of inspection, as there was nothing in the man's personal appearance to suggest disease other than a slightly flushed face, which was easily accounted for by his occupation. Thermometer indicated a rise in temperature, and a 12-hour observation demonstrated a typical case of yellow fever. During the fiscal year just ended numerous improvements have been made on the station. One new set of officers' quarters has been built and a very efficient launch purchased. San Diego (Cal.) quarantine.-Acting Asst. Surg. W. W. McKay in charge. Three hundred and seventy-eight vessels were inspected and passed. Four vessels were fumigated. These vessels carried crews aggregating 6,662 and 3,180 passengers. Port Harford, Cal.-Acting Asst. Surg. C. J. McGovern reports as follows: Fifty-nine steamers, carrying 2,197 crew, were inspected ducing the fiscal year. No quarantinable diseases were observed. San Francisco (Cal.) quarantine.-Passed Asst. Surg. M. W. Glover in charge. During the fiscal year 576 vessels were handled at quarantine, and 74,584 persons inspected, of which 40,585 were crew men and 33,999 passengers. Summarized, the transactions were as follows: Steam vessels inspected and passed.. 439 110 20 5 2 2 1 184 31 124 261 Vessels held for violation of consular surgeon's requirements.-The British steamship Bessie Dollar, tonnage 3,679, arrived on November 18, 1912, with a general cargo from Shanghai. Owing to the failure of the master to comply with the requirements of the service representative at Shanghai, the vessel was placed in quarantine and fumigated with sulphur dioxide for 24 hours, the crew taken ashore, bathed, vaccinated, and effects disinfected. Vessels with quarantinable disease aboard.-The Pacific Mail steamship Nile, plying between the Orient and San Francisco, arrived on November 11, 1912, with a case of smallpox in the person of a Chinese child 4 years old. The vessel was placed in quarantine at the station. The passengers and crew were removed to the station, bathed, vaccinated, and all of their effects disinfected with formaldehyde. The entire vessel, with the exception of the captain's quarters (which were treated with formaldehyde) was fumigated with sulphur dioxide, 24 hours' exposure. The passengers were released on November 12, the crew on November 14, and the patient on November 30, recovered. The Pacific Mail steamship Manchuria arrived at this port on June 16, 1913, from the Orient. During the usual quarantine inspection it was discovered that one of the steerage passengers, a Spaniard, 22 years old, was afflicted with tubercular leprosy. The diagnosis was confirmed by microscopical examination. Prior to coming to San Francisco the patient had worked on a sugar plantation near Hilo, Hawaii, for nearly two years. The man was removed from the vessel and detained at the quarantine station for 10 days, at the expiration of which time he was returned to Honolulu by the same vessel which brought him to San Francisco. The steerage quarters in which the man had lived during the voyage from Honolulu were fumigated with sulphur dioxide. Smallpox being more or less prevalent in the region of San Francisco Bay the crews of vessels going to Alaska were inspected and vaccinated for the protection of that district. In addition to the quarantine work the boarding officers examined the crew and passengers on the smaller steamers and sailing vessels for diseases and conditions forbidden by the immigration law. Two fumigations of quarters on vessel for tuberculosis were done at the request of the vessels concerned. This was in response to a recommendation of the medical officer in charge of the San Francisco Marine Hospital. Eureka, Cal.-Acting Asst. Surg. Charles C. Falk reports that during the year 6 steamers and 5 sailing vessels were inspected and passed, and one steamer fumigated. Fort Bragg, Cal.-Acting Asst. Surg. G. P. Purlenky in charge. Two vessels were inspected and passed. Los Angeles (Cal.) quarantine station and subports.-Surg. S. D. Brooks in charge. This station includes three ports for quarantine inspection of vessels San Pedro, Redondo, and Santa Barbara (including Gaviota). No quarantinable disease was found during the year. Port Townsend (Wash.) quarantine and subports.-Passed Asst. Surg. Baylis H. Earle in charge. Two steamers were spoken and passed, 164 steamers were inspected and passed and 20 detained, and 60 sailing vessels were inspected and passed and 23 detained. The steamers carried a total of 15,000 members of crews and 13,406 passengers, and the sailing vessels a total of 1,173 members of crews and 44 passengers. Of the vessels detained, 19 steamers, 13 schooners, and 10 barks were fumigated for the destruction of rats and other vermin, and the U. S. S. Snohomish was fumigated for measles and held under observation for four days. Coos Bay (Wash.) subport, North Bend.-Acting Asst. Surg. I. B. Bartle reports 5 vessels inspected and passed. South Bend (Wash.) subport.-Acting Asst. Surg. Wilson Gruwell reports 10 sailing vessels inspected and passed. Port Angeles Wash.) subport.-Acting Asst. Surg. F. S. Lewis reports that 1 sailing vessel was inspected and passed. Tacoma, Wash.-Acting Asst. Surg. F. J. Schug reports that 10 vessels from the west coast of South America were fumigated during the year. Columbia River (Oreg.) quarantine and subports.-Post-office and telegraphic address, Astoria, Oreg. Passed Asst. Surg. H. G. Ebert in command. During the year 63 steamers and 92 sailing vessels were inspected and passed, 64 vessels were fumigated, 4,668 crew and 325 passengers were inspected. Ketchikan, Alaska.-Acting Asst. Surg. Henry C. Story reports as follows: 66 vessels were inspected and passed, together with 7,107 passengers and crew. TEXAS-MEXICAN BORDER INSPECTION. El Paso, Tex.-Acting Asst. J. W. Tappan reports that during the year 10,000 passengers arriving on trains were inspected, and in addition 8,365 aliens were examined at the immigration station. Brownsville, Tex.-Acting Asst. Surg. G. D. Fairbanks reports as follows: Train service across the international bridge was started March 22 and continued intermittently until May 9, when it stopped on account of the revolution. Thirty-six trains were inspected during that period, carrying 1,477 passengers, also freight trains are inspected several times a month to determine the character of merchandise being brought into the port and its sanitary condition. Four thousand one hundred and thirteen aliens were examined for the immigration authorities, and 7 physical examinations made for the United States Life-Saving Service. Four examinations of stools made for uncinaria with negative results and superficial inquiry as to the number of lepers in the vicinity disclosed six supposed cases on the United States side and probably more on the other side of the boundary. Eagle Pass, Tex.-Acting Asst. Surg. Lea Hume reports that during the year ended June 30, 1913, there were inspected on trains and at the immigration station 19,971 persons arriving from Mexico, of which number 13,777 were immigrants. Owing to the disturbed conditions in Mexico, no trains came to the American side of the Rio Grande after February 28, 1913. After March 9, 1913, trains were run between Monclova, Coahuila, Mexico, and Piedras Negras, Coahuila, Mexico, only, on the Mexican International Railroad. No quarantinable diseases arrived on the trains. During the months of December and January of the past fiscal year cerebrospinal meningitis was present in Eagle Pass and Piedras Negras, Mexico, in epidemic form, there being 15 cases in Eagle Pass and 11 deaths. Laredo, Tex.-Acting Asst. Surg. H. J. Hamilton reports that during the fiscal year 481 passenger trains entering from Mexico were inspected. These trains carried a total of 48,683 persons, as compared with 1912, when 735 passenger trains were inspected, carrying 44,344 passengers. No passenger trains have crossed the border at Laredo since March 12, 1913. 20139°-14- -6 INSULAR QUARANTINE. OPERATIONS OF THE SERVICE IN THE PHILIPPINE ISLANDS. The work of the United States Public Health Service in the Philippines divides itself readily into the conduct of: (1) National quarantine. (2) Consular quarantine. (3) Immigrant medical inspection. (4) Physical examination of masters, mates, and engineers in the Philippine coastwise trade. (5) The sanitary maintenance of vessels. There are seven ports of entry in the Philippine Islands, the quarantine work at each of which is conducted by an officer of the service. In addition, there is maintained a large quarantine station at Mariveles, at the entrance of Manila Bay and approximately 30 miles west of Manila, which is also in command of a service officer. In connection with the station at Cebu there is operated a modernly equipped quarantine station, which serves the needs of the southern islands. Vessels bound for the United States fall under the head of consular quarantine and receive the same inspection and application of sanitary measures as those which depart from foreign ports at which service officers are stationed. The conduct of the medical examination of arriving aliens is likewise vested in the service. Dur The physical examinations made of masters, mates, engineers, pilots, etc., imposes a large amount of work upon the officers. ing the year 283 examinations were made. The sanitation of ships refers to sanitation other than that necessitated by the presence of quarantinable diseases, and is the direct outcome of the agitation for this line of work which has been waged by the service for many years, with the result that recently there have been promulgated regulations based on the customs laws of the islands, which make it possible materially to improve the cleanliness of the ships and the comfort of the traveling public. The Mariveles quarantine station is one of the largest in the world, and the magnitude of its operations is comparable with those of the largest ports of Europe or America. PRINCIPAL EVENTS OF THE YEAR. The responsibility of preventing the introduction of both plague and cholera during the year has been very heavy, because plague prevailed in epidemic form in near-by foreign ports, and epidemics of cholera occurred both in China and Japan at ports which are within five days' steaming distance of the Philippines and, therefore, well within the incubation period of this disease. Experience had with plague, both in Manila and in preventing its introduction, clearly points to the fact that the present methods of quarantine will require further perfection before the introduction of plague can be prevented with more certainty. The inspection of thousands of tons of cargo showed that much of it consisted of goods packed in straw, of eggs, dried vegetables like garlic, onions, potatoes, etc. Much of this cargo is poorly crated and some of it is only covered with burlap, so that there is ample opportunity for rats to enter the cargo at the port of embarkation and to remain there undisturbed until it is delivered in the warehouses in the ports of the Philippines. Another important development has been that of ship sanitation, of which mention will be made under a separate head. Probably one of the most satisfactory events of the year was that, in spite of the serious epidemic of cholera prevailing both in China and Japan, no quarantine detention was imposed upon arrivals from those countries. Complete reliance was placed upon the medical inspection made at the time of arrival and the laboratory examinations of the stools. As soon as these were reported negative, detained persons were released, usually within 48 hours from the time of their arrival. This procedure greatly facilitated the work of the. service and reduced the hardships upon those who were required to travel, as well as greatly decreased the expense of the transportation companies, and at the same time was effective. CHOLERA. For the first time in many years not a single case of cholera was reported anywhere in the Philippine Islands, which fact made it all the more important for the service to prevent the introduction of this disease from foreign countries. The Philippines were seriously threatened by the outbreak of cholera, which was first reported in Shanghai and later spread to the Chinese ports to the south of Shanghai and to the Japanese ports to the north of it, especially those in the Shimonoseki Straits. Many coaling vessels arrived from ports along the Shimonoseki Straits, and as most of their crews are peculiarly liable to cholera, special attention was given the personnel of vessels from those ports. In several instances persons with a form of diarrhea which might be described as cholerine were encountered, but as no vibrios could be found in the stools, the diagnosis of cholera could not be made. Such persons, however, were detained aboard the vessels during their stay in port. In the conduct of the cholera quarantine no detention was imposed except that necessary to make the routine laboratory examination of the stools for the cholera vibrio. The stool examinations were continued throughout the entire fiscal year of all steerage passengers from infected ports. During the quarantine period from July to November, 1912, the work was done at the Mariveles quarantine station by a special detail of officers from the bureau of science. After the close of the quarantine the work was done at Manila. The last true cholera vibrio carrier was found June 30, 1912. Three persons showing vibrios were found between November, 1912, and June 30, 1913, but were, after extensive investigation, declared not to have the true vibrio of Koch. In addition to the examination made for the cholera vibrios, examinations were made for hookworm and other intestinal parasites with the following results: Specimens examined for cholera.. Cholera vibrios found in.. Hookworm found in.. Ascaris found in... Trichiuris found in. 6, 997 0 375 1, 777 931 |