The contagious diseases reported from January 1, 1913, to May 31, 1913, are as follows: Rats. The Yokohama city health department bought during the year ended December 31, 1912, 258,592 rats, which were examined and destroyed. For these rats the sum of 9,451.26 yen was expended. A sum of 2,136.10 yen was also expended for the purpose of encouraging the breeding of cats. No rat infected with plague was found. Vaccination. During the year 1912 there were 17,363 vaccinations made by Government officers, of which 9,224 were successful, 7,916 unsuccessful, and 223 with results unknown; 465 vaccinations were made by private practitioners, of which the results were 445 successful and 20 unsuccessful. Typhoid fever. There were 257 cases of typhoid fever during the year ended December 31, 1912, with a death rate of 19.06, somewhat less than the death rate of the year 1911, which was 19.60. Typhoid fever seems to be constantly present in Yokohama, and specially prevalent during the months of August, September, and October, when the number of cases for these three months was 156 cases, or more than one-half of all the cases for the year. Paratyphoid fever. Sixteen cases have been reported during the year 1912, with 3 deaths. Death rate, 18.75. Dysentery. Seventy-five cases were reported during the year 1912, showing 15 cases more than the year 1911. Death rate, 18.76, against death rate of 16.66 for the year 1911. Diphtheria.-One hundred and twenty-nine cases of diphtheria were reported during the year 1912, 24 cases less than in the year 1911, with death rate of 22.48 against death rate of 30.71 for 1911. Scarlet fever.-Twenty cases were reported during the year 1912, which shows a decrease of 57 cases reported in year 1911; death rate, 22.72. Smallpox. There was no case of smallpox reported in Yokohama during the year 1912. Vaccination was regularly enforced by order of the city health office throughout the year, and particularly from April 4 to April 10 and November 1 to 30, 1912. Plague. No case of plague has been reported in Yokohama for the year 1912. The last infected rat reported in Yokohama was in the year 1909. Trachoma.-The number of school children inspected for trachoma during 1912 was males, 26,455, and females, 25,526. Among those examined 1,609 males and 1,482 females were found to be suffering from trachoma, and 19 cases were very severe. All vessels bound for the United States and possessions were inspected as near to the hour of sailing as practical. The vessels that were empty were fumigated by sulphur burned in the presence of water in all the holds, storerooms, and forecastles, according to the regulations. Many rats and bugs were destroyed. The procedure of the inspection of steerage passengers has been changed by an order from the bureau dated February 17, 1913, that the bathing and disinfection of the baggage of steerage passengers bound for the United States would not be required, so that from the reception of this order the steerage passengers bound for the United States have not been bathed and their baggage has not been fumigated. The steerage passengers bound for Manila on vessels going direct, i. e., not calling at Hongkong, have been bathed and their effects disinfected, according to instructions from chief quarantine officer of the Philippine Islands Surg. Heiser. Boat notes for all cargo to be shipped to the United States as well as the invoices and cargo manifests have been viséed. Cholera in Japan.-Cholera was reported to be raging violently in the Miyako Islands in July, 1912, and a dispatch from Naha, Loochoo Islands, reported that on the Miyako Islands, lying between Loochoo and Formosa, there were 81 cases on July 10, and later that nearly half the inhabitants were affected. Three cases of cholera were reported at Kyoto, Japan, on August 10 (not official), and a case of cholera was found on board a vessel of the Russian volunteer fleet, the steamship Pensa, on August 10, and a second case on the same steamer on August 13. A case of genuine Asiatic cholera was reported from Moji, officially, by the governor of the Fukuoka-ken, Japan. The Nippon Yusen Kaisha's steamship Yokohama Maru sailed from Shanghai on August 18, and on arrival at Moji on August 25 a Japanese cabin passenger was found to be sick of Asiatic cholera. The governor of Nagasaki reported that on August 1 the steamship Otaru Maru arrived at Nagasaki, and one of the ship's cooks was found to be suffering from cholera. A second case of cholera, a European cabin passenger, occurred on the Yokohama Maru on August 21. Cholera cases were found on the Japanese steamship Mexico Maru at Moji, the steamship Seiun Maru at Nagasaki, the steamships Nitssho Maru and Kobe Maru at Dairen (Dalny), all these vessels having sailed from Shanghai about the last of August. Early in September quarantine was declared against Shanghai as the seat or origin of the cholera, and a strict inspection of vessels from Shanghai was made. The number of vessels coming to Yokohama from Shanghai is about 20 a month. Extra precautions were taken against the introduction of cholera into Yokohama, and quarantine was declared against Moji. The funeral rites of His Imperial Majesty Mutsuhito, the late Emperor of Japan, were celebrated on September 13. As the obsequies attracted to Tokyo large numbers from all over Japan, Chosen, and China, they served as a means of spreading the cholera from the foci already established in Fukuoka and Yamaguchi kens. Cholera appeared in Yokohama on September 20 and in Tokyo on September 27. On account of the rapidity of the spread of cholera from the south of Japan to Kobe, Osaka, and Tokyo during the last part of September, intending second cabin and steerage passengers or the United States were kept under observation in Yokohama for a period of 10 days. The length of time of observation of intending passengers, second cabin and steerage, from infected localities was changed from ten to five days on October 5th. This observation of passengers from infected localities by daily inspection was continued until the epidemic of cholera was officially declared at an end. The following account of the epidemic of cholera was written by Senior Surg. Fairfax Irwin, Yokohama, September 30, 1912: THE EPIDEMIC OF CHOLERA IN JAPAN. Some observations on this subject at this time may not be without interest. The outbreak of the disease in the capital by its very suddenness and territory covered has served to demand instant attention of the sanitary authorities, before rather inclined to look on the outbreak in other parts of the Empire as the usual cholera epidemic of small foci of the disease confined to a few ports, appearing in August and disappearing with the advent of cold weather. That the spread of the disease and the number of cases is more serious is attested by its sudden appearance in Tokyo, there having been 19 cases since the 24th instant, and these cases located in widely separated districts of the city, some of these being in Chiba across the bay. Many of these cases appeared simultaneously, and it does not seem to be known when the first case actually occurred. It is thought possible that carriers may have brought the disease to the city at the time of the Emperor's funeral, where about all the conditions for the spread of an epidemic were present. It is reported that the Government medical experts believe that the disease was imported very recently. Judging from the fact that many of the places where cases have occurred have no direct communication with each other, it may be said that food or drink was probably the means of the spread of the epidemic in Tokyo. If this was the case the articles in all probability were brought in from outside of the city, possibly fish or vegetables. It hardly seems possible that the water supply was infected in the first place; but it must be remembered that many wells are still used in Tokyo-fu. According to investigations, most cases of cholera in the city and suburbs were caused by eating raw fish in sushi, a kind of rice ball treated with vinegar; further it was found that the fish came from western ports which are said to be cholera infected. My opinion is that the epidemic was in all probability started by carriers of the bacillus coming from Shanghai. The quarantine inspection of Japan is strict enough ordinarily, but many vessels arrived at Nagasaki and Moji from Shanghai with cholera aboard, and although the usual detention of five days was enforced on all such vessels and thorough disinfection carried out, the carriers may have been many, and in that case account for the rapid spread from many different foci. A late dispatch from Shanghai states, that while there are no new cases among foreigners, 220 Chinese died from cholera during the week. The epidemic in Japan can thus be fed indefinitely from its source. Again, under date of October 6, Senior Surg. Fairfax Irwin wrote: In Yokohama 14 cases have occurred, but so far only 4 have been certified. The officials at Yokohama are greatly puzzled, it is stated, as to the manner in which cholera was introduced into the port. The harbor sanitary authorities are positive that no suspicious cases passed through their hands, and the police of the municipality are equally certain that no violations of sanitary regulations have occurred on land. The usual precautions are being taken at this port. A special circular has been issued to the steamship companies and passenger agencies, embodying the requirements of the American public health regulations briefly. All steerage and second-class passengers from infected districts are being held five days under observation, their persons bathed and baggage steamed. Steerage passengers on vessels in transit are prohibited from coming ashore. Raw foodstuffs are not permitted to be carried on ships. Medical officers of ships are requested to report the sanitary history of their vessels. Finally, a most careful supervision is kept of articles shipped by freight; human hair, hides, feathers, and old clothing must be disinfected, and all foodstuffs, must be provided with certificates of origin. This epidemic of cholera has been characterized by two distinct periods, one following the obsequies of the late Emperor in September, and a distinct recrudescence after the review of the Imperial Japanese Navy in Tokyo Bay in November. It continued during the winter, defying the cold weather, and not disappearing finally until about the middle of March, 1913. Measles in Yokohama.-Measles have prevailed in Yokohama, and have been unusually severe. No statistics are furnished by the authorities, as it is not a reportable disease here. Relapsing fever.-Thirteen cases in Tokyo in April, 1913, and a few cases in Yokohama were reported. Plague in Formosa. Sixteen cases of plague with 13 deaths were reported in the district of Kagi, Formosa, in April, 1913. Poliomyelitis.-This disease is not reported to the authorities and there are no statistics. Tuberculosis is very prevalent in Japan. Leprosy is always present. Precautions have been taken against the spread of this disease, and hospitals have been established for lepers. The population of Yokohama according to the census of December 31, 1912, is 455,241. Registered births during the year 1912-males 4,713, females 4,529, making a total of 9,242. The deaths were 6,135. Death rate 13.47, as compared with 15.22 for last year. Trachoma.-Among 433,674 conscripts examined 104,067 were found to be suffering from trachoma. Rate 239.96 in 1,000. Venereal diseases. Among the conscripts examined 1,840 were found suffering from syphilis, 2,232 from soft chancre, and 6,834 from gonorrhea. Rate 25.33 in 1,000. Typhoid fever at Yokosuka.-Yokosuka, one of the largest naval stations in the Empire of Japan, about 20 miles from Yokohama by rail and 5 miles from Yokohama across the bay, suffered from an epidemic of typhoid fever in July and August, 1912. About 400 cases were reported. Another epidemic occurred at Yokosuka in January, 1913, especially among the officers and men of the fleet of the imperial navy. Meningitis. There was an epidemic of meningitis, probably cerebrospinal fever in Okayama-ken during September, 1912. About 350 cases were reported. Hookworm. Strict examination is made by the Japanese authorities for hookworm in intending passengers for the United States, and certificates are given by the official Japanese inspector to Japanese emigrants for the United States that they are free from hookworm and trachoma. The personnel of the office changed on February 6, 1913, when Senior Surg. Fairfax Irwin left Yokohama to take charge of the marine hospital, Chelsea, Mass., and Acting Asst. Surg. Worden was left in charge. KOBE, JAPAN. Acting Asst. Surg. Garland P. Moore reports in part as follows on the transactions at this station during the fiscal year ending June 30, 1913: Steam vessels inspected and granted bills of health... Total bills of health granted. Passengers on the above vessels inspected. 278 1 279 41, 518 38, 961 Pieces of baggage disinfected. Number of persons bathed, disinfected, and their effects disinfected. Vessels fumigated..... Pieces of freight inspected and disinfected. Manifests viséed for 204,957 tons of cargo. 5, 621 4, 986 36 792 Consular bills of health were issued to 279 vessels, of which 34 were original and 245 were supplemental. The crews and passengers of all these ships were inspected at the time of their departure. Thirteen cases of infectious diseases were discovered on ships in this harbor, to wit: Typhoid fever, 2 cases; dysentery, 2 cases; cholera, 3 cases; measles, 1 case; leprosy, 5 cases. Thirty-six ships were disinfected with sulphur dioxide gas for the destruction of rats. Every precaution was taken to prevent the access of rats to ships, rat guards being used on lines to lighters when loading and discharging cargo, and all lighters used to convey cargo to ships were subjected to frequent deratization by sulphur fumigation. All cargo of a charaoter likely to attract rats or afford a nesting place for them, such as peanuts and grain, was required to be stowed in rat-proof godowns and packed in new bags before shipment. Inspection and supervision of cargo godowns were made with a view of eliminating rats. Shipping orders, or boat notes, for cargo destined to the United States were required to be submitted for approval and signature before loading, and no cargo was allowed alongside of ships in lighters that did not bear a certificate of fumigation. All manifests were viséed after loading. In this way a complete check is kept of every item of cargo leaving Kobe for United States ports. A case of cholera occurred on the 18th of August on the steamship Yokohama Maru, en route from Hongkong to Seattle via Japan ports. The case was discovered in a first-cabin passenger, who was removed at Moji. The ship then proceeded to Kobe, a few hours distant, where she was placed in quarantine for five full days, fumigated with sulphur dioxide gas, the passengers and crew bathed, and their effects disinfected with steam. All stores were removed, and the storerooms were washed with mercuric chloride solution. The compartments for passengers and crew and the decks were washed down and sprayed with solution of carbolic acid. The water tanks were emptied and disinfected. No further cases occurred on board. The steamship Mexico Maru, en route from Hongkong to Tacoma, also arrived at Moji a week later, with two cases of cholera and three suspects on board. The ship was brought to Kobe, detained in quarantine, and the necessary precaution taken under the supervision of the United States Public Health Service. Disinfection of feathers, rags, old rubber, skins, hides, human hair, and personal effects with a doubtful sanitary history was done. Sanitary conditions, city of Kobe.—The population of Kobe, according to the census taken at June 30, 1913, was 451,010. The registered births were: Male, 5,058, and female, 4,843, making a total of 9,901. The birth rate for 1912, based on the new census figures, was 22.95 per 1,000, while the death rate showed only 2.03 per 1,000. The sanitary condition of the city during the past fiscal year remained about the same as the preceding year. Cholera made its |