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Columbia (Hnttiem'tp
intiifCtfpofllrttJgork

COLLEGE OF

PHYSICIANS AND SURGEONS

LIBRARY




Digitized by the Internet Archive

in 2010 with funding from
Columbia University Libraries



http://www.archive.org/details/annualreportofsu33unit



ANNUAL REPORT



OF THK



SURGEON-GENERAL



OF THE



PUBLIC HEALTH A\'I) MARIXE-HOSPITAL
SEK\1CE OP THE LiNTTED STATES



FOR THE



FISCAL YKAR 1904.



WASHINGTON:

GOVERNMENT PRINTING OFFICH =
1904.



Treasi'ry Department,

Ddcuinent X(i. 21^78.

Public Health and Marlne-IIosjntal Serrice.



OPERATIONS



UNITED STATES PUBLIC HEALTH AND
MARINE-HOSPITAL SERVICE.



I



904



C O N T F N T S .



Page.

Secretary's letter of transmittal to Congress ]'A

Report to the Secretary — summary of operations 15

Division of personnel and accounts '6',]

Personnel:

Connnissioned officers — promotions, appointments, resignations, and

casualties 35

Chief of division of pharmacology, Hygienic Laboratory 36

Advisory board for Hygienic Laboratory 36

Noncommissioned officers — sanitary inspectors, acting assistant surg-
eons, medical inspectors, internes, pharmacists, pilots, and marine

engineers 36

Hospital attendants 37

Boards convened 37

Details of officers to represent the Service at meetings of medical and

public health associations - 38

Accounts:

Vouchers passed for payment and settlement 39

Financial statement 39

Administrative details — circular letters 41

Division of marine hospitals and relief 43

Relief of seamen 45

Relief stations 45

Inspection of stations 45

INIonthly statement of expenditures 45

Aid to other branches of the Government service: Revenue-Cutter Serv-
ice, Steamboat-Inspection Service, Life-Saving Service, Light-House
Service, Civil Service Commission, Isthmian Canal Commission,. Immi-
gration Service 46

Physical examinations of merchant seamen 46

Examination of drugs 46

Sanatorium for consumptive seamen. Fort Stanton, N. Mex. (report of

medical officer in command ) 47

Report of operations bacteriological laboratory, Fort Stanton Sanatorium

(Asst. Surg. J. W. Trask). 56

Purveying depot at New York (report of medical purveyor) 62

New hospitals : Pittsburg, Pa. ; Savannah, Ga 64

Repairs and improvements made to buildings and grounds, inchiding work

under contract and repairs to heating ai)paratus of marine hospitals 65

Division of sanitary reports and statistics 69

Cholera 71

Yellow fever 73

Plague 75

United States (California) 75

Foreign and insular , 76

Smallpox 80

United States 80

Foreign and insular 97

Division of foreign and insular quarantine (embracing medical inspection of

immigrants ) 103

Cuba 105

No yellow fever 105

Personal health certificates at Habana 105

7



8 CONTENTS.

Division of foreign and insular quarantine — Continued. Page.
Cuba — Continued .

Reports of transactions:

Habana 105

Matanzas 107

Nu.evitas 109

Santiago 109

Cienf uegos 113

Porto Rico 114

Title to Mirafiores Island declared good 114

ObserAations on leprosy in Porto Rico 114

Reports of transactions:

San Juan and subports 116

Ponce 118

Mexico 118

Detail of officers, season of 1903 118

Rei>ort3 of transactions:

Veracruz 118

Tampico 119

Progreso 119

Season of 1904 120

Reports of transactions:

Veracruz 120

Tampico ~. 122

Progreso 123

Central and South America 123

Fruit-p(jrt inspection service 123

Letter of instructions 124

Reports of transactions:

Port Limon 1 25

Puerto Cortez 127

Livingston 128

Bocas del Toro 1 29

Ceiba 130

Bluefields 132

Belize 133

Panama 134

Details medical officers to protect Canal Zone 134

Republic of Panama requests assistance of Service officers on duty at

foreign ports 1154

Bills of health fur Panama to be signed by Ser\-ice officers at foreign

ports 135

Recommendation that incoming quarantine be placed in hands of

Service 137

Assistant Surgeon Pierce appointed health officer at port of Panama. . 141

Detail of Surg. H. R. Carter 142

Surgeon Perry and Assistant Surgeon Pierce report to Canal Com-
mission 142

Reports of transactions:

Colon 143

. Panama 144

Ecuador:

Report of transactions at Guayaquil 145

Peru:

Report of transactions at Callao 146

Brazil :

Officer detailed to Rio de Janeiro 147

Report of transactions at Rio 147

Hawaii 152

Report of transactions at Honolulu and subports 153

Philippine Islands 155

Transfer of Mariveles quarantine 155

Vessels from L'nited States to Philippines not required to carry bills of

health (decision of solicitor) 158

Commutation for quarters allowed officers of the .Ser^nce 159

Ins-tructions sent to officers serving in Orient to cooperate with chief

quarantine officer of Philippines 161

Military services of Asst. Surg. M. K. Gwyn 162

Manila and subports 163



CONTENTS. 9

Division of foreign and insular quarantine — Continued. Page.

Japan 185

Reports of transactions:

Yokohama 185

Na<rasaki 185

Kobe 186

China 186

Reports of transactions:

Hongkong 186

Shanghai 188

India (detail of oflicers at Calcutta and Bombay) 192

i\Ie<licai inspection of immigrants 193

Question of stripjiing aliens for detecting venereal diseases 193

Officers at ports in China and Japan directed to examine aliens 195

Reports of transactions:

United States 197

Porto Rico 212

Hawaii 213

Philippines 213

Canada 216

Italy ( Naples and Palermo ) 217

Japan ( Yokohama ) 219

(Kobe) 220

China ( Hongkong ) 220

Division of domestic quarantine 223

Plague in San Francisco 225

Statement of conditions 225

Resolutions adoj^ted regarding 226

Report of Passe<l Assistant Surgeon Blue 227

List of plague cases 230

Yellow fever 230

Correspondence 231'

Report of Surgeon Guiteras 303

Report of Passed Assistant Surgeon Richardson 320

Smallpox in the United States 326

The national quarantine stations 328

Annual reports from stations 329

Portland 329

Eastport 330

Ree<ly Island 330

Delaware Breakwater 331

Alexandria 333

Cape Charles 333

Cape Fear 334

Newbern 335

Washington, X. C 335

Savannah 335

South Atlantic 337

Bnmswick 338

Tampa Bay 339

Cumberland Sound 340

St. Johns inspection station 340

Kev West 341

Boca Grande 343

Cedar Kevs 343

St. Georire Sound 343

Santa Rosa 344

Biscayne Bay 345

Pascagoula 345

Gulf 345

San Diego 346

Los Angeles , 348

San Francisco 349

Eureka 350

Columbia River 350

Hoquiam 352



10 CONTENTS.

Division of domestic quarantine — Continued. Page.
The national quarantine stations — Continued.
Annual reports from stations — Continued.

Port Townsend 353

Seattle 354

South Bend 354

Port Angeles 355

Sitka 355

Texas-Mexican Border Quarantine 355

Laredo 35G

El Paso 356

Conclusion 356

Division of scientific research and sanitation 357

Transactions of the division 359

Yellow-fever institute 359

Etiology of yellow fever 359

Collection and identification of mosquitoes 360

Mosquito destruction 361

First antimosquito convention 361

Cooperation with State and lociil boards of health 361

Spotted fever 362

Second General International Sanitary Convention of American Republics. 363
Second Annual Confei'ence of State Health Officers with the Public Health

and Marine-Hospital Service 363

Aid to management of the Louisiana Purchase Exposition 365

National Association for the Study and Prevention of Tuberculosis 365

Porto Eican Aufemia Commission, preliminary report 366

International Sanitary Conference at Paris 370

Inspection of manufacture of vaccines, serums, etc 371

Hygienic Laboratory, report of the director 373

Opening of new laboratory building 373

Improvements needed 373

Laboratory course for student oflicers 374

Laboratory bulletins 374

Standard for dipbtheria antitoxin 375

Examination of vaccines 376

Car sanitation 377

Pathologic specimens examined 378

Suspected cases of plague at quarantines 379

Examination of drugs and chemicals 379

Exhibit for St. Louis Exposition 379

Disinfectants and germicides 379

Yellow fever 380

Malarial fevers 380

Dengue 381

Hooikworm disease 381

Tuberculosis - . 381

Typhoid bacillus in drinking water (report of Passed Assistant Sur-
geons Perry and Anderson) 381

Chloride of zinc and chloride of lime as disinfectants (report of Assist-
ant Surgeon McClintic ) 386

Division of zoology, report of chief of 394

Division of pharmacology, report of chief of 397

Ye'llow fever, abstract of report of French commission 399

Sanitation of railway coaches and Pullman cars 403

Reports of officers detailed to represent the Service at meetings of medical

and public health associations 404

Mosquito extermination convention (report of Passed Asst. Surg. J. C.

Perry) 404

Association of American Bacteriologists (report of Passed Asst. Surg.

M. J. Rosenau) 405

American Rontgen Ray Association (report of Surg. Fairfax Irwin).. 405
National Association for the Prevention and Study of Tuberculosis

( report of Passed Assistant Surgeon Rosenau) 408

American Medical Association, Atlantic City, N. J..:

Remarks by the Surgeon-General 408

Report of Asst. Surg. Gen. G. T. Vaughan 411

Report of Asst. Surg. Gen. H. D. Geddiugs 412



CONTENTS. 1 1

])i\ isioii of scientific research and sanitation — Continned. I'liKc
Reports of ollicers detailed to represent the Service at meetings of niccUcal
and pnl>lic lieaUh associations — Continned.

American Medical Association, AtlantU; City, N. J. — Continned.

Remarks hy Asst. Snrjjf. (<en. li. 1). (ieddings 412

Report of Snrg. V. M. Carrington 415

Report of Tassed Asst. Hurg. M. J. Koseiian 415

Mississi|)pi State Medical Association (report of Dr. Charles Wardell

Stiles) 41(3

Eleventh International Congress of Hygiene and Demography (re-
port of Passed Asst. Snrg. J . M. Eager) 417

Texas State Medical Association (report of Surg. H. R. Carter and

his address before the association ) 4135

Cerebro spinal meningitis in Hartford, Conn, (report of Passed Asst. Surg.

J. E. Anderson 443

Insanitary dwellings and the rehousing problem in foreign cities 444

Miscellaneous division (including contributed articles and necroi)sy reports).. 447

Transactions of the division 449

Contributed articles:

Chronic pancreatitis with induration. By Asst. Surg. L. P. H. Bahren-

burg 451

Leprosy in Sulu Archipelago. By Asst. Surg. J. W. Amesse 455

Sanitary improvements at Naples. By Passed Asst. Surg. J. M. Eager. 458
Catheter in l)ladder; removal through perineum. Reported by Passed

Asst. Surg. J. A. Nydegger 463

Reports of fatal cases, with necropsies 464

Necropsies of plague cases 545

Statistical tables 575

Index 641



LETrER OF TRANSMirrAL



Treasury Department,

Washi7i(/tov^ D. 61, Decemher 5^ lOOlf..
Sir: In accordance with section 9 of the act of Congress approved
Jul\' 1, 1902, entitled "An act to increase the efficiency and change
the name of the Marine-Hospital Service," I have the honor to trans-
mit the annual report of the Surgeon-General of the Public Health
and Marine-Hospital Service for the fiscal year 190*.
Respectfulh',

Leslie M. Shaw,

Secretai'y.
The Speaker of the House of Representatives.

13







ANNUAL REPORT



SURGEON-GENERAL, PUBLIC HEALTH AND
MARLNE-HOSPITAL SER\^ICE.



REPORT TO THE SECRETARY.



Treasury Department,

Bureau of Public Health and

Marine-Hospital Service,
Washington^ D. 6', September 17^ 190 J4..
Hon. Leslie M. Shaw,

Secretary of tit e Treasury.
Sir: I have the honor to submii:;, for transmission to Congress, in
accordance with the act of July 1, 1902, the following report of trans-
actions of the Public Health and Marine-Hospital Service of the
United States for the fiscal year ended June 30, 1904, the same being
the thirty-third annual report of the Service, in the one hundred and
sixth year of its existence, and the third annual report under its new
name.

The operations of the Service have been conducted under the act
above referred to, and Service regulations in accordance therewith
promulgated by the President August 12, 1903, which supersede the
regulations of November 29, 1902.

PERSONNEL.

COMMISSIONED CORPS.

At the close of the fiscal year the commissioned corps of the Service
consisted of 118 officers, as follows: The Surgeon-General, 6 assistant
surgeons-general, 25 surgeons. 36 passed assistant surgeons, and 50
assistant surgeons. Four candidates passed a successful examination
for admission to the corps and were commissioned assistant surgeons.

CASUALTIES.

Among the casualties enumerated in the report from the division
of personnel and accounts should be specially noticed the sad death
of Surg. Iv. D. Murra}', due to an accident while engaged in the sup-
pression of yellow fever at Laredo, Tex. The details are mentioned

15



16 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE.

in the report of Surgeon Guiteras on pp. 31-1:-315 of this report.
8urg-eon Murra3''s skill and devotion through thirt}' 3'ear8 of service
in the suppression of epidemic diseases, particular!}- yellow fever,
were so marked as to give him a national reputation and to make his
loss a public misfortune.

ACTING ASSISTANT SURGEONS.

At the close of the fiscal 3-ear there were 194 acting assistant sur-
geons, including 8 appointed for duty at fruit ports of Central and
South America whose services will be terminated at the close of the
quarantine season.

PHARMACISTS.

At the close of the fiscal year there were 49 pharmacists, as follows:
Pharmacists of the first class, 16; of the second class, 25; of the third
class, 8.

ATTENDANTS.

At the beginning of the fiscal year there were 577 hospital attendants
at the marine hospitals, quarantine stations, and on epidemic dut}^
The number at the close of the fiscal vear was 643.



During the fiscal year 41 boards of medical officers were convened
for the physical examination of officers of and applicants for entrance
into the Ke venue -Cutter Service.

EXPENDITURES.

«

SERVICE FUND.

The balance of the appropriation for the maintenance of the Public
Health and Marine-Hospital Service at the beginning of the fiscal year
was $486,638; the receipts from all sources, tonnage tax, repayments,
care of foreign seamen, and reimbursements from the Immigration
Service, etc., were $937,257.61. The expenditures for the same period
were $1,168,252.36, leaving a balance on hand at the end of the fiscal
year of $255,643.25. These expenditures included improvements and
repairs to marine hospitals, heating apparatus, furniture, and fuel,
light, and water, these items being no longer included by Congress m
annual appropriations.

EPIDEMIC FUND.

The amount available of the appropriation for preventing the spread
of epidemic disease at the beginning of the fiscal year was $489,051.99;
the expenditure was $211,461.82, leaving a balance June 30, 1904, of

$277,590.17.

QUARANTINE FUND.

The amount of the appropriation was $325,000. There were repay-
ments for the care of foreign seamen, etc., of $1,605.88. Congress
also made a deficiency appropriation of $9,500 for "quarantine serv-
ice, 1904, repairs to floating property." When all of the accounts are
adjusted, a small balance of these appropriations will remain.



PUBLIC HKALTH AND MARINE-HOSPITAL SERVICE. 17

^MARINE HOSPITALS AND RELIEF.

The relief statistics; for the year arc as follows:

Total number of patients 58, 550

NuiuIht of patients treated in hospital 14, 803

^■unllH•r of patients treated in dispensary 44, 253

Total ninnher of days' relief in hospital 415, 292

])e(Tease in total iuind>er of patients as eonipared with last year 17

Increase in nundR'r of hospital patients over previous year 738

Increase in number of days' relief 31, il03

The Service controls and operates 22 hospitals, all of which are
owned by the Government.

In addition to the marine hospitals there are 122 relief stations
where seamen receive hospital and dispensary treatment. A relief
station was established during the yeav at Ketchikan, Alaska.

NEW HOSPITALS.

Pittsburg, Pa. — As authorized by act of Cong-ress approved March
3, 1903, the Secretary of War, on "^the Tth of May, 19(14, transferred
to the custody and control of the Treasury Department a portion of
the United States arsenal grounds, Pittsburg, Pa., 5 acres in extent,
to be used as a site for the proposed marine hospital.

Buffalo, N. Y. — A site for the marine hospital was purchased during
the 3^'ear at a cost of $22,000. The site is 3 acres in extent and is sit*
iiated on Main street, 3i miles from the city hall.

SaTannah, Ga. — Contract has been let for the construction of the
new hospital for $96,170, the building to be completed August 15, 1905.

SANATORIUM FOR CONSUMPTIVES, FORT STANTON, N. MEX.

The number of patients cared for in this institution continues to
increase. Three hundred and eighty-six patients have been treated
during the year, exceeding the number for the previous 3^ear by 112.

Number of patents treated 386

Number discharged, cured 16

Number discharged, disease arrested 9

Number discharged, improved 87

Number discharged, not improved 19

Number discharged, nontubercular, recovered 1

Died 62

Kemaining under treatment 192

PURVEYING DEPOT, NEW YORK, N. T.

During the year 718 requisitions were filled, and supplies furnished
to the marine hospitals and quarantine stations in the United States
and its dependencies. Supplies were also purchased for the Immigra-
tion Service and for the vessels of the Revenue-Cutter Service and the
Coast and Geodetic Survey. Provision has been made for an examina-
tion of drugs by the Hygienic Laboratory in order to determine the
purity of those purchased for issue.
8629—04 2



18 PUBLIC HEALTH AND MARIJSE-HOSPITAL SERVICE.



Ain TO OXnEK SERVICES.



Aid was extended to other branches of the Government, in the mat-
ter of physical examinations, as follows:





Ser\'ice.


Examined.


Rejected.


Revenue-Cutter Service




728

1,812

1,161

53

12

1,405

2


128


Steamboat-Inspection Service;


126




37


Coast and Geodetic Survev


6


Light-House Service


3


Civil Service Commission


89


Isthmian Canal Commission













Total


5,173


389









Physical examinations were also made of 604 American merchant
seamen, of whom 88 were rejected; and of 6 foreign seamen, of whom
3 were rejected.

MEDICAL INSPECTION OF IMMIGRANTS.

During the fiscal year 840,714 immigrants were inspected by ofii-
cers of the Service to determine their physical fitness for admission,
as prescril)ed b\' the immigration laws. At all ports of the United
States wliere aliens seek admission ofiicers have been detailed in
accordance with the law, and on request of the Immigration Service,
for the purpose of making these examinations. The details of officers
for a like purpose at Naples, Italv, and Quebec, Canada, have been
continued, and additional officers have been stationed at Vancouver
and Victoria, British Columbia, for the same purpose by special
request of the Immigration Bureau.

By request of the honorable Secretary of Commerce and Labor,
and with j^our approval, all the officers on dut}" in Japanese and Chi-
nese ports were directed to make medical inspection of aliens embark-
ing for the United States at said ports, and to certify upon each
immigration manifest that those whose names are inscribed on the
manifest are free from loathsome or dangerous contagious disease.
In the event of the detection of a would-be immigrant with a pro-
hibitive disease the ofificers were instructed to notify the steamship
companies accordingl}^, it being well understood that such immigrants,
if carried, would subject the steamship companies to penalties on
arrival in the United States. This proAnsion has been executed with-
out friction and with great Ijenefit both to the Immigration Service
and to the steamship companies, statistics which will doubtless be pub-
lished b}" the Commissioner-General of Immigration showing that a
large number of immigrants have been prevented from leaving for
the United States who would have been rejected on arrival, and would
have caused an infliction of penalty upon the steamship companies.
The steamship companies themselves made request for this arrangement.

The officers in Japanese and Chinese ports were further directed to
make a descriptive list of aliens recommended for rejection copies of
list to be sent immediately to the medical officer at the port of arrival,
to the Commissioner-General of Immigration and to the Public Health
and Marine-Hospital Bureau.



I'lJHLIC HEALTH AND MARINE-HOSPITAL SERVICE. 19



ko iiiTiint^emont for iininif^rimts leaving Europojin ports for tho,
tic i)orts of tho rnitod Stutos is dosirahlc hut as yet has not



A lik(
Athmtic i)oi , ^

hecn oll'octod save at tlie poi't of Naj)h\s, where tlie inspection ])y an
otticcr of tliis Service is made hy recpiest of the Italian Government.



SMAIXI'OX.

The report of the division of sanitary reports and statistics shovvs
that (hirin*;- the six months ended December 81, liKKi, smallpox was
reported from 85 States, with a total of 18,789 cases and ()()(5 deaths,
Dnrini;- the six months ended flune 80, 1904, smallpox was reported
from 87 States and Territories, with a total of 11,8(J7 cases and 512
deaths. Total for the year, 25,10() cases and 1,118 deaths. Total for
the previous fiscal year, 1908, 42,590 cases and 1,()42 deaths.

This is a o-reat decrease since last year, and would indicate that the
disease had reached the highwater mark in 1902 and will continue to
decrease in the future.

This decrease may be due, in part at least, to fewer mistakes in
diagnosis. Within the past year the Bureau certainly has received
fewer requests for expert diagnosticians and fewer communications
than formerly, showing that the writers confused the disease with
other maladies. It is believed, too, that there is greater confidence in
vaccination and that the vaccine itself has been so improved by the
manufacturers as to remove in a great measure such prejudice as has
existed against it. The fact that all of the manufacturers of vaccine
are now required b}- law to have their establishments licensed after a
rigid examination b}^ Government authority is a good reason for the
growth of confidence in the purity and potency of vaccine.

The Service has continued to transmit its pamphlets upon protection
against smallpox, has rendered aid when requested, but has also con-
tinued in the policy which was announced in the annual report for
1898, leaving to the States themselves the suppression of the disease
therein, believing that a disease so easily conquerable should be left to
the management of State and municipal authorities. The result has
been a strengthening of the medical authorities of the States and cities,
both by the enactment of necessary State and municipal laws and
thi'ough the administrative activity required of State and municipal
ofiicers.

The aid rendered to the State health authorities of Maine in the
exclusion and suppression of smallpox at the Canadian border was
continued throughout the jem\ The oflacers engaged in the work
report a total of 93 families under observation, 3,753 persons inspected,
1,736 persons vaccinated, 206 cases of smallpox treated, and 111 dwell-
ings and 20 schoolhouses disinfected.

LEPROSY.

In the annual report of 1902 reference was made to the report of
the commission of medical ofiicers of this Service appointed by law
to investigate the origin and prevalence of leprosy in the United
States and report upon measures necessary for the prevention of its
spread. The commission recommended at least one leprosarium in
the United States where lepers found in the se\ eral States could be
segregated, and a bill was prepared, but owing to the consideration of



20 PUBLIC HEALTH AND MARINE-HOSPITAL SERVICE.

the matter of leprosy in the Hawaiian Islands and sucrgestions which
were made of sending there all lepers from the United States, it was
deemed inadvisable to present a measure to Congress without further
consideration of this feature of the subject.

I have to recommend the establishment of a leprosarium in the con-
tinental United States. It is believed that the necessar}" site can be
found on Government land, and it is proposed to submit for 3'our
approval a bill containing necessary provisions. In the meantime the
health authorities of the HaAvaiian Islands have signified their earnest
desire that this Service should make use of the opportunity presented



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