Reexamination.-There has not been any reexamination of patients during the period covered by this report. There are, however, from 15 to 18 patients who may be eligible for parole at such time as the president and members of the board of health may see fit to arrange for such reexamination.

In conclusion I wish to express my great appreciation to the president, members, and officer of the board of health for uniform support and attention to my requirements, also to the superintendent of the leper settlement for unfailing cooperation and support at all times.

Respectfully,

W. J. GOODHUE, M. D., Resident physician, leper settlement.

UNITED STATES PUBLIC HEALTH SERVICE.

In spite of the continuance of the influenza epidemic and the greater number of arriving passengers a decrease in the incidence of communicable diseases observed on incoming vessels at quarantine was noted during the year. A total of 133 vessels, 15 per cent of those inspected, had communicable diseases aboard. The infections. were as follows: Influenza, 261; tuberculosis, 119; pneumonia, unclassified, 84; mumps, 54; measles, 34; malaria, 15; chicken pox, 9; typhoid, 6; miscellaneous, 87.

Influenza among passengers or crew was reported on 29 arriving vessels, the largest number of cases on any one vessel being 60. The disease manifested itself principally between January 15 and April 15, the infection continuing later on vessels from oriental ports, especially China, rather than from the States. It should be stated, especially in view of the experience of the Hawaiian Islands with disease, that there is no known method of maritime quarantine, short of complete interdiction of traffic and cutting off of commercial relations, capable of preventing the ingress of this disease to uninfected territory. In the case of small communities of minor commercial importance such procedure may be warranted, but necessarily this measure could not be applied to cities and districts occupying the commercial position of these islands.

Quarantine restrictions have been imposed against vessels arriving in the Hawaiian Islands from Mexico and Central and South American ports, where sanitary conditions are questionable as regards yellow fever, and 29 ships were held outside the harbors until fumigated for the destruction of mosquitoes. In addition, the usual precautions exercised to prevent the introduction of plague-infected rodents have been continued.

As indicative of the commercial position of the Hawaiian Islands it may be stated that a total of 792 vessels were boarded and inspected at Hawaiian ports during the year, in comparison with 609 vessels for the previous year. The figures for the various ports are as follows: Honolulu, 728; Hilo, 41; Mahukona, 2; Kahului, 14; Lahaina, 5; Koloa, 2. The incoming passengers numbered 107,018, an excess over the previous 12 months' period of 32,841; in other words, an increase of 44 per cent. Outgoing bills of health were issued at the various ports to 1,007 vessels, 41 of which were destined for eastern ports by way of the Panama Canal.

MEDICAL AND SURGICAL RELIEF.

A total of 340 beneficiaries of the Public Health Service were furnished hospital treatment in Hawaiian institutions during the year, the majority of these patients being cared for at Queen's Hospital and Leahi Home. The recent act of Congress which provides that discharged service men suffering from disabilities incurred or aggravated by their military duty are entitled to necessary hospital attention at the expense of the Government has served to increase the number of beneficiaries. Contracts have been entered into between the Territorial board of health and the Public Helath Service for the care of such patients at all institutions controlled by the former organization.

During the influenza epidemic, at the request of the Territorial board of health, the quarantine station was made available for the reception of such patients as could not be provided for in other hospitals, a total of 25 patients, nearly all of whom were afflicted with pneumonia, being so received. There were seven deaths. all of these cases the Territory provided subsistence and nursing attention, while the Public Health Service furnished hospital accommodations, the necessary drugs, and medical service.

PLAGUE PRECAUTIONARY MEASURES.

In

In cooperation with the Territorial board of health the Public Health Service has continued the trapping and examination of rodents in the city of Honolulu, the recent recrudescence and extension of plague at ports in the United States and elsewhere adding to the importance of this procedure. There were 14,055 rodents, rats, mongoose, and mice captured during the year, of which number 13,851 were trapped, found dead, or shot, while the remainder were obtained from the fumigation of vessels. Upon examination none of these rodents was found to be plague infected.

PLAGUE ON THE ISLAND OF HAWAII.

The continuance of plague in the Hamakua district of the island of Hawaii is to be noted in spite of all precautionary measures. The Territorial board of health, in cooperation with the plantation owners, as in previous years, has exercised an energetic campaign for the eradication of this nidus of infection but the physical handicaps are of such a nature that these efforts have not been accompanied by the desired results, although unquestionably the danger of the dissemination of the disease, both to man and rodents, has been lessened. The fact that no human cases of plague occurred in the previous year, and only one infected rodent was discovered, gave rise to encouragement, but the recrudescence of the past 12 months would seem to indicate that the infection has not been eradicated and is as formidable as at any previous time.

Eleven human cases of plague, all resulting fatally, developed during the year, constituting the greatest number which has occurred since 1910. Most of the victims were laborers employed on the vari

ous plantations of the Hamakua coast and all of the cases, with one exception, were of the bubonic type.

MEDICAL INSPECTION OF IMMIGRANTS.

A total of 3,571 incoming aliens were inspected at the port of Honolulu during the fiscal year ending June 30, a slight decrease over the arrivals of the previous year. Of this number 151 were certified for diseases or disabilities.

No decided change in the character of the immigration has been observed, the majority of aliens being Japanese. Five fines of $200 each were imposed against steamship companies for violations of the provisions of the immigration law.

NATIONAL GUARD OF HAWAII.

Organizations.-On July 16, 1919, this office received a communication from the Chief of the Militia Bureau, War Department, allotting the following National Guard units to the Territory of Hawaii: Coast Artillery, 2 companies; Infantry, 1 battalion, 1 machine-gun company, and 1 supply company.

A second communication of August 27, 1919, from the Chief of the Militia Bureau, War Department, modified the allotment of National Guard units by adding one headquarters company of Infantry, and changing the designaton of Company B, Fifth Hawaiian Infantry, National Guard, to machine-gun company, same regiment.

General Orders, No. 5, was published October 1, 1919, changing the designation of the Fifth Hawaiian Infantry, National Guard, to First Hawaiian Infantry, National Guard.

Instructions dated November 14, 1919, authorized the organization of the following Infantry units: One battalion, 1 headquarters company, 1 machine-gun company, 1 supply company.

On March 4, 1920, the Chief of the Militia Bureau, War Department, authorized the organization of the following units: Infantry, 2 regiments, Coast Artillery, 2 companies; Signal Corps, 1 telegraph

company.

Federal recognition has been extended to Companies A, B, C, D, E, headquarters, machine gun, and supply company. The Tenth, Eleventh, Twelfth, Thirteenth, Fourteenth, Fifteenth, Sixteenth, Seventeenth, Eighteenth, Nineteenth, Twentieth, Twenty-first, Twentysecond, and Twenty-third Provisional Companies are being formed. Armory instructions.-Schools for officers and enlisted men in Honolulu are conducted once a week under the supervision of the senior inspector-instructor and the sergeant-instructor detailed from the United States Army. This work is in addition to the regular assemblies. Schools, drills, and exercises are being carried forward on prepared schedules of instructions approved by the commanding general Hawaiian Department.

Camps of instruction.-No camp of instruction was held by the organization during the year. Seventeen officers of the First Hawaiian Infantry, National Guard, attended a camp of instruction for

National Guard and Reserve officers at Schofield Barracks, Hawaii, for 14 days from June 6 to June 19, 1920.

Equipment. Companies A, B, C, D, E, headquarters, machine

gun, and supply have been partly equipped.

Strength. The strength of the National Guard of Hawaii, June 30, 1920, is:

During the half month between the organization of Territorial government and the beginning of the first complete fiscal year the collections amounted to $7,454.30.

Special tax stamps and certificates of registry, year ended June 30, 1920.

Importers, manufacturers, etc., of narcotics, act of 1918

: Wholesale dealers of narcotics, act of 1918

57

Retail dealers of narcotics, act of 1918-

20

Practitioners, hospitals, etc., of narcotics, act of 1918

220

Dealers in untaxed narcotic preparations, act of 1918

63

Total

2,869

Internal-revenue receipts and disbursements, fiscal years 1919 and 1920, and 20 complete fiscal years since organization of Territorial government.

There were 211 cooperative stations in operation at the close of the fiscal year, 59 of which report daily maximum and minimum temperatures in addition to rainfall. There are 68 of these stations on Hawaii, 53 on Kauai, 46 on Oahu, 41 on Maui, 2 on Molokai, and 1 on Lanai. There is also a station at Waikiki Beach, Honolulu, to record daily temperatures of the sea water at that place; a cooperative station at Fanning Island, and a special meteorological station at Midway Island. Cable reports of the weather at Midway Island are received in Honolulu each evening.

The Hawaiian Volcano Observatory, at the Volcano of Kilauea, island of Hawaii, was maintained as a scientific part of the Weather Bureau, with Dr. T. A. Jaggar, jr., volcanologist, and R. H. Finch, meteorologist, cooperating. The Alika flow from Mauna Loa, the