their state or of disinfection are checked up here so as to meet requirements for admission at port of entry. Hides, skins, human and animal hair, bristles, old personal effects, household goods and embroideries, and cases which use straw in packing, are carefully watched and cleared up.

At present the requirements set forth in circular No. 491 are closely adhered to in the treatment of hides.

Vessels bound for the United States, whether they lie in stream or at wharf, are required to use measures against rat invasion, such as loading only from registered lighters and using rat guards. If at wharf they are required to fend off 6 feet, use rat guards on lines to wharf and lighters, to have a foreign watchman, under supervision of this office, on duty continuously; to raise gangways at night; to work cargo in day as near as possible; to limit communication between boat and shore as much as practicable.

Any vessels which become empty here are advised to fumigate. This is generally done, but a few prefer to be disinfected at port of entry.

Vessels are inspected as nearly as possible to the time of sailing.

The general health of the settlement is good, the number of communicable diseases being about the average. There have been reported 22 cases of smallpox among foreigners, and a few have died. There were 57 cases of death reported among the natives.

No cases of human or rat plague found.

Two deaths of cholera among natives reported in August. There were 14 cases of tuberculosis among foreigners reported and nearly 1,200 deaths among the natives.

Over a hundred cases of dysentery among foreigners and 89 deaths among natives.

Other diseases appear occasionally, as reported last year.

Rinderpest and foot-and-mouth disease are present most of the time to variable extent.

Anthrax was reported in a few cases among horses and cattle in this settlement.

Asst. Surg. M. S. Lombard reports as follows: From April 1, 1917 (the beginning of the close quarantine season), to June 30, 1917, the transactions of this office were as follows:

Vessels inspected but not fumigated (on account of being docked at localities not infested with aedes calopus) __.

88

Passengers examined and passed and the quarantine officer at port of destination notified by letter_.

42

Every effort has been made to secure information as to the prevalence of quarantinable disease, especially yellow fever. Thus far the disease has not been reported in Tampico, nor has there been any evidence presented to indicate its existence.

The chief activities of the service representative have been confined to the inspection of personnel and the treatment of vessels prior to sailing so as to render them free of mosquitoes, in accordance with bureau circular letter of March 16, 1917. The authority of the referred to circular has also been exercised in exempting from fumigation vessels which have lain at wharves above or below the city of Tampico at the various oil terminals, and which have not been exposed to mosquito infestation. The expense of the fumigation of vessels has been borne by the shiping interests, and for the purpose of carrying out this procedure the services were secured of three ex-employees of the United States Public Health Service who formerly had served at New Orleans on the plague eradicative force at that place. These specially qualified men were under the supervision of the service representative and complied with his instructions as to all measures carried out in the fumigation of vessels. Vessels sailing for the United States that had been exposed to mosquito infestation were fumigated prior to departure either by sulphur dioxide or by hydrocyanic acid gas. The shipping interests of Tampico, realizing the many advantages of the use of cyanide gas, have made an effort to secure sufficient sodium cyanide to fumigate all vessels outbound.

The population of Tampico is estimated at 50,000. The city is located on the Panuco River, about 63 miles from the Gulf. It is provided with electricity and an underground sewage system, and receives its water supply from the Tamesi River, the pumping station being about 24 kilometers north of the city. The Ultra-Pura Water Co. furnishes drinking water, treated with ultra-violet rays, at the rate of 50 cents for 5 gallons.

The vitality statistics are not entirely dependable, but such as they are would indicate during the past three months an annual death rate of about 30 per 1,000, one-quarter of the mortality being due to malaria infection. Gastro-intestinal diseases and tuberculosis also account for a considerable number of deaths.

TUXPAM, MEXICO.

Acting Asst. Surg. A. J. Hoskins reports as follows:

All vessels referred to are tank steamers used in conveying crude oil, and fumigation is confined to superstructure only. The sanitary condition of the port of Tuxpam is fair, but is not improving. All vessels are loaded at sea from one-half to 1 mile from shore.

VERA CRUZ, MEXICO.

Acting Asst. Surg. L. B. Cooke reports as follows:

Owing to the entry of the United States into the European war and the consequent restrictions placed on immigration, the number of

passengers from Vera Cruz to United States ports during the period April 14 to June 30 was only 65. Notwithstanding this small number for the United States there sailed on vessels bound for American ports 3,122 passengers for Progreso, Habana, and Barcelona, the large majority being for Progreso and being almost wholly composed of laborers and their families gathered up throughout the interior of Mexico, many of them from the much congested and typhus or smallpox-ridden cities of the Mexican plateau. They are sent under contract to labor in the Government-controlled sisal fields of Yucatan, and are entirely of the lowest classes, many of them being old and infirm and having the cutaneous evidences of syphilis and other diseases, as well as having pretty generally disseminated among them the various types of pediculi.

These people are transported from Vera Cruz with but little care, from 300 to 600 being herded on the deck of small schooners or steamers, practically no attention being given to sanitary considerations. Under these circumstances it has been found physically impossible to satisfactorily inspect each individual. The service representative has, therefore, attempted to compensate by requiring the strictest segregation of passengers bound for the United States, together with their baggage, and arranging with the steamship agents concerned to have all passengers for the United States, sailing on such immigrant vessel, freshly vaccinated previous to embarkation.

All efforts directed toward interesting the local health authorities in instituting measures for eradicating lice among these steerage passengers have entirely failed, thorough disinfection of the vessel at Progreso after discharge of the passengers seeming to be the chief measure to be relied upon in preventing the spread of disease from this source.

So far no case of either typhus or smallpox has been reported aboard these immigrant vessels, and it would seem that the measures instituted have been entirely efficient.

Summary of transactions.

Steamships inspected and issued bills of health.
Sailing vessels inspected and issued bills of health_
Steamships fumigated for destruction of mosquitoes_.
Sailing vessels fumigated for destruction of mosquitoes_
Passengers examined bound for the United States_
Total number of passengers examined_.

Total number of crew examined___.

MEDICAL INSPECTION OF IMMIGRANTS.

20

1

3

1

65

3, 187

1, 325

During the fiscal year ended June 30 there were examined by medical officers of the United States Public Health Service 528,648 immigrants for the purpose of detecting disease and physical or mental defects, in accordance with the provisions of the United States immigration laws. This number of aliens examined, as compared with 481,270 for the previous year, shows an increase of 47,378. The number of immigrants certified for disease or physical or mental disabilities was 20,261, in contrast with 16,327 so certified during the preceding year.

In addition to the immigrants examined there were also examined, as provided in the act of February 5, 1917, 41,693 alien seamen.

The number of officers assigned to the medical inspection of immigrants has varied during the year, but on an average some 82 officers were exclusively engaged in this duty. In addition to this a number of service officers stationed at marine hospitals and quarantine stations also perform medical examinations. The various officers stationed at consulates in foreign ports likewise made physical examinations of intending immigrants, in order that the latter might be aware of any conditions which would operate to their exclusion, and also in order that the shipping agents might be advised of any defect that would tend to prevent the admission of aliens into the United States. This function as carried out at foreign ports tends to prevent loss of time and money to the alien, and it is likewise of some assistance to the steamship companies in avoiding penalties provided in the United States immigration law against common carriers for bringing in certain defective aliens.

The reduction of immigration during the past three years has afforded greater opportunity to medical officers for performing more intensive examinations of arriving aliens, especially as to their mental condition. As an index of the increasing efficiency of the medical examination of arriving aliens, there are given in the following table the percentages of defectives, both mental and physical, recorded at all the immigration stations by officers of the Public Health Service in the period 1912 to 1917.

The statistics indicates a steady and progressive increase in the number of alien defectives discovered each succeeding year.

The new immigration law of February 5, 1917, became operative on May 1, and chiefly affected the service by the inclusion of a requirement for the medical examination of all alien seamen. The provision for the medical examination of aliens by not less than two medical officers likewise may necessitate an increase in the number of medical officers performing immigration examinations. The full effect of the alien crew inspection probably will not be felt until after the European war shall have terminated and immigration increases, but at the ports of New York, Baltimore, and San Francisco the demands of the crew examination have necessitated additional officers. At New York, for instance, during June there were inspected 6,799 immigrants and 16,028 alien seamen. This inspection of seamen has to be carried out on board ship and under conditions far from conducive to the satisfactory performance of the duty. Formerly a small force of officers was sufficient for performing the medical inspection of aliens on board vessels; that is, first and second class passengers and such alien seamen as had indicated their desire to

land. Cargo ships that carried no passengers were boarded by medical officers who had ample time to attend to any matters concerning the medical inspection of aliens and return to the boarding. cutter while it was still alongside. In this way, medical officers were not required to stay on board the usual tramp or freight steamer, but could successively board a number of this class of vessels. Under the new law all this is changed. The medical officer has to stay aboard these vessels to conduct the medical inspection of all alien crew, regardless of whether they may or may not contemplate landing in this country. When it is considered that some of the transAtlantic liners before the war carried crews numbering several hundred, approximating almost 1,000 in some cases, it is evident that at the larger seaports the medical inspection of aliens after the resumption of uninterrupted commerce will necessitate a medical force very much larger than that heretofore employed. The inability of assembling the crews at one point for conjoint inspection, such as is done in the inspection of steerage passengers, greatly adds to the difficulty of the work.

A board of officers was convened at New York by the Surgeon General for the purpose of revising the regulations governing the medical inspection of aliens and making them conform to the act of February 5, 1917. The work of the board was exceedingly thorough and painstaking, and as a result there was prepared a set of regulations which it is believed effectively cover all the essential points involved in the medical inspection of aliens and the conduct of the examination.

Surg. Mullan during the year made valuable contribution to the general knowledge of mental diseases through the preparation of studies on the normal mentality of the various races as evidenced by the classes arriving at the New York immigration station.

A manual for the guidance of service officers in determining mental diseases was likewise prepared from collaborated studies by various officers at Ellis Island.