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Aliens inspected and certified at all ports and places in the United States and its dependencies and in Canada.

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Surg. J. A. Nydegger reports as follows: Owing to the continuation of the European war the medical examination of alien passengers has continued at a minimum throughout the year, the total number of immigrants arriving being 218, distributed on 1,479 vessels. In addition to the 218 alien passengers and 97 stowaways examined there were 7,694 alien seamen. Since May 1, the date on which the new immigration law became effective, the work at this station has greatly increased, notwithstanding the assistance of two additional medical officers for the purpose of conducting the medical examination of alien seamen on board their respective ships. The number of foreign vessels which arrived at this port during the year ended March 31, 1917, was 1,549, with officers and crews totaling 43,372. Based on these figures, it is estimated that the number of alien seamen to be examined throughout the year will approximate 45,000, making no allowance for a possible increase in the shipping. Considerable difficulty was experienced during the early days of the medical inspection of alien seamen on account of the great extent of the port and the lack of suitable transportation facilities to the various docks widely separated on the water front. Through the assistance extended by the collector of customs service officers detailed for the medical examination of alien seamen were extended the facility of boarding from the customs cutter, and this arrangement has greatly expedited the work of the medical examination of alien seamen on board vessels. Construction of the immigration hospital at Fort McHenry is now almost complete and the building will shortly be ready for the installation of furniture and equipment. During the year hospital treatment was recommended in the case of 10 foreign seamen. No other aliens were admitted to the hospital during the year, and no other deaths occurred. Of the 7,694 alien seamen examined, 307 were certified, 105 of whom were suffering from mandatorily excludable diseases, 66 from conditions affecting ability to earn a living, and 136 from minor defects. Of the 218 alien passengers examined, 7 were certified for mandatorily excludable diseases and 7 for other causes. Of the 97 stowaways examined,

8 were certified for mandatorily excludable diseases and 3 for other defects.

BELLINGHAM, WASH.

Acting Asst. Surg. L. R. Markley reports as follows:

The medical inspection of aliens at this port has very materially diminished. The duties of the medical officer are chiefly the inspection of "warrant" cases for the immigration service, and the examination of aliens applying for naturalization papers.

BOSTON, MASS.

Asst. Surg. M. Victor Safford reports as follows:

During the year there arrived at Boston from foreign ports 1,053 vessels of which 177 had alien passengers: Although the new immigration act requiring a medical examination of all arriving alien seamen did not go into effect until May 1, lack of advance information regarding arriving ships, owing to war conditions, necessitated provision for the boarding of practically all arriving vessels by a medical officer of the service during the entire year.

Immigration at Boston was derived the past year from countries bordering on the Mediterranean and from Portugal and the Portuguese possessions. To a great extent it was made up of persons who were in a poor physical condition, and so far as males were concerned nearly all had been exempted from military service by reason of age or physical disabilities.

One apparent result of the new immigration law with its severe penalties for the bringing of inadmissible aliens and its literacy test, which went into effect May 5, has been a reduction of the proportion of cases calling for medical certificates since that date and a disappearance to a noticeable extent of the type that it had previously been found necessary to hold in embarassing numbers for mental examinations.

The medical inspection of arriving cabin passengers has formerly been made on shipboard at this port, but during the past year they have as a rule been removed from shipboard ashore for the purpose of all the examinations contemplated in the immigration laws. This change in the method of handling cabin passengers has for a long time appeared to be desirable in the interest of greater efficiency in the immigration examination processes and especially in the medical examination. There were various practical difficulties to be considered in making this change, including its effect on the duties of the customs officials and apprehended objections on the part of the passengers themselves, but these difficulties have apparently been overcome and the new plan now seems to be working to the satisfaction of everybody concerned.

The character of the passenger travel at Boston with respect to classification on shipboard and necessity for medical certification is indicated in the following tables Nos. 1 and 2:

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It is to be observed from the foregoing tables that while the number of alien passenger arrivals was slightly less than the preceding year there was an actual increase in the number of certificate cases, and this increase was in certificates of a more serious character. Compared with the previous year there was an increase in the number of second-class passengers. The proportion of this class of alien passengers certified remained, the same as for the previous year, at 25 per cent. The number of steerage passengers certified was 1 in 10, as compared with 1 in 11 for the previous year.

One thousand one hundred and twelve aliens, amounting to 8 per cent of the total alien arrivals, whose appearance aroused suspicions on arrival and whose medical examination could not be satisfactorily completed on the day of arrival, were brought to the immigration station or sent directly to the hospital for more careful investigation. Of this number it is to be noted that 560, or over one-half, eventually received medical certificates. The laboratory facilities at the immigration station were used chiefly for preliminary or confirmatory examinations. The eight local contract hospitals were utilized to a great extent for diagnostic work as well as for treatment.

During the latter part of the calendar year a number of children both from Italy and the Azores were certified for the effects of recent attacks of poliomyelitis. The histories of these cases pointed to the prevalence of this disease in both these regions during the season of 1916 and were suggestive of possible conveyance of infection by the summer passenger travel from this country.

Local epidemic outbreaks of malaria in New England, indicating the possibility of infection from recent immigrants, led the medical officers at Boston to undertake a closer examination for evidence of malarial infection among aliens coming from districts where the disease was known to be prevalent. A special study of this matter was made by Acting Asst. Surg. Riemer, but owing to the necessity of

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