objects, as thimble, cup, pencil, pen, sugar, salt, keys, coins, penknife, colors, numbers, and letters. Description of simple pictures, fitting together broken objects, and the use of modified apparatus after the plans of Healy, Goddard, and others.

The ability of the alien to name the ship on which he arrived, to answer simple questions as to what he saw en route, the time and by what means he traveled from his home town to the port of embarkation, why he came, what ideas he may have as to future intentions, and his age, in connection with which to tell what his age was four years past and what it would be three years hence.

Following this, his intellectual and moral judgment is brought out by his interpretations of sentences containing impossibilities or gross errors of fact-differences between right and wrong by the use of questions involving lying, stealing, and the proper course for one to pursue, after breaking, injuring, or losing something belonging

to another.

Home surroundings are added in order to make sure that the new scenes and questions have not confused the alien to the point of defective answers, but it is also taken into consideration that the defective brain is often very capable in memory of past experiences, quite accurate as to time and place, but it is of value to have this information to see if the alien can form new images from past associations; the normal can, but the defective fails. Questions as to daily duties, recognition of native coins and their value, characteristics of animals and their habits if the alien is from the country, if from the city descriptions of customs and use of appliances in trade. Ability to tell time, to tell something of the origin of various articles of wearing apparel, significance of the principal holidays in his home district, and testing desires by letter or oral request. The latter is of value in bringing out the logical or illogical wishes of the person.

Testing by aid of simple numbers has been found useful, for among the illiterate the child automatically learns to recognize numbers and something of their values, while letters follow more as a matter of educational teaching. To those that have had school training more detailed examination after the method of Binet is used in connection with the general outline described.

Racial viewpoints of life problems are so different that often considerable time and patience must be used before deciding in what class the individual belongs. Sometimes legal appeal taken cites that the alien certified is a fair standard of his race and while he may not compare well with certain other races he ought to be considered on his own racial standard. In these cases it should be considered that it is rather for the alien to conform to a standard for the protection of this country rather than for the United States to seek the standards of other races or people. Of course it may be fairly said that as yet no entirely satisfactory standard definition exists as to what constitutes the morone and different races having different degrees of intelligence. Nevertheless all races do have certain things in common, such as normal reaction to outside stimulation and coordination as shown in their ability to put past images in new combinations.

The question of military service if of age is also investigated to see if the alien has served; been rejected, or discharged for some defect.

Delusions, hallucinations, and illusions if suspected are sought for and traced until satisfactory evidence is offered of the sanity or insanity of the alien. It should always be borne in mind that in handling the large number of people and the limited time that can be given to each that some are sure to pass through, for the inspection is rather more of a sieve than a dam and it would be obviously unfair to write certificates on suspicion alone.

In conclusion the procedure given and used at this station has been with the object of bringing out the fact whether or not the suspected alien has, in his existing social condition, the mental ability to assume normal relations with society in new environment.

Friendly relations exist between the State institutions, State board of lunacy, and this station. This has resulted in interchange of ideas and visits of mutual benefit so that the State officials are familiar with conditions at this port and the efforts made to keep out the mental as well as the physical unfit.

Attention should be called to the fact that the station is sadly cramped for room and badly in need of apparatus, modern books, and files of medical periodicals in order that the efficiency may be kept up.

Name....

Birthplace.
Occupation.
Schooling..

Family history.

[Chemical Research form in use at Boston, Mass.]

U. S. PUBLIC HEALTH SERVICE,
U. S. IMMIGRATION STATION,
Boston, Mass.,

19...

Alcohol...

(For full description of significant abnormalities found see detailed records of the case.)

HONOLULU, HAWAII.

Ten thousand five hundred and thirty aliens were examined on arrival; of these 2,772 were Spanish and Portuguese from Europe and the remaining 7,758 consisted principally of Chinese and Japanese; 10,037 were passed and 493 certified in accordance with the immigration laws and regulations.

On January 1, 1913, the examination of arriving aliens for hookworm was begun, and in the period elapsing 28 aliens were found to be infected; of these, 21 were deported, 4 held and treated until cured, and 3 are pending at the close of the year.

It has become quite a general practice for the surgeons of vessels carrying immigrants to administer thymol during the voyage; this was done on quite an extensive scale with the Spanish and Portu

guese immigrants arriving from Europe, and to a lesser extent with aliens from the Orient.

It is questionable whether the administration of thymol to immigrants just previous to arrival is either a safe or suitable routine measure, for the reason that it is believed the drug so stupefies the worm for a few days that no eggs are laid, thus rendering the stool examination probably negative.

MANILA, P. I.

The number of arriving immigrants inspected increased from 3,132 last year to 6,581 this year. The arrivals by port were as follows: Manila, 5,312; Iloilo, 439; Cebu, 114; Jolo, 326; Zamboanga, 390. The rejections were among the following nationalities: Chinese, 15; East Indians, 52; Japanese, 58; Spaniards, 1; Turks, 1.

At the immigrant medical inspection made at the various ports of the islands the arriving aliens examined were classed as follows:

This is the first year that uncinariasis was classified as an excludable disease. There were in all 5,271 examinations made for hookworm of aliens and steerage passengers; of these 388 resulted positively. There were 84 cases of hookworm treated, all of which were negative to subsequent tests except 4, and these were certified and deported. The percentage of hookworm infection by nationality was as follows:

The largest percentage of rejections is still due to trachoma. The number from this cause during the year being 90, or 71 per cent of the total rejections, with 83 deportations. The percentage of rejections for all causes was 1.93 per cent, of which 106, or 1.6 per cent of the total arrivals, were deported; and while this percentage is lower than last year, it is believed that it is still a higher percentage of rejections and deportations than is made at the several ports of the United States.

The principal increase in the number of immigrants took place among Chinese, Japanese, and East Indians. By race the East Indians had the largest percentage of rejections, and they were almost all due to trachoma. The Indians, after gaining admission to the Philippines, generally depart for the United States soon afterwards.

NEW YORK, N. Y.

The work performed by medical officers detailed for immigration duty at New York may be classified in four divisions:

(1) Cabin inspection. Officers engaged exclusively in the medical inspection of cabin passengers board incoming ships at quarantine and the inspection is conducted while the ship is proceeding to the dock. This work is of an especially delicate nature because of the indisposition of the steamship companies to cause any seeming annoyance to saloon passengers, the difficulty in segregating aliens from the large number of citizens in the first cabin and the confusion incident to approaching debarkation. These problems are gradually being solved, and in the meantime medical officers have been instructed that the segregation of aliens in the cabin is a function of the immigration authorities upon whom they must necessarily depend for the presentation of such aliens for medical inspection.

(2) Line inspection. The inspection of aliens from the steerage is conducted at Ellis Island and this includes the bulk of the work of medical inspection.

This division embraces the primary line inspection, the secondary examination of those set aside for further physical or mental examination, the designation of cases to be sent to the hospital, reexamination of cases certified and subsequently appealed, and examination of cases in public institutions at the request of the commissioner of immigration. Three daily visits are also made to the detention rooms for the detection of cases of illness and sanitary reports are made to the commissioner when requested. Examination of aliens suspected to be idiots, imbeciles, or feeble-minded is a most important phase of this work, to which an increasing degree of attention is being paid and which has undergone a marked development during the year. One hundred and thirty-two persons of this type were certified during the fiscal year 1912; 520 certificates of this type were issued during the past year. The increase in the percentage of aliens certified for such defects is due to increased experience, improved methods of examination, and the painstaking work in this field which has been done by the officers engaged in it. It is hoped that larger opportunity may be had during the coming year for the prosecution of the original work already tentatively begun. To extend this work and insure rapidity and accuracy in its execution a larger medical force will be required as well as the employment of interpreters for exclusive duty in connection with the medical inspection.

(3) Immigrant Hospital (General).-In addition to the varied activities of a general hospital, many aliens are sent to this institution for observation of conditions involving medical certificates. All cases of suspected trachoma and suspected insanity, for instance, are admitted to hospital for diagnosis. A considerable number of suspected feeble-minded are also handled in hospital. These special