Annual report of the Supervising Surgeon-General of the Marine Hospital Service of the United States (Volume 1876-1877) online

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Treasury Department. Marine-Hospital Service.



ANNUAL REPORTS



OF THE



SUPERVISING SURGEON-GENERAL



MARLNE-HOSPITAL SERVICE OF THE UNITED STATES.



FISCAL YEARS 1876 AND 18TT.



(John M. Woodworth, M. D.)



V^ASHINGTON:
GOVERNMENT PRINTING OFFICE.

1878.



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To the Hon. John Sherman,

Secretary of the Treasur//:

Sir: I have the honor to submit herewith a report of the
operations of the Marine-Hospital Service for the fiscal year
1877, being the seventy-ninth year of the Service, and my sixth
aimiial report.

As the report of the operations of the Service for the year
1876 was not printed, the recommendations therein made and
the statistics for that year are also included.
I am, sir, very respectfully,

JOHN M. WOODWORTH,

Supervising Surgeon- General.

Office Supervising Surgeon-General,

November 20, 1877.



CONTENTS.



Page.

Letter of Supervising Surgeon-General submitting Report vii

Operations of the Service 3

Financial Exhibit 3

Relief 4

Care of Insane Seamen 5

Care of Seamen employed on Vessels of the United States Government 5

Care of Foreign Seamen G

Care of Seamen returned from abroad by United States Consuls 6

The Sick Mariners' Fund of the Dominion of Canada 8

Medical Otficers of the Service, etc 9

Medical Examining Boards, etc 10

Port Inspections 11

The Division of the Service Relief -Stations into Districts 11

Fraudulent Master's Certificates 12

Medical Inspection in the Life-Saving Service 12

Physical Examination of Seamen 13

Quarantine, Cholera and Yellow Fever 13

The Handbook of Medicine and Surgei-y for Ships 14

The Centennial Exhibition 15

The Pur\'eying of Medical Stores 15

Seamen's Time-book and Schedule of Hospital-dues 15

Regulations of tlie Service 16

Disposition of Ett'ects of Seamen who Die on the Voyage 16

National Protection of Seamen 17

Marine-Hospital Buildings and Grounds 18

Bedloe's Island as a Site for a Marine-Hospital for New York 21

Office-work of the Supervising Surgeon-General 22

Statistics : Fixancial and Economic 27

A. — Summary Statement of the Operations of the Service for 1876 and

1877 27

B. — Comparative Economic Exhibit 27

C. — Statement of Hospital-dues Collections, by Quarters, and by Ocean,

Lake, and River Ports 28

D. — Financial Statement of the Service from October 1, 1798, to June

30, 1874 28

E.— Financial Statenjent of the Service from July 1, 1874, to June 30, 1877. 29
F. — Tabular Record of Marino-Hospital Buildings and their Cost from 1800

to June 30, 1877 30



VI CONTENTS.



Statistics : Medical and Surgical 31

Comments on the Medical and Surgical Statistics 35

I. — Table of Hospital-Relief Districts 37

II. — Statement, by Districts, of the Number of Patients treated (in hos-
pital) each Mouth during the Year ended June 30, 1876 .39

III. — Ratio of Hospital Patients treated in each District, 1876 39

IV. — Average Duration of Treatment in each District, 1876 39

V. — Tabular Statement of Diseases and Injuries Admitted and Treated

(in hospital) each Month in each District, 1876 40-93

VI. — Relative Proportions of Diseases and Injuries 94

VII. — Causes of Death, by Months and Districts, 1876 95-102

VIII. — Ratio of Deaths from Specific Causes, 1876 102

IX. — Hospital Patients, by Months and Districts, 1877 103

X. — Ratio of Hospital Patients in each District, 1877 103

XI. — Duration of Treatment in each District, 1877 103

Appendix :

Comments on the Contributed Papers 109

Metric Weights and Measures for Medical and Pharmacal Purposes, by Oscar

Oldberg, Phar. D 113

Physical Examination of Seamen, by Surgeon P. H. Bailhache 147

River Exposure and its Effects upon the Lungs, by Surgeon "Walter Wyman. 157

Yellow Fever at Savannah in 1876, by Assistant Surgeon George H. Stone. 167
Yellow Fever at Savannah and Brunswick, Ga., in 1876, by Assistant Surgeon

Henry Smith 175

Yellow Fever at Fernandina in 1877, by Surgeon Robert D. Murray 191

Index 203



OPERATIONS



UNITED STATES MARINE-HOSPITAL SERVICE:

1877.

(1 M H)



THE MARINE-HOSPITAL SERVICE OF THE UNITED STATES



DURING THE



FISCAL YEAR 1876-'77.



FINANCIAL EXHIBIT.



The collections of liospital-dues covered into the Treasury within the
fiscal year ended June 30, 1877, amounted to («)$372, 465 70

While the expenditures by warrants on account of the
Marine-Hospital Service were ... (^>368, 395 28



Showing a siu-plus of receipts over expenditures of . . . . 4, 070 42



This result is the more gratifying, in view of the fact that no deficiency
appropriation has been made for the Marine-Hospital Service since the
session of Congress of 1873, and none will be asked of the present Con-
gress, while the average annual deficiency appropriation made during
the twenty successive sessions preceding 1873 was 1182,452 50. It
should also be stated, in this connection, that since July 1, 1871,
extraordinary expenditures have been made out of the Marine-Hospital
fund, amounting to $120,883 31, to which there were no corresponding
expenditures or offset during the same number of years immediately
l)receding. These iuclude the cost of repairs of hospital buildings,
and fuel, light, and water, i)ay of engineers and assistants, and the

a This sum represents the amounts covered into the Treasury during the year. As monthly returns
fire made of this iiospital.dues collections. It necessarily follows that at least one month intervenes
lietween the date of the collection of the hospital money and the date of its reception into the Treas-
ury; hence the al)Ove amount includes the hospital. dues collected near the close of the fiscal year
i-ii'ded June SO, 1876, while it does not incluilc the lio.spitaldues collected near tlie close of the year to
'A'hich this report relates. The amount of liospitiil-ducs collected l)y the customs officers within the
ijmr was S3C8,873 30, (iucluding SI. 396 collected in fon-isn i)orts by United States consular officers.)

6Thisauiount represents the luonoys paid out of the ainii<)i)riatioii from Julv 1. 1876. to June 30.

ERRATA.

Page 119, line 16, erase the words "i^er cenV

Page 130, loth line from bottom, for the word " more " nsad " icss."

,, ^..„ ..^„.., V.,.,.,...... •..., oainiKn ./I i/iiiuoi n aim oiiii»iu.y i-n til 11H3 otn\ice, auu ail oilier

costi of a<liiiiniHtration, iiiHtruments, hospital furniture, &.C. ; the repairs anil preservation of buildings
and iiroiinds. fiirnituic and repairs of furniture, heating apparatus, fuel, light, and water, and other
iiiiHC<dlanw)UM items forni<;rly paid out of moneys specially ai)proi)riated therefoi', have also been paid
for out of the Marine- Hospital fund, hy flirect'ion of the Assistant Secretary, since the beginning of
the tlscal year 1875, and the expenditures for these items are included in the aggregate here given.



THE MARINE-HOSPITAL SERVICE OF THE UNITED STATES



DURING THE



FISCAL YEAR 1876-'77.



FIXAXCIAL EXHIBIT.



The collections of Lospital-dues covered into the Treasury within the
fiscal year ended June 30, 1877, amounted to («)$372, 465 70

While the expenditures by warrants on account of the
Marine-Hospital Service were (^^3Q8, 395 28



Shoeing a sm-plus of receipts over expenditures of 4, 070 42



This result is the more gratifying, in view of the fact that no deficiency
appropriation has been made for the Marine-Hospital Service since the
session of Congress of 1873, and none Avill be asked of the present Con-
gress, while the average annual deficiency appropriation made during
the twenty successive sessions preceding 1873 was $182,452 50. It
should also be stated, in this connection, that shice July 1, 1871,
extraordinary expenditures have been made out of the Marine -Hospital
fund, amounting to $126,883 31, to which there were no corresponding
expenditures or offset during the same number of years immediately
preceding. These include the cost of repairs of hospital buildings,
and fuel, light, and water, pa}' of engineers and assistants, and the

aThis Slim represents the amounts covered into the Treasury during the j-ear. As monthly returns
are ma<le of thy hospital-dnes collections. It uecenHarily follows that at least one month intervenes
between the date of the collection of the hospital money and the date of its reception into the Treas-
ury: hence the above amount includes the hosi)ital-diie8 colleetwl near the dose of the fiscal year
ended June 30, 1876, while it does not include the hospital-dues collected near the close of the year to
which this report relates. The amount of hospital-dues collected by the customs officers within the
year was S.'i68,873 30. (includiuf; Sl.SitG collected in foreign ports by United States consular officers.)

6 This aiiHiunt represents the moneys paid out of the api)ropnation from July 1, 1876, to June 30,
1877. less the repayments credited during the year. Asarule, bills for relief furnished by theMarine-
Hospital Service are paid monthly, and never in advance. Hence the amount of expenditures during
any year from the fund does not represent the actual cost of the service for that year. Monthly
re]M)ftB of the transactions of the Service are made by the disbursing agents, and the bills for relief
e.tteniled near the close of each year are consequently settled in the year immediately following. The
actual cos! of the Service for and during the year 1876-'77, (indutlin'g the relief furnislied forei>;n and
other HHamen not subject to hospital tax, for which relief a reimbursement is made of the actual cost,)
wat J:«;7.(;-J0 28. The average cost i)er patient, computed from this amount, was S24 22. The relief
includes medical and surgical treatment, medicines and surgical appliances, food, shelter, hospital
clothing, washing, nursing, etc. ; and tlu' expenilitures cover the cost of the foregoing, together with
the coht of isolated treatment of contagious diseases, the transportation of patients to lios])ital jmrts,
the burial of the dead, &c., and the salaries of officers an<l employi''s of the Stl-vice, and all other
costs of a<)ministratioM. instruiiufnts, hospital furniture, ifcc. ; the repairs and jueservation of buildings
and ;:roiinds. furniture and repairs of furniture, heating apparatus, fuel, light, and water, and other
miscellaneous items formerly paiil out of moneys specially appropriated therefor, have also been paid
for out of the Marine-Hospital funri, by direction of the Assistant Secretary, since the beginning of
the llscal year 1875, and the expenditures for these items are included in the aggregate here given.



4 MAEINE-HOSPITAL SERVICE.

compensation of tlie employes of the Supervising Snrgeon-GeneraPs
office — expenditures whicli were formerly paid out of special appropria-
tions made for these pur]Joses.«

RELIEF.

There were 15,175 seamen relieved by the Marine-Hospital Service
during the last, fiscal year, at an average cost of $24 22, & the lowest
ever reached, having been reduced from $38 41 in 1870 to these figures.
Of this number 10,975 were treated as hospital patients, and 4,200 as
office or " out-patients." Formerly all seamen who applied for relief
were sent to hospital, without regard to the nature of their diseases or
injuries, whereas now, at ports where medical officers of the Service are
stationed, trivial cases, not requiring rest or nursing in hospital, are
relieved by furnishing such remedies as may be required without send-
ing the seamen to hospital. It is, in fact, the adoption into the
Service of a common-sense principle followed in every community.
Not every one who takes sick goes to bed and sends for a physician ;.
many go to a physician's office, obtain a i^rescription, and go on
their way. The number of office or out-patients of the Service has.
gradually increased year by year since the seamen have learned that
such relief can be obtained, and, as a natural consequence, the number
of hospital cases has measurably diminished, with a corresponding in-
crease in their gra^dty. It is believed that this policy has poijularized
the Service with a large number of seamen, while a few, who were in
the habit of making the hospitals convenient boarding-places during
the closure of navigation, are disappointed. Seamen requiring medical

aDuring the past four years two new hospitals have been furnished and opened for the reception of
patients, and two others that had been leased were taken possession of, refurnished, and again occu-
pied for the exclusive accommodation of seamen. These four hospitals were the only marine-hospitals
opened since 1861. The Chicago mariue-hospital was furnished in November, 1873, and $8,240 98 was
expended for hospital furniture, bedding, clothing, and other necessary outfit to comijlete the estab-
lishment. The San Francisco marine-hospital, turned over to the service by the superintendent of
construction, in June, 1875, was furnished at an expense of $9,430 73. It should be stated that
$6,892 64 was expended, under the direction of the Supervising Architect, for furniture for the Chicago
marine-hospital, in addition to the $8,240 98 paid out of the marine-hospital fund; while the $9,430 73,
expended for furnishing the San Francisco marine-hospital, covered all the furniture, &c., purchased
for that institution — even the building itself having been taken possession of in an unfinished state.
The Mobile marine-hospital was reopened in September, 1875, and refitted and furnished at a cost of
$2,683 39; and the Louisville marine-hospital in January, 1876, for the furnishing of which $3,362 18
was expended. From the reorganization of the Service, in 1871, to June 30, 1875, the aggregate expen-
ditures, oiit of the marine-hospital fund, for items formerly paid out of specific appropriations, were
$13,616 23. In August, 1875, it was ordered, by the Assistant Secretary, that after that time all expen-
ditures on account of the repairs and preservation of marine-hospitaf buildings and grounds, and for
heating apparatus, furniture and repairs of furniture, fuel, light, water, and miscellaneous items for
the same, be paid out of the marine-hospital fund. During the fiscal year ended June 30, 1876, the
expenditures on account of these items accordingly amounted to $44,306 52, and during the fiscal year
ended June 30, 1877, to $42,938 91. If to these amounts be added the cost of furnishing and opening
the four hospitals occupied since 1873, and the cost ($2,304 37) of caring for American seamen employed
on Government vessels, (for which the Service is reimbursed,) which amounts are included in the
total expenditure.^, as stated in my annual reports, it will thus be found that $126,883 31 have been
expended out of the marine hospital fund for extraordinary purposes, for which no corresponding
expenditures or offset existed during the ten years preceding 1871.

6 Computed on the basis of the expenditures by warrants issued within the fiscal year, the average
cost per patient would be |24 28 ; but this is not the true cost, as will be seen from the foot-note on
page 3.



SIAEIXE-HOSPITAL SERVICE. 5

or surgical atteutiou aucl rest iu hospital are furnished board, mirsing,
washing, hospital clothing, (if necessary,) treatment, medicines, and
surgical appliances. At ports where the number of applicants for relief
is too small to warrant making provision for the treatment of patients,
except such as cannot be removed without prejudicing their cases,
transportation is fiu-nished to the nearest relief-station. Incurable
patients often request to be fiu-nished transportation from hospital to
their homes or friends, if they are so fortunate as to have such, and
ai>plications of this character are granted on condition that further
relief, at the expense of the marine-hospital fund, for the same disease
for which the patient is at the time under treatment will not be asked
or furnished. In illustiation may be cited the case of an American
seaman — a native of Sweden — under treatment for phthisis pulmoualis,
from which there was no hope of recovery, chiefly on account of his
excessive homesickness, and who had parents lining in Sweden capa-
ble and willing to receive and care for him. Had he been refused trans-
portation to his home, he would, without doubt, never have left the
hospital, probably remaining several months under treatment, with no
other residt than to retard somewhat the progress of the disease;
whereas the. cost of the transportation furnished him — thirty-five dol-
lars—was little nu)re than the cost of one month's board, nursing, and
treatment, while the joy of rejoining his family and friends and the
•change of climate offered him better prosjiects of recovery than any
hospital treatment he could receive.

INSANE SEAMEN.

Under the act of March 3, 1875, eight insane seamen, contributors to
the marine-hospital fund, have been since that time admitted to the
Government Hospital for the Insane, near Washington City, and of
these, two liave recovered and been discharged, two have died, (one of
whom was probably fatally ill wlieu admitted, and the other suffering
from chronic diarrhoea,) and four still remain under treatment.

SEAMEN EMPLOYED OX VESSELS OP THE UNITED STATES GOVERN-
MENT,

When sick or injured, are admitted for treatment by the Marine-Hos-
]»ital Service, under the act above cited, upon the application of their
<;omlnanding officers. Seamen of the Navy, (at places where no naval
hospital exists,) of tlie Coast Survey, Eevenue-Cutter, and Light-liouse
Services, and of the vessels of tlie Engineer Corps of the Army, have
thus been cared for during the two years just closed. In this conuec-



6 MAKINE-HOSPITAL SEEVICE.

tioii it is proper to again call attention to the fact tliat, altliougli these
seamen ship indiscriminately on Government vessels and merchant-
men, and may thus have paid hospital-dues on Revenue-Marine and
merchant vessels, they do not pay such dues while employed on the
other vessels referred to, and consequently were debarred from hospital
relief until the passage of the act of March 3, 1875, under which act
they are now cared for, the Marine-Hospital Service being reimbursed
the actual cost.

FOE.EIGN SEAMKN

Are admitted to the marine hospitals upon the application of the con-
sular officers of their respective nationalities, or of the masters of their-
vessels, under the act of May 3, 1802. A large number of sick foreign
seamen are now annually treated by the Service at rates prescribed by
the Secretary of the Treasury, under the act of March 3, 1875.

HOSPITAL-DUES COLLECTED FEOM VESSELS SOLD OR TRANSFERRED
ABROAD — NO PROVISION FOR THE CARE OF SICK AND DISABLED
DESTITUTE AMERICAN SEAMEN (WHALERS, ETC.) RETURNED FROM
ABROAD BY UNITED STATES CONSULS.

Under section 4586, Eevised Statutes, (29th April, 1864, c. 70, v. 13,,
p. 61,) consular officers of the United States are required to collect of
the masters or agents of vessels of the United States, sold or trans-
ferred in foreign i^orts or waters, the hospital-dues that may have
accrued up to the date of such sale or transfer. The first time any
receipts from this source have been covered into the Treasury to the
credit of the fund for the relief of sick and disabled seamen, for which
they are appropriated by law, occurred in the fiscal year ended June
30, 1876, when $5,419 76, collected during portions of 1874 and 1875,
was credited to that fund. Prior to that time all amounts collected under
the above section were covered into the Treasury to the credit of the
appropriation for the relief and protection of American seamen in
foreign countries. The seamen emi)loyed on the vessels sold or trans-
ferred in foreign ports are under the law contributors to the marine-
hospital fimd, and entitled to its benefits. Yet, while, as indicated,
a considerable portion of the hospital-dues has not been available for
the Marine-Hospital Service, destitute American seamen returned to the
United States from foreign ports under section 4577, (at the expense of
the appropriation for the relief and protection of American seamen in
foreign countries,) who may not be entitled to the benefits of the
Marine-Hospital Service, cannot under the law, if sick or disabled
upon arrival in a port of the United States, be admitted to hospital for



MARINE-HOSPITAL SERVICE. . 7

treatment. These men naturally seek the marine hospital, and cases
are on record where the condition of the apjilicant was such as to pre-
clude the possibility of refusing admission without fatal consequences
and causing scandal. In some cases medical officers of the Marine-
Hospital Service have even preferred to admit the men to hospital upon
their own personal responsibility rather than to refuse relief, then im-
mediately reporting the facts to the Department.

A letter was received in July, 1874, by the Department, from the
surgeon of the Marine- Hosmtal Ser'sace in charge, at San Francisco, Cal.,
stating that an American seaman — M. Sylva — returned to the United
States from Yokohama by the United States consul at that port, had been
sent directly from the vessel on which he arrived to the marine hospital,
his condition l)eing such as to render i^revious application at the sur-
geon's office impracticable. It was afterwards ascertained that the
seaman was not, under the law, entitled to the benefits of the Marine-
Hospital SerNice, having been employed on a, whaler, and not being a
contributor to the marine-hospital fund; that he was not a resident
of San Francisco, and consequently had no claim upon any charitable
institution in that city, and he was retained in hospital in the interests
of humanity. He was suffering from small-pox in an advanced st?ige,
and died after a period of twenty days. A communication was ad-
dressed, July 27, 1.S74, by the Honorable the Secretary of the Treasury
to the Honorable the Secretary of State, transmitting a copy of the
surgeon's letter, above referred to, and calling attention to the case in
question and to the fact that similar cases necessarily occur from time
to time, the object of the communication being to ascertain " whether
any action may be had through the Department of State, whereby on
the one hand the expressed intent of the law with regard to the marine-
liospital fund may be fulfilled without entailing colorable charges of
inliumanity ui^on those charged with its administration, and on the
other the interpretation of the law-merchant in the interests of the sailor
inay be made effective." Tlie reply of the Honorable the Secretary of
State, dated August 12, expressed a desire on the part of the Depart-
ment of State that the law be liberally construed in tlie interests of the
beneficiaries of "the fund provided for the relief of destitute seamen
abroad," and that Dejiartment saw no good reason why the exi)enses
attending the care of such seamen invoking relief in a foreign country,
whose health and physical condition indicate sending them to the
United States to be treated in a marine hospital, should not be paid
out of tliat fund, which is disl)ursed uiuler the direction of the Secretary
of State. Another letter was then (August 15, 1874) addressed to the



Q MAEINE-HOSPITAL SERVICE.

Department of State, proposing the course wMcli seemed best suited to
attain tlie objects in view, and a reply, dated 20tli August, received, in
wliicli the Secretary of State signified his concurrence in the views of
the Treasury Department.

The bill for the care and treatment by the Marine-Hospital Service,
of the seaman, M. Sylva, above referred to, at San Francisco, Gal., in-
cluding his burial expenses, was subsequently forwarded to the Hon-
orable the Secretarj?^ of State for approval, was by him approved to be
paid out of "the fand for the relief of destitute American seamen in
foreign jiorts," and thereupon referred to the Fifth Auditor of the
Treasury Department for settlement. That officer deemed the charge
not a proper one against said fund, and the case was finally referred to
the Honorable the First Comptroller of the Treasury Department for