duties, which are quite apart from the ordinary routine of a hospital, involve much time and labor and a larger staff is desirable. (4) Immigrant Hospital (contagious disease).-Infectious cases developing among aliens on shipboard or at Ellis Island are admitted. The majority of patients are children suffering from measles, scarlet fever, and diphtheria. The death rate is materially influenced by the reception of a considerable number of moribund patients and those suffering from more than one infectious disease. On account of the increasing number of patients handled and the congestion in the wards at certain seasons a larger staff-especially a larger nursing staff is needed. In this connection it may be stated that the sick are brought to Ellis Island from the ships on barges, along with the steerage passengers, and it has been the practice to place all patients, irrespective of the nature of the disease, in a single room on these vessels. This abuse, which accounts for at least some of the multiple infections treated in hospital, has been brought to the attention of the commissioner of immigration, who has made vigorous representations to the steamship companies and a betterment of these conditions is in sight. During the year passengers arrived at New York from foreign ports as follows: Twenty-two thousand seven hundred and thirty-three aliens were certified for physical or mental defects. The certificates are classified as follows: Class A (I), including 8 idiots, 48 imbeciles, 464 feeble-minded, 8 epileptics, Class A (II) (dangerous contagious and loathsome contagious diseases). Class C (diseases or defects of less degree)... Class A (I): Disposition of immigrants certified. Cases pending at beginning of year.. 699 1, 176 15, 287 5, 571 20 699 719 624 57 38 31 1, 176 1, 207 1, 098 62 47 In the two immigrant hospitals there were treated during the year, 10,381. Immigrant hospital (general): Remaining at beginning of year. Admitted during year, including 29 born in hospital. Total to be accounted for.. Discharged.... 162 8, 849 9, 011 8,736 97 178 54 1, 316 1, 370 1, 062 180 128 Fifty-nine aliens, requiring immediate attention, were removed upon arrival and cared for by the steamship companies in various hospitals. Upon the request of the commissioner of immigration medical officers visited 149 aliens who had become public charges or inmates of various institutions in New York and the vicinity and examined them to determine the nature of the disease or defect and to ascertain whether due to causes existing prior to landing. Summary of hospital transactions at Ellis Island. Patients admitted to hospital during year... Number of patients in hospital at beginning of year. 216 10, 165 Total treated (men 5,420, women 2,431, male children 1,306, female Births (male 15, female 14). 10, 381 29 Deaths (men 28, women 16, male children 115, female children 118). 277 Pay patients treated during the year. Free patients treated during the year. 9, 921 460 Days treatment for pay patients. 79, 797 Immigrant hospital: From previous year. Days treatment for free patients.. Total days treatment for hospital cases. Maximum number of patients in hospital at any one time during year. Daily average number of patients in hospital.. Patients in hospital at end of year. 3, 919 83, 716 397 229 306 216 Admitted during year. Total treated. Recovered.. 10, 165 10, 381 5, 302 The number of aliens arriving at the port of Philadelphia, for the fiscal year ending June 30, 1913, was the largest in the history of that port. The total number arriving was 64,666 and of this number, 2,359 were certified on account of disease or defect, physical or mental. The new immigration detention house at Gloucester City, N. J., was opened for the reception of detained aliens on the 19th of August, 1912, and from then on, the medical officers of the Public Health Service have had charge of the sick and injured among the detained aliens, in addition to the medical inspection of arriving aliens. 20139°-14- -11 Diseases and injuries treated at immigration detention house Gloucester, N. J. 1 Hernia navel.. Influenza.. Inflammation glands of neck.. Acute inflammation left ovary. Child birth. Convulsions.. 1 Measles.. Congestion of liver.. Constipation... Carbuncle on neck.. Crushed finger.. 1 1 1 Congestion of breasts.. Scarlet fever.. Peritonitis, tubercular. Suppuration middle ear. 3 1 3 1 53 4 1 1 321116 QUEBEC, PROVINCE OF QUEBEC, CANADA. At the port of Quebec, during the fiscal year (from July 1, 1912, to November 20, 1912, and April 27, 1913, to June 30, 1913) 252 ships, an increase of 21 ships as compared with the preceding year, landed 22,196 passengers, destined to the United States, an increase of 5,229 passengers; also, 7,835 passengers in transit through the United States to Canada via the Grand Trunk Railway system. The 22,196 passengers arriving subject to inspection by the medical officer of the service, were divided as to citizenship and classification on shipboard as follows: There were 90 records of minor defects, regarded as of little practical importance as to self-maintenance, and 215 certificates issued for physical or mental defects, which were likely to affect the alien's ability to earn a living. The port of Quebec was closed as usual the latter part of November and the medical officer was detailed to St. John, New Brunswick, where the inspection of immigrants for the winter season is conducted. SAN FRANCISCO, CAL. During the fiscal year ending June 30, 1913, the total number of immigrants inspected by the medical officers of the Angel Island (San Francisco) Immigration Station was 13,893, an increase of slightly more than 3,000 over the number inspected during the preceding year, and of this number 1,888, or more than 300 more than during the preceding year, were certified as presenting one of the various conditions of which notice must be taken under the immigration law. Of the 1,888 cases certified for all causes 1,740, or about 400 in excess of last year, were certified as being afflicted with uncinariasis. As the method of examination to detect the presence of hookworm is substantially the same as that used last year, the increased number of cases certified is probably due to the greater number of cases examined. The opinion of the medical officer in charge, expressed in the annual report of 1912, that it is quite impossible in oriental races to detect on primary examination that is, on board ship, by attempting to observe symptoms of anemia, emaciation, lassitude, etc.-anywhere near the number actually infected with hookworm has been greatly strengthened by a year's further observation and emphasizes, when dealing with orientals coming from a known infected region, the futility of any attempt at diagnosis except with the aid of the microscope. During the year data have been kept on oriental applicants for admission showing the age, height, weight, and whether or not the alien presented any visible anemia or lassitude, together with the_result, positive or negative, of the microscopical examination. The results are extremely interesting in that they not only show the absence of "apparent" symptoms in a very considerable percentage of infected persons but that very often the microscope demonstrates an infection in people with unusually good physique and healthy appearance. This absence of apparent" symptoms of course obtains to a certain extent among white races, but seemingly it is more usual among orientals, illustrating possibly a greater degree of immunity or perhaps a greater percentage of "hookworm carriers." Commencing with January 1 a new system was put in operation by the Immigration Service, namely that of demanding from each arriving alien a medical certificate stating that he was free from infection with hookworm and of refusing to grant hospital treatment to those not supplied with such certificate. The chief medical officer did not feel that such certificates should be accepted as final negative evidence, and the microscopical examinations were continued at this station with the result that while the percentage of infection has markedly decreased our examinations still show such a percentage of positive results as to render their continuance imperative. Nearly twice as many cases of trachoma were certified this year as last, but only a very few should be considered extremely severe. fact the number of fines imposed upon the steamship companies for bringing dangerous contagious disease of this type have been very small, it being felt by the medical officer in charge that, speaking broadly, the ships' surgeons were making an earnest effort to eliminate cases of this character and that a legitimate difference of opinion might exist as to diagnosis in mild border-line cases. In |