

Tampico. 

hey issue certificates of immunity to passengers who prove that they have had 
ow fever or that they have resided ten years in an endemic focus of yellow fever, 
hey will bum pyrethrum powder in the holds of vessels at the ports of departure, 
hey place a guard on board of vessels which anchor away from the wharf to pre- 
t anyone from going ashore except the captain or anyone from going aboard 
spt the laborers. 

here is no line of vessels coming from Mexiciui ports which have Habana as a 
1 port of destination. They are all in transit to somewhere else, except the cattle 
lels, which go back within twenty-four hours. 

U the r^ulations are based on the mosquito principle, and no attention whatever 
aid to fomites on the vessels or at the yellow-fever hospital, 
onsidering the transient vessels, which only touch at Habana, the following are 
regulations governing them : 

eceels which have anchored awa^ from the wharf and which have no passengers, 
n arriving at Habana are not disinfected, but a guard is placed on board until 
f are ready to proceed to New York, etc. 

: such transient vessels carry passengers, those having certificates of immunity are 
free at onc*e. 

hoee which have no such certificates are detained at Triscomia. 
heir detention begins from the day of departure. 

ransient vessels wnich have come to the wharf at the Mexican ports or have had 
imunication with any other suspected or infected craft are considered infected. 
: they have no passensers they are not disinfected, but a guard is placed on boani 
il she leaves for New York, etc. 
[ they have passengers the immunes are set free. 

he nonimmunes are detained at Triscornia for five days, the detention begiiming 
n the day of arrival at Habana. 

Dien a transient vessel arrives at Habana with a case of yellow fever on board, 
case is taken directly to Las Animas Hospital. 
he immune passengers are set free. 

he nonimmunes are taken to Triscornia station for five days. 
he vessel is disinfected for mosquitoes with formalin or sulphur. 
. guard is placed on board until the vessel is ready to go to New York, etc. 
hould a staying noninfected vessel come to Hatmna the passengers are treated 
,bove; the crew are kept aboard; the vessel is disinfected; she is not detained if 

days in transit, but is detained if less than five days; a guard is placed on board. 
honld a staying infected vessel come to Habana the immunes are set free; the 
immunes are sent to Triscomia; the case is sent to Las Animas direct; the crew 
ept Gve days on board; the vessel is disinfected; she is detained five days in the 

from the completion of the disinfection. 

a short, immnnes are never detained under any circumstances, even those coming 
ictually infected vessels. 

onimmnnes from all kinds of vessels are sent to the detention station of Tris- 
lia, where they are detained five days, except those which have come on a vessel 
eh has anchored in the harbor at the port of departure. 



106 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

When a case of yellow fever is found on board it is sent direct to the Las Aninuifl 
Hospital. 

Vessels which come to stay are treated as we treat them. 

No transient vessel is disinfected unless it had a case of yellow fever on board. 

Triscomia is an observation station across the bay to which are sent nonimmune 
passengers from vessels from infected ports. 

There also are sent the immigrants until they find employment in the city or in 
the island. 

Mariel is a quarantine detention station situated on the coast, about 20 miles from 
Habana. 

The Bureau wished to know exactly how the Service work in regard 

to vessels leaving Habana for United States ports was being conducted, 

so wired Trotter as follows: 

[Cablegrams.] 

April 15, 1908. 
Trotter, Habanay Cuba: 

Wire briefly description of quarantine work now being done under yonr direction, 
showing employment of each officer; also same report of precautions to be taken 
after m&y 1. Doctor Del«wlo will report to you before May 1, especially for fiu^ 
nishing information regarding the sanitary condition of shipping ana port' 

Wyma». 



Habama, April 16, 190S, 
Wyman, Washington: 

Quarantine work now being done consists of inspecting of vessels, crews, and us- 
sengers when bound direct to United States ports, issuing of certificates and laod* 
ing of baggage lx>und for Florida. Doctor Echemendia issues certificates, Friek 
inspects baggage and with myself clears vessels. After May 1 Florida boats will 
transact business under sanitary guard and passengers for Florida will be required to 
obtain certificates of health. Vessels for Gulf ports will aak disinfection after 
May 1. Tbotthl 

DISINFECTION AT HABANA OF. VESSELS LEAVING FOR UNITED STATES 

PORTS. 

Several requests were made to the Bureau for the disinfection of 
vessels leaving Habana for the United States. On account of the 
excellent sanitary record of the island and very efficient methods of 
incoming quarantine practiced by the quarantine authorities, the 
Bureau did not consider that any quamntine procedures against the 
island were justifiable. It was agreed, however, to use the Sanaiar 
for the disinfection of vessels sailing from infected Mexican ports for 
the United States via Habana, and the following letter was written to 
the medical officer in command at Habana, giving him instructions on 
the subject: 

[Letter.] 

Treasury Dbpartmsnt, 
Bureau of Public Health and Marine-Hospital Sbrvice, 

Washingtmiy July 3, 190S. 

Medical Officer in Command, 

PixhHc Health and Marine-Hospital Service-j Habana, Cuba, 

Sir: You are informed that the Bureau has been requested to fumigate vessels sail- 
ing from Mexican ports, infected or suspected of being infected with yellow fever, for 
ports in the ITnitea States south of the southern boundary of Maryliuad via Habana. 
In view of these requests, you are directed to disinfect such vessels upon request of 
their agents or masters, with the distinct understanding that the disinfection is done 
on account of the sailing from the Mexican port, as long as sanitary matters are as 
satisfactory in Cuba as at present. 

Respectfully, Walter Wyman, 

SuTffeon'Oeneral, 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 107 

HABANA. 

Report of Asot. Surg. F. E. Trottbr, in temporary charge. 

Public Hbal/th and Marinb-Hobpital Service, 

Office of Medical Officer in Command, 

Hahana, Cuba, July 2f^, 190S. 

TELZ I have the honor to submit the followmg report of the transactionB at this 
t for the fiscal year ended June 30, 1903: 

lie following changes occurred among the personnel : Surg. A. H. Glennan, who was 
leved August 23, 1902, served as chief quarantine officer of Cuba from July^ 1900,. 
May 20, 1902, deserves especial credit for the able and systematic organnsation 
the Cuban quarantine service, as well as for its efficient administration, which 
vented the introduction of yellow fever into Cuba, and thereby assisted greatly in 
; eradication of that disease from Habana. 

Ictin^ Asst. Surg. John Frick was relieved on April 28, 1903, and assigned to duty 
ranopico, Mexico, his position being filled by the appointment of Acting Asst. Surg. 
Bi. Delgado. 

The work of the Service has continued upon the lines established during previous 
118 and has been uniformly carried out. The alcovapor launch of the disinfecting 
ainer Somatar has been used since the 20th of May, 1902, for boarding and clearing of 
eels and has rendered ^rly efficient service, but owin^ to her size, beins^ but 26 feet 
er all, she was found to be too small and had to be laid up whenever the water in 
3 bay became at ail rough. Even in moderate weather she is a verv wet boat, 
in^ to her low freeboard, and a wetting of all on board usually results on such 
msions. 

rhrough the courtesy of the Republic of Cuba the Service still retains the use of 
$ laiige office room in the passenger building fronting on the bay, a most convenient 
angement, as all of the shipping entering and departing can be seen, and as all 
nengers enter and leave Habana from this building the issuing of health certificates 
d labeling of baggage is performed without delav. 

Daring the fiscalyear the boarding launch ancf Sanator have been kept in good 
ndition. The latter was docked this spring, and besides being cleaned, a new pro- 
ller, stem bearing, etc., were installed; in addition, new mast and booms were put 
and general repairs made, so that at the present time the vessel is in first-cIasB 
ndition and ready for any service. 

During the quarantine season of 1902 immune certificates were issued to passeneers 
• Newi ork who were entitled to them. Only immune travel was permittea to 
orida ports, and passengers for Gulf ports were required to obtain a certificate of 
od heuth prior to embarkation. Baggage for New York was passed without inspec- 
»n, while that for Florida ports was inspected and passed if clean, and disinfected 
not 0o. Ba^age for Gulf ports was disinfected. 

rhe present year is the first in manv years that nonimmune travel was permitted 
Florida ports, this being due to the freedom of Cuba from yellow fever. Wo health 
rtificates are required for ports in the United States except those of Florida. Pas- 
tigers bound for the latter State are required to obtain a certificate of health twenty- 
or hours before the sailing of the vessel and have their bagjsage inspected, the latter 
Ing passed if clean and containing no bedding, and if dirty, disinfected and the 
doing removed. Passengers for New York and the Gulf ports were inspected on 
lard prior to sailing. Baggage for these ports rec^eived no treatment whatever. 
The quarantine laws and regulations of tne United States were made applicable to 
iba by order of Brigadier-General Wood under date of April 29, 1902, and these 
Mrs and regulations have been enforced by the Cuban quarantine service since May 
, 1902. The following modifications relative to yellow fever were made by the 
cretary of government under date of June 9, 1902: 

department of government. 

Decree No. 39. 

In virtue of the authority conferred upon me by the constitution, I deem it well to 
omnlgate the following: 

I. 

The crew and passengers of any vessel proceeding from a port infected with yellow 
eer will be subjected, in the ports of Cuba, to a sanitary observation of five days 
^ich will be counted from the hour of the arrival in port. 



108 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

II. 

The crew and puflsenffera of any vessel coming from ports infected with smallpox, 
who have not good marks to show that they have been successfully vaccinated, will 
\)e vaccinated and subjected to the necessary sanitary observation. 
Habana, June 9, 1902. 

T. Estrada Palm a, 

Pretidad. 
Diego Tamayo, 
Secretary of GowmmeiA, 

Under December 5, 1902, the following additional decree was issaed by the 
tary of government: 

DEPARTMENT OP GOVERNMENT. 

The secretary of dispatch, by agreement of this date, dictates the following 
lution: 

In virtue of the powers conferred upon me by article 3rd of Military Order No. 12S, 
current series, and Presidential decree No. 40, 1 have deemed it well to dictate the fol- 
lowing regulations, which shall be observed by the employees of the maritime qIla^ 
an tine service of the Republic: 

'* For the purpose of quarantine against yellow fever which proceeds from MezioOb 
Central America, or any other point where this disease exists, we will consider the 
vessels (coming therefrom) as *mfected' and *not infected.' ** 

(A ) "The vessels (considered) *not infected * are those which daring their stay ia 
the ports of the above-cited countries have anchored more than half a mile from tbe 
wharf or coast, and that no other vessel, which because of its conditions is oonsideffBd 
* infected' by the Cuban medical officer (stationed in that country), has been alcof^ 
side of the 'noninfected ' vessel; or in case of a vessel which has not fulfilled tboe 
conditions, but has been fumigated at a distance of more than half a mile from tbe 
wharf or coast by means of pyrethrum iK)wder, one pound for each thousand cobk 
feet of space, under the inspection of a Cuban medical officer properly detailed or 
that purpose." 

(B) "The vessels (considered) infected' are all of those from ports mentioned 
al)ove which have not complied with the above requisites; these are prohibited to 
tie up at the wharves in the ports of the Republic. Such vessels will continue to be 
considered 'infected' so long as they have not been disinfected." 

(C) "For passengers who are not immune that arrive aboard of vessels (consid- 
ered) *not infected,' the period of quarantine will be counted from the time of tbe 
sailing of the vessel from the port where such passengers embarked, if the vessel has 
always complied with Sec. A of this decree in all of the ports of call, and if no pts- 
senger (in transit) has gone ashore in such ports." 

( D) *' Passengers who arrive aboard of vessels which are included in the provisioitf 
of Sec. B are to be subjected to five days quarantine, which period will begin from 
the moment that they disembark." 

(E) ''The workmen who load and discharge cargo in the 'infected' vessels will 
have to be certified immunes, properly autnoriz^ by the maritime quaiantiiie 



service." 



Eduaroo Ykbo, 
Secretary of GovemmeML 

This order is published in the official Gazette of the Republic of Cuba for tbe gen- 
eral information. 
Habana, December 5, 1902. 
The chief of dispatch. 

JosB Sabz Medika. 

By the 1st of May, 1903, the Cuban Government had medical officers stationed at 
Vera Cruz, Progreso, and Tampico, the duties of these officers being to inspect ves- 
sels bound for Cuban porte, to disinfect same for mosquitoes prior to sailing wbeii 
requested, and issue certificates of immunity, the evidence of immunity upon which 
a certificate was based being the same as that prescribed in oar quarantine laws 
and regulations. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 109 

The President of Cuba under date of January 2, 1903, issued decree No. I, nomi- 
uUini? the members of the superior sanitary board of the island of Cuba. The 
olloW'ing is a copy of the translation: 

DEPABTMBNT OF GOVBRNMBNT. 

Decree No. I. 

In virtue of the provisions of articles 1 and 3, first section of military onler No. 
59, series of 1902, with the object of proceeding with the constitution of the superior 
anitary board of the island of Cuba, and as proposed by the secretary of government, 
' have to promulgate the follow^ing: 

Abticle 1. The nominations of the members of the superior sanitary board of the 
Bland of Cuba made under military order No. 179, of the date of the 18th of March 
aat, being of a temporary character pending their approval by the Government of 
ifae Republic, are hereby revoked. 

Abt. 2. The following are appointed as active members of the superior sanitary 
XMKrd of the island of Cuba: Dr. Joaquin L. Dueftas, as resident memoer in the city 
li Habana, and in his capacity of president of the special commission of hygiene of 
the island of Cuba; Dr. Ennque B. Barnet, as resident member in the city of 
Sabana, and Drs. Juan Guiteras and Ambrosio Grillo, representing the western and 
eafllem parts of the island, respectively. Doctors Guiteras, Grillo, and Barnet will 
bold office for a period of two, three, and four years, respectiveljr. 

AsT. 3. The following-named persons because of their official positions are appoi nted 
m honorary members of the aforesaid superior sanitary board: Dr. Hugo Koberts, 
§nt phyeiaan of the port of Habana, and Dr. Joaquin L. Jac^obsen, president of the 
league afcainst tuberculosis. In representation of the respective corporations, Dr. Juan 
BantoB Fernandez, for the Academy of Sciences of Habana; Dr. Jos^ Varela Zequeira, 
for the University; Dr. Gonzalo Arostegui, for the boanl of education, and Dr. Jos^ 
del Caeto y Pazos, professor of law, for the law faculty. 

Art. 4. The superior sanitary board of the island of Cuba will act as a dependency 
(bureau) of the aepartment of government (interior) in accordance with tne provi- 
Bons of decree No. II, of this Presidential office, dated May 20 last. 

Art. 5. The secretary of government will dictate the necessary measures to give 
p oBDCOo ion of the offices to the gentlemen appointed, and will propose what in deemerl 
necessary to establish this dependency (bureau) and the offices of the superior sani- 
tary board in harmony with the fundamental law of the Republic. 
Habana, January 2, 1903. 

T. Estrada Palma. 
The Secretary of Government. 

Eduardo Yero. 

This board immediately assumed charge of all sanitary matters, including the 
qoarantine service. For various reasons, principally political, the members of the 
Cuban quarantine service who had been trained were gotten rid of and their places 
tdken by men who had had no quarantine experience whatever and who were not 
fitted for the positions. The amalgamation of the quarantine service with the internal 
sanitary affairs of the island was a mistake and resulted in the breaking up of an 
excellent quarantine system, which the officers of this Service had lal)ored so faith- 
fully to complete. 

The relations existing between this office and the (]uarantine and sanitary depart- 
ments of the Cuban Government have been most cordial, the officials of l>oth branches 
having rendered us full reports on all matters pertaining to sanitary affairs. I desire 
to express my appreciation to Drs. Juan Guiteras and Carlos J. Finlay for numerous 
courtesies extended. 

I inclose herewith list of vessels arriving at quarantine with yellow fever aboard, 
together with the mortuary report, report of vessels inspected, disinfected, etc. 
Respectfully, 

F. E. Trotter, 
Assistant Surgeon in Temporary Charge. 

Subgbon-Gskeral, Pubuc Health and Marine-Hospital Service. 



110 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

[Inclosiires.] 
VESSELS ARRIVING WITH QUARANTINABLB DISEASES ABOARD. 

Auffust 4, 1902, — American steamship Vigilanciat from Vera Cruz and Progre*©, 
with one ca^e of yellow fever among the crew. The patient, a coal passer, was sent 
to hospital and the crew's quarters disinfected by the Cuban quarantine service. 
In this case the man became infected at Vera Cruz, the ship having lain at the wharf, 
and the man gave a history of having been ashore at night. Case ended fttiyilj 
August 6. 

September 8, 1902, — American steamer Monterey ^ from Vera Cruz and Procreso. 
with one of ship's crew, a waiter, ill with yellow fever. Case was removed and 
quarters disinfected. The ship laid at the wharf at Vera Cruz and the man was 
ashore at night. Case recovenxi. 

September 15 ^ 1902. — American steamship Havana, from Vera Cruz and Proereaa 
On tlie 16th, the day after arrival, a third-class passenger in transit for New York 
was found with fever and removed to Las Animas Hospital, where a diagnoaifl of 
yellow; fever was made. The patient, a Turk, had resideii in Mexico for two and t 
half years and for past month had liveil at Progreso, where he undoubtedly recdved 
his infection. Case recovered. 

September SO, 1902, — Spanish steamship Onton, from Hamburg and Bilboa, with 
one of the crew ill with smallpox. Case was removed to I^s Animas Hospital and 
crew vaccinated. The vessel was disinfecteti by this service. Case recovered. 

November 17, 1902. — American steamship Esperanza, from Vera Cruz and Progresa 
A nonimmune passenger from this vessel under detention at Triscomia detention 
station, was found with fever and transferred to Las Animas Hospital, w^here he 
developed a severe case of yellow fever. This passenger had been in Vera Cruz eight 
days, and embarked on the Esperanza on November 13. The vessel arrived here on 
the 17th and the patient was sent to Las Animas on the 18th. The case ended faMj 
December 3, 1902. 

December 11, 1902. — American steamship Maianzas, from Tampico. One of the oew. 
an Italian, was taken sick on the nij^ht of arrival with fever, and was removed 
the next morning to Las Animas Hospital, where the Commission diagnosed the case, 
and decided it to be one of yellow fever. This vessel had been at dock at Tampico, 
and this sailor had been ashore. Case recovered. 

Febnuiry 12, 190S. — American steamship Esperanza, from Vera Cruz and Progreso, 
with one cabin passenger ill with symptoms of yellow fever. The case was removed 
to Las Animas Hospital, and diagnosis confirmed by Yellow Fever Commission. 
The patient, a captain in the New York and Cuba Mail Steamship Company, had 
resided at Progreso for some months. He was taken ill on February 7, boarded 
the Efperanza on the 9th, so he was on the fifth day of his sickness on arrival at this 
port. 

May 1, 190S. — Spanish steamship Monlserrat, from Spain, Canary Islands, and Porto 
Rico, with one case of smallpox among steerage passengers. This case and the 
remainder of family were removed to La^ Animas Hospital, where two other meni' 
bers of the family developed the disease. The cabin passengers were vaccinated and 
allowed to land, while the steerage passengers, unprotected oy previous attack, were 
sent to Mariel Quarantine Station for fourteen days' observation. The bacgageof 
passengers and the vessel were disinfected by this Service upon request ^Oabn 
authonties. All of the cases recovered. 

May 16, 1903. — Spanish steamship Ernesto, from Liverpool, with one of the crew ill 
with smallpox. Case removed to Las Animas, crew vaccinated and vessel disiiifected 
by this Service uj)on request of Cuban authorities. Case recovered. 

June 16, 1903. — American steamship Niagara, from Tampico, with one of the crew 
ill with fever. Case died while bemg taken ashore, and autopsy at Las Animas 
Hospital showed death to l>e due to yellow fever. Vessel was disinfected by this 
Service upon request of the Cuban authorities. 

June 30, 1903. — American steamship Matanzas, from Tampico, with one cabin 

Caenger ill with yellow fever. Patient was taken ill at Tampico on Jane 25, and 
rd^ the steamer Matanzas on the afternoon of the following day. Case waa 
removed to Las Animas Hospital, and cabin compartments on vessel disinfected. 



PUBUO HBALTH AND HABINE-HOSPITAL 8EBVICE. 





Jnljr- 


An«. 


aci>t. 


Oul. 


Nov. 


Dec. 


Jmn. 


F»b. 


Hu. 


Apr. 


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June. 


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ipohcD 
ted 


D 

n 
u 

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13 

18 

13 
2,701 


4 


S,2« 





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a 

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C 

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Mortuary data of Habatia for fitoal year ended Junt SO, 190S. 



HoDlh. 


„?3S?£I 


Uonth. 


Number 

»fde.tht 


1003. 


M4 
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j.„„„ '»=. 







































tsUu during <reu, B,4n. 



Rkpobt op AatT. Bpbo. B. H. von Ezbort. 

FuBuc Health and Marine- Hospital 8eiiticb, 

Office of Medical Officer in Command, 

Maianzat. Oabn, Augtul II, I90S. 
'. have the honor to submit herewith an annual report of the transactions at 
t for the period covered from July 1, 1902, to June 30, 1903, inciiisive. 
bject of toe Krvic« at this port has been to enforce the United States qnar&n< 
ulations to be observed at foreign ports, with reference to tlie sanitary con- 
if the paseensers, cargo, anil crew of vetwels wlioee ultimate deatination was a 
the United States. A bill of health, in duplicate, setting forth these facts, 
Md to each such veesel after satislying myself that the requirements were 
mplied with. 

liis purpose an inspection of the vessel, car^, passengers. an<l crew was made 
iDstance where a veesel was leavine this port <lirect for the United States, and 
ditjons found noted on the bill of health. Where a vessel was leaving via 
uban ports a Inll of health was issued in the office. 

act of having made a personal iniipectioD wau always noted on the bills of 
and if any person on board at such inspection was found sick, a short history 
gnosis was also noted. Several instances occumd where one of the crew was 
g with typhoid fever or tuberculosis. Instructions of precautionary meas- 

be taken were issued either verbally or in writing to the captains of the 
ve ve«els. 
ig the close quarantine season of 1902 vessels leaving for New Orisons or 

were disinfected immediately prior to sailing. This work was done under 
soruJ snpervieion by the Cuban ouamntine service, which is fully equipped 

Soaling aiainfecting plant as established by the Service during the ir* 

the United SUtes. 



112 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVIOX. 

The necessity of disinfection of vessels during close qaamntine of 1903 has so far 
not arisen, as quarantine against Cuba by the Southern States has been leas rigid, a 
disinfection upon arrival at port of destination being the onl^ reqairement. 

For the period covered by this report, the sanitary condition or the port has been 
good, and the diseases prevailing have been reported on the bills of health as 
"ordinary." 

In relation to the quarantine service conducted by the Cuban authorities at tiiifi 
port, it may be said that it has been efficient and rigid, the same officer and employcei 
trained under the American regim^ being in control. 

A quarantine by Cuba was declared against vessels from Mexican ports early in the 
year. Vessels so quarantined were required to keep their quarantme flag hoisted, 
and no communication with shore was permitted except by persons holding an 
immune certificate and by the steveiiores employed in loaaing or unloading the cai^x 

No (juarantinable disease has during this period appeared upon any vessel enta>- 
ing this port. When anyone has been reported sick aboard any vessel arriving, the 
quarantine officer has invariably notified me. 

Weekly reports of the transactions of the Service at this port have been regulariy 
submitted. 

The good sanitary work in the city continues under the direction of its effideol 
health officer. Dr. Alberto Schweyer. 

The streets are kept clean, garbage is collected daily, inspection of houses mada 
every day and, when found necessary, are limed and disinfected. No accumulation d 
filth is tolerated anywhere. A report of all infectious diseases occurring is reqoirad. 

A summary of such reports for the year follows: 



DiseaHes. 



Typhoid fever. 
Diphtheria . . . . 
Scarlet fever . . 

Dysentery 

Leprosy 



Cases. 



20 




2S 




2 




1 




2 





Deattaa 



The following are the statistics of the transactions for the period covered by thia 
report: 

Bills of health issued 279 

Crew of vessels 8,320 

Passengers 1,386 

Vessels disinfected 16 

Immune certificates issued 15 

Total deaths in city of Matanzas 828 

Annual rate of mortality 17. 25 

Estimated population 48, 000 

Quarantinaule diseases reported None. 

Pleasant relations with the Cuban authorities have been maintained and every 
facility has been offered and extended by them for obtaining the required facia ii 
the conduct of this office. 

Respectfully, R. H. von Ezdorf, 

Passe^^ Assistant Surgeon, 

Surgeon-General, Public Health and MARiNS-HosprrAL Sjebvice. 



NUEVITA8. 

Report of Actinci Asst. Suro. E. F. McConnxll. 

Public Health and Marine-Hospital Ssbvice, 

Office of Medical Officer m Command, 

NtieviUUf Cuha^ July 6, 190S. 

Sir: I have the honor to inclose herewith repprt of the transactioDS of this station 
for the fiscal year ending June 30, 1903. 

No renairs or improvements were done at this station during the past year, and 
none will be necessary during the ensuing year. 



PITBL1C HBAI.TH AND HAKINE^BOSPITAL SERVICE. 



113 



Mtiibuy coRditian of this port is and has been excellent tlirbughout the year. 

nntiiiaible diseaseA were reported. 

lose mortuary reporta of the city nf Puerto Principe and thie port, which 

■ the viilsgee of Lugsreoo arid Eoeensda. 

teepectfnlly, E. F. McCo.skbll, 

Aclhig Amintaiit Snri/eoii. 



com-Geneul, Public Hbalth a 



Mari 



E-HOKPITAL KbBVIC 





Jnl7. 


i». 


Bet*. 


Oct 


Kov. 


Dec, 


J«n. 


Feb. 


lUr. 


Apr. 1 May. 


lune. 


Tuli.1. 


■pokan 


O 

331 

IflO 


ITH 




i 


am 

lis 




1» 




a 


4 
196 


S 


«5 


I2g 


1* 


11 



97 
O 


^ 


r-si-a 






^ 


a -lling 


S.9DH 


ft"" "" 


3.1 ^ 


1 4ra 








• 



Mortality r^xtrt/or Ihe Itpelve monllu ending June 30, 1903. 

PDERTO PRINCIPE, CUBA. 
{EHlDUtcd population. 30,000.] 



«nfd«.h. 


July. 


-Aug. 


Sepl. 


Oct. 


».„, 


DOC. 


J*„. 


Feb. 


M«. 


Apr. 


May. 


June, 




1 




1 


1 


I 






4 

2 




a 










8 


! 


« 


i 


1 


? 


1 








1 


1 






1 




















1 


s 

1 

1 


4 








i 


....; 


5 

1 








...; 


1 
3 


1 


■■■ft 






1 




■ 












1 






i 

9 


,1 


::::.: 


» 


5 




















IS 
6 

IS 


8 









s 


9 


a 












6 

J 


6 
1« 


i 


4 


J 


4 
•J* 


I 

at 


a 






1^ 










'" 








67 


" 


.. 


" 


" 


^ 


" 


r.i 


.1 


W 


sa 









114 PUBLIC HEALTH AND MABIKB H08PITAL SEBVICE. 

MorlalU!/ report/or Ihf (iwin; montht fnding June SO, J*eW— Condnoed. 
NIIEV1TA8. CUBA. 


C*uiia of denth. 


J..1J-. 


AUK.Skpt, 


Oct. 


Nov. 


Dee. 


Jm. 


Feb. 


Mu. 


Apt. 


lur. j™. 






^ 












































1 








! 










1 


1 1 








1 




1 








s 


I 


























I 








' 


^ 


1 




1 




















{!=; 




1 


! 


— 


» 





i 
































































1 > 


» 










> 
























1 


1 
















1 




2 












s 


" 


1 


1 


ri 






4 






2 1 a 1 a 


'1 * 


3 




1, < 




12| 11| ft 


U 


' 






' 


» 


s| I 






ToUl dealhs, M. 

























Report o 



SANTIAGO. 



AcriNd Abst. Scan. Richard WiiaoN. 



Public Health and MARiNB-HoaptTAi. SntvicB, 

OmirB OP Mbdical Officeb ik Comicaicd, 

Santiago df Caba, Jidy IS, ISO). 

Sir: I bave tlit; hoaur to mako the following report (or the fiscal year ended Jwt 
30, 1903. 

July 1, 1902, found Acting Aset. Surg. Alexander B. McDowell in charge. He w 
taken sick soon after thia and went to Habana, li-avinK here Julv 9. He left Dr. 
H. S. Caminero, the port physician, in charge of his work, leaving nim some billet' 
health signed in blons. 

On July 15 I received a telegram from Surgeon Glennan, then at Habana, nomi- 
nating me acting assistant Burgeon, to dale from the 16th. 

The United States consul had not ^et arrived, and through the courtesy of Dr. 
H. S. C^minero, port pliysician and director of the fourth maritiine diatrict of Cnla, 
the Service was occupying a room in the office of the Banidad Maritimo. IJte 
Doctor McDowell, 1 was treated with tlie greatest conaideiatian, and was allowed Iba 
use of the steam launch for ofHcial duties. 

On July 20 Consul R. E. Holaday arrived. He oi>ened his office July 30, Oa 
July 31 the consul signed his first bill of health; banning with this one, I sigiied 
them in the margin. On July 31 the consul was officially notified by tel^rsph Ihil 
I was attached to his office, and on August 2 I moved in. 

On October 15 I was informed by tel^iam that c!o»«d quarantine against Cnba had 
been removed. Another tel^ram, dated October 20, informed me that this "did 
not apply to Porto Rico; — ' j:.!^i— *.■— i. x- 



November 1 this too was removed, 



. , disinfection." 

then no vessel has been disinfected. 

Lost July the work at this station consisted of the following: To sign bills of health, 
inspect passengers and crews, supervise disinfection of vesels bound for the United 
States and Porto Rico, certify to same, and forward weekly reports. 

You will notice by referring to tbe summary of the work done during this fisnl 
year (inclosure No. 1 ) that at first tliere were from two to four veeeels disinfected 
every month. I was alwaj-s present on these occasions and watched the process to 
see that evervthing was well done. After November 1 there has been no VMSel dii- 
Infected. ^\''itli thia exception the work has not changed. 

The number of vensele going to the United States has increased slowly and sl^btlv. 
It is likely to decrease again a little, aa part of this increase was caused bv veaelt 
going to I&iquiri bein^ compelle<l to come toSantian>deCuba to enter ana clearin 
the custom-house. This began the end of March and continued until the banning 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 115 

of June, when it waa discontinued a^n. The smallest number of vessels leaving 
Santiago for the United States was in September, 1902, when there were only twenty. 
The greatest number was in March, 1903, when there were 34. 

The greatest number of passengers went off in March, 1903, the total being 402; 
the smallest number in April, 1903, there being only 140. 

Personal certificates were issued only during July and August, 1902; then they 
were discontinued. 

Bamige continued to be inspected or disinfected and properlv labeled until the 
end oTC^tober, 1902, when the disinfection of vessels was stopped. 

HBALTH OF THE CnT. 

Taken as a whole, the health of the city has been good. The only contagious 
disease present has been diphtheria, of which a few cases have been reported during 
the year. To the best of my knowledge there were only 5 deaths from this cause 
during the fiscal year. 

No case of yellow fever has developed in this city, nor has any been brought here 
from foreign ports. 

There has been no smaHpox in the city or surrounding district, but for the last 
five months the dty authorities have been vaccinating several thousand every month. 
These have been prindpidly children. 

The greatest mortality in this city is caused by general diseases (Bertillon classifi- 
cation), especially by tuberculosis. During the year 1902 there were 170 deaths 
from tuberculosis, this being about one-fiftn of the total deaths. During the first 
semester of 1903, there have been 78 deaths, which is about one-sixth of the total 
deaths. 

After general diseases the greatest mortality is caused by digestive diseases, of 
which, in 1892, there were 141, which is about one-sixth of the total deaths. Of this 
number 80 were under 2 years old. During the first semester of 1903, there have 
been 118 deaths from digestive diseases, which is not quite one- fourth of the total 
deaths. Of this number 69 were under 2 years old. 

In June, 1903, the total deaths from digestive diseases was 49, which is a tremen- 
dous increase, being more than three times the number for May, 1903, which was 15. 
In Jane, 1902, the mortality from this cause was 14, and in June, 1901, the mortality 
was 19. Of these 49 deaths, 46 were under 2 years old, and most of these under 1 
year. I do not know to what to attribute this enormous death rate among infants. 
Probably the long severe drought, followed by the heavy rains of this season, would 
account for part of these cases by affecting the water supply; bad care and excess of 
moist heat nave undoubtedly caused many to succumb. 1 am glad to say that the 
first week of July has shown a decrease in the death rate. 

For farther details I will refer you to inclosure No. 2, which is a table of mortality 
statistics for the fiscal ye&r 1902-3. 

The streets of the city as a whole are kept clean; even out-of-the-way places are 
8wept» bat these are difficult to clean, being unpaved and wearing out unevenly, 
lea^iQ^ holes for dirt and water to collect in. 

SANIDAD MARiriMA. 

The Cuban quarantine officers at this port seem to be doing good work, but should 
a vessel come m requiring disinfection, the^ will be at a great disadvantage, for not 
only is the disinfecting bai^ Rough Rider in bad condition, but the detention camp 
at Gayo Duan has wen taken away from them and all the property has been 
removed, so that they have no place where thev can send contagious diseases. 

The new vessel, San Rafael (the purchase of wnich was announced in Public Health 
Reports, Vol. XVIII, No. 26), has not yet arrived. 

MosQurro brigade. 

A ^[Uig of eight men, with a boss, has been or^nized under the orders of the 
medical director of the sanitary department of the city, whoso business is to make an 
inspection of the houses and streets and drain or put crude petroleum wherever they 
deem it necessary in order to kill the larva; of mosquitoes. This is a permanent 
omnization, witn a sufficient appropriation to do the work well. They will work 
only within the city limits. They b^n work with the new fiscral vear, July 1, 1903. 

I inclose herein a tabulated summary of the work for the nscal year 1902-3 
(inclosure No. 1), and a table of mortality statistics for the fiscal year 1902-3 
(indosore No. 2). 

Bespectfally, Richard Wilson, 

Acdng ilssurfant Surgeotv, m CWrgf . 

SvBOBOK-GjonEBAXy PuBuc Hkalth and Marine Hobpitai. Eeswc^ 



116 PUBLIC HEALTH AND MABISE-HOSFITAL 8BBVIOR. 

(iDclosDie No. 1.) 
Summary of wort at Santiago dt Cuba for liiefiteal year ending June SO, 1903. 









1W-. 














0. 










ir 


1 


1 


1 




i 


i 
1 


1 


1 


i 


3 


1 


BUb of be>lth lamed uid onlgolng 

0^"^-::::::::::::::::: 


■i\ 


4 

71 

Ml 




4 


Q 

a 

ft 

("1 


S2 

ft 




a 

* 

(*) 


202 




at 

a 






7S 
ft 


i 








U 
4 


2b 

8K 

1 





w 
a 











S 
» 











































Deallii [ruiD all catueB (Hllllblrthi 












Cup* cil othpT contiKloiu dlwuea 




malnsoldeaUbodleslotlieUDited 










i«B. 


1903. 






ThJrd 
qiurter. 


Fourth 


Total. 


FIfrt 
quarter. 


HeeoDd 
quarter. 


Total. 


total 


Billa of health Imwd and ontgolDg 


'I 

27 
18 

210 


70 
2,«I 

829 

2 

28 
210 


u 

27 
18 

120 

I'l 


ii 

! 

221 



2.M& 

TO* 




D 

287 


'1 






1 












'iii 






It 


Certincales inued: 














Pieceii of outbound bi«K*«e: 
















DeMhj) Irom all caura (nUllblrtb. 










[/) 


Certlflpstea iwuwt for sti'lppliKt re- 
mainsofdeadbodlegtotbsUnltcd 

































a Dtphthi^rU. 

fc Two to 4 riuKB of diphtheria reportod each m 

<• ShlpplDg body to Pnuice Tla New York. 



<> American aoldlera 



PUBLIC HBALTH AND VARINE-HOSPITAL SEBVIOE. 117 



orlalHy ilatMa at Saittiaffo de OAa/or the fiieal year ending June SO, 1903. 





!*«. 


1»S. 




1 


1 


1 

1 


1 


1 


1 
I 

li 





1 


1 


i 




■J 


1 

2 


1 


,n™l^l-.-. 


u 



o 

Q 

2 

« 


IS 
4 

o 


10 

I 


8 



8 

1 





"n 


iasuM ol Uw iwrTima amem »nd of ot- 


^ 




s 


MMej oJ^thB BMilw-"iuWrr applet™ 


1^ 






—■aaiSSSi'SSSS,"-::: 













5SKJ~i«™™'-""- 











Jffl 


n 


4« 
14 


'i 


11 


11 


U 


11 


SO 

li 


ss 


JI 












Toulo«cl.lnmnl«rota«th- 


.1 


SO 


ft! 


" 


w 


81 


« 


83 


M 


•• 


88 


lis 






IVB. 


ixe. 






Thlri 


^^^ 




'r' 


Bee- 


.,„, 




«nd 

ilal. 




2S 
18 

i 


\ 


80 

11 

i 

30 


31 



i 


w 
11 


11 






W 




IM 






asiiS^r"?^"'?^;;;: 


s 






SsffiSSS".".'"^'-"".::: 










3S 


■St 


ta 


2» 


»^ 


7» 












Total oOcUliKunbetaldefttUi 


2*3 


■at 


182 


270 


•K 


iM 


>••" 



118 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 



CIENFUEG08. 

Report of Acting Asst. Surg. R. L. McMahon. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Ck>MMAND, 

CienfuegoHf Cuba, June SO, 1903. 

Sir: I have the honor to make the following annual report of the transactions at 
this station, health condition, sanitation, and other matters pertaining to the public 
health for the year ended June 30, 1903: 

Statement of the office transactions and inspection service. 



Month. 



1902. 
July 

August , 

September 

October 

November 

December 

1903. 

January 

February 

March 

April 

May 

June 

Total 



Bills of 
health. 


Veteels 


Crews 


Passen- 


Health 


Immune 


in- 
epected. 


in- 
spected. 


gers in- 
spected. 


certifi- 
cates. 


certifi- 
cates. 


16 


16 


592 


106 


15 


7 


16 


16 


627 


110 


15 





15 


15 


641 


73 


16 





14 


14 


514 











11 


11 


412 


19 








17 


17 


633 


24 








11 


11 


397 


34 








23 


23 


746 


70 








23 


23 


781 


74 








25 


25 


819 


35 








16 


16 


460 


8 








17 


17 


536 


1 








204 


204 


7,067 


554 


46 


7 



Vessels 
disin- 
fected. 



2 
S 
4 















All bills of health issued at this port during this year were clean. 

No quarantinable disease appeared among either crews or passengers. 

In addition to the alcove service performed, four shipments of bones and hides were 
inspected and passed for shipment, being dry and in good condition. 

The remains of two dead bodies were inspected and proper certificates given for 
shipment to the United States. 

Only water and stone ballast was taken from this port and properly inspected 
before departure. 

Mortuary report for Cienfuegos for the year 190^-S. 

[PopuUUon, 30,080.] 



Month. 



1902. 

July 

August 

September. . 

October 

November.. 
December . . 

1903. 

January 

February . . . 

March 

April 

May 

June 

Total. 



Tubercu- 
losis. 



18 
7 
6 
10 
12 
14 



12 

12 

5 

8 

9 

17 



Malaria. 



130 



Pemi- 
ciosa. 



8 
2 
8 
7 
1 
1 



2 
2 
2 
2 
5 
3 



43 



Palu- 
dijsm. 



7 
6 
12 
8 
5 
9 



4 


9 
2 
7 
7 



76 



Gastro>in- 
testinal 
diseases. 



7 
5 
16 
9 
2 
6 



1 

10 
6 
9 
7 
7 



84 



Tetanus. 



2 
4 
4 
1 
1 
1 



6 
4 
4 
4 
1 
2 



34 



Menin 
gitis. 



2 
2 
3 


2 



1 
1 
3 
3 
3 
2 



22 



Conta- 
gious dis- 
eases. 



«1 
ftl 



ftl 



Other 
causes. 



44 

23 
18 
87 
36 
19 



50 
21 
23 
17 
39 
36 



863 



Total. 



78 
49 
67 
72 
67 
51 



77 
51 

fa 

56 
72 
76 



736 



a Anthrax. 



b Diphtheria. 



UBLIO HEALTH AND HABINE-HOSPITAL SERVICE. 



119 



Comparative table of mortality for past three years. 



Month. 


1900-1901. 


1901-2, 


1902-3. 




80 
89 
72 
66 
84 
78 
102 
76 
72 
69 
87 
87 


80 
86 
60 
60 
60 
69 
64 
67 
64 
68 
61 
61 


78 




49 




67 




72 




67 




61 




77 




61 


...••••••••..••.••••••« •••••••■•••••••••••««i.».. ..••••. 


62 




66 




72 




76 








966 


769 


756 







BANITATION. 

f)ly, — The water supply of Cienfuegos is obtained from a small river 5 miles 
y. This water is not of good qualitv for drinking purposes, but is used 
lany people after being boiled and filtered. 

lOt sufficient for the needs of the city, and most of the people depend on 
tored in cisterns. During the protracted dry season the cistern water 
id there is often a great scarcity of water, especially among the poorer 

-There is practically no sewerage system in the city. Kitchen slops, 
and other liauid refuse from the houses are thrown into the streets, and 
(age is placea in boxes and removed at night by garbage wagons to the 
the city and burned. 

he houses are provided with cesspools, but a great many of the poorer 
only surface closets. 

s of the city are kept fairly clean all of the time by sweepers. 
. — With the exception of the distribution of a little oil by a few families, 
ten no effort made here to extinguish these pests, which abound in great 
i of all varieties. 

mpection bv Cuban quarantine officials, — All vessels entering this port are 
id treated by the Cuban quarantine officer the same as is practiced under 
States quarantine laws. The work done here by these officials is vei^ 
1 no contagious sickness has been allowed to enter the city through this 
this year. 

mment, — Sanitary and health affairs are controlled by a local board of 
h is surbordinate to the superior board of health of Habana. In addition 
board there is a provincial inspector (physician) for the entire province 
ira, who makes investigations regarding health conditions and reports 
the superior board. 

Iso a local board consisting of four physicians whose duty it is to investi- 
;)icious conta^ous and quarantinable sickness that might appear in the 
view to making a proper diagnosis. 

r fever has appeared here during this year, and with the continuance of 
strict quarantme maintained against infected ports there is not likely to 
duced through this port 
i honor to be, respectfully, R. L. McMahon, 

Acting Assistant Surgeon, in Charge, 

7BNEBAL, Public Health and Mabine-Hospital Service. 



Porto Ricxd. 

the past year the sanitary condition of Porto Rico has been 
•actor}'. On October 22, 1902, Passed Assistant Surgeon 
n was relieved from duty as chief quarantine officer for 
), and Asst. Surg. W. W. King was ordered from Ponce to 



120 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

San J uan to succeed him. On April 21, 1903, Asst. Surg. Joseph Gold- 
berger was ordered from Ponce to Vera Cruz, Mexico, Acting Asst 
Surg. F. Aleman being left in temporary charge. The following named 
acting assistant surgeons were on duty at the subports: P. F. Martek, 
atHumacao; E.Lopez, at Fajardo; J. T. Piza,at Arroyo; Manuel Mar- 
tinez Rossello, at Arecibo; J. Benejam, at Aguadilla, and BaiEMl 
Mimnda, at Mayaguez. Acting Asst. Surg. J. F. Torres relieved Dr. 
Aleman at Ponce. 

TITLE TO MIRAFLORES ISLAND. 

As it is proposed to make considerable improvements to the qo&nui- 
tine plant on Miraflorcs Island, in San Juan Harbor, it became neoes- 
sarv to investigate the validity of the title of the Service to that island, 
and the following correspondence ensued: 

[Letters.] 

Treasury Department, 
Bureau of Public Health and Marine-Hobpital Sertics^ 

Wmhingkmy April 10, 190S, 

Sir: I have the honor to request that the proper anthoritiefl ascertain whether the 
title of tlie Department to Miraflorcs Island, in San Juan HaHwr, Porto Rioo^is 
properly vt'Steil in the United States? Miraflores I>land was transferred by Execs- 
tive onfer July 22, 1902, to this Department for use by the Public Health and Maiine- 
Hospital Service as a quarantine station. 

Respectfully, Walter Wyman, 

Surffeon^OmeraL 
The Secretary of the Treasury. 



Treasury Department, Office of the Sbcrktart, 

WajthingUm, April 14, 190S. 

Sir: This Department has the honor to acknowled^ the receipt of your letter of 
the 10th instant, re^iuesting ''that the proper authorities ascertain whether the title 
of the Department to Miraflort^s Island, in San Juan Harbor, Porto Rioo, is properly 
vested in the United States." You st^te that Miraflores Island was transferred hj 
Executive order July 22, 1902, to the Treasury Department for the use of the Public 
Health and Marine-Hospital Service as a quarantine station. 

In reply, you are advised that the effect of the proclamation referred to is not to 
change, in any way, the title of the Unite<l States to the island in question, bat to 
place the cu8to<ly and control thereof under this Department for the use of theBoretn 
of l*ubli(; Health and Marine- Hospital Si»rvice for the site for a marine hoflpital, orfor 
a quarantine station, or for both of these purposes, as recited in said procIamatioD. 

Assuming that the title of the United States to said island is good, this Department 
has the undisputed custody and control of said island for the objects and piuposei 
mentioned. 

Respectfully, M. E. Ailbs, 

AssistatU Secntary. 

Surgeon-General, Public Health and Marine-Hosppfal Servici. 



Treasury Departmsmt, 
Bureau of Public Health and Marine-Hospital Seevicb, 

Washinffton, May IS, 190S. 

Sir: Referring to Exe<rutive onler of July 22, 1902, transferring Mirafloree Island, 
San Juan Harbor, P. R., to the Treasury Department for the use of the Public 
Health and Marine- Hospital Service as a quarantine station, I have to reouest that a 
written opinion be recjuested from the honorable the Attomey-Genenu, as to the 
validity of the title of the United States to the property, and that a copy of such 
opinion be furnished t^ this Bureau. 

The full description of the property in question, by metes and bounds, is as 
follows: 



PUBLIC HEALTH AND MARINK-HOSPITAL SERVICE. 121 

"All that piece of land in the easterly nart of the harbor of San Juan, P. R., known 
IS Mirafiores Island, and which is lx)unaed and de8(;ril)e<l liH follows: 

" Beg[innhig at the westerly end of the stone pier on the wenterly side of said 
islaiid, in the center of said westerly end, and running: thence N. 39° 15'' W. 930 feet; 
khenoe N. 64*» 4(K W. 1,200 feet; thence N. 88° 45^ K. 1,500 feet; thence S. 58° 45^ 
E. 400 feet; thence N. 79° 30^ E. 900 feet; thence S. 6° 45^ E. 1,650 feet; thence S. 
M*> 4<K W. 830 feet; thence N. 46° 20^ W. 840 feet to the point or place of beginning. 
"Together with a right of way out by the present roadway to tne military road m 
Santarce. 
" Together with the land under water adjacent to said island to deep water.*' 
Respectfully, 

Geo. Purviance, 
Acthig Stirgeon-Oeneral, 

SUFERVISINO ARCHrTBCT, 

TVeamtry Department^ WathingUm, J). C, 

The Executive order above referred to is as followa: 

[Executive order.] 

Whfte House, Washington^ D. C, July ^Sy 190S, 

By virtue of the authority vested in me bv the act of Conj^ess approved July 1, 
1902, entitled "An act authorizing? the I*resitlent to reserve public lamls and build- 
inn in the island of Porto Rico for public uses an<l panting other public lands and 
tNiildin^ to the gt)vemment of Porto Ric!0, and for other puri>oses," Mirafiores 
[dmnd, in the harbor of San Juan, P. R., is hert»by reserved for use as a quarantine 
itation or a site for a marine hospital or for both said purposes, under the control of 
the Public Health and Marine-Hospital Service of the United States. 

Theodore Roosevelt. 

A reply has been, received from the Supervising Architect stating 
that the matter has been referred to the Attorney-General with request 
Por opinion as requested, 

STEGOMYIA MOSQUITOES IN SAN JUAN. 

The following report by Passed Assistant Surgeon Lumsden as to 
the number ot stegomyia mosquitoes in San Juan is interesting, 
ihowing the necessity for strict quarantine against ports infected with 
irellow lever: 

San Juan, Porto Rico, June 17, 190S. 

8ib: I have the honor to report that, after making a very slight stud)r of the nios- 
niitoefl of this city, I am of the opinion that the proportion of the species stegomyia 
Jaaciata is rather large. 

For instance, daring the evenings of the 13th and 14th instant, in a well-ventilato<l 
toom at the Hotel Inglaterra, I succeeded in capturing five mc>s(iuitoos of this snecies. 

The Hotel Inglaterra is centrally locate<l, and the neighborhood immediately sur- 
roonding it is in better sanitary condition than are many other parts of the city. 

The number of mosquitoes generally in San Juan at the present time seems to me 
to be only moderate, as compared with the numbers found in many of the cities of 
the Sonthem States during the summer months, and therefore the number of speci- 
mens of stegomyia fasciata seen here l)ecomes conspicuous. 

It is my intention to make a further study of this subject and to communicate the 
findings to the insular superior boanl of health, with the hope that some measures 
may be adopteil tending to the extermination of the stegomyia fasciata in this port. 
Reflpectfully, 

L. L. Lumsden, 
Passed Assistant Surgeon. 

Surobon-Gbnkral, Public Health and Marine-Hospital Service. 



122 PUBLIC HE-ALTH AND MABINE-H08PITAL 8EBV1CE. 

SAN JUAN AND 8UBPORT8. 

RspoBT BY P. A. SuBO. L. L. LuMSDEN, AcTiNG Chief Quabantine Officbb op 

PoBTo Rico. 

Public Heai/th and Mabike-Hobpital Sebvicb, 

Office of Medical Officbb in CoifMAND, 

San JuaUf Porio RicOy July 7, 1903. 

Sib: As directed by Bureau letter of June 13, 1903, 1 have the honor to submit the 
following report of the transactions at this station for the fiscal year ending Jane 30, 
1903: 

SAN JUAN. 

Equipment. — The addition of one 10-ton baive, constructed in accordance ^^nth 
Department authority of August 12, 1902, intenaed for use in transporting persons 
and bagsage to the quarantine station from the vessels in quarantine, marks the only 
change auring the year in the equipment of the station. 

In quarantine. — All vessels subject to quarantine inspection arriving at San Joan 
are required to tiy a yellow flag at the foremast head from the time of their entrance 
into the bay until pratique is given by the quarantine officer. They are boarded 
and inspected in the "out-quarantine" anchorage, which anchorage is located about 
1 mile from the main water front of the city. 

Vessels are inspected between sunrise and sunset, except in case of vessels in dis- 
tress. The method of making the inspection has been described in full in previous 
annual reports from this station. It is similar to that followed generally at the 
national quarantine stations in the United States. Particular search is made to 
determine whether or not there are mosquitoes on board vessels which come from 
ports infected with or suspected of being infected with yellow fever. Vessels from 
clean ports with satisfactory sanitary history while at ports of departure and en 
route are inspected and allowed to dock. 

Vessels arriving with cases of quarantinable disease on board or with histories 
indicating that they have been exposed to and are probably harboring infection 
of quarantinable nature are taken to the *'in-quarantine" anchorage, which is 
located opposite the quarantine station and about 2 miles from the city. There 
the disinfecting barge Defender is placed alongside and the vessel disinfected in 
accordance witn the United States Quarantine Regulations. Personal effects of 
passengers and crew, baggage, and mails are disinfected in the Kinyoun-FranciB 
chamli^rs on the Defender, either steam or formalin being used as indicated. Pm- 
sengers and crew are taken to the station on Miraflores Idand, where they are given 
a bath and change of clothing and placed in detention barracks. 

The sick are isolated in the "lazaretto," and necessary precautions taken to pre- 
vent communication between the sick and well. When the illness is yellow fever 
all possible care is taken to prevent mosquitoes ^^aining access to the patients. 

Vessels from infected or "suspected " ports with no history of quarantinable dis- 
ease having developed aboard en route, and which stop at San Juan for only a lew 
hours and then proceed to their regular ports of destination, are held in qoarantiike 
during their stay at this port and allowed to take passengers and cargo under goazd. 

Of this class of vessels there arrive here monthly, on regular scheaulCj three pas- 
senger steamers which come from ports infected with or suspected of being infe^ed 
witn yellow fever. Of these, two are of the (American) Rea D Line and one of the 
Spanish Transatlantic line. The steamers of the Red D Line come from Puerto Cabello, 
La Guaira, and GuraQao. They remain at Smi Juan about six hours, discharging 
and taking passengers and caigo, and proceed on their regular run to New York. 

The steamers of the Spanish Transatlantic Line come from Habana, Port Limon, 
Colon, Barranquilla, Curasao, Puerto Cabello, and La Guaira via Ponce. They remain 
at San Juan about twenty-four hours, dischar^ng passengers for Porto Rico, taking 
coal, water, and passengers, and depart on their regular run to Barcelona, Spain. 

Passengers for this port arriving on vessels of these lines, or on other vessels com- 
ing from similar ports, who can prei?ent evidence of immunity from yellow fever, are 
allowed to land after an inspection of their baggage has been made to determine its 
freedom from mosquitoes. Passengers who can not present evidence of such imma- 
nity are detained at the quarantine station for the required observation period (five 
days) before being allowed to land. 

The quarantine restrictions placed on vessels of this class during their stay at this 
port are, briefly, as follows: The vessel is held in the "out-quarantine'' anchorage 
and required to anchor as far as is practicable from other vessels lying in the bay. 
Quarantine attendants, presumably immunes, are stationed aboard as guards to see 



PUBLIC HEALTH AND MABINE-HOSPITAL SEBYIOE. 123 

It there is no unauthorized communication held with the veesel. No persons 
aathorized by the quarantine officer are allowed to go within 200 feet of the vessel. 
enforce this restriction the quarantine launch Long is used to patrol the anchor- 
» when considered necessary. The stevedores employed to Trork cargo and the 
atmen employed to transport passengers to and from the vessel are required to 
ssent evidence that they are inmiunes, and be so registered at this office. 
rhe number of small boats which take passengers and cai^go to and from the ves- 
is limited as much as possible, and the boats designated for that purpose are 
nstered at this office. 

the captain and other officers of the vessel are allowed to go ashore during the 
y to transact necessary business. No others of the vessel's personnel are allowed 
lore. 

By a rigid enforcement of these precautions the danger of infection being brought 
lore from these (only) presumably infected vessels becomes apparently very slight; 
sli^hty in fact, that the method appears preferable to one of disinfecting and 
tai fling these vessels upon arrival here, since such an extreme measure as the lat- 
- ^roola probably drive considerable commerce away from the port 
During the year 3 vessels have arrived at San Juan with cases of quarantinable 
lease on board — 2 with yellow fever and 1 with smallpox. Two of these vessels 
sre disinfected and held; the third, viz, the Spanish steamship Buenos Aires, from 
•ntral American and Venezuelan ports, with a case of suspected yellow fever on 
and, declined disinfection and put to sea. The suspected case died soon after the 
seel arrived here, and the findings at the autopsy tended to confirm the diagnosis 
yellow fever. 

Two vessels without cases of illness aboard were disinfected during the vear. 
lese were the Dutch schooner I\rader and the American schooner Corozon de Maria, 
lese vesRels came from a port infected with yellow fever, and mosquitoes (stego- 
jria) in considerable numbers were found aboard at the inspection. 
Qui Quarantine. — As this port throughout the year has been free from quarantin- 
le diaease, with the exception of a few sporadic cases of smallpox, there has been 
me practiadl]^ no quarantine work on outgoing vessels. Certificates of vaccina- 
^n have been issued to passengers leaving here bound for ports in Cuba and Santo 
>niingo. No disinfection of outgoing ba^age, mails, or cargo has been done. 
At the Public Health and Marine-Hosijital Service office, located at No. 3 San Justo 
reet, San Juan, the general administrative part of the quarantine work of the island 
transacted. In this office the clerical work of San Juan quarantine station is done, 
e Marine-Hospital business for San Juan transacted, the reports hrom the subports 
■eparedy etc. 

No eases of yellow fever have occurred on the island of Porto Rico during the 
ical year. 

A report obtained from the office of the superior board of health, containing the 
imber and location of cases of smallpox occurring in Porto Rico during the fiscal 
sar ended June 30, 1903, shows 103 cases, with no deaths, a marked improvement 
, the smallpox situation on the island, as during the fiscal year endea June 30, 
K>2, there occurred 920 cases, with one death. 

Efforts have been continued to exterminate mosquitoes at the quarantine station on 
Liraflcnes Island, and the results are somewhat encouraging. The number of mos- 
nitoes prevailing there appears to be not greater than about one-fourth of what it 
as. It is now very unusual to see a specimen of the Stegom3ria fasciata on the 
ation, while formerly they were quite numerous. 
Samples of blanks used at this station are herewith inclosed. 

SUBPOBTB. 

The six snbports reporting to this office are Mayaguez, Aredbo, Humacao, Aguadilla, 
mroyo, and jFiuaido. An acting assistant surgeon is in charge at each of these 
tations. Weekhr and monthly reports of all quarantine transactions at, and mor- 
yity statistics of, each of these subports are rendered to this office. 

None of the substations are eqmpped for the disinfection of vessels, and vessels 
equiring disinfection arriving at any of these subports are remanded to San Juan or 
V)nce for treatment 

The station at Mayaguez Is provided with facilities for the disinfection of mails 
nd bagsage by means of formaldehyde gas generated with an autoclave into a 
oetallic-lined room. 

The amount of shipping at the other five subports has not been considered suf- 
idently large to yet warrant the making of any provision for disinfection at these 
ilaoes. Thus the statioDS at these subports are maintained principally as inspection 



124 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



At Humacao a 20-foot Whitehall, received from the porroying depot in Angnl, 

190'^, IB used for boarding purposes, and at the end of the fiaeal year a boathoon ii 

nearing completion at tliat station. 

At the other aubportfl vceeels are boarded in boats operated by the caatomB wrrica. 

Daring the year no veesels with cases of qnoiantinable disease on bo«nl hive 

arrived at any of the aubports. 

Respectfully, I-. L. LnMBors, 

Patted Auittaiil fiaryem. 
Acting CftiV/ QiMranHne Offictr/or I'irto Sie». 
The StrttoBON-GENRKAi., 

Public Health and Martne-HotpiUU Service. 



Annual report of 


[iDcloauret.] 
flteat yenr ended June SO, ISOS. 


le Station f»r Ik 




Jul)-. 


Aug. 


Sept. 


».]».. 


Dec 


J«n. 


y,b. 


Mm. 


Apr. 


M&y. 


11 

1.1^ 

ex 


i 
« 
1 

« 

11.111 







IS 
1,170 




Ml 

6 

I.IU 







4 

t 

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fa 

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4 


4 


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1.3W 

Ma 



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1.6(W 

7B1I 




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n 

l.»5 
1» 
822 


»,161 


222 

42 




-^Sr^'si".- 


^Sr"""" 


Crew on niUiiK 


IngvuBel. 


[Acllng AiM 


Sot tkefitcal year ttided June SO, 1903 

Arroyo, P. R. 
Surg. J. T. na. In rhuse of M>ll<».| 


nJIfawft 


port^ 


Bills of health imued 








1 










Paseengera inapeoled (tota 
Vessels detained in quarar 








tine" 
«d 






1 








Person H votx-iiia 
Ve«eelBdiHinfec 










e<i 




1 



[Acting AM, 8urK. Uanuel U. Romolln. In cluuBe of 



m.] 



Vessels inspected during the year 31 

Bills o( health issued H ! 

Crews of vesaeU inspected 1,0H 

Paasengera insjjected (total) Ifi 

Vessels detained in <)uarantine , 

Pieces of Ijoggoge disinteetol . 

t'ersons vaccinated 3S 

Vessels disinlected 



It. Bui;. Rafael U. L. Ultando, in chug* of itatloQ.] 



Isinspected 7,4!l 



PUBLIC HEALTH AND HARINE-HOSFITAL SEBVICE. 135 



:era inepcctol (total) 2,706 

detained in qiiArantine 18 



FAJABDO, F.B. 
[ErtetMO Lbpet, acting uiIiUd 





July. 


Aug. 


Sept. 


OCU 


Not. 


Itcc. 


Jan. 


Fob. 


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Jona. 


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HDUACAO, P. R. 
[Psblo rtmt r Hortelo, meting MiliUnt niigeon.] 



led and 
] 



AUUADILLA. P. R. 
[Jallan Benejun, Acting AadBtant Bnrgoon.] 



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126 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

rONCE. 

Report by Acting Asst. Surg. J. F. Torres. 

Public Health and Marine-Hospital Sehvicx, 

Office of Medical Officer in CJommakd. 

Ponce, P, A, July S, 190S, 

Sir: In accordance with Bureau letter June 13, 1903, I have the honor to forward 
the following report of the quarantine transactions at this station for the fisol yeir 
ended June 30, 1903: 

Vessels inspected 168 

Vessels in quarantine 46 

Vessels disinfected Q 

Crew inspected 7,870 

Passengers for Ponce inspected ^ 

Passengers in transit inspected 4,378 

Pieces of baggage inspected 2S 

Pieces of bagga^ disinfected ^ 

Sacks of maiTdisinfected 19 

Bills of health issued 248 

During the year no vessel arrived with quarantinable disease on board. Veeseii 
from suspicious ports of Cuba, Haiti, Santo Doming, and Central and Sooth 
America tiave been held in quarantine, but were not disinfected, as they remained in 
port only a few hours, transacting business under guard, and only such commuiiici> 
tion with the shore as was necessary and not considered dangerous. 

Nonimmune passengers from suspicious or infected ports were detained in the 
bar^ Argus. Baggage and mail of these ports were also duly disinfected in the bai^ 

Since the last report of this station, dated October 20, 1902, for the fiscal yetr 
ended June 30, 1902, the same has been furnished with a disinfecting barge contain- 
ing the appropriate machinery for disinfection, which has been a great improvement 
added to this station. 

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, etc, of 
this district. 

Very respectfully, J. F. Torres, 

Acting Asngtanl Surgeon, 

Respectfully forwarded. 

L. L. LuMSDBN, Paued Assittant Surgeon, 
Acting Chief Quarantine Officer for Porto IKw. 

Surgeon-General, Public Health and Marine-Hospital Servicb. 



Mexico. 

piuague in ensenada and mazatlan. 

On December 8, 1902, Assistant Surgeon Decker, at San Diego, Cal., 
sent the following communication to tne Bureau: 

[Telegram.] 

San Diego, Cal., December S, 190t. 

The president of the local health board has information from phjrsician of Ense- 
nada, Mexico^ that 10 cases and 10 deaths by very suspicious disease have occorred 
there since middle of October. First case in Chinaman, rest in Mexicans, last death 
on December 5. Sickness lasts from two to eight days and glandular swellings have 
been observed. Rats dyin^. There is traffic bv steamer with this port 6 times a 
month, also some overland travel. Health authorities here anxious to have an 
inspector sent to investigate. 

Dicker. 

The Surgeon-General. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 127 

On December 12, 1902, Passed Asst. Surg. S. B. Grubbs was ordered 
o Ensenada, Mexico, to investigate these rumors of plague. Doctor 
Jiceaga, the president of the superior board of healtn of Mexico, 
urnisned him with a letter of introduction to the Mexican authorities 
t Ensenada. He arrived at that place on the 17th instant, and imme- 
iiately proceeded to investigate tne suspicious sickness prevailing in 
he toVn. On December 26 he wired the Bureau as follows: 

[Telegram.] 

Enbbnada, Mexico, December S6^ 1902. 
argeon-General Wyman, 

WaBhingUm: 

Provisional dia^osis, plague. During past twenty-four hours there have been 2 
eaths; very suspicious. There are cases reported at Mazatlan, Mexico. Local quar- 
ntine officer thinks it is plague. Port Pacific Mail Line for Chinese. Steamer once 
lonth to 'Frisco touches here and other Mexican ports. 

Grubbs. 

On January 1, 1903, he reported to the Bureau by letter as follows: 

[Letter.] 

Ensenada, Mexico, Jantuiry /, 190S. 

Sir: I have the honor to submit the following summary concerning the epidemic 
hat has existed in £nsenada, Mexico, during the past ten weeks: 

Ensenada is a town claiming 1,400 inhabitants, situated on the northern slope and 
lUdn at the extremity of the Bayo de Todos Sajntos, which is about 70 miles south 
i San Diego, Cal. 

The town has no sewers or waterworks, but is kept fairly clean. Most of the 
KMJses are separated one from another, and are built well up off the ground. 

The first case of the suspicious malady occurred on October 20, 1902, and was 
reated, together with 6 other cases, by Dr. L, Goldschmeidt. He has written some 
txcellent notes on these cases, from which I quote the following: 

"Number of cases under treatment, 7; number of deaths, 7. [Besides these, 8 
ither cases with 6 deaths are reported.] '' 

In conclusion, I would state that I believe some, if not a majority, of the above 
ases were due to plague. However, I believe the conditions here are favorable to 
he extinction of the disease, built as Ensenada is, of email houses, well separated 
ind flooded with sunlight. Ck>nsidering the proximity, the danger of spread to the 
Jnited States is also not very ^reat, in my opinion, especially under mild precautions. 

The stage line, running 3 times a week, carries fewpassengers and no freight on 
ts two days' trip to Tiajuana on the boundary line. The St, Deiinis^ making 6 trips 
k month to San Diego, stops but twelve hours, lies at anchor, lighters from the beacn, 
md carries very little freight north. 

I have to acknowledge the courtesy of all Mexican oflScials I have met while in 
Snsenada, especially Doctor Peterson, the local representative of the Consejo de 
salubridad. My thanks are also due to Dr. E. B. Alexander, Dr. C. H. Power, and 
[)r. L. Goldschmeidt for very valuable assistance rendered. 

Respectfully, S. B. Grubbs, 

Passed Assistant Surgeon. 

Subgbok-Genbral, Public Health and Marine-Hospital Service. 

Upon receipt of foregoing news from Doctor Grubbs active raeas- 
ires were taken to prevent infection bein^ brought into the United 
States, and inspectors were placed at all tne points on the border at 
irhich danger was most to be apprehended. 

On December 22, 1902, Dr. Eduardo Liceaga, president of the 
superior board of health of Mexico, wrote the Bureau as follows: 

[Letter.] 

Mexico Crrv, Mexico, December jft?, 190£. 

Sir: With regret I have to inform you that a disease has appeared in the port of 
Vlazatlan which is similar to the plague. I have already aent a\yae\mo\cy^ps^\iCk>iX!k»X. 



128 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

place, in onler that he may study tlie nature of the disease. The symptoms lead tu 
to presume that it is reallv the plague, and up to the present 50 cases nave appeued 
in the poorer quarters of the city. I make this declaration to yon in accordance with 
the resolution of the Washington convention. I am obliged to you for your telegram of 
the 20iht and liave sent to Chicago ordering a supply of sermn from the firm whose 
name was given me from Washington at your request 

Respectfully, £. Lickaga. ^ 

The Surgeon-General Public Health and Marinb-Hospital Sbsvice. 

Ensenada in a small town of 1,400 inhabitants, on the western ooast 
of Mexico, about 70 miles south of San Diego, Cal. From the b^n- 
nine of this outbreak of plaeue, on October 20, 1902, the Mexican 
health authorities adopted ana enforced all possible means of sup- 
pressing the epidemic. An isolation hospital was established, where 
all cases were taken for treatment, and a thorough system of disin- 
fection was adopted in houses where infection had occurred, including 
means to insure the destruction of rats. These same measures were 
also instituted at Mazatlan. 

Foci of infection appeared in Oso, Siqueros, and Villa Union, towns 
near Mazatlan, but under the stringent measures adopted by health 
authorities the plague was speedily stamped out. 

On February 13, 1903, Asst. Sur^. Edward Francis was ordered from 
the Hygienic Labomtory at Washington to the City of Mexico to con- 
fer with Doctor Liceaga and to keep in touch with the situation. 

Doctor Liceaga reported the existence of plague in Mazatlan and 
Ensenada to the Bureau of American Republics, Washington. D. C. 
on December 22, 1902, and December 31, 1902, respectively, and 
declared Ensenada free of plague on February 7, 1903. On April 18, 
1903, United States Consul Kaiser at Mazatlan reported that plague 
was officially declared extinct at that port. 

DETAIL OF OFFICERS TO VERA CRUZ, TABIPIOO, AND PBOOBESO ON 
ACCOUNT OF PREVALENCE OF YELLOW FEVER. 

Owing to the important shipping interests connecting ports on the 
Gulf coast of Mexico with ports in the United States, meaical officers 
of the Public Health and Marine-Hospital Service were detailed for 
duty in the office of the consul at Vera Cruz, Progreso, and Tampico, 
Mexico, as follows: On April 21, 1903, Asst. Surg. Joseph Golaber- 
ger was ordered from Ponce, P. K,, to Vera Cruz, Mexico; on April 
16, 1903, Acting Asst. Surg. J. F. Harrison was ordered to Progreso, 
Mexico, and on April 21, 1903, Acting Asst. Surg. John FricK was 
ordered from Habana, Cuba, to Tampico, Mexico. The following is 
a copy of the letter of instructions sent to each of these officers: 

ILettcr of instmctioxis.] 

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

WasfdngUm^ May 4, 190S. 

Sir: RefcrriD^ to Bureau telegram of April 21, 1903, detailing yon for daty in the 
office of the United States consul at Vera Cruz^ Mexico, I have to inform yoa that 
vour duties comprise the enforcement of the United States quarantine regalatiozui for 
foreign port^, including the inspection of all vessels leaving^ Vera Croz for porti <^ 
the United States, either direct or via other ports, and signing, in conjunction with 
the United States consul, the bills of health issued to same. 

You are requested to make a weekly report to the Bureau of yoar traimctioDfl, 
detailing also the public-health conditions of Vera Cruz and vidnity. 



PUBLIC HEALTH AND MARINE-HOSPITAL 8KRVICE. 129 

Yoar attention is speciallv called to the agency of the Steoomyia fasciata as the 
intermediate host in yellow fever, and all due precaiitlonH should be taken to prevent 
veeeels leaving your port for the United States Ironi carrj^ng any of these mosquitoes. 
Yoo will find in the files of the consulate a letter from Surg. H. R. Carter, of this 
'ice, under date of March 8, 1902, which it will be well for you to read, as it con- 
tains many suggestions of interest on the subject. 

You are also requested to enter into communication with medical ofiicers of the 
Pablic Health and Marine-Hospital Service located on the Texas-Mexican border, 
with a view to mutual interchange of information concerning matters of public health. 
Their addresses are as follows: Acting Asst. Surg. Lea Hume, Public Health and 
Marine-Hospital Service, Eagle Pass, Tex. ; Acting Asst. Surg. E. Alexander, Public 
Health and Marine-Hosi'ital Service, El Paso, Tex.; Acting Asst. Surg. H. J. Ham- 
ilton, Pablic Health and Marine-Hospital Service, I^reilo, Tex. 

You should keep complete records of all transactions, in order that report of the 
flame may be transmitted at the close of the season. You are also informed that it 
will be your duty to submit a complete report of transactions at your station from 
the time of your arrival up to and mcluding June 30 of this year. This report you 
will submit to the Bureau immediately after July 1, 1903. 

Should any cases of yellow fever orV^ases suspected of l>eing yellow fever occur at 
year port, you will immediately inform the Bureau by wire ot the fact. 

The Dejpartment of State has been requested to infonn the consul at Vera Cruz of 
year detail and to instruct him to afford you any assistance he can render. 

A copy of the United States laws and regulations will l)e forwarde<l to you under 
separate cover, also list of property left in charge of the consul by the acting assistant 
m^geon on duty at the port last year. The consul will be instructed by the State 
Department to turn this property over to you upon your arrival. 
Bespectfully, 

Walter Wyman, Surgeon- General, 

ISSUE OF CERTIFICATES OF I^IMUNITY FORBIDDEN. 

The issuance of certificates of immunity was considered such an 
imxx)rtant matter last summer by the Bureau that orders were sent to 
the acting assistant surgeons serving at Vera Cruz and Progreso, 
Mexico, not to issue immune certificates, as it was not thought that 
they could collect or properly certify to the necessary daUi for issuing 
such a certificate, founded on either a previous attacK of yellow fever 
or residence for at least ten years in tne yellow-fever zone. During 
the present season the same orders have held good. 

INVESTIGATION AS TO MOSQUITOES CARRIED BY SHU'S. 

The following letter from Surg. H. R. Carter, in response to Bureau 
invitation, contains suggestions which formed part of the instructions 
to the officers at Mexican ports: 

[Letter.] 

Public Health and Marine-Hospital Service, 

Office of the Medical Officer in Command, 

Baltimore J Md., April 29 y 1903, 

8ib: In amnnrer to your letter of the 23<1 instant, asking for a copy of my letter of 
March 8, 1902, relative to mosquitoes alwarcl ship, I would say that I can find no 
copy of said letter on my files. My recollection is that as the subject of the letter 
was in no way related to any of my duties at this station, I did not think it proper 
to write on it officially, and wrote said letter i)er8onally to the Surgeon-General. As 
well as I recollect it, the substance of said letter was as follows: 

The parjpcse is to find out: (1 ) What vessels from tropical ports bring stegomyia to 
the United States; (2) which of these bring stejjoniyia coming aboard at the tropical 
port with immigrants; (3 J which take stegomyia aboard at a Unite<l States oort and 
return with them, the active stegomyia making a roimd trip, as it were; (4) to find 
at what anchorages in tropical ports vessels are liable to receive stegomyia from 
shore — ^i. e.^ what anchorages are safe or unsafe for vessels in the event of yellow 
fever prevailing in said port. 

H. Doc. 338 9 



130 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

For this there should be undertaken a systematic examination of vessels for ste- 
eomyia at the tropical port and the United States port of arrival, and (if a regplar 
liner) of departure. This is best done by exposing bowls of water in various 
places — especially dark places — and hatching the eggs; i. e., bowls should be placed 
aboard at the United States port, to be renewed on arrival at the tropical port and 
examined there; fresh bowls to be placed aboard on arrival, to be removed either 
when she leaves or when she reaches her United States destination. 

Adult stegomyia should also be looked for; but failure to find them is far bom 
conclusive evidence of their absence, unless they be sought for, and carefully sought 
for. several days at the proper time of day — late afternoon. 

Obviously a vessel which has stegomyia aboard on arrival at a tropical port need, 
not be investigated there to see if other stegomyia go aboard her from that port li, 
however, a vessel is free from stegomyia on arrival at a tropical port, the presence of 
such insects aboard while in port, en route, or on arri\'al at a united States port is 
evidence (proof if larvae on arrival be excluded) that such stegomjda were received 
aboard in the tropical port 

It is obvious then that the class of vessels the examination of which will yield the 
most information are those between ports in both of w^hich we have oar own officen 
and an observation of which could be made at both ports. It is also important that 
most of these vessels should come to the tropical port free from stegomjoa. 

For the solution of the fourth question, vessels arriving free from stc^myia lying 
at moorings at different places in the harbor should be examined. I can not tnink 
much would be leamea by examining any vessel lying at a wharf, like those in 
Habana; she would almost certainly acquire stegomyia. Similarly the examinatioii 
of vessels arriving with stegomyia aboard — no matter where they lay — would give, I 
think, no useful data. I think that in this latter category would fall the regular 
liners from the (lulf and South Atlantic ports. Of the regular liners at Cuban ports 
I think the Ward and Munson vessels offer the best chance for this information, or 
would if the New York quarantine people would cooperate with us. 

However, many vessels come clean of stegomyia to Habana from Eoropean ports 
and clear for United States ports from Philadelphia south. Indeed, we can do with- 
out the cooperation of the New York people by letting the bowl placed aboard in 
Habana stay aboard until the vessel returns to that port the chance of getting 
stegomyia alx)ard in New York being so small that it may be neglected. 
Respectfully, 

H. R. Carter, Surgeon, 

The Surgeon-General Public Health and Marine-Hospital Service. 

DISINFECTION AT MEXICAN PORTS OF VESSELS SAILING FOR THE 

UNITED STATES. 

The following letter of instruction was sent to each of the medical 
officers at Vera Cruz, Tampico, and Progreso relative to disinfection 
of vessels leaving for United States ports: 

[Letter.] 

Treasury Departmsnt, 
Bureau of Public Health and Marine-Hospital Skrvicb, 

WashingUmj May 18, 190S. 

Acting Assistant Surgeon in Charge ^ P^ihtic Health and Marine-Hospital Sertfieej care 
United States Consulate: 

Sir: You are informed that the Bureau has tentatively entered into an arrange- 
ment for the disinfection of vesselsof the regular lines sailing from Vera Croa, Tampico, 
and Prc^reso for points on the Gulf coast of the United States, which arrai^ 
ment is in effect a disinfection of the vessels by their owners under the supervision 
of a ser\ace officer, in ordet to meet the objections of the Mexican Government to 
the establishment of disinfecting plants in Mexican ports. 

Under the provisions of this agreement, each one of the regular lines wiU provide 
on board of each of their vessels a designated number of pots (Dutch oyens) for sul- 
phur fumigation and an equal number of water containers for use in oomonction 
with these pots, and the companies will ^ree that the orders of medical officers of 
the Public Health and Marine-Hospital l^rvice with regard to the difiuileqtion of 



"PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 131 

heir veesels above referred to, shall ))e rigidly carried out by the captains of their 
refleels. 

The diainfection in all cases is to be done after the vessel has left her dock and is 
yinii; well out in the stream, so as to prevent any fresh influx of mosquitoes aboard 
he vessel, if such prevention is at all possible, and the method to be pursued will 
le 88 follows: 

Each compartment of the vessel must be subjected to a fumi^tion with sulphur 
lioxide gas of 2 per cent volume for at least two hours. This volume of gas is 
>btaiiied by burning sulphur at the rate of 2 pounds for each 1,000 cubic feet of air 
rpace to be disinfected. The compartments must in each case be tightly closed. 
me two hours prescribed is deemed sufficient to kill all mosquitoes — the object 
levied. 

To prevent danger of fire the sulphur should l>e burned in the following-described 
nanner: Place a Dutch oven in a tub or pan of considerably greater diameter than 
tseH. The tub or pan should contain water to a depth of at least 2 or 3 inches, and 
i the Dutch oven has no legs to raise it above the water level, brick or stone may be 
Ribstitated. No Dutch oven should be more than half fnll of sulphur, a portion of 
irhich should be pulverized, and a small (]|uantity of alcohol poured thereon and 
iie flame started with a match, great care being taken to observe in each case before 
Joeing the door that the fire is well started and there is no danger of its going out. 

This process is to be simultaneous in every part of the vessel except the engine 
"ooms, which are not believed to need it, and the passengers must be put on deck 
mder an awning or in some other manner provided for until this fumigation is over. 

It 18 imperatively necessary, and in no instance must there be any departure from 
lie rale, that this ramigation shall take place after the vessel has cleared, all passen- 
tm and crew are on board, and no one else shall return ashore subsequent to this 
lifiinfection except yourself, and you must in all cases remain on board until two 
tionrB' fumigation has been assurea under your observation. 

When yon have assured yourself that all these matters have been attended to, you 
iriU fuiTiish the captain with a certificate stating exactly what has been done, and 
;hen allow the vessel to proceed on her voyage. 

Respectfully, Geo. Purviance, 

Acting Surgeon- General, 



VERA CRUZ. 
Report of Transactions at Vera Cruz, by Asst. Surg. Joseph Goldkkroer. 

U. S. Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Vera CruZf MexicOy July ff, 1903. 

Sir: I have the honor to transmit herewith a tabulated statement of the transac- 
tions of this station for the year ended June 30, 1903. It will l)e noted that this 
covers only the six months of the quarantine season, or, more accurately, only five 
and a half months, inasmuch as the transactions for May date from the 18th of that 
month, the date of my taking charge. 

During the period under consideration, bills of health were issued to 148 vessels, 
which were manned by a total of 6,015 crew, and carried 2,699 passengers. The 
bills of health are iasued after inspection, and are signed jointly by the consul and 
myself. 

The boarding of vessels is done either at the wharves or anchorages. In the latter 

se it is done in a small boat provided by the vessel's agent or in one hired by the 



Service. 

This station is provided with one Kinyoun- Francis autoclave, which will require 
overhauling and repair to be made serviceable. In view of our knowledge oi the 
mode of transmission of yellow fever (the only disease that need he considered with 
reference to quarantine measures to be taken at this port), this apparatus is more 
than sofficient. No disinfection was done during the period under consideration. 
Bespectfolly, 

Joseph Gk>LDBERaER, AsmMarU Surgeon, 

The Subgion-Gknsral Pupuc Health and Marine-Hospital Service. 



124 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

At IIumHcaa a. 20-foot Whitehall, received from the purveying depot in Angort, 

1902, is used for boarding purposes, and at the end of the fiscal year a boMhoon ii 

nearing completion at tl)at station. 

At the other subports vessels are boarded in boata operated t^ the customs serviiA 

During the year no vessels with cases of quanntinable disease on IxMinl hive 

.__!.._ 1 _, 1 .1.. ^iibporte. 

L. L. LUMBDKN, 

Patted Atiiitaiil .Sargeim, 
Acting Chit/ Quarantine Offierr/or I\iTto Jtko. 
The Subobon-Gbneral, 

Public Health and Itarine-Hotpilal Service. 

[iDclonim.] 





July. 


Allg. 


Sept. 


«,. 


N,.v. 


Dec. 


Jan. 


Feb. 


Uu. 


Apr. 


M-y. 

D 


JBOB 

i.ia 


MO. 


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Report of qimranline troMaetioiufiir Ikefitealytar rtiiled June SO, 1903, nt the niApori ^ 

Arroyo, P. R. 

{AcllDg Ami. Surg. J. T. Pla. In ctkuge o( rikUan.] 

Vessels inspecte<l during the year IS 

Bills of health issaed ^ 

Crewe of vetvels inspected 217 

Passengers inspwteii (total) 4 

Veseels detained in quarantine 

Pieces of baj^gage disinfected 

Persons vacemaled 

Vessels disinfected 

Report of quarantine trantacti'iiix /or thejiKcal year nulnl June SO, 1H03, ut the tuhport i^ 
Areribo, i'. R. 

[Acting Awl. Riirg. Uannet II. Ronelln. In dutgeof lUtlon.] 

Vessels inspected during the year SI 

Bills of health issued 5! 

Crews of vessels in H|)ected 1,024 

Passengers inspected (total),,, ,. 163 

Vessels detained in quarantine 

Pieces of l)a)igage disinfected 6 

Persons vaccinated 33 

Vessels disinfected 

Rtport o/ quarantine trantactiont /ur the fiical year ended June SO, 1S03, at (A« lutpart t^ 

Mayaguex, P. R. 

[Acting A>n. SaTg. Rabcl U. L. HInindft. In cbaige of aUtlon.] 

Vemels inspected during the year Ul 

Bills of health issued 174 

OrewB of veawls inspected 7,4S4 



PUBLIC HEALTH AND HA BINE- HOSPITAL 8EBVICE. 125 

igere inspected (total) 2,706 

la detuned in qnarantine 18 

I of bai^csge disinfected 188 



FAJARIK). p. H. 
[Brtebui L6pei, *cUiis anlataiit ■Diseon.l 





July. 


Aug. 


Sept. 


twi. 


Nov, 


Dl-c. 


J... 


Feb. 


«„. 


Apr. 


M»r. 


June. 


Tol»l. 




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AQDADILLA, ?. R. 
a Bencjun. AcUng Avlstuil StitgMn.] 



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126 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

PONCE. 

Report by Acting Asst. Surg. J. F. Torres. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Ck>iiMAND. 

P(mc€f P. IL, July 5, 190S. 

Sir: In accordance with Bureau letter June 13, 1903, I have the honor to forward 
the following report of the quarantine transactions at this station for the fiscaJ yev 
ended June 30, 1903: 

Vessels inspected 

Vessels in quarantine 

Vessels disinfected 

Crew inspected 

Passengers for Ponce inspected 855 

Passengers in transit inspected 4, 378 

Pieces of baggage inspected 225 

Pieces of baggage disinfected 353 

Sacks of mail disinfected 19 

Bills of health issued 248 

During the year no vessel arrived with quarantinable disease on board. VesBete 
from suspicious ports of Cuba, Haiti, Santo Doming, and Central and South 
America nave been held in quarantine, but were not disinfected, as they remained io 
I>ort onlv a few hours, transacting business under guard, and only such communicap 
tion with the shore as was necessary and not considered dangerous. 

Nonimmune passengers from suspicious or infected ports were 'detained in the 
bar^e Argus. Baggage and mail of these ports were also auly disinfected in the barge. 

Since the last report of this station, dated October 20, 1902, for the fiscal year 
ended June 30, 1902, the same has been furnished with a disinfecting barge contain- 
ing the appropriate machinery for disinfection, which has been a great improvement 
added to this station. 

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, etc., of 
this district. 

Very respectfully, J. F. Torres, 

Acting Amstani Surgeon. 

Respectfully forwarded. 

L. L. Lumsden, Passed Assistant Surgeon^ 

Acting Chief Quarantine Officer for Porto Rieo, 

Surgeon-General, Public Health and Marine-Hospital Sbrvicb. 



Mexico. 

plague in ensenada and mazatlan. 

On December 8, 1902, Assistant Surgeon Decker, at San Diego, Cal., 
sent the following communication to tne Bureau: 

[Telegram.] 

San Diboo, Cal., Decembers, 190i, 

The president of the local health board has information from physician of Ense- 
nada, Mexico^ that 10 cases and 10 deaths by very suspicious disease have oocorred 
there since middle of October. First case in Chinaman, rest in Mexicans, last death 
on December 5. Sickness lasts from two to eight days and glandular swelUnss have 
been observed. Rats dying. There is traffic bv steamer with this port 6 times a 
month, also some overland travel. Health autnorities here anxious to have an 
inspector sent to investigate. 

Dbckkr. 

The Surgeon-General. 



PUBLIC HEALTH AND MABIITE-HOSPITAL SERVICE. 127 

On December 12, 1902, Passed Asst. Surg. S. B. Grubbs was ordered 
to Ensenadn, Mexico, to investigate these rumors of plague. Doctor 
Liceaga, the president of the superior board of health of Mexico, 
furnisned him with a letter of introduction to the Mexican authorities 
at Ensenada. He arrived at that place on the 17th instant, and imme- 
diately proceeded to investigate the suspicious sickness prevailing in 
the town. On December 26 he wired the Bureau as follows: 

[Telegram.] 

Ensbnada, Mexico, December 26 , 1902, 
Smgeon-General Wyman, 

WathmgUm: 

Provisional diaf^osis, plague. Daring past twenty-four hours there have been 2 
deaths; very suspicious. There are cases reported at Mazatlan, Mexico. Local quar- 
antine officer thinks it is plague. Port Pacific Mail Line for Chinese. Steamer once 
month to 'Frisco touches here and other Mexican ports. 

Grubbs. 

On January 1, 1903, he reported to the Bureau by letter as follows: 

[Letter.] 

Ensenada, Mexico, January 1, 190S, 

Sir: I have the honor to submit the following summary concerning the epidemic 
that has existed in Ensenada, Mexico, during the past ten weeks: 

Ensenada is a town claiming 1,400 inhabitants, situated on the northern slope and 
plain at the extremity of the Bayo de Todos 8ajito6, which is about 70 miles south 
of San Biego, Cal. 

The town has no sewers or vraterworks, but is kept fairly clean. Most of the 
hooseB are separated one from another, and are built well up off the ground. 

The first case of the suspicious malady occurred on October 20, 1902, and was 
treated, together with 6 other cases, by Dr. L. Goldschmeidt. He has written some • 
excellent notes on these cases, from which I quote the following: 

"Number of cases under treatment, 7; number of deaths, 7. [Besides these, S 
other cases with 6 deaths are reported.] '' 

In conclusion, I would state that I believe some, if not a majority, of the above 
cases were due to plague. However, I believe the conditions here are favorable to 
the extinction of the disease, built as Ensenada is, of small houses, well separated 
and flooded with sunlight. Considering the proximity, the danger of spreaa to the 
United States is also not veir ^reat, in my opinion, especially under mild precautions. 

The stage line, running 3 times a week, carries few passengers and no freight on 
its two days' trip to Tiajuana on the boundary line. Tne St, Dennis^ making 6 trips 
a month to San iHego, stops but twelve hours, lies at anchor, lighters from the beacn, 
and carries very little freight north. 

I have to acknowledge the courtesy of all Mexican officials I have met while in 
Ensenada, especially Doctor Peterson, the local representative of the Consejo de 
Salubridad. My thanks are also due to Dr. E. B. Alexander, Dr. C. H. Power, and 
Dr. L. Goldschmeidt for very valuable assistance rendered. 

Respectfully, S. B. Grubbs, 

Passed Assistant Surgeon. 

Surgeon-General, Public Health and Marine-Hospital Service. 

Upon receipt of foregoing news from Doctor Grubbs active meas- 
ures were taken to prevent infection bein^ brought into the United 
States, and inspectors were placed at all the points on the border at 
which danger was most to be apprehended. 

On December 22, 1902, Dr. Eduardo Liceaga, president of the 
superior board of health of Mexico, wrote the Bureau as follows: 

[Letter.] 

Mexico City, Mexico, December 22^ 1902, 

Sir: With rap!et I have to inform yoa that a disease has appeared in the port of 
Mazatlan whicn is similar to the p\ague. 1 have already sent a\)8LC\iei\o\o^V.\AVc!^ 



128 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

place, in order tliat he may study the nature of the disease. The symptoms lead as 
to presume that it is really the plague, and u|) to the present 50 cases have appeared 
in the poorer quarters of tne city. I make this declaration to you in accordance with 
the resolution of the Washington convention. I am obliged to you for year tel^;rBm of 
the 20th, and have sent to Chicago ordering a supply of serum from the firm whose 
name was given me from Washington at your request. 

Respectfully, £. Licraoa. 

The Suroeon-Genkral Public Health and Marinb-Hospital Service. 

Ensenada in a small town of 1,400 inhabitants, on the western coast 
of Mexico, about 70 miles south of San Diego, Cal. From the bee^n- 
ning of this outbreak of plague, on October 20, 1902, the Mexican 
health authorities adopted ana enforced all possible means of sup- 
pressing the epidemic. An isolation hospital was established, where 
all cases were taken for treatment, and a thorough system of disin- 
fection was adopted in houses where infection had occurred, including 
means to insure the destruction of rats. These same measures were 
also instituted at Mazatlan. 

Foci of infection appeared in Oso, Siqueros, and Villa Union, towna 
near Mazatlan, but under the stringent measures adopted by health 
authorities the plague was speedily stamped out. 

On February 13, 1903, Asst. Surg. Edward Francis was ordered from 
the Hygienic Laboratory at Washington to the City of Mexico to con- 
fer witn Doctor Liceaga and to keep in touch with the situation. 

Doctor Liceaga reported the existence of plague in Mazatlan and 
Ensenada to the Bureau of American Republics, Washington. D. C., 
on December 22, 1902, and December 31, 1902, respectively, and 
declared Ensenada free of plague on February 7, 1903. On April 18, 
1903, United States Consul Kaiser at Mazatlan reported that plague 
was officially declared extinct at that port. 

DETAIL OF OFFICERS TO VERA CRUZ, TABiPICO, AND PBOORESO ON 
ACCOUNT OF PREVALENCE OF YELLOW FEVER. 

Owing to the important shipping interests connecting ports on the 
Gulf coast of Mexico with ports in the United States, meaical officers 
of the Public Health and Marine-Hospital Service were detailed for 
duty in the office of the consul at Vera Cruz, Progreso, and Tampico, 
Mexico, as follows: On April 21, 1903, Asst. Surg. Joseph Golober- 
ger was ordered from Ponce, P. R„ to Vem Cruz, Mexico; on April 
16, 1903, Acting Asst. Surg. J. F. Harrison was ordered to Progreso, 
Mexico, and on April 21, 1903, Acting Asst. Surg. John Frick was 
ordered from Habana, Cuba, to Tampico, Mexico. The following is 
a copy of the letter of instructions sent to each of these officers: 

LLettcr of instractloziB.] 

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

Washinfftonf May 4, 190S, 

Sir: Referring to Bureau telegram of April 21, 1903, detailing you for duty in the 
office of the United States consul at Vera Cruz^ Mexico, 1 have to inform you that 
vour duties comprise the enforcement of the United States quarantine regnlations for 
foreign ports, including the inspection of all vessels leaving Vera Cruz for porta of 
the United States, either direct or via other ports, and sigmng, in conjunction with 
the United States consul, the bills of health issued to same. 

You are requested to make a weekly report to the Bureau of your tranaactions, 
detailing also the public-health conditions of Vera Cruz and vicinity. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 129 

Your attention is epeciallv called to the agency of the Stegomyia fasciata as the 
intermediate host in yellow fever, and all due precautions should l>e taken to prevent 
yemels leaving your port for the United States from carrying any of these mosquitoes. 

Yoa will find in the files of the consulate a letter from Surg. H. R. Carter, of this 
Service, ander date of March 8, 1902, which it will be well for you to read, as it con- 
tains many suggestions of interest on the subject. 

You are also requested to enter into communication with medical ofHcers of the 
Public Health and Marine-Hospital Service located on the Texas-Mexican border, 
wiUi a view to mutual interchange of information concerning matters of public health. 
Their addresses are as follows: Acting Asst. Surg. Lea Hume, Public Health and 
IfariBe-Hospital Service, Eagle Pass, Tex. ; Acting Asst. Surg. E. Alexander, Public 
Health and Marine-Host ital Service, El Paso, Tex.; A(;ting Asst. Surg. H. J. Ham- 
iltoD, Public Health and Marine-Hospital Service, lAretlo, Tex. 

You should keep complete records of all transactions, in order that report of the 
tune may be transmitted at the close of the season. You are also informed that it 
will be your duty to submit a complete report of transactions at your station from 
the time of your arrival up to and mcluding June 30 of this year. This report you 
will submit to the Bureau immediately after July 1, 1903. 

Should any cases of yellow fever or cases suspected of l)eing yellow fever occur at 
your port, you will immediately inform the Bureau by wire of the fact. 

The Department of State has been requested to inform the consul at Vera Cniz of 
your detail and to instruct him to afford you any assistance he can render. 

A copy of the United States laws and regulations will be forwanled to you under 
separate cover, also list of property left in charge of the consul by the acting assistant 
gmgeon on duty at the port last year. The consul will be instructed by the State 
Department to turn this property over to you upon your arrival. 
Respectfully, 

Walter Wyman, Surgeon- General, 

ISSUE OF CERTIFICATES OF IMMUNITY FORBIDDEN. 

The issuance of certificates of immunity wa.s considered such an 
important matter last summer by the Bureau that orders were sent to 
the acting assistant surgeons serving at Vera Cruz and Progreso, 
Mexico, not to issue immune certificates, as it was not thought that 
they could collect or properly certify to the necessary data for issuing 
such a certificate, founded on either a previous attack of yellow fever 
or residence for at least ten years in tne yellow-fever zone. During 
the present season the same orders have held good. 

INVESTIGATION AS TO MOSQUITOES CARRIED BY SHIPS. 

The following letter from Surg. 11. R. Carter, in response to Bureau 
invitation, conto,ins suggestions which formed part of the instructions 
to the officers at Mexican ports: 

[Letter.] 

Public Health and Marine-Hospital Sehvice, 

Office of the Medical Officer in Command, 

Baltimore, Md., April 29, 1903, 

Sib: In answer to your letter of the 23<1 instant, asking for a copy of my letter of 
March 8, 1902, relative to mosquitoes alward ship, 1 would nay tlmt I c^n find no 
copy of said letter on my files. My rei'ollection is that as the subject of the letter 
was in no way related to any of my duties at this station, I did not think it proper 
to write on it officially, and wrote said letter i>er8onally to the Surgeon-General. As 
well as I recollect it, the substance of said letter was as follows: 

The purpoee is to find out: (1 ) What vessels from tropical ports bring stegomyia to 
the United States; (2) which ot these bring stegomyia coming alwanl at the tropical 
port with immigrants; (3) which take stegomyia aboard at a United States port and 
return with them, the active stegomyia making a round trip, as it Avere; (4) to find 
at what anchorages in tropical ports vessels are liable to receive stegomyia from 
shore — ^i. e.^ what anchorages are safe or unsafe for vessels in the event of yellow 
fever prevailing in said port. 

H. Doc. 358 9 



130 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

For thiH there should be undertaken a systematic examination of vessels for ete- 

?;omyia at the tropical port and the United States port of arrival, and (if a regular 
iner) of dei>arture. This is best done by exposing bowls of Mrater in varioas 
places — especially dark places — and hatching the ^gs; i. e., bowls should be pla^ 
aboard at the United States port, to be renewed on arrival at the tropical port and 
examined there; fresh bowls to be placed aboard on arrival, to be removed eiUier 
when she leaves or when she reaches her United States destination. 

Adult stegomyia should also be looked for; but failure to find them is far from 
conclusive evidence of their absence, unless they be sought for, and carefally sought 
for. several days at the proper time of daj — late afternoon. 

Obviously a Vessel which has stegomyia aboard on arrival at a tropical port need, 
not be investigated there to see if other stegomyia go aboard her from that port If, 
however, a vessel is free from st^omyia on arrival at a tropical port, the presence of 
such insects aboard while in port, en route, or on arrival at a United States port is 
evidence (proof if larv« on arrival be excluded) that such stegomyia were received 
aboard in the tropical port. 

It is obvious then that the class of vessels the examination of which wiU yield the 
most information are those between ports in both of which we have our own officers 
and an observation of which could be made at both porta. It is also important that 
most of these vessels should come to the tropical port free from stegomyia. 

For the solution of the fourth question, vessels arriving free from et^gomjiA lying 
at moorings at different places in the harbor should be examined. I can not think 
much would be leamea by examining any vessel l]ring at a wharf, like those in 
Habana; she would almost certainly acquire stegomyia. Similarly the examination 
of vessels arriving with stegomyia aboard — no matter where they lay — would give, I 
think, no useful data. I think that in this latter category would fall the regular 
liners from the Gulf and South Atlantic ports. Of the regular liners at Caban ports 
I think the Ward and Munson vessels offer the best chance for this information, or 
would if the New York quarantine people would cooperate with us. 

However, many vessels come clean of stegomyia to Habana from European ports 
and clear for United States ports from Philadelphia south. Indeed, we can do with- 
out the cooperation of the New York people by letting the bowl placed aboard in 
Habana stay aboard until the vessel returns to that port, the chance of getting 
stegomyia alward in New York being so small that it may be neglected. 
Respectfully, 

H. R. Oabtbr, tSiirgeon. 

The Surgeon-General Pitrlic Health and Marine-Hospital Service. 

DISINFECTION AT MEXICAN PORTS OF VESSELS SAILING FOR THE 

UNITED STATES. 

The following letter of instruction was sent to each of the medical 
officers at Vera Cruz, Tanipico, and Progreso relative to disinfection 
of vessels leaving for United States ports: 

[Letter.] 

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

WashingUmy May 18, 190S, 

Acting Amstani Surgeon in Charge, I^jUIc Health and Marine-Ho9pilal Service, care 
United States Ckmsvlate: 

Sir: You are informed that the Bureau has tentatively entered into an arrange- 
ment for the disinfection of vessels of the regular lines sailing from Vera(>u«, Tampico, 
and Prc^reso for points on the Gulf coast of the United States, which arranflie- 
ment is in effect a disinfection of the vessels by their owners under the supervision 
of a service officer, in ordet to meet the objections of the Mexican Groveniment to 
the establishment of disinfecting plants in Mexican ports. 

Under the provisions of this agreement, each one of the regular lines will provide 
on board of each of their vessels a designated number of pots (Dutch ovens) for sul- 
phur fumigation and an equal number of water containers for use in oonranction 
with these pots, and the companies will agree that the orders of medical officers of 
the Public Health and Marine-Hospital l^rvice with regard to the dlMnfection of 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 131 

their vessels above referred to, shall be rigidly carried out by the captains of their 



The disinfection in all cases is to be done after the vessel has left her dock and is 
IviDK well out in the stream, so as to prevent any fresh influx of mosquitoes aboard 
me vessel, if sach prevention is at all possible, and the method to be pursued will 
be as follows: 

Each compartment of the vessel must be subjected to a fumigation with sulphur 
dioxide gas of 2 per cent volume for at least two hours. This volume of gas is 
obtained by bummg sulphur at the rate of 2 pounds for each 1,000 cubic feet of air 
space to be disinfected. The compartments must in each case be tightly closed. 
The two hours prescribed is deemed sufficient to kill all mosquitoes— the object 
desired. 

To prevent danger of fire the sulphur should be burned in the following-described 
manner: Place a Dutch oven in a tub or pan of considerably greater diameter than 
itself. The tub or pan should contain water to a depth of at least 2 or 3 inches, and 
if the Dutch oven has no legs to raise it above the water level, brick or stone may be 
mbstitated. No Dutch oven should be more than half full of sulphur, a portion of 
which should be pulverized, and a small quantity of alcohol poured thereon and 
the flame started with a match, great care being taken to observe in each case before 
dosing the door that the fire is well started ana there is no danger of its going out. 

This process is to be simultaneous in every part of the vessel except the engine 
rooms, which are not believed to need it, and the passengers must be put on deck 
under an awning or in some other manner provided for until this fumigation is over. 

It is imperatively necessary, and in no instance must there be any departure from 
the rule, that this fumigation shall take place after the vessel has cleared, all passen- 
ms and crew are on board, and no one else shall return ashore subsequent to this 
disinfection except yourself, and you must in all cases remain on board until two 
hours' fomigation has been assured under your observation. 

When you have assured yourself that all these matters have been attende<l to, you 
will fttmish the captain with a certificate stating exactly what has been done, and 
then allow the vessel to proceed on her voyage. 

Respectfully, Geo. Purviance, 

Acting Surgeon-Genercd, 



VERA CRUZ. 

Report of Transactions at Vera Cruz, by As«t. Surg. Joseph Goldjierger. 

U. 8. Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Vera Cruz^ Mexico^ July 6, 190S, 

Sir: I have the honor to transmit herewith a tabulated statement of the transac- 
tions of this station for the year ended June 30, 1903. It will l)e noted that this 
covers only the six months of the quarantine season, or, more accurately, only five 
and a half months, inasmuch as the transactions for May date from the 18th of that 
month, the date of my taking charge. 

During the period under consideration, bills of health were issued to 148 vessels, 
which were manned by a total of 6,015 crew, and carried 2,699 passengers. The 
hills of health are issued after inspection, and are signed jointly by the consul and 
myself. 

The boarding of vessels is done either at the wharves or anchorages. In the latter 
case it is done in a small boat provided by the vessel's agent or in one hired by the 
Service. 

This station is provided with one Kinyoun- Francis autoclave, which will require 
overhauling and repair to be made serviceable. In view of our knowledge of the 
mode of transmission of yellow fever (the only disease that need be considered with 
reference to qnarantine measures to be taken at this port), this apparatus is more 
than sufficient No disinfection was done during the period under consideration. 
Bespectfolly, 

Joseph Goldbeeger, AssiMarU Surgeon. 

The SuBaaox-GiNiBAL Pufuc Health and Marine-Hospital Service. 



182 PtJBLIO HEALTH AND MARINE-HOSFITAL 8EBVICE. 





Vera Cni2 foreign 
June SO, 190S. 


^iMtrorKirK tiation fo 


ryear 


e„di^ 




July. 1 Aug. 


Sept. 


Oct. 


Vij. 


Jane. Tout 




1,4 i 4 


■a 

1.062 
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l.OK 


i 

4Z7 




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Public Hbalto and Marinb-Hospitai. Skrvice, 

Opficb of Medical Officer in Comuano, 

Tampico, Mexico, SejpUmber gO, 1902. 
Bir: As directed b^ Bureau letter of May 27, 1902, 1 hav6 the honor to fepoK 
herewith the transactions of the Service at thia port from Jaly 1 to and incluoing 
September 15, 1902. During thia period there were inspected a total of 78 Teawls, 
2,410 oSieerH anil crew, and 133 passengers. Included in thia ere 23 vessels (xrrriog 
535 officers and crew and 4 paasengers, cleared for Cuba, which were inspectea on 
behalf of the Cuban Government 

There were issued two certificates: One, of immunity from y^ellow fever to a con- 
valescent from that diaeaae bound to (jalveeton to rejoin his ship; the other of free- 
dom from infection of the dead body of a Cuban who died here of poisoning by 
headache powders and nephritis. 
There were no vessels nor baggage disinfected during this period. 
The port has been free from quarantinable disease except for two cases of yellow 
fever imported from Vera Cruz, Doth of which were reported to the Bureau. 
Respectfully, 

Joseph GoLDBEROKa, Atnitemt ^rgeaa. 

SUROBON-GBNBItAL PltBUC HBALTH AND MaRINB-HOSPITAL SbSVICB. 

During the summer of the present year yellow fever has been epidemic 
in Tampico, and the large number of vessels plying between this port 
and the Gulf porti^ of the U nited States, together with the shortness of 
time consumed on the voyage, has made the danger of the carrying of 
infection very great. Acting Asst. Surg. John Frick was taken sick 
with malarial fever on June 23, 1903, and was unable to perform his 
duties. A local physician wa-s selected by the consul to perform his 
duties temporarily, during his absence on account of sickness. 



June so 


1903, by Acting Ant. Sarg. John Frict. 


year 


eTuUd 




JuIt- 


Aug, 


- 


Oct. 


«ov. 


Dee. 


Jul 


^b. 


Uar. 


Apr. 


May. 


June. 


ToUI. 


''l^'^TT.. 


























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40 

i 


S 


K 


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n 


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PUBLIC HEALTH AND MAEINE-HOSPITAL SEKVICE. 






TKAKBACnONI AT PrOOREBO B 



Acting Asbt. Si'ro. J. F. HARRiaoH. 



Pdbuc Health and Marinb-Hobpital SsHvirR, 

Opficb of Mbdical Officer in Cohmahr, 

Progreio, Mexico, August SO, 190S. 
Sib: I heremth inclose report forpart of Maj' and the whole of JuDe, 1903, the 
period covered Id my records — May 20 to June 30, inclueive. 
Bespectfollf, 

J. F. Harbison, 
Acting AuuUml Surgeon. 
SintQBON-GKNKBAL Pdbuc Health and Marinb-Hobpital Sbbvick. 



[InckHUre.] 



AnnwU report of traruadiont a 







n 


F.HuTlwn 


kcUDgMdl 


Upl^rgeon.) 












lulj. 


Ans. 


S«pL 


Oct. 


Not. 


-1- 


Feb. 


Mm. 


Apr. 


1I«. 


June 


Total. 
























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4S 
43G 

a 




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JalTlOiUOS; dupllcate.Augiuta), 1903. 



Central and South America. 

fruit pobt insfecnon bebvice — season of 1902— july to november. 

port lihon. 

Bepobt oi TRAjraAcnoNS at Pobt Limon, Cobta Rica, by AcnHO Aasr. Surq. 
Wm. H. Carbon. 

Pdbuc Health and Marinb-Hospttal Sbsvicb, 

Office of Medical Officrb in Command, 

Port Limon, OoOa Rica, September 16, 1903. 
8ib: I hare the honor, compljring with Bureau letter dated May 2tt, 1902, to trans- 
mit herewith my Bupplemental report of transactions at this station from July 1, 1902, 
to and incltidiiig September 15, 1902: 

Passengers inspected from this port 209 

Paanngers inspected in transit 261 

Vaccinated 

Vessels inspected 61 

Ve«els dinnfected 

Pieces of baggage inspected 2 

Hecea of baggage dial niected 2 



134 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVIOE. 

There were 75 deaths here from all causes, mainly due to malarial fever and gastro- 
enteric diseases, and there were 11 cases of yellow fever, 7 originating in this port, 
4 being brought here from points on the Costa Rica Railway between this port and 
Saji J<^, the capital, only 2 of these cases resulting in death. 
Respectfully, 

Wm. H. Cabson, 
Acting Assistant Surgeon. 

Surgeon-General Public Health and Marine-Hospital Service. 



PUERTO CORTES. 

Reports of Transactions by Actinq Asst. Surg. S. H. Backus. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 
Puerto Cortes, Honduras, September 25, 1902. 

Sir: I have the honor to hereby make my report of the transactions at this station 
from June 30, 1902, to September 15, 1902: 

Vessels inspected 29 

Passengers inspected H9 

Pieces baggage inspected 30 

Pieces^ba^age disinfected 160 

Respectfully, 

Samuel Harris Backus, 

Acting Assistant Surgeon. 

Surgeon-General Public Health and. Marine-Hospital Service. 



Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Puerto Chrtes, Honduras, October 30, 190S. 

Sir: I have the honor to herebv make a report of transactions at this station from 
September 1«5 to October 31, and also a r^sum^ of the entire work done here this 
season: 

Vessels inspected 20 

Pissengers inspected 39 

Pieces baggage disinfected 63 

report on total work done. 

May 1 to June 27 (30): 

Vessels inspected 23 

Passengers inspected 77 

Piecas oaggage disinfected 120 

June 27 (30) t« Septeml)er 13 (15): 

Vessels inspected 29 

Passengers in8|)ected - 89 

Pieces baggage disinfected 160 

Septeinl)er 13 (15) to October 25 (31): As above. 

May 1, 1902, to October 31, 1902: 

Passengers inspected 205 

Vessels inspectcil 71 

Pieces baggage disinfected 343 

Respectfully, 

Samuel H. Backus, 
Adlxng AsfMiacni Surgeon, 

The Surgeon-General Public Health and Marine-Hospital Sbrvicx. 



PUBLIC HEALTH AND MABINE-H08PITAL SERVICE. 



135 



BOCAS DEL TORO. 
RXPOBTB OF T&ANBACnONS BY ACTING ASST. SURO. PaUL OotBRHOUT. 

Public Health and Marine-Hospital Service, • 
Office of Medical Officer in Command, 
Bocas del Toro^ Colombia, September 16, 190S, 

8ib: As per instnictions contained in Bureau letter dated May 28, 1902, I have the 
honor to transmit herewith a supplemental report of the transactions at this station 
for the period from July 1, 1902, to September 15, 1902, inclusive: 

Vessels inspected 33 

Persons inspected: 

Ships crews d51 

Passengers 2 

Total 653 

No baggafce inspected or disinfected. 

Respectfully, Paul Osterhout, 

Acting Assistant Surgeon, 
The Surgeon-General. 



PuBUc Health and MARiNs-HosprrAL Service, 

Office of Medical Officer in Command, 
Boccu del TorOf Colombia^ November 5, 190^, 

Sir: I have the honor to submit the following report of the transactions at this 
station for the period September 16, 1902, to November 1, 1902, inclusive: 

VesBelfl inspected 17 

Persons inspected: 

Ships crews 332 

Passengers - 29 

Total 361 

Pieces of baggage inspected 22 

Pieces of baggage disinfected 20 

Respectfally, 

Paul Osterhout, 

Acting Assistant Surgeon, 
The Surgeon-General. 

CEIBA. 



Report of Transactions by Acting Asst. Surg. W. B. Robertson. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 
La Ceiba, Honduras, C, A., September 16, 190fS, 

Sib: I have the honor to submit the following supplementary report on the condi- 
tions and transactions at this port from July 1 till September 15, 1902, inclusive: 

The ^neral conditions remain the same as those stated in the general report for 
the period ending June 30, 1902. 

There has, wim one exception, been no passenger traffic from this port. The 
statistics are: 

Passengers inspected 1 

Passengers vaccinated 

Vessels inspected 25 

Vessels dismfected 

Heoes of baggage inspected 1 

Pieces of baggage dismfected 1 

The general health of the crews of the vessels inspected has been uniformly good. 
Repeated searches for the presence of mosquitoes aboard the vessels at anchor in 
this harbor have been attended with negative results. 



136 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

General remarks. — The estimated population is about 4,000. The deatha during 
past two and one-half months about 12. 

The prevailing diseases have been principally malarial, and usually mild types 
thereof. Some pneumonia and bronchitis, also a few cases of phthisis. 

The general health conditions of the port and vicmity for the period have been 
uniformly good. 

On Julv 16 to 18 an inspection was made of the islands of Utilla and Roatan and 
the health conditions there found to be good. 

On September 4 an inspection trip was made to Truxillo and the health condi- 
tions ttiere found to be very good. 

On August 21 assumed temporarily the duties of resident inspector for the 
Louisiana State board of health, vice D. P. Ahrons, absent on sick leave. 
Respectfully, yours, 

W. B. ROBEBTBON, 

Acting Asn^ani Surgeon, 
The Surgeon-General. 



BLUEFIELDS. 

Report op Transactions by Acting Asst. Surg. D. W. Goodman. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

BluefieldSf Nicaragwij September 16, 190t, 

Sir: I have the honor to submit the following report of the transactions at this 
station from July 1, 1902, to and including September 15, 1902: 

Twenty-three 8hii)s have l)een examined and given bills of health for ports of the 
United States; 49 passengers have been inspect^ and passed, and their 68 pieces of 
baggage have been disinfected. In addition, the clotning'of about 40 laborers for 
each of the 23 fruit vessels was disinfected prior to their going aboard the vessels to 
receive and store the fruit. 

This has been an unusually protracted and severe rainy season, resulting, however, 
in keeping Bhiefields in a healthful condition, the immense amount of water flushing 
the natural and artificial sewers and washing all surface filth into the lagoon. Twelve 
deaths have occurred in the two and one-half months, which, based on an eetimated 
population of 4,000, gives a rate of 14.4 per 1,000 per annum. None of these deaths 
were from quamutinable diseases, tuberculosis ana malarial fever being given as the 
cause in the larger number of the deaths. 

Respectfully, D. W. Goodman, 

Acting Aatistant Surgeon. 

The Surgeon-General. 



BELIZE. 



Public Health and Marine-Hospital Servicx, 

Office of Medical Officer in Command, 
Belize, British Honduras, September tO, 190f, 

Sir: I have the honor to submit supplemental report of the transactions at this 
station covering the period from July 1 to September 16, 1902. 

From the Ist of July to 15th of Septem])er 26 vessels cleared from Belize for ports 
in the United Stat oh; 687 crew were inspei'ted; 59 passengers were given certificates 
from this port, and 1 13 pieces of baggage were disinfected. 

Of the 26 ve«8t*l8 cleareil, 16 were for New Orleans, 6 for Mobile, 2 for Pensacola, 
Fla., and 1 each for Norfolk, Va., and Boston, Mass. 

The health of Belize and adjacent country has remained good, there being very 
little sickness in the citv. During the inontns of July and Au^:u8t there were some 
ten or twelve cases of diphtheria in Belize with 2 deaths, which were reported in 
weekly report for July 26. 

Respectfully, R. H. Peters, 

Acting Assistant Surgeon. 

The Surc.eon-Cjeneral. 



PUBMO HEALTH AND MARINE-HOSPITAL SKRVICE. 137 

SEASON OP 1903 — APRIL, MAY, JUNE. 

On March 28, 1903, the following officers were detailed for service 
at the ports named for the present season, ending November 1, 1903, to 
inspect vessels, their cargoes and crews, leaving said ports for ports of 
the United States: Acting Asst. Surg. Fleetwood Gruver, Port Limon, 
Costa Rica; Acting Asst. Surg. C. S. Carter, Puerto Coi-tez, Honduras; 
ActingAsst. Surg. R. H. Peters, Livingston, Guatemala; Acting Asst. 
Surg. Paul Osternout, Bocas del Toro, Colombia; Acting Asst. Surg. 
W. B. Robertson, Ceiba, Honduras; Acting Asst. Surg. I). W. Good- 
man^ Bluefields, Nicaragua; Acting Asst. ourg. W. H. Carson, Belize, 
British Honduras. 

The following letter of instructions was sent to each of these officers: 

[Letter of instructions.] 

'' Treasury Department, 

Bureau of Public Health and Marine-Hospital Service, 

Washington, March ^8, J 90S. 

Sm: Referring to Bureau tetter of 24th instant, transmitting your appointment as 
an acting assis&nt surgeon at the alK)ve-named port, you are requested to obser\'e 
the following instructions in carrying out your duties. As soon as possible an order 
will be issu^ attaching you to the consular agency, in accordance with the law of 
Febroanr 16, 1893. 

You BDonld call upon the consular agent imme<liatelv upon your arrival and in- 
form him of your orders. The State Department will he requ^ed to instruct said 
oonsalar agent to transfer to vou the public property left in his custody by your 

EredeoesBor at the close of the last quarantine season, a list of which is inclosed 
erewith. 

I have transmitted to you under separate cover certain blank forms and printed 
iiiBtractions for your guidance as described below, a copy of the United States quar- 
antine laws and r^ulations with amendments to date, also copy of the special rules 
provided for the government of vessels engaged in the fruit trade between the fruit 
ports of Central and South America and the ports of the United States, as promulgated 
m Department circular No. 134, of August 31, 1900. Amendment to the last-nameil 
ciicnlar is inclosed herewith, reducing the i)eriod of detention of pros))ective passen- 
gers from ten to five days. ' 

Baggage of passenj^ers bound for places north of the southern boundary of Mary- 
land ne^ not De dismfected. 

I have to also transmit a supply of two blank forms, one of which is an individual 
certificate to be issued to each passenger about to embark on a fruit vessel bound to 
a United States port; the other is a certificate to be issued to the master of the vessel 
as an adjunct to the bill of health, which certificate he may deliver, if requeste<l, to 
the quarantine oflScer at the port of arrival. One copy of each certificate issued by 
you should be inclosed with the weekly report from vour station. 

Your attention is called to the spread of yellow fever through the agency of the 
mosquito known as the stegomyia fasciata, and special precautions should t>e taken 
to prevent their presence aooara vessels. 

At the close ot each week you should transmit a report of conditions and transac- 
tions at your port on the blank form, a supply of which has l)een forwarded. 

Should yellow fever break out at your port you are requested to immediately cable 
the Bureau. Yon should keep complete records of all transactions in order that a 
report of the same may be submitted at the close of the season. You are informed 
that the active quarantine season for the States of Louisiana, Alabama, and Texas 
will take effect on the 1st day of April. 

You should, immediately upon your arrival, ascertain the amount of supplies on 
handf and should make timely requisition for replenishing the same, in order tnat you 
may be fully equipped to carry out the duties assi^ed to }rou. 

An immediate actnowledgment of receipt of this letter is requeste<l, and you will 
report to the Bureau the date of your departure and also the date of your arrival at 
destination. 

Respectfully, ^^ Walter Wyman, 

Suryeati- General' 



138 PUBLIC HEALTH AND MA BINE-HOSPITAL 8EBVICE. 

ADDITIONAL PRECAUTIONS ON ACCOUNT OF YELLOW FEVER AT POET 

LIMON. 

Owinf^ to an outbreak of yellow fever at Port Limon, Costa Rica, 
it waa considered necessary to take additional precautions to prevent 
infection of passengers or crews on fruit vessels bound for the United 
States. Hence the following telegram was sent to the medical officer 
stationed at Port Limon: 

[Telegram.] 

Washington, July 8j J903. 
GRUViai, American ConsiUaiey Port Limony Costa Rica: 

During prevalence yellow fever take temperature passengers and crews veseels 
boimd for United States. Detain all with temx)erature above normal. Authorize 
to purchase dozen thermometers. 

Wyman, Surgeon- General. 

After sending the above telegram the following circular letter of 
instructions was forwarded to the medical officer for his information 
and guidance. A copy of this letter was also sent to all the medical 
officers serving at the fruit ports in South and Central America for 
their instruction and guidance. 

[Circular letter.] 

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

Washington f July 11, 190S. 

Sir: Should yellow fever break out at your port, you are directed to take the tem- 
perature of the passengers and crews of all vessels leaving the port for ports of the 
United States, and if the temperature of an}rone is found to be above normal you 
will detain the patient until positive diaj^nosis can be made. These precaotions 
relate to yellow fever only. You will realize the importance of this precaution when 
you are informed that auring this season two instances have occurred in which 
persons sick with yellow fever have been allowed to sail from a port infected with 
yellow fever to the United States. Hence the importance of taking the temperatare 
of every person who leaves a port infected with yellow fever before granting the 
bill of health. 

You are especially directed to personally supervise the taking of temperatureB so 
that no fraud can oe practiced, such as holding ice water in the mouth before inser- 
tion of thermometer, or keeping the mouth open, etc. 
Respectfully, 

Walter Wyman, Surgeon-GeneraL 

OFFICER AT LIVINGSTON AUTHORIZED TO ISSUE CERTIFICATES TO 
VESSELS SAILING FROM PUERTO BARRIOS. 

[Ixjtters.] 

I^uBLic Health and Marine-Hospital Sbrvxcb, 

Office of Medical Officer in Command, 

Livingstony Guatemala, April 14, 190S. 

Sir: I have the honor to ask for instructions as to Puerto Barrios. I find no record 
in the office here as to former actions in regard to same. Puerto Barrios ia only 
about 12 or 13 miles from Livingston, and is under this consulate. Nearly all the 
passengers embark from there on the mail steamers, and it will be nebessanr for me 
to go there to issue certificates, as well as in Livingston. I would reepectrally ask 
for copies of former instructions, or for new ones, as to my duties at Paerto Barrios, 
as I do not like to act without authority in such cases. 

Respectfully, R. H. Petebs, 

Acting Asgittant Surgeon. 

The Surqeon-General. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 139 

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

Washingiariy April 24^ 190S, 

i: Referring to your letter of the 14th instant, re^uestinff to be authorized to 
Paerto Barrios, to be present on the day of the sailing of tne mail steamers from 
port so that you can issue certificates to passengers embarking there, you are 
med that you are authorized to make these necessary visits so that you can con- 
tioofily sign the certificates and bills of health, 
direction of the Surgeon-General; 
R^pectfully, W. J. Pettus, 

Am9tai\t Surgeon-General, 
ting Asst. Surg. R. H. Peters, 
V. S. Public Health arid Marine-HospUal ServicCy 

Livingstorif Guatemala, 

PORT LIMON. 
report op transactions by acting asst. SURG. FLEETWOOD GRUVER. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Port LimoUf Costa Bica, July 1, 1903. 

v. I have the honor to inclose herewith a tabulated statement of transactions at 
port for that part (from April 9, 1903) of the year ending June 30, 1903, during 
fi I have been in charge of this station. I subitiit also a supplemental detailed 
't of conditions and transadious during that period, 
lire my arrival here, on April 9, to date this port has not been free of yellow 

infection. Within that period 40 cases have oeen treated at the several hospi- 
vith a total mortality of 11, an increase, as compared with the record of the same 
ter in 1902, of 22 cases and 10 deaths. Total number of deaths from all causes, 
ter ending June 30, 1903, was 66, or an annual death rate for the quarter of 6oi 
L,000. During the same quarter in 1902 the total number of deaths was 46; 
al rate per thousand, 46. 

e sanitary condition of Limon continues very poor, and yellow fever infection 
nfined to no particular section. Many of the cases come from the interior. 
, Rio Blemco, Matina, and Castro, small settlements within a radius of 30 miles 
men, are infected. The infection of Rio Blanco seems directly traceable to the 
ity Hospital here. In this case I would report that fomites seemed to play an 
rtant part in the primary infection of Rio Blanco, which, with a susceptible 
lation of about 15, furnished 5 cases. However, the opportunities of studying 
)aratively the mosquito and fomitic theory of the origm of yellow fever are so 
lere that no intelligent report can be rendered on that subject. 
e Limon cuartel or jail has furnished 8 cases of yellow fever, and a^in fomites 
ed to be an important causative factor. The infected houses in Rio Blanco were 
gated with sulphur, but, owing to the open character of the structure^ I would 
o no purpose. The same can oe said of the cuartel, which was fumigated by 
18 of formaldehyde gas generated by an autoclave. 

le recommendations for sanitary improvement on the part of the city officials in 
m to the faculty at San Jos6 were, I understand, never transmitted, and the 
ity of the authorities in cleaning the city, reported to you under date of April 24, 
«ased. (See Public Health Reix)rts, May 15, 1903, p. 750.) The only sanitary 
fures really enforced are the quarantine against Bocas del Toro on account of 
lj)ox and compulsory vaccination here. 

iring the quarter ended June 30, 1903, I have examined and passed 60 steamers 
'nited States ports, as follows: For New York, 19; New Orleans, 31; Mobile, 8; 
> Rico, 2. Oi the steamers clearcnl for New York 7 were fruiters with c^rgo 
id direct to England. These took American papers in case it should be found 
ssary to put into New York. 

.e health of the passengers on all the steamers examined was good. A few cases 
lalarial infection were noted among the crews of several steamers, and after 
lination allowed to proceed. On May 30 David Close, a fireman on the steam- 

AppomattoXf suffering from typhoid fever, was removed to the United Pruit 
pany's hospital, where he subsequently contracted yellow fever. 
e sanitary condition of the steamers was, with a single exception, satisfactory, 
exception was in the case of the steamship John. Bright^ whicn was cleaned and 
gated before being allowed to proceed to Mobile. This was reported under date 
ay 21. 



140 PUBLIC HEALTH AND MARINE -HOSPITAL SERVIOE. 

From the reports of medical officers and maatere of eteameia arnTing here I find 
a unanimity oi opinion as re^rdii the nseleeeneee of pyrethrum powder fomigatim 
for the destruction of moequitoes. The observations as to the length of time the 
mosquito remains on hoard during the voyage from here to New OrieMu or Hobik^ 
and from there here, varies from two daya to the entire trip. 

Intercourse with the shore by all vessels intending to clear for a port in the United 
States has been reduced to a mmimum. The import«Qce of this reguIatioD is shown 
Iq the experience of the sloop Simbeam, which arrived here in the early part of Hsf 
from Bluefields. It had open communication with the shore and a member of the 
crew developed yellow fever on the return trip, 

binally, I have to invite attention to the thoroughly nnreliahle chaiscter of the 
bills of health issued by the health authorities and the foreisra conanla here. With 



m ports. The minister of the interior, Doctor Floree, himself a phymcian, al 

Teceiving a tel^rom from the medico del pueblo of Limon, reporting yellow iever 
here, ordered a clean bill of health to be issued. 
Respectfully, 

Flketwood Gbutxb, 
Acting Aiii»tant Surgeon, Public Health and Marine-Hoipitat Semet. 
The SuBasoN-GEHEBAL, Public Hbaltb and MAEiNE-UosprrAL Sebvick. 



[laclosure.] 
Summary of trataadiant at Port lAmon, Co^a Rica, for the quarter ending Jtate SO, ISOS. 
[Thii report ii [oi Ibo period from April ID lo June 30, IMH.— Pleelwood Orover, actlac uAttat 





... 


AiiK. 


Sept. 


Oct. 


Krtv. 


nec- 


Jan. 


Pub. 


MBf. 


Apr. 


M.y. 


lone. 


TouJ. 


Ve«jM. spoken 
























893 


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PCEBTO COBTB8. 

Rbpokt op TRANaACTioNH Bv AcTTiNO ABSiaT. Strsa. C. 8. Cabteb. 

Public Hiulth and Mabinb-Hobpftal Bebvich, 

Office of Medical Opficbb ih Cohhamd, 

Puerto Oirta, Hondara*, July J, 190S. 
Sir: 1 have the honor to submit the following report of transactions for Pnerto 
CorieH lor the quarter ending June 30, 1903: 

Certificates have been issued during the months of April, May, and Jnne to 50 
Rteamers. One hundred and forty-three passengers have t>een given certificates, and 
229 pieces of baggage have been disinfected. 

I also vis6d the consul's bills of health of the shipfl of the Caribbean Bqnadron; 
also the steamship Maneunia going to Boston, and schooner Oarib II, bound for Ne* 
York. 

Our efforts here against the moeqaito have consisted of three methods, the fumi- 
gation of all b^^^^ by steam and formaldehyde, and the baniing of pyrathmm 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 141 

owder in the forecastle, cabin, and quarters of the vessel immediately before sailing. 
Jso, all of the captains are requested to keep covered up all the open water vessels, 
nd if possible to nave the cabm and quarters screened m and to use mosquito bars. 
teazners which I have boarded on their arrival have been mostly free from mos- 
nitoee. Only two have complained of having them during the vovage down. 

After using the pyrethmm powder captains have stated that the ship has been 
nee from tbem after leaving the port, while before having used the powder quite a 
lumber were found on board at least one day out and probably longer. This pow- 
er baa added much to the comfort of officers and crew, and especially the crew. 
Hiile this powder has been a great help in ridding the ship of these pests I do not 
hink it could be relied on entirely for tneir destruction. 

The health of this port has been very ^ood, and there has been very little sickness 
luriiig the past three months, the prevailing diseases being malarial fever of a mild 
orm, and intestinal troubles. 

At San Pedro, 36 miles from here, on the line of railroad, there is considerable 
ickness among the children (cholera infantum) and several cases of dysenterv. 
leveral deaths nave occurred from the former, and as far as I have learned only 
toe from the latter. Information received from as far into the interior as the 
apital, shows that there is no contagious or quarantinable diseases of any kind, 
ieporto from the Pacific coast say while no yellow fever has been announced, 
here have been several cases of pernicious fever, with several deaths. The sick- 
less mentioned at San Pedro is due to the drinking water, which is very bad. 
The general sanitary condition of the place, for a tropical town, is fairly ^ood. 

The different small towns along the coast report no sickness of any kind. Since 
be change of administration at this port, the health authorities seem to be taking an 
ctive interest in having the town put in proper condition; streets are being cleaned, 
■tile roonded up, grass cut, yards cleanea, etc. 

The chief of police, who is the head of the health department, informed me that 
le was going to issue an order that all water tanks and open water vessels should be 
overed and oil should be placed in each of the tanks and in vessels in which water 
ras kept for any purpose. As he is a very efficient officer, I think this order will 
e earned into effect. 

Any vessel coining to this port with a contagious or infectious disease on board 
roula be promptly quarantined and treated very energetically by the authorities at 
tiis port 

COMMUNICATION WITH PACIFIC COAST TOWNS. 

In regard to communication from infected Pacific coast towns, a person coming 
iirect from the Pacific coast to Puerto Cortes would take from twelve to fifteen days 
n route; via Puerto Burios, about seven days; coming from the Mexican border via 
Belize, sailing vessel or steamer, about five days. 

All pMersons who wish to go as passengers to the United States must have a consu- 
ar certificate or reliable physician's certificate stating that the passenger has been 
ipder his supervision for five days prior to starting for this port These certificates 
iTB placed on file for future reference, if necessarv. Special attention has been paid 
o persons from interior points and from the Pacific coast towns. Only three passen- 
gers have sailed from here who have been to the coast, returning this way. 

VESSBLS LOADING ON COAST. 

The United Fruit Company has one vessel which loads along the coast, going to 
Tela and Omoa. The J. d. Cefalu Company has one vessel. This steamer only goas 
JO Omoa, 20 miles away. These vessels nave been inspected from time to time while 
)n the coast by the representative of the Louisiana State board as well as myself, and 
the r^ulations are carried out as far as the captain's word goes. I understand that 
iieie nave never been inspectors on board these ships, but if yellow fever should 
sreak out I think that, unless the inspector stationed nere inspects them, insi)ectors 
ihould be placed on these vessels. 

Respectfully, C. S. Carter, 

Acting Assiglani Surgeon. 

TheJSUBGJBON-GKNSRAL, PUBLIC HXALTH AND Ma&INS-HoSPITAL SsBVICJS. 



14'i PUBLIC HEALTH AND MARI N E -HOSPITAL SERVICE. 

[[uctomrc.J 
Summary of trantadUfru at Puerto Cortes, Honibirai, for quarler tndtd Jutu SO, ISOS. 





July. 


.» 


Sept. 


«.. 


N„. 


Dec. 


,„. 


Feb. 


.., 


Apr. Ubj. 


June. 


ToUI. 






o 






























O D 


» 


M 




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Balllng venels In- 








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Crew OB Mlllng 


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ingVBBClH 





Rejected fi plecea buggage (boie 



-1 



LmNGffTOS. 

Report of Tranxaltionk bv Acting Abbt. Sdrq. R. H. Petbrs. 

PtiBtic Health and Marine- Hospital Sbbvick, 

Ofi^icb of Medical OFricBR in Coxhahd, 

Liinngelon, Gnale7n(da, Jviy 6, 1903. 

Sir: In compliance with Bureau letter, June 13, 1903, directing the forwarding of 
report of transactions at this etation tor fiscal year ending June SO, 1903, I have the 
honor to Hutinjit the followintc report; 

The station was opened on April 7, 1903, from which date active work commeaced. 
Ab directed in Bureau letter of April 24, 1903, I have regularly visited the port of 
Puerto Barrios to inspect the mail sleamers and issue certincatee to paseengen 
embarkina; there. No passengers have left LivingBton direct, as the steamers from 
this port do not carry tnem. The I^uisiana boanl of health has a steam -disinfert- 
ing chamber at Puerto Barrios which has been need for diBinfectins bag^ige, but its 
uae has been discontinued. All liaggf^ is sealed and kept eealed until arrival at 
the Mississippi Kiver quarantine station, at which place it is subjected to steam 
disinfection. 

Since the opening of the station 26 vessels have been inspected and given certifi- 
cates, and 617 crew inspected; 99 passengers were given certiflcatee, and 141 pieces 
of baggage disinfected. 

Of the 26 voFRcIs cleared 14 were from Livingston and 12 from Puerto Batrioa. 
Their destination in the United States were: New Orleans, 16; Mobile, 7; New 
York, 1. Livinj!7<ton has been free from all c|uarantinable diseases^ and there has 
been very little BJcki 



there were a number of c 

trouble is malarial. 

Respectfully, 

The Suboeoh-Gbnrra!., 



the town. In the ^ast part of May and first of June 
of varicella of a mild type; otherwise the prindp*! 



R. H. : 
Aaing AuuUng Surgetm, 
i Marin K-HoePTTAL Bervicb. 



PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 143 

[Inclomre.] 
SammaTtf of Iraniiaetumi at lAringilon, OvaUmaUt, /or guarler ending JuntSO, 1903, 





July. 


Aug. 


Sept 


Oct. 


Nor. 


Deo. 


"-■ 


T>A. 


Mar. 


Apr. 


M«r. 


Jnne 


Total. 






























^^^^ 




















7 


« 


10 


2S 
























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«7 






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BOCAB DEL TORO. 

Report of Actiko Abst. Suro. Padl OsTBiittoin'. 

PiTBUC Hkaltb and Marine- Hospital Bbrvicb, 

Opfice or Medical Okficbr in Comhand, 

Boca* lie! Toro, (Mojnbia, July 2, 1903. 
Sib: In obedience to instnictione contained in circular letter, datvil May II, 1903, 
pertainiDK ti 
30, 1903,1 h. 

In idoition to this there were IT piecee of baggage disinfected by me. 
The ohIt pablic property at thie etation ie tbe fumigating apparatus, and tliat is in 
Edrij Rpoa condition. 

Beqiectfally, Paul OerBRHour, 

Acting Aitailant Surgeon. 
Tbe Suxobon-Gkhkbal, Public Health and Mabine-Hobpital Sebvicii. 



[Incloirare.) 
of trmaaetions at Boeat del Tom, OAombia, for quarter mding June SO, 190S. 





July. 


Aug, 


Sept. [ Oct. 


Nov. 


Dec. 


J.n. 


Feb. 


War. 


Apr. 


Msy. 


Jooe 


T..tal. 














































16 


ir 


16 


49 


Etnmen dl.in- 




















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144 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

CEIBA. 

Report op Transactions by Acting Asst. Surg. \V. B. Robbrtbon. 

Public Health and Marine- Hospital Service, 

Office of Medical Officer in Command, 

La Ceiba, Hondunu, July 1, 1903, 

Sir: I have the honor to submit the following general report of the conditions and 
transactions at this station from the date of opening till Jmie 30, inclusive: 

This station was reopened April 13, and active quarantine began at once for the 
States of Alabama, Lomsiana, and Texas; that for the remaining territory was insti- 
tuted May 1. 

There is a disinfecting plant, consisting of a Kuhn generator, replacing the auto- 
clave formerly in use, and a supply of wood alcohol for same. 

The boarding of vessels is done* by boats furnished by the agent or master of the 
vessel for which the inspection is made. 

The staff consists of an acting assistant surgeon only. Any labor required in 
boarding vessels or in disinfecting is provided by the fruit companies. 

The duties of the acting assistant surgeon consist in: (1) A general supervision of 
the shipping entering the harbor; (2) keeping a check upon the working of the ship; 
(3) inspecting vessels, crews, and passengers, and issuing certificates for same; (4) 
inspecting and disinfecting baggage, clothing, etc; (5) investigating the health con- 
ditions of the port and vicmity and furnishing weekly reports thereon, and indorsing 
same upon bills of health. 

At present no passengers are being carried from this port. 

Disinfection of baggage is not required up to the present, owing to the absence of 
passenger traffic. Should such become necessary, formaldehyde gas, from Kuhn gen- 
erator, would be used. 

Laborers' clothing is disinfected by sprinkling with formalin and keeping in a 
closed box for twelve hours. 

Total number of vessels inspected was 42 (39 steamships and 3 sailing vessels). 

Mosauitoes on vessels, — Repeated examinations have failed to detect their presence 
aboard the vessels in this port. 

General remarks. — The health conditions of this port from a quarantine standpoint 
have been excellent since the opening of the season, and such has, so far as can Iw 
ascertained, been the case for several years. But the local authorities place no 
restrictions upon traffic with infected ports. 

The estimated population is about 4,000. 

From April 13 to June 30 of this year there were only 6 deaths recorded, but owing 
to the disturbance of official system by the revolution and the consequent reocm- 
structive changes, the mortality records are not to be relied upon. 

The general health conditions are even better than for the same period of last 
year, though the average temperature has been higher with little or no rainhill, 
and the authorities now entering office seem disposed to improve the cleanlinesB and 
sanitation of the town. 

Malaria is the prevailing disease, generally manifesting itself in the milder forms 
of intermittents and short remittent«i, occasionally assuming the bilious remittent 
type, and in some cases being complicated by dysentery. 

The ascaris lumbricoidesis exceedingly prevalent in children. 

Respectfully submitted. 

W. B. ROBBRTBOK, 

Acting Asdst^ni Surgeon. 
The Surgeon-General, Public Health and Mabine-Hospital Ssbvicb. 



PUBUO HEALTH AND MAEINE-HOSPITAL 8EBVIGE. 14 

pnclomre.] 
Sujmnary q/ tnauactioru at Za OeUm, Hondarat, for quarUr ending June SO, 1903. 





Jul)-. 


AU«. 


Sept. 


OpL 


Nov 


D.e. 


J«.. 


FeL. 


M«r. 


Apr, 


V^y. 


JUflP 


Totol. 






























■^ar^ 


la 


« 


ID 


H 












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n 


H 


n 


■Ks!?-!-;. 














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BLITBFtELDS. 

Beport of TsANSAcnoNS BY Acrmn Asot. Sdbo. D. W. Goodkan. 

D Mabinb-Hospital Her vice, 
f Medical Qrrwait ih Couhand, 

Muefitldf, Mtaraffiin, Jvlii 1, 1903. 

Snt: I hare the honor to Bubmit the following as part of Die annaal report of 
traoMctions at this port lor the year ended June 30, 1903. It commences April 15, 
when this station waa opened for the quarantine season. Inclosed is tabulated state- 
ment of Bteamere inspected, with number of pasBengere and crewB thereof. 

The baggage of theee 62 paBsenjiers, 92 piecea in all, was disinfected by means of 
ritber the st«am chamber or formaldehyde, ae was also the elotbing of the laborera 
employed on the various fruit veseels loaded at this port. 

Bln^elds, from ita topomph^-, being situated on a lagoon at the loot of a ranro 
of hills, with a rolling simace inclining to the water's edge, is naturally healthful. 
Tinb previuling dieesset are mainly due to malaria and auto- infection from the intee- 
tinal tract 

The natare of the food and its improper preparation for digestion, used by the 
lower classes of the population, readily accounts for the latter condition; the pres- 
(nce of the anophelee and the many breeding places therefor furnished by the tanks 
of nuD water explain the former. 

For the trimester ended June 30 there occurred in this town of 4,000 inhabitants 
21 deaths from various causes. This rate — per 1,000 per annum — of 21 is larger than 
(or the last tew years, due to the 1 deaths in the Government hospital of aoldiers. 
<rf which an nnusually large number have heen kept here in anticipation of political 
tronble. 

The town has been tree of anyquarantinable disease, and, with proper precautions, 
aa be easily kept so. The only danger point is Port Limon, Costa Rir;a, 120 miles 
toath, with which there is occasional intercourse bv sailing craft. 

When Port Umon was reported infected with yelliiw fever by the actinjj assistant 
tnrgeon, United States Public Health and Marine- Hospital Service, in Apnl last^ the 
hf^th authorities here were so informed and were urged to take extra precautions. 
About May 1 they established a detention quarantine of six or more aays against 
(Taft« from that port This was most fortunate, for on May 8 the schooner Smibeam 
wrived here from Port Limon with a (ase of yellow fever aboanl. The schoonerand 
W personnel were put in quarantine, proper disinfection done b^ the sctingassistant 
mgeon, United Slates Public Health and Marine- Hospital Ser\-ice, at the request of 
the local aatborities, and sis days' detention and observation enforced thereafter. 
The nosJi recovered and no other case developed. 

The SUgomyiafatdatn does not abound in this port or vicinity, but exists in suffi- 
cient numbers to propagate yellow fever should favorable opportunities be given. 
KcepectfuUy, 



The ScBaaoH-GniXBAi, Vvblw Hkau 
H. Doc 33S 10 



D. W. Goodman, 
Aaing Amttant Sargeon. 
I AND Maeink HospTtM. BrasvcE. 



146 PUBLIC HEALTH AND MAEraE-HOSPITAL 8EBVICE. 

[laclomire.) 

ffammnry of tmTuactions at Bluefidds, Nicaragua, for quarier end'nxg Jnne SO, 190S. 

[D. W. Uoudnun, acting uniiunl aiugeon. Un1(«d SUtea Public Reallh &Dd Uaiine-HcHplta] Srartet.! 





July. A 


"i-"- 


0... 


S.O,. 


«... 


J.n. 


tub. 


«.,. 


Apr. 


M«y. 


June. 


roui 


''S£«T'"".'"'. 


I 






















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Bkpoht ov Transactionb by Acting Ahbt. Sl'ro. Wiluak H. Cabsoh. 

Public Health and Mabinb-Hospital Sbhvicb, 

Officb op Mbdical Ofpicek in Comhahd, 

Bdhe, British Hondunu, July 1, 190S. 
Bib; J liave the hooor, complying with circulnr letter dated May 11, 1903, to tren»- 
mit herewith my reportof the transactions at this etation for (April, May, andJane) 
the fiscal year ending June 30, 1903. 

No cont^giouB or inlectioua diseases of a quarontinable character hftve occomd at 
the port of Belize during the pa^it three months, and I can also reaaonably etale 
that equally satisfactory sanitary conditions [>revail in the surrounding territory. 

Forty-six deaths {4 white, 42 colored— 14 infants) occurred in the port o( Beliie 
(population, 6,500) during the past three months — April, May, and Jnne — mainly 



The SuROEON-GBNatiAL, Public Health a 



Wm. H. Carbon, 
Acting Amaiant Surgeon. 
Mabinb-Hospital Sbrvick. 



[Inc1o«ure.] 
■aiuaciimis lit Sdizf, Britith Ilondumt, fi/r quarter ending June SO, 190S. 
[William H. CBison. ■cling snlstent mirgeon.) 





Ji.ly. 


Aug, BepL 


Oct 


Mov. 


Deo. 


J«n. 


l^b. 


««. 


AlB. 


lUy. 


June. 


IM. 


VBMlnxpokenand 






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ast 


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atcsmen inspocl^ 




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, 





PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 147 

Hawah. 

title to quarantine island at honolulu confirmed. 

^he lonff-disputed title of the Government to Quarantine Island in 
Dolalu Harbor has been cleared, as shown by the following letter 
m the Acting Attorney-General: 

[Letter.] 

Department of Justice, 
WashingtoUj D. C, March ^5 y 190S. 

[r: I have the honor to transmit to you herewith sundry papers forwarded to 
Department by the United States attorney for the district of Hawaii with a letter 
3d the 17th of January la^t, all relating to the title to certain land at or near the 
bor of Honolulu, known as Quarantine Island, which is occupied by the Marine- 
^pital Service. Among these papers are the following-described instruments: 
. Deed of the Dowsett Compan^, Limited, dated June 30, 1902, granting to the 
ted States an imdivided half of the premises (which include said island), upon 
ain conditions therein expressed. 

. Deed of Alfred W. Carter et al., as trustees, dated July 9, 1902, releasing the 
[uises described in the deed next above mentioned from the operation of two 
ain deeds of trust made by said Dowsett Company, dated January 19, 1900, and 
reh 30. 1900, respectively. 

. Deed of the Oahu Railway and Land Company, dated October 16, 1902, grant- 
to the United States an undivided half of the same premises, upon the same 
ditions hereinabove referred to. 

liese deeds have been duly acknowledged and recorded. They are the result of 
>mpromise of an action of ejectment involving the title to the granted premises, 
terms of which compromise are more particularly set forth in the recitals of the 
t and last of the above-mentioned deeds. From an examination of the accom- 
lying papers I am of the opinion that the United States derives under said deeds 
ood and vaUd title to the premises thereby granted, subject to the conditions 
ireased therein. 

I am, sir, very respectfully, H. M. Hoyt, 

Acting Attomey-GeneraL 
"he Skcretaky of the Treasury. 

HONOLULU AND SUBPORT8. 

Report of Transactions by Passed Asst. Surg. L. E. Cofer. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

HonolxdUy Hawaiif July 7, 190S. 

ir: In compliance with Bureau circular letter of May 11, 1903, and also with 
reau letter of June 13, 1903, both letters being from the division of foreign and 
iilar quarantine, I have the honor to make the following report of all of the trans- 
ions at this station for the fiscal year ended Jime 30, IS^: 

ROSTER OF officers ON DUTY IN THE HAWAIIAN ISLANDS. 

'aased Asst. Surg. L. E. Cofer, chief quarantine oflScer for Hawaii, 
'art of Honolulu. — Passed Asst, Surg. L. E. Cofer (iii command), As^. Sure. 
C. Hobdy, Asst. Surg. F. J. Thornbury, Asst. Surg. J. M. Holt, Asst. Surg. R. L. 
Ison, Acting Asst. Surg. A. N. Sinclair, Pharmacist F. L. Gibson, Medical Inspec- 
E. F. Smith, Pilot FrMerick Rouse (steam launch}. Engineer Charles E. Bradley 
sam launch). Engineer B. B. Courtney (quarantine station), Engineer Samuel 
lao (channel wharf), and 17 attendants. 
^ort o/HilOf Hawaii. — Acting Asst. Surg. J. G. Grace. 
^ort of Kahvlui, Maui. — Acting Asst. Sure. John Wewldick. 
^orto/Kihgi, Maui. — Acting Asst. Surg. K. H. Dine^r. 
^ori <^ LahaiwifMaui. — Acting Asst. Surg. William Peters. 
^ort of KcHoa, Kauai— Acting Aest. Surg. E. G. Groodhue. 



148 PUBLIC HEALTH AND MABIHE-H08FITAL 8EBVICB. 

HONOLULU— I NCOMINO HCABANTISI. 

i^tmtnary of incoming 





July. 1 Aug. 


«.. 


Oct 


Sot, 


Dec 


Jan. 


Peb. 


Mar. 


Apr. 


Mar. 


iun. 


IMlL 




1 


17 

•a 


IB 

22 

32S 
3.<i6 


1? 
S.(BS 

i,ai 




20 

!.M5 
8.*5B 


17 
25 

2.ea 


W 

1,037 
B.215 


24 
23 



2D » 


» IS 

.»%=: 

178 3» 
2,309 g.6IS 




BlauBcndMnfoct- 


: 

3.5(» 


Ifl 

1,935 
330 


» 


lolled and 








Craw on sailing' 


nn 


PftsBenitera on 
Ine vends 


<i.n 



3 QDARANTIKB. 

Incoming ipuirariline Ir/imactiom at the mbporU in the Sawaiian Itiands. 



I^lialna.1 Eoloa. 



Venela liu>p«eu>d 

Crew Inspecled 

Fiusengen 1n^«cteil. 



The following restrictionB t 



] gnABANTlNB. 

« carried out in this division: 



( 1) Your veeset to lie not lees than 6 feet from the dock at all tiraee, with rat fan- 
nets and tar on all lines. PunnelB to be not leea than 3 feet in diameter. All ropM 
to be tarred for at least 2 feet immediately to the landward side of the funnels. Pnn- 
nels to be 80 placed that they will be at least 6 feet from the wharf, from all other 
ropee, and from contact with anything whatsoever, Fminels mnst be kept etiSened, 
so that the rim of same is at all times equally distant from the line encircled. 

(2) The gangway to be well 1i|;hted at night and a special guard (man) Btatiooed 
there to prevent any rats from goine aboard or comine ashore. When it is not piac- 
ticable Co have this gateway guard, you will have tiie gangway raised clear of the 
dock at night by not fese than 6 feet. 

(3) All peiBono to be on board by 10 p, m, every night and to pass the rest of the 
night on board, 

^4) This office must be notified of the intended shipment of all baggage and certain 
freight, as hides, scrap iron, household goods, and personal effects. 
(6) AH persons embarking at this port to be inspected immediately before sailing. 



(1) Must be fumigated unless they have laid either in the stream or at railroad 
wharf No. 2 during their entire stav in port In the latter case there most be no 
contact with other wharves or vessels. 

{ 2) Must not lie at night alongside of interisland steamers. 



PUBLIC HEALTH AND MABINB-H08P1TAL SERVICE. 149 

(3) Cfews must be inspected just before departure of vessel, and crew's bag^ace 
lost be disinfected at the United States quarantine wharf (Channel Wharf) the nignt 
elore sailing day. After crew's bagsage has been disinfected and^ returned aboard 
oar veeael it must not be unseal^, unpacked, nor disturbed in an^ way until 
ispected by the officer in chai^ge of outgoing quarantine business immediately before 
liuns. 

(4) Mafirt;erB must arrange personally for the disinfection of their vessels or else 
Iroagh their accredited commercial agents. 

RXSTRICnONB POB flTKAMXBS, IN ADDITION TO ABOVS POB BOTH fTTEAM AND BAILING VBaBRU. 

(1) An alphabetical typewritten list of cabin and steerage passengers in duplicate 
mbarking at this port to be furnished the officer in chaige of outgoing quarantine 
cisineeB two hours oefore sailing hour. 

(2) On day of departure as soon as hour for sailing has been determined upon the 
ifficer in charge of outgoing quarantine business must be notified of such sailing hour. 

(3) Steerage passengers ana new crew to report at United States quarantine wharf , 
oot of Punchbowl street, at 9 a. m. on the day prior to the steamer's sailing day, 
>ringing all baggage, after which permits for travel will be issued. Steerage pas- 
engers must have the final inspection at the gang plank upon the wharf and will not 
)e permitted to embark carrying personal effects, as hand oaggage, undisinfected. 

HONOLULU. 

The ontgoing quarantine transactions at Honolulu were as follows: Number of ves- 
sels di^fected, 113; number of vessels inspected, 197; number of cabin passengers 
inspected, 1,972; number of steerage passen^rs inspected, 2,156: number of crew 
inspected, 3,360; number of pieces haggaae disinfected, 3,931; number of hides disin- 
fected, 4,660; number of pelts disinfected, 1,024; number of bags of hide trimmings 
dianiected, 40; number of bags of bones disinfected, 79; number of cases of lily 
bulbs disinfected, 115; number of wharves fumigated, 6; number of pieces of freight 
disinfected, 4; number of pounds of sulphur consumed in disinfecting, 52,620. 

HILO. 

The outgoing quarantme transactions at Hilo, island of Hawaii: Number of ves- 
sels disinfectea, 14; number of crew inspected and passed, 229; number of cabin pas- 
sengers inspected and passed, 173; number of pieces of baggage disinfected, 382; 
number of vessels disinfected, 14. 

DIVISION OF QUARAKTINB STATION PBOPER. 

Number of persons detained under observation, 648; number of persons bathed, 
648; number of persons vaccinated, 1,042; number of ptersons sick with quarantina- 
ble disease, 4; number of })ersons sick with nonquarantinable disease, 15; number of 
pieces of baggage disinfected, 1,790. 

DIVISION OP FREIGHT CERTIFICATION. 

During the fiscal year just closed 197 vessels have had their cargoes certified to. 
This has been done by the shippers appearing at the office with the shipping permit 
containing a description of each package or set of packages. Each shipping permit 
has been indorsed when the shipment was not barred by regulations, otherw^ise a 
memorandum of the intended shipment was made and the articles ordered to the 
Channel Wharf for disinfection. The arrangement of certificates for freight from 
noninfected ports in the other islands of this group has been carried out at this office. 
The transactions in this division is roughly estimated at 3,940 certificates. 
Respectfully, 

L. E. COFER, 

Passed Assidani Surgeon^ Public Health and Marine-Hospital Service, 

Chief Quarantine Officer, Territory of Hawaii, 

The Subobon-General, Public Health and Marine-Hospital Service. 



150 PCBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Philippine Islands. 

assistant surgeon heiser detailed as chief quarantine officer. 

On July 17, 1902, and November 21, 1902, the following orders were 
issued, assigning Asst. Surg. V. G. Heiser for duty as chief quarantine 
officer for tne Philippines, to succeed Passed Asst. Surg. J. C. Perry: 

[Lettera.] 

Washington, July 17, 1902, 

Sir: Upon being relieved by Asst. Surg. W. C. Billings you are directed to proceed 
to Manila, P. I., and report to chief quarantine officer of said islands for duty. 
Respectfully, 

Walter Wyman, Surgeon-GeneroL 
Asst. Surg. V. G. Heiser, 

Public Health and Marine-UospUal Serviee, St, Johiis^ New Brunstvick, 

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

Washingtonj November SI, 1902, 

Sir: Referring to Bureau order of July 17, 1902, directing you to proceed to Manila, 
P. I., and report to Passed Asst. Surg. J. C. Perry for duty, you will, after thoroogfaly 
familiarizin]^ yourself with the duties of the station (for at least one month, or longer, 
if, in his opinion, a greater len^h of time will be necessary), relieve Pa^ed Assistant 
Sui^geon Perry, receipting to nim for the public property now in his chai^ge, and, 
under the provisions of Executive order of January 4, 1900, assume the duuee of 
chief quarantine officer of the Philippine Islands. 
Kespectfully, 

Walter Wyman, Surgeon-Oeneral. 
Asst Snrg. V. G. Heiser, 

Public UecUth and Marine-Hospital Service, Washington^ D, C. 

Approved. 

H. A. Taylor, 
Acting Secretary, 

WORK OF PASSED ASSISTANT SURGEON PERRY COMMENDED BY PHILIP- 
PINE GOVERNMENT. 

Upon receipt of the news that Passed Asst. Surg. J. C. Perry had 
been relieved as chief quarantine officer for the Philippine Islands, the 
ifollowing letter was written him, expressing, in behalf of the govern- 
ment of the Philippines, their hearty thanks for the good work he had 
done in so successfully carrying out the arduous duties falling upon the 
chief quarantine officer during his term of office: 

[Letter.] 

The Government of the Philippine Islands, 

Executive Bureau, 
Manila, P, /., March 26, I90S, 

Sir: I have the honor to acknowledge receipt of your letter of the 24th instant, 
mforming me that you have been succeeded as chief quarantine officer for the PhiUp- 

Sine Islands by Dr. Victor G. Heiser, of the United States Public Health and Marine- 
[ospital Service. 

On behalf of the government of the Philippine Islands, and in the name of the dvil 
governor thereof, I desire to assure you of tne hearty appreciation of your excellent 
work during your i)eriod of service as chief quarantine officer, and to extend to you 
the expressions of gratitude of the government for same. 
Very respecuuUy, 

Beekman Winthbop, 
Acting Executive Secreiary, 
Dr. J. C. Perry, P. H. and M, H. S., 

Chief Quarantine Officer for the Philippine Islands^ Manila, P, I, 

A true copy: 

Victor G. Heises, 
Assistant Surgeon, Omf Quarantine Officer for the Philippine Idands, 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 151 

MANILA AND 8UBPORTS. 
>BT OF TRANBACnONB JtTLT 1 TO SsFTEMBBR 15, 1902, BY PaSSKD AfiBT. SUBG. 

J. 0. Pkrrt, Chief Quarantine Officer. 

Public Health and Marine-Hospital Service, 
Office of Chief Quarantine Officer for Philippine Islands, 

Manila, P. /., October 10, 1902, 

s: I have the honor to hereby submit supplemental report of quarantine trans- 
ms in the Philippine Islands for the perioa from July 1 to September 16, 1902. 
lere is little new in a general way to report, although when a number of the porta 
le Bouthem islands b^ame infected by the cholera spreading overland ana the 
ise was carried to adjacent ports by bancas and paraos, the quarantine regula- 
i were modified in accordance with circular submitted below: 

Office of Chief Quarantine Officer for Philippine Islands, 

Manila, P. /., July 19, 1902. 
£amMp agents, Manila, P. /. 

Bs: Owing to the fact that other ports in the Philippine Islands have become 
*ted with cholera, the following regulations governing maritime quarantine in the 
ippine Islands will apply until further notice: 

Veesels sailing from one badly infected port to another seriously infected port 
not be subject to quarantine at port of departure or upon arrival. 
Vessels sailing from infected ports to infected ports via clean ports will be sub- 
to quarantine at port of departure to protect the clean port. 
Vessels sailing from infected ports to clean ports will be subject to quarantine 
mal, preferably at port of departure. 

Vessels which have been quarantined at port of departure will not be quaran- 
1 at port of arrival, unless vessel has sickness of a contagious nature on board. 
Vessels sailing from one clean port to another clean port will not be subject to 
antine. 

Vessels sailing from a clean port, via an infected port, for a clean port, will be 
?ct to quarantine upon arrival at the clean port. 

Under the above r^ulations the following ports are considered infected: Manila, 
Fernando, Taal, Balayan, Batangas, Calapan, Naujan, Vigan, Boac, Gasan, and 
^Is will be cleared from Manila to any of tnese ports direct or via other infected 
9 without quarantine at Manila. 

The ports that are considered infected will vary from time to time, since new 
i will probably become infected, and the disease will disappear from those pre- 
aly infected. 

mnce Cebu, Nueva Caceres, and Catbalogan are not yet seriously infected, a 
antine of three days will be imposed on vessels sailing from Manila to these ports, 
ring the time of the voyage to complete the five days' detention and observation. 
. It is recommended that agents arrange the schedule of their vessels so that 
will either sail to clean porto or infected ports only on the voyage. 
. No green vegetables, except potatoes ana onions, must be taken either as cargo 
od for crew and passengers. 

. Vessels desiring to sail for infected ports must anchor in the bay, raise the yel- 
flag, and wait for the inspection and clearance from both the quarantine officer 
customs officials. 

. Agents must notify quarantine officers to what ports the vessel will sail, and 
hange must be made in this schedule after clearance under penalty provided for 
ktion of quarantine regulations. 

Beep^^liyi J- C. Perry, 

Passed Assistant Surgeon, 
Chief Quarantine Officer for the Philippine Islands. 

I July 28, upon the request of the commissioner of public health for the Philip- 
Islands, Asst. Surg. Ii. A. Stansfield, on duty at Cebu, was detailed as supervisor 
le (quarantine enforced at ports in the Cebu collection district, with instructions 
I this office, and the result has been a cooperation on the part of the different 
antine officers, the institution of uniform regulations for all the ports, with the 
jpearance of much of the friction and delay to commerce, 
iring this period Cebu has suffered from a severe epidemic of cholera, and the 
ids of Pkuiayand Negros are badly infected; in fact, the epidemic of cholera 
le last-named places has assumed alarming proportions, and Iloilo province has 
ired more severely than anv other province. An outgoing quarantine was insti- 
1 at both Cebu and Iloilo for vessels sailing for clean ports, in order to afford as 
h protection as posaibJe. 



152 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



The cholera epidemic at date of writing shows improvement, except in the islands 
of Negros and Panay, and the disease has practically disappeared from the provinces 
that were infected at an early date. The situation m Manila is much improved, toad 
this fact is demonstrated by the occurrence of fewer cases on board vessels in quarantine. 

The electric-lighting plant at the Mariveles quarantine station has been completed 
and accepted; but the plan to install a small motor, to be operated by a water wheel, 
has been abandoned, emce a careful study of the water pressure showed that it im 
impracticable to use it as a motive power. 

On August 30 the transport Sherman, in docking for disinfection, on account of 
cholera on board, struck the wharf at Mariveles bow on, and did damage to the 
structure in amount of $6,000. A claim was made to the quartermaster*^ deparlaneiit 
for repair of the damages, and this has been allowed, consequently this woik will be 
accomplished at an early date. 

The work performed and disbursements made are hereby submitted in the usual 
tabulated form: 



MANILA. 



Statistics of quarantine transactions at the port of Manila^ P. J., for the period from July 1 

to September 16, 190S, 



Month. 



July 

August 

September 1-15 

Total.... 



Veflsels inspected 
from— 



Foreign 
ports. 



55 
46 
20 



121 



Domestic 
ports. 



182 
149 

77 



406 



Vessels in 
quaran- 
tine. 



44 

24 

9 



77 



Vessels 
disin- 
fected. 



43 

25 

9 



77 



Bills of 
healtli 
issued. 



189 

188 

96 



3T3 



PieceHof 
fee ted. 



10,106 

4,876 

662 



15,644 



Pieces iD- 
spected 

and 
passed. 



61 

106 

42 



212 



Month. 



July 

August 

September 1-15 

Total 



Crew in- 
spected. 



9.821 
8,218 
3,608 



21,642 



Passengers in- 
spected. 



Cabin. 



1,875 

1,024 

600 



2,899 



Steerage. 



8,183 
8,470 
1,921 



18,574 



Persons vacci- 
nated. 



Crew. 



46 

88 



134 



Passen- 
gers. 



Persons 
bathed and 

effects 
disinfected. 



28 
6 



34 



5,797 

2,546 

771 



9,U4 



Persons 
quaran- 
tined (sus- 
pects). 



4,472 

1.500 

799 



6,771 



Outgoing quarantine transactions at the port of Manila, P. I., for the period from July 1 

to September 15, 1902. 



Month. 



July 

August 

September 1-15 

Total.... 



Vessels in- 
spected. 



154 

170 

38 



362 



Vessels 
in quar- 
antine. 



154 
99 
33 



286 



Vessels 
disin- 
fected. 



2 
1 



3 



Vessels re- 
manded to 
Mariveles. 



16 
9 



25 



Pieces of 

ba«Ka«e 

lisinlected. 



21,760 
7,199 
4,420 



88,869 



Pieces of 
baggage in- 
spected and 



3,041 

l,8Sa 

922 



6,316 



Month. 



July 

August 

September 1-15 

Total 



Crew (out- 
going) in- 
spected. 



21,486 

15,792 

4,913 



42,191 



Crew quar- 
antined. 



5,206 

5,450 

866 



11,522 



Passeneers 
(outgoing) 
inspected. 



60,964 

30,110 

4.586 



85,660 



Passengers quaran- 
tined. 



Cabin. 



2,968 

2,246 

175 



5,406 



Steerage. 



18,820 
7,868 
1,197 



22,875 



Quaiantin- 
able dis- 
eases in 
quaran- 
tine—chol- 
era. 



18 

7 



25 



PUBUO HEALTH AND ICARINK-HOSPITAL SERVICE. 



153 



munary of qttarcmtme transacHons at Manila^ P. /., for the period from July 1 to 

September 15, 1902, 

easelfl isroected 891 

easels held in quarantine 363 

esBels disinlected 80 

ilia of health iflsaed 373 

ieces of baggage disinfected 49, 013 

iecee of baggage inspected and passed 5, 527 

laes of quarantinable diseases occorring on vessels quarantined prior to 

aailiiig— cholera 25 

peiw in quarantine 15, 585 

lasengers in Quarantine 30, 991 

rew inspected 63, 833 

BBsengers inspected 102,133 

ersons vaccinated 168 

ersons bathed and effects disinfected 9, 114 

aspects and contacts in quarantine at Mariveles quarantine station 6, 771 



CEBU. 



\alxitic9 of quarantine tranaactions at the port of Cebu, P. Lyfor the period from July 1 to 

September 16, 1902, 



Month. 


Vessels inspected 
from — 


Vessels 
inqoar- 
anone. 


Billsof 
health 
issued. 


Crew in- 
spected. 


Pajnengers in- 
spected. 


Persons 

held 
in quar- 
antine. 


Crew and 
passen- 


Foreign 
ports. 


Domestic 
ports. 


Cabin. 


Steer- 
age. 


gers vacci- 
nated. 


ily_ 


4 
4 
2 


60 
89 
46 


8 


60 
91 
45 


1,865 
2,679 
1,197 


141 

176 

87 


712 
633 
289 


60 


700 


OgfOSt ........ 




ipCember 1-16 














Total.... 


10 


195 


3 


196 


5,741 


304 


1,634 


60 


700 



hUgoing quaranHne traruactions at the port of Cebu, P. /., for the period from July 1 to 

September 15, 1902, 



Month. 



iiy 

ngust 

eptember 1-15 



Total. 



Vessels 
inspected. 



170 

164 

61 



Vessels in 
quaran- 
tine. 



170 

149 

40 



Vessels 
disin- 
fected. 



9 
8 
5 



395 



359 



I 



22 



Pieces of 
baggage 
disin- 
fected. 



115 
164 
148 



427 



Pieces of 

baggage 

inspected 

and passed. 



289 
86 



325 



Crew 

(outgoing) 
inspected. 



7,535 
7,962 
2,312 



17,809 



Month. 



ily 

ngosct 

eptember 1-15 



Total. 



Crew 
quaran- 
tined. 



1,607 

1,878 

570 



Passengers 
(outgoing) 
inspected. 



2,225 

3,310 

283 



Passengers quaran- 
tined. 



Cabin. 



102 

• 53 

11 



3,955 



5,818 



166 



Steerage. 



343 

440 

58 



841 



Persons 
bathed and 

clothing 
disinfected. 



92 

114 

88 



294 



Cases of 

cholera on 

vessels. 



10 

11 

8 



29 



ummary of quarantine transactions at Cefm, P, J., for the period from July 1 to Septem- 
ber 16, 1902. 



'essels inspected .* 

^eesels held in quarantine 

'essels disinfected 

tills of health issued 

ieces of baggage disinfected 



600 
362 
22 
196 
427 



ieces of baggage inspected and passed 325 



154 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



Cases of cholera occurring on vessels 29 

Crew in quarantine 3, 999 

Passengers in Quarantine 1,023 

Crew inspectea 23,560 

Passengers inspected ^ 7, 756 

Persons vaccinated 700 

Persons bathed and effects disinfected 294 

ILOILO. 

SUUigtics of qtiarantine transactions at the port of Iloilo, P. J., for the period from JuUf 1 

to September 15, 1902. 



Month. 



July 

AUgUBt 

September 1-15 , 
Total 



Vessels inspected 
from — 



Foreign 
ports. 



3 
9 
6 



18 



Domestic 
ports. 



83 
83 
65 



181 



Vessels in 
quarantine. 



15 
3 



18 



Vessels di»- 
infected. 



Bills of 
health 
issued. 



12 

IS 

120 



1« 



Month. 



July 

August 

September 1-15 



Total 



Pieces of 
baggage- 



Disin- 
fected. 



192 



192 



Inspect- 
ed and 
paned. 



44 



44 



Crew 
in- 
spect- 
ed. 



1,166 
1,963 
1,168 



4,297 



Passengers 
inspected. 



Cabin. 



159 
890 
143 



632 



Steer- 
age. 



275 
710 
584 



Persons 
held in 
quaran- 
tine. 



866 
27 



1,569 



398 



Penons 
bathed 
and ef- 
fects di»- 
infected 



148 



148 



Outgoing qaaranline transactions ai the port of Uailo, P. /., for the period from July 1 to 

September 15, 1902. 



Month. 


Vessels in- 
spected. 


Vessels 
in quar- 
anUne. 


Vessels dis- 
infected. 


Pieces of 
fee ted. 


Pieces bag- 
gage in- 
spected and 
passed. 


Number 
crew lonir 
going) in- 
spected. 


July 














August 


50 
102 


48 
62 


6 
6 


412 
165 


82 
510 


1,746 
8.204 


Sentember 1-15 




Total 


152 


110 


12 


517 


542 


4,950 




Month. 


Number of 
crew quar- 
antined. 


Number 
passengers 
(outgoing) 
inspected. 


Passengers quar- 
tlned. 


Persons 
bathed and 

clothing 
disinfected. 


Cases of 
cholera on 




Cabin. 


Steerage. 


vessels. 


July 














AUflTUSt 


362 
843 


714 
1,174 


26 
27 


142 
830 


64 
68 


4 


Sentember 1-15 


7 






Total 


1,205 l-8«« 


53 


472 


132 


11 













Summary of qtuirantine transactions at lloilo, P. I., for the period from July 1 to September 

15, 1902. 

Vessels inspected 351 

Vessels held in quarantine 128 

Vessels disinfected 17 

Bills of health issued 145 

Pieces of baggage disinfected 709 

Pieces of baggage inspected and passed f^ 



FDBUO HEALTH AND MABINE-HOSPITAL SEBVIOE. 



155 



1868 of quarantinable diseases occurring on vessels quarantined prior to sail- 
ing, cholera 11 

new in quarantine 656 

iBsengers in quarmitine 1, 867 

rew inspected 9, 247 

iBBengers inspected 4, 089 

iiBons bathea and effects disinfected 280 



FINA14CIAL STATEMENT, UNITED STATES CURRENCY BASIS. 

ece^^ts and disbursements for the United States quarantine service for the Philippine 
IslandSy during the period from July J to September 15 ^ 1902— funds of fiscal years 190fS 
andlSOS. 

DEBITS. 

ily 1. Balance from June account current $10,430.36 

ily 1. Received refund subsistence furnished 32. 50 

ily 29. Received of treasurer P. A., A. W., 1769 10, 000. 00 

Dg. 1. Received refund disallowment 11.25 

Dg. 1. Received refund subsistence furnished 4. 80 

ug. 5. Received refund subsistence furnished 14. 00 

ug. 9. Received of treasurer P. A., A. W., 1769 1, 430. 10 

ug. 23. Received of treasurer P. A., A. W., 1795 6,000.00 



ug. 28. Received refund subsistence furnished 
spt. 1. Received refund subsistence furnished 
spt 2. Received refund subsistence furnished 
spt. 11. Received refund subsistence furnished 



40.55 

15.50 

9.00 

7.50 



Total cash receipts 127,995.56 



RKFUNDfl TO TRRA8URXR. 



ily 21. Refund to treasurer, rece 
aly 21. Refund to treasurer, rece 
ily 21. Refund to treasurer, rece 
ug. 28. Refund to treasurer, rece 
ug. 28. Refund to treasurer, rece: 
3pt 13. Refund to treasurer, rece 
^pt. 15. Refund to treasurer, rece 
spt. 15. Refund to treasurer, rece 
^pt. 15. Refund to treasurer, rece 



pt5502 .04 

pt5503 2,543.54 

pt5504 88.42 

pt6181 30.05 

pt6180 40.55 

pt6411 1,699.66 

pt6427 9.00 

pt6449 23.00 

pt6450 1,856.03^ 



6,290.29 



Balance to be accounted for 21,705.27 

CREDITS. 
DT8BUB8BMKNT8. 

ily: 

Station supplies and disinfectants $1,017.50 

Office and miscellaneous expenses 82. 50 

$1,100.00 

ogost: 

Salaries and wages of personnel 5, 059. 22 

Laimch expenses, supplies, and repairs 252. 06 

Rents, new construction, and equipment 1, 766. 38 

Station supplies and disinfectants 1, 969. 77 

Office and miscellaneous expenses 519. 29 

9, 566. 72 

5ptember: 

Rents and new construction 2, 000. 00 

Station supplies and disinfectants 178. 03 

2, 178. 03 

Total disbursements 12,844.75 

Balance on hand Hongkong and S. Bank $20,822.23 Mexican cur- 
rency, at 2.35 8,860.52 

21, 705. 27 



156 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVI0E. 

Total erpcnditureii hy details, July 1 to September 15, 1902. 

Compensation of personnel $5, 099. 22 

Stationery, blanks, and printing 0.00 

Incidental expenses, general service 681. 79 

Laonch supplies and repairs to launches 2St2. 06 

Station supplies, including disinfectants 3, 165. 30 

New construction and station equipment 3, 686. 38 



12, 844. 75 



ExpendUures hy station. 
Manila: 

General service expenses $2, 291. 73 

Launch expenses 999. 65 



3,29L38 ! 



Mariveles: | 

General service expenses 4,284.34 

New construction and equipment 2, 700. 00 



Cebu: 

Greneral service expenses 134". 80 

Launch expenses 127. 61 

Station equipment (barge) 486. 95 

lioilo: 

General service expenses 748. 42 

Launch expenses 417. d4 

Station equipment (barge) 653. 41 



6,984.34 



749.25 



1,819.77 



Total disbursements 12, 844. 75 

Respectfully, J. C. Psbbt, 

Passed Assistant Surgeon^ 
Chief Quarantine Officer for the PhUippine Itiands. 

The Surgeon-General, Public Health and Marine-Hospital Sbrvics. 

FLOATING DISINFECTING PLANTS (bARGES) AT ILOILO AND CEBU. 

[Letter.] 

Office of the Chief Quarantine Officer 

FOR THE PhIUPPINB ISLANDS, 

Public Health and Marine-Hospital Sbrvicb, 

MdnUay P. /., January il, 190S, 

Sir: I have the honor to hereby report for your information the following, relative 
to the floating disinfecting plants that have been equipped and installed at the ports 
of Iloilo and Cebu: 

The barge at Iloilo is of 138.75 gross tonnage, 95 feet long, 23 feet wide, and 9 feet 
deep, and has been named Esmeralda. The bai^ge is a dismantled schooner bought 
ana equipped for this purpose. The equipment consists of .two 9 foot 6 inch Kinyoun- 
Francis disinfecting chambers with formaldehyde attachment, one 40-hon9epower 
vertical boiler, one sulphur furnace, and one bichloride force pump. 

The baree at Cebu has been named Protecdon, and is a new bulge, built in 1901, 
and is of the following dimensions: One hundred and eighteen feet long, 23 feet wide, 
and 9} feet deep. The equipment of this barge is the same as that given in describ- 
ing the Esmeralda. 

The Proteccionf as already reported to the Bureau, was wrecked in a trohoon while 
en route to Cebu, and after considerable difficulty was raised and brougnt to Manila 
for thorough repair. This has been completed and the bai^f^ is now moored at the 
port of Cebu in as good a condition as she was before the accident oocuned. 
Respectfully, 

J. C. PSBBY, 

Passed Assistant Surgeon, 
Chief Quarantine Officer for the Philippine Islands. 

The Surgeon-General, Public Health and Marine-Hospital Sibyicb. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 157 

MANILA AND SUBPORTS. 

OP Tranbacttonb to June 30, 1903, by Asst. Surg. V. G. Hbiseb, Chief 

quabantinb officer. 

Tbbasury Department, 
Public Hbalth and Marine-Hospital Service, 

Office of the Chief Quarantine Officer 

FOR the Philippine Ihlandb, 

'Manila, P. /., July SI, 190S, 

Sib: In porsnance of the instroctions contained in Bureaa letters of April 11, 1903, 
md Mav 11, 1903, I have the honor to submit herewith a report of the quarantine 
ranaactions in the Philippine Archipelago for the year endeil June 30, 1903. 

I reported for doty at Manila, February 17, 1903. The greater portion of the work 
A the year therefore was done under the direction of Passed Asst. Surg. J. C. Perrv, 
irho was relieved by myself March 24, 1903, and I shall therefore quote liberally 
Irom his reports. 

CHOLEBA. 

Sixty-eight vessels with cholera on board arrived at this port, and 37 vessels had 
cholera appear on board during the time they were serving their outgoing quarantine. 
This makes a total of 105 vessels disinfected for cholera. 

The epidemic has taxed the resources of the stations to the utmost, and the long 
period over which it has continued has left several of the offi(!ers on duty in the 
riands almost phvsically exhausted. The large amount of work cause<l by the inany 
infected ships ana the incoming and outgoing quarantine can scarcely be realized by 
the perusal of the figures alone. It is probably the first time in the history of quaran- 
tine that so manv ships were treatea in a scientific manner. It is a matter of con- 
pitalation that the practice prescribed by the quarantine laws and regulations has 
been so thoroughly vindicated by practical exi)erien(!e. Of the 105 cholera-iufected 
iressels that were oisinfected at the Manila station, only 1 developed the disease after 
being released from quarantine, and then nine days after disinfection, the c^a^es devel- 
oping in the ship's hospital amon^ the dysentery cases. The protection afforded the 
Lnited States ports by quarantining vessels pnor to their departure for the United 
States is strikingly illustrated by the vessels of the army transport service. During 
the period from July 1, 1902, to January 1, 1903, 12 transports carrying steerage passen- 
zers cleared for the United States. Of this number 4 vessels had cholera develop on 
board before the expiration of the quarantine period. When it is remembered that 
these ships carried 10,708 steerage passengers, some of them carrying as high as 1,800 
persons of this class on one vessel, it will be realized what a large number of human 
lives were saved, pain and suffering avoided, and danger to the United States obviated, 
[t has been contended that with the facilities of the modern troopship cholera could 
t)e as effectualljr stamped out while the vessel is at sea as when the facilities of a 
nodem quarantine station are at hand. That such is not the case was well shown 
m the instance of the United States army transport Sherman^ which left here Sep- 
tember 4, 1902. Two days after her departure cholera developed on board and before 
the port of Nagasaki could be reached four cases had made their appearance, and before 
the passengers could be properly quarantined on shore six more cases developed. 
(Vhen it is considered that the four cases mentioned above occurred on a moaern 
»)Opship, where every possible provision is made for stamping out infection, that 
these vessels have medical officers on board who have had special training, and that 
n spite of these advanta^ the cholera spread, it is certainly reasonable to assume 
Jiat quarantine for all ships in cholera epidemics like the present one is a necessity. 
The assumption is still further fortified by the fact that three other vessels had expi^- 
riences similar to that of the Sherman, and in the large number of cholera-infecte<i 
vessels treated at Mariveles one case after disinfection was all that ever appeared, and 
iven that himpened only once. It has been the experience here that on the appear- 
mce of the firet case prompt removal from the ship of the patient and the contacts 
uid disinfection of the vessel generally resulted in the disease being confined to the 
>riginal case. Had the cholera on the Sherman occurred in mid-ocean or at a place 
where the facilities of a quarantine station were not at hand, it is difficult to say when 
the spread of the disease would have been checked. In this case the vessel was only 
two days' away from Nagasaki when the dis^use appeared. 

The dissemination of the cholera has been widespread throughout the islands. 
From the commencement of the epidemic, March 18, 1902, until the ending of the 
fiscal year 1903 there have been reported and made a matter of record 138,639 cases, 
with 88,761 deaths, which gives a mortality of 63 per cent. A conservative estimate 
made by medical men of Isirge experience in the islands is that at least one addi- 
tionaJ caB0 occamd for every one that was reported, which nvotiIV^ m«3tftmTw«A 



158 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

numbers abont 300,000 cases. The proximity of the islands to one another, and the 
many small craft that ply between the islands at places where inspection is practi- 
callv impossible, rendered interisland maritime quarantine almost UBeleas as a means 
to cneck the spread of the disease when it had once gained a foothold in the islands. 

One of the most difficult problems encountered has been the management of cano, 
and especially of vegetables. The daily question has been: ''Are they infecte<u" 
An extended search through the literature of the disease &uls to reveal much infor- 
mation that would be of service to the quarantine officer. Opinions, presumptions, 
and unsupported statements occur in profusion, but so far it nas bee^ impossible to 
find an authoritative statement that sheds much light on the question. The question 
of vegetables is a very serious one to Manila. All products of this kind are not pro- 
duced in sufficient quantities in the islands to anect the market, and they most, 
therefore, be imported. The principal importations come from China. Since 
cholera is practically endemic in the districts m which the vegetables are grown, and 
the farms are fertilized with liquid human excrement, it would seem that the exclu- 
sion of vegetables from these districts was justified on theory at least. On the 
other hand it is pertinent to state that during the i>ast six months the city of Hong- 
kong has been consuming the vegetables from districts which were suspected of being 
infected, and yet no case of cholera has made its appearance in that city during the 
period mentioned. It is a serious matter to deprive a city like Manila of a great por- 
tion of its food supply in the way of vegetables. The price of these products became 
greatly enhanced. The population had to depend principally upon canned goods for 
their supply of vegetables. During the latter portion of the epidemic the trouble was 
overcome to a great extent by the officers of the Public Health and Marine-Hospital 
Service stationed in China and Japan being able to certify that such vegetables as 
were allowed to be shipped to Manila had not been grown in infected territory or 
exposed to infection in transit. With the view of being able to obtain more acctunte 
information about cargo, the detail of a competent bacteriologist has been requested. 
The material exists here for making practical tests of this nature and resulte might 
be obtained which would make it possible to lessen the restrictions which are placed 
upon commerce at the present time. 

During the early part of February, 1903, the cholera situation improved so much 
in Manila that the circular letter of February 4 (copy of which is appended) was 
issued. On May 7 the cholera again assumed such proportions in Manila that an 
outgoing quarantine of five da^^s was placed on vessels carrying steerage passengers to 
the Unitea States. The situation up to the present time has not warranted the com- 

Slete withdrawal of the restriction. The principal danger at this writing, so far as 
[anila is concerned, is the fact that cholera is present in the villages situated on the 
watershed from which the city drinking water is obtained. During the past few 
weeks there have been several cases reported daily from the village of San Mateo, 
which is situated on the bank of the Mariquina River, about a mile above the point 
at which the intake is located. The rainy season has not commenced yet, and for 
that reason the water in the stream is low, and if the river should become infected 
most of the infection would find its way into the Manila water system. The con- 
stant menace which hangs over the city will therefore be appreciated. For a detailed 
report of the management of the cholera quarantine, see the report of Passed Asst 
Surg. J. C. Perry, wnich was in course of preparation at the time ne was relieved from 
duty at this station. (Doctor Perry's report will be found under ''Contributed 
articles.") 

PLAGUE. 

It is particularly creditable to the officers on duty in China and Japan that not- 
withstanding the fact that plague has been epidemic at Hongkong and Amoy during 
the year, and present at other ports in those countries, not a single case of this dis- 
ease found in Manila could be traced to introduction from without. This fact is par- 
ticularly noteworthy because the plague at Hongkong and Amoy has been epidemic, 
and these ports are only two and three days' sail, respectively, from Manila. It is 
also a matter for congratulation that the plague has be^n confined to l^anila. So far 
the other ports in the Philippines have not become infected. Much of the success 
in the management of the plague is no doubt due to the mutual cooperation which 
exists between the board of health and the Public Health and Marine-Hospi^ 
Service. An effort has been made to fumigate with sulphur, for the purpose of Kill- 
ing rats and vermin, the entire shipping which enters the port of Manila. This work 
has been almost accomplished, there being very few vessels that have not been fumi- 
gated at least once. Tne board of health has kept a force of rat catchers along the 
water front and has fumigated with sulphur all the smaller vessels which are engaged 
in river and harbor work. 

During the year 163 vessels were fumigated, for which purpose about 20 tons of 
ealpbur were ueedL In the treatment oi thiB \arg^ nmnY^x olN^cB^xs^an^ V^^v'^^^cal 



PUBLIC H£ALTH AND MARINE-HOSPITAL SERVICE. 159 

ith r^ard to the technique of fumigation were learned which will be made 

>ject 01 a special report later in the year. 

he whole we-have nad the hearty cooperation of the shipping interests in this 

In addition to the destruction of rats, the destruction of cockroaches and 
rermin on board vessels was very agreeable to them. The work, so far, has 
oeomplished with practically no delay or loss to shipping. It had been the 
1 heretofore to suggest to the steamship companies not to brin^ steerage pas- 
5 daring that portion of the year at which plague was at its height in Uon^- 
nd Amoy. This suggestion has always been complied with in the past This 

different course was pursued. It was found tnat abolishing the steerage 
nodations for the time being resulted in that class of passengers engaging 
Lccommodations. This made the • last condition worse than the first, because 
voided thereby the measures which would have been employed had they been 
i to come as steerage passengers. The method of procedure this year has 
ivhenever possible, to aetain them under medical observation for seven days 
port of embarkation, and after bathing them and disinfecting their effects 
ere permitted to proceed to Manila. Upon their arrival here they were again 

ana their effects disinfected. If they made no objection, the board of health 
d them with shiga serum before landing. In summing the matter up, how- 
b is probably safe to say that the principal factor in dealing with the plague 
at the rats and vermin were destroyed in the vessels before the plague epi- 
began and then kept free from vermin since that time. The same course has 
pursued at the other ports of entry in the islands. Two vessels which were 
n the harbor were reported to us by the board of health as having had a case 
ue on board. These vessels were remanded to Mariveles and thoroughly dis- 
d and held to complete the incubation period of the disease. No farther cases 
ped on either vessel. 

SMALLPOX. 

vessels arrived at Manila with smallpox onboard. The usual course was pur- 
nothing of note 0i!curred. Eight thousand nine hundred and seventy-two 
8 were vaccinated. 

LEPROSY. 

disease was detected on five vessels during the year. Four of the cases were 
sit to Hongkong. One was ordered returned to Hongkong by the collector of 
IS acting on the authoritv of the immigration laws. The remaining case was 
n chai^ by the board of health and placed in the San Lazaro Leper Hospital, 
cessary precautions to prevent the spread of the disease were taken in each 

56- 

STATION AT JOLO SBTABLISHED. 

Lpril 13, 1903, Assistant Surgeon Amesse was detailed by the following letter 
', Jolo and Zamboanga and report upon advisability of opening a new sSeition. 

[Letter detailing Ajtsistant Surgeon Amesse to investigate.] 

ICE OF THE Chief Quarantine Officer for the Philippine Islands, 

Manila, P. /., April IS, 1903, 

You are directed to proceed to Zamboanga and JdIo for the purpose of making 
Bstigation as to the advisability of establishing a quarantine service at those 
inder the direction of the Public Health and Marine-Hospital Service. It is 
ilarly desired that you ascertain whether it would be practicable to open a 
at one or the other of these ports which would meet the quarantine require- 
of both Zamboanga and Jolo. 

are requested to submit, as soon as possible, to this office a full report of the 
Df your investigation^ with such recommendations as you may think advisable, 
the completion of this duty you are directed to await further orders at the last 
sited. 
Q your arrival at the above-named ports your status will be that of temporary 

Respectfully, Victor G. Heiser, 

Assistant Surgeon, 
Chief Qtuirantine Officer for the Philippine Islands, 
. Sui^. J. W. Ambbse, 
U. S. Public Health and Marine-Hospital Sertnce, 

Manila, P. I. 



160 FUBUO HEALTH AND MABINE-HOSPITAL 8EBVI0B. 

[Report of Assistant Surgeon AmesBe.] 

Public Hralth and Mabins-Hobfttal Sskvics, 

/oto, P. /., April f», 190$. 

Sir: Pnrsnantto instractions in your letter of the 14th inatant, directiiig me to 
pnx^ed to Jolo and Zamboanga for the purpose of asoertaminfi; whether oonditiQis 
warranted the establishment at one of these ports of an inspection station under the 
authority of the Public Health and Marine-Hospital Service, I have the honor to 
make the following report: 

Securing transportation on the U. S. army transport Liscwn, which left Manila 
on April 14, 1 amved in Jolo four days later, and through the courtesy of the collector 
of customs was promptly placed in possession of full data bearing upon the Bubjects 
of forei^ and domestic trade, immigration, and sanitation. 

Jolo IS a flourishing town located on a small bay indenting the northwest coast of 
the island of that name, affording a safe anchorage at all seasons. 

It is the home of the sultan of the Sulu Archipelago, and has been for many yean 
the most important commercial outpost in the Moro country, by reason of its acces- 
sibility to the neighboring ports of Singapore and Sandakan. 

This favorable geograpnical relation makes it the natural distribating center of 
commerce, not onlV for the Sulu group, but also, through the branch houses of the 
large Chinese wholesale establishments of Jolo, for the entire southern portion of 
^e island of Mindanao. 

In the past year there have been 43 entries from foreignports, bringing car;^oes con- 
sisting cmefly of rice and other food stuffs, clothes, illuminating oil, and opium. 

From Jolo these vessels return to Singapore by the wa^ of SSmboanga and Iloilo, 
or via Zamboanga to Sandakan, or the Uerman possessions in the Celebes group, 
carrying as exports hemp and hemp rope, copra, gums, pearls, and pearl shells. 

Notwithstanding the severe cholera epidemic of the last year, wnich almost pa^ 
alyzed trade throughout the Philippines as a whole, and in spite of the unrest follow- 
ing the Moro uprising in Mindanao, the volume of foreign trade increased 10 per 
cent over the year 1901, and the outlook for the future seems very bri^hL 

The civil govemm^t has recognized this in the recent appropriation of a lai^ 
amount for the purchase of a suitable building to be used for a custom-house, and for 
the extension or the pier begun during Spanish control, whereby lai^ge steamers may 
discharge directly at the wharf. 

When this latter facility is secured, it is expected that a direct bimonthly service 
will be established with Singapore and additional coastwise vessels placea on the 
local route to Mindanao. 

In addition to island steamers making Jolo a regular port of call, there is a fleet of 
perhaps 500 Moro sailboats, or ''sapits, as they are called, measuring from 3 to 12 
tons, and with crews of 4 or 5 each, trading among the adjacent islan<& with Jolo aa 
a rendezvous. 

These boats touch at all the coast towns of the archipelago, going frequently as far 
south as Borneo and carrying with absolutely no surveillance, as fiir as customs and 
quarantine are concerned, lai^ numbers of passengers and important consignmentB 
of native products. 

They constitute, therefore, a constant menace, and become the chief agency in the 
dissemination of epidemic diseases. 

It was through tnis avenue that cholera entered the island of Jolo last year, and, 
though checked at the gates of the town by the vigorous and consistent quarantine 
maintained by the miRtary authorities, it spread with great rapidity among the 
neighboring Moro villages. 

From Jolo I proceeded via the U. S. C. T. Formom to ZamboangiL arriving there 
April 25. This is a rapidly growing town of 8,000 inhabitants, situatoa in the extreme 
southwestern part of the island of Mindanao, on a strait about 9 miles in width, 
through which the tide nins at a rate of 5 to 7 knots an hour. 

Here are located the headquarters of the Department of Mindanao and Jolo, 
together with a small garrison, and on account of its strategic position will doubtlese 
long remain an imporSmt military post. 

It is also the traaing center for numerous large cocoanut plantations, copra being 
the chief item of export. There is no harbor at Zamboanga, and but one smal! 
wharf, owned by the army and used exclusively by its transports. Commercial ves- 
sels are therefore obliged to anchor and discharge under very adverse circumstances 
in the open roadstead. 

Trade is almost entirely domestic. During the year 1902 there were 118 arrivals 
from Philippine and 25 m)m foreign ports, and of these latter entries 18, or 72 per 
cent, were by way of Jolo. During this period 157 immigrants were admitted. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 161 

In view of the policy of the civil government to promptly discontinue ports of 
entry which enjoy bat limited foreign trade, as was shown recently in the case of 
Aparri, and in consideration of there being another port in close proximity to Zam- 
boanga ( Jolo) which could issue special license for such trade as might offer, it seems 
probable that Zamboanga will be abandoned for some protected port on the north 
coast of Mindanao. 

It is evident from the facts that Jolo would be the logical point for the institution 
of an inspection service, since practically all vessels from foreign ports could be exam- 
ine immediately on entering American waters, and all subs^uent ports of call be, 
in a measure, protected. 

Masters of vessels could be instructed here to promptly report at way points any 
ackness appearing aboard after clearing from Jolo. and customs inspectors at those 
stations could be authorized to remand any vessel snowing quarantinable diseases for 
disinfection to Iloilo or Cebu. 

In view of these natural advantages for the prompt detection of infected vessels, I 
have to respectfully reoonmiend that an inspection station be immediately established 
at the port of Jolo. 

Respectfully, J. W. Ambbse, 

Asgislani Surgeon (on temporary d^U), 

Asst. Surg. Victor G. Hbiser, 

Chief QfMtrantine Officer for the Philippines^ Manila, 

htation at .lom) opened. 

Office of the Chief Quarantinb Officer 

FOR the Philippine Islands, 
Public Health and Marine-Hospital Service, 

Manila f P. /., May 16, J 90S. 

Bib: I have to confirm my tele^m of May 6, namelv: 

** In accordance with the provisions of executive oraer of January 3, 1900, )^ou are 
hereby detailed temporary quarantine officer of the port of Jolo. Institute inspec- 
tion at once. Boat shipped you last week. In meantime if can not board with cus- 
toms, authorized to hire rowboat not to exceed $20 gold per month. '* 

Your renort upon the advisability of establishing a quarantine station at Jolo 
under the direction of this Service has been received. 

Your nomination as permanent quarantine officer at the port of Jolo has been for- 
warded to the Secretary of the Treasury for apnroval. In the meantime you are to 
act as temporary Quarantine officer at Jolo unacr the direction of this office. The 
adjotant-general of the division has been informed of our action with the request 
that the proper military authorities at Jolo be notified by his office. 

You are directed to institute a thorouf^h quarantine inspection based upon the 
United States quarantine laws and regulations. Questions to which the above rules 
and regulations do not seem applicable should be submitted to this office for decision. 
It is ]Muticularly desired that you attempt to regulate the traffic carried on by the 
small boats, which you mentioned in your report and which receive no inspection 
at the present time. 

You will keep the necessary records required by the regulations and transmit the 
osoal weekly reports to the Surgeon-General through this office. 

The insular purchasing agent has l>een directed to ship you the rowboat, which 
arrived here May 2. You are hereby authorized to employ two sailors to man it, at 
a compensation not to exceed $10 United States currency per month each. 

Inform this office at once whether it will be necessary to rent an office and, if so, 
what the rate per month will be. You are further directed to make requisition for 
such supplies as you need. 

In view of the fact that estimates for appropriations must be submitted by June I, 
1908, vou are directed to prepare and forwanl to this office at once an estimate of the 
probable expenses of the Service at your port for the coming year. 
Respectfully, 

Victor G. Hbiser, 

Assistant Surgeon^ 
Chief Quarantine Officer for the Philippine Islands. 

Awt. Sui^. J. W. Amesse, 

Pubhc Health and Marine-Hospital SerxicCy 

Jolo, Jolo, p. I, 

H. Doc. 338 11 



162 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

EXAMINATION FOR CHOLERA INFECTION IN PA8IG RIVER WATER. 

On Jane 12 the deduction that cholera infection was located in the P&sig was 
practically confirmed by report of Assistant Surgeon Long. 

[Letter.] 

Public Health and Marine-Hospital Sebvicr, 
Office of the Chief Quarantine Officer for the Phiuppinb IsLANoe, 

Manila, P. L, June It, 1903. 

Sir: I have the honor to transmit herewith the weekl]r tabulated report of cholera 
cases which occurred in Manila and the provinces during the week ended June 6, 
1903. 

The cholera situation has been improving steadily. At the present time there are 
only a few cases daily. 

The investigation made by Assistant Surgeon Long on the whole confirmed the 
opinion expr^ed in the report of May 26, namel)r, that the majority of the cbolen 
could be traced to the shallow side of the Pasig River. Numerous samples of water 
were taken from the river and examined bacteriologically. The samples that gave 
the most pronounced cholera reactions were those taken from places in the river at 
which cholera-infected vessels had been lying. It is extremely regretted that the 
great amount of work and the few officers on duty here prevented us from making 
the water examination complete. From a scientific standpoint it can only be con- 
sidered as preliminary. The insular board of health has been requested to continue 
the examination. Their investigation has so far confirmed our work that they are 
now discussing plans for ridding the river of infection. 

The army transport service is carrying out rigid rules directed against using water 
from the Pasig River, and since this practice was adopted no further cases of cholera 
have appeared on their vessels. 

The report of Assistant Surgeon Long is inclosed. 

R^pectfully, Victor G. Heisbr, 

AssigtarU Surffean, 
Chief Quarantine Officer for the Philippine Idand*. 

Surgeon-General Public Health and Marine-Hospftal Service, 

WashingUm, D. C 

[Inclo#?ure.] 

Manila, P. I., June i, 1903, 

Sir: I have the honor to report that in accordance with verbal orders received 
from you on the 26th ultimo I began an inspection of the cascos and other craft in 
the Pasig River with a view to determine, if possible, the source of infection of the 
cases of cholera that have been and are occurring in the river. A careful inspection 
was made, extending over a period of two days, of the cascos themselves and the 
persons living aboard of them. No cases of sickness were found. The cascos were 
m a fair sanitary condition. The sources of food and water supply were inquired 
into, and it was found that the food was gotten in the markets of Manila, the partic- 
ular market being determined by the location of the casco at the time of buying, no 
more than a day' s supply being purchased at one time. Drinking water was invariably 
obtained from the nearest fountain of the city supply. The food was almost always 
of a kind that needed cooking before eating, the only eatable particularly open to 
suspicion being a sort of sweet made from rice and ground cocoanut, which was sold 
in small cakes or wrapped in a piece of palm leaf. The buvo leaf also is open to Ques- 
tion. It is chewed in connection with the betel nut. The custom is to keep uiem 
continually moistened with water to keep them green, and prospective buyers usa- 
ally handle the entire stock in trade, in order to get the most tender leaves before 
buying. Several schooners and launches, from which cholera cases had been 
removed, were visiteil with the purpose of tracing the infection, if possible. Nothing 
in addition to the above was learned, however. 

One almost universal custom was noted, bathing, either by swimming in the river 
or by drawing buckets of water from the river; the rice was frequentlV w*ashed in 
river water prior to cooking, as are also the dishes and cooking utensils. In order 
to determine the condition of the river water twelve samples were taken, as follows: 

No. 1. Near the Farola dry dock, close to shore. There are alwajrs numbers of 
cascos and small schooners at this place, and an estero empties into the river a short 
distance above. 

No. 2. South bank, just below the Bridge of Spain. A favorite anchorage for inter- 
island schooners and smaller craft. The steamship Bun Van on one occasion had a 



PDBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 



163 



of cholera while lying here, as also had the launch Mariposa and the Japanese 
oiship Meiko Mara. 

o. 3. Near Anda Monument, at the lower extremity of the anchorage for small 
>onerB. 

o. 4. At the mouth of the Binondo Canal, an anchorage for island boats and 
oe. The launch Alpine Eagle had a case of cholera occur on boanl at this point, 
o. 5. Opposite the captain of the \k>tVs, at the upper end of the anchorage for 
)onerB. Here there is a public latrine emptying direct into the river. 
o. 6. At the captain of the port's, where a sewer empties, and all '* floaters'' are 

up awaiting removal. 

o. 7. Above San Mi^el Brewery, a favorite place for washing clothes, bathing, etc. 
o. 8. Below Santa Mesa. Cascos tie up here; also considerable washing and 
ling done. 

o. 9. Chinese dry dock, north bank, just above suspension bridge. Several 
ers and esteroe emptv near this point, and a large number of cascos are always 
here. The river close to shore is very black, contains refuse, and a foul 
r is always present There is very little current close to shore, 
o. 10. At the mouth of the estero of Santa Cruz, north bank. A landing place 
river boats, and a favorite place for tying up i^ascos, lighters, etc. No current 
bore, water filthy, and foul odor always present. 

o. 11. Na&;ta|a, north bank, between Malacaflan and Santa Mesa; a favorite place 
iraflhing dothes and bathing. 

o. 12. Water barrel, steamship Tagadito, Everyone wishing a drink dips in with 
first convenient vessel. 

small bottle of water was taken from each of the above places on the 28th ultimo. 

y were taken to Mariveles for examination. 

ach sample was placed in the centrifugal machine, and a flask of Dunham's solu- 

inoculated from the sediment. 
bese were incubated for eight hours, and examined as follows: 



pie 
>. 


Appearance of 
culture. 

1 


Hanging drop. 


Stained slided. 


Reaction on 

addition of 

H80. 


Motility. 




Cloudy 


Commas, spirals, 
and 8 forms nu- 
merous. 

Organisms numer- 
ous; tendency to 
curve, but not 
marked. 

Commas and spirals 
numerous. 

and 8 lormR. 
Curved organisms. . 

Commas and S- 
shaped organisms 
numerous. 

YeasMike bodies; 
curved organisms. 

Organisms slightly 
curved. 

Numerous curved 
and semispiral or- 
ganisms. 

Curved organisms 
numerous. 

Curved organisms.. 

Few nonmotile or- 
ganisms. 


Commas and 8 
forms numer- 
ous. 

Short thick rods; 

• no commas or S 
forms. 

Commas and few 
incomplete 8 
forms. 

Commas and few 
Incomplete spi- 
rals. 

Commas numer- 
ous. 

Commas and in- 
complete 8 
forms. 

Curved organ- 
isms: no 8 forms 
or spirals. 

Slightly curved 
organisms. 

Few commas 
seen. 

Curved forms 

numerous. 
Numeroiw curved 

and some spiral 

forms. 
No distinctive 

organisms. 


Marked red... 
Yellowish.... 

do 

do 

Marked red... 
Yellowish 

do 

Faint red 

Marked red... 

Yellowish .... 
Marked red... 

Yellowish 


Marked. 




do 


Do. 




do... 


Do. 


— 


Cloodv, slight 
pellicle. 

Cloudy 


Do. 
Do. 




do 


Do. 




do 


f curved orRan- 
ismg, marke<l. 

Not marked. 

Marked. 




Slightly turbid . 
do 




do 


Do. 




do 


Do. 




do 


None. 




• 





a In hanging drop other organisms numerous: confused view of comma. 
^Several slides made, but none turned out well. 
Several slides tried; results not as good as wished. 

he examination was necessarily incomplete on account of lack of time plating out 
misms and the preparation of the media. It will be noticed that in four of the 
pies diganisms were found in which all the tests applied agreed with the reaction 
faced by the cholera oiiganism, while in others there was some resemblance, but 



164 PUBLIC HEALTH AND MABINE-HOSPITAL 8EBVI0E. 

it was not carried out in all the tests. It will also be noticed that marked reaction 
took place in the samples obtained from the situations in the river where the most 
of the cases have occurred. To conclude, it would seem from the foregoing that the 
food and water supply can hardly be infected, else there would be many cases, as 
the source is the same for all, and as there is constantly being fed into the river 
through esteroe, etc., cholera-infected material, and as cholera '^ floaters" are fre- 
quently found, the river must necessarily be infected a portion of the time at least 
Respectfully, 

J. D. Long, Assistant J^irgeon, 

Chibp QuASAiniNB Officer for the Philippine Islands, 

ManUOf P. L 



FUMIGATION OF VESSELS AT SUBPORTS. 
[Circular letter.] 

U. »S. Public Health and Marine-Hospital Sbrvicb, 

Office of the Chief Quarantine Officer 

FOR THE Philippine Islands, 

Manila f P. J., June i?i, 190S, 
Medical Officers in Command, 

U. S, Public Health and Marine-Hospital Service^ 

Philippine Island ports. 

Sir: It has been the custom here to fumigate with sulphur all vessels which come 
from foreign ports, or which carry cargo from foreign ports, whenever the caigo or 
vessels have been eitposed to plague infection, or if it is not possible to certify that 
they have not been exposed to plague infection. 
In order to make the practice uniform you are directed to take the same action. 
You are directed to acKnowledge receipt of this circular. 
Respectfully, 

Victor G. Heiskr, 
Assistant Surgeon, Chief Quarantine Officer for the Philippine Iskmds. 

Decisions No. 4, Volume III, of April 30, 1903. On pafi[e 41, No. 86, you will 
observe that the United States Public Health and Marine-Hospital Service has been 
placed in charge of the medical inspection of arriving aliens. You are directed to 
commence this examination July 1, 1903. The same is to be conducted in accordance 
with the general rules and regulations promulgated by the Suigeon-Oeneral and 
approve<i by the Acting Secretary of the Treasury, January 15, 19^. 

It is expected that the necessary blanks and books required for this purpose will 
soon arrive, whereupon a supply will be sent you. In the meantime you are directed 
to keep an accurate record of the number of pieople examined and the number of cer- 
tificates issued. The name, date, nationality, and the disease should be recorded in 
every certificate issued and a copy kept thereof. When such questions come up as 
are not covered by the r^^lations, you are directed to submit the matter to this office 
for decision. 

Respectfully, Victor G. Hsissr, 

Assistant Surgeon, Chief Quarantine Officer for the Philippine Iskmds. 

summary. 

Personnel, — There are now on duty in the Philippines 4 commissioned officers at 
Manila and Mariveles — 1 each at Cebu, Iloilo, and Jolo, 1 pharmacist at Manila, who 
acts as disbursing officer, chief clerk, and pharmacist; ana 70 attendants who act in 
the capacity of clerks, launch crews, quarantine employees, etc. 

Vessels disinfected.— -One hundred and sixty-three vessels were fumigated with sul- 
phur. One hundred and five cholera-infected vessels were disinfected. Five small- 
pox and 2 plague infected vessels were disinfected, and in addition to these large 
figures there were 119 vessels disinfected because they came from infected ports. 

Mariveles, largest disinfecting station in the vxrrld. — With the possible exception of the 
work done at Tor, Egypt, there is probably more disinfection accomplished at the 
Mariveles Quarantine Station than at any other plant in the world. When it is con- 
sidered that the work had to be performed with labor that speaks a foreign tongue 
and at best is disinclined to work, the result is to be marvelcxl at and re&cts gmt 
credit on the officers who brought it about. 



PUBMO HEALTH AND MARINE-HOSPITAL SERVICE. 165 

Officers break down from exhauMion cauned by overwork, — The strain has told on the 
ficers severely, two of them breaking down from phjrsical exhaustion. When the 
noant of work is taken into consideration and that this is a trying tropical climate, 
ith few dualities for obtaining labor, it would seem to be wise to fall into the foot- 
eps of the Army and make the detail in the islands not to exceed two years. 

Phj^tical examinationSf masUrs, pjlotSj etc. — In addition to the quarantine work the 
»irice has conducted the physical examination of masters, pilots, patrons, and 
igineers, and also the men who enter the Coast Guard Service. A total of 165 
[>plicantB were examined, eleven of whom were rejected. 

JmmiararU inspedian, — Commencing with the fiscal ^ear 1904, the physical examina- 
ons of arriving aliens will also be done by this Service. 

VegseU disinfecUd; rinderpest and diseases ofcaUle. — A considerable number of vessels 
ere disinfected, upon the request of the ooard of health, because they had carried 
limals infected with rinderpest and other diseases peculiar to cattle. 

Condition of steamers operated by Service, — ^The steamers operated by the Service in 
le different ports of the islands have been kept in a hign state of efficiency, and 
le seamanlike manner in which they are handled has been the subject of much 
ivorable comment. This is especially encouraging because the vessels are operated 
lore economically than any similar vessels in the islands. 

Comments on quarantine of the future in the Philippines. — ^To prevent the occurrence 
I Quarantinable diseases in the islands after those present have been stamped out, 
ill require the strict observance of the quarantine laws and regulations at tne ports 
I entry. As some of these ports are less than forty-eight hours by steamer from 
)untries in which diseases like cholera are endemic, the problem will be a difficult 
ae, and perhaps more than can be expected of the quarantine service alone, but 
ith the assistance of an intelligent ana energetic board of health it should not be 
npoflsible. 

Tbbles of statistics. — ^Tables in accordance with those prescribed by the Bureau are 
ppended. In order to bring out the work in more detailed form a number of addi- 
onal tables are submitted. 

Financial report. — The financial report showing the receipts, expenditures, and dis- 
arsements is also appended. 

Work at substations. — With the exception of the report on transactions, the work of 
le Service at the substations is all included in the reports of the chief quarantine offi- 
)r under the separate headings as directed by the Bureau. 

wnmary of quarantine transactions at Manila j P. /., during fiscal year ended June SO, 

190S. 

essels inspected 5, 921 

essels heui in quarantine 666 

ifected vessels disinfected 231 

essels fumisated to kill rats 163 

ills of health issued 4, 012 

ieces of baggage disinfected .* 101, 395 

ieces of baggage inspected and passed 21, 539 

ases of quarantinable diseases aetected on vessels: 

Cholera 129 

Smallpox 6 

Plague 2 

Leprosy 6 

pew in quarantine 20, 902 

assengers in quarantine 46, 898 

rew inspected 238,635 

assengers inspected 257, 602 

ersons vaccinated (includinjo^ 2,220 residents of village of Mariveles) 8, 972 

ersons bathed and effects disinfected 24, 813 

jspects and contacts quarantined at least five days at the Mariveles quaran- 
tine station 10,867 



166 



?aBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



SlatiMU'x of incoming (/iianrntim' transadiom at the p(trt of Mimiia^ P. /., ftjr the fiscal 

year ended June 30^ liH)S. 



Month. 



1902. 

July 

August 

September 

October 

November 

December 

1903. 

January , 

February 

March 

April 

May 

June 

Total 



Vesssels Inspected 






from— 


Vessels 
in quar- 


Vessels 
disin- 






Foreign 


Domestic 


antine. 


fected. 


ports. 


ports. 






55 


182 


48 


43 


46 


149 


26 


26 


51 


160 


19 


18 


66 


283 


3 


20 


74 


260 


4 


10 


61 


326 


8 


4 


62 


293 


6 


6 


49 
71 
70 


288 
387 
379 




4 

6 

n 




7 


64 


411 


16 


98 


61 


297 


3 


86 


723 


3,415 


140 


836 



Bills of 
health 
issued. 



Pieces of 
fected. 



189 
188 
221 
300 
321 
863 



872 
366 
434 
448 
461 
866 



4,012 



10,106 
4.876 
2,541 
4,675 
3.428 
1,923 



945 
Q62 
3,661 
4,177 
1,451 
1,920 



Baggage 

inspected 

and 

passed. 



106 

46 

1.061 

CM 

40S 



SO 
8M 
980 
890 
271 
419 



40,663 



6,171 



Month. 



1902. 

July 

August 

September 

October 

November 

December 

1903. 

January 

February 

March 

April 

May 

June 

Total 



Crew in- 
spected. 


Passengers 
inspected. 








Cabin. 


Steerage. 


9,821 


1,376 


8.183 


8,218 


1,024 


3,470 


8,269 


1,174 


3,962 


9,661 


1,219 


7,168 


11,069 


1,689 


8,414 


11,482 


1,312 


6,067 


10,827 


1,209 


4,690 


10.781 


1,091 


6,796 


13.841 


1,839 


8,485 


18,628 


1,701 


8,146 


16,108 


2,090 


7,999 


14,681 


2,891 


16,678 


137,686 


18,017 


89,058 



Persons vaccinated. 



Crew. 



46 
88 
42 
36 
69 
28 



76 
26 
42 
29 
32 
114 



Passen- 
gers. 



28 

6 

2 

12 

61 



8 

8 



4 
2 

8 



628 



124 



Persons 
bathed and 
effects dis- 
infected. 



5,797 
2,616 
1.266 
8.631 
2,751 
632 



630 
611 
908 

1,841 
560 

1,440 



21,908 



Persons 
quaran- 
tined (sus- 
pects). 



4,472 
1,500 

1,007 

139 

1,612 

28 



390 

416 

1,308 



10, «7 



Statistics of ovigoing quarantine transactions at the port of Manila^ P. /., for the fiscal year 

ended June SO, 1903. 



Month. 


Vessels 

in- 
spected. 


Vessels 
in quar- 
anUne. 


Vessels 
disin- 
fected. 


Vessels 
remand- 
ed to 
Mari- 
veles. 


Pieces 
fected. 


Pieces 

baggage 

inspected 

and 

passed. 


Number 
crew 
(outgo- 
ing) in- 
spected. 


Number 
of crew 
quaran- 
tined. 


1902. 
July 


164 
171 
176 
271 
281 
309 

812 
61 


154 
99 
79 
78 
48 
50 

15 
1 


2 

1 
1 


16 
9 

1 
2 
5 


21,750 
7,199 
7,864 
4,208 
4,712 
7,446 

2,476 
2,174 


8,041 
1,862 
2,112 
478 
1,089 
2,007 

799 
2,118 


21,486 
16,792 
18,237 
14,280 
10,228 
12,206 

9,626 
1,496 


5,206 


Auirust 


6.4.^0 


Sentembcr 


2,277 


October 


2.101 


November 


1 


1,621 


December - 


1,867 


1903. 
JnniiArv _ 






345 


Febniarv 








March 








Anril 


















May 


85 
24 


1 
1 


81 
22 




1,298 
2,216 


568 
1,800 


l.OU 
1,692 


181 


~*' 

June .^. ....... .T^-- 


1 


174 






Total 


1,783 


626 


68 


84 


60,882 


16,868 


100,960 


18,725 







PUBUO HEALTH AND MABINK-H08PITAL SERVICE. 



167 



SUUemeni of outgoing qtiarcmtine iranaadions at the port of Manila^ P. J. , for the JisocU year 

ending June 30, 190S — Continued. 



Month. 


Number 

passengers 

(out- 

imqpected. 


Panengers quar- 
antined. 


Persons 
vaccin- 
ated. 


Persons 
bathed 

and 
clothing 
disin- 
fected. 


Cases of quarantinable 

diseases among persons 

in quarantine. 




Cabin 


Steerage. 


Leprosy. 


Small- 
pox. 


Cholera. 


1902. 
July 


60,964 
80,110 
10,872 
14,796 
9.488 
14,836 

4,069 
1,968 


2,988 
2,245 
822 
264 
172 
167 

18 


13,820 
7,858 
1,460 
1,994 
1,724 
1,786 

19 




984 

667 

33 

66 

101 






18 


AnffUfft 








7 


SeDtember 








1 


October 








2 


NoTinnber 








8 


December 










1903. 
XfunmuT 












Febroarr 












March .' 
















April 


















1^::::::::::::::: 


6,941 
6,609 


106 
118 


1,121 
982 




436 
618 








Jone 




1 


1 










Total 


160,627 


6,880 


30,764 




2,906 




87 








' 





Report of patients treated in hospital at the Mariveles quarantine station during the fiscal 

year 1903, 





Num- 
ber of 
cases. 


Nationality. 


Result. 


Diaeaae. 


Ameri- 1 Porto Rl- 
cans. cans. 


Filipinos. 


Chinese. 


Recov- 
ery. 


Death. 


Smallpox T 


8 
16 
3 
1 
1 
1 




3 

12 




1 
7 
3 


2 


Cholera 


\ 




9 






3 






Tubercle oi lungs 


1 





1 


Deseneratloii oiheart, fatty 






1 




1 


Affraris lumbricoldef 




1 




1 













The small nomber of cases of cholera and other diseases treated in the hospital at 
the quarantine station is accounted for b^ the fact that most of the cases of sickness 
were removed to the hospitals of Manila before the vessels were remanded to 
MariveleB. 



REPOBTS OF TRANSACTIONS AT SUBPORTS. 

Rep orts from Assistant Surgeons Carroll Fox, M. K. Gwyn, and 
J. W. Amesse, in charge, respectively, at the ports of Cebu, lloilo, 
and Jolo, follow: 

CEBU. 

Report by Asst. Suro. Carroll Fox. 

Public Heai/th and Marine-Hospital Service, 

Office of the United States Quarantine Officef., 

Part of Cebu, P. /., July 30, 1903. 

Sra: I have the honor to report as follows with regard to the maritime quarantine 
conducted by the Service at the port of Cebu, P. I., during the fiscal year ended 
June 30, 1903: 

The health conditions at Cebu and surrounding islands at the beginning of this 
year were ffdrly good, with the exception of smallpox, which is always present in 
varying amount, and leprosy in the Lazaretto. 

Qoarantinable diseases were present in Hongkong, from which port vessels came 
to Ceba on an average of two per month. 



168 PUBLIC HEALTH AND MARIKE-H08PITAL SERVICE. 

A large number of vessels came from Saigon, but that port remained uninfected 
and danger from there was comparatively small. 

As an instance of the danger from Hongkong, one vessel, the Kaifing, had on 
arrival 134 stowaways, who of course were not Known to have embarked by the 
officer on duty there and were not disinfected. This happened while Hongkong 
was badly infected with cholera. 

Shipping during the vear increased about 25 per cent, most of which was confined 
to the coasting traide; there was, however, a slight increase in foreign trade. Hemp 
is shipped in considerable quantity to the United States, principuly to Boston via 
Suez. 

The health conditions remained good until July 9, when cholera made its appear- 
ance, having been brought from the island of Leyte to a small town 4 miles from 
Cebu and thence down the coast. On the appearance of cholera in Manila, a quar- 
antine was instituted aeainst incoming vessels of all descriptions. 

Native vessels, called '*bancas,'' enter Cebu at the rate of 20 and SO daily; carry 
laree numbers of natives and are the great source of danger to the port. It is inipoe- 
sible to control their movements after they leave the larger ports, as they exist by 
thousands, ape dirtv, and peopled by the most ignorant natives, who take no precau- 
tions whatever. There is no doubt that the ranid spread of cholera from island to 
island was due principally to these. Most of the cholera cases taken from vessels 
durine the epidemic came from these boats and from those lying in the mud flats 
near iSiore, as they get their water supply from the wells in the lowest portion of the 
city, where it is likely to be infected from drainage and seepage. No method is used 
to dispose of sewage except to throw it upon the ground. A lai^ge number of these 
vessels were disinfected by the Service after having eases on board. 

Immediately on the appearance of cholera, an outgoing quarantine of five days was 
instituted against vessels leaving for other ports in the islands. This included bancas, 
and at one time 70 vessels and 600 people were in quarantine. This was rigidly 
enforced until July 30, 1902, when an oraer from the chief quarantine officer per- 
mitted vessels to clear for infected ports without detention. The detention was still 
necessary for vessels to clean ports. The epidemic was at its height from July 9 to 
about the middle of October, during which time there were in the city 1,300 cases 
and 700 deaths. After this the number of cases gradually decreased until only an 
occasional case was noted. The town had enough cases still to be considered con- 
tinually infected. 

In the early part of the epidemic the barge Proteocion started from Manila to Cebu 
in tow of a steamer. She broke from her tow during a storm and went ashore. She 
was finally recovered, but bv the time she was raised and repaired did not arrive in 
Cebu until December 10, 1902. In the meantime disinfecting was done under great 
difficulties, but with fairly good results. After the arrival of the barge fewer diffi- 
culties were encountered. 

During the year no plague and only 1 case of smallpox was found on a vessel. 

One case of leprosy arrived on a steamer from Hongkong and was certified as such. 
This case was returned to Hongkong on the same vessel by the collector of customs, 
acting as immigration officer. 

Respectfully, Cabboll Fox, 

AmgtajU Surffeoii, 

Asst Surg. V. G. Heiser, 

Chief Quarantine Officer, 

Summary of quarantine tranBoctUms at Cebu, P, J., for the fiscal year ended June SO, 190S. 

Vessels inspected 3, 390 

Vessels held in quarantine 483 

Vessels disinfected 48 

Bills of health issued 1,668 

Pieces of baggage disinfected 2, 245 

Pieces of baggage inspected and passed 536 

Cases of ouarantinable diseases detected on vessels: 

Smallpox 3 

Cholera 51 

Leprosy 1 

Crew in quarantine d, 095 

Passengers in quarantine 1, 857 

Crew inspected 76,920 

Passengers inspected 25, 806 

Persons vaccinated 753 

Persons bathed and effects disinfected 808 



PUBUO HEALTH AKD MABINE-HOSPITAL SEBVICE. 



169 



islics ofinanning quarantine transactions al the port of Cebu^ P. /., Jot the fiscal year 

ended June SO, 190S. 



Month. 


Veflsels inspected 
from— 


Vessels in 

quaran- 

Une. 


Vessels dis- 
infected. 


Bills of 
health 
issued. 


Pieces bag- 
gaee dis- 
infected. 


Foreign 
ports. 


Domestic 
ports. 


1902. 


4 
4 

8 
4 

8 
7 

5 

8 
12 

6 
16 

8 


60 
89 
104 
126 
146 
126 

118 
114 
152 
398 
686 
567 


8 




60 
91 
112 
120 
187 
129 

126 
111 
141 
170 
178 
194 




BSt 






ember 


2 
3 
6 
1 


2 
1 

1 

1 


806 


ber 


204 


ember 


892 


fmbfrr 


88 


1908. 

latry 




TULry 


3 
6 
4 
2 
8 


3 
6 

4 
3 
8 


41 


A?..: ::::::::.:: 


248 


1 


297 




14 


t 


109 






Total 


78 


2,685 


88 


29 


1.668 


1,649 







Month. 



1902. 

xukV.'.'.'.'.'.'.'.'.'.. 

ember 

tber 

ember 

1908. 

Mury 

nmry 

ch 

il 

B 

Total 



Crew in- 
spected. 



1,866 
2,679 
2,769 
8,170 
8,787 
8,388 



8,840 
8,276 
4, otK) 
5,600 
8,631 
7,402 



60,690 



Passengers in- 
spected. 



Cabin. 



141 
176 
118 
188 
188 
237 



204 
112 
185 
267 
263 
180 



2,279 



Steerage. 



712 
633 
618 
802 
896 
1,394 



836 
717 
1,208 
1,751 
3.840 
2,248 



16,150 



Persons 
held in 
quaran- 
tine. 



60 



79 

98 

238 

22 



32 
83 
41 
10 
66 



724 



Persons 
bathed and 
effects dis- 
infected. 



79 
84 
58 
22 



87 
131 
97 
10 
84 



602 



Crew and 

passengers 

vaccinated. 



700 



15 
12 
10 
16 



753 



isHcs of outgoing quarantine transactions at the port of CebUf P. I., for the fiscal year 

ended June 30, 1903, 



Month. 


Vessels In- 
spected. 


Vessels in 
quaran- 
tine. 


VesHsels 
disin- 
fected. 


Pieces bag- 
gage disin- 
fected. 


Pieces bag- 
gage in- 
spected and 
passed. 


Crtw (out- 
going) in- 
spected. 


1902. 

r 


170 
164 
146 
148 


170 

139 

68 

68 


9 
8 
2 


115 
164 
233 

84 




7.685 


QSt 


239 
135 
162 


7,962 


iiember 


6,804 


>ber 


8,929 


ember 






no ber- - r - r r t ......,..- 














1908. 

tiM.nr ...•.,.. 














niajv 














lUWJ 

nh rrr.-^»r--r- 














n 














r 














B. ,,. 




























Total 


627 


446 


19 


596 


536 


26.280 







170 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



Statistics of outgoing (juarantitw trm\saciions at the port of Cebu, P. /., for the fiscal ijenr 

ended June SO, lOOS—Contmixed. 



Month. 


Number 

of crew 

quaran- 

Uned. 


Number 
passengem 
(outgoing) 
inspected. 


Paasengen 
quarantined. 


Persons 
vacci- 
nated. 


Persona, 
bathed and 

clothing 
diainfectedl 


CasM 
choleni 


Cabin. 


Steer- 
age. 


on ves- 
sels. 


1902. 
July 


1,507 

1,878 

1,477 

991 


2,225 
3,310 
1,835 
1,007 


102 
53 
18 
31 


843 
440 
170 

218 


• 


92 
114 


10 


August 




11 


September 




4 


October 








November 






December 














1903. 
January 














Pebniary 












1 


March. .'. 












........... .|. ......... 


April 












1 


May 














June . , ,- 












1 
















Total 


5.853 


8,377 


2(H 


1.171 




206 % 











ILOILO. 



Kkport by Asst. Suro. M. K. Gwyn. 



Public Health and Marine-Hospital Service, 

Office of the United States Quarantine Officer, 

Port oflUnlo, P, J., July SI, 190S, 

Sir: I have the honor to submit the following report on the trftnsactions of the 
Service during the fiscal year ended June 30, 1W3: 

The city of floilo, Panay, has an estimated population of about 20,000. The cen- 
sus figures not being available yet, accurate information can not be given. Situated on 
a low plain a few feet above the level of the sea, with an arm of the sea, the Uoilo River, 
placing it on an island, and the island of Guimaras giving a sheltered harbor for the 
largest vessels. The population is made up, with tne exception of the troops, of a 
few Americans, Englishmen, quite a number of Spaniards, and a lai^ number of 
Chinese and Filipinos. 

The city is the principal sugar-exporting port in the islands. 

The river is navigable for vessels drawing not over 14.6 feet for a mile, that being 
the depth of water on the bar at high tide. 

About 100 foreign vessels touch there per year. These arrive with general caigoee 
and rice, and take out sugar and dyewood. 

For boarding purposes a boarding launch 65 feet long, 9 crew, with a speed of 7 
knots, is inaintainea. 

A floating plant, the barge Esmeralda, crew of 4, with two modem steam cham- 
bers and a sulphur furnace, is used for disinfecting purposes. The barge arrived at 
the station August 27, 1902. 

The office of the quarantine officer is located in the building occupied as ofiloes by 
the depot quartermaster. 

During the past year an epidemic of cholera visited Iloilo. The first cases were 
found on a small banca, which had been lying in the river several days. Out of a 
crew of 12 there were 6 cases and 2 deaths. 

These men were promptlv isolated, but my impression at the time was that the 
infection took place in Iloilo. After finding these cases, there was a lull of several 
days, during wnich there were rumors of cases all over the city. Then the board of 
health began reporting from 10 to 30 cases per day. August 27 I found a case of 
cholera on a lorcha in the river. This removed all doubt in my mind as to the town 
being infected. The epidemic reached its height in November. December saw the 
decline of the epidemic and the advent of the northeast monsoon. 

In all about 4,000 lost their lives — with a few exceptions all natives and usuaUy the 
poorer ones. 

This is not surprising when we consider the insanitary condition of the native 
shacks, the under part of which is used to deposit all refuse and sometimes made the 
house of the family pig, the chickens and aogs occupying their ownexB' beds and 
rooms. 



PUBLIO HEALTH AND MARINE-HOSPITAL SERVICE. 171 

Water is obtained from sarface wells, naturally very easy to infect. Contrast this 
kith the white population who used distilled water and ram water in tanks, usually 
»f iron and placed above the ground, and paid some attention to cleanliness and food, 
ind we have a reason why they escaped cholera. 

The Chinese population were also remarkably free from cholera. Few, if any 
ases ooeurred among them, due probably to theu* tea-drinking habits, and most of 
hem belonging to the merchant class were better able to look after themselves. The 
^tdnese shopkeepers who handled articles of food had lattice screens in front of their 
■oonters to prevent their customers, principally natives, from handling articles in 
he shop and thus infecting them. 

From December to May there was entire absence of cholera. In the latter month 
here occorred five cases, all of which proved fatal. 

&nallpox occurs seldom, as considerable compulsor}r vaccination has been done. 

There is said to be considerable leprosy in the interior of Panay, but in Iloilo but 
iew cases can be seen on the streets. At one time all the lepers were segregated, but 
)wing to lack of funds this policy was abandoned. 

So uir as I know there never has been any plague in the city. 

There have been several epidemics of dengue, but no reported fatal cases. 

Beriberi and dysentery occur frequently, but malaria occurs seldom in town, but 
in the surrounding country it is frequently very fatal at certain seasons of the year. 

As soon as the cholera was officially declared an outgoing quarantine was estab- 
jshed, vessels for clean ports being detained five days and disinfected if infected. 

As new ports were declared infected, and before Iloilo became infecte<l, rigid 
parantine was enforced. But information was very difficult to obtain, and it was 
leqaently necessary to hold vessels on suspicion based on rumors and information 
pven by local firms through their correspondents. This information was usually 
Dond to be correct, especiaBy so since no detention was imposed on vessels sailing 
or infected ports. 

Another difficulty was the smaller vessels, the praos, bancas, and viloses. These 
mall Graft, ranging in size from 1 to 10 tons, carrying from 8 to 30 crew, represent the 
lative trading element. They go from port to port, from Mindanao on the south to 
[jaum. on the north, on voyages of several months' duration. Their usual cai^goes 
ue hats and clothes, linen and cotton goods. 

Others take shorter voyages of a week or two, bringing in fish, dyewood, and 
Irewood. 

A g^reat many are the only means of communication between the smaller towns. 
Sereial thousand of them touch annually at Iloilo. 

Bespectfully, M. K. Gwyn, 

AsgistarU Surgeon, 

AsBt. Surg. V. G. Hbiseb, 

Ckief QuararUine Officer. 

htnmary of quarantine transactions at Iloilo^ P. 7., for the fiscal year ended June SO, 1903, 

Tenels inspected 2, 093 

iTesKls held in quarantine *. 217 

jTeasels disinfected , 35 

inis of health issued 1,269 

of baggage disinfected 2, 368 

of baggage inspected and passed 7, 265 

of quarantinable diseases found on vessels: 

Cholera 33 

Smallpox 1 

jKvW in quarantine 2, 077 

.\uBengers in quarantine 1, 677 

>ew inspected 42, 561 

iVusengers inspected 25, 102 

'Arsons bathed and effects disinfected 899 

i'lttsoDS vaccinated 932 



172 



PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



Statistics of incoming (juitmntine trcinsaciions at the port of Ilmlo^ P. L^ for the fiscal yenr 

ended June SO, 190S. 



Month. 



1902 

July 

August 

September 

October 

November 

December 

1903 

January 

Febniary 

March 

April 

May 

June 

Total 



Vessels inspected 
from— 



Foreign 
ports. 



3 
9 
9 
2 
1 
4 



1 
4 
5 
4 

6 

7 



55 



Domestic 
ports. 



33 
63 
197 
202 
195 
243 



114 
33 
62 
44 
71 
56 



Vessels in 

quaran- 

Une. 



Vessels dis- 
infected. 







15 


5 


13 


2 


6 


2 


5 


1 


2 


2 


1 


1 






1 
.•••••••.•(••••. ••••... 



1,803 



I 



42 



13 



Bills of 
health 
issued. 



12 
13 
258 
185 
166 
252 



82 
42 
48 
40 
74 
97 



Pieces baggage— 



»«--- 'SC 



fee ted. 



passed. 



192 

286 

156 

22 



200 
75 



44 

417 

m 



78 



1,269 



931 



791 



Month. 



1902. 

July 

August 

September 

October 

November 

December 

1903. 

January 

February 

March 

April 

May 

June 

Total 



Crew in- 
spected. 



1,166 
1,963 
3,084 
2,593 
8,361 
8,548 



2,604 
1,381 
2,111 
1,858 
2,728 
2,371 



28,768 



Passengers inspected. 



Cabin. 



159 
880 
250 
195 
209 
243 



278 
216 
298 
254 
828 
829 



3,079 



Steerage. 



275 
710 
1,586 
1,911 
2,987 
2,825 



861 
831 
701 
896 
1,410 
629 



15,612 



Persons 
held 
in quaran- 
tine. 



866 

249 

209 

9 



141 
100 



1,074 



Persons 
bathed and 
effects dis- 
infected. 



148 

68 

126 

9 



141 
100 



592 



Crew and 
passengen 
vaccinated. 



SUUtistics of outgoing quarantine transactions at the part of Ihilo, P. L, for the fiseal 

year ended June SO, 1903, 



Month. 


Vessels in- 
spected. 


Vessels in 
quaran- 
tine. 


Vessels dis- 
infected. 


Pieces bag- 
gage dis- 
infected. 


Paasengers quaran- 
tined. 




Cabin. 


Steerage. 


1902, 
July 














August 


50 
201 
192 
171 
121 


48 

109 

9 

8 

1 


6 

11 

8 

1 
1 


412 

688 

267 

68 

62 


26 
68 
42 

7 


142 


September 


646 


October 


12D 


November 


26 


December 




1908. 
January 






February 














March 














April 














May 














June 




























Total 


735 


175 


22 


1,427 


138 


RSt 







PUBLIC HEALTH AND HABINE-HOSPITAL SBBVICE. 



173 



of (rtiiffoing quarantme tranMcUons at the port of IhUoy P. L,/or the fiscal 

year ended June SOy 190S — Continaed. 



Month. 


Penons 
vacci- 
nated. 


Peraonfl 
bathed 

and 
clothing 
disin- 
fected. 


Cases 
cholera 

on 
vettels. 


Pieces 

baggage 

Inspected 

and 

passed. 


Crew 
(outgoing) 
inspected. 


Crew 
quaran- 
tined. 


Passcngera 
(outgoing) 
inspected. 


1902. 
JnlT 
















Aofoipt 




64 
174 


4 

10 
8 

1 
2 


32 

1,796 

1,173 

107 

3.366 


1,746 
4,329 
1,771 
2,619 
3,883 


362 

1,104 

111 

185 

7 


714 


flcpttrmber ... 




2.119 


0i^6ber 




54 

8 
7 


994 




• 


2,465 
119 


Deoemlwr 




190B. 
laimaiy 






FebmarT 


1 










March ' 


1 j 










ADfil 


: i 










fi^.: 


1 








JnnA 


•»•«•■•••.•>>•••■«*> 














1 












Total 




307 


20 


6,474 


13,798 


1,719 


6,411 









JOIiO. 



Rbpobt bt Abst. Subo. J. W. Amebse. 

Office of the United States Quarantine Officer, 

P&rt of JdOf JolOy P, /., July SI, 190S, 

8ir: I have the honor to make a brief report of the transactions of the Public Health 
•nd Marine-Hospital Service for the period from the opening of this station to the 
ending of the fiscal year 1903, as follows: 

On the 6th of May telegraphic orders were received from the chief quarantine offi- 
cer for the Philippine Islancb detailing me temporary (quarantine officer of the port 
of Jolo, whereupon an inspection of arrivinj^ vessels was immediately instituted under 
the ]»x)vi8ions of the United States quarantine laws and regulations. Previous to this 
time the quarantine supervision was under the control of a medical officer of the 
United States Arm^. 

The port of Jolo is the center of the shipping interests for the islands of the Sulu 
0onp and of southern Mindanao. There is considerable traffic at all times between 
Jolo and the nearb]^ islands of the Celebes group, also Borneo, Saigon, and Singapore. 
QaAte a number of interisland steamers make Jolo a port of call, as do also a number 
of foreign vessels en route to and from other island ports. During tlie p|aBt year there 
were 43 entries from foreign ports, and a steady increase in the foreign trade has 
been observed. In addition to the above there are about 500 small sail boats ( ' * Sapits 
or More sail boats"), whose headauarters are at Jolo, and these vess^els ply between 
Jolo and all the surrounding islands; in fact, they come in and go out unrestricted, 
land at any place along the coasts, whether a port or not, discharge and load cargo, 
and even go to and from many of the nearbv foreign ports, carrving large numbers of 
nasBengere and valuable cargoes. These sail vesseGi, as well as the other vessels enter- 
ing the port in the past, received very little sanitary supervision, only such as was 
possible and absolutely necessary, owing to the military status of the district and the 
exigencies of war. 

Immediate action was taken to gradually obtain control over the many small Moro 
sailing craft. This, on account of tne peculiar characteristics of the Moro, and in order 
to prevent antagonism on their part, was done with the greatest caution and in a 
manner to create the impression among them that the work done is for their V)enefit 
and is not compulsory . Should the measures become objectionable to them, they 
would land tiieir caigo and passengers at the nearest village and not come into the 
port of Jolo proper, and thereby all control over them would be lost. 

Vessels entering this port between sunrise and sunset are now inspected immedi- 
ately. The bouding so far has been done by means of a rowboat manneil by two 
Filipino attendants. 

An office was secured in the Government building used as the custom-house. No 
funuBhiiigs for the office have as yet been obtained, although the collector of cus- 



174 PUBLIC HEALTH AND MABINS-HOSPITAL SERVICE. 

toms kindly loaned the Service sufficient fomitnre to conduct the office work until 
such as was necessary could be secured from Manila. 

During the past four months the health conditions of the island of Jolo have 
greatly improved. The epidemic of cholera has almost entirely sabsi4ed. In the 
walled city, Jolo proper, there has been no cholera; all the cases occurred in the 
adjoining Moro villages. 

The work institute by the Service lias progressed without friction or oppootioii 
from any quarter, and the Service enjoys tne respect and support of both militaiv 
and insular autliorities. The importance of a station at Jolo can not be overesti- 
mated. Its proximity to the infected ports in the Celebes, the Dutch Indies, and 
Straits Settlements make the port a vital one, as through this port quarantiDable 
diseases could quickly gain a foothold in the island of Jolo and the infection be rap- 
idly disseminated to the other islands of the Philippine Archipelago by the htmdreds 
of small boata which stop at every landing on the coasts oi the adjoining islands. 
The primary infection of the cholera epidemic of 1882 was directly traced to Jok), 
and from there carried to the other islands and Manila by vessels. 

During the two months much has been accomplished. The quarantine work has 
been placed on a rational and scientific basis. Masters, owners, and agents of venek 
have been persuaded to adopt sanitary measures and to maintain their vessels in a 
better panitary condition not only when entering port, but also throughout the 
voyage. The cooperation of the quarantine officers and customs inspectors at the 
ports of Siassi ana Bongao has been obtained and uniform regulations relative to 
the arrival and departure of interisland vessels prevail in the larger ports of the dis- 
trict. While but little quarantining and disinfecting of vessels was accomplished 
(only one vessel bein^ disinfected), yet the work done and results obtained are 
gratifying when the existing conditions are taken into consideration. 

The port of Jolo promises to be one of the principal gateways to the Philippinee 
and one of the most important ports. The fine harbor, and the fact that vessels will 
soon be able to come directly alongside the wharves to load and discharge, will no 
doubt cause every vessel coming from the south to make Jolo the first port of caU. 
Thus, from a quarantine standpoint, Jolo will be the point for the detection of qoar 
antinable disjsases before the same have entered far into American territory. 

The United States quarantine laws and regulations of 1903 were put into effect at 
this port on June 1 , 1903. 

The provisions of circular letters of June 21 and 22, issued by the chief c]|aarantine 
officer lor the Philippine Islands, were immediately put in force upon their receipt, 
although the provisions relative to mechanical cleanliness of vessels Had already been, 
in a meajsure, successfully carried out. No vessels were fumigated with sulphur to 
kill the rats and other vermin on board during May or June. 

Every assistance possible has been given uie customs authorities to regulate the 
Moro sailing craft, it being desired that these vessels be regularly enrolled (for which 
no charge is made) and that they carry ''ship's papers'' Uie same as other coaftwise 
vessels. These measures have l>een successful to a degree, about 150 of the '^sapits" 
being registered. The bearing of these regulations on sanitary matters is palpable, 
since the efficiency of the quarantine service in the archipeli^ must be m direct 
proportion to the measure ot official control over the vessels ^ich are engaged in 
the interisland traffic. Where vessels enter and clear at island ports an inspection 
and supervision is possible, but no control can be exercised over such as come and 
go when and where they like, many of them as far as Borneo, and all too swift to be 
overtaken even by ordinary steamers. 

There are two attendants on duty at the station. They are the acting oarsmen, 
who man the boarding boat. The advisability of remanding the disinfecting baige 
Proteccion from Cebu to Jolo, as soon as the contemplated quarantine station at Ce&i 
is finished, is now under consideration. 

The quarantine transactions for the two months during which this station has been 
under Service (control are shown in the inclosed tabulate statements. 
Respectfully, 

J. W. Ambssb, 
Asststard Surgeon, in Temporary Command. 

Asst. Surg. V. G. Heiseb, 

Chief Quarantine Cfficer, 



FDBUO HXAI.TH AJXO HABINE-HOSFITAL SEBVICE. 



175 



of quarantine trangactiaiis at JolOy P. /., during Oie fiscal year ended June SO, 

190S, 



[Station opened May 5, 1908.] 



ispected 

eld in quanmtine 

iainf ectod 

ealth iflsaed 

baggage dkiiifected 

baggage inepected and passed 

inanmtinabfe diseases found on vessels: 
era 



43 

1 

27 







Ipox 

jnarantine 

re in Quarantine. 









1,780 

re inspected 1,081 

lathed and effects disinfected 

'aodnated 

ranMcUons at Jolo, P. J., national quarantine station fur year ended June SO^ 

190S. 



[Station opened May 5, 1906.] 



ken and passed 

M>6cted and passed 

innfected 

wis inspected and passed 

lels dlsinlected 

crew on tteamexB 

crew on sailing vessels 

passengers on steamen 

paasengers on sailing vessels 



May. 


Jnne. 


is* 


2i' 


2 


2 


1 




864 


884 


14 


18 


654 


427 


2 


8 



Total. 



89 



4 

1 

1,748 
82 

1,061 
10 



if quarantine tranmctions at the port of Jolo, P. /., during the fiscal year ended 

June SOy 190S. 

[Station opened May 5, 1903.] 



Month. 


VesseUi inspected 
from— 


Number 
of 

Ve88C>l8 

disin- 
fected. 


Bills of 
health 
issued. 


Number 

of 
crew in- 
spected. 


Number of paa- 
sengeni inspected . 


Foreign 
ports. 


Domestic 
ports. 


Cabin. 


Steerage. 




2 
3 


18 
20 


1 


12 
16 


878 
902 


100 
64 


566 




371 










5 


88 


1 


27 


1,780 164 


92V 











AL STATEMENT — QUARANTINE SERVICE IN THE PIin.IPPINE 
ISLANDS (united STATES CURRENCY). 

/. Appropriation account^ insular treasurer , fiscal year 190S. 

Debits. 

priation, act 430, quarantine service $26, 940. 66 

priation, act 490, quarantine service 24, 440. 00 

priation, act 595, quarantine service 53, 141. 00 

tal 104,521.66 



176 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVI0E. 

Credits. 

By net withdrawals by disbursing officer 164, S50. 93 

By amount credited insular purcnasing agent 6, 772. 02 

By amount credited bureau of printing .'. 395. 40 

By balance un withdrawn 32, 403. 31 

Total 104,521.66 

II. Staiemenl of funds (disbursing officer) ^ appropriations of fiscal year 1902. 

Debitr. 



I 



♦ 



1 

July 1. Balance June, 1902, account current $10, 430. 36 i 

Aug. 9. Received from treasurer, A. W. 1769 1,430.10 . 

1903. ■ 

Apr. 11. Received from treasurer, A. W. 3013 160.72 f 

Total 12,020.18 



I 



Cbbditb. 

1902. 

July 21. Refund to treasurer, receipt 5502 .04 

July 21. Refund to treasurer, receipt 5503 2, 511. 04 

July 21. Refund to treasurer, receipt 5504 88. 42 

Sept. 13. Refund to treasurer, receipt 6411 1,699.66 

Sept 16. Refund to treasurer, receipt 6450 1, 856. 03 

1903. 

Apr. 11. Balance to be accounted for by disbursements 5, 865. 99 

Total 12,020.18 

III. — Statement of funds {disbursing officer) appropriations of fiscal year 190S. United 

States currency. 

Debits. 

1902. 

July 29. Received from treasurer, A. W. 1676 $10,000.00 

Aug. 27. Received from treasurer, A. W. 1795 6, 000. 00 

Sept. 30. Received from treasurer, A. W. 1934 3, 000. 00 

Oct. 30. Received from treasurer, A. W. 2058 7,500.00 

Dec. 1. Received from treasurer, A. W. 2236 6,640.00 

Dec. 31. Received from treasurer, A. W. 2397 4,000.00 

1903. 

Jan. 26. Received from treasurer, A. W. 2483 13, 000.00 

Feb. 24. Received from treasurer, A. W. 2728 3, 600. 00 

Mar. 24. Received from treasurer, A. W. 2926 4,000.00 

Apr. 28. Received from treasurer, A. W. 3087 4, 400. 00 

May 20. Received from treasurer, A. W. 3241 7,000.00 

June 22. Received from treasurer, A. W. 3375 2, 660. 00 

Total 70,600.00 

Credits. 

1902. 

Oct. 22. Refund to treasurer, receipt 7165 1,041.14 

Nov. 6. Refund to treasurer, receipt 7432 369.43 

1903. 

Jan. 16. Refund to treasurer, receipt 8653 460. 37 

June 30. Refund to treasurer, receipt 259 3,678.13 

Jiuie 30. Balance to be accounted for by disbursements 64, 950. 93 

Total 70,500.00 



PUBLIC HEALTH AND MARINE- HOSPITAL SERVICE. 177 

SUxtemetit of funds to be accounted for by expenditures July i, 19f)£f to June 30^ 1903. 

!)i8bureement8 by disbursing o£9cer, funds fiscal year 1902 $5, 865. 99 

^iflbursements by disbursing officer, funds fiscal year 1903 64, 950. 93 

Insular purchasing agent, 8U{)plie8, funds fiscal year 1903.' 6, 772. 02 

bureau of public printing, printing, funds fiscal year 1903 395. 40 

Total 77,984.34 

Expenditures. 

Fuly, 1902: 

Launch and bai^e expenses, supplies and repairs $82. 50 

Station supplies and disinfectants 1, 017. 50 

$1,100.00 

iugust, 1902: 

Compensation of personnel 5, 059. 22 

Office and eeneraf service expenses 519. 29 

Launch and barge expenses, supplies and repairs 252. 06 

Station supplies and disinfectants 1, 969. 77 

New construction and new equipment 1, 766.38 

9,566.72 

September, 1902: 

Compensation of personnel 2, 491. 58 

Office and eeneral service expenses 579. 03 

Launch ana barge expenses, supplies and repairs 195. 06 

Station supplies and disinfectants 496. 00 

New construction and new equipment 2, 478. 78 

6,240.45 

October, 1902: 

Compensation of personnel 3, 537. 89 

Office and general service expenses 385. 89 

Launch ana barge expenses, supplies and repairs 655. 62 

Station supplies and disinfectants 300. 90 

4,880.30 

November, 1902: 

Compensation of personnel 142. 95 

Office and general service expenses 43. 51 

Launch and barge expenses, supplies and repairs 160. 37 

Station supplies and disinfectants 299. 71 

New coi struction and new equipment 1, 201 . 05 

1,847.59 

>ecember, 1902: 

Compensation of personnel 6, 052. 92 

Office and general service expenses 951. 14 

Launch and barge expenses, supplies and repairs 1, 432. 62 

Station supplies and disinfectants 324. 16 

New construction and new equipment 1, 715. 61 

10,476.45 

anuary, 1903: 

Compensation of personnel 2, 946. 27 

Office and general service expenses 537. 50 

Launch and barge expenses, supplies and repairs 1, 605. 74 

Station supplies and disinfectants 290. 66 

New construction and new equipment 2, 855. 32 

8,235.49 

ebruary, 19a3: 

Compensation of personnel 2, 687. 67 

Office and ^neral service expenses 1, 061 . 78 

Launch and barge expenses, supplies and repairs 197. 41 

Station supplies and disinfectants 354. 69 

Repairs to buildings and wharves 4, 498. 00 

8,799.55 

[arch, 1903: 

Compensation of personnel 3, 447. 46 

Office and general service expenses 754. 09 

Launch and barge expenses, supplies and repairs 159. 61 

Station supplies and disinfectants 254. 96 

4,616.12 

H, Doc. 338 12 



178 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

April, 1903: 

Compensation of personnel $3, 267. 90 

Office and general service exi>ense8 451. &i 

launch and barge expenses, supplies and repairs 98. 09 

Station supplies and disinfectants 348. 75 

New construction and new equipment 160. 72 

$4, 327. 10 

May, 1903: 

Com|)ensation of personnel 2, 443. 58 

Office and general service expenses 636. 02 

Launch and barge expenses, supplies and repairs 248. 30 

Station supplies and disinfectants 363. 15 

Repairs to Duildings and whar\'es 1, 911 . 25 

5,602.30 

June, 1903: 

Compensation of personnel 3, 043. 60 

Printing blanks, books, and stationery 395. 40 

Office and general service expenses 1, 048. 63 

launch and barge expenses, supplies and repairs 3, 325. 44 

Station supplies and aisinfectants 3, 603. 10 

Repairs to buildings and wharves 593. 87 

New construction and new equipment 282. 23 

12,292.27 

Total 77, 984. 45 

Total expendUurcii^ (juarantine service in the Philippine Idandu^ July /, 1902^ to June SO, 

1903. 

DKTAII-S. 

Compensation of personnel $35, 121. 04 

Printing blanks, books, and stationery 395. 40 

Office and general service expenses 7, 051. 02 

launch and barge supplies and repairs 8, iJ.*W. 32 

Station supplies and disinfectants 9, 623. iio 

Repairs to buildings and wharves 7, 0(W. 12 

New construction and new equipment 10, 460. 09 

Total expenditures. United States currency 77, 984. 34 

Expenditures by station. 

Manila: 

General service expenses $17, 404. 92 

Launch expenses 8, 391. 49 

New station equipment 199. 10 

$25, 995. 51 

Mariveles: 

General service expenses and supplies 19, 255. 39 

Repairs to buildings and wharves 7, 003. 12 

New construction and new equipment 2, 860. 72 

29, 1 19. 23 

lloilo: 

General service expenses 3, 514. 04 

launch and barge expenses 4, 273. 19 

New station ecjuipment 924. 31 

8,711.54 

Cebu: 

( Joneral service expenses 3, 614. 13 

launch and barge expenses 2, 910. 21 

New station equipment 7, 113. 35 

13, 637. 69 

Jolo: 

General service expenses 437. 24 

New station equipment 83. 13 

520. 37 

Total exiKinditures, United States currency 77, 9S4. 34 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. l79 

SUUemetd miscellaneous receipts. 

[Expreflsed in United States currency.] 

Debits— 1902. 

July, collections for sabsistence at maritime quarantine station $32. 50 

Aagu^t, collections for subsistence at maritime quarantine station 59. 35 

September, collections for subsistence at maritime quarantine station 32. 00 

October, collections for subsistence at maritime quarantine station 46. 00 

November, collections for subsistence at maritime quarantine station 51 . 50 

December, collections for subsistence at maritime quarantine station 60. 00 

1903. 

January, collections for subsistence at maritime quarantine station 62. 00 

February, refund Hongkons and Shanghai Bank, excess deposit account 1 . 50 

February, collections for subsistence at maritime quarantine station 57. 50 

March, collections for subsistence at maritime quarantine station 56. 00 

April, collections for subsistence at maritime quarantine station 62. 00 

May, collections for subsistence at maritime quarantine station 47. 00 

June, collections for subsistence at maritime quarantine station 93. 00 

Total 660.36 

Credith— 1902. 

Jaly 21. Deposit insular treasurer, receipt 5503 32.50 

Aug. 28. Deposit insular treasurer, receipt 6180 40. 55 

Aug. 28. Deposit insular treasurer, receipt 6181 18. 80 

Sept. 11. Deposit insular treasurer, receipt 6427 9. 00 

.Sept 28. Deposit insular treasurer, receipt 6449 23. 00 

Oct. 1 1 . Deposit insular treasurer, receipt 6999 7. 50 

Oct 15. DeiMisit insular treasurer, rtHieipt 7000 38.50 

Nov. 1 1- Deposit insular treasurer, receipt 7500 51. 50 

Dec. 8. Deposit insular treasurer, receipt 7991 60. 00 

1903. 

Jan. 16. Deposit insular treasurer, receipt 8852 62.00 

Feb. 20. Deposit insular treasurer, receipt 9251 59.00 

Mar. 14. Deposit insular treasurer, receipt 9652 56. 00 

Apr. 7. Deposit insular treasurer, rei^eipt 10058 62.00 

May 20. Deposit insular treasurer, receipt 10834 47. 00 

Jane 9. Deposit insular treasurer, receipt 1 1278 46. 50 

June 27. Deposit insular treasurer, receipt 11672 46. 50 

Totol 660.35 

Respectfully submitted. 

Victor G. Heiser, 
Asst.Snrg., P. If. mid M. H. S., 
Chief (^inrantive Officer^ Philippine Mauds. 
The Surgbon-General Public Health and Marine- Hospital Service. 



Japan. 

destruction of rats on vessels leaving plagu1'> infected ports. 

In order to insure thorough cooperation between the officers sta- 
tioned at Jajwuiese ports and the chief quarantine officer of the Philip- 
pines in all measures for protection against plague, the following letter 



180 PUBLIC HEALTH AND MABINE-HOBPITAL BEBVICE. 

was addressed by the Bui'eaii to its officers at Yokohama, Naga^kt, 
and Kobe; 

Treasdry Dbparthbnt, 
BuHBAU OK Public Hbaltb and Maainb-Hohpital SEBvirs, 

Washington, June S6, IBOS. 
Sir: Your attention is called to the circular letter eeut out to the offi<%r« of thig 
Service on duty in China and Japan, under date of April 29, 1003, b;^ Aset tiutf. 
Victor G. Heieer, chief quarantine officer for the Philippine Islands, in which be 
requeetH cooperation aa Ear aa possible in the fumigation of veeaele with sulphur to 
kill rats ana vennin as a preventive measure against the plague gaining tMx^ewlo the 
United States. 

You are informed that the Bureau approves of this letter, and requests that ^ 
cooperate in securing the fumigation as far as possible, as the mattco' of deetrojini 
rate and vermin on vessels is considered a very important quarantine measure. 
Respectfully, 

Geo. Pubviamcb, 
Acting ^rgeon-OairraL 



yokohama. 

Rkpobt of Transactions by Asot. Sdro. Duhlop Moors. 

Public Hralth and Marinb-Hospital Srbvicb ov tbb Unitbd States, 

Office op the Medical Officer in Command, 

Yokchama, Japan, July 18, IMS. 
Sir: I have the honor to transmit herewith a report of transactions at this station 
for the year ended June 30, 1903. An additional report is in prepaistion, which will 
be forwarded to the Bureau as soon as certain desired data can be secured. 
Respectfully, 

Dun LOP MooBB, 
Jwuhint iVurjiran. 

The BtiHGKON-GENEKAU 

[InclODUre.] 
Summary o/ iTontaetiom at Yotohama, Japan, /or ytar mding June 30, 1903. 





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PUBLIC HEALTH AlfD MABms-HOSHTAL dEttVlClC. 181 

NAOA8ASI. 

Report of Tkakhactionh bv Sanitarv Inhpector R. J. Bowie. 

Pi;blic Health ako Marikb-Hohpital Bbrvicb ok the United Stateh, 

Office oi* the Medical Officer in Couhand, 

Nogatahi, Jnp'Ut, July 10, inoS. 
8ib: In accord&nce with thetenoBof the circular letter of May 11,1 have the honor 
to inclose herewith my report for the year ending June 30, 190a. The fiRures are 
rily incomplete, as 1 did not receive my appointment until July 29, 1902. 



H 1 did not r 
Under the heading of "Veeeele epokeE 
brthe Japnneee officiale or by this " 
and no outside lookout m maintaine< 



J record kept either 



[h maintained. With the exception of the cholera epidemic 
Taod bll, the health of the oort has been v^ry good. I hav(^ Kept no 
record of cases rejected for any cause. With a few excepliona, traclioma haa b^en 
the main cause of rejection. Tneiitringent provieione of the recently-amended immi- 
gration act have developed an excessive timidity on the part of the BteajiiNhip sur- 
geons, and a number of Bteeraffe panengera were refused passage after they hail been 
examined by me and certified to the agents aa entitled to paee. Consequently 1 have 
made it a rule to let the ship's doctor examine them firet. Should Congrefs ameDd 
the act, as seems likely, I respectfully sugnest that the opinions of examining sur- 
i^ns at ports of departure be obtained. The steamship companies trading from 
Oriental ports have expressed their earnest desire to meet the tiovemment more 
than half way. As I imdetvt&nd my dutv, it is to safeguard the health of the people 
of the United States and to assist trade wnen compatible with the law. Uncier jjres- 
ent conditions, owing to lack of uniform application of the regulations, injustice is 
done both to the corporations and to individuals, for those refused ^ssage by our 
^eatners simply travel via Victoria, an<l cross over the border from British Colum- 
bia- I am further of the opinion that a feeling of resentment is gradually being 
engendered in the minds of the Japanese, which will manifest itself later on. This, 
however, is only submitted as information, 

BeflpectfnUy, Robert J. Bowie, 

Saniiary Inspei'tnr. 
[Incl»ure,l 

Sumimrry of trantaeHon* al Nagatati, Japan, for year ending June SO, 190S. 





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TrA KB ACTIONS h 



AcTiNO AssT. SiTRo. J. B, Fowler. 



Public Health wu Marine-Hosfital Service, 

Office Sanitary Inspector, 
KiAte, Japan, SepUuiber, 190S. 
Sib; I have the honor to submit the following report of the transactions at the 
port of Kobe, Japan, covering the period from June 30, 1902, to and including June 
30, 1903. 



182 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

I have officially inspected 251 vessels bound for ports in the United States and 
ports in the possession of the United States. 

Of these vessels 56 were under the United States flag, 127 were British, 51 Japa- 
nese, 10 German, 3 French, 2 Norwegian, and 1 Austrian. j 

Their ports of destination were as follows: ' 

Manila 56 ' 

San Francisco 52 

New York 46 " 

Seattle 36 ^ 

Tacoma 35 ; 

Portland .' 14 : 

Port Townsend 4 f 

Astoria (Oreg. ) 2 [ 

Cebu : 2 ! 

Iloilo 2 ' 

Honolulu 1 J 

Port George 1 ]; 

The crews of these vessels amounted to 22, 193. 

Of these vessels in8pecte<l 232 were steamers and 19 were sailing shipn, and «jf the 
steamers 116 carried steerage passengers as follows: 

Steerage passengers embarked here for — 

Honolulu : 828 ' 

San Francisco 521 

Seattle 1,044 ■ 

Portland 242 

Tacoma 192 

Manila 313 

Canada 96 

Steerage: 

Chinese through from Hongkong 6, 236 

Koreans through from Nagasaki 5% 

Chinese through for Manzanillo 1,&48 

11,906 

The number of steerage passengers, 11,906, added to the crews of all vessels 
inspectetl, 22,193, gives a total of 34,099 individually examined by me during the 
penod of the twelve months. 

All emigrants and steerage passengers whoso port of departure is Kobe are also 
thoroughly examined by myself the day before the vessel sails; then on their fitness 
being aetermined their inspection cards are collected and taken to the United States 
consulate, and are there officially stamped and then distributed to the emigrants on 
board ship, where they ^o through the usual inspection before departure. 

Present method of uisinfection of baggage is by superheated steam and bichloride 
of mercury. 

Doctor Boyer acts as the inspector of baggage fumigation. 

The number of pieces of baggage inspectS and disinfected for the period of twelve 
months was 3,273. 

CHOLERA IN 1902. 

The total number of cases reported in the empire was approximately 5,239, of 
which 2,625 ended fatally. 

Authorities say that the cholera was first brought to Karatsu by a Chinese junk, 
and from there carried by boat to Tokyo, where the disease was at once diagnosed 
and every meiieure taken to stamp it out, but with only partial success. 

The first axfie in Kol^e and Hyogo occurred on June 16, and the last case on Decem- 
ber 2, 1902. In June there were 3 cases and no deaths; July, 10 cases and 6 deaths; 
August, 29 cases and 13 deaths. 

On the 8th of August all matting, strawbraid, and other articles from the City of 
Okayaiiia, or within 5 miles of it, were prohibited from being dispatched from Kobe 
for any port in the United States. 

On the 28th of August an American citizen, a first-class passen^r from Shanghai, 
via Nagasaki, died on board steamship Snih/o Mara from Asiatic cholera; the ship 
was ordered into quarantine and remained there eight days, six cases and three deaths 
occurring on board while in quarantine. In September there were 105 cases and 108 
deaths; Octol)er, 110 cases and 46 deaths; November, 5 cases and 11 deaths; Decem- 
ber, 1 case and 1 death. 



PUBLIC HEALTH AND' MARIN E-HOSPItAL SERVICE. 183 

This makes a total of 263 cases and 185 deaths from cholera in Kobe and Hyogo 
prefectures. 

Scarlet fever in Kobe and Hyogo prefectures: In January, 1903, there was 1 case 
and 1 death; in February, 1903, no deaths; in March, 1903, 1 case and no deaths; in 
April, 1908, 1 case and no deaths. 

Smallpox in Kobe and Hyogo prefectures: In April, 1903, there were 7 cases and 
no deaths; in May, 1903, 10 cases and no deaths; in June, 1903, 10 cases and no 
deaths. Last case on 13th of June. 
Respectfully, 

J. BucKNiLL Fowler, 

Ading Assistant tSurgeon. 
To the Su AG eon-General. 



China. 

destruction of rats on vessels leaving plague-infected ports. 

A letter similar to that sent the officers of the Public Health and 
Marine-Hospital Service at Japanese ports was sent to the Service offi- 
cers at Hongkong and Shanghai, China, relative to destruction of rats 
on vessels leaving those ports, in accordance with the request of the 
chief quarantine officer or the Philippines at Manila, Asst. Surg. V. (x. 
Reiser. (A copy of the letter in full will be found under 'Mapan" 
immediate!}'' preceding this chapter.) 

HONGKONG. 

Report op Transactions by Pahskd Asot. SuRn. John McMullen. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Oommand, 

Honghmg^ China, Sepieinher i.*>, 190S. 

Sir: I have the honor to submit herewith the annual report of transactions at this 
etation for the year ende^l June '^, 1903. 

The year just ended has proved a more busy one at this station than the ])receding 
<«e, as the increased num^rs of vessels inspected, individuals bathed and bagga^ 
disinfected will show. During the year bills of health were issued to 481 steamers 
and 23 sailing vessels, representing a total of 39,537 ofhcers and crew, and 21,103 pas- 
eeDgfim — 7,131 cabin ancl 13,972 steerage. Two hundred and ninety-five individuals 
were rejected for various causes just prior to sailing. A majority of these vessels 
were bound for the Pacific coast and the Philippine Islands, although quite a num- 
ber cleared for New York. 

inspection service. 

Inspections have been made on all vessels gran te<l bills of health with the exception 
of verv small craft bound for Manila and men-of-war. The time of sailing of the small 
humcnes to Manila is so uncertain that these vessels have l)een sent to Mariveles 
quarantine direct for treatment, but the crews are always inspected before delivery 
of bills of health. Inspection of vessels has l)een made as near the sailing hour as 
possible, when all persons sailing with the ship and the carjjo are required to Ix* on 
Board. The different steamship companies have always furnished launches for these 
inspections, and with one exception there has been no great trouble expi»rience<l in 
this regard. If, however, a launch could be furnished this offit^ it would facilitate? 
the work^ obviate any trouble, and make this office more independent in this res|)i'<t. 
All Asiatic crews and steerage passengers have l)een examined physically, with spe<'ial 
reference to tlie glandular regions, and any case of illness at all suspicious rejwted. 
The temperatures of all Asiatic steerage passengers have been taken at the time of 
disinfection and noted on the disinfection card given the passenger, but the temm^ra- 
tnres of the crews have not been taken except for some special reason. The snips' 
manifest, or, when none has l)een prepare<l, the Iwat notes, are examined at the timi' 
of inspection and a note made on the bill of health of any cai^o which is considerctl 
Bospidoos. 



184 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 

DISINFECTING WORK. 

Asiatic crews and steerage pafisengers on vessels boand for the Pacific coast and 
the Philippine Islands and Guam have been bathed and their clothing disinfected 
in a routine way during the entire vear, but those for the Atlantic coast have been 
inspected only, and not disinfectea. The reason for not disinfectins^ the latter is 
beaiuse of the length of time required for the passage, and a number oi these vessels 
change their crews at Singapore. 

During the past year 40,517 individuals were bathed and 45,304 pieces of bagp^ 
disinfected. This work was done on the disinfecting hulk, which has been described 
previously. Considerable improvement is reouired on this plant, as the disinfection 
IS not BO satisfactory in some respects as would be desired, and it is often overtaxed. 

Great difficulty fias been expierienced in obtaining all bedding, clothing, etc., for 
disinfection, since the crew, in nearly all instances, either secrete their clotning, etc, 
on board or put it into a sampan until after the disinfection is completed, when the 
the nondisinfected articles are put on board. In many instances tnis has been dis- 
covered at inspection just prior to sailing. All of these vessels are thoroughly searched 
at the time that clotning is sent to the disinfecting hulk and all articles found are 
immediatelv taken over to the hulk for treatment This practice of the Chinese, 
however, of putting their clothing off the ship temporarily, until after disinfection 
and then takmg on board, makes it exceedingly difficult to certify that *'all clothing 
has been disinfected.'* 

While this difficulty has been noted upon all classes of ships, it is more noticeable 
on Manila steamers that are disinfected about once a week, and these crews give no 
little trouble and annoyance in this regard. Another difficulty which has been 
noted in doing this work here is the substitution of one Chinaman for another. 
This has been detected and the man, of course, rejected, 1)ut it is a difficult matter 
usually to say positively whether the passenger embarking is the same individual 
bathed at the disinfecting hulk. A number of ships have been fumigated with sul- 
phur for the destruction of rats, ete., when it was suspected that rate had gone on 
E)oard here by reason of the vessel being in dock. 

SUPERVISION OF CARGO. 

Owing to the epidemic of cholera last year all fresh fruit and vegetables were pro- 
hibited shipment and none were allowed until December, when fresh fruit was pa&ied. 
No fresh v^:etables, however, have yet been allowed shipment from here into the 
Philippine Islands, by order of the dhief quarantine officer for the Philippine Islands. 
Supervision of all cai^o shipped has been maintained throup^hout the year, and all 
shipping orders of Chinese cargo for the United States are vis^ at this office before 
Being taken on board, and the invoices also inspected and initialed. All articles on 
the shipping order not allowed shipment were crossed with red ink and the order 
signed with red ink, and those whose nature was not clearly understood were inspected. 
Two hundred and forty-seven bales of hides were disinfected with sulphur fumes for 
shipment to Manila. The following cargo was inspected and held in an approved 
goaown for at least thirtv days prior to shipment: 1,291 cases of bristles, 81 cases 
human hair, 243 bales of hides, and 883 bales feathers. The majority of this cargo, 
with the exception of the hides, was shipped to New York via the Suez. 

QUARANTINABLB DISEASES. 

The only ouarantinable diseases which have occurred in the colony for the period 
covered by tnis report are cholera, plague, and smallpox. 

CHOLERA. 

The cholera epidemic, which commenced the latter part of February, 1902, con- 
tinueil until about September 1, when it began to decrease, and by October 1 the 
epidemic had practically ceased in the colony, since only 8 deaths occurred from 
October 1, 1902, to January 1, 1903. From July 1, 1902, to June 30, 1903, there were 
110 cases with 99 deaths. Only 5 cases have been reported from January 1 to June 
30, 1903. The whole of southern China suffered to a great extent from this cholera 
epidemic, during which time many foreigners died of the disease, and probably no 
district escaped its ravages, which were greatly aggravated by the long absence of 
rain and scarcity of water. The consular rejwrts concerning tne health of the vari- 
ous districts have proved of much value to this office, and especially bo during the 
epidemic of cholera. 



PUBLIC HEALTH AND XARINE-HOSPITAL SERVICK. 



Conmdenbtj more plwne tiaa occmred i 

preceding, 1,479 CMSswiUi 1,403 datthab»TL^ ^ .— .„. ._ 

30, tiid l,2fB of IhoK occurred betwen Januarj 1 aud June 30. Only a few a 

occnrred daring the winter months, bat the number incree^ed in Februar>-and con- 
tiDDed to increaae, whila last je«r the epulemiu did not commence uittil April. The 
local health aatbmilieBhavearegnlarforceof rat catiliera who ha^'l' iH'^n iiiiinuniied 
with Uaflkine'8 wnun, and no deaths have otvurred from j>lii)fue among theee. 

Previoua to organising this force rats werv caught and bruught in by anyone, but 
this was diacontmned, rince 75 per cent of tho«e eu enjii^eil dieil of the plague. 
Juet prior to the epidemic, commencing in February lu^, the ntiinberof infi-cteilnita 
caogot showed a marked increase, as did the prevmud year, and thid is the history 
of previous epidemica. The history of plague in Hongkong for pomu years [ia)>t shows 
that thfldincaoo commemiea about February, March, or April, and dei-rea«e:>sudi)enly 
aboat AaguBt 1. After theoe montlis there arv very few cases, althuugh 2 to 7 per 
cent of the rats caoi^t ahow plague infection. The t«nitary board endeavor at alt 
timeB to eradicate the plague by thorough dbinfection of houses where pli^e lias 
occurred, etc, but it is often atlifficultmatter, if not an iiiipoesiliility, tiilcnow where 
the patient died, mnce the Chinese are in the liabit of 'Mumj>iug"'the bodies some 
distance from the house in which theydied. dreading the difinfection more tlmii the 
disease. The city bacteriologi^hasfound the plague bacillus in fowls taken from the 
centiai market here, also in the flea, bedbug, and moequito. A luiger ])enfntnge 
of Europeans have been attacked the post year than usuhI, 34 having contracted the 
disease. A Quml>er of ateeB occurred on vessels in Ihe harbor, and several of these 
were on H. H. 8. Oeain, British battle ship. The great majority of the rasis were 
Chinese of the cooly class, but some were Japanese, Indians, and Portuguese. 



There have been sporadic cases of smallpox throughout the year, Chinese gener- 
ally, the total number of cases rei>orted being 57, with 4;t deaths. One hundred and 
forty-two deaths from tuberculosis were reported for the twelve mtmtha. Uealhs 
from all causes for the year amounted tu 7,121 iu a population, estimated, of 300,(100." 
Reepectfully, 

JoilS McMui.LKN, 

I'liiatd Amiitaiil ftUTt/eim 



Tbe BusaioN-GiNKRAL. 



[Incloiun'.] 
C Ilimgbmg, Chinn, /iir year nulnuj Jmir SO, I90S 
cMlTLLSN, Paaea Autnlimt Surgnm.] 





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"The other communicable (liseui<eH reiiorteil for the year areas follows: Knteric 
fever, S7 cases and 20 deaths; <liphthcriH, 17 cases and 4 deaths; scarlet fever, 7 <»aee 
and iM> deaths. 



f 



186 PUBLIC HEALTH AND MABINE-HOBPITAL SEBVIGE. 

SHANGHAI. 

Rbport of Tranbactionb by Acting Asst. Subo. S. A. Banbom. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Coicmand, 

Shanghai, China, July J5, 190S, 

Sir: I have the honor to transmit herewith the annual report of transactions at 
this station during the fiscal year ende<i June 30, 1903. 

This station was established in August, 1902, work being formaiiy commenced on 
the 26th of that month. There were some difficulties to be overcome, not the least 
of which was the attitude of the merchants and shipping people, who regarded the 
restrictions imposed as an invasion of their rights, and they were inclined to arKoe 
that because in the past they had been allowed to ship any and everything at all 
times with no quarantine supervision there was no cause for *'the useless hampering j 
of trade" by the enforcement of the regulations. \ 

This difficulty wa.s, however, finally surmounted, partly through the good offices 
of Consul -General Goodnow, who throughout has supported and aided this office in 
every possible way, and partly through strict adherence to the regulations and the 
impartial treatment accorded to all. 

Another difficulty arose from the fact that the office was opened in the face of an 
epidemic of cholera which had existed for some little time, and it was almost impos- 
sible to make the laity understand why restrictions not imposed at the beginning of 
the outbreak should l>e imposed at all, and this, of course, interfered to a greater or 
less extent with the work of the offic^e. 

It required also not a little trouble to become acquainted with the shipping interests 
that are represented here, and a very considerable expenditure of time and energy 
to become familiar with the conditions which obtain with regard to the various 
articles exported from this port to the United States, and which might be conveyors 
of infection. 

The work done here includes the inspection of vessels, crews and passengers, and 
freight, such disinfection as may be deemed necessary, together with the issuance of 
bills of health and general sanitary supervision over all vessels and cargoes boond to 
ports of the United States or dependencies. 

Inspections are made of all 8hii)S leaving Shanghai proper and bound to American 
ports, and vessels remaining more than forty-eight hours at Woosong, at the month 
of the W'hangpoo River, 1^ miles from Shanghai, and which clear from here, are 
also subjected to inspection, as are all tenders leaving Shanghai with paasengera for 
vessels bound to American ports. And any vessel en route to an American port, 
arriving at Woosung with suspicious sickness on board is, irrespective of the length 
of her stav, rec^uired to undergo inspection by this office beiore bill of health is 
granted. ^Po this end agents are required to present at this office the pratic^ue lasaed 
by the quarantine officer of the imperial Chinese customs (an English phjrmcan) and 
a certificate from the ship's surgeon as to the character of any sickness which may 
have occurreil during the voyage, from which data it is determined whether an 
inspection of the vessel herself is necessary or not 

The inspections as conducted here by this office consist of an examination into the 
general j)nysical condition of every member of the ship's company and the taking of 
the temperature of all Asiatics; not cabin passengers. 

It is required of all ships that they keep their Asiatic crews and steerage paasengers 
on board during their stay here. This is somewhat difficult to carry out with regard 
to the crews of vessels remaining here forty-eight hours or more, but I believe it is 
carried out to the letter on the regular passenger boats which remain here only a 
short time, and it undoubtedly has the effect of preventing the men on the other 
ships from getting their luggage ashore so that it might become infected. This pre- 
caution is taken on account of the presence of smallpox here at all times, to say 
nothing of the other conuimnicable diseases which are not officially reported. 

Such disinfection a.s has been attempte<l has been carried out under considerable 
difficulties, ovvin^ to the lack of suitable apparatus to do the work. 

In the fumigation of vessels which was done in three iiistances on account of the 
occurrence of smallpox on board, and once on account of cholera, sulphur was 
burned l)y the pot method, and for the disinfection of the clothing of the crew 
(there were no passengers) sulphur was the only thing available once, the use of the 
munici[)al diHiniecting chaml)er bein^ secured upon the other three occasions. This 
chamber of the do Mayer pattern is situated at the general hospital which renders it 



PaBMO HEALTH AND MARINE-HOSPITAL SEBVICE. 187 

more or \ee» inaccessible, and in addition it is out of service a good part of the time. 
It is also rather small. 

For the disinfection of steerage passengers* effects, from which all bedding except 
blankets is excluded, tor nialine-saturated sawdust (usin^ an average of 30 c. c. of 
formaline, 40 per cent to each trunk or box) has been spnnkled between each layer 
of fabrics, and the whole put in a tight box and sealed lor not less than twenty-four 
hourci, the seal being inspected and broken here before shipment. This method has 
also been followed in cases where one or two new members of crew liave been shipped 
here. 

For the disinfection of freight formaline or sulphur has Ijeen used, the former by 
dipping the articles ( vegetables for Philippine ports) in a 2 per cent solution and the 
latter by burning in poto. 

All freight shipped from this port to the Uniteil States or its possessions is subject 
to the visiS of this office. This was formerly done by lyquiring the ship|>er8 to bring 
in the boat notes or shipping orders for signature. This caused the parties interested 
more or less inconvenience, and upon the sulinidonoe of fholera which prevailed 
at the time this method was adopted, and no other condition existing which in the 
opinion of this office justified the pro<*e<lure, it was dist^ontinued, and in its stead 
the method now followed, the vi8<S of the cjtrgo manifesb^, adopted. 

This will explain why Table No. 2 does not show the number of pieces of freight 
visetl after December, 1902. 

The only recommendation that this office has to submit is that a launch be pro- 
vidwl for the transportation of tlio inspecting officer to and from vessels. As stated 
in a previous communication on this subject, this would facilitate to a considerable 
degree the work done hero by making it ]>ossible to visit ships at such time as was 
desired instead of being com!>elled to suit otiicial visits to the convenience of the 
shipping people. It would also enable this office to maintain such su{)ervision as 
was desirable over vessels during their st^iy in this port, and this advantage during 
the prevalence of an epidemic could hardlv l)e overcKtiinated. There are other 
advantages which could be enumerated, but It is hardly thought necessary. 

As previout<lvstated, a suitable launch could Ih) purcha^fK^d here for Ijetween $3,500 
and $5,500 gold, but it may }>e as well to mention in this connection tliat it is under- 
stood U|>on good authority that there were recently turned over by the military 
authorities to the Philippine civil government some 50 launches, many of which 
are now at Manila unused. One of these boats might 1)e obtaine<l and sent here for 
use on an army transport. 

It is needless to say that it would \ye a great advantage to this station if it were 
Boppliedwith apparatus for steam and formaldehyd disinfection, sufficient in size to 
take care of small lots of clotliing, etc. This luis Ix^en suggesteil to the Hhii>ping 
interests here, but they can notapprei'iate that a plant of this nature would be of any 
advantage to them, and hence are unwilling to iucur any expense in that direction. 

An autoclav3 for the disinfe<!tion of small compartments on l)oard infe<!te<i ships 
would he a very useful adjunct, although there have not Iwen so far very many 
instances in whi<'h it could have lK»en profitably uwed. 

The health of the Kuroixian settlement of Shanghai during the year just closed, 
with the exception of the epidemic of choh'ra last summer, has been, generally 
speaking, good. The quarantinable diseaw^s rcj><)rt<Ml present were cholera, smallpox, 
and typhus fever, and the annual report of the nuinicipal health officer for the calen- 
dar year 1902 shows that the former dLseasi^ was responsible for the death of 41 
Europeans and 1,500 natives, while 6mall]X)x claime<l 4 victims among the foreign 
population and 434 among the ("hinese. Typhus fever caused the death of 1 for- 
eigner, but is not reported among the Chinese. 

It might be mentioned in passing that the death rate for cholera last year is 
estimated as having been alvout 50 \)eT cent of the cases. 

Typhoid fever, diphtheria, starlet fever, and tul^erculosis caused, respectively, 12, 
8, 34, and 15 deaths among the foreigners, while from scarlet fever 1,493 deaths, and 
from tubentulosis 1.828 deaths occurred am<mg the Chinese jwpulation. Diphtheria 
caused the death oi a nund)er of Chinese, but the statistics seem not to be Kiven. 

Beriberi is more or less prevalent here among the natives at all times. The mor- 
talitv is stated as 10, with 52 cases. 

Diarrheal diseases, exclusive of typhoid fever and (cholera, were responsible for 
the death of 18 foreigners. The mortality from thest^ diseasc^s among the Chinese is 
not given, but it is certainly quite high. 

The deaths from all causes among foreigners is statetl to have l)een 263, estimated 
population 7,000, and among the (-hini^; 10,801, estimate<l population 350,000. 

Among domestic animals rinderi)est, glanders, and rabies prevail here, the former 



PUBLIC HEALTH AND MAKINE-HOSPITAL SBBTICE. 



while cliicben rholera Itae been vi 



e' with little 



\a 30.01. 



not beirif; ctated. 



■e here, aud throufcb their own ingpcctors, as there is no comitul^ 
conUeioiia dieeaaes. And as a good many of these inepectora are Cnint 
or no Knowled^ of diBcaae, and a majority of the natives in the settlement {latroDiie 
Chinese physicians only, who make no report to the munidual authoriliea, it vill 
be readily understood that many inaii'oiirsciefl may creep into the resnlta obtained. 

It should also be remembered that the statistics pnbhshed by the health officer do 
not include any of the Chinese who live onteide the settlement limits, nor those in 
the native city of Shanghai, numbering probably 1,000,000 or more souls who have 
tree access to the settlement, and many of whom have their employment here. Tbe 
mortality Btate<l, therefore, repreeenifi but a small percenta):^ of the deattis which 
actually occur in Shanghai and its imrnediaU) environs. For inptance, 1.500 dcatlu 
from cholera were reported last year, wiiile through other chaniiels, which I have 
every reaaon to believe to be thoroughly reliable, I learn that the mortality from 
that disease among the natives between June and Ot'toberwas froui 18,000 to 20.000, 

The only quarantinabte disease reported in Shanghai since January 1, 190:;, *■»$ 
smallpox, from which 210 deaths seem to have occumd, while tbe cases are reporitd 
as 27. 

The mean barometer for the year n 

The mean temperature 60.4, the m: 

but rarely freezes here in the winter, however, while in the si ._ 

frrauentiv rises to considerably alwve 100 in the shade, with a great deal of humidity. 

The rainfall for the year was 39.35 inches. 

Two tables are appended to this report, No. 1, sup|)lied by the Bureau, and So. 2, 
to give some additional data. It will be observed tnat a discreiiancy exists between 
thenumberof ships inspected and the number of bills of health issued. Thlab 
accounted for by the fact that some of tlie r^ular linera remain at Woosung instead 
of comine up to Shanghai, and in these cases the tenders ami passengers, and not 
the vessels themselves, are inspected. 

In closing this report I desire to state tliat this ofiice is much indebted to Consul- 
General Goodnow and Deputy Consul-General White at this port for many courte- 
sies extended and much valuable aaaistaace in carrying out the aims of the Men-ice. 
Very respectfully, 

S. A. Ransom, Actifig AwiOant Surgeon. 

The Sukubon-Gkneral. 

[Incloeiires.] 

Summari/ of tratunrii'nii' til Slunt^fhiil, Cbinn, fur year ending June SO, 1903. 

TABLE 1. 





July. 


A^. 


Sept. 


u,,. 


Uov. 


I«^, 


Ju,. 


«. 


M„. 


Apr. 


M.y. 


Jane 


TalA\. 


"Voe^lBpolienftnd 






















i 






* 


,. 


■1. 


• 


» 


1 




' 


' 


Id 


■' 


M 


^n^".^:.":. 






SBllins THBels in- 
jpeoted a«d 






■i 

M 

4S7 


■ 


• 


■ 


1 


8 


■ 


' 
















U33 


" 


MO 


am 


398 
ISO 


" 


3 


6dD 


sue 

■ST. 






Crew OQ B&IIIng 






^S^"e&"" ™ 




■m 


"-64 

































PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 



189 



TABLE 2. 



BUlsof 
health 
I iflBued. 



jDly 

Auguft 

September 
Oelober... 
KoTvmbcT 
December. 

January 

Debmary . 
March 

iC.:::::: 

June 



Pieces of 

freight 

vised. 



I 



Pieces of 
freight in- 
spected 
and passed. 



Pieces of 
freight dis- 
infected. 



Pieces of 

freight 

rejected. 



Pieces of 
fee ted. 



4 

20 
19 
13 
14 
12 
11 
11 
14 
16 
12 



21,295 
128,952 
87,075 
86,582 
80,000 



Total. 



146 



348,904 



201 

94 

1,145 

195 



25 
59 



552 

2,717 

52 

8 

5 



26 
11 



57 



52 

303 

1 ' 



1,635 



447 



16 

38 

9 

23 



3,33^ 



175 



India. 

detail of medical officer to united states consulate at cal- 
cutta on account of prevalence of plague. 

Owinff to the alarming prevalence of plague in many parts of India, 
and the danger of its being brought to the United States oy vessels sail- 
ing from Calcutta and Bombay to ports of this countrv, the following 
detail for duty in the office of the United States consul-general at Cal- 
cutta, India, was made under authority contained in the act approved 
February 15, 1893: 

[Letters detailing Passed A»d.<)tant Surgeon Spragne.] 

June 25, 1903 

Sir: Yon are hereby relieved from duty at Fort Stanton, N. Mex., and directtetl lo 

Sroceed to Calcutta, India, where you have been assigned, by approval of the Presi- 
ent, to duty in the oflSce of the consul-general. Copy of letter approved by the 
I^resident is herewith inclosed. 

Letter of instructions relative to your duties will form the subject of a separate 
eommunication . 

Respectfully, Walter Wyman, 

Surgeon- General. 
Paaseil Asst Sui^. E. E. Spraoub, 

Public Health and Marine-HospUal Service^ Fort Stanton j N, Mex, 

(Through medical officer in command.) 



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

Washingtonf June 18y 190S. 

Sib: Yon are hereby detailed for duty in the office of the United States comnil- 
general at Calcutta, India, signing bills of health in connection with the consul- 
general, in accordance with the provisions of section 2 of ** An act granting additional 
quarantine powers to and imposing additional duties upon the Marine-Hospital 
Service," approved February 15, 1893. 

Respectfully, Walter Wyman, 

Surgeon- Oeneral, 
Passed Asst Surg. E. K. Spraoue, 

Public Healm and Marine-Hospital Servicey Fort Stanton^ N. Mex, 

(Through medical officer in command. ) 

June 19, 1903. 

Approved: 

H. A. Taylor, Acting Secretary. 



Approved: 



White House, June i^Sy 190S, 



190 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

[Letter of instructions.] 

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

Washington, June j?7, 190S. 

Sir: Refemng to orders of the 25th instant, detailing you for duty in the office of 
the United States consul-general at Calcutta, India, you are informed that the duties 
required of you are enumerated in the United States Quarantine Regulations, under 
the heading of quarantine regulations to be ol>served at foreign ports and at ports in 
the possessions and dependencies of the United States. 

You will sign the bills of health in conjunction with the consul-general, and the 
State Department has been requested to notify him of your detail, so that he may 
render you the necessary courtesies and assistance. Your attention is especially 
called to the prevalence of plague in different parts of India, and hence to the 
importance of preventing the presence of rats and vermin on vessels leaving India 
for ports in the United States, its possessions, or dependencies. 
Respectfully, 

Geo. Purviance, 
Acting Surgeon-General, 

Passed Asst. Surg. E. K. Sprague, 

Public Heallh and Marine-Hoiqyital Service, Fort Stanton^ N. Mex, 

(Through medical officer in command.) 



Egypt. 

inspection of disinfection of ua(j8 at alexandria and cairo. 

While en route to the PhilippinevS to relieve Passed Assistant Surgeon 
PeriT as chief quarantine oflicer of those islands, Assistant Surgeon 
Heiser was detailed as representative of the Public Health and Marine- 
Hospital Service at the Eyptian Medical Congress which met at Cairo 
on December 19, 1902. As the Bureau was anxious to learn the 
methods for the disinfection of rags in the ports of Cairo and Alexan- 
dria, Drior to their shipment to the United States, the following order 
was addressed to Assistant Surgeon Heiser. His report on this inspec- 
tion is given below. 

[Letter.] 

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

WaMngton, November ^4, J 90S. 

Sir: Wliile in Egypt, as representative of tho Public Health and Marine-Hospital 
Service, at the Egyptian Medical (k)ngreos, to meet at Cairo, December 19, 1902, you 
are directed to make an inspection of the methods of disinfection of rags at the 
port.s of Cairo and Alexandria, preparatory to shipment to the United States, under 
the United Staters Quarantine liegulations in recard thereto. 

You are informed that the State Department has been requested to authorize tho 
consul-general at Cairo to affonl you the necessary facilities for the above inspec- 
tions. Tlio State Department has notified this Bureau that the above infltructions 
will be sent to the consul-general at Cairo, Egypt. In this connection, you are 
informed tliat this is by no means an inspection of the consular methods; it is simply 
as to the methods of disinfection of rags as above alluded to, so you will observe 
every courtesy in making these inspections. 

Respectfully, Walter Wyman, 

Surgeon- General 

Asst. Surg. V. G. Heiser, 

Public Health and Marine-Hospital Service, Neiv York, JV". Y, 



PUBUO HEALTH AVD MARINE-HOSPITAL SEBVICE. 191 

Bkfobt of Absuttant SuKCiBON Heibek. 

Alexandria, Eoypt, January S, 190S. 

Sir: In poranance of the instructions contained in Bureau letter of November 24, 
19Q2, relative to the disinfection of rags preparatory to shipment to the United States, 
[ have the honor to sabmit the following report: 

On stating the object of mv mission to Gonsul-Greneral Long, he expressed himself 
■ beinff much pleased that the Service had extended hitn this aid in connection with 
the tecnnical part of the disinfection, and that he wan also glad boi'ause it gave him 
in opportonity to have me inquire into some sanitary matters upon which he was 
deoroos of having further information. He stated that he would be pleased to put 
in force any sugsestions which might be ma^le. 

On inquiry I^am that no rags have been shipped to the United States for more 
than a year. This is due to the fact that the Egyptian Government has not permitted 
the transportation of rags during this period owing to the presence of cholera and 
plague in the country. 

The insjpection of the disinfecting facilities was very unsatisfactory because they 
were not m working order. But from such inspection as I was able to make it was 
^te evident that tne facilities were much better than when I was here before on 
similar duty. 

The names of *the firms and the details connected with the business are the same 
DOW as three years ago. In order to avoid repetition, for further particulars I would, 
therefore, respectfully refer to my report of December, 1899. 

It has been customary to keep rags here after their disinfection for periods amount- 
ing sometimes to a vear or more. This is open to the objection that the rags may 
bcwome infected before shipment, but the pnncipal objection is that it is difhcult to 
identify the rags as the same which have been previously disinfe(;ted. It is also open 
to the objection that fraud is much more i)ossible when long i)eriods exist between 
the disinfection and the shipment. 

1 inclose herewith a copy of the report containing the suggewtions t^) the consul- 
general. 

The raic business between E^pt and the United States seems to Ih^ on the dcK;line; 
the rag merchants attribute this to the increase in the use of woo<i ])ulp in the manu- 
iKture of paper. 

Beepectfully, Victor G. Hkiser, 

Asgiatant Surgeon. 

The Subgbon-Gkneral. 



[Incloeurc.] 

Alexandria, Egypt, January 7, ltX)fi. 

Sib: In aooordance with your verbal reqiiest relative to the disinfection of rags 
intended for shipment to the United States, I have the honor to report as follows: 

Owing to the net that the shipment of rags has been prohibited for more than a 
year by the Egyptian Government, the various rag establishments have not been 
operated, thus making the inspection of their disin/ecting facilities rather unsatisfac- 
tory, beckuse they are out of repair owing to disuse. In ttic case of the establish- 
mait of I. Salama, of Cairo, an exception can, however, l)e made. From an inspection 
of hia disinfecting room, it is evident that no amount of rejmirs can make it a tight 
room within the meaning of the regulations. I would suggest that a new room be 
ooD0tracted. In the construction of rooms, particular attention should l>e given to 
the doors, in order to insure their fitting pn)perl^ when closeil. The racks nmst be 
80 constructed that the sulphur fumes can come in contact with the rags on all sides. 
The dLdnfecting room of L. Onofrio, of Alexandria, has been found very satisfactory 
in practice. 

Before disinfection is again commenced, I would respectfully suggest that you 
have an inspection made of the various disinfecting rooms in order to insure toeir 
being put in good repair. 

I would also suggest that the disinfe(;tion of rags at long j)eriods before shipment 
be discouraged wherever possible. It is always possible that they may become 
infected while being thus stored, and in that case require a second disinfection. 

In conclusion, I nave to thank you for the many courtesies which you have 
extended me since my arrival. 

Respectfully, Victor G. IIeiser, 

Assistant Surgeon. 

Hon. John G. Long, 

XhwUd States Agent and Conml-Gima'alj Cairoj Egijpt. 



192 PUBLIC HEALTH AND MARINE-HOSPITAL BEBVIOE. 

England. 

Asst. Surg. Carroll Fox, stationed in the office of the United States 
consul at Liverpool, England, under the authority of section 2 of the 
act approved February 15, 1898, was detached from that station on 
the 15th of September, and ordered to proceed to Manila, P. I. 

LIVERPOOL. 
Report by Asst. 8ur(i. Carroll Fox. 

Liverpool, England, September SO, 190t, 

Sir: I have the honor to make the following brief report for the period between 
June 30 and September 15, 1902. During this time there were 78 cases of smallpox 
and 7 deaths, 2 of these occurring in un vaccinated people, 3 occurring in people who 
had been improperly vaccinated, and 2 in persons with good scars. None of the 
cases in which death took place were re vaccinated. For the same period there were 
idso 34 cases of typhus fever, with 8 deaths. 

The hospital accommodation for infectious diseases is very good, there being in all 
6 municipal hospitals. The newest hospital is worthy of description. The site, 
comprising 120 acres, is situated just without the city in practically open countrj', 
and near tne railroad station. It is an ideal spot for a contagious hospital, and tl^e 
grounds cover such a large area that it will be impossible to erect dwellings or such 
8tructur«j in too close proximity to the hospital buildings. There are at present 
about 4 pavilions, 3 of which are wooden and were erected hurriedly at the time of 
the plague outbreak. Thev are only intended for temporary buildings but are well 
planned and built, and I should imagine c^uite as satisfactory for permanent use as 
more elalxirate brick structures. These buildings are however not plastered inside 
which is a fault, as it has been the experience that nurses and attendants are more 
apt to contract disease when working in rooms where the walls and ceilings are of 
wood. It is the intention to demolish these three buildings, utilizing the fourth, 
which is of brick, for smallpox, and building another of about 300 beds in a different 
part of the grounds in which to care for other infectious diseases. 

All of the city hospitals are equipped with a steam disinfector and modem laundry. 
In the hospital under consideration the clean end of the steam chamber opens into 
the laundry so that clothes after disinfection can be taken out and immediately sub- 
jected to the washing process. 

An interesting feature of this hospital is the sjrstem by which refuse water from 
the wards and laundry is filtered before passing into a little stream which carries it 
away. There is a separate filter for the wards and one for the laundry. Each filter 
is composed of two beds. The bed consists of a layer of coke having a depth of two 
feet and resting on a layer of cement. The water after passing through the fi^rst filter 
flows into the second bed of similar composition, but on a lower level. Before 
emptying into the stream there is a scheme used by which the filtered water is 
mixed with a disinfectant as it passes out. The results obtained have been extremely 
satisfactory, as is proven by tne bacteriological examination of the filtered water. 
This filter is worthy of a longer and better description, but I am unable to go further 
into detail. 

The steam disinfectors used by this city differ somewhat from those used by the 
Service. Thev are alike in that there is a central chamber surrounded by a jacket 
which can be heated and maintained at a certain temperature; and there' is also a 
steam vacuum apparatus. But the steam for the chamber just before entering passes 
through a hot copper coil to insure its noncondensation, and, after withdrawing the 
steam and producing a second vacuum, instead of allowing cold air to pass in, air 
heated by first passing through the before-mentioned hot copper coil is allowed to 
enter in order to dry the clothes more thoroughly. There is no formalin apparatus 
attached to any of these disinfectors. In fact, formaldehyde gas is not often used as 
a disinfectant. 

The doors are screwed tight in a similar manner to ours, but the nuts are larger 
and heavier, and are tightened by means of handles permanently attached to them, 
and no wrench is required. Nor are there as many nuts used as in our apparatus. 
It would seem that unnecessary time and labor were expended in applying and reap- 
plying a wrench to a number of nuts in order to tighten them, ana the leverage 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 198 

obtained by so doing is sufficient to twist off a screw, as has been done several times 
to my knowledge, especially where the chaml>er has been used many times. 

In comparing the steam disinfectors used here with those of the Service I have 
always kept in mind the disinfecting chamber at the Port Townsend quarentine sta- 
tion, as it was there that all m^ practical experience in disinfecting was obtained. 
This, however, may not be a fair comparison as that particular chamber was of an 
old type. 

I have been much interested in seeing some typhus fever during my stay here. I 
am told that nearly all cases show marked evidence of having been bitten by fleas or 
bedbugs. This would probably also be true of many cases ofother infectious disease 
admitte<l to the city hospitals; but taking into consideration the facrt that typhus 
fever outbreaks have always arisen in dirty, overcrowded ships and jails or among 
the filthy slum population of a cit^, it is not at all unlikel]^ that fleas or bedbugs or 
both may play an miportant part m the carrying of contagion. 

The following speaks well for vaccination. All nurses and attendants, inspectors, 
etc, who are likely to come in contact with infectious diseases are thoroughly vac- 
cinated and revaccinated. Not one of these employees has caught smallpox, though 
a number of them have been many times exposed to it. On the other hand, ^30 
have contracted those diseaises against which there is no known method of producing 
an acquired immimity, as typhus, enteric, and scarlet fevers. • 

Respectfully, Cabroll Fox, 

AasistatU Surgeon. 

MEDICAL INSPECnON OF IMMIGBANTS. 

DETAIL OF OFFICERS TO UNITED STATES PORTS AND QUEBEC, CANADA. 

During the fiscal year ended June 30, 1903, 867,046 immigrants came 
to the United States. Practically all of these were physically exam- 
ined by officers of the Service. 

The new immigration law, entitled ''An act to regulate the immi- 
gration of aliens mto the United States," approved March 3, 1903, put 
into effect more stringent laws against the landing of aliens afflicted 
with loathsome or with dangerous contagious diseases, idiots, insane 
persons, epileptics, and persons who have Deen insane within five years 
previously, persons who have had two or more attacks of insanity at 
any time previous, or who from physical causes are likel}'^ to become a 
poblic charge. These increased restrictions added greatly to the i"espon- 
sibUity ana amount of work to be done by officers of the Service 
detailed for the medical inspection of aliens, and upon request of the 
Commissioner-General of Immigration, the following-named medical 
officers were detailed exclusively for the ph vsical examination of aliens: 
Asst. Surg. M. W. Glover at Baltimore, Md., Asst. Surg. A. M. Stim- 
son at New Orleans, La., Asst. Surg. C. E. Lord at San Francisco, 
Oai., and Acting Asst. Surg. M. V. Safford at Boston, Mass. Asst. 
Surg. W. C. BilTings, who was stationed at St. Johns, New Brunswick, 
where aliens bound ifor the United States were examined during the 
closure of navigation in Canada, was moved to Quebec as soon as the 
spring season allowed the reopening of navigation. In addition to 
these special details all medical officers of the Service stationed at points 
on the Dorders between the United States and Canada, and Mexico, 
were instructed to physically examine all immigrants referred to them 
by the immigration officials. Under the new immigration law the 
iService is reimbursed by the Bureau of Immigration for all expen- 
ditures incurred in carrying out the medical inspection of aliens. 

The following general letter of instructions was sent to all of the 
above-mentioned officers. 

H. Doc. 338 13 



194 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 

[Letter of instructions.] 

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

Washinfftan, July 3, 1903. 

Medical officers^ ax^ing asfistant mrgeonSy Public Health and Marine-Hospital Service, and 
others concerned: 

Your attention is called to paragraph 804, Revised Reg:alation8 of the Service, and 
^ou are directed in future to physically examine all aliens submitted to you by the 
immigration officer at your port. In making this physical examination you will 
follow, as far as possible, the directions in the Book of Instructions for the Medial 
Inspection of Immigrants. 

Respectfully, Walter Wyman, Surgeon^GtnenL 

BOOK OF INSTRUCTIONS. 

To insure uniformity in the method of conducting the medical 
inspection of immigrants the Bureau detailed a board of medical officers 
t^ prepare a book of instructions for the medical inspection of immi- 
grants. This book of instructions has proved to be of great advan- 
^ee in conducting these inspections. It was sent to ea(^ medical 
officer. 

CERTIFICATES OF INSANITY. 

The following correspondence in regard to the requirement of Dara- 
graph 810 of the Revised Regulations, that at least two medical omcers 
of the Service should concur in issuing certificates of insanity, is self- 
explanatory. 

[Letters.] 

Treasury Department, Bureau of Immioratioh, 

WaMngUm, June S, 190S, 

Sir: With reference to paragraph 810 of the R^ulations of the Public Health and 
Marine Hospital Service, I have to invite attention to a case where an exception 
thereto would seem to be desirable, to wit: Under the laws of the State of P^insyl- 
vania no one can be admitted to a hospital for the insane unless two physicians make 
certificates as to the person's insanity, and in the case of aliens who become public 
charges in Pennsylvania on account of being insane it is suggested, subject to your 
approval, that the rule mentioned be amended so that the certificate of but one 
medical otficer in your ser\'ice will be necessary. The case which broueht this 
matter up arose in the city of Philadelphia, where there is but one marinehotpital 
surgeon available for immigration work, and the regulation is tacitly complied with 
by the State law mentione<l, two civil physicians making the examination upon 
which original commitment is made. 

Respectfully, F. H. Labnkd, 

Acting CommiMioner-GeneraL 

The Surgeon-General Public Health and Marine Hospital Sxevick. 



Treasury Dbpabtmxnt, 
Bureau of Public Health and Marine-Hospital SKRvicSy 

WcuhingUm, June 11, 190S, 

Sir: Referring to vour letter of the 8th instant, with reference to para^prnph 810 of 
the Regulations of tne Public Health and Marine-Hospital Service, askins that this 
paragraph l:>e amended so that the certificate of but one medical officer of this Ser- 
vice will be necessary in giving a certificate of insanity at the port of Philadelphia, 
Pa., and stating as a reason for this request, that there is but one marine hospital 
surgeon available for immigration work at that port, I have to inform yoa that Uie 
medical ofiicer in command at Philadelphia, Surg. Fairfax Irwin, is prepared at any 
time to examine aliens in conjunction with Assistant Surgeon Kom in compliance 
with paragraf>h 810 of the regulations of this Service. 

In this connection you are informed that the same rule holds good in such cases at 
the ports of New Orleans, La.; Baltimore, Md.; Boston, Mass.; San Frandsoo, €al.; 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 195 

Detroit, Mich., and Buffalo, N. Y. At all of these places the medical officers in 
command have been directcKl to assist the medical officer specially detailed for the 
medical inspection of immijin'ants when he is in need of assistance. 
Respectltdly, 

Walter Wyman, 

Surgeon- General, 
The C'ommissioner-Genbral of Immioratton, 

Treasury Departmenty Washington D, C 

BOARDS OF MEDICAL OFFICERS TO CONSIDER SPECIAL CASES. 

Under the provisions of paragraph 813 of the Service regulations 
authorizing the Surgeon-General to appoint a board to consist of at 
least three medical officers of the Service to serve at ports where 
immigrants are landed for the consideration of such cases as may be 
brought before it under the provisions of paragraph No. 811, the fol- 
lowing letter was sent to burg. Fairfax Irwm, Public Health and 
Marine- Hospital Service, Philadelphia, Pa.; Surg. H. R. Carter, Bal- 
timore, Md.; Surg. R. M. Wood!ward, Boston, Mass.; Surg. G. W. 
Stoner, Ellis Island, New York, N. Y. ; P. A. Surg. C. P. Werten- 
baker, New Orleans, La.; P. A. Surg. Hugh S. Gumming, San Fran- 
cisco Quarantine, Angel Island, Gal.; Surg. H. W. Austin, Marine 
Hospital, Detroit, Mich.; Surg. Eugene Wasdin, Buffalo, N. Y.; P. A. 
Surg. L. E. Gofer, Honolulu, Hawaii; Asst. Surg. V. G. Heiser, 
Manila, P. I.: 

[Letter.] 

April 6, 1903. 

Seb: Under the provision of paragraph 813, Regulations of the Public Health and 
Marine- Hospital Service of the Unitea States, November 21, 1902, you are hereby 
designated as chairman of the board for the consideration of such ca^es as may be 
brought before it under the provision of paragraph 811 of the above regulations. 

The other two members of the board will be the oflScers who may be on duty at 
jrour station at such time as you may convene the board. 
Respectfully, 

Walter Wyman, Surgeon- Generai, 

NIGHT INSPECTnON AT QUEBEC, CANADA. 

Upon receipt of the following letter from the C/ommissioner-General 
of Immigration, the telegram appended below was sent to Asst. Surg. 
W. C. Billings, Quebec, Canada: 

[Letters.] 

Treasury Department, Bureau op Immigration, 

Washington, May tf, 190S, 

Sir: Conditions in the matter of inspection of aliens at Canadian ports differ widely 
from those existing at ports within the United States. At the former we have to 
dcsal with the matter of passengers professing to he destined to points in Canada; 
with these passengers we nave nothing to do, but it has been found impracticable to 
postpone inspection of those coming under our jurisdiction until after the Canadian 
authorities have inspected the passengers going to that country only. In consequence, 
it has been found necessary to make inspections at night or any time that the ships 
arrive, in order to prevent the landing of our passengers along with those going to 
Canada. 

At Quebec, Doctor Billings declines to make medical inspection at night, citing 
with perfect propriety the regulations of your Service. Inasmuch, however, as it 
will be absolutely netressarv to continue inspection at night, so far as Quebec is con- 
cerned, I have to request that you will issue a waiver of the regulations in this case 
for the reasons citea. Every facility for night inspection will be provided Doctor 
Billings. 

Respectfully, F. H. Larnkd, 

Acting Commissioner- General. 

The Subgsqn-Obneral, Public Health and Marine- Hospital Skrvicb* 



196 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVI0E. 

Treasury Dbpartment, 
Bureau op Public Health and Marine-Hospital Servictb, 

WashingUmf May 13, 190S, 

Sir: Referrins to your letter of the 6th instant, stating that it was abflolately neces- 
sary to make tne medical inspection of aliens at Quebec, Canada, at nlgnt, and 
requesting that a waiver of the regulations be issued so that Assistant Suiigeon Billings 
can make the inspection at night, I have to inform vou that, in view of the emer- 
gency stated, a telegram has been sent to Doctor Billings to make the examination 
as requested. 

Resi)ectfully, Walter Wyman, 

Surgeon- Genenil. 
The Commissioner-General of Immigration, 

Treasury Department, Washington, D, C. 



[Telegram.] 

Washington, May 15, 190S, 
Billings, 

(Care 13. S. Commissioner of Immigration, Quebec, Canada.) 

inspect at night. Consider each one an emeraency. Commissioner-General states 
every facility for night inspection will be provided. 

Wyman. 

ships' MANIFESTS OF IMMIGRANTS NOT TO BE SIGNED BY SERVICE OFFICERS. 

Several requests have been made to officers of the Service engaged 
in the medical inspection of inmfiigrants to sign ships' manifests of 
immigrants. The following correspondence in that connection is here- 
with shown: 

[Letters.] 

Public Health and MARiNB-HosprrAL Servicb, 

Office of Medical Officee in Command, 

San Juan, P, R., May 26, J 90S. 

Sir: I have the honor to request the decision of the Bureau as to whether it is the 
duty of a medical officer, Puhlic Health and Marine-Hospital Service, to sign the mani- 
fest of immigrants goin^^ from here to the United States. 

These manifests are signed by the ship's surgeon, but when there is no surgeon on 
board the law allows the agent to have any reputable physician to sign them. Xately, 
however, they have been brought to this office for signature, presumably to save t£e 
fee paid to the private physicians. 

Respectfully, W. W. King, 

Assistant Surgeon, 
Chief Quarantine Officer for Porto Bieo. 

The Suhobon-General, Public Health and Marine-Hospital Service. 



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

Washington, June 2, 290S. 

Sir: Referring to your letter of May 26, requesting a decision from the Bureau as 
to whether it is the dutv of the medical officer of this Service to sign the manifests 
of immigrants coming from your port to the United States, you are informed that 
such duty does not belong to officers of this Service, and it is not deemed advisable 
for them to perform it. 

The law says, ** If no surgeon sails with any vessel bringing aliens, the mental and 
physical examinations and the verifications of the lists or manifests shall be made 
by some competent surgeon employed by the owners of the said veesel." 
Respectfully, 

Geo. Pubtiance, 
Acimg Surgeon-OeneraL 
Asst. Surg. W. W. King, 

Public Health and Marine Hospital Service, 
Chief Quarantine Officer, San Juan, P. R. 



PUBLIC HEALTH AND MABtNE-HOSPITAL SERVICE. 197 

INSPECTION OF IMMIGRANTS FROM R4RKENTINE VERA CRUZ WRECKED 

NEAR NEWBERN, N. C. 

On May 7, 1903, the barkentine Vera Cruz^ with several hundred 
immigrants on board, was wrecked near Newbern, N. C. Upon the 
request of the Commissioner-General of Immigration that a medical 
officer of this Service be detailed to make the medical inspection of 
these aliens, the following telegram was sent to Surg. H. K. Carter, 
Baltimore, Md. Assistant Surgeon Glover's report of the inspection 
of these aliens is hereto appended: 

[Telefirram.] 

Washington, May 12 ^ 190S, 

Smg. H. R. Cabteb, Marine Uospilaly BaUimore^ Md.: 

Instmct Glover proceed by first train to Newbem, to assist Inspector Stamp by 
medical inspection immigrants. 

Wyman. 



Rbfobt of Assistant Surgeon Glovxb. 

Public Health and Marine-Hospftal Service, 

Office of Medical Officer in Command, 

Baltimore^ Md,, June S, 190S, 

Sib: I have the honor to submit the following report of special duty under Depart- 
ment telegraphic orders of May 12, 1903: 

I left my station, Baltimore, Md., on May 12, 1903, for Newbem, N. C, meeting 
Imipector Stump and stenographer en route, and arrived at destination about 6 p. m.. 
May 13. Was met by Doctor iVimrose, who had been in charge of the aliens, and 
drove with him to the Government dock, where the immigrants were held by order 
of the collector of customs. The only accommodations for the aliens consisted of an 
old shed without any windows, about 100 by 30 feet in size. This was divided into 
two unequal portions by a wooden partition. In the smaller room were placed the 
22 women and 3 children, with considerable bag^gage, while in the larger room the 
reel of the aliens were housed. I found that there were 1 1 ill — 10 men and 1 woman — 
with severe diarrhea. All the aliens were insufficiently clad and suffered greatly 
from cold, particularly at night. Fortunately, all through this time the weather was 
fair, for the shed would have afforded little protection from rain. As soon as con- 
veiBant with the situation a recommendation was made to Mr. Stump that those who 
were ill be placed in more suitable quarters, where they could receive proper atten- 
tion. There is no hospital in Newbern, and none nearer than Wilmington, N. C. 
It was therefore imperatively necessary to rent a house and fit out a temporary hos- 

gital, as no tents could be secured. Fortunately, a large building used for church 
lirs and other festal occasions was available, and witn Mr. Stump's approval was 
rented and a dozen wooden cots, blankets, sheets, pillows, necessary medicines, 
food, etc., purchased. A negress was secured as nurse and a white man as watch- 
man and orderly. By 9 o'clock that night the 1 1 patients had been transported to 
this hastily organized hospital and started upon a proper routine of diet and medi- 
cation. 

On the 14th the inspection of the aliens was begun bv Mr. Stump, and as this 
necessitated my presence on the dock I turned the care of those in the hospital over 
to Doctor Primrose. On making rounds among the aliens 3 were discovered ill 
and ordered to the hospital. I decided to change the diet from canned meats to 
soap, mush, milk, breaid, and coffee. It was found to be a difficult matter to secure 
the necessary food stuffs— not only on account of the limited facilities of the town 
but also on account of the lethai^y of its inhabitants. In the evening 3 more were 
taken to the hospital with fever and diarrhea. Owin^ to the mixed-up condition of 
the manifests and lack of accommodations the inspection was of necessity slow. 

On Friday, the 16th, the women and children were removed from their cramped 
quarters and placed in the upper floor of the hospital building. Five more ailing 
aliens were sent to the hospital in the morning and evening. Eleven were dischai^ged 
from the hospital much improved. 



198 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

On Saturday, the 16th, the infipection was concluded. On this da^ there were 10 
discharged from the hospital and 5 admitted — 2 in the morning and 3 in the eyenins. 
There were 6 cases of trachoma found among the aliens, for the most part well- 
marked cases. Taken as a whole the aliens were in good condition considering the 
privations they had undergone. They were a cleanly, docile class of negroes. The 
diarrhea from which so many sufferred was caused, I think, hy the eating of large 
quantities of canned meats, which, with bread, constituted their sole diet for almcMt 
three days after being landed in Newbern. They had suffered greatly from lack (A 
food and water on board ship and when landed goreed themselves on potted ham 
and tongue and canned beef, many eating two and three cans at a meal. The dis- 
order, however, yielded quickly to proper diet, rest in bed, and simple medication. 
In a few cases it was necessary to use rectal irrigations of »alt solution. The iUness 
was confined almost wholly to the men, but 1 woman being afflicted, due in all 
probability to the fact that the males were the stronger and the greedier. 

On Sunday, the 17th, preparations were made by Mr. Stump to move the aliens 
to New Bedford, Mass. Seven were discharged from the hospital, leaving 3 who 
were unable to travel. These were Manoel Jose Barbossa, admitted May 16; Fran- 
cisco Pires and Eugenio dos Santos, admitted May 14, the last named being the most 
seriously ill. The trip to New Bedford required two nights and a day and a half. 
There were several cases of colic and diarrhea and a number of sick headaches, due 
to riding in the cars. To these relief was given from the few drugs carried along 
from Newbern, N. C. On arrival at New Bedford the medical care of the aliens was 
transferred to Doctor Bullard and his attention called to a few cases coming under 
Class B for disposal. 

I desire to express my thanks to Mr. Stump, the inspector in charge, for his hearty 
cooperation in my work, by which it was possible to render necessary relief promptly 
to these poor aliens; also to Doctor Primrose, who, by his energy and knowledse of 
the resources of the town, rendered possible the establishment oi a hospital in three 
hours and whose care and attention to the patients therein was such as to enable us 
to depart with all but 3 of the 30 sick. 

Respectfully, M. W. Glover, 

Amstant Surgeon, 

Respectfully forwarded. 

H. R. Carter, Surgeon, 

The Surgeon-General, Public Health and Marine-Hospital Service. 

United States, 
boston, mass. 

Report on Medical Inspection of Alien Immigrants at BoerroN, Mass., bt 

Acting Asst. Surg. M. V. Safford. 

United States Immigration Service, 

Office of Commissioner, 

BoOoUf July S, 1903, 

Sir: I transmit herewith, duly filled out, the blank referred to in Bureau circular 
letter of May 14, 1903, and also in compliance with said letter I would beg leave to 
call attontion to the following matters in connection with the medical inspection of 
aliens at this port: 

The figures given under the head "numbers inspected'* in the blank above men- 
tioned and as well in the monthly reports of this inspection work conform to the 
official figures of the Immigration Bureau for "immigration" at the port of Boston. 
Owing to the large Canadian and transit travel through this port, the number of 
aliens who arriv^ here subject in every way to our immigration laws (except in 
matter of head tax) and covered by our medical inspection was, during the past 
fiscal year, 89,561. The total number of arriving passengiers, among whom me above- 
mentioned aliens were mixed, was 120,291. 

It has been the practice of the medical officer directly engaged in the inspection 
work to make meaical certificates in such cases as are specifically excluded by the 
immigration laws or mentioned as certifiable in the Bureau regulations, and includ- 
ing aiiy case where the person's physical condition in itself seemed to justify a refer- 
ence to the board of special inqmry to determine the person's right to land. 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 199 

reference to the disparity between the number of cases certified and those 
led, it is to be noted that the cases of serious physical disability are not likely 
aooepted for passage unless those representing the steamship companies are 
m1, toroogh previous correspondence, that such cases are good business risks and 
slatives und friends on this side will be able to sustain the contention that the 
rrivals are not likely to become public charges. 

addition to the 308 certificate cases, the attention of the immigrant inspectors 
larin^ the year, brought to about 2,100 less serious defects— defects in which, 
medical examiner's opinion, the question of release or holding for the board 
dal inquiry might properly be left to the judgment of the immigrant inspector 
t whom the passenger would come. In accordance with arrangements made 
I the year, statements of this character are transcribed by the immigrant 
tor in column 21 of the manifest sheet, and thus become a part of the perma- 
records of the office. In this category were included all ordinary instances of 
>hysique and of physical deterioration incident to age. 

thus leaving the matter of the person's detention in these cases to the discre- 
f the immigrant inspector, it would appear that the provisions of section 17 of 
t of March 3, 1903, requiring the examining medical officers ''to certify, for the 
tuition of the immigration officers and the boards of special inquirv, any and all 
»1 and mental defeitts or diseases," was observed, and that at the same time 
were avoided an unnecessary multiplication of special inquiry cases and a tend- 
)n the part of immigration officers to look on a formal medical certificate as 
ioesBaruy important. 

y often one of these notations of so-called ** minor defects'' is really the factor 
I determines an alien's exclusion, but it seems impracticable to attempt to 
oat in a formal report the part which this important phase of the medical 
plays in the exclusion of aliens. 

in^ the year the medical examiner has turned back to the custody of the 
ship companies all passengers whom, by reason of disease, acute illness, or 
dty for further medical examination, he could not pass. Whenever the welfare 
poseengers or the interests of the medical examination demanded, it has been 
poflsibre without formal contracts to make satisfactory arrangements for the 
er of nearly all such cases to hospitals in this vicinity. Bills for maintenance 
t)een rendered by the hospitals directly to the steamship company concerned. 
ing the year 105 passengers have been so transferred. If the steamship com- 
I had had the opportunity to unload their detained on the immigration office, 
amber of such hospital cases would easily have been doubled, and as the 
2^tion Bureau expects in a few months to have at this port a detention station, 
I we will assume charge of detained passengers, it may soon be found necessary 
ke some changes in the existing arrangements for the care of hospital cases. 
( immigration at this port in physical condition, resources, and self-reliance is 
or to tne immigration to this country as a whole. The Italian passengers are 
led to an inspection at Naples far more thorough than anything in existence 
' other foreign port, and the passengers from British ports are comparable only 
;hose arriving at New York by the White Star or Cunard lines. 
» number of immigrants at Boston for 1903 is practically double that for 1902 
iree times that for 1901. Even though immi^tion as a whole is now likely 
;in to almte, the indications are that further increases for this i>ort may l>e 
ted, accompanied by a deterioration in its present quality. New arrangements 
inection with the plans of the International Mercantile Marine and the break- 
ray of the Cunard Line from the conference agreements will tend to bring the 
lental type of immigrant more into prominence here. 

tbermore, when tKe new detention station is completed, it is expected that 
grants will be brought direct from Hamburg and Antweri). The companies 
&d in passenger business from these ports already have freight ships running 
ind terminal facilities for forwarding passengers. 
Respectfully M. V^ictor Safpord, 

Acting AsgiMant burgeon. 
5. R. M. Woodward, 
Public Health and Marine-Hospital Service, 

pectfally forwarded. 

R. M. Woodward, Surgeon. 



sou PUBLIC HEALTH AND UARtNE-HOSPITAL 8EBVICE. 



.»«. 


Number 
i^eclrf. 


eertlfled. 


Hnmber 
aeporWd 


Cwueoldcpoitatloii. 


1(02. 


6,«7 

S,IHO 

2.066 

9,7S4 

a, 192 


IS 
S 

1» 


l|prohlWWddl.e«.l 




G Prohibited dl«eai0. I: likelr lo be- 
come public char^. B. 


<l«.Unh» 








17 
22 


P^wJSa^a^falS^i' llkelT W b^ 


December 


mine public oh«rge. S. 


i«as. 


come public chuge,*. 

Prohibited dlaeuex. 1: likely (o be- 
come public chnise. 2. 

Pl^b^i^^^Li^s' likely to I* 


Febrmrr 


Much 




come public chaiKe, 9. 


lU 


P^M^^'dteS^j' likely to be. 




come public charge, 12. 
Prohibited dlJKMe*. 8; likely lo be- 
come public Cbaige. 14. 






(I6.1M 


308 


m 









NEW YORK. 

tof iiupedionqfaUen* at lie port of NetD York during thtyfarend^Jimf 30, Jses. 





K 


Num- 
l*r cer- 


Num- 
ber de- 
ported. 




Cau-en 


dcporlBHi. 


. 






Clawl. 


CllB 11. 


ClMllI. 


CluIV. 


llnnlh. 


1 


■s 


f 




1 

s 


1 


d 


■nd iDjo- 




n.m 

101,872 
78] 289 


307 

fa 

382 
3C1 

MS 


60 
M 

Ml 


IIjO 
181 










! 








-..-.- 

1 






















" 
























im. 


, 




I 








— -j- 












1 
















....!. 


■ "J 


w 








Total.— 


W9,3e8 


4,121 


1,318 


7« 


« 


a 


" 


' 


at 


& 


49» 



PUBLIC HEALTH AND MABINE-HOSPITAL SEBVIOE. 



201 



BUFFALO, N. Y. 



^iqMTi of inspection of aliens at the port of Buffalo^ N, Y.y during the year ended 

June SO, 190S, 



Month. 



1902. 

list 

ember . . . 

»ber 

ember . . . 

^mber 

1908. 

MU7 

raary 

eh 

a 

B 

Total... 



Number 


Number 


Number 


in- 


certi- 


de- 


spected. 


fied. 


ported. 


159 








46 


1 


1 


96 


4 


4 


88 


5 


5 


106 


7 


7 


146 


6 


6 


89 


4 


4 


27 


10 


10 


46 


6 


8 


48 


8 


8 


96 


8 


8 


83 


9 


9 


974 


69 


59 



Cause of deportation. 



Hernia. 

Valvular 'disease of heart (mitral), 2; double 

hernia, inguinal, 1; senility, 1. 
Favus (one aouble hernia), 8; hernia and lame, 

1; trachoma, 1. 
Susp. trachoma, 8; hernia and heart disease, 1; 

poor physique and carbuncle, 1; psoriasis, 1; 

senility, 1. 
Trachoma, 4; ulcer of both cornea, 1. 



Trachoma, 3; dislocation of hip, 1. 

Trachoma, 9; hernia and senility, 1. 

Trachoma, 2; hernia and senility, 1. 

Poor physique, 2; lichen, 1; syphilis, 1; tra- 
choma. 1; enteric, 1; yalvular disease of heart, 
1; senility, 1. 

Trachoma, 8. 

Trachoma, 6; senility, 2; poor physique, 1. 



PHILADELPHLk, FA. 

POBT OF iNBPBCnON OF AlIXN ImMIQRANTB AT PHILADELPHIA, Pa., BT AB8T. SuBO. 

W. A. KORN. 



United States Immiobation Sebvice, 

Office of the Commissioner, 
Philadelphia, Pa,, July 7, 190S. 

m: Aa directed by Bareaa letter of June 13, 1903, I have the honor to forward a 
ort of the transactions at this station for the fiscal year ending June 30, 1903, aa 
owe: 

migrants inspjected 28, 060 

iiigrants certified 389 

migrants deported 64 

nausea of deportation, and number of cases: 

1 



Curvature of spine and deformity of 

chest 1 

Hydrocele 1 

Blind in one eye, corneal ulcer in 

other 1 

Delirium tremens 1 

Impaired mentality 1 

Corneal ulceration 1 



ni8 

gnant 4 

rulent conjunctivitis 1 

bchoma 36 

t>ility 1 

)r physique 4 

mia 9 

>bili8, secondary 1 

aracts of both eyes 1 

n addition to the above, the following: 

mber of landed immigrants examined at office 80 

mber of landed immigrants examined at hospital 303 

jbA number of times that cases at hospital were visited 850 

Respectfully, W. A. Korn, 

Assistant Surgeon. 
leepectfnlly forwarded. 

Fairfax Irwin, Surgeon, 

Phe Subobon-Genebal, Public Health and Marine-Hospital Service. 
(Thitnig^ medical officer in command.) 



202 



PUBLIC HEALTH AND MABINE-H08PITAL SERVICE. 



[Inclosure.] 

Report of ingpecUon of aUeris at the port of PfdUidelphiaf Pa. , during the year ended June 

SO, 190S, 



Month. 



1902. 

July 

August 

September . . . 

October 

Noyember . . . 
December 

1903. 

January 

February 

March 

April 

May 

June 

Total... 



Number 

in- 
spected. 


Number 


Number 


certified. 


deported. 


1,427 


25 


2 


1,419 


A 


2 


1.955 


27 


8 


2,258 


23 


2 


1,087 


7 





1,S31 


21 


4 


728 


18 


2 


2,281 


20 


8 


2,272 


24 


13 


5,841 


100 


21 


8,800 


54 


5 


4,071 


54 


7 


28,060 


889 


64 



Cause of deportation. 



Favus, 1; pregnant, 1. 

Purulent conjunctivitis, 1; preirnant, 1. 

Trachoma, 3. 

Trachoma, 2. 



Trachoma, 8; pr^^nant, 1. 



Trachoma, 2. 

Debility, 1; trachoma, 2. 

Poor physique. 1; hernia. 2; trachoma, 7; syph- 
ilis, sectondary, 1; curvature of spine and de- 
formity of chest, 1; cataracts, both eye«, 1. 

Poor physique, 8; hernia. 2; hydrocele. 1; tra- 
choma. 12; delirium tremens, 1: pregmant, 1; 
blind in 1 eye, corneal ulcer in the other, 1. 

Trachoma, 8; hernia, 2. 

Impaired mentality, 1: corneal ulceration, 1; 
hernia, 8; trachoma, 2. 



BALTIMROE, MD. 

Bbfobt of Inspbction of Alien Immigrants at Baltimore, Md. by Suro. H. R. 

Carter. 

PuBuc Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Baltimore f Md., July 18, 190S, 

Sir: I have the honor to forward herewith the report of immigrants inspected at 
this port for the past fiscal year, as called for by Bmreau circalsS letter ( H. D. G., 
C. D.) of May 14, 1003. 

It is to be noted that a considerable namber of cases of trachoma were found op 
to February or March, 1903, since which time this disease has been decidedly rare 
among our immigrants. By inquiry I find that a large number (from 6 to 25) of 
passengers are now refused ticsets at Bremerhaven each trip on account of "tra- 
choma, or suspected trachoma.'' The winnowing of these cases, then, is now done 
abroad. 

Respectfully, H. R. Carter, 

Surgeon, 

The Surgeon-General. 



[Indosure.] 

Report of ingpecUon of aliens at the port of Baltimore, Md., during the year ended June 

SO, 190S. 



Month. 



1902. 

Jnly 

August 

Septemher . . . 

October 

November . . . 
December 



Number 

in- 
spected. 


Number 


Number 


certified. 


deported. 


8,807 


7 


6 


2,089 


14 





8,149 


19 


8 


8,667 


17 


4 


2,684 


5 


2 


8,898 


81 


11 



Cause of deportation. 



Class 1. 1. 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 



203 



f of inspection of aliens at the port of Baltimore^ Md. , during the year ended June 

SO, 1903 — Ck^ntinued. 



Month. 


Number 

in- 
spected. 


Nnmber 
certified. 


Number 
deported. 


Cause of deportation. 


1903. 
V 


2,077 
3,120 
8.0»4 
7,051 
9,447 
G,996 


7 
13 
48 
47 

ai 

76 


2 

:4 

lU 

J3 

5 




ry 


Clam I, 5. 




Class I, 24: Cla« IV. 10. 




Class I. 7: Class IV. 12. 




Class 1. 1; ClafBlV. 12. 




Class I. 3; Class IV. 2. 






otal 


&4,954 


367 


94 









NORFOLK, YA. 

of inspection of cdiens at the port of Norfolk, Va. , during the year ended June SO, 

190S. 



Montli. 



1902 

ber .. 

r 

ber ,. 
t)er... 

1903. 

)' 

ry ... 

9tal.. 



Number 

in- 
spected. 


Number 
certified. 


Number 
deported. 



4 

1 






I 





















oooooo oooooo 


5 









Cause of deportation. 



KEY WEST, FLA. 

of inspection of aliens at the port of Key West, Fla., during the year ended June 

SO, 190S, by Surg. R. D. Murray. 



Month. 



1902 

ber.. 

>cr .. 
•er... 

1903 

r 

ry ... 

Jtal.. 



Number 

in- 
spected. 







1 







3 

1 



Number 


Number 


certified. 


deported. 

















































































Cause of deportation. 



Ley West no inspections are made except on call of the immigrant inspector 
le has suspicion of dangerous contagious disease. 



204 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



NEW ORLEANS, LA. 

Report of inspection of aliens at the port of Neiv fhrleans during the year ended Ju 

190S, by Passecf Asst. Surg, C P. Wertenbaker. 



Month. 



1902. 

July 

August 

September . . . 

October 

November . . . 
December 

1903. 

January 

February 

March 

April 

May 

June 

Total... 



Number 

in- 
spected. 


Number 


Number 


certified. 


deported. 


12 








10 








24 








2,796 


7 





2M 


1 





10f> 


1 





64 


4 


4 


418 


3 


1 


162 


2 


1 


69 


4 


2 


1,014 


10 1 2 


97 


4 1 


4,974 


86 


10 



Cause of deportation. 



Trachoma, 4. 

Trachoma. 1. 

Trachoma and blindness, 1. 

Tuberculosis of lung, 1: poor physique,! 

Tuberculosis of lung, 1; insanity. 1. 



GALVESTON, TEX. 

Report op Inspection op Imhighants at Gai.veston by Asst. Surg. C. E. D. 

Public Health and Marine-Hospital Service, 

Oppice op Medical Ofpicer in Command, 

Galveston J 7>ir., July i, li 

Sir: I have the honor to transmit herewith the annual report of inppecti 
immigrants at the port of Galveston, Tex., and would respectfully state that th 
crepanev existing between my figures and those of the immigrant inspei'tor s 
port is due to the fact that, with one or two exceptions, I have only been n.*qi 
to inspect the ships belonging to the North German-Lloyd Steamship Com 
whereas immigrants have been brought over in twos and threes in several 
lines. 

Also, in the month of April, he has reported 186, while we have none, due 
fact that the ship came in late in the evening on April 30, and I did not inspect 
until the next morning, which was May 1, making that number retumaole 
our report for May instead of April. 
Respectfully, 

C. E. D. Ix>RD, Assi^ftant Surg* 

The Surgeon-General, Public Health and Marine-Hospital Service. 



[Inclosure.] 

Report of inspection of aliens at the port of Galveston, Tex., during the year endec 

SO, 190S. 



Month. 



1902. 

July 

August 

September . . . 

October 

November ... 



December. 



Niiiul>er 

in- 
spected. 


Number 


Number 


certified. 


deported. 











66 


1 





812 


5 





222 


2 





98 





1 


223 









Caujje of deportation. 



Held from October and deported; tubei 
lungR. 



PUBUC HEALTH AND MABIHE-HOSPITAL BEBVIOE. 



205 



*.epfjrt of inspedioti of alierut at ike port of Galveston, Tex.j durin{f the year ended June 30, 

190S — CJon tin ued . 



Months. 


Number 

in- 
spected. 


Number 
certified. 


Number 
deported. 


Cause of deportation. 


19U8. 
iftf^PAry 


177 


8S2 


885 

814 


1 

6 


4 

1 





2 

3 






Fff l^ncmry 




Ilarcb 


Valvular disease of heart (mitral); trachoma. 


kpril 




Mfay 


Trachoma: varicose veins; poor phvsiqne; 

atrophied right arm and shoulder, due to 

paralysis. 
Held over. 


June 






Total 


2,U8 


20 


6 









EAGLE PASS, TEX. 
Report of iNSPScnoN of Alien Immigrants, by Acting Asst. Surg. Lea Hums. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Eagle Pass, Tex., Jxdy S, 1903, 

Sib: I have the honor to transmit herewith report of inspection of aliens at port of 
Eagle Pass, Tex., during the year ended June 30, 1903. 
Respectfully, 

Lea Hume, Acting Assistant Surgeon, 

The Surgeon-General, Public Health and Marine-Hospftal Service. 



[Inclosnre.] 

Report of inspection of aliens ai the port of Eagle Pass, Tex., during the year ended June 

30, 1903. 



Month. 


Number 

in- 
spected. 


Number 
certliied. 


Number 
deported. 


Cause of deportation. 


1902. 
July 


112 

104 
204 


9 

4 
4 


9 
4 


Senility, 2; arthritis deformans, 1; insane, 1; 

syphilis, 4; tuberculosis, 1. 
Idiocy, 2; tuberculosis, 1; senility, 1. 
Cripples, 2; tuberculosis, 1. 
No transactions. 
Preirnancv. 1: senllitv. S: idiocv. 1: trachoma. 1. 


August 


September 


4 


October 


November 


ioo' 

125 

194 
125 

50 
50 
90 
31 


6 
10 

28 
14 

7 
3 
2 
6 


6 


D*cen»b«*r - - r - 


10 Senility, 4; syphilis, 1: tuberculosis, 2; paraly- 
1 sis, 2; cripple, 1. 

28 Trachoma. 24: blindness. 1: insanitv. 2: favus. 1. 


1903. 
January 


P'Jbruary - 


14 

7 
3 
2 
6 


Pregnancy, 1; senility, 8; trachoma, 8; blind 


Vsrch 


and cripple, 1; insane. 1. 
Trachoma, 5; senile, 1; juvenile, 1. 


April 


Senility, 3. 


mSv 


Senility, 1; insane, 1. 


June 


Trachoma, 2; insane, 1; pediculosis, 3. 






Total 


1,185 


93 


93 















206 



PUBLIC H£ALTH AND MARINE-HOSPITAL SERVICE. 



LAREDO, TEX. 

Report OF Inspection op Alien Immigrants, by Acting Asst. Surg. H. J. Ha 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Laredo^ Tex.^ July Sy J 

Sir: I have the honor to inclose report of aliens inspected at this port duri 
year ended June 30, 1903. Since the month of November, 1902, quite a large n 
of Syrians have arrived for inspection; they came via Marseille, France, an< 
Cruz, Mexico. It is possible that route was selected to avoi<l medical insjiec 
Marseille for immigrants going to New York or other United States Atlantic 
I may state there are always some affected with trachoma. I am inform^ that 
are at present a large number still in Mexico. A good idea would be to indu 
Mexican Government to have European immigrants inspected at Vera On 
Tampico, more so in the future, as I understand there is another line of stean 
be put on between Mediterranean ports and Mexico. 

The Immigration Bureau has now a station at this port in which immigrar 
inspected more conveniently and with better satisfaction. Formerly inspectit 
accomplished on railroad car and in the open on foot and tramway bridge. Ir 
tion to report inclosed there were 460 immigrants and immigrant children vacc 
upon entry during year ended June 30, 1903. 1 also note that railroad emp 
frequently inform immigrants that are deformed, blind, etc., that it is useL 
them to try to enter, as they would be returned to Mexico; otherwise there 
probably be more certified to than as it is. 

There seems to be no means for hospital treatment at this port of immigran 
fering from infectious diseases who would recover with proper treatment in a 
time. 

Respectfully, H. J. Hamilton, 

Acting Assistant Surg 

The Surgeon-General, Public H3ALTn and Marine-Hospital Service. 



[Inclosure.] 

Report of inspection of aliens at the port of Laredo y Tex.^ during the year ended Jn 

1903. 



Month. 



1902. 

July — ^ 

August 

September . . . 

October 

November . . . 
December 

1903. 

January 

February 

March 

April 

May 



June 



Total. 



Number 

in- 
spected. 



134 
!61 
208 
107 
161 
99 



172 
99 
60 
95 

172 



198 



1,666 



Number 
certifled. 



2 
2 

None. 

None. 
1 
3 



6 



Number 
deported. 



•> 



6 



8 



30 



2 
2 

None. 

None. 
1 
3 



2 

6 



2t* 



Cause of deportation. 



Insanity, 1; deaf mulo, 1 ^Mexican). 
Blind, 1: lupujs of face, 1 (Mexican). 



Blind (Mexican). 
Trachoma, 3 (Syrian). 



Trachoma, 6 (Syrians) . 
Trachoma, 2 (Syrians). 

Loss of 1 eye, senilitv, general debility, 
ican) ; loss of vision of right eye. k 
finger rieht hand, 1; 3 fingers righ 
atrophied and anchyloHcd, 1: catarr 
thalmia blepharic, 1; loss of right eye 
6 fingers right hand contracUKl fro 
trices, 1; gonorrhea. 1. 

Enlarged right wrist, right hand atr 
limited motion right hand, valvula 
disease, trachoma, J (Mexican); gcn< 
bility. senility, blind, trachoma, 1 (Mi 
purulent opthalmia, 1 (Mexican); a 
opthalmia, 1 (Mexican); right arm 
tated at elbow, I (Mexican); tul 
phthisis, tubercular synovitis of righ 
1 (Chinese); trachoma, 2 (Syrian). 



PUBLIC HEALTH AND MA BINE-HOSPITAL SEBVIGE. 



207 



EL PA80« TEX. 



Eeoori of intpection of aliens ai the port of El Paw, Tex,, during the year ended June SO, 

190S, by Acting Asst. Surg, E, Alexander, 



Month. 


Mumber 

in- 
■pected. 


Nnmber 
certi- 
fled.a 


Nomber 

not 
eligible. 


CauK of deportation. 


19Q2. 
jBly 


8M 

W8 
756 
644 

457 
508 

669 
868 
658 
410 

449 

257 




10 


Likely to become public charge, 4; chronic 
rheumatism, 8; man with only 1 arm and no 
means, 1; man with palsy and no means, 1; 
man with scrotal hernia and no means, 1. 


AmfOK. ••••••.•• ....a. 




Bnrtemher 








Octob< r 




6 

2 
6 


Chronic rheumatism, no means. 2: ecsema of 






body, no means, 1; man with 1 leg, 1; tuber- 
culosis, no means, 2. 
Chronic rheumatism, no means, 1; abdominal 


December 




dropsy, no means, 1. 
Fava,- no means, 1; chYonic rheumatism, no 


1908. 
llODAiy 




means, 2; tuberculosis, last stage, 1; woman, 
abdominal dropsy, husband, no means, 2. 


FrtvojuT 








» ¥mv^ 


•-• 


8 

8 

4 


Idiocy, no means, 2: chronic rheumatism, 1. 


• April 


Chronic rheumatism, no means, 1; inguinal 






hernia, 1: gonorrheal opthalmia, consisting 
of woman and 4 children, 5; tinea tonsurans, 
no means, 1. 
Tuberculosis, no means, 1; scrotal hernia, no 


Jniu! 




means, 1; woman, paralysLs, husband, no 
means, 2. 










Total 


6,898 




89 











oNo certiflcatefc issued because Mexican authorities permit me to make inspection at Juarez, Mex., 
and floch as are ineligible are not permitted to enter the United States. 

aAN FRANGISOO, GAL. 

RiPOBT OF Medical Inspection of Alien Immigrants at San Francisco, Cal., by 

Passed Asst. Suro. H. S. Gumming. 

PuBuc Health and Marine-Hospital Service,. 

Office of Medical Officer in Command, 
San FranciKO Quarantine Station, Angel Island, Oal., July fO, 190S, 

Sir: In compliance with "Instructions for the medical inspection of immigrants" 
and Bnreau letter of Mapr 14, 1903, I have the honor to transmit the accommuiying 
report of inspection of aliens at this port during the year ending June 30, 1903. 

Daring the year an important ruling was made which vastly increases the work 
lod the efficiency of the Service at this and other Pacific coast ports. 

Up to May 6, 1903, under rulings by the Commissioner ui>on the old law, Chinese 
arriving at this port were held not to be subject to medical im miction inspection, 
bot in response to a letter from this office April 22, 1903, instructions were received 
under which Chinese aliens suffering with a loathsome or a dangerous contagious 
disease are debarred as other aliens. The importance of this ruling is shown by the 
figures. For the ten months preceding the ruling an average of 7.9 persons per 
month were certified and 3 deported, while for the two months during which Chinese 
were examined an average of 38.5 per month were certified and 24 per month were 
deported. 

The immigration conditions at this port are rather peculiar. There is no place 
provided by the Immigration Service, nor by the transportation companies for the 
examination of arriving aliens, the medical officer is provided with no office or room 
for examination, nor is there any arrangement witn hospitals for the treatment of 
detained immigrants needing such treatment. 

The quarantine officer is in charge of the medical inspection of aliens, and such 
inspection is made upon the vessels while in quarantine; consequently, owing to the 
rigid phvsi(»l examination for quarantine reasons, the examination is very thorough. 
Aliens detained for temporary physical ailments, or reauiring further observation 
before certification, are kept upon vessels or in the detention shed of the Pacific Mail 
dock. 



208 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVIOS. 



A commissioned medical officer of experience has been detailed under the q 
tine officer for this work, and I hope an office will soon be provided and thj 
visions will be made for hospital facilities. 

In addition to the inspection of aliens arriving upon regular paaaenger 
during the past year, inspection was made of alien members of crews of Bsilii 
sels, so that should an attempt be made to land them certificates will be h^d 
immigration authorities. 

At the request of the immigration authorities authority was requested by z 
nven by the Bureau to allow the use of this station for the detention of < 
English mechanics pending their trial and use as witnesses for violation of tl 
tract labor laws, the Service having been reimbursed the cost of subsistenGe foi 
and their guards. 

The relations between this Service and the Immigration Service are pleasai 
every endeavor is made to assist in carrying out the law. 
Respectfully, 

Hugh S. Gumming, 
Passed Assistant Sur^ 

The Surgbon-Gbneral, Public Health and Marine-Hospital Service. 



[Incloeure.] 
Report of inspection of aliens at port of San Francisco during the year ended June SO 



Month. 



1W2. 
July 

August 

September . . . 

October 

November . . . 
December 

1903. 

January 

February 

March 

April 

May 

Juno 

Total... 



Number 

in- 
spected. 


Number 


Number 


certified. 


deported. 


600 








761 


1 


1 


668 


8 


2 


761 


9 


7 


618 


1 





622 


8 


7 


542 


13 


1 


524 


11 


2 


869 


17 


2 


824 


16 


8 


1,309 


83 


20 


763 


44 


28 


8,851 


156 


78 



Cause of deportation. 



Gonorrhea. 
Tubercle, syphilifi. 
Trachoma, gonorrhea. 

Trachoma, varix, hernia, piles, hydrocf 
riasifi. 

Trachoma. 

Do. 
Alcoholism, valvular disease of heart 
Cataract, loss of eye, trachoma, coxitis. 
Amputation of hand, blindness, here 

choma, gonorrhea, opacity of cornea, a 
Trachoma, gonorrhea, syphilis, lucoma 

eye, anchylosis, tubercle. 



ASTORIA, OREO. 

Report of Alien Immigrants Examined at the Port of Astoria, Orbg., by 

Surg. B. H. Earle. 



Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 
Columbia River Quarantine Station^ Astoria, Oreg., July 8, 1 

Immigrants inspected 

Immigrants passed 

Immigrants certified as physically unsound 

Respectfully, 

Baylis H. Earle, AssiMafnl Surg 



PUBLIC HEALTH AND MABINE-H08PITAL SERVICE. 209 

PORT TOWN8END, WASH. 

RspoBT OF Immigrants Ikspbcted at Port Townsend, Wash., during the Fiscal 
YsAR XNDiNG JuNB 30, 1903, BY Pahsed Asbt. Surg. M. H. Foster. 

Immigrants inspected 597 

immignints passed 596 

Immigrants certified on account of dangerous, conta^ous, or loathsome diseases, 
or for other physical causes (hernia, oblique inguinal) 1 

M. H. Foster, Passed Assistant Suryeori, 



Porto Rico. 



SAN JUAN. 



Report of Inspection of Alien Immigrants at Port of San Juan, P. R., during 
the Year ended June 30, 1903, by Passed Asst. Surg. L. L. Lumsden. 



Month. 

1902. 

July 

Aufost 

September.... 

Oclober 

November 

December 

1908. 

Jtnnary 

Pebmarr 

Mtieh 

April 

May 

June 

Tbua.... 

>- — 



Nomber 

in- 
spected. 


Number 
certified. 


Nnmber 
deported. 


148 
125 
120 
116 
188 
106 

97 

85 

94 

168 

106 
U6 






































3 





1 





1.455 


4 






Cauuie of deportation. 



3 certified as likely to become public charges; 
admitted by special board of inquiry. 

1 certified as likely to become a public charge; 
admitted by special board of inquiry. 



MATAOUEZ. 

Bkpobt of Inspection of Immigrants at Mayaguez by Passed Asst. Surg. H. S. 

Mathewson. 

San Juan, P. R., September 16 ^ 190$, 

Sm: The following is a statement of the number of immigrants examined at the 
port of Mayagnez, P. R., from July 1 to September 15, 1902, mchifiiive: 

Immigrants inspected 46 

Immigrants passed 46 

Immigrants certified as physically unsound 

Respectfully, 

H. 8. Mathewson, Passed Amstant Surgeon. 

The Surgeon-General, Public Health and Marine-Hospital Service. 
H. Doc. 838 U 



210 PUBLIC H£ALTH AND MAEINE-HOSPITAL SEBVIOE. 

HUMAGAO. 

Rkport of Medical Inspbction op Alien Immigramtb at Humacao, P. R., by 

P. A. Surg. H. S. Mathewson. 

San Juan, P. R., September 16, 190S. 

Sib: The following is a etatement of the number of immigrants examined at the 
port of Humacao, P. R., from July 1 to September 15, 1902, incluaye: 

Immigrants inspected 4 

Immigrants passed 4 

Immigrants certified as physically unsound 

H. S. Mathkwson, 
^ Passed Asgisiant Surgeon, Chief Quarantine Officer for Porto Rico, 



PONCE. 



Report of Medical Inspection of Immiorantb at Ponce by Acting Abbt. Subo. 

J. F. Torres. 

Public Health and MARiNB-HosprrAL Service, 

Office of Medical Officer in Ck>MMAND, 

Ponce, P. R., July g, 190S, 

Sir: In accordance with paragraph 815 of Regulations, Public Health and Marine- 
Hospital Service, I have the honor to make the following report of medical inspec- 
tion of immigrants at this port during the fiscal year ended June 30, 1903: 

Inspected 39^ 

Passed 394 

Rejected 2 

Respectfully, 

Juuo Ferrer Torres, 
Acting Asgistant Surgeon, 
Respectfully forwarded. 

L. L. Lumsden, 

Passed Assistant Surgeon, 
The Surgeon-General, Public Health and Marine-Hospital Service. 



Hawaii, 
honolulu. 

Medical Inspection of Alien Immigrants at Honolulu, H. I., by PAaaED Assr. 

Surg. L. E. Gofer. 

Public Health and Marine-Hospffal Service, 

Office of Medical Officer in Command, 

Honolulu, if. /., July S, 190S. 

Sir: In compliance with Bureau letter (H D G) of May 14, 1903, from the division 
of foreign and insular quarantine, I have the honor to forward herewith the report 
of the me<lical inspection of aliens at this port for the fiscal year ended June 30, 1903. 
The report is made out on the prescribed olank form. There are no facts of interest 
in connection with the medical inspection of aliens at this station worthy of men- 
tion, save perhaps the fact that I have added to the r^jular examination the reauire- 
ment that every immigrant must jump up on a box 15 inches high in order to aetect 
beriberi. Even a slight loss of muscular power in the leg extensors may be detected 
by this method. Of course pr^mant women are not required to make the jump. 
Our inspection work here has been somewhat hampered by the lack of proper 
landing facilities. In the near future a regular immigration station will be bailt, 
and our officer will be furnished with the proper ofiice and other ^idlities. 
Respectfully, 

L. K Gofsr, 
Passed AssisOmt Surgeon, Chief Quarantine Officer, 

Territory of HawaiL 

The SurgboN'Geseral Public Health and Marine- Hospital Service. 



FUBUO HEALTH AND XABINE-HOSPITAL 8EBVI0B. 



211 



[Inclosore.] 



Report ofintptdum of aliens at port ofHonoltUu, H, L , during the year ended June SO, J 90S. 



Month. 


Nnmber 

in- 
spected. 


Number 
certified. 


Nnmber 
deported. 


Cause of deportation. 


11MI2. 
JalT 


1,814 
874 
557 
1,205 
2,061 
1,600 

1,861 
726 
754 
M8 

1,857 
712 


2 

2 
4 
46 
206 

218 
16 

4 
29 
12 

8 


1 

1 
4 
46 
189 

218 
15 

4 

29 
15 

8 


Syphilis. 


Al^DSt 




September 


Trachoma. 


October 


Trachoma. 8: tubercle 1 




Trachoma. 


Oeoanber 


Trachoma, 187; syphilis, 2. 
Trachoma. 


1908. 
' Jtnmrr 




Do. 


^ Mnr^h .'. 


Trachoma. 2; tubercle, 1; tricrophytosis, 1. 
Trachoma. 


h April... 


I sK 


Do. 


JSe.:::::;;:; 


Do. 






Ttotal 


12,964 


588 


620 


Trachoma, 514; syphilis, 8; tubercle, 2; tricro- 
phytosis, 1. 





Canada. 



QUEBEC, QUEBEO, AND 8T. JOHN, NEW BRUNSWICK. 

RiFOBT OF InSPBCTION OF IMMIGRANTS AT QUBBBC AND St. JoHN, BY ASBT. SURG. 

W. C. BlLLINOa. 

Quebec, Canada. 

Sot: The following is a report of the medical inspection of alien immigrants at the 
ports of Quebec, Quebec, and 8t John, New Brunswick, Canada, during the fiscal 
year 1903, giving the number inspected, the humber certified, the number deported, 
and the cause of deportation, by months, during that period of time: 



Month. 



' 1902. 
Jnlf 

Aofoit 

September . . . 
October 

IfofeBiber ... 
MccBiber. . . . 

ISOS. 

hmmrj 

FebfOftry 

Mareh 

ApfU 

lUy 

June 

T6tel... 



Number 

in- 
tpected. 


Number 


Number 


certified. 


deported. 


2.827 


108 


86 


2,220 


68 


16 


2,172 


64 


89 


1,786 


42 


24 


1,687 


84 


17 


781 


41 


24 


1,2S7 


61 


20 


806 


89 


6 


1,678 


86 


10 


1,196 


16 


8 


2,601 


44 


7 


2,604 


56 


10 


21,402 


572 


211 



Cause of deportation. 



Trachoma, 82; varicose veins, 1; valvular dis- 
ease of heart, 1; pregnancy, 1; tubercular 
peritonitis, 1. 

Trachoma, 18: motor paraljrsis, partial, 1; 
broncho-pneumonia, 1: tubercle knee Joint, 1. 

Trachoma, 37; favus, 1; tubercle Icnce Joint, 1. 

Scoliods, 1; trachoma, 17; hernia. 1; syphilis,!; 
emphysema, 1; favus. 1; poor pnjrsique, 2. 

Trachoma, 14; favus, 2: hernia. 1. 

Trachoma, 17; poor physique, 2; senilitv and 
debility, 1; opacity, both comese. 1; tubercle 
of lung, 1; valvular disease of heart, 1; 
favus, 1. 

Trachoma, 17; favus. 2; feeble-minded, 1. 

Trachoma, 8; favus, 1; hydrocele of cord, 1. 

Trachoma, 8; irregular nearts action, 1; poor 
physique, 1. 

Favus, 2; trachoma, 1. 

Deaf and dumb, 1; favus, 1; trachoma, 2; tachy- 
cardia, 1; poor physique, 2. 

Trachoma, 7; favus, 3. 



Respectfully, 

W. C. Billings, AmsUtnt Surgeon. 

The SUBGBON-GXNBRAL, PUBLIC Hs.ALTH AND MaRINB-HosPITAL SeKVKE. 



212 PUBLIC HEALTH AND MABINE-H08PITAL SEBVICB. 

Italy. 

inspection op aliens at genoa, naples, and palermo. 

The lar^e number of immigrants arriving in the United States froni j 
Naplen and Palermo necessitated the continuance of the detail of the 
medical oflBcer of this Service at Naples, Italy, for the purpose of . 
examining the aliens embarking for ports in the United States. He 
also inspects those sailing from Palermo for the United States. 

Reports of Inspection op Emigrants from Genoa, Naples, and Palermo by 

Passed Asst. Surg. J. M. Eager. 

Public Health and Marins-Hospital Service, j 

Office of Medical Officer in Command, ' 

United States CkmrnUde^ Naples, Italy, September £;?, 190?. \ 

Sir: I have the honor to make the following supplementary report of tlie tranaac- 
tions of the Service at this port covering the penod from July 1 to September 1^ 
1902, inclusive: 

Statistics of the Service at Naples, 





Month. 


Ships. 


Number of emigrants. 


Ba<?g«^\ 




Genoa. 


Naples. 


Palenno. 


In- 
spected. 


Disin- 
fected. 


July 


1902. 


15 

14 

5 


679 
689 
870 


6,962 
8,740 
4,089 


885 


1,620 

2.146 

911 


9,KO 

10,150 

3,697 


AufiTUHt 




September 1-15 . 




653 




Total 


34 


1,538 


19,791 


1,438 


4,676 


2J,tr7 





Ejections advised. 



Month. 


Tra- 
choma. 


Pavus. 


Her- 
nia. 


Ring- 
worm. 


Small- 
pox. 


Measles. 


Fever. 


Other 
causes. 


Total. 


1902. 
July 


368 
804 
251 


12 
24 
13 


24 
26 
10 


1 
5 
4 






10 
10 


10 
13 

4 


415 


August 


2 


1 


384 


September 1-16 


282 












Total 


913 


49 


69 


10 


2 


1 


20 


27 


1,081 





Proportion of rejections advised to emigrants inspected 4.75 per cent. 
Respectfully, 

J. M. Eager, 
Passed Assistant S^irgefm. 

The Surgeon-General, Pubuc Health and Marine-Hospital Service. 



PUBLIC HEALTH AND MABING-HOSFITAL SERVICK. 



218 



Public Health and Marinb-Hospital Service, 

Office of Medical Officer in Command, 

U. S. Consulate, XapUs, Italy, July /, 1903. 

ave the honor to make the following report of the transactions of the Serv- 
port covering the period from September 15, 1902, to June 30, 1903, inclusive: 

SUxtiilict of the Service at Xaples, 





Shipci. 


Number of emigranta. 


Baggage. 


Month. 


Genoa. Naples. 


Palermo. 


In- 
8pe<*te<l. 


Disin- 
fected. 


1902. 
6-30 


12 
19 
16 
14 

21 
21 
32 
32 
25 
18 


401 

1,857 

765 

581 

503 
1,278 
1.380 
2.354 
1,4M 

987 


7,234 

12,961 

9,054 

6,199 

8,549 
18,799 
31,738 
29,865 
23.712 
12,109 


2,694 
944 
733 
932 

1,365 
1.067 
1,875 
1.995 
1.002 
855 


1,918 
3,424 
2,339 
1,677 

2,181 
1,447 
2,634 
2,614 
2,817 
2,164 


12,488 




19,358 




13,615 
8,097 

12,918 
29.050 




1903. 






42,966 
40,181 






88,254 
19,206 








210 


11,560 


160,220 


13,462 


23,210 


231,188 





R^ections advised. 



Month. 



1902. 
6-30.... 

1903. 



Tra- 
choma. 


Favus. 


Heniia. 


Ring, 
worm. 


Measles. 


Fever. 


Other 
causes. 


556 
1,126 
1,054 

535 

996 
1,803 
1,434 
941 
852 
595 


15 
20 
18 
40 

23 
24 
37 
56 
38 
41 


86 
25 
15 
10 

13 
20 
12 
13 
8 
9 


9 
5 
1 

1 




2 
3 
5 

1 


22 
12 
15 
18 

18 
14 
20 

4 
11 

7 


2 
2 




2 
1 

2* 

1 


3 


1 
2 
4 
I 
5 


8 

1 
1 


9,892 


311 


161 


22 


12 


24 


141 



Total. 



640 
1,193 
1,110 

606 



1,050 
1,867 
1,506 
1,020 
918 
660 

10,068 



Iready used for another purpose, I suggest that the report on Trachoma aa 
lie and Maritime Disease, submitted June 15, 1903, be added to the yearly 
he Naples station, 
pectfully, J. M. Eager, 

Passed Assistant Surgeon. 
igeon-Genbral, Public Health and Marine-Hospital Service. 



ctfuUy submitted. 



J. W. Pettus, 
Assistant Surgeon- General. 



DIVISION OF DOMESTIC QUARANTINE. 



215 



ov<r 






I 



r 



PUi.-.iv. iJi^WAKY. 



4 '..<-:, HC*. n MID 



J 

II 



>BT OF THE DIVISION OF DOMESTIC QUAEAlTrnrE. 

By A. H. Glennan, 
' Surgeon- General^ Public Health and Marine-Hospital Senricey in charge. 

lave the honor to submit the following report of the opera- 
he division of domestic quarantine of the Fublic Health and 
ospital Service for the fiscal year ended June 30, 1903. 

PLAGUE IN SAN FRANCISCO. 

le date of the last annual report of the Service, November 1, 
laths from plague have occurred in San Francisco, Cal. — 6 
id 1 Japanese, the latter a woman who lived in the Japanese 
rhich is located immediately adjoining Chinatown. 
E tJiese deaths occurred in November, one in December, 1902, 
rch, and one in June, 1903. 



Number. 



Race. 



Chinese . 

do... 

do... 

do... 

Japanese 
Chinese . 



Discovered. 



Nov. 15,1902 
Nov. 18,1902 
Nov. 26.1902 
Dec. 11,1902 
Mar. 16,1908 
June 5,1903 



Died. 



Nov. 16,1902 
Nov. 19,1902 
Nov. 26,1902 
Dec. 11,1902 
Mar. 16,1903 
June 5,1908 



:i 






i 

i: 

I 

;r 



1 1 

■I I 

f.i 



he representative of this Service to the State of California 
iference with the governor, in regard to the cooperative work 
ion of Oriental settlements outside of San Francisco, and an 
J to that effect was being favorably considered, a telegraphic 
of the result of the conference of the State boards of nealth, 
w Haven, Conn., October 28-31, 1902, was communicated to 
ive officials of San Francisco, and they were greatly agitated 
r of quarantine against California by the otner Stat^. In 
dis unnecessary alarm, the Bureau gave out the following 
which was telegraphed to the officials at San Francisco: 

conference State boards health at New Haven this week was regalar 
jrence that organization. Surgeon-General Wyman not member oi^^an- 
received invitation be present as an act courtesy in view close relations 
te boards and Public Health Service provided for by act of Congress 
Iv 1, 1902. Resolutions regarding California State board of health orig- 
Bly with members conference, and were prepared by committee and 
passed without any discussion. No movement to quarantine several 
it California was sugg^ested other than suggestion relating to possible call- 
conference. No special conferences now being held or have oeen held in 
to determine action Federal Government. 

ing mayor of San Francisco, H. U. Brandenstein, wired 
]uests lor the presence of Governor Gage and of the mem- 
5 State board of health at a conference to be held at the 



■ I 



It 



« ■ « 






218 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

mayor's office, November 3, and invited representatives of this Service 
to be present. The governor replied that ne was already in communi- 
cation with the representative or the Government with a view to coop- 
erative action in tne State; but after further pressure detailed the sec- 
retary of the State board of health to attend. 

This conference was held in the mayor's office, November 3, as set 
forth in the following telegrams: 

[TelegraniB.] 

San Francisco, Cal., NovernberS, 190S. 

Surgeon-General Wyman, WcLshington: 

Secretary State board health conferred with local board of health, the aedoi 
mayor, the senior United States Senator, and others to-dav. Secretary of State 
board of health assured his conferees that Sui^eeon-General would not quanmtbie 
California. Secretary of the State board of health willing to institute mroughoot 
California any reasonable recommendations made by Surgeon-General. Have fdly 
informed Glennan. Your November 1 statement to correspondents respecting tw 
New Haven conference known here and relieves excitement. 

M. J. WHim 



San FnANasco, Gal., November 4, 1909. 

Sui^geon-General Wyman, Washington: 

Situation approaching cooperative action. Acting mayor called a meeting to^y 
to consider the Eastern dispatches threatening quarantine against California. Hie 
newspapers here, by request, publish nothing. Invited, but avoided attendanee 
because local authorities not autnorized body to take wide action. State auUioritiei 
pleased with mv stand. By previous arrangement and direction of the governor a 
conference will be held Thursaay to frame line of procedure for his and vourapproi^. 
Reports of New Haven meeting have aroused anxiety. Hope that other States wiU 
not take precipitate action agamst California until outcome of conference is known. 

Glsnman. 

On November 6 Surgeon Glennan met the representatives of tie 
governor in San Francisco with a view to outlining a method of pro- 
cedure in the sanitary inspection of the State upon the lines mentioned 
in the following correspondence: 

[Telegram.] 

San Fbancisco, Cal., November 6, 1902, 
Surgeon-Greneral Wyman, Washinglon: 

In conference to-day with representatives of the governor and submitted following 
memorandum, which was favorably received, for his and your approval: 

(1 ) By mutual approval governor will appoint a disinterested professional resident 
of State, who, with representative of Service, ma]^ make recumng sanitary sorveyB 
of suspected places outside of San Francisco, and, if necessary, bacteriologiod exaood- 
nations to aid and confirm dia^osis. 

(2) Where continued suspicion exists in any locality house-to-house inapectionS to 
be made, recurrent when necessary, by competent persons under supervision proper 
health authorities, and systematic effort made to exterminate vermin. 

(3) As precautionary measure to satisfy national and other State authorities, to 
essentially adopt plague-preventive measures promulgated by Grerman Government, 
amended to conform to State laws, legislative action if necessary, and similarly 
adopted b^ other Pacific coast States. 

(4) Legislative act to be considered prohibit dwelling and sleeping beneath groond 
in city or town of State, with other general sanitary tenement restrictions. State 
authorities appreciate and will cooperate with you upon these broad lines without 
agitation and publicity, but information and action may be furnished by you to 
other State boards of Heedth. 

Glknnan. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 219 

[Letter.] 

San Francisco, Cal., November 7, 190S. 



I Bent you last night a diBpatch, condensed as far as possible, giving a digest of a 
nemorandum (copy herewith inclosed), which I submitted to the governors secre- 
tary and the secretary of the State board of health, designated by the governor to 
neet me with power to give assurance of the governor's action. 

The first and second paraffraphs were accepted without discussion; the third, relat- 
ng to the adoption of the pTaffue-preventive measures promulgated by the German 
government, as printed in the Public Health Beports, copies of which I handed them, 
vere objected to as possibly tending to create public excitement and would require 
cypalative action to he effective. I stated in reply that the desire was to have tlie 
State aathorities approve a definite line of procedure for use in case of necessity; that 
t would strengthen outside confidence in future sanitary work in this State; also 
Jiat I had no doubt that the Surgeon-General of this Service would recommend and 
idviae aimilar policy and action to other Pacific coast States, thereby obtaining uni- 
btniity withoat discrimination. This paragraph was thereupon allowed to stand for 
iliHBgovemor's consideration. 

The last section was a suggestion for future legislative action, and stood for what it 
Do^ht be worth and could be accomplished in the future along that line. 

It seems beet to start out upon a few broad lines, upon the cooperative plan unre- 
lervedly accepted in the first paragraph, and future action be guided b^ events as they 
J Dst at this time I have no reason to believe that the State authorities will not act 



petfectly fair in the investigation^ while at the same time thev profess to believe that 
the baoUos found in these cases is a jiseudo one found in all localities where Chinese 
are collected toother, and existent in this State for years. I replied that it would 
be very intoresting to find out if similar cases existed in outside localities where these 
people were collected, and if the proposition was true it would hold good in Portland, 
Seattle, and Victoria, which could be demonstrated later. They claim that the 
ptrop^esies of Kinyoun and others, of a direful epidemic, have not been fulfilled; that 
ninetv-odd cases in thirty-three months establishes no such claim, and does not oorre- 
spond with the course of plague in places in the world where true plague has 
obtained a foothold. 

My present belief is that they will cooperate fairly — not hide cases— and endeavor 
to ascertain the truth. 

Bespectfully, A. H. Glennan, Surgeon, 

The SuBoaoN-GsNERAL- Public Hbalth and Marinb-Hospital Servicis. 



[XncloBore]. 
Memorandum. 

First By mutual approval, the governor will appoint a discreet, disinterepted, 
professional man, a resident of the State of California^ who, together witli a repre- 
sentative of the Public Health and Marine-Hospital Service, shall make a sanitary 
inapection of towns and places outside of San Francisco, to which suspicion is, or has 
at any time been directed. These inspectors shall be duly authorized by the gov- 
ernor and credited to the local health and other authorities to enable them to make 
a quiet sanitary investigation and furnish report of the same to the governor, through 
the State boara of healtn, upon the following lines: (A) Name of place; population, 
white and foreign. (B) Local board of health or health ofhcer. (C) Causes of 
death during the past year. (D) Crowded dwelling places of any classes of [persons 
or conditions tending to propagate contagious or quarantinable disease. (E) If any 
suspicious cases of such oisease exist, a full history, clinical and otherwise, Hhall lye 
obtained, and, if necessary to aid or confirm the diagnosis, a bacteriological exnniina- 
tion may be made. These inspections of outside places shall be made at different 
recurring intervals, if necessary, and after sufiicient periods of time to eliminate all 
suspicion. 

Second. In case suspicion of a contagious or ouarantinable disease continues to 
exist in any locality in the State, a systematic house-to-house inspection shall be 
made by competent persons under the direction of the State and local health authori- 
ties, lliese house inspections shall l>e recorded upon printed blank forms, giving 






220 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

the number, location, and sanitary history of the premises, number of resideDtB, 
occupation, drainage, plumbing, etc., particular attention to be paid to the groond 
floors. 

A systematic and continuous effort should also be made for the extermination ol 
vermin. 

Third. As a jprecautionary measure, and to satisfy the health authorities of other 
States and Territories, as well as the public health laws and regulations of the United 
States, the State board of health of California will adopt essentially the pisgae pn- 
ventive measures promulgated by the German Government; the phraseology of 
these reflations to be modified to correspond to the proper health and municipal 
authorities under the laws of the State of California. 

Fourth. It is further recommended that a law be enacted, as a general sanitary 
measure, that within a reasonable len^h of time no persons shall thereafter, in any - 
city or town of the State of California, use for dwelling or sleeping purposes any 
place beneath the surface of the ground. 

The questions of overcrowding, ventilation, air space, sunlight, etc, in tenement 
districts might also be embodied in this act. 

As an indication of the tendency of public opinion to exaggerate the 
seriousness of the plague in San ItTrancisco, the following is given: 

[Letters.] 

New Orleans, La., November 4, 190i. 

Dear Doctor: The conference of State boards of health states that there have 
been about 2,000 deaths from plague in San Francisco since the beginning of the 
disease. Is that number correct? Kindly state the number of deams among the 
C^casians. 

Yours, very truly, Edmond Souchon, M. D^ 

PreiideTU Louisiana Slate Board ofHeaWi, 

Surobon-General Public Health and Marine-Hospital Service. 



Washington, November 7t 190S. 

Sir: Referring to vour letter of the 4th instant, in which you state that the con- 
ference of the State boards of health states that there have lieen about 2,000 deaths 
from plague in San Francisco since the beginning of the disease, asking if this num- 
ber is correct, and desiring to know the number of deaths among Caucasians, I have 
to inform you that so far as the information in the Bureau extends, since and includ- 
ing March 6, 1900, 90 persons have died of plague in San Francisco. Of this number 
6 or 6 were Caucasians, but the exact number of Caucasians is not positively known. 
Respectfully, 

Geo. Pubvianck, 

Acting Surgeon- General 
Dr. Edmond Souchon, 

President Louisiana Slate Board of Health, New Orleans, La, 

Following the negotiations for this plan of inspection, Governor 
Gage met tne Service representative at the Palace Hotel, San Fran- 
cisco, upon November 12, 1902, acquiesced in the plan in general, but 
felt averse to selecting his inspector outside of the membership of the 
State board of health, as related in the follo¥ring telegrams: 

[Telegrams.] 

San Francisco, Cal., November 12, 1902, 
Surgeon-General Wyman, Washington: 

In conference with governor here this afternoon he expressed earnest wish to 
cooperate with you. He hesitates use men outside State health officials, and suggests 
secretary State board accompany your representative, make quiet preliminary 
inspection places you wish, calling bacteriologist when necessary. I replied you 
might possibly desire his agent, one not preWously identified prominently with 
Question; that I would wire you his proposition to-night and ask that you telegnph 
direct to him at Sacramento, where he will be Wednesday. 

Glbnnam. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 221 

Wahhington, November 12^ 1902. 
3on GiJENNAN, San Preaicisco, Col.: 

feiring to your telegram of to-day, prefer to conduct negotiations through you. 
telegrams I would send governor I, would also have to send copies to you to 
yoa posted. Therefore please advise with the governor again and request that 
id the State board name some one who has not heretofore neen connected with 
le situation. This would be in accordance with understanding that disinterested 
es would conduct inquiry. If you deem it advisable, visit the governor at 
imento, or conduct the matter by telegraph, as you deem best. Wire result. 

Wyman. 

s a compromise, the selection of Dr. Matthew Gardner, chief sur- 
1 of the Southern Pacific Railroad, wan made. 

[Telegrams.] 

San Francisco, Cal., November 14^ 1902, 
eon-General Wyman, Washington: 

e governor agrees to send as a representative of the State board with me to 
line health conditions in outside towns Doctor Gardner, chief surgeon Southern 
ic, but wishes name of your representative immediately. I consider proposition 
Are you willing to accept the governor's proposition? Rush answer; very 
•rtant Should have reply at once. 

Glennan. 



Washington, November 15, 1908, 
rNAN, San Francisco, Cal.: 

ferring to your telegram of November 14 received this morning, accept gov- 
r's proposition; you to be Service representative unless some reason unknown to 
au makes it necessary for you to be otherwise engaged. 

Wyman. 



San Francisco, Cal., November 20, 1902. 
eon-General Wyman, Washin^on: 

lave just received telegram from Governor Gage officially confirming vJanlner; 
and moile of procedure at my disposition. Will begin immediately; everything 
ingly very satisfactory: am endeavoring to keep the investigation quiet; fear 
I notoriety will defeat object. 

Glennan. 

he following correspondence shows the progress of the work: 

[Telegram.] 

San Francisco, Cal., November 24, 1902. 
eon-General Wyman, Washington: 

ive made preliminary inspections of Oakland, Berkeley, and Alameda. Will 
proceed to San Jose, working outward. Report mailed. 

Glbnnan. 



INSPECTION OF OAKLAND. 

[Letter.] 

San Francisco, Cal., I^ovember 2S, 1902. 

i: Following your letter of instructions to me dated October 4, 1902, handed to 
n Washinj^n, to proceed to the State of California, and immediately after 
ition to some Service business at San Diego to call upon his excellency, Henry 
age, governor of California, and express your wish that he designate a represent- 
to coojjerate and accompany your representative in making inspections of cer- 
places in this Stat« to which suspicion of the existence of plague has been 
ted, I have made report to you from time to time, as to the progress of these 



222 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

n^otiations. Progress in this matter has been necessarily a little slow, for 
already known and anticipated by you, but it is only ^r to say that Governor Gage 
has always expressed the desire to cooperate with you in an impartial investigrtioB 
of the plague situation in the State of California. 

After some casting around for a disinterested State representative, it ooconied to 
both sides, somewhat independently, that Dr. Mat Gardner, chief surseon ol the 
Southern l^cific Railroad Company, would be mntuallv acceptable for the doty— in 
fact I invited him to accompany me to a conference with the governor, withoatany 
reference to his possible selection. 1 state this to show the diainterested way in 
which it was brought about. Doctor Gardner is a man of large experience in pn^ 
fessional and business affairs, is broad minded, has the courage of his convictioiii^ 
and will call a spade by its proper name. 

Immediately upon the official confirmation of the selection of Doctor Gardner bj 
the governor and your concurrence in the same, I proposed that we make a prelim- 
inary investigation of the places adjacent to San Francisco and work out to the moie 
distant points. 

In accordance with this plan we proceeded on Saturday morning, November 2S; 
to Oakland, across the bay from San Francisco, connected by ferry, and having the 
relative business and social connection as Brooklyn to New York. The Twdflh 
Census of the United States, 1900, gives the population of Oakland as 66,960; OhinoB 
950, and Japanese 194. 

The city tx)ard of health consists of seven members: Dr. O. D. Hamlin, presidfiot; 
Dr. Edward von Adelung, health officer; and Daniel W. Doody, secretary. Our 
first call was made uix)n Doctor Hamlin, and the nature of our buouiesB made known 
to him. He kindly delayed some professional calls and talked freely upon the 
plague situation. The board of health employ three sanitary inspectors, who fe 
thn>ngh their small Chinese district at least twice a month. Over two years ago^ 
during the acute agitation in San Francisco, they employed additional inspecton^ 
and stationed guards at the ferries, but at no time did they detect any aospicioai 
cases of sickness. There was a possibility that a sick person might lie conoealed 
amongst these T)eople, but not prooable in any number of cases. I then sii^fied a 
desire to see tne death recoras and he accompanied us to the small frame hedtb* 
office building adjoining the city hall, where the secretarv is on continuooa dnty. 
We examined the mortuary records in a large well-kept alphabetical book. Doiii^ 
the ])a.st twelve months or more there were, by actual count, eight Chineee dealhs 
and one Japanese, as follows: 

February 5, 1902 — Wong Lung Bene, insufficiency heart valves, bicuspid. 

September 19, 1901 — Hee Ah, acute dilatation ventricle. 

August 29, 1902 — Hong Quong Ye, pulmonary tuberculosis. 

October 22, 1902 — Hung Toy, pneumonia. 

April 3, 1902 — Kee Sud, inflammation of liver. 

September 4, 1902— Malsumota Nooki, Japanese, student, nephritis, treated at tbe 
Fabiola (Homeopathic) Hospital. 

September 13, 1902— -On Wong Bo, cancer of liver. 

December 21, 1902 — Quon Gee Kee, male, 71, valvular disease of heart. 

January 16, 1902— Yon Gee, male, 29, pulmonary tuberculosis. 

Three of the Chinese deaths are certified to by the coroner, Dr. H. B. Mehrmaim. 

This gentleman is confined to his house b>[ illness, so an interview with him was 
deferred. The Chinese do not employ American physicians, as a general rule; for 
this reason the coroner examines and certifies to some deaths. I have the names of 
the other attending physicians, for future use, but do not set much value upon buried 
history. 

Our next interview was with Doctor von Adelung, somewhat recently appointed 
health officer. He stated that the city has no place to isolate contagions disease, 
and that he was urging the business men to see that such a place is proWded, on the 
ground that he might be obliged otherwise to quarantine a public building or hotel 
at any time for smallpox or other disease. He recognizes the existence of pU^gue in 
San Franciseo, accepts the diagnosis, but feels no special apprehension of its 
obtaining a foothold or spread in Oakland. They have kept watcn during the past 
two years, but have not had a suspicious case. All the Chinese in Oak&id 
are in free communication with San Francisco, going over at night at least twice a 
week. Tlie Chinaman who sickened there over two months ago in the McPike 
family was of this class. Their first notice of this case was from the gentle- 
man himself, who wished his house fumigated, which they did, at least the 
room wlii(!h the Chinaman occupied. He granted that solitarv cases might be con- 
cealed in the city, but not very probable, and thought that all deaths were recorded. 
The Chinese do not own a foot of land in Oakland. For that reason their burials 
are made in San Francisco, in the San Mateo Cemetery, where they are allowed to 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 223 

nU*r the remains when ready to send them to China — a religious ohligation. The 
k'ilege t(> disinter is not granted in Oakland. Their relief societies are located 
^mn Francisco, where they go when sick or out of work. This seems to be con- 
ned by the sinall number of deaths recorde<l in Oakland and the statement of two 
:hree intelligent Chinamen to me to the same effect. It is, of course, possible that 
sw of the wealthier class might pay well to hide a sick nerson in Oakland if the 
pection became too hot upon the other side, but it woula only be done to avoid 
opsiee and burial in lime. Cremation would greatly injure investigation, on account 
heir ciuton of returning the bones of all deceased to China. All these statements 
presented for what they may be worth, and in a preliminary way. The general 
jmuui on given by the medical men in Oakland whom we met is that they have 
lung to conceal; that there is little strife, friction, or fear of having the truth 
ywn. The point to be observed is their possible lack of training as health officials 
the detection of an insidious disease, as well as the lack of acumen of the general 
tctitioner in signing certificates of death. 

>r. J. M. Kane, clinical bacteriologist to the board, appears to be competent, but 
s not have the time or facilities to carry on experimental work, nor does he 'see 
oners' cases. We suggested to Doctor Hamlin the desirability of his seeing the 
lies of all deceased Chinamen — few in number — in conjunction with the coroner, 
i this will probably be done in future. 

>ne of the mspectors was detailed to con<luct us through the Chinese district, which 
npies four or five city blocks, mainlv frame buildings, and all above grouna. The 
m are comparatively clean, and will compare favorably with tenement districts in 
I East. The stairways and rooms are small and close, as in other places, but 
iDT rooms are held by Chinamen who are out at work during the day, so that 
lOie floors are vacant at this time. They distrust each other so far as their worldly 
ids are concerned, and use the latest improved padlocks u{X)n their doors, but 
my of the rooms we could see into, which contained only a wooden bunk for sleep- 
l purposes. In one place several healthy-looking Chinamen were smoking opium 
a daied condition and coiled up under the care of the proprietor. In several 
ler places we came upon them in dark holes and comers, ana I examined them 
' gundolar tenderness or enlargements. A considerable percentage of Chinese are 
ind with glandular enlaraement, tubercular and venereal in character, and a lai^ 
iportion of deaths are due to tuberculosis. I noticed a considerable number of 
a^ all, with one or two ezceptioiiH, in sleek condition. Rats were said to be scarce, 
d no d^sad ones found. All the conditions seemed to show that Oakland is a tem- 
rary abiding place for those having employment there; that when sick, out of 
Tk, or seekm^ amusement they cross over to San Franciscro and return by the 
ry the same night when necessary. Their Chinese doctors and hospital are upon 
i other side, so that it may i&irly l>e considered at the present preliminary stage of 
B investigation that the endemic focus of infection is located in the San Francisco 
inese quarter, with which there is free communication. Rumors of the sick being 
:en across to Oakland to avoid discovery may or may not be so, but it is not exten- 
e or probable, from present indications. The Chinese have no great family ties 
relations in a foreign country. They seem to congregate in the large San Fran- 
co Quarter, radiating from that point and returning when out or work or in distress. 
ii ttiis investigation the facts will be reported as found, without regard to rumors 
theories. In some respects the Chine.8e are given too much credit for acuteness 
i duplicity, nor does it seem netjessary to advance strained reasons whv a greater 
OEiber of cases of plague are not found. The facts seem to show that the disease 
^pogates slowly in this climate where di^erent conditions prevail and a certain 
oont of sanitary control has been maintained. 

)n Monday, November 24, it is intende<l to make inspections of Berkeley and 
uneda; the following day proceed to San Jose. 

Respectfully, A. H. Glennan, 

Surgeon f Inspector, 

The Subobon-Gbneral, Public Hbalth and Marine-Hospital Service. 



INSPECTION OP BERKELEY AND ALAMEDA. 

[Letter.] 

San Francisco, Cal., November e5, 1902, 

tiB: The towns of Berkeley and Alameda, situated east across the bay from San 
incifloo by ferries, are located to the north and south sides of the city of Oakland 
I connected by trolley cars. 



224 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 



BBRKBLET. 



The census of 1900 gives Berkeley a populatiou of 13,214; number of Chineee, 154, 
and Japanese, 17. The number of Chinese at this time of the year may be more^ 
but it is not an important matter. Dr. F. H. Payne is the health officer. He mdiei 
personal inspections of the few Chinese tenements, which are detached frame build- \ 
mgs, without underground quarters of any kind. There has been only one death of ] 
a Chinese in ttie last two years or more, and that caused by railroad accident. Thc^ 
are scattered through the town as domestic help, keep a few small rooms in thor 
tenement houses, and go to San Francisco when sick or out of employment. Doctor 
Payne states there have been no suspicious cases of sickness at any time, and that he 
would know. Dr. F. C. McCleave confirms these statements. He was for two veui 
in the army in Cuba and the Philippines and saw some cases of plap^e in the latter ' 

Flace. He is in practice, the son of an army officer, and his observations are reliabla 
n company with Doctor McCleave I inspected the few Chinese buildings- The 
premises are in fair condition; there are a number of cats and few rate; no dead onei 
have been noticed. I inspected all the rooms, which contained little f umitnre tDd 
the usual wooden bunk for sleeping purposes. We found two Chinamen in differeot 
places, stowed away aloft, sneering with colds or other slight indisposition, butt 
careful examination of these people revealed nothing suspicious. 

ALAMEDA. 

The population of Alameda is given at 16,464; number of Chinese 255, and Japaneee 
110. Dr. L. W. Stidham has been health officer for a number of years and 1UKie^ 
stands his business. Our call upon him was unexpected, and he was a little reticent 
until'assured of our honest inqmry. He feels perfectly sure that if a suspidoos cmb 
existed at any time they would know it. I asiced if a mild case of plague would be 
recognized by the ordinary practitioner. He stated that the profession in Alameda 
readily consult with each other and that there would be no hesitation in pronoDndng 
the true cause of the disease. Over two years ago he received a telegraphic dispatch, 
without any explanation or reason, from Doctor Kinyoun to quarantine, which, after 
some correspondence with him, he did. He placed guards and inspectors upon the 
roads and water lines. No suspicious case was found at any time. Dr. E. M. Kejs, 
an intelligent practitioner, confirmed these statements, and said that he accepted the 
diagnosis at that time, and even visited San Francisco to see a case of plague, but for 
some reason was not allowed to when he arrived there. The Chinese in both of these 
towns seem to be under fair obser\'ation, and from my personal observation a critical 
inspection of all of them could be made in a few hours. Communication with 8tD 
Francisco is quick and easy, so that they naturally go there for medical aaeistanoe 
from their own kind. The issue of death certificates and restrictions upon the tnuu* 
portation of dead bodies and watching of the companies' agents render it improbii>le 
that smuggling of corpses is done. These towns are clean, houses detached, and 
yards tidy. For these reasons it does not seem probable that a focus of infectioa 
could }ye established in either of these towns without its being readily known and 
quicklv eradicated. 

ilespectfuUy, A. H. Glennak, 

Surgeon^ Irutpieetor, 

The Subgeon-Gknkral Public Health and Marine-Hospftal Service. 



INSPECTION OF SAN JOSE. 

[Letter.] 

San Francisco, Cal., November SO, 190t, 

Sir: Accompanied by Dr. M. Grardner, I proceeded on the morning of Wednesday, 
November 26, to San Jose, situated 51 miles by rail, south by east, from San Frwi- 
cisco. Its population, according to the last census, was 21,500, but they claim 4,000 
more at the present time. The number of Chinese, by the same census, is given at 
553 and Japanese 44. The Chinese Six Companies give their number at San Jose as 
1,200, whicn, however, includes all employed upon the ranches in the sorroonding 
district. 

In figuring upon their numbers given by these Chinese societies I find that they 
daim a total of 35,800 in the State of California. The United States censos of 1900 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 225 

Fives the number of 24,435 enumerated in cities and towns having a population of over 
2,500. This leaves 11,365 for the ranches and smaller places, which seems to be alx)ut 
sorrect. The number of Chinese has diminished considerably in the past few years, 
3fn mcoount of the exclusion act and returns to China. Those of the worthless class, 
i)om in this country (cutthroats and gamblers), live in Chinatown in ** the City," as 
3An Francisco is generally called. 

The board of health of San Jose consists of Dr. F. C. Gerlash, president; Dr. M. D. 
McDoagaU, secretary and health oflScer; Dr. J. J. Miller, who was formerly health 
sfficer; Dr. William Simpson, county health oflScer, and Dr. H. C. Brown. Mr. 
Corcoran, aasistaut secretary, keeps the records at the city hall. The board is not 
ftrongly impreesed with the importance of its sanitary duties, convening at rare 
internals. 

There have been 67 cases of smallpox here in the past month, with the prospect 
i£ many more, on account of imperfect isolation and aisinfection. Last year a large 
tmniberof vaccinations were maue with vaccine virus from Parke, Davis & Co., which 
iras practically a failure and gave a false sense of security to many people. The few 
who did recognize the superiority of Alexander's product have obtained better 
reeolts. 

There are about 19 Chinese deaths recorded at the city hall during the past eight- 
een months, besides a few accidental deaths and suicides by hanging, as follows: 

November 25, 1901: Ah Toy, 65, male; consumption, certified by M. D. Kell, 
coroner. 

November 12, 1901: Bang Sins, 44; suicide, hanging. 

March 7, 1901: Bing Long; tuberculosis; coroner's case. 

February 3, 1901: Ching Ding; pneumonic phthisis; C. B. Habletzel, M. D. 

January 25, 1901: Hoy Lee; tatty degeneration (?); F. C. Gerlash, president board 
of health. 

May 27, 1901: Jak Lai; asthma and gangrene of leg; coroner's case. 

December 27, 1901: Jan Jew Yee, 64; pneumonia and old age; Doctor Habletzel. 

February 11, 1901: Key Way, 49; tuberculosis; coroner's case. 

September 5, 1901: Onehundi Kahi, Japanese, 29; pericarditis; Dr. J. D. Gussin. 

Jxny 3, 1902: On Foo, 54; pulmonary disease (?); J. F. Wallace, acting coroner. 

April 19, 1901 : See Yet Lai, female; phthsis pulmonalis; Elizabeth Gallimore, M. D. 

October 1, 1901: Way Ginn, male, 54; consumption; coroner's case. 

November 14, 1901: Way Wing, 48, male; dropsy; coroner's case. 

September 11, 1901: Ohm Lee, 64, male; consumption; coroner's case. 

January 7, 1902: Chew Ling, 46, male; consumption; coroner's case. 

February 22, 1901: Yenn Chin Wong, 79, male; old age; endocarditis; Doctor 
Habletzel. 

April 28, 1901: YongSing, female, 2 vears; dysentery; Doctor Habletzel. 

Jane 7, 1901: Yike Wong Ting, female, 1 vear; abscess throat; coroner. 

August 4, 1901: Yunc Yee, 70, male; paralysis; Doctor Caldwell. 

In some certificates the duration of sickness is given, but the coroner is not a phy- 
rician, and certifies to the cause of death in most cases without other professional 
examination. We called the attention of the health officer to this fact, and he has 
instituted an immediate reform in this matter. Thus far in our investi^tions this 
town shows the greater degree of disregard to the requirements of niimicipal health 
laws, while there is the usual absence of harmony l)etween county and city officials. 

San Jose is a winter resort for Eastern people; has about 18 drug stores; between 
70 and 80 physicians in the city, and over 100, including all, in and near the town, 
but all do not devote their whole time to the profession, the bulk of the work being 
in the hands of some twenty men. There is not a competent bacteriologist in this 
district. The place will bear watching. 

November 29 I returned alone to San Jose and, accompanied by Doctor McDou- 
gall, the health officer, visited the Chinese quarters, situated upon the outskirts of 
the city. It is located upon private property, owned by one person, consists of several 
fenc€Ki-in blocks, and the houses all above the surface of tne ground. The health 
officer is not very familiar with the place. From a white mechanic who spends con- 
siderable time at work there I gainea what appeared to be some reliable information. 
The Chinese are superstitious about having a death occur in their houses; for this 
reason, when possible, they place their sick in an outhouse. We found such an old, 
one-etory, fiame building near by, detached from other inhabited houses. There 
was one old man in the room sick from chronic tubercular disease. 

The Chinese in San Jose have purchased a piece of ground in connection with the 
city cemetery for a burial place and, after some time^ are given permits to disinter 
the bones for shipment to China. I made particular mquiry into this matter because 
it has been stated that a considerable quantity have been shipped from this point, 

H. Doc. 338 15 



226 PUBLIC HEALTH AND MARINE-HOSPITAL 8EKVICB. 

and one lot had been held up by the. San Francisco board of health. There does not 
appear to be anything irregular, from the information obtained at the city hall and 
tne health ofl5cer. 

A conversation with Dr. J. J. Miller, a member of the board, did not develop any 
further information. He stated that they have had no suspicious case of pla^e, nor 
suspicious circumstance to attract their attention. With their loose system it is not 
probable that they would be aware of a case among the Chinese, if it existed. 

It will be noticed that the recorded deaths which occurred in 1901 greatly exceed 
the number in the present year, and I am trying to obtain a satisfactory explanatioD 
of this fact for further report. 

Resi)ectfully, A. H. Glknnak, 

Surgeouy Intpedor. 

To THB Suroeon-Gbneral, Public Health and Marine-Hospital Ssrvicb. 



INFECTED RATS IN SAN FRANCISCO. 

The cooperative assistance rendered the city health authorities of 
San Francisco was continued at the laboratory, 641 Merchant street, 
where necropsies and bacteriological investigations were made by 
Service officers upon all dead suspected with plague, upon information 
furnished by the city authorities. 

At the same time examinations of rats were made for pest infection, 
as set forth in the following telegrams from Asst. Surg. M. J. White: 

San Francisco, Cal., November 28, 1902: Five dead rats found in streets to^y, 
plague provisionally. 

ifeceinber 1 : Three dead rats yesterday, plague. 

Decembers: Pest-infected rat trappea in sewer comer Dupont and Washington 
streets to-day. Fish-alley rat found November 24, is pest. 

December 4: From November 24 to December 4, 16 pest rats have been found iu 
Chinatown and immediate vicinity. 

December 4: Local board of health exterminating Chinatown rate, but in view of 
the recent finding of pe8t-infecte<i ones have decided to request funds from supervis- 
ors for extension of work throughout the city. I consider it very important that 
coastwise and other vessels docking here ^uard against infected rata, and I especially 
commend this matter for your consideration. 

The systematic eflfort to destroy rats seemed to eliminate the infection 
among those rodents in thi« limited area, and although the bacterological 
exammation was continued, and some rodents from other sections of 
the city and along the wharves were examined, no further infection 
was found 

ADDITIONAL INSPECTORS IN SAN FRANCI800. 

While the inspections of places outside of San Francisco were in 
progress it was suggested tliat an additional inspection force, to be 
paia by the State, but under the direction of this Service, might be of 
advantage in the infected district in San Francisco, this suggestion 
coming from Dr. M. Gardner, representative of the State. 

The follovring correspondence will furnish the information upon the 
progress made in this direction : 

[Telegrams.] 

San Franciboo, Gal., 

November SO, 190f. 
Surgeon-General Wyman, Washington: 

Have inaileii report Saa Jose. Sixtv-seven smallpox, November. Will start as 
soon as possible for ^arramento, Da vis vi lie, and Stockton. I want blanket au^ority 
immediately to use White or Currie at any point in the State, where I may need them 



PUBLIC HSALTH AND MABINE-HOSPITAL SERVICE. 227 

a short time, on telegraphic orders from me. Will arrange if can puesibly do so 
Oalifomia appoint 3 or 4 sanitary inspectors detectives cooperate in San Francisco 
and Chinatown onder State regulations; also urge governor to designate bacteriologiste 
from two universities of California to cooperate with the Service. 

Glennan. 



Washington, December i, 190S. 
Glkitnan, San FraneiscOf Cal.: 

Yom* SDggeeted arrangement to liave California appoint three or four sanitary 
inspectors aetectives to cooperate in San Francisco ana Chinatown under the State 
regulations deemed very wise. Wire me as soon as this is done, that I may notify 
M. J. White that his operations must be subjected to your own. Your telegram not 
clear concerning bacteriologists, two universities Califomia. Do you wish me to 
urge, or will you urge, governor? 

Wyman. 



Washington, December i, 1902, 
Surgeon Glknnan, San Francisco, Cal.: 

Your letters of November 25 and 29 and your telegram of November 30 all received, 
and indicate very satisfactory progress. Have wir^ White to respond immediately 
to demands for his services or Cume'& 

Wyman. 



San Francisco, Cal., December i, 190!^. 

Suigeon-General Wyman, Washington: 

Have had a consultation with the governor to-day. Agrees in the matter tele- 
graphed yesterday. Will appoint 4 detectives sanitaoy inspectors, and can arrange 
the other proposition suggested by me. 

Glennan. 



San Francisco, Cal., December 6, 1902. 
Soi^geon-General Wyman, Washington: 

Returned from investigation Sacramento, Davisville, and Stockton. Will mail 
report Friday night. Accompanied governor to large formal meeting of Six Com- 
panies. He told them 4 sanitary insf^ctors would make careful inspection of China- 
town, San Francisco, under our direction; would treat them fairly; mutual benefit; 
wished to see all cases sickness; requested their aid and support; they pledged it. 
William Chickering, their attorney, was present, unexpectedly to the governor and 
me. He spoke favorably and earnestly. Request strong instructions be sent M. J. 
White to cooperate and aid in every way. Must have support from every quarter or 
work is useless. Mayor assures me he will render any assistance. * * * 

Glennan. 

While this inspection of the Chinese district in San Francisco was 
under consideration the inspections of outside placets were continued. 

The following are inspection reports of sanitary investigations of 
Sacramento, Davisville, btockton, and, later, Fresno and Bakersfield. 

INSPECTION OF SACRAMENTO, DAVISVILLE, AND STOCKTON. 

San Francisco, Cal., December 8, 1902. 

8ra: On Wednesday morning, December 3, accompanied by Doctor Gardner, I com- 
menced a saniUuy investigation of Sacramento, three hours by rail from San Fran- 
cisco, with which the Chinese have free communication. 

SACRAMENTO. 

The last census gives the population as 29,282, Chinese 1,065, Japanese 336. The 
Chinese themselves estimate their number at 2,600 including the surrounding district. 

(^e of the editors of the Occidental Medical Times, Mr. James H. Parkinson, resi- 
dent of Sacramento, toother with a daily, the Sacramento Bee, has taken an active 
ixktmet in the plagne situation, more upon the ground to eBta\)\Ae\i «Ji^ ^TQ(^ai\si\}ci^ 



228 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

diagnosis of the disease, as against the party arrayed for its concealment (mingled 
with political issues and State pride), than from fear of an epidemic of the diseiise. 
All this contention and strife has caused the State capital to be particularly watcMil 
and guarded against the introduction of plague from San Francisco. Sacramento is 
the home of several of the belligerents upon both sides, yet no case of the dread dis- 
ease has been detected or the suspicion affirmed or denied bv either party. It has 
been said to me by several high State officials, confidentially, that for'anvone to 
denv that plague exists in San Francisco was foolishness, but that the oftensive 
methods adopted in the beginning of the trouble to proclaim the diagnosis and force 
harsh, roughshod restrictive measures had roused the State against it, and when 
once so committed there was no possibility of publicly receding from that podtioiL 
They would gladly aid and assist in the eradication of the disease without stultifyii^ 
themselves, while the opposing party would rather compel the public acknowledf- 
ment of the diagnosis, even to the development of a widespread epidemic, to estab- 
lish their side of the question. I mention this condition of affairs, which I have 
gather^ from undoubted and reliable sources in both parties, to show how party 
feeling has perverted their judgment from the welfare of tne Commonwealth. 

Dr. H. L. Nichols is the secretary and health officer of the city board of health. 
I made the usual examination of the mortuary statistics in his office. Mr. Geom 
McMullen, the coroner, is not a physician, though Doctor Nichols claims he sees ul [ 
coroner's cases. The Chinese distnct covers about six half city blocks, kept in &ir I 
condition. This portion of the city was formerly a marsh, built upon, then filled in 
to the height of 6 feet, making a cellar space which the Chinese occupy as well aa 
the upper floors of the houses. Accompanied by Greorge W. Herr, the sanitary 
inspector, we went through many of these places, and they seemed to be under good 
supervision. 

In conversing with Doctor Ross, a local physician, I gained no idea of suspicion of 
the place, nor did Doctor Hatch, a member of the State lunacy commission, give any 
hint of plague suspected. This district here is a familiar locality to Doctor Ganlner, 
who first practiced medicine in Davisville for several years, then removed to Sacra- 
mento, where he commanded a large and lucrative practice at the time of accepting 
the position he now fills as sui^eon of the Southern Pacific Railroad. He was a 
member of the board of health of Sacramento some years, establishing; its efficiency. 
Whenever he xiaita the city former patients seek his professional advice, which goes 
to show the man's influence and known ability. Doctor Gardner was also a clasB- 
mate of Surgeon Carmichael, of our Service, and Doctor Osier, of Baltimore, in a 
Canadian school of medicine. 

The officials here claim that they record all Chinese deaths, and I am fairly con- 
vinced that this is so; also that they make a superficial inspection of the dead; yet 
there is the chance that the diagnosis of death from plague might be overlooked. 
Against this is the fact that there has been no group of cases nor special circumstance 
to attract attention, while the death certificate show duration of sickness, attend- 
ance, etc. The following Chinese dead are recorded for the year 1902: 

January 2: Yet Choy, 65, male; bronchitis; coroner, George C. McMullen. 

January 8: Look Hong, 56, male; la grippe. Dr. H. W. Strader. 

January 12: Wohg Sing, 42, male; sarcoma. Dr. George M. White. 

February 17: Ah Lack, 26, male; cancer, coroner. 

February 17: Ah Ying, 50, male; consumption, coroner. 

February 25: Jjook Quong Dong, 55, male; consumption. Dr. Strader. 

February 25: Fong Low, 65, male; valvular disease heart, Dr. F. B. Sutliff. 

February 27: Ah Goah, 44, male; cystitis, coroner. 

March 11: Yen Fook, 71, male; marasmus. Doctor Nichols. 

April 6: Ah Kim, 50, male; consumption, coroner. 

April 14: Long Sing, 60, male; consumption, coroner. 

June 17: Wong Wee, 34, male; consumption, coroner. 

July 4: Ton Tun^, 50 male; gunshot wound, coroner. 

July 9: Mock Wing, 41, male; consumption, coroner. 

August 4: Whing Wing, 41, male; consumption, coroner. 

August 14: Lee Chee, 33, male; drowning, accidental. 

August 22: Dan Ding, 59, male; traumatic bronchitis, Dr. H. H. Look. 

August 31: Jan Tong, 62, male; typhoid fever, Dr. G. W. Ogden. 

September 1: Lee Sing, 52, male; heart disease, sick one month, coroner. 

September 6: I^ee Wing Dong, 56, male; phthisis pulmonalis. Dr. J. C. Simmons. 

October 2: Fon Sue, 50, male; typhoid fever, coroner. 

October 15: Wong Yung Ching, 63, male; accident, coroner. 

Octoljer 24: Lee King, &, male; consumption, coroner. 

November 20: Gee Fong, 57, male; tubercle lung. Dr. F. B. Terrill. 

November 26: Chin Moy, 52, male; '* natural causes," coroner. 



PUBLIC HEALTH AND MABINE-H08PITAL SEBVIOE. 229 

DAVISVILLE. 

Fourteen miles from Sacramento is the villaf^ of Davisville, at a railroad jonction, 
the station being called Davis on the railroad time 8(:hedule. The population is a 
little over 600, including about 30 Chinese. These few Chinamen collect m one frame 
building, doing duty also as laundry and agency for hiring the Chinese to the out- 
lyini^ ranches, reenforcing their numbers from San Francisco when the demand 
ret^oires it. I inspected this building throughout, and found it in fair sanitary con- 
dition and the occupants healthjr. Dr. Walter E. Bates, the only physician, pro- 
prietor of the drug store, and president of the county board of health, was an assist- 
ant professor of one of San Francisco's colleges, but resigned on climatic reasons. 
He knows all the Chinese living in and about Davisville. When Doctor Bates re^ 
the report in a Sacramento paper regarding the Chin Suey Kim ca«t», who died in San 
Francisco of plague, he immediately made inquiries, but could get no trace of him. 
It is possible that the man went out by the way of Winters and returned sick soon 
after oy wav of Davis station. I inclose the written statement of Doctor Bates, which 
also eives the names of their board of health. I developed the fact that in all these 
emalT places having a Chinese laundry they also are agents, and secure batches of 
laborers for the ranches; know where good pay is, and where it is slow; return to San 
Francisco when sick or out of employment Chin Suey Kim went out in one of these 
labor ganps. 

There nave been no deaths of Chinese in Davisville or upon the neighboring 
fanches, and it is fair to conclude that there is no focus of infection in this region. 
These are the reasons why the territory outside of the Chinatown in San Francisco 
has not developed the disease, due to the habits of these Mongolians. This may not 
apply to the more distant points, which will be shown as the investigation progresses. 

STOCKTON. 

We arrived at Stockton Thursday morning, December 4, and met there Doctor 
Roggles, resident member of the State board of health, a fine, truthful, old gentle- 
man. In private conversation he said that he regretted very much the course pur- 
sued by some members of the State board; that plague undoubtedly existed in San 
Francisco; that he was satisfied as to the diagnosis, from the character of the men 
who made it, but had been personally powerless to influence a different course from 
that which they had adopted. The Chinese quarter here is a small one, and the 
cleanest I have seen. It is inspected regularly, and they claim not to have seen a 
sospicious case. A little over two years ago there was an epidemic of pneumonia in 
Bakersfield. Three cases in white persons came from there at about the same time, 
and died in Stockton, which excited their suspicions, but nothing came of it; no 
further developments. They understood afterwards that Doctor Ophuls, bacteriologist 
at the Cooper Medical College, went to Bakersfield to make scientific investigation, 
and pronounced it pneumonic plague (or pernicious pneumonia). I will trace this 
accidental information further. 

Dr. H. E. South worth, recently elected coroner, was county physician for the past 
year; studied in San Francisco; took a course in l>acteriology, and saw cases of plague 
while there. He has his eyes open, and will prolmbly show the older men a case of 
plague if it develops in Stockton. The census gives the population of this citv as 
17,506; Chinese 593 and Japanese 39. The Chinese themselves figure 1,000 of their 
number in the district. 

Our next investigation will probably be made in Fresno and Bakersfield. Bouldin 
Island has only direct communication by freight steamer at irregular intervals. Gov- 
ernor Ga^ has requested me to go to Los Angeles also. When I expressed a doubt 
as to its immedia^ necessity, he replied that it was his home and that he did not 
want the criticism made that he did not have his own neighborhood investigated. 

While the inspections now being made of places outside of San Francisco may not 
conclusively prove the existence or nonexistence of plague in those places, either 
now or in the past, nevertheless the personal contact of the Service with the physi- 
cians in active practice throughout the State will be valuable in the future. The 
majority of the profession are truthful and honest in their opinions, and this includes 
the local health officials. Their Chinese quarters in most instances are connected 
with the city sewers and water supply; they have flush closets, and even electric 
lights in the streets; their sanitary inspectors keep up a certain amount of supervi- 
sion, all of which nyes a hopeful outlook. 

On the 20th of December, Mr. Daniel Kevane, secretary of the State board of 
examiners, vacates that office. He has been the leading official in the opposition 
and disbursing officer of the State health funds. 



230 PUBLIC HEALTH AND MAEINE-HOSPITAL 8EBVI0E. 

Doctor WilliaraBon, president of the San Francisco board of health, vacates Jan- 
uary 1. If sufficient pressure can be brought for the reorganization of the State 
board of health, the present condition of amiirs will be greatly improved. 
Respectfully, 

A. H. Glennan, Surgeon, 

The Surobon-Genebal, Pubuc Health and Marine-Hospital Service 



[Inclosore.] 

Signed skUement of Dr, W, E. Bates, of DavisvilUf Go/., in regard to reported cage of plague 

from that place. 

Chinaman, named Suey Kim. was said to be at work on a ranch near Wint^s, 
reported in Sacramento paper that a case had died in San Frandsoo from the plagae, 
Dr. Bates reported to health officer at Woodland (Dr. H. D. Lawhead) and tnen to 
Dr. R. Cadwsdlader, at Winters, and tried to get trace of said case. No such man to 
be heard of. 

W. E. Bates, President, 

H. D. Lawhead, Secretary and Health Officer, 

R. Cadwalladeb, Winters, Vol., 

T. Dixon, Grafton, Oal, 

County Board of Health. 



INSPECTION OF FRESNO AND BAKERSFIELD. 

San Franciboo, Cal., 

December i^, 190S. 

Sir: The following report of a sanitary investi^tion of Fresno, GaL, made Decem- 
ber 10, 1902, in company with Dr. M. Gardner, is respectfolly submitted: 

The last census gives Fresno a population of 12,470; Chinese, 1,104 and Japanese 
175. The Chinese Six Companies claim 3,000 in this county, but the number of 
Japanese are said to be increasing and replacing the Chinese. The city has paved 
streets, electric lights, trolley cars, water supply, and some sewerage. The streets 
are wide and clean, but the back premises show scavenger neglect 

Dr. G. H. Aiken is president of the city board of heaUh; Dre. T. M. Hayden, J. L 
Maupin, G. A. Hare, and J. D. Davidson, members; Dr. P. N. Russell is secretary 
and health officer since July, 1901, Doctor Hayden having occupied the office before 
that time. Mr. L. O. Stephens, the mayor, is also the principal undertaker, and appoints 
the members of the board of health. Dr. G. L. Long (homeopath) is the present 
coroner, but Dr. A. B. Cowan has been elected to that office to date from January 1, 
1903. 

The Chinese own their cemetery, situated about 1 mile north of the city. In the 
spring of 1901, thev were given a permit to ship a lot of bones to China as is their 
custom, but only the bones of those buried for several years were exhumed. The 
Chinese quarter is situated to one side of the city, west of the railroad, has sewer 
system, electric lights, and water supply. Dr. Law Keem, a very intelligent China- 
man, lives in this section, has a good practice, and has been a resident of this conn- 
try for twenty years. He attended the Adventist Collie at Healdsburg, Oal., being 
a member of that faith, afterwards graduating at the California Medi^ College in 
1900. Doctor Keem inspected Chinatown wiui us, and thinks that he would know 
plague clinically if he saw it. Our call upon him was entirely unexpected, and he 
seemed very frank and truthful in his statements. He has lost a number of cases of 
pneumonia, one a Japanese aged 35 years, who lived at Sanger, came to his sanitarium, 
and died November 12, after an illness of thirteen days. The Japanese seem to be 
of more frail constitution and subject to pneumonia and typhoid fever. 

Doctor Aiken, president of the city board of health, is of middle life and consider- 
able practice. He has not heard of any sickness suspicious of plague. The Chinese 
here, as well as in other places, are usually seen by the Amencan physicians only 
after death, when they are called and paid a fee for the certificate of death. The 
examination is of a perfunctoiy character and '* natural causes" often given in the 
certificate, which is legal, but should not be accepted by the health officer. Section 
11, Health Regulations, ordinance No. 397, city of Fresno, certificftteB of death. 



PUBUO HEALTH AND MARIITE-HOSPITAL SEBVICE. 231 

ondertrnkeTB, etc, readaas foUows: "If a person die or is foonii deail, not having had 
a medical attendant, it shall be the duty of the first physician who sliall see the 
remains to famish such certificate of death', if he be satisfied' that the said penk>n died 
from natural causes; otherwise he shall notify the coroner, who shall take charve of 
the body." I inclose copies of their certificate of death and ** burial permit/* wnich 
would seem sufficiently comprehensive if intelligently filled out. 

In a private conveisation with Doctor Russell, the present health officer, he thought 
that a year or two ago he saw one or two Chinese deail with buboes, but was not 
particularly attracted by the fact No investi^tion was made, and it seems possible 
that during the inspection and disinfection m 8an Francisco some sick may have 
Gome to Fresno, diea, and were buried without establishing the infection. In nearly 
all the Chinese quarters they place their sick and dying in an outbuilding for supef- 
stitiouB reasons, which, with prompt burials, has been a sanitar\' benefit and possibly 
prevented the spread of the oisease. 

During the month of December, 1901, out of a total of 35 deaths 14 were Chinese 
and Japanese, as follows: 

December 6: Kataoke, Japanese, 25, male; typhoid fever, certified by Dr. B. 
Okonaji, Japanese. 

December 6: Len Loy, 56, male; pneumonia. Doctor Hopkins. 

December 6: Ah See, 42, male; pneumonia, Doctor Adau. 

December 12: Ivasode, 26, male; Japanese, suicide, Doctor Long. 

December 12: hesL Kee Day, 65, male; trautmatie gangrene, Dr. Law Keem. 

December 15: 8ing Chung, 47, male; consumption, Doctor Adau. 

December 17: Linn Bock, 61, male; dropsy, Doctor Adau. 

December 19: Lee Kow, 43, male; pneumonia. Doctor Long. 

December 21: Wang Wah Noe, 59, male; impaction of bowels, Doctor Thorn. 

December 23: Hoe Wah, 73, male; old age. Doctor Cowan. 

December 23: Chong Kung, 54, male; tubercle. Doctor Cowan. 

December 24: Lon Yen, 52, male; natural causes, Doctor Cowan. 

December 28: Ginn Fon, 46, male; natural causes, Doctor Cowan. 

December 30: Low Yon, 45, male; congestion of limgs, Doctor Aiken. 

BAK£B8FIELD. 

One of the railroad stations is situated at Kern City, 1 mile from Bakersfield. 
connected by trolley cars. Doctor Kellogg, the health officer at Kern City, stated 
that there was no special sickness among the Chinese or elsewhere, nor had he seen 
a siKipicion of pla^e. Two years ago there was a fatal type of pneumonia in this 
section which excited their suspicions, but bacteriological examination showed only 
an infectious pneumonia. 

The census of 1900 gives the population of Bakersfield as 4,336, Chinese 428, and 
Japanese 20. The present population, however, is nearer 7,000, on account of the 
rush to the oil fields two years ago, and during that winter the weather was unusu- 
ally foepy, accommodations scarce, men slept upon the sidewalks, Immxjin floors — 
everywhere. It is a "wide-open" town with a tough name, but is becoming more 
orderly and settled. The streets are paved, electric lighted, trolley crars, water supply, 
and some sewerage is in evidence. 

Conversations with Doctor Carson and Doctor »Schaeffer did not develop any sus- 
picion of i>lague. The large mortality from pneumonia two years ago excitetl their 
apprehension, but bacteriological examination excluded plague. Two experts came 
to the city about it, one a Federal officer, but they did not remember nis name. 
Afterwards I learned that it was Dr. Hill Hastings of this Service. 

A wave of epidemic pneumonia appears to have covered this sec^tion of country 
and the adjoimng Stat^. The sickness was of short duration and fatal ty])e. Do(*.tor 
Schaeffer informed me that he was in dispairas to any form of treatment, and finally 
tried to avoid attending further cases. During the month of January, 1901, there 
were 48 deaths from pneumonia in Ix)s Angeles, where the disease prevailed consid- 
erably the same winter. Franz Buckteus, the coroner of Bakersfield, is an old 
ex-army steward, a trained, methodical man. He informed me that Chinese who 
sickened upon the neighboring ranches were taken to the county hospital, and that 
he had not seen any with bub<^ or suspicion of plague. 

The city marshal, who has held the office for eight years, accompanied us upon 
the inspection of the Chinese quarter. He is a keen, alert man, and nolds full sway 
over the C^nese and turbulent element of the town by force of character backed 
up with his gun. The Chinese houses, few in numlier, are in an open section, 
nearly all above ground, and easy of inspection and quarantine, if necessary. 



232 PUBLIC HEALTH AND MABINE-H08PITAL SERVICE. 

They have an intelligent Chinese physician who keeps a drug store, and has lived 
here twenty-six years, making occasional trips to his native country. He daims to 
have seen plague there, but none like it here. 

I inclose listo of Chinese deaths in Fresno and Bakersfield for the year 1902. 

SUMMABY. 

The sanitary reports made to you of the investigations made of places outside of 
San Francisco tairly establish the fact that no groups of plague cases seem to haye 
existed; there is the possibility, however, that single cases of the disease may have 
left San Francisco, died and were buried from these more open and sanitary Cftiinese 
quarters without recognition, no infection seeming to follow. 

A perfect investigation would require that a bacteriologist quietly remain in these 
places for some time, and keep in touch with the health officer and coroner. Such 
a man at Fresno could cover Bakersfield at the same time. These two places, 
together with San Jose, would be the most likely trend of the disease to tiM 
southward. 

Respectfully, A. H. Glennak, 

Surgeon, 

The Subqbon-General Public Health and MABiNs-HosprrAL Service. 



[Indosure.] 

List of Chinese and Japanese deaths recorded at the health office, Fresno, CaL^ durmg the 

year 190£. 

February 5, 1902: Ah Toy, 59, male; natural causes, certified to by Dr. A. B. Cowan. 

February 15, 1902: San Yen, male, 75; natural causes, certified to by Dr. G. L 
Long, coroner. 

February 16, 1902: See Kow, 62, male; impaction bowels. Dr. J. D. 

March 10, 1902: Jeu Duck, 60, male; natural causes. Dr. J. J. Spattswood. 

March 16, 1902: Lew Ching Hoy, 64, male; tubercular peritonitis. Dr. Law Keem. 

April 14, 1902: Chew Duck Yan, 42, male; natural causes. Doctor Spattswood. 

April 25, 1902: Ah Wing, 10 months; cap. bronchitis, Doctor Spattswood. 

June 28, 1902: Ny Fe Kowen, 64, male; natural causes. Doctor Spattswood. 

July 3, 1902: Yung Tun, 55, male; natural causes. Doctor Spattswood. 

July 6, 1902: Lung Wing Hoy, 64, male; natural causes, Dcictor Long, coroner. 

July 19, 1902: Chung Hoo, lobar pneumonia, 4 months old. Doctor Russell. 

August 11, 1902: Yong Ying, 57, male; natural causes, Dr. T. M. Sample. 

August 18, 1902: Lung Lei, 54, male; apoplexy. Doctor Long, coroner. 

September 3, 1902: Wong Eh Hing, 50, male; pneumonia. Dr. C. H. Adair, eclectic 

September 29, 1902: Chen Ping Yet, 42, male; strangulated hernia, Doctor Long, 
coroner. 

October 23, 1902: Ah Tong; natural causes. Dr. W. M. Thorn. 

October 10, 1902: Y. Lenga, Japanese; tyi>hoid fever. Dr. B. Okonaee, Japanese. 

October 14, 1902: F. Doi, Japanese; malarial fever. Doctor Masuki, Japanese. 

October 15, 1902: One June Yami; typhoid fever, Doctor Masuki, Japanese. 

October 16, 1902: F. Wahayama, 34, male: typhoid fever. Doctor Okonage. 

October 16, 1902: F. Wah; typhoid fever. Doctor Okonage. 

November 12, 1902: Kitaio Ishyama, Japanese, 35; pneumonia. Dr. Law Keem. 

November 16, 1902: Chim Yung, 54, male; natural causes. Doctor Thorn. 

November 27, 1902: Jue Ha};, 60, male; old age, Doctor Adair. 

December 8, 1902: Shiohashi Ti^ora, Japanese, 40; malarial fever and diarrhea, 
Doctor Keem. 



[Xnclosoie.] 

List of Chinese deaths recorded at the health office, Bakersfield, Cal., for the year 190i. 

January 5: Ah How, 50, male; Bright' s disease. Dr. J. L. Carson. 
January 8: Ah Tock Chew, 52, male; consumption, coroner. 
March 9: Fung Hee, 55, male; pneumonia, Franz Buckreus, coroner. 
May 31: Fat Sun Tune, 52, male; heart disease. Doctor Carson. 
March 28: Git Chin Yen, 59, male; gunshot wound, coroner. 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 233 

March 9: Hie Fang, 55, male; pneumonia, coroner. 

Febroary 19: Kubo (Japanese), 26, male; typhoid pneumonia, Doctor Schaeffer. 

August 11: Frank McKenzie, 34; natural causes, coroner. 

July 19: Gee Noon, 59, male; heart disease, coroner's jury. 

September 9: Ying Chung, 53, male; natural causes, no certificate. 

November 6: Fook Tong, 50, male; consumption. Dr. A. F. Schaeffer. 

October 11: Shin Bow, 62, male; consumption, coroner. 



VISIT OF THE 8UHGEON-GENEBAL TO SAN FRANCISCO. 

In December Surgeon-General Wyman visited the State and arrived 
in San Francisco on Wednesday, December 17, and Governor Gage 
bein^ in the city, called first upon him as the chief officer of the State 
board of health. The same afternoon he called upon Doctor William- 
son, the president of the city board of health, at his office, and met 
there, by his call. Doctor O'ferien, the city health officer, and Doctor 
Buckley, a member of the city board. 

The same afternoon, accompanied by Doctor Glennan and Doctor 
Currie, inspected the laboratory of the Service, and at night paid a visit 
to Chinatown with a representative of Governor Gage, the governor 
having offered this coui'tesy, which was accepted. 

The following morning, December 18, with Doctor Tabor, State 
health officer oi Texas, ana Doctor Glennan he again visited the labo- 
ratory of the Service, and after another inspection thereof went with 
Doctor Currie, who had been making the bacteriological examinations, 
and Mr. Wong, the Chinese interpreter of the Service, and made a 
still closer inspection of Chinatown, visiting the worst places. 

On Friday afternoon the Surgeon-General, accompanied by Doctor 
Glennan and Mr. Chickering, attorney for the Chinese Six Com- 
panies, visited the governor-elect, Doctor Pardee, in Oakland, and in 
the afternoon called upon Mayor Schmitz at his office, but was unable 
to see him, and made an appointment for the following morning; had 
an interview with Mayor ochmitz on Saturday morning, and m the 
afternoon called upon Doctor Williamson, president of the city board of 
health, who sent tor members of the board, with whom the situation 
was discussed. 

The same afternoon visited the Chinese Six Companies; had an inter- 
view with them concerning the situation, and at night received calls 
from Doctor Williamson and members of the city board of health, and 
one or two other members of the profession. 

The Surgeon-General left San Francisco on Monday, December 22. 
His personal observation confirmed the fact that the efforts of the city 
health officials of San Francisco in the eradication of plague infection 
had been carried on under unusual difficulty and lack of support of the 
then existing: State health authorities. 

As a result of this visit a cordial understanding was reached and the 
way prepared for future cooperative action, after the inauguration of 
the new State officials in January of the following year. 

CORRESPONDENCE RELATIVE TO REPRESENTATION OF CALIFORNIA AT 

PROPOSED CONFERENCE IN WASHINGTON, ETC. 

The following correspondence relates to the inauguration of the new 
State officials of California and the selection of a State representative 



234 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

to the conference of State boards of health to be held at Washin^D, 
D. C, January 19, 1903: 

[Telegrams.] 

San Franciscx>, Cal., January 6, 190S. 
Surgeon-General Wyman, WaahingUm: 

Governor Gage's final message to legislature to-day reiterates his position. Attacks 
Kinyouu and press publishing false epidemic predictions. Holds out the hope that 
no unnecessary quarantine against the State will be imposed, but after wordy denial 
plague situation, finally recommends city and State take measures for removal China- 
town. 

Glknnak. 



San Franciscx), Cal., January 7, 190S. 
Surgeon-General Wyman, Washington: 

Gage's appointments past two years, including members State board health, failed, 
confirmation now pending Pardee's action possible reorganization State board. Pto- 
dee's inaugural address avoids reference to health matters. Mayor names Stinson 
to succeed Williamson. Request quick confidential information if governor appoints 
suitable representative, whether member State board health or otherwise, would he 
be recognized at meeting the 19th? 

Glennan. 



Washington, January 8, 1903. 
Glennan, San Francisco^ Cal.: 

Law requires me to invite one representative of each State lx)ard making request. 
If State board, through governor or otherwise, makes request I hereby extend invita- 
tion, which you will please forward. 

Wyman. 



San Francisco, Cal., January 6j 1903. 
Surgeon-General Wyman, Washington: 

City supervisors appropriated $1,000 for further destruction of rata. 

Glennan. 



[Letter.] 

Occidental Hotel, 
San Francisco f Or/., Januarys, 1903. 

Dear Governor: As suggested bv Surgeon -General Wyman at our recent visit to 
you in Oakland, I inrloso a copy of his letter of instructions, delivered to me in 
Washington when 1 was ordered to proceed to this State. 

The act of Congress, approved July 1, 1902, provides: **That it shall be the duty 
of the surgeon-general to call a conference upon the applicxition of not less than five 
State or Territorial boards of health, quarantine authorities, or State health olficere, 
each of said States and Territories joining in such request to be represented by one 
delegate." 

Eleven or more of the States have made such a request — to consider the plague situ- 
ation in California — and the date of conference has been fixed for January 19, 1903. 
Not understanding that California has requested representation at this conference, 1 
wired an inquiry to the surgeon -general and rec^eived the inclosed reply to-day. 

This conference will l>e of vital importance to the State of California, and it seems 
to me personally that as the ofiicers of the present State board of health have taken 
such a radical stand against the welfare of their State their statements regarding 
health matters have lost value for presentation at this conference. 

Therefore, seeing that the time is short in which to consider this matter and take 
action, pardon me if I suggest that you wire Surgeon-General Wyman at Washington 
to the end that this State have suitable representation at this conference of the State 
health authorities. 

If you should so desire, I shall l)e glad at any time to come to Sacramento to 
see you. 

Respectfully, A. H. Glennan, 

Surgeon^ I^iblic Uealth and Marine- UospUal Service, 

His Excellency George C. Pardee, 

Stale Capital, SacraineixiOy C*il. 



PUBLIC HEALTH AND MAEINE-H08PITAL SERVICE. 235 

[Tel^rram.] 

San Francisco, Cal., Januarys^ 190S. 
in-General Wyman, WcahingUm: 

Hmve advised and have assurance that present secretary of the California board of 
liadth will not be represented at conference. Have an appointment with the gov- 
ernor at Sacramento to-nieht in regard to the matter. Will wire particulars. Hope 
xio member present State board will be selected. 

Glennan. 

In response to a telephone message January 9, 1903, from Governor 
!Piardee, Surgeon Glennan visited Sacramento the same evening, for 
conference with the governor. As a result of this, Dr. Matthew Gard- 
ner was selected to represent the State of California at the confer- 
ence of State boards of health to be held at Washington, D. C, 
January 19, 1903, and Doctor Gardner's name was sent to the legisla- 
tive assembly to fill a vacancy in the State board of health. 

[Letter.] 

Sacramento, Cal., January 9, 190S. 
Dr. A. H. Glennan, San Francisco, Cal. 

Dbab Doctor: Our interview of this date has, of course, rendered unnecessary any 
reply to yours of yesterday, except to thank you for your kindness and to assure you 
of my desire to continue the cordial relations you have kindly permitted me to 
otablish. 

I inclose herewith the telegram to you from General Wyman. 

Very truly, yours, Geo. C. Pardee. 



[Telegram.] 

Washington, January IS, 190S. 
Hon. Gboboe C. Pardee, Oovemor, 

SacramentOy Cal. 

Will be pleased to have State of California represented- January 19. 

Wyman. 

DATA FOR CONFERENCE. 

The following telegraphic request for information to be presented to 
the conference was sent to the oervice representative in San Francisco, 
and his reply appears in the report, of the conference. The memo- 
randum following gives full information on this point. 

[Tejegram.] 

Washington, January 17, 190S. 

Glknnan of Cctrrie, San Francisco, Cal.: 

Wire immediately how many cases occurred in Chinatown and how many in other 
parts of city or county, how many white cases and how many Chinese. All data to 
cover from March, 1900, to present time. Give also date of last case outside of China- 
town, stating whether it was traceable to Chinatown. 

WVMAN. 

The telegraphic answer appears in the report of the conference. 
Following IS a memorandum, giving the information in full: 

(Memorandum Prepared by Asst. Surg. D. M. Currie. ) 

Ninety-three cases of plague have occurred within the city of San Francisco between 
the dat^ of March 6, 1900, and December 11, 1902. Six of these were whites, 4 Jap- 
anese, and the remainder Chinese. Six have been pneumonic, of which 2 were 
purely pneumonic; the others probably secondarily pneumonic; that is, secondary 
to bubonic. Two have been purely tonsilar. Four have recovered; 89 proved fatal. 



236 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

In 8 cases the claim was made that they had cx)me from other parts of the State. 
All were taken sick in the Chinese quarter with the exception of 5 ( 1 Japanese and 
4 whites), the former almost certainly being infected in the Chinese quarter. One 
of these whites was a w^oman whose husband was a teamster for the Chinese, and she 
herself lived within a block of the Chinese quarter. Another, a trained nurse, wa 
infected from a Chinese patient. Another, a white sailor, who denied having been in 
Chinatown for a year and a half, and the last a white clerk, who was known to have 
cone on sprees, and therefore whose movements were doubtful, to say the least. The 
longest lapse that has occurred between cases is ninety-two days, during which time 
Chinatown was being cleansed by the State l)oard of health; the next longest seventy- 
two days, which ended February 22, 1902. There have been three lapees of fifty 
days. All the causes occurring in the Chinese quarter beginning March 6, 1900, up to 
date have been about equallv distributed throughout, although, taking a given 
month, they are fre(]uently found to have occurred in a comparatively localised 
area. So far as is known, there have not been over 5 cases that are even probahlj 
contacts, and as to one or two of these the connection is doubtful as to wnether it 
was contagion from one to the other or from a common source. It is probable that 
all the dead in Chinatown are seen. We have had some evidence from Chinese 
sources in several cases tliat sick have been removed in order to avoid autopsy. In 
these particular cases we have been unable to find out whether it was true. Ii cases 
were removed from the city, from what we have observed here, namely, that few or 
no contacts contract the disease, it is probable that no spread of the disease would take 
place. 

Except from the certificates of the attending physicians, we have no means of 
ascertaining whether the whites dying in different parts of the city are infected witii 
plague. 

The city board of health says that after the population of Chinatown is takoi, 
exclusive of Japanese, the mortality runs 30 per 1,000, which is high, conadering 
there are very few children. But these statistics are based on the dead we see, the 
grreat majority of which are not plague. 

The Chinese object to autopsy to a moderate extent, but not seriously as a rule; 
not as much so as the whites. We autopsy all cases (1 ) that have been seen by 
us during life and are regarded as suspicious of plague, such as acute buboes, pneu- 
monia, and acute febrile diseases, the causes of which are doubtful or can not be 
ascertained; (2) all cases which have not been seen by us and which, on an inspeo 
tion of the IkkIv, the cause of the death is not evident, such as a fracture of the 
skull, chronic tuberculo-sis, ascites, etc. The only exceptions that have been made 
to this rule have l)een in two ca.«e8 of pneumonia ana one, a well-nourishe<l man 
dying suddenly, in which legal action was threatened by the Chinese, and these 
bodies were passed by the city board of health against our recommendations. All 
cases of plague and all cases suspicious of plague that have been autopsied have been 
carried through all the usual and ordinary bacteriological tests before dia^osia has 
been made. If a case is regarded as suspicious of plague, the city bacteriologist is 
notified and is present at the autopsy. In addition to this, the city board of health 
is notified that the provisional diagnosis of this oflBce is "bubonic plague." 

The contacts (except in pneumonia cases) are not quarantinea as a rule. By 
** contacts" in pneumonic cases are meant those men who are found in the room 
when the i>olicoman arrives to institute theji]uarantine. After the body is limed it 
is hermetically sealed in a zinc coffin and buried by the Chinese undertaker. There 
is no reasonable doubt about the disposition of the bodies. The clothes are buried 
with them. 

No person attending the autopsies has contracted the disease, nor, so far as we know, 
did any case of plague develop among the 135 white men employed in cleansing 
Chinatown. 

It would appear that the months of July, August, September, and early October 
are the months of maximum plague mortality and those of November, December, 
and January the minimum. 

The population of Chinatown is roughly 15,000 during the winter months, namely, 
from November to March, inclusive, and smallest between March and November, as 
about 5,000 Chinese leave the city for the ranches in the State and the Alaskan can- 
neries. The greatest number of cases of plague is in the seasons when there is the 
smallest population. Up to the last few weeks, most weeks showed a larger namber of 
dead than sick. In other words, while I believe we see all the dead, there are a great 
number of sick, even from ordinary ch»onic diseases, which are not seen during life. 
Every effort has been made to see all the sick, but, owing to lack of cooperation of 
the Chinese and their fear of quarantine, such has been impossible; but during the 
last few weeks there has been a very marked and favorable increase in the number 
of sick seen by this office. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 237 

The method hy which we see the sick is as follows: It is known to the Chinese 
hat ail cases which have been seen by us during life and found not to be plague will 
le paaaed without autopsy. Therefore a certain per cent of the population report 
heir sick to us for the sole purpose of avoiding autopsv in case of death. This, as 
rill be readily seen, permits us to visit only those sick whom the Chinese believe are 
loing to die. We have repeatedly, through the Six Companies and directly, urged 
hevhinese to report even trivial cases to us, assuring them that their interests would 
Kit be injured thereby, but up to the present time, possibly owing to contrary infiu- 
snoes brought to becur against us by the agents of the State board of health, we have 
leen unabfe to secure their full confidence and cooperation. 

As a rule the Chinese laymen and physicians strongly suspect plague even at an 
sariv stage of the disease; but, on the other hand, any acute febrile illness they rc^rd 
a aoout the same light. In short, they are not able to make a ver^^ accurate differ- 
ntiation between acute febrile cases. The cases which occur with well-marked 
Imboes they recognize as readily as do the traine<i white physicians. If the Chinese 
believe the case to be one of plague they rarely report it to this offic^e, because their 
irhole fear is the quarantine and the autopsy of the body. All they can hope to gain 
bj reporting is the prevention of the autopsy of the body, and therefore they have 
ao inducement in this case to report. 

There were examined previous to November 8, 1902, some 50 or 60 rats (estimated), 
Rrhich were obtained at irregular intervals by offering small rewards. The examina- 
tion of these showed none to be infected with plague. On Noveml)er 8 the city board 
)f h^dth began to systematically trap rats in Chinatown, employing 3 men and 
50 traps. The traps were set entirely in the sewers. These men were also instructed 
to look for dead rats in Chinatown and bring them with the live to this laboratory. 
The live rats were chloroformed on arrival here and with the dead rats autojpsied 
md examined bacteriologically. Of the 481 rats examined so far, 15 were foimd 
to be infected with plague. Of the 15, 13 were caught or found dead (mostly the 
latter) within a radius of 100 feet from 629 Merchant street, which is one-half blot^k 
» the east of Chinatown. The other 2 were caught in various parts of Chinatown. 
The rats in this city other than the district known as Chinatown, and possibly a 
>lock or two bevond its borders, have not been examined. 

Respectfully forwarded. 

A. II. Glennan, Surgeon. 



Plague Conference. 

In accordance with request from a number of State boards of health, 
wd under authority of section 7 of the act of Congress approved July 
I, 1902, a conference with regard to the plague situation was held in 
the office of the Surgeon-General of the Public Health and Marine- 
Hospital Service, January 19, 1903. 

The conference held two sessions, one in the forenoon and the other 
in the afternoon of January 19, adjourning on the same date. 

At 10.25 a. m. the conference was called to order by its chairman, 
5urgeon-General Walter Wyman, of the Public Health and Marine- 
Sospital Service. The roll was called and the following answered to 
:heir names: California, Dr. Mathew Gardner; Connecticut, Dr. C. A. 
Ldndsley; Colorado, Dr. II. K. Bull; Delaware, Drs. C. W. Cooper 
md Alex. Lowber; District of Columbia, Dr. William C. Woodward; 
[ndian Territory, Dr. M. K. Thompson; Iowa, Dr. T. L. Kennedy; 
Indiana, Dr. J. N. Hurty; Louisiana, Dr. Arthur Nolte; Maine, Dr. 
Charles D. Smith; Maryland, Dr. John S. Fulton; Minnesota, Dr. 
tt. M. Bracken; North Carolina, Dr. R. H. Lewis; New Jersey, 
Dr. Henry Mitchell; New York, Dr. Daniel Lewis; Pennsylvania, 
Dr. Benjamin Lee; Rhode Island, Dr. Gardner T. Swarts; South 
!)aroIina, Dr. T. Grange Simons; Tennessee, Dr. J. A. Albright; 
Vermont, Dr. H. D. Holton, and Virginia, Dr. P. A. Irving. 



238 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

RESOLUTIONS PASSED HY THE CONFERENCE. 

I. 

The presence of plague in California is established beyond debate by — 

1. The investigations of Kellogg, of the San Francisco board of health; Ryfkogel,for 
the California State lx>ard of health, and Kinyoun, for the United States Marine- 
Hospital Service. 

2. By tlie later investigations of Pillsbury, for the State board of health, andbj 
those of J. Wliit4», M. White, Flint, Currie, Carmichael, Blue, and Glennan, for the 
United States Marine- Hospital Service. 

3. By the findings of Flexner, Barker, and Novy, composhig a special committee 
acting im<ler Federal authority. 

4. By the findings of independent and disinterested investigators (supplied with 
materials from autopsies made at San Francisco, and working in San Frandaoo, . 
Chicago, Boston, New York, Washington, Baltimore, Philadelphia, and Ann Arbor). ^ 

5. By the occurrence of a case of human plague in Ann Arbor due to an accident 
in the manufacture of Haffkine's prophylactic fluid with a culture of plague badUoa 
obtained in California. 

6. Bv the auti^psy records of 90 cases of plague, now in the possession of the United 
States Marine-Hospital Service and of the San Francisco board of health, and pttb- 
lished in part in the Occidental-Medical Times, of San Francisco. 

The presence of plague in any community where proper restrictions are not taken 
to prevent its spread is an injury to the best interests of that community. Such 
injury is in any case avoidable by the proper cooperation of all interest involved— 
conuiiercial, professional, and governmental. This conference r^ards the habitual 
publication of tlie actual facts relative to infectious disease and preventive prooedoree 
as the surest route to popular confidence, and is one of the means best adapted to 
minimize the injury liable to result from the presence of such diseases. 

III. 

The present danger to California and to the United States lies primarily in the per 
sistence, during noiirly three years, of a definite nidus of plague infection in that part 
of San Francisco known as Chinatown; but the gravity of this circumstance ia greatly 
increased by the gross neglect of official duty* by the State board of health of Cali- 
fornia and the obstructive influence of the recent governor of California, by the fail- 
ure of the city government of San Francisco to support its city board of health, and 
by the obstacles opposed to the operations of the United States Public Health Service. 

IV. 

The conference will consider the safety of the country sufficiently assured as soon 
as satisfied that a competent city board of health of San Francisco and a competent 
State board of health, m cooperation with the United States Public Health Service, 
will proceed under definite, harmonious, and effective laws and ordinances; that 
they are provided with ample funds, and that they are jointly and seveiully in the 
free exercise of their lawful powers. 

V. 

The conference expresses its conviction that the United States Public Health Serv- 
ice hjis deserved well of the State of California and of the coimtry, and that it would 
go far toward the restoration of popular confidence if the United States Public Health 
officials were a(^imitte<l to the same relations with the State board of heedth as have 
been steadily maintained with the city board of health of San Francisco. 

The praise of this conference and the gratitude of the city of San Frandaco are due 
tx) Drs. John M. VVMllianison, Vincent P. Buckley, W. B. Lewitt, Rudolph W. Baum, 
Louis Bazett, and Dr. McCarthy, of the city board of health of San Francisco. These 
men possess the unreserved confidence of the executive health officers of the country. 

VI. 

Rewhedy That the Surgeon-General of the Public Health and Marine-Hoepital 
Service be requested to inform the various State lx)anis of health at least two weeks 
before the annual meeting of the Public Health and Marine-Hospital Service and the 



PUBLIC HEALTH AND MARIN E-Ht>SPlTAL SERVICE. 239 

State boards of health to what extent the sanitarv recomnn^nfiations this day made 
to control and prevent the existence of plague in California have bet»n t^arritHf out, to 
the end that they mav then he prepared to take further action that may lie nei*t*(<&qiry 
to accomplish the end desired. 

A detailed report of this conference was published in supplements 
to Pnblic Health Reports of January 23 and February 6, 1\M)S. 

Following the conference of State boards of health, the following 
correspondence in regard to the same was had: 

[Tclegriims.] 

San Framish-o, Cal., Jnnunn/ ,v>, /.'vji,v. 

Sor^geon-General Wyman, Washington: 

Referring to telegraphic report proceedings State boards ht*alth, yesteniay nioru- 
ing, papers publish following statement from Governor l^anlee: '* Whatever the 
Marine- Hospital Service desirer* me to do in the way of public health pn^^rvation 
ehall be done. If Surgeon-General Wyman and his confen^^t? decide that the safety 
of the country or any |tart of it would \yo. enhanccil by a iiion* stringent adheri'iKv to 
the laws of sanitation in California, their dei'ision will Ik* res«pecte<l by me and car- 
ried out in accordance therewith to the best of mv ability and the State's available 



resources." 



Glknnax. 



Washington, Jaiiuarif -?/, UHli. 

Baigean Glxnnan, Son FrandscOj Oai.: 

The resolutions jjaHsed by the conference but feebly express the very strong and 
determined feeling which prevailed. Other resolutions, not i)ublishcd, calling niK»n 
Secretary of War to remove transport service from San Francisco and calling upon 
Sui^reon-Cieneral to place inspectors on trains out of California were jMjstponeil for 
consi<leration until general conference of all the States, to l>e held in April. It is 
absolutely necessary- that confidence on the jiart of the health otlicers toward Cali- 
fornia authorities shouM be restored, and 1 am convinceil this can not W- <lone unless 
the governor in some manner acknowledges the pn»sence of plague in Chinatown, 
San Francisco. Your telegram quoting (lovemor Panlee's statement in morning^s 
paper, while encouraging and much appreciated, will not, if publisluMl in the Public 
Health Re])orts, inspire entire confidence in the minds of the health otliceiv, inasmuch 
as It contains no acknowledgment that plague exists. You are authorized, within 
your discretion, to show this telegram to the governor and to urge that lM)th he and 
the mayor in sr^me manner admit the presence of plague. It would clear the situa- 
tion more than any other one thing, and would promptly turn the feeling of resent- 
ment into one of confidence. One resolution passtnl hy the confen'uce snnimarizen 
the proofs of plague as follows: ** By investigations of Kellogg, of city board, Kyfko- 
cel, of State rxjard, Kinvoun. of Marine- Hospital Service; later, IMllsbury, ot' State 
Board, J. White, M. Whftc, Flint, C/Urrie, Cannichael, Blue, ami (tlennan, of Marine- 
Hospital Service; by the findings of Flexner, Barker and Novy, si)ecial comiiiission; 
by findings of inde*i;)endent investigators, supplied with material from San Fnm- 
cisco, working in San Francisco, Chicago, Boston, New York, Washington, Balti- 
more, Philadelphia, and Ann Arl)or; by (K'currence of human case at Ann Arbor, 
due to accident in use of culture of plague bacillus received from ('alifornia, and by 
autopsies of 90 cases of plague." It would seem that this accumulated evidence 
would give Governor Panlee sufficient ground on which in some manner to acknowl- 
edge the presence of plague. It might l>e done by the use in anv teU'gnun or letter 
to me of the expression, ** elimination of plague." The situation is now entirely 
change<l, and al^solute frankness on the part of authorities of city and State is neces- 
sary to prevent pronounced hostile action, particularly when the conferen<*e of all 
the States meets in April. 

Wy.man. 



Wasiiinoton, Jainmry ;?/, 1903, 
Glennan, $San Francisco, CftL: 

Doctor Gardner has just sent the following telegram to (rovemor Pardee: *' Wouhl 
advise you confer with Mayor Schmitz and turn over entire management of ])laguo 
situation to Public Health and Marine- Hospital Service. CJeneral Wyman assures 



240 PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 

me, if asked by proper authorities, he will, if it meets the approval of the Secretary 
of the Treasury, as he believes will be the case, take control at once, all employees 
to be selected by and be under absolute control of his officers, the State or dhr, as the 
case may be, to bear general expenses other than the pay and allowances oi service 
officers so employed. At present it is believed there is no necessity for any radical 
change in the method of work. Advise prompt action in this matter. Wire me soon 
as possible, so that I can confer further with Surgeon-General W^man before leaving." 
On consultation with the Secretary he insists that the assumption of control must be 
upon voluntary request of the State and city authorities. 

Wtilan. 



San Francisco, Cal., January ei, 190S. 
Surgeon-General Wyman, Washingion: 

The following delegation are in Sacramento this afternoon to confer with Governor 
Pardee presumably favorable to matter in your telegram just received. Mayor 
Schmitz, W. P. Herrin, Henry T. Scott, W. J. Martin, Fremont Older, and T.T. 
Williams. 

Glemnan. 



San Francisco, Cal., January 29^ 190S. 
Surgeon-Greneral Wyman, Washington: 

The Sacramento Bee, in an interview with Governor Pardee, gives the following 
statement from him: **I want to say that I propose to act in complete harmony wim 
the federal authorities. They must be satisfied so as to restore public confidence, and 
my plans therefore will be made to fit in with theirs. The medical authorities have 
emphatically declared that plague has existed and does exist in San Francisco, ami 
that settles it as far as I am concerned. It matters not what one's belief may be as to 
the existence or nonexistence of this disease — medical men say it exists ana there is 
no goin^ behind the returns. Consequently, I stand ready to do what the Federal 
authorities desire. What we want to do is to put an end to the suspicion with 
which California is regarded outside the State's limits." 

Glenn AN. 



San Francisco, Cal., January £7, J90S. 
Surgeon-General Wyman, Washinffton: 

Accompanied by Cumming, I attended meeting to-day of a committee representing 
all the commercial bodies this city for consideration plague situation. They fear 
official acknowledgment existence plague will cause quarantine and removal trans- 
port. 8er\'ice. I assured the contrary, showed your telegram to me January 21. 
Wire ine some assurance upon this point. They will support the service, secure 
State and city official cooperation in the eradication of plague in Chinatown, if 
thereby they obtain outside confidence without damage to the State. They will 
wait Ganlner's return and invited me to join them in conference with the governor 
at Sacramento. They wish 50 copies your plague pamphlet and other printed matter. 
Please mail same to me quickly. 

Glennan. 



Washington, January S8^ 190S. 
Glennan, San Francisco ^ Ckd.: 

The acknowledgment of the existence of plague would not affect the transport 
service in San FranciscO; nor the matter of quarantining the State, for the Bureau and 
the conference both know the diseaFe is there as well as if the State admitted it; bat 
if acknowledgment is not made by California authorities the work of elimination is 
necessarily embarrassed and when conference meets again emphasis will be laid on 
this fact an<l suspicion thrown on the work as undertaken and may occasion the 
passing of the transport and train-inspection resolutions which were postponed. 

Wtman. 



PUBLIC HEALTH AND MABINE-HOSPITAL 8EBVI0E. 241 

Washington, January f .9, 190S. 
GUDiKAN, San FhincUcOf CaL: 

Following is copy of telegram sent by Doctor Gardner to W. F. Herrin, Janu- 
ary 21: 

"Wired iiovemor Pardee what I think necessary in the plague situation. In order 
to mvert quarantine by the twenty-one States represented at the conference prompt 
acdon must be taken on the lines I have indicatea in my tele^m to Pardee. Recog- 
nition of plague, in which I concur, is necessary. No reply fiora Pardee. Answer."* 

Also, the following: 

** J. J. O'Connor, Hospital Department S. P. Co., San Francisco: Wired Herrin 
as to situation here; plague must be rec<^ized as existing in order obviate hostile 
action of State boards. Show this to heads of departments quick. Answer." 

Wyman. 
CORRESPONDENCE RELATIVE TO WORK IN CHINATOWN, SAN FRANCISCO. 

The following telegrams indicate the status of the work in China- 
town at that date. 

[Telegrams.] 

Washington, January j?P, 1903. 
Glennan, San Francisco^ CcU.: 

Wire complete statement showing work now beinj? done in Chinatown, including 
our own service organization, the attitude and personnel of the agents of the city 
board of health and just how they are operating; and also whether the State board 
of health has anv inspectors at work in Chinatown, and if so who they are and how 
they operate. 1^our weekly report should also include statement of all work done 
by any persons in Chinatown. Unless you wire me not needed will send Blue. 

Wyman. 



San Francisco, Cal., January fP, 190S. 

Surgeon-General Wyman, Washington: 

Present work in Chinatown is as follows: Currie visits all sick reported by Wong 
(Chinese interpreter), and inspects dead, making necropsies when necessary. Lloyd, 
with his interpreter, locates and inspects sick who will not report; assists in labora- 
tory and autopsies. Doctor Wilson, inspector city board, visits sick and dead upon 
information from Currie only. Morrow, city bacteriologist, cooperates. No change 
in attitude city board. Inspectors of the State board health are Lawlor and Read, 
who visit sick reported by their interpreter and attend necropsies. No friction in 
any quarter present time. Probably all sick not yet seen. Please send Blue soon as 

poflslDie. 

Glenn AN. 

Some apprehension was felt as to the effect of poison to be used in 
flushing sewers upon the fish in the bay of San Francisco, and in order 
to have an authoritative opinion on the matter, the opinion of the 
Commissioner of Fish and Fisheries of the United States was obtained, 
as shown by the following: 

[Letters.] 

San FRANasco, Cal., January 24^ 190S. 

Sir: At the request of the chemist and also the city health oflBcer of San Francisco, 
I have to request that the Bureau obtain from the United States Fish Commissioner, 
Washington, D. C, an expression of opinion as to whether the use of poison in the 
sewers of the Chinese quarter in this city to kill rats, would ultimately affect the 
food fish in the bay. Nearly three years ago phosphorized oil, and also arsenic, 
were separately used in these sewers, killing many rats without causing any damage 
to the mh in the harbor. But the city board of liealth desire to be fortifi^ with an 
official opinion, to ward off any unreasonable complaint. 

I am urging the wholesale destruction of rats as an aid to the eradication of plague 
in this district, and the city board of health have promised me to proceed m this 

H. Doc. 338 16 



242 PUBLIC HEALTH AND MAB1NE-H08PITAL SEBVICE. 

matter as soon as a favorable opinion is received. I would like a telegraphic reply, 
in advance of the mail, as the matter is of great importance. 
Respectfully, 

A. H. Glennan, t^rgetm. 

The Subgeon-General Pubuc Health and MARiNB-HosprrAL Sbrvicx. 



UNriED States Commission of Fish and Fibhbrieb, 

Washingionf D. C, January SO^ 190$. 

Sir: The Commission acknowledges the receipt of a communication from Surg. A. H. 
Glennan, of San Francisco, with your indorsement thereon, in regard to the use of 
poisons for killing rats in the sewers of San Francisco, and its prolmble effect on the 
food fish of San Francisco Bay. 

In the opinion of this Commission, the poisons mentioned would be so mnch dilated 
by the time they reached the waters of the bay or shortly thereafter that little, if any, 
damage would be caused to the fi^h life, especially as no fishes of any great impor- 
tance commercially would probably resort to the vicinity of the sewers. It is sug- 
gested, however, that when the use of posion is begun, its possible effects on the fiwi 
life be l)ome in mind and a watch set, so that the proposed line of proc^iure may be 
modified if found necessary. The Fish Commission steamer Albatross is now at San 
Francisco, and if desired by your bureau, an assistant could be detailed to look into 
the matter of the effect of the poisons on fishes of the bay. 

Very respectfully, Geo. M. Bowers, Commutgifmer. 

The Surgeon-General Pubuc Health and Marine-Hospital Service. 

A request being made for the detail of the oflScer from the Albatross^ 
as referred to in above letter, the commanding officer of the Alhatnm 
was instructed by letter of the Fish Commissioner, dated February 7, 
1903, to make said detail. 

The commercial bodies of San Francisco, recognizing the necessity 
for unity of action and cooperation of the city and State authorities in 
the joint work of sanitation and eradication of plague from Chinatown, 
called a meeting of all these commercial bodies. A subcommittee of 
each was fonned to act as a standing joint committee for the purpose, 
a list of which subconunittees follows, and the correspondence snows 
the favorable action which ensued. 

MEMBERSHIP OF THE JOINT COMMITTEE OF COMMERCIAL ORGANIZATIONS OF SAN 

FRANCISCO, CAL. 

Chamber of Commerce, — Greorge H. Newhall, 309 Sansome street; E. Scott, 433 Cal- 
ifornia street; W. J. Dutton, 401 California street 

Merchants* Exchange, — R. P. Schwerin, Wells-Far^ Baildinff, Second street; T. C. 
Friedlander, 320 Sansome street; George W. McNear, 326 California street 

Board of Trade.— A. A. Watkins, 811 Market street; H. L. Smith, 202 Martlet 
street; Lippman Sachs, Bush and Sansome streets. 

Manufacturers and Producers* Association, — A. Sbarboro, 618 Montgomery street; 
C. E. Bancroft, Mills Building; J. P. Currier, 8 Sutter street 

Merchants* Association, — Frank J. Symnies, 725 Mission street; L. M. King, Mills 
Building; Andrew M. Davis, The Emporium. 

State Board of Trade. — N. P. Chipman, Parrott Building; J. A. Pilcher, Ferry 
Building; Arthur R. Briggs, 1001 Pine street (Bella Vista Hotel). 

California Promotion (hmmittee. — Rufus P. Jennings, 25 New Mont^mery street; 
Frank J. Symmes, chairman joint committee; L. M. King, secretary joint committee. 



[Telegrams.] 

San Francisco, Cal., February 3, 1903. 
Sui^geon-General Wyman, Washington: 

Following confidential until official papers reach you. Commercial associations 
met to-day, adopted strong resoulutions calling upon mayor and governor to reoog- 



PUBLIC HSALTH AND MAMNE-HOSPITAL 8EBVICE. 243 

niae and take hold plaeue situation immediately under supervision this Service. I 
drew up and suggested loUowing supplementaiy statement be attached, to be signed 
by theee associations, the mayor, city health officer, representative State board, gov- 
ernor, and sent you as assurance of good faith. It was adopted. " Whereas compe- 
tent medical authority having declared that bubonic pest has existed to a limited 
extent in the restricted area known as Chinatown in San Francisco, the last case 
having been reported December 11, 1902, and although the health authorities have 
exerdsed sanitary supervision over this section in the pa«>t, nevertheless this under- 

3' ;ned joint official statement is promul^ted in accordance with the resolutions 
opted at the conference of State health officers, held at Washington, I). C, January 
19, 1903, as an assurance that there is no present or future danger from that disease, 
inasmuch as complete and harmonious action by all the health authorities concerned 
10 hereby assured and will be maintained.'' 

I accompanied committee of fifteen to mayor's office; resolutions read, all sinia- 
tnres obtained except governor's, whom same committee and myself will see in Sac- 
ramento Tuesday. The desired recognition is secured ; unanimity of opposition inter- 
ests is obtained. 

Glennan. 



San Francisco, Cal., February 5, 190,^, 
Wyman, Washinglon: 

Have forwarde<i in registered mail resolutions adopted by committee commercial 
organizations San Francisco, also joint official statement, acknowledgement, and 
assurance harmonious and immediate action. Some signatures obtained with diffi- 
culty on account fear injury to State, but you may publish in daily and medical press 
and public-health reports with the confidence that you will restrain any unnecessary 
quarantine or damage to the State. 

Glennan. 



[Letter.] 

San Franctsco, Cal., February 4^ 1903. 

Sir: I have the honor to re]>ort that on January 26, 1903, an organization was 
effected composed of representatives of all commercial organizations of San Francisco 
for the purpose of taking action in regard to the sanitary condition of Chinatown and 
to render every aid possible to eradicate the infection of pest in that district. At a 
meeting of the joint committee of these commercial organizations Mr. Frank J. 
Symmes was elected chairman and Mr. L M. King, secretary. A list of the mem- 
bers of this joint committee is herewith inclosed. 

The inclosed resolutions (inclosure No. 1) were adopted by this body, addressed 
to the mayor of San Francisco and the governor of the State, uivin^ the governor of 
the State and the mayor and supervisors of San Francisco to take immediate coop- 
erative action for the eradication of the disease. I suggested that a supplementary 
official statement be prepared, to l>e signed by the State and city officials and the 
representatives of these commercial orp^anizations, to be sent you as an assurance 
that complete and harmonious action will be taken in accordance with the resolu- 
tions adopted at the recent conference of State health officers at Washington. This 
signed statement is inclosed (inclosure No. 2) with the understanding that you may 
publish it when and in what manner you may deem best. 

On Monday morning, February 2, I a(!Companied this committee, which went in 
a l)ody to the mayor's office where the chairman read these resolutions to the mayor 
and received his signature to the statement and assurances of harmonious coopera- 
tion. On the following morning 1 accompanied this same committee to Sacramento, 
where these resolutions were read to the governor, and he repeated his former assur- 
ances of everjr cooperation in the work. 

The resolutions themselves may possibly be given out by the committee here. A 
great deal of credit for the result attained is due to the members of this joint com- 
mittee of commercial organizations, and especially to Mr. Frank J. Symmes, presi- 
dent of the Merchants' Association and chairman of the joint committee, and also to 
Mr. L. M. Kiiu^, secretary. 

Keepectiully, A. H. Glennan, Surgeon, 



244 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE, 

[Inclosure No. 1.] 
RESOLUTIONS OF MERCANTILE JOINT COMMITTEE. 

San FRANasco, Cal., February £, 190S. 

Whereas the boards of health of other States and Territories have become alarmed 
at the reports of bubonic plague in San Francisco during the past three ^ears; and 

Whereas but 93 cases have been reported by all health authorities during a 
period of these thirty-five months, and that the last case reported was December 11, 
1902; and 

Whereas the health authorities of 21 States and Territories, in a conference called 
for that purpose at Washington, January 19, declared that the presence of pla^ 
had " been established beyond debate by the investigations of Kellogg, of theatj 
boanl; by Pillsbury and Ryfkogel, of the State board; by J. White, M. White, Flint, 
Currie, Carmichael, Blue, and Glennan, of the Public Health and Marine-Hospital 
Service; by Flexner, Barker, and Novy, a special commission acting under Feaeral 
authority; by independent and disinterested investigators in Chicago, Boston, New 
York, Washington, Baltimore, Philadelphia, and Ann Arbor, working from material 
obtained in San Francisco; by a case of human plague in Ann Arbor due to an acci- 
dent ia the handling of a culture of plague bacillus obtained in California," and said 
plague conference did attempt to declare a quarantine against California, to cause the 
transport service to be removed from San irancisco, and to place medical inspectors 
upon all the trains going out of the State, and but for the most strenuous efforts of 
Doctor Gardner, representative of the State board of health, could have succeeded in 
so doing; and 

Whereas said conference did demand that the city and State health authorities 
act in harmony with the Public Health and Marine- Hospital Service to carry outuiy 
sanitary regulations which that Service may deem necessary, or quarantine would be 
established a<rainst California at its next meeting, to be held in April; and 

Whereas the great interests of California and esi)ecially those of San Franci^xj, 
demand that no neglect of our citizens should hinder the march of progress which 
has now been so happily begun; it is, therefore 

Resolved, That this mercantile joint committee, consisting of the officers and other 
representatives of the State Board of Trade, the San Francisco Board of Trade, the San 
Francisco Chamber of Commerce, the Merchants* Association of San Francisco, the 
Merchants' Exchange of San Francisco, the Manufacturers and Producers' Association 
of California, and the California Promotion Committee, hereby strongly urges the 
governor of the State and the mayor and supervisors of San Francisco to take such 
steps at once as shall secure a prompt cooperation of the boards of health of the city 
and the State, under the supervision of the Public Health and Marine-Hospital Serv- 
ice to the end that all danger from the bubonic plague may be eradicates; thai all 
fears of infection may be removed; that the confioence of the boards of health of the 
other States and Territories may be restored, and that no injury, however remote, 
may result to the foreign and interstate commerce, and to this end we hereby pledge 
to the officials of the State and city every aid and support of the various commercial 
bodies which we represent; and we also ask that the governor of the State and the 
mayor of the city join in the signing of the following statement: 

Whereas competent medical authority has declare! that bubonic pest has existed 
to a limited extent in the restricted area know as Chinatown in San Francisco, the 
last case having been reported December 11, 1902, and although the health authori- 
ties have exercised sanitary supervision over this section in the past, nevertheless 
this undersigned joint official statement is promulgated in accordance with the resolu- 
tions adopted at the conference of State health officers, held at Washington, D. C., 
January 19, 1903, as an assurance that there is no present or future danger from 
that disease, inasmuch as complete and harmonious action by all the health authori- 
ties concerned is hereby assured and will be maintained. 

Mercantile Joint Committeb. 
Frank J. Symmes, Chairman, 
L. M. King, Secretary, 

Representing California State Board of Trade, San Francisco Board of Trade, San 
Francisco Chamber of Commerce, Merchants* Association of San Francisco, Mer- 
chants' Exchange of Ran Francisco, Manufacturers and Producers' Aflsodation of 
California, CaliK)mia Promotion Committee. 



PaBLIC HEALTH AND MABINE-HOSPITAL SEBVICE. 245 

[Inclosure No. 2.] 
8m*PLEMENTARY OFFICIAL STATEMENT. 

San Francwco, Cal., February 2, 1903, 

Whereas competent medical authority has declared that bubonic peet has existed 
to a limited extent in the restricted area known as Chinatown in San Francisco, the 
bat case having been reported December 11, 1902, and although the health authori- 
ties have exercised sanitary supervision over this section in the past, nevertheless 
thu undersigned joint official statement is promulgated in accordance with the reso- 
lutions adopted at the conference of State health officers, held at Washington, D. C, 
January 19, 1903. as an assurance that there is no present or future danger from that 
disease, inasmuch as complete and harmonious action by all the healm authorities 
eoncemed is hereby assured and will be maintained. 

Geo. C. Pardee, Oovemor, 
M. Gardner, M. D., 
Representative State Board of Health. 
E. E. ScHMrrz, 

MayoTy San Francwco. 
A. P. O'Brien, M. D., 
Health Officer^ San Francisco. 
A. H. Glennan, 
Surgeon^ Public Health and Marine Hospital Service. 

Arthur R. Briogs, 
Vice-President California State Board of Trade. 

A. A. Watkins, 
President San Francisco Board of Trade. 
George A. Newhall, 
President San Francisco Chamber of Commerce. 

Frank J. Symmes, 
President MerchanU^ Association of San Francisco. 

George W. McNear, 
President Merchants^ Exchange of San Francisco. 

A. Sbarboro, 
Manufacturers and Producers' Association of California. 

RuFus P. Jennings, 
California Promotion Committee. 

Following the action of this joint commercial committee, Dr. M, 
Gardner was designated by the governor to represent the State; Dr. 
A. P. O'Brien, city health officer, to represent the city, and with the 
Service representative plans were formulated for the increased work 
of supervision and sanitation of the Chinese district, as shown. 

[Letters.] 

San Francisco, Cal., February 12 ^ 1903. 

Sib: I have the honor to inclose herewith copies of correspondence in relation to 
bringing about joint action for the elimination of plague infection in San Francisco. 

It is impossible for me to report in detail all the preliminary work leading up to 
the present harmonious state of affairs. The old members of the city board of 
health are pleased wnth the turn of affairs, and attribute the break in the deadlock 
in the election of their president to these events. The new president of the board, 
Mr. Casey, in company with Health Officer 0*Brien, visited the laboratory February 
10, when we started the reenforced work of inspection of Chinatown, and pledged 
his undivided support. All opposing interests have withdrawn and the contentions 
of the past few years are dissipated, so far as a clear field for the elimination of 
plague is concerned. The problem now is simply to carry on effective inspection 
service, with measures to eradicate the infection. The cit^ chemist is preparing 
poison for the wholesale destruction of rats. This poison will be introduced in the 
Chinatown sewers in a few davs. This will be followed by the use of traps in the 
Chinese quarters and areas ana, if necessary, bjr a per capita tax on rats. The cubic 
air space regulation is being enforced by the chief of pohce, and he assures me that 



246 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

his whole force is at our command, if necessary. The board of public works and 
supervisors is controlled in our interests by the citizens' committee, who stand ready 
to back us in any reasonable request. 

The detail work is harmoniously organized and reenforced, to be carried on for an 
indefinite length of time. Cases of plague will probably be found in due season, bot 
the situation is well in hand. On account of the continued heavy rains no sickneeB 
will probably develop just at the present time. It is propoeea to inspect all Uie 
Chinese wash houses in the city outside of Chinatown ana also to have an eye upon 
the so-called Latin quarter. The two sanitary inspectors are also obeerving the 
outlets to the city. 

««««««« 

Respectfully, 

A. H. Glennan, Surgeon. 

The Suroeon-General Public Health and MARiNE-HosprrAL Service. 



San Francisco, February 4^ 1909. 
Hon. George C. Pardee, 

Governor State of Cdtrfomia^ Sacramento^ Cat.: 

Doctor Gardner sa^s he has no authority from you to act in conjunction with 
Doctor (ilennan and city heaUh officer on work in Chinatown. Will you send him 
proper instructions and also replace present inspector and increase number to seven? 

Frank J. Symmeb, 
Chairman Mercantile Joint CommHUe. 

Note. — Telegram was also sent the governor February 7, 1903, requesting him to 
notify the mayor and city board of health, officially, of his direction for cooperative 
action, which he did the same day. 

Glknnan. 



ExEciTivE Department, State op California, 

Sacramento, Febmary 7, 1903. 
Dr. Matthew Gardner, 

Member State Board of Health, San Francisco, Cat. 

Dear Sir: This is to inform you that I have authorized and do hereby authorize 
you to act for the State and represent its interests by cooperating with the &ui Fran- 
cisco board of health and with the Public Health and Marine-Hospital Service of the 
United States Government in the adoption and execution of such measures as may 
be necessary for the elimination of contagious disease in San Francisco. 
Very respectfully, 

Geo. C. Pardee, 
Governor of the State of Califomia. 



ExEciTTivE Department, State of California, 

Sacramento, February 7, 190S. 
Dr. A. H. Glennan, 

Occidental Hotel, San Francisco, Col. 

Dear Sir: Inclosed please find a copy of a notification which Governor Panlee 
has sent to the president of the San Fnmcisco board of health. 

Very respectfully, A. B. Nye, 

Private Secretary to Governor. 



February 7, 1903. 
Dr. J. W. Ward (Acting President), 

President San Francisco Board of Health, City Hall, San FranciKO, Cdl. 

Dear Sir: I hereby inform you officially that I have authorized Dr. Matthew 
Gardner to cooperate, as the State's representative, with the department of public 
health of the city and county of San Francisco and with the Public Health and 
Marine-Hospital Service of the United States Government in all measures which it 
may be found necessarv to adopt for the elimination of contagious disease in San 
Francisco. 1 respectfully request you, as president of the San Francisco board of 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 247 

health, to inform such board of the fact when you have received this notification, 
and I tniHt that all due credit and authority will be accorded Doctor Gardner as the 
State's representative in this matter. 

Very respectfully, Geo. 0. Pardbe, 

Governor of the State of California. 

Note. — At special meeting of the city board of health Monday morning, February 
9, 1903, Mr. Michael Ca<»ey was elected president, and the above letter read and 
^pted. Mr. Gasey is also a member oi the board of public workn. 



San Francisco, February 7, 190S, 
Dr. A. H. Glennan, 

United Statin Marine-Hospital Service, Occidental Hotel. 

Dbab Sir: In accordance with the verbal understanding which was reached at a 
conference between the representatives of the various mercjintile bodies of this city 
and our representatives on Wednesday last, we beg to state that this association 
desires to aid you and any other authorities representing the health boards in any 
investigation which you may desire to make of the health conditions in Chinatown. 
For that purpose we shall be pleased to send a representative with you at any time 
to any quarters which you may desire to investigate. You may secure such repre- 
eentative by either telephoning or personally calling at our headquarters. No. 738 
Commercial street. If at any time you find that you can not get access to sick people 
of the Chinese race in this city, we shall be pleased to exert in vour behalf such 
influence as we may possess to allow you to visit such sick room. We have no power 
to compel the patient to employ a wHite physician, but we think that we can give 
you an opportunity of examining the patient. 

Awaiting your pleasure, we b^ to remain, very truly, yours, 

Chinese Consolidated Benevolent Association, 
By Yee Fun, Secretary. 

DAILY sanitary REPORT TO PUBLIC HEALTH COMMISSION. 

Inspector's report for 190. . 

Street Building No Room No 

Name of occupant 

No. persons occupying premises No. rooms 

Boilding used as (dwelling or store) 

Sanitary condition of building 

Sanitary condition of rear areas 

Condition of plumbing 

Are there flush closets? 

How is building lighted? 

SICK REPORT. 



Name Age 

Nativity I.ast residence 

Occupation How long sick 

Attending physician 

Probable nature of illness 

Remarks 

, Inspector. 



a preliminary plan for the eradication op plague in chinatown, as agreed 
upon by dr. gardner, personal representative op the governor; dr. a. p. 
o'bribn, city board of health, and drs. glennan and blue for the united 
states public health and marine-hospital service. 



1. Dr. Matthew Gardner, representing the State, will pay three 
two sanitary inspectors, and two Chinese interpreters. 



medical inspectors. 



2. The city boaM of health will bqgin immediately the extermination of rats by 
means of traps and poison, emploving three sewer men for the purpose. Fifty addi- 
tional traps will be supplied for this work. The city agrees also to disinfect imme- 
diately all infected places, and will cause the renovation of such habitations in a 
aatis^urtory manner to the tiealth authoritiet*. 



248 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

3. The city further agrees to have the streets of the Chinese district thoroughly 
swept at least three times a week, and the same flushed with water once a week. A 
per capita price will be paid for rats found in Chinatown. An extra effort will be 
made tor tne removal of garbage and the sanitation of Ixack areas, etc. 

4. The United States Public Health and Marine-Hospital Service will exerdae 
immediate supervision over this work in conjunction with State and city authoritieB, 
and will furnish for the prosecution of the work a bacteriologist and laboratory, three 
medical officers (more it needed), and two Chinese interpreter?. 

Finally, it is a>;reed that all cases of pla^e shall be reported to the proj^er author- 
ities; that all inspectors shall report daily at 641 Merchant street, United States 
plague laboratory, for instructions; that inspectors shall be required to makedailj 
reports of their observations and the number of sick and dead seen by them. Theu* 
whole time shall be devoted to such duties. 

That the Chinese make every concession toward a thorough inspection of all the 
sick and dead in Chinatown. 

The above work to be continued for at least one year from date of adoption of the 
plan. 

The city board of health agrees to recommend to the board of public works and to 
the board* of supervisors that Dupont street be paved with bitumen from Califomii 
street to Broadway street. 

The city board of health to immediately memorialize the board of supervisors to 
provide sufficient funds for the purpose of carrying out the obligations assumed by it 
nerein. 



Department op PrBLic Health, 
Oppice op Board op Health, City Hall, 

San Francisco f CW., February 10, 1903. 
Dr. A. H.Glennan, 

Surgeon J Public Health and Marine-Hospital Service j 641 Merchant Street, City. 

Dear Sir: At a special meeting of the board of health held Monday, February 9, 
1903, the preliminary plan for the eradication of contagious disease in Chinatown 
agreed upon by the representatives of the State, Marine-Hospital Service, and the 
city board of health was presented by Dr. A. P. O'Brien, health officer, and adopted 
by resolution of the board, with certain additions in amendments which do not sub- 
stantially alter the plan of action, but are assumptions of certain obligations of detail 
by this feoard. 

I am, resi)ectfully, yours, James A. Emert, Secretary, 



Letter sent to health officers at Oakland, Berkeley, Alameda, Sacramento, DavisviUe, Stock- 
ton, Fresno, Bakersfidd, Watsontille, Los Angeles, etc, 

641 Merchant Strekt, 
San Francisco, Cat., February 10, 190S. 

Dr. , 

HeaUh Officer, , Cal, 

Dear Doctor: The Federal, State, and city health authorities, working in com- 
plete harmony, commence a careful medical and sanitarv inspection of Chinatown, 
in this city, to-day, to continue over a considerable period of time. 

It has been claimed that in past investip[ations in this district, when the inspection 
is followed up closely, that some sick Chinese have left or been sent away for other 
Chinese quarters in the State, with the liabilitjr of spreading infectious disease. Par- 
don us. Doctor, if we suggest that from this time you cause the Chinese (quarter in 
your city to l)e kept under close surveillance, especially for Chinese arriving from 
San Francisco. The inspection in this city will be systematic and thorough, and in 
case we detect the departure of sick Chinese for your locality we will promptly wire 
you the fact. We also wish to say that we will be glad to quickly give you the 
tem^rary services of an expert, upon telegraphic request, in case you detect any 
suspicious sickness. 

Yours, very truly, M. Qabdner, 

RepresentaJdve State Board Health. 

A. P. (VBbien, 

Health Officer San Frcmcisoo. 

A. H. Glknnan, 
Surgeon, P, H. and M. JET. S 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 249 

[TeJegTams.] 

San FiLiSCisco, Cal., Febman/ P, 190S, 
lOH-GsNSRAL, Washington: 

>ur request the goyemor has officially notified the city health authoritiee that 
9 designated Gardner as his personal representative' for cooperative work in 
town. City board of health held special meeting this morning. Crave Health 
r O'Brien raU authority to cooperate with Federal and State forces, adopted 
reliminary plan inspection of sick and destmction of rats; also elected Micnael 
president of the boanl, which seems satisfactory. We have selected Doctors 
3, Mattheii-son, and Woolsey, and two sanitary detectives, all paid by the 
and absolutely under the supervision of Blue.' This additional force com- 
i work Tuesday. Chief of pohce assures me will aid us every way possible, 
-t from Fish Commission steeuner Albatross reported to-day. 

Glknnan. 



San Francisco, Cal., Ftbniary 11, 190S, 
son-General, WashingUm: 

r health officer and myself named the 3 new medical inspectors, 2 Chinese 
reters, 2 sanitary detectives; total 7, paid by State. This additional force is 
lereil sufficient at the present time. They report daily to Blue at laboratory 
itructions. The inspection work is organized and under way. 

Glenn AN. 

REIN8PECTION OF SAN JOSE, CAL. 

report of a reinspection of San Jose, Cal., follows: 

San Francisco, Cal., February f^, 190S, 
I have the honor to report that I revisited San Jose, Cal., and called upon 
'illiam Simpson, county health officer and member of the city board of health, 
sited the city hall and inspected the death records for the past two months. 
my last inspection, some important corrections have been made by the health 
rities in their methods. Certificates of death in coroner's cases are now^ require<:l 
certified to by a physician, and the term '* natural causes'* is not accepted in 
^rtificate. 

ade inquiry in regard to a Chinese child which was taken from Chinatown, 
'rancisco, aoout December 6, 1902, to avoid inspection. This child died \\\\ou 
1 at San Jose, was detected by the authorities, an autopsy made, and the cause 
.th ascertained to have been from pneumonia. 

\ chief of police informed me that be has a man stationed at the depot to observe 
•iving ana departing Chinese; that the week previous he had detected two Chi- 
.oming from San Francisco, who seemed sick, had them examined and found 
to be suffering from chronic troubles. Doctor Simpson expressed himself as 
d at the present attitude of the State officials, and the solution of the plasma 
3m in San Francisco. There had never been a doubt in his mind as to the 
osis, and he gave strong assurances that San Jose would be guarded aj^^ainst the 
ion. He is a man of capacity and considerable practice and standing in his 
unity. 

n now satis6ed, from different sources of information, that all the cities and 
in California having Chinese settlements are watching their foreign quarters 
aforcing sanitation. 

Fresno, necropsies are now made upon Chinese where the exact cause of death 
:nown. As one health officer expressed it to me, **they have the interests of 
homes and communities at heart and would use every endeavor to protect them 
luarantinable disease; that the course which had l>een pursued in San Francisco 
t past had been unjustifiable and a damage to the State in denying the diagno- 
pl^^e by competent authority, and using every effort to eradicate it." 
(re IS a strong reaction throughout the State working for good. 
Respectfully, 

A. H. Glenn AN, Surgeon. 

i Surgeon-General, Pubuc Health and MARiNS-UosprrAL Service. 

COLORADO REIMPOSES QUARANTINE. 

1 a result of the joint action taken in San Francisco for the eradi- 
n of plague infection, and its limited extent not being fully under- 
l in some of the other Statos, the health board of tlv^ StftlA o< 



250 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Colorado reimposed their original quarantine order of May 28, 1900, 
against infected places in California, which the correspondence follow- 
ing will show, but as the conditions were more fully understood its 
enforcement was not prosecuted. 

[Telegram.] 

San Francisco, Cal., February 18^ 190S. 
Surgeon-General Wyman, Washington: 

State board of health of Colorado have reimposed their quarantine order of May 
29, 1900, requiring every Chinaman entering the State to have a health officei^s cer- 
tificate from city of departure of nonexposure to plague during previous six weeks. 
It is suggested that a statement from you to that might suspend this action at the 
present time. 

Glennan. 
[Letter.] 

San Francisco, Cal., February 18^ 190S. 

Sir: Referring to the telegram sent you this date in regard to the action of the 
Colorado State boanl of health quarantining Chinese traveling from this State, 1 
inclose copies of correspondence in regard to the matter. It would seem that jost 
at this time the reimposition of this original quarantine order of May 28, 1900, is 
Qnnece>«ary and liable to embarrass our present work in California. For this reason 
I have wired you in regard to this action with the idea that possibly a statement of 
the fact of the present condition and work in San Francisco might cause a suspension 
of this quarantme order. 

Respectfully, A. H. Glennan, 

Surgeon, 

Surgeon-General Public IIealtr and Marine-Hospital Service. 



[Inclosnres.] 

Union Pacific Railroad Company, 

Omaha^ Nebr., February JO, 190S. 

Dear Sir: For your information inclose copy of letter from J. N. Hall, secretary 
Colorado State l)oard of health, relative to their notice of quarantine on Chinamen. 

Our general agent advises us that owing to the large number of bubonic plague 
cases in San Francisco and Mexi(;o City the Colorado State board of health has been 
very active, and we further understand that they desire regulations as to Chinese to 
be carefully observed, in onler that they will not be called upon to take further and 
more stringent measures against California. 

Yours, truly, E. L. Lomax. 

Mr. T. H. Goodman, 

General Pansenger Agent Southern Pacific O)., San FrancutcOy Cal. 



Coi/)rado State Board op Health, 

Denver f Oo/o., February 4, 1903. 

Dear Sir: We beg again to call vour attention to the bubonic plague quarantine 
established by the Colorado State board of health May 28, 1900, reading as follows: 

** To whom it may concern: 

*' In accordance with the powers conferred by law upon the State board of health, 
and for the purpose of preventing the introduction of bubonic plazue into the State 
of Colorado, it is hereby ordered that until further notice no Cninaman wiU be 
allowed to enter the State of Colorado without a certificate signed by the health 
ofhcer of the city from which he has come, to the effect that he has not been exposed 
to bubonic plague during the six weeks immediately preceding his departure. 

" Bv order of the State board of health. 

**G. E. Tyler, Secretary. 

"Denver, Colo., May 28, 1900.'* 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 251 

There is no poesible question of plague being in California, as more than 90 autop- 
iee have been performed upon those who died of plague. The pressure brought to 
ear by 21 States and Territories represented at the recent conference at Washmgton 
M placed California in such a position that she is about to admit openly the 
ratence of pli^ue. We feel that this is the first step toward its suppression. 
It 18 the earnest request of the State board of healtn that the accompanying order 
f Quarantine be again placed in the hands of every agent in the State of Colorado, 
na that they be enjoined to rigidly enforce the order. 
Kindly let us hear from you at your earliest convenience, and oblige. 
Yours, truly, 

J. X. Hall, Secretary. 
The General PAassNOER Aoent, 

Union Pacific RnUroad^ Oily. 



The Denver and Rio Grande Railroad Company, 

Denver t Colo.y February 6, 190S. 

Dear Sir: I am in receipt of your favor, Februarv 4, inclosing copy of resolution 
Bflsed by the State board of health in regard U) the transi)ortatiou'of Chinamen, 
ith the view of preventing the introduction of the bubonic x)lague into the State of 
olorado. 

It is the desire of the Denver and Rio Grande Railroad Company to aid in this 
atter to the fullest extent necea-ary to prevent the introduction of the disease, but 
hardly feel that the requirements net forth in vour letter, that the order be placed 
, the hands of every agent of the Denver and ilio Grande Railroad in the State of 
Dionuio, is necessary to accomplish this end. 

As I understand the situation the bul)onic plague exists only in the State of Califor- 
a, and under Mr. Tyler's former order, dat4xl May 28, 1900, of which you inclosed 
•py, we arranged with him tliat we w^ould instruct the general passenger agent of 
le Southern Pacific Company, which company alone sells tickets from California 
a our line, not to sell any tickets into the State of Colorado to Chinamen unless 
ery requirement of the Colorado State board of health was (complied with, and not 
pell anv tickets whatever with destination in the State of Colorado where there 
as any doubt whatever existing. 

This arrangement was accepted by Mr. Tvler as perfectly satisfactory, in view of 
»e fact that there is some Chinese travel (very little) from territory where the 
a^ue does not exist, and there is no danger whatever, for instance, on west-bound 
isaneas. 

If this method is adopted and the Southern Pacific carry it out, which they for- 
erly did most rigidly, I think all clanger will be averted. 
I would be glad to have your reply, consenting if possible to this suggestion. 

Yours, truly, 

S. K. Hooper, 
General Passenger Agent, 
Mr. J. N. Hall, 

Mce-Presidenl and Sfcretary Colorado State Board of Health, 

Chpitol Bnildingy Denver. 



QUARANTINE BY MEXICO ANT) ECUADOR. 

[Telegrams.] 

San Francisco, Cal., February SI, J 90S. 
irgeon-Creneral Wyman, Washington: 

Work of joint committee resulting in harmonious cooperation of city and State 
ealth authorities with Federal health service considered here satisfactory. If pos- 
ble please telegraph a statement of present conditions which can be published and 
low that quarantine by Ecuador and Mexico not nei'essary now. Tnis committee 
ill Bee to publication here. AIho please advise what action taken by you at Wash- 
igton regarding Guayaquil and Mexico quarantine now existing. Surgeon Glennan 
B8 seen this telegram and indorses this request. 

Frank J. Svmhbs, 
Chairman Mercantile Joint Cammittce. 



252 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

San Franciscx), Cal., February 21, l$(a. 

Sui^on-General Wyman, Washington, D. C: 

Please send statement referred to in previous telegram either through CrOTemor 
Pardee or send him similar statement for benefit of entire State. 

Frank J. Symmsb, 
Chairman MercofUQe Joint (Committee. 



Washington, February St^, 190$. 

Frank J. Symmes, Chairman Mercantile Joint CommiUee, 

San Francisco, Cal, 
Governor Pardee, Sacramento, Cal,: 

Replying to inquiry, I have to say that no case of plague has been discovered in 
San Fiincisco since December 11, nearly two and one-half months ago, and then 
only one case. Official reports show that the national. State, and city authorities are 
now working in thorough harmony under the leadership of the Federal ofioers; that 
searching inspections are being made daily in Chinatown, and proper sanitary meas- 
ures are being rigidly enforced, including radical measures for the aestruction of nit& 
Bacteriological examinations of captured rats are being made daily, and the last infected 
rat was found on December 8, since which time bacteriological examinations ha?e 
been made of 324 dead rats and none found infected. The State Department was 
requested last week to notify the Governments of Mexico and Ecuador of the satis- 
^tory conditions now prevailing and which have prevailed for some time at San 
Francisco, and doubtless this has been done, and the above facts have been mcNne- 
over communicated to the International Union of American Republics. 

Wymax. 



Washington, Febrtutry £2, 1903, 
Governor Pardee, Sacramento, Cal.: 

Telegram of to-day was sent at request of Frank J. Symmes, to whom I sent the 
same. Doubtless the State Department has wired Mexico and Ecuador as requested; 
but to-day and to-morrow being holidays, I can not so positively assert until Wednes- 
day. I thank you for the cooperation which you have given, which I am sore is 
gratifying to the whole medical profession. 

Wyman. 



Washington, February es, 1903. 
Frank J. Symmes, San Francisco, Cal.: 

Your first telegram came too late for action last evening. Have no doubt Secre- 
tary of State has wired Governments of Mexico and Ecuador as requested by Treasary 
Department; but to-day and to-morrow being holidays, can not say so positively. 
If anything further desired added to my tel^ram, wire me. Have sent same to 
governor. Please show Glennan. 

Wyman. 



[Letter.] 

Washington, February 22, 1903. 

Sir: In accordance w^ith Resolution VII, passed by the First General International 
Sanitary Convention of American Republics, held m Washinflrton December 2 to 4, 
1902, 1 beg to notify you, and through you the several Republics of America, that 
no case of plague has been discovered in San Francisco since December 11, nearly 
two and one-half months ago, and then only one case. Official reports show that 
the national. State, and city authorities are now working in thorough harmony under 
the leadership of Federal officers; that searching inspections are being made daily in 
Chinatown and proper sanitary measures are being enforced, including radical meas- 
ures for the destruction of rats. Bacteriological examinations of captured rats are 
being made dailjr, and the last infected rat was found on December 8, aince which 
time bacteriological examinations have been made of 324 dead rats and none found 
infected. 

Respectfully, Wai/teb Wyjcan, 

SargeonrQtneral, 

Sbcretary Bureau of the American Republics, 

Washington, D. C, 



PUBUO HEALTH AND MARINE-HOSPITAL SERVICE. 253 

[TelegramB.] 

Sacramento, Cal., February 22^ 190S, 

Smgeon-Greiieral Wyman, Wathmgton: 

Your dispatch announcing the satisfactory conditions as to public health existing 
in San Francisco, and showing that State and Federal authorities are working in 
thorough cooperation to maintain this gratifying state of affairs, has been received 
with much pleasore. I trust that no enort will be spared by the State Department 
to give authorties in all Pacific Ocean and other ports correct information of condi' 
tions in San Francisco, and to secure revocation of (luarantines established under mis- 
taken impreaeion as to situation. 

Geo. C. Pardee, Governor Calif omia. 



San Francisco, Cal., February 2S, 1903. 

Soigeon-Creneral Wyman, WatihingUm: 

Governor Pardee transmitted your dispatch to the legislature with the following 
meeaage to-day: *'I have the honor herewith to transmit for your information a copy 
of dispatch which has been received from Sui^eon-General Wyman, of the Public 
Healu and Marine-Hospital Service of the United States Government. If you will 
observe this dispatch shows that the United States authorities believe the health 
oonditions in San Francisco are now satisfactory, and they have proceeded to com- 
municate a knowledge of the actual situation to the government of countries which 
Qnder a misapprehension had established quarantines against ships sailing from that 
port. The showing thus made is one which the people of California can regard with 
considerable satismction, and I believe that the policy of cooperation between the 
Federaiy State, and municipal governments is being justified by results." 

Glennan. 



San Francisco, Cal., February 24^ 1903, 
Snrgeon-Greneral Wyman, Wa&hingUm: 

Your statement has had general publication, but full cooperation of the press is 
difiScoU to obtain. I have nothing turther to suggest, but anxious for positive infor- 
mation on the requested action of Secretary of State. 

Frank J. Symmes, 
Chairman Mercantile Joint Committee, 



Washington, February 25, 1903, 
Frank J. Symmes, San Francisco, Cal,: 

Am informed at the State Department that telegrams were sent to Mexico and 
Goayaquil February 20. 

Wyman. 



[Letter.] 



Treasury Department, Office of the Secretary, 

Washington, March 10, 1903. 

Sir: I have the honor to inform you that this Department is in receipt of a request 
from the commercial bodies of San Francisco, Cal., that steps be taken looking to a 
removal of restrictions placed by Sidney, Australia, on vessels from San Francisco 
for that port on account of bubonic plague. 

The Sui^geon-General of the Public Health and Marine-Hospital Service states that 
while it is impossible to make absolute statement to the effect that no infection may 

Set be found in Chinatown, San Francisco, none has been found for three naonths. 
fo infected person has been found since December 11, although an inspection has 
just been completed of the whole district, and no infected rat has been found since 
December 8, althoQgh all obtainable specimens have been examined. 

He farther states that the national. State, and city authorities are working in har- 
mony; that sewers are being flushed and streets swept frequently and sprinkled with 



254 PUBLIC HEALTH AND MABJLNE-HOSPITAL SEBVICE. 

bichloride of mercury solution, and that rat poison has been placed in all the sewen, 
and believes therefore that an inspection of vessels on arrival should be sufficient 

In view of the alxjve statement of the Surgeon-General, I have to request that tel- 
egraphic information of these facts may be sent to the consular officer at Sidney. 
Respectfully, 

L. M. Shaw, Secretary, 
The Secketary of State. 

ANOTHER CASE OF PLAGUE. 

From February 10, 1908, the joint work of inspection and disinfec- 
tion continued effectively and uninterruptedly. 

Upon March 17 a Japanese woman died at 520 Dupont street in the 
Japanese district adjacent to Chinatown. The bacteriological exami- 
nation confirmed the cause of death as plague. This was the first case 
found from December II, 1902 — an interval of ninety-six days. This 
small Japanese district was immediately included in a house to house 
inspection and disinfection where required. No more cases were 
found. 

The necropsy report in this Japanese case was as follows: 

[Letter.] 

San Francisco, Cal., March 19, 190S. 

Sir: Referring to my telegram ** Provisional diagnosis of plague in case necropoed, 
bubo-septi(«*mic, Japanese female. Originated in San Francisco. Present: Ducton 
O'Brien, Gardner, Morrow, Woolsey, Mathewson, Wilson, Yost, Blue, Currie, and 
myself," dated March 17. I have tlie honor to further report as follows: Mrs. Ai 
Minegiahi died at 520 Dui)ont street; was necropsied March 17. This case was not 
seen clinically by this office. 

This case developed in the Japanese district upon Dupont street between Calif omia 
and Pine, immediately adjoining Chinatown. Our corps of inspectors and disinfect- 
ors are now covering this Japanese territory. 
Respectfully, 

A. H. Glennan, Surgeon, 

The Surgeon-General Public Health and Marine-Hospital Service. 

[Inclosure.] 

Mabcit 17, 1903. 

Mrs. Ai Minegishi, age<l 20 years; died at 520 Dupont street; cause of death, 
plaeue. 

Necropsy by Asst. Surg. Donald H. Currie. 

Woman dieH March 16, 1903; autopsied March 17. Present: Sura. A. H. Glennan, 
Passed Asst. Surg. Rupert Blue, Drs. Chester H. Woolsey, L. S. Schmitt, F. P. Wil- 
son, Matthew Gardner, A. P. O'Brien, Howard Morrow, and Carleton Mathewson. 
Body that of a well-nourished Japanese female, about 20 years of age, Rigor mortis 
fairly well marked. Slight post-mortem lividity. Sclera very slightly injected. 
Pupils moderately contracted. No glandular enlargement noted in either axilla or 
in cervical region. No glandular enlargement noted on palpation in the right 
inguino-femoral region. In the left inguino-femoral region inspection shows an area 
about as large as the hand, of a light-yellow color, due to oedema, as is shown by 
pressure causing pitting in this region. There is a feeling of resistance in the tisAit^ 
of this area, but no glandular enlargement can be noted on palpation. IndMon 
carried through this and an enlarged hemorrhagic gland found. While attempting to 
enucleate this a large, broken-down gland discharges its contents into the incision. 
Just above this another similar nei^rotic, very much congested gland, is found and 
smears made from it. Smears from this gland show a number of doughnut-ehaped 
bacteria, together with a great number of other disint^rated bacilli. Autopsy 
postponed for half an hour to notify Doctor Gardner and Doctor O'Brien. These 
gentlemen l>eing present, it is resumed. Long median incision made. Subcu- 
Umeous fat very well pn^served. Mu.sdes dark red in color, fairly moist. Peri- 
toneal cavity opened. Intestines slightly dintonded and bulging to the level of 
the abdominal opening. Spleen removed without difficulty; enlai^ged to about 
twice its normal size. Capsule very tense, of a uniform reddish color, showing 



PUBLIC HEALTH AlV^D MABINE-HOSPITAL SERVICE. 255 

no 8nbca|>su]ar nodules. The consisteiicy of the oi^n is soft, cuts easily; cut 
sarface fairly rich in blood, showing slight bulging; of the pulp and enf^orgement 
of the vessels, some prolwibly representing hemorrhages. No connt^'tive tissue 
increase. Liver visible two finger breailths below the costal Iwrder, barely visible 
in the inammary-umbilical line. Glands back of the jH^ritoneum enlarged,' hemor- 
rhafpc and necrotic. These glands are removed in part. Thorax opene<l by removal 
of ptenium. Costal cartilages slightly ossified. Richt lun^ retrat^ted; cut'border of 
the left lung extends slightly beyond and towanl the median line. Left lung d<K»s 
not completely collapse, anteriorly is adherent at the ai)ex, adhesions lx*ing soft 
anrl fresh in character. Organ removed from the thorax. St>m('what enlarged, does 
not c«jI lapse completely, pita slightly on pressure, deficient in crepitiition, moderately 
firm ill consistency. Cuts easily; cut surface of lower lolx*, preijsjuv caust^s l)loocl, 
geruiii, and air to exude in the usual pro[X)rtions, conilition )K>ing terminal (edema. 
There is no evidence of pneumonia. Pericardial sac opene<l. ( 'ontains only a small 
amount, poHsibly 15 c. c. of clear serum. Heart surface modemtd v rich in fat, shows 
one milk spot. Apex fonned chiefly by left ventricle. Rigfit vrntnclesoft and flabby. 
Left ventricle shows a less ct^nsistency than usual. IV-rirardial surface shows'a 
sliicht diffuse dilatation of its vessels, but no hemorrhages. Cultures taken from the 
heart. Left ventricle opene<i, contains a lan^re (|iiantity of post-mortem clots. 
^ght ventricle contains post-mortem clots and flui<l bl(K»d. lA'ft auricle contains 
post-mortem dots. Ri^ht auricle, fluid blood an<l post-mortem clots. lA'ftanri(^ulo- 
ventricular opening admits six glovwl fingers easily. Right auriculo- ventricular 
opening, same number. Heart removed by severing tlie vessels, hi-it heart oi)ened. 
Aorta smo'.ith, slightly staine<l; aortic valves normal; <roronary openings patulous. 
Under the endcK-anlium, left heart, arc? several hemorrhagtis. Otlu-'rwise the nmscle 
appears normal, showing no fattv or fibroid change or acute febrile degeneration. 
Left lung wlherent to pleura on all sides. Adliesions (jnit(» firm in chamcter. With 
difficulty the ot^n is removed from its cavity. The other lung lias tenninal <i'dema. 
There is a large, broken-down, semi-calcare<.>us gland |N)sterior to the me<.liastinum, 
evideutl^r tubercular. The pleura of the right lun>^ is thickene<l and corrui?ate<l 
through its whole surface. Oi^n is finn, esi>ecially in nodules, these nodules rxMng 
most numerous about the apices of the upper and lower lobes, (.'uts with con- 
siderable resistance; cut suriaw shows numerous miliarv tul)ercles, e8i>ecially of 
the upper lobe, also connective tissue increa.'H>, the condition being fibroid phthisis. 
There are several calcareous de|)osit«. Left kidney removed. Fattv cai)sule fairly 
well preserved. Immense hemorrhage between the fatiy and fi()rou8 caj)8ules. 
Fibrous capsule strips off readily, leaving a smooth, pinkish >eIIow surface in 
which the stellate veins show up prominently, giving the organ a general bluish- 
red color. Organ increased in size. Cuts easily; cut surface ri<'h in blood. 
Contrast between cortex and pvramids well retained. Cortical bonier nonnal in 
breadth. Organ has a generaf light-creamy color, mixed with the normal red, 
probably an early stage of cloudy swelling. Liver remove<l without ditticultv. 
About normal in size for the individual, of a mottled light-yellow and re<ldisfi- 
brown «!olor; rather soft in ('onsistenc^; lower border not thickened. Cuts easily, 
without grate. Cut surface fairly nch in bloo<l, i)resenting two ap[)eanmces, 
one being roughly confinetl to the upper portir)n of the left lol)e and t\w other 
to the lower. The upper is lK»iled, light yellow, structureless in appearance — 
cloudy chancre. The lower differs from the upper in showing marked venous 
congestion, the difference in position probably making a difference in appearance. 
Right kidney remove<l. »Same hemorrhajft^ Ivtwet^n the fibrous and fatty cap- 
snles and under the fibrous capsule exists in this and es[>ecially the former. 
Fibrous capsule stripe off rearlily and leaves the same surface, with the i)osFible dif- 
ference that the stellate veins are not as prominent as in its fellow of the opposite 
side. The cut surface presents the same pictun* as its fellow of tht^ opposite side. 
Smear from the spleen shows large numl)ers of cocco l)acilli, taking a bii)olar stain 
when stainetl with thionin, occurring singlv. l>toma<'h opened. I)ark-brown fluid 
flows; odorless. Mucosa shows nothing abnormal except vascular dilatation and 
possibly some hemorrhages. There are numerous signs of l)eginning digestive 
destruction of the mucosa. Intestines not injected; very slightly distended. The 
glands in the mesentery show slight enlargement and injection, but so slight that 
the possibility of its being the primary bul>o can l>e ex(4ude<l. Incisicm made over 
the right inguino-femoral region; found to be <lry and shows neither ccdema nor 
enlarged glands. Incision carried over the right axillary region; nothing abnormal 
noted. Left axillary region, nothing abnormal note<l. Anatomical conditions met 
with: Dilatation of the heart; tubercular infiltration of riglit lung; pulpitis of sj)leen; 
cloudy swelling of liver and kiilnevs; htmiorrhage into the caiwule of the kidneys; 
polyadenitis, especially of the left injrui no-femoral region. Cause of death was con- 
firmed by bacteriological examination. 



256 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

MEXICO AGAIN QUARANTINES. 

Early in March, 1903, Mexico again instituted quarantine a^inst 
San Francisco at her Pacific ports. 

The following correspondence indicates the conditions and the action 
taken by the Service in the matter: 

[Letters.] 

United States Senate, 
Washington, D. C, March 18, 190S 

My Dear General: Last week you kindly informed me that you nad the State 
Department wire to Mexican authorities that no plague or other infectious diseifle 
prevailed in San Francisco. I so advised our people in San Francisco, for whidi they 
expressed high appreciation of your efforts to remove this stigma from the commerce 
of their port. It seems, however, that the Mexican authorities of the west coast ports 
have not been advised by their superior officers in the City of Mexico, or, if so. they 
have failed to act, as you will see from the inclosed copy of telegram received ths 
morning. 

Kindly inform me by bearer if you have any further advices relative to the matter, 
that I may wire to San Francisco, and oblige, 
Yours, very truly, 

Geo. C. Perkins, U. S. 8. 
Surgeon-General Walter Wyman, 

Public 'Health and Marine-Hospital Service. 



[Inclusure — Telegram.] 

San Francisco, Cal., March J7, 190S. 
To Hon. Geo. C. Perkins, 

United StcUes Senate: 

Curacao idle since December. Have almost daily informed Mexican authorities 
health conditions San Francisco do not warrant quarantine against this port. March 
14 received telegram from Mexico reading: "As San Francisco has pls^gue, imposBi- 
bie remove quarantine.*' Rear-Admiral Glass telegraphed from Acapulco to-dar 
asking \(. Curacao would sail Magdalena Bay. Answer: " Mexican authorities will 
not permit Curacao call at scheduled ports without intolerable restrictions, which 
health conditions San Francisco do not warrant. Unable obtain redrej^. Can not, 
therefore, say when vessel will sail." We earnestly appeal to you endeavor remove 
this serious embargo on our commerce and unwarrantea aspersion on our healths. 

J. F. Lawless, 
Manager Pa^fic Coast Steamship Company. 



Washington, March 19, 190S. 

Dear Senator Perkins: I have this morning received a dispatch from our officer 
in Mexico City, dated March 18, in which he says Doctor Licea^ president of the 
superior boarcl of health of Mexico, Ihas recommended the raising of quarantine 
against San Francisco. Favorable action will be taken shortly. 

Very sincerely, yours, Walter Wyman, 

Surgeon- GeneraL 
Hon. George C. Perkins, 

United States Senate. 

C50NTINUATI0N OF INSPECTION AND DISINFECTION WORK IN CHINESE 

AND JAPANESE QUARTER, SAN FRANCISCO, CAL. 

The inspection and disinfection work was prosecuted in the Chinese 
and Japanese districts without further incident or opposition, and in a 
very satisfactory manner. 

A summary of this work from February 10, 1903, until June 30, 
1903, is appended, as is also the report of Passed Asst. Surg. Rupert 
Blue for the fiscal vear ended June 30, 1903. 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 257 

[Telegram.] 

Bakebsfield, Cal., April ^f 1903. 
iT^geon-General Wyman, Wathingion: 

B4ein8pected Fresno Satorday with Foster, secretary State board health; Bakers- 
^Id Snnday. Returned San irancisco to-night. 

Glknnan. 

[Letter.] 

San Francisco, Cal., May 4, 190S, 

Sir: I have to report that with the commencement o! the joint inspection and 
Isiiifection work in this city I devised a plan b^ means of rough diagrams to show 
le daily progress of the work in the infected districts by means of colored pencils. 
he first solid shading showed the daily work of inspection from block to block until 
le Chinese and Japanese districts were entirely covered. Following this came the 
ork of disinfection, which was extende<l to wider limits. I inclose a copy of the 
>inpleted diagram, showing the work from February 10 to April 30, 1903. Two 
>iiiDlete house-to-house inspections of this district have been made in that time, 
eeidee irregular ni^ht and day inspections to any points where suspicion was 
irected. Valuable mformation has been furnished by our night sanitarv insi^ector. 
'he first disinfection consisted of strong English chloride of lime, whicn has been 
sed twice over the whole district in the basements, area ways, allevs, and even up 
1 the third an<l fourth floors. This was followed by 5 per cent solution of strong 
arbolic acid, useii with a hand force pump, hose, and sprinkler. The rat poison, 
onsisting of phosphorus paste, has he^n used in large quantities in all the sewers 
rona Powell street on the west to Montgomery on the east and from Broadwav to 
(ush street. In addition, a numl)er of trails are also used. It is a fact, noticed by 
be inhabitants themselves, that rats, flies, and fleas have l)een remarkablv decreased 
a this district, more so than ever before in the memory of the place. The board of 
(ublic works and the city board of health are continuing the destruction of the old 
rooden rookeries, which obstruct the rear areas and alleys, and this is being followed 
ip with whitewashing, plumbing, and concreting. It is generally believ^ that all 
his work is now showing results, and it will be continued mdefinitely upon the same 
inee. 

Respectfully, A. H. Glknnan, 

Surgeon, 
*o the Surgeon-General, Public Health and Marine-Hospital Service. 



[Telefirrams.] 

San Francisco, Cal., Aprils, 190S, 
•ui^geoD -General Wyman, Washington: 

New State board of health, organized at Sacramento April 1, elected M. Gardner 
^resident, and N. K. Foster secretary. Adjourned so meet at San Francisco April 2. 
Visited Servic^e laboratory, on Merchant street, in a body. 

Inspected Chinatown and passed vigorous resolutions indorsing the present joint 
fork of Federal, State, and municipal authorities under direction of the Service. 

Glennan. 



San Francisco, Cal., April 18^1903. 
turgeon-General Wyman, WashingUm: 

Dr. Matthew Gardner, president of the new State board of health, died this morning 
fter an operation for appendicitis. 



BEIN8FECTION OF STOCKTON, CAL. 

[Telegram.] 

San Francisco, Cal., May 8^ 190S. 
aiigeon-General Wyman, WaMngton: 

I reinspected Chinese quarters in Stockton, Thursday, accompanied by Foster, 
ecretuy State board, and City Health Officer Davis. 

Glennan. 

H. Doc. 338 17 



258 PUBUC HEALTH AND MARINE-HOSPITAL 8EBVICE. 



INSPECTION OF CHINESE SHRIMP CAMPS AT SAN PABLO BAY, CALIFORNIA. 

8an Francisco, Cal,, May 11, 1903. 

Sir: I have the honor to inclose herewith report of Asst. Surg. Donald H. Corrie 
of an inspection of the Chinese shrimp camps situated on San Pablo Bay, these 
camiw bemg located near Ross Station, where Doctor Currie was temporarily read- 
ing. I directed him to take one of our Chinese interpreters and make this investiga- 
tion of these shrimp camps. The report shows that these pla<«s are in fair sanitary 
condition and that no danger is to be apprehended from them. 
Respectfully, 

A. H. Gleknan, Surgeon. 

The SURGEON-CiENERAL, PUBLIC HEALTH AND MaRINE-HoSPITAL SeRVICB. 

[iDClOBUrt.'.] 

San Franciscx), Cal., May 5, 190S. 

Sir: I have the honor to make the following report on my trip of inspection to the 
Chinese shrimp camps situated on San Pablo Bay. In compliance with your instnic- 
tions, I, together with Chinese Interpreter Fong Dont, on April 20 procured two sad- 
dle horses at Sun Rafael and visited these camps. They are situated alx)ut 6 miles 
due east of San l^fael, on the beach, at a point 2 milei^ above where the main c^oonty 
road strikes the bay. The first shrimp camp wo reached is situated on a narrow, 
sandy, gently sloping beach, just at the foot of a bluff some 50 or 60 feet in height. 
The inhabitants appeared to be somewhat alarme<l at first at our sudden arrival, 
probably taking us for their natural enemies, the Fish Commission men, but upon the 
interpreter explaining they became extremely friendly, showing us ♦hroueh all the 
buildings and rooms, answering questions, and even volunteering the information 
that another camp was located about 1 mile south of them, a fact I had not pre- 
viously heard. W ithout going into unnecessary details, this camp is composea of 
two buildings used as living quarters and five buildings used as storehouses, a wharf 
consisting of a few ])iles across which rough boards had been nailed (a poor structure, 
but one incapable of harlwring rats), and a Chinese junk tied to this wharf, the lat- 
ter for use during the fishing season, which l)egins May 1. 

The buildings and grounds about this camp were iii a surprisingly cleanly condi- 
tion, and with the exception of the occasional smell of opium smoke there were no 
disagreeable odors anywhere noticed. The sewage is deposited directly into the bay, 
where evidently the combination of the tide and the outgoing current of the Sacra- 
mento River remove it completely, for I saw no evidence of filth of any kind having 
been washed ashore. During the active season, however, I have no doubt that owing 
to the large quantities of shrimp that are dried on the l^nk preparatory to being 
ground and shipped to China, the lack of odors would not be so noticeable. At the 
time of my visit there were 6 men and 1 woman living at this camp, and these 
informed me that this was the regular working force enga^d here, and tnat the only 
increase that occurred during the active season was a few professional gamblers that 
operated in the lareer camp to the north of them. This statement I do not vouch 
for, but it was confirmed at all the other camps visited. 

From there we walked south for a mile along the (*oast (the trail being inaccessihle 
for horses), and reached the camp farther south, of which the inhabitants of the 
first camp visited had informed us. This camp was found to consist of 32 buildings, 
mostly ased for storing nets and shrimji, and employing a force of 17 men. Except 
for size the conditions were identical with those met witn in the camp just described, 
namelv, an irregular group of rough, boanl, fine-story buildings, having no cellar, 
and slightly raised from the ground. From there we turned north, walking up the 
coast pa.«t the first camp visited, and soon reached camp No. 3. The third camp wc 
found to consist of 27 of the same kind of boanl shanties, and three or four wharves 
and junks identical in ay)pearance with those alrea<ly described. Most of the shan- 
ties were used as storehouses, probably 80 per cent, the rest as living quarters, com- 
mon kitchens, etc. This camp employs 32 males and 2 females. In addition to the 
other structures mentioned, this camp has a joss-house and a fan-tan joint. 

AVhile inspecting this place, I endeavored to ascertain what was done with the sick 
and dead. This is a delicate question from the Chinese standpoint and one that they 
are not fond of discussing, but finallv one old man was persuaded to inform as that 
for the pa.st two years (the time he had been a resident of the camp) no death had 
occurred, owing to the fact that all sick were sent to San Francisco, where they 
remained until death or recovery took place. While visiting this camp I found one 
living house closed, and was informed that the owner had gone to San Frandsoo a 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 259 

Bw days 1)efore and that he was unwell. About a week later we necrotinied this 
ime individual at the moisue at 641 Merchant street, he having died in tho Chinese 
taurter of San Fancisco. This incident would appear to l)ear out the old man's 
tatement. From there we visited the fourth camp, distant about two miles from 
be camp farthest south, and found 22 buildines, with a population of 23 men, 
! vomen, and 1 lx)y about 10 years of age. The hygienic conditions met with here, 
18 well as its arrangement and structure, were the same as the others. I did not find 
lease of sickness of any description during this inspection and only one man in 
)ed. I examined him and found his statement, that he ''had been smoking and 
ns asleep/' to be correct. 

The water used in these camps, I was told, is obtained from wells. This state- 
Dent I did not investigate, as the Chinaman boils all of his water that he uses for 
Irinking, and even if he did not, it was of no importance from a plague standpoint. 

I would conclude from what I saw at these camps that at present there is no mfec- 
bos disease among them; that the only probable way by which pla^ie could ever 
e introduced there from San Francisco is by means of rats carried m goods from 
hinatown on the before-mentioned Chinese junks, but from the nature of the sur- 
mnding locality I think it would be a very difficult matter to infect these settle- 
tents with plague. 

Respectfully, Donald H. Currie, 

Asdstant Surgeon, 
Surg. A. U. Glennan, 

Public Health and Marine- Hospital Service ^ San IiYanciscOj Cul. 



R. N. K. FOSTER DELEGATED TO ATTEND CONFERENCE OF STATE BOARDS 
OF HEALTH WITH THE PUBLIC HEALTH AND MARINE-HOSPITAL 
SERVICE. 

[Letter.] 

San Francisc-o, Cal., May 15 y 190S, 

Sir: At a meeting of the California State lx)ard of health held in Sacramento, May 
;, 1903, Dr. N. K. Foster, secretary to the l)oard, was delegated to attend the annual 
mference of State boards of health [with the Public Health and Marine-nospital 
?rvice] to be held in Washington, June 3, 1903, with suitable instructions and 
Barances from the l)«)ard. I inclose official copv of resolutions adopte<l at the same 
leetin^ of the board in regard to the strict enforcement of sanitary regulations in 
le Chinese quarter of San Francisco, Cal., and the ultimate disposition of this alien 
istrict. 

Respectfully, A. H. Glbnnan, 

Surgeon. 
The Surgbon-Gbneral, Public Health and Marinb-Hospital Service. 



[Incloeure.] 

At the meeting of the State board of health held in Sacramento May 11, 1903, the 
>llowmg resolutions were unanimously adopted: 

Whereas the presence in the heart of a great city of a laige alien and unassimilable 
opulation is a constant and serious menace to the health, commerce, and industries, 
ot only to the city itself but also of the State and even the nation at large: There- 
)jre be it 

Resdvedf That this board unqualifiedl}^ approves and ur^es the removal of China- 
3wn from its present site in San Francisco to some outlying and i8i>lat*'d district, 
rhere under new conditions strict sanitary regulations may be enforced, l>oth in 
egard to erection of buildings and their occupancy, and where if necessary strict 
aaiuntine may be enforced without prejudice to local interests. 

Resolved, That pending such removal, in addition to the measures at present 
mployed, the inhabitants of Chinatown, if legally possible, be removed from all 
nderground and other tenements not freely accessible to light and air. 

Refolred, That the attorney of this board be, and is hereby, instructed to inform 
8 fully, and as early as possible, what procedures would be necessary to accomplish 
beee purposes with the greatest certainty and the least delay. 



260 PUBLIC HEALTH AND MARINE-HOSPITAL 8EKVIGE. 

Besolvedy That the eecretary be instructed to furnish copies of these resolutions to 
the board of liealth of the city of San Francisco, the United States Marine-Hospital 
Service, such public bodies as may interest themselves in the sanitary conditioiis of 
San Francisco, and to the public press. 

M. Rbgensbitr(;er, Premdad, 
N. K. Foster, Secretary. 

ECUADOR AGAIN QUARANTINES. 

[Telegram.] 

San Francisco, May 12^ 190.$. 
Surgeon-General Wyman, Wn»hinglon: 

Ecuador a^ain quarantined aeainst California. Important to remove same at once. 
Please take necessary steps and wire us results. 

Frank J. Symmios 
Chaimum Mercantile Joint CammiUee. 



Washington, May 16, 190S. 
Frank J. Symmbs, 

Chairman Mercantile Joint Committee y San Francisco, Col.: 

Have taken up matter of your telegram with State Department. Favorable reBoits 
expected. 

Wyman, Surgeon- General 



Washington, May £S, 1903. 
Frank J. Symmes, 

Chairman Mercantile Joint CommitleCy San FrancvfcOy Cal.: 

State Department wired legation at (fuayaquil a week ago to protest a^nst qtla^ 
antine, and Secretary of Treasury has requested Secretary of State to w^ire again a 
further protest. 

Geo. Purviance, Acting Surgeon-General. 



Department of Statib, 
Washington, June 2, 190S. 
Mercantile Joint Committee, San Francisco, Cal.: 

Our minister to Ecuador cables that quarantine now in force will be abolished to 
vessels leaving San Francisco on or after June 16. 

Frank B. Loomis, 
Assistant Secretary. 

SATISFACTORY ATTITUDE OF GOVERNOR AND STATE BOARD OF HEALTH. 

[Letter.] 

San Francisco, Cal., May 36, 190S. 

Sir: I have the honor to report that, accompanied by Doctor Blue, I had a con- 
ference yesterday. May 25, with Governor Pardee, at the capitol, Sacramento, in 
order to introduce Doctor Blue to the governor and have him in thorough touch with 
the situation, (lovernor Pardee statea emphatically that the State of C&lifomia owes 
us a <lel>t of gratitude for the present condition of affairs, and gave strong assurances 
that he would support Doctor Blue in anything which he desired and that the pres- 
ent work would be continued throughout the year, and additions made if necessary. 
He also stated that the case of plague reported March 17 was acknowledged arid 
reconle<i in the printed monthly circular of the California State board of health, for 
the month of March, 1908, and if any future cases were discovered they would be 
printed in the monthly circulars of the State board. It seems to me that the present 
attitude of all the State authorities is everything that could be desired. 

On this same day he appointed Dr. F. G. Ainsworth as a member of the State board 
of health, to till the vacancy cAU^^ed by the death of Dr. Matthew Gardner. I per- 
sonally knew Doctor Ainsworth at Ix)s Angeles, where he was the local euroeon of the 
Southern Pacific Railroad. He is now chief sui^geon of the Southern Pacific Railroad 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 261 

It San Frandflco. He is a brother of Brigadier-General Ainsworth, U. S. Armv, 
[ihief of the Record and Pension Bureau at Washington, I). C. He stands all right 
» the diagnosis of j)lague, and I believe his appointment as a member of the S&te 
board of health a g€Nod selection. 
Respectfully, 

A. H. (iLENNAN, Surgeon, 



[Inclosure.] 

XTRACT FROM MONTHLY CIRCULAR OF THE CALIFORNIA STATE BOARD OF HEALTH FOR 

MONTH OF MARCH, 1903. 

Reports for March from 28 cities and towns, aggregating a population of 881,235, 
low a mortality of 1,454 or a monthly death rate of l.(>5 per thousand. 

The general health conditions are favorable. Consumption, pneumonia, and heart 
isease are still the most prevalent causes of death. Smallpox has been quite prev- 
lent, but is responsible for but one death. 

The work of cleaning up and disinfecting the Chinese and Japanese quarters of 
ftn Francisco is still goin^ on. The local and State boards of health are working in 
>njunction with the United States Public Health and Marine- Hospital Service, 
ader the general direction of Dr. A. H. Glennan of the latter Service. The woo<ien 
Tuctures which obstructed the light and air entering the main buildings are being 
>m down. The doctors daily make a tour of inspection, visiting the sick. The 
aildings and cellars are l)eing disinfected with lime and carbolic acid, the streets 
nd alleys washed with bichloride solutions. Sewers are frequently flushed, and 
le rats are being exterminated. Evervthing that sanitary science can suggest and 
loney can do, is being done to put Chfnatown in a healthful condition. 

On the 16th of March, a Japanese woman was discovered sick on the eilge of China- 
3wn with suspicious symptoms. The place was thoroughly disinfectea and quar- 
ntined and all clothin|; aestroyed, ana a partial diagnosis made of plague. The 
utopsy and bacteriological examination proved it to be such. Forty-ttree days 
ave passed since its discovery, with no more cases appearing. 

SURGEON GLENNAN RELIEVED BY PASSED ASSISTANT SURGEON BLUE. 

Surgeon Glennan having been relieved from further duty in the 
>tate of California in connection with the plague situation, turned over 
he management of affairs to Passed Asst. Surg. Rupert Blue, Public 
lealth and Marine-Hospital Service, and departed May 30, 1903, 
inder orders to report for duty at the Bureau. 

Nothing of particular importance occurred during the balance of 
he fiscal year, and the inspection and disinfection work has been 
uninterruptedly prosecuted, l)oth in the tiapanese and Chinese quarters, 
md later the work was extended to the so-called Latin quarter, which 
mmediately adjoins the Chinese district. Following is the report of 
Passed Asst. Surg. Rupert Blue, of the transactions of the Service 
luring the fiscal year: 

Report of Passed Asst. Surcj. Rupert Blub. 

U. S. Public Health and Marine-Hospital Service, 

^ORATORY 641 Merchant Street, 
Sa7i Francwco^ CaL^ AnguH 7, 1903. 

Sir: I have the honor to submit the following report of the work 
)f this station for the fiscal year ended .lune 30, 1903: 

There were 454 deaths among the Chinese of San Francisco during 
,he year. Deducting from this number 2G deaths classed under the 
lead of " violent" would give a mortality of 428 due to natural causes. 
In estimate based on an average population of 13,500, would show an 



262 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

annual death rate of 31.70 per thousand, a mortality that does not 
appear excessive when it is remembered that many of these deaths 
occurred among invalids sent in from other towns and cities for treat- 
ment, and among others while temporarily sojourning in San Fran- 
cisco for various pui'poses. Following is a transcript of the r^s- 
tered deaths among the Chinese since 1897, taken from the reports of 
the city statistician: 



'. 






Year. 


Deaths. 


Year. 


Deatlii 


1896-97 


462 
454 
548 


1899-1900 




1 897-98 


1900-1901 


1898-99 


1901-1 902 







MORTUARY STATISTICS. 



The number of deaths due to infectious and contagious diseases for 
the year under review was as follows: Tubercular oiseiise, 178; diph- 
theria, 1; influenza, 1; typhoid fever, 5; bubonic plague, 36. 



NECROPSY REPORT. 



Number of dead examined, 462; number of necropsies, 175; number 
passed, not recjuiring necropsy, 289; number of bodies showing plague 
infection (Chinese 36, Japanese 1, white 1), 38. (See List of cases, 
Exhibit C.) 

Taking into consideration the general conditions under which the 
early part of the work was conducted the situation with regard to 
plague would appear favorable. While there has been an increase of 
cases from 24 in 1901-2 to 38 in 1902-3, no extension of the disease to 
other sections of the city has occurred. The lateness and mildness of 
the rainy season in the fall of 1902 may account in part for this increase 
in the number of cases. But two deaths occurred between December 
11 and June 30, namelv, in a Japanese woman, March 16, and a China- 
man, June 5. It will be seen that an interval of ninety-five days 
elapsed between the case of December and that of March. This, I 
believe, is the longest intermission yet to occur between cases. Our 
experience and the experience of others in similar work in other places 
lead us, however, to oe conservative, and we do not know how much 
importance to attach to the seeming favorable conditions. 

Plague mortality among rats, which began in November, ceased 
early m December and did not again appear during the year. No 
doubt the disappearance was due largely to the energetic measures 
pursued for their extermination. These measures consist in trapping 
and in wholesale poisoning, the poison (phosphorus bane, as a rule) 
being placed in the sewers in and surrounding the infected district. 
Later, when large quantities of chloride of lime and carbolic acid were 
used in disinfecting, the rats and other vermin xyere probably driven 
off to adjacent districts. 

THE COOPERATIVE PLAN. 

With the inauguration of Governor Pardee in January began the 
present cooperative regime in regard to the eradication of plague in 
California. A new State lx)ard of health was appointed in March, 
whose members, without exception, recognized the existence of infec- 
tion in Chinatown, and who joined in the cooperative work which 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 263 

involved the adoption of more radical measures than had hitherto 
been practicable. Early in February, all discordant elements having 
been harmonized, a preliminary plan was drawn up and signed by the 
Iftte Dr. M. Gardner for the State, Health Officer A. P. O'Brien for 
the city, and Surg. A. H. Glennan for the Marine-Hospital Service. 
This plan (see appended copy) provided for the appointment of a force 
of medii^l and sanitary inspectors and a corps of disinfectors who 
were to devote their entire time to the work under the supervision and 
direction of the Service. From time to time, as occasion demanded^ 
new and important features have been added, and the force increased 
by the addition of one medical and two plumbing inspectors. 

On April 2 the State board of health, m a lx)dy, inspected the United 
States Public Health and Marine-Hospital Service Laboratory at 
64:1 Merchant street, and the joint work then in progress in Cfiina- 
town. A resolution indorsing these sanitary measures and advising 
a continuance of the same was adopted. (Exhibit B.) 

Probably the most important feature added to the original plan was 
the work of condemning and destroying insanitary wooden additions 
erected by Chinese tenants on the sides and roofs of the original 
buildings. In this way, areas, courts, and blind alleys intended origi- 
nally to supply sunlight and air, have been filled in by wooden struc- 
tures which have become, after decades of improper ventilation and 
drainage, a menace to the public health. With a strong determina- 
tion to effect the thorough cleaning of Chinatown, the city board of 
health, working with the )x)ard of public works, began opemtions 
about the latter part of March. Many of these areas have since then 
been cleaned out from roof to cellar, the dirt and filthy debris hauled 
out and burned, the ground cemented, and the walls lime washed. As 
stated, the work has progressed satisfactorily, and it is hoped that 
by the end of summer all such structures in the 14 blocks comprising 
dninatown will have been condemned and destroyed. Moreover, 
many insanitary dwellings have been vacated by order of the board of 
health until renovated and repaired. Following is the record of this 
work in Chinatown: Number of buildings vac^ated, 35; number of 
structures condemned and destroyed, 49; numl>er of plumbing 
nuisances actually abated, 109. Dunng the last six months special 
attention has been given the tributary sewers of side streets and 
alleys in which, owing to the gradient, retardation or stagnation of 
contents is liable to occur in the dry season. Frequent flushings from 
the city hydrants have been in order and in a few of them work has 
begun for the correction of such faults of construction as could be 
reached. 

INSPECTION AND DISINPEtrTION. 

Active operations for the systematic inspection and disinfection of 
Chinatown began February 10 with an organization consisting of 5 
medical inspectors and their interpreters, 2 sanitary inspectors, a doc- 
tor in charge of the disinfecting crew, and 3 sewer men. In the early 
part of the work the medical inspectors covered as nmch of the terri- 
tory as their several abilities ancl inclinations dictated, but later it was 
thought best to divide the territorj^ into districts, and to make an 
inspector responsible for but one district. This plan has worked well. 
It affords an opportunity for the inspector to know personally many 
of the people m his district, and by kind treatment and attention to 
their needs to come in closer touch with them. Daily reports on blank 



264 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVI0E. 

f o rms prepared for the purpose have been required. This report shows, 
among other things, the number of buildings and rooms, their sanitary 
condition, and the number of persons inspected during the day, a por- 
tion of the sheet being reserved for a separate report of the sick. In 
this routine way the whole district has been inspected six or seven 
times since the beginning of the work. From the reports of theae 
inspections it has been ascertained that there are 1,200 street numbers 
or entrances, 9,370 rooms, and 450 buildings in the district known as 
Chinatown. Counting the Chinese laundries and cigar factories scat- 
tered throughout the city, would place the number of buildings actu- 
ally occuj)ied by Chinese at 650. 

The disinfecting crew, under the direction of a competent physician, 
operated from house to house, beginning on the northwestern side of 
tne district, in the direction of the prevailing winds. Carbolic acid 
solution (1-20) and English chloride of lime have been used rather 
liberally in toilets, on stairs and halls, cellars, and the soil of basements 
and back areas, the solution being applied by means of a force pamp 
and hose. In some of the more insanitary places the wooden flooring 
was removed in order to reach the soil with the acid solution. The 
crew has been assisted, throughout the six rounds of the district by a 

policeman and a Chinese interpreter, who were detailed for that purpose. 

n the four months they have been working over 28,000 pounds of 
chloride of lime, 600 pounds bichloride of mercury, and 1,644 gallons 
of carbolic acid have been used. 



K 



PLAGUE IN OTHER PARTS OF THE STATE. 



In no case has the infection been traced to an outside origin with 
any degree of probability. Reports that certain cases may have orig- 
inated outside of San Francisco were based solely on statements made 
by the ChinCvSe, and such assertions, when carefully investigated by 
officers of this laboratory, have been found to be mere fabrications 
born of the erroneous belief that if suspicion were thrown on some 
other locality the home of the man and his friends in San Francisco 
would escape disinfection. There are, no doubt, other motives of a 
superstitious or mercenary nature behind these attempts at conceal- 
ment of facts in connection with the place of infection. With regard 
to other possible foci, it should be stated that several inspections have 
been made by Surg. A. H. Glennan, of all other cities in the State 
having a considerable Chinese population, but with negative results. 

The report of Asst. Surg. Donald H. Currie, the bacteriologist of 
this station, is herewith inclosed. (Exhibit D.) 
Respectfully, 

Rupert Blue, 
Passed Assistant Surgeon. 
Sukgeon-General, Public Health and Marine-Hospital Service. 

Exhibit A. 

A preliminary plan for the eradication of plague in Chinatown^ as agreed upon by Dodor 
Oaraner, personal rejyresentnlive of the governor, Dr. A. P. O'Brien^ city board of l^eallh, 
and Doctors Glennan and Blue for the United ^States Public Health ana Marine- Hospital 
Service. 

First. Dr. Matthew Gardner, representing? the State, will pay 3 medical inspectors, 
2 sanitary iiinpectors, and 2 Chinese interpreters. 

Second. The city board of health will l)egin immediately the extermination of 
rats by means of traps and poison, employing three sewer men for the parpoee. Fifty 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 265 

Lditional traps will l>e supplied for this work. The city agrees also to disinfect 
amediately all infected places, and will cause the renovation of such hahitations in 
Batiefactofy manner to the health authorities. 

Third. The city further agrees to have the streets of the Chinese district thoroughly 
irept at least three times a week, and the same flushed with water once a week. A 
er capita price will be ])aid for rats found in Chinatown. An extra effort will be 
lade for the removal of garbage and the sanitation of back areas, etc. 

Fourth. The Unite<l States Public Health and Marine- Hosj>ital Service will exer- 
ise immediate superx'ision over this work in conjunction with State and city authori- 
ie», and will furnish for the prosecution of the work a Imcteriologist and lalx)ratory, 
I meilical officers (more as neede<l), and 2 Chinese interpreters. 

Fimilly, it is agreed that all cases of plague shall l>e reported to the proper authori- 
ies. That all inspectors shall rt»port daily at 641 Merchant street, United States 
f^a^e laboratory, for instnictions; that inspectors shall l)e recjuired to make daily 
sports of their observations and the numlx^r of the sick and dead seen by them. 
their whole time shall be devoted to such duties. 

That the Chinese make every concession toward a thorough inspection of all the 
nek and dead in Chinatown. 

The above work to be continued for at least one year from date of adoption of the 
plan. 

The city board of health agrees to recommen<l to the boani of public works and to 
the board of supervisors that Dupont street l)e paved with bitumen from California 
street to Broadway street. 

The city board of health to imme<liately memorialize the board of supervisors to 
provide sufficient funds for the purpose of carrying out the obligations assumed by it 
nerein. 



Exhibit B. 

Whereas the State board of health organized in Sacramento, Cal., April 1, 1903, 
adjournal to meet in San Francisco, Cal., April 2, 1903, and in a l)ody visited the 
Unite<l States Public Health and Marine- Hospital lal)oratory at 641 Merchant 
street and inspected the same; and from there procee<led to certain points in China- 
town to view its extremely bad sanitary con<lition. Also insjKM'ted places and work 
of renovation now l^eing conducted by the city board of health of San Francisco. 

Retiofred, That this l)oard heartily approves the work of renovation in Chinatown 
now being i)rose<!Uted by the city lx)ara of health of San Francisco, and the restora- 
tion of the buildings in Chinatown to their normal condition, for the admission of 
flonlight and air between these buildings. 

And we further in<lorse the general work of inspection and disinfection now being 
conducted by the Federal, State, and municipal authorities in that district. 



Exhibit C. 
Lift of plague cases for the year ended June SOy 190S. 

68. Chin Guie, 32; July 13, 1902; 737 Jackson street; male. 

59. Leong Ngan, 27; July 18, 1902; 632J Jackson street; male. 

60. Yee Woon Chun, 56; July 19, 1902; 7.*^ Jackson street; male. 

61. Chew Hork, 45; Jul v 20, 1902; 737 Jackson street; male; pneumonic. 

62. Fimg Chin, 26; August 6, 1902; 16 Ross alley; female. 

63. (lee Pla Yen, 25; August 17, 1902; IK) Waverly place; male. 

64. Yam Ching, 45; August 19, 1902; 742 Washington street; male. 

65. Leong Toy, 45; August 19; 722 Jackson street; male. 

66. Soo Wing, 35; August 20; ^36 Pacific street; male. 

67. Quong Kuin, 29; August 22; 918J Duj)ont street; male. 

68. Lee Yin Ming, 57; August 23; ?K)9 Dupont street; male. 

69. Tang Hung Fong, 35; August 26; 1025 Dupont street; male; tonsilar; found 
Angust25. 

70. Dong Hip, 42; August 30, 1902; 605 Jackson; male; tonsilar. 

71. Lin Hea, 35; September 1, 1902; 827 Sa<'ramento street; female; found August 31. 

72. I^eong Chong, 54; Septeml)er 2, 1902; 810 Jackson street; male. 

73. Chin Mon Yung Shee, :W; Septenil»er 9, 1902; 40 Fish alley; female. 



266 PUBLIC HEALTH AND MARINE-HOSPITAL 8EEVICE. 

74. Ng. Chew Ho. 25; September 11, 1902; 730 Washington street; male. 

75. Laii Ho(!k Chmg, 58; September 10, 1902; 742 Washington; male. 

76. Chin Hong Mon, 47; September 16, 1902; 800 Washin^on; male. 

77. Lee G(mg, 48; September 20, 1J)02; 10 Waverly place; male. 

78. Huie ChongBow, 36; September 23, 1902; 808J Sacramento street; male. 

79. Mrs. Gam Fong, 51; September 25, 1902; 904 Dupont; female; found Septan 
ber 23. 

80. Chin Kung Poo, 38; September 26, 1902; 19 Prospect place; male. 

81. Hoo Chung, 38; September 26, 1902; 1018 Stockton street; male. 

82. Yee Foo Lai, 52; October 4, 1902; 724 Commercial street; male. 

83. Chew 1^(1, 28; October 5, 1902; 811 Clay street; male. 

84. Chew Mon Keock Shee, 27; October 5, 1902; 838 Dupont street; female. 

85. Wong Chew Chong, 54; October 8, 1902; 753 Clay street; male; found October 7. 

86. Yee Pang Wo, 36; October 11, 1902; 767 Clay street; male. 

87. One Yue Noni, 48; Ootol>er 16, 1902; 615 Jackson; male. 

88. Hoo Iling Hong, 47; October 16, 1902; 743 Clay street; male. 

89. Arthur W. Caswell, 33; October 31, 1902; 409 Turk street; found October 28. 

90. Wong Nj^an, 30; November 16, 1902; 37i Brenham place; male; found Novem- 
ber 19; bulK)-pneumonic. 

91. Wonglloi, 30; November 19, 1902; 7 Brenham place; found November 18; 
tonnilo-bubo-pneuuionic. 

92. Leong Sen, 50; November 26, 1902; 838J Washington street; male; bobo-pn«u- 
nionic. 

93. Deong Yuen Yum, 38; December 11, 1902; 726i Pacific street; male. 

94. Mrs. Ai Min^ishi, 20; March 16, 1903; 520 Dupont street; female; bubo-s^ 

caemic. 

95. Wong Tzse Hop, 46; June 5, 1903; 27 Brenham place; male. 



FXHIBIT D. 

PaUiological and bacteriological report. 

San Francisco, Cal., 

Auffust 7, 190S. 

Sir: I have the honor to make the following report of the pathological and bacte- 
riological work performed in this lal Moratory dunng the fiscal year ended June 30, 
1903. During this period 175 bodies were necropsied, including all doubtful or sua- 
picious cases and all cases not seen by us during life. All cases which appeared 808- 
picious at necropsy have been followed by a complete bacteriological examination. 
Of the 175 cases thus necropsied, ,*^ have been proven to have died of plague. 
During the same perio<l, of the 2,060 rats caught or found dead in the various parts 
of the city and examined bacteriolo^ically, 15 have shown pest infection. These 
latter were (liacovere<l during the period extending from November 8 to Decembers, 
inclusive. Of thenc*, 3 were founci in the Chinese quarter proper, the other 12 one- 
half block east of this dijitrict in the vicinity of Merchant street and Dunbar alley. 

The above has constituted by far the greater part of the work performed in this 
laboratory, but a number of minor experiments having a practical bearing on the 
work of eradication of plague have been performed from time to time, such as the 
testing of Danyecz's virus and several chemical poisons as to their relative efiSciency 
in the extermmation of rats, the examination of cultures and specimens obtained 
from more or less Fuspicious cases occurring in this and other States, etc. The more 
importimt of these experiments have been made the subject of special reports. 

we regret that no experiments having in view the discovery of the means by which 
plague is naturally spread from animal to animal have been attempted. Owing to 
the location and structure of this laboratory such experiments w^ould have been aocom- 
panieil by an unuHual amount of danger to the occupants of this building. 

The importance of such a series of experiments, however, if succesisful in demon- 
strating by what means the disease is spread from animal to animal, and other phases 
of its natural life history, can hardly be overestimated. In view of the fact that this 
disease is slowly but certainly spreading to or threatening almost the whole seacoast 
of the world, and that our present knowledge of its life history is extremely limited, 
without which knowledge all measures against it n»uj?t be base<l upon doubtful the- 
ories, it is not too much to say that this is one of the most important bacteriological 
problems of the day. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 267 

The methods generally employed in this laboratory art* as IoHowh: All cases dying 
n the infecte<l (listrict which have not been seen during life by one of our inspectors 
ire necropsied, as well as all suspicious or doubtful cases, whether they have t)een 
«en during life or not. The necropsies are performed in the pret*ence ol representa- 
ives of the city and State boards of health, and smears are made from the lymph 
lodes and viscera and stained with carbol-thionin. If on a<Tount of the gross patho- 
Qg:ical findings or microscopical examinations, or both, the c&i^. appears to t)e sus- 
Hcioos of plague, a^^r cultures are taken from the various organs and animals inoc- 
ilate<l by the dennic method with a portion of the spleen or gland. Pending the 
U*ath of the inoculated animal, an attempt is made to isolate H. uestls from the agar 
nilture taken directly from the human subject. This can usually be done without 
much difficulty, but sometimes it recniires fo long to accomplish this isolation that 
the inoc^ulated animal dies l)efore it has been completed, in which case we take cul- 
tures from the heart blood of the animal, and in 90 per cent of the cases these 
(nilturea^ show pure pest, even though the tissues used for inoculation contain rela- 
tively few pest bacilli and a large numl>er of other organisms. The dermic method 
is especially useful when the pest infection is accompanied by a mixture of virulent 
diplococci and streptococci. 

These two organisms frequently grow as fast or faster than B. peHis when inocu- 
lateil into an animal by the subdermicor intraperitoneal methoils und on this account 
frequently cause considerable annoyance, but since the discovery of the dormic nietho<l 
no ditticulty of this kind has been exi)erienced. The latter iiiethoil, while now gen- 
erally known, might be worth again describing. It was discovere<i by Professor 
KoUe, of Berlin, and was first published in this country in one of the United States 
Public Health Reports of August, 1902, in the form of a letter from Acting Assistant 
Surgeon Ilavelbui^, of this Service. The method is as simple as it is effec^tive. The 
belly of the guinea pig is shaved, care \mng taken not to break the skin. After wash- 
ing anil drying the latter a few drops of blood containing the bacilli are rubbed on 
the skin, using the back of the scalpel, and continuing this rubbing process until the 
blo^xl is perfectly dry. A variation frequently made in this laboratory, when speed 
is desire*!, is to scanty down to the lymphatic layer of the skin and then proceed as 
de«cril)e<l. It is found tliat when the modified method is used the animal dies more 
j»romptlv, and apparently the process of elimination of contaminating organisms is 
ulmoFt, if not (juite, as effective as when the original method is employed. In the 
originul method death takes place in from three to twelve days, with typical buboes 
and white sulx^apsular nodules of the spleen. 

In inv experience, when this method is employed with agar cultures instead of 
tiraue, tlie animal sometimes fails to sicken, probably owing to the greater difficulty 
Df rubbing the drier agar culture into the liair follicles. When a pure culture has 
been obtained by one of these methods it is carried through the ordinary media an<l 
finally into a guinea pig and a pigeon. Bacteriological test« should l>eand are made 
in eacrh case of plague or suspected plague; nevertheless it is a fact that 80 per cent of 
bubonic cases which we have seen here are as typical in their gross anatomical apjK^ar- 
uioes as are cases of chronic ulcerated pulmonary tuberculosis, and could be diagnoseil 
had the bacnlli never l)een discovered. 

I mention this fact l)ecause it is important to the general practitioner and health 
Dfiicer in places removed from bacteriological knowledge and appliances. If this fact 
was more thoroughly known by the general medical public tne chances of a case 
going unrecognized would be very much decreased. The microscopical study of one 
or two slides that some one has p\en him is far more apt to lead into error those 
untrained in microscopical examination than the relying upon the gross anatomical 
appearances, and I believe that a good description of the latter sent to the health 
Dfficers in localities where cases might occur would enable them as a rule to recognize 
the first case coming under their observation. This, of course, does not apply to 
purely pneumonic cases, but they are rare at the beginning of an outbri^ak, none of 
this type having Ix^en observed in this city up to the time of the present writing. 

All rats found dead in any of the districts before mentioned are brought to this 
lalK>ratory, where they are autopsied and examined bac^teriologically and their 
bodies burned. 

All rats caught alive are either chloroformed and examined bacterologically, or 
are placed in detention cages and ol)ser\'ed for incubation perio<i of pest; and, if 
healthy at the end of this time, they are chloroforme<l and auto])sied; if sick or dead 
they are examined Iwicteriologically, and by this last means we discovere*! two of 
the before-mentioned 15 rats showing pest infection. Both of these animals when 
brought to this lalioratory apy)eare<l to be in ])erfect health. They died on the third 
day of observation, and examination showe<l typical pest infection. 



268 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



One of the pest rata examined last November showed a condition which is interest- 
ing, and may play a part in the carryinfs: on of live cultures durin;; periods of quieec^ce. 
The rat was brought to this laboratory apparently in perfect health; was immediately 
chloroformed and autopsied; it showed a broken-down suppurating gland which had 
become completely ** walled off" from the general circulation; cultures and smean 
taken from the pus showed a pure culture of B. pestis, while cultures from the 
spleen were entirelv sterile. The animal's nutrition was apparently undisturbed. 

An interesting observation made by Asst. Sui^. M. J. White, while performing 
necropsies in this morgue, was that quite a lai^ per centum of the Chinese of this 
city are infected with the oriental liver fluke Distoma Sinense. 
Respectfully, 

Donald H. Cubrib, 

Assigtard SurgwiL 
Passed Asst. Sure. Rupert Blue, 

Public Health and Marine-Hospital Service^ San Francisco^ Cal. 

Respectfully forwarded. 

RupBBT Blue, 
Passed Assistant J^rgeon, 

The Surgeon-General, Public Health and Marine-Hospital Service. 

Summary of work of inspection and disinfection in the Chinese^ Japanese, and Latin quar' 
ters in San Francisco^ CcU,, from February 10, 1903, to June SO, 1903, 



Buildings inspected and reinspected 
Rooms inspected and reinspected . . . 
Persons inspected 



MORBIDITY REPORTS. 

Sick inspected 

Sick seen and prescribed for at Oriental Dispen- 
sary 



REPORT OP THE BACTERIOLOGICAL EXAMINATION 

OP RATS. 



Rats delivered alive at the laboratory 

Rats found dead delivered at the laboratory 
Pla^e-infected rata 



Total 

Rats showing phosphorous poisoning. 

NKCROP8V REPORT. 

Bodies necropsied 

Plajnie-infected bodies 

Bodies not requiring necropsy 



DISINFECTION. 

Places disinfected with carbolic solution and 
with chloride of lime 



Febru- 
ary. 



962 
7,310 
9,498 



143 



71 

34 





March. 



609 
3,094 
3,8S0 



162 
40 



J. 



105 



11 
26' 



142 

81 





173 



21 



17 

1 

31 



1,768 



April. 



1,126 
8,060 
8,115 



222 
40 



209 

60 





269 



May. 



904 
6.819 
6,609 



156 
41 



277 

25 





302 



25 
17 

""'si' 

3.084 



10 
5 

3,878 



June. 



724 
5,941 
5,686 



124 
54 



250 
9 




259 



12 

1 

19 



8,181 



Total 



4,225 
81,214 
33,1S8 



175 



949 

1» 




l.ltt 



66 



62 

2 

129 



11.296 



MEASURES ON UNITED STATES-MEXICAN BORDER AGAINST INTRODUCTION 

OF PLAGUE FROM MEXICO. 

The inspection service upon the Mexican border has been continued 
a£fainst the introduction of smallpox, yellow fever, and later the 
pTague, which last-named disease made its appeamnce in December at 
Ensenada, Lower California, and Mazatlan, upon the west coast of 
Mexico. Officers experienced in bacteriological diagnosis and the 
work of inspection were immediately detailed along this threatened 
border, and not an officially reported or authentic case of plague 
gained entrance to the United States. 



PUBLIC HEALTH AND MABINB-H08PITAL SERVICE. 269 

The following oorrespondence outlines the measures taken at the 
Onlifomia, Arizona, and Texas borders to prevent the threatened 
introduction of plague: 

[Note. — Service measures at infected points in Mexico are reported 
under Division of Foreign and Insular Quarantine.] 

[TelegraiDM.] 

WABHiNCiTON, Jauufiry 5, I90J, 
Dr. Edmond 80UCHON, 

Pretident Louinana Stale Board of Healthy New Orleans^ La.: 

Your telegram of the third received. Our inspectors are acting for the best interests 
of Looifiiaiia as well as Texas and other States. 

Wyman. 



Washington, January 5, 1903. 
Dr. J. A. Albright, 

Secretartf State Board of IleaHh, NasJivilUj Tenn.: 

Have official information that precautions are taken at Mazatlan, which is without 
railroad connection, and Pacific mail steamships have withdrawn from that port. 
Have a man at Knsenada, Lower California, with instructions, and expect a report 
from him daily. With regard to San Francisco, precautions are being taken by con- 
itaiit examination of Chinatown and other ordinary means of d^ing with the 
disease. Matters there are progressing favorably. 

Wyman. 



Washington, January S, IDOS. 
Gbubbs, 

{Care Decker) ^ San Diego, Col.: 

Wire full report concerning situation at E^nsenada, supplemental to your letters of 
December 18 and 22. Are the local authorities managing the situation well? Make 
reoommendation as to what the Bureau should do to protect California from Knse- 
nada. Also wire your opinion how long disease has l)ecn in Ensenada and whether 
it is probably traceable to San Francisco or China direct, or possibly to Mazatlan. 
Alter wiring await orders in San Diego. 

Wyman. 



Washington, January 7, J90S. 

Grubbs, Los Angeles, Col.: 

Nominate Alexander and place him on duty. Direct him to report frequently to 
Decker. Inform Decker names of cases, enabling him to determine if two recent 
deaths were in same family. 

PURVIANCE, 

Acting Surgeon-Oeneral. 



Washington, January 7, J90.S.. 

Dbckbb, San Diego, Cid.: 

Grubbs instructed to i>lace Dr. Alexander on duty Ensenada, with orders to report 
frequently to you. Advises that customs inspectors have all parties from Ensenada 
to San Diego report to you. Will endeavor to have this done. Meanwhile advise 
me as to practicability of customs inspection. 

Pcrvianck, 
Acting Surgeon- General. 



Washington, January 7, 190S. 

Chamber op CoannEBCE, Tacson, Ariz.: 

Have officer en route to Gua}rmaj4. Understand Mexican Government has quaran- 
tined Mazatlan, but will investigate whole situation. 

Wyman. 



270 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Washington, January 15, 190S. 
CJoLLBCTOR Customs, fikin DiegOy Cal.: 

Telegram January 14 received. Surgeon-General informs me that vessels from 
St. Denis will be carefully examined at San Diego quarantine, and must have certifi- 
cate of medical officer stationed in Ensenada as to safety. With regard to laud 
quarantine, telegram yesterday establishes same and requirements. Yesterday's tele- 
gram will be enforced till further orders from Department. 

H. A. Taylor, 

Acting Stsartary. 



Washington, January 15, 190S. 
Decker, San Diego CaL: 

Can you nominate a good physician for duty at Tiajuana? Be prepared to give 
him <'opy of article 12, Canadian and Mexican frontier regulations. Proposed now 
to have Alexander issue certificates to all seeking to come overland and give bills of 
health to vessels leaving Ensenada, which would include an inspection of personnel 
going aboard. 

Wyman. 



Washington, January 15, 1903. 
Dr. George R. Tabor, 

Stai-e Health Officer, AvMin, Tex,: 

Ensenada, Lower California, is infeirted, though but two cases reporte<l rincc 
Christmas. I have an oflicer there and have established inspection on tlie bonier. 
GuaymaH, Mexico, in rejwrted as not infected. Doctor Grubbs is there now. Mazat- 
lan is reporttMi officially as infected. 

W^YMAN. 



Washington, January 14, 1903. 
Decker, Smi Diego, CaL: 

Gruhba recommends customs inspectors at Tiajuana make careful inspection and 
make everyone from Ensenada report to you. Is this practicable? The Secretary 
has wir(»d collector of customs to have his inspectors at Tiajuana inspect all people 
from Mexico, and if anv suspicious cases report to you immcnliately. Keep in touch 
with the collector and keep me advised of the situation, and wire opinion whether 
medical officer should be sent to Tiajuana. 

Wyman. 



Washington, January 14, 1903. 

Collector of Ci'stoms, Han Di^'go, Col.: 

Instruct your two inspectors at Tiajuana to carefully inspect all passengers over- 
land in that vicinity from Mexico, with special reference to detecting any possible 
cases of infection from plague from Ensenada, and to report by every available mail 
or messenger all passengers inspected to Assistant Suria:eon Decker at San Diego, and 
if any suspicious cases are found to hold the same until Doctor Decker can he com- 
municatea with. 

\l. A. Taylor, Acting Secretary. 



Washington, January 2S, VfOS. 
Power (through Decker), San Diego, Cat.: 

Pro<ee<l to Tiajuana, where your duty will Ijo to pass upon suspicious cases. The 
customs oflicers, with whom you will cooperate and who have been directed by the 
Se<rretary to assist in quarantine, will stop at frontier all persons not certified as safe, 
and any such person whom you can not acquit by careful examination of suspicion 
should be turned back to Mexico. You will report to Decker by letter (or other 
means) your a<'tions in order that Bureau may be fully posted. Be diligent to 
prevent anyone escaping careful inspection on entry to tJnited States. W'hen you 
admit anyone not certified by Alexander certify him yourself. 

Wyman. 



r 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 271 

Washington, January 22^ 1903, 
Son DUffOf Oal.: 

Furnish copy of telegram sent Power through yon tonlay to collec^tor of customs 
r his infonnation. Ootaia aseistanee of local health authorities in seeing that none 
^;ter San Diego from lower California without certificate from Alexander or Power. 

Wyman. 



Washington, February 28, 1903, 
ILTON, Laredo, Tex,: 

Confidential at present. Assistant Surseon Francis, recently sent to City of 
^^.BAexioo, wires Bureau that Liceaga reports disease suspicious of plague at Torreon, to 
J wrhich place he goes to-day. So far as known to Liceaga only five cases outside of 
" tlan, at Oso, near Quila. Be on your guard. 

Wyman. 
Same to Huue, Eagle, Pass, Tex. 



■ Washington, February 28, 1903, 

\ ^l^KBTENBAKKR, Ncir Orleans, Tai.: 

t Turn station over to Kerr, who arrives to-morrow morning, St. Charles Hotel. 

■ ^^nfer with him, then proceed immediately to Kl Pah^o and confer with but do not 
r MQpersede Alexander. lou will supervise matters at Kl Paso with reference to j>ro- 

tbcctlon from plague, particularly if Francis wirt^s Torreon infected. Grul)l)H at 

■ Onaymas. Lumsaen ordered to Nogales as inspector of line between Yuma and El 
'"^ Important to take train to-morrow forenoon if |H)68ible. Wire arrival. 

Wyman. 



I 



Washington, February 28, 1903, 
XuMSDKN, Angel Island, Cal.: 

(Through Commanding ()fl5cer. ) 

Believed from duty at Angel Island. Proceed to Los Angeles, iiscertain imnie and 
^>ther facts concerning suspected case from Cobb, then proceexl to Phoenix to trace 
«Me. Consult with local ooard, inforiiiing tliem confidentially of situation. Wire 
Bareaa essential facts. Intention then to order you to Nogales and other Mexican 
frontier ports, particularly rail and wagon road crossings betwt^en Yuma and Kl Paso, 
tncloding both. Your duty to keep Bureau w<*ll informed u|)on danger from plague 
over Mexican border, making recommendations and submitting names if local 
mspectors are necessary, but not employing until authorized. Wire Bureau your 
intended departure from each place and arrival at next place. Must keep in tele- 

Eiphic touch. Francis, special agent of Bureau in Mexico, wires only five cases 
own to Liceaga outside of Mazatlan, at Oso, near Quila; but suspicious disease at 
Torreon railroad center. He goes there to-day. Grublw still at Guaymas. Have 
appointed inspector at Nogales. Inform (ilennan your orders. Acknowledge. 

Wyman. 



Washington, February 28, 1903. 
State Health Officer Tabor, Austin, Tex.: 

For your information, and recommend that you consider it confidential at present,. 
Assist^t Suiigeon Francis, an expert recently detaile<l to confer with authorities in 
City of Mexico, wires Liceaga states there are onlv 5 cases of plague outside of Mazat- 
lan or at Oso, near Quila, but also wires information of suspicious disease at Torreon, 
to which place he goes to-day. Have notified inspectors on border. 

Wyman. 



Washington, March 1, 1903. 
Dr. A. L. Gustbtteb, Nogales, Ariz.: 

Eniployment begins to-<iay. Full instnictions by wire to-morrow. In meantime 
wire Bareaa any information or rumors concerning plague in Mexico and state how 
many trainB a day cross the border into Nogales and average number of passengers 

per day. 

Wyman. 



272 PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 



DETAIL OF SURG. G. M. GUITERAS, TO INSPECT MEXICAN TOWNS ALONG 

THE BIO GRANDE RIVER. 

[Letter.] 

Washington, March S, 190S, 

Sir: When you have arrived at Eagle Pass, Tex., pursuant to travel orders of this 
date, you are directed to inspect the station and work of Acting Asst. Buiv. Let 
Ilume, and to confer with him regarding the possible routes of entry from Mexico 
into the United States at or near Eagle Pass, and any methods by which pUigQij 
might gain entry into the United States from Mexico over said routes. 

You will advise with and instruct him in such quarantine details and methods 
are applicable to this work. 

You should visit the Mexican town on the opposite side of the Rio Grande Bifeff. 
and post yourself fully as to its sanitary condition, so as to be in a position to meet 
any problems which may arise in the future in connection therewith. 

It IS possible that you may be ordered to proceed to other towns on the bords^ 
and should this be done, the work desired at these points is of the character i^mrt 
stated. 

It is the wish of the Bureau to obtain the fullest possible information as to com- 
munication l:)etween points, sanitary condition of these points, the possibility or 
probability of infected persons, baggage, or merchandise beinjg conveyed over the 
lines of communication between them, and any other information which may occnr 
to you as pertaining to the prevention of the introduction of plague into the 'United 
States. It is to the end tnat the Bureau may obtain this information that yoor 
present orders have been issued. 

You will, therefore, pursue research of this character at every place to which yoa 
are sent while on this aetail, unl^s spe<*ificAlly ordered to the contrary. 

You will keep the Bureau as fully posted as possible by frequent letters, and 
wherever the information is of such a character as in your opinion to justify haste, 
you will use the telegraph. Wire arrivals and departures in all cases. 
Bespectfully, 

Walter Wyman, Surgexm-GeneroL 

Surg. G. M. GriTERAs, 

PuNic Health and Marine-Hospital Service^ Philadelphia^ Pa, 
(Through medical officer in command. ) 






[Telegrams.] 

WAsniN(iTON, March S, 190S, 
LuMSDEN (care Cobb), Los Angeles, Cal.: 

Upon arrival Phoenix carefully inspect sanitary conditions throughout, and do 
same at Tucson en route to Nogales, wiring summary of conditions to Bureau and 
needs at both points. 

By direction Surgeon-General: 

White, Assistant Surgeon- GeneraL 



Washington, March S, 190$. 

GusTETTER, Nogaks, Ariz.: 

Telegram received. Carefully inspect all arriving persons, holding any from 
infected localities. Fuller instructions by mail. 
By direction of the Surgeon -General: 

WnrrE, Assistant Surgeon-General, 

SUMMARY OF PRF:GAUnOXARY MEASURES ON THE MEXICAN FRONTIER 
TO PREVENT THE INTRODUCTION OF PLAGUE ACROSS THE BORDER 
INTO THE UNITED STATES. 

Following is a summary of the precautionary measures which were 
adopted with a view to preventing entrance of persons from infected 
districts without careful examination; also for the investigation of 
rumors which frequent!}^ prevail under these circumstances, and the 



PUBLIC HEALTH AND MABINE-HOSPITAL SEBVIOE. 273 

.racing down of which, with negative results, renews confidence. 
These measures, therefore, were chiefly precautionary. 

The latest official and reliable information from Mexico showed that 
he Mexican authorities had the situation well in hand and that their 
(fforts were meeting with success. 

DETAU. OF OFFICERS. 

Asst. Surg. L. L. Lumsden, ordered from San Francisco, left on 
dttrch 3 for Los Angeles, where he remained one day to obtain facts 
onoeming Chinaman suspected of plague and supposed to have come 
rom Phoenix; thence he went to Phoenix, investigating this matter 
ad reportinj^ that circumstantial evidence rendered the diagnosis of 
ilague in this case highly improbable; thence to Tucson, Nogales, and 
>oiiglas. He had charge of a continuous line inspection of points on 
he border of the United States and Mexico from Yuma to El Paso, 
loth places inclusive. 

Acting Asst. Surg. A. L. Gustetter was on duty at Nogales. 

Acting Asst. Surg. E. Alexander was on duty at El Paso. 

Acting Asst. Surg. Lea Hume was on duty at Eagle Pass. 

Acting Asst. Surg. H. J. Hamilton was on duty at Laredo. 

Acting Asst. Surg. F. T. Wright was on duty at Douglas. 

At Naco, which, Rke Douglas, is in the general vicinity of Nogales 
at a short line railroad crossing into Sonora, Mexico, measures were 
taken to establish an inspection station. 

Passed Assistant Surgeon Wertenbaker was sent to El Paso as 
supervisor to temporarily strengthen the inspection service at that 
point. He arrived March 4, reported conditions and inspection good, 
and was ordered to rejoin his station. 

Passed Asst. Surg. S. B. Grubbs was at Guaymas, Mexico, where 
he was able to obtain considerable information from Mazatlan, and 
keeps the Bureau informed as to the situation on the coast, outlets from 
Sinaloa, etc. Doctor Grubbs is, moreover, a competent bacteriologist. 

Asst. Surg. Iklward Francis, also a competent bacteriologist, arrived 
in the City of Mexico on February 24 to confer with Dr. Eduardo 
Liceaga^ president of the Superior Board of Health, and keep the 
Bureau informed of Mexican measures. He took with him a complete 
bacteriological outfit. 

Surg. G. M. Guiteras left March 4 for Ea^le Pass to strengthen the 
inspection service at that point and the vicinity. His knowledge of 
the Spanish language made him valuable for duty in Mexico. After 
completing a thorough inspection of f^^le Pass and vicinity he was 
ordered to the City of Mexico to confer with Doctor Liceaga. 

[TeleerFamB.] 

Washington, March 5, 1903. 
Wright, Douglas^ Ariz,: 

Wire confidentially if you have had any suspicious cases or any rumore you have 
heard elsewhere. Should expert bacteriologist be needed at any time wire Bureau. 

Wyman. 



Washington, March 6, 1903. 
GuermTKR, NogaleSf Arix,: 

Have wired Pftssed Assistant Sui>2;eon Grubbs, Guaymafl, to certify caiyo if it can be 
miely done, and if arriving with Grubb's certificate, you can pass it. 
By direction Suigeon-General: 

White, AsHnUmt Surgeon-General, 

H. Doc. 338 18 



274 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Washington, March 6, 190S. 
Wertbnbaker (care Alexander), El Paso^ Tex.: 

' Have just wired Liceaga, ''No quarantine against Sonora at Ncgalefi or other border 
points. Am only inspecting at those points in order to apprehend any po^bie 
travel from infected localities, and it is understood Mazatlan and 0«) are the only - 
uifected localities, '^ in answer to his telegram protesting against a quarantine against 1 
Sonora. 
By direction Surgeon-General: 

White, Assistant Surgeon-GeneraL 

Same to Hume, Eagle Pass, Tex.; Hamilton, Laredo, Tex.; Wright, Douglas, Arix.; 
Gustetter, Nogales, Ariz. 

Washington, March tf, 190S. 
Webtbnbaker, 

(Care Alexander), El Paso, Tex.: 
Nothing wrong at Torreon. Francis gone to Durango for short time. No known 
infection anywhere outside Mazatlan ana Oso, but keep alive to any mmors. 
By direction Surgeon-General: 

White, 
Assistant Surgeon-OmenL 



March 8, 1903: Wertenbaker at El Paso ordered to rejoin station at New Orleans. 

March 13: Assistant Surgeon Lumsdenat Nqgales, Ariz., ordered to proceed imme- 
diately to Douglas, confer with Acting Assistant Siu^eon Wright, and wire Bureta 
his opinion. 

March 18: Lumsden, Douglas, Ariz., ordered to visit Bisbee and Morenci. 

March 21: Acting Assistant Surgeon Hume, Eagle Pass, Tex., ordered to proceed 
to crossing opposite Moral and report necessities. 



[Letter.] 

Washington, May J6, ISOS. 

Sir: Referring to your letter of 9th instant, stating the possibility that infection 
may \yQ brought across the border from Mexicans engaged in the construction of an 
extension of the Nacozari Railroad, and asking instruction in the premises, you are 
informed that the Bureau does not contem])]ate any permanent provision for deten- 
tion at Naco, and therefore deems it advisable for you, as suggested by yonrself, to 
communicate bv telegraph in the event of any necessity arising, taking snch action 
as may be absolutely necessary pending answer to your tel^ram. 
By direction of the Surgeon-General: 

Respectfully, J. H. White, 

Assifiant Surgeon-GeneraL 
Acting A«?st. Surg. F. T. Wright, 

Public Health and Marine-Hospital Servicey Douglas, Ariz. 



[Telegram.] 

Washington, May 97 ^ J90S. 

Gustetter, Nogales, Ariz.: 

■ Referring your telegram 23d, passengers known to be from Mazatlan should be 
kept out of the United States until seven days have elapsed since leaving Mazatlan. 
By direction of Surgeon-General: 

Whitb, 
Assistant Surgeon-OeneroL 

At the close of the fiscal year, the plagiie having died out in Mexico, 
all special inspectors were withdrawn with the exception of Doctor 
Gustetter at Nogales, Ariz. , who is still on duty at that point. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 275 

Yellow Fever. 

NO yelix)w fever in the united states. 

Fortunately no cases of this still dreaded disease have been officially 
reported in the United States during the fiscal jear, although it is 
now epidemic in our southern neighborhood. This fortunate state of 
affairs has been effected not only by the alertness maintained at the 
quarantine stations, both State and national, but also by the continued 
satisfactory state of sanitary affairs in the island of Cuba, in marked 
contrast to the constant menace to our Gulf States in past years from 
that source. 

MODIFICATIONS IN QUARANTINE REGULATIONS. 

Modifications were made, consistent with safety, in the treatment of 
vessels and their personnel. 

Under the provisions of the Quarantine Laws and Regulations of the 
United States, revised edition. Treasury Department, 1903, practical 
recognition, in the interests of commerce, was given to the recent 
advances made in the knowledge of the origin and propagation of 
yellow fever. 

PATROL OF THE MISSISSIPPI GULF COAST AGAINST YELLOW FEVER. 

Elarly in April it was deemed advisable to maintain a constant sur- 
veillance of tnis portion of the Gulf coast to prevent the introduction 
of yellow-fever infection and to detect first cases, should any arise. 
For this duty the following-named temporary acting assistant surgeons 
were appointed at the places noted: W. T. Bolton, Biloxi; W. R. Kell, 
Scranton; R. J. Turner, Bay St. Louis; J. J. Washington, Pass Chris- 
tian; O. L. Bailey, Ocean Springs; A. R. Robertson, Longbeach; E. 
M. Fahnestock, Delisle; C. A. Sheely, Gulfport; J. J. Harry, 
Handsboro. 

The following general letter of instructions was issued to each 
inspector, setting forth his duties during the summer season: 

[Letter of itiMtructioiiH.] 

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

Washington^ April 10, 190S. 

Sib: Referring to your previous service as acting assisting surgeon for temporary 
dotj during the summer oi the year 1900, the Bureau desires to know if you will accept 
a similar appointment at the present time and perform service identical with that 
rendered at that time. On account of the continu^ prevalence during the past winter 
of yellow fever on the Mexican littoral it is deemed of the utmost importance to keep 
a watch upon our own coast and be assured that the disease does not obtain a foot- 
hold at any point; and the Bureau desires to be apprised, if possible, of the very first 
case occurring in any community in order that sul necessary measures incumbent 
upon both national and State authority may be taken promptly to eradicate the 
diseajse. 

Should you accept this appointment you are informed that a medical officer of the 
Public Health ana Marine-IIospital Ser\ice will be placed on duty along the coast, 
and that his instructions will be to visit each of the coast towns and confer with the 
acting assistant surgeons upon temporary duty, receiving as confidential communica- 
tions any information which they may l)e able to impart, and to this oflficer you 
should report anything of interest occurring. If a case of vellow fever should unfor- 
tunately supervene it should be reported to the Bureau directly by wire, using the 



i 



276 PUBLIC HEALTH AND MARINE- HOSPITAL SERVICE. 

code word which will later be sent you for this purpose. These measures are not 
taken because the Bureau entertains any idea that there is any yellow fever on the 
coast at the present time, but simply out of the abundance of caution neoeasitftted by 
the conditions on the Mexican littoral, as aforesaid. 

I have to request that vou will reply by tele^^ph as to whether or not you will 
accept the position offered at the same salary as was given you in 1900, viz, $50 per 

month, for duty at . 

Respectfully, Walter Wyman, Surgeon-Gaural. 

In addition to these safeguards, Asst. Surg. T. F. Richardson was 
directed to make an inspection of all the abovcrnamed points and con- 
fer with the tempoi-ary inspectors above enumerated. The following 
telegraphic instructions were given Doctor Richardson, and his reports 
upon his work in this section are printed below: 

[Telegram.] 

Washington, April fO, 190S. 
Richardson, New Orleans^ La,: 

(Through Commanding Officer Marine Hospital. ) 

Proceed at once, inspect towns on Gulf coast from Bay 8t Louis to Pascagoula, 
inclusive. Bureau has acting assistants for duty at these points as follows: Bay 8t 
Louis, Turner; Pass Christian, Washington; Long Beach, Robertson; Handsboro, 
Harry; Gulf port, Rohmer; Biloxi, Bolton; Ocean Sprines, Bailey; Scranton, Kell; 
Pascagoula, Duke. Object of inspection to make sure of absence yellow fever present 
time, and impress on acting assistants necessity of constant watchfulness and proper 
handling of first cases. You may communicate direct by wire to Bureau, insteaa of 
through commanding officer, while on this detail. After completion, wire Bureau 
and await orders. Contemplated to return you to New Orleans and start you oat 
again at frequent intervals. En route make informal inspection Ship Island and 
Pascagoula quarantines. Wire arrival and departure each point 

PURVIANCE, 

Acting Surgeon-OeneraL 



Reports op Assistant SuanKON Richardson. 

I*UBLic Health and Marine-Hospital Sbrvicb, 

Office of Medical Officer in Command, 

New Orleans La.^ May 4, 1903, 

Sir: I have the honor to report as follows on the inspection of the Gulf-coast towns 
of Mississippi, made by me in obedience to Bureau tel^raphic orders of 20th ultimo. 

Bay St. Jxmis. — I arrived at Bay St. Louis on the night of 21st ultimo and called 
upon Acting Assistant Surgeon Turner the following morning. Doctor Turner 
reported the health of the city of Bay St. Louis and vicinity as excellent He had 
in his practice only a few cases of grippe and one case of typho-malarial fever, and no 
cases of fever with gastric symptoms. 

There are two other practicing physicians in Bay St. Louis, Doctors Von Gohren 
and Rohmer, but Doctor Turner, I understand, has most of the practice of the place. 

Doctor Turner seemed thoroughly impressed with the neceasitv for a careful look- 
out and prompt isolation and screening of first suspicious cases, should any occur. 

Pass Christian. — Acting Asst. Surg. J. J. Washington was visited at noon of the 22d 
ultimo. He reported the j^eneral health of Pass Christian and surrounding country 
as very good, and had in his practice only maternity cases; no fever cases whatever. 

Two other physicians practice in Pass Christian, Acting Assistant Surgeon Robert- 
son, of this Service, and Dr. M. W. Rainold. Neither of these had any febrile cases 
under treatment. 

Pass Christian has no industries to speak of, and is mainly dependent on the sum- 
mer and winter tourists who visit the place. 

There is no commerce save by rail and with the adjacent coast towns by schooner; 
so infection, unle8s it were a recrudescence, would not be expected to become mani- 
fest here, except secondarily to some other place along the coast. 

Ijong Beach. — Acting Assistant Surgeon Robertson, who holds the appointment 
for Long Beach, is a resident of Pass Christian and practices in both places. At 
present he reports there is no one ill in I»ng Heach, to his knowledge. 

In company wuth Doctor Robertson I visited, on the afternoon of the 22d ultimo, 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 277 

some of the country along the shores of Bay St Louis, and found a condition of 
a&drs which I have already reported to the Bureau under date of April 22 in a 
letter from Pass Christian, in which I recommended the appointment of Doctor 
Fahnestock, of De Lisle, as an acting assistant sui^geon for duty in the region around 
Bay St. Louis. 

uulfpoH. — I arrived at Gulfport on the morning of the 23d ultimo, and upon 
inquiring for Doctor Rohmer, the acting assistant surgeon accredited to that place, I 
learned that he had been a resident of Bay St. Louis for at least two years, and had 
n<>practice whatever in GulfiK>rt, nor did he ever visit the place. 

The physicians practicing in Gulfport are four in number, including the county 
health officer, Dr. C. A. Sheely, who holds the largest practice of the town. Doctor 
Sheely informed me that the population of the city was about 4,000, and that the 
prevailing diseases were malaria and variola. The latter is among the negroes (there 
have been only 2 cases among whites), has existed for about two months, and is now 
apparently abating. 

I saw in company with Doctor Sheely some 20 cases of this disease in negroes in 
the isolation camp established by the county. I also saw 2 cases among the better 
class of whites, and these were not isolated nor guarded in any way, nor was the 
house in which they were sick placarded. 

Smallpox, judging from the number of recentlv pitted faces seen in the streets, has 
been epidemic among the negroes of Gulfport for some time, but I understand its 
mortaJitjr has been nu. 

The disease has not been properly taken in hand, owing, I was informed by Doctor 
Sheely, to lack of funds in tne county treasury. 

An attempt to disinfect all negro premises known to have harbored a case was 
made (though I do not think the disinfection was efficient), and recently the isola- 
tion camp above mentioned, in the woods back of the town, was opened. 

Vaccination has probably been quite general in the last week or so, and most of 
the nnpitted blacks met on the streets showed sore arms. 

There seems almost complete indifference to the presence of the disease in Gulf- 
port itself, all the apprehension and fear being felt in the other coast towns, notably 
Biloxi. 

I advised Doctor Sheely, in view of the manifest impossibility of doing proper 
disinfection and isolating all cases with the means which he said were available, to 
bend all his energies to thorough vaccination of the community. This, he stated, he 
would do and would appoint the other physicians of the town as vaccinators. 

Gulfport has an important and growing maritime and inland commerce, and is, in 
my opinion, one of the most exposed towns to infection along the Gulf coast. 

The acting assistant surgeon stationed here should be a constant resident and a man 
in practice in the town. It is manifestly impossible for a nonresident physician to 
keep in touch with the health conditions of the place, and for that reason I tele- 
graphed the Bureau recommending that Doctor Rohmer' s services be dispensed with 
and that Doctor Sheely be appointed in his stead. 

While in Gulfport I visiteti President Jones, of the Gulf and Ship Island Railroad, 
and discussed with him the maritime quarantine protection of Gulfport and the 
national quarantine laws and regulations. 

Handibrmigh. — Acting Assistant Sui^eon Harry, of Handsbrough, was found in Gulf- 
port, where I understand his business as manager of a canning factory keeps him 
most of the time. He reported the health of Hansbrough and Mississippi City as 
excellent; no febrile or gastric case in either place. 

Doctor Harry inform^ me that last season he isolated, treate<l, and buried within 
two hours after death an undoubted case of yellow fever, which ha<i come from New 
Orleans on an excursion train. This information was volunteered by the doctor in 
response to my mentioning to him the necessity for prompt and proper measures 
witn first cases. 

Biloxi, — I arrived in Biloxi at 7 p. m. of the 23d ultimo, and visited Acting Assist- 
ant Surgeon Bolton the following morning. Doctor Bolton reports the health of his 
district as good, with only a few cases of malarial fever prevailing. His principal 
fear for Biloxi at this time is smallpox from Gulfport. There is no school vaccina- 
tion law extant in the city of Biloxi or its county, though Doctor Bolton informed 
me there would be one passed at the next meeting of the county supervisors, and 
that he would endeavor to go further even and have a compulsory law for all daeses 
of inhabitants enacted. 

Doctor Bolton is the only officer on the coast who is provided with blanks for 
reporting mortality statistics and he stated he expected to forward the Bureau a 
wec^y report 



278 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

I visited the Ship Island Quarantine Station on the 24th and 25th ultimo, and shall 
make the report of this inspection the subject of another communication. 

Ocean Springs. — Acting Assistant Surgeon Bailey was seen at his residence during 
the afternoon of the 24th ultimo. The doctor stated the population of Ocean Springs 
was 1,200 to 1,500; that there was no floating population to speak of, and that the 
prevailing diseases were malarial and grippal. He was impres8e<i with the neces- 
sity for a careful lookout for possible first cases and their proper isolatioD. 

hcranUm, — Acting Assistant Surgeon Kell stated that tne population of Scranton 
waf? about 3,000, with a large floating element. The prevailing iuseases w^ere malarial 
and diarrheal. The former were always present, he said. There had been no dis- 
ease of a suspicious nature in the locality. 

Pasca^oula. — The appointee for Pascagoula, Doctor Duke, is also in charge of the 
quarantme boarding station at that place. 

Doctor Duke informed me that the population of Pascagoula was about 750, with 
no floating population, atid that the place was healthy, with no sickness at the present 
time. 

Pascagoula is practically one with Scranton, though I was informed that malaria 
does not prevail here to anything like the extent that it does in Scranton. 

At Moss Point, an adjacent town to Scranton-Pascagoula, Doctor Duke informed me 
that malaria prevaile<l extensively during the summer. 

The inspection of the Pascagoula quarantine will form the subject of a separate 
communication. 

I rejoined my station on the night of the 27th ultimo. 

Respectfully, T. F. Richardson, 

Assistant Surgeon, 

(Through medical offlcer in command.) 

Respectfully forwarded. 

C. P. Wertenbaker, 

Passed Assistant Surgeon, 

The Surgeon-General Public Health and Marine-Hospital Service. 



Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

New OrleanSf La.^ July IS, 190S. 

Sir: Replying to Bureau letter of 10th instant, I have the honor to give herewith 
a summary of the work done by me up to and including June 30, 1^33, along the 
Mississippi coast in connection with my special detail. 

One inspection only had been made to the date above mentioned. This included 
the towns of Bay St. Louis, Pass Christian, Delisle, Longbeach, Gulf port, Hands- 
boro, Biloxi, Ocean Springs, Scranton, Pascagoula, and the national quarantines at 
Ship Island and Pascagoula. 

Acting assistant surgeons were found on duty at all of the towns mentioned except 
Delisle and Gulfport The name of a local physician at each of these places was 
submitted by me to the Bureau with the recommendation that they be appointed 
for duty in their respective towns. 

No disease of a suspicious character was seen by me or reported to me by the local 
appointee or practitioners. The general health of the entire coast was considered 
excellent. 

The necessity for constant vigilance and the early recognition and prompt and 
proper treatment of possible first cases was impressed upon each of the acting 
assistants. 

The inspections of Ship Island and Pascagoula quarantines were informal in char- 
acter. At the first-named station a large amount of unserviceable property was 
inspected and condemned by me. 

Respectfully, T. F. Richardson, 

Assitiani Surgeon, 

(Through medical officer in command. ) 

Respectfully forwarded. C. P. Wertenbaker, 

Passed Assistant Surgeon, 

The SuRO eon-General, Public Health and Marine-Hospital Service. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 279 

flTTATE HEALTH AND QUARANTINE OFFICERS NOTIFIED OF YELLOW FEVER 

IN FOREIGN PORTS. 

During the active Quarantine season all importani. information 
received as to the prevalence of yellow fever in foreign ports and liable 
to become a source of danger to ports along our coast was immediately 
repeated to State health officers and quarantine officers concerned. 

Smallpox in the United States. 

Reports to this Bureau, published weekly in the Public Health 
fieports, in accordance with the act of Congress approved February 
X5, 1893, show the continued prevalence of tnis disease in a very mild 
form in nearly every State ana Territory of the Union. These weekly 
liealth reports are mailed to every State and local health officer as a 
valuable source of information ana help in their sanitary work. 

In a previous portion of this report, under the heading "Division of 
sanitary reports and statistics," has been shown the number of States 
mnd Territories in which smallpox prevailed, giving the number of 
cases and deaths in each, so far as the same have been reported to the 
Bureau. 

assistance rendered state health authorities. 

In accordance with the established custom of the Service aid has been 
rendered during the past year to various State and local boards upon 
their request, both in the diagnosing and in the suppression of small- 
pox in several States. 

Besides the entry by waterways, the land approaches to the border 
States have been guarded against the admission of this disease. 

MAINE. 

In October, 1902, the health authorities of the State of Maine 
received notice that smallpox was quite prevalent in the province 
bordering the northwest boundary of the State; that this disease was 
propajgated in the lumbering camps, practically without restraint by 
isolation or vaccination. 

The State authorities immediately placed inspectors at exposed 
points, but on account of the difficulties encountered, smallpox was 
introduced into a considerable number of camps in the Jackman 
region by men coming across unguarded trails. The disease spread to 
lumber camps upon the North Penobscot, the Seven Islands, and the 
upper St. Jonn's region. In January of this year the disease appeared 
at Van Buren and I^resgue Isle and the so-called Madawaska region 
above Fort Kent. In February an experienced officer of this Service 
was detailed to confer with the officials of the State board of health 
as to what aid was desired in the way of assistance from this Service 
under its regulations. This officer made an inspection at necessary 
points, including roadways across the ice upon Glazier Lake, where a 
vaccination and disinfection camp was established. From this period 
until June about 300 returning lumbermen were intercepted and 200 
vaccinated. Preventive measures were also instituted in the vicinity 
of Lowelltown, Me. , and other places. 



280 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Report op Surq. P. C. Kalloch. 

Public Health and Marine-Hospital Seryics, 

Office of Medical Officer in Command, 
Portland Quarantine^ PorilandL, Afe., July j8^, 190S, 

8ib: In compliance with Bureau letter of the 10th instant, I have the honor to 
make a report of the operations of the Service under my direction for the prevention jj 
and suppression of smallpox in the State of Maine to June 30, 1903. j 

I will first give the history of the epidemic, which is kindly fomished by Dr. 
A. G. Young, secretary of the State board, as follows: 

** In the latter part of October, 1902, the secretary of the State board of health of 
Maine received a notification that smallpox was quite prevalent in the counties of the 
Province of Quebec upon the northwest boundary of the State of Maine, just acroa 
from Jackman. It was reported that there had been 28 cases of smallpox in one 
lumber camp across the line; that the loc^l provincial authorities had quarantined 
the camp, but that the men had broken quarantine and gone to their homes. The 
State board immediately put a medical inspector on. the old Canadian road which 
comes down from this part of the Province tnrough the State of Maine by the wayol 
Jackman, on the Canadian Pacific Railroad. Arrangements were made with a hotel 
keeper at the line so that all men cominj; across the Tine seeking employment in the 
lumoer camps were stripped, given a disinfecting bath, put to 1x3, and their clothiiy 
and bundles disinfected. The men were vaccinated and in due time received their 
disinfected clothing, were presented with a certificate showing what had been dons 
with them, and allowed to proceed on their way. Of the hundreds of men thm 
treate<l at this inspection station not one subsequently came down with smallpox, and 
not one communicated smallpox to the crews of any of the lumber camps. 

'* In spite of this work, however, smallpox was introduced into a considerable nmn- 
ber of lumber camps in the Jackman region by men who had come acroes on varioai 
trails that could not be guarded. The policy pursued by the inspectors of the State 
board of health when smallpox was reported m a lumber camp was to get there as soon 
as possible, to remove the infectious person or persons from tne camp, to isolate them 
in a small, special camp built for the purpose, to vaccinate the remainini^ men of the 
crew, and to disinfect the camp as thoroughly as it was possible to do such work 
under such disadvantageous conditions. A smallpox hospital was established near 
Jackman and all smallpox patients found in lumber camps were removed to this 
isolati6n hospital unless the distance from the hospital was so great as to make thii 
impracticable. 

*' Circular letters were sent early to the lumbermen asking their cooperation, 
advising them to employ no Canadians in their cam{)s who had not presented them* 
selves at the inspection station and received a certificate of disinfection and of vattn- 
nation, apd not to receive into their camps transient or unknown men, but to baild 
a small special camp which might be used for loilging unvouched-for wayfarers ind 
which might be used also for the isolation of any of the members of their crews who 
might have suspicious symptoms. 

'*The smallpox, which at first appeared to be more prevalent in the part of the 
Province of Ciuebec! opposite to the Jackman region, rapidly spread southerly in the 
direction of Megantic and northwardlv up along the northwest boundary, so that 
successively lumber camps farther north in the State of Maine were infected from 
across the line. 

'* December 12 a telegram was received by the secretary of the State board of health 
saying that smallpox had broken out in lumber camps on the north branch of the 
Penobscot^ camps in whic^h there were altogether about 500 men employed. A tele- 
gram was sent to Doctor Nichols, chief inspector for the State board of health, to 
attend to the matter. He took with him an experienced nurse, disinfectants, vac- 
cine, etc., found 3 cases of smallpox, isolated them, vaccinated the exposed persons, 
left the cases in charge of the nurse, and returned. No other cases oocarred m thoee 
camps. Deceml)er 26 it was learned that smallpox existed in the Seven Islands 
region on the upper waters of the St. John River, still farther noKh. I)octor Nich- 
ols was sent to Fort Kent, thence up the river by team, a three days' joumey. He 
found that smallpox had existed for some time and counted up 58 cases in \'arioa8 
camps, many of them widely distant from each other. Fixing them up as well a^ 
possible, he returned to Fort Kent for further supplies. 

'*Dr. E. T. Flint was then sent to take charge of the various outbreaks in the 
Seven Islands region and remained there until the middle of February, when the 
outbreak was cleared up with the exception of one man, who was left in chaigeof a 
Canadian physician to disinfect and to release from quarantine. \ 

i 



PUBLIC HEALTH AND MARINE- HOSPITAL SERVICE. 281 

''January 5, 10 cases of smallpox and many exposures were reported in Van 
Buren. This outbreak was speedily stamped out by the health officer of the local 
hoard of health with the aid and advice of the inspec-tor of the State board. About 
the same time a serious outbreak of smallpox was reported in Presque Isle and an 
investigation made bv the State board of health showtAl that smallpox had existed 
for some months in tne five towns northwest of Presque Isle, and that many lumber 
campe still farther west and north, particularly along the newly opene<f railway 
from Ashland to Fort Kent, had been infected. In one of these towns, at least, it 
was found that as many as 100 houses had \yeen infei'ted. The job of disinfecting in 
the dead of winter and much of the time at zero weather wa.H rather a discouraging 
prospect. The secretary of the State board of health met through previous arrange- 
ment the local boanls of health in the village of Presque Isle and arrangements were 
there made for the work of disinfection. Each town was to build a disinfec^ting 
cabinet for formaldehyde disinfection, to be placed in a portable protective shed, 
heated with a woo<l-buming stove. The door of the disintei^ting ciininet opcne<l to 
the outer air, but on the other three sides the disinfecting cabinet was surrounded 
by warm air. Each town was further required to furnish two good, intelligent men 
to constitute a disinfecting gang. On the part of the State lx>ard of health a skilled 
disinfector was to he sent to instruct succeHsivelv crew after crew and to work with 
them until the work of disinfection was well under way. Good and efficient work 
waa done by these local Ijoards of health, and in a com{)aratively short space of time 
Uie outbreaks in these towns were well under control. 

"The most serious problem, however, has been the control of smallpox in the 
BO-called Madawaska region, which extends from al)ove Fort Kent to oelow Van 
Boren along the St. John River, settled almost exclusively by the French descendants 
of the refugees from Arcadia. Here outbreak after outbreak has been stamped out 
with surprising rapidity, considering the unfavorable circumstances, only to be fol- 
lowed by new outbreaks in the same towns and plantations, or elsewnere. The 
infection which has started many of these outbreaks has been imported from that 
part of the Madawaska settlement acrot<s the St. John River in the Province of New 
Bmnswick, and many have been started by persons who have returned to their 
homes from infected lumber cam})s and river drives.'' 

On February 15, in accordance with a telegram received from the Surgeon-General, 
I called upon Dr. Charles D. Smith, president, and Dr. A. G. Young, secretsiry of 
the State board of health, and consulted with them as to whut was desired in the 
way of assistance from the Service. It was thought best to visit some points in the 
northern part of the State and to establish inspectors and disinfecting camp at the 
points where lumbermen were passing on their return from lumber (^mps m north- 
ern Maine and southern Canada. In company with Doctor Young I visited Milli- 
nocket and Ashland, and with Doctor Nichols, representing the State boanl, I visiteil 
Fort Kent and Connors, New Brunswick. At the latter platre we mot Dr. E. Bavurd 
Fisher, secretary of the provincial l>o:ird of health, and lie consented to establish a 
camp on the Temiscouata Railroad, a few miles from the Maine border. 

This railroad and a "tote road," which crosse<l Glasier I^iike, were the two ways 
by which lumbermen returned to this section of the Stiite from the lumber camps, 
some of which were known to be iufectiHl with smallpox. A camp was therefore 
established at Glasier I^ke, on the Canadian side, by the Service, under the direc- 
tion of Acting Asst. Surg. Luther Mason, asslste<l by two heljwrs. 

A small building was erected for the inolatioii of any cases of smalli)ox which might 
be found, and the clothing of passing lumlx^rmen was disinfec^ted with formaldehyde. 
Some trouble was experiencea in vaccinating, as many of the men refused to have it 
done. One party of 30, unusually lacking in respect for law or custom, passed by 
without submitting to inspection. 

The men were aetainea long enough for inspection and the disinfection of their 
effects, board and lodging being supplie<l by a local resident. The camp was ready 
for work on March 12, and during tne first tliree days Doctor Mason reiwrted the 
inspection and disinfection of 53 men. Most of these refused vaccination, and lis 
they lived in isolated parts of Maine and Canada, where there were no local boards 
of health, there was no way of inflictinir a pcmalty. 

The subsequent reports show that there were' about 300 men detained and 200 
vaccinated at this camp before June 1, at which date the camp was discontinued. 
Doctor Mason being transferred to Fort Kent, Me., where he has been engageil in 
disinfecting houses and visiting suspicious cases. 

The lack of rain throughout this region in the early summer interfered seriously 
with log driving, so that communication l^tween the cam|>s and towns was quite 
irregular, and the necessity for watchfulness and sanitary work continued beyond 
the end of the fiscal year. 



282 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

On or about January 1 Acting Asst. Surj?. J. M. Boothby began the inspection of 
persons passing in the vicinity of Lowell town, Me., near the western border of the 
State. As there was no provision for disinfection, the persons who were regarded 
as suspicious were turned back. 

On April 6 Dr. Estes Nichols was appointed inspector at Sandy Bay Plantation, 
this being one of the points of entry from the lumber camps in eastern Quebec. He 
was given two helpers and was provided with the means of disinfecting clothing. 
During the time up to June 30, 1,138 persons passed the camp and two cases of 
smallpox were treated. 

Respectfully, P. C. Kalloch, 

Surffeoii, 

The Surqeon-Gbnbral, Public Hbaltu and Marinb-Hospital Sbrvicb. 

MORGANTOWN, W. VA. 

Early in March reports were received at the Bureau as to the preva- 
lence of .smallpox in Morgantown, W. Va. Following the usual policy 
of the Bureau, advisory aid and assistance were rendered, upon the 
request of the proper State health authority, as the following corre- 
spondence will show: 

[Telegrams.] 

Washington, March 5, 190S. 
Dr A R Barbeb 

Secretary State Bmrd Health, Point Pleasant, W, Va,: 

Have request from Representative Dayton to send expert to Moiigantown, bat ai 
customary wish to do so with a thorough understanding with you as repreeenting 
State board. Please send request. Matter believed to be urgent. Will send experi- 
enced officer. 

Wyman, Surgeon-GeneroL 



Point Pleasant, W. Va., March 6, 2903, 
Walter Wyman, 

Surgeon-General, Washington, D, C: 

Will appreciate your sending expert to Morgantown. Would like report. 

A. R. Babbkb. 



Washington, March 5, 1903, 
Carter, Marine Hospital, Baltimore, Md,: 

Have request from Representative Dayton for an expert at Moiigantown, W. Va. 
One thousand students in university. Smallpox diagnosis doubted and called chick- 
enpox. Have wired Doctor Barbee, secretary, at Point Pleasant, W. Va., for re<^ue8t 
for expert. £xpect reply. Proceed as soon as possible to Morgantown, wireamval, 
and await orders. 

Wyman. 



Washington, March 6, 1903. 
Dr. S. N. Myers, President State Board Health, 

Martinsburg, W. Va.: 

Surg. H. R. r^uler will be in Morgantown to-day and will consult Doctor Warren. 
By direction of the Sui^geon-GenenJ: 

White, Assistant Surgeon-GeneroL 



[Letter.] 

Washington, March 6, 1903. 
Dr. A. R. Barbeb, 

Secretary State Board of HeaUli, Point Pleasant, W. Va. 

Sir: Referring to your telegram of the 5th instant, stating that you would appre- 
ciate the sending of an expert to Morgantown, and would like a report, I have to 
inform you that Surg. H. R. Carter, of this Service, will be in Moigaatown to-day. 



PUBLIC HEALTH AND MABINE-H08PITAL SERVICE. 283 

He has been directed to confer with the local health officer and investigate the 
under suspicion. A copy of his report will be sent you when it is received by 
Ihe Bureau. 
By direction of the Sui-geon-General: 

J. H. White, 
Assistant Surgeon-General, 



[Telegram.] 

WASHiNCiTON, March 6, 190S. 
-Snr^. H. R. Cabteb, 

Public Health and Marine-HospiUU Servicey Morgantmim^ W. Va.: 

Have receiveil request for your services as diagnostician from both State board health 
•nd Congressman Dayton. See Health Officer E. McL. Warren, and after conference 
vith him investigate matter in hand. Wire Bureau when investigation is complete 
for return orders. 
By direction of Surgeon-General: 

WnrrE, 
Assistant Surgeon-Oeneral, 



Report of Surgeon Carter. 

Baltimore, Md., March 11 ^ 1903, 

Sib: As directed by Bureau telegram of March 5, 1903, I proceeded by the mid- 
V night train to Mora;antown, W. Va. Arriving there, after receipt of instructions from 
^ the Bureau, I held a conference that night with the board of nealth and the health 
^ officer, and the next morning, in company with the latter, visited 20 patients, in 13 
^ housee, suffering, or having recently suffered, from an eruptive disease. Of these, 3 
were varicella. Of the remainder, 9 were certainly smallpox, and the 8 others, judg- 
ing from their history and conditions of occurrence, were with reasonable certainty 
the same disease. 

This smallpox has been in Morgantown since early January or late December. 
There had been the usual disagreement as to the dia^osis of the disease, and conse- 
quently no efficient steps have been taken to check its spread. I advised with the 
health officer on measures for the suppression of the disease. I especially ureed that, 
in spite of the existence of varicella, any eruptive disorder should be guarded by vac- 
cination and isolation as if it were certainly smallpox. 
Respectfully, 

H. R. Carter, Surgeon. 

The Surqbon-Gensral, Public Health and Marine-Hospital Service. 

LUMPKIN, GA. 

Surg. W. P. Mcintosh reports from Mobile, Ala., April 7, as fol- 
lows: 

In obedience to telegraphic orders of the 4th and 5th instants, to "proceed to 
Lumpkin, Ga., as expert to decide diagnosis in suspected case of smallpox,'' I 
left Mobile at 12 o'clock (midnight) April 5, arriving at Lumpkin the following 
morning. 1 visited the office of the mayor, who imirediately called a meeting of 
the boara of health. After ascertaining tne condition of affairs, I visited, in company 
with the president of the board of healtn. Doctor Carter, several of thesuHpected c^ses. 
The first case I saw was a negro, suffering from a severe attack of semiconfluent 
smallpox, the eruption on face and parts of body being confluent, the conjunctiva 
badly affected, the patient suffering from secondary fever at time of visit. The wife 
of thifl man had just recovered from a mild attack, and two or three children were 
suffering from a mild form of the disease. In only one child was the eruption severe 
and umbilicated. There were a number of negroes in the yard and near the house, 
and no doubt many cases will follow. I saw only one case in a white man, and he 
was convalescent. I was informed that the wife of a prominent merchant was very 
ill with confluent smallpox, but I did not nee her. The cases are either in the city 
limits or in suburbs. 

After seeing the cases I again visited the mayor's ofKce. The meeting of the board 
of health was reconvened and a meeting of the council also called. I was requested 



284 PUBLIC HEALTH AND MABINE-H08PITAL SEBUICE. 

to make a short talk and did so, pointing out the necessity of immediate vaccinatiot 
of everyone, also the advisability of opening a pesthouse or smallpox hospital, tbi 
isolation of the sick, and quarantine of the mfected part of the town nntil all hilf^ 
been vaccinated and thoroughly disinfected with moist sulphur dioxide, scro 
with bichloride solution, 1 to 800; whitewashing of cabins and houpen, lioiling ii 
water of all clothes and bedclothes, emptyine mattre88e><, burning the straw and * 
ing the ticking, all this to be followed by a thorough airing and expasing of 
and habituations to sunlight, the premises to be cleaneil up generally and i 
articles burned. The gentlemen present were very earnest in their support of 
measures. It was decided to carry out compulsory vactcination an<l a sufficient 
ply of vaccine was ordered by telegraph. Steps were taken looking to the estahli 
ment of a smallpox hospital, the placing of an efficient guard around the infe 
area, and the thorough cleaning ana disinfection of infectSl or suspected prem 

I was aske<l concerning the schools, in which a few cases had oi*curred alxjut tl 
weeks ago. I advised a proper vaccination of alljpupils and the immediate isolatioti 
of infected children should infection occur, but I do not think it necessary to 
the schools. The postmaster asked me regarding the mails, particularly reja 
the writing of letters by persons suffering from the disease, an«i related the c^JBeof 
man who had come into the office with the eruption all over his hands and 
written a letter, used blotting pad, etc. I explained that all infected people woi 
be quarantined. I also requested the healtn officters to disinfect all mail oomi 
from infet!ted places, and explained to the postmaster how to clip the end« 
envelopes and drop in a few drops of formalin, then place the letters in a cigar boi 
with siK)nge saturated with formalin, seal, and keep in a warm place twelve boon 
The county judge and the ordinary were present a part of the time diuing tiM 
meeting and were very earnest in their participation in the proceedings and offers of 
assistance. 

In the afternoon I visited the cases a second time in company with a number o( 
the local physicians, pointing out the characteristics of the disease. 

SMALLPOX PATIENTS RECEIVED AT ANGEL ISLAND, CALIFORNIA, FROM 
NAVAL TRAINING STATION ON GOAT ISLAND, CALIFORNIA. 

The Service in one instance cared for smallpox patients from the 
naval training station, Goat Island, California, as shown by letter from 
the medical officer in command of San Francisco Quarantine Station, 
Angel Island, California, upon this subject. 

[Letters.] 

San Francisco Quarantine, 
Angel Islandy California^ February j?6*, 190S. 

Sir: I have the honor to inform you that at the remiest of the commandant United 
States naval trainm^; station, Goat Island, California, I have admitted to the isolation 
hospital at this station 2 cases of smallpox, toother with 2 contacts who will take 
care of the patienta during their detention at this place. 
Approval of my action m this case is respectfully requested. 
Respectfully, 

Hugh S. Gumming, Passed AssiMarU Surgeon. 
The Surgeon-General, Public Health and Marine-Hohpital Service. 



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

Washington^ March 5, 190S, 

Sir: Referring to your letter of the 26th ultimo, stating that you have, at the 
reouest of the commandant of the United States naval trainmg station, Goat Island, 
California, admitted to the isolation liospital at your station 2 cases of smallpox, 
together with 2 contacts who will take care of the patients daring their detention, 
you are informed that your action is approved. 

Respectfully, W. Wyman, 

Surgeon- General 
Medical Officer in Command, P. H. <fe M. H. S., 

San Francisco Quarantine^ Angel Island^ Col. 



PUBLIC HEALTH AND MAKINE-H08PITAL SERVICE. 285 

AID RENDEBED POSTAL SERVICE. 

during the year at several points, where smallpox prevailed, it 

ame necessary for the postmasters to fumigate the post-offices and 

ils in order to expedite the service. 

Small bills for the actual disinfecting material used were received 

m the Postmaster-General, and the amounts paid by this Service. 

The following letter will show the attitude of the Ser\ice in this 

;ard: 

[Letter.] 

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

Washingtorif April ^, 1903, 

[b: Beferring to your letter of the 6th ultimo, making inquiry as to the proper 
hod of defraying the necessary expense of fumigation of post-office premises and 
1 matter, I have to inform you that this Bureau has adopted the custom of defray- 
the expense incident to providing disinfecting materials, such as sulphur and 
oaldehyde, in cases where the local hoard of health or other competent authority 
decided that disinfection is necessary, hut has not undertaken to pay for either 
>r or apparatus involved in such disinfection. 
his custom has now heen in vogue for several years. 
Bespectfully, 

Walter Wyman, Surgeon-General, 

iBST Assistant Pootmaster-General, 

Post-Office Departvfienty WuMngUmy D, C, 

Leprosy. 

lince the presentation of the report of the commission of medical 
sers of the Service relative to the prevalence of this disease in the 
itcd States no developments have occurred, nor is there special 
prehension felt as to its introduction from other countries, or from 
existence in certain dependencies of the United States, where it 
lears to be under suitable supervision. 

Revision of Quarantine Reguijitions. 

>wing to the advances made in the scientific knowledge of the origin 

I propagation of certain quarantinable diseases, the quarantme 

^iations of the United States Treasury Department were modified 

the interest of commerce with due regard to safety. 

These regulations were approved and a new edition issued April 

1903. 

The National Quarantine Stations. 

rhe operation of the 37 quarantine disinfection and inspection stations 
s continued and reenforced during the fiscal year. The advances in 
; scientific knowledge of the origin and propagation of quarantinable 
ease have been promptly made effective in tne interests of commerce, 
isistent with the safety of health of the people of the United States. 
A.11 the j)ortiils of entry are now guarded by these national stations, 
jetber with the several State and municipal inspection and disinfec- 
n stjitious, with which harmonious relations have been maintained. 
During the year 5,922 vessels were inspected before entering at these 
tional stations, and 352 vessels disinfected. 



!86 PUBLIC HEALTH AND MARINE-HOSPITAL BEKVICE. 

A report of transaction.'^ from each quarantine station follow«i 

PORTLAND, 

IPortUnd qiuronline: poat-ofllcc addiess, PanlaDd, Me.) 
Kaportof Uie medical olScer In comnund, Suig. P. C. KbIIogIi. Anumed comnuuid undti i 





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KA8TPORT. 

(Baii^rt (Me.) Quaianline.) 

[Report of Acting Ant. Surg. E. H. Small, In rbaige.) 

Eastport, Mb., July 1, I90S 
Sir: Inclosed please find my annual report for fleca) year ending June 30, 1903. 
Sydney, Cape Breton, haaa fewcwesotamallpox, aleo RichibucW, NewBnuwwii 
Baiwor, Me., reporta a new case. 

Beepectiully, Edward M. Shau.^ 

Acting Auitlant SuTgem 
The Surobon-Gbnkral, Public Hbaltr and Marinb-H<«pitai. Service. 



TnttuaclioniatlheEailport {ife.) Natumal Quarantine Station for the year ending Ji 



Jul]-. AuR. Bept. Chrl. Nov. Dec. Jiui. Feb. Mm. Apr. Uay. Junr. T( 



VokIe spoken and 
StesmenlnBpecled 
Steamen dliln- 
Balling TCMcla In. 

SdUngriiaeiadlit' 

Intecled 

Ciew oo aaillnB 

PafBeDgerHonnll. 



PDBLIO BEALTH AND MARINE-HOSPITAL SERVICE. 287 

BEEDY ISLAND. 
\StKSj IdKDd (to*i>ntlne; poH-offlw kddren. \ix Port Penn. Del.] 
rtotpBBcdABt.SnrK.B.W.WlFkai. AmmeilcommuilaiMleTomclaloidenal March 13,1903.) 
PUBUC HkALTR and MABINS-nOWITAL fiSKVICK, 

OrricB or Mkdical OrpicEB in Comhand, 
Btedy lOand QuaranlxTir, via Fort Petm, Del., July SO, 190i. 
■■ Ai directed in Borean letter of 27th iastjuit, I have the honor to submit here- 
the following report of tnnsactioiu at this station fur tbe fiscal y«ftr 1902-3: 

•]a B[)oken and passed 35 

lerg inspected vid passed 932 

lere disinfected 2 

ig veeeela inspected and passed 141 

ig veesels diAnfected 1 

on eteamere inspected 36,100 

on Buling vesKls inspected ,.-. 2,054 

ngeraon steameta inspected 32,816 

Bailing vesBelB inspected 2 

H. W. WiCKBB, Fatted AttUlant Surgeon. 
} SttBGRON-GBinmAi, Ptrsuc Health and Marinb-Hospttai. Service. 
irDDKh medical officer in command of national quarantine service on Delaware 
iDd River.) 



[Incltmire.) 
ttetiontiU Reedy MandXnlioiuil QunrantitifSnlinnfoTlheyrnTrndiiigJuneSO, I90S. 





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DELAWARE: BREAKWATER. 

[Delaware Bre&kwaler Qnarandiic; iXBl-offlce addrem, via Lewe*. Del.) 

-I ol Ibe medlcitl oIDfer In rflmmani. PiifiKd Aint. and Suik. C. H. Lavluder. Anomed com. 
mnnd under offlelal orden ot March S. 1901.) 

PuBuc Hbaltit and Marine-Hospitai. Service, 

Ofpicb op Medical Offtckb in CaXMANPr 
Delaimre Breakiraler, Dttaware, July 31, 1903. 
: In connection with th« tabulatpd Btatistical report of the quarantine transac- 
of thiB station for the fiaiail year ending June 30, 1903, I have the honor to 
it below fuller detailH: 

tre were boarded during the year a total of 149 vesBela of all classes. This is an 
ise over the total nUTiit>er lioarded last yenr. ft is however a dei^ided decrease 
1 number boarded lipre three or four veare sro. The shipping at this port has 
y decreased during this time, from whnt caUHea I am unable to say. 



280 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

Report op Subo. P. C. Kalloch. 

Public Health and Marine-Hobpital Servick, 

Ofpice of Medical Officer in Command, 
Portland Quarantine^ Portland^ Mc, July fiS^ 190S. 

Sir: In compliance with Bureau letter of the 10th instant, I have the honor to ] 
make a report of the operations of the Service under my direction for the prevention ^ 
and suppression of smallpox in the State of Maine to June 30, 1903. , 

I will first give the history of the epidemic, which is kindly furnished hy Dr. j 
A. G. Young, secretary of the State board, as follows: 

*' In the latter part of October, 1902, the secretiuy of the State board of health of j 
Maine received a notification that smallpox was quite prevalent in the counties of thi 
Province of Quebec upon the northwest boundary of the State of Maine, just acros 
from Jackman. It was reported that there had been 28 cases of smallpox in ona 
luml)er camp across the line; that the local provincial authorities had quarantined 
the camp, but that the men had broken quarantine and gone to their homesL The 
State board immediately put a medical inspector on. the old Canadian road which] 
comes down from this part of the Province through the State of Maine by the wayoli 
Jackman, on the Canadian Pacific Railroad. Arrangements were made with a hotd : 
keeper at the line so that all men coming across the Tine seeking employment in the 
lumner camps were stripped, given a disinfecting bath, put to b^, and their clothini ■• 
and bundles disinfected. The men were vaccinated and in due time received thor 
disinfected clothing, were presented with a certificate showing what had been dooi 
with them, and allowed to proceed on their way. Of the hundreds of men thai 
treated at this inspection station not one subsequently came down with smallpox, ud 
not one communicated smallpox to the crews of any of the lumber campe. 

'^In spite of this work, however, smallpox was introduced into a considerable num- 
ber of lumber camps in the Jackman region by men who had come across on variooi 
trails that could not be guarded. The policy pursued by the inspectors of the StUt 
board of health when smallpox was reported in a lumber camp was to get there as sooa 
as possible, to remove the infectious person or persons from the camp, to isolate then 
in a small, special camp built for the purpose, to vaccinate the remaining men of the 
crew, and to disinfect the camp as thoroughly as it was possible to do such woik 
under such disadvantageous conditions. A smallpox hospital was established netr, 
Jackman and all smallpox patients found in lumber camps were removed to thii 
isolatidn hospital unless the distance from the hospital was so great as to make thii 
impracticable. 

** Circular letters were sent early to the lumbermen asking their cooperation, 
advising them to employ no Canadians in their camps who ha<l not presented them- 
selves at the inspection station and received a certificate of disinfection and of Tiitj- 
nation, apd not to receive into their camps transient or unknown men, but to btiik 
a small special camp which might be used for lodging unvouched-for wayfarers ud 
which might be used also for the isolation of any of the members of their crews who 
might have suspicious symptoms. 

''The smallpox, which at first appeared to be more prevalent in the part of the 
Province of (Quebec opj)osite to the Jackman n^ion, rapidly spread southerly in the 
direction of Megan tic and northwardly up along the northwest boundary, so thai 
successively lumber camps farther north in the State of Maine were infected from 
across the line. 

*' December 12 a telegram was received by the secretary of the State board of health 
saying that smallpox had broken out in lumber camps on the north branch of the 
Penobscot, camps in whi(*h there were altogether about 500 men employed. A tele- 
gram was sent to Doctor Nichols, chief inspector for the State board of health, to 
attend to the matter. He took with him an experienced nurse, disinfectantB, va^ 
cine, etc., found 3 cases of smallpox, isolated them, vaccinated the exposed peraonfl, 
left the cases in charge of the nurse, and returned. No other cases occurred in those 
camps. Deceml>er 26 it was learned that smallpox existed in the Seven Islaadfl 
region on the upper waters of the St. John River, still farther north. Ekxrtor Nich- 
ols was sent to Fort Kent, thence up the river by team, a three days' joamey. He 
found that smallpox had existed for some time and counted up 58 cases in \'arioafl 
camps, many of them widely distant from each other. Fixing them up as well a# 
possible, he'returneil to Fort Kent for further supplies. 

**Dr. E. T. Flint was then sent to take charge of the various oatbrnks in the 
Seven Islands region and remaineil there until the middle of Febraaiy, when the 
outbreak was cleared up with the exception of one man, who was left in chaigeof a 
Canadian physician to disinfect and to release from quarantine. 



PUBLIC HEALTH AND MARINK-HOSPITAL SERVICE. 281 

** January 5, 10 cases of smallpox and many exposures were reported in Van 
Buren. This outbreak was speeuily stamped out by the health officer of the local 
board of health with the aid and advice of the inspector of the State board. About 
the same time a serious outbreak of smallpox was rejvorted in Presque Isle and an 
investigation made by the State board of health showed that smallpox had existed 
for some months in the five towns northwest of Prest^ue Isle, and that many lumber 
camps still fkrther west and north, particularly along the newly opened railway 
from Ashland to Fort Kent, had been infected. In <me of these towns, at least, it 
was found that as many as 100 houses had l>een infected. The job of disinfecting in 
the dead of winter ana much of the time at zero weather was rather a discouraging 
prospect. The secretary of the State Injard of health met thrrmgh previous arrange- 
ment the local boards oi health in the village of Presque Isle an<l arrangements were 
there made for the work of disinfection. Each town was to build a disinfeding 
cabinet for formaldehyde disinfe<!tion, to be placed in a portable protective shed, 
heated with a wood-burning stove. The door of the disinfecting cabinet opene<l to 
the outer air, but on the other three sides the tlisinfecting cabinet was surrounded 
by warm air. Each town was further required to furnish two good, intelligent men 
to constitute a disinfecting gang. On the part of the State l)oard oi health a skilled 
disinfector was to l)e sent to in8tru(>t succeHsively crew after crew and to work with 
them until the work of disinfection was well under way. Good and efficient work 
was done by these local boards of health, and in a comparatively short space of time 
the outbreaks in these towns were well under control. 

"The most serious problem, however, has been the control of smallpox in the 
BO-called Madawaska region, which extends from above Fort Kent to oelow Van 
Buren idong the St. John River, settled almost exclusively by the French descendants 
of the refugees from Arcadia. Here outbreak after outbreak has been stamped out 
with surprising rapidity, considering the unfavorable circumstances, only to be fol- 
lowed by new outoreaks in the same towns and plantations, or elsewhere. The 
infection which has started many of these outbreaks has been imported from that 
part of the Madawaska settlement across the St. John River in the Province of New 
Brunswick, and many have been started by persons who have returned to their 
homes from infected lumber camps and river drives.'' 

On February 15, in accordance with a telegram received from the Surgeon-General, 
I called upon Dr. Charles D. Smith, president, and Dr. A. G. Young, secretary of 
the State board of health, and consulted with them as to what was desired in the 
way of assistance from the Service. It was thought best to visit some points in the 
northern part of the State and to establish inspectors and disinfecting camps at the 
points where luml)ermen were passing on their return from lumber camps m north- 
em Maine and southern Canada. In company with Doctor Young I visitetl Milli- 
nocket and Ashland, and with Doctor Nichols, representing the State Iward, I visite<l 
Fort Kent and C/onnors, New Brunswick. At the latter platie we met Dr. E. Bavard 
Flaher, secretary of the provincial l)oard of hejilth, and he consented to establish a 
camp on the Temiscouata Railroad, a few miles from the Maine bonier. 

This railroad and a **tote road," which crossed Glasier I^ike, were the two ways 
by which lumbermen returned to this fie(!tion of the Stiite from the lumber cam{)s, 
some of which were known to be infectc<i with small j)ox. A camp was therefore 
established at Glasier Lake, on the Canadian side, by the Service, under the direc- 
tion of Acting Asst. Surg. Luther Mason, assisted by two helpi^rs. 

A small building was erected for the isolation of any cases of smallpox which might 
be found, and the clothing of passing lumlx'nnen was disinfected with fonnaldehyde. 
Some trouble was experienced in vaccinating, as many of the men refused to have it 
done. One party of 30, unusually lacking in respect for law or custom, passed by 
without submitting to inspection. 

The men were detained long enoush for inspection and the disinfection of their 
effects, boanl and lodging being supplied by a local resident. Tlie camp was ready 
for work on March 12, and during tne first three days Doctor Mason reported the 
inspection and disinfection of 53 men. Most of these refused vaccination, and as 
they lived in isolated parts of Maine and Canada, where there were no local lK)ards 
of health, there was no way of inflicting a penalty. 

The subsequent reports show that there were about 300 men detained and 200 
vaccinated at this camp before June 1, at which date the camp was discontinued. 
Doctor Mason being transferre<i to Fort Kent, Me., where he has been engaged in 
disinfecting houses and visiting suspicious cases. 

The lack of rain throughout this region in the early summer interfered seriously 
with log driving, so that communication l>etween the camps and towns was quite 
irregular, and the necessity for watchfulness and sanitary work continued beyond 
the end of the fiscal year. 



282 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

On or about January 1 Acting Asst. Sui>?. J. M. Boothby began the inspection of 

g arsons passing in the vicinity of Lowelltown, Me., near the western border of the 
tate. As there was no provision for disinfection, the persons who were regarded 
as suspicious were turned back. 

On April 6 Dr. Estes Nichols was appointed inspector at Sandy Bay Plantation, 
this being one of the points of entry from the lumber camps in eastern Quebec He 
was given two helpers and was provided with the means of disinfecting clothing. 
During the time up to June 30, 1,138 persons passed the camp and two cases of 
smallpox were treated. 

Respectfully, P. C. Kalloch, 

Surgeon. 

The Surqeon-General, Public Health and Marine-Hospital Service. 

MORGANTOWN, W. VA. 

Early in March reports were received at the Bureau as to the preva- 
lence of smallpox in Morgan town, W. Va. Following the usual policy 
of the Bureau, advisory aid and assistance were rendered, upon the 
request of the proper State health authority, as the following corre- 
spondence will show: 

[Telegrams.] 

Washington, March 5, 190S. 
Dr A "R Sarbeb 

Secretary SkUe Bmrd Health, Paint Pleasant, W, Va,: 

Have request from Representative Dayton to send expert to Moi^gantown, bot ta 
customary wish to do so with a thorough understanding with you as representioj; 
State board. Please send request. Matter believed to to ui^nt. Will send experi- 
enced officer. 

Wyman, Surgeon-General 



Point Pleasant, W. Va., March 6, 190S. 
Walter Wyman, 

Surgeon-General, Washington, D. C: 

Will appreciate your sending expert to Morgantown. Would like report. 

A. R. Babb: 



Washington, March 5, 190S, 
Carter, Marine Hospital, Baltimore, Md.: 

Have request from Representative Dayton for an expert at Moi^gantown, W. Va. 
One thousand students in university. Smallpox diagnosis doubted and called chick- 
enpox. Have wired Doctor Barbee, secretary, at Point Pleasant, W. Va., for rec^uest 
for expert. Expect reply. Proceed as soon as possible to Moigantown, wire amval, 
and await orders. 

Wyman. 



Washington, March 6, 1903, 
Dr. S. N. Myers, President Staie Board Health, 

Martinsburg, W, Va,: 

Suiv. H. R. Carter will be in Moiigantown to-day and will consult Doctor Warren. 
By direction of the Surgeon-General: 

White, Assistant Surgeon-CfeneroL 



[Letter.] 

Washington, March 5, 190S, 
Dr. A. R. Barbbb, 

Secretary State Board of Health, Point Pleasant, W. Va, 

Sir: Referring to your telegram of the 5th instant, stating that you would appre- 
ciate the sending of an expert to Morgantown, and would like a report, I hare to 
inform you that Burg. H. R. Carter, of this Service, will be in Moigaatown to-day. 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 283 

as been directed to confer with the local health officer and investigate the 

ttder suspicion. A copy of his report will be sent you when it is received by 

reMi. 

irection of the Sui^geon-General : 

J. H. White, 
AagistarU Surgeon-General. 



[Telegram.] 

Washington, March 6, 190S. 
i. R. Cabtbr, 
hlic Health and Marine-ffaspUal Service, MorganUAvn, W. Va,: 

; receiveti request for your services as diagnostician from both State board health 
ngressman Dayton. See Health Officer E. McL. Warren, and after conference 
iiii investigate matter in hand. Wire Bureau when investigation is complete 
irn orders, 
irection of Surgeon-General: 

WnrrE, 
Assistant Surgeon-OeneraL 



Report of Suboeon Carter. 

Baltimore, Md., March 11, 190S, 

As directed by Bureau telegram of March 5, 1903, I {)roceeded by the mid- 
rain to Moreantown, W. Va. Arriving there, after receipt of instructions from 
reau, I held a conference that night with the board of health and the health 
and the next morning, in company with the latter, visited 20 patients, in 13 
, suffering, or having recently suffered, from an eruptive disease. Of these, 3 
Eiricella. Of the remainder, 9 were certainly smallpox, and the 8 others, judg- 
DOi their history and conditions of occurrence, were with reasonable certainty 
ae disease. 

smallpox has been in Morgantown since early January or late December. 
ba<l been the usual disagreement as to the dia^osis of the disease, and conse- 
r no efficient steps have been taken to check its spread. I advised with the 
officer on measures for the suppression of the disease. I especially ursed that, 
J of the existence of varicella, any eruptive disorder should be guardea by vac- 
Q an<l isolation as if it were certainly smallpox. 
Respectfully, 

H. R. Carter, Surgeon. 

Surgeon-General, Public Health and Marine-Hospital Service. 

LUMPKIN, GA. 

g. W. P. Mcintosh reports from Mobile, Ala., April 7, as fol- 

be<iience to telegraphic orders of the 4th and 5th instants, to " proceed to 
:in, Ga., as expert to decide diagnosis in suspected case of smallpox,'' I 
obile at 12 o'clock (midnight) April 5, arriving at Lumpkin the following 
ig. 1 visited the office of tlie mayor, who immediately called a meeting of 
Lrd of health. After ascertaining the condition of affairs, I visited, in company 
le president of the board of health. Doctor Carter, several of the suspected cases, 
rst case I saw was a negro, suffering from a severe attack of semiconfluent 
3x, the eruption on face and parts of body being confluent, the conjunctiva 
iffecte<i, the patient suffering from secondary fever at time of visit. The wife 
man had just recovered from a mild attacK, and two or three children were 
ig from a mild form of the disease. In only one child was the eruption severe 
ibilicated. There were a number of negroes in the yard and near the house, 
doubt many cases will follow. I saw only one case in a white man, and he 
ivalescent. I was informed that the wife of aprominent merchant was very 
I confluent smallpox, but I did not see her. The cases are either in the city 
)r in suburbs. 

• seeing the cases I again visite*! the mayor's office. The meeting of the board 
th was reconvened and a meeting of the council also called. I was requested 




284 PUBLIC HEALTH AND MARIITE-HOSPITAL 8EBUICE. 

to make a short talk and did so, pointing out the necessity of immeiiiate vaccinatioa 
of everyone, also the advisability of opening a pesthouse or smallpox hospitai, tbt 
isolation of the sick, and quarantine of the infected part of the town until all hai 
been vaccinated and thoroughly disinfected with moist sulphur dioxide, ^TubbW 
with bichloride solution, 1 to 800; whitewashing of cabins and houfien, boiling ig 
water of all clothes and bedclothes, emptying mattresses, burning the straw and boit 
ing the ticking, all this to be followed by a thorough airing and ex|K>siug of artidii 
and habitations to sunlight, the premises to be cleaneil up generally and ii0da| 
articles burned. The gentlemen present were very earnest in their support ifl tben^ 
measures. It was decided to carry out compulsory va(!ci nation and a sufficient s 
ply of vaccine was ordered by telegraph. StejMj were taken looking to the etitahli 
meut of a smallpox hospital, the placing of an efficient guard around the infe 
area, and the thorough cleaning ana disinfection of infect^ or sus|)ecte<l iirem 

I was asked concerning the schools, in which a few ca.ses had occurred ali<jut ihn£ 
weeks ago. I advised a proper vaccination of all pupils and the immediate isolatioA. 
of infected children should infection occur, but I do not think it necessary to dam 
the schools. The postmaster asked me reganling the mails, particularly Vegai 
the writing of letters by persons suffering from the disease, and related the cue 
man who had come into the office with the eruption all over his hands and 
written a letter, used blotting pad, etc. I explained that all infected people wooH. 
be quarantined. I also requested the health officers to disinfect all mail comiM 
from infected places, and explained to the postmaster how to clip the ends m 
envelopes and drop in a few drops of formalin, then plac^ the letters in a cigar box 
with sponge saturated with formalin, seal, and keep in a warm place twelve hoofli 
The county judge and the ordinary were present a part of the time diuing tht 
meeting and were very earnest in their participation in the proceedings and offeisof 
assistance. 

In the afternoon I visited the cases a second time in company with a number of 
the local physicians, pointing out the characteristics of the disease. 

SMALLPOX PATIENTS RECEIVED AT ANGEL ISLAND, CALIFORNIA, FROM 
NAVAL TRAINING STATION ON GOAT ISLAND, CALIFORNIA. 

The Service in one instance cared for smallpox patients from tto 
naval training station. Goat Island, California, as shown by letter froB 
the medical officer in command of San Francisco Quarantine Station, 
Angel Island, California, upon this subject. 

[Lctteni.] 

San Francisco Quail\ntinb, 
Angel Island, OcUi/omia, Febrtuiry 2ii^ 1903. 

Sir: I have the honor to inform you that at the request of the commandant United 
States naval training station, Goat Island, California, I have admitted to the isolatioii 
hospital at this station 2 cases of smallpox, together with 2 contacts who will tike 
care of the patients during; their detention at this place. 
Approval of mv action in this (rase is respectfully requested. 
Respectfully, 

Hugh S. Gumming, Passed Asgistant Surgeon. 

The Surgbon-Gkneral, Public Health and Marine-Hohpital Service. 



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

Washington^ March S, 190S. 

Sir: Referring to your letter of the 26th ultimo, stating that you have, at the 
reouest of the commandant of the United States naval training station, Goat Island, 
California, admitted to the isolation hospital at your station 2 cases of smallpox, 
together with 2 contacts who will take care of the patients daring their detenUon, 
you are informed that your action is approved. 

Respectfully, W. Wyman, 

Surgeon' GeneraL 
Medical Opfickr in Command, P. H. & M. H. S., 

San Francisco Quarantinef Angel Island^ OcU. 





PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 285 

. AID RENDERED POSTAL SERVICE. 

I During the year at several points, where smallpox prevailed, it 
kcame necessary for the postmasters to fumigate the post-offices and 
pails in order to expedite the service. 

Small bills for the actual disinfecting material used were received 
m the Postmaster-General, and the amounts paid by this Service. 
The following letter will show the attitude of the Service in this 
rd: 

[Letter.] 

Treasury Department, 
^ BuBBAU OF Public Health and Marine-Hospital Service, 

^ Washington^ April f , J90S, 

. Sir: Referring to your letter of the 6th ultimo, making inquiry as to the proper 

hod of defraying the necessary expense of fumigation of post-office premises and 

1 matter, I have to inform you that this Bureau has adopted the custom of defray- 

the expense incident to providing disinfecting materials, such as sulphur and 

laldehyde, in cases where the local ho&td of health or other competent authority 

decided that disinfection is necessary, but has not undertaken to pay for either 

r or apparatus involved in such disinfection. 

This custom has now been in vogue for several years. 

* BespectfuUy, 

t Walter Wyman, Sargecn-OeTieral, 

\ Finar Assistant Pootmaster-General, 

Po9t-Office Departmeiiiy WushingUmj D. C. 

Lepkosy. 

Since the presentation of the report of the commission of medical 
officers of the Service relative to the prevalence of this disease in the 
United States no developments have occurred, nor is there special 
apprehension felt as to its introduction from other countries, or from 
iti existence in ceiiain dependencies of the United States, where it 
appears to be under suitable supervision. 

Revision of Quarantine Reguijitions. 

Owing to the advances made in the scientific knowledge of the origin 
and propagation of ceiiain quarantinable diseases, the quarantme 
re^^umtions of the United States Treasury Department were modified 
in the interest of commerce with due regard to safety. 

These regulations were approved and a new edition issued April 
1, 1903. 

The National Quarantine Stations. 

The operation of the 37 quarantine disinfection and inspection stations 
was continued and reenforced during the fiscal year. The advances in 
the scientific knowledge of the origin and propagation of quarantinable 
disease have been promptly made effective m tiio interests of commerce, 
consistent with the safety of health of the people of the United States. 

All the j>ortals of entry arc now guardea by these national stations, 
together with the several State and municipal inspection and disinfec- 
tion stations, with which harmonious relations have been maintained. 

During the year 5,922 vessels were inspected before entering at these 
national stations, and 352 vessels disinfected. 



JOO PUBLIC HEALTH AND MARINE-H08PITAL 8ER\TCE. 

A report of tmntjuctions from eiii-ii ijtianmtine station follows: 

PORTr-AND. 

[Portlnni] iinnninllTii!; [lOHt-offliw utdresn. Pontaud, ilt.] 



[Report ol Uie medical otBcsr la » 



n!otDeoembtr27,H01.] 



Mar. Apt. May. Imc.'lHd . 



Veneli apoken 

ed and paosod ... 

Sleamcn dlnlo- 

fectffl 

Sa!uj^Teneia dlih ' 
InleL'led 

Crew on salUag' 
FasKDgEn on sall- 



EA8TPOBT. 

(EHBlporl (Me.> Qualantlne.) 
[Report ol Actlug Ast Sarg. E. M. Small. In phaise.] 

Easttpoht, Mb., July S, 1903. 
8ib: Inclosed pleaae find my annual report tor fistail year ending June 30, 1903. 
Sydney, Cape Breton, has a [ewcaseaof emallpox, olsoKkhibucIo, New Bmnewtd. 
Bangor, Me., reports a, new ease. 

ReepectCully, Euwami M. Small, 

Jetitig Antitlanl Surgeim. 
The Burg koh-Gbhrral, Public Health and Mahins-Mobpital Ssrvick. 





Inly. 


AlW. 


Sopl. 


Oi'l. 


Nos. 


Dec. 


Jan. 


?eb. 


Mu. 


Apr. 


May. 


1U«^ 


IMl 


VoBek •poken >nd 


3 

t6 



1,314 

48 
1,5S7 






2.(183 

m 
o 


I, WW 


H 






en 

'■'i 

i.asi 


D 




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« 

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a 


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1.07V 


M 



1.411 

M 

t,4S3 




2 



11 

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u 


m 
11 

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H 


BtlltHgT^ta In- 
spected and 




»g™_,.dt 


^ 






PaaeengerB on 


"■" 



PCBLIO HEALTH AND MARINE- HOSPITAL SEBVICE. 



UBEDY ISLAND. 

[Rceilr bland QuuMitlne; poit-offlce iddnw, tI& Port Penn. Del.] 

[Report ol FMBed Ant. Suix- R. W. Wlckex. AKoined command under oDIcIhI oiden ot March 12. ItMS.] 

Pdbuc Hralth akii Mahink-Hobpital Smvick, 

OrficB OF Mbdical Officbr in Command, 
Reedy Aland Quaratititif, via Port Penn, Del., July SO, 190S. 
Sir: Ah directed in Buretra letter of 27th inHtant, I have the honor U> aubniit here- 
with the following report of traoBsctione at this titaUon for the fiscal year 1902-.1: 

Venels spoken and passed 35 

Bteamera inspected and passed 932 

Stewnera disinfected 2 

Sailing vessels inspected and passed 141 

Bailing vessels disinfected 1 

Crew on steamers inspected 36,100 

Crew on sailing veBsels inspected ,... 2,054 

I^sKngers on steamers inspected 32,816 

Psnrrnrrm nn sailing vessels inspected 2 

Beepectfally, 

H. W. WlcKKS, Pautd ^uiibinl ffurgeon. 
The Sdkobon-Gbkebal, PoBur HEAi,rR and Marine-Hospital Service. 
(ThroDgb medical officer in command of national quarantine service on Delaware 
Bay and River.) 



[IncloMin;.] 
TrajVKtrtion$ nt Reedy tlinnd Nntimu'l QtuiTaal'me Sintinnfitr flit year ending June SO, 190S. 





Jolj. 


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DELAWAHE BRKAKWATEB. 
■e Breakirater Qnarandne; poet-oWce addreni. via Lewes. Di 



ntcportof tbe di 



l1 oOleer in oommnn 






3f March MMl.] 



. AnUDied « 



Public Health and MARiNK-HoBprrAL Service, 

OfKicB OF Medical Officer in CoMMANDr 
DeUnixire Itrmtwater, Delaware, July SI, 190S. 
SiHr In connection with the tabulated atatiatical report of the quarantine traneac- 
tione of this station for the fi«-aL year ending June 30, 1903, I have the honor to 
submit below fuller details; 

There were boarded during the year a total of 119 vesselH of all classes. Tliis is an 
Increase over the total number )ioarde<l last ymr. It is however a decided decrease 
in the nnmber boarded here tlin^e or four ve&rs afio. The shipping at this )x>rt has 
gmttly decreased during this time, from what lauws I am unable to say. 



PUBLIC BEALTH AND MARINE-HOSPITAL 8ERVIGE. 



Ii<.'l<l in quarantine and were diHpowd 



DnrinR the year the following veweh wer 
of m follows: 

Brilii^h Btenmer AUanlon with sagar, from Java ports, arrived September 30, 1903, 
with hislfry ol B death from rliolera while in Javn. Helil in quarantine for a few 
houra and releaae<l on Bureau order. 

Russian 8tean)er Baron IMaen with sugar, from Java ports via Suei C«n»l, 
arriveii November 2, 1902, wi(h the body of a dead eeamai) on board, the liietorr of 
whoi4eillnu« led toa suspicion of plu^ie. The vc8f«l was ijuarantiiied, the body 
removed, and an autoppy performed. Specimens tnken were examined by AaJBlant 
Sargeon-General Ueddint» on the station, and were finally taken by bim to the 
Hygienic Laboratory for animal inoculation. After being held for eevenJ daystb* 
vee^l was releaMd, under Bureau onler, without pratique, and the quarantine oScH 
of her port of destination was informed of the fartH in the case. During her gtay 
here a part of her living compartments were disinfect*-d twice by formaldehyde pt 
and waaliing down with bichloride solution. 

American schooner MUlU R. Bohanon with cool, from Pliiladelphia, arrived Huth 
16, 1903, with 1 cane of sinallpox on board. The case was removed and the veaad 
with ail hands remanded to Reedy Island for treatment 

BritiHh steamer Riverdaie, with pig iron, from Middlesboro, arrived March 27, 19D3, 
with 2 cases of amallpoi. The cases were removed, and lateral! onboard (30) wen 
transferred asliore, bathed, all effects disinfected, vaccinated, and held for fonrteai 
days. No fresh cases developed. A fresh crew were put aboard the vessel and An 
was towed to Reedy Island for treatment, 

British steamer Timnvanila, in water ballast, from Manchester, arrived April 1, 
1903, with 1 case of smallpox on hoard. The case with hisattendant (the only man 
on board n^nrded as a contact) was removed, and the vessel remanded to Reedy 
Island for treatment. 

In addition \o tliis, the British steamer Milton, with sngar, from Alexandria, was 
r«Bsed without pratique and report^l to the Bureau. She was granted pratiqiie by 
Bureau onler January 21, 1903. Acase of eruptive disease was removed from fishing 
schooner I'klor, from Uloiicester, on April IS, 1903; the oaw) proved to be one of 
general dermatitis. The Italian Imrk Beixh Holm, with sugar from Callao, refused 

Erali<iite, and reported to the commanding officer at Pliiladclphia; granted pratique 
y his order Juno 7, 1903, Dutch liark Anitlerdam, from Java ports, with sugv, 
arrived June 10, 1003, with sevemi of her crew sick. Held a few hoars for ohserva- 
tion of sick. Dia^ositt made o( beril>eri and vessel released. 
Respectfully, ' 



\e-IItnffnittl Service. 

nd National Quarantine Service, Delaware Bay 



TVonmctioninlf/ 


June SO, 1903. 


rlA^ 


yearending 




Jnly. 


Aug. 


w.. 


Oft. 


«.v. 


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■Feb. 


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Apt. 


May. 


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16 


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lUKvenel* 


3.«« 



•I RemXKlFcl lo Rciily t> 



!• I>aillall]r dtolnfeetcd. 



PUBLIC HEALTH AND HABINE-HOSFITAL SERVICE. 

ALKXANDBIA. 

[BcimM of AiMjig Amt, Soni. Arthur Snowden, In chuKC.] 





Jnly. 


Aug. 


*^ 


Ocl. 


Nov. 


Be*. 


J«i. 


Feb. 


Um. 


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CAPE CHAKLR8. 



offlcUJ Olden ol November 3 



K.] 



CaPB CnARLBH Ql'ARANTINR, 

Fortret* Monrof, la., Jitfy JS, 130S. 
Referring to Bureau letter of the 27th inHtant n»ardiiig Iho anniml report of 
tion, I have the honor to state tlmt 276 vcrhcIh of all ili.>a(.Tiptions <»me under 
iadictionof this etation, of which 32 were 8atlii)|; vessels an<l 244 were Htmrnern. 
eamere and 1 Hchoonor were epoken anil pasMHl, whilo 240 xtcamerH iuiil 30 
resselB wen.' iaepected and paeeed. Two steamcra and 1 miling vessel wpre 
lad. 

re thousand eight hundred and elghty-eicht meuiberaof crewe were inspct.'ted, 
h 11,832 were on nteamera and 1.05U on iw.i1in^ ^'ceeela. One Iliouftanil two 
d and twenty-four passenseni on steamers were inHi>ected, while none were on 
veseels. No patients with quarantinable diseafic were treated at the isolation 
] at FiehermanB Island, 
teepectfully, John S. Boocehn, 

Aagutiint Siitgeutt. 
}urgeon-Gbnbbal Public Health ano Maihnb-Hospital Sbrvice. 



[InrluBUre.] 
Horn at the Cape Charlni Nnliimal Quaranline StaUon /or the yeur ending June 













SO, 190S. 


















July. 1 Aug. 


Sept. 


Oct. 


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Dec- Jul. 


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43 




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11.8M 


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£■. Zteo. 33S 19 



I'UBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 



[Cspc Fear Qiianinuno: i>»il-um<.*r vlilrpw, via Hoiithport. K. C.| 
[Rcpuit o[ thu mvillcal offlcvr In cunimHiK], Awl. Siiib. B. S. Warren. Aniiirai'd cDnunuiil udiJkMI. 

CaPK FeAB QhARASTISB fJIATIOK, 

.Soidhpori, .V. C, AuffuM 2S, 1903. 
Sir: I have the honor to Btato that 1 assumed M>mmanii of thia etatioa on April 3, 
IHOU, relieving Asst. Surg. L. D. Fricke. 

During the ycar56veBKlB were hoarded, 51 were passed, and 5 disinfected. SiiMs 

were from the West Indies, 4 from South America, 8 from South Africa, U (ran 

Europe, 4 from Cuba, and 10 from domestic ports. 

Of the 5 veeHele disinfected 3 were from South Africa and 2 from South AmericL 

Respectfully, 

R. S. Warken, Atmiaiil fyurgt 

The Sukiieon-Genbral, Pudlic Health and MARiNE-HoHPriAL Sebvice. 



[Invlogore.] 
ci( llie Cape Fmr Nationai Qunmnline fUnfionJnr Ihe ynir niding Jinu- .«!, lUO-l 





JuW, 


Aug. 


».l.t. 


■»,.„„,. 


t)ve. ' Jnii. 


>-i-l>. 1 M«r. 




HI,.-, T.«l. 


pa-i'il 





u 


. 


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19 



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Crew^n'mifuTii' 


711' M 


"iSEr:""':: 





ll-rfp„rt of tl 



Ih'lal 



il t>rdei 



■ o( May 2. 



Iiil?}'. Awuined chai^F 



Pl-BUI- HeALTU and MARIHE-UoePITAL SERVICE, 

Office ok Medical Offickr in Command, 
Saivundh Quarantiiif, fiai-annnh Ga., Auguii I, 190S. 

Slit: In c^)ropliance with intftruclions receivetl in Bureau letter dated July 27, 1903, 
I have the honor tn suhmit the following report of transactions at this Htation (or 
the fiecal year ended June 30, 1903: 

One liundreil and cij,'lil_v-»ix steamships and 1 16 sailine vesaela, carryiuR 6,806 sea- 
men and 53 p!LsiH!ngeT)>, were iMarded and ins;>ected. One hundred and sixty-nine 
of the former were civen pratique immetliately after inspection, 7 held for disinfec- 
tion, 1 held fur two hours and 1 for four days and then released without disinfection, 
and 1 other held for fumigation, but departed without it, having received orden to 
sail for another port> Three of the steomships held for (juaraiitme regulations were 
disinfected and detained for observation or instructions. One of these was held for a 
pcrioii of six days, 1 two davs, and 1 four <!iiyn. 

The other 4 were simply fumigate<l to kill rats or luosquitoes and then relea8e<t, 3 



FDBLIC HXALTH AND M A RI HE-HOSPITAL SERVICE. 391 

le EBiling reeeela were boarded at the 
, . >S were given pratique on inspection, 

lined for disinfection, and 4 held from one to eeven days before being reieaeed 
.t diidnfection. Nine of the 27 ve»ela boarded in the roada were given pn- 
n inspection, 6 of them sabeeqnently poaeing up to Savannah and 4 patting to 
'he other 18 were held for either fumigation or duinfei'tion. Twelve of th«ae 
?ea, and 6 pasted up to &a^'snnah after treatment at quarantine. Seven railing 
were disinfected and held for obeervation, and 26 were fumigated to kill mla nr 
.toes and then releaaed, the average period of detention for the former being 
) and for the latter 2^^ day a. 

e iStolum /or the yoir rnding June 



Jalj. Aos. Sept. OcL XOT. Xiw. Jan. Feb. Hai. Atn- H«y. Jane Tnli 



pokenuiil 
•inn«ctcd 



vmielH Innpiiaiil uiiil pwmud" in Iliu nhii 
e olbi-r port; also 4 other vi'st-la deUlncd 

Xatiimaiity anil dim iif cemels Inmrded darhuj tlie year. 



1 S 



Trealmait of vrj»d» arriving during the year. 



ed and passed 

)r dieinfection 

>r fumigation, but put to eea. 
lan eteamehip Colilmtz held o 
steamship Darlington held tw 



392 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBV1CE. 

HAILING VESSELS. 

Inspec'teti an<l passeil 58 

Held for disinfecrtion 27 

Tybeo for orders: 

Inspected and passed — 

Put to sea 4 

Passed up to Savannah 5 

Hel<i under observation — 

Put to sea 12 

Passed up to Savannah after treatment 6 

Russian barkentine Latwiga held seven days pending diagnosis caae of enteric fever 
and released. 

American schooner/. IF, BuUrickf case of malaria removed and vessel proceeded to 
Brunswick without pratique. 

Norwegian bark Smarts case of inflammation of lymphatic glands of groin, removed 
and vessel proceeded to Glasgow. 

American schooner Abbie Bawker^ provisioned in quarantine and proceeded to 
Philadelphia. 

Countries from which detained vessels came. 



South Africii 20 

Cuba via Philadelphia 1 

Venezuela 1 

Uruguay 1 

East Indies via Liverpool 1 



East Indies via New York 1 

French Guiana 1 

Brazil 1 

West Indies 13 



Cargoes and ballast Itroughl Ity detained vessels. 



Salt and general 1 

Molasses 1 

Light 8 

Sand 5 



Sand and stone 16 

Water 6 

Stone 2 

Iron slag 1 



No infected vessels were treated during the year. Two thousand three hondred 
and seventy-five tons of ballast were discharged. 

The following cases of sickness were observed aboard vessels on arrival at quaran- 
tine: 



Valvular disease of heart 1 

Enteritis 1 

Malaria 5 

Enteralgia 1 

Inflammation of lymphatic glands, 

groin 2 

Syphilis 2 

Respectfully, Wm. J. Linlbt, 



Acute articular rheumatism 2 

Myal^a 1 

Entenc fever 1 

Acute lobular pneumonia 1 

Suppurative arthritis kneejoint 1 

Beriberi 1 



Acting Assistant Surgeon, 
The Surgbon-General, Public Health and Marine-Hospital Service. 



SOUTH ATLANTIC. 

[South Atlantic Quarantine; post-office addr&w, via InycmeflB* Qa.] 

[Report of the medical officer in command, Amt. Surg. O. M. Corpnt. Anumed command under offi- 
cial orders of November 25, 1901.] 

South Atlantic Quarantine, via Inveknbbb, Ga., July i, 190S, 

Sir: I have the honor to submit the following report of transactions at this station 
during the fiscal year ended June 30, 1903: 

Two 8teainshi[)e, wnth a total tonnage of 7,327 tons, were disinfected and detained; 
22 steamships, with a total tonnage of 45,452 tons, inspected and passed; 1 steamship 
spoken and passed. Eighteen sailing vessels, with a total tonnage of 17.098 tons, 
were inspecte<l and passed ; no sailing vessels disinfected during the year. No vessels 
were remanded here from otlier porta, and no sickness has occurred in quarantine 
during the year. 



PUBIIO HXALTB AlfD UABINB-HOSPITAl. SEBTtf^. 



293 



The health of officers and attendanta has been exceptionally good. Two slight 
cases of malarial fever oct-'iured among the attendants; in both cases disease was 
acqaired ashore. The men recovered rapidly under ordinary treatment. 

A rule requiringallattendantstoreportimmediateiyany slight illness among them 
haa been rigidly enforced, and has, in my opinion, done much good in maintaining 
the general Deaith of the force to a high standard. 

In conclusion, I have to reapectfiilly report that relations with local and other 
health authoritiee have been, without exception, pleasant and harmonious. 

A request for information concerning mosquitoes on vessels from foreign ports was 
rw«ivefl from thehealthofficerof Louisiana, and was replied to through the Surgeon- 
General, Public Health and Marine-Hospital Service. 

Many requeats for permission to visit and canip on the reservation liave been 
received, bat as in my opinion the granting of such requests was not good quarantine 
practice, and would probably have eetabliahed a bad precedent, they were refused. 
Beepcctfully, 

G. M. CoBPUT, Astixlunl Snrgmn. 

The ScRoioN-GaNKRAL, Pcbuc Hbalth and Marinb-IIosfitai. Skhvick. 





juir. 


Aug. 


Sept. 


Ocu 


«... 


Dm. 


j„. 


,«., 


Unr. 


Apr. 


«„. 


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To-,. 


*'s2r""'"' 
















', 








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BHUN8WIOK. 



la Bnmawlck, Ol] 



offldal orden 



Sure, J. n 



EBmniwlck Qni 
(Report of mcdlcil offlcer In co 

Brdnsa-ick QtiAKANTiNB Statioh, July so, 190S. 

Sir: I have the honor to acknowledge receipt of Bureau letter, dated July 27, with 
the inclosed copy of Bureau letter of May 11, and one blank statistical form letter. 

In reference to the information that only the Btatistiial fonn letter showinff trans- 
actions at this station during the Hecal year ending June 30, 1903, waa received, I 
would slate that Imade out in addition to this a complete report of transactions, as 
directed in Bureau letter of May II, and direcleel the acting Stewart to attach the 
two securely together. I can not account for Its loss, as a copy of the report appears 
in the copving book at this station. 

I have tile honor to transmit herewith the annual report of transactions uf lliis 
station, together with the statistical form letter. In column of " Vessels spoken and 
paaued" I have included also all vessels boarded and paseed. 

ReepectfuUy, Jno. T. Burkhaltbr, 

AtMUnil .Surgeon. 

The BuaaEON-GiNKaAL Pitsi.ic Healtfi .^Nti Ma rink- Hospital Sbrvics. 



PUBLIC HEALTH AKD MARIKE-BOBPITAI SERVICE. 



r llie year md'av/ 

Tho inclosed Bchedule ithows that 22 veHsela were epoken and paaeed, 20 fclaumn 
inspected and pafsed, 61 Bailing veeeels inspected an<l passed, and 22 sailint; \tm^ 
disinfected. 

In addition to llie>«, two sailing vctiseis disinfected in Habnna were held in aoir- 
antine to discharge their ballast. One pailini; vessel from Buenos Ayres, bouiiJ for 
Sapelo, put into this port on account of stonn, and was held pubject to qnarantipe 
inspection at Sapelo. One KillinK veswl from Savannah, l>onnd north, met with i 
Htomi and arrived in Quarantine with thi: captain and mate sufferint; with a severe 
attack of malarial fever. Tlie American steamer M. F. Flant was held one dav in 

Juarauljne to tllagnose a case of fever, which proved to be roalariat. She was fitun 
acksonville, Fla. 

Sixteen steamers and 5 sailing vessels, coastwise, were epolien and passed, liaving 
arrival in the States from noninfected foreign porta. One sailing; vessel from Poan 
was pasHed on certiGcale of an officer of the Serviite. 

Nationality of veseela disinfected: Norwt^ian, E>; Spanish, 6: Swedish, 3; Britiab, 3; 
Portuguese, 1. 

Porta from which they arrived: South African, S; Cuban, C; Brazilian, 8. 

No vessel arrived at this station with a quarautJnablc diseaw aboard. 

All vessels were examinetl to discover presence of mosquitoes, hut without resolte. 





July. 


Aug. 


8ep[. 
■ 


0.. 


»„. 


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Jbii. 


Feb. 


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Apr. 


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[Tamptt Bay Qualsntlnt 
(ReiHirt •>[ mt^dlral officer in rommanil, Ai 



TAMPA BAY. 

poKlflffice addren. via Tampa, FIl] 
It. Sarg. C. C. Pierce; ai 



K asmmcd commaiid udiIfi 



(ifflriil 



Tampa Bay Qbaraktinb, 
MuUel Key, na Tampa, Fla., July I, 1903. 

Sir; I have the honor to inclose herewith tlie tabulated report of transactioiis nl 
this station for the fiscal year ended June 30, 1H03, as directed by circular letter of 
Mayn,ltH>3: Steamers intmccteiland passed, 67; sailingvesBeisinspected and pawed, 
123; steamers disinfected, 9; sailing vessels di!>infected, 17. 

Eleven sailing vessels were required to discharge ballast and were afterwards dis- 
infe<'te<l, fQiiiigated for rets, or mechanically cleaned, as the conditions required. 

Con)|iaring the number of steamers inspected and passed during thiH fiwal year 
with the nuinlier last year, viz, 108, shows a decrease of 41. This is not <lne to less 
commerce nt this port^ but to certain changes, both in the practice of the station and 
the character of tlie vessels. 

DuriiiB the fiscal year jirereding this one the State authorities had charge of this 
station (luring the month of July, and rci]uire<l every foreign steamer entering coast- 
wise from American ports to nndergo a second inspection here, which practice was 
continued by this Service until the end of the closeit quarantine season oi 190Z, when 
it was discontinued under pro|>er authority. 

Such inspection was unneceeearv and caused coni^ideralilc loss of time in case a ves- 
sel arrived just after dark and lia<l to remaiti at anchor all night for inspection the 
next dtty. 



PUBLIC HEALTH AMD HARINE-fiOSPITAL 8£HVIC£. 



295 



exjioKinK of ckttletoCnba ban been almoet entirely diBcoatiaaed, tbus«lecn.>as- 
tenally toe number of veMele inspected and paeeed, a considerable portion uf 
were reluming cattle veeeela. The amount of phoapbate sent out thia year 
l,01S tou?. being an increase of I0,&43 tons over the pre<'eding Gtical year, 
ng the fiscal year ended June 30, 1902, there entered thia j>ort a total of 459 
red vemels, of which 266 were inapecled or quarantined at thia station, thus 
els entering were subjected to eome quarantine 



I, the total number of veeeela 
els over last year. The num- 
e 21S, being 45} 



g that 58 per cent of all v 
jona during that year. 

ng the Qbc&I year just closed, on June 30, 1 
ig up to June 27 waa 474, an increase of 15 v 
veeaels sabjected to quarantine restrictions during the y 
it of all veAela entering, 
only case of qnarantinable disease was one diagn't^ed mild yellow fever, taken 
le British stcamHhip Aberfdday, arriving December 27 from Tampico with one 
ck. He was isolated ashore and hia blood examineil repeateiUv, showing the 
e of Plasmodia. Recovery waa prompt. The vessel was tfisinfected and 
d after five days' detention with all well on board. 

uly 22 the German ship Siam arrived from Limerick, Ireland, with 800 tons of 
One member of the crew developed a mild case of enteric fever the second 
er anchoring here. The water tanks in use were emptied, clt>aneil, and refilled. 
seel was disinfected on August 4, but on account of some li^al trouble with 
-, parties remained at anchor at the station until August 28, when pratique was 
¥itb all well on board, the case of enteric fever having recoverecl before that 

Norwegian bark PnlUu arrived October 27, from Delagoa Bay, in ballast One 
id acute pulmonary tuberculosis, the diaKnosis bein^ confirmed byB bacterio- 

examination of his sputum. The vessel was disinfected, in accordance with 
ment circular, No. 15, of February 11, 1902, and also fumigated for rats. 
une 16 the British steamship Elmiick Manor, from Vera Cruz, was disinfected 
tained five days. This vessel was bound for Port Innlis, 100 miles north of 
t which place there is no health officer, as but few vessels load there. leading 

from lighters at a distance of about 10 or 12 miles from shore. This was the 
seel disinfected at this station for porta other than those on Tampa Bay since 
te transferred charge to the Treasury Department. 

snly vessels arriving with cargo which were inspected were some small schoon- 
h cedar logs from Cuban porta and thoae engaged in the fruit business from 



infected ports. 



BuRaBON-GSHBRAL, PtTBLtC HbALTH A 



Claude C. Pibrcb, 

Aa'Mant Surijnm. 
n MARiNiE-Hoapn'AL Service. 





JdIt. 


Ang. 


BepL 


Oct. 


»„. 


°- 


Jm. 


y.^ 


Uu. Apr. 


Vmj. 


J„n„ 


T,,U,. 


pokenand 


«l 





" 


: 




A 





TO 


ss 






10 10 

lao M 
a 


4 


e 

3 




'■^" 


r„ 


led and 




nnUdt>- 


u' i 


' 


r*^»2'g 


m -JCT 1 «l 


»v i>v< , i,t™ 


liter* on 


U J u' n 


ia 


■ri« 




" 


.' . 


1 


>■ 


w 



PUBLIC HEALTH AKD MABINE-H0.8PITAL SERVICE. 

CUMBERLAND SOUND. 

[Cumberland Soand quanutlnc; pMt-oOlcc wldKtiii. via FemuidfiiB. Fla.] 
[Report of Acting Ant. Burg, J. Voal» Horse)', in charge.) 





July. 


Aug. 


Bept. 


Oct. 


Nov, 


».,. 


t.n 


Fob, 


Mac. 


Apr. 


Ma). Jwhl't^ 


Viiw]l>«FO]unimd 






1 


at 




2 


• 


„ 





117 
11 


« 




"SS-..".'-!.";. 


'; ' 


/ ;' • 


SBUUiKVUWilii iii- 
ppeotod «nd 


3 
13» 









ui a' 3t 


Craw on Btaunen . 
Crew on nilUng 


'^ '^ "X" 


'"rt^m"™'"' °" 


a! oi 1 i 1 




• 


u! s a 



MAYPOHT. 



[SI. Johni Rtver iiupecUon 
(Report of Acting Aj 



caulay 



ia Uayport. I 
I charge.} 



St. JonNa Kivrr Inspbction Station, 

Mayport, Fla., July SI, ISOS. 
Sib: I herewith have the honor to tranmnit my annual report of the tranBaetiou 
at this station for the fiscal year ending June 30, 1903. 
Bespectfully, 

Geoikir Macau lay, 
Acting AioulaTit Surgeon, PiMic HeaUh and Marine- Honpital Strvite. 
The Subokon-Ubkbuai., Public Hbaltii ani> Mabinb-Hospital Sbbvice. 



Jul]-. Aug. Sept. Ck'l. 



Vends apukCD ii:i 

Bloamurs iogpcct- 
ed nod paand... 

Btaamen d i - ' ~ 
(ecU-d 

Sailing venela In- 

B^l^v^'b dlH^' 

iDfoetcd... 
CrewonBtean . .. 
Crew on sailing 



PUBLIC HEAI/TH AND MABINE-HOSPITAL SERVICE. 297 

BlEY ¥nE8T. 

[Key West Qnanntine; postofflce address, Key Wt«t, Fla.] 
[E^Mirt of Sanitary Inspector Y. Porter, in temporary cbunrc.] 

Key Wbbt Quarantine »Station, 

Key West, FUi,, July 6', 1903. 

Sir: I have the honor to incloee, in obedience to Bureau ciri'ular letters of May 11 
and June 26, current year, a statistical table of quarantine in»pection and disinfei^tion 
of vesBels arriving at this port, and likewise of inspection of passengers and crew, for 
the period ending June 30, 190^. In compliance also with instructions, the following 
report on the condition of the quarantine service at the port of Key West, Fla., 
together with a statement of condition of the ap]>liance8 and machinery c*onnected 
therewith, is respectfully submitted for your information: 

There have been no incidentfl of marked sanitary importance or interest in quaran- 
tine management at this port during the past year, but the work of the station has 
been conducte<l with careful attention to details of law and regulations. The freedom 
of the island of Cuba from ]^ellow fever has not onl v simplified quarantine procedures 
for all of the ports of Florida having commercial relations with Cuba, by lessening 
many burdensome, although at one time necessary, restrictions, but has greatly 
relieved the tenseness of mental anxiety, and consequent worry to the quarantine 
officials, which formerly harrassed and annoyed the citizens of the State as each 
summer season came around. 

There is no longer a necessity for an imposition of immunitv requirement against 
yellow fever on iMiasenger service to and from Cuba, and disinfection of baggage has 
altogether ceased, except as may be demanded at odd times as a precautionary meas- 
ure against introduction to the State from foreign sources of the contagious maladies 
of scarlet fever, diphtheria, or smallpox, although as regards the last named^ and 
speaking for Cuba, there has not been a case reported in Habana as of mumcipal 
development since 1900. Passengers arriving at Key West from foreign ports are 
examined as to general healthfulness at time of arrival, and if from known yellow- 
fever ports where bills of health vis^l by a medical officer of the United States Pub- 
lic Health and Marine-Hospital Service show existence of yellow fever at ports of 
departure, must be immune to yellow fever and to smallpox by successful vaccina- 
tion and free from leprosy, else the vessel, with passengers, will be remanded to the 
quarantine station at the mouth of Tampa Bay on Mullet iLey, If passengers at the 
time of quarantine inspection show evidences of any constituuonallv dangerous com- 
municable disease the immigration agent of the United States is informea, who calls 
to his assistance in determination the medical officer of the Service who is charg^ 
with such service at this port. 

It will be remembered that the disinfecting plant for this port is located ashore 
and on property rented from the Peninsular and Occidental Steamship Company. 
The machinery and house is owned by the Service. The machinery was purchased 
from the Florida State Board of Health in 1901, and had been used by tliat organiza- 
tion for two years, consequently it was a second-hand machine and machinery when 
bought. The condition at the present time is fair and in good repair. 
Respectfully, 

Joseph Y. Porter, 
Sanilary Ingpedor, Public Health and Marine-Hoispitul Service, 

in Charge of Station, 

The Surobon-Genkral, Public Health and Marine-Hospital Service. 



PUBLIO HE&LTB AlfD HABINE-H08FITAL 8SBTICB. 



TVonandton* at the Keg Wetl (Fla.) NaiumtU Quarantine Station Jor Qu year oiduif 
Juiu SO, I90S. 





Joly 


AiW. 


8«.t. 


Oct. 


Uov. 


Deu. 


Jm. 


-b. 


».. 


ipr. lUj. 


Ji>ac.T«Bi 


VeawlHntokcnimd 


























"sa" ■"■""'■■■ 


3 

llfl 
■47 


10 

l.UM 

121 


«31 

63 


10 

1,0U9 


S3 


^ 


,. 


an 


,. 


"i " 


» 


m 


eaUtng venelB iti- 
^■1 ■"■■ 


16 


fl] 11 


6 


11 




U 


41 




'SL^--'^ 




CrewcinsalllnK 


1.074 
106 
UK 

Iffi 


1,0G2 


: 





783 

to 
ft) 




l.lffi 


l.l« 

AM 

* 






"I'iiSvliil".'!. 


" 



BOCA OBAMDB. 

[Boca Orande Qiunntlns: pOHt-oDlce addren. via Piinu Qofda, Fla.] 

(Report ol Acting AaM, 8uig. B. B. Blount, in chBige.] 



Sib: I have the honor to incloee anniul report of tnneactioiie at Boca Grande 
Qnarantine Station for year ending June 30, 19(». 

It«epectfully, B. B. Bloitht, 

Acting Attitlanl &iTffe(m. 
The Bubobon-Gbhbraj., Pdbuc Hbalts and Marinb-Uoapitai. Ssbvice. 



Fab. liar. Apr. Ita;. Jiu& ToML 



VokIs ipokcD and 

Steunen luipevlr 
ed and paned . .. 

Sleainen dldn- 
Iwted 

Sailing tcmcIh I 
ipecjed an- 

iDfetted... 
Crew on m 

Passenger 
nailing ve» 



fOBUO EKALTH ABD MABINE-HOenTAL 8KBVICS. ^9 

CEDAB KBTS. 



[CeduiKBTiC 



M TlaOciUr KCT^ PU.) 
t. Sms. K. T. Walker, In charic.] 





July. 


Ane. 


A'pt 


f)CL 


N«,. 


IHV. 1 JlUl. 


Prb. 


Hw. 


Apr.JM.>-. 


'•- 


™.,. 


"SS""""', 




















1 




"s^iisr 




■ 










. 






1 




1 




























■ p^t™ •nd 






































































« 








































'«!S^""" °" 




























^trisr.^-. 























































ST. GKOBQE SOUND. 



[St. Oeoite Bonod qiwrantlDe, I 
[Reportol Acting J 



It F<ua(aolhtTigatWeMPwa).Ciim.belle. F1a.J 
It. Sutg. E. L. filewirt. In chaiKe.) 





jQly. 


Aug. 


Sept. 


Oct. 


Kov, 


Dm. 


J... 


r.b. 


M„. 


Apr. 


».,.!,.»,. 


T.^.. 




• 


2 


1 


5 


fl 


10 


i 


s 


t 


7 


la 


< 




Bteunen taupeclcd 




■S^"-' 




























jjj^.d.nd 


' 


I 


. 


^ 


& 


» 


' 


. 


' 


• 


.. 


• 




■Sl™"'^ 
































Cj^„ -"'» 


M 


• 


IB 


» 


« 


M 


» 


" 


' 


M 


" 


•= 


«7 






* 

























































PKNSACOLA, 

« AM. Burg. R. C. White, li 



l«.l 



[SUDUl Bon Qiian 

[Report ol Acting AsHt. Burg. F 

Santa Roba Qii.4 

}'a\mcola. Fin., Aii^itt 3, 190S. 
Sir: As directed in Bureau letter of July 27, 1903, I have the honor to trauemit 
herewith report of the qnarantine tranBoctions at this etation during the fiscal year 
ended June 30, 1903. 

Eeepectfully, H. C. Whits, 

Aaing AKiMiini Surgeon, in charge. 
TheSdKOBnN-GBNEtiAL, PuBi.if Hbai.th ani> Mabikb-Hobpital Srrvick. 



300 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

[Incloaure.l 
Thtntactunu at the Santa Rata National Quarantine iSatioa for the iiear ending Jmu 





July- 


Aug. Iflppt. 


Ort- 


Kov. 


Dtc. 


Jan. 


ri-b. 


Miir. 


...,. 


M-Jf- 


i„..,T»l 


^SSf."'.™""' 






M 


S 


43 








i . 




iss;^ 


la 

■t 


w 


■M 

■xa 


» 
«» 


19 


1 


6 


"i »■ 


BmillnK TuwtB in- 








ISd 


"1 '" , 


ll • 


Crew on »alllng 


am 


IW7 




Mol «.ni 


^rtUS^"""" 


ll 


^"v^S"""- 


11 




, 






















1 



July, 1902 1 

AngUBt, 1902 1 

September, 1 902 t 

May, 1903 I 

June, 1803 S 

18 



Beeidee the number of paseengers enumerated c 
there were the following etowawaye: 
Od steamers: 

August, 1902 

September, 1902 

October, 1902 

Jannnry, 1903 

May, 1903 



Bteainera and sailing veeeeU 



MIAMI. 




[BlUHyiio Boy Qinimiillni-; ihmI-uOIci.- ikIiI 


n*., Tta Miunl. Plfcl 


IRcpuTt ol AcUliK Awl. 9utB. Jamw M. Ja 


fliBdii, jr., Ill charfo.) 



BiocAVNK Bay Quarantine Station, 

Miami, Fla., July 6, 1905. 
Sir: 1 have the honor to herewith hnnd you annual reports of truiBactioas at thii 
station for fiscal year ending June 30, 1903. 

Very reepeutfully, Jaum M. Jackbok, Jr., 

Acting Aaiitant Surgeon, in Charge. 
The SuKUHON-UsKiutAL, PuBUc Health and Makwb-UospitaIi Skrvicb. 



PUBUC H£ALTH AKD HAKINE-HOSPITAL 8EBV1CE. 301 

-fittru at Ikr Bucayne Bay iVnlionnl QuaraMitu Station /irr the i/nir ending June 





lulj. 


Aug. 


Sept. 


Opl 


Nuv 


D«. 


JiLII. 


F^L. 


M.r.[Arf,|M..>'. 


J.m. 


Tiilal. 


[..kmnitd 


• 
i 


s 




U 

■0 

( 
8 

M 




t 





14 


9 
1 

S 

S 




u 

i 
p 

1 


19 

"I 


lb 
MT 


IS 


10 
M 








10 



■! 









rEs 


« 


r":;"u 




«»clidl» 






a, TIB 


;eni on 




232""— 


70 



PUNTA KAB8A. 

(PunuBuHliupecUoD Buttons poat-olBc? uldien, tU PunU Ruh, PU.) 

[Report of Sanlury Guard G. R. ShulU. In chuse.J 

PuNTA Rabha, Fla., June 30, 1903. 
I have tho honor to report that (or the year ending June 30, 1903, no veeaeb 
/ from foreign ports liave arrived at thii port. 

county (l.ee) has lieen quit« free from contasioiiH eicknem, with but a few 
'malaria, and nothing hafl been reported to medarinK the year tocausealarm. 
Respectfully, 

G. R. Saui.'i?, Sanilary Guard. 



[Indoiuirc.] 

^niionitl Qi 
le SO, 1903. 



w 


Aug. 
3 


«. 


,.,. 


Nov. Doc. jjiin. 


Fob. M.r- 


Apr. 


"■' 


Jnne. 


Tol»l. 


pokenand ' 




' 












'XT"^ 2 


i 


1 


1 










i dlKin-l 






1 1 




rL-Mli In- 
cd uid 


4 








7 


■ 




Si-i-e: . ' 




1 










n tttllnir' 


30 
















a 


.; 




Hera on 






1 


















1 





































iboN'e veaeeta were from Cnba anO inspected at Key Weet, Fla. Loaded at this 
ith cattle and Ii-ft for Ki-y Wirst, thence cleared for ports in Cuba. From 
, 1902, to May, 1(103, nothing from foreign or contagious porta, 
leapectfully, 

G. R. SiiULTZ, Sanitary Ouard. 



PUBLIC HEALTH AND MARINK-HOHPITAt 8EBVICB. 



PASCAGOULA. 



[Bepon of ActtnK A» 



, qiurnDUne.] 
B, P, Duke. In chMge.] 

PABCAliOULA, M18B., Jolt/ 1, 1903. 



Sir; I have the honor to submit herewith oonual report of tranaai-tioiis a1 
tion for ttie year ending yesterday, which I trust will be eatisfactory. No qnai 
tinable disease has appeareit on any vessel during the year. The health of the j 



The SuROttON-GENERAL, PUBLIC IIkaLT 



B. F. DcKE. 
Acting Anii^nl Surgeon, in Charge. 
fi> Marine-Hospital Sbbvice. 



[Inclosiire.] 
Thjiua<^um»/U tilt P(mxigoulnNationtUQuaraiUineSUUi(m/orlht year aiding Jtiiu SO, IStOt. 





July- 



Ang. 

I 


Sept. 



— 


No¥. 

1 


Dec. 


Jan. 


Feh. Mat. 


Apt. 


M.y. 


udv.'tmiI. 


'^Sr'-"'.'' 




1 


' 


Hi*" 


. 


WHnBVMBlBlii- 
■peclL'd and 


^ 





. 


' 


U 


5 


i 


» .. 


' 


13 




SiUi^wwiidi'i- 




CrewuDmcununi.. 
Crew on ulUng 


a 


a 





" 


„ 


S» 





■a b 


» 


a 


Ifi 


Pa^^^rVVn- 


i 










' 1 , 






J 















OULP. 
;;: puat-office aildreaa. via Bl 






Gulf Quarantine Station, Julg S8, IMS. 
Sir; I have the honor to make the foifowinK report of traosactioos at this station 
for the year ending Jnne 30, 1903, as per table attached. 
Eighty vessels were inspected and pajwed, while 78 were disinfected. 
One case of yellow fever, received during the year, was treated in the station hofr 
pitaland dl«:liaived; recovered. 

Respectfully, 8. B. Grcbbs, 

Pa$ied AstiMtant Surgeon. 

The SL'ROBON-GliNBKAL, PuBLLC HbaLTH AND MaBINB-HoBPITAL SbRVICR. 



PUBLIC HEALTH AND MARINE -HOSPITAL 8ERVI0E. 



Wioni at Iht Gvlf Natumal QuaranH, 


eSualon/ 


r (fe 


year 


ending JuneSO 


/SOS. 




July. 


Aug. 


..p,. 


.V,. 


N-„v, 


W... 


J*.n. 


F.b, 


„., 


.p. 


«... 


June. 


Tow. 


ipokenwd 


a 

13 


a 

i 
U 

m 


3 

i>4 


4 


'" 


a 

1 


16 

« 







« 

10 

IH 




M 





8 

n 

1 


lat 


3 

lid 






s Iiupect- 


" 


s-:ft 




•r-"- 


71 


In HtUng' 


as 


geri on 


'■'» 


mon uil- 
»el« 


1. 



SAN DIEQO. 
[San Dlegn Qiunnlinv; poal^lUce (uldnM. via San Diego, Cut.] 
ol medical officer Id charge. Acting AsM. Surv. W. W. HcKay. Asnimcd cl 

oH^nof Apra4.18«e.| 

San Dibgo Quarantine Station, 

San Diego, Gd., Jvly IS, 1903. 
Inaccordaucewith Bureau circular letter of date May 11, 1903, 1 have the honor 
lit herewith the tiansactiona of this station for the liiwal year ending June 30, 
During this period, as noted on the accompanying report, 151 veseelB arrivinK 
rantine were iaspected and posned and 2 were dieinlected, making a total of 
meU. One of the vessels disinfected was bound from ^an Francisco to Panama. 
about 300 mites oS San Die^, smallpox broke out aboanl and the vessel, which 
I American schooner, put into San Diego Quarantine Station for relief. The 
ressel disinfected was the U. S. training ship Adamt. The disinfection waa 
n request of tbe commaading officer o[ the vessel on account of measles having 
I out among the apprentices. The sick were isolated in tents ashore and the 
disinfected. No further cases occurred. 
Beepectfully, W. W. McKav, 

Acting Aiaitlanl Sargetm, in Charge. 

StIBOBON-U ENSEAL, PuBbIC HbaLTH AND MaRINK-HoBPITAL SBRVICB. 



efioru at 


he San Diego (Oil.' 


ne SO, 190S. 


the year ending 




JDly. 


Aug. 


Sept. 


0.. 


Not. 


Dec. 


Jan. 


Feb. 


K«r. 


Apr. 


Hay. 


Jnne. 


Total. 


pokenand 





iw 





I 

130 




MS 
104 

S 










a 






10 

s 

7S1 


> 




■ Inipect- 
llpalKd.. 
B dlain- 


" 


ted and 


1 


r"'"* 




n vilW 


7w' 4,<W 


iBBra on 


° 


- 



804 PUBLIC HKALTH AND MARlNE-HOflPITAL SERVICE. 



IX>S ANGKI.R8 AND SANTA DAKBAKA. 



[L» Ansclea QiursiKlnc ni 
[Report ri[ medical OIBccr In 



Hiibporl Ssiils BHrbnni; poni-ofllciMnWrem. vl» Loa Anirelw. C 
dudbikI. SIII8' J- O, Cobb. Araumcd romnumd tinder olDclil 



Ihintatlioni nl tnt Lot Angek* Nalioiuil Qtiaranline IHalum/or Uie year ending Sunt tC 





July. Ai«[. Sept. Oc'L 


Nov.'lJf.. 


,...- 


,.b. 


""■ 


Apr, 


Har-jJuniL'Toul. 




1 ] I 


: ; 


• 


3 


S3 


SI 


! »' 


StVHincni inspecl- 


1 


U7 'iH 








>l ) 


Sailing THuel-i In- 
■ pectod mid 


1 


SBJIEngTeMliidH- 


g 


CiowonBlEamcBi. 
Crew on BailliiK 


n „„: . 




InBVwSls?".. 


<•: ' 





Ji.lr, Aug. Sepu (X:t. 


K„. 


r«: 


JHII. 


,.v 


M.; 


Apr. 


Mar 


Juno 


TnMI- 


V^^k..n.nd 


\ 


• 


• 










" 




1 

IR 




"".'nS'.ier'.'r:'. 








8t«»cr. di-l... 


«! «; 





• 


• 


• D 


" 




" 




ai^nT^^liin■ 
■ pcotpd and 




8«ffi^r»ei«dl»- 


1 . ; 






















Crew on nlling- 






" 






17 








Pii^cnBerK on 








• 


" 


I 


I 




Pn men (tern on 
mUiaf! vearelpi... 





PUBLIC HEALTH AKB MASINK-H08PITAL SERVICE. 805 

SAN FRANCISCO. 
[San FimneiiBO Qausntiiie: poil-oaee addim, rim, Angel IiiUnd, Oal.] 



'Report of medical oflleertn cammmaA, ftif if AmL Siiig. Hugh 8. Cnmminir. Amimed command 

imder oOeial orden of December 29, 1901.] 

San Fraxci8cx> Qiabantixb, 

Anffel J$land, Oi/., July i, /flOt. 

Sir: I have the honor to saboilt report of transactions at this station liiiritig the 
fiscal year ended June 30, 1908: 

The past year has been cme of daily anxiety and apprehension for the quarantine 
officer at this port 

The time has passed when this coast was protected by its distance from the endemic 
centers of cholera and j lest and consequent length of the passage. The epidemic of 
plague along the Mexican coast, its i)reeence to an unknown and consequently dan- 
gerous extent upon the South American coast, its spread in Australia, the f^hilip- 
pines, and Asia, and the epidemic of cholera which is sweeping the coast, ci>nstitute, 
m my opinion, a graver danger to this country than the cholera epidemic's in Europe 
in times past, and the sitoation demands the very best work of our Ser\'ice and the 
increasing vigilance of its officers. 

During the cholera epidemic of 1893 most vessels from the danger points in 
Europe took more than twelve days en route. The large swift vessels alreaily Imilt 
or nnder construction for trade between here and Asia are modem vessels and the 
trip has been made in less than eleven dam The greatest safeguani is in having 
reliable officers at ports of departure as well as at our own ports. 

During the past year 256 vessels have arrived at this port from ports where cholera 
or plague or lx>th prevail, and 52 from yellow-fever ports. 

Glandular examinations or temperatures or both are made of the steerage passen- 
gers and crew of all vessels from plague ports and of cabin passengers when (teemed 
advisable. The baggage of persons en route direct from ye\ low-fever \H^Tts to S< mthern 
folates has been disinfected when necessary. Tlie condition of water and f(>o<l supply 
is determined bv the certificate of medical officers at ports of departure. 

There are still no customs guards placed upon vessels arriving at night and this 
Service maintains an efficient svstem of guarding vessels at night, at its own expense. 

Daring the latter part of 1902, several foreign ports quarantined against this ]K>rt 
on account of the plague situation. I was requested by the British eonnul -general 
and others to disinlect outgoing vessels upon their request; authority to do this was 
Qot given until after the city authorities had commenceil work u[)on our refusal, and 
DO vessels have been so disinfected at this station. 

At the request of the senior medical officer, United States naval training station, 
Goat Island, I inspecte<i that station and advise<l measures for stanipini; out Hniall{K)x, 
iiphtheria, measles, mumps, and scabies upon the station and the U. S. S. Penmrola. 

Tents were advised during the disinfection, cleaning, re[>ainting, etc., but owing 
to lack of room, the detention camp, Angel Island, was 8uggeste<l by nie; |)ending 
its occupancy by the crew of the U. S. S. Afohican disinfected here, the facilities of 
this station were extended the Navv and accepted. The personnel of the naval sta- 
tion and U. S. S. Pensacola were bathed, and the personal effects, library, books, etc., 
disinfected. 

Daring the year 13 cases of smallpox, 23 cases of diphtheria, 1 case of measles, 1 
[)f beriberi, and 4 of mumps were treated in the vanous isolation hospitals here. 
There was 1 death from benberi. 

In addition to the quarantine work of the port the medical ins]KH;tion of aliens for 
the Immigration Service is done by the quarantine officer, and a niling secured !)y 
him that Chinese aliens should be subject to the same inspection as other aliens has 
greatly increased his work. 

The relations of the Service at this station with local authoritic^s and ccKinlinate 
branches of the Federal Government continues friendly. 

Your attention is respectfully invited to the advisability of dc^tailingn^ular offit^ers 
tor dutv, especially upon boarding duty, at this station, 
feespectfully, 

Hugh S. Cummino, 

Patned AsmMant Surgeon. 

The SUBGBON-CiBNERAL, PuBLIC HkALTH AND MaRINE-HoSPITAL SEBVICE. 

H. Doc. 338 20 



306 PUBLia HEALTH AND UARIITE- HOSPITAL BEBVIOE. 





July. 


Aug. 


aept 


oc. 


Kcv. 


iK,. 


J.n. 


Feb. 


Mar. 


Apr. M.r. 


,.„.. 


TotiL 


"sar'."-;" 


46 

40 
8,Mfl 

S,7« 





3.1TS 
6,4«i 


it 

7!) 


il,-237 


i.ao 
sat 
s,»o 







MO 

J.71V 




3a 

J. 135 
l.ftl» 



XI 

3B 

3,21B 

4,606 


W| 36 

1 

M 

lul .1. 








- 


Bpected •nd 








g^r;kir.-;a- 


»•• 


Pasiitngcrl on 




4,HG 

in 


KOI 



VoBels from porta InfeclEd with cholemor babon to plague or both K 

Vewelsfrom yellow-ftver porta it 

Persona delalDed in quanuiline j.j» 

Cuei treated III InlauonhoiiplUlaliuiullpox .IB; dlnhlberla,38iDieulea,l:beilberl.liiiiuiiipii.l). It 
Ve«tl» held for dlagnoils i 



[Bnreka (C^.) QiuuADtine. ] 

[Report ol Acting AmI. Suig. B, V. Harris. In chkisc.] 

Tratimclioru at the Eureka ( Col. ) National Qrutranline Station /or the year en^ng Jw 





July. 


Aug. 


Bert. 


^t- 


Ko.. 


r,«. 


Jan. 


Feb. 


Mar. 


Apr. 


M.J. 


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PUBLIC muuB Jim aAsnn-HoanTAL sebvice. 



[OitaBtte Bbcrqv 



& TiB Utocik. Oat.] 



[Bainrtof iMdifBlaae 



«.8B«.kTlkH.Kde. J 











.taw JO, /MS. 














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HOQUIAM. 

[Hoqulkm, Wtab.. quknntine.] 
[Report of Aetlns AmL Surg. T. C. Fnir. In vhUKv.] 

PoBT or HoQUiAM, Wash., Attgutt .1, 190S. 

Sib; I have the honor of ackaowledging letter dated July 29, directini; iiui ti> (<ir- 

»ud report of quarantine tnuisBctiona at port of Hoquiam, Wash., for the llik-al yi«r 

endinn Jone SO, 1903. I have no ref^lar blank on which to make this n>iM;rl,' but 

incloee a report which I trust will embnce tlie quarantine tranBactions at tbiii {Mirt. 

Keepectfally, 

T. C. Fbarv, Ailiii;/ ,lM(j*.fii( S„r;i>-,»i. 
ThB SirROBOK-GKHKBAL, PUBLll' HiALTn AND MaRINB-HohPITAI. SEKVirK. 



[Inclomire.] 

V«flBelB arriving from foreign ports 31 

Crew on veeBela from foreign porta - 306 

Faeeengere on veeeels from foreign ports 27 

Veasels disinfected from foreign ports 

Vessels disinfected from domestic porl« 

Veseels from foreign ports inspected and passed 31 

PORT TOWNSEND AND 8UBPOUTS. 
IPoit TownBencl Qimniiillne: pont-olHce Brtirem, via Port Towniwrid. Wuh„ kikI iiiit)]»>rlii Hnillle, 

[Reporl uF medlcnl uflicei In comoiBnil, Famed Aiat. Burg. J. H. Oaklt^y. AmiDiHl I'lininuiiiit iiliilar 
official orden of Umrls. 1S03.I 

Port Townbbnd Quarantink Station, 

Port Tmmyiend, Wa»h., AuguM X, I90S. 

Sir: I have the honor to report on the transactions at this (|uarentinD Htatinti dur- 
ing the fiscal year ending June 30, 1903, an follows: The total numtivr nC vi!him9Ih 
lioarded was 433, of which 250 were mil and 1S3 steam. Oi the 433 vessels l>oarded, 
408 were inspected and passed, and 26 were sent to the quarantine station fur 'lisin- 
lection in whole or in part. The crews on these vessels numbered 18,090 jierHons, 
and there were 19,161 passengers. Theglandular regions of all male stperagt jiwBim- 
gera and of the crew on vessels from piagiie-infecled ports wen? examini-d. 

Dunns the year 11 Teesels arrived with a history of sickness or duatii having 
occurred en route. 



308 PUBLIC HEALTH AND HABnfS-HOSFITAL BKBVICE. 

During the year 1 csae of acute inflanimaldon of the bladder and 1 case of emjUtpoi 
were treated at the quarantine station. Both caaea recovered. 

The case of smallpox was removed from the U. B. Fish. CommisHion steamer, A^ 
tro*t. The officers and crew were vaccinated and the qoattera wherein the oue htd 
been isolated were disinfected. 

Keepectfullj, J. U. Oaklkv, 

Patted Aigittant Surgeem. 
The SuaaBON-OENBRAL, Public Health and Marin B-HosprrAL Skrvick. 





Julj. 


Aiig. 


Bq.L 


0«L 


KOY. 


Lor. 


Jan. 


R*. 


ilmi. 


Apr. 


Umy. 


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1,311 


22 
J.265 


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1.107 
1G8 
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B0BPOBT8. 

Pout Townsene 

Port Ttnmtmd, IViuk., Jnly S, ISOS. 
Sir: 1 have the lionor to transmit herewith annual reports of transai'tions at tht 
BubportH of Seattle, Toi^nia, Port Angeles, and Southbend, Wash., for the fiscal 
year ending June 30, 1903. 

Respectfully, J, H. Oaklbv, 

Pnaed Anitlnnt Surgeon. 
The Surokon-Gbnbbal, Public Hbalth and MAiuNE-HofliiTAL Servick. 



Trananctionii itt the SeaiOe ( 


Walk.) National Quarantit 

SO, 1903. 


\eSuaioa/ 


trlhe 


ymr 


fnrfiny yim* 




July. Aag. 


Bcpl. 


OM. 


H=T. 


». 


JAD. 


Feb. 


Xt. 


Apr. 


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PUVLK HKALTH AKO )(AMSE-Bi«PlTAL ftEBVICE. 



Tacomi, W.ub.. Jul^e. I 
Snt: IhaTOtlieboiMirtDKMrtdwialknrinf nanMctioDsat thi$ port for th« divkl 
,of CluBow food ttiilfa »-■ *^-- '^ -' - 



year ending Jnne 30^ 
bemDber, 1902. M 
6, IDOK, 43 pMk^M peralB 
— ■ r ■taaiiMBip fifc 



1 oiercfaandise ilbiinf^'ted, i 



Miupl „ „- . . ,. 

per Bteunship Dtdx nf Fife, boat Hon^onr; DManbrr 39. 1902, :tS jiai-katiw per 

atetunsbip Lgra, fmn H ^~ — ' '* "™* ' — ' — ' ' ' " ' ' 

peanntB, all dry; Maj 7 
'Uongkong. 

BwpectfiiUj, F. J. St-Rii;. 

Attiag Antutanl Suriitim 
Pined AnL Sui^ J. H. Oaklkt, 

Port TbKMOtrf QMOnDiti'iv, Fort Totmtmd, WaiA. 





JUIT. ABB. 


eqrt. 


OcL 


KOT. 


ft«. 


Jan. Feb. 


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ht 


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SOUTHBBND. 





National Quarantine 
xne SO, 190S. 


Slai 


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julr. 


Am. 


8epL 


Oat. 


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PUBLia HEALTH AND MARIHE-H08PITAL SERVICE. 



NOME, ALASKA. 

(Nome, Alailu. Qiunntine,! 
[Report of AcHns Ant, ems. A. L. Derbyshire, In pharge.) 

Nome, Ai.abka, July 5, 190S. 
Snt: I have the honor to truieinit herewith annual report of traneactions at Nixne, 
Alaska, National Quarantine Station for year ending June 30, 1903. 
Reepectfully, 

A. L. Debbtbhibx, 
' Acting A$»iManl ^rgeon, 

I'ubtir Henllh and Marine- HtmpHal Senitr. 
The Stii«i»>N-GBNERAi, PuBiJc Health and Marimb-Hobfital Sbbvick. 



llnolo»iire.] 
SO, 190S. 


um/' 


Tthr 


year 


■nJi,, 


- 




July. AnB- 


Sepl. 


0«1. 


Nov. 


Pet!, 


Ji.«. 


Feb. 


Slur,' Apr. 


Uky.p>iii..,T«.I. 1 


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Texas-Mexican Boedek Quabantdje. 

This border inspection has been continued at El Paso, Gagle Pass, 
and Laredo, Tex., to prevent the introduction of smallpox, yellow 1 
fever, and possibly typhus forer into the United States, cooperating | 
with the health authorities of the State of Texas. 

The following reports have been received from the officers stationed 
at those poinbj of entry: 

I^REDO, TEX. 
Rkpokt of AcTiNQ Abst. Sinta. H. J. Haniuton. 

Lakbdo, Tei., July 10, 190S. 
fliit: I have the honor to submit followitiK report of traiuBctionH at this etation (or 
year ended June 30, 1003: During the period mentioned there were 711 jiaseen^Kr 
trains enterini; from Mexico, iiiBpect^l; permnson trains entering from Mexico, 28, 7M 
inspected. There were US peTsons detained at detention camp or refuaed entry, to 
comply with quarantine regulatjone. Disinfected 43 trunks, 2 valisee, ajid 17 bondiM 
of baggage, presumably infected. Inepectedl,6e6iinmigrsnt«uponeDtry; vaconaled 
460 immigrants upon entry. Imnli^ajitB certified, 30; immin^nta deported, 29. 
During the perioil mentioned the National de Mexico Railroad, which croeBn the 

is point, has broadened its gauge to the standard of the United States 

■ption 01 about 100 miles at the noath end, which will also soon be aocom- 

from Mexico Gty to I«rado will be twen^-^ght or thirty 

o, ni.n,i< ni,. u»,^ no doubt, the effec^ ' ' ... a .... 

iderably. 

Reepectfully, H. J. Hamiiaoii, 

Aetintf A 



^ the pel 
frontier at thie ^ 
with the eicepti< 
plished, when tt 

which will have. 



The Si'sasmi-GENWRAi., Ptmi.ic Health .>,t;i> M mhne- Hospital 



PUBLIO HEALTH AND MARINE-HOSPITAL 8EBVICE. 311 

EL PASO, TEX. 
Rkpobt of AcnNo Aserr. Subg. E. Alexander. 

El Paso, Tex., Augtist 2, 190S. 

Sir: In Bureau letter dated July 20, 1903, I am directed to forward report of quar- 
antine transactions at mv station during the fiscal year ending June 30, 1903. I 
would respectfully state that such report was forwarded June 30, 1903. 
Re^)ectfully, 

E. Alexander, Acting AssisiarU Surgeon. 

The Subobon-General, Public Health and Marine TIospttal Service. 



[Incloflure.] 
TranmctUma for the fiscal year ended June SO, 190S. 

Inspection Mexican Central passengers 9, 719 

Inspection Rio Grande and Pacific passengers 1, 024 

Inspection Mexican immigrants (>, 893 

Inspection of certificates of death of bodies transported into tho United Staten 7 

Inspection (special) on account of yellow fever and bubonic plague 135 

Dismfection soiled linen imported for laundry pieces. . 21, 022 

Disinfection of cattle hides: 

Loose 4,041 

Carloads 3 

Disinfection of bones carloads. . 1 

Disinfection of baggage, trunks, and household goods pieces. . 95 

Detention from one to three days each of passengers from Tampico and Vera 

Cruz and lower coast of Mexico 28 

VacciDations 189 

KAGLE PASS, TKX. 
Report of Actino Ahht. Suro. Lea Hume. 

Eagle Pass, Tex., August i, 190:i. 

8ir: I have the honor to make the following report of inspection of person^) enter- 
ing the United States via this port during the fiscal year ended June 30, 1903: 

Trains inspected 380 

Persons inspected on trains 13, 428 

Persons inspected on Rio Grande River .'>, 631 

Heces of ba^age disinfected 20 

Persons detain^ in quarantine 11 

No contagious diseases developed at the detention during the year. 
Re8i)ectfully, 

Lea Hume, 
Acting AmMant Surgeoriy in Charge. 
The 8urgbon-(jeneral, Pubuc Health and MARiNE-Iio»piTAL Service. 



Police Power of National Quauantlve Of^^c^eks. 

In relation to the police power of medical officers in command of 
United States quarantine stations, on September 19, 1902, the niedieal 
officer in command of the Gulf Quarantine Station, Biloxi, Miss., 
addressed a letter to the Bureau on this subject. 

As the question concerned all the quarantine stations of the Service, 
the Honorable, the Secretary of the Treasury, was requested to obtain, 
for the use of the Service, a decision upon the matter from tho Solicitor 
for the Treasury Department. The following is the correspondence: 



312 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

[Letten.] 

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

Washington, November 5, 190i. 

Sir: I have the honor to mcloee herewiUi a communication from the medical 
officer in command at the Gulf Quarantine Station asking instructions as to the 
extent of his authority in maintaining discipline, and whether he may or may not 
confine an unruly individual or bring about a punishment for him furuier than his 
discharge. 

It should be stated .in this connection that Quarantine stations are, as a role, bo 
isolated that the assistance of any police official can not be obtained, and conse- 
quentlv the whole responsibility for the preservation of discipline and order rate 
upon the officer in command of the station. 

In view of the above-stated facts I have to recommend that this letter be referred 
to the Solicitor for the Treasury for an opinion in the premises. 
Respectfully, 

Geo. Purvianck, 
Acting Surgeon- General. 

The Secretary op the Treasury. 

[Incloflure.] 

Gulf Quarantine, 
BUoxif Muis., September 19^ 1909. 

Sir: I have the honor to request information as to what policepower the officer in 
command of a quarantine station of the Service can exercise. The case in point is 
that of Attendant Richard Johnson, who to-day became intoxicated, unnuy, and 
violent. He was immediately sent ashore, but a simple discharge is a wholly inade 
quate punishment for such an offense, and if the station had been in strict quarantLoe 
would not have been possible. 

I would like to aak: 

(1) Can the commanding officer confine, tie, or handcuff such a person till such 
time as he can be disposed of? 

(2) Can he obtain any punishment }>eyoml his discharge; if so, by what method 
of procedure? 

Such an occurrence as we have had is not only very detrimental to discipline unlen 

Eunished, but could easily result in violence to other persons on the station, who 
ave a right to protection. 

Respectfully, S. B. Grubbs, 

PcLued Asgistant Surgecn. 

The Suroeon-Gbneral, Public Health and Marine-Hospital Service. 



Department of Juotick, 
Office of the Soucitor of the Trbasurt, 

Washington f D, C, November 11, 190f. 

Sir: A communication from the Acting Suiigeon-General of the Public H^th and 
Marine- Hospital Service, dated the 5th instant, has been referred to this office by 
Acting Secretary H. A. Taylor, with a request for my opinion upon the following 
questions: 

First. Whether tlie officer in command of the Gulf Quarantine Station may arrest 
and confine and tie or handcuff an intoxicated attendant of the station, who is 
unruly and violent, until such time aa he can be disposed of. 

Second. Whether any punishment beyond the dischaige of such person may be 
imposed, and if so, by what proce<lure. 

I am informed that this station is located on Ship Island, in the Gulf of Mexico, 
and that it is in command of one of the surgeons of the Public Health and Marine- 
Hospital Service. 

Ship Island lies about 12 miles off the Mississippi coast It was ceded to the 
United States by an act of the l^slature of the State of Mississippi, November 15, 
1858 (Laws Miss., 1857-58, p. 49) , and has, by Executive order, been made one of the 
military reservations of the United States. 

There is no Federal statute which gives a marine-hospital saigeon the power to 
arrest and confine a hospital or station attendant for dnmkenneas or disoraerly con- 
duct The Marine-Hospital Service is no part of either the militarv or naval estab- 
lishments of the United States, and the employees therein are not liable to arrest and 
confinement for breaches of discipline or disorderly conduct except in so fur as the 
offense m&y be cognizable by the civil authorities. Hence the power to arrast and 



PUBLIC HEALTH AND MABIKE-HOdPITAL SERTICK. 313 

confine a hospital attendant who is intoxicated, violent, and unnilv nioi^t be deter- 
mined by the laws of the United States or of the State in force in sncli locality where 
the offense is committed. 

There is no Federal statate which makes intoxication or disonlerly conduct on the 
part of an employee of the Marine-Hospital Service an offemii' against the United 
States. But the act of CongresB, July 7, 1898 (80 Stat. L., 717 ). provides as follows: 

**Sbc. 2. That when any offense is committed iu anyplace, juris«lic*tion ovor which 
has been retained by the United States or ceded to it by a State, or which has U^en 
purchased with the consent of a State for the erection of a fort, ansenal, dtx^kyanl, 
or other needful building or structure, the punishment for which offi'use is not' pro- 
vided for by any law of Sie United States, tne person ix^mmitting such offense shall, 
upon conviction in a circuit or district court of^ the United States for the district in 
which the offense was committed, be liable to and receive the same punishment as 
the laws of the State in which such place is situated now provide for the like offense 
when committed within the jurisdiction of such State, and the said oimrts are hereby 
vested with jurisdiction for such purpose, and no subsequent repeal of any such State 
law shall affect any such prosecution." 

And by the laws of Mississippi drunkenness and profane swearing in the presence 
of two or more persons are made offenses punishable by fine of |10 tor e&eh offense. 

I do not find that a common assault or affray, or breach of the iteuce, is in terms 
made an offense or misdemeanor under the laws of the State of Mississi])])i. But 
conduct of this kind is a misdemeanor at conmion law (4 Bl. Com., 145, 216), and the 
common law, except where changed by statute or unsuited to conditions existing in 
the State of Mississippi, is still in force in that State. ( Noonan r. State, 1 Sniedes & 
Marsh., 562.) 

By the common law a private person — that is, a person not a peace officer — can not 
make an arrest without a warrant, except where an offense is committed or about to 
be committed in his presence. The right of a private pi^rson to make an arrest with- 
out warrant is not limited to cases in which a felony has l>een or is about to 1k^ com- 
mitted in his presence. He may arrest another for' an affray or )>rearh of the [>eu(*e 
committed in his presence; and when a misdemeanor amounts to a breach of the 
peace he not only may, but is bound to, interfere and suppress it; and in luise of mis- 
demeanors which do not amount to a breach of the peace, he may, m^conling to some 
authorities, make an arrest without warrant, but is not bound to do so. (2 Am. and 
£ng. Encyc. of L., 2d ed., p. 888.) 

But this power of a private person to make an arrest with<»ut warrant for a misde- 
meanor is strictly limited to cases in which the misdemeanor is committed in his 
presence, and a person so arrested must be carried without delay before the nearest 
m^:istrate. (Id., pp. 880, 888.) 

From this review of the authorities, I conclude that the surgeon in charge of the 
station on Ship Island, as a private person, or any private person there, may, with- 
out warrant, make an arrest of an attendant who, in the ))resence of two or more 
persons, is intoxicated and violent, and may detain such person until lie can, with 
reasonable dispatch, be taken before the nearest magistrate to l)e dealt with acconling 
to law, and that he may use such reasonable force, including tying or handcuiling, as 
may be necessary to accomplish the detention. 
Very respectfully, 

F. A. Keevr, Acting Solicitor. 

The Secretary op the Treasury. 



Treatment of "Via" Vessels at Southern Stations. 

On May 2, 1903, a letter of inquiry was received by the Bureau 
from the medical officer in command of Cape Charles Quarantine, 
Fortress Monroe, Va., in regard to the interpretation of paragraphs 
102 to 109 of the United States Quarantine Kegulations of the y<^ar 
1903, under the heading: "Special regulations on account of yellow 
fever." The foUowing correspondence ensued: 

[Lettcrn.] 

Cape Charles Qharantinr, 

F(/rtreHn MtmroCy Va., May ?, li*OS. 

Sib: I have the honor to inquire if the Bureau construes naragraphs 102 to HH>, 
inclusive, of the revisecl quarantine regulations, Ix-ing *'SjMHial regulations on aarount 
of yellow fever," as applying to via vessels fruui nohiniecled \x>t\ja vjXvwviXJcvvst^vA^^v^ 



314 PUBLIC HEALTH AND MARINE-HORPITAL SERVICE. 

Public Health and Marine-Hospital Service officer, and also whether thev apply 
to via vessels from noninfected ports where there is a Public Health and ^larine- 
Hoflpital Service officer. 

Respectfully, Jno. S. Booobbs, 

Assistant Surgeon, in CkmuticnuL 



Treasuby Depabtment, 
Bureau of Public Health and Mabine-Hohpital Sebvice, 

Waxhington, May 4i lOOS. 

Sib: Referring to j^'our letter of the 2d instant, asking if the Bureau construes ()an* 
firaphs 102 to 109, inclusive, of the revised quarantine r^ulations as applying to 
'* via " vessels from noninfected ports where tnere is no Pm)lic Health ana Marine- 
Hospital Service officer, and also whether they apply to "via*' vessels from non- 
infected ports where there is an officer of the Public Health and Marine-Hospital 
Service, you are informed that these paragraphs apply to any vessel arriving at your 
station from a yellow fever infected port via a port north of the southern lx>undary 
of Maryland, unless the vessel has been so treated at the port north of the southeni 
boundary of Maryland as to obviate the danger of her still conveying the inftx^tion 
of yellow fever. 

If proper measures have been taken at the northern port and evidence is placed 
in your possession which satisfies you of this fact, you will make due allowance for 
the measures in Question. 

Respectfully, Geo. Purviance, 

Acting Surgcon-Gencnd, 

Medical Officeb in Ck>MMAND, P. H. <& M. H. S., 

Cape Charles Quarantine, Fortress Monroe, Va. 



Conclusion. 

The above report covers the work of the service coming under the 

Surview of the Bureau Division of Domestic Quarantine during the 
seal year. 
Respectfully submitted. 

A. H. Glennan, 
Atmstant Surgefm- GcnrraL 



DIVISION OF SCIENTIFIC RESEARCH. 



a If) 



BEPOBT 07 THE DIVISIOV OF SdEVTIFIC BB8SAECH. 

By H. D. Gkddings, 
AsgisiarU Surgeon-Cteneral, PMic HecUth and Marine-Hospital Service, in Charge. 

Sir: I have the honor to submit the following report of the opera- 
ons of the Bureau division of scientific research for the fiscal year 
Qding June 30, 1903: 

Transactions of the Division. 

The work of the division has been continued this year as in the previous 
ears, embracing the review of medical and scientific journals and the 
ird indexing of all subjects pertinent to the communicable diseases 
id to the public health. It is to be noted that the files in relation to 
iberculosis and plague are growing rapidly, and the number of ref • 
•ences accumulating in these subjects is very large. From time to 
Die by your direction indices have been opened for new subjects, and 
le system promises in the future to be of great value as a matter of 
ureau reference. 

Yellow Fever Institute. 

The work of the institute has been continued. Meetings of the 
tecutive board have been held from time to time as required. Con- 
•ibutions have been received from various correspondents and mem- 
ers of the institute, and the following bulletins have been published 
uring the past year: In July, 1902, Bulletins Nos. 9 and 10, entitled, 
3specti vely , ' ^ Are Vessels Infected with Yellow Fever ? Some Personal 
Observations," by Surg. H. R. Orter, and *'The Methods of the Con- 
ey ance of Yellow Fever Infection," by the same author, the demand 
3r which latter was so active that a second and revised edition had to 
e issued. In March, 1903, Passed Asst. Surg. S. B. Grubbs con- 
ributed an article entitled, '* Vessels as Carriers of Mosquitoes," 
^hich was published as Bulletin No. 11; and in the same month a 
ontribution was received from Passed Asst. Surg. J. M. Eager, at 
laples, Italy, on "The Ekirly History of Quarantine," whicn was 
»ublished as Bulletin No. 12. 

In view of the unsettled sentiment in the scientific mind as to the 
tiology of yellow fever, it was deemed expedient that the matter 
hould be investigated by the Yellow Fever Institute, and by and with 
he approval of the honorable the Secretary of the Treasury, under 
late of March 5, 1902, a working party composed of Asst. Surg, (now 
^assed Asst. Surg.) H. B. Parker and Acting Asst. Surgs. George E. 
Jeyer and O. L. Pothier, was organized and dispatched, and arrived in 
Tera-Cruz on May 12, 1902. The labors of the working party at Vera- 
/Hiz terminated about the end of October, 1902, when the party 
eturned to the United States, and the time between October, 1902, 



318 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

and February, 1903, was spent in a review of the notes and material 
collected by the party and in preparing a report to the Sureeon- 
General. This report has been published as Bulletin No. 13 of the 
Yellow Fever Institute. 

It was deemed important to still further investigate this subject, and 
about May 1, 1903, working party No. 2, composed of Passed Asst 
Surg. H. B. Parker, chairman; Asst. Surg. Edward Francis, and Act- 
ing Asst. Surg. George E. Beyer, was dispatched to Vera Cruz for 
this purpose. The party is still at work, but no report of importance, 
other than a report of progress, had been received at the close of the 
fiscal year. 

Further investigations of questions related to the etiology and method 
of transmission of yellow fever are contemplated, and an opportunity 
only is awaited to enter upon the investigation of dengue and other 
communicable diseases. 

Spotted Fever. 

For a number of years a disease of mysterious 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 onty a limited 
amount of success. 

At the request of the State board of health of Montana, the Surgeon- 
General consented in April, 1903, to dis^mtch Passed Asst. Sur^. John 
F. Anderson, assistant director of the Hygienic Laboratory, to Missoula, 
Mont., for the purpose of making investigations as to the nature of 
the disease and aiding with his advice the local and State health authori- 
ties in their efforts to accomplish the eradication of the malady. Doctor 
Anderson is still engaged upon his investigations. Reports received 
from time to time show that the disease is widely scattered over quite 
a large area of country; that it is violent, and that the mortality from 
it is considerable. It is hoped in the near future to publish something 
authoritative from him as to the nature of the disease. 

First General International Sanitary Convention or American 

Republics. 

The Second American International Conference of the Pan-American 
States, held in the City of Mexico, October, 1901, to Januarj% 1902, 
passed resolutions that a sanitary convention should convene in Wash- 
ington within a year of the signing of the resolutions on sanitation 
and quarantine, and that the said convention should elect an inter- 
national sanitary bureau, which should have permanent headquarters 
at Washington, D. C, for the purpose of rendering effective service 
to the different republics represented in the said convention. In pur- 
suance of this call, the convention assembled at the New Willard Hotel, 
Washington, D. C, December 2, 1902, and continued in session to 
December 4, inclusive. The republics of Central and South America, 
Mexico, and the United States were represented by delegates as 
follows: 

Chile. — Dr. Garcia y GallaOy Dr. Eduardo Moore. 
Cotita Jiira. — Dr. Juan J. UUoa. 
Oi/xi. — Dr. Juan Guiteras, Dr. CarloH J. Finlay. 
Ecuador, — ^Miuister Louis Felipe Carbo. 



PUBLIC HEALTH AWD MABINK-H08P1TAL 8EBVICE. 319 

Ouatemala. — Minister Lazo-Arriaga. 

Honduras. — Nicanor Bolet Peraza. 

Mexico. — Dr. Eduardo Liceaga, Dr. Joee Ramirez. 

Nicaragua. — Dr. D. Roman. 

Paraguay. — Mr. John Stewart 

United ^ates. — Surg. Gen. Walter Wyman, Dr. M. J. Roeenau, Dr. H. L. E. John- 
son, Dr. James Taggaji Priestly, Dr. Arthur R. Re3mol(l8, Dr. Charles B. Adams, Dr. 
Edmond Souchon, Dr. Fred W. Powers, Dr. Joseph Y. Porter, Dr. Alva H. Doty, 
Dr. L. M. Powers, Dr. Frank Wm. Porterfield, Dr. J. Glendower Owen, Dr. Rhett 
Goode, Dr. Irving A. Watson, Dr. George P. Bradley, U. 8. N. ; Dr. P. W. McCaw, 
U. S. A. 

Uruguay. — Luis Alberto de Herrara, charg^ d'affaires. 

The following resolutions were adopted by the convention prior to 
its adjournment: 

[NoTK.— All of those resolutions were adopted unanimously.] 

I. 

Convention to be governed by resolutions of conference in Mexico. 

Resolved J That tlie convention shall be governed by the resolutions agreed upon by 
the International Conference of American States held in Mexico in 1901 and 1902. 

II. 

Time of detention and disinfection at quarantine. 

Resolved, That the time of detention and disinfection at maritime quarantine sta- 
tions shall be the least practicable time consistent with public safety, and in accord 
with scientific precepts. 

III. 
Yellow fever, mosquitoes, and quarantine. 

(a) Resolved, That measures of prophylaxis against yellow fever shall be based 
upon the fact that up to the present time the bite of certain mosquitoes is the only 
proven natural means of propagation of yellow fever. 

(6) Resolved, That the governments represented in this conference approve the 
measures employed in Uabana for the prevention of the spread of the disease on land, 
for the isolation of cases, and the fumi^tion of building, it being understood that 
said measures are based upon the principle enunciated m resolution (a). 

(c) Resolved, That the prevention of the importation of the disease by vessels, 
wherein persons actually infected are found, must conform to the methods employed 
on land, yet there are Questions concerning the importation of infected mosquitoes 
that require further study before any decided modification of the quarantine laws 
can be recommended. 

{d) Resolved, That the subject of brining the quarantine laws to conform with the 
new doctrine of mosquito infection shall be referred to the International Sanitary 
Bureau of the American Republics, for report at the next meeting. 

IV. 

Geographical distribution of yellow-fever mosquito. 

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. 

V. 

Garbage, louder animals, and disease. 

Whereas bubonic plague and other diseases are spread by rats, mice, and other 
lower animals, which, to a sreat extent, find sustenance in animal and vegetable 
kitchen wastes commonly called garbage; therefore, be it 

Resolved, That all organic waste or garbage shall be kept separately on the premises 
untU it can be removed, unmixed with anything else, and destroyed. 



320 PUBLIC HEALTH AND MARINE-HOSPITAL BEBVIOE. 

VL 
T\/phoid fever and cholera — Dmnfedion of discharges, 

Wliereas typhoid fever and Asiatic cholera are caused by sveallowing food or drink 
contaminated by the dischar^ of previous cases; therefore, be it 

Resolvedy That it be recognized by this conference that if all the dischargee of every 
existing case of typhoid fever and Asiatic cholera were instantly disinfected, typhoili 
fever and Asiatic cholera would cease to be a menace to the world. 

VII. 

International Sanitary Bureau — To aid and to he aided by the several republics. 

Whereas the Second American International Conference of the Pan-American 
States, held in the City of Mexico, October, 1901, to January, 1902, provided that a 
sanitary convention convene in Washington within one year from the signing ol the 
resolutions on sanitation and quarantine, and shall elect an international sanitary 
bureau with permanent headquarters at Washington for the purpose of rendering 
effective service to the different republics represented in this Convention; it is hereby 

Resolved (a), That it shall be the duty of the International Sanitary Bureau to 
urge each republic to promptly and regularly transmit to said bureau all data of 
every character relative to the sanitary conditions of their respective ports and terri- 
tories. 

(6) And to furnish said bureau every opportunity and aid for a thorough, careful, 
and scientific study and investigation of any outbreaks of pestilential diseases which 
may occur within the territory of any of the said republics. 

(c) It is further resolved that it shall be the duty of the International Sanitary 
Bureau to lend its l)est aid and experience toward the widest possible protection of 
the public health of each of the said republics in order that disease may be eliminated, 
and that (commerce between said repuolics may l^e facilitated. 

(d) It is further resolved by this convention that it shall be the duty of the Inter- 
national Sanitary Bureau to encourage and aid or enforce in all proper ways the sani- 
tation of seaports, including the sanitary improvements of harbors, sewerage, drainage 
of the soil, pavinK, elimination of infection from buildings, and the destruction of 
mosquitoes and other vermin. 

(e) It is also recommended by this convention that in order to carry out the above 
measures a fund of $5,000 shall l)e collected by the Bureau of American Republics in 
af;cordance with ]mragraph 7 of the resolutions of the Second International American 
Conference above referred to. 

The convention elected the following International Sanitary Bureau, 
the office of which bureau is permancnth^ located in Washington, D. C: 

International Sanitarif Bureau. — Surg. Gen. Walter Wyman, chairman; Dr. Eduardo 
Liceaga, of Mexico; Dr. Eduardo Moore, of Chile; Dr. Juan Guiteras, of CuIm; Dr. 
Juan J. Ulloa, of Costa Rica; Dr. Rhett Goode, of the United States; Dr. A. H. Doty, 
of the Uniteil States. 

The transactions of this convention are published as Senate Docu- 
ment No. 169, Fift^'-seventh Congress, second session. 

Plague Conference. 

On January 19, 1903, in accordance with a request from a number of 
State boards of health and under authority of section 7 of the act of 
Congress approved Jul^y 1, 1902, a conference with regard to the 
plague situation in the city of San Francisco and the State of California 
was held in the bureau. The States represented and their delegates 
were as follows: 

California, Dr. Mathew Gardner; Connecticut, Dr. 0. A. Lindsle^; Colorado, Dr. 
H. R. Bull; Delaware, Dr. C. W. Cooper, Dr. Alex. Lowber; Distnct of Columbia, 
Dr. William C. Woodward; Indian Territory, Dr. M. K. Thompeon; Iowa, Dr. T. L 
Kenne<lv; Indiana, Dr. J. N. Hurty; I^ouisiana, Dr. Arthur Noite; Maine, Dr. Charles 
D. Smith; Maryland, Dr. John S. Fulton; Minnesota, Dr. H. M. Bracken; New Jer- 



PUBLIC HEALTH AND MARINE-HOSPITAL SEBVICE. 321 

eey, Dr. Henry Mitchell; New York, Dr. Daniel Lewis; North Carolina, Dr. R. H. 
Lewis; Pennsylvania, Dr. Benjamin Lee; Rhode Island, Dr. Gardner T. S warts; 
South Carolina, Dr. T. Grange Simons; Tennessee, Dr. J. A. Albright; Vermont, 
Dr. H. T. Holton; Virginia, Dr. P. A. Irving. 

The transactions of the conference were published in full in the 
Public Health Reports of January 23, 1903, and February 6, 1903. 
(See also reference to this conference under report of domestic quaran- 
tine division.) 

First Annual Conference of State and National Health 

Al^thorities. 

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 
cnange the name of the Marine-Hospital Service," the first annual con- 
ference of State health authorities with the Public Health and Marine- 
Hospital Service was held in Washington on June 3, 1903, being called 
to order at 10 a. m. The meetings were held at the New Willard 
Hotel, the Surgeon-General presiding. Introductory addresses were 
made by the Assistant Secretary of the Treasury, Mr. Armstrong, and 
the Surgeon-General. Twenty-three States ana Territories were rep- 
resented by delegates. 

In his opening address the Surgeon -General referred to the proposed 
organization of these conferences in the following words: 

CONFERENCE ORGANIZATION. 

I have deemed it necessary to give this somewhat extended account of the organi- 
zation of the Service, both that our aims and methods may be understood and that 
1 may the more readily explain a proposed method of making these annual confer- 
ences of practical utility. It mignt be advisable to appoint on special committees 
members of the conference especially interested in the several subjects to be consid- 
ere<i by these committees, said committees to remain in organization during the year 
and to" receive for further conference with the Surgeon-General such matters ^ mificht 
be pertinently referred to them by him. The titles of these committees would hnd 
their analc^es in the several divisions of the Bureau. The reports of these com- 
mittees could be read to the full conference at ite annual meeting, and, if adopted by 
the Bureau and the conference, would have a force and influence which would natu- 
rally result from the conjoint action of the national and State authorities. I would 
suggest tentatively the following committees: First, on scientific research and sanita- 
tion; second, on the prevention and spread of epidemic diseases; third, on morbidity 
and mortality statistics; fourth^ on State legislation; fifth, on education. In addition 
to these, there might be special committees on certain specified diseases, namely, 
cholera, yellow fever, plague, smallpox, tuberculosis, leprosy, typhoid fever. To 
these committees might be committed such resolutions as may be offered here, but 
the adoption of any resolutions by this conference, it seems to me, should not be until 
after a report thereon had been made by the special committee to which it is referred. 

It is believed that the above plan is at least worthy of trial. It would give real 
aid and would stimulate the members of the committees in an investigation of the 
subjects confided to them, and might pnxluce a uniformity of effort, a coordination 
of work in different parts of the country, which now does hot obtain. 

The above plan of organization was approved by the conference, as 
evidenced by the following resolution, subsequently passed: 

Resolved, That the methods of cooperation between national and State health 
authorities suggested by the presiding oflicer in his address meets the approval of the 
conference. 

H. Doc. 338 21 



322 PUBLIC HEALTH AND MAB1NE-H08P1TAL SERVICE. 



CONFIDENCE AS TO PLAGUE MEASURES IN SAN FRANCISCO. 

The conference also passed the following resolution with regard to 
the plague situation in California: 

Whereas the conference of the State boards of health of the United States with 
the Public Health and Marine-Hospital Service, having confidence in the earnfist 
efforts and ability of the governor and State board of health of the State of CalifomJA, 
acting in harmony with the Bureau of Public Health and Marine-Hospital Service, 
to thoroughly eradicate bubonic plague heretofore existing in the city of San Fran- 
cisco, do resolve that in the judgment of this conference, so long as the present 
effective work is continued, there is no need for quarantine restrictions of travel or 
traffic to or from that State. 

INFORMATION AS TO STATE HEALTH ORGANIZATIONS. 

Following the opening address by the Surgeon-General, each dele- 
gate present addressed the conference, giving information as to die 
organization, powers, etc., of their respective State health establish- 
ments. These addresses (together with subsequent information invited 
by Bureau circular letter from those present as well as States not rep- 
resented at the conference) will appear in the transactions of the con- 
ference, which will constitute a separate publication. 

LIST OF DELEGATES. 

Following is a list of States represented at the conference, together 
with the names and titles of those representing them: 

California, Dr. N. K. Foster, secretary State hoard of health. 
Connecticut, Dr. J. H. Townsend, memher State board of health. 
Delaware, Dr. E. \V. Cooper, president State board of health. 
District of Colmnbia, Dr. William C. Woodward, District health officer. 
Florida, Dr. Joseph Y. Porter, State health officer. 
Illinois, Dr. J. A. Egan, secretary State board of health. 
Iowa, Dr. R. E. Conniff, member State board of health. 
Kentucky, Dr. William Bailey, member State board of health. 
Louisiana, Dr. Edmond Souchon, president State board of health. 
Maine, Dr. A. G. Young, secretary State board of health. 
Maryland, Dr. J. S. Fulton, secretary State board of health. 
Michigan, Dr. U. B. Baker, secretary State board of health. 
Minnesota, Dr. F. F. Wesbrook, delegate State board of health. 
Mississippi, Dr. J. F. Hunter, secreta^ State board of health. 
Missoun, Dr. A. W. McAlester, president State board of health. 
Ohio, Dr. C. 0. Probst, secretary State board of health. 
Oregon, Dr. Andrew C. Smith, president State board of health. 
Pennsylvania, Dr. Benjamin Lee, secretary State board of health. 
Rhode Island, Dr. Gardner T. Swarts, secretary State board of health. 
South Carolina, Dr. T. Grange Simons, chairman State board of health. 
Texas, Dr. George R. Tabor, State health officer. 
Utah, Dr. T. B. Beatty, delegate State board of health. 
West Virginia, Dr. Samuel IS, Myers, president State board of health. 
Total, 23. 



Report of the Hygienic Laboratory. 

(Prepared by Dr. John F. Anderson from notes left by the director, Dr. M. J. Boaenau, who wai tt 

Vera Cruz, Mexico, working in yellow fever at the time.) 

PERSONNKL. 

^ Asst. Surg. Edward Francis, who was detailed for duty in the Hy- 
gienic Laboi-atory August 22, 1901, pursued the course as outlined in 
BuJletJ/i No. 8. During this time he completed the subject of pathol- 



PUBIrlO HEALTH AND MABINK-HOSPITAL SERVICE. 323 

ogy and bacteriology, especially devoting attention to those portions 
having a bearing upon the public health. The latter portion of the 
time of his service in the laooratory was devoted to original investi- 
gation of the Tryp<m09O7na Lewisi, the results of his labors having 
been published in Bulletin No. 11. Doctor Francis also rendered much 
assistance in the examination of bacteriological impurities in vaccine 
virus and the antiseptic and germicidal value of glycerine. He was 
relieved from duty m the latoratory February 13, 1903, and ordered 
to Mexico in connection with the plague then prevailing in Mazatlan. 

Asst. Surg. Allan J. McLaughlin was detailed to the laboratory 
April 30, 1^2, for instruction, and pursued the course in pathology 
and bacteriologv. Doctor McLaughlin also did original work on the 
inefficiency of ferrous sulphate as an antiseptic and germicide, the 
results of his labors having been published in Bulletin No. 15. He 
was relieved from duty October 27, 1902. 

Passed Asst Sur^. Herman B. Parker was detailed to the laboratory 
October 27, 1902, m order that he might have the opportunity of 
completing the examination of specimens collected by working party 
No. 1 of the Yellow Fever Institute and the preparation of his report. 

Asst. Surg. Thomas B. McClintic was detailed to the laboratory 
November 17, 1902, and has steadily pui-sued the course in patholo^ 
and bacteriology outlined by the director. He has shown special 
aptitude for laboratorv work and is now engaged in original research 
work in connection with tvphoid fever. 

Asst. Surg. Clarence W. Wille was detailed to the laboratory 
November 21, 1902, and has now about completed the course outlin^ 
for the instruction of student officers in the laboratory. 

Much of the time of the director during the year was occupied in 
superintending the construction of the new laboratory building. 
Questions constantly arose in regard to the details of construction in 
which it was necessary that he should be consulted by the supervising 
architect. A large portion of his time was also taKcn up m super- 
vising and instructing student officers in the laboratorv. At the 
request of the president of the Naval Medical School the director 
delivered a series of lectures on immunity to the students; also two 
lectures on disinfection. During the year he compiled Bulletins Nos. 
8 and 12. 

Passed Asst. Surg. John F. Anderson, assistant director, has assisted 
in the instruction or the student officei*s, has done original work on for- 
malin as an antiseptic and germicide, and on April 23, 1903, was 
detailed by the Surgeon-General to proceed to the Bitter Root Valley, 
Montana, to investigate the so-called "spotted fever." The results of 
his work there have oeen compiled and are now in press in the shape of 
Bulletin No. 14 of the Hygienic Laboi-atoiT, entitled "Spotted Fever 
(Tick Fever) of the Rocky Mountains; a New Disease." During the 
absences of the director the assistant director performed his duties. 

On Au^st 16, 1902, Dr. Ch. Wardell Stiles was appointed chief of 
the division of zoology. Hygienic Laboratory, and one of the three 
divisions authorized b^ act of Congress, approved Juljr 1, 1902, was 
organized. Doctor Stiles was directed to proceed to various points in 
the South on September 24, 1902, for the purpose of investigating the 
prevalance of hookworm disease. His report, which has excited a 
great deal of interest, has been published as Bulletin No. 10, Hygienic 
Laboratory. 



324 PUBLIC HEALTH AND MARINE-HOSPITAL 8EBVICE. 

STUDENT OFFICERS. 

During the past year five commissioned officers have been detailed 
for a course of instruction in the laboratory. Two of the number 
have completed the course; the others are now undergoing instruc- 
tion. 

The great value of a laboratory course, especially in connection with 
the public health work of the Service, has long been realized, but the 
lack of available officers, on account of the nema of the Service at our • 
quamntine and hospital stations, has prevented the detail of more than 
two at one time; but it is hoped, and earnestly recommended bv the 
director, that the needs of this Service may be such as to allow the 
detail of at least five officers for instruction each year, 

It seems to the director that a detail to the laboratory before doing 
quarantine duty would be preferable, as in connection with the course 
tnere is given very complete instruction in practical disinfection, so 
that when an officer arrives at a quamntine station he can put into 
pmctice the theory that he learned at the laboratory. Moreover, by 
having a large number of officers trained in laborator}' work, there 
would be at command of the Service just so many trained l)acteriolo- 
gists who would be able to make diagnoses of cases of suspected plague, 
cholera, yellow fever, and other iniectious diseases. The great value 
of this from a quarantine point of view and the great saving to the 
commercial world is at once apparent, and it is hoped that this may 
become a routine practice for quarantine officers as they enter the 
Service. 

Up to the present time ten officers have received the laboratory course 
and are now competent to do independent bacteriological, diagnostic, 
and research work:. 1 think that this is a larger numl>er of traineil 
bacteriologists than any other Government medical service possesses. 

JOURNAL CLUB. 

The labomtory receives about forty publications, about one-half of 
the number being foreign. In order to have the benefit of this large 
amount of litemture and to keep pace with the progress of scientific 
research in different countries, the director assigned a certain number 
of journals to each officer on duty in the laboratory. One night each 
week the officers meet and each presents a brief r^sum^ of Uie prin- 
cipal articles in the journals whicn have been assigned to him. This 
plan has been of great benefit to all connected with the laboratory. 

BULLETINS. 

During the year the laboratory has issued Bulletins Nos. 8 to 13, 
inclusive, and Bulletins 14 and 15 have been submitted for publica- 
tion. The titles are: 

Bulletin No. 8. — Laboratory course in pathology and bacteriology; by M. J. Rosenau. 

BuUelin No, 9. — Presence of tetanus in commercial gelatin; by John F. Anderson. 

Bulietin No. 10. — Report upon the prevalence and geographic distribution of hook- 
worm disease (uncinariasis or anchylostomiasis) in the United States; by Ch. Waidell 
Stiles. 

Bvdlelin No. 11. — Experimental investigation of Trypanosoma Lewis! ; by Edward 
Francis. 

BiiUeiin No. 12. — The bacteriological impurities of vaccine virus; an experimental 
study; by M. J. Bosenau. 



PUBLIC HEALTH AND MABINE-HOSPITAL SERVICE. 825 

BxiUelin No. 13.— A statistical stndy of the intestinal parasites of 500 white male 
patients at the United States Government Hospital for the Insane; by Philip £. 
Garrison, Brayton H. Ransom, and Earle C. Stevenson. A parasitic roundworm 
(Agamomermvi culicia n. g., n. sp. ) in American mosquitoes ( Culex soUicitans) ; by Ch. 
Wardell Stiles. The type species of the ceetode genus Hymenolepis] by Ch. Wardell 
Stiles. 

BuUetion No. 10, on account of its economical importance, has elicited 
^eat interest throughout the entire South. 

Bulletin No. 12 has received much attention, especially on account 
of the act of Congress approved Juljr 1, 1902, requiring the inspection 
of establishments manufacturing viruses, serums, toxins, and analo- 
gous products. The warning given that manufacturers of vaccine had 
been putting the green product on the market with a high degree of 
bacteriological impurities has resulted, according to the examinations 
which have been conducted in the laboratory, in a decided improve- 
ment in the product. 

This has been decidedly the banner year for publications by the 
laboratory. 

REPORTS OF CONVENTIONS. 

The director of the laboratory was detailed as the representative of 
the Public Health and Marine-Hospital Service to act upon the com- 
mittee of revision of the Pharmacopoeia of the United Sdites concern- 
ingthe introduction of diphtheria antitoxin into the next Pharmacopceia. 

The director was also aetailed to represent the service at the meeting 
of the International Sanitary Conference which met in Washington, 
December 2 to 6, 1902, and his report thereon is hereinafter published. 

STANDARD ANTITOXIN. 

In view of the duties imposed upon the Public Health and Marine- 
Hospital Service by the act of Congress approved July 1, 1902, entitled 
" An act to regulate the sale of viruses, serums, toxins, and analogous 
products in the District of Columbia, to regulate interstate traffic in 
said articles, and for other purposes," it is greatly to be desired that a 
standard antitoxin should be prepared in tne laboratory in order to 
supply the same to the various manufacturers. At the present time 
the only standard antitoxin that is prepared is made in Germany and 
only one or two manufacturers in the United States obUiin this. The 
other manufacturers have adopted an arbitrary standard based upon 
. the strength of a toxin of varying potency and on the recent inspection 
of these establishments by the director and assistant director of the 
laboratory the hope was expressed by each manufacturer that the 
hiboratoiy would prepare a standard antitoxin for distribution to the 
manufacturei's. The following letter to the Surgeon -General by the 
director of the Hygienic Laboratory in reference to this matter is 
appended: 

I have the honor to invite your attention to the fact that it v;ould seem to be the 
duty of the hygienic laboratory to prepare a standard diphtheria antitoxin for free 
<ii8tribution to reeponsible laboratories engaged in original investigation and to estab- 
lishments licensed to manufacture and sell this product in accordance with the law 
approved July 1, 1902. 

During uiy recent trip of inspection I was told bv all the firms making diphtheria 
antitoxin that they looked to tnis laboratory for their standard, and they all urecKl 
lluit we take the matter up. Doctor Anderson tells me the same as a result of nis 
inH[)ection trip. 

Further, 1 am informed that at a recent meeting of the Americaw Ph«uxxxvwiKV3L\\sia\. 



326 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

Association which convened at Mackinac a resolution was ado]>te<l requesting the 
hygienic laboratory of this Service to furnish such a standard unit for testing anti- 
toxins. 

The regulations made in accordance with the law of July 1, 1902, r>rovide tltat 
diphtheria antoxin shall have a definite potency; but as there is no leij^l standard it 
would be quite impossible to enforce the requirements of this part of the regulations, 
even though a firm made an inert product. 

I have to especially invite your attention to the fact that in order to produce a 
standard antitoxin the constant services of one man skilled in this work will Ite 
required. A standard of this character must be made with the greatest precision, 
and the minutest precautions with every detail are necessary in order that the stan^l- 
ard shall not deviate the smallest frat^tion from its true unit value. In the preinmt 
state of our knowledge there are no special difficulties to be encountered in makin«: 
and distributing such a standard value. It is more a question of infinit«» patience 
and attention to minute details. 

In order to eliminate the personal factor from biological work of this character, it 
is of the greatest importance that one person be detailed for this duty; and in view 
of this phase I have, therefore, to recommend that it be done by a commissioneii 
medical oflicer of the Service. 

PLAGUE. "^ ^ 

Several specimens from cases of suspected plague were received at 
the lal>oratory during the year. In one of these cases from the Xi»w 
York (|uarantine the plague bacillus was demonstrated and a report 
thereon was made. The other cases were examined with negative 
results, so far as the presence of the Bacilhis yestin is concerned. 

A test of the efficiency of a lot of Yersin serum, which had been in 
the laboratory about two years, was made, and it was definitely dem- 
onstrated that during that time the serum had lost its protective and 
curative properties. 

An abstract of the methods of preparing various plag le vaccines is 
given in another portion of this report. 

WEEKLY INSPECTIONS. 

Upon the reorganization of the laboratory on July 1, 1902, weekly 
inspections such as are observed at all stations were inaugurated hy 
the director. Ekch Saturday morning complete and thorough inspec- 
tion of the lal)oratory is made by the director or assistant director. 
This plan has resulted in much benefit to the general appearance of the 
laboratory, and it is contemplated that when the new building is occu- 
pied the inspection and fire drill shall be carried out as at all stations 
of the first class. 

WATER ANALYSIS. 

A number of samples of water were received in the laboratory for 
analysis, both chemical and bacteriological. Complete reports of 
these were made. 

PATHOLOGICAL REPORT. 

During the year a number of pathological specimens were received 
in the laboratory for diagnosis. They are as follows: 



Epithelioma 7 

Carcinoma 12 

Sarcoma 4 

Pajpiloma 1 

Fibroma molluscum 1 

Mvoma 1 

Fi oroma 1 

Lipoma 1 

Tuben^uloiis fosti'cle *^ 



Tubercnloufl proetate 1 

Tabercolar adenitifl 3 

Acute yellow atrophy 1 

Cerebrospinal meningitifl 2 

Popliteal artery from case of gangrene . 1 

Nodular leprosy 1 

Chancroid ulcer 1 

Typhoid ulcer of the intestine 1 

\ X.p\>eTvv\\cea 11 




PHOTOQIAPH or TUMOR MTtft RE«OM fcj_ 



Replilt rulilli' II<-allli nnil MtkrincHiwiiltal f^Tylr,; I'XEt. 




Hf]K>rt lliMlc Ili'Hilli III!') MnrliK-IliH'llnl >et\>,.... |g([t. 




HEM*LUM AND EOSIN. '' ABOUT 250. 



PUBLIC RKALTB AND MABINE-HOSPITAL 8£BVIG£. 327 

A complete report with diagnosis of each of these specimens was 
orwarded to the sender. The receipt of these specimens in the lab- 
oratory has been of great interest, as well as assistance, to the student 
officers undergoing instruction, and it is to be hoped tnat interesting 
pecimens of pathological processes collected at our hospitals will l)e 
orwarded to the laboratory in order that they may be placed in the 
aboratory collection. 

LEPORT OF A CASE OF LIFOliA ARBORESCEN8 WITH MICROPHOTCKJRAPIIS. 

By Affit. Surg. T. B. McClimtic. 

This laiiety of bitty tumor apparently has attract€<l but little attention, and con- 
Bqnentfy meaical literature on the sabject is limited and unsaUsfactury. Some of 
^e iMdiK ptftholonsts make no reference in their works to a fatty tumor of this 
atmw ZeUer, in his Special Pathology, only briefly mentions it in his discussion 
f artiuttfa odbrmans, in which he states that when fat is later deposited in the 
>ldsmdfringeBof the affected joint a condition known as lipoma arborescens results. 
The American Textbook of Pathology speaks of it as a proliferation of fatty tissue 
i the efnovial layers, in which the jomt recesses are fill^ by papilliform branching 
t mamm; that it is rather frequently observed in joints already affected with tuber- 
ilorie or aithritia deformans, and is rarely observed as a disease of tend(m sheaths. 
It ie now held hy some to be more fre<]uent than has been supposed, especially in 
mnection with diseased ioints, and that conditions often clashed as simple hyper- 
ofdiiee really belonjg under thb heading. Evidently they couHider it a secondarv 
lange, having its origin in the joint structures or tendon sheaths, and usually a result 
; some chronic patholo^cal process, as arthritis deformans, tuberculosis, etc. 
Hm case under consideration differs from the idea conveved al>ove in several 
aterial Mints. At the time of removal the tumor jpresentea the apt)caraiice of a 
lultiple linoma, being made up of numerous lobes of various shapes and sizes rang- 
1^ in weignt from a gram or so to 300 or 400. The lobes had various attachments, 
line seasiTe, others i^unculated, which on the whole gave it a very ragged apiiear- 
ice. It was located in the connective tissue of the back of the thigh extending 
om the lower border of the gluteus maximus muscle to a point 1 inch below the 
neejoint, but having no connection with the loint. The only osseous relation to 
B foond at all was a small bone about the size of a hickory nut encysted in the tumor 



It is not known whether it originated in some tendon sheath or not; but it is poe- 
ble, aa the muscles in its neighborhood were affected. The size of the tumor, too, 
as nnnanally lai^, weighing at the time of removal 2,000 grams. 

On flection it appeared to be composed of adipose tissue inclosed in a strong fibrous 
ipflole. After careful examination it was seen that the tumor did not have the 
enign characters observed in simple lipoma, but showed a tendency to invade the 
inacolar tissue in its vicinity, replacing and destroying it. Another evidence of its 
ot being wholly benign is its tendency to recur, having been removed twenty years 
^ and again five years previous to the last operation. Portions of it showed micro- 
^idcally the conaition ordinarily observed in simple lipoma, while other portions 
ave quite a different picture. 

The fibrous tissue was abundant and particularly so where the muscular tissue was 
ivolved. The epimysium, perimysium, and endomvsium were much thii^keneii, but 
1 composition did not differ materiallv from normal tissue found here, ex(Xipt that 
iirroumling the individual muscle fibers (endomysium) which was relatively well 
applied with nuclei. This showed that it was not as fully developed as the other, 
»'!iich consisted principally of dense, wavy, fibrous l>andd almost m^e from nuclear 
lements. It seemed that the proliferation of the fibrous tissue surrounding the 
ius<*le (epimysium) first took place, later that surrounding the nuiscle bundles 
perimysium), and finally that enveloping the individual muscle fibers. 

After this proliferative process had reached a certain stage of development the for- 
lation or deposition of fat would begin. From this increase of intermuscular tiM.sue 
he muscular fibers would l)e forceil apart and isolated. The effect of this was that the 
luscular fibers lost their striation, became more or less homogeneous, and finally 
trophied or disappeared. The fat cells are larger than ordinarily observed in adipoiHe 
issue, and appear to be formed at the cxpenne of the fibrous tifflue until there is only 

framework of the latter remaining, i. e., a process of metaplasia. 

The blood vessels are not abundant, but are distributed in the connective tissue 
nd branch freely. The different coats of the vessel are not distinguishable, but 



328 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

that portion next the lumen is very rich in cellular elements, which gives it the 
appearance of a newly formed blood vessel. 
There is some round-celled infiltration in the perivascular space, but not abundant 
The accompanying photographs show particularly the involvement of the muscu- 
lar tissues. 

MICROPHOTOGRAPHY. 

During the year there was supj)lied to the laboratory a complete Zeiss micropho- 
tographic apparatus, and with this some very satisfactory microphotographs of oac- 
teria and tissues have been made. 

The photographs accompanying the article on lipoma arborescens wer^ taken with 
this same apparatus. 

DISINFECTANTS. 

Mucn work was done the past year with various disinfectants. Upon 
the request of the Clavton Fire Extinguishing and Disinfecting Com- 
pany, the director of the laboratory was directed by the Surgeon- 
General to proceed to New York for the purpose of making tests of 
their apparatus. His report upon this subject has not yet been 
completed. 

The work upon the inefficiency of ferrous sulphate as an antiseptic 
and germicide was published as a bulletin. 

Work upon formalin as an antiseptic and germicide is now being 
prosecutea in the laboratory, and wnen completed it will be the sub- 
ject of a bulletin. 

During the year, in view of the fact that glycerine is used by all 
vaccine manufacturers in conserving their product, an extended series 
of experiments on the antiseptic and germicidal value of glycerine in 
various percentages was done in the laboratory. This work has Wen 
about completed, and the results are now being compiled for publica- 
tion as a bulletin. 

TLAOUE VACCINES. 

The following is a brief summary of the various methods for the 
preparation of plague vaccines: 

Haffkine*8 prophylactic. — A 2-days-old virulent serum culture of BcuiUus pofiis from 
the heart's blocxl of a plague-inoculate<l rat is used. Subcultures from this are made 
by inoculating fl&sks containing about 1.5 liters of nutrient bouillon. These are 
grown at 30° C. for one month. The flasks are shaken at inter\'al8 of a few <lay.*. 
The cultures are sterilized at the end of this time in a water bath by heating at fO° 
C. for one hour. After sterilization 0.5 per (»ent of carbolic acid is added. 

The dose of this vamne for a man is 3 cm.*. 

77i« vaccijie of the Qerman plague commimon. — The Grerman plague commission, while 
working in Bombay, believed that a^ a result of their experience a more exact dose 
of the vaccine could l>e obtained than is nossible with the vaccine pre{>ared by Haff- 
kine's method. Their method was as follows: 

As an original culture they use a serum culture. From this they inoculate fla^kp 
of agar havmg a large surface. These are grown in the incubator at 30° C. for three 
dav.s, then floodc<l with sterile bouillon and the suspension sterilized by heating at 
65° C. for one hour. For every 10 cm.' of culture surface 3 cm.' of bouillon are 
use<i. The dose in the .«ame as that for Haffkine. 

Vaccine of Lnaliii'Galcotli.—howiWow is inoculated with a 2-diy8-old serum culture 
and grown in tlie mcubator at 30° C. for two days; then flasks of agar with a large 
surface are inoculat4»d heavily from this bouillon growth. After three or four davs 
incul)ation at 30° C. the agar plates are flooded with 1 per cent caustic potash solu- 
tion; then the flasks are well shaken, with the result that the culture forms a mass 
resembling the white of a hen's egg, rather sticky, and permitting to be drawn out 
into threads. The mass is then poured off into l)eaker8 and mixed with 1 per cent 
acetic acid constantly stirred, produ(!ing a flocculont precipitate, which settles to the 
bottom. The superriatent fluid is decanted and dLsainled. The sediment is gathered 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 329 

on filter paper, washed with sterile water until the filtrate is of a neutral reaction. 
The residuum left upon the filter is placed in watch crystals and dried in vacuo; then 
the dry mass is pulverized, and in this state will keep for a long time. Lustig and 
Galeotti believed this to be a nucleo-proteid. 

The dose of this vaccine for a man is 0.0133 gram of the dry substance; 0.04 gram 
of the powder is dissolved in 21 cm.' sodium carbonate solution, and this is sufficient 
for three immunizing doses; or by dissolving 2 grams of the drv powder in 1 liter 
of sterile sodium carbonate solution we have a quantity sufficient tor immunizing 143 
persons. 

Modification of Lustig's vaccine, — ^The Grerman plague commission made some tests 
with a combination of Haffkine's and Lustig's method. They used a culture 1 
month old in the same way that Haffkine's vaccine was prepared. This was precipi- 
tated with ammonium sulphate and filtered. The residuum was washed witn 1 per 
:«nt potash solution, then with 1 per cent acetic acid solution and precipitated with 
I few drops of 5 per cent hydrochloric acid, and it was allowed to settle. The sedi- 
ment was collected on filter paper, washed with sterile water until the filtrate was 
>f a neutral reaction, then placed in watch crystals, dried in vacuo, and pulverized. 
This gave a brown powder, which was dissolved in 1 to 2 per cent sterile carbonate 
lolution before injection. 

Vaccine of Calmette. — This vaccine consists of cultures dried directly upon agar or 
bouillon cultures, filtered, and the residue allowed to dr^. The mass thus obtained 
is placed in hermetically sealed tubes. This is readily dissolved and injected. 

The results of this method have no advanta^ over Lustig's method; but, on the 
(x»ntrary, it is more dangerous in the preparation of large quantities, and, therefore, 
it was liot tried in the laboratory. 

Antipesi vaccine^ antichoUra vacdne^ and antityphoid vaccine. — A forty-eight-hour 
old culture of agar is used. The surface is scraped and emulsified in a small amount 
of physiological salt solution, then heated at 00^ C. for one hour in the water bath. 
The emulsion is then poured into a cylindrical vase containing agglutinative serum, 
which agglutinates the bacilli. Two layers are formed: The microl)es on top and 
the serum below. The clumps at the junction of the two form larger and larger 
until finally they drop to the bottom, the supernatant fiuid Ix^coming clear. This is 
decanted and discarded. The mass at the bottom of the fiask is thoroughly washed 
in a centrifuge with phvsiological salt solution until the last trace of serum disap- 
pears. The mass whicn remains is pasty, semiliquid white, and mixed with 
physiological salt solution gives a fine homogeneous emulsion. This is the vaccine. 

Anticholera and antityphoid serum are made in the same way, except that the 
bacteria and the serum are mixed before washing. The serum must be very actively 
agglutinative, not necessarily protective or prophylactic. The nucTol>es must be 
thoroughly washed of all serum. It is claimed that the vaccine thus prepared has 
lost all toxic action. Immunity in a mouse appeared forty-eight hours after injec- 
tion and lasted five and one-half months. In a guinea pig immunity was ()08ses8ed 
for five and one-half months. 

NEW lABORATORY BUILDING. 

The new building, an appropriation of $35,000 for which was 
approved March 3, 1901, is now about completed, and a description of it 
might be of interest. It is constructed of aark, hard-burned brick, two 
stories and an attic. 

On the first floor at the west side of the entrance is the general oflBce 
for the stenographer and pharmacist. Adjoining this is the private 
office of the director. To the east of the entrance is the reception 
room, and adjoining this is the oflSce of the assistant director. A large 
room, 17 by 27 feet, in the east wing has been set aside for the division 
of zoology. This room will be divided by glass partitions, so that there 
will be one large general workroom and two smaller rooms for special 
work. Opening oflf this room is the private office of the chief of the 
division. The large room, 17 by 27 feet, in the west wing of the build- 
ing on this floor is to be devoted to photography. In tnis room will 
be placed the microphotographic apparatus, cases for the preservation 
of negatives, and the storage of any special photographic apparatus. 
This room will be provided with a large roll curtam, so that lantern 
exhibitions may be given to the student officex*. C;Owwe,^Veftk.mNi>ow>X\\^ 



830 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

room is the dark room. This room is provided with a window of rich, 
orange-colored glass. In it are the necessary sinks and a special cabinet 
for plates. South of the main entmnce is the library, 14 by 19 feet, 
whicii will contain sufficient shelf room for about 10,000 volumes. This 
room will be fitted with a long table in order that it may be used for 
board meetings. 

The second floor has in the center, facing north, 3 rooms for the 
chiefs of the divisions of pathology and bacteriology, chemistry, and 
pharmacology, respectivelv. The west room, 28 by 28 feet, is for the 
division of pathology ana bacteriology. This room contains work- 
benches so arrangea that 9 officers may be easilv accommodated, each 
with an entire window for his own use. The desks will be so arranged 
that there will be ample locker and drawer room. Small sterilizers 
will also be placed in tnis room, with a large sink for washing small 
glassware, a small post-mortem table, a table for the microtomes and 
reagents for urinalysis. A special apparatus for the deliver}^ of trikre- 
sol, distilled water, and tap water wiU be installed at each workbench. 
The runways for pipes are so arranged that there are no pipes exposed 
to view. The east room on this floor is for the use of the divisions of 

()harmacology and chemistry. Complete workbenches with necessary 
ockers and^ drawers will oe installed. Two large tables are to be 
placed near the center of the room for general work. A chemical 
nood and a large sink are also to be proviaed. 

On this floor are the incubator ana cold rooms. It is contemplated 
that the incubator room shall be maintained at a uniform temperature 
by electric heaters. In the cold room a low uniform temperature is 
to be maintained by means of a special system of brine circulation 
through pipes placed near the ceiling. 

The attic, while not to be used for storage, is light and roomy. In 
the southwest and southeast ends are to be placed two large tanks, 
capacity about 1,000 gallons. The tanks for trikresol and distilled 
water will also be placed in the attic. 

In the basement are located the heating plant (steam), the necessarr 
storage for coal, and two large general storage rooms. The large steril- 
izers and a larjre sink for the cleaning of heavy glassware will also be 
loc4ite.d here. 

The building is provided with two lifts running fi'om the basement 
to the attic, one on each side of the stairway. 

All workbenches, cases, cabinets, tables, and other fittings will be of 
oak with a golden oak finish. 

A large flag pole surmounts the building, from which the national 
ensign will float. 

Following is the report of the chief of the Division of Zoologv, 
Dr. Ch. W. Stiles. 

REPORT OF THE DIVISION OF ZOOLOGY OF THE HYGIENIC LABORATORY. 

By Dr. Ch. Wabdell Stilks, Chief of Diyiidon. 

Sir: I have the honor to submit the following report of the Division 
of Zoology for the ^cal year ended June 30, 1903: 

TEMPORARY QUARTERS. 

Pending the completion of the new laboratory building this division 
has been occupying tempomry (quarters from August 16, 1902, to Juno 



PUBLIC HEALTH AKD MARUiE-HOSPITAL SEBVIOE. 831 

1, 1903, in the laboratory of the Division of Zoology, United States 
Bureau of Animal Industry, and from June 1, 1903, to date in the 
Medical School of Creorgetown University. 

The fact of being in temporary quarters has naturally interfered 
some with r^ular routine work. 

FIKLD WORK. 

Three field trips have been undertaken, namely, one through the 
Southern Atlantic States by myself to study hookworm disease; one 
through the antliracite coal region of Pennsylvania by myself to study 
the parasites of the coal miners; and one to Middletown, Conn., by 
Mr. (jarrison to study the parasites of the insane. 

HOOKWORM DI8EA8K (uncinariosiit). 

By far the most important work of the division this year has been 
the determination of the prevalence and geographic distribution of 
hookworm disease in the Southern Atlantic States. The results 
obtained are printed in Bulletin No. 10^ Hygienic Laboratory, United 
States Public Health and Marine-Hospital ^rvice, Washington. 

Since the scientific and press reports of this investigation have 
appeared my observations nave been confirmed by a number of prac- 
titioners, who report excellent results with the thymol treatment. 
Almost every week letters are received from various practitioners 
telling of cases they have found. Of such correspondents I would 
mention in particular Dr. E. D. Bondurant, of Mobile, Ala.; Do<*.tor 
Harrison, oi Talladega, Ala.; Doctor Julian, of Thomasville, N. C; 
and Dr. J. S. Helms, of Tampa, Fla. 



PARA8ITB8 OF PENNSYLVANIA MINERS. 



In accordance with instructions from the Surgeon-General, dated 
March 5, 1903, I visited the anthracite coal region of Pennsylvania to 
determine whether hookworm disease was present in that re^on. 

The statements relative to anaemia among the Pennsylvania miners, 
gathered from the daily press, were very contradictory, but there were 
good a priori reasons for assuming that hookworm disease would be 
found. I was unable, however, to find any cases. 



INTESTINAL PARASITES OF THE INSANE. 



In order to ascertain the approximate frequency of various intes- 
tinal paiTLsites of man in this country according to sex. age, and race, 
arrangements were made with the Government Hospital for the Insane 
to obtain material from all the patients of that institution. The results 
of the first 600 examinations have been published in Bulletin No. 13, 
Hygienic Laboratory, United States Public Health and Marine-Hospital 
Service, Washington, pages 5-13. The results of further examinations 
at this hospital will be published during the fiscal year 1903-4. 

In order to obtain similar statistics for some other locality as a basis 
for comparison, an arrangement has been made with the Connecticut 
Hospital for the Insane, at Middletown, Conn., where we shall make 
1,000 examinations. 



&S2 PUBLIC JaEALTH AND MARINE-HOSPITAL SERVICE. 

THE DWARF TAPEWORM {Jlymenolepis nana) present in the united states. 

Incidentally the division has been able to show that the dwarf tape- 
worm is mucn more common in this country than has hitherto been 
supposed. A bulletin which has been prepared by Mr. Ransom deal- 
ing with this subject will soon be submitted for publication. 

THE zoological COLLECTION. 

Following the precedent of the United States Bureau of Animal 
Industry, the specimens of our zoological collection have !>een given 
numbers in the Helminthological Collection of the United States 
National Museum. The museum numbers reserved are as follows: 

Nos. 1-4700 have been set aside for the United States Bureau of 
Animal Industry. 

Nos. 4701-9400 have been set aside for the miscellaneous spe<;imens 
of parasites deposited in or presented to the United States National 
Museum or sent to the Museum for determination. 

No. 9491 has been set aside for the United States Public Health and 
Marine-Hospital Service. 

The advantage of this plan is self-evident. According to the sundry 
civil act of March 3, 1879, scientific specimens collected by any serv- 
ice in this Government eventually become the property of the National 
Museum when the service collectmg them has no further use for them. 
By the plan adopted every specimen collected will retain its original 
serial number, thus preventing future confusion which would result 
from a change of number. 

The following specimens have been entered in our collection during 
the fiscal year 1902-3: 



PUBLIC HEALTH AND KABIITE-HOSFITAL SEBVIOE. 



333 




3 3 i 3 3 33 3 331 I! 



334 



PUBLIC HEALTH AKD MARWB-HOUFITAL 8EBVICE. 




PUBLIC HEALTH AND MARIIfE-HOSPITAJ. 8EBV1GE. 835 

DETAIL TO UNITED STATES BUREAU OK ANIMAL INDUSTRY. 

Upon request of the Secretary of Agriculture I was detailed to act as 
consulting zoologist of the United States Bureau of Animal Industry, 
and as such 1 have continued to have supervision over the division of 
that Bureau. 

DETAILS TO MEDICAL AND SCIENTIFIC MEETINGS. 

I have attended the following medical meetings upon request on 
the part of the respective societies to the Sureeon-General that 1 be 
detailed to address them on the subject of hook-worm disease: 

Meeting of the Alabama State Medical Association, held at Talla- 
dega, Ala., April 21-24, 1903. 

Meeting of the Texas State Medical Association, held at San Antonio, 
Tex., April 28-May 1, 1903. 

Meeting of the American Medical Association (section on medicine), 
held at New Orleans, La., May 4-8, 1903. 

Meeting of the North Carolina State Medical Association, held at 
Hot Springs, N. C, June, 1903. 

Eespectfully, Ch. Wardbll Stiles, 

Chief .^ Division of Zoology ^ Hygienic Laboratory. 

To the Director of the Hygienic Laboratory, 

U. S. P. H. AND M. H. S. 



Reports of Officers Detailed to Meetings of Medical and 

Public Health Associations. 

Rrport on Msetinq op the Association of Militaby Surgeons, at Boston, Mass., 

May 19-21, 1903. 

By AflBt. Stug. Gen. Osobok T. Vauohan. 

Trsasuby Depabthbnt, 
Bureau of Public Health and Marine-Hospital Service, 

Washington^ July IS, 190S, 

Sir: In accordance with Bureau letter of May 15, 1903, detailinjg me to represent 
the Service at the meeting of the Association of Military Surgeons in Boston, May 19, 
20, and 21, I have the honor to make the following report: 

The opening exercises were held at 10.30 a. m.. May 19, at Faneuil Hall. 
Addresses were delivered by Governor John L. Bates, Dr. George A. Francis, and 
the president of the association, Gen. Robert A. Blood. 

The foreign dele^tes were: Colonel Wreden, from Russia; Colonel Charlton, from 
£ngland; Colonel Kyerson, from Canada; Colonel Augurre, from Mexico, and Lieu- 
tenant Castelli, from Italy. 

Other oflBcers of the Public Health and Marine-Hospital Service in attendance 
were Surg. Gen. Walter Wyman, Sui^gs. S. D. Brooks, D. A. Carmichael, and R. M. 
AVoodward, Asst. Surg. W. C. Rucker, and Acting Asst. Sui^g. W. H. Marsh. 

The second Enno Sander prize was awarded to Asst. Surg. W. C. Rucker, Public 
Health and Marine-Hospital Service, the title of the paper being **The differential 
diagnosis of typhoid fever in its earliest stages." This paper was read by its author 
and discussed by Surg. Gen. Walter Wyman and others. 

In the report of the necrology committee one item of interest to the Service was 
mentioned with reference to the death of Surgeon Vansant, namely, that some years 
ago he had published an article on certain bodies he had found in the eruption of or 
in connection with smallpox, which were thought to have an important relation to 
its etiology. 

In the evening a reception was given by the First Corps Cadets, M. V. M., to the 
members, ladies, and invited gue^te. 

May 20: The association met at 10 o'clock a. m., the president. General Blood, in 
the chair. Papers were r^ as follows: " The education of the medical oflScer," by 
Maj. William U. Borden, U. S. Army; ** My first aid to the wounded: the trip of the 
steamer S. R. Spaidding, transporting our wounded priaouera trom CSvt^ YwslVN^^ 



336 PUBLIC HEALTH AND MAKINE-HOSPITAL SERVICE. 

to Philadelphia after the Seven Days' Battles in 1862," bv Lieut. Col. Hcnr\' O. 
Marc^% U. 8. Volunteers; *'New England men in the Medical Corjje of the Navy of 
the Lnited States,'* by Medical Inspector Franklin Bache Stephenson, U. 8. Navy; 
and *' Service conditions, retirement and pensions," by Medical Director John C. 
Wise, U. S. Navy. 

The nominating committee was then appointed, and the writer waa appointed on 
this committee to ca«t the 10 voten to wlncn the Service is entitled. The association 
adjourned at 1 p. m. to lunch given by Dr. H. 0. Marcy at his house. At 2.30 the 
association was called to order by the ])resideut, and the following papers read and 
discussed: "The acting assistant sur^^eon, United States Army," by Maj. Azel Ames, 
U. S. Volunteers; "On the prevention of the spread of infectious diseases on boani 
ship," by Surg. Henry G. Beyer, U. S. Navy; and "Appendicitis," by Dr. E. 
Castelli, of the Italian army. 

At 7 p. m. the nominating committee met and unanimouslv submitted the follow- 
ing slate for confirmation b)^ the assotMation: President, Medical Director John 0. Wise, 
U. S. Navy; first vice-president, Surg. Gen. Walter Wyman, United States Public 
Health arid Marine- Hospital Ser^'ice; second vice-president, Maj. A. H. Brijjgg, 
New York National Guard; third vice-president, Sui^g. Gen. Rol>ert M. O'Reilley, 
U. S. Army; treasurer, Maj. Herljert Arnold, National Guard Pennsylvania, St. 
Louis was recommended as the next place of meeting. 

Ill the evening the association attended an exhibition of the ambulance corpe, 
Massachusetts Volunteer Militia, Capt. Robert E. Bell. 

May 21. The association met at 10 o'clock a, m., the president in the chair. The 
following papers were read and discussed: "Results of treatment of tul)erculo6iii! at 
Public Healtn and Marine-Hospital Service sanatorium, Fort Stanton, N. Mex.,'* by 
Surg. P. M. Garrington, Public-Health and Marine-Hospital Service. A syno])idsuf 
this i)aper was read by Asst. Surg. Gen. George T. Vaughan and photograptis of the 
station were exhibited. "The treatment of anterior dislocation of the shoulder, with 
report of a case in which reduction was prevented by the detached greater tul>ero8itv," 
by Asst. Surg. Gen. George T. Vaughan, Public Health and Marine-Hospital Ser\'ice; 
"An external suture," by Capt. Thomas Page Grant, K. S. G.; "Sixteen casts of 
tropical abcess of the liver," by Lieut. E. W. Pinkham, late U. S. Army, and "Three 

cases of fracture of the base of the skull," by , Massachusetts Volunteer 

Militia. 

The report of the nominating committee was confirmed and the selei^tion of tbe 
next place of meeting was left to the executive committee. 

The new president was installe<l and about 1 p. m. the association was invited to 
take a trip to Lexington and Concord on automobiles, through the courtesy of the 
Automobile Club of Massachusetts, and other excursions by land and water were 
tendered for the next da v. The association having adjourned, I left Boston about 7 
o'clock p. m., reaching Washington about 10 o'clock a. m.. May 22. 
Respectfully, 

Gborge T. Vaughan, 
AsnHant Surgeon-General. 

The Surgeon-Grnbral, Public Health and Marine- Hospffal Service. 



Report on Meeting of toe American Public Health Association, New Orleans, 

La., December 8-13, 1902. 

By Surg. H. R. Carter. 

Public Health and Marine-Hospital Service, 

Office of Medical Officer in Command, 

Baltimore, Md., December JO, 190 J. 

Sir: As directed by Bureau orders of December 3, 1902, I have the honor to sub- 
mit the following report of the meeting of the American Public Health AsBociation 
heM in New Orleans, La., from December 8 to December 13, 1902: 

The first day of the meeting was devoted to the bacteriological section of the asso- 
ciation. Owing to the train being late, I was unable to attend the morning seaeion 
of the section, whicli I regret, as it was devoted to the Bacillus coli and its congenen 
and metluKls of detecting and differentiating these oivanisms in waters, a subject 
of the greatest importance and interest to sanitarians. At the afternoon session there 
were a nmnl)er of interesting mpers read — two, by Mazyck P. Ravenel and E. A. de 
Schweinitz, respectively, to show the identity of bovine and human tubercalosis, a 
view which I think was sustained; one by Doctor Park on an epidemic of dysentery 



PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 337 

in New York and New Jersey marked in a laree proportion of the cases examined by 
the pretaence of Shiga's baciilas. A paper by McFarland, on the ''Value of antisep- 
tics to preserve serums," was, I thmk, of importance to the Service. Of carbonc 
add, tricresol, and formalin, the substances tested, he found that formalin, one-tenth 
per cent, was the most efficient except against molds. In sufficient large amount 
to prevent molds (one-half per cent^ it was objectionable from the pain produced 
by the injection. In spite of this, he ranks formalin the best, and carbolic acid, 
one-half per cent, the next best, and does not approve of the use of tricresol. 

A paper on "The differential morphology of^tne B, diphUieriXy B. paeudo-diphthe- 
rue, ana B, xerosis,^* by Denny, of Brookline, Mass., was also interesting from a prac- 
tical standpoint. Reclaims that the differentiation of the first organism from the 
oUier two is easy from their morphology in j^ure cultures of over twenty-four hours 
old, the difference becoming more marked with the age of the culture. In cultures 
symbiotic with the pus organisms — such as are always depended on for the diagnosis 
of diphtheria by most boards of health — this difference in morphology is slight and 
not aependable. A most important observation if confirmed. 

A paper on "Formaldehyde disinfection," by Hill, of Boston, seemed to me to be 
of less practical value than similar work by Geddings and Rosenau, of this Service. 
He laid stress, as do all, on the need of the presence of moisture with the gas for it 
to be most efficient. In the debate on this paper an instance was related by a mem- 
ber of the use of paraform in what seemed great excess with failure to kill test organ- 
isms. No explanation was vouchsafed, but from the statements of the reporter it 
seems to me probable that he had evaporated the paraform as such without decom- 
posing it 

The morning session of the second day was occupied by a paper on "The exami- 
nation of the waters of the United States," by Mr. Leighton, United States Hydrog- 
rapher, a paper valuable for the work outlined rather than as a report of work done. 
The examination contemplated was commercial, not sanitarv, but took cognizance of 
contamination from the commercial standpoint This was followed by a symposium 
on the disposal of city refuse bv a number of prominent men. Only brief abstracts 
of the papers, made b^ Rudolph Herring, were read. It was easy to see that garb- 
age generally-r-as distinguished from sewage — was considered as h nuisance rather 
than as a menace to heiuth. 

In the afternoon session the paper by Doctor Licea^ on the "Sanitary measures 
proposed to railroad companies seemed the most important. He did not state 
that the measures were adopted by the companies^ and I am inclined to think that 
some of them would not willingly be carried out if avoidable. 

I was unable, on account of sickness, to be present on the third day (December 10) 
until the evening session. The feature of the session was the symposium on yellow 
fever. Doctor Liceaga stated that the yellow fever epidemic in Vera Cruz had 
diminished as soon as "war was made'' on the Stegamyia^ but that owing to the 
nature of water supply the measures against this mosquito could not be carried out 
with completeness. The next summer this could be done, and he then hoped to 
show the same results in Vera Cruz as had been obtained in Habana. Doctor Iglesias, 
of Vera Cruz, recommended the disinfection of all cars, especially Pullman cars, with 
SO, when leaving a focus of yellow fever. He does not seem to have tried it, and, 
however advisable it may be, there are some obvious difficulties. The two papers 
by Ross, U. S. Navy, and Gorgas, U. S. Army^ both defending the thesis that yeflow 
fever is only transmissible by means of an infected Stegomyia mosquito, were the 
papers of the evening, and they alone were debated. The paper of Ross, in particular, 
excited much favorable comment as a close argument. Unfortunately the debate 
began late and was thus less interesting than would otherwise have been the case. 
Only one man, Souchon, of the Louisiana board of health, opposed the position taken 
in the above papers, although, to my knowledge, there were several in the audience 
(Matas and Parnam, of New Orleans, Porter, of Florida, and others) who agree<l with 
him. It was late and the feeling was that nothing would be settled by debate. 
There is a disposition in New Orleans to await further direct evidence as to other 
alleged means of conveyance, such as the present quarantine of Habana against Vera 
Cruz — a quarantine a^inst vessels and people, but not against fomites — may give. 
I believe that the sentiment among the profession in New Orleans is changing toward 
the view that the StegoTiiyia is the only means of conveyance of yellow fever, but it 
has not entirely accepted it yet. 

The papers of the last day, save one of Liceaga on arm-to-arm vaccination, and one 
by Formento on agricultural colonies for tuberculosis, were of little Service interest. 

Sureeon-GeneralWyman, Public Health and Marine-Hospital Service, was elected 
presi<jfent for the ensumg year and was installed amid general enthusiasm. He was 
nominated by Dm:gin, of Boston, and was seconded by Montizambert, of Canada 

H. Doc. 338 22 



338 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE. 

and Conn, of New Hampshire, in speeches at once highly laudatory and very hope- 
ful of the good that would result to sanitation in America through oim from the law 
of July 2, 1902. 

The meeting adjourned December 12, 1902, to meet in Washington, D. C, next 
year. 

Respectfully, H. R. Cabtkb, 

Surgeon^ Public Health and Marine-Ha^pilal Semct, 

The Surgeon-Gbneral Public Hbaufh and MARiNS-HosprrAL Skrvics. 



Mbeting of Spbcial Committke with Committee on the Revision or the Phab- 

MAOOPCEIA OF THE UNITED STATES. 

By Passed AseX. Surg. M. J. Roaenau, Director Hygienic Laboratory. 

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

Hygienic Laboratory, 
WathingUm^ March 11, 1903. 

Sir: In compliance with Bureau orders of February 28, 1903, I have the honor to 
report that I attended the meeting of the special committee called to confer with the 
committee on revision of the Pharmacopoeia of the United States. 

The object of the meeting was to decide upon the advisability of admitting diph- 
theria antitoxin and serum products into the Pharmacopoeia and further to deter- 
mine the methods of standaraizing serum products for potency and purity. 

The committee met at the residence of Prof. Joseph Price Remington, 1832 Pine 
street, Philadelphia, Pa., at 4 p. m., Saturday, March 7, 1903, and remained in con- 
tinuous session until after midnight of that same dav. 

The following were present: Dr. Theobald Smith, chairman, profesBor of com- 
parative pathology. Harvard Medical School, and director of pathological U^r- 
atories of State board of health, Cambridge, Mass. ; Dr. William tiaUock Park, 
assistant director of the research bacteriolo^cal laboratories, department of health, 
New York, N. Y. ; Dr. Herbert D. Pease, director of the antitoxin laboratory, New 
York State department of health, Albany, N. Y. ; Dr. J. J. Kinyoun, director of the 
biological laboratory, H. K. Mulford & Co., Glenolden, Pa.; Dr. £. M. Houghton, 
director of the pharmacological department, Parke, Davis & Co., Detroit, Mich.; 
Prof. Hobart A. Hare, professor of therapeutics, Jefferson Medical CoU^e, Phila- 
delphia, Pa.; Capt. Joseph E. Craig, U. S. Navv, Washington, D. C; Dr. M. J. 
Roeenau, passed assistant surgeon and director h^enic laboratory, U. S. Public 
Health and Marine-Hospital fervice, Washington, D. C. 

There was a unanimity of opinion among uiosepresent that diphtheria antitoxin 
should be admitted into the Pharmacopoeia. The PharmacoixBia, however, de 
manded that the standard be accurately described and theantitoxic unit be definitely 
defined. On account of the complications and difiiculties surrounding these defini- 
tions, and on account of certain differences of opinion, it was impossible to recondk 
all the members present, so that we could not agree upon a standard and proper 
definition. 

Other minor details arose, which reauired further elucidation, and it was finally 
decided to adjourn the meeting until May, when all the members constituting the 
committee will be in Washington to attend the meeting of the Society of American 
Pathologists and Bacteriologists. 

B^pectfully, M. J. Rosknait, 

Passed Assistant Surgeon and Director Hygienic LabcroJUny, 

To Thb Surgbon-Gbneral, Public Hbaltk and Marinb-Hospital Sbrvicb. 



Report on First Egyptian Medical Congress, Cairo, Egypt, Dbcsmbbr 19-24, 1902. 

By Aast. Sun^. Victor G. Hciser. 

Cairo, Egypt, January S, 190S. 

Sir: In accordance with the instructions contained in Bureau letter of No