The duties of the acting assistant surgeon at this port include the examination of arriving aliens, aliens detained on warrant, aliens who have entered the United States without proper inspection, and the medical care of all detained aliens.

In addition to the regular duties required of the medical officer in connection with the United States Immigration Service, the medical officer examined 45 applicants for commissions in the Officers' Reserve Corps, United States Army. This service was performed voluntarily and gratuitously in order to aid the local committee in charge of this work at Port Huron.

PROVIDENCE, R. I.

Surg. D. E. Robinson reports as follows:

The number of immigrants arriving at this port during the fiscal year was 18 per cent greater than for 1916, notwithstanding the operation of conditions which have tended to a marked decrease in immigration in general. This is accounted for largely by the fact that immigrants for this port are drawn from those countries least affected by the war (Portugal and Azores) and the lessened dangers of trans-Atlantic travel from those countries as compared with other parts of Europe. Although the number has increased over the previous year, the physical standard was lower. The total number inspected was 5,296, of whom 369 were certified for disease or defect, physical or mental.

RIOGRANDE, TEX.

Acting Asst. Surg. J. H. Hunter reports as follows:

During the early part of the fiscal year service transactions were performed in tents provided for that purpose, but during the latter part of the year the work has been conducted in a new building recently erected by the department for quarantine purposes. The plant is substantial, neat in appearance, and is situated on a United States Government reservation at Fort Ringgold, which adjoins the town of Riogrande, and is located at the ferry landing. The building has three rooms, one of which is shared jointly with the immigration inspector. Since the establishment of the station there appears to be a decrease in the number of contagious diseases on the Mexican side of the border, and the improvement in the cleanliness of the Mexican people is marked.

SAN FRANCISCO, CAL

Surg. W. C. Billings reports as follows:

The fiscal year 1917 shows a decrease, compared with last year, of approximately 20 per cent in the total number of immigrants inspected at this station and a proportionate decrease in the number of aliens brought from the vessels upon which they arrived to Angel Island for further examination. No particular reasons are known for this decrease other than those which at the present time are everywhere limiting ocean travel.

Twelve thousand three hundred and thirty-five aliens were examined during the year and of this number 6,311 were referred to the hospital for more thorough examination than is possible on shipboard. Of the latter number 910 were certified to the immigration

authorities as presenting some condition falling within the various medical provisions of the immigration law. Eight of these 910 were class A (1) (mental or tuberculous), 617 were class A (2) (dangerous or loathsome contagious disease), 64 were class B (affecting ability to earn a living) and the remainder were such medical conditions as fall within the province of the class C certificate.

The only two departures of importance from the routine of the last preceding year were certain changes in the handling of second cabin passengers, and the ruling of the bureau that clonorchiasis, paragonimiasis, and schistosomiasis should be considered as class A (2) diseases.

Trachoma continues to present itself in approximately the same percentage as in the few last years and it seems unnecessarily unfortunate that this should be so. Effort is continually made by the medical division of this station to establish a definite understanding as to what conjunctival conditions are considered here as constituting trachoma, and the medical officers attached to this division are always ready to demonstrate these conditions clinically to the surgeons of the various trans-Pacific ships if they care to avail themselves of the opportunity offered, but nevertheless trachoma continues to arrive and necessitates the imposition of a section 9 fine.

Concerning uncinariasis and the methods in operation to limit its introduction, nothing can be added to what was said in the annual report of 1916. There were over 500 cases of this condition detected at this station this year.

The hospital still remains unprovided with any isolation facilities for defense against contagious disease, notwithstanding the fact that such diseases frequently appear-ranging from mumps to diseases of the greatest import this year the latter type being represented by two cases of smallpox.

year

The work of the medical division has run smoothly during the and desire for cooperation by both services interested has at all times been manifested.

Acting Asst. Surg. F. R. Underwood reports as follows:

During the fiscal year 1917 there was a marked increase in the number of aliens inspected, there being 6,268 during the past fiscal year as compared with 4,833 in the preceding one. From September 16 to March 17 the inspection of aliens for immigration purposes was performed at the Port Townsend quarantine station, as during that period incoming vessels from the Orient were detained for quarantine purposes. During the year the routine examination of all steerage

passengers for uncinariasis was inaugurated, with the result of a material increase in the number of certificates issued for this condition, and it would appear that a thorough examination at the port of embarkation is not being enforced. The number of aliens presenting evidences of uncinariasis was approximately 6 per cent of all those entering. The facilities at the immigration station for the detention and examination of aliens, however, are very much restricted, and when an unusually large number of immigrants arrive a number of them are forced to sleep on the floors, and the crowding results in a very insanitary and uncomfortable condition of affairs.

TAKOMA, WASH.

Acting Asst. Surg. F. J. Schug reports that 122 aliens were inspected, 3 being certified.

VICTORIA, BRITISH COLUMBIA.

Acting Asst. Surg. C. Denton Holmes reports as follows: Presumably on account of war conditions, the lower type of aliens have been reduced in number, and the class of aliens passing through the immigration station have been of a superior kind and fairly well to do. Consequently there has been a decrease in the number of certifiable conditions. Of the 4,091 immigrants inspected 74 were certified on account of disease or physical or mental defect.

WINNIPEG, MANITOBA.

Acting Asst. Surg. C. Y. Douglass reports as follows:

During the year there were inspected 10,984 immigrants, of which number 1,436 were certified on account of disease or mental or physical defect.

The medical work at this station is rapidly growing in importance, the number of immigrants certified being practically double that of the preceding year and four times that of the fiscal year 1915.

Those who entered the United States seeking permanent homes were mostly of the agricultural class and of European origin, who, for some reason, had found Canada not to their liking. Large numbers of Ruthenians and Poles emigrated during the winter months. Such settlers were generally healthy, yet furnished many certifications for various deformities and most of those for pregnancy. Some, after a few years of the hardships of homesteading, were seeking less rigorous conditions, more or less diseased in mind or body. The proportion of mentally diseased attempting to pass through appears to be increasing. Many others are noted as being exceedingly peculiar, but with present facilities, actual defects of mentality can not be certified to in such cases.

Of those wishing to enter for a temporary sojourn, one group requires much attention of the medical examiner. It consists of those suffering from major and minor illnesses, and anxious to take treatment at hospitals in the United States under the supervision of famous specialists. This group accounted for about 60 per cent of the 1,436 certifications at this station. Each of these cases was given as thorough an examination as conditions would permit, in order to

determine the nature of the disease, its classification, and the likelihood of permanent disability resulting, and this information was embodied in each certification for the consideration of the board of special inquiry, who then determined the admissibility of the case. Of those going for treatment afflicted with debarrable diseases, 24 were admitted temporarily under bond.

Owing to the fact that Canada has recently enacted a law forbidding the emigration of males between 18 and 45 years of age, it is probable that the number examined this next fiscal year will be less, but the number of certifications may be expected to show a still further increase, as American hospitals are becoming better known and more popular in central Canada each year.

The quarters occupied by the immigration service are wholly inadequate. Aliens are often kept waiting for several hours and in some cases for two or three days before their cases are finally determined, and they are forced to sit for hours in a small room without proper ventilation, all classes mixed in together. The data clerks are compelled to work in this atmosphere daily.

The room set apart for the medical examiner is light and suitable for the purpose, but is furnished only with an old dilapidated couch and a desk. No provision is made for running water, which is almost a sanitary necessity. It is to be hoped the department will in the near future see its way clear to provide an examining table and a small laboratory to cost, perhaps, $500 or $600.

DOMESTIC (INTERSTATE) QUARANTINE.

During the early part of the fiscal year the extensive poliomyelitis outbreak at New York City and in other portions of the United States necessitated the detail of a large number of officers to infected districts in an endeavor to limit the interstate spread of the disease. The operations for the suppression of plague at New Orleans have been continued with encouraging results, and the infection gives every indication of being reduced to the point where it can no longer be considered a serious menace. The reentrance of plague into San Francisco County is to be noted. The work of suppressing the disease among ground squirrels in various parts of California, in order to prevent infection of urban communities, and the antiplague measures at Seattle have been continued. Efforts toward the prevention of the spread of Rocky Mountain spotted fever in interstate traffic have been conducted as heretofore, but at the termination of the fiscal year the eradication and control of the focus of the disease in the Bitter Root Valley were transferred to the State authorities. Certain revisions of the interstate quarantine regulations have been effected, and the revised as well as the preexisting regulations have been enforced, while numerous special investigations of water supplies, the sanitary condition of public buildings, and other problems have been undertaken. The work of the various interstate sanitary districts has been considerably broadened, and additional laboratory facilities have been provided for the conduct of the necessary operations.

MEASURES FOR THE CONTROL OF THE INTERSTATE SPREAD OF POLIOMYELITIS AT NEW YORK CITY.

The summer of 1916 witnessed an outbreak of poliomyelitis (infantile paralysis) of unprecedented proportions in various sections of the United States. Beginning early in June in the congested districts of the city of New York, the wave of infection rapidly extended for a hundred miles in every direction, and finally touched even far distant sections, invading in its passage across the country more than 30 States. The crest of the wave was reached early in August, after which time the disease slowly subsided, but it was not until late autumn or early winter that the epidemic could be regarded as quiescent and a normal incidence of the disease again obtained. The number of cases actually recorded from the inception of the outbreak until its close was more than 27,000, nearly half of which developed in New York City alone, and if unreported and unrecognized

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