attention to other daily routine duties it could not be made as comprehensive as was desired. It has been a regular practice at Boston to make examinations of the blood of all arriving aliens who appear anemic or in whose cases there otherwise appeared to be indications for a blood examination. Where there might be suspicions of malarial infection it had been the practice to make or have made microscopical examinations of fresh specimens or of stained thin smears of the blood. In addition to continuing this practice with greater care than previously, Dr. Riemer supplemented it by thick smear examinations, following the method of the late Surg. von Erzdorf, and by examining, so far as he could find opportunity to do so, the blood of persons from malarial districts who appeared healthy. Of the Greeks examined, including persons who were apparently in good health, Dr. Riemer found 20 per cent of malarial infection, and of the Italians, including also persons who were apparently in good health, 10 per cent showed malarial infection. Parasites of both the tertian and estivo-autumnal types of the disease were demonstrated, and some individuals who were carriers of the gamete forms of the latter type were apparently in robust health and, without treatment, gained in weight during their detention at the immigration station. The transfer to the Boston immigration station of a considerable number of excluded African natives of the Cape Verde Islands gave an opportunity to study some of the diseases prevalent in these tropical islands, although before embarking the passengers had been subjected to a medical examination with view to preventing rejections on arrival here. Hookworm infection, as might be expected, appears to be common among these natives but by no means as prevalent as is to be found in some other tropical regions. Infection with intestinal parasites of some form or other is, however, practically universal. Infection with such parasites, including the hookworms, does not appear to be necessarily incompatible with apparent good health. Routine blood and stool examinations made at the Carney Hospital during the year continue to indicate that while an eosinophelia does not necessarily mean hookworm infection, an absence of eosinophelia may be regarded as an absence of hookworm infection. With view to its practical value in immigration examination work observations on this matter have now been continued over several years, covering Europeans, Chinamen, Negroes, and others, and thus far in every case of hookworm infection found there has also been found an eosinophelia to a demonstrable degree, even though the hookworm infection may have been apparently slight.

In view of the part that the Cape Verde Islands have played in the Negro slave trade it may be of interest to note that the parasite found in natives of those islands is theAgchylostoma duodenale. From studies also made of an ulceration of the shins, with which practically all natives of those islands are afflicted at some time or other, it would appear that the disease is a form of leishmaniasis.

ALIEN SEAMEN.

During the last two months of the fiscal year the medical officers at this station have had to meet the problem of making the medical examinations of alien seamen on arriving vessels as required by the

new immigration act. So far as freight and So far as freight and passenger vessels are concerned, fairly satisfactory methods have been devised for carrying on this work, and its demands with respect to the time and services of medical officers can be estimated with a reasonable degree of certainty; but the problem arising from the practice of the large New England fishing fleet to bring to Boston aliens who to a great extent man this fleet and join the vessels at Canadian ports has not yet been touched. These vessels, both steam and sailing, are run on what virtually amounts to a partnership arrangement instead of signing crews on ships' articles, and the problem is further complicated by the fact that these vessels usually come into port during the night and are exempt from quarantine inspection and customs entry and clearance. The examination of alien seamen and fishermen arriving at the smaller subports in the Boston district also remains to be provided for.

The medical examination of alien seamen on freight vessels alone arriving at the port of Boston proper has been found to render the service of one of the three medical officers at the station practically unavailable for any other regular medical work from 7 a. m. until sunset, and not infrequently the absence from the station for several hours of two of the three medical officers. As a result it has been found necessary to give up practically everything in the way of laboratory work at the immigration station and otherwise curtail diagnostic work in the matter of both mental and physical examinations. Various propositions have been considered for lessening the demands of the medical examination of arriving seamen on the time of the medical officers. A brief experience has shown that the enforcement of the immigration laws require that the examination of seamen should at least be begun before or as soon as a vessel docks, and that it is impracticable for the purposes of administration of the law to defer this examination. Consequently the inspection of seamen on ship at this port entails the absence of a medical officer from the immigration station of from one to three hours. The extent of the water front, as well as the size and character of the ship examined, are factors in determining this matter.

It would seem advantageous to have the medical examination of seamen for the purposes of the immigration laws begun in conjunction with the quarantine inspection. But after realizing the length of time it is often necessary for a medical officer to spend on a freight ship if the objects of the immigration law are not to be virtually ignored and considering other work which both the quarantine and immigration officers of the service are now expected to perform at this port, and taking into account certain difficulties of a local character, the plan of having the immigration examination of alien seamen undertaken at quarantine, either by the quarantine officers or by having one of the medical officers at the immigration station sent to quarantine for this purpose, appeared to offer no advantage in saving the time or services of medical officers at this port over the practice which is now being followed of boarding ships at the immigration station.

The medical examination of alien seamen at Boston may be expected to call for the boarding of about 1,200 freight and passenger vessels a year. Conditions are even less satisfactory for making on

shipboard the required medical examination of the crew of a freight ship than for examining passengers on a passenger ship, and frequently it is obviously impossible to undertake the medical examination of seamen without removal to the immigration station or to hospital. In such cases the medical officer is likely to be confronted with the claim that the "seaman" in question does not intend to leave the ship, and that whereas the law specifically contemplates removal of passengers from shipboard for examination purposes at the expense of shipowners, it does not do so in the case of seamen. Without conceding anything to the claim that this particular law fails to provide the authority to make effective its specific requirement for a medical examination of alien seamen and yet offering a possible means of avoiding an unnecessary expense to shipowners and a waste of the time of the medical officers, the following procedure was adopted at this port in conducting the medical examination of alien seamen.

On boarding a ship the medical officer takes the following rubber stamps, each small enough to be included between the horizontal ruling on the official crew list and within the margin to the left of the space for names of the crew:

is

Each alien on the crew list is subjected to such an examination as appears to be called for after inspection and as seems practicable to undertake on shipboard. If the examination can be satisfactorily completed on shipboard, "passed" or "medical certificate" stamped in the left-hand margin of the crew list opposite the individual's name. Medical certificates are issued and delivered when and where requested by the immigration officer, but at the time of the examination a note is always made under remarks in the righthand margin of the crew list opposite the individual's name indicating the nature of the certificate. When a satisfactory medical examination can not be made on the ship, and when the duty of completing the examination for the possible imposition of penalties or for providing suitable hospital care is not involved, “medical exam. uncompleted" is stamped on the crew list opposite the individual's name. By such use of this stamp the medical officer practically makes the seaman an inadmissible alien for the time being and forces upon the ship's representatives the choice of guarding the seaman subject to the penalties provided by law in the case of the escape of an inadmissible alien or of incurring the expense incident to the completion of the medical examination. Recourse to this procedure also tends to relieve a medical officer of the temptation to take chances and pass an individual when the indications for a thorough examination are not definite and the procedure may seem liable to result only in unnecessary expense and trouble to those concerned.

Since May 1, approximately 3,500 alien seamen have been examined at Boston. One hundred and twenty have received medical certificates and 25 have been left in the status of "medical examination uncompleted." While the proportion of certificate cases among seamen may be expected to increase somewhat as more efficient methods

18643°-17-11

of handling this proposition are developed. it is to be noted from the foregoing that the proportion certified has been small in comparison with passengers, and will undoubtedly remain so. Also, as might be expected. the experience of two months has shown that the detection of infection with venereal diseases and trachoma is going to be a much more important factor in the medical examination of seamen than it has been in the case of passengers. Seven cases of acute venereal disease have been found on a single vessel, and if the Wassermann test is to be used to the same extent as it has been among passengers when suspicions of syphilitic infection have been aroused, special provision for carrying on such work is needed.

IMMIGRATION STATION.

While the immigration laws do not contemplate any responsibility on the part of service officers for sanitary conditions at an immigration station or even provide for the medical care of detained aliens by service officers, it has been found in actual practice that the duties imposed by law with respect to the medical examination of aliens has rendered unavoidable the assumption of their medical care, and by thus having charge of both the examination and medical care of aliens, officers of the service are placed to a certain extent in a position of actual responsibility for health conditions at immigration stations that can not be escaped. Since the beginning of the war the immigration service at Boston has repeatedly been obliged to assume the custody and care of detained aliens in numbers far in excess of the designed capacity of the quarters provided for the purpose, and the time and attention of the medical officers have been largely diverted from the strictly legal duty of examining arriving aliens to attend to the treatment of the sick and devise schemes to check the spread of illness among those detained for any reason.

The detention quarters at this station consist of 2 dormitory rooms, one containing 204 three-tier berths and the other 124 berths. When occupied to berth capacity the former room provides an initial per capita air space of about 100 cubic feet and the latter of about 80 cubic feet. There are in addition 2 rooms of about the same dimensions intended for occupancy during the day and a room designed to provide temporary emergency hospital accommodations pending the transfer of cases to regular contract hospitals.

To the Boston detention station are brought not only detained aliens arriving at Boston but all those detained at Providence, New Bedford, and other New England subports as well. In addition to arriving aliens all aliens taken into custody in the New England district under department warrants of arrest are kept in these quarters, and since the declaration of war with Germany the Boston immigration station has come to serve the purpose of a repository for interned alien enemies. For these reasons, and owing to the practical suspension of deportations, the demand for detention accommodations has increased instead of diminished with the decrease of immigration, since the war began. In the meantime what was once an unimportant part of the duties of the officers of the service at this station has become a troublesome medical and sanitary proposition.

During the past year the number of persons held in the detention quarters has frequently exceeded 300, made up of persons of both sexes, and including a large proportion of medical certificate cases. On one occasion the number of inmates reached 382 and over 350 persons have been kept in these quarters for varying periods on several occasions. To make matters worse local hospitals have been unusually crowded during the year and the number of detained aliens actually in need of hospital care has at times exceeded available accommodations in the various hospitals. On this account it has been necessary to keep at the detention station many cases which should have been transferred to appropriate hospitals. At times the number of persons requiring daily medical or surgical treatment in the detention quarters has exceeded 40 a day. It has been necessary to keep constantly at the detention station communicable diseases of one sort or another and to trust to various devices to lessen the danger of their spread. Tonsilitis and catarrhal conditions directly attributable to overcrowding have been prevalent throughout the year, and middle-ear complications have been common. Symptoms of tonsilitis or in fact any inflammatory throat symptoms have been deemed sufficient to warrant the removal of persons from the station as soon as detected. Other precautionary measures have included daily inspections and examinations. Practically every detained alien has been examined stripped. Daily temperatures have been taken of all children and to a considerable extent of adults as well. In spite of all precautions on three occasions during the year diphtheria has developed in the detention quarters resulting in two deaths. On each occasion prompt and energetic measures were, however, successful in preventing any spread of the disease. These outbreaks of diphtheria were unrelated as to source of infection. Other contagious diseases that have developed at the station during the year have included scabies, measles, chicken pox and mumps, but a general spread of these diseases has been avoided. Even in the matter of mumps only two or three cases possibly attributable to infection in the detention quarters have occurred.

Acknowledgment is made of the cooperation and assistance rendered during the year to the officers of the service at this station by Commissioner of Immigration H. J. Skeffington, Deputy Commissioner J. J. Hurley, and by the immigration officers and employees. under their charge. The faithful and efficient services of Acting Asst. Surgs. A. J. Nute and H. B. C. Riemer and of Clerk J. L. O'Neil also call for mention.

BUFFALO, N. Y.

Acting Asst. Surg. W. L. Savage reports as follows:

For the fiscal year ending June 30, 1917, the report of transactions shows a marked increase over that of last year. The medical officer, in addition to the medical inspection of aliens, is also called upon to care for and examine aliens detained by the immigration authorities in the county jail and other places of confinement.

The difficulties to the proper performance of the work at this office are lack of proper janitor service, the insanitary, foul-smelling condition of the lavatories throughout the building, lack of towels, soap, etc., dirty windows, no window screens, an abundance of shadflies and