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ANNUAL REPORT
OF THE

SURGEON GENERAL OF THE
\A.'5, PUBLIC HEALTH SERVICE
OF THE UNITED STATES
FOR THE FISCAL YEAR

1931

UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON : 1931

For sale by the Superintendent of Documents, Washington, D. C,


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Price 85 cent,, Cloth

TREASURY DEPARTMENT

Document No. 8042
Public Health Service


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LETTER OF TRANSMITTAL
TREASURY DEPARTMENT'
OFFICE OF THE SECRETARY'

Washington, December 7, 1931.
Sm: In accordance with section 9 of the act of Congress approved
July 1, 1902, I have the honor to transmit herewith the report of
the Surgeon General of the Public Health Service for the fiscal
year 1931.
Respectfully,
A. w. MELLON,
Secretary.
The SPEAKER OF THE HousE OF REPRESENTATIVES.
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CONTENTS
Page

Foreword _______ . ___ . _______ .. _ .... _______ __ ___ .. ___ .. _. _ _ _ _ _ _ _ _ _ _ _ _ _ _
Division of Scientific Research _____ .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _
Cancer _______________________________ . __ . __ .. _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _
Leprosy_ _____________________________________________________
Malaria ______ ·- -· _________________________ .. _________________ ______
Nutritional diseases __ . _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Rocky Mountain spotted fever___________________________________
Tularaemia___________________________________________________
Tick paralysis_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Child hygiene investigations ____________ ------------------------In~m;~rial ~ygi~ne and sa.nitation_______________________ _________
J\,J1lk mvest1gations_______ ___ _ _ _ _ _ __ _ __ _ _ _ _ _ _ __ __ ___ _ ___ _ ____ ___
Statistical invei-tigations_ _ ____ __ _ ___ _ _ ___ _ __ _ ___ __ __ _ _ ____ _ __ _ _
Stream pollution _______________ . _________________________ .. _ _ _ _
Studies of public health methods_________________________________
National Institute of Health ________ -·____ _______________________
Serums, vaccines, and analogous products _____ .. _____________ .. ____
Miscellaneous ____ -·___________________ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Division of Domestic (Interstate) Quarantine______________________ ___
Plague-suppressive measures ___________________ .. ________________
Plague in ground squirrels___________________________________
Measures taken aga,inst rats______________ _________ __________
Operation of Public Health Service laboratory____ ____ ________
Trachoma-prev('ntion work_____________________________________
Supervision of water supplies used by common carriers _____________
Shellfish sanitation _____ ____ ________ .. ____________ __ ·- ____ .. ____ . :. _
Public health engineering abstracts_______________________________
C0operative sanitary work _______ ------------------------------Mosquito control, District of Columbia_____________________________
Summary of work carried on -by the various districts __ . _ _ _ _ _ _ _ _ _ _ _
Interstate sanitary districts _______ ----------- --··--_____ ________
R eport on the work of mosquito control in the District of Columbia_
Rural health work__________________________________ ___ __________
Cooperation with State and mnnicipa.l boards of health in the provision of Rdequate rules and regulations for the prevention of the
introduction and spread of contagious and infectious diseases___ ___
Miscellaneous activities ______ .. ___ . _____________________ . ___ .. .: _ _ _
Conference of the Surgeon General with the State and Territorial
health officers_ . ___ .. _ . __ .. _____________________ .. _ .. _____ .. __ . _
Division of Foreign and Insular Quarantine and Immigration___________
Quarantine transactions _____ .___________________________________
General prevalence of quarantinable diseases_____________________
Changes in quarantine procedure________________________________
Meningococcus (cerebrospinal) meningitis________________________
Psittacosis_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Sanitary control of aerial navigation__ __________________________ _
Rat proofing of vessels_________________________________________
Floating equipment___________________________________________
Violations of quarantine laws________________________ ____ _______
Quarantine transactions at continental and insular quarantine stations_
Summary of quarantine transactions at continenta l and insular
stations for the fiscal year ended June 30, 193 L _ _ _ _ _ _ _ _ _ _ _ _
Transactions at continental maritime stations_________________
Transactions at United States airports of entry for airplanes from
foreign ports_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Reports from continental quarantine stations_________________
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Division of Foreign and Insular Quarantine and Immigration-Contd.
Quarantine transactions, etc.-Continued.
Mexican border stations __________________________________ _
Quarantine operations along the Mexican border _____________ _
Transactions at insular quarantine stations __________________ _
Reports from insular quarantine stations ____________________ _
Operations of the service in Hawaii_ ____________________ _
Operations of the service in the Philippine Islands ________ _
Operations of the service in Porto Rico ___________ :.. _____ _
Operations of the service in the Virgin Islands ___________ _
Transactions at foreign ports __________________________________ Reports from foreign ports _________________ - _- ___ - - - - - - - - - - - - - Service operations in Europe ____________________________ - - - - - - Summary of quarantine transactions at continental, insular, and
foreign stations _________________________________ - ___ - - _- - - - Medical inspection of aliens ___________________________________ _
Examination of prospective immigrants abroad __________________ _
Summary of medical inspection of aliens ________________________ _
Immigration on the Eastern Hemisphere ________________________ _
European ports __________________________________________ _
Immtgration on the Western _Hemisphere _________________ -- -- -- Canada, Cuba, and Mexico _______________________________ _
Reports from immigration stations ___________________________ -- _
Division of Sanitary Reports and Statistics __________________________ _
Morbidity and mortality reports _______________________________ _
Current prevalence of communicable diseases ________________ _
Current State mortality statistics __________________________ _
Collaborating and assistant collaborating epidemiologists ______ _
Telegraphic reports ______________________________________ Monthly State reports _____________________________ .'. ______ _
Annual State morbidity reports ____________________________ _
Weekly and annual city reports ____________________________ _
Insane, feeble-minded, and epileptics _______________________ _
Foreign reports __________________________________________ _
International exchange of sanitary information ___________________ _
Prevalence of communicable diseases during calendar year 1930 _____ _
Inquiries as to health conditions _______________________________ _
Directories of health officers ___________________________________ _
Survey of health education by radio in the United States ____________ _
Radio lectures by the Public Health Service _____________________ _
Legislation and court decisions relating to public health ____________ _
Publications issued by the division _____________________________ _
Section of public health education ______________________________ _
Publications distributed by the division _________________________ _
Division of Marine Hospitals and RelieL _________________________ .., __
Classes of beneficiaries and amount and character of services rendered_
Summary of services by class of beneficiary __________________ _
Dental treatment _________________________________________ _
Coast Guard ____________________________________________ _
Employees' compensation commission ______________________ _
Examination in first aid ___________________________________ _
Operating costs ______________________________________________ _
Economies __________________________________________________ _
Abstracts of reports from marine hospitals and selected relief stations_
Consolidated and detailed reports ______________________________ _
Tables ______________________________________________________ _
Di vision of Venereal Diseases ______________________________________ _
Scientific research ____________________________________________ _
Studies at the marine hospital, Stapleton, N. Y ______________ _
Studies at Chicago, IlL ___________________________________ _
Malaria treatment of neurosyphilis _________________________ _
Clinical research _____________________________________________ _
Cooperative clinical studies ________________________________ _
Studies at United States marine hospital, Ellis Island, N. y _____ _
Hot Springs clinic ________________________________________ _
Prevalence studies ____________________________________________ _
Cooperation with other divisions of the service ___________________ _


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CONTENTS

Division of Venereal Diseases-Continued.
Cooperation
with the Office of Indian Affairs, Department of the In-_
terior _____________________________________________________
Study of syphilis among rural negroes __________________________ _
Health education ____________________________________________ _
Cooperative activities with States ______________________________ _
Notification of cases ______________________________________ _
Clinic activities __________________________________________ _
Tables ______________________________________________________ _
Di vision of Mental Hygiene _______________________________________ _
Studies of the nature of drug addiction and methods of treatment __ _
Dissemination of information __________________________________ _
Studies
of drugs
the abusive
use and the medical and scientific needs of_
narcotic
_____________________________________________

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Administration of narcotic farms _______________________________ _
Medical and psychiatric services in Federal penal and correctional
institutions ________________________________________________ _
Studies and investigations on the causes, prevalence, and means for
the prevention and treatment of nervous and mental diseases ____ _
Division of Personnel and Accounts ________________________________ _
Public health districts ________________________________________ _
Personnel ___________________________________________________ _
Commissioned officers ____________________________________ _
Reserve officers __________________________________________ _
Acting assistant surgeons _________________________________ _
Attending specialists _____________________________________ _
Internes ________________________________________________ _
Pharmacists and administrative assistants ___________________ _
Nurses, dieticians, and reconstruction aides __________________ _
Contract dental surgeons __________________________________ _
Epidemiologists __________________________________________ _
National Institute of Health ___________________________________ _
Boards _____________________________________________________ _
Property records _____________________________________________ _
Accounts section _____________________________________________ _
Personnel statement ____________________________________ - _____ _
Chief Clerk's Office _______________________________________________ _
Personnel on duty in the bureau _______________________________ _
New administrative building for the service at Washington ________ _
Printing and binding _________________________________________ _
Public Health Service library ____________________________ - _ - - - - _
Supplies, equipment, etc __________ -~ ____________________ - _____ _
Appendix _______________________ .______________________ - _- - - - - - - - Financial statement ____________________________________ - _____ _
Quarantine service-Expenditures by stations _______________ _
Miscellaneous receipts ________________________________________ _


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ANNUAL REPORT OF THE SURGEON GENERAL
OF THE PUBLIC HEALTH SERVICE
TREASURY DEPARTMENT'
BUREAU OF THE PUBLIC HEALTH SERVICE,'

Washington, October 15, 1931.
Srn: In accordance with the act approved July 1, 1902, I have
the honor to submit for transmission to Congress the :following report o:f the transactions o:f the Public Health Service of the United
States for the fiscal year ended June 30, 1931. This is the sixtieth
.annual report of this service, covering the one hundred and thirtythird year of its existence.
The Public Health Service is charged by law with the prevention
,of the introduction and spread o:f infectious diseases from foreign
-countries into the United States. This is one o:f the important public health duties o:f the Federal Government. The relation of commerce in connection with the spread of epidemic diseases is well
known. In carrying out the requirements of law with reference
to the defense of our territory :from invasion by contagious diseases
:from foreign countries, especially in view of the new problems occa·sioned by the rapid increase o:f international aerial transportation,
it is important to keep currently advised as to the prevalence o:f
-disease not only in the United States but throughout the world, in
-so :far as may be practicable.
WORW HEALTH CONDITIONS

As heretofore, during the past fiscal year there was a constant
interchange o:f sanitary information with other nations of the world
through the International Office o:f Public Hygiene of Paris, the
Pan American Sanitary Bureau, and the health section o:f the Secretariat of the League of Nations. Useful epidemiological intelli:gence was also received by the Public Health Service through Amer1ean consuls, officers of the service stationed abroad, and directly
from foreign governments.
Internart10nal sanitary agreements-the Internationat Sanitary
Convention of Paris and the Pan American Sanitary Code-have
operated to improve the promptness and completeness of the in-formation relating to the prevalence of disease received :from various
foreign governments.
Cholera did not appear in continental United States, but an outbreak began in the Philippine Islands in May, 1930, and continued
throughout the fiscal year, although during May and June, 1931, the
number o:f cases and deaths was comparatively small. During the
~alendar year 1930 about 4,600 cases o:f cholera, with about 2,700
-d eaths, were reported in the Philippines. Cholera appears every
year in parts of Asia, and under present conditions outbreaks in the
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Philippine Islands may be expected; but the numbers of cases and
deaths are much smaller than they were a few decades ago.
Cholera was more prevalent during the calendar year 1930 than
it was during 1929, although in 1930 it was not reported outside of
Asia and the adjacent islands. In India 366,951 cases of cholera
were reported in 1930 and 285,792 cases in 1929.
During the calendar year 1930 plague in human beings was not
reported in the Unifed States or its possessions, but one plague-infected rat was found in the Hamakua district of the island of
Hawaii. In May, 1931, another plague-infected rat was found in
the same district, and in May and June, 1931, 6 plague-infected
ground squirrels · were reported from Monterey County, Calif., in a
locality where intensive squirrel-destruction work was being carried
on in the endeavor to stamp out plague in rodents.
In South America plague was reported during the calendar year
1930 in Brazil, Ecuador, Peru, and Argentina. Over the world generally plague was as widespread as it has been in recent years, although the total number of reported cases was smaller than it was
in 1929. In 1930, 35,644 cases of plague were reported in India, as
compared with 97,346 cases in 1929.
During the fiscal year yellow fever was present in Brazil, in South
America, and in the Gold Coast and British Cameroons, in Africa.
One case was reported at Lagos, Nigeria, which was said to have
been infected in a laboratory. The disease was not reported in the
city of Rio de Janeiro, Brazil, nor in Colombia during the fiscal
year, although four cases were reported in Magdalena Province,
Colombia, in July, 1931.
Soon after the close of the fiscal year, in July and August, 1931,
cases of yellow fever were reported in Africa and in Brazil.
The world prevalence of typhus fever has been decreasing since
the decline of the great epidemics which followed the World War.
The disease, however, is still reported from all the grand divisions
of the world. The largest number of cases is reported by the Union
of Sovjet Socialist Republics.
During the calendar year 1930 there were 510 cases of typhus fever
reported to the Public Health Service from the United States; 474
of these cases were in States south of Pennsylvania and the Ohio
River and east of the Mississippi. Nearly all of the typhus fever
in the United States is the mild type, formerly known as "Brill's
disease," now sometimes spoken of as endemic typhus, but the virulent type is always present in Mexico, and sometimes this type of the
disease appears in the southwestern part of the United States.
Smallpox is widespread, and during the calendar year 1930 there
were cases of the disease reported from nearly all of the countries of
the world, although most of the countries of western Europe reported comparatively few cases. England and Wales reported
11,865 cases in 1930, as compared with 10,989 cases in 1929. The
disease in England, as in the United States, is mild in type, and
there is strong opposition in certain quarters to vaccination. In
1930 England and Wales reported more cases of smallpox than
did all the countries of continental Europe, and the United States
reported more cases than any other single country, with the exception
of British India.


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HEALTH CONDITIONS IN THE UNITED STATES

Reports of the prevalence of communicable diseases received by
the Public Health Service from State health officers and preliminary
reports of deaths from several sources indicate that the health record
for the United States for the calendar year 1930 was exceptionally
good. The record for the first half of the year 1931 was also generally good, although an epidemic of mild influenza during the
early months of U?,31 increased the death rates for a time and gave
the year an inauspicious beginning.
The geographic distribution of srn.allpox in the United States is
very irregular. Seven States----Connecticut, Delaware, District of
Columbia, Maine, Maryland, New Hampshire, and Rhode Islandreported no case of smallpox in 1930. The greatest prevalence of
smallpox that year was in South Dakota, with 259 cases per 100,000
population. Indiana reported 164 cases of smallpox per 100,000 population, and the State of Washington 152 cases per 100,000.
During the calendar year 1930 the incidence of influenza in the
United States was unusually low. The death rate from influenza
for the year 1930 was 18.7 per 100,000 population, as compared with
54.6 per 100,000 in 1929 and 42.1 in 1928. The death rates per
100,000 population from influenza and pneumonia combined for
these three years were as follows: 1930, 101.8; 1929, 149; 1928, 143.2.
The :fact that there was no general outbreak of influenza during
1930 probably helped greatly in keeping the general death rate for
the year low, as there is usually an increase in the number of deaths
attributed to certain other diseases when influenza is prevalent.
Infantile paralysis was more prevalent during the calendar year
1930 than it was in 1928 or 12,29. In the spring of 1930 the reports
showed increa 9ed incidence of infantile paralysis on the Pacific coast,
and later considerable numbers of cases of the disease were reported
in other parts of the country, especially in Louisiana, Oklahoma,
and some of the North Central States. In the country as a whole
infantile paralysis reached its peak for the year about the 1st of
October. An outbreak began in New York City soon after the close
of the fiscal year.
The tuberculosis death rat e for the calendar year 1930 was the
lowest ever recorded by the Public Health Service. It was 68.5
deaths per 100,000 population, as compared with 73.1 in 1929 and
76.4 in 1928. In 1900 the Census Bureau recorded a death rate from
tuberculosis of 201.9 per 100,000 population. The difference between the tuberculosis death rates of 1900 and 1930 represents a
saving of more than 160,000 lives in 1930, which would have been
lost from tuberculosis in the United States if the 1900 r ate had
prevailed that year.
The prevalence of typhoid fever has been decrea.s ing in the United
States since comparable yearly statistics of cases and deaths have
been available. During the calendar year 1930, a slight reaction
was s~own by the reports. ~he increase was reported during the
last s!x months of 1930, and m som_e. State,s, :3-t least, it may have
b_een rnfluenced by the drought cond1t10ns, which resulted in pollution of water supplies or necessitated the taking of drinking water


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from new or unknown sources. The typhoid fever case rates, as
computed from reports to the Public Health Service, were as follows:
Cases per 100,000
population

1930------------------------------------------------------ 22.0
1929-----------------------------------------------------19.0,
1928
______________________________________________________ 22.7

Ten years earlier, 1920, the typhoid fever case rate was 38.5 per
100,000 population.
The case and death rates for diphtheria in •1930 ·were · the lowest
which the Public Health Service has ever recorded-54.2 cases and
4.9 deaths per 100,000 population. ',Ten years ago, in 1920, the diphtheria case rate was 155 per 100,000 and the death rate was 15.3 per
100,000.
From 1924 to 1928 there was an increase in the prevalence of pellagra in the United State.s. In 1929 the reported incidence of the
disease decrease_d somewhat, and there was a further decrease during
the year 1930. During the first six months of 1931, howev:er, 16,385
cases of pellagra were reported to the Public Health Service, as
compared with 13,359 cases reported during the first six months
of the preceding year.
Tularaemia was reported during the calendar year 1930 from all
of the States except Maine, New Hamp.shire, Vermont, Connecticut,
Rhode I sland, and Arizona. Massachusetts reported one case of the
disease. The reports are incomplete, but a total of 660 cases of tularaemia was reported.
From 1924 to 1929 there was a steady increase in the incidence
of menin,gococcus meningitis in the United States. During the
year 1930, however, there wa_s a decrease as compared with the figures
for the preceding year. In 1930, 7,747 cases of meningococcus meningitis were reported to the Public Health Service; in 1929, 9,584:
cases; and in 1928, 5,252 cases.
More than 1,450 cases of undulant fever were reported to the
Public Health Service for the calendar year 1930. The disease has
been recognized in every State of the Union.
Rocky Mountain spotted fever is not reportable in many of the
States east of the Rocky Mountains. In 1930, 167 cases were reported in California, Colorado, Idaho, Montana, Nevada, Oregon,
Washington, and Wyoming. During the year worker.s of the Public Health Service identifi€d, by laboratory and clinical studies,
Rocky Mountain spotted fever, eastern type, in several States along
the Atlantic seaboard. There is evidence to indicate its existence
in this area at least since 1909. In 1931 cases were reported in the
District of Columbia and Maryland.
PREVENTION OF THE INTRODUCTION OF DISEASES FROM .ABROAD

During the fiscal year no instance occurred of the importation
from abroad of any quarantinable , disease into the United States.
Four cases of smallpox reached our quarantine stations and were
detained. Two cases of cholera occurred on interisland vessels in
the Philippine Islands.
At the beginning of the fiscal year cholera was present in epidemic
form in several of the islands in the Visayas. There was also a


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minor epidemic in t1:e city of Man_ila, some 50 cas_es occurring there.
Interisland quarantme was put mto effect agamst several po~ts,
effective at various times during the year, viz, Manila, Cebu, Ilo1lo,
the Province or Iloilo, the Province of Capiz, the island of Bohol,
and the island of Samar. This epidemic, however, can not be attributed to any recent importation, as past history shows that cholera
recurs in epidemic form in these islands every four or five years
and may be considered as endemic there.
Health conditions reported during the year regarding the possible
presence of yellow fever near certain ports of South America on the
Carribbean coast, particularly the western part, and on the east
coast from the Amazon River to Rio de Janeiro, were such as to warrant the issuance of instructions to quarantine officers at stations
located on the Gulf and Atlantic coasts south of the southern boundary of Maryland to be on the alert in making the quarantine
inspection of vessels which have called at these ports, especially at
the smaller ports along the east coast of South America. The port
of Para (Belem) at the mouth of the Amazon River is regarded as
infected, and scattered cases have been reported at various interior
points more or less close to several of the seaports along the coast.
It is understood that the Brazilian authorities are maintaining an
effective antimosquito campaign in the principal seaports and that
danger of maritime spread is decreased accordingly. Information
has also been received from reliable unofficial sources indicating the
occurrence of suspected cases of yellow fever in the interior of
Colombia in the region of Santa Marta ·and Barranquilla, but as yet
these reports lack official confirmation.
At domestic ports during the year 14,955 vessels, 773,743 passengers, and 1,039,524 seamen were inspected on arrival by quarantine
officers; at insular ports 3,417 vessels, 161,037 passengers, and 235,537
seamen were inspected; and at foreign ports 4,132 vessels, 365,194
passengers, and 316,711 seamen were inspected prior to embarking
for the United States.
Of the passengers who embarked at European ports, 41,737 were
vaccinated and 38,639 were deloused under the supervision of medical officers of the service. Clothing and baggage of these passengers,
amounting to 54,763 pieces, were disinfected.
A total of 4,072 vessels were fumigated either because of the occurrence of disease aboard or for the destruction of rats as a plaguepreventive measure. Of the rodents recovered following :fumigation, 6,073 were examined for evidence of plague infection.
While Executive Order No. 5143, approved June ~1, 1929, restricting for the time being the transportation of passengers from certain
ports in the Orient, remained in force during the fiscal year 1931
the regulations prescribed in accordance with the provisions of this
Executive order have been modified from time to time as conditions
warranted, so that now the very minimum requirements are imposed
and no undue hardship results. In connection with the occurrence
of cases of cerebrospinal. mening~tis among st~erage passengers on
vessels en route from oriental ports, the Public Health Service is
now conducting a study of ventilation and berthing facilities on
vessels of _a steamship line en~aged in the carriage of oriental steerage to Umted States ports. Tnese studies are being conducted jointly


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by representatives of the Public Health Service, the steamship line
medical service, and the University of California.
The problem of the sanitary control of aerial navigation has been
receiving international attention for several years, finally culminating in a proposed international convention for the sanitary control
of aerial navigation. This proposed convention formed the principal
topic for discussion at the last two meetings o:f the permanent committee of the Office International d'Hygiene publique, in Paris, October, 1930, and May, 1931, as well as at the meeting in April, 1931,
of the Second Pan American Conference of Directors of Health
held in "\Vashington, D. C., under the auspices of the Pan American
.Sanitary Bureau. Thus the views o:f the two most important international health bodies were incorporated in a final draft as adopted
by the permanent committee of the Office International d'Hygiene
publique at its meeting in Paris in May, 1931.
Of international interest also is the problem o:f the control of
p sittacosis. This subject will form one of the major topics for discussion at the forthcoming meeting of the permanent committee of
the Office International d'Hygiene publique in Paris in October, 1931.
The regulations o:f the United States for the control of this disease,
prescribed in accordance with Executive Order No. 5264, issued by
the President on January 24, 1930, restricting for the time being the
,i ntroduction of parrots into the United States, have been modified
during the past year to permit the importation of commercial shipments o:f these birds under approved sanitary restrictions relating
to crates, air space, and other conditions of transportation. This step
was taken after very careful deliberation on the part of the Public
Health Service and aft(jr a conference with representatives of the
Pet Dealers Association of America and members of the Biological
Survey of the United States Department of Agriculture.
During the past year a change has been made in the application
of the measures designed to prevent the spread of typhus fever at
•ports of embarkation. This step was taken in view of the better
organization of sanitary services and improvement in sanitary conditions now obtaining throughout Europe. Where formerly the
application of the measures designed to prevent the spread of typhus
fever were based upon broad geographic areas, now their application is contingent upon the actual endemic or epidemic prevalence of
typhus fever in such ports, places, or areas from which persons
destined for the United States have originated or embarked.
During the fiscal year the special studies o:f the fumigation of
ships as a plague-preventive measure, which were begun last year
at the New York quarantine station, were continued with marked
progress. A summary of these investigations has been prepared
for the information of the members of a special commission to make
a study of the fumigation of vessels, appointed by the health section
o:f the League of Nations, which will visit the United States during
the autumn, to study methods in use at United States ports, with
particular reference to the fumigation o:f ships with various forms
of hydrocyanic acid upon arrival from plague-infected ports while
cargo laden.


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MEDICAL EXAMINATION OF ALIENS

At domestic ports, 761,436 alien passengers and 916,868 alien seamen were examined by medical officers under the immigration laws.
Of this number, 19,962 passengers and 1,597 seamen were certified
for various diseases and disabilities. The most important causes
and the numbers of aliens certified therefor were as follows: Trachoma, 340; tuberculosis, 181; feeble-mindedness, 114; insanity, 75;
syphilis, 281 ; gonorrhea, 315. Of the alien seamen examined, 21
were certified for trachoma, 26 for tuberculosis, 178 for syphilis, 178
for chancroid, and 447 for gonorrhea.
There has been no material change during the past year in the
system of making medical examinations of applicants for immigration visas in their countries of origin in Europe. On July 1, 1930,
an office was opened in the American consulate at Vienna, Austria,
where applicants are medically examined before visas are granted.
The system of the medical examination of applicants for visas at consulates was inaugurated during the past year in other forei~n countries, viz, Canada, Mexico, and Cuba. At several of the Canadian
stations medical officers of the Public Health Service are performing the medical examination of intending immigrants for both the
local office of the Immigration Service of the United States Department of Labor and for the Department of State.
During the fiscal year ended June 30, 1931, a total of 103,078 applicants for immigration visas were given medical examination in
the country of origin. Of this number, 79,058 were examined by
medical officers of the service attached to American consulates in
Europe; 15,080 of these, or 19.7 per cent, were found to have mental or physical defects; 7,413, or 9.6 per cent of the total examined,
were refused visas for medical reasons. Of 94,412 aliens who had
been given a preliminary medical examination abroad and to whom
visas had been issued, only 11 were finally certified upon arrival at a
United States port as being afflicted with class A diseases, resulting
in mandatory deportation.
l'REVENTION OF THE SPREAD OF CONTAGIOUS AND INFECTIOUS DISEASES
IN INTERSTATE COMMERCE

During the year changes in procedure in carrying out the certification of drinking-water supplies used by common carriers and
vessel water-supply systems tended to increase the efficiency of this
work. Approximately 87.5 per cent of 2,275 drinking-water supplies
used on interstate trains and 88 per cent of the 243 . supplies on
interstate vessels were inspected and reported upon. Of the 2,118
vessels listed as engaged in interstate traffic, 1,124 were inspected,
and of these 893 were given favorable certification. With the continuance of the procedure now in force it is believed that the percentage of_ water supplies supervised and controlled will be materially increased. With more frequent yearly inspections of vessels
the interest of operating companies is maintained, resulting in
fewer violations once a vessel has met the requirements.
The present method of control over shellfish sanitation has been
reasonably satisfactory, but some change in the procedure is being


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considered whereby this control may be improved. In Massachusetts approval has been given tentatively for the interstate shipment of clams conditioned in water made sterile by chlorine, provided that the plants are operated under State supervision. Threeconditioning plants are already in operation in Massachusetts, and
a fourth one is under construction. Further study of methods of'
conditioning are necessary, but the process is one presenting many
possibilities.
Cooperation with other governmental bureaus and agencies in.
connection with advice and assistance in sanitary engineering and
sanitation problems increased during the year. This work has.
become a very appreciable part of the activities of the sanitary
engineers of the service, occupying 31 per cent of the time of the.field force.
At the request of the Commissioners of the District of Columbia.
and the Director of Public Buildings and Public -Parks, the service has undertaken the coordination and supervision of mosquito
control work in the District of Columbia. The number of agencies
involved somewhat complicates the problem, but the cooperat10n received and the interest taken have made possible fairly effectivecontrol during this first year.
Regular cooperative rural sanitation demonstration projects were
conducted in 223 counties in 28 States. On January 1, 1931, a
survey made by the Office of Rural Sanitation showed that therewere 557 counties with full-time health service in the United States ..
This represented a gain of 52 over the preceding year.
On February 6, 1931, Congress appropriated to the Public Health
Service the sum of $2,000,000 for emergency health work in thedrought-stricken areas. In carrying out this work a modification
of the plan used for the regular cooperative rural sanitation activities was adopted, with the result that details of administration werequickly worked out with the States, and field projects were under way within a short time. By June 30, 1931, there were in operation in the 16 States within the drought areas 333 field organiza-tions, including projects covering 395 counties. The work carried
on has consisted in the activities usually conducted by full-timecounty health units, with special emphasis upon the prevention of
communicable diseases by general immunization, the sanitation of·
milk and water supplies, the improvement of excreta disposal conditions, and attention to the health of infants, children, and mothers.
It is believed that many of the temporary units organized will'
serve to stimulate the establishment of permanent health depart-.
ments supported with local funds in the future.
Trachoma-eradication work was continued at Rolla, Mo., Knox-ville, Tenn., and Richmond, Ky. Following the prevalence survey·
made by the Public Health Service at the request of the State commissioner of health of Georgia, arrangements were made for theopening of a treatment center at Bainbridge, in Decatur Countv.
The work carried on in the several States included not only opera-.
tions upon cases in dispensaries and hospitals, but searches :for affected individuals, follow-up visits, and general educational activities
carried on in the rural sections by public health nurses attached to.
the clinics. A total of 66,000 individuals were examined in schools,.


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homes, field clinics, and dispensaries. There were 1,196 operations
and 8,380 other treatments given to 3,895 cases seen.
Plague-eradication activities included intensive rodent control
measures carried on in cooperation with State and local authorities
in four California counties-Alameda, Contra Costa, San Francisco,
and San Mateo. In addition to the work done by the Public Health
Service in these four counties, a large amount of ground squirrel
eradication work was carried on by the county horticultural commissioners and the State health department in other localities. Two
new foci of plague in ground squirrels were found in Monterey
County. Rodent surveys, trapping operations, sanitary inspections,
and laboratory examinations were continued in San Francisco. Approximately 36,000 rats trapped in San Francisco and Oakland were
examined. No case of plague infection was found among the rats
examined during the year.
I

INVESTIGATIONS OF PUBLIC HEALTH PROBLEl\IS

The appropriation available for cancer has permitted the expansion and reorganization of the work along the following lines:
Studies at the cancer investigation station located at the Harvard
Medical School, Boston, Mass., are divided as follows:
( 1) Studies of the biological effects ·of radiation. This includes
the investigation of the biological action of the whole spectrum of
radiation, from the highest-frequency X rays to electromagnetic
radiation.
(2) Studies of resistance and immunity to malignant growths.
Experiments have shown that mice bearing the strain of mouse sarcoma designated as No. 180, rats bearing rat sarcoma No. 10, or
chickens bearing the Rous fowl sarcoma, which had recovered from
these tumors as the result of treatment with high-frequency currents
are frequently resistant to reinoculation. In the case of mouse sarcoma No. 180, if this be inoculated into the tail of the animal the
tumor grows much more slowly than when implanted in the usual
sites of the groin or the axilia. The diminished rate of growth gives
time for fuller development of the tumor. If, then, after suitable
interval, the tail tumor is destroyed by the application of high-frequency currents or amputated, in about 70 per cent of the cases the
animal is found to be immune to reimplantation in the usual site.
(3) Study of the biochemistry of malignant cells. Efforts will
be directed toward an intensive study of the inorganic constituents
of malignant as compared with normal cells, particularly with
reference to inorganic constituents which are present in minimum
amounts.
(4) Studies of susceptibility to malignant growths and its modification. Experiments are now under way designed to study the
modifying effects, if any, of certain procedures on the tumor rate.
Sufficient time has not yet elapsed to determine the outcome of these
experiments.
Studies at the National Institute o.f Health relate particularly to
the :factors concerned in the growth of normal cells and cancer cells.
This is of fundamental importance, since an outstan¢ling character80597-31-2


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istic of cancer cells is their unrestrained proliferation in the human
and animal body. It has been shown that glutathione apparently
plays an important function in cellular metabolism, and its effect
on cell division has emphasized the need for further chemical and
biochemical know ledge of this substance. Measurement of the
hydrogen-ion concentration of tumors is of value in work on cultures of malignant and normal tissues, so work is being done on the
development of a microelectrode suitable for such measurement.
The treatment of leprosy patients at the station in Hawaii continued to be directed mainly toward determining and relieving abnormal
conditions and applying general therapeutic measures, since experience has shown that attempts to treat leprosy specifically with any
known remedy is productive of only indifferent results.
The continuous and intermittent dusting studies for the control of
the Anopheles mosquito, begun in the early summer of 1929, were
continued during the present fiscal year. The results of this year's
progress indicate a considerable degree of success.
Special studies have been conducted in the bionomics both of
malaria and of its vector, the Anopheles mosquito, in an effort to
develop a biological attack against the disease.
A new study has been undertaken to determine the best method of
transmitting a pure strain of benign tertian malaria to various institutions for the insane to be used in the treatment of paresis.
Studies in nutrition have consisted largely of the determination of
the relative pellagra-preventive potency of single staple food and
foodstuffs. A study of canned spinach showed it to contain the antipellagric vitamins, but not to a degree sufficient for complete protection against the disease, while canned turnip greens gave complete
protection. Canned green stringless beans were shown to be a relatively poor source of the antipellagric vitamin. The determination
of the pellagra-preventive value of canned foodstuffs is of immense
practical value, since they may be obtained at the time of the year
when the diet is most restricted and p ellagra is most prevalent.
Studies of the fatty degeneration of the liver in dogs have been
completed, and the results indicate that the condition is probably due
to some dietary deficiency.
The increasing knowledge of the extent and importance of tickborne diseases in this country, and particularly of Rocky Mountain
spotted fever, has led to the need for additional space, which has
been met by the act of Cangress approved February 27, 1931, providing for the purchase of the Montana State Board of Entomology
Laboratory located at Hamilton, Mont., and for the construction of a
new laboratory building.
The amount of Rocky Mountain spotted fever vaccine manufactured has been doubled during each of the past four years. The
season of 1931 is the first since the use of the vaccine was begun in
1925 during which it has been possible to fill all requests. There
were 54.1 liters distributed, as compared with 31.2 in 1930. It seems
certain that the demand for vaccine will continue to increase. There
is a growing demand for vaccination among Federal employees in
exposed occupations.
Evidence has been secured that second infections of Rocky Mountain spotted fever ma y occur. It is likely, however, that the gen-


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erally accepted idea that infection confers immunity of long duration is justified in most cases.
Two important discoveries in connection with the investigations
of typhus fever have been made during the year. The suggestion
that some vector other than the body louse may be responsible for
the transmission of endemic typhus of the United States has been
made by a number of investigators, and during the year service
officers discovered that fleas served as vectors of the disease. Further epidemiological and laboratory studies are being made on this
subject.
A disease of the Rocky Mountain spotted fever type has been
identified as occurring in States in the eastern and southeastern sections of the United States. During the course of field investigations
of endemic typhus it became apparent that many of the cases observed differed materially in clinical aspects from endemic typhus
as described by earlier investigators. It was noted that many of the
cases suffered from a very severe disease which did not correspond
to the clinical picture of endemic typhus and which resembled the
spotted fever of the Rocky Mountains more closely than it did any
other disease. Moreover, quite a high proportion of these cases gave
a history of tick bite within a short time preceding onset. Laboratory studies confirmed the epidemiological findings. This eastern
type of spotted fever has so far been found to exist in rural communities in Delaware, Pennsylvania, Maryland, the District of
Columbia, Virginia, and North Carolina.
The study of the mental status of children of various types of
birth includes the investigation of their family history, significant
experiences, home environment, developmental history, medical history, personality traits, the behavior record, and school life, together
with the obstetrical history of the mother. ·when these factors are
correlated it is believed that some light may be shed upon the effect
on the child of various obstetric procedures.
The need for further research in the mental hygiene of childhood
has long been recognized, and a study of children of patients in
State hospitals for the insane has been begun in an attempt to
determine the effect, if any, upon them which may be attributed to
association with psychotic adults.
Three additional studies of the health of workers exposed to dust
have been completed. No excess in the sickness rate from respiratory or nonrespiratory disease was found when a group of street
cleaners in the downtown area of a large city were compared with a
similar group in a residential area where the dust content of the air
was much less. Study of the effect of dust in a cotton-cloth-manufacturing plant showed no apparent relation between the dust and
disease. Similar negative results were obtained in a study of dust
exposure in a silverware-manufacturing plant. These results confirm those obtained in the first two dust studies (Portland cement
and granite), to the effect that the relation of dust to health depends
on the quantity and nature of the dust and on the duration of
exposure.
The s_tudies of the hazards in the radium-dial-painting industry
have shown that there is evidence of the accumulation of radioactive material even under the improved conditions which have ob-


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tained since 1926, although there is no indication that any individual
employed since 1926 has been injured. It is believed, however, that a .
still further· marked reduction of exposure to prevent accumulation
and to provide a sufficient factor of safety under varying conditionsshould be made.
The possible hazard from methyl alcohol used as a substitute for·
denatured alcohol to prevent freezing in automobile radiators has
been brought to the attention of the Public Health Service, and an
agreement has been reached with the industry for the adoption of
safeguards. In this agreement, reliance is placed on a distinctive
coloring, a chemical deterrent, and a warning label.
The final report in the studies of physical development and posture has shown that the most marked characteristic of the data
obtained was the wide variation in postural relations from person
to person. No fixed types of posture could be found. Gradual variation of such magnitude as to defy classification into particular types
was the rule.
There are now 437 cities located in 24 States which have adopted
the standard milk ordinance for the improvement of milk supplies
recommended by the Public Health Service. A number of research
activities in connection with milk investigations were inaugurated.
These studies include (1) means for heating the air and foam above
the milk in pasteurization vats, (2) the determination of the most
effective and practical devices and methods for the bactericidal treat7
ment of utensils and equipment at dairy farm and pasteurization
plants, (3) the public health importance of milk cooling, ( 4) theproper design of milk-sample shipping containers, ( 5) the public
health value of chlorine disinfection of udders and hands in connection with the/rocess of milking, and (6) laboratory methods for
the estimation o milk quality from the public health point of view_
Records of illness during a 12-month period in a group of about.
10,000 families scattered throughout the United States have been
made available to the Public Health Service. These data are being
tabulated, and it is expected that this study, which represents a very
complete and detailed statement of the illnesses and medical care
received by the family during the year, will be of great value in the
field of epidemiology and public health.
The resurvey to determine the present sanitary condition of the
Ohio River between Cincinnati, Ohio, and Louisville, Ky., has been
completed. This resurvey has included the collection of 2,000 water
samples, the chemical and bacteriological analyses at 10 main river
points and from 4 of the larger tributaries between Cincinnati and
Louisville, and the collection and tabulation of the necessary hydrometric data and information relative to contributing population and
sources of existing pollution. Preliminary analyses indicate that
important changes have occurred in the river since the previous
investigation in 1914-1916 and suggest rather definite conclusions as
to the effect of canalization during the summer period.
Studies of the efficiency of artificial water purification processes
have made it possible to prescribe definite limits in accepted bacteriological terms for sources of raw water from which purified water
supplies in the Great Lakes and Mississippi River basins are derived.
This is perhaps the most practical immediate result of the studies,
though of scarcely secondary importance is the knowledge which


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-they have afforded of the fundamental characteristics and limitations
,of water. purification processes in general.

The office of Studies of Public Health Methods was reorganized.
-Oonsultation service to local health officers has been continued, and,
in addition, stress has been placed on scientific research in administrative practice. Plans have been developed for a special study
to determine the public health needs of people living under rural
conditions, how these needs are being satisfied, and the extent to
·which the small county health department is capable of meeting the
demand now being imposed on it.
An appropriation of $300,000 was authorized under the second
•deficiency act for the fiscal year 1931 to begin work on new buildings
for the National Institute of Health, such buildings not to exceed
·a total of $750,000. The necessity for these buildings is urgent to
_provide the required facilities for work now being conducted by the
National Institute of Health.
Studies indicate that approximately one half of the cases of
·undulant fever reported are traceable to the use of raw milk from
infected animals, and the other half are due to contact with infected
.animals on the farm, in stockyards, or in packing establishments.
In a considerable number of the cases in which infection was prob.ably received through contact with infected animals there is also
.a history of the use of raw milk. The prevention of milk-borne
undulant fever can be accomplished by pasteurization of the milk,
·but the prevention of the contact-borne cases lies in the detection
:and elimination of BmceU(J) infection from the livestock herds of the
country.
The State of Delaware was added to the area of distribution for
·tularaemia, leaving only the four States of Maine, New Hampshire,
Vermont, and Connecticut in which the infection has not been recognized. Studies on tularaemia at the field laboratory of the service
located at Hamilton, Mont., have been directed toward determining
·susceptibility of various animals and the transmissibility of tula.raemia by mosquitoes.
Studies of postvaccination encephalitis have resulted in a col:lection of data for 62 proved or probable cases for the past 10 years.
Extensive attempts to produce the disease in laboratory animals
by means of vaccine virus have uniformly failed to give the pathological picture of the disease.
Studies of the effect of hemolytic streptococci and their products
-0n leucocytes has established that a toxic substance which disintegrates the leucocytes is produced by the action of hemolytic strepto-cocci on red blood cells.
A new organism, designated Alcaligenes faeoalis, subspecies ra.dicoms, was described. It was obtained by blood culture from a mild
case of enteric disease which at first resembled typhoid fever.
The results of studies of the etiology of the epidemic of ginger
paralysis showed it to be due to the consumption of ginger extract
adulterated by the addition of triorthocresyl phosphate. Further
studies have been made on the toxic action of other esters of phenolic compounds as compared with that produced by triorthocresyl
phosphate.
Work on the chemotherapeutic action of arsenicals has been continued, particular attention being paid to the mechanism of the


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action of arsenic on protoplasm. Research was completed on the.
relation of arsenic to the fixed sulphydryl groups of proteins, with
interesting findings with reference to the physiological and pharmacological function of proteins.
A number of new sugar compounds have been discovered in connection with the sugar researches. The studies of these new compounds, which are of importance in the field of sugar -chemistry,.
which, in turn, is of importance in many problems of health and
disease, may also help, as similar studies have in the past, to increase
our know ledge concerning chemical constitution in organic chemistry
in general.
The first meeting of the National Advisory Health Council was
held on April 9 and 10, 1931, when the work of the Public Health
Service was reviewed. Suggestions were offered for new lines of
endeavor, but the council as a whole felt that the present work should
be continued without material change.
THE MARINE HOSPITALS AND OTHER RELIEF STATIONS

In 157 ports of the United States and its possessions hospital care,.
out-patient treatment, and other medical services were furnished to
American merchant seamen and other legal beneficiaries. Although
90 per cent of the hospital treatment is furnished in the marine
hospitals, contracts are maintained with 196 public and private hospitals in the smaller and remote ports. Merchant seamen continued
to be the most important class of beneficiaries, receiving 3.3 per cent
more hospital treatment and 14 :per cent more out-patient relief than
in the preceding year. In addit10n to the treatment provided at the
marine hospitals and other regular relief stations for the Coast
Guard, which now has a personnel of more than 13,000 men, 22·
medical and dental officers were detailed for duty on vessels and
elsewhere and 108 part-time local physicians served isolated Coast
Guard units. The usual assistance was §o-iven to the Civil Service
Commission, the Steamboat Inspection ervice, Employees' Compensation Commission, Veterans' Administration, and other Government establishments.
The medical services furnished for the Employees' Compensation
Commission would, it is estimated, have cost the compensation fund
more than $1,000,000 if obtained from private sources. A daily
average of 842 patients of the Veterans' Administration were treated
in marine hospitals in ports where the use of these, institutions has
made the construction of special hospitals unnecessary. Cooperation
with the Veterans' Administration has been close and cordial.
For all classes of beneficiaries an aggregate of 1,666,215 hospitalpatient days and 910,466 out-patient treatments were furnished and
94,487 physical examinations made for purposes other than medical
treatment. The number of leper patients at the National Leper
Home increased from 308 to 337 during the year.
Satisfactory progress has been made with the building program.
Construction of the new marine hospitals at Galveston, San Francisco, and New Orleans has been nearly completed and work has
commenced on the Seattle institution. The contra.ct has been let
for the addition at Key West. Architects are engaged in the preparation of plans for the new marine hospital buildings at Stapleton, New


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York, Baltimore, Norfolk, Louisville, Chicago, Evansville, Detroit,
Memphis, and Mobile. The building program not yet provided for
includes additional or improved hospital facilities for the National
Leper Home and the marine hospitals in Boston, Buffalo, Pittsburgh,
St. Louis, Portland (Me.), and Fort Stanton (N. Mex.).
PREVENTION AND CONTROL OF VENEREAL DISEASES

During the fiscal year ended June 30, 1931, the State health officers
of 43 States reported to the Public Health Service 227,470 cases of
syphilis, 154,809 cases of gonorrhea, and 3,987 cases of chancroid.
These diseases as a class continue to exceed the number of cases reported during the calendar year of any other single communicable
disease, with the exception of measles. The research activities have
been continued along the lines followed in the preceding year.
Special studies of the carrier problem of syphilis were inaugurated
in the research laboratory of the marine hospital at Stapleton, N. Y.,
from the standpoint of determining the duration of infectivity in
treated and untreated syphilitics. The search for an efficient prophylactic method was continued during the year with inconclusive
results.
Increasing importance is attached by syphilographers to the early
diagnosis and treatment of syphilis. The possibility of extending to
rural and remote districts the advantages to be derived from early
diagnosis by means of microscopic examination was studied, and
one method was worked out. This method has been tested by other
observers and at present is in operation by the health department of
one State and is under consideration by others.
Valuable research on the use of biologic products in the diagnosis
and treatment of gonorrhea was continued during the year to include fractioning the gonotoxin, which should lead to some definite
knowledge with r·e gard to the therapeutic values of the separate
fractions.
The malaria treatment of general paralysis of the insane is now
generally considered the most effective treatment of this condition.
As a result the Public Health Service receives each year an increasing number of requests for infected material for inoculation purposes. Plans are under' way to supply this need and to make further
studies of this method of treatment in cooperation with various institutions where it is being applied.
The special study of syphilis among negroes in rural areas, in cooperation with State and local health authorities, inaugurated in
1929 with the financial assistance of the Julius Rosenwald Foundation, was expanded to include areas in five other States. A total
of 28,195 negroes were serologicalli ~~sted, and of. this number 5,785i
or 20.5 per cent, wer·e found syphilitic on the primary survey. Or
these positive cases approximately 75 per cent were placed on intravenous medication, and at the close of the year 45 per cent of them
had received treatment in amount considered sufficient to render
them noninfectious.
An important feature of the year's work has been the expanding
cooperation in the service and with other Feder·a l and nonofficial
agencies. Notably has this been the case between the Venereal
Disease Division and (a) the Hospital Division in the preparation

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of standardized case record forms, and (b) the Division of Mental
Hygiene in the establishment of standards for treatment of venereal
diseases among inmates of Federal penal and correctional institutions, with the Department of Justice (Board of Parole) in the
pr·e paration of a plan for additional treatment for discharged or
paroled prisoners, and with the Office of Indian A.:ff airs in the mass
control of syphilis among reservation Indians.
A 1-day census of the cases of venereal disease taken in three cities
shows marked variation in the relative incidence and prevalence of
these diseases as observed in different localities. A resurvey of one
entire State and of a number of communities originally studied in
1927, made in order to determine the trend of venereal diseases and
the effect of the methods ,e mployed for their control during the 3year period, disclosed the significant point that in communities where
increases in the prevalence rates were found . they occurred in the
group of chronic cases, an indication that patients are being treated
for a longer time than formerly.

1

NARCOTIO FARMS AND MEDICAL AND PSYCHIATRIC CARE OF FEDERAL
PRISONERS

The year ended June 30, 1931, marks the first full 12 months'
activities of the Division of Mental Hygiene. The functions of this
division, as defined by law, are both administrative and investigative
:in character.
During the year studies have been continued of the nature of drug
addiction and the best methods of treatment and rehabilitation of
persons addicted to the use of habit-forming drugs; information has
been disseminated on r'eSearches in this particular field; State and
local jurisdictions have been cooperating with the view to their providing facilities for the care and treatment of narcotic drug addicts,
while other agencies, both governmental and voluntary, have cooperated with a view to better coordination of effort in these particular functions.
Studies have been conducted dealing with the subject of the abusive
use of narcotic drugs and the quantities of such drugs necessary to
supply the normal and emergency medicinal and scientific requirements of the United States.
The site for the first narcotic farm, near Lexington, Ky., was acquired during the year and plans were begun for the development of
the necessary buildings to accommodate 1,000 inmates. A site for the
second narcotic farm, near · Fort Worth, Tex., was selected by the
three Cabinet officers charged in law with this responsibility.
A significant change affecting the individual · Federal prisoner
occurred during the fiscal year ended June 30, 1931. Under the act
approved May 13, 1930, the service inaugurated a system for supervising and furnishing medical and psychiatric services for Federal
prisons. This new function involved the employment of additional ·
medical and technical personnel. After preparing regulations governing the relationship to be maintained between the two departments concerned, the work was inaugurated at the United States
penitentiary, Atlanta, Ga., and the Federal Industrial Institution
for Women, Alderson, W. Va., on September 1, 1930; the United
States penitentiary, Leavenworth, Kans., on October 1, 1930; the


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United States Industrial Reformatory, Chillicothe, Ohio, on February 1, 1931; the Federal Prison Camp No. 2, Petersburg, Va., on
April 1, 1931; and the United States penitentiary, McNeil Island,
Wash., on June ·15, 1931. The medical work at the United States
penitentiary annex, Fort Leavenworth, Kans., was furnished by the
service in connection with the special studies of the nature of drug
addiction conducted among the drug-addict Federal prisoners segregated and confined in that institution.
Thus far, in the conduct of this important adjunct to the rehabilitation of Federal prisoners, the service has been concerned almost
wholly with the administrative problems involved. Future investigmtions and research studies have been planned, however, using the
clinical material available in these institutions.
COOPERATION WITH OTHER AGENCIES

During the past fiscal year the Public Health Service continued its
extensive cooperation with other public health agencies-international, F ederal, State, and local-and with private and voluntary
organizations. In certain instances these cooperative activities are
required by law, while in other cases they are considered essential for
proper public health administration. Among the most important of
such activities may be mentioned the following:
1. With t he Depar tment of State in the t reatment of sick , destitute seamen
retu rned from abr oad; in detailing commissioned medical officer s fo r duty at
consu lates in E urope, the British I sles, Canada, Mexico, a nd Cllba t o examine
intending immigrants for visa purposes, for the issuance of bills of health by
American consuls, and r elated quarantine work ; in the assignment of a medical
officer as one of t he delegates on the part of the United States to t h e Conference on the Limitation of t he Manufacture of Narcot ic D rugs, held in Geneva,
Switzerland; in a preliminary investigation of the health hazards connected
with the smelter f umes at T rail, B r itish Columbia.
2. With other bu reau s of the T r easury Depart ment in hospital care and
medical and hospital services to the Coast Guard, including retired personnel ;
by the assignment of medical and dental officers for duty at sh ore stations and
on vessels of the Coast Guard; by assignment of dental officers to the Coast
Guard cutter North,land, making a cruise to Alaska; in the development of
Yenereal disease control activities among Coast Guard personnel; in making
sanitary surveys of Coast Guard stations; in furnishing permits to ships for
medicinal liquor and narcotics ; service of Public Health Service officers on
committees for the examination and disposition of narcotic drugs; with the
Office of the Supervising Architect in the preparation of plans for the erection
of the first narcotic farm near Lexington, Ky.; and plans for water-supply and
sewage-disposal systems at border stations.
3. With the War and Navy Departments in physical examination of applica nts for Officers' Reserve Corps and citizens' militar y training camps; medical
a n d hospital services for civilians employed on vessels of the Mississippi River
Commission, Army :Inngineer Corps, and Army transports; treatment of officers
an d enlisted men of the armed forces (as pay patients) ; advising the P hiladelph ia Navy Yard regarding their mosqu ito-control problems.
· 4. With the Department of Justice in assigning a number of officers to furnish the medical and psychiatric services in Federal penal and correctional
institutions ; making sanitar y surv~ys of water-supply and sewer age systems and
milk supplies at penal instit utions ; in the sta ndardization of the treatment of
the venereal diseases in F ederal penal and correctional institutions ; in advisl..
ing with officials of the Bureau of Prisons relative to the location and planis
for t he Hospital f or Defective Delinquents a uth orized by the act of May 13.,
1930; assisting in medical pr oblems incident t o t he u se of contract jails and
prisons; wit h the Prohibition Bureau in the preparation of r eports on the
etiology of the epidemic of ginger paralysis.


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5. With the Post Office Department in supplying first aid and special physical
examinations; inoculation, against typhoid feYer, of employees handling mails,
and vaccination against smallpox; medical testimony in the suppression of
.
frauds.
6. With the Department of the Interior, Office of Indian Affairs, in a study
of dental caries due to dietary deficiencies among the Indians; in the investigation of water-supply and sewerage systems on Indian jurisdictions; in the
development and organization of mass control of syphilis among reservation
Indians; in continuing the assignment of medical officers to supervise medical
work among the Indians; the National Park Service in maintaining the joint
venereal disease clinic for indigents at Hot Springs, Ark. : and in the sanitary
supervision of national parks and monuments.
7. With the Department of Agriculture by the inoculation of certain field
employees against typhoid fever and vaccination against smallpox; by assisting
in the local enforcement of plant and animal quarantine; with the Bureau of
Animal Industry in cooperative milk studies to determine the relative merits
of goat, Holstein, and Jersey milks as a food for infants; with the Food and
Drug Administration in the enforcement of the pure food law in relation to the
adulteration of shellfish and by expert testimony ; with the Forest Service in
making sanitary surveys of national forests and watersheds.
8. With the Department of Commerce in the matter of standardizing and
administering procedures required of aircraft arriving in the United States
from foreign countries, and the development of marine standards, in cooperation with the American Marine Standards Committee, relating to ship sanitation; with the Bureau of Standards by the detail of a medical officer to give
medical relief and study industrial hazards; with the Bureau of the Census
by the collection of statistical data on crime, and on the defective, dependent,
and delinquent classes; with the Bureau of Mines in continuing a medical
officer on duty as chief medical officer, supervising the activities of a number
of civil-service physicians furnished by the Public Health Service, but whose
salaries are paid by the Bureau of Mines; with the Steamboat Inspection
Service in giving physical examinations and instruction and examination in
the principles of first aid of applicants for license as ships' officers; treatment
of lighthouse keepers and seamen from vessels of the Lighthouse Establishment, Coast and Geodetic Survey, and Bureau of Fisheries; furnishing medical supplies to lighthouse vessels; making sanitary surveys of lighthouse stations and examination of drinking-water systems on vessels; with the Bureau
of Fisheries in a survey of malaria conditions at the United States fisheries
station, Orangeburg, S. C.
9. With the Department of Labor by examining immigrants in the United
States and abroad and treating detained aliens, and standardizing and administering procedures required of aircraft arriving in the United States from
"
foreign countries.
10. With the Civil Service Commission by physical examination of applicants and employees, and for reinstatement and retirement.
11. With the United States Shipping Board in the physical examination of
crews and in the development of a program for prevention of venereal diseases
among seamen in the American merchant marine.
12. With the United States Employees' Compensation Commission by
furnishing hospital and out-patient treatment of disabled Federal employees ;
by physical examinations and special investigations; by providing a permanent board of medical officers for disputed and difficult claims; by medical
assistance in carrying out the longshoremen's and harbor workers' compensation act and the District of Columbia workmen's compensation act.
13. With the United States Veterans' Administration in physical examinations and hospital and out-patient treatment of patients; in furnishing advice
to the engineers on water-supply and sewerage systems at the veterans' hospital at orthport, N. Y.; with the Bureau of Pensions in physical examinations of applicants for civil-service retirement and for military pensions requested by that bureau.
14. With the Committee on Claims, House of Representatives, in giving
physical examinations of subjects of special bills.
15. With the Office of Chief Coordinator by detailing medical officers for
service on committees of the Federal Specifications Board and on the Federal
Standard Stock Catalogue Board.
16. With the Office of Public Buildings and Public Parks of the National
Capital in the sanitary inspection of Government office buildings in Washing-


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ton, and in mosquito control work on Government reservations in the District
of Columbia.
17. With the Federal detention headquarters in New York City in a study of
ventilating conditions at the headquarters.
18. With the Federal Trade Commission in rendering expert medical opinions
in determining justification for claims.
·
19. With the Health Department of the Panama Canal by the detail of an
officer to conduct special studies in malaria and of the bionomics of .Anopheles.
20. With the Office International d'Hygiene Publique, Paris, and the Pan
American Sanitary Bureau, ·w ashington, D. C., in matters relating to maritime
quarantine, and the exchange of information relative to the prevalence of quarantinable diseases. Officers have been detailed to the Pan American Sanitary
Bureau, and through that bureau have extended aid to various countries in
South America with relation to the suppression of quarantinable diseases.
21. With the health section of the League of Nations in the collection of data
requested from this country to be used in a world-wide clinical study of syphilis,
and in supplying information as to the prevalence of diseases in the United
States.
22. With all States of the Union in the collection of morbidity reports and
-epidemiological data relating to communicable diseases,
23. With all States in the supervision and certification of water supplies used
by common carriers in interstate traffic.
24. With State departments of health in securing reports of cases of venereal
diseases and compiling and publishing reports of State control and clinic
..J
.activities.
25. With the State departll}ents of health in segregating lepers at the National
Leper Home, Carville, La.
26. With the New York State Department of Health in the development of
,educational work on the prevention of venereal diseases.
27. With Mississippi, Alabama, Georgia, Tennessee, North Carolina, and
Virginia in the development of State venereal disease control activities.
28. With the States of Alabama, Arizona, Arkansas, California, Florida,
-Georgia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan,
Mississippi, Missouri, Montana, New Mexico, North Carolina, Ohio, Oklahoma,
Oregon, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington,
and West Virginia in making cooperative demonstrations in county health work
in counties in these States.
29. With Arkansas, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Montana, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia,
and West Virginia in cooperative county health work in the drought-stricken
.areas.
30. With Alabama, Connecticut, Delaware, Florida, Georgia, Louisiana, Maine, ·
Maryland, Mississippi, New Hampshire, New Jersey, New York, North Carolina,
Pennsylvania, Rhode Island, South Carolina, Texas, Virginia, and ·w ashington
in the investigation of shellfish-growing areas and the development of local
sanitary control machinery.
31. With Kentucky, Missouri, Tennessee, Georgia, Illinois, Oklahoma, and
Texas in measures for the prevention and eradication of trachoma, and with
Kentucky, Missouri, and Tennessee in maintaining hospitals for trachoma.
32. With Utah, Indiana, and Massachusetts in making surveys and furnishing
advice concerning mosquito-control measures.
33. With Colorado and Oklahoma in studies of public health admini tration.
34. With South Carolina in furnishing biological products used in the prevention of epidemic diseases.
35. With New York in an investigation of cases of psittacosis.
36. With Maryland in regard to a problem in connection with the effluent of
sewage treatment plant discharges.
37. With Delaware in the investigation of a suspected case of typhus.
38. With Louisiana in advice regarding the sanitary condition of drainage
channels in the vicinity of New Orleans.
.
39. With Tennessee in a survey of industries in Kingsport, with particular
reference to tuberculosis.
40. With Texas in developing a malaria control program, including a countywide screening project.
41. With Alabama by supplying a lecturer at the sanitary inspectors' school.
42. With New Jersey in the diagnosis of a case of spotted fever.


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43. With Oklahoma by the detail of an officer to outline a malaria control
program in that State.
44. With Iowa in a study of their lake and stream pollution problems.
45. With Louisiana by detail of an officer to assist in planning an investigation of the pollution of Bayou Bienvenue.
46. With Utah in connection with their mosquito control problem.
47. With California in an investigation of the outbreak of multiple neuritisresulting from drinking Jamaica-ginger extract, and in problems regarding thefunctionin g of the State narcotic farm.
48. With Wisconsin in advice concerning the sewage-di~posal and waterfiltration problems of the city of Milwaukee.
49. With Georgia by the detail of an officer to study the prevalence of"
endemic typhus fever in that State.
50. With Missouri by investigation of a suspected outbreak of smallpox.
51. With Georgia and Tennessee by county-wide dusting studies for the control of Anopheles mosquitoes.
·
52. With the State and city health departments of Wilkes-Barre, Pa., and
Baltimore, Md., in a survey of the public health administration of their city
health departments.
53. With the cities of Baltimore (Md.), Charleston (W. Va.), and New
Orleans (La.), and the States of Illinois, Arkansas, West Virginia, Kentucky~
and Oregon in venereal disease prevalence surveys.
54. With 17 States by the distribution of Rocky Mountain spotted fever-vaccine.
55. With the District of Columbia in mosquito control work in the District
and in .a study of causes for the disintegration of a concrete sewer.
56. With San Francisco, Calif., and with the •cities and counties in thevicinity of San Francisco Bay in rodent control and the operation of the plague
laboratory at San Francisco.
57. With Knoxville, Tenn., and El Paso, Tex., in making studies of public·
health administration.
58. With the Canadian Health Department in the enforcement of Canadianand American r egulations concerning water supplies u sed by foreign vesselsoperating on the Great Lakes and in shellfish sanitation work.
Cooperation has also been carried on with a number of organizations engaged.
in public health activities, namely, the infantile paralysis commission of Harvard University in studying the effect of artificial fever upon the development
of tlle virus of poliomyelitis; the Julius Rosenwald Fund in the promotion of·
syphilis control demonstrations among rural negroes in the Southern States;
the Milbank Memorial Fund in r esearch in syphilis and in studies of physic-al
impairments and occupation; the National Safety Council by officers serving on
.several committees; the Gorgas Memorial Laboratory in special studies of:
malaria; the drug committee of the National Research Council; the statistical
committee of the American P sychiatric Association; the psychiatric committeeof the American Medical Association; with the Bureau of Social Hygiene, New
York City, in matters r elating to mental hygiene; the governor's commission for
the State of Massachusetts appointed to study and survey the narcotic drug
situation in that State; with the Narcotic Education Association of the Community Chest Fund of Detroit, Mich., relative to the treatment, care, and after
care of drug habitues of that community, with special reference to the functioning of a local "narcotic farm"; with the American Hospital Association
concerning the best method of restricting to indispensable purposes the use of
na rcotic drugs in American hospitals; with the. American Social Hygiene Association in the conduct of venereal disease prevalence surveys and the publication and distribution of scientific literature on the management of syphilis and'
gonorrhea and the prevalence of these diseases; with various committees qf
the White House Conference on Child Health and Protection in preparation of
committee reports; with the Committee on the Costs of Medical Oar e in a study
of the inciden ce and cost of illness ; with the World Association for Adult
Education by Radio Committee in making a survey of State and local health
departments to determine the extent of the use of radio in the United States
for health education; the National Research Council by representation on the
Committee on Drug Addiction; the revision committee of the United States
Pharmacopreia in the development of certain standards; the Missouri Pacific
Railroad in a survey of malaria conditions along the southern portion of th1s
railroad; the American Railway Association in the formulation of regulations
concerning the sanitation of railway water supplies and coach-yard sanitation;.


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American Standards Association in assisting in the formulation of standard
specifications for household refrigerators; the Federation of Sewage Works
Association in formulating plans of research work in sewage-disposal problems;
with the Rockefeller Foundation in cooperative county health work and emer.g ency health work resulting from the drought; with the department of chemistry, College of Hawaii, in investigations of a preparation reported to be a
water-soluble derivative of chaulmoogric acid; with the Girl Scouts of the
District of Columbia and the Neighborhood House in making physical examinations; the American Social Hygiene Association in the conduct of venereal disease prevalence surveys and the publication and distribution of scientific literature on the management of syphilis and gonorrhea and the prevalence of
these diseases; with the reorganized committee on clinical research in syphilis,
comprising the directors of the syphilis clinics of Johns Hopkins University,
Mayo Clinic, University of Michigan, University of Pennsylvania, and Western
Reserve University ; and with the Marine Library Association in the distribution of educational material to seamen in the merchant marine.
By means of the cooperation maintained between the several divisions of
the bureau, advantage is taken of facilities, including hospital and laboratory,
for the efficient execution of the special work of a particular division.
During the year cooperative assistance has been received from a number
of unofficial organizations and laboratories. Laboratory facilities and other
valuable assistance have been furnished in connection with service investigations of cancer, leprosy, syphilis, mental hygiene, and trachoma; Harvard
Medical School, University of Hawaii, University of Kentucky, the Columbia
(S. C.) State Hospital for the Insane, Missouri School of Mines, and the Johns
Hopkins University for office space and records in the study of mental health
of the child of various types of birth. In addition, the Public Health Service
desires to acknowledge assistance received from the following agencies:
Florida State Board of Health, Indiana State Board of Health, Washington
State Board of Health, the city health departments of Baltimore, Buffalo,
and Milwaukee, and the University of Kentucky for Wassermann tests performed; the Department of Health of Porto Rico for the use of its laboratories;
the New York State Institute for the Study of Malignant Diseases for the care
and study of cases of suspected cancer. The cooperation rendered by these
several agencies is hereby acknowledged. Through this means the conduct of
important activities has been made practicable. This mutual relationship on
the part of official and unofficial agencies is to be encouraged in the interest
of the public health.
PERSONNEL

Shortly after the beginning of the fiscal year all of the personnel
changes made immediately necessary by the passage of the act approved April 9, 1930, had been made. It is apparent that the enactment of this legislation already has done much toward further
elevating the morale of the commissioned personnel.
RECOMMENDATIONS

The development and administration of Tesearch in public health
may be likened to the mining and recovery of a valuable metal.
The mining operations which require scientific knowledge, skill, and
patience, and necessitate constant exploration into unfamiliar
g:,;ound, correspond to the important and necessary research that
must be conducted in the public health laboratory, in the field, and
in the realm of public health administration. For considerable
periods these efforts may seem unprofitable, useless, and quite expensivei just as costly exploration by shafts and drifts, the thinning
of a vem, and the necessity for handling low-grade ore often make
the wisdom of mining operations seem questionable. From time to
time, however, public health research results in important discov-


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eries, emphasizing the necessity for cons!antly sel:Lrch~ng o~t and
testing new deposits of knowledge that await the patient mvestigator.
Following the discoveries, a _little more ~~an ha~f a century ~go,. of
the bacterial cause of many diseases, addit10nal important scie?-tific
discoveries were relatively easy, just as gold nuggets may be picked
up and "bonanza" ore deposits ~ound in a rich area in _the regi?n
of the mother lode. As explorat10n progresses, the makmg of discoveries becomes more difficult; as the field is more thoroughly
worked there follows a period of more routine activity, and the
important finds are less frequent; but exploration into what for a
tim~ may seem an unpromising field oftentimes yields results that
are most useful.
And, as with mining operations, investigative work into the cause
and prevention of disease is not without danger; several workers
of the United States Public Health Service have lost their lives in
line of duty in connection with studies of various diseases. The
Public Health Service has been the pioneer in opening up a number
of new fields of scientific inquiry relating to the cause, the mode of
spread, and the prevention of disease. In continuing the analogy
it might be pointed out that scientific studies and laboratory investigations which contain new data or any new £acts must be carefully
worked over and these new facts must be assembled and interpreted,
just as an ore must be treated and refined.
However valuable ore or metal may be, it fa of no benefit to mankind until it is actually utilized. This principle applies as well to
scientific discoveries, which, although important and of value, must
be put into actual use by public health officers in order that the benefits to be derived from these discoveries may be obtained.
With the progress of public health during the past half century
there has been much improvement in conditions of general environment, such as water supplies, milk, food, housing conditions, and
related matters having to do with the environment of the general
population. Although there is still need for constant vigilance in
these matters, there is not at the present time so urgent a need for
correction of general environmental conditions. However, with the
continued increase of the population jn many sections, there are still
many important problems relating to sewage disposal and water
supplies which must be considered. With the improvement of general environmental conditions, there is need for more emphasis upon
the environment of the individual as relates to occupation, personal
health) and similar matters. One of the important needs of the
present day in public health is the development of facilities for the
application of known facts relating to the prevention of disease.
This means a strenothening and development of health service as
rendered by local, 'state, and Federal health officials. Important
scientific discoveries may be made; but unless such discoveries are
applied to the prevention of disease, little benefit results. The following recommendations regarding the more important needs are
submitted:
SCIENTIFIO RESEARCH

An appropriation of $300,000 for beginning construction of an
additional building at the National Institute of Health was secured
in the second deficiency act for the fiscal year 1931. Careful study
has been given to the arrangement and character of the building to

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be constructed so that it may best fit in with the growing needs of
the National Institute of Health. This building should be completed as soon as possible in order properly to house work now being
carried on by the institute.
The act of February 27,.,. 1931 (Walsh), authorized the purchase
o:f the laboratory o:f the ~tate Board o:f Entomology o:f Montana
and the construction of a new building. The second deficiency act
for 1931 appropriated the funds for this purpose. This construction
is urgently needed, not only to provide facilities for the manufacture
of an increased amount of vaccine for the prevention of Rocky Mountain spotted fever, which is being demanded of the Public Health
Service, but also to accommodate the increased personnel engaged
upon this work.
Plans have been begun for the construction of a laboratory unit
at the marine hospital at San Francisco which will be devoted to
scientific studies. This construction will form the fourth unit for
laborator:v research. These units are the National Institute 0£
Health, Washington, D. C.; the stream pollution investigations laboratory at Cincinnati, Ohio ; the Rocky Mountain spotted fever
laboratory at Hamilton, Mont.; and the San Francisco laboratory.
This chain of laboratories should be developed as rapidly as possible
to allow facilities for the progress of scientific investigations and,
of more importance, for the training of officers and scientific
personnel.
RU RAL HEALTH

WORK

It is believed that rendering assistance to State and local authori=ties by the Public Health Service in the development and extension
of adequate rural health service constitutes one of the most important
activities of the Federal Government. The best way to prevent the
interstate spread of disease is to prevent the occurrence of transmissible illness at the source; sanitarians generally now concede.
that attempts to prevent the spread of highly contagious infections
through the application of local quarantine measures are effective
only to a very limited degree. The control of communicable diseases
has become largely a matter of community-wide activity, in which
environmental sanitation, general immunization, and intensive educational work play the most important part. The number of counties in the United States as yet provided with reasonably adequate
health service is comparatively very small, and it is difficult to
convince local authorities in many communities of the necessity for
such service until tangible results of the work have been demonstrated. To the end that extension of rural health service may
go forward more rapidly, it is considered most important that the
Public Health Service be enabled to continue this demonstration
work.
LEGISLATION

There should be legislative authority for paying the expenses of
the return to their former homes, or such other places designated by
their next of kin, of the dependents and personal effects of officers
who die in line of duty. At the present time, in the event of an
officer's death, only the expense of preparation and shipment of his
body to his home is authorized. The cost of bringing home his

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dependents and personal belongings must necessarily be borne from
private funds. It is felt that this is a financial obligation which
should be assumed by the service which has ordered him away
from his home in the discharge of its official functions.
Since the only allowance now made to commissioned personnel
assigned to temporary duty away from official station is mileage
at the rate of 8 cents per mile, subsistence, as well as transportation,
must be paid from this allowance. Should the assignment extend
over a considerable period of time, as the exigencies of the service
often require, and the temporary station is so far removed as to
preclude the daily return to the permanent station, the officer must
subsist himself from personal funds at his t~mporary duty station.
It would appear that the only source of relief to commissioned personnel from this financial burden would be through legislation, and
it is urgently recommended that such legislation be sought.
M ARITIME QUARANTI N E

The probability of the importation of disease via airplanes is
becoming more and more a problem of international interest. Regnlar lines of aircraft have been established, providing direct and
rapid communication between areas in Africa, Asia, and South America which have long been endemic centers of various pestilential
diseases. The journey by airplane from most of the endemic centers
of these diseases is usually less than their incubation period. An
example of this is shown in the recent reported occurrence of prob.able cases of yellow fever in the interior of Colombia, in the region
of Santa Marta and Barranquilla. Quarantine officers are required
t o be ever on the alert to detect cases of these diseases. In order
to carry out existing pro-visions of quarantine and immigration
laws relating to the medical examination of persons from foreign
countries, all airplanes from foreign countries should be required
to undergo quarantine and medical immigration inspections upon
arrival at designated airports of entry; and it is recommended that
the designation of airports as airports of entry should be limited
in number and confined to the principal airports possessing adequate
facilities along the frontiers, at many of which locations personnel
are already available. The designation of numerous airports as
airports of entry, particularly those in interior locations without
adequate facilities for the conduct of quarantine and immigration
functions, practically prevents the proper and necessary medical
inspection of planes and their passengers, inasmuch as medical personnel are not available for this work.
Properly to maintain the boarding and fumigating vessels required at the various quarantine stations, some 60 in number, a continuous replacement program is necessary. These vessels are
engaged in arduous duty, which requires special design for boarding and fumigation work in exposed locations, as well as especially
rugged construction. The continuation of the minimum-replacement program of two vessels per year, based upon a useful life of
30 years, is required to maintain this essential floating equipment,
a large portion of which is attaining advanced age and an additional
portion of which was of war-time construction, subsequently transferred to the Public Health Service without cost.
·

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In recognition of the performance of foreign quarantine operations as a Federal function, several States relinquished their performance to the Federal Government with the understanding that
facilities adequate to the needs of such work would be maintained
and supplied by it. In some instances adequate facilities are not
available, and in order properly to perform quarantine duties for
the protection of ports in these States in particular, and the country
in general, against the possible introduction of exotic and pestilential diseases from infected places abroad, it is recommended that
facilities adequate to the needs of such ports be provided.
PRINTING

There is an increasing need for more adequate appropriations for
printing. The establishment of the Division of Mental Hygiene,
with the natural increase of its work in connection with the development of the narcotic farms, the furnishing of medical service in Federal penal and correctional institutions, and the studies of the amount
of opium that may be allowed to be imported to meet the normal and
emergency needs of the United States, have all served to increase
the printing needs of the service. There has also been an increasing
demand from State and local health authorities for pubUcations
relating to the various phases of public health. The number of
requests from individuals for publications continues to increase.
PREVALENCE OF DISEASE

Many requests have reached the Public Health Service for authoritative information as to the effect of the present economic situation
upon the public health. Such information as was available was
furnished. Some of this information was rather meager. It
would have been most desirable to have been able to supply more
complete and comprehensive -information upon this subject. It
will be recalled that recommendations have been made for several
years past that a small appropriation be made for the purpose o:f
developing and stimulating better reporting of the notifiable diseases. Had such appropriation been available, the data furnished
in response to the inquiries received would have been much more
satisfactory and useful.
PERSONNEL

The widening scope of service activities and the increasing obligations imposed upon it, calling for additional specialized personnel,
as illustrated by the accomplishments heretofore mentioned, and
the future obligations involved call attention once more to the
pressing need for enlarging the number of regular medical officers
so as to permit and provide specialization in certain lines of its
essential work.
More regular medical and dental officers are needed for assignment to the marine hospitals and Federal penal and correctional
institutions, where the best service is provided by career men with
singleness of purpose, belonging to a mobile corps. Additional
medical officers are needed to make additional physical examinations
80597-31-3


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for the Civil Service Commission, :for which the present force is
inadequate, and to comply with requests from the Department of
Commerce and Department of Agriculture for medical supervision
of large groups of Government employees.
The sanitary engineering work conducted by the service for other
departments and bureaus of the Federal Government has rapidly
increased to such an extent that the present number o:f engineer
officers does not enable the service to meet the demands for snch
assistance and at the same time discharge properly its duties prescribed by regulations and law in relation to preventing the interstate spread of disease. If additional work be undertaken for other
governmental agencies, additional sanitary engineer officers will
be needed.

H.

s. CUMMING,

Surgeon General.

Hon. A. W. MELLON,
Secretary of' the Treasury.


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Federal Reserve Bank of St. Louis

DIVISION OF SCIENTIFIC RESEARCH
In charge of Asst. Surg. Gen. L. R.

THOMPSON

CANCER

Surg. J. W. Schereschewsky has continued in charge of the office
of field investigations of cancer, with headquarters at the Harvard
Medical School, Boston, Mass . .
During the past fiscal yea~ a considerable increase in the appropriation available for cancer investigations has permitted a corresponding expansion of the scope of the work. A biologist, a biochemist, and additional laboratory attendants were added to the staff
during the year, so that by the end of June, 1931, there •were 12 persons engaged in the work at this station. Consjderable time and
effort were also expended during the year in expanding the facilities
and in planning for and procuring the additional equipment required for the work.
The cancer research work has been organized and is being developed along the following lines :
(1) Studies of the biological effects of radiation.
(2) Studies of resistance and immunity to malignant growths.
( 3) Studies of the biochemistry of malignant cells.
(4) Studies of susceptibility _ to malignant growths and its
modification.
Studies of the biological effects of radiation.-The projected scope
of these studies includes the investigation of the biological action of
the whole spectrum of radiation, from the highest-frequency X rays
to electromagnetic radiation.
The following progress along these lines has been made during
the fiscal year :
Apparatus is being assembled and preparations are being made
to undertake a study of the biological action of X rays. The im portant physical factors to be determined are the wave length of
the radiation, the total energy of the beam, and the amount of
energy absorbed by the cells. Although much work has been done
to investigate the action of the X rays upon living cells with respect
to the wave length of the radiation, the results so far obtained can
not give more than a rough idea of such process, because the
physical factors involved have been determined only in approxjmate
fashion.
The plan of study now being developed at this station contemplates the use of methods much more precise than those which have
hitherto been employed, as shown by the following outline.
An X-ray generator has been designed and delivered which permits the variation of wave lengths within wide limits (from wave
lengths corresponding to 10 to those corresponding to 350 kilovolts) an~ which furnishes radiation of sufficient energy for th.is
27

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type of experiment at the various wave lengths within its range. By
means of a specially-constructed X-ray spectrograph of the Compton
type, provided with a special collimating device, radiation from
the X-ray generator may be analyzed so as to deliver beams of
homogenous X rays which at each frequency will have an intensity
sufficient to show a biological action on certain types of living cells.
It is proposed to begin with Drosophdw eggs as the biological
material, as these have been shown to be very sensitive to radiation,
and, in addition, as has been shown by numerous investigations,
their reaction to radiation can be measured with a considerable degree of accuracy. Other experiments are planned with bacteria,
embryonic tissues, malignant cells, and the like.
While it is possible to measure the absolute energy of the beam,
satisfactory information may also be obtained by measuring relative
intensities. This may be done by the use of an ionization chamber
of special construction filled with the rare gases, xenon ana krypton,
which have a high absorbing power for X rays. It will likewi~e
be necessary; in this connection, to measure the absorbing power of
the biological material in order to determine the amount of energy
which this absorbs.
It is hoped that this line of investigation will yield the following
information :
(1) The dependence, under exact physical conditions, of the biological
reaction upon the penetrating power of the radiation.
(2) The dependence of the reaction up·o n the energy density.
(3) The "mortality curve" for different energies at a given wave length.
( 4) The relative and perhaps an estimate of the absolute energy necessary
to destroy a cell.

Mitogenetic radiation.-In 1925 _Alexander Gurwitsch published
the exceedingly interesting observation that dividing cells emit a
radiation of a frequency in the -qltra-violet of somewhere in the
neighborhood of 2,000 to 2,400 Angstrom units. This radiation
emitted by the dividing cell has, according to Gurwitsch, the property of stimulating the process of cell division in neighboring cells.
Since the publication of Gurwitsch's original paper much work in
extending his original observation has been done by him and his coworkers, and his results have apparently been confirmed by competent European investigators. So far, in the United States, this work
appears to have attracted but little attention, as only one paper
( confirmatory of Gurwitsch's results) has appeared in an American
journal.
Since malignant cells are said to emit this so-called mito2;enetic
radiation, it would appear that the study of this phenomenon is of
importance, not only from fundamental biological considerations but
also as tending to throw light upon one of the problems in relation
to cancer, namely, the mechanism by which malignant cells induce
the body to furnish them with a supporting stroma and with a blood
supply. Work has therefore been begun during the past -fiscal year
in order to determine the actuality of mitoaenetic radiation, and
further, if found to be present, to study its physical properties.
In this connection Biophysicist Lorenz has constructed and has
been engaged in perfecting a very sensitive apparatus for detecting
and measuring extremely small quantities of radiation-the so-called


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Geiger counter tube. The apparatus consists essentially of a photoelectric cell which, by sp_ecial choice of materials, may be made extremely sensitive to radiation in the ultra-violet portion of the spectrum. Electrical impulses caused by the entrance of radiation
through the quartz window of the cell may be amplified in an amplifier of special design so that they may be made audible by the use
of a loud-speaker, or may operate a counting device which records
numerically the impulses resulting from the incident radiation.
This instrument is now being employed in the study of mitogenetic
radiation in the following ways :
(1) Its use will permit the direct determination of the presence or absence
of the so-called mitogenetic radiation.
(2) By developing modifications of the instrument which are sensitive only
to certain regions of the spectrum, especially the long and the shor t ultraviolet regions, some general information will be obtained as to the region of
the spectrum (now in dispute) to which mitogenetic radiati_o n belongs.

As the result of preliminary runs with the apparatus, certain
sources of error were found, and it also appeared as though the general sensitivity of the apparatus could be improved. Consequently
during the last quarter of the fiscal year considerable developmental
work was done with respect to this type of photo-electric cell. A s a
result of these studies, optimum sensitivity of the cell has been secured, so that it will be possible to make runs under test conditions
in the near future.
B iological studies of mitogenetio radiation.-In addition to the
physical methods, the presence of mitogenetic radiation was investigated in a preliminary way by biological methods.
According to the published observations of Gurwitsch, Reiter and
Gabor, and others, onion rootlets are stated to be very sensitive indicators of mitogenetic radiation. These, together with yeast cells,
have been used as indicators in a series of experiments by which it
is hoped to determine whether or not radiation is actually present.
So far these experiments have been inconclusive, but they will be
contmued until this question has been satisfactorily answered.
Studies of electromagnetic radiation.-Steps are being taken to
construct a new oscillating circuit employing the " magnetron " tube
recently developed by the General Electric Co. by means of which
frequencies of the order of 400,000,000 cycles per second with considerable energy output may be obtained. When this circuit has
been set up and tested, further observations of the biological action
of these frequencies will be made.
Toward the end of the fiscal year this station cooperated with the
infantile paralysis commission of Harvard University in studying
the effect of artificial fever caused by exposure to a condenser field
excited by a high-frequency oscillator upon the development of the
virus of poliomyelitis.
A special oscillator has been constructed with accessory apparatus
by which it is possible, while employing a frequency from 40,000,000
to 50,000,000 cycles per second, to raise the temperature of animals,
such as monkeys or rabbits, to 43°-44° C. within a short time. So far
the studies have been limited to determining the maximum temperatures and lengths of exposure to which experimental animals may be
safely exposed.


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Studies of iwmunity to malignant g1·owths.-The general problem
of immune reactions to malignant growths is being studied by
Biologist H. B. Andervont.
Previous investigations have repeatedly shown that, in the case of
many transplantable tumors, recession of the tumor is followed by
resistance to reinoculation.
Experiments at this station, already reported, have shown that
mice bearing mouse sarcoma No. 180, rats bearing rat sarcoma No.
10, or chickens bearing the Rous fowl sarcoma which had recovered
from these tumors as the result of tr~atment with high-frequency
currents are frequently resistant to reinoculation.
During the fiscal year a study was made of various methods of
immunizing laboratory animals against a variety of transplantable
tumors.
In the case of mouse sarcoma No. 180 it is believed a new method
of immunization was developed which appears to be successful in
about 70 per cent of the cases. If mouse sarcoma No. 180 be inoculated into the tail of the animal, the tumor, in this situation, grows
much more slowly than when implanted in the usual sites of the
groin or the axilla. Nevertheless, the presence of the tumor excites
the reaction in the usual way, the diminished rate of growth giving
time for its fuller development.
If, then, after a suitable interval, the tail tumor is destroyed by
the application of high-frequency currents, or if the tail be simply
amputated, the animal is found in a large number of instances
(about 70 per cent) to be immune to reimplantation in the usual
site (groin or axilla).
·
Effects of temp·erC1Jtwre upon the grow/th of tumors ari,.if) development
of immunity.-The effects of temperature upon the growth of
tumors and on the development of immunity were studied during
the year. It was observed that when mice inoculated in the tail with
mouse sarcoma No. 180 were kept at a relatively high temperature
(33°-34° C.) the tail tumor grew much more rapidly and attained
a much larger size than in control animals kept at a room temperature of 15°-16°. Although they readily become adapted to this
temperature, the tail tumors grew much more slowly than in the
animals kept, respectively, at room and· at incubator temperatures.
Studies are therefore under way to determine the effect of the ·
temperature of the environment on the development of immunity
to mouse sarcoma No. 180. These experiments are still in progress.
Inhibition of the immune 1·eaction.-During the year experiments
were undertaken to determine methods by which the immune reaction following the inoculation with a transplantable tumor could
be inhibited. Mice were immunized against mouse carcinoma No.
63 by the well-known procedure of injections of emulsions of mouseembryo skin. The resulting immunity could be " broken down " by
the injection of trypan blue, so that the mice treated in this way
developed tumors upon · inoculation with mouse carcinoma No. 63,
while the control animals were resistant to the implantations.
While these experiments were in progress a paper was published
in Europe by a British investigator reporting similar findings.
Studies of organ ewtracts.-In the previous annual report mention
was made of certain experiments in which the effect of aqueous


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extracts of adrenal cortex upon the growth of transplantable tumors
was studied. These studies were undertaken because of newspaper
reports early in 1930 of the favorable effects on human cancer of
an extract of adrenal cortex developed by Doctors Coffey and
Humber.
Although no details of the methods of preparation of this extract
were at hand, a number of extracts of adrenal cortex were prepared
at this station and observations were made of their effect upon the
growth of transplantable tumors. No significant effects were
observed from the administration of any of these extracts.
Early in the present fiscal year a copy of the patent granted to Doctors Coffey and Humber for their extract was obtained. This document contained a full description of the method of preparation. A
batch of the extract was therefore prepared in strict conformity with
the specifications of the patent and then tested for any inhibiting
action on the growth of transplantable tumors. The extract, prepared
according to the Coffey and Humber directions, proved no more
effective against transplantable tumors than the other extracts above
mentioned.
About this time an effort was also made to confirm the results
reported by Arloing and his coworkers to the effect that the adrenals
of rabbits prepared by the injection of mouse tumor cells when transplanted subcutaneously into mice would inhibit the growth of
transplanted mouse tumors.
No rabbits happened to be available at the time, but rats were
used. These would appear to be suitable animals for such an experiment, as they have a strong immunity to mouse tumors. A number
of rats, accordingly, were prepared by the repeated injection at
suitable intervals of a considerable quantity of the cells of mouse
sarcoma No. 180, whereupon their adrenals were transplanted subcutaneously into mice which were simultaneously inoculated with
mouse sarcoma No. 180. As controls, a similar number of adrenals
from normal rats were transplanted in mice, also bearers of the
mouse sarcoma. No differences in the growth of the tumor in both
groups of the animals were observed. The rate of growth was the
same as in the stock used for the routine propagation of this tumor.
Studies with other ewtracts.-During the year numerous experiments were made with various forms of organ extracts, especially
extracts made from the tissues of mice resistant to transplantable
tumors. None of these extracts was found to be effective in inhibiting
the growth of transplantable tumors.
Action of frog ewtract.-A 25 per cent alcoholic extract from tissue of the frog was found by Pharmacological Assistant Henry
George to have a considerable inhibitory effect upon the growth of
mouse sarcoma No. 180. In mice treated with small doses of this
extract which appeared to have no deleterious effect upon the animals, the rate of tumor growth was only about one-half that in a
similar number of controls. Although the rate of growth was
diminished, nevertheless recessions did not occur.
Biochemistry of malignant cells.-Since the appointment of a
biochemist, effort has been mainly directed toward organizing and
equipping a chemical laboratory and making a survey of the cancer
literature bearing upon the lines of investigation planned.


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It is expected that a beginning will be made in the near future
by an intensive study o:f the inorganic constituents o:f malignant as
compared with normal cells, particularly with respect to inorganic
constituents which are present in minimal amounts.
In connection with the investigation o:f immunity, biochemical
studies have already been begun concerning the :fractionation o:f extracts o:f tumor tissue, embryonic tissue, and immune serum with a
view to separating substances which tend to :favor or to inhibit the
generation o:f immune reactions.
Spontaneous twmor colony.-The colony o:f mice (Buffalo strain)
susceptible to spontaneous tumors, mentioned in previous reports,
has continued to grow during the fiscal year notwithstanding a
severe epidemic of mouse typhoid. The colony has now attained a
sufficient size to begin to offer material for experiment, although the
problem o:f providing adequate space :for the suitable expansion o:f
the colony still remains to be solved. Because o:f the limitations o:f
space it has been n_ecessary to restrict breeding considerably below
the natural rate o:f mcrease.
Experiments are now under way designed to study the modi:fying
effects, i:f any, o:f certain procedures upon the tumor rate. As severai
months must elapse before the outcome o:f such experiments can be
determined, these must necessarily be the subject o:f future reports.
PLANS FOR THE FUTUR,EJ

FaC'ilities for ewpansion.-At the present time the Office o:f Field
Investigations o:f Cancer is occupying practically all the space not
otherwise utilized in the department o:f preventive medicine and
hygiene at the Harvard Medical School. The university authorities
have assigned to this office the use o:f six rooms, besides the almost
exclusive use 0£ a large laboratory. Nevertheless the quarters are
crowded, especially in regard to adequate space for animals. This
particularly applies to the colony of spontaneous tumor mice, which
should probably be maintained at a population of 5,000 or so if
sufficient experimental material is to be available. Although the
possibilities for additional room are practically exhausted, future
plans contemplate the addition of a cytologist and an assistant
biophysicist to the staff.
Inasmuch as the systematic program which has been drawn up has
in view the extension o:f the cancer research work o:f the Public Health
Service, it is evident that future plans must take into account the
provision o:f laboratory facilities commensurate with the importance
o:f this field o:f investigation.
LEPROSY

The leprosy investigation station at Honolulu, Hawaii, has been
conducted under the direction of Surg. N. E . Wayson, with Passed
Asst. Surg. J. R. Murdock assisting.
The two medical officers supervise, direct, assist in, or execute all
medical activities at the Kalihi Receiving Hospital, adjoining the
investigation station. T he volume and nature of these activities is
reflected by the following statistics :


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In-patients, July 1, 1930_____________________________________________
New admissions ________________________________,_____________________

118
62

Readmissions ------------------------------------------------------Escaped patients returned___________________________________________
Transferred to Kalaupapa___________________________________________
Paroled to out-patient status_________________________________________
Patients escaped---------------------------------------------------Deaths_____________________________________________________________
Patients remaining June 30, 193L____________________________________

12
1
4
23
5
2
166

Details of relief measures afforded:
Intramuscular injections _____________________________________________ 3,090
Cutaneous injections_________________________________________________
322
Intravenous injections_______________________________________________
65
Physiotherapy treatments (including the application of heat, light, and
massage) _________________________________________________________ 8,748
Diatheramy treatments ______________________________________________ 1,067
Surgical operations__________________________________________________
104
Surgical dressings ___________________________________________________ 18, 291
Nose
Eye treatments-----------~----------------------------------------treatments _____________________________________________________
Physical examinations_____________________________________________ __
Clinico-microscopical examinations__________________________ _________
Obstetrical deliveries________________________________ ________________
Out-patients examined and treated____________________________________

1,803
4,420
386
707

2
71

Clinical studies.-Efforts to individualize in the study and care
of patients have been continued. The experience of the staff of the
station for the past 10 years has shown that attempts to treat leprosy
specifically with any known remedy is productive of only indifferent
results. The results of therapeutic measures during the year give
further support to these conclusions. Two groups each of 20 to
25 patients to whom no "special" remedies were administered have
made changes which were comparable in degree and duration to
those treated by parenteral injections o-f preparations now recommended. Hence investigations and treatments of patients have been
directed toward determining and relieving abnormal conditions which
might unfavorably influence their recovery from leprosy. Further
studies have confirmed the previously reported prevalence of tuberculosis among the patients. Physical examinations supported by
laboratory tests, repeated tuberculin t ests, and X-ray photographs
have shown that 10 to 12 per cent have manifest tuberculosis, and
an additional 15 to 20 per cent have findings which may be considered presumptive of tuberculosis. The continued treatment of
these patients by intramuscular injections of frritating substances
has been followed by aggravation of the tuberculous infection, and
is contraindicated in pulmonary and laryngeal affections. The
course of leprosy seems also to be greatly influenced in many cases
by the course of a concomitant tuberculosis.
The induction of fever of 37.5° C. to 38.5° C. for short periods
by the intramuscular or intracutaneous injection of nonspecific oily
substances, such as sulphurized olive oil, has been further studied
on a group of cases. This procedure is followed in some instances
by leprous reactions, with subsequent rapid or gradual clinical improvement. H owever, it is very difficult to evaluate this method
o_f therapy, since other cases similarly treated do not respond in a
hke manner, and experience indicates with increasing positivity that
cases of v1:1-rying degrees of clinical severity may rapidly improve
under hygiene and supportive measures. The parenteral injections


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of the sulphurized oil afford a measure for the induction .of a fever,
which may be controlled to a relative degree by the alterations of
the dose administered, but the indications for this therapy and the
frequencv and amount of dosage have not been finally determined.
It has "'been found during tests made by the intradermal injection
of tuberculin that the usual wheal and in.filtrated papule will develop on the tuberculous patient, though the skin be altered by
leprous infiltration at the site or indirectly through damaged
circulation.
A continuation and extension of the study of the changes in the
bones of leprous patients has been carried out by Passed Assistant
Surgeon Murdock, with the assistance of Maj. H. J. Hutter, United
States Marine Corps, and the cooperation of the medical officer in
command of the Tripler General Hospital and of other members of
its staff. The findings of these studies confirm those of previous
workers, including the staff of this station, but they also contribute
evidence of severe, relatively acute, and apparently specific changes
which have not been widely recognized. X-ray pictures which simulate the fulminating processes occurring in acute osteitis of pyogenic
and tuberculous origin in adolescents have been observed in cases in
which clinical evidence of secondary infection was not discovered.
These very destructive processes may be followed in a rather short
period of time by remarkable morphologic restoration and function.
The results of the study will be the subject of a special report which
is now being prepared.
Systematic observation and treatment of the manifestations of the
disease in the mucous membrane of the nose and throat has led to
the belief that many of the complicating inflammations of the eye
may be favorably affected by treatment of the lesions of the internal
nose. It seems evident also that the application to the nasal membranes 0£ escharotics, fulgurants, radium, and other agents whose
action is difficult to control may result in the formation of deep scars
which tend to become ulcerated. Such ulcers frequently erode
through the cartilaginous septum. Lesions have been observed whose
morphology and clinical pathology suggest the likelihood of their
being so-called trophic ulcers. The finding of acid-fast bacilli on
the nasal mucosa of cases without demonstrable lesions of the membrane has been repeatedly confirmed. It has also been determined
that it is probable that the numbers of acid-fast bacilli on these
membranes may vary widely at any one period of examination. It
also appears that the case which may be apparently quiescent clinically for an extended period, but in whose nasal mucosa the bacillus
may be occasionally demonstrated, is prone to have generalized
reactivations.
Observations made during the past few years, and more especially
during this year, suggest that the course of leprous ulcers, especially
of the extremities, is prone to reflect the course of the disease in
the individual, namely, as the general condition improves the ulcers
heal. However, local supportive treatment, such as strapping with
adhesive tape, and posture, which favors venous circulation, appear
to be of therapeutic value.
Experimental investigations.-White rats which were injected
intravascularly with suspensions of material from lesions of rat leprosy developed lepromata or leprous infiltrations which were dis-


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seminated generally through the organs and bones. However, a
preponderant selectivity for the skin and lungs was evident in both
the numbers of granulomata and degree of involvement. The histology of the individual lesions simulated that found in human
leprosy. The processes appeared to have originated and spread from
the perithelial spaces of the vessels, as might be expected. The
selectivity of the sites of development and the resemblance to the
histological picture of many of the lesions of human leprosy suggest a further analogy between these two diseases and contribute
experimental evidence to the hypothesis that the latter may be disseminated in the body from a local source by the blood stream.
Rats were inoculated by dropping into the nose, without injury
to the mucosa, a suspension of either of the organisms of human or
of rat leprosy. It was found that eitl}.er of these organisms will apparently penetrate the mucous membranes of the respiratory tract
· of these animals and may be recovered in numbers in the cervical
lymph nodes, lungs, and spleen of the animals so treated. The
cervical lymph nodes are commonly and rapidly affected. Acid-fast
bacilli were found in the cervical or mesentery nodes of 15 of 23
animals treated. In 2 animals examined for this purpose organisms
were recovered in 17 and 19 hours, respectively, after they were
deposited in the nose. Similiar findings were not obtained in
untreated animals from the same stock pens.
'
The subcutaneous inoculation of kittens with large doses of suspensions of material from the lesions of human and rat leprosy
has been followed by granulomatous tissue reactions. These have
become definite and prominent after from 12 to 20 days from the time
of inoculation. In some instances both the macroscopic and microscopi? appearance o~ t~e granuloma has suggested that they . w_ere
· growmg when exammed as late as 21 days after the date of mJection. The results may indicate that the kitten has less natural
immunity to these organisms than that which apparently prevails in
man and the rat, respectively.
·
Further efforts have been made to learn the immunological relation of B. tuberculosis, B. leprae, Stefansky's bacillus, margarine,
and mist bacillus. Likwise, experiments have been continued in
the attempt to grow the two leprosy bacilli. These studies have not
led to any conclusive results.
In cooperation with the department of chemistry of the College
of Hawaii investigations were made of a preparation reported to be
a water-soluble derivative of chaulmoogric acid. The hypothesis
advanced by the college authorities is that it readily hydrolyzes and
will do so in the tissues, and deposit chaulmoogric acid, which is
presumed to be antagonistic to the growth of the ba-cillus of leprosy.
Tests were made by suspending material from the lesions of rat
leprosy in a 2 per cent solution of the preparation and allowing it
to act for a period of 17 hours at 5° C. ( the low temperature is necessary to inhibit the growth of other bacterial contaminants), subsequently washing the tissue suspension with tyrode solution and injecting it into rats. All the animals developed typical lesions of
rat leprosy to a degree entirely comparable with that of control
animals inoculated with material which had been handled in a like
manner, except that it was exposed to the action of water only.
Other tests were made to determine the toxicity of the product. The

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lethal dose was :found to be very inconstant in different dilutions and
in different batches of the same dilution. Rats which were inocu. lated with material from rat leprosy lesions, and promptly treated
by intramuscular injections of the preparations during a period of
four months, developed the disease in a manner and to a degree
entirely comparable with others handled similarly but not treated by
the preparation.
Other activities.-Surg. N. E. Wayson represented the Public
Health Service in the conference of the leprosy commission of the
League of Nations at Bangkok, Siam, and served as a member of
the international conferences at Manila, under the auspices of the
Leonard Wood Memorial.
A case of suspected plague was investigated, and technical procedures were outlined at the request of and in cooperation with the
chief quarantine officer of Honolulu.
A series of clinics for the local medical profession and a clinic for
public health nurses and social welfare workers have been conducted.
MALARIA

Field investigations of malaria have continued under the direction
of Surg. L. L. Williams, jr. The aim of field research in malaria
and malaria control has always been to so reduce the cost of effective
measures that the rural population might afford to protect themselves
against infection.
PARIS GREEN

•

Continuous dusting.--In cooperation with the State board of
health and local authorities, a study of continuous dusting was inaugurated in the early summer of 1929 in Dougherty County, surrounding Albany, Ga. Surg. T. H. D. Griffitts was placed in immediate
charge and was assisted by Sanitary Engineer W. H. W. Komp
until April, 1931.
·
The aim of this study has been to determine whether dusting all
the Anopheles-producing areas within the county every 10 days with
Paris green diluted to 10 per cent in lime would so reduce the
number of Anopheles quadrima,culatus as to control malaria. The
details of the method of procedure have been described in the 1930
annual report. The results of this year's progress indicate a considerable degree of success. Before dusting, the average quadrimaculatus catch at a typical catching station was 32.4. During the
past year this has been held to 6. The results in malaria reduction
compared to the adjoining county of Lee, where no dusting has
taken place, show that the Dougherty County malaria rate has fallen
from over 40 per cent to less than 7, whereas Lee has fallen from
24 to 11 per cent. These figures were obtained by blood examination
among the rural school children. Although the difference in the
malaria rate between the two counties is not as great as might have
been expected, it must be remembered that the unusual drought of
the summer of 1930 enormously reduced the mosquito-producing
areas of the undusted county. Drought conditions have not prevailed at the end of the present. fiscal year, and indications are that
the coming year will be about normal. It is intended that a fall


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index shall be taken early in the next fiscal year and the study
brought to a close.
Intermittent dusting.-In cooperation with the Tennessee State
Board of Health, studies of intermittent dusting have been carried
on under the immediate direction of Sanitary Engineer J. A.
LePrince and Passed Asst. Sanitary Engineer H. A. Johnson, in
Dyer County, surrounding Dyersburg, Tenn. The details of this
investigation were described in the 1930 annual report.
This study differs from the Georgia investigation in that the interval between Paris green applications is 21 days instead of 10.
Intermittent dusting at approximately 3-week intervals is based
upon the observation that, when production from breeding areas is
stopped, the death rate of the previous crop of Anopheles is greatly
accelerated. Although production is immediately resumed and the
number of adult mosquitoes is quickly brought to the maximum,
there is a minimum of the earlier broods, and therefore a minimum
chance of containing an infected Anopheles.
As in Georgia, it is intended to continue the study ·d uring the
summer of 1931, take a blood index in the fall, and brmg the study
to a close. However, should the results of blood indices taken within
the dusted county be closely paralleled by the malaria rate in the
adjacent nondusted county of Lauderdale~ it will be necessary to
continue the investigation.
Flotation.-This study was begun by Special Entomologist A. L.
Dolloff during the summer of 1929 and continued through the fiscal
year 1930, but with no positive results. It was independently
studied by Passed Asst. Sanitary Engineer H. A. Johnson with certain forms of floating Paris green which have been treated with small
quantities of oils. His work has confirmed that of Doctor Dolloff
and has simplified the process of mixing. There are as yet undetermined factors necessary of solution before complete dependence can
be placed upon flotation of Paris green. Therefore this study is
being continued.
OTHER STUDIES

Plasmochin.-Ever since Doctor Barber showed that small doses
of plasmochin so reduced the viability of the gametocyte of estivoautumnal malaria as to prevent its infecting mosquitoes, we have
been attempting to determine whether it would be similarly effective applied to benign tertian. This work has been under the direct
supervision of Sanitary Engineer W. H. W. Komp. During the
present fiscal year it has been impossible to secure proper benign
tertian gametocyte carriers, and therefore no progress in the study
could be made. In order to have a longer malaria season in which
to pursue this study and to cooperate in studies of the bionomics of
Anopheles and special studies in malaria, Mr. Komp has been detailed to Panama to work in cooperation with the Gorgas Memorial
Laboratory and the Health Department of the Panama Canal.
111easuring malarria.-A necessary part of the field studies is accurately to measure malaria within the area of attempted control, as
well as in near-by areas of no control. For this purpose our thickfilm laboratory has been continued. Eighteen thousand blood slides
have been examined and 38,000 have been stained. Twelve thou-


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sand of these slides were stained for the State of Texas for examination in their own laboratory by a microscopist trained by our
workers.
Malaria:l inomdation in paresi,s therapy.-The most successful
treatment of paresis is to induce an attack of benign tertian malaria.
Institutions for the insane frequently lose their strain of malaria
and are confronted by difficulties in securing a new one. In cooperation with the Venereal Disease Division we are working to develop methods of supplying inoculation material. Through the cooperation of the State hospital for the insane at Columbia, S. C.,
we have set up a field laboratory under the immediate supervision
of Special Expert Bruce Mayne.
Preliminary investigations have been made to determine the present inoculation procedure at the various psychiatric hospitals in
order that our studies might develop methods to overcome difficulties
now experienced.
We do not know ( 1) what method of inoculation will most certainly insure an infection, (2) the best method of keeping a good
strain indefinitely, and (3) what is the most effective way for shipp jng a live strain of malaria to distant points of the country. It
will be necessary to determine the feasibility of supplying the infection from a central point and to test the viability of the malarial
organism in the mosquito's body after the mosquito has been ground
up in various media.
NUTRITION AL DISEASES

The studies in nutrition were continued both at the Milledgeville
State Hospital (formerly the Georgia State Sanitarium), Milledgevme, Ga., and at the National Institute of Health, Washington, D. C.
The studies at the Milledgeville State Hospital, under the direction
of Surg. G. W. Wheeler, have consisted largely of the determination
of the relative pellagra-preventive potency of single staple foods and
foodstuffs by feeding experiments in the human.
The study of canned turnip greens and canned spinach, begun
during the preceding fiscal year, was completed and the results
presented for publication.
It was found that canned spinach contains the anti pellagric
vitamin, but the addition of 482 grams (including the can liquor)
to an otherwise pellagra-producing diet was not quite sufficient for
complete protection against the disease.
The same quantity of canned turnip greens (including the can
liquor) showed complete protection. This result is considered
highly practical from the standpoint of pellagra control. This
foodstuff is usually well relished and may be cheaply and easily
grown throughout the pellagrous sections (rural cotton belt) and
may be made available at the time of year (spring and early summer)
when the diet is most restricted and pellagra most prevalent. With
a small amount of well-directed effort on the part of local health
agencies and others concerned, its production and consumption may
be increased almost indefinitely.
Canned green stringless beans were tested for. their pellagrapreventive value and the results presented for publication. While
the antipellagric vitamin is present in this foodstuff, it must be
regarded as a relatively poor source of it.

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A test of canned English peas, begun early in the fiscal year, is
still in progress.
In cooperation with the clinical director of the Milledgeville State
Hospital a test of the influence on idiopathic epilepsy of a diet low
in the pellagra-preventive vitamin was conducted. It was found
that, coincidentally with the development of pellagra., there was, in
most instances, a sharp reduction in the number of epileptic seizures
which, however, returned to the usual level upon recovery from
pellagra. A full report of this study was published in Public Health
Reports for April 10, 1931 (Reprint No. 1468).
Cooperation has been extended to various individuals and agencies
interested in combating pellagra, more especially the home economics and nutrition services of the Georgia State College of Agriculture and the Spartanburg County (S. C.) Health Department.
The studies at the National Institute of Health under the direction of Passed Asst. Surg. W. H. Sebrell have been, in part, a further
continuation of the program inaugurated by the late Surg. Joseph
Goldberger, of testing individual foodstuffs, particularly in the dog
in order to determine their probable pellagra-preventive value. This
work has been supplemented with studies on the antineuritic vitamin
and feeding experiments with purified amino acids. During the
fiscal year a special report was made of the blacktongue preventive
value of Minot's liver extract (Public Health Reports for December
12, 1930: Reprint No. 1433). The results of this work demonstrated
that Minot's liver extract contains the antipellagric vitamin, and
therefore would probably be of some value in the treatment of
pellagra.
Tests of the blacktongue preventive action of fresh cabbage, lettuce, canned turnip greens, autoclaved cottonseed meal, canned
spinach, and rice polishings were completed during the fiscal year.
Tests of canned evaporated milk, collard greens, canned corned
beef, navy beans, kidney beans, and Irish potatoes are in progress
at the close of the fiscal year.
Studies on the fatty degeneration of the liver in dogs were completed, and the results indicate that the condition is probably due
to some dietary deficiency. It is expected that the results of these
experiments will be given in a special report.
In collaboration with Senior Chemist E. Elvove, of the Division
of Chemistry, the following experiments were conducted:
Studies of the anemia-producing substance in onions were continued, and the results to date indicate that the active material
probably resists steam distillation and may be extracted with dilute
alcohol.
Studies in the rat led to the development of an intraperitoneal
method of injection of antineuritic concentrates, and the preparation and assay of several antineuritic concentrates was made the
subject of a special report (Public Health Reports, April 17, 1931;
Reprint No. 1470). Attempts to develop a satisfactory rat
method for determining the presence of the antipellagric vitamin are
progressing slowly.
In collaboration with Biochemist M. X. Sullivan and Junior
Chemist W. C. Hess, of the Division of Chemistry, studies were
begun on the feeding of purified amino Rcids. A report on the sub-


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stitution of cystine amino for cystine in the diet of the white rat
was published (Public Health Reports, May 29, 1931; Reprint No.
1479). It was found that cystine, tyrosine, and glycine in relatively
large amounts are toxic to white rats, and that tyrosine and cystine
tend to counteract the toxic effects of each other when fed simultaneously. The ,s ymptoms of tyrosine toxicity were found to be
strikingly differ ent from those of cystine toxicity. A report on the
results of these experiments is in the course of publication.
In collaboration with the National Drought Relief Committee,.
Passed A sst. Surg. "\V. H. Sebrell served on the subcommittee on
nutrition information, and assisted in the preparation of Department of Agriculture Extension Service Circular No. 139, Buy Health
Protection With Your Food Money, published in November, 1930.
ROCKY MOUN TAIN SPOTTED FEVER

The studies of Rocky Mountain spotted fever and associated tickborne diseases of man being carried on at the Hamilton (Mont.)
field station under the direction of Special Expert R. R. Parker
have been characterized by the same continued growth of activities
under way and the same increasing demand for services which have
mar ked this work during recent years.
The Public Health Service has been almo.s t continuously engaged
in the study of tick-borne infections in the United States since 1903.
During this period the problem has grown from one supposedly
concerning only one tick, Dermacentor andersoni Stiles, and its
t ransmission of Rocky Mountain spotted fever in a limited portion
of the Rocky Mountain region to one involving at present several
disea.ses of man, their transmission by a number of species of ticks,.
and a tremendous increase in the area within which these diseases
are known to be endemic. Besides Dermacentor andersoni Stiles,.
it is now known that Rocky Mountain spotted fever is transmissible
by the American dog tick, Dermacentor variaJbilis Say, Dermacentoir occidental-is Neumann, and the rabbit tick, H aemaphysalis
leporispalustris Packard. Since the initial studies D ermacento(f"
andersoni has apparently extended its range considerably in some
sections, pushing out beyond the Rocky Mountain region; Dermacentor v·ariabilis is prevalent in most of the Central, Eastern, and
Southern States and in California and .s outhern Oregon; Dermacent or occidentalis occurs throughout California and in southwestern Oregon; H aemaphysaZis leporispal'IJ)Stris is country-wide, but
fortunately does not bite man and functions only in the maintenance
of Rocky Mountain spotted fever virus and tularaemia in nature;
tularaemia is transmitted by the same four ticks ; tick paralysis and
Colorado tick fever haye been reported only following the bite of
Dermacentor anclersoni. Tularaemia. is not solely a tick-borne disease. This disease, first found in California only 20 years ago, is.
now known to occur in all but five States, and Dermacentor andersoni and variabilis are among the proved agents of human infection.
Tick paralysis, originally reported from eastern Oregon, is now
known in five additional States of the Rocky Mountain region and
in Canada, and is doubtless even more widely distributed. Colorado tick fever has been reported only from the States of Colorado


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and Wyoming. Ticks are also responsible for numerous instances
of local and systematic pathological conditions of uncertain nature,
while in many sections of the Rocky Mountain region the actual or
po~ential economic eff ect.s of the occurrence of these infections are
ser10us.
Along with the increasing knowledge of the extent and importance
of tick-borne diseases in this country there has been a corresponding
increase in the demand for the services rendered by the Hamilton
(Mont.) laboratory. This has resulted in an expansion of station
activities, and a corresponding increase in personnel to a point where
the resultant laboratory space requirements are not available to the
Public Health Service in the Montana State Board of Entomology
Laboratory. Additional space to meet the need created by these
demands has been provided for by an act passed by the Seventy-first
Congress, permitting the purchase from the State of Montana of this
laboratory building, which is especially designed and constructed to
meet the specialized requirements of work with ticks, and also for the
erection of an additional building similarly constructed for the sole
use of the Public Health Service.
Arrangements have been made for temporarily taking over on July
1, 1931, research studies on tick parasites which were initiated five
years ago by the Montana State Board of Entomology.
The amount of vaccine manufactured has been doubled during each
of the past four years. For the season 1931, 117.2 liters were prepared, as compared with 55 liters in 1930. This amount was intended
to meet an estimated minimum demand of 50,000 c. c. This discrepancy between the amount manufactured and estimated minimum
demand is unavoidable, since experience has shown that allowance
must be made for a possible 50 per cent loss because of low potency.
Unfortunately, it has thus far proved impossible to produce a constantly potent product, even when the technique used is always the
same. The reasons for this variation in potency are not known. In
previous years vaccine has been manufactured largely from adult
ticks which had been infected as larvae. This year a comparison has
been made between vaccine thus prepared with vaccine made (1)
from adults infected as nymphs and (2) from adults which fed on
infected hosts as both larvae and nymphs. This one year's data
suggest that vaccine from ticks infected by either of the last two
methods is likely to be more constantly potent than that from ticks
infected as larvae; and it is possible that some simple change in
technique, such as that indicated by the above finding, may mean the
production of a more nearly standard product. If this can be done,
the cost of manufacture can be reduced materially, since a constantly potent vaccine would halve the volume of production now
necessary and would also make possible its manufacture in much
larger units ( the present unit is 400 c. c.), with a saving of at least
1,000 laboratory animals every year. Attempts to culture the virus in
the hope that a more simple method of vaccine production might be
developed have proved abortive.
The season of 1931 is the first since the use of the vaccine was begun
in 1925, during which it has been possible to fill all orders. The
amount distributed through June of this year was 54.1 liters, as
80597-31--4


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compared with 31.2 in 1930. This quantity of vaccine has bee~ distributed in 17 States, the heaviest users berng Montana, 16.24 hters;
Oregon, 14.25; Wyoming, 11.1; and Idaho, 7.5. The other States
listed in order of amount of vaccine used are as follows : Nevada,
Colorado, California, Washington, Utah, New Mexico, South D akota,
Nebraska, Maryland, Massachusetts, Pennsylvania, Minnesota, and
Missouri. For the most part the vaccine is forwarded directly _to the
physicians who use it, but it is also distributed to some extent
through State and loc·aI health officials.
It seems certain that the demand for vaccine will continue to increase. So far as the Rocky Mountain region and adjacent areas are
concerned, it has grown rapidly during the past two seasons, in spite
of a decreasing prevalence of fever. It has not been unusual to supply single physicians with sufficient vaccine for from 100 to 200 persons. If the prevalence of Rocky Mountain spotted fever in this
section conforms to the recent cycles, gradually increasing prevalence
may be looked for during the next five years, reaching a peak in
1936, and it is likely that the vaccine demand 'rill increase proportionately. To what further extent this foreseen demand will be increased by the now recognized occurrence of what is apparently
Rocky Mountain spotted fever in eastern States, it is difficult to
judge, but since the disease in these States appears to be limited to
focal areas the use of vaccine would appear to be logical. In the
West there is an increasing tendency for companies and corporations
employing men in capacities which expose them to tick bites either
to insist on vaccination or to make certain at least that the vaccine is
available for such employees as desire to take it. There is also an
increasing demand among Federal employees in exposed occupations.
In discussing the results of the use of the vaccine it is necessary
to differentiate between vaccination in areas where relatively mild
infections prevail and those in which the local strains of virus are
extremely virulent, with an accompanying high death rate. Additional data resulting from the present year's use do not indicate any
modification of the general conclusions as to prophylactic value which
have been previously made, namely, that against the milder strains of
Rocky Mountain spotted fever the average person is fully protected,
but that against _the highly virulent type the protection afforded is
usually but partial, though sufficient to markedly ameliorate the
symptoms and insure recovery. Among approximately 25,000 persons vaccinated against the milder strains only two mild cases have
occurred, while in localities or groups which have been adequately
controlled the evidence o:f usual full protection has been convincina.
In the Bitterroot Valley region of western Montana seven year~'
complete data are available of persons vaccinated against the most
fatal strains known. During this period there have been 54 local
cases, o:f which 36 were in nonvaccinated and 18 in vaccinated persons.
Of the nonvaccinated cases 26 have died, a mortality of 72.22 per
cent; of the vaccinated cases 3 have died, a mortality of 16.66 per
cent. Of the persons vaccinated in this region manv have been
vaccinated two, three, four, five, and six successive years", and several
cases have occurred in persons vaccinated two or· more consecutive
seasons. The clinical data for these cases suggest that in some persons, but not in all, there is a gradually increasing degree of immunity resulting from consistent annual vaccination.


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Most cases in vaccinated persons have occurred in those ~accinated
the same year as infected. Two 1931 cases, however t-..were m persons
who had omitted vaccination for the current year. ..tror one of these
no data are available. The other, a case occurring in the Bitterroot
Valley region, was vaccinated in the two preceding years. Clinically, this case was the mildest local case ever observed in a person
not vaccinated the same season as infected, this mildness being
definitely attributable to a persisting partial protection. It is possible sonie degree of immunity persists for more than one season
in a higher percentage of vaccinated persons than has thus far been
supposed.
·
Reports from physicians in areas where mild infections prevail,
and where the incubation period is frequently 7 to 10 days or longer,
indjcate that in persons vaccinated soon after the bit~ of an infected
tick the course of infection may be alleviated and shortened and
convalescence be more rapid. Similar evidence is favorable, though
less conclusive, in the case of persons bitten by ticks carrying
highly virulent strains, for which the incubation period is usually
only 3 to 5 days. The result will doubtless vary with the individual,
but in any event present evidence suggests that, whether against
mild or severe strains, vaccination immediately following tick bite is
definitely worth while.
EPIDE'.MIOLOOY

So far as indicated by 1931 reports thus far received, Rocky Mountain spotted fever in the western United States is at a low point of
prevalence; previously low points occurred in 1924 and 1917. Montana is the only State showing increased incidence for the year.
Reasonably convincing evidence that second infections of Rocky
Mountain spotted fever may occur has been secured. It is likely,
however, that the idea generally held that infection confers an immunity of long duration is justified in most cases.
STUDIES OF ROOKY MOUNTAIN SPOTTED FEVER VIRUS IN NATURE

Ecological investigations being made on the east and west sides
of the Bitterroot Valley in connection with the studies planned to
determine the factors responsible for the constant regional virulence
of Rocky Mountain spotted fever have been continued. These are
long-term studies, from which definite results, if obtainable, are not
expected for some years. The most important observation resulting
thus far has been the definite demonstration that Rocky· Mountain
spotted fever virus is able to maintain itself in ticks in nature as a
low-grade virus. It has been possible to demonstrate it in rodents
on which east-side ticks have fed, but thus far transmission from
ticks through rodents and back to ticks has not been accomplished.
The demonstration of the natural maintenance o:f this type o:f
Rocky Mountain spotted fever virus is important, since it shows that
a low-grade virus incapable of producing symptoms in man can
persist in an area without its presence being suspected. Apparently,
then, it is possible that many instances of case occurrence in areas
previously thought :free of infection may be due to an increase o:f
virulence of low-grade local strains rather than to spread of in:fection
from a more or less distant focus. How extensively low-grade virus


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of the inapparent infection type may be present in ticks in sections
of the United States in which Rocky Mountain spotted fever is not
now known to be endemic is a question which only future observations can decide. The possibilities in this direction, however, are
indicated by the fact that studies under way at the Hamilton (Mont.)
station in cooperation with Dr. R. G. Green, of the University of
Minnesota Medical School, have revealed the occurrence of this type
of Rocky Mountain spotted fever virus in about 1 per cent of several
hundred specimens of Dermacentor variabilis collected near Lake
Alexander, north of Cushing, Minn.
In connection with the studies on virulence it has been necessary
to devise a scale by which the degree of virulence of Rocky Mountain
spotted fever virus in individual ticks can be measured. To this end
the reaction of guinea pigs injected with individual ticks is utilized.
In further connection with these studies, tests were initiated in the
spring of 1931 to determine whether or not Rocky Mountain spotted
fever virus is being transmitted in nature by parasites other than
ticks. Numerous Anoplura, Siphonaptera, and Acarina collected
from susceptible Bitterroot Valley rodents have been tested, thus far
with negative results.
LABORATORY STUDIES, OF ROCKY MOUNTAIN SPOTTED FEVER

The following strictly laboratory investigations have been made
in connection with the Rocky Mountain spotted fever studies: Complement fixation; the effect of vitamin-free diet on the course of
infection in guinea pigs; the adsorption and elution of antibodies;
the complement and hemolysin content of convalescent serum of
guinea pigs and man; precipitin antisera for the specific determination of blood meal in ticks; bactericidal properties of immune sera
for Proteus X organisms; continuation of observations on the WeilFelix reaction with available strains of Proteus X; attempts to isolate
Proteus X organisms, which might be more specific for Rocky
Mountain spotted fever than those now in use, from the urine of
human cases and infected guinea pigs; transmission of the virus
by copulation between male and female Dermacentor andersoni/
transmission by mosquitoes; transmission by fleas; transmission by
excreta of infected Dermacentor andersoni; transmjssion by Riphicephalus sanguine'UJS.
TULARAEMIA

The danger of laboratory infection with tularaemia is an acute
problem incidental to the work being carried on at the Hamilton
(Mont.) station. Twelve infections have thus far occurred among
the laboratory staff, four of them, one fatal , during the present fiscal
year. The majority of these cases have resulted from direct or
indirect contact with ticks collected from nature in which infection
was not suspected. These infections, which are a danger inherent
to the work being carried on, are a constant menace to the physical
well-being and even the life of staff members, besides causing a
serious disruption of the station work. Considerable time and effort
have therefore been expended during the year in attempts to prepare
a vaccine. All experimental products used have either proven useless
or have resulted in definite sensitization.


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The following animals not previously reported have been tested
for susceptibility : Black bear ( U rsus americanus), apparently
mildly susceptible; black-footed ferret (Mustela nigripes), highly
1:iUsceptible; mountain weasel ( M ustela; ariz.onensis) , highly susceptible; ow 1 (probably Striw occidentalis), mildly susceptible; mallard
duck (Amas platyrhynchos), marked difference in susceptibility o:f
individual birds; and magpie (Pie(]). pica hwdsonica), young birds
apparently highly susceptible.
Tests to determine the transmissibility of tularaemia by mosquitoes
have proved abortive except for a single instance of mechanical
transmission by Aedes aegypti Linneaus. In tests with Aedes vexans
Meigen, infectious excreta were recovered 1 day after feeding on an
infected host, while viable organisms persisted in the body 'for 15
days. Several instances of suspected human infection through the
agency of mosquitoes have been reported. The experiments thus far
made, however, suggest that infection by this means is probably
unusual.
Additional laboratory studies have been made as follows: The
effect of various preservatives on the agglutinability of Bacterii(/Jn
tularense / the bactericidal properties in vivo and in vitro of sera
from convalescent cases and rabbits "vaccinated" with Bacteriwm
tularense/ the presence of a heterophile antigen in Bacterium

tularense.
Tests of western Montana ticks and reports rrom the eastern portion of the State, when compared with data of recent seasons, indicate a gradually increasing incidence of tularaemia infection in
Dermacentor andersoni during the past two years. This suggests
that there is an increasing prevalence of the disease in nature in
Montana and that a resulting increased danger of human infection
may be anticipated during the next few years.
TICK PARALYSIS

Tick paralysis in man, which was unusually prevalent in 1930, has
been reported but a few times during 1931. A considerable outbreak in sheep in Park County, Mont., was investigated, without
significant findings.
CHILD HYGIENE INVESTIGATIONS

The activities of the Chila Hygiene Office were continued under
the direction of Acting Asst. Surg. E. Blanche Sterling. These included studies in ( 1) the mental hygiene of childhood; ( 2) the
vision of school children; ( 3) dental caries; ( 4) statistical studies
in the physical status, growth, and development of school children;
and ( 5) miscellaneous and cooperative work.
THE MENTAL STATUS OF CHILDREN OF VARIOUS TYPES OF BIRTH

The study of the mental status of children of various types of
birth, begun in March, 1930, made satisfactory progress during the
fiscal year 1931. The generous cooperation of the Johns Hopkins
Hospital throughout the year has been most gratHying. The records
of the obstetrical clinic of Dr. J. Whitridge Williams were made


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available for our study, and over 5,000 obstetrical histories have been
obtained from these records.
Of this number approximately 4,000 were spontaneous deliveries,
the remainder consisting of forceps deliveries, breech births, Cesarean
sections, and version and extraction cases. The children of these
births furnish the clinical material of the investigation.
A special detailed outline for the study of these children was
prepared which will facilitate the acquisition of a large amount
of data.
Various social agencies in Baltimore have furnished information
concerning many of these cases. One of these agencies supplies a
worker to read and abstract their records for this study.
A large amount of work is involved in the study of these children;
and the investigation of their family history, significant ·experiences,
home environment, developmental history, medical history, personality traits, behavior record, and school life will be added to the
obstetrical history of the mother. When these factors are correlated with the type of birth, some light may be shed upon the effect
on the child of various obstetric procedures.
A STUDY OF CHILDREN OF PATIENTS IN STATE HOSPITALS FOR 'l'HE INSANEl

It was felt that a study of children of patients in State hospitals
for the insane might be of definite value to those States which
are planning the extension of their mental-hygiene service. In view
of the neecl of further research in the mental hygiene of childhood,
the Child Hygiene Office began in the last quarter of the fiscal year
a study of the children of patients in mental hospitals in Maryland.
This study is under the immediate direction of Dr. George H. Preston, Maryland State commissioner of mental hygiene and a consultant
of the Public Health Service.
By means of this study it is hoped the following questions may
be answered: (1) Do children living with family groups which have
contained definitely psychotic persons show potentially psychotic
behavior, delinquency, school maladjustment, or personality problems to a greater extent than children who have not been associated
with psychotic adults? (2) Do any significantly causative relationships exist between the behavior of children and the presence of
psychotic adults in the family group? (3) Do children living in
family groups which contain psychotic adults constitute a responsibility which should be met by some specific public health, or welfare agency or by some designated member of the hospital staff?
THE VISION OF SCHOOL CHILDREN

The study of the vision of school children, in progress for several
years, came to an end with the close of the fiscal year.
One of the primary objects of this investigation was to determine
the changes, if any, which may occur in the eyes of rapidly growing
children who are constantly calling on their eyes for more intensive
work as their school life progresses. At the close of the study we
had secured two tests of 1,000 children, the majority with an interval
between the examinations of approximately two years. An addi-


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tional 500 children had had three tests, many covering approximately a period of four years.
At the present time the data seem to indicate that myopia increases to a fairly marked extent from 8 to 12 years of age. The
cases of myopia are increased mainly by hyperopic cases becoming
myopic. Many myopic cases increase in degree; and hyperopic
cases, as well as cases of hyperopic astigmatism, have increased in
some instances and decreased in others.
Many of the children examined showed marked defects of vision.
while others revealed minor deviations from the normal.
DENTAL OARIES IN RELATION TO DIET AND CLIMATE

The study of dental caries in relation to diet and climate, begun
jn the preceding fiscal year, made marked progress during 1930-31.
In October and November a special effort was made to secure dental
records of children in presumably climatically unfavorable sections
of the country. Through the courtesy of the United States Coast
Guard, it was possible to visit the remote station at Neah Bay, on
the Strait of Juan de Fuca, and some much-desired data from the
cloudy section around Puget Sound were obtained.
In the spring dental records were obtained from Wisconsin and
South Dakota. Over 4,000 records -have now been obtained from
various sections of the country. The completed study will probably
include at least 6,000 records.
The data relating to the diet of the mothers of the children
studied, as well as that of the children themselves in their early
years, have been compiled. Interesting information concerning
breast feeding among the Indian tribes and the feeding habits of
both adults and children have been obtained.
PREVALENCE OF DENTAL DEOAY AMONG NOORO AND WHITE CHILDREN OF THE BAME
LOCALITY

The statistical study, conducted by Acting Asst. Surg. Amanda
L. Stoughton, is an analysis of the oral examinations of 997 negro
and 3,112 white school children in Orange County, Fla. The study
indicates that the extent of dental decay was less among negro than
among white children, but that the white children received much
better dental attention. This report is the third in a series on the
prevalence of dental caries.
THE PHYSICAL STATUS, GROWTH, AND DEVELOPMENT OF SCHOOL CIHILDRE'N

Much advancement was made in the statistical analysis of the
extensive data on the physical status, growth, and development of
school children obtained in the course of the United States Public
Health Service child hygiene studies in Hagerstown, Md.
There is in proo-ress an analysis, by age and sex, of the sickness
records and the physical measurements. This will include a study
of seasonal sickness and the influence of sickness on change of
weight. The study of physical measurements will include the mean
measurements of each sex at different ages and the average annual
and seasonal increments in various measurements.


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COOPERATION WITH OTHER AGENCIES

During the fiscal year the cooperation of the Child Hygiene Office
has been chiefly as follows :
With the Girl Scouts of the District of Columbia: As in the
preceding 10 years, physical examinations were conducted of the
girls who registered for attendance at the Girl Scouts camp. At
the close of the fiscal year, 266 such examinations had been made.
In addition about 30 of the Scouts were examined as a prerequisite
to swimming during the season between encampments.
With the American Association of University Women : Material
on child hygiene was furnished for use by study groups composed
of members of the association.
·
With White House conference committees: Articles on the work
of the Public Health Service were prepared for the Committee on
Parent Education and the Committee on Maternal and Infant Care.
With the Neighborhood House : Fourteen children in the day
nursery and kindergarten of the institution were given physical
examinations.
MISCELLANEOUS

Through direct correspondence from the Child Hygiene Office,
health education material has 'been sent out in response to requests
from all parts of the country. The correspondence during the fiscal
year amounted to approximately 13,500 letters.
In addition to the activities mentioned, an outline for a school
health program was sent to the Canal Zone. Papers were read at
the twelfth annual conference of the National Federation of Organizations for the Hard of Hearing, at Chicago, Ill., and at a
parent-teachers' meeting at the Maryland State Normal School, and
lectures on child hygiene were given at the National Institute of
Health.
INDUSTRIAL HYGIENE AND SANITATION

The activities of the Office of Industrial Hygiene and Sanitation
were carried out under the direction of Surg. L. R. Thompson until
he was relieved from duty on August 15, 1930, and since October 27,
1930, under the direction of Senior Surg. J. P. Leake.
DUST STUDIES

Mwnicipal dust.-In order to determine the effect of municipal
dust upon the health of the inhabitants, a study was made of the
rate of sickness occurring among two groups of New York city
street cleaners, one working in lower Manhattan and the other in a
residential district of Brooklyn. The dust to which the first group
was exposed ( about 4,000,000 particles per cubic foot of air) was
taken as representing the maximum that the average city dweller
might be subjected to.
The sickness rates of the street sweepers were neither high nor low
when compared with sick benefit association experience and the
results of the other dust studies. In addition, using the sweepers in
Brooklyn as an immediate control from the standpoint of dust ex-


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posure, no excess in the sickness rate from respiratory or nonrespiratory diseases was found.
A report of this investigation will be submitted for publication as
a Public Health Bulletin.
Effect on health of cotton-cloth manwfacturing.-This investigation, report of which will be submitted for publication, gives a fairly
accurate picture of the amount and character of dust and the temperature and humidity conditions which one may expect to find in a
cotton-cloth-manufacturing plant in the Southern States in which
air conditioning ( apart from the introduction of moisture) is not
used. The lack of any relationship between dust and minor respiratory diseases in this study bears out the observations obtained in the
other studies as to thEr health of workers in the dusty trades. A
possibly significant excess of asthma was found; a mild, nondisabling
fibrosis was quite prevalent, as indicated by X rays.
The observation by English investigators, to the effect that there
was no excess of sickness in the humid sheds compared with the nonhumid sheds, seemed to be borne out in this study, although workers
in this investigation were exposed to a much more severe condition
of temperature and humidity.
Silverware manufacturing.-With the exception of a very few
occupations, dust exposure in the silverware-manufacturing plant
studied was very low in comparison with most of the other dust
studies.
Comparison of morbidity rates by specified respiratory cause with
rates found in the other dust studies showed that silver polishing
had a comparatively low respiratory rate and no excess from any
specific cause. Comparison with rates in a rubber company ( with
no industrial hazard predisposing to respiratory illnesses) showed
no significant differences.
Hard ood so ft coal.-The report of these investigations was practically completed during the year.
Labora.tory studies in pneumonoconiosis.-Laboratory studies on
the effect of dust of varying kinds and concentration were continued.
Study of the efficiency of ventilating devices in the re11Wval of
dusts and ,qases.-The current investigation in this series has to do
with the determination of the relative degree of hazardousness of
sand-blasting operations. Complete surveys were made of 25 industrial establishments located in Connecticut, Michigan, Illinois, and
Wisconsin, and were so planned as to include a proportional representation of various manufacturers' equipment and various types of
equipment in different kinds of establishments, such as foundries,
enameling plants, and car-cleaning plants. The data gathered consisted of complete sanitary surveys of each workroom studied, ventilation studies, data on sand-blast equipment, occupational analyses,
and histories of workers. Two hundred and five atmospheric dust
samples were collected to show the dust exposure associated with
various sand-blast occupations and equipment. Samples were also
obtained and analyzed for the mineralogical composition of the
dusts encountered in the study and, finally, samples of atmospheric
dust were procured for particle-size measurement. Experimental
tests of positive-pressure air helmets were also made. The study
was made in cooperation with a committee of the National Safety
Council.

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OTHER STUDIES ON HEALTH I N INDUSTRY

Frequency of pnewmonia amonq iron and steel workers.-Reports
of sick-benefit associations to the Public Health Service revealing
consistently higher pneumonia incidence rates in the iron and steel
industry than among industrial workers as a whole led to an intensive study of pneumonia among the employees of a large st eel plant
i Pennsylvania. The disease was found to occur with abnormal frequency among men exposed intermittently to extremely high temperatures, among those working outdoors in all kinds of weather, and
among persons exposed to humid, drafty conditions, such as were
encountered in the chipping sheds. The coal miners and their helpers also experienced pneumonia at higher than average frequency.
A factor in common in these different occupations appears to be liability to sudden cooling or chilling of the body as an occurrence of
greater frequency than among persons not exposed to such conditions. Other factors in the working environment, such as gases,
smoke, and dust, appeared not to be associated appreciably with a
high incidence of pneumonia ( with certain exceptions), and such
nonoccupational factors as age, race, and economic conditions did
not account for the major part of the excess incidence. A conservative estimate of the excess number of cases of pneumonia among
428,000 men employed in blast furnaces, steel works, and rolling
mills in the United States over t hat experienced by an equal number
of men in other industries is 642 per year (the rate being 4.3 per
thousand, as against a normal rate of 2.8) , and the number of excess
deaths about 160 annually. Few specific diseases of occupation cause
so many serious illnesses or so many deaths per year.
Studies of the haz(Jjf'ds in the radium-diafl-panntinq industry.Analysis of the data obtained in this investigation was completed
during the year. A discussion of the subject was given before the
American Medical Association in May, 1931, in which the conclusion was reached that there is evidence of the accumulation of radioactive material even under the improved conditions which have
obtained since 1926. The amounts of radium found in the workers
are small relative to those amounts previously noted in serious or
fatal cases of radium poisoning, and there is no indication that any
individual employed since 1926 only has been injured. The evidence
does, however, show the necessity for a still further and marked
reduction of the exposure to prevent further accumulation and to
provide a sufficient factor of sa:fety under varying conditions.
L ead poisoning.-Data were obtained in an investigation o:f the
nature and severity o:f the effects of exposure to the lead hazard in
a storage-battery plant, and an analysis of the material is in
progress.
T etraethyl lead qasoline.-Observations in regard to the use of
tetraethyl lead gasoline were continued.
M etlwmol as an antifreeze.-A possible hazard from methanol
(methyl alcohol or wood alcohol) used as a substitute :for denatured
ethyl alcohol to prevent freezing in automobile radiators has been
brought to the attention of the Public Health Service on several
occas10ns.
The Bureau o:f Mines, under an agreement with the manufacturers
of synthetic methanol, had undertaken a study of the toxicity of


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methanol. The Public Health Service made brief, independent field
observations as to the extent of the hazard.
In accordance with a request from the conference of State and
Territorial health officers to the Public Health Service to reach an
agreement with the industry for the adoption of safeguards, representatives of the industry were asked to meet with representatives
of the United States Public Health Service to discuss the matter.
Following this conference a preliminary suggested agreement was
sent to the manufacturers, and by the latter part of June favorable
replies had been received from so many of them that it was believed
that the most important sources of methyl alcohol in the United
States would be covered by the agreement. The several State health
officers were accordingly so notified.
In this agreement reliance is placed on a distinctive coloring, a
chemical deterrent, and a warning label. The color selected was
purple ; the most important deterrent was chloroacetophenone (tear
gas), which gives a very burnin~ taste and under severe exposurefor example, close to the vent ot a boiling radiator-would produce
the tear-gas effect. For general industrial use of methanol reliance
is placed on the same warning label as is used for antifreeze and
on withholding new extensions of the use of methyl alcohol in
industry until the co_n ditions under which the substance can be
safely used are scientifically investigated.
I ndustrial dermatoses.-An investigation of skin diseases of industrial workers was begun during the fiscal year, surveys being made
in four candy factories in New York City, two silk-dyeing factories,
a worsted mill handling dyes, a fur-dyeing plant, and an oil company. About 6,000 persons were examined for presence of dermatitis, and this group will be kept under observation for one full year.
One hundred and ninety cases of dermatitis were found.
A discussion of a skin disease due to contact with Brazilian walnut
wood was submitted for publication in the Public Health Reports.
An extensive bibliography on industrial skin affections_ was completed d urin~ the year.
Oornparative air pollution of cities.-The most extensive investigation undertaken during the year relates to the determination of
the comparative pollution of the air of 14 of the largest cities. During the year the plans were perfected, necessary personnel trained,
instruments tested and calibrated, conferences held, and the field
work commenced.
Loss of light due to smoke.-Records of daylight illumination at
Baltimore to show the effect on illumination of the smoke in a
downtown district have been completed and a report is being
prepared.
Natural illumination in factories, schools, hospitals, etc.-During
the year a report was prepared covering the results of measurements
made at the experimental daylight building at Arlington, Va. Additional measurements for a more intensive study are being made at
the present time.
Sichness ctrmong indu.r:strial emrployee.<:s.-For the tenth consecutive
year reports of cases of sickness and nonindustrial accidents causing
disability for more than one week have been received from a group
of about 35 companies in which some form of sickness insurance
requires a record of the cases occurring. Among about 140,000 men

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included in this sample of the industrial population a favorable
health report was indicated all through the year 1930. During the
first quarter of 1931 low sickness incidence rates were shown for
the more important disease groups, with the exception of influenza,
the rate for which was high on account of the widespread epidemic
occurring in January and February, 1931. The pneumonia rate,
however, failed to rise in proportion to the increase in influenza, indicating the relatively mild nature of the outbreak. The nonrespiratory disease rate in the past year has differed little from its incidence
in the preceding year.
Surv·e y of the work of employee 'm utual benefit associations.-The
Office of Industrial Hygiene and Sanitation cooperated with the
National Conference on Mutual Benefit Associations in a survey of
the work of industrial sick-benefit associations with special reference
to the extent to which such organizations have developed programs
of health improvement and better medical care for _their members.
It was found that a large majority of the associations are essentially
insurance organizations, making no attempt to control either the
incidence or the duration of the disabilities afflicting their members.
Mortality in an industrial group.-The death rate among males
in an industrial group under a highly organized plan £or the care
and prevention of sickness and accidents was compared with male
mortality at the same ages in the State at large. During the 5-year
period 1925-1929 the industrial group showed a decline from the
1913-1924 average that was approximately 14 per cent greater than
the decrease in the rate among males at the same ages in the State
at large.
Health of women in indrustry.-A study was outlined and begun
in regard to health of women in industry, utilizing particularly the
sickness records in the industries surveyed.
Studies of physical dev·e lopment and posture.-The final report of
this investigation (IV. Postural Relations as Noted in 2,200 Boys
and Men) was published during the year as Public Health Bulletin
No. 199. Three photographs (profile, front, and back) were taken
of each person nude, and these were supplemented by a complete
physical examination. A large number of measurements of body
angles were made on each of the photographs in order to yield quantitative indices of postural relations.
The most marked characteristic of the data obtained was the wide
variation in postural relations from person to person. Equally
great variability was found in the youngest children studied. No
uniform type of " good " posture could be identified.
Physical impairment and occupational groups.-Two studies of
physical impairments and occupation, involving 100,000 medical examinations, have been completed in cooperation with the Milbank
Memorial Fund. The first study dealing with broad occupational
classes was published in the Public Health Reports (August 22, 1930;
Reprint 1404), and the second, dealing with 28 specific occupations,
will be published early in the next fiscal year. A relation between
physical impairment and occupational class, such as has been found
in the past in official mortality data, was clearly brought out in these
studies.
Role of physical ewaminations in researoh.-A paper in regard to
the necessity for standardizing the technique of making physical

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examinations was read before the Philadelphia County Medical
Society and submitted for publication in the Public Health Reports.
0 onsecnJJtiv'e readings of JYU,lse rate Olfh a small group of olerks . Daily observations were made in regard to the pulse rate of a group
of clerks, 11 men and 11 women, over a period of months, the results
of the study being published in the Public Health Reports (December 19, 1930; Reprint 1435). It was.found that readings deviating
as much as 10 to 15 'beats per minute from the true average might
occasionally be expected without having any particular significance.
Special surveys.-In the course of the year a number of special
surveys were made, the results of which have not been analyzed for
publication. Included among these was a survey of the industries
in Kingsport, Tenn., to determine the presence of possible hazards
with respect to tuberculosis; a survey of hazards in a large rubber
company; a study of the ventilation of the Federal detention headquarters in rew York; an investigation of atmospheric dustiness in a
Maryland plant engaged in the grinding of quartz for abrasive purposes; and a study of the efficiency of ventilating devices in a granitecutting plant in Massachusetts.
COOPE&ATION WITH THE BUREAU OF MI ES

Surg. R. R. Sayers continued as chief of the health and safety
branch, and as chief surgeon of the health division of the Bureau of
Mines, being assisted by other officers detailed from the Public Health
Service and by other personnel from the Bureau of Mines.
H ealth division.~Work of the health division included chemical
and pathological studies of asphyxia by carbon monoxide and by
atmospheres deficient in oxygen for the purpose of obtaining fundamental information on the response of the organism to asphyxia}
environment, and especially for developing the best method of treating moribund cases of carbon-monoxide poisoning. The first report
of a series on this subject has been published.
Since 1926 studies have been made of chemical warning agents for
fuel gases. Crotonaldehyde was found to be a promising warning
agent of the nose and throat irritant type. Allyl alcohoJ on laboratory tests proved to be similar to or better than crotonaldehyde as
a warning irritant. The most promising warning agent of the
unpleasant-odor type was found to be ethyl mercaptan, but it does not
waken sleeping persons unless present in high and impractical
concentrations.
In cooperation with the safety division a study was made and a
report submitted for publication showing the accident experience of
coal miners in Utah, 1918 to 1929. Data have been compiled and a
report is being prepared on the causes of death among coal miners,
metal miners, and employees of metallurgical plants as compared with
farmers and with " all other adult males."
Studies of the toxocity involved in the use of aniline and dimethyl
aniline, benzol, dichloro-difluoro methane, carbon monoxide, and
methanol were continued during the year.
Acrolein was found to be a suitable warning agent in the leakage
of certain refrigerants. Work was carried on as usual in gas analysis,
stream pollution, and gas masks.


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MISCELLANEOUS ACTIVITIES

A new draft was prepared for a proposed sanitary code for industrial workers under the auspices of the American Standards Committee. This draft is under consideration at the present time.
Passed Asst. Surg. A. E. Russell represented the Public Health
Service at an international conference on silicosis held at Johannesburg, South Africa, August 13-927, 1930.
An exhibit on the subject of silicosis and tuberculosis in industry
was prepared and shown at the annual meeting of the American
Medical Association in Philadelphia, June 8-12, 1931.
At the request of the S tate D epartment, a survey was made of the
practicability of an investigation into the effect of sulphur-dioxide
fumes from a smelter upon the health of persons living in the vicinity
(Stevens County, Wash.).
A pamphlet was prepared for use of the National Safety Council
on the methods and value of industrial health sur·veys.
COOPERATION WITH INDUSTRIAL AN D OTHER AGEN CIES

Members of the staff have represented the service on various technical committees engaged in the pre1?aration of specifications and codes
relating to industrial hygiene activities.
Cooperation with the Bwre{JJ/JJ of Standards.-An officer was attached to the Bureau of Standards during the year for the following purposes: (a) Cooperation in care of injuries and preparation
of sickness reports; ( b) studies of hazards in general ( for instance,
osmium poisoning); (c) study of applicability of methods worked
out or on trial at the Bureau of Standards to public health problems; ( d) as requested by the American Federation of Labor, a study
of possible hazards to industrial workers of new pr·ocesses and substances devised or tried by the Bureau of Standards for industry.
Cooperation with the Eniployees' Oompens(J)tion Commission.-As
in the past, an officer of the section is detailed to have charge of the
medical work in the Employees' Compensation Commission. The
officer in charge of the section serves as recorder of a board passing
upon claims for· compensation.
MrLI<:

I N VESTIGATIONS

The activities of the Office of Milk Investigations were carried on
under the direction of Sanitary Engineer Leslie C. Frank, with
headquarters at Washington, D. C. The work has been along the
following lines:
Committee 'work with the White House Conference on Child
Health and Protection.-Approximately half of the time of the qffice
and field staff of this office for the fiscal year was devoted to field
and office work connected with the preparation of the Report of
the Committee on Milk Production and Control of the White House
Conference on Child Health and Protection. The preliminary report was published in the Public Health Reports ( April 3, 1931 ;
Reprint No. 1466), and gives the milk sanitation status of 430
American cities.


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As a result of this committee report the White House conference
recommended that laws or regulations for the supervision of milk
supplies, whether local, State, or Federal, should incorporate, in
so far as practical, uniform requirements at least the equivalent of
those contained in a milk ordinance to be recommended by the
United States Public Health Service and the Bureau of Dairy Industry of the United States Department of Agriculture. The White
House conference further recommended that inasmuch as the laws
and regulations relating to the public-health supervision of milk
supplies deal only with measures which are designed primarily to
protect the public health, they should, when practical, be made the
function of health authorities, local, State, and Federal.
Cooperation writh the United States Department of Agriculture.During the year, in accordance with the recommendation of the
White House Conference on Child Health and Protection, an agreement was reached with the United States Department of Agriculture
under which that department approves the 1931 edition of the ordinance and code recommended by the Public Health Service. Such
joint support of both the Public Health and the Agricultural authorities should be rapidly effective in establishing a nation-wide unification of milk control upon sound lines.
Publioations.-During the year Associate Milk Specialist Franklin
A. Clark, of the Public Health Service, and Mr. W. Scott Johnson,
chief public health engineer of the Missouri State Board of Health,
prepared a paper on the operation of the standard milk ordinance in
Missouri (Public H ealth Reports, June 12, 1931, Reprint No. 1484).
It may be summarized as follows : (a) There are 19 Missouri cities,
having a population of 315,127, operating under the standard milk
ordinance; ( b) the sanitary quality of the retail raw milk has improved 54 per cent; (c) the sanitary quality of the raw milk delivered to pasteurization plants has improved 90 per cent; ( d) the
pasteurization plants themselves have improved 60 per cent; (e)
there has been a material increase in the consumption of pasteurized milk (two cities now have over 50 per cent of their supply
pasteurized and two others between 40 and 50 per cent; pasteurized
milk sales have increased 108 per cent); (f) the consumption of
market milk has increased 18 per cent; (g) the per capita consumption of milk in 17 of the 19 cities is 0.74 pints per day.
A paper entitled "The Public Health Control of Milk Supplies"
was prepared by Sanitary Engineer L. C. Frank and submitted for
publication in the Public Health Reports. It embodies answers
to the following questions : (a) How frequent are outbreaks of
milk-borne disease; (b) what type of milk ordinance should be
adopted and enforced by the municipality or county in order to
provide the maximum protection against such outbreaks ; ( c) how
should the milk ordinance be enforced; ( d) should the health
officer recommend compulsory pasteurization or should he promote
pasteurization by purely educational methods; ( e) what recordkeeping system should the health officer adopt; (f) how may the
results of milk-ordinance enforcement be measured; (g) how may
the health officer determine whether a given disease outbreak is
milk borne; ( h) what should be the function of the State health
department with reference to the public health control of milk sup-


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plies,; (i) how may small communities and villages which are
unable to provide their own full;time milk control staff secure an
adequate public health control of milk supplies.
Extension of the adoption of the standard niilk ordinance by
Americarn W/Jj}'/,icipaJlities.-The number of American cities which
have thus far adopted the standard milk ordinance recommended
by the Public Health Service for the improvement of milk supplies
has increased from 379 as of June, 1930, to 437 as of June, 1931.
These cities are located in 24 States.
Research activities.-During the year Passed Asst. Sanitary Engineer F. J. Moss completed studies of devices and methods for the
heating of the air and foam above the milk in pasteurization vats.
These studies were considered particularly important in view of
the fact that in the past most of the designs of pasteurization machinery have £ailed to render the milk foam non dangerous, but
have nevertheless permitted the foam to be discharged into the milkbottling system. Since foam is a poor conductor of heat, previous
pasteurization devices have been unable to insure the killing of all
pathogens within it. By the means of specially designed steaming
connections in the upper part of each vat jt has been possible to
overcome this difficulty.
.
A study of the results of the enforcement of the standard milk
ordinance in 152 municipalities located in 14 States has given the
following information: (a) The raw-milk ratings of the 152 municipalities prior to the adoption of the standard milk ordinance averaged 64 per cent; (b) the raw-milk ratings of the same 152 municipalities after the enforcement of the standard milk ordinance averaged 91 per cent, the period o-f enforcement ranging from several
months to 6 years; ( c) the pasteurized-milk ratings of the 152
municipalities prior to the adoption of the standard milk ordinance
averaged 62 per cent; ( d) the pasteurized-milk ratings of the same
152 municipalities several months to 6 years after the enforcement
of the standard milk ordinance averaged 87 per cent ; ( e) the per
capita daily market milk consumption in the 152 municipalities increased from 0.48 to 0.58 pint, an increase of about 21 per cent;
(f) the percentage of milk pasteurized increased from 33 per cent to
45 per cent. The actual gallonage of pasteurized milk sold per day
has nearly doubled.
A study to determine the most effective and practical devices and
methods for the bactericidal treatment of utensils and equipment at
dairy farms and pasteurization plants was assigned to Sanitary Engineer A. W. Fuchs and Associate Milk Specialist M. M. Miller. It is
considered important, because our knowledge of the efficiency of bactericidal treatment of utensils and equipment as now practiced at
dairy farms a_nd pasteurization plants is extremely unsatisfactory.
An attempt will therefore be made to develop a laboratory criterion
for proper bactericidal treatment and then, by means of this criterion,
to determine the most effective means of securing adequate bactericidal treatment for each of the various types of devices used at pasteurization plants.
A study to determine the public health importance of milk coolinohas been assigned to Associate Milk Specialist F. A. Clark, with heaf
quarters at Austin, Tex. ~pecial _studies are being undertaken to
show the effect of proper milk coolmg, both at the plant and in the
1


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home, in retarding the growth of the various types of pathogenic
organisms transmissible through milk supplies.
A study to determine the proper design of milk-sample-shipping
containers has also been assigned to Associate Milk Specialist F. A.
Clark. Milk samples are shipped over longer distances in Texas
than in any other State, and are exposed to as high temperatures as
obtain in any State. The most advanced designs of milk-sampleshipping containers at present available, namely, those using frozen
brine pads, have not proven entirely satisfactory ~or use during the
hottest seasons. Special studies are therefore being undertaken with
a view to designing a satisfactory shipping case for the use of the
many health officers who are not provided with local laboratories,
but must ship their milk samples to distant laboratories. Doctor
Clark has been requested to study the possibility of using carbondioxide ice in a thermostatically controlled shipping container. Such
a design should be light and effective over long distances.
A study of the public health value of chlorine disinfection of
udders and hands in connection with the process of milking has been
assigned to Milk Specialist W. H. Haskell, with headquarters at
Portland, Oreg. The washing of hands and udders as usually carried
out at dairies is_ considered quite unsatisfactory, and for this reason
the present study is intended to determine whether a significant improvement can be effected by the use of chlorine solutions as recommended in the Standard Milk Control Code.
A study of laboratory methods for the estimation of milk quality
from the public health point of view has been assigned to Assistant
Milk Specialist R. C. Thomas, located at Montgomery, Ala. Special
studies have been outlined by means of which it is hoped to determine the most satisfactory laboratory method for the measurement
of initial contamination in milk, and also for the measurement of
subsequent bacterial growth. All present day laboratory methods are
being subjected to relative evaluation, including the bacterial plate
count, the direct microscopic count, and the reductase test.
A swrvey of wuk-borne disease owtbreaks reported for th0 year
1930.-During the year 1930 the following outbreaks of milk-borne
disease were reported to the Office of Milk Investigations by State
and city health authorities: Typhoid fever, 27; septic sore throat, 9;
scarlet fever, 2; miscellaneous, 6; total, 44.
STATISTICAL INVESTIGATIONS

The Office of Statistical Investigations continued under the direction of Senior Statistician Selwyn D. Collins, with Principal Statistician Edgar Sydenstricker actmg as a consultant. The investigations include work carried on in the Office of Statistical Investigations independently as well as in collaboration with the other stations of the Division of Scientific Research and with other divisions
of the service.
Study of the incidence and cost of illness.-By an arrangement
with the Committee on the Costs of Medical Care, records of illness
during a 12-month period in a group of about 10,000 families scattered throughout the United States have been made available to the
Public Health Service as a cooperative study with that committee.
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By this arrangement these data are being tabulated in this office,
but clerical assistance is being furnished by the committee. The
major part of the clerical work perfqrmed during this year has been
on •this study, because the schedules represent a very complete and
detailed statement of the illnesses and the medical care received by
the family during the year.
.
The nature of the data that will be made available in this study
may be summarized as follows:
·
( 1) Sickness records similar fo the Hagerstown records, but for
a group of families scattered throughout the United States, both
urban and rural, and covering two or three times as many years of
exposure as the Hagerstown study. These sickness records include
(a) nature of and duration of each illness ; ( b) type of attendant,
·whether general practitioner, specialist, osteopath, chiropractor, or
other practitioner; ( o) kind of specialist in attendance upon case;
( d) number of consultations or treatments for each type of practitioner; ( e) kind of nurse and days or visits in attendance; (f) kind
of laboratory or other special service, including X ray, received by
th.e patient; (g) place of treatment of the case, as office, clinic, home,
hospital; ( h) kind of clinic or hospital, type of accommodations, and
kind of special services received there; (i) extent of prenatal, natal,
and postnatal care in maternity cases and by whom rendered.
(2) -A complete record of surgery performed on members of these
families during the year, includmg (a) the nature of the operation;
(b) the diagnosis of the illness in connection with which the operation was performed; ( o) whether the operation was performed by a
general practitioner or a specialist and the nature of the specialty if
a specialist d.i d the work. ( d) the place of the operation, as office,
clinic, home, or hospital.
(3) A complete record of all preventive medicine, such as vaccinations, toxin antitoxin, antitetanus, antirabies, cold vaccine,
physical examinations, etc_., in this group of families, with a record
of who did the work; that is, whether it was done by a private
physician or public clinic.
(4) A record of all eye refractions.
( 5) A record of all dental cases, together with the nature and
extent of the work done.
For practically all these items there are now no data available on
any sizable group of persons, and it should be remembered that each
of the items that have been mentioned can be considered by age,
sex, season of the year, and in connection with various other factors,
including the income of the family, the occupation of the person,
etc. It is planned during the next fiscal year to make a number of
studies from these records, and it is believed that they will be of
great value in the field of epidemiology and public health. Data
on the cost of these various types of cases will be used by the Committee on the Costs of Medical Care. Of more interest to the Public
Health Service are data on the number of physicians' calls on various
types of cases and other measures of the extent of medical service
rendered. In a few instances, however, such as surgical operations,
the cost of the operation will be of some value in judging whether
it was a major or a minor operation, particularly when cases are
eliminated where the operation was said to be done at a reduced fee.


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Field studies of morbidity.-The periodic canvassing of some
1,400 families in a rural area in Cattaraugus County, N. Y., and a
like number of families in the city of Syracuse, N. Y., has been continued. One of the purposes of this study was to compare the incidence and severity of illness in the farm population with that
in the industrial city population. It is expected to continue the Cattaraugus County study of illness through the fiscal year 1932, because very few data are available on the nature and severity of illness
in rural areas. It is also expected to undertake certain special
studies of epidemics that may occur in the rural area, with special
reference to the spread from family to family in an area where interfamily contacts are much less frequent than in urban areas.
During the past fiscal year a paper was published on the Age
Incidence of Communicable Diseases in a Rural Population (Public
Health Reports, January 16, 1931; Reprint No. 1443). During the
next fiscal year the tabulation of the data from both the rural and
the urban areas, with further comparisons of the incidence of illness
in the two places, will be continued.
l nfi11,enza studies.-The studies of influenza during the epidemic
of 1928-29 were continued, but have not been a major part of
the year's work. Two rather extensive papers have been published
during the fiscal year and three are now in proof.
(1) Influenza Mortality jn 50 Cities, 1910-1929. Public Health Reports,
September 26, 19-30; Reprint 1415.
(2) The Incidence of Influenza Among Persons of Different E conomic Status
During the Epidemic of 1918. Public Health Reports, January 23, 1931;
Reprint 1444.
(3) Age and Sex Incidence of Sickness and Mortality from Influenza and
Pneumonia During the Epidemic of 1928-29, with Comparative Data for the
Epidemic of 1918- 19 (in proof).
( 4) Excess Mortality from Causes Other than Influenza and Pneumonia
During Influenza Epidemics ( in proof) .
( 5) Detailed Study of Influenza in About Twelve Surveyed Localities of
1918 ( in proof) .

A further pa per on the details of the 1928-29 epidemic in each of
about · 14 surveyed localities is to be presented for publication in
the near future.
Current mortality (l)nd disease prevaience statistics.-The collection and publication of monthly mortality statistics from such States
as could furnish data to the Public Health Service was continued
throughout the yeari in cooperation with the Division of Sanitary
Report s and Statistics. The present plan of publication of these
current mortali_ty rates is to publish_ about three summaries during
the year, covermg for the States with the most recent data available the periods January to March, January to June, and January
to September, ~ith an annual summary for the entire calendar year.
Each summary mcludes not only data for the specified period of the
cur~ent .calendar year but ~omparative rates for corresponding
per10ds m about four precedrng years. The death rates are given
by States_ and by cause... The purpose ?f these publications is to
make available to the var10us Stat~ and city health officers mortality
data from as many State_s '.1S possible at as early a date as possible.
, vhen the work was origrnally started several years ago it was
found by correspondence with the various State health departments
that many States tabulated their deaths by months and could fur-


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nish the data to the Public Health Service with little additional
work. In some instances the State itself publishes a monthly or
other current summary, but it was felt that the publication of the
rates in the various States in a uniform manner and the circulation
to health officers through the Public Health Reports would be a
distinct ad vantage in keeping them informed of changes in current
mortality.
Monthly summaries have also been published on the prevalence of
disease in the United States. These summaries are based on weekly
telegraphic reports received from the States.
In view of the undue prevalence of meningitis during the past
three or four years a paper was prepared by Consultant A. W.
Hedrich on the movements of that disease in the United States since
1915, with comparative data for various other countries.
Cooperation with other offices and divisions of the service.-A con•
siderable part of the work of the Office of Statistical Investigations
consists of rendering assistance to other offices and divisions of the
-service. This assistance comprises the following: ( 1) Technical advice and criticism on statistical procedure, (2) temporary assignment
of statistical personnel to assist other units, and (3) use of mechanical tabulating equipment and of operators. Active cooperation in
one or more of these respects has been continued throughout the year
with the child hygiene and industrial hygiene offices and with the
divisions of venereal diseases and mental hygiene.
STREAM POLLUTION

The administrative headquarters and specially equipped labora\t ories for stream-pollution studies located at Cincinnati, Ohio, have
lbeen continued under the direction of Sanitary Engineer J. K.
'.Hoskins, assisted by a staff of experienced technical personnel.
In addition to the major divisions of research in progress during
the year, special attention has been paid to the completion for publication of monographs on field investigations. At the end .of the
years the results of biological observations on the Illinois River had
been published as Public Health Bulletin No. 198, and a bulletin
describing the studies of the pollution of the upper Mississippi River
was in press. The results of an epidemiological study of the relationship of typhoid-fever incidence to quality of the public water
supply in six Ohio River cities were published in the Publc Health
Reports.
SURVEY OF THE PRESENT SANITARY CONDITION OF THE OHIO RIVER B,E TWEEN
CINCINNATI, OHIO, Al'l'D LOUISVILLE, KY.

The Ohio River·, because of its many characteristics representative
of the larger streams of this country and of its heavy pollution load,
was selected during the years 1914-1916 for intensive study of the
fundamental principles of sewage disposal by dilution and of the
natural process of stream purification as related to the problem of
safe drinking-water supply. Since that time extensive changes have
taken place, including complete canalization of the main channel
during periods of low flow and normal increases in population and
industry contributing polluting wastes. A resurvey of the section


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of the river from above Cincinnati to the mouth of the Kentucky
River was inaugurated in September, 1929, to measure quantitatively
the effects on the stream of such changes, especially during critical
periods of low flow. These observations were continued for a period
of 16 months, ending with December, 1930. At the request of the
Kentucky State Board of Health and the Louisville Sewerage Commission, and with their active cooperation, this study was extended
downstream in May, 1930, to include the section from the mouth of
the Kentucky River to a point about 5 miles below the Louisville
metropolitan district. Observations in this latter section were concluded in May, 1931, thereby covering a period of 13 months.
The general scope of the resurvey has included the collection of
nearly 2,000 water samples for chemical and bacteriological analyses
at 10 main river sampling points and from 4 of the larger tributaries
between Cincinnati and Louisville, and the collection and tabulation
of the . necessary hydrometric data and information relative to contributing population and sources of existing pollution. Data are
therefore available for an 8-months' period representing conditions along the entire section, 165 miles in length, from above Cincinnati to below Louisville, and for over a year of conditions within
and below the metropolitan areas of these two cities. Separation of
the results into seasonal averages makes possible comparisons between open-river conditions at present with those of 15 years ago,
open-river with pool-stage conditions at the present time, and present summer pool-stage conditions with open-river conditions in the
summers of 1914 and 1916. In addition, an opportunity is presented
to compare rates of bacterial disappearance, deoxygenation, and reaeration at the present time with those observed previously under
similar river conditions, and to study the changes in these rates with
modifications in the controlling factors due to pool-stage conditions
and greatly lengthened times of flow.
Preliminary analyses indicate that certain changes have occurred
in the river since the previous investigation and suggest rather
definite conclusions as to the effects of canalization during the summer period. Suplementary evidence from ad<.litional sampling
stations during the present resurvey has supplied information tending to modify somewhat certain of the earlier conclusions relative to
bacterial death rates and the oxygen relationships in polluted
streams.
Among such indicated changes may be mentioned the concentration of purification processes in shorter stream lengths during pool
stages which results in improved sanitary condition of the water at
points distant from sources of pollution but which has the effect of
intensifying dissolved oxygen depletion immediately below such
major contributions of pollution. The oxygen requirement within
the zones of pollution is likewise increased by the settled sludge
deposited on the river bed as a result of slower velocities of flow
through the pools. It also appears that points of maximum bacterial concentration are nearer to sources of pollution during pool
stages, although the density of bacteria was found to be less at such
times than during periods of unobstructed flow in the open channel.
Another observation which confirms previous experimental evidence
is that tributary inflow below a zone of sewage contamination ap-


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pears to produce bacterial increases in the main stream below the
point of dilution.
The field data collected during the course of the survey are now
being studied critically in preparation for publication.
STUDIES OF THE EFFICIENCY OF ARTIFICIAL WATER PURIFICATION PROCESSES

Collective and experimental studies of the efficiency of artificial
water purification processes, begun during the summer of 1924 and
continued actively up to August, 1929, were brought to a definite
conclusion during the past fiscal year with the publication in the
Public Health Reports (July 4, 1930, and July 11, 1930, Reprint
1392, and December 19, 1930, Reprint 1434) of the fourth and fifth
reports of a series dealing with the results of experimental studies
and with the preparation of the sixth and final report of the same
series for publication in the near future.
These studies originated in a preliminary series of observations
of the Cincinnati and Louisville filtration plants and were later
ext@ded to include 17 additional plants, 10 of which serve Ohio
River cities and 7 are located on various rivers of the Midwestern
and Eastern States. Still later, a group of 14 municipal filtration
plants taking their raw water supplies from the Great Lakes were
included in the survey. A complementary study consisted of observations extending over a period of five years at a fully equipped
large-scale experimental filtration plant of the rapid sand type constructed on the headquarters station grounds. During this entire
period, under a cooperative arrangement with the operators of several municipal filtration plants along the Ohio River, monthly
reports of daily operation results were furnished with a view to
maintaining a continuous record of performance throughout the
progress of the experiments.
It is now possible, as the result of these studies, to prescribe defi·nate limits, in accepted bacteriological terms, for sources of raw
water from which purified-water supplies in the Great Lakes and
Mississippi River basins are derived. This is perhaps the most
practical immediate result of the studies, though of scarcely secondary importance is the knowledge which they have afforded o:f
the fundamental characteristics and limitations of water purification
processes in general.
EXPERIMENTAL STUDIES OF NATURAL PURIFICATION IN POLLUTED WATER

Studies of the motivating biological factors in the natural purification process have been continued . throughout the year. The
nature and scope of this experimental work is clearly set forth in
the article appearing in the Public Health Reports, February 20,
1931, discussing the role of the bacteria-eating plankton in the
biochemical oxidation of organic matter, in which it is demonstrated
that certain varieties of these microorganisms are essential to the
sustained oxidizing activity of the bacteria. By themselves, how.ever, the plankton appear not to be effective in the destruction of
organic matter by oxidation.
Another paper on the selection of a standard dilution water for
use in oxygen demand tests published in the Public Health Reports,


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May 8, 1931, has shown that the nature and concentration of the
mineral salts present in a water may be of minor importance in
determining the rate and extent of biological purification, granting
always that some such salts are present. The results of this study
i1ave a direct bearing on problems of self-purification in brackish or
sea water and in waters heavily charged with industrial wastes of
mineral origin. They are likewise related to the question, in sewage
treatment, of the relative effect of hard or soft waters as carriers of
pollution.
A third comprehensive report appearing in the Public Health Reports, May 29, 1931, dealt with the accurate determination of rates
of purification in the presence of aerated or the so-called activated
sludge, in which it is concluded that the high rate of oxidation is
apparent only and is to be ascribed to adsorption or storage f organic
matter in the sludge. In these studies use was made of a statistical
procedure for the treatment of reaction-velocity data developed with
the assistance of Consultant Lowell J. Reed and considered of sufficient interest to warrant separate publication in the Journal of Physical Chemistry (vol. 35, pp. 673-689, 950-971; 1930) for the use and
information of workers in allied fields. Other publications have included a monogram for the calculation of dissolved oxygen, published
as Supplement No. 95 to the Public Health Reports, and a set of
detailed instructions for th~ determination of dissolved oxygen and
of oxygen demand in polluted liquids, published as Supplement No.
90 to the Public Health Reports.
Other phases of this general study in progress at the end of the
year deal with (a) the development of a suitable dilution water for
use in the bacteriological laboratory, (b) the general course of oxidation in the nitrogenous stage, and (c) the specific relationship of
algae to the oxidation process.
A correlative study of natural purification processes has been concerned with the changes occurring in a stream of polluted water
flowing through a series of artificial channels where such :factors as
sunlight, velocity, depth, and degree of pollution ma,y be modified
at. will.
MISCELLANEOUS ACY.I'IVITIES

In addition to the publication of monographs on research studies,
constructive service has been rendered by the personnel in a variety
of ways, including conferences, investigations, and reports upon perplexing sanitary problems confronting States and municipalities;
presentation of technical papers before national and sectional organizations interested in stream sanitation; service on technical committees of such organizations; and supplying instruction in procedures
developed and employed by this station in stream examinations.
Studies of State and local sanitmry pr,,,oblems.-During the year a
rather comprehensive study was made of the present sanitary condition of the public water supply of Milwaukee, Wis., in response to
requests of State and local officials. The report submitted advised
the installation of additional safeguards in the form of filtration.
' Biolo!!ical !!rowths in the bodv of water receiving- the treated
sewage of Baltimore, Md., have created objectionable conditions difficult to control. Assistance was rendered in planning and conduct~
ing experiments for the development c,f possible remedial measures.

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Difficulties have been experienced with excessive growths of taste
and odor producing organisms in certain lake waters of Iowa used
for water supplies and recreational purposes. Following a survey
of field conditions, advice was given the State and local authorities
regarding advisable control procedures.
The State health authorities of Louisiana were advised regarding
the methods for ascertaining the present sanitary condition of certain of the drainage channels serving the area in the vicinity of
New Or leans.
Instruction in technical prooedures.-For the third successive year
a. two weeks' course of instruction in the technique and interpretation o:f data o:f stream-polution examinations has been presented to
employees of State health departments at the request of the Conference o:f State Sanitary Engineers. This year one member from
each of 18 States was in attendance. By thi$ means the States
are encouraged to undertake studies of their own problems in stream
sanitation, employing the procedures that have been found to be
most reliable for that purpose. Members of the staff haye also
assisted in short courses . of instruction offered by various State
health departments to sewage-plant and waterworks operators.
STUDIES OF PUBLIC HEALTH METHODS

The Office of Studies of Public Health Methods is an outgrowth
of the Office of Administrative Health Practice, which was discontinued in December, 1929. Surg. Joseph W. Mountin was as$igned
to duty in charge of the studies of public health methods on February 1, 1931, and on June 10, 1931, Asst. Surg. J. 0. Dean was
assigned to assist him in this work.
Special surveys of the city health service in Wilkes-Barre, Pa.,
and Baltimore, Md., undertaken at request of State and local health
officials, were in progress at the close of the fiscal year.
The original purpose of the Office of Administrative Health
Practice, to give consultation service to local health officers, is to
be continued, but greater stress is to be placed on scientific research
in administrative practice. The facts revealed through investigations in the basic sciences need to be applied under controlled conditions before being incorporated into public health programs.
Furthermore, a large part of the content of public health programs
has been built on the collected _e xperience and judgment of practical
health administrators. Such programs need to be analyzed to determine the effectiveness of procedure as well as the economy of
its application.
A special study is being projected for the coming year to determine the public health needs of people living under rural conditions,
now these needs are being satisfied, and the extent to which the
small county health department is capable of meeting the demands
now being imposed on it. Upon the completion of this study, data
will be available for the guidance of health authorities of other
counties of similar circumstances.
The future program of the office also contemplates not only the
study of specific measures in disease control and health promotion
from the analytical point of view, but the conduct of experimental


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work to develop and test new methods. Such measures should obviate the necessity of trial and error which results if various procedures are immediately incorporated into public health programs.
NATIONAL INSTITUTE OF HEALTH

The administration of the National Institute of Health for the
fiscal year 1931 was continued under the supervision of Director
George yV. McCoy and Assistant Director R. E. Dyer.
Legislation.-Congress passed an appropriation bill of $300,000 to
begin work on new buildings for the institute and authorized the
Secretary of the Treasury to enter into contract for such buildings
not to exceed a total of $750,000.
Publications.-Four laboratory bulletins were issued during the
year and one was in proof. A considerable number of papers on
scientific subjects were prepared by workers at the institute for presentation at professional meetings and fqr publication in various
scientific journals and in the Public Health Reports.
Library.-Five hundred and twenty-seven volumes were added to
the library, bringing the total number of volumes to 14,995. Annual
reports from State and municipal health departments, as well as publications from various scientific institutions, were also added to the
collections.
STUDIES OF NUTRITION AL DISEASES

Nutritional studies at the institute were conducted under the direction of Passed Asst. Surg. W. H. Sebrell, with general supervision by
Suro-. G. A. Wheeler at Milledgeville, Ga.
•
The work consisted of testing individual foodstuffs in order to
determine their probable pellagra-preventive value. This work was
supplemented with studies on the antineuritic vitamin and feeding
experiments with purified amino acids.
In collaboration with the Division of Chemistry, studies on the
anemia-producing substance in onions were continued. Experiments
were conducted with rats, which led to the development of an intraperitoneal method for testing antineuritic concentrates, and several
active concentrates were prepared.
A more detailed report of the nutrition studies, as carried on both
at the National Institute of Health and at the Milledgeville State
Hospital, will be found on pages 38-40.
DIVISION OF PATHOLOGY AND BACTERIOLOGY

Vndulmnt fever.-Field investigations of undulant fever were continued under the direction of Senior Surg. H. E. Hasseltine.
Reports received through the various State departments oct: health
show that 1,385 cases of undulant fever were reported officially, and
also indicate that the reports in some States are far :from complete.
In cooperation with the authorities of one State tuberculosis sanatorium, information has been gathered showing that a considerable
part of the inmates give laboratory evidence of having, or having had
Brucella infection in addition · to tuberculosis. In a few instances
undulant fever apparently has been the cause of sending patients to
the sanatorium when they did not have tuberculosis.


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One small outbreak of undulant fever was traced to the use of raw
milk from a heavily infected dairy herd, Brucella abortus being isolated from the milk of some of the animals of this herd. The use
of raw milk from this dairy was prohibited by the State department
of health, but the sale of milk from this herd was permitted after
pasteurization. No cases occurred after pasteurization was begun,
indicating that the process of pasteurization is an efficient measure in
the prevention o,f milk-borne undulant fever.
While most of the cases attributable to contact infection by persons
engaged in some phase of the meat industry have been found in persons who work on pork and pork products, one case has been studied
in which contact with hogs could not be traced. This man worked in
a meat-packing plant, skinning the legs and heads of slaughtered
beeves and sheep.
From studies made it appears that approximately half of the cases
of undulant fever are traceable to the use of raw milk from infected
animals and the other half due to contact with infected animals either
on the farm, in the stockyards, or in packing establishments. In a
considerable number of the cases in which infection was probably received through contact with infected animals there is also a history
of the use of raw milk.
The prevention of milk-borne undulant fever can be accomplished
by pasteurization of the milk, but the prevention of the contactborne cases lies in the detection and elimination of Brucella infection from the livestock herds of the country. This is a gigantic
task, that is essentially a problem for the veterinary profession and
livestock sanitary authorities, and measures to solve it merit the
whole-hearted support of all health authorities.
Laboratory studies made by Medical Director Edward Francis
on the agglutinin absorption test have demonstrated that certain
Brucella cultures, requiring carbon dioxide :for their isolation, gave
the melitensis A serological reaction of Brucella melitensis, thus
showing that agglutinin absorption is not a reliable test for the
differentiation of Brucella abortus of Bang :from Brucella melitensis
of Bruce.
Tularaemia.-Studies of tularaemia under Medical Director Edward Francis may be summarized as follows:
(1) The State of Delaware was added in December, 1930, to the
area of distribution, leaving only :four States in which the infection has not been recognized, namely, Maine, New Hampshire,
Vermont, and Connecticut.
(2) During the calendar year 1930 the number of serums received at the National Institute of Health :from 29 States and :found
positive for tularaemia was 159.
( 3) Prevention of tularaemia in man calls for refrigeration of
market rabbits at a temperature just above freezing for a period
of time sufficient to allow the tularaemia infection to die before
the rabbits are sold to the public. Complete experiments upon
artificially infected rabbits refrigerated at 3° C. have demonstrated
the isolation of the infection from practically all such rabbits after
1 month, from a smaller proportion after 2 and 3 months, from
6 rabbits after 4 In;Onths, from only 1 rabbit after 5 months, and
from none after 6 months.


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( 4) Special Expert R. R. Parker at the field station at Hamilton,
Mont., isolated Bacterium tularense in May, 1930, from a snowshoe
rabbit captured sick near Varenby, British Columbia. This is the
first strain isolated from Canada, although McNabb in January,
1930, obtained the first agglutination of Bacterium tularense from
the blood serum of a Canadian, a resident of Timmons, Canada.
Researches on tularaemia conducted in the Rocky Mountain
Spotted Fever Laboratory at Hamilton, Mont., are reported on
pa~~.
Typhus-Rocky Mountain spotted f ever.-Studies upon endemic
typhus of the United States have been conducted with increasing
interest for a number of years. The investigati_On$ for the. fiscal
year just closed were continued under the direction of Surg. R. E.
Dyer. Associated in the investigations were Passed Asst. Surgs.
A. Rumreich and L. F. Badger. Toward the close of the fiscal
year· Asst. Surg. E. T. Ceder was added to the group.
The investigations for the past fiscal year have fallen under two
headings, as it became apparent that two disease entities were concerned-typhus and Rocky Mountain spotted fever. An account
of the work and its results appeared in the Public Health Reports
for February 13 and 27 and June 12, 1931.
.
The suggestion that some vector other than the body louse may be
responsible for the transmission of endemic typhus of the United
States has been made by a number of investigators. In connection
with epidemiological investigations of typhus it was found that 78
per cent of cases of endemic typhus occurred in persons who worked
on rat-infested premises. Strams of endemic typhus virqs were isolated from rat fleas removed from wild rats trapped on such premises,
indicating that rat fleas serve as vectors of the disease.
It became evident very early in the course of field inve.s tigations
of endemic typhus that many of the cases observed differed materially in clinical aspects from endemic typhus as described by Brill,
Maxcy, and others.
It was noted that most of the cases living in rural districts in
the northern tier of the States covered by the investigation and
urban dweller.s vacationing in the country suffered from a very
severe disease, which did not correspond to the clinical picture of
endemic typhus and which resembled the spotted fever of the Rocky
Mountains more closely than it did any other disease. A quite high
proportion of these cases gave a history of tick bite within a short
time preceding onset. Furthermore, there was seldom evidence of
rodent infe.s tation in association with these cases.
In view of these facts analysis was made of 100 selected cases
separated on the basis of epidemiologic considerations into two
groups of equal size. The first group was essentially urban and
consisted of persons who, in most instances, had not left city environment; these cases were clearly New World endemic typhus.
The other group, composed of cases of known or presumed rural
origin which followed tick bite or occurred under conditions which
made tick bite possible, clinically resembled Rocky Mountain spotted
fever. The onset, fever range, rash, physical findings, general
symptoms, nervous and mental symptoms, laboratory findings, complications, and sequelae all indicated a disease entity separate from


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-endemic typhus. Moreover, there was no death in the endeinie
typhus group, whereas in 93 cases of the Rocky Mountain spotted
fever type occurring in five State,s and the District of Columbia in
the spring and summer of 1930 a mortality rate of 22.6 per cent
resulted.
Immunologically in animals this disease is not distinguishable
from Rocky Mountain spotted fever but is distinct from European
and endemic typhus (Brill's disease). However, certain variations
have been noted in animals inoculated with the viru.s of the disease
as it occurs in the Eastern States when compared with animals
inoculated with a strain of Rocky Mountain spotted fever obtained
from Montana. In general, the eastern type virus is apparently
somewhat less virulent than the we~tern type. Accordingly,
attempts were made to transmit this type of the disease by the American dog tick (,Dermaoento1· variabilis), inasmuch as this tick has a
wide distribution in the eastern part of the United States and is
the common tick in the areas where the eastern type of spotted fever
has been found.
Female ticks ( Dernwcentor variabilis) were obtained from the
field and allowed to depo.s it eggs. Larvae from these eggs were fed
on guinea pigs infected with the eastern type of spotted fever and
after engorgement on the infected guinea pigs were allowed to moult
to nymphs. The nymphs were fed to engorgement on a noninfected.
guinea pig and then ground up and injected into fresh guinea pigs.
This resulted in establishing a strain of virus in guinea pigs. In a
second instance the nymphs transmitted the infection by feeding.
Ticks which, as larvae, had been fed on guinea pigs infected with
the eastern type of spotted fever and had transmitted the infection
as nymphs, were allowed to moult to adults. Being fed as adults,
they transmitted the virus.
Results of cross-immunity tests between both the western and
the eastern types of .s potted fever and the virus recovered from the
tic~s justify the conclusion that the virus of the eastern type of
Rocky Mountain spotted fever is preserved in the body of the American dog tick (Dermacento!l' varriabilis) through at least two moults
and that this tick is capable of transmitting the disease by its bite.
The eastern type of Rocky Mountain spotted fever has so far been
found to exist in rural communities in Delaware, Pennsylvania,
Maryland, the District of Columbia, Virginia, and North Carolina.
The laboratory investigation on the typhus-spotted fever group
has been greatly hampered by the scarcity of healthy guinea pigs,
and the consequent total loss of many experiments due to secondary
infections.
Trachoma.-The laboratory investigation of trachoma was continued by Senior Bacteriologist Ida A. Bengtson, in conjunction
with the trachoma-prevention work. Material for study was obtained from the trachoma hospitals at Rolla, Mo., and at Richmond, Ky., and also from cases in Decatur and Mitchell Counties,
Ga., where field work was carried on by the medical officer in charge
of the trachoma-prevention work. The results of the study of the
Georgia cases proved of interest, in that the bacterial flora was
found to differ rather definitely from that of the Missouri and
Kentucky cases. During the winter months hemoglobinophilic organisms, streptococci, and pneumococci were much in evidence. In

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a series of cases studied in May these organisms were found less frequently, but two varieties of Gram-negative small rod-shaped organisms were present in such numbers that they would appear to be
of some significance in the disease. The methods used by Noguchi
for the isolation of Bacterium granwlosis were followed, using semisolid leptospira media in tubes and horse-blood agar plates. In the
leptospira media one of the cultures was present in approximately
75 per cent of the tubes and often in pure culture. Primary growth
of the culture was not obtained on the horse-blood agar plates.
Comparative cultural and serological tests show that neitker of the
cultures correspond with N oguchi's organism. Suggestive lesions
have been obtained by inoculating rhesus monkeys, though sufficient
time has not yet elapsed to determine whether the condition will become chronic. The Georgia disease resembles the trachoma of Missouri and Kentucky clinically, though it appears more amenable to
treatment.
Disease of unknown etiology.-During July and August, 1930, a
mild epidemic simulating food poisoning, and which had occurred
for many years in various national parks, was studied by Surg.
R. R. Spencer at the request of the National Park Service of the
Interior Department. The symptoms and mode of spread of this
affection have suggested that it has not been described hitherto and
is a condition distinct from bacillary dysentery and food infections.
The cause and source of the malady has not been ascertained, but
further studies will be carried out when the opportunity presents
itself.
Poliomyelitis.-Studies were carried out by Surg. W. T. Harrison on the antiviral properties of tissues of normal animals, and
attempts were made, without success, to adapt the virus of poliomyelitis to the smaller laboratory animals.
Relapsing fever.-Studies on relapsing fever were made by Medical Director Edward Francis. Ticks of the species Ornithodorus
turicata collected in Mills County, Tex., received in December, 1930,
at the National Institute of Health, injected into white mice and
white rats were found infected with the spirochete of relapsing fever,
which organism had recently been found in the blood of human cases
in Texas. Bedbugs artificially infected in the laboratory have been
found to harbor the organism five months after their last infective
feed. Ticks collected in caves in Mills County and San Saba County,
Tex., were able to convey their infection, acquired in nature, to
monkeys on which they fed in the laboratory.
Vaccination complications.-Studies by Surg. Charles Armstrong
on postvaccination encephalitis have resulted in the collection of data
·for 62 proved or probable cases for the past 10 years, 11 of which
occurred in 1928, 14 in 1929, and 21 in 1930.
Attempts to produce the complication by inoculating monkeys and,
rabbits with spin_a l fluid, blood, or excreta from four postvaccination.
encephalitis cases, followed by vaccination, uniformly failed.
Vaccine virus was recovered from the brain of one nonvaccinated'.
rabbit inoculated intracerebrally with spinal fluid from one of four·
human cases tested. Four human spinal fluids were tested for·
"viricidal" antibodies, which were demonstrated in only one case ..
In this instance the flui d was tinged with blood.


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Extensive attempts to produce postvaccination encephalitis in monkeys and rabbits by means of vaccine virus have uniformly failed to
give the pathological picture of the disease. Guinea pigs were also
tried, but spontaneous infections led to their abandonment in :favor
of the white rat, which was found to be susceptible to our heatselected strain both by way of the skin or intracerebrally.
Postvaccination encephalitis is being studied along other lines, hut
l·esults are not yet available.
Tests indicate that vaccinia does not render monkeys more susceptible to poliomyelitis than our nonvaccinated controls. It has
been determined that vaccinia in rabbits does not decrease the amount
of complement per volume of blood (rather is the complement found
increased after vaccination), possibly owing to dehydration, since
vaccinated animals often fail to eat their cabbage which supplies the
water in their diet.
Jine cases of postvaccination tetanus were reported for 1930.
Shields or dressings were used in seven of these, while in two, replies
to inquiries were not secured.
An exhibit on postvaccinal tetanus at the American Medical Association received the award of a certificate of merit.
One hundred and thirty-three individuals were vaccinated as a
means of virus control.
Pathology.-W ork in the section of pathology has been carried on
chiefly by Passed Asst. Surg. R. D. Lillie. The histologic diagnostic
service to marine hospitals and other agencies has been continued;
1,621 specimens were received, of which number 1,563 have been
examined and reports submitted. On account of the volume of other
·work it became necessary to suspend examination of r:outine autopsy
::material in February; 58 such cases have accumulated since that
.time. The amount of material received for diagnosis shows an in-crease of 493 specimens, or about 43 per cent over the preceding year.
The increase is in part due to the addition of a new source of material,
the United States penitentiaries, by reason of the act of May 13, 1930,
placing prison medical relief under the jurisdiction of the Public
Health Service.
In addition to this diagnostic work, histologic studies were made
on partial or complete autopsies on experimental animals. These
comprised material from typhus, eastern and western spotted fever,
tularaemia, psittacosis, toxicology of amino-acid excesses in rats, of
triorthocresyl phosphate in various animals, experimental tumors,
vaccinia, undulant fever, meningococcus meningitis, diphtheria toxin,
syphilis, osmic-acid toxicology, and further studies on the histologic
reaction in guinea pigs to a microorganism regarded by some workers
as,causally related to cancer.
A review of the pathologic histology of smallpox and vaccinia
and National Institute of Health Bulletin No. 156 on experimental
vaccinia in rabbits have been published. A study on melanosis of
the appendix and a report of a case of mast cell leucemia in a cat
are now in press. Reviews and further studies in human and experimental tularaemia and psittacosis are in preparation.
There follows a tabulation of the specimens received in the Division of Pathology and Bacteriology during the fiscal year.


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A. Tissue specimens of' human origin :
Hospitals and relief stations of the Public Health Service________ 1, 420
United States penitentiaries___________________________________
95
Other Federal agencies________________________________________
27
Field investigations of the Public Health Service_______________
26
In cooperation with State health agencies _______._______________
25
Miscellaneous __________________ __ :._ _______.____________________
28
~

Total human _________________________ __; _____________________ 1,621 '
B. Pathology of experimental diseases ______---------------------.- ~---592
Total ___________________ __ __________________ ___ _____________ 2,213
Specimens prepared for other divisions but not examined in section on pathology___________________________________________
26
.

Total specimens prepared for histologic ~amination____________ 2, 239
C. Routine examinations and tests:
Wassermann tests (blood and spinal fluid) _____________________ 12,·147
BloodCount ____________________________________________________
20
Tularaemia_______________________________________________
521
Undulant fever___________________________________________
695
Typhus fever __________ ___________________________________ 1,176
Typhoid fever, para A and para B----------------------------177
Urinalyses____________________________________________________
36
CulturesDiphtheria________________________________________________
78
Miscellaneous_____________________________________________
53
Sputum______________ _________________________________________
5
Brain for rabies, animaL______________________________________
9
Miscellaneous-------------------------------~----------------17
Feces ____________ ~----------------------~ ------------------4
Water_____ ___ ____ _____ __ _____________________________________
74
T?tal _______________________________________________________ 15,012

Serology.-Surg. R. R. Spencer has attempted the cultivation
of the virus of Rocky Mountain spotted fever and smallpox by a
method of gradual adaptation to various culture media and to
susceptible animals. No suggestive results were obtained.
The chemical decomposition products and enzymes in the filtrates
of cultures of about 100 nonpathogenic bacteria and molds have been
studied for their viricidal effect upon the virus of Rocky Mountain
spotted fever and typhus fever. It was hoped that some of the
bacterial products would be antagonistic to the development of the
virus when mixtures were injected into susceptible animals. So far
no positive results have been noted.
By following the technique of Hadley for obtaining filtrable
forms of the B. dysenteriae, filtrable forms of . B. proteus X 19 ( the
organism used in the serodiagnosis of typhus · and Rocky Mountain
spotted fever) have been obtained. These filtrable strains derived
from B.· prot&us X 19 have not proven to be pathogenic for· animals,
nor do they •bear any relation to the virus of typhus and Rocky
Mountain spotted fever.
Studies of streptococci.-A study of the effect of hemolytic streptococci and their products on leucocytes was made by Senior Bacteriologist Alice C. Evans. It was established that a toxic substanc~ which disintegrates the leucocytes is produced by the action
of hemolytic streptococci on red blood . cells. This leucocidic substance is distinct from the skin toxin and it is distinct from
hemolysin.

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Studies on streptococcus bacteriophage are in progress, with particular reference to (a) the relationship between hemolytic streptococci from scarlet fever, erysipelas, and puerperal fever as revealed by
their susceptibility_to a certain strain of bacteriophage; and (b)
the nature of bacteriophage.
New organwm.-A new organism, designated AlcaUgenes f aecalis
subspecies ra,dicans, was described by Senior Bacteriologist Alice C.
Evans. · It was obtained by blood culture from a mild case of enteric
disease which at first resembled typhoid fever.
STW)IES OF BIOLOGIO PRODUCTS, INOLUDING THE .ARSPHElNAMINES

Scarlet f ever.-Studies on problems related to the use of biologic
products for the prevention and treatment of scarlet fever have been
continued by Surg. M. V. Veldee. The production of scarlet-fever
toxoid has been shown to be possible, and clinical data indicate that
toxin so modified by heat and formalin retains its antigenic properties.
A clinical study of the therapeutic effects of various commercial
antitoxins has been conducted in a mid-western city. This work has
not been completed.
The search for a laboratory animal method for standardizing
scarlet-fever biologics has been continued. Toward the end of the
fiscal year results developed that are at least very encouraging for
the future. Animal reactions were obtained which correspond very
favorably with similar reactions in susceptible human beings. The
work is being continued.
Diphtheria prophylaotias.-Studies were continued by Surg. W. T.
Harrison on the effect of low temperatures on 0.1 L+ dose toxinantitoxin mixtures. Mixtures preserved with the newer mercurial
compounds do not show any appreciable change on freezing, and it
was therefore recommended to manufacturers that one of these compounds be substituted for the phenoloid preservatives.
M eningitis.-These studies were continued by Senior Bacteriologist
Sara E. Branham. Many new strains of meningococci were received,
chiefly from outbreaks in Eastern States. A total of 320 strains were
studied intensively. The serological classification of these strains
and the relation of the groups to each other and to the original type
strains of Gordon were given special attention. A report was published discussing this phase of the work. Ninety-five per cent of
these strains could be placed in Gordon's four groups, but Groups
I and III, as found in these epidemics, were so closely related to each
other and their separation was so laborious that the practical value of
placing these strains into two groups has seemed doubtful: Groups
I and III have been predominant, together comprising 82 per cent
of the entire number of strains received.
The cultural and fermentation reactions of all these strains and
the relation of temperature and medium to growth and viability have
been studied as a basis for further investigations. All strains of
meningococci have been found to ferment dextrose and maltose.
Temperature and medium have a marked influence upon the viability
of all meningococci, but individual strains vary much in this respect.
A study of different methods of evaluating therapeutic serum has
been recently undertaken and is now in progress. It is hoped that


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comparison of these methods will aid in determining the therapeutic
value of antimeningococcic serum.
,Gas gangrene antitoxin.-An increased interest having become
manifest in gas gangrene antitoxin and in response to requests from
the manufacturers of biological products for standards to be used in
testing the potency of their products, w9rk looking toward the establishment of standards for all the antitoxins contained in the gas
gangrene antitoxin has been begun by Senior Bacteriologist Ida A.
Bengtson. The unit for measuring the potency of perfringens ( 0.
welchii) antitoxin was revised, the present unit being one one-hundredth that of the former unit. A supply of perfringens toxin was
prepared in a sufficient amount so that it may be furnished to the
manufacturers for testing purposes, as has hitherto been done in the
case of tetanus toxin.
Arsphenamines.-Studies by Assistant Pharmacologist T. F. Probey on the activity of neoarsphenamine in experimental syphilis in
rabbits have been continued. The reported lack of agreement between the spirocheticidal activity in rabbits and the trypanocidal
activity in rats seems to be further indicated. N eoarsphenamines
varying in their trypanocidal activity are apparently parallel in protecting rabbits from the development of the disease by one prophylactic dose and in curing the animals of the disease by one sterilizing
dose. The routine examination of the arsphenamine preparations has
continued to indicate the excellent quality of commercial arsenicals.
DIVISION OF ZOOLOGY

The following work has been pursued by the Division of Zoology,
under the direction of Medical Director C. W. Stiles.
lnt01"fl)a,tional Oommmssion on Zo1J,l ogical Nomenolature.-Oooperation with the International Commission on Zoological Nomenclature
has continued as in preceding years. Various questions on nomenclature and terminology have been submitted to the division for
advice or decision by a number of governmental departments and
universities in the United States and abroad.
BiDlleti™.-National Institute of Health Bulletin 155, on the parasitic diseases of bats, in relation to the diseases of man, has been
issued from the press.
National Institute of Health Bulletin 159, on the parasitic diseases of insectivores in relation to the diseases of man, is in press.
An additional bulletin on the parasitic diseases of carnivores in
relation to the diseases of man is practically finished and will be
forwarded for publication in the immediate future.
Ew{l//n,inationJ of intestilnaJl prurasites for di(J)[/n.osis.-This part of the
routine work of the division has been continued throughout the year,
and 303 specimens have been examined for various Government hospitals, State health departments, universities, and :for practicing
physicians.
Survey, of hookworm, disease.-A survey of 98 white schools in the
sand-land districts of the Southern States was made for clinical
evidence of hookworm disease. Of 18,649 children recorded it was
estimated that at least 20 per cent showed clinical hookworm disease.
80597-31-6


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There appeared to be a definite correlation between hookworm disease and retardation of the pupils.
· As a result of the survey a plan for the modification of hookworm
control work as applied to the schools was discussed with a number·
of State, county, and city health officers, State and county superintendents of education, and pr~ncipals and teachers in the schools.
DIVISION OF PHARMACOLOGY

The following work was pursued by the Division of Pharmacology
under the direction of Pharmacologist Director Carl Voegtlin.
Ohemds try of deU division.-An outstanding characteristic of cancer
cells is their unrestrained proliferation in the human and animal
body. It is therefore of fundamental importance to ascertain the
chemical :factors which either favor or inhibit cell division. In the
1930 annual report attention was called to the lack of information
relating to this subject. The results of a preliminary study of cell
division in Amoeba; proteus under carefully controlled conditions had
shown that glutathione, a sulphur· containing polypeptide occurring
in both normal and malignant animal cells, exerts a stimulating
action on cell division. During the present fiscal year these studies
have been continued. The following results were obtained:
(1) Under normal conditions the process of cell division depends
on the cell volume.
(2) Exposure of amoebae to relatively low concentrations of glutathione ( reduced and oxidized form) results in more nuclear and cell
divisions and ID:Ore polynucleate cells than in the controls.
(3) Glutathione apparently has a specific action on the cell
nucleus. It favors nuclear growth, maturation, and division, this
being accompanied, under the experimental conditions employed, by
a marked decrease in cytoplasmic volume.
(4) Exposure of amoebae to extremely dilute copper salt solutions
(m/500 million) inhibits cell division. This action of copper is accompanied by a marked reduction in nuclear growth and is apparently a reversible effect, as transfer of these cells to a normal cultural
environment is followed bY. growth. This observation is of interest
in view of the wide distribution of copper in all living cells, and
therefore is a contribution to the biological significance of copper.
This phase of the work forms part of a systematic study of the influence on cell division of the heavy metals which are normal cellular
constituents.
During the progress of this work it became evident that further
information on the relations between cell gr·owth and cell division
under cultural conditions was very desirable for the progress of the
chemical studies. A comprehensive research dealing with the growth
rate of the cytoplasm and nucleus, the nucleocytoplasmic ratio, and
the relation of these factors to the cell-division process under normal
cultural conditions was completed.
Oxidation catalysis of glutathione.-Previous work of the division
has shown that glutathione apparently plays an important functioq
in cellular metabolism, and its effect on cell division emphasized the
need of further chemical and biochemical knowledge of this substance. As previously stated, glutathione can exist in a reduced and
oxidized form. A systematic investigation of the oxidation of
1


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glutathione was completed. The principal results obtained indicate that of a large number of metal compounds studied, copper is
by far the most effective oxidation catalyst of crystalline glutathione.
The so-called autoxidation of glutathione in reality is due to the
minute amounts of copper present in the crystalline substance. It
was possible by special methods to remove practically all copper
from crystalline glutathione and thus to decrease to a negligible
degree the rate of oxygen consumption of its solutions in buffers of
physiological pH. It is believed that these and other results of this
work have a broad physiological significance and may have some
bearing upon the action of glutathione and copper on cell division.
Tissue citltures.-ln previous work on this subject the great need
for better control of the chemical constancy of the culture medium
became apparent. Observations have shown that with the existing
methods a marked alkaline drift of the culture medium occurs soon
after the cultures are set up. This is followed under certain conditions by a drift toward the acid side. A technique has therefore
been developed which permits control of and largely eliminates these
drifts in hydrogen-ion concentration. Using this technique, a systematic research was carried out on the influence of variations in
pH of the culture medium on the growth of fragments of embryonic
chick heart. Further attempts have been made to obtain cultures
from single cells, but so far without success.
The Jensen rat sarcoma has been kept continuously in cultures
for several months. Chemical studies on these cultures have been
initiated toward the end of the year.
Hydrogen-ion concentration of tu-mors.-VVork was continued on
the development of a microelectrode suitable for the measurement of
the hydrogen-ion concentration of tumors and normal tissues in living
animals. Practically all knowledge of pH measurements under
physiological and pathological conditions relates to the blood and
other body fluids. Nothing is known concerning the important pH
of living tissues. This is due to the absence of reliable and suitable
electrodes. A purely physicochemical research on the glass electrode
was completed. It was found that with proper construction relatively thick walled soft-glass tubing will permit the measurement of
the pH of solutions, and clues were obtained as to improvements in
t.he construction of microelectrodes of the capillary type. During
the latter part of the year Pharmacologist Director V oegtlin and
Senior Biophysicist Kahler have tested the reliability of the microelectrode and found it very satisfactory. Preliminary observations
also indicate that the true pH of tumors in the living animal can be
measured. Such measurements compared with measurements on
normal tissues and benign tumors are of considerable importance for
deciding the question as to whether or not the infiltrating properties
of malignant tumors are due to excessive formation of lactic acid.
They are also of value in work on cultures of malignant and normal
tissues.
Glutathione content of tumors.-During the latter part of the year
a reinvestigation was begun of the glutathione content of malignant
and benign transplantable tumors by means of improved analytical
methods. The results confirmed and extended previous findings in
this laboratory, showing that malignant tumors contain a relatively


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high concentration of glutathione in the reduced form and no detectable free cystine or cysteine. These results are of interest in connection with the discovery of the stimulating action of glutathione
on cell division.
Chemotherapy of tumors.-During the latter half of the year a
systematic investigation was initiated of the possible therapeutic
value of heavy metals which are known to occur normally in tissues.
In view of the preceding observations referring to the action of
copper on cell division and the oxidation of glutathione, compounds
of this metal were made, tested as to their toxicity in rats and as
to their therapeutic action on two strains of transplantable rat
tumors, propagated in two inbred strains of rats fed on a diet of
constant composition. It is too early to reach any definite conclusions.
Ginger parralysis.-In collaboration with the Division of Chemistry, and chemists of the Prohibition Bureau, two reports were
published on the etiology of the epidemic of ginger paralysis which
occurred early in 1930. The results left no doubt that these cases
of paralysis were due to the consumption of Jamaica-ginger extract,
adulterated by the addition of about 2 per cent triorthocresyl
phosphate. This conclusion was reached on the basis of sufficient
epidemiological, pharmacological and chemical evidence, all indicating that previous to the tim~ of the occurrence of the epidemic
this adulterated ginger had been distributed over wide areas of the
country and had been consumed by thousands of people. Probably
as a result of the wide publicity given to this epidemic in the daily
press most of the adulterated ginger was withdrawn from the open
market and no new cases developed in the following summer and
fall. Another epidemic of minor proportions ( about 125 cases)
occurred early in 1931 in Los Angeles and neighborhood. A careful
investigation of this epidemic also showed that it was caused by
ginger extract adulterated with triorthocresyl phosphate. It was
possible to reproduce the disease in animals by feeding them this
adulterated product, or triorthocresyl phosphate alone. Genuine
U. S. P. extract of ginger gave negative results.
Principal Pharmacologist Smith, in collaboration with Passed
Assistant Surgeon Lillie, completed a research dealing with the histopathology of triorthocresyl phosphate poisoning in man and experimental animals. The results indicate that this multiple neuritis
is essentially a myelin sheath degeneration of the peripheral nerves,
with a variable amount of relatively moderate central degenerative
changes affecting the anterior horn cells throughout the spinal cord,
particularly those in the lumbar and cervical regions.
Further studies were made on the toxic action of other esters o.f
phenolic compounds as compared with that produced by triorthocresyl phosphate. So far the latter substance is the only compound
of this group producing motor paralysis. This poison is retained by
the body over a remarkably long time and exerts a cumulative injurious action.
Attempts have been made to develop a treatment, but so far without avail.
Ohemotherape11,tic action of arsenicals.-During the year the work
on this subject was continued, particular attention being paid to the


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mechanism of the action of arsenic on protoplasm. It was found
that the marked reduction in the rate of oxygen consumption of
living tissues in vitro, caused by exposure of the tissues to arsenions
oxides, can be prevented by the addition of an adequate amount of
SH glutathione. This substance in the disulphide form is inactive.
These results are therefore in harmony with previous reports of the
division, showing that SH glutathione prevents the toxic and chemotherapeutic action of these arsenicals. Further observations were
made on the action of glutathione, iron compounds, cyanide, etc., on
the fundamental process of tissue respiration. Research was completed on the relation of arsenic to the fixed sulphydryl groups of
proteins. It had been suggested in previous papers from the division
that, besides glutathione, other physiological sulphydryl compounds,
.as proteins, may be concerned in the chemical interaction of arsenic
with living cells. The present work furnished conclusive proof with
:regard to proteins containing SH groups. Proteins without this
grouping do not combine with arsenious oxides. This evidence is of
interest also as a contribution to the subject of the physiological and
pharmacological function of proteins.
Erg·ot standardization.-The conditions under which deterioration of the official extract of ergot occurs were studied, and partially
.successful attempts were made to prevent this deterioration during
.storage by the addition of certain reducing substances.
Effeot of fat ingestion on liver.-With the cooperation of Passed
Assistant Surgeon Lillie, a research was completed on dogs, on the
-effect of ingestion of a diet rich in fat. This diet causes a slight
.i mpairment of liver function as determined by the bromsulphthalein
test. If the liver has previously been damaged by chloroform or
~arbon tetrachloride, lipemia produces a greater impairment of liver
function. The functional change was studied in relation to the histological liver picture.
Miscellaneous.-The chief of the division is a member of the
rommittee on drug addiction of the National Research Council.
This committee is engaged in directing a comprehensive chemical
.and pharmacological investigation for the discovery of non-habitforming substitutes for the opium alkaloids.
Principal Pharmacologist Smith is collaborating with the revision
committee of the United States Pharmacopooia in the development
of suitable standards and methods for fluid extract of ergot and
pituitary extract.
DIVISION OF OHEMISTRY

The work of the Division of Chemistry was continued under the
direction of Prof. Claude S. Hudson.
Sugar researches.-These reseai;ches are of a fundamental character. While the primary purpose is to further perfect the systematization of the relations between rotatory power and structure in the
sugar group, a number of new sugar compounds have been discovered in connection with these researches. The studies of these
new compounds, which are of importance in the field of sugar chemistry, which, in turn, is of importance in many problems of health
and disease, may also help, as similar studies have helped in the
past, to increase our knowledge concerning chemical constitution in


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organic chemistry in general. In addition to the discovery of new
compounds, these researches provide opportunity for improving the
methods of preparation and the yields of sugar derivatives previously discovered, as well as the obtaining in pure crystalline state
of such derivatives which heretofore could be obtained only as
sirups.
An improved method was worked out for the complete determination of the configuration of the most important sugars. Improvements were also developed in the methods for the preparation of
tetracetyl-,B-methyl d-mannoside, lactose carboxylic acid, a-methyl
mannoside, and dibenzylidene a-methyl mannoside. Suitable procedures were devised for the comparatively large-scale preparation
of perseitol, d-mannoheptose, a-d-mannoheptonic lactone, and the
barium salts of alpha- and beta-mannoheptonic acid. Experiments
on the course of fermentation of hydrolyzed lactose solutions with
yeasts demonstrated the possibility of utilizing such fermentations
for obtaining galactose, in good yields, from lactose.
The results of the studies of the several new derivatives of rhamnohexose show that the rules of isorotation hold in this series and
throw light on the structure of the sugars possessing a similar configuration. The methylation of pure .B-triacetyl 1-rhamnose with
silver oxide and methyl iodide yielded a mixture of the known alphaand beta-methyl rhamnoside triacetates, thus showing that beta-triacetyl rhamnose does not possess the ortho-ester structure proposed
by Freudenberg and Haworth for triacetyl-gamma-methyl rhamnoside. The data obtained in connection with the study of the new
.B-methyl d-mannoside show that it possesses the 1.5 ring structure.
Sulphwr nietabolism,.-Further applications of the Sullivan reaction for cysteine were made. It was demonstrated that by means of
the Sullivan colorimetric method cysteine can be estimated quantitatively in any proportion of glutathione, at least up to 100 glutathione to 1 of cy tine. The cystine content of 23 purified proteins
,vas determined by estimating the cystine in their hydrolysates.
Likewise, the cystine content of round steak, sirloin steak, haddock,
halibut~ and salmon was determined, using both the fresh material
and tissue powders dehydrated and defatted by acetone and ether.
Studies were made on the rate of absorption of cystine, fed as the
sodium salt, from the gastrointestinal tract of the rat. The Sullivan and Okuda methods were found to give closely agreeing results.
The value found by these methods was, in round numbers, 50 milligrams of cystine per 100 grams of body weight per hour-a value
which puts cystine in the same class as other amino acids as far as
absorption is concerned.
·
Experiments were also carried out in which dithioethylamine
( cystine amine) was substituted for cystine in the diet of the white
~·at. The results show that both· cystine 3:nd cystine amine gave
mcreased growth of the rats over that given by the basal diet
and that the cy tine amine can replace cystine to a considerable
degree for the purpose of growth of the young white rat.
Analytical work.-About 258 various analyses of miscellaneous
material were carried out. In addition, there were examined about
64 arsenicals, and several toxicological examinations were made on
body fluids, food, and miscellaneous material. In connection with


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this work there was a continuation of the cooperation extended to
the work on the relation of diet to pellagra. Analyses were carried
out of the salts used, the required standard acids were prepared, and
chemical examinations were made of some of the foodstuffs used.
Cooperative work.-The cooperative work of this division in the
studies of the relation of diet to pellagra, which have for their aim
the preparation of active concentrates of the P-P. factor, was continued. Standard buffer solutions were prepared for use by various
workers.
Miscellaneous.-Expert chemical advice and assistance were given
by the various members of this division to workers in allied fields,
and memoranda on a variety of subjects were prepared .

•

SERUMS, VACCINES, A

D ANALOGOUS PRODUCTS

Government control of the manufacture and interstate sale of
biological products in conformity with the law of July 1, 1902, continued under the supervision of the director of the National Institute of Health. At the close of the fiscal year, 38 licenses were held
by domestic manufacturers and 12 by foreign producers. These
licenses cover 137 different preparations. As usual, all establishments in the United States were personally inspected and an officer
was detailed abroad for foreign inspections. An account of the
investigations concerning these products will be found on pages
72-73.
The following is a summary of the routine tests carried on at the
institute during the year in the control of biologic products:
Serums, vaccines, toxins, etc. :
Tested for sterility------------------·---------------------------- 1, 851
Tested for potency_______________________________________________
665
2, 516

Arsphenamines :
Tested for toxicity_______________________________________________
Tested for solubility and stability_________________________________

228
515

743
·Total __________________________________________________________ 3,259
MISCELLANEOUS

By the act of April 9, 1930, the name o:f the Advisory Board of
the Hygienic Laboratory was changed to the National Advisory
Health Council, five additional members were authorized, and the
:functions o:f the council were broadened. The first meeting of the
new council was held on April 9 and 10, 1931, and the work of the
Public Health Service was reviewed. While suggestions were
offered :for additional lines o:f endeavor, the council as a whole felt
that the work now being carried on was of inestimable value in the
field of public health and should be continued without material
change.
During the fiscal year there have been 3 Public Health Bulletins, 4
National Institute of Health Bulletins, and 157 scientific articles for
the Public Health Reports or for outside publication submitted
through this division :for review and recommendation as to publication.

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DIVISION OF DOMESTIC (INTERSTATE) QUARANTINE
In. charge of Asst. Surg. Gen. W. F.

DRAPER

PLAGUE-SUPPRESSIVE MEASURES IN CALIFORNIA

The continued existence of foci of rodent plague in California
required that plague-suppressive measures be carried on in cooperation with State and local authorities as in previous years. The plan
of. work was essentially the same as that follow'ed in 1930, with the
combined activities of the cooperating agencies falling into the folJowing divisions: (a) Plague in ground squirrels and control measures directed against these rodents, ( b) rodent surveys and sani~ary
inspections in San Francisco, and ( c) work performed in the U mted
States Public Health Service laboratory.
.
No human case of plague has been reported during the year.
PL.AGUE IN GROUND SQUIRRELS

Control measures directed against ground-squirrel infestation in
California are being carried on by horticultural commissioners in the
several counties for economic reasons, although attention is _paid to
the eradication of these rodents :from a public health stand pomt. In
the event that a survey determines existence of foci of plague infection in a county, State aid is secured in the eradication of ground
squirrels, particularly around such foci, as a public health measure.
The work carried out by these county officials operating with county
funds, and in certain instances with funds :from the State, has been
more intensive d1t1ring the past three years, and tangible results are
being accomplished.
The work of the Public Health Service consists in operations in
four counties around San Francisco Bay for the purpose of eradication of rodents around centers of population, particularly the East
Bay cities. All of the work in San Mateo and San Francisco Counties is conducted by the Public Health Service employees. In the
counties of Alameda and Contra C<?sta the operat10ns are carried
out conjointly with the horticultural commissioners. This work has
been prosecuted in accordance with a definite program, and marked
improvement has been effected. Limited shooting operations were
carried out against ground squirrels at Sunnyvale, Santa Clara
County, Calif., the site selected for the dirigible base, and in a portion of San Francisco County. This work was done in order to
determine whether any infection existed among the ground squirrels
in these specific localities. No infection was found.
Limited shooting operations also were carried out by the State
board of health during the fiscal year for the purpose of determining
foci of infection in ground squirrels, and two foci of the disease were
demonstrated in Monterey County. It is considered likely that
plague infection still exists in other counties, particularly in remote
districts where intensive squirrel control measures have not been carried out. If extensive shooting operations were permissible to obtain
80

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81

an adequate sample o:f the squirrel population, it is not improbable
that foci o:f plague infection still would be demonstrated in most
of the counties in which it was originally determined.
Although ~he eradica~ion and. control of ground ~quirrels has been
more extensively practiced durmg the past three years, this work
must remain continuous in order to insure satisfactory results, particularly in counties where plague infection ha.s been recently demonstrated, in order to prevent the spread o:f the disease among these
rodents and also to prevent rein:festation of areas in which they have
been destroyed by intensive operations. In some areas the work has
not yet reached a stage sufficient to insure the eradication o:f ground
squirrels, particularly on grazing lands, where the infestation is most
pronounced.
.
·
Field operations carried out by the Public H ealth Service are
tabulated as follows :
Number
Number
Number
Number
Number
Number
Number
Number
Number

of inspections___ ____________________ ______ __ ____ _______ __
1,205
of reinspections__________________________________________
3,959
of acres inspected_________________________________ _______
249,805
of acres reinspected ___________________________ ___________ 1,017,332
of acres treated with waste balls__________________________
2:S, 601
of acres treated with poison grain_________________________
218, 775
of burrows treated with carbon bisulphide ________________
120, 535
of burrows treated with grain and paper _______ .:____________
6,670
of acres treated with calcium cyanide_____________________
50

Material 'tts ed
Number of gallons of carbon bisulphide_____ ________ __ _____________
2, 049
Number of waste balls____________________________________________
120, 535
Number of pounds of calcium cyanide------------------------------====5
Number of pounds of poisoned grain:
Strychnine___________________________________________________
23,544
Thallium---------------------------------------------------_41,
003
Phosphorus _____________________________________________________
6,_6_8_4

71,231
Poisoned barley mixed for private landowners under the supervision
of emp!oyees of the Public Health Service; number of pounds,
strychnine_____________________________________________________

195

MEASURES TAKEN AGAINST RATS

The operations against these. rodents consist of (a) trapping and
r.xamination o:f rats, (b) inspection o:f premises where rat infestation is reported, and ( c) inspection and report on buildings that are
insanitary and constitute rat harbor ages to the extent that they have
become a menace· to public health. This program has been continuous for several years and has been confined to San Francisco,
with the exception of the examination of rats trapped in Oakland
and examined in the Public Health Service laboratory. A sufficient
number of rats are caught and examined in order to furnish reliable
information as to whethe:r: plague infection has gained an entrance.
Rat swrvey in San Francisco.-Trapping operations are carried
out by 6 employees-2 Federal and 4 city. These operations are in
djstricts where the heaviest infestation exists and where, i:f plague
infection should gain entrance, it most likely would be encountered.
Therefore, trapping has been centered in the slaughterhouse district,
in business sections, and particularly around markets and food stores.
The residential section has received less attention because there is
less potential danger in such districts, although all reports of rat

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PUBLIC HEALTH SERVICE

infestation made to the office are investigated, and trapping is carried
out in apartment houses and other structures when evidence of
infestation exists.
The rats are examined in the Public Health Service laboratory in
San Francisco. While the number of trappers does not permit of
eradicative measures and are employed mainly at strategic points
for survey purposes, the operations furnish a reliable index of pathological conditions existing among these rodents, and even these
limited measures would furnish prompt knowledge of a focus of
plague infection, thereby permitting intensive operations by the city
health department before any spread probably would occur. The
adva:µtages of such a survey far outweigh the cost, which is small
in comparison with the possibility of securi~g definite knowledge as
to whether infection is present.
Rat survey in Oakland.-The rats caught by two trappers employed by the Oakland Health Department have been examined in
the laboratory of the Public Health Service in San Francisco, but
the number of rats caught is too small to furnish any index as to
whether infection exists. More trappers should be employed in this
work, particularly in districts where the rat infestation is large.
The importance of an adequate survey in this city can be emphasized
on account of bubonic plague having occurred in Oakland as late
as 1924.
Sanitary inspections in San Franci&co.-This work, as related to
plague-suppressive measures, is performed by one inspector in cooperation with the health department of the city of San Francisco.
Inspections are made of insanitary premises upon which rat infestation has been reported. A trapper is often sent to such places
and advice is given relative to corrective measures to prevent
reinfestation of the premises.
Another phase of this activity which is of major importance as
it relates to permanent improvement is the inspection of old, insanitary buildings which furnish rat harborages. R eports are made
to the city health officer and definite recommendations are made as
to correction.
Following is a tabulation of inspec!ion activities:
Rat complaints investigated____________________________________________
Insanitary premises inspected__________________________________________
Number of buildings submitted to board of health for condemnation______
Number of buildings acted on by board of health and condemned_________
Number of buildings acted on by board of health and not condemned _____
Number of buildings abated following condemnation proceedings: By repair, 4 ; by demolition, 126 ___________________________________________
Number of buildings condemned and remaining unabated________________

927
184
139
105
34
1

130
49

OPERATION OF PUBLIC HEALTH SERVICE LABORATORY

The Public Health Service laboratory, although located in an
old building unsatisfactory for such an installation, has .nevertheless
functioned satisfactorily durin~ this and preceding years. Arrangements are being made for a modern laboratory structure to be erected
on the marine hospital reservation, which will not only be adequate
for the routine work now being carried out but will permit of more
research investigations.
1 These include some buildings acted upon during previous years, hence they will
not balance.


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PUBLIC HEALTH SERVICE

The laboratory work £alls into the following divisions: (a) Routine
examinations of rodents to determine plague infections; ( b) serological, bacteriological, and pathological work for other Public
Health Service stations in the district; ( o) service performed for
other Government agencies; and ( d) special investigations of matters which may affect the public health.
During the year examination was made of 32,000 rats trapped in
San Francisco and 3,764 from Oakland. The classification of the
rats with totals are submitted in the accompanying tabulated statement. No plague infection was found among the rats examined
during the year, although some rat leprosy and hemorrhagic
septicemia was noted during the examinations.
All serological work required at the San Francisco Marine Hospital, San Pedro Relief Station, and the Angel Island Immigration
Hospital was performed in this laboratory. These examinations
are made twice a week. Blood cultures and agglutination tests and
some tissue mountings and examination of specimens for pathological conditions also were made.
A large number of samples of water used on interstate carriers,
both vessels and trains, were examined. The work for other departments included bacteriological and serological examinations made
for the Indian Service, National Park Servwe, Immigration Service,
and the Federal penitentiary at McNeil Island. The work for the
latter institution was a new activity and consisted of an average of
30 serological examinations weekly.
The laboratory operations carried on during the year are shown in
the following tabulation :
Classification of rats
Rats from
Rattus
Rattus
Rattus

San Francisco :
norvegicus ________ 29, 749
rattus____________ 2, 063
alea:andrinus _____ 2, 348

TotaL_________________ 34, 160
Rats from fumigated ships:
Rattus norvegicus________
8
Rattus rattus____________
507
Rattus alea:andrinits _____
816
TotaL_________________

Rats from
Rattus
Rattus
Rattus

Oakland :
norvegicus _________ 3, 681
rattus _____________ 129
alea:andrvnus ______
329

TotaL__________________ 4, 139
Squirrels:
From San Francisco County_
65
From Santa Clara County_
30
TotaL__________________

95

1, 331

Summary of laboratory operations
Received
rodents
for plague:
Examinations
Rats from of
San
Francisco
___________________________________________________ _
34,160
Rats from Oakland ________________________________________________________ _
4,139
Rats from fumigated ships _____________________ ----------------------------1,331
Squirrels from San Francisco and Santa Clara Counties ____________________ _
95
Serological examinations:
Wassermann reactions (blood) ___ ------------------------------------------- ___________ _
Wassermann reactions (spinal fluid) _________________________________________ -----------,vidal reactions _______________________________ _________ _________ _____ __________________ _
Bacteriological examinations (culture and microscopic):
Water _______________
-- -- ____ ---- ------------ ----- ----- . ------- -- --- -- ---- --- --_____
-- -----Blood
for diphtheria _________________________________________________________
_____--_
Welch's gas bacillus ____________________________________________________________________ _
Bacteriological examinations (with animal inoculations): Tuberculosis _____________________ _
Agglutination test: Abortus and melitensis ___________ __ _________________________ -----------Histological examination ___________________________________________________________________ _


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Examined

32,000
3,764
1,322
95

5,486
144
1
397
4

1
72
1
1

84

PUBLIC HEALTH SERVICE
TRAcHoMA-PREVENTION

vv oRK

Trachoma-prevention work is based on two principles-removing
sources o:f infection by bringing active cases under treatment, and
educating the :families o:f trachoma patients about the dangers of
contracting the disease when care,less toile.t habits are pursued.
Along with this prevention work there arises the necessity o:f a.
certain amount o:f salvage effort. This might be termed direct prevention o:f blindness. The lid deformities that so o:ften arise in
untreated severe trachoma will soon cause blindness unless the
lid deformity is corrected. A great deal o:f vision can often be
restored by simple operations.
Trachoma-prevention activities were continued by the PublicHealth -Service, in cooperation with State and local authorities, during the fiscal year 1931 in Missouri, Kentucky, and Tennessee. As a
result o:f a survey made late in the preceding year, new work was
undertaken in cooperation with the State board of health in southwestern Georgia. Cooperation also was extended to Illinois and
Texas.
M issouri.-In a recent study of the trachoma records from three
contiguous counties in southern Missouri covering 2,506 square miles.
and with a population of 51,000, it was :found that 2 per cent of the·
population had trachoma in either active or arrested state. Of the·
1,005 cases in this area, .139 were industrially blind or worse, in
both eyes, from trachoma. The trachoma in Missouri is of a more
severe type than that :found in Kentucky or Tennessee. This fact
is especially brought out by a comparison of the virulence index
o:f these areas :for the past five years. This virulence index is the
ratio between the number o:f blind eyes :from trachoma and the
number o:f individual trachoma cases. The State board o:f health
has taken an increased interest in the trachoma field work and hasdetailed a full-time nurse to assist in this activity. The number
o:f field clinics have increased, and the treatments given at these·
clinics have enabled many people to be benefited who otherwise would
have been unable to obtain treatment. No operative field clinics
were held during the year, due to lack of funds for this phase of
the work. The hospital at Rolla, Mo., at this time has a waiting·
list o:f 50 names. During the past year there were more days of
hospital relief extended than at any time in the history of the·
institution. The average stay in the hospital increased eight days.
This was probably due to many cases of increased virulence being
admitted. During the year the efficacy of ultra-violet treatment.
in trachoma was tried out, as was also diathermy. A water-cooled
ultra-violet machine and a diathermy unit were provided :for three
months through the kindness o:f a large manufacturer of electric
appliances. No results of any significance were obtained with ultraviolet therapy. Diathermy seems to have possibilities in this work.
Efforts along this line will continue. The number of applications
for treatment :from trachoma sufferers in the State of Arkansas
continued to increase.
Kentucky.-This State has a virulent form of trachoma, which
produces much blindness. Active field work was continued throughout the year. The trachoma hospital at Richmond gave more relief


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PUBLIC HEALTH SERVICE

85

than at any other time in its history, and the institution has been
taxed to its capacity most of the time. A recreation room is badly
needed at this place. The medical officer at the hospital in Richmond
has been very careful in his choice of patients, and only those cases
showing most urgent need of care have been admitted. The percentage of new admissions has been high for the past year. Two
months of field work in Knott County during the past fiscal year
disclosed only 24 active cases of trachoma. Between 1913 and 1923
there were 742 cases of trachoma hospitalized from this county.
Tennessee.-The trachoma hospital at Knoxville, Tenn., was closed
September 30, 1930, as it had served its usefulness. Trachoma survey work in cooperation with the State board of health was continued in the State by a medical officer of the Public Health Service.
This survey work has been conducted the past two years for the
purpose of studying the incidence of trachoma in Tennessee and to
see in what areas it is a real problem. This activity came to an end
in April, 1931, with the greater portion of eastern Tennessee surveyed. During the past year 23 counties were surveyed. It is interesting to note that out of 30,277 school children examined only 213
cases o:f trachoma were found, while out of 2,757 people examined in
field clinics and in the home there were 660 cases of trachoma found.
This shows that school examinations alone will not suffice for the
purpose of obtaining an index of trachoma prevalence.
Georgia.-Work has been carried on in southwestern Georgia for
the past five months in cooperation with the Georgia State Board
of Health. A fairly large number of trachoma cases have been
located through the activities of two field nurses and a local physician who is a part-time employee of the Public Health Service.
Treatment clinics were organized at strategic points and held at definite intervals, usually once a week, and in some cases twice a week.
These treatment clinics were conducted by a nurse trained in trachoma
work and who had seen enough trachoma complications to know
when a case is not doing well. Seventy of these clinics have been
conducted and 4,943 treatments given by the nurse. One day each
week was devoted by the local physician to seeing and treating any
trachoma case that needed his services or had been referred in by
the field nurse. Suspicious cases were also examined on that day.
At irregular intervals several operative clinics were held. The
operative cases averaged 6.2 days' hospital care. The Georgia trachoma is of a very mild type and complications are rare.
/llinois.-Diagnostic clinics were held in southern Illinois at the
request of the Illinois State Board of Health and much trachoma of
a severe type was discovered. The State health commissioner has
been employing two field nurses for trachoma work. The attempt
has been made to transport the cases needing hospitalization to the
Illinois Eye and Ear Infirmary in Chicago.
Tewas.-A trachoma survey was carried on in the lower Rio Grande
Valley. A trachoma field nurse, with a nurse furnished by the Texas
State Department of Health, examined 11,054 individuals. Of
these, 1,800 had suspicious lid conditions. Most of these suspicious
cases were examined at diagnostic field clinics, and only a few mild
active cases of trachoma were found. Several inactive cases of a
severe type were found, but all had moved in :from other parts of the


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86

PUBLIC HEALTH SERVICE

country. A very large number of cases of follicular conjunctivitis
were seen in both Mexican and American school children. Some
schools showed 60 per cent involvement.
Tr{J)choma reseairch.-Research into the etiology of trachoma was
continued throughout the year by Dr. Ida A. Bengtson. Material
from trachoma cases in southwest Georgia, Kentucky, and Missouri
was furnished for this work.
Statistical tables showing the work done in the field clinics and in
the hospitals are submitted as part of this report. The tables show
particularly the large number of cases that are reached through the
field workers and field clinics.
Dispensary and hospital relief, operations, etc., fiscal year ending June 30, 1931
Bainbridge, Richmond, Rolla, Mo. Knoxville,
Ky.
Ga.
Tenn.I

Total

DISPENSARY RELIEF

Number examined _________________________
Old cases trachoma ________________________
New cases trachoma _______________________
Total attendance __________________ ------ __
Average daily attendance __________________
Corneal opacity from trachoma ____________
Blindness both eyes from trachoma ________
Blindness one eye from tracho'.ma __________
Ulcer from trachoma _______________________
Pannus from trachoma _________ __ _________
Entropion from trachoma __________________

1,522
863
274
1,522
2 54. 35
24
0
2
2
192
3

692
245
250
692
1. 89
145
1
5
35
221
39

2,275
934
405
2,375
6.43
158
3
24
57
347
88

339
246
34
339
4.4
9
0
0
8
9
2

4,828
2,288
963
4,928
67. 07
336
4
31
102
769
132

175
168
1,085
1,085
$423. 15

339
244
10,238
12,414
$4,523.05

320
183
11,916
13,611
$5,887.61

44
25
1,393
1,865
$703. 83

878
620
24,632
28,975
$11,537.64

0. 824
30. 2

0. 882
37. 23

0. 753
31. 65

-----------------------

0. 0027

0. 028
. 047

0. 074
.083

0
0.023

-----------------------

9
156
157
3
5
0
0
0
5
0
0
0
0
0
0
0

5
199
147
23
32
0
0
0
0

0
1
1
0

1
211
93
55
24
4
6
1
15
3
5
2
1
0
0
1

0
16
15
1
0
0
0
0
0
0
0
0
0
0
0
0

15
581
412
82
61
4
6
1
20
3
5
2
1
1
1
1

0
0
0
0

0
0
0
0
0
0
0
0

17
10
6
3
281
291
8
2

0
0
0
0
0
0
0
0

17
10
6
3
281
291
8
2

HOSPITAL RELIEF

Cases admitted during the year (total) _____
Number cases first admission ______________
Days relief furnished ______________________
Rations furnished ____ ____________________ _
Cost of rations _____________________________
Hospital capacity efficiency ________________
Average stay in hospitaL _______ _______ ____

-----------6. 2

Virulence a index for past year------------Virulence index for past 5 years ____________

------------

OPERATIONS

General anesthesia _________________________
Local ·anesthesia ___________________________
Grattage ___________________________________
Entropion _________________________________
Canthoplasty ______________________________
Tarsectomy
__ ---------------------------Pterygium, transplant
oL _________________
Blepharoplasty ____________________________
Cautery puncture ____ --------------------Ulcer cauterized with iodine _______________
Electric sparking __________________________
Kuntz operation ___________________________
Ectropion ________________________________
Chalazion, incised and curretted ___________
Evisceration __ _____ __ --- -- -- ------ -- -- - Trauma ___________________________________

--

0

0
0

SPECIAL TREATMENTS

BimosoL ___________ -- ___ - _________________
Sterile milk __________________________ ______
Autohemotherapy _________________________
Typhoid injections ______ -----------------Ultra-violet-ray treatment _________________
Diathermy ___ _____________ ___ ------------Refractions ______ ______ _________ ___________
Salvarsan ____ _____ _________ _____ ___ ____ ____

0

0
0
0

Knoxville Hospital closed to patients Sept. 15, 1930.
Held 1 day a week.
Virulence index is figured by taking number of eyes blind from trachoma seen during year and dividing
by number of new cases of trachoma. No blind eye counted more than once.
1
2

3


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87

PUBLIC HEALTH SERVICE
Field activities
Missouri

Arkan• Georgia Illinois Ken•
tucky
sas

Tennessee

Texas

Total

- -- -- -- ---- - - - Number of clinics held _____________
Number persons examined _________
Trachoma cases seen _______ ___ _____
Former hospital cases ______________
Suspicious cases seen ____ ___________
Treatments given at clinics _________
Physicians ___________ ---·------- ___

1
77
8
0
5
0
4

26
3,148
859
0
472
621
19

6
660
245
0
37
0
24

12
1,116
299
196
4
400
33

56
4,121
2,058
401
354
2,070
44

73
1,494
382
86
88
346
12

11
1,866
0
75
0
0

185
12,482
3,895
683
1,035
3,437
136

Public talks given ___________ ___ ___ _
People (estimated) in audiences ____
Homes visited _________________ _____
People examined in homes ___ ______
Number pupils examined in schools_
Suspicious cases in schools. _________

1
50
0
0
0
0

7
525
210
993
8,137
1,167

1
150
0
0
0
0

57
4,959
1,119
6,003
1,448
36

92
4,020
1,660
3,956
3,437
58

I 651
23,768
I 343
I 21,263
13 30,277
I 187

0
0
25
101
11,054
1,800

809
33,472
3,357
12,316
54,353
3,248

Number
nurse
only ____ treatment
___ _____ __ __clinics,
___________
___
Number treatments by nurse ______

0
0

70
4,943

0
0

0
0

0
0

0
0

0

0

70
4,943

Total number of new individual
trachoma cases discovered ________

8

708

245

233

767

862

44

2,867

44

1"IELD NURSE ACTIYITIES
I

1 Represents work of nurse and field clinician.
2 There were 169 cases of trachoma in these homes.
a There were 213 cases of trachoma among these school children.

SUPERVISION OF

,v

.ATER SUPPLIES USED BY COMMON CARRIERS

While the cooperative plan between the State health departments
and the Public Health Service for the certification of water supplies
used on interstate carriers continued in operation as heretofore, certain changes in procedure were made involving some decentralization
and more cooperation with the States. This 'brought about better
reporting and increased the number of inspections and certifications,
as shown in the accompanying tables.
During the year assistance was rendered various States in making
inspections of 98 water supplies used hy common carriers.
The yearly inspection and certification of water supplies used by
common carriers entails a large amount of work 1 which may be unnecessarily increased where sources not used are listed by the carrier.
E:ffort toward elimination of sources not used but listed by the carriers has brought about a reduction in number of sources from 2,953
in 1928 to 2,518 in 1930.
The following comparative tabulation of the percentages of completed certification indicates the status of this work and shows the
results of the changed procedure:

•

{}~~y~~~~fl~~~~--:: ::: == ===: ==:: :: :: == ====== ========: === == ====

1927

1928

1929

1930

Per cent

Per cent

Per cent

Per cent

80

82

81

75

78

78

87. 5
88. 0

INTERSTATE CARRIER W ATEm SUPPLIES

The following tables covering the calendar year 1930 give the
status of this work by States :


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PUBLIC HEALTH SERVICE

Railroad supplies for calendar year 1930
Certification status

Source classification

Per
cent
sources
Pro- Action
ProRail- Total SatisPribib- vision- pend- acted
Public 1 vate
2
upon
factory ited
road
ing
al
--- ------ --- ------ ------

State

Alabama_ .• _________________
Arizona _______________ . ______
Arkansas. ___________________
California ________________ . ___
Colorado ..• _________________
Connecticut. _____ • ______ . ___
Delaware. __________ • ______ ._
District of Columbia ________
Florida. __________ . ___ .. _____
Georgia ___________ . ____ . _____
Idaho ______________ . _______ ._
Illinois _____________ . _________
Indiana __________ • ___________
Iowa _________________ -------Kansas. _____________________

!i:;JJ~!L::::::::::::::::::
Maine .. _. _______ • ________ • __
Maryland ___________________
Massachusetts _______________

t~~i;f:S~~a::::::: :: ::::::::::
t~~~~~~f~~::::::::::::::::::
Montana. ______ . ________ • ___

Nebraska.• ____________ . _____
Nevada ______________________
New Hampshire _____________
New Jersey__________________
New Mexico _________________
New York ___________ ________
North Carolina ______________
North Dakota ______________ _
Ohio ___________ ____________ __
Oklahoma _______________ ____
Oregon. ___________________ __
Pennsylvania ___________ • ___ .
Rhode Island _____ .. _______ ..
South Carolina. ______ • ____ _.
South Dakota .• _____________
Tennessee. __________________
Texas __________ ______ . ______ .
.. -------------------Utah
________ . __ ____ ._. ____.
Vermont
Virginia .. _____ ______________
Washington _________________
West Virginia. ______________
Wisconsin ___________________
Wyoming ____________________
Totals. ________________

71
28
34
35
15
34
63
48
31
55
22
33
9
20
30
8
85
43
16
66
47
28
118
2
29
23
28
112
11
12
40
26
30
52
13

0
1
6
7
3
2
0
0
1
1
2
1
0
1
0
9
4
0
1
0
12
3
2
3
2
0
1
0
0
1
3
l
2
2
0
1
6
0
2
0
4
7
4
1
1
1
6
12
0

2
5
6
26
5
0
0
1
7
1
9
14
6
6
6
12
10
5
1
0
3
21
6
5
9
17
12
1
0

1,799

116

360

40
15
42
48
27
11
6
1
43
52
17
66
51

63

11

13

4
9
12
3
4
15
0
1
8
6
45
5
1
4
4
6
11
2

42
14

0
7

45
31
42
75
15

10
67
25
27
58
2
32
15
35
51
17
13
36
26
37
48
9

0
0
4
1
0
0
0
0
0
1
4
2
3
1
4
0
1
0
0
0
2
3
0
3
1
l
1
0
0
0
2
1
0
4
3
4
0
0
0
1
1
1
0
0
0
2
2
7
0

2
0
0
4
6
2
22
34
28
4
4
0
18
2
0
6
0
0
23
4
0
2
0
0
4
13
5
1
3
8
0
0
0
0
5
2
112
3
1
0
2
3
15
6

2,275

1,540

60

396

42
21
54
81
35
13
6
2
51
54
28
81
57
70
77
49
48
40
17
34
78
72
39
63
33
50
22
21
30
20
101
48
27
80
50
33
139
2
32
31
38
164
20
]4

23
56
21
11
6
2
47
47
22
57
19
22
62
32
40
21
15
34
68
63
36
37
23
0
19
21

28
16
86

42

11
23

11

I

0
0
16
1
3
0
0
0
0
0
0
0
1
19
7
13
7
1
0
0
2
6
3
0
5
49
0
0
2
0
0
0
16
6
14
2
81
0
0
10
0
0
0
0
9
1
0
5
0

100
100
70
99
91
100
100
100
100
100
100
8100
98
73
91
73
85
97
100
100
97
92
92
100
85
2
100
100
93
100
100
100
41
93
72
94
42
100
100
68
100
100
100
100

279

87. 5

80

97
100
93
100

1 This column includes supplies owned by municipalities as well as those used by municipalities but
owned by private companies.
2 A "Private'' supply refers to a small well or spring used only by the carrier and the person owning it.
a Based upon watering point sanitation as well as source of supply.

Reca,pitulaJ,Uon of railroad supplies by districts
Source classification
District

•

Pro- Provi- Action
SatisPublic Private RailTotal factory
road
hibited sional pending
--- --- --- --- --- --- ---

3. - - - - - - - - - - - - - - - - - - - - - - - - - - 1. - ------ ---------- --------- -

118
25,9
106
488
481
347

Totals _________ ________

1,799

5. - -- - --- -- - ------- ---- ---- -2. - -- -- -- - - --- ---- - --- - --- - -6- - -- ------------ ----------- 4_ - -- -- - - - - - - - - - - - - - -- - - -- - - -

I
I


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Federal Reserve Bank of St. Louis

Certification status

17
13
6
35
33
12

101
107
35

116

360

64
25

28

I

199
297
140
624
621
394

143
264
107
383
369
274

2
4
11
17
24
2

50
20
14
164
114

2,27/i

l, 540

60

Per
cent

---

34

4
9
8
60
114
84

98
97
94
90
82
79

396

279

87. 5

89

PUBLIC HEALTH SERVICE
Vessel supplies for calendar year 1930
Source classification
State
Public I

Certification status

Per
cent
sources
BatisProProAction
Priv- Com- Total
facbib- vision- pend- acted
upon
pany
ate 2
ing
tory
ited
al
- - - - --- - - - - - - ---

-Alabama •.___________________
--·· · · ····· ·······
Arkansas.
California ___________________
Connecticut _________________
Delaware ____________________
District of Columbia ________
Florida ____________________ -Georgia __ _____ ____ ___________
Illinois ______ •• ______________
Indiana _________ . ____________

f;~f~i!:.
~~= == == == == ========
Maine _______________________
Maryland ___________________
Massachusetts _______________
Michigan ________ ____ ________
Mississippi. _________ ________
Missouri. ___ _________ ________
New Hampshire _____________
New Jersey __________________
New York ______ _____________
North Carolina ______________
Ohio ___ ______________________
O•egon ______________________
Pennsylvania __ ____ __ ________
Rhode I sland ________________
South Carolina __ ________ __ __
Tennessee ___________________
Texas ____________ ______ ______

~T!;f
~~~~ ~ ==============
====
Wasbington
___________ . _____
West Virginia _______________
Wisconsin ___________________

1
2
19
8
2
1
4
2
5
5
3
2
9
5
16
9
4
1
1
13
14
2
9
8
7
4
3
2
7
1
12
20
3
4

0
0
2
0
0
0
3
0
1
0
0
2
0
2
0
0
0
0
0
3
1
0
0
0
0
0
0
0
7
0
0
2
0
0

0
0
1
0
0
0
3
0
0
0
0
2
0
1
0
0
0
0
0
0
0
0
0
0
0
0
1
0
2
0
2
0
0
0

---- --·
Total __________________ - -208
12
23

1
2
22
8
2
1
10
2
6
5
3
6
9
8
16
9
4
1
1
16
16
2
9
8
7
4
4
2
16
1
14
22
3
4

1
0
12
8
2
1
10
2
4
1
1
6
5
7
16
9
3
1
1
14
15
2
9
4
1
4
4
2
5
0
8
17
3
4

0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
2
0
0

0
0
3
0
0
0
0
0
1
3
1
0
4
1
0
0
0
0
0
0
0
0
0
4
0
0
0
0
9
1
0
0
0
0

0
2
7
0
0
0
0
0
0
1
1
0
0
0
0
0
1
0
0
2
0
0
0
0
6
0
0
0
0
0
6
3
0
0

100
0
68
100
100
100
100
100
100
90
67
100
100
100
100
100
75
100
100
88
100
100
100
100
14
100
100
100
100
100
57
86
100
100

243

182

5

27

29

88

1 This column includes supplies owned by municipalities as well as those used by municipalities but
owned by private companies.
2 A "private" supply refers to a small well or spring used only by the carrier and the person owning it.

Reciprocity with the Department of Pensions and National Health
of Canada, covering both the certification of water supplies used
by common carriers crossing the international boundary and inspection of vessels operating on the Great Lakes and border waters,
continued. During the year certificates were received from the Canadian authorities covering 34 supplies used by United States carriers operating in Canada, and 13 certificates were forwarded to
them covering supplies used by Canadian carriers operating in the
United States.
RAILWAY SANITATION

Cooperation with the joint committee on railway sanitation of
the American Railway Association was continued throughout the
year. The report of the committee was completed in June, but had
not been acted upon at the close of the. year. One engineer devoted
a considerable portion of his time to the work of this committee in
the preparation of the report and in carrying on tests of devices m
service or proposed.
80597-31--7


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90

PUBLIC HEALTH SERVICE

Two hundred inspections of coach yards and terminals were made
as time would allow and corrections in sanitary conditions brought
about. There appears to be some difference of opinion as to jurisdiction over the sanitation and handling of drinking water in coach
yards and at watering points. In general, the States have considered this is a function of the Public Health Service and have not
included such work in their regular control activities. Illinois is
the only State considering the handling of water by the railroads
as an integral part of the carrier drinking-water-supply system and
bases its recommendations for certification on the water as delivered
to the cars rather than to the yard. At the close of the year Texas.
adopted the same procedure.
SUPERVISION OF WATER-SUPPLY SYSTEMS ON VESSELS

Control over drinking and culinary water-supply systems on vessels engaged in interstate traffic has been extended during the year..
With more routine inspections and the issuance of regular certificates, greater interest is being shown by vessel owners. The number
of temporary certificates issued is being rapidly decreased, and plans
are being made to discontinue issuance of this type of certificate.
Requests for inspection and advice by companies operating vessels:
in foreign traffic, as well as by Federal agencies, indicate increased
interest in properly protecting drinking-water supplies aboard
vessels.
During the year 317 vessels received their first inspection, while
807 were reinspected. The number of favorable certificates issued
was 895.
The following table gives the status of this work for the calendaryear 1930:
Certification of vessels for calendar year of 1930

District

Vessels
on
active
status

Per cent
of total
vessels in
district

Permanent
certifications

Temporary
certifications

Total
certificates
issued

Per cent Per cent
of disof total
trict total vessels
certified certified

·- - - - - - - - - - - l_ -- - - - - - - - - - - - - - - - - - - - -- - -- - - 2 __ -- -- - -- - - - - - - - - - -- - - - - -- - - - 3_ -- - - - -- - - - - - - - - - --- -- - - -- - - - 4_ - - --- -- - - -- - - - - - - - - - - - - -- - -- 5-6. - - - -- -- -- -- -- - - - - - - - - - - -- - -

862
102
546
198
410

TotaL __________________

2,118

40.6
4.8
25. 0
9. 3
19.0

----------

91
96
454
40
214

377
4
58
126
68

468
100
512
166
282

895

633

1,528

54.2
98
93. 7
80.3
68. 7

22.1
4. 7
24.2·
7.8.
13. 3,

----------

Percentage of total given permanent certificates, 42.2; percentage of total given temporary

--72.1

certificates ►

29.9.

N 0TE.-Only the latest certificate issued on a vessel was counted in case that vessel was both temporarily and permanently certified during the year.

Investigations were made of cases, of typhoid :fever occurring·
among crews and passengers where indications were such as to,
implicate water supplies. During the year 63 cases were reported
as occurring among crews, a reduction of 12 cases over 1929. Of
this number 17 occurred on Federal vessels not under the jurisdiction.
o:f the Interstate Quarantine Regulations.


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PUBLIC HEALTH SERVICE
SHELLFISH SANITATION

The procedure in carrying on this work was not changed during
the year. However, changes are being considered in an effort to
encourage and maintain greater activity on the part of the producing
States. Listing of certified dealers is instrumental in maintaining
fairly satisfactory control, its efficiency depending upon the use made
of the list by the consuming States and cities.
The establishment of chlorinating plants for treating clams in
Massachusetts is a forward step, and the results obtained in that
State are being watched with great interest.
Some change or modification of the present method of bacterial
examination of shellfish, and particularly soft clams, has been indicated by the laboratory work carried on in connection with the
shellfish-conditioning plants.
'
During the year 1,060 certificates were approved, and the number
of shippers listed at the close of the year was 1,550 .
. Reciprocity with the Canadian Department of Pensions and National Health continued, and that department was supplied with
copies of all certificates issued by the producing States. They, in
turn, certified 32 Canadian shippers.
PUBLIC HEALTH ENGINEERING ABSTRACTS

The demand for this publication has shown an increase, as have
references to it in the technical literature.
The abstracts issued during the year totaled 1,398. They required
442 mimeographed pages and were taken from 115 domestic and
157 foreign publications.
The following table gives the status of this publication for the
year 1931 in comparison with the preceding years:
Fiscal year ended June 30
1928

- - - - - - - - - - - · - - - - - - - 1 - - - - 1 -Publications avilable ___ • ___ . _••.•. _______ • ____ . __ . ____ . _.. __ • _.
116
Abstractors. _____ ._._ ...•. _______ ._ ... _._ .•. _. __ . __ . _____ ...• __
85
Weekly issues ___ ... ____ ._. ____________ .. _._._._._._. ______ .. __ _
53
Articles abstracted_ ..... _. ___ ... ______ . ______ ._. ______ .. __ . ___ _
896
Mailing list._. __ ---------------· _____________________________ _
684

COOPERATIVE SANITARY

1930

1929

-

1931

-----207
87
52

295
89
52

1,426
835

1,445
883

312
97
52
J, 398
986

w ORK

The cooperative sanitary engineering work with other divisions
of the Public Health Service and other Federal and State governmental agencies was extended during the year. A total of 1,250
engineer days were devoted to this cooperative work.
The work with the National Park Service and Office of Indian
Affairs, in connection with surveys, reports, preparation of plans,
and advice, occupied a major part of the time devoted to this cooperative work, amounting to 824 days. Assistance rendered the


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Federal Reserve Bank of St. Louis

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PUBLIC HEALTH SERVICE

Supervising Architect's Office in making surveys and recommendations for water supply and sewage disposal at the new border customs and immigration stations required considerable time during
the year.
Additional governmental agencies to which assistance was rendered
were:
(1) Lighthouse Service: Studies of drinking-water systems on
vessels, with advice as to corrections.
(2) Bureau of Prisons : R eviews of plans, surveys, and advice
relative to sanitation of institutions.
(3) District of Columbia: Studies of the disintegration of a concrete sewer, and assistance_in the mosquito control problem.
( 4) Veterans Bureau, Coast Guard, Army, Reclamation Service,
Forest Service: Surveys and advice relative to matters of sanitation.
( 5) Utah, Intliana, Massachusetts: Surveys and advice relative
to mosquito control measures.
MosQmTo CONTROL, DISTRICT OF CoLUMBIA
With the passage of the necessary legislation and appropriations,
active control measures were instituted in August, 1930. The ~ork
was organized in accordance with the plan presented in a report
prepared by the Public Health Service in 1929. At the request of
the Commissioners of the District of Columbia and the Director
of Public Buildings and Public Parks, the two major agencies involved, the Public Health Service was requested to coordinate and
supervise the work.
The control problem, as such, offers no particular difficulty; but
the fact that, in addition to the District of Columbia and the Office
of Public Buildings and Public Parks, there are some 28 other
Federal and district agencies having jurisdiction over certain areas
complicates the problem.
All agencies have cooperated in carrying on a coordinated control,
permitting the setting up of a reasonably smooth running control
organization.
SUMMARY OF

w ORK

CARRIED ON BY THE VARIOUS DISTRICTS

D istribution of time in days of the field versonnel under the engineering section,
fisoal year, 1931

Interstate
quarantine:
Office ____________________________________________________________
1,279
FieldWater _____________________ ·-------------------------------- ·_ 880
Shellfish _______________________________. _____________________ 342
National
Service:
OfficePark
_______________________________________________________
. ____ 290
Field____________________________________________________________
96
Indian Service :
Office____________________________________________________________ 201
Field____________________________________________________________

137

Other agencies :
Office____________________________________________________________
Field-----------------------------------------------------------Technical
meetings___________________________________________________
Leave_______________________________________________________________

274
282
34
223

Total days accounted for _______________________________________ 4,038


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PUBLIC HEALTH SERVICE

93

TABULAR SUMMARY OF .ACTIVI'I'.IES IN .ALL D-ISTR,I OTS, FISO.AL YEAR 1931

Vessel water-suppl-y s·u pervision

Inspections :
First inspectionsPassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
ReinspectionsPassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
Certificates issued :
Regular, favorablePassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
Regular, unapproved _____ _
Temporary, favorablePassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _

139
174
4
373
423
11
407
634
7
1
185
415

Plans of vessel water systems
examined:
31
Approval granted________ _
23
Approval withheld_______ _
Major conferences :
79
With shipping officials____
28
With others__________ ____
Water examinations made:
U. S. Public Health Service
4
laboratories_____ ________
Other laboratories ________ 2,563
Typhoid fever cases reported :
U. S. Public Health Service
47
hospitals________________
U. S. Public Health Service
1
quarantine stations______
15
Health departments _______

7

Railroad, sanitation supervision

Inspections :
98
Sources of water supply____
130
Coachyards_____ __________
65
Terminals_________________
5
Watering points___________
49
Dining cars_______________
Certification :
Data reports reviewed _____ 1,836
Certificates prepared for 2,338
State,s __________________

Water examinations made:
U. S. Public Health Service
laboratories ____________ _ 502
Other laboratories ________ _ 1,825
Major conferences:
62
With railroad officials ____ _
With others (principally
health authorities) ______ _
91

Shellfish sanitation supervision

Inspections :
Areas ___________________ _
5
Plants ___________________ _ 688
State certificates:
Approved ________________ _ 1,060
Not approved ____________ _
6
Approval withdrawn ______ _
0

State certificates-Con tinued. _ _
Canceled ________________
Laboratory examinations made:
U. S. Public Health Service
laboratories ____________ _
Other laboratories ________ _
Conferences __________________ _

98
628
674
118

Miscellaneous

Cooperation with Governmental
agencies:
Public Health ServiceSurveys _____________ _
Conferences __________ _
Office of Indian Affairs- _
Surveys ______________
Conferences-___________ _
National Park Service- _
Surveys ______________
Conferences __________ _
Bureau of PrisonsSurveys ______________ _
Conferences __________ _


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6
11
64
40
27
44
16
23

Cooperation with Governmental
agencies-Contin ued.
Supervising Architect's OfficeSurveys _______________ .
Conferences___________
State health departmentsSurveys_______________
Conferences___________
Other Governmental
agenciesSurveys_______________
Conferences___________

26
43
3
42
25
22

94

PUBLIC HEALTH SERVICE
INTERSTATE SANITARY DISTRICT S

DISTRICT N O. 1.-MAINE, N EW HAMPSHIRE, VERMONT, M.ASSACHUSETTS,
RHODE I SLAND, CONNECTICUT, NEW YORK, N EW JERSEY , AND PENNSYLVANIA

Sanitary Engineer L. M. Fisher was in charge of the district during
the year. The activities carried on are grouped as follows: (1)
Shellfish sanitation; (2) vessel water-supply and sanitation supervision; (3) railroad water-supply and sanitation supervision; (4)
miscellaneous activities, including cooperation with State health departments, local health departments, and Federal agencies in dealing
with special health problems.
SHElLLFISH SANITATION

Many of the shellfish sanitation activities were concerned with the
supervision of the soft-clam industry. High scores of shucked clams
continued to .be reported at intervals by New York City, particularly
of clams that are sold strung in bunches and originating at points in
New Jersey, near Highlands. The managers of the shucking houses
where these clams are prepared went to considerable expense to
remedy unsatisfact0iry plant conditions, and some improvement in
the scores was noted, but not as much as was anticipated before the
improvements were effected. New Jersey carried on clam-treatment
experiments for a short period, using chlorine somewhat along the
lines followed in Massachusetts, but discontinued these experiments
until a later time, pending the outcome of results obtained elsewhere.
A considerable amount of work was carried on in cooperation with
the Massachusetts State Department of Public Health in studying
and improving the clam-chlorination process. A field laboratory was
established at Newburyport, Mass., and later transferred to Plymouth, where facilities for experimental work were better and the
laboratory was more accessible.
On examining treated clams by our " shot " method, devised in
1927 while oyster meats were being examined, it was n0ited that scores
obtained in this way were not as low as those obtained by examining
shell liquor only. The apparent reason for this discrepancy was
probably due to the fact that in the beginning the chlorination plants
were operated with 0.5 parts per million of free chlorine present in
the water a large proportion of the time. A chlorine content as high
as this interferes with the free feeding of the clams, the result being
that the shell liquor is at least partially sterilized, while the intestinal
tract, gills, and other parts of the clams are not adequately cleansed.
The treatment process was so changed as to allow for the presence of
free chlorine in detectable quantities only during a portion of the
treatment period.
Our experiments also disclosed that clams will not feed actively
if air is blown through the water continuously. As a result, the
treatment process was further modified and the blowing of air was
limited to a 15-minute period each 3 hours in order to mix the
chlorine solution added to the tanks. The studies also disclosed
that the greatest part of the contamination was removed from the
clam in the first 24 hours of treatment, that no great improvement

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PUBLIC HEALTH SERVICE

95

resulted from the second 24 hours, and that there was residual contamination, which was difficult, if not impossible, to remove without
-excessively long treatment periods. Experiment s to ascertain
whether the treatment period could be shortened to less than 24
hours indicated that it would be unwise to do so.
Observation s made during freezing weather indicate that there
is serious interference with the treatment process if the clams are
:frozen hard after being dug. Digging on extremely cold days .
probably should be prohibited. Such days are, however, comparatively rare.
Examinatio ns made of conditioned clams shucked in commercial
shucking houses showed high scores. Investigatio n of this phase
of the problem seems to indicate that even when clams coming from
.approved areas are shucked in commercial ly operated shucking
houses under reasonably clean conditions the scores are considerabl y
higher than when the same cl:;lms are opened in the laboratory for
examination . The determinati on of a suitable standard for shucked
soft clams remains at the present time somewhat in doubt, but it is
apparent that the present standard for shellfish is not applicable to
the soft clam.
As a result of the operation experiments conducted by the State
department of public health and the findings from our own studies,
it was recommend ed that the Public Health Service grant provisional
approval of the process under certain operating conditions, but that
further studies to improve the product be continued. It was also
recommend ed that the State health department be given authority
by the legislature to license all wholesale shellfish plants regardless
of whether or not their product is shipped interstate.
Following the success attained at the two plants in operation dur, ing the year, an additional plant was completed just before the close
of the fiscal year, and a fourth plant is being planned for early construction. Investigatio n made of clams found on the Rhode Island
market disclosed that a considerable percentage came from 'treatment plants in Massachusetts.
In the light of experience gained during the year the regulations
governing the operation of clam-treatm ent plants were revised by the
Massachuse tts State Departmen t of Public Health, and the revised
regulations were approved by the Public Health Service.
Additional shellfish legislation was enacted in Maine and in Massachusetts-in Maine, to give the State agriculture department specific
authority to deal with the various problems involved, and in Massachusetts, further to amplify the existing law.
Conferences with members of State legislatures and State health
authorities were attended at various times for the purpose of fur:n,ishing information in connection with proposed shellfish legislation.
Arrangeme nts were completed to make detailed studies of laboratory methods followed in one o,f the States in this district exercising
jurisdiction over shellfish problems, some question having arisen as
to the adequacy of the methods employed. At the close of the fiscal
year studies had not been completed, due to illness and other delays.
Special shellfish studies were made in the Public Health Service
laboratory in New York with a view to ascertaining whether there
could be evolved a more satisfactory method of expressing the amount


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1

96

PUBLIC HEALTH SERVICE

of contaminati on present in a sample than the present score method,
the object being to find a practical way of expressing the number of
B. coli organisms per shellfish through the use of fermentatio n tubes
only.
A week was spent by our technician in the laboratory of the New
Jersey State Board of Health aboard the launch Inspector for the
purpose of observing the methods followed in that laboratory and to
assist in training personnel recently added to the department . In
the oyster industry conditions throughout the year were, on the whole,
quite satisfactory . Supervised water storage continues in New Jersey. Conditions in Tuckerton Creek are not all that could be desired,
and it is probable that some changes will have to be instituted if approval of State certification is to continue.
Three cases of typhoid fever occurring at Castine, Me., and believed
by the local health officer to be due to contaminate d clams, were
investigated . While the investigatio n indicated that the cases
studied were related to a larger outbreak at Bucksport, the conditions under which clams were handled and stored at Castine could
easily have resulted in contaminat ing them. The clams were not
handled by dealers licensed to ship clams in interstate commerce.
Assistance was rendered the State in correcting the conditions found.
Early in the fiscal year it became necessary for the district engineer
to notify a shellfish-pr oducing State in this district that he could
not longer indorse certificates issued by that State to interstate shippers of shellfish unless certain recommend ed improvemen ts were
made. As a result of this refusal to recommend certification , extensive changes and improvemen ts were instituted.
·
At the request of the National Association of Shellfish Commissioners, a paper on clam chlorination was prepared and read at
their annual meeting.
.
SUPERVISION OVER VESSEL WATER-SUPPLY SYSTEMS AND SANITATION

Following the report to this office of four cases of typhoid fever
occurring among the crew of a vessel arriving in New York from a
cruise around the world, an investigatio n was made as to the probable source of the infection. The vessel took water at 15 foreign
ports and the crew was given shore liberty at most of the ports.
Samples of water examined later showed the presence of contamination. The ship's surgeon, who had not diagnosed the cases of
typhoid fever, was of the opinion that the infection was acquired
ashore, but conditions surrounding the water supply were such as to
make it entirely possible for the infection to have been water borne.
Members of the crew reported that sailors with symptoms similar to
those whose illness was diagnosed as typhoid fever were put ashore
at other places before reaching New York. It should be noted that
vessels engaged in foreign commerce do not come under the jurisdiction of the Interstate Quarantine Regulations , and recommendations for changes aboard such vessels can not be enforced by this
office.
Owing to the limited personnel attached to this office, it is not
practicable to inspect all the vessels whose headquarter s are in this
district without sacrificing more important work. Practically all
the passenger-c arrying vessels were inspected, and conditions on the


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Federal Reserve Bank of St. Louis

PUBLI C HEALT H SERVICE

97

genera lly
whole were found quite satisfa ctory. Vessel owner s health of
the
arding
safegu
in
rate
coope
to
showe d a willin gness
as this
passen gers and crews by carryi ng out such recom menda tions
office deemed necessary.
t apOwne rs of vessels being built for the foreig n trade sough
most
In
.
vessels
such
aboard
s
system
ter
prova l of the drinki ng-wa
coverplans
if
ularly
partic
given,
be
could
val
appro
such
ces
instan
this office.
ino- the ve sel water- supply system were first review ed by
appro val
ed,
accord
not
was
plans
such
review
to
tunity
oppor
e
·wher
ter
ng-wa
drinki
the
since
given,
be
not
of the compl eted work could
d the vesaboar
s
system
water
other
from
te
separa
not
was
system
compa ny
sel. Arran gemen ts were made with a large shipbu ilding t at the
presen
be
could
office
this
from
ve
entati
repres
a
where by
ble.
trial trip of newly compl eted vessels if consid ered advisa
ian DeCanad
the
of
er
engine
chief
the
ed
render
was
ance
Assist
m
proble
with
g
dealin
in
h
Healt
partm ent of Pensio ns and Public
of
view
In
.
vessels
ian
Canad
aboard
water
ng
drinki
of chlori nating
by the
the regula tions of the Steam boat Inspec tion Service, where
d pasaboar
stores
as
or
cargo
as
either
gas
ne
chlori
carryi ng of
with
water
ng
drinki
of
ent
senge r vessels is prohib ited, the treatm
the
is
This
ns.
solutio
ne
chlori
of
use
by
d
effecte
be
chlori ne must
t
distric
this
in
vessels
No
.
proced ure followed on the Great Lakes
being
water
ng
drinki
all
es,
suppli
ter
ng-wa
drinki
chlori nate their
obtain ed from appro ved sources ashore.
work
Statis tics showi ng vessel inspec tions made and other vessel
carrie d on are presen ted in the summ ary table.
SUPERV ISION
RAILROAD WATER SUPPLY AND SANITA TION

throug h
Sampl es of water collected from railwa y coaches passin g
and
tment
depar
health
State
Alban y, N. Y., were exami ned by the
not
did
es
sampl
the
of
Some
office.
this
to
ed
results were report
the
to
due
was
this
ces
instan
meet the Treas ury standa rd. In some
in
ularly
partic
,
spigot
water
the
over
er
strain
placin g of a cloth
stion
sugge
our
At
.
dining cars operat ed by a large railwa y system
this practi ce was discontinued.
the new
At the reques t of certai n of the State health depart ments es was
suppli
ter
ng-wa
drinki
ad
railro
of
cation
certifi
proced ure for
ure. Certif imodified in this distric t furthe r to simpl ify the procedpoint,
accoming
water
given
a
at
water
taking
y
railwa
cates for each
result s
the
and
water
the
of
y
panied by a report showi ng the qualit
office.
this
to
State
the
by
rded
forwa
are
tion,
inspec
of the sanita ry
the
of
copies
and
ses,
purpo
Prope r notati ons are made for record
in
e
Servic
h
Healt
Public
the
itted
transm
are
s
certificates and report
Washi ngton .
tion
Due to the fact that the Joint Comm ittee on Railw ay Sanita ay
Railw
of
al
Manu
the
has not yet compl eted its report on which
assista nt
Sanita ry Practi ce is to be based, and due to the fact that the
ittee,
c~mm
this
of
work
engine er was devoti ng all of his time to the
was
tion
sanita
y
railwa
with
ction
conne
in
little field inspec tion work
in gather carrie d on. Severa l of the larger railro ad systems assisted
ing data for the report of the joint committee. wheth er water drawn
Exper iment s were condu cted to ascert ain
r interv als
from railro ad coach coolers that were not cleaned at regula

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Federal Reserve Bank of St. Louis

98

PUBLIC HEALT H SERVIC E

contin ued of a satisfa ctory quality , upon the efficiency of a hose
tector devised for the Joint Comm ittee on Railwa y Sanita tion, proand
on the washin g of filter stones and in filterin g water in dining cars.
The certification of railwa y wateri ng supplie s is satisfa ctory in all
of the States in this distric t but one.
MISCELL ANEOUS

A large numbe r of miscellaneous activiti es contin ued to claim the
attenti on of this office.
At the directi on of the Surgeo n Genera l, meetin gs called by
a
group of public -spirite d citizens anxiou s to lessen the polluti on
of
harbor and coastal waters in the vicinit y of New York City were
attende d, and assistance was render ed in organi zing those interes
ted
in this matter . Variou s meetin gs were held throug hout the ~ar,
and a commission was appoin ted by the Govern ors of New
,
New York, and Conne cticut to make recomm endatio ns to theJersey
State
legisla tures on which a treaty between the three States could
be
based. This office is now cooper ating with this commission in their
~~
.
. Assistance was render ed the Vetera ns' Bureau hospit al at Northport, Long Island , in connection with proble ms arising at their
sewage -treatm ent plant.
The Superv ising Archit ect's Office was assisted in the prepar
of plans for water- supply and sewage treatm ent at a numbeation
r of
border inspec tion station s to be built for the customs and immig
ration author ities at points on the Canad ian border in this distric
t.
In this connection inspections were made and plans and reports
prepared for each of the follow ing station s : Eustis , Me. ; East Richfo
Beeche r Falls, and Derbyl ine, Vt.; Rouses Point (two stationrd,
s),
Champ lain, Chatea ugay, and Trout River, N. Y.
Assistance was render ed in the matter of decidin g upon
of
sewage -treatm ent structu res for the Federa l penite ntiary at type
Lewisburg, Pa.
A study was made of the ventila tion system :for the Federa l detention headqu arters, New York City.
Assista nce was render ed the Westch ester County Sewera ge Commission in determ ining the effect that the discha rge of sewage
from
Westch ester County would have on shellfis h-grow ing areas in Long
Island Sound.
Invest igation was made of a typhoi d-feve r case occurr ing at the
Coast Guard station at Lovela dies Island , Highp oint, N. J.
Inspec tions were made of prison camps for the Depar tment
Justice at Fort Wadsw orth, Staten Island , and Camp Dix, N. of
J.,
and of milk-p asteuri zation plants supply ing these camps with milk.
Inform ation was collected from variou s cities and States regard
ing rules and regula tions coverin g the install ation, operat ion,
and
mainte nance of refrige rating plants and was forwar ded
the
secreta ry ·of the Mecha nical and Electri cal Engine ers Associtoation,
Johann esburg , South Africa .
Efforts were contin ued to foster the distrib ution of prophy lactic
tubes by shippi ng companies among members of the Ameri
can
merch ant marine in order to preven t the occurrence of venere
al
disease.


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PUBLIC HEALTH SERVICE

99

Assista nce was rendere d the Salt Lake City Mosquito Abatem ent
Distric t in problem s having to do with the control of both diseasecarryin g and pestifer ous mosquitoes at Salt Lake. City, Utah, and
vicinity , and also the State health officer of Indiana in dealing with
a mosqui to-contr ol problem in that State.
At the request of the comma nding officer at Fort Totten, N. Y.,
surveys were made of mosquito prevale nce at that fort.
Assista nce was rendere d the Massac husetts State Drainag e Board
on various occasions in connection with their efforts to lessen mosquito prevale nce, particu larly in the coastal section of the State.
Opport unity occurre d to experim ent with a new type of ultraviolet lamp in steriliz ing water. These experim ents were made in
connect ion with studies on processes for purifyi ng contam inated
clams.
Detaile d plans and specifications were prepare d in this office for
sewage structur es at the marine hospita l at Vineya rd Haven, Mass.
Assista nce was rendere d the Federat ion of Sewage Works Association in formula ting their plan for research work in sewage-disposal problems.
At the request of the State health officer of Maine, the district
enginee r preside d at the public health enginee ring section of the
New Englan d Health Institut e held at Portlan d, Me.
The district enginee r continu ed to represe nt the service on a
sectiona l commit tee of the Americ an Standa rds Associa tion, engage d .
in formula ting standar d specifications for househo ld refriger ators.
TABULAR SUMMARY

Vessel water-supply supervision
Inspectio ns :
First inspectio ns-Passenge r carrying ___ _
Freight (only) _______ _
Water boats __________ _
Reinspe ctionsPassenger carrying___ _
Freight (only) _______ _
Water boats __________ _
Certifica tes issued:
Regular, favorab lePassenge r carrying___ _
Freight (only) _______ _
Water boats _________ _
Regular, unapprov ed _____ _
•Tempor ary, favorab lePassenge r carrying___ _
Freight (only) _______ _
Water boats __________ _

52
16
4
30
12
1
62
18
0
0

65
284
5

Plans of vessel water systems
examine d:
Approv~ l granted ________ _
Approva l withheld ________ _
Major conferen ces:
With shipping officials ____ _
With others ______________ _
Water examina tions made:
U. S. Public Health Service
laborato ries ____________ _
Other laborato ries ________ _
Typhoid fever cases reported :
U. S. Public Health Service_
hospitals _______________
U. S. Public Health Service
quaranti ne stations _____ _
Health departme nts ______ _

23
23
20

13
4

17
20
0

15

Railroad sanitatio n suvervision
Inspectio ns :
Sources of water supply __ _
Coach yards _____________ _
Termina ls ________________ _
W_a~ering points __________ _
D1n1ng cars ______________ _
Certifica tion:
Data reports reviewed ____ _
Certifica tes prepared for
States -------- -------- --


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Federal Reserve Bank of St. Louis

0
6
3
1
4
129

151

Water examina tions made:
U. S. Public Health Service_
laborato ries ____________
Other laborato ries ________ _
lVIajor conferen ces:
With railroad officials _____ _
With others (principa lly
health authoriti es) _____ _

386
220

28
20

100

PUBLIC HEALTH SERVICE

Shellfish sanita-tion suvervisio n

Inspection s :
Areas ____________________ _
Plants ___________________ _
State certificate s :
Approved --------- -------Not approved _________
___ _
Approval withdraw n ______ _
Canceled _________________ _

1

58

591
0
0
11

Laborator y examinati ons made:
U. S. Public Health Service
laboratories_____________ •628
Other laboratorie s________ _
674
Massachu setts Departme nt
of Public Health _________ 1, 193
Conferenc es ___ ________________
78

Miscellane ous

Cooperati on with governme ntal
agencies:
Public Health ServiceSurveys ______________ _
Conferenc es __________ _
Coast GuardSurveys ______________ _
Conferenc es __________ _
Bureau of PrisonsSurveys ____________ __
Conferenc es __________ _
Supervisin g Architect' s OfficeSurveys _____________ _
Conferenc es __________ _

1
3

1
2
4
9

11
35

Cooperati on with governme ntal
agencies- Continue d.
U. S. ·war Departm entSurveys______________ _
Conferenc es __________ _
U.S. Veterans' BureauSurveys _____________ _
Conferenc es __________ _
State health departme ntsSurveys -~------- ----Conferenc es _________
__
Salt Lake City Mosquito
Abatemen t DistrictSurveys ______________ _
Conferenc es __________ _

3
7

3
5

1
28
1
6

DISTRICT NO. 2 .-DELAW ARE, MARYLAN D, VIRGINIA , WEST VIRGINIA
, DISTRICT OF COLUMBI A, NORTH CAROLINA , SOUTH CAROLINA , GEORGIA,
AND
FLORIDA
PERSONNE L AND ACTIVITIES

The work carried on in Interstat e Sanitary District No. 2 was
under· the direction of Passed Asst. Sanitary Enginee r Arthur P.
Miller during the entire year, with the exceptio n of a period of three
months when Passed Asst. Sanitary Enginee r E. C. Sullivan was in
tempora ry charge. On August 1, 1930, Assistan t Sanitary ' Enginee r
J. L. Robertso n, jr., was detached from this station and assigned to
other work. The vacancy was not filled until June 20, 1931, when
Asst. Sanitary Enginee r Vincent B. Lamoure ux was detailed to this
station.
The activitie s of this station may be arranged in order of importance , as follows :
(1) Shellfish sanitatio n, which broadly includes joint investiga tions with State•au thorities of shucking houses and shellfish-prodYcing areas and such cooperat ive efforts as may be necessar y in connection with special problem s or difficulties.
(2) Inspecti on and supervis ion o:f water-su pply systems, storage
faci~ities, and other sanitary and water appurten ances on interstat e
carriers.
( 3) Investig ation of the devices and methods used by railroads
in watering cars.
( 4) Technica l assistance to other Governm ent departm ents and
bureaus.
( 5) Coopera tion with State health departm ents in connection with
matters jointly affecting them and the Public Health Service and in
the certifica tion of common-car•rier drinking -water-s upply sources.


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SHELLFISH SANITATION

The procedure of this office in connection with this activity has
been the same as in previous years. Joint inspection s of shucking
houses are made and assistance is given in the study of shellfishproducing areas. After each series of inspection s it has been the
policy to make a definite report to t_h e State concerned. Due to lack
of sufficient personnel this year the number of inspection s made of
shucking houses fell to 171, as compared with 198 last year. However, an adequate amount of work was done to permit the for·m ulation of an opinion concernin g the effectiveness of the State inspection machinery . In Virginia the administr ation of the laws relating
to the transplan tation of oysters by the commission of fisheries
moved more smoothly this year than in previous seasons. The State
agencies have endeavore d to enforce effectively their regulation s in
this connection, and apparentl y have met with some success. This
office has always insisted that these regulation s can be made effective
if proper· superviso ry attention is- given to the personnel carrying
them out. Our relations with the bureau of shellfish sanitation of
the Virginia State Departme nt of Health have continued , and our
cooperativ e work in connection with the improvem ent of the shellfish industry through better sanitation has been successful to some
extent.
In North Carolina the problem of the small shucking houses,
usually located in the owner's back yard and used only by the owner
or his relatives, has not yet been solved. Pending a better solution
of the problem, the regular State regulation s on shucking houses are
being enforced on these very small ones. At Morehead City it is
believed that this particular difficulty could be surmount ed if the
city authoritie s would build a cooperativ e shucking house for these
small dealers. However, the city governme nt did not act on this
suggestion this year. Work in North Carolina would be more effective also if the field work could be handled by one of the full-time
and regular employees of the State board of health rather than by
a part-time one. This is particular ly true when considera tion is
given to the fact that resurveys of some of the shellfish-p roducing
areas, and especially the boundarie s of those areas, are necessary
from time to time. When the part-time inspector on she~lfish work
is employed only during the winter, he is not available for any
resurvey work necessary during the summer. In Florida, in so far
as shucking houses are concerned, the supervisio n is becoming quite
effective. At Apalachic ola, the largest site of the industry, two
shucking houses have installed blowers for the cleansing of the
shucked shellfish. These are the first blowers seen in the South.
To control effectively shell stock shipped out of the State in bags
and barrels, a double-tag system has been put into use. Double tags
are issued to firms wishing to ship shell stock. One of the tags is
then attached to a shipment and the other, a duplicate, is kept in
the records of the shipping house. In case it is necessary to trace
shipments or if complain t is received about a shipment bearing a
certain tag, the tags on file at the particular shipping house against
which the complaint has been made can be checked over. Inasmuch
as the tags are numbered serially, each one must be accounted for.
The patrol of condemned areas in Florida is handled by the shellfo:h

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Federal Reserve Bank of St. Louis

102

PUBLIC HEALTH SERVICE

commission of the Department of Agriculture. The operation of
this part of the State's shellfish control is not entirely satisfactory.
Improvement has been made in the Georgia shucking houses. In
previous years the authorities there have been somewhat lax in the
enforcement of their requirements, but this year rigid enforcement
was insisted upon, and there has resulted a number of new and
up-to-date houses. However, in this State laboratory facilities for
shellfish work were lacking during almost the- entire year and the
patrol of restricted areas was ineffective.
In Maryland and Virginia the solution of the returnable container
problem is still lacking. A definite stand either against all returnable containers or against the existing ones of poor design is needed.
Last year it was thought that the problem was solved by arranging
for the retinning of all existing returnable containers and their
definite marking as to ownership. It is believed ,t hat a large percentage of them were retinned, but the indication of ownership in
a similarly large percentage was lacking. This indication of ownership is necessary in order that when defective containers are found
responsibility for their condition can be laid on the proper owner.
If no indication of ownership exists on a can, defective cans will be
disowned by everyone in whose place of business they are found.
In Delaware closed shellfish areas were used during the season.
The laws of the State were held to be ineffective against this condition, and new laws were to be sought from the State legislature so
t hat the closure of an area could be made more stringent.
The st ation was somewhat hampered during the season because of
the lack of adequate charts showing shellfish areas, and particularly
restricted grounds. Toward the close of the year an engineering
assistant was placed on duty for the purpose of bringin~ these charts
up to date and making them of value in field work. An effort was
made when possible to call on city health officers and to discuss with
them the desirability of a close check of markets and retail stores
to see that only oyster stock from certified shippers was being sold.
Such effective control, however, can only be possible when there is
sufficient personnel to call on the majority of the larger cities more
than once a season. Adhering to previous standards, the States have
been asked to report on the inspections of their shucking and shell
houses on.ce a month and to inspect shucking houses once a month
and shell houses approximately once every two months. The following tables show the number of shucking houses inspected by the
States and compare the number of inspect10ns by States reduced to
a " per house per month " basis for 1931 and 1930 :
TABLE

1.-'Number of shucking-house inspections a.s reported by States
1930

State
Delaware __ _________ _
Florida _____________ _
Georgia ______ ______ __
Maryland ___ _______ __
North Carolina ___ ___
South Carolina _____ __
Virginia ________ ______
TotaL _________


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Federal Reserve Bank of St. Louis

Septembar
7
0
14
6
0
15
2
44

October

1931

Novembar

Decem•
ber

- - - - - - - -0
0
19
166
38
1
81

7
25
21
175
44
19
178

7
24
23
171
42
16
228

305

469

511

J anuary February March
---- - - ---

Total

---

7
21
26
211
39
22
326

7
20
23
148
39
6
140

0
0
25
286
27
16
155

35
90
151
1,163
229
95
1,110

652

383

509

2,873

103

PUBLIC HEALTH SERVICE
TABLE

2.-Number of inspections by States, reduced to "per house per month "
basis
Shell

Shucking

Inspections per
Inspections per InspecInspechouse per
house per
tions per Average
tions per Average
month
month
number
month
month number
of plants
over
of plants
over
active
period
period
active
per
Septemper
Septemmonth 1930-31 1929-30
month 1930-31 1929-30 ber to
ber to
March
March
- ---- -- ---- ---

State

--

Delaware ___________ _________
Florida ______________________
Georgia __ ___ _______________ __
Maryland __________ ___ ______
North Carolina ______________
South Carolina ______________
Virginia ________ ____ _________

5.0
12. 9
21.6
166.1
32. 7
13. 6
158. 6

5. 9
27. 0
19. 9
226.1
28.4
21. 9
167. 7

0. 8
.5
1.1
.7
1. 2
.6
.9

1.0
.9
1.1

Total.. ________________

410.4

496. 9

.8

o. 0

1.0

0. 0
2.3
6.4
2.1
.0

.8

3.1

8. 7
5. 4
13. 6
13. 6
11.1
187. 7

.8

14. 4

240.1

.8

.7

.4

0. 0
,3
1. 2
.2
.0
.04
. 01
.06

0.0
.3
1.1
.06

.o
.1

. 004
. 016

In briefly summarizing shellfish work in this territory it may be
said that the activity of inspecting shucking houses is improving
and that the general character of the shucking house is on the upward grade, but that the control of the shellfish-produ cing areas,
with particular respect to their frequent investigation to ascertain
whether restriction lines are properly set and the policing of condemned areas to see that oysters are not illegally taken therefrom,
are not satisfactorily carried out.
VESSEL WATER SUPPLIES AND SANITATION

The inspection of vessels operating in interstate traffic in this
territory is usually done by one inspector, who is placed on duty
for three months during the summer. Most of the corrective measures necessary have been taken by the vessel companies in the Southeast, and therefore the inspections are now reduced to a routine
character. The cooperation offered by the owning companies has
been very gratifying, and the fact that the same inspector has been
kept on duty for six years has assisted in this work immeasurably,
because of his knowledge of the officials, masters of the boats, and
locations of the docks. For the first time in the history of this station 100 per cent certification of vessels during a stated calendar
year was accomplished. In previous years this figure has been closely
approached, but never before reached during the season. Only four
noncompliance notices were issued covering violations of the Interstate Quarantine Regulations. It is again suggested that consideration be given to permitting certificates for certain classes of vessels
to run for ,more than a year before reinspection is required.
The Steamboat Inspection Service has continued to cooperate in
forwarding cards showing the inspections of vessels as made by
them.
Eight cases of typhoid fever on eight different boats were reported. None of these was attended by any unusual circumstances.
Only 21 examinations of water from vessels were made this year


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PUBLIC HEALTH SERVICE

by cooperating city laboratories. Plans for one new vessel to be
built by a shipbuilding company in this area were reviewed.
RAILWAY SANITATION

Continuing one of the projects started last year, reports on
watering facilities and devices along the lines of the Western Maryland, Virginian, Baltimore & Ohio, and Norfolk & Western Railroads were completed and forwarded to the common carriers concerned. In addition a survey of the Atlantic Coast Line Railroad
was started, but due to the lack of personnel was not completed
during the year.
The district engineer continued as a member of the joint committee on railway sanitation of the American Railway Association and
attended such meetings of that association as were called.
W .ATER SUPPLIES

The new scheme calling for the decentralizatio n of the certification
of common-carrie r water supplies became effective in this district
during the year. No difficulties were experienced in working out this
plan, as is evidenced by the fact that all the States except one in this
district had complete certification at the close of the calendar year.
In Virginia a suggestion was made concerning the laboratory procedure which made the work there more effective. At the request
of the Foreign Quarantine Division, tests were made of new wells
at the quarantine station at Charleston, S. C., before the wells wereaccepted from the contractor. Similarly, at the request of the National Park Service, tests were made of new wells drilled at
Yorktown, Va., where the Colonial National Monument is beingestablished.
In company with officials of the Food and Drug Administratio n of
the Department of Agriculture, the district engineer made calls upon
the health officials of North Carolina, South Carolina, and Florida
with reference to the question of bottled waters. This work was ini-tiated by the Department of Agriculture, and the district engineer·
gave only such assistance as was found necessary.
COOPERATION WI'I'H OTHER GOVERINMENT DEPARTMENTS,

Assistance was given to the Commissioners. of the District of Co-lumbia in a survey of mosquito infestation until the 1st of August,
when that work was removed from this station upon the transferof Assistant Sanitary Engineer Robertson. A report on the investi-gation of the disintegration of a concrete intercepting sewer was.
transmitted to the District Commissioners during the year.
A survey was made of the Cherokee Indian Reservation at Chero-kee, N. C., under the cooperative arrangement between this service·
and the Office of Indian Affairs. A complete report, with the neces-sary recommendatio ns, was made after this investigation.
A number of trips was made to the Federal prison camp at Petersburg,. Va., in connection with the procurement of a water supply,,
checkmg the quality of the procured water, the building and opera-


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105,

tion of the sewage-treatm ent plant, and the obtaining of a proper
and adequate milk supply. Federal prison camps at Camp George
G. Meade, Md., and at Fort Bragg, N. C., were also inspected and
constructively criticized. Visits were made also to the Federal penitentiary at Atlanta, Ga., and the Federal Industrial Institution for
Women at Alderson, W. Va. At both of these places contact was
made with the medical officers in charge, in accordance with the new
arrangement set up covering sanitation of these penitentiaries.
The National Park Service has been active at Washington's birthplace, Wakefield, Va., and at Yorktown, Va., in the establishment of
new national monuments. Plans for a sewage-treatm ent plant at
Wakefield were passed upon during the year. At Yorktown, where
the Colonial National Monument is being laid out, it is intended tohold a sesquicentennial celebration in October of 1931. As a result,
this office has cooperated with the National Park Service in working
up sanitary measures both for the permanent monument and for the
temporary celebration.
COO·P ERATION WI'I'H STATE HEALTH DEPARTMENTS

Conferences were held and joint work done with all of the State
health authorities and a number of visits were made to each State in
this district.
The application of the Interstate Quarantine Regulations relative
to the use of milk on interstate carriers was again brought to the
front in connection with Asheville, N. C. It is interesting to note
that, partly as a result of the application of these regulations, Asheville has adopted the United States Public Health Service standard
milk ordinance.
A number of meetings of the State water and sewage-disposal
groups were attended by the district engineer, although lack of
personnel did not permit as much contact with these State units as is
considered desirable.
TABULARI SUMMARY

Vessel wa-t er-supply supervision

Inspections :
First inspections8
Passenger carrying_______
4
Freight ( only) _________
0
Water boats___________ _
ReinspectionsPassenger carrying ______ 76
4
Freight (only)__________
9
Water boats -----------Certificates issued:
Regular, favorable-Passenger carrying______ 82
Freight (only)___________ 8
7
Water boats___________ _
1
Regular, unapproved_____ ___
Temporary, favorable-2
Passenger carrying______
0
Freight (only)_______ ___
2
Water boats---------- -80597-31--8


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Plans of vessel _water systems examined:
1
Approval granted____________
0
Approval withheld __________
Major conferences:
3
With shipping officials_ __ ____
0
With others_________________
Water examinations made:
U. S. Public Health Service
0
laboratories_____ __________
Other laboratories ___________ 21
Typhoid fever cases reported :
U. S. Public Health Servke
8
hospitals______________ ____
U. S. Public Health Service
0
quarantine stations________
0
H ealth departments____ _____

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PUBLIC HEALTH SER VICE
Railroad sanitation supervision

Inspections :
Sources of water supply_____ 0
Coach yards________________
0
Terminals___________________ 0
Watering points_____________ 0
Dining cars_________________
0
Certification :
Data reports reviewed ________ 236
Certificates p r e p a re d for
States ____________________ 319

Water examinations made:
U. S. Public Health Service
laboratories ______________ _
Other laboratories __________ _
Major conferences :
With railroad officials ______ _
With others (principally
health authorities)---- ----

0
0

0

1

Sh,ellfish sanitation siipervision

Inspections :
Areas ..:._____________________ 0
Plants ______________________ 171
State certificates:
Approved ---------------- --- 345
Not approved------ --------0
Approval withdrawn_________ 0

StateCanceled
certificates-Con tinued.
____________________ 71
Laboratory examinations made:
U. S. Public Health Service
laboratories_______________
0
Other laboratories___________
0
C~nferences ____________________ 16

Miscellaneous

Cooperation with governmental
agencies:
Public Health Service-Surveys ________________ _
Conferences ____________ _
Office of Indian AffairsSurveys ________________ _
Conferences ___________ _
National Park Service-Surveys ________________ _
Conferences ____________ _

1
O

1
2
0
4

Cooperation with governmental
agencies-Contin ued.
Bureau of PrisonsSurveys_________________ 8
Conferences _____________ 10
S'tate health departmentsSurveys _________________ 0
Conferences _____________ 4
Other governmental agenciesSurveys_________________ 0
Conferences _____________ 1

.DISTRICT NO. 3.-OHIO, MICHIGAN, INDIANA, WISCONSIN, ILLINOIS, MINNE-

SOTA, IOWA, NORTH DAKOTA, SOUTH DAKOTA, AND NEBRASKA

The activities of this district were continued under the direction
of Sanitary Engineer Frank R. Shaw. This office was without an
assistant sanitary engineer during almost the entire year, due to
the death of Associate Sanitary Engineer Elliot R. Gage on July
13, 1930. Assistant Sanitary Engineer Robert W. Kehr, commissioned on June 23, 1931, reported for duty at this office on June 25.
The operations carried on comprised the following: (1) Inspection and supervision, for the purpose of certification, of the drinking
and culinary water supplies and water-supply systems and general
sanitary conditions on vessels operating in interstate traffic on the
Great Lakes and the .St. Lawrence River; (2) cooperation with the
State health departments in the supervision of the water supplies
used for drinking and culinary purposes on interstate common-carrier railroads, the method of loading the water on the trains, and
the general sanitation of coach yards and terminals; (3) cooperation
with the Department of Pensions and National Health of Canada
relative to the sanitary control of drinking-culin ary water supply
sources and water systems on interstate and international carriers:
(4) cooperation with other national governmental agencies, including the Indian Service of the Department of the Interior, the Coast


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Guard and the Customs Service of the Treasury Department, the
Supervising Architect's Office of the Treasury Department, and the
Lighthouse Service of the Department of Commerce ; ( 5) cooperation with the State health departments in matters involving sanitary
engineering.
A. tabular summary of the work appears at the end of this report.
VESSEL WATER SUPPLY AND SANITATION SUPERVISION

The supervision of vessel water supplies extended to 121 vessel
companies and involved 64 passenger vessels and 432 freight vessels,
a total of 496 vessels. A. total of 345 inspections were made, 86 being
on passenger vessels and 259 on freight vessels. The marked reduction in total inspections from 611 in 1929 and 539 in 1930 to 345 in
1931 was due to the necessity of assigning the engineering assistant
to other work.
Twenty initial inspections were made, of which 3 were on passenger vessels and 17 on freight vessels. These inspections were on
vessels launched during the year or recommissioned after two or
more years of idleness rather than on active vessels not previously
.
inspected.
Active interest and excellent cooperation on the part of the licensed
officers and the vessel companies continued throughout the year .
Several expressions of appreciation of the policies of this office have
been received from the vessel companies and numerous favorable
comments have been made by the licensed officers regardiag the work.
The general improvement on the vessels and the effort of this office
to bring all vessels under "Regular certificates" is illustrated in the
following tabulation of the certification status:
Fiscal year
1928_ -- _______________________ ___ __ -- ______ --- -- ___ -- -- - ___ -- -- ___ --- ____ -- -- ___ _
- - -- - - - - -- - - ------_-- - ----- _____________
- -- - ---- -____
-- -- - ----- -- -- ---- -_______
- - - - - ---- --- ______ - - _- -- _---- -______
1929
-- ---______
_____
_________________
1930 __
1931_ __ -- _--- -- _______ -- ___ -- _ .____ -- --- _-- _----- _-- _-- -- --- _-- -- --- __ -- _-- -- -- - -

Temporary Regular
certificates certificates
504
422
125
69

131
280
463
483

A total of 2,109 samples of domestic water taken from vessels were
examined bacteriological ly by six city health departments. The
reduction in the number of samples from 2,646 to 2,109 is due to the
discontinuance of this cooperation by one city department, to another's taking far less samples, and to the lack of reports from the
Canadian Provincial Department at Sault Ste. Marie. The plan of
notifying the vessel companies· of the results of bacteriological ex.aminations by means of post cards immediately after the examinations are completed, inaugurated at the beginning of the 1929 season,
has been continued.
The valuable assistance rendered by the steamboat inspectors of
the Department of Commerce has continued. A.11 offices continued
to report the expiration date of the certificate found posted, making
it possible for this office to insure that all vessels have active certificates. Fewer cases of failure to replace the preceding year's certificate by the new one were reported.


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Vess el statistical data

Number of vessel companies in active file June 30, 193L_____________

121

Number of passenger vessels________________________________________
Number of freight vessels__________________ ______ _______ _____ _______

64
432
496

Total vessels_________________________________________________

Number of officers and seamen involved in crews _____________________ _ 17,699
of vessels found without treatment apparatus and using raw
Number
lake water_______________________________________________________ _

0

Percentage of all vessels' samples conforming to Treas·ury standards :
Calendar year 1928, 230 vessels _________________________ per cent__
Calendar year 1929, 226 vessels ____________________________ do ___ _
Calendar year 1930, 196 vessels ____________________________ do ___ _

84.8
87.6
84.0

TYPHOID FEVER AROARD VESSELS

The typhoid-fever statistics on cases reported by marine hospitals
since 1915- are tabulated under statistical data. These statistics show
a general trend downward from 70 in 1916 to 7 in 1930.
Typhoid fever among sea;men on vessels operatirng in district No. 3
Cases

Navigation season
1915 ____ ---- -- -- --- -- - ---1916 _____ - ---- ---- ----- - - 1917 _____ ------ -- -- _-- -- -1918 ____ -- ---- --- _-- __ -- __
1919 _____ ---- _---- -- ----- 1920 ___ ------- ---- --- - ---1

60
70
49
39
24
20

Also 1 case of dysentery.

Navigation season
-- -- -- -- -- _--- ___ ---_
19211922 ____________________
1923 ___________ __ ___ · ---1924 ____ __ ____________ ___
------ -- -- ---- -- ----_
1925_
1926 ____________________
2

Navigation season

Cases
13
17
25
21
7
29

Cases
10

------- ------1927
_______ ____________ _
1928 2'-----1929 ____________________ _
1930 ____ · -- _______ ----- __
1931_ ___________________ _

Also 3 cases of dysentery.

3 Jan.

11
9

7

31

1 to June 30, 1931.

VENEREAL-DIS.EASE CONTROL AMONG SEAMEN

During 1929 this office cooperated with the Venereal Disease Division in its effort to induce th~ lake carriers of the Great Lakes to
institute the full program suggested by the service for venerealdisease control among seamen. It is believed that the plan is still
opposed by the majority of the companies and, as far as known,
only two or three vessels carry prophylactic material, and only a few
display warning signs. A great majority of the seamen from whom
opinions have been solicited are strongly in favor of the full plan.
The data tabulated hereinafter indicate that the disease continues to
1ncrease.
Venereal disease among seamen applying for treatmer~t at the Chioago outpcttient offioe of the PubUc Health S·e rvice
Calendar
year
1928
New venereal-disease cases __________ ______________ ___ ____________________ .
'fotal venereal-disease treatments ________________________________________ _
Total treatments, all causes ______________________________________________ _


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312
2,333
5,889

Fiscal
year
1930
598
2,115
4,505

Fiscal
year
1931
630
1,890
4,641

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RAILROAD W .ATER SUPPLY .AND GENERAL SANITATION

The plan whereby this office reviews the data reports on railroad
water-supp ly sources submitted by the State health department s and
prepares the certificates for the State health officer's signature was
continued. Two of the States in this district, Minnesota and Illinois, elected to continue to prepare the certificates, but all the papers
were forwarded through the district engineer's office. During the
fiscal year 488 data reports were reviewed and 422 certificates were
prepared by this office for the States.
The Detroit City Health Departmen t continued to collect and
•e xamine samples of water taken from the tanks and coolers on
coaches, Pullman cars, and diners. A total of 1,602 samples were
taken and reported upon this year. The results suggest that improvement in coach-yard sanitation is needed.
The inspection of dining cars was extended so far as possible.
Since 174 diners, practically the entire number entering Chicago,
were inspected durmg the latter part of the last fiscal year, an effort
was made by the engineering personnel when traveling to inspect
such diners as do not enter Chicago. Eight diners were inspected.
Nine coach-yard inspections were made during the year.
COOPERATION WITH FEDER.AL AGENCIES

Office of Indi{l/f/, Affairs.-Coop eration with the Office of Indian
Affairs on matters of sanitary engineering continued during the
year. Surveys were made by this office at two additional field administrative units. Thus far a total of 21 of the 28 administrat ive
units have been visited. Through cooperation with the district engineer, the State sanitary engineer of Michigan surveyed and reported upon the sewage-disposal situation at Mount Pleasant and
the State sanitary engineer of Minnesota surveyed and reported
upon the water supply, sewage disposal, and milk sanitation at two
units of the Consolidate d Chippewa Agency in Minnesota.
Many of the reservations continued to submit samples of the
domestic water supply and the milk supply to the State laboratories
for bacteriologi cal examination , as recommend ed by this office.
Copies of the results were forwarded to this office for review. It is
interesting to note that the early samples on all milk supplies
showed high bacterial counts; but with prompt correction of general sanitation, all supplies from which samples have been submitted have had counts of less than 50,000 per cubic centimeter.
As a result of our recommend ations, plans, and specifications, the
following constructive sanitary engineering wa.s accomplishe d or
started during the fiscal year : ( 1) Standard chlorinators at the
Keshena Agency and the Sac and Fox Sanatorium ; (2) gravity pipe
line to Lake Keshena at the Keshena Agency; (3) sewerage system
and extensive treatment works at the Rosebud Agency and Hospital; (4) sewerage system extensions at the Fort Totten, Turtle
Mountain, and Crow Creek Agencies; (5) water-suppl y development at Fort Totten; (6) steel elevated tank and centrifugal pump
at the Flandreau School; (7) specifications for and advisory supervision of the construction of the sewage-trea tment plant at Lac du


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Flambeau; (8) water-supply development at the Genoa School;
(9) unsuccessful attempt to develop a deep-well water supply at
N eopit under guaranteed contract followed by beginning of the
plans for a purification plant.
In addition, recommendations were forwarded regarding the water
supplies and sewage disposal for Mount Pleasant, Rapid City, and
the Consolidated Chippewa Agencies.
.
Coast GuMd Service.-Following a special request, a survey was.
made of the water supply serving the Coast Guard station at
Cleveland.
Supervising Architect's Office.-As requested by the Office of the
Supervising Architect, surveys were made of proposed sites for
border stations at Ambrose, N. Dak.; Noyes, Minn.; Pembina,.
N. Dak.; and Portal, N. Dak. Recommendations were made regarding water supplies and sewage disposal.
Lighthouse Service.-During December the Commissioner of
Lighthouses requested the Surgeon General to have inspections made·
of the Lighthouse Service vessels in the twelfth district (Lake
Michigan). Detailed inspections were made during January and
February, and complete descriptive and graphic reports were prepared and forwarded. The desirability of providing a domestic·
water as clear and as palatable as the water taken directly from
overboard in midlake, the nece.s sity for conservation of space, and
the advisability of economy led this office to decide upon chlorination
by means of a calcium-hypochlorite solution, followed by dechlorina-tion by means of activated carbon. The study of pump rates and
space available resulted in the development of a simple device, consisting of standard laboratory equipment, costing about $20. Subsequent recommendations called for making the dechlorinating filter of
flanged pipe filled with granular activated carbon and arranged for
upward flow. As the fiscal year closed, arrangements were made for
making one such installation and the determination of its efficiency..
The superintendent of the twelfth district also requested that
surveys be made of the water supplies and sewage-disposal facilities·
at airway weather stations. Five of the ten stations were surveyed
during the fiscal year.
T.ABULARI SUMMARY

V essel water-supp•l y supervision ,

Inspections :
First inspectionsPassenger carrying___ _
Freight (only) _______ _
Water boats _________ _
ReinspectionsPassenger carrying ___ _
Freight ( only) _______ _
Water boats __________
Certificates issued :
Regular, favorablePassenger carryi ng ___ _
Freight (only) ___ ___ _
Water boats _________ _
Regular , unapproved ______ _
Temporary, favorablePassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _


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Plans oC vessel water systems
examined:
3
Approval granted __ _______ _
4
17
Approval withheld ________ _
0
0 Major conferences :
With shipping officials ___ _
3
83
With others _________ ____ _
9
242 Water examinations made:
0
U. S. Public Health Service laboratories_________
0
Other laboratories _________ 2, 109
67 Typhoid-fever cases r eported :
416
U. S. Public H ealth Servo
ice hospitals ____________ _
6
0
U. S. Public Health Service quarantine stations ___ _
0
Health departments ______ _
13
0
56
0

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Railroaa sanitation BUpervision

Inspections :
Source of water supply ___ _
Coach yards _____________ _
Terminals _______________ _
~a!ering points _________ _
Dmmg cars ______________ _
Certification :
Data reports reviewed ____ _
f o r_
Certificates
_______ _____
States _____prepared

Water examinations made:
U. S. Public Health Serv0
0
ice laboratories _________
9·
Other laboratories _________ 1,602
0
0 Major conferences:
0
With railroad officials_____
8
With others (principally
22
health authorities)______
488
422

,Miscellaneous

Cooperation with governmental
agencies:
Public Health Service-Surveys _____________ _
Conferences __________ _
Office of Indian AffairsSurveys ------..-------Conferences--~-------Supervising Architect's Office-Surveys _____________ _
Conferences __________ _

8
14

Cooperation with governmental
agencies-Continued.
Lighthouse Service-Vessel inspections ____ _
Conferences __________ _
Airway weather stationsWater-supply surveys __
sur-_
Sewage-disposal
veys _______________

4
4

State health departmentsSurveys ______________ ·
Conferences-----------

O
3

8
4

5
4
Q

1

DISTRICT NO. 4.-ALABAMA, MISSISSIPPI, MISSOURI, LOUISIANA, OKLA.•
HOMA, ARKANSAS, KANSAS, KENTUCKY, TEXAS, AND TENNESSEE

The district activities were under the direction of Sanitary Engineer H. N. Old, wi'th the exception of the first two months of the
fiscal year, during which time Mr. Old was on temporary duty at
Washington. Past Assistant Sanitary Engineer E. C. Sullivan
assisted in the performance of district duties during the first half
of the fiscal year, but was on temporary duty in Districts Nos. 1 and
2 from January 5 until after June 30.
The activities consisted chiefly of (1) certification of interstate
carrier water-supply sources in cooperation with the States; (2)
supervision of handling, storage, and distribution of drinking and
culinary water on railway equipment and vessels; (3) investigation
of typhoid-fever cases reported by stations o:f the Public Health
Service; ( 4) supervision of shellfish sanitation in cooperation with
the States; ( 5) surveys and consultant service with various Federal
agencies, such as the Office of Indian Affairs of the Interior Department and the Bureau of Prisons of the Department of Justice;
.
and (6) other allied sanitary-engineering duty.
SUPERVISION OF INTERSTATE CARRIER WATER- SUPPLY SOURC'EJS

Within the 10 States comprising this district there are over 700
water-supply sources used by common carriers engaged in interstate
traffic. Every effort has been made by this station to facilitate the
reporting of these sources by the respective State health departments, and to this end surveys are made by personnel of the district
office upon the request of the States in so far as possible.
During the fiscal year 1931 survey data reports on 728 supplies
were reviewed and 1,126 certificates, prepared on the basis of these
reports, were forwarded to the State health officers for signature
and transmitted to the Public Health Service.

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Fourteen surveys were made by district personnel in Arkansas and
Texas. It is encouraging to note that the percentage of total supplies acted upon is increasing each year and that most of the States
within the district are putting forth every effort to attain 100 per
cent in this rating.
During the calendar year 1930 the 10 States of the district reported upon slightly over 90 per cent of the supplies.
SUPERVISION OF RAILROAD WATER-SUPPLY EQUIPMENT

Most of the States feel that the Public Health Service is the
responsible agency in the supervision of railway coach-yard and
terminal sanitation, particularly in the matter of handling, storing,
and distributing the drinking water from the tap to the passenger.
This responsibility in a large measure has been accepted by this
district, and 181 inspections and reinspections have been made during
the fiscal year. These have included the following points: Birmingham, Mobile, and Montgomery, Ala.; Little Rock, Ark.; Covington
and Louisville, Ky.; Alexandria, Ba,t on Rouge, and New Orleans,
La.; Gulfport, Jackson, and Vicksburg, Miss. ; St. Louis, Mo. ; Oklahoma · City, Okla.; Chattanooga, Memphis, and Nash ville, Tenn.;
Beaumont, Dallas, Fort Worth, Galveston, Houston, Paris, and Texarkana, Tex. These surveys have involved all of the larger railway
systems among the 122 rail carriers operating within the district.
Vastly improved conditions in the matter of hydrant boxes, hose
lines, storage and sterilizing facilities, and general operation were
noted over conditions of several years ago.
Some time was devoted to the sanitary supervision of parking of
occupied Pullman cars at the Mardi Gras in New Orleans, the Derby
Day event at Louisville, and the Confederate Veterans' Reunion at
Montgomery. In all but one instance at Louisville very hearty cooperation was shown by the carriers in measures to prevent
contamination of drinking water.
This activity was held somewhat in abeyance during the last few
months of the fiscal year in contemplation of the issuance at an early
date of the final report of the joint committee on railway sanitation
of the American Railway Association.
The sanitary engineering bureau of the Texas State Department
of Health has recently demonstrated an interest in coach-yard and
terminal sanitation, so that such sanitary supervision in Texas has
been taken over by the State, with the Public Health Service acting
m an advisory capacity.
During inspection of dining cars, particular attention was paid
to the source of milk and shellfish used. This has resulted in the
adoption of pasteurization of milk served by several of the transportation companies.
SUPERVISION OF VESSEL DRINKING-WATER SYSTEMS

Amenable to the United States Interstate Quarantine Regulations
md operating within the jurisdiction of this district at the close of
the fiscal year were 53 major vessel companies operating 28 passengercarrying and 98 freight vessels, in addition to which were 12 smaller
:::ompanies operating 18 ferries and similar small craft. Due to
E:"conomi,c conditions and diligence in eliminating vessels not actually
engaged in interstate traffic, there was a reduction from last year.

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Some of these small vessels are operating at remote locations on the
Mississippi and Ohio Rivers and are therefore difficult to reach
annually. The larger and more important carriers, particularly those
engaged in passenger traffic, are inspected annually in order to determine their fitness for favorable certification of the drinking and
culinary water supply systems. The temporary certificates formerly
issued on the basis of vessel masters' statements in lieu of inspection
are being replaced rapidly by regular certificates following inspection
and correction of violations found.
Of the 144 district vessels, 86 were under regular and 36 under
temporary certificates at the close of the fiscal year, with 22 others
holding no certificates.
In the case of 65 vessels, distillation apparatus was used in treating overboard water for drinking and culinary purposes, while the
remaining 79 vessels used approved shore supplies without further
treatment, 29 of which supplies are located within the district, while
21 are located in other interstate sanitary districts.
Most of the violations comprise failure to provide proper warning
signs over taps supplying nonpotable water, existence of uncovered
storage barrels for emergency supply, presence of an occasional cross
connection between the safe water supply and the overboard supply,
and failure to provide .and properly maintain special hose for filling
tanks.
In many instances plans of new vessels to be operated in the district are secured from the builders, and any changes necessary to
place the drinking and culinary water systems in compliance with
regulations are called to the attention of the owners and builders by
the Public Health Service.
It has been found that the small 1-vessel companies are more difficult to deal with than the larger companies, although excellent cooperation has been received from the majority of operators in the
district.
At the request of the chief engineer of the Mississippi -Warrior
Service, 8 or 10 representati ve Federal Barge Line express and tow
boats were thoroughly surveyed with respect to drinking and culinary water facilities. Detailed reports were furnished outlining exactly what requirement s would have to be met if these vessels were
amenable to the Federal regulations. It is understood that these
recommend ations are being adopted as rapidly as possible.
The Cincinnati City Health Departmen t continued to forward regularly reports of analyses of vessel drinking-w ater samples. Several
other inland river cities submitted a few such reports. It is interesting to note that in only 19 samples of a total of 416 was there
found evidence of colon bacillus in 10 cubic centimeter portions.
TYPHOID-FEVER CASES ON VESSELS

During the year 18 typhoid-fev er cases were reported from marine
hospitals within the district. These patients are classed as to origin
as follows: United States Engineer Corps (Army), 8; Federal Barge
Line, 3; interstate carriers,1 4; local or harbor vessels, 3.
1 In 3 of these cases the vessels, while classed as interstate carriers, had been engaged
in local excursion trade at New Orleans and Cincinnati for several months previous to the
occurrence of the cases.


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It will be noted that nearly half of the cases were among civilian
employees of the United States Engineer Corps, being distributed
as follows: St. Louis, 5; Memphis, 2; and Port Arthur, 1.
As a result of the investigation at Memphis it was learned that
three other cases, all within 30 days, had been hospitalized elsewhere. At the request of the district engineer of the War Department a complete survey was made of sanitation on all floating
equipment of the district and detailed report with recommendations
submitted. While the investigation, made about 50 or 60 days after
the start of the outbreak, could not be expected to establish the
cause definitely, it did show grossly defective facilities for the treatment and storage of drinking and culinary water on board some
of this equipment.
Between May 15 and June 15 five typhoid cases reported by the
St. Louis Marine Hospital among United States Engineer Corps
personnel were investigated, and from the description of watersupply facilities as given by these patients the conditions seemed
very similar to those at Memphis.
SHELLFISH SANITATION

The oyster-producing areas of Alabama, .Mississippi, Louisiana,
and Texas were thoroughly investigated between 1925 and 1928,
when bacteriological and sanitary surveys were conducted by the
States and the Public Health Service. Since that time there has
been little or no change in so far as potential pollution of the areas
is concerned. Therefore only a limited amount of resurvey is done
each year. Alabama studied its more important areas in September,
1930, but found conditions unchanged.
Due to the relative safeness of practically all of the producing
areas within the district, the greatest concern is that of shore storage,
shucking, and packing.
On account of the loss in September of the assistant sanitary
engineer who had been supervising shellfish sanitation during the
past few years in Mississippi, the Public Health Service agreed to
render all possible assistance in the emergency. Therefore, most
of the Mississippi inspections until January were made by Public
Health Service personnel. Some of the· main difficulties among the
dealers in this State have been the use by uncertified dealers of cans
bearing valid certificate numbers, purchase of shucked stock from
unapproved sources, and the shucking of oysters on reefs in the
Gulf. This practice is encountered at the opening of each season.
While Texas certified to the Public Health Service two shucking
and packing plants, the production from this State to other States
is believed to be quite small. For this reason not as much attention
was devoted to Texas shellfish sanitation by the Public Health
Service as would otherwise have been the case.
The Public Health Service, in a general sense, continued to act
as an intermediary between the producing and consuming States of
the district in matters of shellfish sanitation by advising the State
health authorities and coordinating their efforts.
There is given below a tabular summary of shellfish sanitation
supervision within the district.


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State

Total

State certificates
approved

Plant inspection
by State
personnel

Plant in•
spection
by U .S.

P ublic
Health
Service
personnel

38
40
42
2

274
309
195
6

106
136
203
0

122

784

445

COOPERATION WITH BUREAU OF I N DIAN AFFAIRS

With the sanitary surveys made at the Haskell Institute and the
Pota watomie Subagency in Kansas in June, all of the 25 Indian
Bureau jurisdictions within the district have been visited and preliminary surveys completed .
. Se_veral _of t~e juri~dictions were revisited for the purpose of spe-cial mvestigat10ns, chiefly for the purpose of consultation and advice
on water-supply problems. Several of these were the result of the
drought situation, felt so keenly in eastern Oklahoma late in 1930
.a nd early in 1931. This condition was particularly acute at the
.Jones Academy at Hartshorne, Okla., and the Sequoyah Orphan
Training School at Tahlequah, Okla.
The Pawnee Agency at Pawnee, Okla., the three Osage villages
in the vicinity of Pawhuska, Okla., and Wheelock Academy at Millerton, Okla., were revisited for·the purpose of following up previous
recommendations, most of which had been adopted.
Two visits to the Haskell Institute were made largely for the purpose of investigating the efficiency of operation of the modified
activated-sludge sewage-treatment plant constructed two years ago.
COOPERATION WITH FEDERAL BUREAU OF PRISONS

During the year two visits were made to the Federal penitentiary
at Leavenworth, Kans., in connection with a matter of sewage disposal in which the States of Kansas and Missouri were involved.
Conferences were held with penitentiary officials and the State sanitary engineers concerned. During these visits consultant advice was
.g iven also concerning mosquito-control measures and other matters
of sanitation. The opportunity was taken to observe the result of
recommendation made at this institution two years ago, following .a
detailed sanitarv survey. Many of the suggested improvements had
been made . .
Two Federal prison camps established during the year at Maxwell
Field, Montgomery, Ala., and Fort Riley, Kans., were visited and
sanitary surveys made at each location. Both of these camps are
located on military reservations and consequently have the advantage
of satisfactory water supply an4 sewage_-dispo~al facilit~e~. Reco_mmendations were made concernmg several mmor cond1t10ns which
could be i.moroved advantageously.


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MISCELLANEOUS ACTIVITIES

Among the miscellaneous district activities were (1) attendance
of station personnel at the conference of State sanitary engineers,
and the sanitary engineering section meetings of the American
Public Health Association at Fort Worth, Tex., in October; and (2)
several sessions of the National Food and Drugs Officials' Convention
at New Orleans, La., in November.
Papers on water supply and treatment were prepared by the district engineer and read at the Texas waterworks short school at
Waco, Tex., in January and the Oklahoma waterworks short school
at SWlwater, Okla., in April.
Frequent conferences were held throughout the year with the various State sanitary engineers and State health officers concerning
cooperative activities in which the States and the Public Health
Service are mutually interested.
TABULAR SUMMARY

Vessei water-supply supervision

Inspections :
First inspections-Passenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
ReinspectionsPassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
Certificates issued :
Regular, favorablePassenger carrying ___ _
Freight (only) _______ _
Water boats _________ _
Regular, unapproved _____ _
Temporary, favorable-Passenger carrying ___ _
Freight (only) _______ _
Water boats _________ _

48
103
0
28
42
1
45
49
0
0
35
44

Plans of vessel water systems
examined:
Approval granted__________
Approval withheld ________
Major conferences :
With shipping officials_____
With others_______________
Water examinations made:
U. S. Public Health Service
laboratories__________ ___
Other laboratories_________
Typhoid fever cases reported :
U. S. Public Health Service
ho-spitals _______________
U. S. Public Health Service
quarantine stations _____
Health departments -------

3
0
48
6
0
416
18
0
0

0

Railroa,d sa,nita.tion supervision

Inspections :
Sources of water supply___
12
Coach yards______________
115
Terminals ________________
62
~a~ering points___________
4
D1n1ng cars_______________
13
Certification:
Data reports reviewed_____
728
Certificates prepared for
States __________________ 1, 126

Water examinations made:
U. S. Public Health Service
laboratories ____________ _
Other laboratories ________ _
~1ajor conferences:
With railroad officials ____ _
With others (principally
health authorities) _____ _

0
3
23

18

Shellfish sanitation supervision

Inspections:
Areas-------------------_
Plants
___________________
State certificates:
Approved ---------------~Not approved ____________ _
Approval withdrawn ______ _


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Federal Reserve Bank of St. Louis

0

445
122
6
0

State certificates-Continued .
Canceled _________________ _
L aboratory examinations made:
U. S. Public Health Service
laboratories ____________ _
Other laboratories ________ _
Conferences _________ _________ _

16
0
0
20

PUBLIC HEALTH SERVICE

117

Miscellaneo·us
Cooperation with governmental
a gencies:
Office of Indian Affa irsSurveys _____ _________ _
Conferences __________ _
Bureau of PrfsonsSurveys ___________ __ __
Conferences __ ____ ___ __

°10
7

Cooperation with governmental
agencies-Continued.
Other governmental agenciesSurveys ______________ _
Conferences___ ____ ____

1
3

3
3

DISTRICT NO. 5.-ARIZONA, CALIFORNIA, COLORADO, NEW MEXICO, NEVADA,
AND UTAH
DIS'l'RICT NO. 6.-IDAHO, MONTANA, OREGON, WASHINGTON, AND
WYOMING

The engineering personnel assigned to these two districts during
the fiscal year was as follows: Sanitary Engineer H. B. Hommon,
in charge; Passed Assistant Sanitary Engineer A. L. Dopmeyer;
A ssistant Sanitary Engineer 0. C. Hopkins.
The activities of the engineers at this station were as follows:
(1) Vessel inspections and interstate water supplies ; (2) sanitation
in national parks and monuments; ( 3) sanitation on Indian reservations; (4) water supplies, sewerage, and sewage disposal at proposed
customs and immigration inspection stations ; ( 5) preparation of
plans for laboratory at San Francisco ; ( 6) miscellaneous activities.
VESSEL W ATER SUP P LY AN D SANI TNrIO N SUPERVI SIO N

The work done in connection with inspections of vessel water-supply systems and sanitation of vessels was carried on by one .sanitary
engineering assistant, and the time devoted to the field and office work
was approximately four and one-half months. During the calendar
year 254 inspections were made, and 215 regular and 74 temporary
certificates were issued. Three cases of typhoid fever among seamen
were reported from marine hospitals.
As a general rule, officials of vessel companies have willingly
carried out recommendations made for improving the water-supply
systems on their vessels, and when corrections have been made they
have been, as a rule, permanent. However, one company, owning
several vessels constructed many years ago, reported that they could
not make any changes in their water-supply systems without automatically bringing their vessels within the Steamboat Inspection
Service laws, which are not retroactive except when repairs of a
certain nature are made. This situation brought up the question
as to whether the Public Health Service law was effective from date
of passage or was retroactive. The local representatives of the
Steamboat Inspection Service and the officials of the vessel companies had the impression that our law is not retroactive, but a recent
bureau ruling states that the law governing the vessel water-supply
systems applies to all vessels in interstate traffic regardless of the
dates vessels went into service.

•


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PUBLIC HEALT H SERVIC E
RAILROA D W ATER SUPPLY A ND SANITAT ION S U
P ERVISION

An active campa ign was carried on during the year to increas
e
the numbe r o:f railroa d water supplie s certified. In Nevad
a
and
Wyom ing, where there are no sanitar y engineers, service engine
ers
made survey s o:f 13 and 14 supplie s, respectively, and in other States
o:f the 2 distric ts 46 supplie s were surveyed.
ProO'ress was made toward enforc ement o:f the recent bureau
regard ing elimin ation or protec tion o:f cross connections. Stateruling
sanitary engineers, mainly throug h person al intervi ews, submit ted more
complete survey reports than former ly.
COOPERATION WITH STA.TE A.ND OITY HEALTH DEPARTM
ENTS

Conferences were held with State health officers or State
y
engineers o:f 10 of the 11 States o:f the 2 distric ts, and withsanitar
waterworks officials of many cities and towns. Experi ence during the
past
year in handli ng the railroa d and vessel water supplie s under
the
presen t method of certification indicat es that in our two distric
the decent ralizat ion plan is more satisfa ctory than the previo ts
us
arrang ement.
SANITAT ION IN THE NATIONA L PARKS A.ND MONUM
ENTS

Gener al.-Th e activiti es carried on in connection with sanitat
in the nation al parks and monuments, other than those that willion
discussed under each park and monum ent separa tely, were as be
lows: (1) Prepar ation of plans for a garbag e incine rator that :foloil for :fuel in place o:f wood and has several improv ements over uses
origina l design ; (2) attenda nce at a conference of field officers the
of
Nation al Park Service and public operat ors in parks, held in Washington , D. C.; (3) conferences in four nation al parks to discuss
general plans for developments involv ing variou s problems of sanitation; and ( 4) cooper ation with chief civil and landsc ape engine
ers
and fire-prevention expert o:f the Park Servic e regard ing the design
and constru ction o:f waterw orks, sewage-disposal plants, and garbag
e
inciner ators.
The routine work carried out in all the parks and monum ents visited include d genera l inspections of all hotels, lodges, cafeter
housekeeping units, swimm ing pools, and other places handli ng, ias,
selling, or serving food produc ts, and inspections o:f Govern ment
automobile tourist camps and other operati ons o:f the Govern ment in
the
parks where proble ms of sanitat ion are involved.
The parks where only routine inspec tions were made are Crater
Lake, Grand Teton, Wind Cave, Rocky Mount ain, Zion, Bryce
Canyon, Genera l Grant, and Platt. The activiti es in the other parks
visited were as follows :
Carlsbad Nation al Park.- Recom menda tions were made for
creasin g the water supply during the curren t year and plans for inentirel y new supply were reviewed. Estima tes were prepar ed foran
a
water- softeni ng plant and for an extension of the sewer system
and
for a sewage -treatm ent plant.


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PUBLIC HEALTH SERVICE

119

Glacier National Park.- Plans were prepare d for a screen and
grit chambe r for water supply at Many Glacier camp ground s and
hotel, and recomm endatio ns were given regardi ng installa tion of
water-s upply and sewerage systems for the camp grounds .
Grand Oanyon National Park.- Plans were prepare d for a
sewage-disposal plant for the camp ground s at Rowe Well, and the
plans submitt ed by the Santa Fe Railroa d Co. :for a pumpin g plant
and pipe line for pumpin g water :from Indian Garden s to the South
Rim, a vertical distance o:f approx imately 3,300 feet, were reviewed.
Lassen V olcarnio National Park.-C omplet e plans with bill o:f materials and specifications were submitt ed for a concrete waterstorage tank and distribu tion system, and a sewerage system and disposal plant for headqu arters area at Minera l, and for a screen and
grit chambe r and water-s upply line at Manzan ita Lake.
M O'Unt Rainier National Park.- Plans, bill of materia ls, and specifications were prepare d for a sewage -disposa l plant for Longm ire,
and specifications were submitt ed for a baling machin e to bale waste
tin cans.
Pinnacles National M onume nt.-Est imates were prepare d for a
new water-s upply system and a sewerage system and disposa l plant.
Platt National Park.- Plans for develop ment o:f Black Sulphu r
Springs were reviewed and recomm endatio ns were submitt ed for
general improv ements to the other springs in the park. The final
plans submitt ed by the town of Sulphu r for a disposa l plant to treat
the sewage :from the town, and Govern ment buildin gs were reviewe d
and recomm endatio ns given regardi ng the design o:f this plant.
Sequoia National Park.-E stimate s were submitt ed for a watersupply, sewerage system, and disposa l plant for the Lodgep ole camp
ground s, and recomm endatio ns were given for extensio n of the
water-s upply system for Giant Forest and Ash Mounta in headquarter s. Estimat es were also prepare d for a water-s oftenin g plant
·
for headqu arters area.
Yellowstone National Park,_:_Plans were submitt ed for a sewagedisposa l plant for Mammo th Hot Springs and Fishing Bridge J unction. Plans were prepare d for a screen chambe r for the combin ed
water-p ower and domestic water-s upply pipe line for Mammo th Hot
Springs , and data were furnish ed for the intsalla tion of the pipe
line. Plans were also submitt ed for two garbage incinera tors.
Yosewi te National Park.- In 1930 plans for a sewage -treatm ent
plant for the floor o:f the valley were prepare d by district enginee rs,
and assistance was given in the prepara tion of plans for approxi mately 4 miles o:f sewer lines. Constru ction work was carried on by
force account through out the fiscal year of 1931. Bills o:f materia ls
and specifications were prepare d by district enginee rs :for all equipment, materia ls, and sewer pipe used in the constru ction of the
treatme nt plant and sewer system, and many visits were made to the
park :for the purpose of consult ing with the local enginee rs regarding the constru ction of the sewer line and treatme nt plant and the
installa tion o:f equipm ent. The total cost of the two projects was
approxi mately $175,000, and they were comple ted and ready to use,
except for waterpr oofing, on June 30, 1931. The sewer system consists of 20-inch vitrified pipe, and the treatme nt plant include s a


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presettling tank, aeration tank, clarifiers, covered sludge-digestion
tanks with gas-recovery equipment, glass-covered sludge beds, and
full automatic chlorine machine for applying liquid chlorine to the
treated sewage in proportion to the flow of the effluent.
Plans were submitted for a water-settling tank for water supply
at Tuolumne Meadows, and data were furnished for installation of
water-supply systems, sewerage systems, and disposal plants for
Tuolumne Meadows and Mariposa Grove.
The daily volume of sewage produced on the floor of the valley
was computed from charts, and an average of five samples of water
per week from the domestic supply and the Merced River were
analyzed at the Federal laboratory for B. coli and the results
tabulated.
COOPERATION WITH 0FFICID OF INDIAN AFFAIRS

The work done in connection with sanitation on Indian reservations
included field trips to the agencies, subagencies, schools, hospitals,
and other places listed below and preparation of general reports and
bills of materials, estimates, and plans for improvements recommended.
Arizona:
Southern Navajo Agency (2) .2
Maricopa Day School and Subagency.
Leupp Indian Agency.
Western Navajo Agency.
Fort Defiance Agency.
Theodore Roosevelt School (2).
Sells Indian Agency.
San Xavier Day School and Subagency.
San Carlos Indian Agency.
Nevada: Walker River Indian Agency.
Montana:
Fort Belknap Indian Agency (2).
Blackfeet Indian Agency.
Wyoming:
Crow Indian Agency.
Tongue River Indian Agency.
Shoshone Indian Agency.

Idaho: Fort Hall Indian Agency (2).
Colorado: Consolidated Ute Agency
(2).

New Mexico:
Charles H. Burke Indian School.
Jicarilla Indian Agency (3).
Eastern Navajo Agency.
Laguna Sanatorium.
Northern Pueblo Agency and subagencies at Santa Clara, Taos,
Tesuque, Picuris, San Ildefonso,
and San Juan.
Southern Pueblo Agency and subagencies at Acomita, Laguna,
Chicole, McCartys, Isleta, Paraje, and Scama.
Mescalero Indian Agency.
Nava Day School and Subagency.
Washington: Tacoma Hospital (2).
Oregon : Salem Indian School.

COOPERATION WITH SUPERVISING .ARCHITECT'S. OFFICE

Field surveys were made at proposed border inspection stations at
Sweetgrass and Roosville, Mont. ; Metaline Falls, Oroville, and
Sumas, Wash. ; Douglas, Ariz. ; and San Ysidro and Tecate, Calif.
A service engineer from districts 5 and 6, assigned to district No. 3,
made surveys at Pembina and Ambrose, N. Dak., and Noyes, Minn.
Plans, bills of materials, and specifications were prepared for water
supplies and sewage disposal for the inspection stations given above
and for water-supply and sewerage systems and sewage disposal for
the Babb-P1.egan station in Montana.
SHELLFISH SANITATION

Practically all the shellfish produced on the Pacific coast come
from the State of Washington. Surveys of all the growing areas
2

Figures in parentheses indica:te number of field trips made to the ag,e ncy or subagency.


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PUBLIC HEALTH SERVICE

121

were made and the shucking and packing houses were inspected. The
general sanitary conditions at the growing areas and in the shucking
and packing houses were very satisfactory .
COOPERATION WITH DEPARTMENT OE' JUSTICE

A survey o:£ the water and milk supplies and sewerage and sewage
disposal at the prison camp, Fort Lewis, Wash., was made.
MISCELLANEOU S

1. Service engineers presented papers at the annual meetings o:£
the Montana section, American Water Works Association, and the
western branch o:£ the American Public Health Association.
2. Plans were prepared under the direction o:£ Medical Director
J.C. Perry :£or a laboratory at San Fran~isco.
3. By request o:£ the director o:£ the National Park Service, the district engineer attended a conference o:£ field officers o:£ the park
service in Washington and cooperated with engineers o:£ the park
service in getting out estimates :£or a water supply, sewerage, and
sewage and garbage disposal :£or the Colonial National Monument
and :£or the sesquicentennial to be held at Yorktown, Va., in October,
1931. The district engineer also reviewed plans :£or water supply,
sewerage, and sewage disposal :£or the George Washington Memorial
birthplace, which later will be created a national monument.
4. A map was prepared showing the domestic and fire service water
lines at the United States quarantine station, Angel Island, Cali:£.,
and specifications were submitted :£or a water softener :£or the domestic supply, and following installation tests o:£ softener were made.
5. Inspections o:£ 24 dining cars were made during the year.
6. A large number o:£ chemical analyses o:£ samples o:£ water from
national parks and monuments , Indian reservations , United States
customs and immigratio n inspection stations, and other Governmen t
agencies were made.
TABULAR SUMMARY

Vessel water-supply supervision

Inspections :
First inspectionsPassenger carrying-'---- Freight (only) __________
Water boats_____________
Reinspection sPassenger carrying ______
Freight ( only) __________
Water boats_____________
Certificates issued:
Regular, favorablePassenger carrying ______
Freight ( only) __________
Water boats_____________
Regular, unapproved__ _______
Temporary, favorable-Passenger carrying ______
Freight (only) ---------Water boats_____________

80597-31- 9


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Federal Reserve Bank of St. Louis

Plans of vessel water systems examined:
Approval granted ___________ _
28
34
Approval withheld __________ _
0. Major conferences:
With shipping officials ______ _
With others ________________ _
156
123 Water examinations made:
0
U. S. Public Health Service
laboratories ______________ _
Other laboratories __________ _
151 Typhoid-feve r cases reported:
143
U. S. Public Health Service
hospitals _________________ _
0
U. S. Public Health Service
0
quarantine stations __ _____ _
Health departments ________ _
70

31
0

0
0
5
0

0
0
0

1
0

122

PUBLIC HEALTH SERVICE

Railroaa sanitation supervision

Inspections :
Sources of water supply_____ 86
CoachyaTds_________________
0
Terminal&_______ ____________
0
Watering points_____________
0
Dining cars _________________ 24
Certification:
Data reports reviewed _______ 255
Certificates p r e p a re d f o r
States ____________________ 320

Water examinations made:
U. S. Public Health Service
laboratories _______________ 116
Other laboratories___________
0
~1ajor conferences:
With railroad officials________ 11
With others (pr inc i pa 11 y
health authorities) ______ __ 30

Shellfish sanita,tion supervision

Inspections :
Areas_______________________
Plants ______________________
State certificates:
Approved ___________________
Not approved________________
Approval withdrawn_________

4
14
2

0
0

State certificates-Continued.
Canceled __________________ _
Laboratory examinations made:
U. S. Public Health Service
laboratories---,-----------Other laboratories __________ _
Conferences _________________ _. __ _

0

0
0
4

M isceUaneous

Cooperation with governmental
agencies:
Public Health ServiceSurveys_________________
Conferences_____________
Office of Indian AffairsSurveys _________________
Conferences_____________
Bacteriological analyses,
water _________________
National Park Service-Surveys _________________
Conferences_____________
Bacteriological analyses,
water--- ~------------REPORT ON THE

4
5
45
17
40
27

40

Cooperation with governmental
agencies-Continued.
Bureau of PrisonsSurveys_________________
Conferences_____________
Supervising Architect's OfficeSurveys _________________
Conferences_________ ____
State health departmentsSurveys_________________
Conferences------~------

1
1
11
4
1
3

231

wORK OF MOSQUITO CONTROL IN THE DISTRICT OF
COLUMBIA

This office was established on August 1, 1930, under the direction
o:f Sanitary Engineer R. E. Tarbett. Coordination and supervision
o:f the activities o:f the several control organizations and administrative details o:f the office were carried out by Assistant Sanitary Engineer J. L. Robertson. Sanitary Engineer H. N. Old was attached
to the office from July 21 to August 16 in an advisory capacity.
A.OTIVITIES

The activities o:f this office were started on August 1. Prior to
_that time, during the period :from July 18 to July 31, inclusive, Mr.
Robertson, who was then attached to Interstate Sanitary District
No. 2, was engaged in preliminary mosquito surveys. The plan for
control measures, as recommended in a report by Sanitary Engineer
R. E. Tarbett, dated November 5, 1929, was followed throughout ·
the year. Under this plan general supervision and coordination of


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PUBLIC HEALTH SERVIOE

123

the activities were carried on by the Public Health Service, while the
actual control work was performed by the District of Columbia
sewer department, the Office of Public Buildings and Public Parks,
the District of Columbia Health Department, and the following
other Federal and District ag~ncies:
District Government:
National Training School for
Girls.
Gallinger Hospital a nd J ail.
Home for the Aged and Infirm.
Public school grounds.
Tuberculosis Hospital.
Department of the Interior:
St. Elizabeths Hospital.
Columbian Institute for the Deaf.
Department of Agriculture:
Agricultural experimental farm.
Greenhouses on the Mall.
War Department:
War College.
Bolling Field.
Arlington Cemetery.
Fort Myer.
Soldiers' Home.
Soldiers' Home Cemetery.

War Department-Continued.
Walter R eed Hospital.
Department of Commerce :
Bureau of Standards.
Navy Department:
Navy Yard.
Naval Air Station.
Naval Hospital.
Naval Observatory.
Arlington Wireless Station.
Naval Laboratory.
Naval Magazine.
Department of Justice:
National Training School
Boys.
Engineer Department:
Dalecarlia Filtration Plant.
McMillan Filtration Plant.
Miscellaneous agencies :
Botanic Gardens.

for

Arrangements were made with a large number of independent
agencies to have control measures carried on in their territories and
buildings by one of the control organizations. It was also arranged
between the control organizations that they should exchange small
outlying areas where treatment could be accomplished more easily
by one than by the other. This made for more effective control and
facilitated the work, eliminating the overlapping of activities.
Plans for control measures and designs of necessary equipment
were furnished to the control organizations. The superintendents of
these organizations were conferred with frequently and instructed
concerning methods of control ·and familiarized with mosquito life
and habits.
Unusual weather conditions were encountered during the year.
During the summer months of 1930 precipitation was below normal
and certain stream areas were dry, but, on the other hand, the large
free-running streams pooled, and prolific breeding places were
formed. In the spring of 1931 frequent rains were encountered and
numerous pools were formed in the wooded sections. Because of
these abnormal conditions emergency measures had to be taken and
no well-defined program could be followed, with the exception of the
catch-basin-oiling activities.
The prevalence of mosquitoes at the Executive Mansion and in the
Mall and Potomac Park areas led to the discovery of large breeding
areas on Columbia Island, situated on the Virginia side of the
Potomac River. The United States Engineer Department had constructed a dike around the island and was carrying on hydraulic
filling operations.
A survey was made of the District of Columbia and vicinity from
September, 1930, to February, 1931, inclusive. Data obtained were
fonrnrded to the several interested agencies, with recommendations
for control measures for the season beginning in April, 1931. Ques-


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tionnaires were sent to the smaller agencies requesting information as,
i't o the number of catch basins, fountains, and other water receptacles
·•on their properties. Upon receipt of this information the District
~of Columbia sewer department was requested to supply these various
:::agencies with oil for use in potential breeding places. When neces;.zsary, other methods of control were recommended.
The control organizations started stream-cleaning operations in
March, preparatory to the 1931 season. The streams were conditioned by the 1st of June. Maintenance work was carried on the
remainder of the year.
Stream-oiling operations were begun on April 22, when Aedes
vewans were found in the stream and pool areas.
On June 13 catch-basin-oiling activities were begun when Oulew
pipiens were found breeding therein. At this time it was found
necessary to begin oiling operations in the marsh areas, and recommendation was made to the sewer department that a boat be equipped
for this purpose. The equipment consisted of a pump so arranged
as to pump water and oil, the water acting as a mechanical conveyor.
The inspection of private properties was begun by inspectors of the
health department about May 1. It was recommended that they report their findings to this office, in order that they might be referred
to the proper control organization.
The inspection of Federal properties was begun about the 1st of
May and biweekly inspections made throughout the remainder of
the year.
The Bureau of Fisheries, the Office of Public Buildings and Public
Parks, and the Public Health Service cooperated in transferring
Gambusia a/finis from the reservoir maintained in the beaver pond
at the Zoological Park to various stream and pond areas within the
District of Columbia and vicinity.
One of the chief functions of the office was the coordination of
reports of breeding and presence of mosquitoes. The inspection system was so set apart from the control organizations that the routing
of such information to the interested agencies was most important.
The sanitary engineer of the District of Columbia sewer department was supplied with estimates of the cost of mosquito-control
measures, with details, for the fiscal year 1932.
Contact was had with the following-named public utilities by this
office and ten ta ti ve plans were made for inspections of their properties, such as manholes, conduit lines, sumps, and trolley tunnels:
The Capital Traction Co.
The Chesapeake & Potomac Telephone Co.
The Chesapeake & Ohio Canal Co.
District of Columbia water department.
Postal Telegraph & Cable Co.
Potomac Electric Power Co.
Washington Gas Light Co.
Washington Railway & Electric Co.
Western Union Telegraph Co.

Frequent rains caused a flushing action in these places an d made
-0bservations difficult and nonrepresentative, with consequent delay
in the work.
The absence of data collected during previous years made comparisons of the prevalence of mosquitoes difficult. Only hearsay and
individual opinions could be considered. These indicated that the

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control measures employed were successful, with consequent diminution of mosquitoes. There were a few local problems which were
not solved completely. Local breeding was the basis of complaint
in the majority of cases. ,vhen local breeding was eliminated, the
areas enjoyed freedom from mosquitoes.
MISCELLANEOUS

During the last month of the fiscal year several experiments were
started, in cooperation with the Office of Field Investigations of
Malaria, the District of Columbia sewer department, and the Office
of Public Buildings and Public Parks, to determine more efficient and
cheaper methods of control.
RURAL . HEALTH

WoRK

Cooperative demonstration projects in rural sanitation were carried on during the fiscal year ended June 30, 1931, in 213 counties
in 27 States, as follows :

State

Number of
counties

Alabama __ _______________ _
Arizona ___________ _______ _
Arkansas _________________ _
California ______ _______ ___ _
Florida_-----------------Georgia _________ _________ _
Idaho __________ ___ _______ _
Iowa _____________________ _
Kansas ____________ _______ _
Kentucky __________ ______ _

10

3

Stc.te

Louisiana ________________ _
Massachusetts ___________ _

2

i ~i~f~!tr~~~==============

4

1
4
9

32

Montana _________________ _
New Mexico _____________ _
North Carolina __________ _
Ohio _____________________ _
Oklahoma _______________ _

Number of
counties

State

Number of
COUn•

ties
Oregon ___________________ _
South Carolina _______ ____ _
South Dakota _________ ___ _

13

i~4 iWashington
:;1;ia~==================
______________ _

11

West Virginia ____________ _

14

TotaL ____ ______ __

213

24
1
5

8
4
1
4

4

1
1

2

The details of the work carried on in the 213 projects will be
made the subject of a special report.
The appropriation for the rural sanitation work of the Public
H ealth Service for the fiscal year 1931 was $338,000. Against the
amount appropriated was set up a budget saving of $13,520. Thus
$324,480 was available for expenditure during the fiscal year 1931.
Of this amount a total of $285,816.45 was expended through specific allotments toward the support of 213 field projects and $17,344.35
was used for special studies and administration.
According to data collected by the rural sanitation offic~ from
the State health departments the number of counties or eqmvalent
divisions provided with local health service reaching all rural sections thereof and under the direction of whole-time county or district health officers was 558 at the beginning of the calendar year
1931. This represented a gain of 53 over the figure for the preceding
year. When it is borne in mind, however, that there are 3,073 counties in the United States, it is obvious that only a relatively small
part of the rural area of the country is as yet p~ovided with_ reasonably adequate health service. The demonstrat10n war k bemg carried on by the Public Health Service in cooperation with the States
and counties has played an important part in such development of
county health service as has been brought about. It is believed that

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continued cooperation on the part of the Federal Government in
this activity is essential to the ultimate success of the program and
that participation in the demonstration work on a larger scale by
the Public Health Service is justifiable, to the end that the area
of rural territory under adequate health service may be extended
more rapidly.
On February 6, 1931, an appropriation of $2,000,000 became available to the Public Health Service for cooperation with the States
in the drought-stricken areas in studies of and demonstration work
jn rural sanitation. The appropriation is for use from the date of
passage of the act until .J une 30, 1932. The provisions of the act
are similar to those of the regular rural sanitation act, with the
following exceptions :
1. The funds are limited to the drought-stricken areas.
2. It is not required that at least 50 per cent of the total cost of
any cooperative project shall be defrayed :from State and local
sources.
3. The appropriation is also available for the purchase and distribution of medical supplies.
4. It is strictly an emergency appropriation to meet emergency
conditions resulting from the unprecedented drought and terminates
upon a specific date.
5. It is to be expended in accordance with regulations prescribed
by the Public Health Service.
6. A report of the extent and circumstances of the several cooperative projects is to be made to Congress at the beginning of each
regular session.
Telegraphic dispatches were immediately issued by the Surgeon
General to all of the State health officers concerned, calling for a
conference in Memphis on February 10, 1931, to consider plans for
carrying out the provisions of the act. Twenty-two States were
considered as being included in the drought-stricken areas, of which
20 were represented at the conference. The conference approved
plans submitted by the Public Health Service for cooperation with
State and local health authorities under the provisions of the act.
In addition the following resolutions were passed by the conference:
1. Resolved, That the public health officials of t lle States of the droughtstricken areas of the United States in assembly in the city of Memphis ask: the
Surgeon General of the Public Health Service, immediately upon his return to
Washington, to confer with and urge the American Red Cross to continue to
furnish necessary medicines, also surgical supplies, to the indigent sick in the
areas as a,n emergency measure. It is the sense of the body that this great international relief organization, designated as an official agency by the Congress,
has always met the actual needs everywhere, a,nd has never failed to afford the
basic elements of disaster relief, whether cyclone, flood, fire, or fam ine. The
first essentials are considered to be necessary food, medicines, and clothes for
the needy. Nothing less can be expected of the American Red Gross by the
American people.
2. That it is the sense of this body that the distribution of medical supplies
referred to in the bill is construed as meaning biological supplies used in the
prevention and control of disease as a public health measure.

The first cooperative budgets under this appropriation became effective March 1, 1931, and extended t o June 30, 1931, at which time new

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budgets were put in operation for the year July 1, 1931, to June 30,
1932.
The States in which cooperative projects were conducted for the
period ending June 30, 1931, together with the number and character
of projects in each State under approved budgets, are as follows:
RURAL HEALTH WORJ{

Cooperative demonstration projeots in rural S(1IYl,itation ( drought-stricken area),
fiscal year ended June 30, 1931

State

Number Health
of ii~~n- districts

Towns

Mobile
units

Central
Administration

1
31 __________ __________ ___ _______
Alabama____________________________________________
2
1
69 __________ __________
Arkansas____________________________________________
2
3
3 __________ __________
Georgia______ ____ ____ ______________________ ________ __
1
2
Illinois____________ ________ _________ ______ _________________________________________
1 ___________________ _
6 __________
Indiana_____ ______ ___________ _________________ _______

gf!r~f~c::::::::::::::::::::::::::::::::::::::: _____ } _::::::::;: ::::::::::::::::::::_________l

4
Montana___________ _________________________ ___ _____
7
Oklahoma________ ______ ________ _____________ ________
_________
__
_______
______________
____
_______
Pennsylvania_______
22
Tennessee__ _____________ _______ __________________ ___
5
Texas_______________ _________________ ___ ____________
20
Virginia_____________________________________________
33
______
West Virginia____ ______ ____ ______ ____ _________
Tota]. ________________________________________ _
269

__________
__________
__________
5 (37)
16 (73)
2 (27)
4 (38)
132(175)

1
__________ ___ ___ ____
2
__________ __________
2
1
__________
1 _________ _
2
1
2
1
__________ ---------10

1

21

icounties in districts.

It was the opinion of the conference that the character and extent
of future cooperative county health work, so far as the Federal Government is concerned, would be determined largely by the manner in
which this appropriation was administered, the uses to which it was
put, and the results accomplished. It is ·w ith satisfaction that this
division is able to report that, without exception, every State which
has requesed cooperation under the provisions of this act has made
an earnest and successful endeavor to comply with the principles
which were adopted at the Memphis meeting, and in spirit and in
practice to organize the work upon a rational, conservative basis,
which may be relied upon to fulfill the hopes and ambitions of those
concerned with the making and administration of the appropriation
and to merit their confidence in future undertakings. The division
has endeavored to serve the States promptly and effectively and to
meet their needs as completely as possible under the limitations of
the regulations which apply to all agencies of the Federal Government. In compliance with the terms of the appropriation act, a
special report will be rendered to Congress at its next session.
CooPERATION WITH STATE AND MuNicIPAL BOARDS OF HEALTH IN THE
PROVISION OF ADEQUATE RuLEs AND REGULATIONS FOR THE PREVENTION OF THE INTRODUCTION AND SPREAD OF CONTAGIOUS AND IN FECTIOUS DISEASES

At the request of State and municipal health authorities, studies
o:f the rules and regulations pertaining to the prevention of the
spread of contagious and infectious diseases were conducted at the

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following places : El Paso, Tex. ; Knoxville, Tenn. ; Colorado State
Hoard of Health; and Oklahoma State Health Department.
A report on the study of the Oklahoma State Health Department
was published during the year. It is expected that reports of the
other studies will be published in the course of the next fiscal year.
SPECIAL WORK IN PUBLIC HEALTH ADMINISTRATION

During the first half of the fiscal year Surg. J. W. Mountin was
on duty with the Tennessee State Department of Health completing
certain studies on the organization and conduct of State and local
public health work. These studies were designed to determine the
public health needs of different areas and the effectiveness of various
public health procedures and plans of organization. The successive
steps in these studies were a study of public health needs, projection
of programs, and appraisal of results. These studies in a great
measure have assisted in formulating the present public health
program in Tennessee, which for the most part is applicable in
many sections of the United States. The findings of these studies,
the methods evolved, and an evaluation of the results may be found
in the following publications :
Policies and Practices of the Tennessee State Health Department. Published
by the State Department of Health of Tennessee.
Manual for the Conduct of County Health Departments. Published by the
State Department of Health, Tennessee.
Record Manual of the Tennessee State Health Department. Published by
the State Department of Health, Tennessee.
Apportionment of Financial Aid for County Health Work. Public Health
Reports, January 3, 1930; Reprint No. 1346.
The Training of County Health Officers. Public Health Reports, Oct. 3,
1930; Reprint No. 1416.
Review of Public Health Administration in Tennessee. (In manuscript.)

During the period of this assignment the officer acted as secretary
of the public health section of the White House Conference on Child
Health and Protection and as such was responsible for assembling
a large part of the data and editing the report.
MiscF,LLANEous ACTIVITIES

In response to a request from the State health officer of Texas, assistance was given in the organization of a special malaria control
demonstration project in the eastern section of the State. Asst.
Surg. C. D. Head was detailed to assume charge of the work for
the State health department during the organization period.
Assistance was given to the State Board of Health of South Carolina through the :furnishing of biologies for use in preventing the
spread of epidemic diseases.
.
Surg. C. V. Akin was detailed to South Carolina for the purpose
of assisting the State health officer in studies and demonstrations in
the control of pellagra.
CONFERENCE OF THE SURGEON GENERAL WITH THE STATE AND TERRITORIAL HEALTH OFFICERS

In accordance with the act of July 1, 1902, the Twenty-ninth Annual Conference of State and Territorial Health Officers with the
Public Health Service was held April 27-30, 1931, in Washington,

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D. C. Joint sessions were held with the Forty-sixth Annual Conference of State and Provincial Health Authorities of North
America. Delegates from 34 States and the District of Columbia
and Porto Rico, and visitors from the Provincial Health Department of Canada and the Pan American Sanitary Bureau were in
attendance.
An interesting program was arranged and the following papers
were presented and discussed :
1. Current national and international public health problems.
2. Essential considerations in connection with the rural health
program.
3. A summary of investigational work on antifreeze mixtures.
4. The problem of postvaccination encephalitis with special reference to the United States.
5. Some recent observations on endemic typhus fever.
6. The epidemiology and clinical recognition of a disease of the
Rocky Mountain spotted fever type in the eastern section of the
United States.
7. The laboratory identification of a disease of the Rocky Mountain spotted fever type in the eastern section of the United States.
8. Expansion of the work of the Public Health Service upon
·
Rocky Mountain spotted fever and other tick-borne diseases.
9. The present status of the morbidity reporting area.
10. Proposed method of reporting efficiency of State control over
shellfish sanitation.
11. The coordination of the sanitary control of bottled mineral
waters.
12. Child hygiene.
13. Our responsibility in the drought area under the new Federal
appropriation.


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DIVISION OF FOREIGN AND INSULAR QUARANTINE
AND IMMIGRATION
Iri charge of Asst. Su'rg. Gen. F. A.

CARMELIA

QUARANTINE TRANSACTIONS

During the fiscal year 1931 medical officers o:f the Public Health
Service engaged in the administration of the United States quarantine laws inspected 22,504 vessels and 2,891,746 persons. O:f these,
14,955 vessels, 773,743 passengers, and 1,039,524 members of crews
were inspected at the continental maritime stations. At insular
stations, 3,417 vessels, 161,037 passengers, and 235,537 members of
crews were inspected. At foreign stations, 4,132 vessels, 365,194
passengers, and 316,711 members of crews destined for ports of the
United States were inspected. There were 2,942 vessels fumigated
or disinfected at continental stations, 540 at insular stations, and 590
at foreign stations. At the border quarantine stations there were
101,970 travelers inspected, exclusive of the local interurban traffic,
numbering 10,304,042 who were under surveillance. In addition,
3,137 airplanes arrived at official airports o:f entry in the United
States from foreign ports requiring quarantine inspection; a total
of 21,028 persons carried on these planes were accorded medical
examination prior to entry.
GENERAL PREVALENCE OF QUARANTINABLE DISEASES

Y ellow f ei,er.-Yell ow :fever continues to be reported from the
Gold Coast and British Camaroons in Africa. One case was reported at Lagos, Nigeria, which was said to have been infected in a
laboratory. Health conditions reported during the year regarding
the possible presence of this disease near certain ports of South
America on the Caribbean coast, particularly the western part, and
on the east coast from the Amazon Rive1r to Rio de Janeiro, were
such as to warrant the issuance of instructions to quarantine officers
· at stations located on the Gulf and Atlantic coasts south of the
southern boundary of Maryland to be on the alert in making th·e
quarantine inspection of vessels which have called at these ports,
especially at the smaller ports along the east coast of South America.
The port o:f Para (Belem), at the mouth of the Amazon River,
particularly is regarded as infected, and scattered cases ha.ve been
reported at various interior points more or less close to several
of the seaports along the coast. It is understood that the Brazilian
authorities are maintaining an effective antimosquito campaign in
the principal seaports and that danger o:f maritime spread is decreased accordingly. Information has also been received from reliable unofficial sources indicating the occurrance of cases of suspected yellow :fever in the interior of Colombia in the region of
130


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Santa Marta and Barranquilla, but as yet these reports lack official
confirmation.
Oholera.-As in previous years, cholera has been confined principally to the continent of Asia. However, at the beginning of the
fiscal year this disease was present in epidemic form in several of
the islands in the Visayas. There was also a minor epidemic in the
city of Manila, some 50 cases occurring there. Interisland quarantine was 1;mt into effect against several ports, effective at various
6mes durmg the year for Manila, Cebu, Iloilo, the Province of
Iloilo, the Province of Capiz, the island of Bohol, and the island
of Samar. This epidemic, however, can not be attributed to any
recent importation, as past history shows that cholera recurs in
epidemic form in these islands every four or five years and may be
considered as endemic there. The number of cases and deaths from
this disease was small as compared with the number during outbreaks which occurred during the latter part of the last century
and the early part of the present century.
Plague.-Plague was reported from nearly all parts of the world
during the year 1930, although the number of cases in British India,
which is the principal world focus of plague, was smaller than the
number reported in 1929. There were a few cases of plague reported in Europe. One case occurred in Paris on July 15, 1930, and
13 cases at Marseilles among dock workers and contacts from August to November, 1930; 14 cases and 10 deaths were reported in
Russia· and 2 ·cases in Greece. In countries adjoining Et1rope,
Egypt heads the list with 966 cases, with 182 deaths.
Plague, by reason of its wide geographical distribution and the
means of its spread, remains one of the major pandemic diseases.
which requires the constant vigilance of health authorities in all
countries. No cases of this disease, however, occurred on board
vessels arriving at United States quarantine stations during the
year.
Smallp·o x.-Smallpox is perhaps the most widespread of the quarantinable diseases. During the fiscal year cases of smallpox were
reported from nearly all the countries of the world. The prevalence of this disease has been increasing in rarts of the United
States for several years; it is, however, very mild in type, with but
few deaths when compared with the large number of cases.
Typhus f ever.-Typhus fever was reported during the fiscal year
from many ports which have commerce with the United States. It
is endemic in Mexico and in many eastern European countries. This
disease occurred in epidemic form in Poland, Rumania, Lithuania,
Morocco, Egypt, Turkey, Algeria, Bulgaria, and Greece, and appeared to a limited extent in Yugoslavia, Portugal, Irish Free State,
Spain, Scotland, and Austria. A mild epidemic occurred during
January and February, 1931, in Czechoslovakia, with a total of 104
cases and 5 deaths.
CHANGES IN QUARANTINE PROCEDURE
AN ACT EXTENDING QUARANTINE-INSPECTION SEIRVICE

The Congress of the United States toward the close of the seventy.first session passed legislation, which was approved by the President
on March 3, 1931, to enable quarantine-inspection service to be pro
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vided after the hour of sunset in those United States ports of entry
in which the need therefor exists. Up to the present the performance
of quarantine inspection has been confined to daylight hours, between
sunrise and sunset, at all ports, with the exception of vessels arriving
in distress and requiring immediate emergency passage through
quarantine.
This new legislation provides that the Secretary of the Treasury
shall establish by regulation, following a determination of the commercial needs of the port for such services, definite hours for the
performance of quarantine inspection at each quarantine station
during the 24 hours each day or any fraction thereof. In those ports
in which an extension of the present sunrise-to-sunset hours for
the performance of quarantine inspection seems desirable, the port
authorities and/or shipping interests in such ports may make an
application for extended quarantine service to the Secretary of the
Treasury, setting forth definitely the period for which it is desired
that quarantine services be made available during each 24 hours and
supported by data showing the commercial necessity therefor. The
Secretary of the Treasury, upon receipt of such application, gives
the matter consideration and prescribes the hours during which
quarantine services may be performed in such ports. Applications
for such extended quarantine services for the ports of New York,
Boston, Philadelphia, San Pedro, and New Orleans are now pending.
However, the quarantine inspection of vessels arriving from ports
infected with quarantinable disease will be restricted to hours of
daylight in all ports, and vessels which are not equipped with adequate artificial lighting facilities to permit of proper quarantine
inspection during hours of darkness also will be inspected only during hours of daylight. Any vessel arriving during hours of darkness may anchor in the quarantine anchorage and may elect to
undergo quarantine inspection the following morning.
This legislation also modifies the charges made for quarantine
services rendered at the port of New York (which heretofore have
been higher) to conform with the charges made at other United
States ports.
Another purpose of the act is to correct a discrimination that
heretofore obtained under existing laws respecting officers and employees engaged in the navigation and care of the quarantine vessels
operated by the Public Health Service in the various maritime
ports of entry. Heretofore personnel of the Public Health Service
employed in the care and navigation of some 70 vessels of the Public
Health Service were the only persons so engaged on American
vessels, either privately owned or Government owned, who were not
entitled to free medical care and hospital treatment in case of sickness or injury; the employees of other Government vessels and of
the American merchant marine were already beneficiaries of the
Public Health Service. This feature of the bill now permits the
Public Health Service to take care of its own seamen on a basis of
equality with the care it is required to furnish seamen employed on
other Government vessels or on the American merchant marine.
In addition, the act provides that officers and employees of the
Public H ealth Service assigned to quarantine duty at any of the
national quarantine stations or at in-fected foreign ports, and who


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are necessarily exposed from time to time to direct infection with
quarantinable diseases and other infectious and contagious diseases
and to injury in the course of their performance of duty incident to
exposure to dangerous gases used in fumigation and disinfection
procedures and to boarding vessels in rough weather, who become
sick or injured in line of duty shall be furnished medical care, hospital treatment, and similar benefits as beneficiaries of the Public
Health Service.
Following is the text of the act:
[Pum,1c-No. 796-71sT

CONGRESS]

(S. 5743)

An .Act To authorize twenty-four-hour quarantine inspection service in certain ports of
the United States, and for other purposes

Be it enacted by the Senate and House of Representatives o,f the United
States of .America in Congress assembled, That the act entitled "An act grant-

ing additional quarantine powers and imposing additional duties upon the
Marine Hospital Service," approved February 15, 1893, as amended, is further
amended by adding at the end thereof the following new sections :
"SEJc. 13. The original bills of health required to be obtained in duplicate
in foreign ports under the provisions of section 2 of this act shall be p:·esented
to the collector of customs in accordance with the provisions o'f section 5 of
this act, and the duplic::i te copies of such bills of health shall be presented
to the quarantine officer at the time quarantine inspection is performed by
him.

"SEC. 14. The Secretary of the Treasury shall establish by regulation the
hours during which quarantine service shall be performed at each quarantine
station, and, upon application by any interested party, may establish quarantine inspection during the twenty-four hours of the day, or any fraction thereof,
at such quarantine stations as, in his judgment, require such extended se:·vice; but the Secretary may restrict the performance of quarantine inspection
to hours of daylight for such arriving vessels as can not, in his opinion, be
satisfactorily inspected during hours of darkness. Nothing herein contained,
however, shall be construed to require a vessel upon arriving at the quarantine anchorage to undergo quarantine inspection during the hours of darkness, unless the quarantine officer at such quarantine statio'n shall deem an
immediate inspection necessary to protect the public health ; nor shall any
provision of this act be construed to require uniformity in the regulation governing the hours during which quarantine inspection may be obtained
at the various ports o'f the United States.
" SEC. 15. The certificate of health required by section 5 of this act shall
u_pon the arrival of any vessel from foreign ports at the anchorage or place
established for quarantine inspection purposes in any port of the United States,
be procurable at any time within which quarantine services are performed
at such station from the quarantine health officer, following satisfactory
inspection.
" SEc. 16. The Secretary of the Treasury is authorized and directed to prescribe a schedule of charges for quarantine services rendered to vessels at each
of the national quarantine stations, which charges shall be reasonable and
unifo'rm for all ports, including the port of New York. The quarantine officer
in each port of entry shall promptly forward to the collector of customs at
such port an itemized statement of the quarantine services rendered to each
vessel at the prescribed charges, which charges shall be paid to the collector
o'f customs by said vessel prior to clearance or departure from such port. All
such collections shall be accounted for by the collector of customs and shall
be covered into the Treasury as miscellaneous receipts.
"The provisions of the act of .June 5, 1920 ( 41 Stat. 875), relating to the
schedule of fees and rates of charges to be adopted and promulgated by the
Secretary of the Treasury at the New York quarantine station, are hereby
repealed.


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·., SEC. 17. Any officer or employee of the Public Health Service on duty at
;any national quarantine station or on a national quarantine vessel, or detailed
:. for duty in foreign ports, under the provisions of sections 2 and 5 of this act,
: who is suffering from sickness or injury incurred in line of duty, shall be a
•~beneficiary of the Public Health Service and shall be entitled to receive all
' necessary medical treatment and other benefits authorized to be furnished to
beneficiaries."
SEc. 2. There is hereby authorized to be appropriated the sum of $100,000, or
so much thereof as may be necessary, to carry out the provisions of this
amendatory act.
SEc. 3. Whenever steamship companies desiring the benefits of such extended
quarantine service at any port shall offer to advance funds in order to permit
the immediate institution of such service at such port, the Secretary of the
Treasury may, in his discretion, receive such funds and expend the same for
such purpose; and the moneys so, contributed shall be repaid by the Secretary,
without interest, from any funds appropriated under authority of section 2 of
this act.
Approved March 3, 1931.
MENINGOCOCCUS ( CEREBROSPIN AL) MENINGITIS

But few cases of meningitis on vessels arrived at Pacific coast
ports of the United States during the past fiscal year, reflecting the
effectiveness of the regulations governing the importation of passengers and crews at ports in Chma and the Philippine Islands and
their transportation to the United States. While Executive Order
No. 5143, approved June 21, 1929, restricting for the time being the
transportation of passengers from certain ports in the Orient, remained in force during the year, the regulations prescribed in accordance with the provisions of this Executive order have been
modified from time to time as conditions warranted until, on N ovember 7, 1930, first-class passengers were exempted from the application of the special meningitis regulations and steerage passengers
were permitted shore liberty in ports of call, provided epidemic
cerebrospinal meningitis was not prevalent in such ports.
In connection with the occurrence of cases of cerebrospinal meningitis among steerage passengers on vessels arriving from oriental
ports, the Public Health Service is now conducting a study 0f ventilation and berthing facilities on vessels of a steamship line engaged
in the carriage of oriental steerage to United States ports. These
studies are being conducted jointly by representatives of the Publjc
Health Service, the steamship line medical service, and the University of California.
PSITTACOSIS

Executive Order No. 5264, issued by the President on January 24,
1930, restricting for the time being the introduction of parrots into
the United States, remains in effect. The regulations promulgated
by the Secretary of the Treasury under date of February 3, 1930,
under the provisions of this Executive order, governing the importation of parrots into ports of the United States, were modified on
October 21, 1931, after a conference w_ith the Pet Dealers Association of America and members of the Biological Survey of the
United States Department of Agriculture, to permit the importation of commercial shipments of these birds under approved sanitary restrictions relating to crates, air space, etc. It is believed
that these regulations represent the minimum conditions under

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which a reasonable protection from such a danger may be had short
of the more drastic prohibitio n of all importatio n, as authorized by
the Executive order. These regulation s have been successful in
preventin g the spread of this disease through the commerci al importation of infected birds, and the past year has shown a decided
decrease in the number of cases of this disease in the United States
as compared with the preceding year.
The problem of the satisfacto ry control of psittacosis has become
of internatio nal interest in the past year, and this subject will form
one of the major topics for discussion at the next meeting of the
permanen t committee of the Office Internatio nal d'Hygiene Publique
in Paris in Octqber, 1931.
SANITARY CONTROL OF AERIAL

NAVIGATIO N

One of the major problems to-day confrontin g not only this
country but the countries of Latin America, Europe, A sia, and
Africa, is the sanitary control of aerial navigation . Regular lines
of aircraft have been establishe d, providing direct and rapid communicatio n between areas in Africa, Asia, and South America,
which have long been endemic centers of various pestilentia l diseases, such as cholera, plague, and yellow fever, and noninfect ed but
infectible territory in Europe, North America, and, in fact, almost
all the rest of the entire world. The journey by airplane from most
of the endemic centers of these various pestilentia l diseases is usually
less than the incubation period of these diseases, excepting journeys
from endemic centers of cholera.
The problem of the sanitary control of aerial navigatio n has been
receiving internatio nal attention by leading sanitarian s for several
years, finally culminati ng in a proposed conventio n for the sanitary
control of aerial navigation , which was drafted by the permanen t
committee of the Office Internatio nal d'Hygiene Publique in Paris
at the May, 19"30, meeting. This item also formed one of the major
topics for discussion at the October meeting of the permanen t committee the same year, and, likewise, considerat ion 0£ the proposed
conventio n formed one of the principal topics for discussion at the
meeting in April of the -second Pan American Conference of Directors of Health held in Washingt on, D. C., under the auspices of the
Pan American Sanitary Bureau. At the May, 1931, meeting of
the permanen t committee of the Office Internatio nal d'Hygiene
Publique a final draft of this conventio n for the sanitary control
of aerial navigatio n was drawn up and adopted.
During the past fiscal year there was inaugurat ed a plan of keeping open for 24 hours daily the principal ports along the United
States-Me xican border. This step was taken largely as a matter of
the promotion of internatio nl comity, and the plan went into effect
February 1 1931. Because of the lack of funds and the consequen t
inability of the Public Health sen1ice to provide additiona l personnel to take care of the added du'tjes incident to 24-hour service,
a rather heavy burden has been placed upon the quarantin e officers
on duty at these ports. To cope with this situation the Public H ealth
Service authorize d border quarantin e officers, at their discret ion, to
issue local quarantin e passes to returning loeal travelers and such


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136

PUBLIC HEALTH SERVICE

other persons with respect to whom they are able to satisfy themselves that the habits, whereabouts, duration of visit, etc., of such
persons while in Mexico would not make them likely to become infected with any one of the quarantinable diseases. Persons holding
such passes may be permitted entry by border guards during such
hours as the port may be open for entry and during which quarantine inspections, etc., are not available. This plan of affording
24-hour service along the border is in the nature of an experiment,
and the practice described appears to be working out temporarily
until sufficient additional funds are available for the employment of
additional personnel to take care of this additional work.
During the past year a change has been made . in the measures
designed to prevent the introduction of typhus fever :from ports of
embarkation in Europe. This step was taken in view of the better
organization of sanitary services and improvement in sanitary conditions now obtaining in Europe. Where formerly the application
of the measures designed to prevent the spread of typhus fever was
based upon broad geographic areas, now their application is contingent upon the actual endemic or epidemic prevalence of typhus fever
in such ports, places, or localities from which persons destined for
the United States have originated or embarked.
The special commission appointed by the health section of the
League of Nations in 1927 to make a detailed study of the fumigation of vessels for the destruction of rats, with particular reference
to the fumigation with hydrocyanic acid of vessels while laden with
cargo, has made plans to visit the New York quarantine station in
September, 1931, to make some practical studies in connection with
this work. This commission first met at Paris on May 14, 1928, for
a preliminary discussion of the lines the study should follow, and
the Surgeon General of the Public Health Service was appointed
chairman. A preliminary report of the investigations carried on in
conformity with these recommendations was submitted by the chairman to the commission at a meeting held in Paris on May 15, 1929,
for which the commission expressed its appreciation, and it was at
this meeting that the commission recommended that certain of its
members and experts visit the United States to study the execution
of the program of the special investigations and researches approved
by the commission. In the meantime the New York quarantine station has been carrying out work along these lines, and in anticipation
of the proposed visit of these experts a resume report of these investigations has been prepared as a guide for the commission.
RAT PROOFING OF VESSELS

Continued interest is being manifested in the rat proofing of
ships, not only in this country but abroad. During the year the principles of rat proofing were demonstrated to nine representatives or
foreign countries, and it is now almost a universal practice to include
rat proofing as a standard requirement for all contracts for the construction of new ships.
The following statistics disclose some interesting facts regarding
the extent of rat proofing of ships in the United States and its adoption by other countries! Rat proofing of ships has steadily increased,


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137

PUBLIC HEALTH SERVICE

until at the present time more than 75 per cent of the better-class
passenger ships regularly entering the port of New York and many
cargo vessels have been or are in process of being rat proofed in
accordance with the methods developed by the Public Health Service, as follows :

•
Number of vessels completed or being rat proofed ____________________ _
Number of owning or operating companies ____ __________ _____________ _
Number of nations to which these ships belong _____________________ ___

288
47
14

Number vessels

rat proofed
Nationality:
American_____________ ____ ____ ____ ______ ____ ________ _____________ 111
77
British_________ ________________ ______ ____ __ ___ ___________________
18
German__________ ___________ ____________________________ _______ __
11
Swedish___________ ___ _____ ______ ____ ______ ___________________ __ __
28
Norwegian_____ ___ __ _________ ____________________________ ________
8
Italian ___________ ___ _____ __________ ___________ ____ __ _____________
8
Spanish_______________________ ___________________________ ___ _____
8
Dutch_______________ ______ _______________ _________________ _____ __
4
French________________________________________ ____ ____________ ___
3
Chilean________ ___ _____ _______________________ ___________________
3
Danish____________________________________ _______________________
1
Republic of Panama__ __________________________________________ __
7
Japanese_______________________________________________________ __
1
--------------~Iexican -------- - ·--------------- ---------------FLOATING EQUIPMENT

Continuing the policy of reclaiming and reconditioning the older
. quarantine vessels whose physical condition warrants the expenditure of funds for major repairs, several vessels were reconditioned
during the year. In addition, new construction is under way and
several new vessels have recently been placed in service. So many
vessels have been condemned as unfit for further service and unworthy of the necessary major repairs that a considerable amount of
new construction is required to replace these vessels. During the
year several stations were without adequate floating equipment, and /
it was found necessary as a temporary expedient to hire launches at
these stations with which to carry on rout,i ne work until such time
as new vessels could be supplied..
The most important work undertaken in the way of reconstruction of old vessels was the complete rebuilding of the tug W. 0. W.
Glazier ( formerly the Elk). This vessel was practically worthless
except for the hull; it was, accordingly, completely dismantled and
converted to Diesel power. New decks, superstructure , and arrangements were worked out, so that this vessel is now completely modernized in all respects and is one of the fastest and trimmest vessels of
this service. It is attached to the Savannah (Ga.) quarantine station. The launch Q-10, which is stationed at the Fort Monroe (Va.)
quarantine station, became useless, due to a worn-out gasoline engine
which could not be placed in operating condition without considerable expenditure of runds. This machinery was removed and a new
Diesel engine installed, which, in conjunction with minor structural
alterations, has made a very handy station boat for use between
Craney Island and the mainland. The launch Q-9 at Savannah,
Ga., was recently converted from gasoline power to Diesel. Arrangements were made both in this launch and the Q-10 for 1-man control
80597-31-10

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138

PUBLIC HEALTH SERVICE

from the steering position, so that in emergency these vessels can be
handled by one competen t employee.
Two 41-foot launches, the Q.-JJ3 and the Q-14, were constructe d
new during the year. These vessels were especially designed for
semitropi cal service, to be used as a means of transport ing freight
and passenger s between the mainland nd the quarantin e station.
The Q-44 is now stationed at the Fort Monroe (Va.) quarantin e
station, and the Q-13 is stationed at the Cape Fear quarantin e station, Southpor t N. C. These vessels, although comparati vely small,
during the trip from the builder's yard at New York down the
coast to their destinatio n proved to be unusually able sea boats and
very easily handled under all conditions. Both vessels have Diesel
power and are arranged for 1-man control from the pilot house.
A new 60-foot all-steel Diesel tug, the W. M. Wightman , was built
at San Francisco and delivered for service at the San Diego quarantine station. This vessel, in addition to the usual pilot house and
engine room, has accommodations for medical officers, as well as a
compartm ent for the transporta tion of freight. It also had a long
delivery trip from San Francisco down the Pacific coast to San
Diego and proved to be one of the most seaworthy vessels of her size.
VIOLATION S OF QUARANT INE LAWS

During the fiscal year it was necessary for the departme nt to
assess fines aggregati ng only $410 for violation of the act of February 15, 1893, due to the failure of masters of vessels to present
American consular bills of health, and for other violations of the
quarantin e laws administe red by the Public Health Service.
QUARANTI NE TRANSACT IONS AT CONTINEN TAL AND INSULAR QUARAN-

TINE STATIONS
TABLE

1.-Swmma ry of quarantine transaction s at oontinental ana insulwr
stations for the fis cal y ear ended June 30, 1931
(1) INSPE CT IO NS
Total
numher

Vessels __________ ----·---------Seamen _______________________ _
Passengers _____ ______________ __

18,372
1,275, 061
934, 780

Passed
fr ee
pratique

Passed
provi sional
pratique

D et 11ined

12,998

5,374

100

R emarks

Includes workaways.
Includes stowaways.

(2) DETENTIO NS

Y ellow fever
Numb er

---------------Vessels__ _________ _______________________________ ______

D ays

1

3

Sick _________ -- --- ------- --------------- --- ___________________________ _
On board interisland vessel at Manila.


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Number

Sm allpox

D ays

--- --- --- --- --- ---

~~~:~~ei:s-------------------------------------------- _____ 33 ______ ::_
1

Ch.o lera

4
175
57
I

23
1,041
342

2 ---- ----

8
229

3
4

20¼

491

6

31

139

PUBLIC HEALTH SERVICE
TABLE

1.-Summary of quarantine transactions at continental and insular
stations for the fiscal year ended June 30, 1931-Contin ued
(3) LABORATORY

Number of rats examined ___________________________________________ _
Number of fleas classified __________________________________________ _
Number persons vaccinated (for smallpox) __________________________ _
Number persons vaccinated (for cholera) ____________________________ _
Other examinations :
Stools examined for cholera ____________________________________ _
Nasal swabs examined for meningococcus._______________________ _
Spinal fluid examination for meningococcu s ___________________ ___

6,073
3,345
18,371
38,487
9,737
9,885
5

(4) TREATMENT OF VESSELS (FUMIGATING , TRAPPING, REMANDING)
(A) FUMIGA TlON

Total

Sulphur

Cyanide

621
88,339,159
706,299
2,097

2,861
Ve~Fe1s- _- -- -- _- -- -- - -- -- - -- -- - - -- -- -- - --- -- -- - -- - -- - - -- 1, 227, 940,
936
Cubic feet fumigated __ ---------- ------------------ -- --8,679,911
N et tonnage ________________________ ---- -- ______ --- - -- - _Rats recovered __ ___________________ _________ __________
9,293

3,482
1, 316, 280, 095
9,386,210
11,390

(BJ TRAPPING

Number of vessels __________________________________________________ _
17
Net tonnage ________________________________________________________ _ 79,017
_
____________
_____________
_____________
Nun1ber of traps _____________
2,584
53
Number of rats--------- ------------- ------------- ------------- ----(C) REMANDS FOR FUMIGATION

Mandatory Periodical
vessels
vessels

For other
purposes

233
221

163 requests.

From other ports __________________ ____ _________ _______________ _
To other ports _________________________________________________ _

1,209
1,191

(5) RESEARCH

The following research work was done at the New York quarantine station:
1. Rat infestation survey as fumigation control.
2. Study of fumigation methods and effectiveness.
3. Study of fumigation as applied to loaded ships.
4. Study of fumigation of cockroaches.
5. Study of ratproofing on ships.
(6) FINANCIAL REPOR'l·

Total amount of bills rendered for quarantine services ____________ $439, 796. 35
(7) PORT SANITARY STATEMENTS AND BILLS OF HEALTH _ISSUED

Number issued ______________________________________________________ 48,989
(8) MEDICAL EXAMINATIO NS OF ALIENS AT QUARANTINE STATIONS
Class certified

Total
certified
C
B
A-11
A-1
--- --- --- --- -----273
179
68
2
4,667
88,534
24 1
894
130
86
599
79
157,255
355,520

Number
examined Intensive

Passengers ___ _______________ • __- _--- -- - Alien seamen ___________________________


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140

PUBLIC HEALTH SERVICE
TRANSACTIONS AT CONTINEN'l'AL MARITIME STATIONS

2.-Summary of transactions at conUnental maritime stations for the
fiscal- year ended Jwne 30, 1931

TABLE

Vesselsin- Vessels fumigatecl PassenCrew inspected i - - - - - - - - 1 gers inspected
Cyanide Sulphur spected
- - - - - - - - - - - - - - - - - - - 1·- - - - - - - - - - - - - - - 1 - -- - Aberdeen, Wash___ _________________ ___ _______ _____
13
O
7
0
512
Angel Island, Calif. (San Francisco)_______________
557
466
0
33,468
31,055
Astoria, Oreg____________ ____________ __ ____ ________
47
18
2
2
2,703
Baltimore, Md ________ _______ _____ ·------------ --731
256
0
293
24,777
Beaufort, S. o____ _______ _____ _____________________
o
0
0
0
0
Boca Grande, Fla___ ______________________________
12
0
0
306
8
Boston, Mass ____ ._ .. ___________________ . ___ __ _____
884
182
0
33,934
60,752
Brunswick, Ga .. ________________________ ___ ___ ___ _
12
0
0
0
275
Carrabelle, Fla____________________________________
0
0
0
0
0
Cedar Keys, Fla_______ ___________ _________________
0
O
0
0
0
Charleston, S. c_____ ____________________ ___ ______ _
139
2
14
254
4,813
Corpus Christi, Tex___________ _____ _____ ___ _______
45
0
5
30
1,554
Eastport, Me______________ _____ ___________________
1
0
0
0
3S
Eureka, Calif.. ______________ ______________________
0
0
0
0
0
Fall River, Mass __________ _________ _______________
62
0
0
5
2,205
Fernandina, Fla. (Cumberland Sound) ____________
4
0
1
0
150
Fort Bragg, Calif.. ________________ ___________ _____
0
0
0
0
0
Fort Everglades, Fla________________________ __ ____
0
0
0
0
0
Fort Pierce, Fla___________________________________
0
0
0
0
0
Fort Monroe, Va____ ______________________________
369
3
73
237
13, 72S
Freeport, Tex__----------------- ----------________
16
0
0
3
575
Galveston, Tex______ ____ __________________________
711
103
0
1,406
26,282
Georgetown, S. c______________ __ ______________ ___
10
0
0
0
148
Gloucester, Mass ________________ ._________________
0
0
0
0
0
Gulfport, Miss._______________________________ ____
31
0
6
3
1,066
Jacksonville, Fla. (St. Johns River) _______________
146
19
0
263
4,493
Key West, Fla ___ ______ _______ _____________________
205
O
12
16,736
13,709
Lewes, Del. (Delaware Breakwater)_______________
2
,0
0
0
18
Marcus Hook, Pa_________________ ________________
887
289
2,182
6
33,048
Marshfield, Oreg. (Coos Bay)_____________________
11
0
3
0
385
Miami, Fla__________________ _________ _____________
793
25
24, 168
0
25,355
Mobile, Ala___________ _______ _____________ ____ ____
242
40
12
191
6,959
Monterey, Calif.______ ____________________________
0
0
0
0
0
Morgan City, La. (Atchafalaya)___ ____ ____________
0
0
0
0
New Bedford, Mass_______________________________
8
0
6g I
4
117
New London, Conn_______________________________
26
O
0
25
803
New Orleans, La___ ____ ___________________________
1,492
318
12, 752
0
59,710
Newport, Oreg____ ________ ________________________
0
0
0
0
0
Newport, R. !____ _________ ___ _____________________
9
0
0
25
226
New
York, N.N.Y.1 ___ ·--- -- ---------------- ----- --512,388
4,258
0
566
609,839
Ogdensburg,
y_____________ ________ ____ ___ _____
0
0
0
0
0
Panama City, Fla_ __________ ______________________
7
2
0
0
183
Pascagoula, Miss__ ________ ________________________
0
0
0
0
0
Pensacola, Fla________________________________ __ ___
60
11
0
2
2,112
Plymouth, Mass._ ----- --- ---------------------- - 0
0
0
0
0
Port Aransas, Tex_____ ___ _________________________
0
0
0
0
0
Portland, Me______ __ ______________________________
111
0
11
91
3,684
Portland, Oreg ___ ---------------------- ----------17
0
12
0
669
P or t St. Joe, Fla___ ____ _________________ ____ __ ___ __
0
0
0
0
0
Port Townsend, Wash.2____ ___ ___________________ _
210
159
7
93
3,507
Providence, R. L______ ____ __________________ ____ _
96
0
1
5,577
6,466
Sabine, Tex _____________ ----- -- ----- ------------ -201
17
0
54
6,847
San Diego, Calif. (Point Loma)_ ___ _______________
607
0
15
15,471
18,278
San Luis Obispo, Calif. (Port San Luis)___________
12
0
0
0
483
San Pedro, Calif.. ___ ----------------------- -----__
1,428
11,031
0
178
59,593
Santa Barbara, Calif.___________________ _______
___
0
0
0
0
0
Savannah, Ga_____________________________________
103
20
0
228
3,679
Searsport, Me __ ---------------------- ------------0
20
8
0
516
South bend, Wash ___________ ·- ·--------- ---- -----6
0
2
0
236
Southport, N. C. (Cape Fear)____ ______ ___________
51
0
10
136
1,901
Tampa, Fla_____________________________________ __
228
65
0
183
5,620
Vineyard Haven, Mass____________________________
0
0
0
0
0
Washington, N. C___ __ _______ __ ___ _______________
0
0
0
0
0
West Palm Beach, Fla____________________________
75 ,
0 ,_
0
166
357
TotaL______________________________ _______ _ 14,955
2, 751
191
671, 7731 1,039,524
Stations

_____ _____ _______

1

Includes Perth Amboy, N. J.


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2

Includes all ports on the Puget Sound.

POR'rS
TRANSACTIO NS AT UNITED STA'r:ES Ant PO'.RTS OF ENTRY FOR AI'.RPLANES FROM FORlDtGN
TABLE

3.-Summary of transactions at continental and insular stations for the fiscal year ended June 30, 1931

Location

Name of airport (officially designated)

Distance
in miles
to nearest
Public
Health
Service
station

Date desig•
nated

of Number of Number of Number of Number
Number of Number
aliens
persons
persons
airplanes
of aliens
airplanes
inspected inspected certified
arriving
inspected
arriving
Public from for• by Public by Public
by
for
from for•
Health
Health
eign ports
Health
disease
eign ports
Service
Service
or places
Service

(2)
8, 1929
Akron, Ohio .................. Municipal Airport 1.................. ..........•......• •.. Apr. 28,
1928 ................. ................. ................. ................. . .
Albany, N. Y ................. .... do.......... .... .................. ............... ....6. . Sept. 15, 1929
0
1
1
22
0
8
..
..
...
...................
Ajo, Ariz ......... . ..... ...... ..... do...............
0
0
0
11
0
5
0
0
0
2
0
1
10
1,161
2,838
~~~i~:~~s::~~:== ========= Municipal Airport......... ........ ........... ============
492
3,475
807
1930
Jan. 8,
5
Brownsville, Tex. ............
0
0
0
0
0
0
1929
10,
June
.
.................
..
..................
...............
do
Buffalo, N. Y ................. ....
Ford Airport 1 ••••••..• ••••••••• • ••.•••• •• •••••.••• ••••••• Aug. 1, 1929 }
0
0
0
0
0
0
1931
10,
Feb.
...........
.................
..
.....
Airport
County
Wayne
Detroit, Mich ...... .......... {
1
0
0
0
0
0
0
~;
itP;fJ1~·1================= ======== ============
Douglas, Ariz ..... ............
0
0
0
10
3
3
l½ Mar. 5, 1930
Eagle Pass, 'l'ex .......... .... Eagle Pass Airport 1.......... . . . . . . . . . . . . . . . . .
?
143
979
979
315
315
1929
15,
Aug.
9
.
.
.
.
.
.
.
.
.
.
.
.
.
.
..
.
1.
Airport
Municipal
Paso
El
El Paso, Tex .. . ..............
(2)
-~
----------------------------- ---------- -----------Great Falls, Mont. ........... Vance Airport 1 ••••• . •••••••••• • ••••••••.•••••••• •••••••.• June 0 2, 1930
0
0
0
0
0
0
0
0
0
0
0
0
is:1930·.
~~!~~lr!!f?:~: === ======================== ============ ·jiini
0
0
0
0
0
0
.......
Ketchikan, Alaska ............ Ketchikan Airport 1••.•••• ••••.••••••.•••••• ••••••••••••••••• •• do20,
0
0
0
2
5
2
1929
Dec.
5
Key West, Fla ............... Meacham Field..... .... .................. .. ..
0
12
71
71
24
24
3½ Jan. 24, 1930
Laredo, Tex . . ....... ......... Laredo Airdrome 1.......... . . . . . . . . . . . . . . . . . .
0
0
0
12
0
6
1930
18,
Malone, N. Y ................ Port of Malone 1 ••••.•••.••••••••• ••••••••••••••••• ••••••• Apr. 16, 1928 }
8½ Oct.
Pan American Field............. . .............
7
992
12,391
12,391
1,480
l,480
1930
7,
Mar.
6
Miami, Fla...... ...... ....... { Dinner Key 1..... . . . . 1. . . . . . . . . . . . . . . . . . . . . . . . .
Hi Apr. 22, 1930
Curtiss•Wright Field ••••••••••••• ••••••••• ••
0
0
0
0
0
0
1929
1,
Aug.
Newport, Vt............... ... Canadian Gateway 1 (at Derby Field) ......... .... ........ June 27, 1929
0
2
39
42
14
15
9
Nogales, Ariz ....... ...... .... International Airport 1................. .......
(2)
---- - ------- ------------ ---------Feb. 2, 1930
----------------------Pembina, N. Dak • ...... •.... Municipal Airport 1• •••••••••••••••••• •••••••• •••• •• ••• ••• June
(2)
------------ ------------ ---------2, 1930
----------------------Plattsburg, N. Y ............. Mobodo Airport 1•••••••••••• ••• ••••••••••••••••• ••••••••• Jan. 8,
0
0
0
0
0
0
1930
•••••.•••••• , •••••••••••.
Portal, N. D ak ........... .... Portal Airport 1 ••••••••••••••••••
0
0
0
0
0
0
.
.......
4 •• ••• •••••••••••••••••• •
do
.....
52
Airport
Angeles
Port
..........
Wash
Port Angeles,
0
0
0
0
0
0
1930
1
18,
June
•
•
Port Townsend, Wash ........ Port Townsend Airport •••••••••••••••••• ••.•••••••••••
0
0
0
(2)
0
0
St. Paul, Minn ............... Municipal Air Field .................. ......... . ........... June 4, 1928
19
1,582
2,402
····· .......... . . Dec. 27, 1928 }
•·····
339
535
•······•···•
Field!··········
{R:;,ans
San Diego Cart
1
24, 1930
•••••••••••••• Lmdbergh Field ............ ...... ................. ....... Jan.
'
' Closed June 30, 1931.
a Authorized for use but not officially designated.
2 No medical officer of Public Health Service.
1 Temporary permission

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3.-Summa ry of iransactions at continental and insular stations for the fiscal year ended J une 30,
1931-Cont inued

Location

Name of airport (officially designated)

Distance
in miles
to nearest
Public
Health
Service
station

Number of l'mmber of Number of Number of Number of Number
airplanes
persons
persons
aliens
airplanes
inspected
arriving
inspected inspected of aliens
arriving
by
Public
from
forby
Public by Public certified
from forfor
Health
eign ports
Health
Health
eign ports
disease
Service
or places
Service
Service

D ate designated

St. Thomas, Virgin Islands ___ St. Thomas Airport a___ ___________________ ____ _______________
_____ _____ __
San Juan, P. R _________ ____ __ {¥sf;a<fr~~~1!i~i_e!~-~============================ ============
,
{Alhambra-W estern Airport Express Field_ ____
12
San Pedro, Calif______________ Allen Field ________________ ~-------~------- --JO
Glendale-Gran d Central Arr TermmaL_ ______
30
Sasabe, Ariz _____ ____________ _ Customs Station
___________ ______ ________________ ____ _____
Scobey, Mont_ _______________ Scobey Airport 1 __ _______________ __________ ___ ------- - - ---

fai:i~Jan.
Jan.
Nov.
Apr.
June

1g: mg }
11, 1930

8, 1930
20, 1929
22, 1931
2, 1930

Seattle, Wash ________________ {f~:~nt,!li~~======== ========================== ========== == te~~~};

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Watertown, N. y ____________
Western Municipal Airport==============
1_______________ _______________ June 2, 1930
West Palm Beach, Fla ___ ____ Palm Beach 1 __________ _ _______________ ____________
__ _ ____ Dec.
2, 1929
TotaL ________ ___ ___________________________________ ________ __________ ____ ___ _________ ______
__ ___ __
1

Temporary permission.

2

No medical officer of Public Health Service.

}
(2)
(2)
(2)

63
254

63
189

154

0

939

0

0

0

0
4
590

0
4
0

0
11
1,766

0
11
0

0
0
0

0
0
0

452
2,124

452
1,667

0
318

0

------------ ------------ ------------ ------------ ----------- ---------- ------------- ------------ --- --------- --- ------------------ ------------ -- ---- ------ ---------- -- ---------213
213
997
997
24
0

4,479

3,137

25,351

21,028

2,672

a Authorized for use but not officially designated.

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Federal Reserve Bank of St. Louis

PUBLIC HEALTH SERVICE

143

REPORTS FROM CONTINENTAL QUARANTINE STATIONS

.Aberdeen, Waish.-Acting Asst. Surg. J. B. Kinne in charge. Post-office and
telegraphic address, Aberdeen, Wash.
This quarantine station serves the three cities of Hoquiam, Aberdeen, and
Cosmopolis, with Aberdeen in the center. The majority of vessels entering
these ports are in the oriental lumber trade, practically all loading lumbe1·
for Japan. Being lumber-carrying ships, they did not, as a rule, harbor many
rats.
During the fiscal year 13 foreign ships were inspected. at this station, of
which number 7 were Japanese, 2 Norwegian, 2 British, 1 Italian, and 1
Belgian. No quarantinable or infectious disease was found among the crew
of any of these vessels.
Baltimore, Md.-Surg. H. F. White in charge. Post-office and telegraphic
address, Curtis Bay, Baltimore, Md.
Shipping entering the port of Baltimore during the past year was slightly
below normal. Vessels brought cargoes from m any 0otmtries and consisted
chiefly of ferromanganese from England; iron ore from Cuba, Chile, Europe,
and Australia; magnesite from Italy; pyrites from Spa in; crude oil from
Mexico, Colombia, and Venezuela; fruit from Cuba, Jamaica, Guatemala, and
Honduras; lumber from British Columbia, the Philippines, and South America ;
and general cargoes from many parts of the world.
There were inspected, fumigated, or otherwise treated during the year, 1,036
vessels, of which number 256 were fumiga ted with hydrocyanic-acid gas and
99 were inspected and given deratization exemption certificates.
The general sanitary condition of the ships entering this port was good and
no quarantinable diseases were discovered. Passenger traffic through this port
has been incidental to cargo vessels having limited accommoda tions; however,
the Baltimore Mail Steamship Co. inaugurated a passenger line operating
from Baltimore to Havre and Hamburg, and it is anticipated that there will
be an increase in such traffic in the future.
Boca Gra;nde, Fla.-Acting Asst. Surg. H. P. Bevis in charge. Post-office and
telegraphic address, Boca Grande, Fla.
During the year 12 vessels arrived at this port from foreign ports and were
inspected. These vessels were practically all new modern ships of the latest
approved construction without rat harborage. No quarantinable diseases were
encountered.
Boston, Mass.-Surg. A. R. Sweeney in charge. Post-office and telegraphic
address, Gallops Island, Boston, Mass.
This station is located approximately 1 mile from the mainland and 5 miles
from the Army base, Boston, where a delivery office is maintained for rhe
reception and storage of station supplies and as a waiting room for station
personnel; also dock space is here available for the station boats when not
in use at the quarantine station. Limited supervision is exercised over the
qua rantine activities at the subports of L ynn, Salem, a nd Beverly.
Beginning September 2, 1930, the station inaugurated the plan of quartering
the boat personnel and one junior medical officer on the station, and t ying
up the boarding boat at the station instead of at the Army base in Boston,
as formerly. As a consequence, early morning boarding is accomplished
more promptly and the change is much more satisfactory to the shipping
interests.
Despite the general decline in commerce as a consequence of the world-,vide
depression, the number of vessels a rriving at this port decreased but 11 per
cent during the past fiscal year. The general character of commerce, notably
passenge r traffic and importation of raw and manufactured materials and
exports, mainly of manufactured products, was maintained. Besides many
foreign vessels making the port of Boston the regular port of discharge for
all cargo, many steamship lines make this the original port of entry from all
parts of the world, handling a great variety of raw and manufactured goods.
These vessels discharge part of their cargo at this port and thence proceed
to contiguous Atlantic ports for final discharge. Some of the main items of
imports are fruit from the West Indies and Ceri.tral American ports ; oil from
Mexico and South America ; coal from Russian ports on the Black Sea and
ports in the United Kingdom ; mahogany, pnlm oil, cocoa beans, ivory, etc.,
from Africa; rubber, coffee, jute, and manufactured goods from the Far and
Near East; coffee, hides, casein, etc., from South American ports; iron ore
from African and Newfoundland ports; and miscellaneous cargoes of raw


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and manufactured goods from the continental European ports on the Mediterranean, Baltic, and Black Seas, Atlantic ports, and ports of the United
Kingdom.
There was a reduction in the number of passengers passing through this
port during the year. This reduction is largely accounted for in the decline in
immigration. Cabin and tourist passenger traffic apparently suffered little
decline. The several large passenger lines operating from German, United
Kingdom, and Irish ports maintained their regular sailings. A Canadian
steamship company inaugurated regular sailings during the year, handling tourists between Halifax, Boston, and West Indian ports. The passengers handled
by this agency has helped to maintain the number of cabin and tourist passengers handled through this port.
During the year 884 vessels were inspected, on which were examined 60,752
seamen and 33,934 passengers. There were 182 vessels fumigated , with a total
capacity of more than 78,000,000 cubic feet and more than 521,000 n et tonnage.
The rats recovered after fumigation were all autopsied and examined for
plague, and inoculations of guinea pigs were made of suspected rodents. No
plague-infected rats were found. Zyklon-B is exclusively u sed as a fumigant.
Fifty-six vessels were issued deratization exemption certificates after thorough
inspection.
Continued improvement is noted in the sanitary condition of vessels entering
this port. Fevver rats are obtained after fumigation, which is no doubt
accounted for by the improved character of construction of new vessels and
the elimination of rat harborages on older vessels, as well as to the greater
precautions taken to prevent the ingress of rats. These facts are evidenced by
the acceptance of 145 foreign deratization certificates and 76 foreign deratization exemption certificates after inspection showed no evidence of rat
infestation.
During the year no vessel was required to be detained on account of quarantinable disease. Special precautions, however, were taken for the prevention
of the importation of smallpox from Central America and certain Far East
ports, and the medical officers were on the alert also for the detection of any
cases of plague from certain South American, West African, and far eastern
ports.
A new Diesel tug, the George B. Loring, 91 feet in length, with 20-foot beam
and electrically driven auxiliaries, was received at the station July 1, 1930.
This tug replaced the old steam tug Waterhouse, which was sold. The other
boat attached to the station, the Town.send, is also of Diesel construction, and
since there has been observed a notable economy, both as regards fuel consumption and in operating personnel.
Brunswick, Ga.-Acting Asst. Surg. H. M. Branham in charge. Post-office
and telegraphic address, Brunswick, Ga.
The foreign commerce entering this port consisted for the most part of cargoes
of sugar from Cuba, crude oil from Mexico, and fertilizing material from Chile
and Germany. The vessels engaged in this trade, with but few exceptions, were
well kept and practically rat free. No quarantinable diseases were encountered
during the year.
Oa,pe Fear, N. 0.-Acting Asst. Surg. J. Arthur Dosher in charge. Post-office
and telegraphic address, Southport, N. C.
Foreign commerce entering this port during the year was very light, but 51
vessels arriving during that period requiring inspection. These vessels were,
for the most part, from the west coast of South America, the West India
Islands, and European ports, with miscellaneous cargoes. All fumigations at
this port are made with sulphur, 10 such fumigations being performed during
the year.
Charleston, S. 0.-Senior Surg. C. M. Fauntleroy in charge. Post-office and
telegraphic address, Charleston, S. C. Administrative headquarters and detention facilities are maintained at the station located on James Island about 10
miles by roadway and about 3 miles by water from the city of Charleston.
The majority of vessels calling at this port are coastwise and therefore
not subject to inspection unless there be quarantinable disease on board. The
few vessels which arrive from foreign ports requiring inspection anive principally from ports in Europe and South America. One vessel carrying fruit
cargo operates on a regular weekly schedule from ports in Central America.
The cargoes received direct from foreign ports consists of nitrates from South
America and general cargo from European ports.


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Owing to the established practice of performing ship fumigations while at
anchor in the open stream, sulphur fumigations have been done for the most
part; however, it is occasionally practicable to fumigate vessels while lying
at the wharves at Charleston, in which case the fumigant used is Zyklon-B.
Oolumbim River, Oreg'. -Acting Asst. Surg. R. J. Pilkington in charge. Postoffice and telegraphic address, Astoria, Oreg.
The great majority of vessels calling at Astoria are freighters. A number of
combined freight and passenger vessels make this a port of call, but for the most
part these vessels have received the necessary quarantine treatment at a prior
United States port. Only two passengers arrived on vessels requiring inspection ; 2,703 members of crew were examined.
During the fiscal year 47 vessels arrived from foreign ports and were inspected. Of this number, 31 were Japanese vessels. Twenty of these vessels
were fumigated-2 with sulphur and 18 vvith Zyklon-B.
Coos Bay, Oreg.-Acting Asst. Surg. Everett Mingus in charge. Post-office
and telegraphic address, 129 Broadway, Marshfield, Oreg.
All fumigations at this port are made with sulphur. As there are no
service facilities available for the performance of this work at this station,
the work is performed by the Indepen'dent Stevedore Co. The vessels entering
this port are of steel construction and are in very good sanitary condition. No
foreign commerce entered this port during the year. The chief export products
were lumber and logs.
Corpus Christi, Tex.-Acting Asst. Surg. M. J. Perkins in charge. Postoffice and telegraphic address, Corpus Christi, Tex.
There has been practically no foreign commerce entering this port during
the year, but 45 vessels arriving during that period r equiring inspection. The
principal exports consist of cotton, lead, and sulphur. There is also a moderate amount of coastwise shipping of merchandise. No quarantinable diseases
were encountered during the year.
Cumberland Sound, Fla.-Acting Asst. Surg. D. G. Humphreys in charge.
Post-office and telegraphic address, Fernandina, Fla.
The foreign commerce entering this port consists principally of vessels from
European ports calling for phosphate cargoes. All entered coastwise with the
exception of four, which were required to undergo inspection, one of these being
fumigated for the destruction of rodents. Because of their construction and
the nature of their cargoes, these vessels presented but slight quarantine risks,
and no quarantinable diseases were encountered.
Eastport, Me.-Acting Asst. Surg. John E. Brooks in charge. Post-office
and telegraphic address, Eastport, Me.
The majority of vessels calling at Eastport are small freighters from Canadu,
which are not required to undergo quarantine inspection. But one vessel
arrived during the year from foreign ports requiring inspection-a Norwegian
steamship, which was inspected and given free pratique.
Fall River, Mass.-Acting Asst. Surg. Thomas Cox in charge. Post-office and
telegraphic address, 1244 Pleasant Street, Fall River, Mass.
During the fiscal year ended June 30, 1931, a total of 62 vessels arrived. The
crews of these ships numbered 2,205 persons; five passengers were carried.
These ships were all oil t an kers sailing chiefly from Curacao, Dutch West
Indies, and owing to the character of the cargo the attending quarantine risks
were slight.
Fort Monroe, Va.-Medical Director J .. W. Kerr in charge. Post-office and
telegraphis address, Fort Monroe, Va.; hospital and detention barracks, Craney
Island, Norfolk, Va.
This station serves vessels entering Hampton Roads destined for Norfolk or
Newport News, Va. Boarding is done at Fort Monroe; whenever necessary subsequent inspections are made at wharves at Norfolk, Newport News, and Berkley.
Sulphur fumigations are performed at Fort Monroe and cyanide fumigations at
the respectives wharves.
During the year 369 vessels from foreign ports were inspected on ~rrival. On
account of the world-wide financial depression, international•commerce was much
diminished. A total of 76 vessels were fumigated to destroy rodents and 9
were inspected and granted deratization exemption certificates. The number of
rodents recovered after fumigation is becoming progressively less, indicating that
the measures taken under the international sanitary convention of Paris, 1926,
are becoming more effective. A total of 237 passengers and 13,728 seamen were
inspected. There were no quarantinable diseases among them.


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During the year the reconditioning of the Ar{fUs, which was delivered at the
Fort Monroe quarantine station during the preceding fiscal year to replace the
station ship Chase, which had become unserviceable, was completed, and this
vessel is now well suited to the needs of the station.
During the year the Engineer: Corps of the Army pumped dredgings over the
island to a depth of several feet, and upon completion of the riprapping of the
shore line, for which provision has been made, it will be practicable to fill up low
places on the quarantine grounds proper, thus making the surface of the entire
island a uniform height.
Galveston, Tex.-Acting Asst. Surg. Fleetwood Gruver in charge. Post-office
and telegraphic address, Galveston, Tex.
The quarantine station at Galveston is situated about 2 miles fr om the city,
at the extreme end of P elican spit, on filled land. This point is inclosed on the
north, east, and part of the west sides by a riprap of granite cubes which form
an admirable breakwater. On the remaining part of the west side is a fill of
gravel and loose rock to a height of from 2½ to 3 feet. On the east side of the
station is a wharf about 125 by 10 feet, set on piles, a.bout 25 feet from the riprap retaining wall and parallel to it. This wharf is connected to the grounds
by a small wooden bridge which approaches immediately in front of the office
building. A steel bulkhead extends from the southeast corner of the station
grounds to the Coast Guard station reservation, a· distance of about) 2,300 feet.
Behind this bulkhead, dredgings from the channel are pumped, and it is expected
eventually that the low land between the station and the Goa.st Guard property
will be filled.
All vessels arriving from foreign ports destined for Galveston or places on the
Houston Channel anchor in the Roads, a distance of l½ to 2 miles, and are
visited there by the medical officer and given the necessary quarantine treatment.
During the past year there has been a perceptible decrease in the number
of vessels arriving from foreign ports, 711 during the fiscal year 1931 , as compared with 804 during the fiscal year 1930. A total of 103 vessels was fumigated
during the year; this was also a decrease as compared with the last fiscal year.
One thousand four hundred and six passengers and 26,282 seamen were examined.
Georgetown, S. 0 .-Acting Asst. Surg. Olin Sawyer in charge. Post-office
and telegraphic address, Georgetown, S. C.
During the fiscal year 10 vessels entered the port of Georgetown direct from
foreign ports. Other vessels arriving at this port were either engaged in coastwise shipping or had landed at other American ports prior to entry at this port
and consequently had received the necessary quara11tine treatment prior to
arrival here. Of the vessels arriving from foreign ports, 4 were American,
4 British, and 2 Norwegian. The Norwegian ships were new, motor driven, and
built of steel, and the others \Vere sailing and motor-driven vessels. All these
vessels arrived empty for the purpose of taking on cargoes of lumber and showed
few rat harborages. The crews manning these ships numbered 148 persons. No
quarantinable diseases were encountered.
·
G11,lfport, M'iss.-Acting Asst. Surg. 0. A. Sheely in charge. Post-office and
telegraphic address, Gulfport, Miss.
Quarantine inspections are conducted in the channel off Gulfport and the
detention station at Ship Island is maintained under the charge of a caretaker.
During the year 31 vessels from foreign ports were inspected. No qua rantinable diseases were encountered.
J acksonviUe, Fla.-Acting Asst. Surg. R. S. Wynn in charge. Post-office and
telegraphic address, Jacksonville, Fla.
There has been a slight decrease in the total number of vessels inspected
during this fiscal year; also a slight decrease in the number of vessels fumigated.
The station is located at the United States Army Engineers dock, and the
service is allowed the u se of their f acilities and equipment at this dock.
The foreign commerce entering this port consists principally of f ertilizer
material. Quite a number of the schooner type of vessel enters this port from
Central and South American ports. During the year a total of 146 vessels
arrived from foreign ports and were inspected, 19 of this number being fumigated. No quarantinable diseases were encount~red during the year.
l(ey West, Fla.-Acting Asst. Surg. J. Y. Porter, jr., in charge. Post-office and
telegraphic address, Key West, Fla.
Boarding of vessels is done both in the stream and at dock; seaplanes are
inspected Vi7here they alight, and land planes are inspected at the Meacham
Airport, located on the southeastern part of the island of Key West. Vessels


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arriving at this port are mainly steamships and yachts from Cuba, the former
bringing fruit and merchandise ; small schooners from Central America and
Cayman Islands, bringing fruit and turtle ; steamships in ballast from Europe,
coming in for bunkers and orders; and occasionally yachts from the Bahama
Islands. The majority of vessels are of the modern steel-hull type, with
slight rat harborages and practically no rat infestation. The schooners, however, are of wood and afford extensive harborage for rats. Fumigatioc1s are
performed ·with sulphur and are accomplished in the stream.
One case of smallpox arrived from the Cayman Islands during the year.
The vessel was detained, routine fumigation was performed, and the crew was
vaccinated.
Two seaplanes, from Habana, Cuba, carrying no alien passengers or crew,
arrived at this port during the year. No quarantinable diseases were encountered ·on these planes.
Marcus Hook), Pa..-Medical Director C. W. Vogel in charge. Post-office and
telegraphic address, Marcus Hook, Pa.
The quarantine station at Marcus Hook, Pa., is the boarding and de tention
station for Philadelphia, Chester, Marcus Hook, Wilmington, and other ports
on the Delaware River. Additional detention facilities are maintained at
Reedy Island. The quarantine station is situated on the west bank of the
Delaware River, about 18 miles below Philadelphia. The medical officer in
charge of the quarantine station at Marcus Hook is also in administrative
charge of the office for the fumigation activities of the service located in the
<'Ustomhouse, Philadelphia. He is also in charge of the medical examination
of aliens for the port of Philadelphia, with a medical assistant in Philadelphia
and one at the im~igration station at Gloucester, New Jersey.
During the year the United Fruit Co. instituted a passenger service to this
port, and in the future one of their large vessels will can at Marcus Hook on
the voyai:re to New York from the West Indies and South American ports. A
total of 887 vessels, carrying 2,182 passengers and 33,048 crew, arrived during
the fiscal year and were inspected. No quarantinable diseases were encountered.
Mia·m i. Fla.-Surg. Carl Michel in charge. Post-office and telegraphic address,
1001-1005 Newstower Building, Miami, Fla.
The majority of vessels entering this port are from the West Indies, and
during the winter months, a great many private yachts are entered. The
number of vessels inspected during the fiscal year was 793, an increase of 77
over the past fiscal year. As there is no anchorage availab1e at this port,
inspection of vessels is made at the various docks about the harbor. The
number of freight vessels ari'iving at Miami is very few, and cons0quently the
quarantine risks are reduced to a minimum. Passengers arriving on vessels at
this port are for the most part American tourists and comparatively few aliens
were inspected during the year.
The port of Miami may be considered a growing port, and a grndual yearly
increase in quarantine activities is anticipated here. The need for a new quarantine station at Miami has been apparent for many years, and for this purpose
the War Department bas transferred to the Treasury Department approximately
14 acres of land on Fishers Island as a site for a new quarantine station. ,vork
on the building of this new station is now in progress.
In addition to the inspection of arriving vessels at Miami, the medical officer
also inspects all airplanes arriving at that port from foreign ports. These
inspections are performed in a special designated quarantine area immediately
after landing. The passengers carried by these planes are of the better class,
corresponding to the first and second class passengers on large liners; the
number of such passengers arriving at l\1iarni during the year was 7.361, which
was an increase over the preceding year. The number of planes· totaled 1,480,
a slight decrease as compared with the year 1930. No quarantinable disrases
were encountered on these planes ; and as a special precaution against the
introduction of smallpox into the United States, all employees of the Pan
American Airways were vaccinated against smallpox.
Mobile, Ala.-Passed Asst. Surg. R. E. Bodet in charge. Post-office and
telegraphic address, Mobile, Ala.
Vessels arriving at this port requiring inspection are boarded under way in
the main channel and allowed to proceed to Mobile while undergoing inspection. Fumigations are performed at the various wharves in the harbor after
the vessels have discharged their cargo, except when a preliminary fumigation
is necessary. The lack of a suitable dock at the station alongside of which
vessels requiring quarantine treatment or detention could be tied up tends to


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PUBLIC HEALTH SERVICE

detract from the efficiency of operation, but the construction of such a station
wharf is contemplated.
The majority of vessels entering Mobile are steel-hulled steamships, many
of which are of rat-proof construction. A small trade is carried on by sailing
vessels with the Cayman and West Indian Islands; these vessels are not rat
proofed. The principal imports are bananas, quebracho and quassi woods,
coconuts, newsprint paper, sodium nitrate, kanite, bauxite, fertilizer, cane·
sugar, molasses, ammonium chloride, manganese ore, and jute bagging. Steamship service from Mobile includes trade with the West Indies, Mexico, Central and South America, Europe, the Philippines, India and the Orient, the
north coast of Africa, and South Africa.
During the year no quarantinable diseases were encountered, but one vessel from Rio de Janeiro arrived with two seamen who had an elevated temperature. The two cases were removed to the station hospital, the crew were
detained at the station, and the vessel was fumigated and allowed to discharge cargo under supervision. It was determined that the cases were not
yellow fever, and as no elevation of temperature appeared among other members of the crew, the crew and vessel were released.
Sulphur as a fumigant has been largely replaced by the use of the hydrocyanic-acid preparation, Zyklon-B and HCN discoids. Fumigations late in
the day, when the use of hydrocyanic-acid gas might be dangerous, are done
with sulphur or with a combination of sulphur and cyanide. Rodents recovered after several mandatory fumigations were examined but none showed
evidence of plague.
During the year a total of 242 vessels were inspected, 52 were fumigated, and
20 exemption certificates were issued.
New Bed.ford, Mass.-Acting Asst. Surg. E. F. Cody in charge. Post-office
and telegraphic address, 105 south Sixth Street, New Bedford, Mass.
Vessels arriving at this port during the year numbered 8, comprising 4
American yachts (3 returning from Bermuda and 1 from a world cruise) and
4 packets in the Cape Verde trade. The packet boats were fumigated after
discharge of cargo. No quarantinable diseases were encountered.
New Orleans, La,. -Surg. T. J. Liddell in charge. Post-office and telegraphic
address, room 305 Customhouse, New Orleans, La.
The new quarantine station in course of construction on the site acquired by
the Treasury Department in 1927 is nearing completion and will be one of the
most modern and up-to-date quarantine stations of the service. It is situated
on the south bank of the Mississippi River, 3 miles below the Algiers landing
of the Canal Street ferry. It is anticipated that this new station will be in
operation about October 1, or shortly thereafter, when it will be possible to
abandon the stations at Flood Street, in the city of New Orleans, and at Quarantine, La., near the mouth of the river, 90 miles below. The fumigation
plant on Chartres Street and the administrative offices in the customhouse can
also be moved to the new site and all activities combined at one place.
During the year a total of 318 vessels, with an aggregate tonnage of 883,222
tons and a cubic capacity of 115,713,493 cubic feet, were fumigated at this
station. Various fumigants were used, but HCN discoids with 5 per cent
chloropicrin as a warning gas have been adopted as the routine fumigant ..
About 20 per cent of the vessels are oil tankers, 40 per cent fruit vessels, and
40 per cent general cargo vessels, including about 4 per cent passenger vessels.
From the South American ports the vessels usually carried petroleum and
bauxite. From the Far East copra and hemp, and the around-the-world Japanese vessels carried passengers. From European ports the cargo was miscellaneous in character, and from the Central American ports the cargo was
principally bananas.
One case of smallpox was removed from the American steamship Parismina
and one case from the American steamship Turrialba. The sick men were
placed in the station hospital at the lower quarantine station and held until
they bad recovered. All contacts were vaccinated and detained until vaccination was protective. Due to an outbreak of smallpox in a near-by Central
American port the personnel of all vessels from that port were required to be
vaccinated.
In accordance with the act extending the hours of quarantine inspection,
the shipping and other port authorities have requested that 24-hour inspection
service be granted the port of New Orleans. From June 1, 1930, to May 31,
1931, about 53 per cent of vessels arrived between 6 a. m. and 6 p. m. and about


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47 per cent of vessels arrived between the hours of 6 p. m. and 6 a. m. Night
inspection of vessels would be of special benefit to vessels with perishable cargo
and passengers, also to tankers, as practically all of them proceed to ports
above New Orleans, and consequently this class of vessels in many instances
would gain about 12 hours by having night inspection.
New York, N. Y.-Medical Director Carroll Fox in charge. Post-office and
telegraphic address, Rosebank, Staten Island, N. Y.
The administrative, boarding, inspection, laboratory, and fumigation headquarters of the station are located at Rosebank; the hospital and detention
units are located at Hoffman Island, approximately 2 miles south of Rosebank.
Swinburne Island remains inactive, but inspections of the property are made
from time to time by officers from Rosebank. An office is also maintained in
the customhouse, New York, for the issuance of port sanitary statements to
outbound vessels; 14,858 such statements were issued during the fiscal year.
Occasionally throughout the year an officer from the New York quarantine
station is sent to Bridgeport, Conn., to inspect an incoming ship. An inspection
station at Perth Amboy, N. J., is under the supervision of this station, a s well
as a station at City Island, N. Y., but the fumigation of arriving vessels, when
required, is done from Rosebank.
The activities of the station are effected, through the following divisions: (1)
Boarding; (2) laboratory; (3) fumigation and ship inspection for rat infestation; ( 4) rat proofing of vessels; ( 5) hospital and detention-Hoffm an Island;
(6) personnel and accounts; (7) material; (8) buildings, grounds, and m echanical equipment; (9) floating property.
During the year, 4,258 vessels were inspected, including 7 at City Island, 3
at Bridgeport, and 76 at Perth Amboy. Of this number, 3,013 were granted
free pratique and 1,245 were permitted to enter subject to the terms of provisional pratique. Of this latter group, 1,167 were reported to the fumigation
division for disposition and 62 were required to hold parrots on board while in
port. Twenty-seven Army and Navy vessels were passed on certificate from the
ship's medical officer. The measures enforced abroad in connection with the
inspection and embarkation of passengers from areas where typhus fever exists
were materially modified toward t he close of the year, with a resulting decrease
in the number of passengers r equiring removal from ve~els for detention at
Hoffman Island; 67 persons were deloused on board passenger vessels at
quarantine.
The practice of assigning two · medical officers from Ellis Island for the
medical inspection of alien seamen and passengers on cargo vessels was discontinued very early in the year. The number of medical officers regularly
nssigned to boarding at this station was correspondingly increased from four
to six. In cooperation with the Immigration Service, the medical inspection of
.alien passengers and seamen on cargo vessels has been carried on as before,
and daily reports are made to the chief medical officer at Ellis Island. This
uuification of administrative control has been found very advantageous. A
total of 966 alien passengers and 67,952 alien seamen arriving on cargo vessels
were examined for immigration purposes during the year.
The boarding of vessels has been done with as little delay as possible, and
there have been but few complaints of delay, except that incident to ships
anchoring at night. It is anticipated that this delay will be taken care of by
the additional hours of boarding, as contemplated under the act recently passed
to extend the hours of quarantine inspection.
The labora tory has continued to examine for plague infection rats fumigated
on ships, with negative results. Identification of rat fleas and identification of
fleas from other stations has continued. The ra t yield of vessels fumigated
during the past year varies greatly with the yield of the previou.s year. This
is due to the fact that steamship companies are u sing various agencies aboard
to keep down the rat population, such as t rapping, poisoning, private fumigations, and lastly but most important, the elimination of rat harborages and
ratproofing.
Vessels arriving from ports on the Parana and Uruguay Rivers and from
Dakar, Africa, are fumigated before discharge of cargo. In some instances,
when deemed necessary, a second fumigation is performed. When the policy
cf fumigating loaded ships at San Francisco, which were destined for New
York, was established, it was agreed to carry out a subsequent observation at
New York by making rat infestation inspections and trapping whenever practicable. During the past fiscal year 21 vessels of this class were observed, one
of which was particularly interesting on account of its rat infestation. Sixty-


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seven rats were picked up during discharge of cargo; 15 rats were trapped, and
6 ,vere killed with clubs. After leaving the port of New York this vessel sailed
for Philadelphia, Boston, and Baltimore, and a total of 39 dead rats were
picked up at these places during observation there.
Heretofore the inspection for rat infestation has always been made at the
clock when the vessel was empty. Towards the end of the present fiscal yenr
a new scheme was inaugurated, that of having the rat-infestation inspection
made while the vessel was being given the regular quarantine inspection at
the quarantine anchorage. By this procedure the boarding medical officer
can receive th e report of a sanitary inspector before the ship is released from
ouarantine, making it unnecessary to issue provisional pratique and fumigation orde'r except when there are distinct indications for them. A total of
1,428 vessels were inspected on the bay and at the docks, resultin g in postponement of fumigation of 966 vessels on account of absence of rat evidence.
The past year has been one of the most active in the history of the ratpro fing division, clue to the extension of the work to foreign shipyards, as well
as to the supervision of the large number of ships being constructed in American shipbuilding plants. It is now almost a universal procedure to include
rat proofing as a standard requirement in all contracts for construction of
new ships. During the year 23 new. vessels that had carried out rat proofing
during their construction were placed in commission. Of this number, 9 were
built in American shipyards, 5 in those of Great Britain, 5 in Japan, 1 in
Sweden, nnd 3 in Germany. There are now under construction 29 vessels
011 which a complete ·rat-proofing program is being carried out.
Of these
ships 18 are being constructed in the United States, 3 in England, 2 in Italy,
2 in France, 1 in Japan , and 3 in Germany. The rat-proofing specifications
have been incorporated in the standard building contracts of the Navy Department, and w-;as included in that of one of the new treaty cruisers that was
awarded recently. Thirteen visits were made to eastern shipyards during the
~-ear to confer with technical personnel to demonstrate proper methods of
rat proofing and to inspect such work as was being incorporated in the construction of new vessels. Numerous conferences we·re held With naval architects and representatives of shipping interests in New York relative to
rat-proofing work. Included in this number were officials of the Italian steamship lines, the Cunard Line, one of the Dutch Far East companies, a Nor,~egian company operating a number of round-the-world freight and passenger
vessels, and two of the Japanese steamship compimies. Instruction in ratnroofing methods was given to eight medical officers of the service and four
sanitary inspectors during the year. This work was Llemonstrated also to nine
representatives of foreign countires, including health ministers of the Argentine Republic and of the Chinese Government, and a representative of the
health section of the League of Nations. Four other Chinese medical officers
were given instruction in rat-proofing work. Conferences were held with several manufacturers of insulating material which is used in t he construction of
refrigerating and air-cooled cargo compartments f or the purpose of getting
better results in the reduction of rat harborages in such sections. Practical
tests were made of some of the asbes tos material to ascertain if it vrns
impervious to rat gnawing under working conditions. Further study will be
devoted to this phase of the work.
The following data show the scope of the work of the rat-proofing d ivision
during the year :
Number of vessels touching at the
Number of flags r epresented, as
port of New York being rat
follows-Continued.
proofed _____ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ 288
Italian _ _ _ __ _ _ _ _ __ __ __ _ _ _ _ _
8
Number of steamship companies
Spanish_____________ _ __ ___
8
represented_ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ 4 7
Dutch___ _ __ __ _ _ _ _ _ _ _ _ __ __ _
8
Number of flags represented, as
French ____________________
4
follows;
Chilean ____________________
3
American ______ ____ ________ 111
Danish _______ _____ ____ ___ _
3
British _______ ____ ____ _____ 77
Republic of Panama___ _____
1
German __________________ ·_ 18
Japa nese_____ _____________
7
Swedish _____ _________ _____ 11
Mexican _____________ ______
1
Norwegian_ _______ _________ 28
Vessels of the U.S. Navy____
3
During the year 2,495 inspections and 67 rat-proofing surveys and 652 ratinfestation inspections were made by the personnel of the division.


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Poosacola, Fla.-Acting Asst. Surg. C. W. D'Alemberte in charge. Post-office
and telegraphic address, Pensacola, Fla.
The Pensacola quarantine station is situated 7 miles from the town of Pensacola, on Santa Rosa Sound. This station is maintained by two caretakers under
the supervi&ion of the medical officer in charge and is being held to accommodate
such cases of quarantinable diseases and contacts as may be encountered at this
port. The boarding and fumigation of vessels are done at Pensacola. All
ves&els entering this port requiring inspection are boarded and inspected at
anchor 1 mile from shore.
The foreign commerce entering the port consists for the most part of steamships and an occasional sailing vessel. All rats destroyed by fumigation at thie
port are subjected to laboratory examination for evidence of plague. Fumigations are accomplished by the use of Zyklon-B. During the year a total of 60
vessels arrived a t this port and were inspected, 11 of which number were
fumigated.
Portlarnd, Me.-Acting Asst. Surg. Albert F. Stuart in charge. Post-office and
telegraphic address, Portland, Me.
During the fi scal year ended June 30, 1931, 111 steamers and sailing vessels
were im~pected at quarantine. These vessels carried 3,684 seamen and 91
passengers. Eleven vessels were fumigated for the destruction of rodents, and
18 dead rats were round following fumigation. No quarantinable diseases
were observed during the year.
Portla,n d, Oreg.-Passed Asst. Surg. F. S. Fellows in charge. Post-office and
telegraphic address, 429 Mayer Building, Portland, Oreg.
Portland, Oreg., is the headquarters for quarantine operations along the
Columbia and Willamette Rivers, and every effort is made to expedite local
shipping. During the year 17 vessels were inspected and 12 ves&els were fumigated. Three deratization exemption certificates were issued. In spite of the
decreased foreign trade and the fact that several oriental shipping lines have
made the Columbia River an intermediate rather than a primary port of call
there were the same number of ve&sels and 30 more seamen inspected at this
station during the fiscal year ended June 30, 1931, as compared with the
preceding year.
Port Towns end, Waslt.-Surg. 0. H. Cox in charge. Post-office and telegraphic address, Port Townsend, Wash. (Boarding and inspection station, Port
Townsend, Wash.; ho&pital and disinfecting station, Diamond Point, Wash.)
The Port Townsend quarantine station serves all ports on the Puget Sound
and its tributaries, the largest port being Seattle. All vessels subject to quarantine entering Puget Sound are boarded and inspected at Port Town&end.
The majority of fumigations are performed at Seattle; a very small number
were fumigated by sulphur while at anchor in Port Townsend Bay.
Providence, R. J.-Surg. H. G. Ebert in charge. Post-office and telegraphic
address, room 403 Federal Building, Providence,, R. I.
Foreign commerce entering thiR port consists of passenger vessels en route
to New York from Mediterranean ports, Lisbon, Madeira, and the Azores
group of islands; tankers from Aruba, Dutch West Indies, and Tampico,
Mexico; colliers from Welsh and Russian ports ; lumber ships from Leningrad and Archangel ; two small schooners carrying passengers from Cape Verde
Islands; and one schooner with salt from Grand Turk. Ninety-six vessels
were inspected, of which 88 were given free pratique and 8 were allowed to
dock under provisional pratique. On vessels subject to inspection, there were
6,466 members of crew and 5,577 passengers. No quarantinable diseases were
encountered.
St. Andrews, Fla.-Acting Asst. Surg. W. J. Blackshear in charge. Postoffice and telegraphic address, Panama City, Fla.
It is anticipated that shipping through this port will show a decided increase
in the near future. An up-to-date dock and terminals have been completed
and a large paper mill has been erected by the Southern Kraft Corporation.
It is reported that there has already been listed for export in the fall and
winter a large quantity of cotton. The amount of foreign commerce entering
during the past fiscal year was very small, but seven vessels arriving from
foreign ports requiring inspection, two of which number were fumigated.
Sabine, T ex.-Surg. W. A. Korn in charge. Post-office and telegraphic
address, Sabine, Tex.
This station serves the ports of Sabine, Port Arthur, Port Neches, Beaumont, and Orange, Tex., and Lake Charles, La. The boarding, inspection, and
fumigation of vessels is done at Sabine, while the general administration of


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quarantine matters of the entire district are maintained in the Federal Building at Port Arthur, Tex.
On the new site for the quarantine station some of the old buildings and
machinery used by the Union Sulphur Co. have been dismantled and removed.
Two accidents occurred to the dock : First, a fire which burned the middle
section and second, a collision of a Texas Oil Co. tanker with the dock, resulting' in aimost complete demolition of the dock and practically. necessitating
the building of a new dock.
Outbound cargoes from the port of Sabine consist of oil and oil products,
lumber, wheat1 and rice. Inbound cargoes are small lots of general merchandise. The vessels arriving at this port am chiefly tankers and consequently the quarantine risks are moderate. No vessels were detained on account of quarantinable disease.
San Diego, Oalif.-Surg. J. W. Tappan in charge. Post-office address, San
Diego quarantine station, Point Loma, Calif. ; telegraphic address, San Diego,
Calif.
No vessels carrying quarantinable diseases entered the port of San Diego
during the year. A total of 626 vessels arrived. There were 283 fishing
boats, which outfit in San Diego and fish off the coast of Mexico before their
return, and 282 other vessels which came from Mexican ports. These latter
were either excursion boats, yachts, or small cargo-carrying vessels with cargo
for San Diego. Vessels from foreign ports, not including those from Mexico,
numbered 43. This number includes intercoastal vessels, via the Canal Zone,
which touched at foreign ports en route.
Beginning November 1, 1930, the routine inspection of airplanes from near-by
airports in Mexico was discontinued. Airports thus involved were Ensenada,
Tia Juana, Agua Caliente, and Mexicali. The quararttine risks from such
travel were considered negligible.
The total number of vessels inspected at this port during the year totaled
607. These vessels carried 15,471 passengers and 18,278 members of crew.
Three hundred and thirty-nine planes arrived from foreign ports and were
inspected, together with 1,582 passengers carried on these planes.
San Luis Obispo, Calif.-Acting Asst. Surg. T. S. Long in charge. Post-office
and telegraphic address, San Luis Obispo, Calif.
The port of San Luis, where quarantine inspections are made, is located in
the town of Avila, 10 miles west of the city of San Luis Obispo. There
are no facilities for carrying out quarantine treatment there.
Steamship service to and from this port is confined largely to oil tankers,
operated for the most part by the Union Oil Co., and to a few small coasting
vessels. Shipments of crude and fuel oils and gasoline amount to about 98
per cent of the total port traffic. Tankers operated by the Standard Oil Co.
requiring quarantine inspection as a rule put into this port instead of Estero
Bay, 15 miles north of San Luis Obispo, on account of inadequate boarding
facilities at the latter place. A total of 12 vessels with 483 seamen were
inspecteo and passed with no infectious or contagious diseases encountered.
San Francisco, Ca.zif.-Surg. H. A. Spencer in charge. Post-office and telegraphic address, Angel Island, Calif.
Quarantine activities are administered from the station office, with a dock
substation in San Francisco adjacent to the boarding tug. Fumigations, ship
inspection for rat infestation, storing of fumigation equipment, and pertinent
certificates are taken care of at that office. Vessels are boarded in the stream
and at anchor. The principal commerce of this port is with the Orient. Vessels
arrive from Europe, South America, and Mexico, but are, with very few exceptions, coastwise. The principal imports are silk, dried vegetable products, rice,
oil cake, canned meats from Japan; vegetable oils·, nuts, rice, tea, and minerals
for use in manufacturing pottery from China ; burlap, pig iron, steel, and
fertilizer from India and Straits Settlements; copra, frozen rabbits, lumber,
and oil cake from Australia; iro)l and steel manufactured goods, fertilizer,
olive oil, glass, toys, and minerals used in tile, brick, and pottery from Europe.
The quarantine risks at this port are somewhat minimized by the time required in transit from the Orient, the presence of ship surgeons aboard all
passenger boats and a decreased incidence of major quarantinable diseases in
the ports visited. Vigilence, however, is continued, and a complete detailed
sick report is required from every vessel carrying a medical officer. In addition,
a careful inspection is made of all persons in the hospital or quarters when the
ship arrives. Ship operators are becoming cognizant of the economic advantages of having competent medical personnel on passenger vessels. One
company gives, when possible, a course of instruction to ship surgeons, stressing
those features pel.'taining to quarantine and immigration problems.

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The only quarantinable disease that arrived at the port during the year were
two cases of smallpox. One, the American steamship Manoa, arrived on July
2, 19'30, from Honolulu, Hawaii, with a passenger _suffering from smallpox. All
were vaccinated at sea by the ship surgeon on June 30. There were 82 passengers and 82 crew aboard. Reactions were read on July 2, and 64 passengers
and 77 members of the crew were released. Fifteen passengers and five of the
crew were revaccinated. The patient, six other passengers. and five members
of the crew were detained at the quarantine station. The second, the American
steamship Tuiseuas, arrived from Seattle, Wash., on January 28, 1931, with a
member of the crew sick from smallpox. The vessel proceeded to dock without
quarantine inspection, the patient was placed in a local hospital, and the crew
was granted shore leave as usual. Thirty-four members of the crew were
eventually brought to the quarantine station, isolated, vaccinated, and released
after developing reactions indicating immunity to smallpox. The quarters in
which the patient lived was washed down with a 1-500 solution of bichloride
of mercury under the supervision of a service officer. All bedding in the
quarters was brought to the quarantine station and sterilized by steam under
pressure. The vessel was not detained. No subsequent cases developed in
either instance so far as known.
Restrictions on the importation of parrots have been enforced as provided
by the Executive order and regulations promulgated thereunder. One hundred
and four parrots have been detained at the station for the 15-day period required; 101 parrots and parrakeets were refused admission and were either
killed or deported. No cases of psittacosis has been observed in either person or
parrot.
Liquid hydrocyanic acid and Zyklon-B, both supplemented with chloropicrin,
constitute the only fumigants used during the year. A total of 557 vessels were
inspected, and 466 of this number were fumigated.
S(l{YI, Ped-ro, OaUf.-Surg. H. E. Trimble in charge. Post office and telegraphic
address, 111 West Seventh Street, San Pedro, Calif.
The administrative activities are performed in a suite of offices convenient
to the :water front. Ships arriving are reported by a marine lookout to the
boarding officer in sufficient time for the quarantine tug to be alongside the
vessel by the time it drops anchor. Customs, Immigration, Agriculture, and
Public Health Service officers board simultaneously. A total of 1,428 vessels,
with 59,593 crew and 11,031 passengers, received quarantine inspection during
the year. The number of vessels fumigated decreased, owing to the increasing
number of acceptable deratization certificates issued at foreign ports and to the
greater number of deratization exemptions found justified upon inspection of
vessels here. Many vessels stop for bunker oil only, and hence warrant remand
to the port at which cargo is to be discharged. During the year 178 vessels were
fumigated, all with Zyklon-B, and 319 deratization-exemption certificates were
given after inspection.
The need of detention facilities at the port of San Pedro is felt, and an adequate site for a quarantine station is now available on Government-owned land
in the harbor.
No aircraft requiring inspection arrived during the year, those from Mexico
having stopped en route at ports of entry on the border. Facilities for inspection, however, are maintained at the Grand Central Air Terminal, Glendale,
Calif.
Sava,rma.h, Ga.-Acting Assist. Surg. M. D. Hollis in charge. · Post office and
telegraphic address, Savannah, Ga.
This station serves the ports of Savannah and Porf Wentworth; the latter
is located about 5 miles west of Savannah. Vessels are boarded as they pass
quarantine, about 14 miles down the Savannah River from Savannah and about
2 miles from its entrance into the Atlantic Ocean. The station is on Long Island,
about 1 mile from a flag station on the Central of Georgia Railroad ('.rybee
branch).
During the year a total of 103 vessels arrived from foreign ports and were
inspected, of which number 78 were given free pratique and 25 were subject to
the terms of provisional pratique. About 35 per cent of the vessels arriving
from foreign ports were of American registry and the remaining 65 per cent
were of foreign registry, representing the following nations: Germany, 17 ;
Norway, 17; British, 13; Denmark, 7; Sweden, 4; Italy, 3; Netherlands, 2;
Japan, 2; Chile, 1; and France, 1. All fumigations are done with cyanide in
the form of Zyklon-B, and vessels are held only about half the time that was
80597-31-11

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necessary in performing fumigations with other methods. A total of 20 vessels
were fumigated for the destruction of rodents and 4 were inspected and granted
deratization exemption certificates. A total of 3,679 seamen and 228 passengers
were inspected under the quarantine laws. No quarantinable diseases were
encountered.
There was an increase of 8 per cent in the number of vessels arriving during
the fiscal year 1931, as compared with the fiscal year 1930; 67 of these vessels
were bound for Savannah and 36 to Port Wentworth. A small per cent of
them arrived from Chile, the United Kingdom, and North European ports.
There were 11 vessels arriving from India, the Mediterranean, Peru, and other
plague-infected ports, with cargoes of burlap, potash, nitrates, etc.
Considerable dredging of the Savannah River has been done by the Engineer
Corps of the Army during the year in order that ships may have access to this
port, some of the mud and sand being pumped around the quarantine station to
fill in the low places and lessen the breeding of mosquitoes.
Seattle, Wash.-Medical Director L. D. Fricks in charge. Post-office and
telegraphic address, 216 Canadian National Pier, Seattle, Wash.
Quarantine activities at the Seattle station during the fiscal year 1931 consisted for the most part, first, of the fumigation of vessels which have received
quarantine inspection either at William Head, British Columbia, or Port Townsend, and, second, of the medical examination of alien seamen and passengers
the
arriving on vessels which have been given quarantine inspection under
1
reciprocal agreement with Canada, at William Head, British Columbia. During the year 154 vessels were fumigated at Seattle and five at Tacoma by the
Seattle fumigating squad. All fumigations were performed with Zyklon-B.
Seventy-nine of the vessels fumigated at this station during the year were
trans-Pacific liners, which, under the quarantine regulations, are given fumigation at the termination of each voyage across the Pacific of approximately two
months' duration. Sixty-four other vessels fumigated were in the mandatory
class, and the majority of these were from oriental ports, but with irregular
sailings. Fourteen vessels were given quarantine inspection at this station
during the year, of which 4 were silk and passenger carrying vessels, which
were allowed to pass Port Townsend at night and receive inspection at Seattle
at sunrise the following morning. Seventeen vessels, which had received quarantine inspection at William Head under the reciprocal quarantine agreement
with Canada, were boarded at Victoria and five were boarded at Vancouver
by a medical officer from the Seattle quarantine station in order to make
medical examinations of arriving aliens while en route to Seattle.
The rat-control program conducted in cooperation with the city health department of Seattle was under the supervision of the Seattle quarantine station,
the rat-control force consisting of five trappers furnished by· the city health
department and two inspectors supplied by the Public Health Service. During
the year 15,110 rats were trapped within the city, 476 dead rats were collected
on board ship following fumigation, and 6,950 rats were necropsied at the rat
laboratory for evidence of plague. Eighty-seven rats were trapped alive and
examined for fleas, on which 183 fleas were collected. In addition to the
rat-trapping program, 159 pounds of poison was distributed during the year.
During the year 590 airplanes, carrying 645 crew and 1,121 passengers, arrived at Seattle airports from foreign countries. AH of these planes came from
near-by Canadian ports. No medical inspections were made of the crews and
passengers on these planes. Th_e danger of the introduction of quarantinable
diseases into this country through these persons is very slight.
South Bend, Wash.-Acting Asst. Sur;?;. Francis W. Anderson in charge. Postoffice and telegraphic address, South Bend, Wash.
Commerce through this port has been very light during the past year. However, considerable dredging is being done in the harbor by the Engineering
Department, and it is anticipated that shipping will increase to some extent in
the future. A large timber concern has taken over the three largest mills in
the harbor, and as there is considerable timber to be shipped, the future should
show an increase in the export trade. Another development at this port is the
inauguration of trade with Japan in cedar squares, and to some extent spruce
logs for veneer. Since the port dock has been completed, this trade has been
the only source of foreign shipping, six vessels having arrived during the year,
two of which were fumigated with sulphur.
1 Practically all vessels entering Puget Sound pass Port Townsend qua.ran.tine station
and stop there for quarantine inspection, thence proceeding to Seattle for fumigation after
discharge of cargo.


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Tampa, Fla.-Acting Asst. Surg. P ercy Ahrons in charge. Post-office address,
Tampa, Fla. ; telegraphic address, St. Petersburg, Fla.
The Tampa Bay quarantine station is located on Mullet Key, 28 miles southwest of Tampa, at the entrance to Tampa Bay. This station serves the ports of
Tampa, Port Tampa, and St. Petersburg. Arriving vessels are inspected at
· anchor off the quarantine station. Fumigation is carried on for the most pa rt
at the station dock, when vessels are not of too deep draft. It occasionally
happens that vessels arrive at this station drawing 18 feet or more, in which
event they are fumigated in the stream or allowed t o proceed to T ampa to be
fumigated before loading.
During the year, 228 vessels arrived at the Tampa Bay quarantine station and
wer~ inspected. The net tonnage of these vessels was 127,408. Of these vessels.
65 wer e fumigated with Zyklon-B, aggregating a total of 20,219,176 cubic feet
of space fumigated.
The character of vessels and cargo entering this port has reduced the quaran·u ne risk t o a minimum. Docks where phosphate is loaded are of skeleton
construction, on an isla nd, with only railroad trestle connecting island wit h
mainland. Docks where lumber is loaded is also of skeleton construction, on an
island, with railroad bridge of trestle construction connecting the island with
the mainland. Very few vessels take cargo at the municipal docks, which are
on the mainland. These docks, however, are of recent construction and are
recognized as rat proof. The dock where grapefruit is loaded is a modern,
rat-proof structure.
West Palm, B eaoh, Fla.-Acting Asst. Surg. J. H. Pittman in charge. Postoffice and telegraphic address, West Palm Beach, Fla.
Practically all vessels entering this port are from the British West Indies,
located about 70 miles from West Palm Beach. With the exception of private
yachts, all are small boats with crews of about four in number. Occasionally
a schooner enters this port for lumber.
The medical officer in charge at this station also has been designated to make
the required quarantine and medical immigration examination incident to the
arrival of aircraft at the officially designated airport of entry. These arrivals
have increased the past fiscal year. Recently the Roosevelt Flying Service has
inaugurated a weekly round-trip schedule to the Bahama Islands, taking in
West End, Bimini, and Nassau.
MEXICAN BORDER STATIONS
'1.'.ABLE

4.-Swmmary of quarantine transactions on the Mea,icarn border for fisoai
year ended June 30, 1931

Station

Number inspected
from interior
Mexico

Total
Total number
Number
Total
num- of persons
of local number ber
of
passen- ofpassenpassed
gers in- gers in- persons
disin- without
spected spected fected
treatment

Brownsville, Tex ______
174
3, 156
859,813
862,969
831,935
Calexico, CaliL ______ _
9,799
9, 799
0
9,677
0
Columbus, N . Mex____
294
8, 422
0
8,716
8,555
Del Rio, Tex __ ___ ____ _ 2,229
112, 797
115,026
1,201
112,836
Douglas, Ariz _____ ___ __ 5,119
0
5,119
0
0
E agle Pass, Tex ____ ___
902,938
8, 515
911,453 10,841
902,938
El Paso, Tex_ ___ ______ 7,926 6,035,547 6, 043,473 24,560 6,072,529
Guadalope Gate, Tex __
498
498
Hidalgo, Tex _____ _____
2,928
330,258
333,186
47
331,902
Laredo, Tex ____ __ ____ _ 57,330 1,688,483 1,745,813
1,456 1,728,539
Minerva, Tex ________ _
0
1,714
1, 714
0
1,457
Naco, Ariz____ _________
34
3,767
3,801
0
3,087
Nogales, Ariz ____ ____ __
22,578
29, 447
12
6,869
28,315
Presidio, Tex _____ _____
476
63,436
63,912
213
63,123
Rio Grande, '.rex ___ ___
386
15,518
15,904
11
15,244
Ro ma, Tex _______ ___ __ 3,508
56, 768
60,276
117
58,291
San Ignacio, Tex_ __ ___
147
59
206
0
97
San Ysidro, Calif_ _____
2,823
8,867
11, 690
0
10,682
Sasabe, Ariz _____ ____ __
431
431
0
352
0
Thayer
________ ___ _
T ex ____ __(Mercedes),
125
105,532
105,657
0
105,252
Ysleta, Tex ___.. ________ - .. -----61,029
61,029 -------Zapata, Tex_ ______ ____
193
15, 700
15,893
237
13,449

- --

38, 869110, 298,260

Total Total
num- number of ber of
sick sick reheld for fused
obser- admisvation sion
--- ---

Total
p1eceso
baggag e
disinfected

1,230
0
0
01
358
122
0
81
129
32
0
980
0
9
649
534
7
0
0
2,654
88 126, 165
0
7,224
0
16
1, 45 6
359 -- ------ -------1,214
17
3
5
17,274
190
0
2,061
257
0
3
0
574
0
69
0
1,110
8
2
13
0
565
11
34 4
649
0
0
93 2
1,868
0
0
0
109
0
0
0
904
104
0
0
77
0
2
0
401
0
5
312 -------- -------1,495
2
0

---- - - - - -~- - - - - -40,277

TotaL __________ 101,970 10,304,042 10,406,012


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Total
number of
persons
vaccinated

224

0

-------447

466 132, 07 2

156

PUBLIC HEALTH SERVICE
QUARANTINE OPERATIONS ALONG THE MEXICAN BORDER

Traffic along the Mexican border has greatly increased during
the past few years. The opening of new railroads, the construction
of good roads, and the establishment o:£ air routes from various
points in Mexico is largely responsible for thi.s increased traffic.
The type of passenger carried on planes has been very good, a great
number of whom are composed o:£ American citizens or business men,
and the quarantine risks from such travel is almost negligible.
However, the journey by airplane in most in.s tances being less than
the incubation period for quarantinable diseases, it is very necessary
to be on the alert to detect any possible cases that might arrive.
Travel by automobile, also, has shown a decided increase. With the
construction o:£ good paved roads, an increasing number of person.s
are attracted to the United States to make purchases or for short
visits. Economic conditions in the United States at the present
time are no doubt responsible :£or the curtailment of immigration
:£or permanent residence.
During the past year the Custom.s Service inaugurated the plan
of keeping open :£or 24 hours daily the principal ports along the
United .States-Mexican border. This step, taken largely as a matter of the promotion of international comity, went into effect February 1, 1931. Because of the lack o:£ funds and the consequent
inability of the Public Health Service to provide additional personnel to take care of these added duties incident to 24-hour service,
a rather heavy burden has been placed upon the quarantine officers
on duty at these ports. To meet this emergency, night quarantine
passes are given pa.ssengers after satisfactory examination, permitting those whom the quarantine officer believes to be not likely to become infected with quarantinable disease to return to Mexico, these
quarantine passes being presented at the border upon their return.
As typhus fever and smallpox are the diseases most likely to be
encountered at port.s along the border, measures in force have been
directed principally against their introduction. During the year
a case with symptoms somewhat resembling typhus :£ever was reported in the city o:£ El Paso, and at the request of the city health
officers the Pubhc Health Service delousing plant was opened for
delousing certain contacts who were sent there, and their clothing
was disin:£ected. Further investigation ,s howed the case not to be
one o:£ typhus. The regular preventive measures, such as delousing
when necessary, together with complete disin:£ection o:£ the clothing
and baggage, are always in :£orce along the border. Every effort
also has been made to prevent the introduction and spread of smallpox from Mexico, and the Mexican population are fast ;realizing the
importance of vaccination and are cooperating in this re.spect to the
greatest degree.
Clandestine crossing of the border continues, but probably due to
the more severe penalty inflicted for illegal entry, or possibly because
of the difficulty of finding employment in the United States, these
crossings appear to be decreasing somewhat.


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PUBLIC HEALTH SERVICE
TRANSACTIONS AT INSULAR QUARANTINE STATIONS
'l'ABLE

5.-Summary of transactions at insular statvons for fisoa,Z year ended
June 30, 1931
Bills of
health
and port
sanitary
state•
ments
issued ·

Vessels fumigated

Cyanide

Sulphur

Passengers in•
spected

0

0

12
179
1

0
6
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0

0
12
35,788
0
0
0
0
0
0

Vessels
in•
spected

Stations

Hawaii:
Ahukini. ••.........................•.
Hilo .. _.............................•.
Honolulu._ ........•. .................
Kahului. .•...........................
Kihei ................................ .
Koloa ..............•..................
Lahaina ...... ........................ .
Mahukona ........................... .
MakawelL .......................... .
Total. ................. ..... ....... Philippines:
Cavite. ...............................
Cebu.................................
Davao.. ............. .................
Iloilo..... ....... ......................
Jolo...................................
Legaspi.............. .. ...............
Manila................................
Olongapo.... . ... ..•.. .. .... ..•. ... . ..
Zamboanga __ .........................
TotaL ... .... _... _.. _...............
Porto Rico:
Aguadilla.... .............. ... ........
Areceibo _. .. . . . .. . . . .. .. . . . . . . .. . . . . . .
Arroyo.. ..... .........................
Central Aguirre.......................
Fajardo.................... .... .......
Guanica.................. ..... .......
Humacao . ............................
Mayaguez .. __ ........... . ............
Ponce ........... _.....................
San Juan. ............ .................
Total........ ........... ....... .....
Virgin Islands :
Christiansted. _. .. ..... ......... .... ..
Frederiksted..........................
St. Johns............ ... ...............
St. Thomas...... .............. .......
TotaL ............. .............. . ..
Alaska:
Cordova._............................
Juneau................................
Ketchikan............................
Seward...............................
Sitka.. .. ...............................
Wrangell..............................
Total.. . ............................
'I'otal all stations....................

0
0
0
2
0

Crews
in•
spected

26,802
33
0
0
0
57
0

29
209

0
471

n1

148
tO
83
45
22
0

: - - - - + - - - • 1 - - - - 1 - -----

35,800
27,363
194
0
6
~~
1====1=====1====11====1=====1====
11
235
104
146
42
7
1,326
0
127

0
2
O

o
o
o

74
0
0

0
130
0
114
0
0
164
0
11

178
3,367
3,597
1,943
1,692
8
90,413
0
7,022

1,721
11,710
7,508
6,501
1,689
332
118,852
0
8,480

1
1, 14
175
371
6

27
1, 58
0
105

----1--......_-•l- ---+--------1----

1, 998
76
419
108,220
156, 793
3, 464
1====1=====1====11====1=======1====

3

0

0

1
2
1
46
37
21
20
104
559

O
0
0
0
0
0
O

19

0
0
0
0
2
0
O
0
0

2
0
0
0
4
144
0
2
23
12,044

233
715
312
267
2,859
31,883

794

21

2

12,219

36,494

5

0

0

59
0
254

O
0
.7

O
O
9

0
2,312
0
1, 151

39
4,445
0
8,508

9

3,463

12,992

0
0
0
0
1,335
0

0
0
0
259
1,636
0

2

129
29
60

69
34
30
19
326
31
55

7

fi8

99
845

1 - - - - : • - - - - + - - - - l ~ - - - + - - - ·:- - -

1--------1--------1318

0

0

0

0
72
23
18
0

0
0
0
0
0

0
0
0
0
0

J

1,566

- - - - -:---•--:-----t-----+-1,335
1,895
113 ~~

.lWl OI

3,417 \ - -

430 ====1==
161,037
235,537

REPORTS FROM INSULAR QUARANTINE STATIONS
OPERATIONS OF THE SERVICE IN HAWAII •

Medical Director S. B. Grubbs in charge. Post-office address,
Federal Building, Honolulu, Hawaii; telegraphic address, Honolulu,
Hawaii.

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PUBLIC HEALTH SERVICE

Only one station equipped to carry on all of the quar3:n~ine activities is maintained in the Territory of Hawaii. In add1t10n, vessels
are inspected at the subports of Hilo, Mahukona, Ahukini, Koloa,
Kahului, and Lahaina.
Ships call at Honolulu :from most of the important ports of the
world. Within the last year the Canadian Pacific Line has made
Honolulu a port of call for some of its vessels plying between the
Orient and Vancouver. More than half of the ships calling at this
port carry both passengers and general cargo. The round-the-wor ld
tourist ships are the only ones which carry no :freight.
On January 15 the American steamship President Linooln arrived
from Manila and oriental ports with a case of cerebrospinal meningitis in a Filipino steerage passenger. Ninety-six contacts among
the steerage were removed :from the ship and detained at the quarantine station for 15 days :from the date of their last exposure to the
infection. There were no secondary cases. A case of cerebrospinal
meningitis was also reported on December 12 in a Filipino who
had arrived in Honolulu :from Manila, in steerage, eight days
previously.
In compliance with the special regulations prescribed in accordance with Executive Order No. 5264, approved January 24, 1930,
for the prevention of the introduction of psittacosis into the United
States, shipments of birds were removed from three ships during the
year and detained at the quarantine station.
On May 5, 1931, the surgeon of the British steamship Empress of
0 anada reported by radio a case of suspected plague in a Chinese
member of the crew. This ship was from ports in China and Japan.
The patient died two days prior to arrival at Honolulu. The vessel
reached the quarantine anchorage on May 8. The vessel was detained at the anchorage, the body was removed, the crew and passengers were examined, and the vessel was inspected for rat harborage and infestation. The master was then permitted to proceed to
the wharf under provisional pratique. Autopsy performed at the
quarantine station showed no conclusive evidence of plague. There
were no cases of suspicious illness among crew or passengers. There
was some rat harborage, but no evidence of recent infestation.
Most of the cargo was in closed wooden cases. The cargo was
inspected to ascertain its freedom from rats both before discharge
from the holds and on the wharf. The vessel proceeded to Vancouver. Laboratory examinations of specimens of the body, both
cultures and inoculated animals, proved negative for plague.
The Japanese steamship Olvichibu Maru arrived on May 14, 1931,
with one case of leprosy in a Japanese steerage passenger. The
patient was an alien. He was detained at the Kalihi Leprosy
Receiving Hospital until deported by the immigration authorities
on May 17.
During the year 194 vessels were inspected at ports in the Territory
of Hawaii. These vessels carried a total of 35,800 passengers and
27,363 crew; of this number 35,788 passengers and 26,802 members
of crew were inspected at the Honolulu quarantine station.


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159

OPERATIONS OF THE SJ!,""RVICE IN THE PHILIPPINE ISLANDS

Surg. R. W. Hart, chief quarantine officer. Post-office address,
Box 424, Manila, P. I.; office, Customhous e; telegraphic address,
Quarantine , Manila.
There are nine ports of entry in the Philippine Islands at which
quarantine transactions are carried on. At the three principal
ports--Man ila, Cebu, and Iloilo-full- time quarantine officers are
on duty; at Davao, J olo, Legaspi, and Zamboanga part-time physicians act as quarantine officers; at Cavite and Olongapo, the two
naval stations in the Philippine Islands, naval medical officers are
detailed to act as quarantine officers.
Two fully equipped detention and disinfection stations are maintained for the islands. Of these, the largest is located at Mariveles,
which is situated at the entrance of Manila Bay, about 30 miles from
Manila. This station is used to serve the northern ports of the
archipelago . The other station is located on the island of Kawit,
near Cebu. It is kept in readiness for the handling 0£ infected vessels entering the southern ports.
The quarantine service in the Philippine Islands carries out practically all the functions of the United States Public Health Service,
such as the physical examination of aliens and the maintenanc e and
operation of quarantine stations and floating equipment. Relief
stations are maintained at the principal ports of entry and outpatient relief is furnished service beneficiaries by the medical officers
of the service, in addition to their quarantine duties. The quarantine.
laws and regulations of the United States are in effect in the Philippines, having been made effective by presidential order of January 4,
1900, and later confirmed by the Administra tive Code of the Philippine Islands, approved March 10, 1917. In addition, certain laws
applying to local conditions have been enacted by the Philippine
government . At the last session of the Eighth Philippine Legislature
a specific act was passed making it unlawful for any person, corporation, or other entity to import or introduce into the Philippine
Islands the virus of yellow fever or any substance which might be
considered infected with the causative agent of yellow fever , or to
experiment on such a virus or substance in the Philippine I slands.
The passage of such an act was considered advisable in view of the
presence in the islands in large numbers 0£ Aedes rogypti mosquitoes,
the vector of yellow fever, and the proved difficulty of controlling
the infection even in experimenta l work in the laboratory.
Smallpox, cholera, and plague are being continuousl y reported as
occurring in most of the countries within a few days' .run of the
Philippine Islands. The proximity of the islands to the foci of
these diseases and the fact that rapidly traveling passenger vessels
have brought these infected places much nearer the Philippines , has
increased the quarantine responsibili ty. However, during the year
under report no cases of quarantinab le diseases occurred in the Philippines excepting leprosy, cholera, and cerebrospin al meningitis,
none of which could be considered as imported. Cholera was present in the Visayas in epidemic form during the first half of the year


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160

PUBLIC HEALTH SERVICE

and sporadic c~ses occurred throughout the remainder of the year.
This epidemic, however, can not be attributed to any recent importation, as past history shows that cholera recurs in epidemic form in
these islands every four or five years and may be considered as
endemic there. During the year, 4,848 cases of cholera with 3,109
deaths were reported. Twenty-five cases of cerebrospinal meningitis
with 11 deaths were reported in the city of Manila during the year,
but this disease was not reported from any other part of the islands.
During the year two vessels arrived at Manila, each with one case
of smallpox on board. Both vessels were treated in accordance
with the quarantine regulations, full advantage being taken of the
immune reaction, thus shortening the period of detention of the
vessel in quarantine. The patients, with their personal effects, were
removed to San Lazaro Hospital. All persons on board were vaccinated against the disease and were detained on board under quarantine, inspection being made twice daily for the reexamination of
personnel and the reading of vaccination reactions. In the case of
one vessel the entire personnel showed immune reactions within 48
hours, and after disinfection of the infected compartment the vessel
was released.
One vessel arrived in Manila on which one case of cerebrospinal
meningitis had occurred in a member of the crew. The case had
been removed from the ship at the port of Hong Kong, but on
arrival at Manila five immediate contacts were removed from the
vessel for detention in San Lazaro Hospital. N asopharyngeal smears
and cultures were taken on all members of the crew. No carriers
were found in this group. The contacts removed to San Lazaro Hospital were detained for a period of 14 days, although no further cases
developed among them.
During the year two interisland vessels, each with one case of
cholera on board, were detained in quarantine. All passengers and
members of the crew were detained for six days, although no further
cases developed. Stool examinations for the vibrio were made on all
those detained.
A total of 1,998 vessels carrying 265,013 persons were inspected on
arrival at the various ports of entry in the Philippines during the
year.
All steerage passengers arriving in the Philippine Islands were
required to present positive evidence of vaccination against smallpox
within one year of arrival or undergo vaccination. This was also
required of all members of crews of vessels calling at Philippine
ports. A total of 18,133 crew members of vessels entering Philippine
ports were vaccinated against smallpox during the year. As most
of the steerage passengers arriving in the Philippine Islands come
from the ports of Amoy, Hong Kong, and Shanghai, practically none
require vaccination upon arrival at Manila, since officers of the
United States Public Health Service stationed at these ports inspect
and vaccinate them prior to embarkation, noting upon each passenger's identification card the result of the vaccination. No steerage
passenger is allowed to embark from any of these ports for the
Philippines until he is known to be immune to smallpox, and upon
arrival is required to produce this evidence of immunity in the form
of an identification card initialed by the United States medical officer
at port of embarkation.
·


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161

INTER.ISLAND QUARANTINE

At the beginning of the fiscal year, cholera was present in epidemic form in several of the islands in the Visayas. There was also
a minor epidemic in the city of Manila, some 50 cases occurring there.
It reached such proportions that it was considered necessary to put
interisland quarantine into effect against several ports. This was
made effective at various times during the year for Manila, Cebu,
Iloilo, the Province of Iloilo, the Province of Capiz, the island of
Bohol, and the island of Samar. In accordance with the provisions
of the international sanitary convention, the 'official representatives
of all countries signatory to the convention were notified of the
presence of cholera in the infected ports. In addition, certain
restrictions were enforced at the ports in relation to all shipping, in
order to minimize the possible infection of vessels calling at these
ports or the spread of the disease to foreign ports through the
agency of vessels having commercial relation with them. All vessels
leaving the above-named ports or provinces during the time that
they were declared infected with cholera were required to secure bills
of health from the local sanitary authorities. All passengers and
members of crews of vessels leaving infected ports were inspected
immediately before departure and were required to produce evidence
of vaccination against cholera within the preceding six months.
These vessels were required to await quarantine inspection at all succeeding ports of call in the islands until a period of five days had
passed. At the same time the shipment of low-growing fruits and
vegetables liable to convey cholera was prohibited from infected
ports.
A total of 472 incoming interisland vessels, 26,028 passengers, and
30,424 crew members were inspected during the period of quarantine
against cholera, and 1,338 outgoing interisland vessels, 28,872 passengers, and 53,772 members of crews were inspected during this period;
71,809 persons were vaccinated against this disease by officers of the
quarantine service. A total of 4,848 cases of cholera with 3,109 deaths
were reported in the Philippine Islands during the year. All vessels
in the interisland trade are required to be fumigated at least once
every six months. During the year 355 interisland ships were fumigated, 1,347 rats were recovered after fumigation, and 1,108 crew
members were vaccinated against smallpox.
OUTGOING QUARANTINE

All steerage passengers preparing to embark for the United States
and Hawaii from the Philippines were required to undergo a ·short
period of detention prior to sailing. Two separate detention camps
were maintained. These camps, although conducted as private enterprises, are under the immediate supervision of the quarantine
service. Daily inspections were made, not only of the passengers
but of the sanitary condition of the camps. While in detention all
prospective steerage p assengers were vaccinated against smallpox
and, during the presence of cholera in Manila, were also vaccinated
against this disease. N asopharyngeal cultures for meningococcus and
stool examinations for cholera organisms were made on all of these
passengers and those found to be harboring either cholera or menin-


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PUBLIC HEALTH SEHVICE

gococcus were sent to the isolation hospital until free of organisms.
During the year 9,450 outgoing passengers were vaccinated against
smallpox, 9,450 stools were examined, and 9,648 nasopharyngeal cultures were made. Of this number, 261 were found positive for cholera
and 149 for meningococcus.
It is of interest to note that during the year the percentage of
cholera carriers among prospective outgoing steerage passengers was
approximately 2.5 per cent, while during previous years when cholera
was not present in epidemic form the percentage of carriers ran under
1 per cent. In the early months of the calendar year 1930, the percentage of cholera carriers ran about 0.64 per cent. This percentage
gradually increased, and during the months of May and June, when
clinical cholera began to be reported, the percentages were 1.62 and
2.33, respectively. This percentage gradually increased to 5.19 per
cent during the month of September. It was during the months of
July and August that the largest number of cases were reported.
Following this, the number of cases gradually decreased and the
percentage of carriers also decreased to 2.3 per cent, the carrier rate
remaining at approximately this figure for the last six months of
the year.
RAT PROOFING AND FUMIGATION

The effort of previous years to reduce the rat population in those
areas adjoining the piers and quays was continued throughout the
past year. This work, at the instigation of the quarantine service,
was carried out by the local health authorities. During the year
56,504 rats were recovered and examined. No cases of plague-infected rodents were found.
During the year 495 vessels were fumigated at Philippine ports,
from which 2,172 rats were recovered. All rats were examined in
the laboratory. A large percentage of the fumigations were carried
out at the port of Manila. Both sulphur and cyanide in the :form of
Zyklon-B mre used in :fumigating.
OPERATIONS OF THE SERVICE IN PORTO RIOO

Surg. L. E. Hooper, chief quarantine officer. Post-office and
telegraphic address, San Juan, P. R.
Quarantine inspections :facilities are maintained at all ports of
entry. San Juan is the principal port and headquarters of the
quarantine service for the island. The administrative offices are
conveniently situated in the city near all of the shipping interests.
The quarantine station on Miraflores Island is equipped for hospitalization and detention purposes. Vessels are boarded and inE:pected at an anchorage in the bay. Fumigations are effected with
Zyklon-B. There is also considerable shipping activity in Ponce,
and adequate boarding and :fumigation facilities are 91-aintained at
that port. Boarding inspection is pro ided at the subports of Aguadilla, Arecibo, Arroyo, Central Aguirre, Fajardo, Guanica, Humacao, and Mayaguez.
The majority of :foreign vessels entering the ports of this island
come from Europe. The Spanish Tr·a nsatlantic Line passenger
ships arrive bimonthly from Mediterranean ports and the Canary


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PUBLIC HEALTH SERVICE

163

Islands. These vessels are handled very carefully to prevent the
possible introduction of plague. Their cargoes are usually vegetables in crates, and these are subjected to fumigation in covered
lighters before they are permitted on the docks. Commerce with
United States ports is very active. The New York & Porto Rico
Line, Bull Insular Line, Red "D" Line, and the Lykes Line, from
Galveston, maintain a regular service and carry passengers and
general cargo. During the winter months many tourist ships making cruises in the West Indies call at San Juan. No quarantinablc
diseases were encountered during the year.
During the year, 189 airplanes from foreign ports arrived at designated air ports of entry in the vicinity of San Juan. There is a
tri-weekly passenger and mail service between Miami, Fla., and San
Juan. These planes call en route . at Habana, Camaguey, Port au
Prince, and Santo Domingo City. The New York, Rio & Buenos
Aires (Inc.) (" Nyrba Line") has been taken over by the Pan
American Airways (Inc.), and once each week a hydroplane of this
line arrives in San Juan from Para, Brazil. These planes call at
Paramaribo, Georgetown, Port of Spain, St. Lucia, Antigua, and
St. Thomas. They are boarded and inspected at St. Thomas before
arrival here. As they usually carry alien passengers, they are again
inspected for immigration purposes at San Juan. The aliens traveling on these planes are all first-class passengers and are of good
type.
,
OPERATIONS OF THE SERVICE IN THE VIRGIN ISLANDS

Passed Asst. Surg. E. H. Carnes, chief quarantine officer. Postoffice and telegraphic address, St. Thomas, Virgin Islands.
The office headquarters are located in the business district of St.
Thomas. The detention station is located at the harbor entrance, a
distance of about 1 mile from the town of St. Thomas. While this
is part of the mainland, the detention station may be reached only
by water, no road having been built to the station.
Situated on or near the regular steamship lanes between the Panama Canal and European ports, St. Thomas, with an excellent harbor, furnishes an important refueling depot, and it is for the purpose of taking bunkers that most ships enter during the winter
months. As these ships are in port only a few hours, quarantine
inspection is expedited as much as possible in order that the tourists
may spend all the time available ashore. During the winter months
pleasure yachts are frequent visitors. Sailing vessels in the interisland trade enter port during the entire year. The Pan American
Airways System operates a weekly north and south bound plane
through St. Thomas.
No quarantinable diseases have been encountered during the past
year. Ships from the east coast of Brazil are subjected to close
inspection, and the regulations to prevent the introduction of yellow
fever are strictly enforced. The presence of yellow fever in Brazil
is a potential source of danger to the Virgin Islands, as ships from
Brazilian ports 2ut into St. Thomas for bunkers where the A ,e des
index is high. Occasionally passengers from Rio de Janeiro and
vicinity arrive in St. Thomas by seaplanes within the incubation


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period of yellow fever. As these passengers are usually in transit
they are not detained, but proceed within an hour or so after arrival
by plane. Should such passengers land, however, it is contemplated
that they will be kept under observation a sufficient time to complete the yellow fever incubation period.
Ships from plague-infected ports of South America constitute a
large number of the ships entering, and strict surveillance of these
ships while in port is maintained to see that all regulations relative
to the prevention of the introduction of plague are complied with.
These ships, in port for bunkers for a few hours only, usually with
full cargo, are not fumigated, but are required to fend off 4 feet
from the dock, apply standard rat guards -on all lines, raise or light
and guard gangways at night, and, in the case of ships from badly
infected ports, are not allowed alongside the wharves after nightfall. The docks and warehouses are so constructed as · to afford but
slight harborage for rats. Zyklon-B is used as the fumigant in
the case of steamships, while sulphur is used for small sloops and
schooners.
During the year 254 steamships and 63 aircraft with total crews
of 8,854 and 1,357 passengers received quarantine inspection at the
port of St. Thomas. At the subports of Frederiksted and Christiansted 64 ships received quarantine inspection, with total crews
of 4,484 and 2,312 passengers. A total of 659 bills of health and
165 sanitary statements were issued at the three ports.
TRANSACTIONS AT FOREIGN PORTS
TABLE

6.-Summary of transactions at foreign ports

Station

Vessels
inspected

Amoy, China .........•...•.•...•...••..............•
Guantanamo Bay, Cuba . ...••••.•.....•.•....... • ••
Guayaquil, Ecuador .•..•.•.•.•...•.....•.•.•.•.•....
Habana, Cuba ......... . ................•............
Hong Kong, China .....••..•.•.....•.......•.•.....•
Progreso, Mexico •..........•.....•...•...••..•......
Puerto Mexico, Mexico .• _•••••.•.•.•.•. _.• _•...•.•••
Shanghai, China .•.••..••... __ •..••.....•.•.•.•......
Tampico, Mexico ..•......•.•.....•........... -·-·-··
Vera Cruz, Mexico . __ ··-·-······ -· -····· ···- ·····-··
Mexico City, Mexico •..•....•••..•....•......•.•.•••

96
1174
48
1,689
357
132
0
375
470
298
0

Total. ... . -•..•...• -•.•.•... - .•... -..... •... - .•

3,639

Fumiga•
tion of
vessels
supervised

Passengers and
crews inspected

Passengers
--- -17,608
0
0
0
0
0
130,019
279
24,1!:l5
0
1
366
10
6
13
4,065
409
18
7,348
10
0
0
127

184,020

Crews

Bills of
health
countersigned

9,498
0
0
181,921
53,213
4,759
0
6,240
18,815
21,998
0

118
174
262
1,689
597
132
85
802
432
298
0

296,444

4,589

EUROPEAN PORTS

861
0
5, 290
38
74
Antwerp, Belgium........... . .......................
111
o
3, 000
o
0
Belfast, Ireland .. _.................. .................
486
O
14,616
93
0
Bremen, Germany..... ..............................
149
O
11,057
0
0
Cobb, Irish Free State... .. ..........................
215
O
940
O
0
Copenhagen, Denmark. . ........... . ........ ........
20
388
17,436
0
108
Danzig, Free City...................................
60
Dublin, Ireland ..........•.•.•...• .....• .....•.••.•. ······--·· .•...........•...... ···-·-··-·
.••....
•..
···-·-·-··
······
-·
·
-····-····
Galway, Irish Free State •.•...•....•...•.•.•••.•.•.• ·-···-···332
0
2,929
30
30
Genoa, Italy 3••••••••••••••••• •• ••••••••••••••••••••
346
0
5, 578
0
0
Glasgow and Grenock, Scotland.....................
20
0
279
0
0
Bergen, Norway•....... ............................
76
o
5,690
0
20
Goteborg, Sweden...................................
1 Navy transports only.
2 Does not include 45 airplanes and 169 vessels passed without inspection.
a Began Oct. 1, 1930.
• Began Dec. 8, 1930.


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TABLE 6.-Surnm.ary of transactions· at foreign ports-Continued

Vessels
inspected

Station

Fumigation of
vessels
supervised

Passengers and
crews inspected
Passengers

Crews

Bills of
health
countersigned

------------------1·--- - - - - - - ---+----

Hamburg, Germany________________________________ _
Liverpool, England _________________________________ _
London, England ___________________________________ _
Londonderry, Ireland __ - ------------------------ ___ _
Naples, Italy----------------~------------- _________ _
Oslo, Norway _____________ ----- --- ---- ---- --------- Palermo, Italy ___________ ---------------------------Patras, Greece 6 ________ _ __ ____________ _____________ _
Piraeus, Greece (Athens) ______________ ____ _________ _
Rotterdam, Holland ________________________________ _
Southampton, England-----------------------------Stockholm, Sweden ___________ --------------- ______ _
TotaL ____________ _____ · ______________________ _

_./

Total, all stations _____________________________ _
6

2
0
0
33
136
0
0
22
30
38
0
0

232
0
0
0
1
0
0
0
0
69
0
0

22,229
13,617
1,124
2,808
35,220
4,960
1,017
2,926
3,183
4,536
22,739
0
181, 174

20,267

6,435.

4,132

690

366,194

316,711

11,034

- -493
- ---463

0
0
0
0
11,968
0
0
4,967
2,944
0
0
0

903
540
598
0
265
109
100
22
70
563
490
99,

Discontinued Feb. 28, 1931.

REPORTS FROM FOREIGN PORTS
AMOY, CHINA.

Acting Asst. Surg. R. Hofstra in charge. Post-office and telegraphic address,
care American Consulate, Amoy, China.
Health conditions in Amoy during the fiscal year 1931 have been fairly satisfactory. An epidemic of plague was reported in cities in the vicinity of Amoy,
approximately 1,500 deaths being reported during the months of June and
early part of July, 1931. It is estimated that about 1 or 2 per cent of these
cases were of the pneumonic type. Only one case, however, was reported in
the city of Amoy.
The Chinese National Quarantine Service is performing the vaccination of
passengers going to Manila; also the inspection of outgoing vessels.
During the fiscal year 1931, 96 vessels were inspected, the crews on which
totaled 9,498 and passengers 17,608; 118 bills of health were countersigned.
GUANTANAMO BAY, OUBA.

Acting Asst. Surg. C. W. Carr in charge. Post-office and telegraphic address,
care United States Naval Station, Guantanamo Bay, Cuba.
Guantanamo Bay is a naval port only, and at the request of the Navy
Department a medical officer attached to the naval station at Guantanamo Bay
is appointed as an acting assistant surgeon in the United States Public- Health
Service to act as quarantine officer for the purpose of signing bills of health
for vessels departing from the naval station at that place, as no American
consul is stationed there.
No passenger vessels, other than United States Navy transports, entered port,
and no commercial vessels stopped here, except those required to put into port
because of emergency. No quarantinable diseases were encountered.
GUAYAQUIL, ECUADOR

Acting Asst. Surg. Carlos V. Coello in charge. Post-office and telegraphic
address, care American Consulate, Guayaquil, Ecuador.
During the fiscal year ending June 30, 1931, there were issued 262 bills of
health to vessels departing from the port of Guayaquil, corresponding to 48
ships inspected, 169 passed without inspection, and 45 airplanes passed without
inspection; all of these were bound for the United States or ta the Canal
Zone, directly or via some port in South America.
Guayaquil and its vicinity has been free from plague since March, 1930, but
this disease exists in several small villages in the interior @:I!· the co:tmtry.


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PUBLIO HEALTH SERVICE

However, the intensive_ ~erati~ation campaign, started in September, 1929, by
the l~cal heal~h authorities, with · the assistance of a representative of the Pan
American Samtary Bureau, is still being carried out. This campaign has been
productive of very good results.
HABAN A, CUBA

Surg. D. J. Prather in charge. Post-office and telegraphic address, care
American Consulate, Habana, Cuba.
The ~ork of this office in brief is as follows: (1) The countersign bills of
health issued by the consul general of the United States to vessels goino- to
the United States and its dependencies, either direct or via foreiO'n ports (these
bills of health are delivered to the vessel at the last mome'Ilt after all the
requirements have been complied with) ; (2) to report the sanitary condition of
the city and port and, if possible, the surrounding country; ( 3) to supervise the
!umigation of vessels bound for United States ports when necessary; ( 4) to
mspect vessels, cargoes, crews, and passengers bound for United States ports
when necessary.
The vessels fumigated in this port are divided into two classes: (1) Vessels
fumigated by the service; these include vessels going direct to the United States
or its dependencies that are fumigated to comply with the United States quarantine regulations; (2) vessels fumigated by the Cuban quarantine officers under
the supervision of the service; these include vessels that require fumigation by
the Cuban quarantine regulations and intend going to the United States, usually
via Cuban ports.
During the fiscal year, 1,689 bills of health were issued at this port-total
crews, 181,921; total number of passengers, 130,019. There has been a decrease
in the number of bills of health countersigned, possibly as a result of the worldwide depression in shipping. There were no cases of quarantinable or other
communicable diseases during the year either in Habana or in the Republic of
Cuba.
HONG KONG, ORIN A

Passed Asst. Surg. A. P. Rubino in charge. Post-office and telegraphic
address, care American Consulate, Hong Kong, China.
Particular attention has been given throughout the year to the examination
of steerage passengers embarking for the United States and its dependencies,
and to the inspection of steerage accommodations aboard the vessel. The
detention of steerage passengers in camps and the laboratory examination for
possible meningococcus carriers were discontinued. However, applicants called
at this station daily for notation of type of reaction to smallpox vaccination
and reported for meningitis clearance within 24 hours before sailing and underwent inspection aboard the vessel. One case of meningococcus meningitis occurring among the European crew was removed from an American vessel bound
for Manila.
During the fiscal year, 597 bills of health were issued and 357 vessels were
inspected prior to sailing. The number of cases of smallpox reported was 14,
with 8 deaths; and 22 cases of meningococcus were reported, with 12 deaths.
Practically all cases occurred among the Chinese population.
MEXICO CITY, MEXICO

Surg. H. F. Smith in charge. Post-office and telegraphic address, care
American Consulate General, Plaza de la Reforma No. 2, Mexico City, Mexico.
A service officer was detailed to the consulate general, Mexico City, during
September, 1930, for the purpose of carrying out the provisions of the quarantine
act of February 15, 1893, and the immigration act of February 5, 1917. Owing
to the delay in the arrival of equipment and the necessity for making arrangements pertaining to suitable office quarters, actual operations were not begun
until December, 1930.
There was a considerable increase in the number of cases of typhus fe-ver
reported in Mexico City during the first six months of 1931 as compared with
a similar period for each of the three preceding years ; 548 cases of typhus,
with 239 deaths, were reported as occurring during the period from January 1,
1931, to June 30, 1931. Of this total, 215 cases with 75 deaths were reported
for the month of March. The majority of the cases are reported as having
occurred within two fairly well circumscribed sections of the city. Since the
inauguration of service activities in Mexico City, special attention has been

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167

given to the examinati on Qf applicants for immigrati on visas with reference
to determini ng the residentia l section of the city whence such applicants come
and their freedom from vermin infestatio n.
A total of 288 cases of smallpox with 134 deaths were reported as occurring
deaths
for the year under report. The monthly distributio n of the cases and in
the
reported was fairly uniform. With the exception of the increase
reported incidence of typhus fever and the customary occurrenc e of smallpox,
no quarantin able diseases were reported by national health organizati ons as
occurring within the Republic.
PROGRESO, MEXICO

Acting Asst. Surg. C. E. Athey, in charge. Post-office and telegraphi c address,
care American Consulate , Progreso, Mexico.
at
The Public Health Service officer attached to the United States consulate
States
the port of Progreso, inspects vessels prior to their departure for United
in
ports and sees that the sanitary conditions pertaining to such vessels whilethe
port are satisfacto ry before countersig ning the bills of health; he inspects
prior to
crew and passenger s on such vessels and takes their temperatu re
departure . During the past fl.seal year, he inspected 132 vessels, 360 passenger s,
and 4,759 members of crew.
the
The amount of shipping at this port has decreased considera bly during
constant
past fl.seal year. This may be accounted for to a large extent by thehave
been
decrease in the shipping of henequen. Health conditions at this port
fairly good.
PUERTO MEXICO, MEXICO

Acting Asst. Surg. J. J. Sparks in charge. Post-office and telegraphi c
address, care British Consulate, Puerto Mexico, Mexico.
during
Health conditions for the port of Puerto Mexico have been very goodsanitary
the past year. Generally , there has been an improvem ent in local has
been
condition s; the water supply has been greatly improved and much
done toward filling in the swampy areas surroundi ng the town. The sanitary
and the
conditions in the oil camps of the surroundi ng country are fairly goodhas
been
amount of malaria is comparati vely low. During recent years, much
done by the State authoritie s, in conjunctio n with the Rockefell er Foundatio n,
regarding the diagnosis and treatment of hookworm.
The vice consulate at this port was closed during the fl.seal year 1928, and the
to
Public Health Service officer has, since that date, issued bills of health the
departing vessels. The total number of such bills of health issued during
current fl.seal year was 85.
SHANGHAI , CHINA

Acting Asst. Surg. Thomas B. Dunn in charge. Post-office and telegraphi c
address, care American Consulate , 1 Canton Road, Shanghai, China.
has
Health conditions in Shanghai, as regards cerebrosp inal meningiti s,prevaimproved somewhat during the past year. This disease has been quitebeen
no
lel}.t in the interior of China, but much milder in type. There have regards
meningiti s patients taken from ships in Shanghai. Health conditions as
request of
cholera in Shanghai also were greatly improved. Previously , at the passenger
s
the Philippine quarantin e service, stool cultures were taken on all
of
and crew destined for the Philippin es; but during the past year, because
the decreased number of cases of this disease, no stool cultures were taken.
During the last two years the Chinese municipal authoritie s of Greater Shanghai, the Internatio nal Settlemen t, and the French Municipal Council have given
fever
a great number of cholera vaccinatio ns. There were two cases of typhus
reported in Shanghai during the year. Smallpox, however, was much less
prevalent, but vaccinatio n of all steer_age passenger s embarking at toShanghai
be vac~
and crews passing through Shanghai for the Philippine s continue
cinated prior to sailing.
TAMPICO, MEXICO

Acting Asst. Surg. W. J. Lynn in charge. Post-office and telegraphi c address,
Comercio 52, Oriente, Tampico, Mexico.
this
During the fl.seal year ended June 30, 1931, 470 vessels cleared from were
180
port through the American consulate for the United States, of which 213
were
cargo boats, 54 passenger ships, and 236 tankers. Of these vessels,
of American registry. All fumigatio ns at this port are with the use of Zyklon-B

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168

PUBL IC HEAL TH SERVI CE

under the superv ision of the medica officer of th~
Public Health Servic e ; 18
such fumiga tions were accom plished lduring
the year.
An antilar val campa ign is being effectively carried
out; and daily house-byhouse inspec tion, togeth er with the oiling of
swamp s, etc., has reduce d
the numbe r of deaths from malari a to 105, aspools,
red with 231 during the
preced ing year. The campa ign agains t plague compa
carrie d out as in previo us years, owing to an orderhas not been so extens ively
curtail ing expend itures, and
during the year 22,741 rodent s were caught , no infecti
on being found among
them.
VERA CRUZ, MEXICO

Acting Asst. Surg. H. E. Gimle r in charge . Post-of
fice and telegra phic
addres s, care Ameri can Consu late, Vera
Cruz, Mexico.
No cases of yellow fever, human plague , or rodent
during the year. One case of typhus fever was report plague were report ed
ed in April ; the source
of infecti on was Mexico City. Antipl ague work during
this period resulte d in
the trappi ng and exami ning of 19,769 rodent s; none
was found infecte d. Antimosqu ito work resulte d in the finding of 46,017 mosqu
ito-bre eding places . The
exami nation of the larvae showe d a great numbe r
of Anoph eles but only eight
Aedes argent eus.
Durin g the y~ar, 298 vessels, carryi ng 21,998 crew and
7,348 passen gers, were
cleared from Vera Cruz for United States ports.
Fumig ation by the service
was carried out with hydroc yanic acid gas on 10 vessels
by the Mexic an health depart ment on 18 vessels were . Cyanid e fumiga tions
Vessels visitin g this port are mostly combi nationinspec ted.
freigh t and passen ger
steame rs, bringi ng in genera l cargo and taking
out banan as, coffee, broom root,
minera ls, hides, and other Mexic an produc ts. The
passen gers are mostly salesmen and tourist s.
SERVI CE OPERA TIONS IN EURO PE

Medic al Direc tor John McM ullen in charge. Post-o
ffice and tele•
graph ic addre ss, Amer ican Emba ssy, 5 Rue de
Chail lot, Paris ,
Franc e.
The office in Paris is the super visory headq uarter
tions of the Publi c Healt h Servi ce in Europ e, s of the opera .
which embra ces
quara ntine and immi gratio n activi ties and includ es also
medic al services at the variou s consulates, to which miscellaneous
tache d as medic al advisers. In additi on, this office officers are atis in close contact with the Intern ation al Office of Publi c Hy~ie
facili tating the
exchange of sanita ry inform ation and simpl ifymgne,
coope rative activities of the service.
Owin g to impro ved health condi tions in Europ e, the
quara ntine
regul ations were modified :for the contr ol of typhu
s £ever and the
geogr aphic al line divid ing quara ntina ble from nonqu
areas was abolished. The new regul ation is based upon aranti nable
the epide miology of typhu s. Passe ngers from count ries where
typhu
s is only
endemic are not detain ed, if they are found to be
from countries in which this disease is epide mic are clean ; but those
plete 12 days from the date of depar ture from the requi red to cominfect ed area to
date of arriva l at a Unite d State
be deloused befor e emba rkatio n. s port. All infest ed perso ns must
There has been no ship-s ide inspe ction by a servic
way, Irish Free State , durin g the prese nt year, £or e officer at Galthis appea red unnec essary in view of the small amouthe reaso n that
Irelan d. Howe ver, the officer statio ned at Dubli n has nt of typhu s in
visite d Galw ay
occasionally to inspe ct the metho ds of handl ing passe
port by the steam ship company. There is at Galw ngers at that
well-e quipp ed plant £or disinf ection and disinf estati ay a mode rn,
on of such passengers requi ring treatm ent, and the work is appar ently
perfo rmed
in a satisf actory mann er. Also, in view of the dimin
ution of trave l

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169

and the improved health conditions at Patras, Greece, it was deemed
unnecessary to continue longer a medical officer o:f this service on
duty at that port, and this work was discontinued effective April 30,
1931. For the same reason it is believed unnecessary to continue
the quarantine inspection at Londonderry, and this work will probably be discontinued at that place early in the next fiscal year. On
the other hand tra.vel has materially increased at Gdynia, Poland,.
and the local authorities are building a large plant for the disin:festation and housing of immigrants. Passengers sail direct to the United
States from this port and also via British and French ports.
During the year, 181,174 passengers and 20,267 members of crew
were inspected for quarantine purposes at European ports of embarkation. This number included all persons who embarked by
direct lines to the United States from ports where medical officers
were stationed, as well as those who were transshipped to such lines
from some other port. Of the above numbers, 41,737 passengers and
1,000 members of crew were vaccinated against smallpox, and
38,639 passengers and 154 members of crew were deloused for the
purpose of preventing the occurence of typhus fever.
Typhus fever has prevail1ed in endemic form in several countries
during the year, as follows: Poland, 1,818 cases with 119 deaths;
Rumania, 1,391 cases with 127 deaths; Lithuania, 445 cases with
21 deaths; Morocco, 284 cases and 9 deaths ; Egypt, 242 cases with
31 deaths; Turkey, 202 cases with 24 deaths; Algeria, 183 cases;.
Bulgaria, 144 cases with 16 deaths; Greece, 105 cases with 10 deaths.
This disease appeared to a limited extent in Yugoslavia, with the
occurrence of only 85 cases; Portugal, 52 cases; Irish Free State, 34
cases; Lettonia, 23 cases; Spain, 12 cases; Scotland, 8 cases; and
Austria, 2 cases. A mild epidemic of typhus fever occurred during
January and February, 1931, in Czechoslovakia, with a total o:f 104
cases and 5 deaths.
Smallpox of a mild type prevailed in Great Britain throughout
the year, 7,446 cases with 12 deaths, showing a decrease of 41 per
cent compared with the number reported during the preceding year.
Smallpox appeared in Portugal, 1,180 cases with 45 deaths being
reported; Turkey,· 423 cases with 36 deaths; Spain, 383 cases of
variola minor with 2 deaths and 110 cases of variola major with
5 deaths; Morocco, 170 cases; Tunisia, 34 deaths; Scotland, 26 cases
and 2 deaths; Poland, 15 cases and 3 deaths. Some cases of smallpox have been reported in Algeria, Greece, Rumania, Russia, and
Egypt.
There were a small number of cases of plague reported in Europe
during the year. One case occurred in Paris on July 15, 1930, and
13 cases at Marseilles among dockers and contacts from August to·
November, 1930; 14 cases and 10 deaths were reported in Russia, and
2 cases in Greece. In countries surrounding Europe, Egypt heads:
the list with 966 cases and 182 deaths; Algeria follows with 95 cases
and 14 deaths; then Morocco with 88 cases and 16 deaths and, fourth ,.
Tunisia with 71 cases and 15 deaths.
No case of chorera has been reported in Europe during the fiscal
year.
The accompanying four tables summarize the quarantine activities
of the various European ports where officers are stationed.
80597-31-12


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170
TABLE

PUBLIC HEALTH SERVICE
1.-Primary treatment of passengers and crew prior to embarkation,
from July 1, 1930, to June 30, 1931
Port

Antwerp ___________________________
Belfast_ ____________________________
Bergen 1 _________________ __________
Bremen ______________ ______________
Cobh _______ ___ ____________________
Copenhagen _______________________
Danzig _____________________________
Genoa 2 • __________________ _ ________
Glasgow __________ __ _______________
Goteborg ___________________________
Hamburg. _________________________
Liverpool..---------------------London.
__________________
_________
Londonderry _______________________
Naples _____________________________
Oslo _______________________________
Palermo ___ ------------------ -----Patras s______________
__ ------------ •----- - ------Piraeus
_____________
Rotterdam _________________________
Southampton ______________________

P assen- Crew P ass- Crew Passen- Crew Passen- Passengers in- inspec- angers vaccin- gersdegersde- gers redevaccin- ated loused
spected
ted
loused tained jected
ated
-- -- - - - - -- - - - - - - - - - - - 5,231
0
0
357
0
0
357
0
3,000
0
0
400
0
0
2
0
279
0
0
0
0
0
0
0
14,616
2,796
0
0
0
119
0
108
11,057
0
0
2,983
0
0
0
0
940
0
0
0
0
0
0
0
10,817
388
0
9,688
0
23
0
0
2,929
1,204
0
0
108
0
0
0
5,578
0
0
0
0
0
0
0
5,690
0
0
181
0
146
0
0
22,159
0
0
1,441
0
0
267
3
13,617
101
0
0
331
0
7
0
1,124
0
0
0
0
0
0
0
2,808
0
0
936
0
0
0
0
35,220 11,968 35,220
0 9,280
0
0
0
4,960
0
0
0
0
0
0
0
1,017
879
0
143
0
0
2
0
2,926
4,967
1,275
118
480
131
8
0
3,002
2,944
2,845
882
2,612
0
167
0
4,536
0
0
0
294
0
298
0
22,739
0
0
4
0
0
3
0

TotaL _______________________
1

TABLE

Began Dec. 8, 1930.

174,245
2

41,533

1,000

32,034

154

1,364

123

a Discontinued Feb. 28, 1931.

8.-Treatmen t of passengers coming from other points for embarkatio-n
(transrnigran ts) from July 1, 1930, to June 30, 1931
Treatment

Passengers inspected _______ • ______________
Passengers vaccinated ____________ _________
Passengers deloused _______________________
Passengers detained _______________________
Passengers rejected ________________________
Baggage disinfected and passed ____________
Baggage inspected and passed-- __________ .
TABLE

20,267

Began Oct. 1, 1930.

Antwerp

Copenhagen

59
0
59
0
0
46
17

1,141
0
0
0
0
0
0

Goteborg

Rotterdam

SouthTotal
ampton
---- ---277
1,632
3,285
0
0
0
0
210
415
0
0
146
0
0
0
0
52
343
0
96
113

176
0
146
146
0
245
0

9.-Primary treatment of passengers proceeding to another port for
embarkation from July 1, 1930, to June 30, 1931
Treatment

Class

Antwerp

Danzig Ham- Piraeus Total
burg

- - - - - - - - - -- - - - - - - --1- -- - - 1 - - -- 1 - ~ - - I - - - - - - --

Total transmigrants _______ . - - . - -- - . - - . - - - . - - -- -- -- {~8i;&i~== ==

0
59

310
6,309

Passengers vaccinated.----- - ---- - - . - . --- - -- -- - -- -- {~8i;&i~=== =
Passengers deloused and passed _______ __ __________ {~8i;&i~====

0
0

0
0

Passengers inspected and passed without delousing. {~~i~i~====
Baggage disinfected and passed ____________________ {~~i~i~====
Baggage inspected and passed _____ ______ ____ ____ __ {~~&i~====
COUNTRIES OF DEPARTURE

0
59
0
0
0
46
0
17

162
6, 179
148
130
206
5,610
0
0

3

67
2

34
0

56
1
11

0
69
0
146

44
137
32
136
13
136
31

357
6,572
34
170
175
6,430
180
142
206
7,542

1

0
1,817
0
843

0

1,005

l-----t----t----t---f---jl---

Albania________ __________________ ______ ____ _____ __ ____ ________ ________ ___ _____ ________
2
Cyprus____________________________________________ _________ ___ ________ ________ ________
1
Danzig____________________________________________ _____ __ __ ___ ________
14 _______________ _
Estonia______ _____ __________ __ __________ _____ __________________________
5 _______________ _
Germany_____________________________________________________________________
11 _______ _
Greece___________ __ _______ _______ _______ ___________ ___________________ __ ______________
169
Hungary________________________________ ___ __________ _____ _________ ___________
Italy. -- . - . --- - . _.. _______________ . _. ___ . _. _________ . _______ . _____________ __ . _.. _. ____2. _______7_
Latvia_--------- ------------------ ---------------- ____________ ________
32 _______________ _
Lithuania_________________________________ ____________________ ___
_____
279
23

i~~:fi~::::::::::::::::::::::::::::::::::::::::: :::::::::::: _____: _ --6'~:-

2g ::::::::

Persia___ ______________________________________________________________________
2 _______ _
Turkey_________ ___ _________________________________ ___ _________________ ______________
1
Egypt ____ _____________________________________________________________ ---------------1

!


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Federal Reserve Bank of St. Louis

2

1
14
5
11

169
2
7

32
302
6,307
26
47
2

1
1

171

PUBLI C HEALT H SERVIC E
TABLE

iaries from July
10.-Tr eatme nt of baggage, vessels, and service benefic
1, 1930, to June 30, 1931
Baggage Baggage
Vessels
inspected Vessels
disinfumiinspected gated
and
f~~~d
passed
passed

Port

- - - _ __ ,__ _

- - - - - - - - - - - - - - 1 - - - - - - - - - -Antwerp __________________ _______________ __
Belfast_ __________________________________

198
117

- -----_
------------______ --------Bergen
_______
_________
_________
Bremen1_________
Cobh _____________________ _______________ _
Copenha gen ______________________________ _
Danzig ___________________________________ _

2,930
1,087

___ _
Genoa 2 _ --------- --------- --------- --________ --------- - --------- ------Glasgow
Goteborg _________________________________ __
_________
_________
Hamburg _____ _________
------- -----------------_________
oL------_________
_______ -_
Liverpo
London _________
Londond erry _____________________________ _

====
: =:::::
=::::::::
=: =: =: =:::::::
:i~les=:_________
~
_
_______
_________
_________
Palermo
Patras a__________________________________ _
__- --------- --------- --------- ----Piraeus
Rotterda m _______________________________ _
.Southam pton _______ _____________________ __
Stockhol m _______________________________

TotaL --------- --------- -------- -- _
1

Began Dec. 8, 1930.

2

0

0

970
4,636
0
0

0

8,918

524

0
0

245
2,753
0
0

74
35,549
0

543
2,368
1,817
420
2

0
0

20

2
0
0
33
136
0
0
22
30
38
0
0

36,276

0
0

74
28,434
0
992
2,581
842
1,261

0

2
0

57,015

77,289

38
0
0
93
0
0
0
30
0
0
232
0
0
0
1
0
0
0
0
69
0
0

74
0
0
0
0
0
108
30
0

196
501

Medical
Bills of examination of
health
counter- service
benefisigned
ciaries

463

493

861
111
20
486
149
215
20
332
346
76
903
540
598
0
265
109
100
22
70
563
490
99

19

6,375

286

8

4

10
6
17
0
5

1
5

1
8

19
0

94
0
0

26
14
2
5

4

a Disconti nued Feb. 28, 1931

Began Oct. 1, 1930.

AT CONTI NENTA L, INSUL AR,
SUMM ARY OF QUARA NTINE TRANS ACTION S
NS
STATIO
N
AND FOREIG
TABLE

ntal, insular , a;nd
11.-Su mmary of quara;n tine transac tions at contine
1931
30,
June
ended
year
fiscal
the
for
s
foreign staition

Passenge rs
Vessels
Vessels infumigate d inspected
spected

Station

Crew inspected

Bills of
health and
port sanitary statements
issued

Continen tal ••• ____ ._. _____________________
Insular ____________________________________
Foreign ___________________________________ .

14,955
3,417
4,132

2,942
540
590

1

773,743
161,037
365,194

1,039,524
235,537
316, 711

41,385
7,604
11,034

4,072

1,299,974

60,023

22,504

1,591,772

Total ..• _._ - _•..• -•. - •• - • -. -• -- -- -• --

101,970. Statistics do not include "local" travelers at bor1 Maritime stations, 671,773; border stations,
surveilla nce.
der stations, numberin g 10,304,042, who, however, were under

MEDIC AL INSPEC TION OF ALIEN S

s of
Durin g the fiscal year there were exami ned by medical officer
for
gers
passen
alien
6
the Unite d States Public Healt h Service 761,43
proas
es,
diseas
or
s
defect
l
menta
or
al
the purpo se of detect ing physic
916,868
vided by the Unite d States immig ration laws. In additi on,June 30,
ended
year
fiscal
the
during
alien seamen were inspec ted
1917.
1931, as provid ed for in the act of Febru ary 5,
Medic al
Durin g the past year the Regul ations Gover ning thefor distrible
availa
made
and
d
revise
were
Aliens
of
n
Exam inatio
1917, and
bution . The previo us regula tions were promu lgated inmade in the
ces
advan
with
accord
to
ed
requir
was
n
theref ore revisio
lines.
detect ion of diseases, etc., as a result of research along these

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Federal Reserve Bank of St. Louis

172

PUBLI C HEALT H SERVIC E
EXAMI NATIO N OF PROSPE CTIVE IMMIG RANTS
ABROAD

There has been no mater ial chang e during the past year
in the
system of makin g medical exami nation s of applic ants for
tion visas in their count ries in Europ e. On July 1, 1930, an immig raopened in the American Consu late Gener al at Vienn a, Austrioffice was
applic ants were exami ned accord ing to the intens ive metho a, where
d before
visas were grante d.
The system of the medic al exami nation of applic ants for
visas at
consulates which was inaug urated in the Weste rn Hemis
Montr eal, Canad a, during the fiscal year 1929 was extend phere at
ed durin g
the past year to Hamil ton, Ottaw a, Quebec, Toron to, Vanco
Winds or, Winni peg, . Yarm outh; Haban a, Cuba; and Mexic uver,.
Mexico. At several of the Canad ian station s medic al officer o City,
Public Healt h Service are perfor ming the medical exami s of the
nation of
intend ing immig rants for both the local office of the Immig
Service of the Unite d States Depar tment of Labor and ration
for the
Depar tment of State.
There were 103,078 applic ants for immig ration visas
ned by
medic al officers in foreig n countries. Of this numbe r, exami
79,058
were
exami ned by medical officers of the service attach ed to
Ameri can
consulates in Europ e, and 1,622 were report ed by these officer
s to the
consu lar officers as afilicted with one or more of the diseas
class A as map.datorily excludable; 13,458 were report ed es listed in
as afilicted
with a disease or condit ion listed in class B as liable to affect
their
ability to earn a living . Of the 24,020 aliens examined
by
medic
al
officers of the Public Healt h Servic e in their countries of
origin in
the Weste rn Hemis phere, 180 were report ed to consu
lar
afilicted with one or more of the diseases listed under class officers as
datori ly excludable, and 2,287 were repo['ted as afilicted withA as manor condit ion listed in class B as liable to affect their abilitya disease
to earn
a living .
Of 94,412 aliens who had been given a prelim inary medic
al examinatio n in foreig n countries and to whom visas had been
issued
, only
11 were certified upon arriva l at a Unite d States port
as being
afilicted with class A diseases, result ing in mand atory depor
tation .


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Federal Reserve Bank of St. Louis

TABLE

s
12.-Alien passengers inspected and certified at maritime ports in the United States and its dependencie

bD

s;::

;

Class

Class A

"'P.,c,

a,

Place

Important diseases for which class A certification was made

Alien passengers certified

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.....
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Qol

'§£gi!

~@e
ol,e

~:a~~
-~~·~rs $~~;a

;::lp,";i;l8

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Embraces Newport News, Va., and Norfolk:, Va.


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Federal Reserve Bank of St. Louis

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bD ol

i::l--"

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0
8
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8
A
A
-~ -- -- -- ---.-!

a,..cl

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Atlantic coast
Baltimore, Md _______________________________ _
129
5 ----- --- -----Beaufort, S. C ________________________________ _
0
23
244
2
2
6,140
Mass __ -- -- --------------- -- -- -------Boston,
Brunswick, Ga _________ ________________ ______ _
0
Charleston, S. c _____________________________ _
185
Fall River, Mass _____________________________ _
1
Fernandina, Fla _______ ______ ________________ _
0
Fort Everglades, Fla ___ ______________________ _
0
Fort Monroe, Va.I ____________________________ _
167
Fort Pierce, Fla __________ _____ _______________ _
0
Georgetown, S. c ____________________________ _
0
Gloucester, Mass _____________________________ _
0
Jacksonville, Fla _________________ ____________ _
120
1 -------- -- - -Key West, Fla ____ ___________________________ _
16 ---- -5,825
---------- ---------Lewes, DeL _____ __ ___________________________ _
0
2
3,225
-----------------------------___
Fla
Miami,
New Bedford, Mass __________________________ _
62
New London, Conn __________________________ _
0
Newport, R. L ______________________________ _
0
19
8,979 -----56
New York, N. Y. (Ellis Island) _____ ____________ 205,712
Perth Amboy, N. J _______ __ ______________ __
2
Philadelphia, Pa _____________________________ _
521
Plymouth, Mass _____________________________ _
0
Portland, Me _________ _____ _______________ ___ _
91
4
69
Providence, R. L __ __________________________ _
2,051
Savannah, Ga ____________________________ --- __
116
Searsport, Me _____________ ______________ _----0
Vineyard Haven, Mass ______________________ _
0
1

a,

:aa,
~

......
00 «l'
~~

Class
C

~

::cl
0.

ol

~
H

Q

i:?

::,

8

~

0.

~

UJ

ol

--"

0

>.

UJ

2

5
0

271
0
0
0
0
0
0
0
0
0
1
16
0
8
0
0
0

9,500
0
0
0
0

73
0
0
0

2 ------ ------ - -- ---

1 ------ ------ ------

3 ------

1 ------

00
t,:j

~H
1 ------ ------ ------ ------ ------ ------

7 ------

8

20 ------

2

2

24 ------

0

t;l

TABLE

12.-A.Uen passengers inspected and certified) at maritime ports in the Un4tea Statos
an<Z its dependenc ies-Continu ed.
Alien passengers certified

fa>

Important diseases for which class A certification was made

bl)

A

a>

°''d

Place

i::
~
a, ....

=i~~
°':=:

.._. M

.§"~~g

~~
oo>

...
s::i
<l)

,0

z
Atlantic coast-Continu ed.
Washington, N. C_ - - --- -------- ----- - __ ·--- __
West Palm Beach, Fla___________________ ___ __
Wilmington, N. c______________ _____________ _

Class
B

Class A

!

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A a> o

....

'·
0 0 03
~

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:,.';

20

.s
£
0

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W~8;a
-~~~-s ,g~ ~~ gggi.g...... ~
E-<z~ .g ~..c:i_e.
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3
..... ~ .....
......
C)

Class
C

>,

~

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0

:;:l

p.

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p.

0

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0

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- - - - - - - - - - - - - - - - - - - - - - - - -~- -~eO'O bD

o ___ _____ _____ _____ _____ ___ ___ ____ _

31 _____ _______________ ------·- ____ _
116 __ ________ __ _______ _ __ __ ____ _____ __

<l) bl)

a>

'u'i
0

........

oo

cl

~

:5

A
cl
.Cl

p.

;!:!

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;>.
U]

0

0

U]

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b,Ccl

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A

cl

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o>i;::
-+->O

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c:!:)

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0

------ --

0 ------ ------ ------ ------ ------ ------ --- -- - ------ ------ ------ ------ -----0
0

TotaL _- - --------------- -------- ------ -- 224,494-- -21- ---64-9,3 10!_4_79-l--9-,8-7-4--6-t--l---7---i --o21
0
4
28
0
l===ll===l ===l===l= ==l===l== =l===t-==l ===l===l= ===J:==
Gulf coast
Boca Grande, Fla_____ __ _______ ________ _______
o
Carrabelle, Fla______________________ __________
0 ------ ----- - ------ ----- - ------ ------ ----- - ------ ------ ------ ------ --- -- O
0
Cedar Keys, Fla________ ___________ ____ _______
o
0
Corpus Christi, Tex____________________ _______
28
0
Freeport, Tex_________________ ____ ___ _________
o
0
Galveston, Tex_____________________ _________ __
198
0
Gulfport, Ala_______ ______________ ____ _____ ___
O
0
Mobile, Ala_________ __________ ___________ _____
54
0
Morgan City, La. (Atchafalaya)______________
o
0
New Orleans, La_______________ ______ ____ __ ___
3,662
10
12
26
Panama City, Fla_____ ________ ___________ _____
4 ------ ------ ------ ------ -----o
0
Pascagoula, Miss______________________________
o
0
Pensacola, Fla ____ --------- ------------ ------1
0
Port Aransas, Tex___ ______________ ___ _________
O
0
Sabine, Tex__ ___ _________ _____________________
27
0
Tampa, Fla_ ______ _____________________ _____ __
113
0
Port St. Joe, Fla_____ ____________ __ ___________
o
TotaL ________ __ _____ ________ ___________


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1 - -- -1-- - -1- - - -1- - - - -:- -

0

4,083
0
4
10 I 12
26
O _l._
l====t== ==l==== 1: === :===l==== r-==I
,

0

0

0

0

4

0

o l__
o__o_,___o_

Pacific coast
------------- -Aberdeen, Wash __ ------------__________ _
Calif. (San Francisco)
Angel Island, _____________
____________________ _
Astoria, Oreg
Eureka, CaliL _______________________________ _
Fort Bragg, CaliL ___________________________ _
_
Marshfield, Oreg. (Coos Bay) ________________
Monterey, Calif__ ____________________________ _
Newport, Oreg ___________________________ --- -Portland, Ore ____________________________ --- -San Diego, Calif_ ____________________________ _
_
San Luis Obispo, Calif_ ______________________
San Pedro, Calif_ ____________________________ _
Santa Barbara, Calif_ ________________________ _
Seattle, Wash.2 _______________________________ _
South Bend, Wash ___________________________ _

0

0

172

200

20

8,089

2
0 ------------ -------- -------- -----0' ------------ -------- -------- -----0
0
0
4

983
0

7,463
0

4,585

1
2

-----=

2
1
3 -------- -----------3- ----- 22 ---8

-----------________9___ -----19-

49

---62-

0

1 - - - - 1 - - - - - - 1 - - - - 1 - - - - t -- -1

Total. _______________ •. __ -- -- --- -- -----Insular
Alaska: Ketchikan ___________________________ _
Hawaii: Honolulu __ .------------ ------------Philippines:
Cebu ______________ - _- -- - -- -- - -- - -- -- - -- -- Davao ________________ ------------- - --- -- -- - - -- --- - - -- -- Iloilo _____________________
J olo. _____________________________________ _
Legaspi __________________________________ _
Manila ___________________________________ _
Zamboanga __ ------------- ------------- --TotaL _________________________________ _

21,126

13

0

0

4,099

23,686
205

285,620


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

2

2

4

0

0
44

0

180

0
0

0
0

0
0

124

5 ------

0
0

2 ------

4

2

1 ------ ------ ------ ------ ------ -----2 ------ ------ -----1 ------ -----1 ------ ------

1 ------ -----2

2

0

Total, all stations_______________________

34
0
139
0

6 ------

2 ------ ------

0

11

0
0

0
2

0

1

1 ------ -----8

7

0

11

2

0
0

0

0

1

1

12

3

0

1

0
0
0
0
0

0

0

67
1

68
1

68

69

0

24
10
0

1 -- --------

35

4

0

4

194

9, 790

65 ------ ------ ------ -----2
135 ------ ------ ------ ------ ------ -----1 ------ ------ -----2 ------ ------ ------ ------ ------ ------ ------ -----.1
0
0
0
2
65
0
0
0
0
0
0
137
-----0 ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ -----0
0
0
0
0
0
0
0
6

2
0
0
0

1
23
7,772

1 ------ ------ ------ -----1 ------ -----1 ------

574

83

23, 98~

4
5
0

242

0

7,832

Embraces all ports on Puget Sound.

0

12

0
0
0
0
0
0

273

12

Rico: ________________________________ _
Porto
Aguadaila
Arecibo _____________ ------ _-- --- --- --- --- - -- --- ------ ---Arroyo _____________ ------Central Aguirre (Jobos) __________________ _
Fajardo ___ _________ ____ , _________________ _
Guanica __________________________________ _
Humacao ____________________________ - _- _- _
Mayaguez ________________________________ _
Ponce ____________________________________ .
San Juan ____________________________ -----TotaL _________________________________ _

2

46

6

392

6 ------ ------ ------

778

10, 797

8

3

11

13

0

22

35

65

15

7

46

4

......

-.:f

Ol

TABLE

:>,

A

l,

a,
o:l

El

~

Alien passengers certified

p.
El

ClassA

~
p.

s

bl)"O
A a,

bl)"O
A a,

..... A

,!,d• ....

Place

13.-Alien passengers inspected and certified at international border stations

....A

o:i El
Elo:i
~

a,

a,

§t'

§t'

~A
a,a,
p.

~§3

~

a,

.c

~

z

...

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z

a,

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a,
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El

~

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A

·-A
.!<I·...
o:is
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p.

Class B Class C

Important diseases for which class A certifications were made

a,::,
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~·ao

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a>o:iu

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s·s~
3
Ul

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..... A

~~
"' ....

...,0
~

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~

0

2
~$
a,;..

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a,
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0

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0

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0

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Ajo, Ariz_____________________________
O
Brownsville, Tex____________________ 1,977
Calexico, Calif________________________
364
Columbus, N. Mex. _________________________ _
Del Rio, Tex_ ______ - ----------------45

242
1 -------- -------1
11,678
472 ------ ------ -----4
296
132
40
4 --- --9,435
10
155
108
4
33
2 ------ ------ --- --2
719 ---------- -------- -------- -------·
0
4,792
2
18
3
8
5
2 ------ ------ ------ -- - --- ----- 3,276
16
141 - ----- ------ -----4
37
84
4 ------ -----2
25
4,348
4
13
44
1
1 -----1 -----1
12,120
9
52
248
855
381
1,536
12
14
14
3
40
El Paso, Tex__----------------------- 1,951
Guadaloupe Gate, Tex_______________
O
498
2
13
15 ------ -- ---- ------ ------ ------ -----Hidalgo, Tex_________________ _____ ___
424
3,600
2
200
39
321 ------ ------ -----80
2 -----1
Laredo, Tex_ _________________________ 20,712
8
79
275
12
374
16,933
5
2
1 ------ -----~
2
Naco, Ariz____________________________
17
3,784
29
219
15
45
130
1
9
4
3
1 -----Nogales, Ariz_________________________ 5,030
17,368
13
237
7
1
2
2
1
2
52
256
558
Presidio, Tex_ ______________ __________
11
6,625
1
97 ------ ------ -----88
4
4
1 ------ -----Rio Grande, Tex_____________________
5
907
1
11
4
4
20 ------ ------ ~----1 ------ -----Roma, Tex____________ ___________ ____
4
5
852
27
37
69 --- - -- ------ ------ ------ ------ -----San Ysidro, Calif_____ ________________
513
11,177
10
65
346
16
437
3 ---- -- -----7 -----5
Sasabe, Ariz__________________________
6
425
1
1
2
4 ------ -----1 ----- - ------ -----Thayer, Tex___________ _____________ __
8
2
14
850
6
6
------------------------------Tucson, Ariz ________________________ __ __ ___ __
509
137
33
19
194
5
3
4
11 -----12
Ysleta, Tex __________________________________ _
118
3
3
-------- -------514
8
5
2
Zapata, Tex_--- -------- ------- - -----152
TotaL _________________________ 33,465
110,770
911
146
2,386
1,257
4,700
33
20
20
72
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97 ------ ------

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-----1 ------ ------ ----2- -----35 -----1 -----1 ----------- ------ ------ ------ -----2
3
2
143
1
59 ----------- ------

2 ------ ------ ------

67
5
1
1
2
7
20
1
12
36
10 -----11
1
4
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------ ------ ------ -----1
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286

34

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1 ------ ------ ----- 1 -----3 -----52
1
25
7

246

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226

29

Canadian border

Bellingham, Wash____________________
Blaine, Wash_______ __________________
Buffalo, N. y_________________________
Calais, Me___________________________
Detroit, Mich_________________ _______
Duluth, Minn________________________
Eastport, Idaho_____________________ _
Eastport, Me_________________________
Erie, Pa______________________________
Halifax, Nova Scotia, Canada________
Havre, Mont_________________________
Houlton, Me_________________________
International Falls, Minn____________
Jackman, Me_________________________
Lewiston, N. y_______________________
Malone, N. y__ ______________________
Montreal, Canada____________________
Newport, Vt_________________________
Niagara Falls, N. y___________________

0
700
411
552
1,889
13
245
6
0
1,247
0
617
85
224
1,189
25
1, 794
695
329

n~~~~=====================
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N. y____________________
Ogdensburg,

4~
132
34
32
249
2, 731
1,292
67
640
92
4
161

Oroville, Wash_______________________
Portal, N. Dak_______________________
Port Huron, Mich____________________
Quebec, Can ada_ ___ __________________
Rouses Point, N. Y ___________________
St. Albans, Vt________________________
St. Johns, New Brunswick, Canada__
Saulte Ste. Marie, Mich______________
Scobey, Mont________________________
Sumas, Wash_________________________

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Vanceboro, Me_______________________ 1,089

Vancouver, Canada _________________________ _
693
Victoria, Canada_____________________
Winnipeg, Manitoba, Canada________ 1,526
874
Yarmouth, Nova Scotia, Canada______

3
637
446

8,272
6,059
301

39,725
0
504

41
12
200,022
59
24,646
122
1,867
1,067
1,516
103
88
11
15, 764
52
707
3,206
0

75
456
0

52
254
1,238
1
442
1,900
0

2,008

31
13
1
30

-----T -----67- -------44
70
48
456

6
4
17

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19
8
5
1 ----------------- ----------------- -------- -------- -------298
147
5
8
----------------- -------- -------2
4
2
3
7
6
10
13
9

11
1
1
6
12
2
11
7
8
3
2
2
0

1
2
3
0
3
38
6

3
11
6

311,656

Total, all stations_______________ 53,390

422,426

241

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4 -----19
10
3 ------ -----1
6
133
2
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1
8
110
3 ------ ------ -----4 -----2
2
1

192

2,785

1,247

4,465

73

28

44

84

7

83

1,103

5,171

2,504

9,165

106

48

64

140

17

155

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180
264
94
27
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Atlantic coast
Baltimore, Md __________________________________ 17,923
Beaufort, S. c__________________________________
0
Boston, Mass ___________________________________ 54,655
Brunswkk, Ga__________________________________
235
Charleston, S. c________________________________ 3,336
Fall River, Mass________________________________ 1,221
Fernandina, Fla________________________________
0
Fort Everglades, Fla____________________________
0
Fort Monroe, Va.1 ______________________________ 13,838
Fort Pierce, Fla_________________________________
0
Georgetown, S. c_______________________________
0
162
Gloucester, Mass________________________________
Jacksonville, Fla________________________________ 2,578
Key West, Fla__________________________________ 2,526
Lewes, DeL__________________ __ _____ ____ ____ ____
18
Miami, Fla __ ----------------------------------- 10,628
New Bedford, Mass__ _____ ______________________
0
New London, Conn_____________________________
117
Newport, R. !___________________________________
0
New York, N. Y. (Ellis Island) _________________ 546,374
Perth Amboy, N. J _________________________ ____ 3,250
Philadelphia, Pa ________________________________ 25,279
Plymouth, Mass________________________________
0
Portland,
Me_----------------------- --- -- ----- 3,684
Providence,
R. !________________________________ 5,344
Searsport, Me_______________ ______ ______________
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296

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19

8
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7 -------- ------

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1 ------ ------

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13

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32

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3

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0
Washington, N. c ___________________ ____ ____ ___
0
West Palm Beach, Fla _________________________ _
134
Wilmington, N . C ___ __ __ _______ _____ ______ __ __ _ 1,418
Total ______________________________ ____ . __ 695, 426

0 ------ -- - -- - --- - -- --- · -- ------ -- - --- --- --- ------ ------ ------ ------ ----- 0
0
0

265
149
101
0
15
16
0
4
867
42
269
546
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204 ---------- ---------- -------- -----Boca Grande, Fla____________ _______ ____________
0 __________ __________ ________ ______
Carrabella, Fla. (St. George Sound)_____________
0 ---------- ---------- -------- ·-----Cedar Keys, Fla________________________________
844 ---------- ---------- -------- -----Corpus Christi, Tex_____________________________
0 ---------- ___ _______ ________ ______
____
_________________
Tex______________
Freeport,
45 ________ ______
Galveston, Tex __________________________________ 23,367
0 ---------- ---------- ________ ______
____
_________________
Gulfport, Miss_____________
---------- -------- -----______________________ 4,8970 ---------Mobile, Ala_______________
____________________ . _______ _ ______
Morgan City, La. (Atchafalaya)_ _______________
146
35
128
7
New Orleans, La ________________________________ 37, 153
76 __________ __________ ________ ____ __
Panama City, Fla_________________ __ ___ __________

------ ------ -----· ------ ----------- ------ ------ ___________ _
------ ------ ------ ___________ _
44 _____ _
------ ______
------ ------ ------ ------ _____ _
------ ------ ------ ------ -----0 ______ ------ ------ ------ ------ ____________
0 ____________ ------ ________________________ ------ _______________________ _
10
57
7
46
6
1 ______
4
2 ______
316
0 ______ ------ ------ ------ ------ ------ -----0 ____________ ------ ------ ------ ------ -----0 ____________ ------ ------ ------ ------ ______
45 __________________________________________
0 ____________ ------ ------ ------ ------ ______

0 ____________ ------ ------ __________________ ------ _______________________ _

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Total ___ ______________________________ __ __ 75, 465

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183

46

148

384

2

0

4

47

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15

103

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Pacific coast
----- ----_
----- ------ - --________
Wash.-------Aberdeen,
____ ____ __________________
Oreg
Astoria,
____________ _
Angel Island, Calif. (Saa Francisco)
Eureka, Calif.. ________________________________ _
Fort Bragg, Calif ______________________________ _
Marshfield, Oreg. (Coos Bay) __________________ _
Monterey, CaliL ______________________________ _

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512
2,705
61

2

0
0

385

0

0
0

688
6,765
380
San Pedro, Calif. ___ ________ ___ _____ ___________ _ 50,381 ---- - Santa Barbara, CaliL __________________________ _
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Seattle, Wash. 2__________________ _______________ _ 9,485
South Bend, Wash _____________________________ _
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Duluth, Minn ______________________ -----------319
Eastport, Me_________________ -- ------------ ___ _ 1,388

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Alaska: Ketchikan__ ______ __ ____________________
0
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41
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33
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l=::::::a:==l=====l=====l====l=== l=====l===l====½===1===!c===t ====Jc===!====!===l==:::j====F=
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0 __________ ---------- ------- - ______
0 ____________ ------ ______ ------ ------ ------ ------ ------ ------ ------ -----.Davao________________ _______ _______________
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0
Iloilo____________ ________ ______ _______ ___ ____
0 __________ ---------- ________ ______
0
Jolo________ _________________________ __ ______
O ---------- ---------- -------- ______
O
Legaspi_ ___ _________________________________
0 __________ ---------- ________ ______
0
Manila______________________________________ 1,425 ___ _______ ---------- ____ ___ _ ______
0
Zamboanga________________________ __ _______
0 __________ ________ __ ________ ______
0
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129
0 ------ ------ ------ ------ ------ ------ ---- -- ------ ------ - - - - -- - - ---- ----- Arecibo ____________________________________ _
0
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Arroyo ____ ________________ -_____ ------- --- -7
0
Central Aguirre ________ __ __________ ________ _
7
1
1 -------- -----1 -----Fajardo ____________________________________ _
128
0
Guanica _______________ _____________________ _
521
1
1 -----1 ------ -- --- - -Humacao __________________________________ _
136
0
Mayaguez _________________________________ _
152
0
Ponce ______________________________________ _ 1,231
1
2
4 --- -- - ------ ------ ------ -----1 ------ --- - -- -----4 ------- - -----11
11 ------ ------ ------ ------ ------ ------ ------ -----3
San Juan ____________ -------------------- ---- 19,274
5
3
TotaL ____________________________________ 21,585 o
17
o
o
17
o
o
o
o
o
o
0
0
9
4
l===t====l=====!===l===t====t===l====l====IF===l===t===l====l===!===l====l===t==
447
13
178
2
178
Total, all stations_------------------------ IH6, 868
21
864
507
205
1,597
4
2
9
5
O
26
21
I-ti

q

b:l
~

1-4

a

lJ:1
t;I

>
~

1-3

lJ:1
Ul
t;I

~
1-4

a

t;I

,00
,-


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Federal Reserve Bank of St. Louis

182

PUBLIC HEALTH SERVICE
TABLE

15.-Summmry of me&ical inspection of aliens
MARITIME STATIONS

GROUP !.-ALIEN PASSENGERS NOT EXAMINED ABROAD, EXAMINED UPON ARRIVAL

Certified on arrival

IntenTotal ex- sivelyexamined amined

Total
certified
A-II
B
C
---- ------- --- --- - -----

Class

70,898
First_ ___________________________
- -- -- --- -- - -- - -- - -- -- --Second
50,235
Third __________________________ 119,113
Stowaways ____________________ _
650

TotaL ____________________

240,896

Passed

A-I

698
1,792
9,554
516
12,560

70,559
49,632
116,526
606

8
8
13
1

31
12
128
21

221
488
1,864
14

79
95
582
8

339
603
2,587
44

237, 323 1

30

192

2,587

764

3,573

GROUP IL-ALIEN PASSENGERS EXAMINED ABROAD, REEXAMINED ON ARRIVAL

Total
examined

Class

Certifi.ed on arrival
(condition noted
abroad)

Intensively Passed Passed
on
exam- abroad arrival
ined

---

--

First _________________ 2,241
Second ______________ 10,927
Third _____________ --- 31,556

29
87
590

2,057
9,124
26,349

2,048
9,122
26,330

184
1,801
5,197

2
10

44,724

706

37,530

37,500

7,182

1211, 194

-----TotaL ________

Total
certiNum- fled
ber
C certifled

Number A-I A- B
C certiII
fled

B

--- ---

Certified on arrival
(condition not noted
abroad)

-

184 ---1,803
1
5,207
4

- - - ---9
19
---- 9 1
---- 1 192 1,805
---5,226
2 12

5

21

2

2

7,224

30

GROUP !IL-ALIEN SEAMEN, EXAMINED ON ARRIVAL

IntenTotal ex- sivelyexamined amined
Alien crew _____________________
Workaways ____________________
TotaL ____________________

TABLE

Certified
Passed

Total
certified
A-I
A-II
B
C
--- ------ --- ---

893,235
158

319,595
75

891,820
152

19
0

893,393

319,670

891,972

19

864
0

331
4

202
2

1,416

864

335

204

1,422

6

- - -- - - - - - - - -

16.-Summary of medical inspection of aliens

CANADIAN AND MEXICAN BORDER STATIONS
GROUP !.-ALIEN PASSENGERS NOT EXAMINED ABROAD, EXAMINED UPON ARRIVAL

Class

IntenTotal ex- sivelyexamined amined Passed

Certified on arrival
A-I A-II

B

C

Total
certifled

---- ---- -- -- -- -Statistical, making permanent entry
(bona fide immigrants) ______________
Statistical, making temporary entry ____
Nonstatistical,
making entry (local
crossers, etc.) _________________________
Total_------------------- ________


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Federal Reserve Bank of St. Louis

51,022
27,421

29,979
9,042

48,000
25,832

196
56

234 1,687
142 1,025

392,351

55,903

470,794

104,924

387,960

131

727 2,322 1,211

461,792

383 1,103 5,034 2,482

3,022
1, 589

905
366

-

4,39
9, 002

183

PUBLIC HEALTH SERVICE
TABLE

16.-Summary of medical inspection of aliens-Continued.

GROUP IL-ALIEN PASSENGERS EXAMINED ABROAD, REEXAMINED ON ARRIVAL

Class

Total Intensively Passed Passed
on arexam- examined ined abroad rival

Certified on ar- Certified on arrival (conrival (condition dition
not noted abroad)
noted abroad)

B

- Statistical, making permanent entry (bona fide
immigrants) _______ ___ ___ 2,368
Statistical, making ternporary entry ___ ____ ______ 2,608
Nonstatistical, making entry (local crossers, etc.) __
46
TotaL _____________ • 5,022

-

---

2,361

2,248

2,240

2.608

2,608

2,591

46

46

28

5,017

4,902

4,859

Number A-I A-II B
C certifled
--- -

-

Total
certiNum- fled
ber
C certifled

-

---- ----- 3 5
----- ---- ------ ~ ----- 15 -------- ---- ------ 2 ----- ---- 16
119
1
120
4 ----- 18 21
119

1

----

120

8

128

17

17

18

18

43

163

GROUP III.-ALIEN SEAMEN, EXAMINED ON ARRIVAL
IntenTotal
examined sivelyexamined
Alien crew ____________ _________
Workaways ____________________
Total ______ ______ ______ __

Certified

Total
certifled
A-II
B
C
- -- - - - - - - - - - - - - 23,475
22,020
23,300
2
175
172
1
0
0
0
0
0
0
0
0
0
23,475

22,020

Passed

A-I

23,300

2

0

172

1

175

IMMIGRATION ON THE E.ASTEJRN HEMISPHERE
EUROPE.AN PORTS

Medical Director John McMullen in charge. Post-office address:
American Embassy, 5 rue de Chaillot, Paris, France. Telegraphic
address: Amembassy, Pubhealth, Paris.
The medical examination of applicants for immigration visas at
the several consulates in Eur·o pe has continued along the same lines
as in previous years. A series of intelligence tests was given during
the year by, or under the direction of, Surg. Lawrence Kolb to 1,200
aliens applying for visas at Dublin, Cobh, Cologne, Stuttgart, Oslo,
Stockholm, Goteborg, Naples, and Southampton. This was a continuation of mental studies previously started, and about 2,500 applicants have now been examined in order to determine the effect of
race and envir'onment on intelligence test ability and to establish
more nearly exact methods for evaluating mental capacity in the
routine examination of immigrants.
Regular applicants for visas continually decreased during the
fiscal year; however, at the request of the State Department, aliens
who had previously made application for visa and were on the
" waiting list " were requested to apply at the consulate for examination on specified dates. As a result of this order the work of the
medical officers attached to consulates was materially increased during this period and it became necessary temporarily to increase the
number of medical personnel from 32 to 35 medical officers. The


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Federal Reserve Bank of St. Louis

184

PUBLIC HEALTH SERVICE

total number of aliens examined during the year was 79,058, as compared with 156,370 during the preceding year, a decrease of 77,312,
or 49.4 per cent. The economic depression in the United States and
the issuance of an Executive order in September, 1930, for a temporary restrictive immigration are responsible for· the decrease in the
number of aliens applying for visas.
While the total number of aliens examined was considerably less
than in the preoeding year, the percentages of notifications for
classes A and B conditions were notably in excess of last year. Of
the 1,622 class A certificates issued, about one-third were for mental
conditions. 0£ the aliens certified for class B conditions, 43.4 per
cent were refused visas by consular officers.
On July 1, 1930, a medical officer was assigned to duty at the
American consulate at Vienna, Austria, for the purpose of examining
applicants before visas were granted. During the year the medical
examination of applicants for immigration visas at the ports of
Bergen and Oslo was conducted by one medical officer, who traveled
between the two points. This is true also · for Goteborg and
Stockholm.
17.-Distribution accordilng to class of applicants for irnmigration visas
who were medically exarnined at each station frorn July 1, 1930, to June 30,
1931

TABLE

Country and consular office

Total
appli•
cants ex•
amined

Number of applicants
in each class
Quota

Non•
quota

Per cent of applicants
in each class

Nonim•
migrants

Non•
Nonim•
quota migrants
-----------Quota

Belgium: AntwerP--- · ··-······

609

415

194

0

68.1

31. 9

England, totaL .-·-············

7,031

5,777

1,254

0

82.1

17. 9

0

2,491
3,464
1,076

2,156
2,729
892

335
735
84

0
0
0

86.5
78. 7
82.9

13. 5
21.3
17.1

0
0
0

7,089

6,647

438

4

93. 7

6.1

.1

Cobh. ···-········ ····-·····
Dublin •. _.•..••... ~ .....•..

2,760
4,329

2,602
4,045

158
280

0
4

94. 3
93.4

5. 7
6.5

0
.1

Northern Ireland: Belfast.•..•.•

1,234

1,117

117

0

90.5

9. 5

0

Scotland: Glasgow.• ··········-·

3,928

3,295

632

1

83.9

16.0

.1

Germany, total. ••.•.. -._·······

16,452

14,845

1,586

1

90.3

9.6

.1

4,129
1,475
3,738
1,234
5,856

3,637
1,310
3,439
941
5,518

492
165
299
292
338

0
0
0
1
0

88.1
88.8
92. 0
76. 3
94.3

11.9
11.2
8.0
23.6
5. 7

0
0
0
.1
0

Liverpool. ••.• --· •••.•.. ·-··
London ___ ·--········-·····
Southampton ....•·-·····-··
Irish Free State, total. __ •.•..•.
\

Berlin_-·-····-··-·-·-·-····
Bremen __ -----·-·-···-·-···
Cologne._---·-·····-·····-Hamburg.•• ··-·-·--··-·-···
Stuttgart._ •.... _._._ ._. _._.

----- - - - - - - - - - ----- ---- -----

----- ----- - - - -

-----

Holland: Rotterdam.._ ..• _•.•.. ~
Poland: Warsaw... ·-·-····-····

10,148

1,578

162

7

90.1

9. 5

8,223

1,925

0

81. 0

19.0

0

.4
0

Denmark: Copenhagen-·--·····

1,477

1,236

241

0

83.6

16.4

0

Norway, totaL ••• _... _...•. _._.

3,737

3,376

361

0

90.4

9.6

0

1,097
2,640

967
2,409

231

0
0

88.,2
91. 2

11. 8
8.8

0
0

2,326

1,997

329

0

85. 7

14. 3

0

1,231
1,095

1,044
953

187
142

0
0

84.8
87.0

15. 2
13.0

0
0

Bergen.
__ .. -·-- _----------·
Oslo __ ______________________
Sweden, total·----------------Goteborg _______________ -·-Stockholm_._---·---- ---·---


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- - - ----

---130

PUBLIC HEALTH SERVICE

185

17.-Distr ibution according to class of appUcanta for immigran ts viBfL.$
who were meaioally ea:amvned at eaoh station from July 1, 1930, to June
30,

TABLE

1931-Con tinued.

Country and consular office

Italy, totaL _____ __ _____________

Number of applicants
in each class ·

Total
applicants examined

17,178

Genoa ______________________ ----2,712
Naples ___________________ __
10,518
Palermo ____________________
3,948

Quota
5,653

Nonquota

Per cent of applicants
in each class

NonimNonNon immigrants Quota
quota migrants
- - - - - - - - - - - - - -- -

11,525

0

31.8

68.2

0

2,514

0
0
0

40.3
29.4
36. 3

59. 7
70.6
63. 7

0
0
0

----- ---1,094
1,618
7,393
---------1,434

Czechoslovakia: Prague ________
Austria: Vienna ____ ______ ______

2,810

1,840

968

2

65.4

34.5

1,081

811

270

0

75.0

25.0

All countries _____________

76,827

56,810

20,002

15

73.9

26. 0

.1
0

.1

Preliminary or informal examinations at Cologne, Berlin, and Vienna (not included in
above), 2,231,
making the total number of applicants examined 79,058.

18.-Distr ibution according to sea: of applicants for immigra-ti on visas
who were medically ea:amdned, at each station from July 1, 1930, to June
SO,

TABLE

1931

Country and consular office

Number of each sex Per cent of each sex
examined
examined
Male

Female

Male

Female

- - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - ·- - -

Belgium: Antwerp ________________ ____ ________________________ _
England:
Liverpool ______________________ ____ __________________ _____ _
London __________________________
______ ____________ _______ _
Southampto n __ ------------ ------------- ------ -------- '~--IrishCobh
Free____________
State:
·
__________________________________ _______
Dublin ____ ______ ________________________ _________________ __
Northern Ireland: Belfast __________________ ______________ ____ __
Scotland: Glasgow _________________ ______ ________ _______ __ ____ _
Germany:
Cologne _____________
~~~~1!in=====
____________
======= ==_____________
___________
=== "':: == == ==__
== =
=== == == ======
== ====== ==_
Hamburg ____________________ _____________
________________ _
Stuttgart
___________
~-----------------------------------Holland: Rotterdam ___________________
__• ___________
_________ -_
Polland:
----- -------- _______________ _
Denmark:Warsaw_--Copenhagen------------_____________
___ _______________________ _
Norway:
Bergen ___________________________________________ _________ _
Oslo _______________________________________________________ _
Sweden:
Goteborg __________________________________________________ _
Stockholm _________________________________________________ _
Italy:
Genoa _____________________________________________________ _
Naples ____________________________________________________ _
Palermo_._. ___________________________________ • __________ _
Czechoslovakia: Prague--· ____________________________________ _
Austria: Vienna _______________________ •• _______ • ______________ _
All countries. ____________________ • __ •• __________________ _

80597-3 1-13


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Federal Reserve Bank of St. Louis

298

311

48.6

51.4

1,044
1,530
550

1,447
1,934
526

41. 9
44. 2
51.1

58.1
55.8
48. 9

1,014
1,455
434
1,403

1,746
2,874
800
2,525

36. 7
33. 6
35.1
35. 7

63. 3
66.4
64. 9
64.3

1,884
660
1,652
618
2,375
943
5,641
784

2,245
815
2,086
616
3,481
804
4,507
693

45. 6
44. 7
44.2
50. 0
40.6
53. 9
55.5
53.0

54.4
55. 3
55. 8
50.0
59.4
46.1
44. 5
47.0

546
1,043

551
1,597

49.8
39. 5

50.2
60.5

580
495

651
600

47.1
45. 2

52.9
54.8

862
4,387
1,481
1,258
547

1,850
6,131
2,467
1,552
534

31.8
41. 7
37. 5
44. 7
50.6

68.2
58.3
62. 5
55.3
49.4

33,484

43,343

43. 5

56. 5

PUBLIC HEALTH SERVICE

186

19.-Numbe r and percentage of applicants medically e{Camined who were
notified for different classes of disabilities from July 1, 1930, to June ~0,

'l'ABL£

1931
Per cent of applicants
notified for-

Number notified forCountry and consular office
Class A

Class B

Total,
AandB

Class A

Class B

Total,
AandB

--- ---

73

74

0.1

12. 0

12.1

14
10
11

513
571
138

527
581
149

.5
.3
1.0

21. 0
16.4
12.8

21. 5
16. 7
~3. 8

48
61
40
17

504
674
373
373

552
735
413
390

1. 7
1. 4
3. 0
.4

18. 3
15. 5
30.1
9.5

20.0
16. 9
33. 1
9. 9

68
13
52
10
43
10
181
2

1,132
200
705
104
851
340
1,687
146

1,200
213
757
114
894
350
1,868
148

1. 6
.8
1. 3
.8
.7
.6
1. 7
.1

27.4
13. 5
18.8

29.0

14.5
19.4
16. 6
10.0

14.3
20.1
9. 2
15. Z
20. 0
18.3
10.1

3
15

237
738

240
753

.2

.5

21. 6
28.0

21. s.
28.5

Sweden:
Goteborg ______________________________
Stockholm ____________________________

11
15

178
173

189
188

.9
1. 3

14. 4
15.8

15. 3
17.1

Italy:
Genoa _____________ • _•• _. _____________
Naples ________________________________
Palermo _______________________________
Czechoslovakia : Prague ___________________
Austria: Vienna ___________________________
All countries __________________________

168
378
345
80
26
1,622

577
1,773
974
319
105

745
2,151
1,319
399
131

6.2
4. 9
8. 7

21. 2
23. 0
24.6
11. 3
9. 7

27.4
27.9

13,458 :

15,080

Belgium: Antwerp________________________
England:
-----------------------Liverpool_--_
_______________
London _______________
Southampton _________________________
Irish Free State:
----------------------------Cobb ___
__
_______________
_______________
Dublin
Northern Ireland: Belfast_ ________________
_________
Glasgow _______________
Scotland:
Germany:
Berlin _________________________________
Bremen _______________________________
Cologne ________ ._. ____ ___________ _____
Hamburg __ ___________________________
Stuttgart_ ____ • ________________________
_______________ • ______
Holland: Rotterdam
___________________________
Poland: Warsaw
____ __ ___ ____ ______
Copenhagen
Denmark:
Norway:
Bergen ____________________________ • ___
Oslo __________________________________

2.8
2.4
2. 2

8.4

, .,.

33.3
14. 1
12.1

17. 5 ~

2O.-Percen tage distribution of male a.n (l female applicants e{Camined,
notifiecl according to class of disability from July 1, 1930, to June 30, 1931

TABLE

Country and consular office

Per cent of applicants who hadClass A

Class B

Per cent of males
who hadClass A

Class B

Per cent of females
who hadClass A

Class B

1---- ---- ---- ---- ---- ---- - - - - - - - - - - - - - - 1____
0. 1
12. O
0.1
4
0
Belgium: Antwerp _______ _____________
England:
•5
21. O
.5
---LiverpooL ----------- --- - --------.3
16. 4
.3
London_______________________________
.9
8
12.
O
1.
Southampton _-------------- ---------Irish Free State:
1. 4
18. 3
1. 7
Cobb_________________________________
1. o
15. 5
1. 4
Dublin________________________________
L1
30.1
3. O
Northern Ireland: Belfast__ _______________
.4
5
9.
.4
Scotland: Glasgow________________________
Germany:
6
1.
4
27.
6
1.
Berlin__ _______________________________
.9
13. 5
.8
Bremen__ ________ _______ ______________
1
l.
8
18.
L3
Cologne_______________________________
.6
8. 4
.8
Hamburg_--- --------------- ---------6
.
5
14.
.7
Stuttgart____ __________________________
.5
19. 4
.6
Holland: Rotterdam______________________
4
1.
6
16.
1. 7
Poland: Warsaw________ __________ ________
.2
10. o
.1
Denmark: Copenhagen___________________
Norway:
.1
21. 6
.2
Bergen________________________________
.8
28. O
.5
Oslo__________________________________
Sweden:
1.1
4
14.
.9
Gotebor g______________________________
1. 4
15. 8
1. 3
Stockholm____________________________
Italy:
5. 9
2
21.
6. 2
Genoa __ --------------- --------------2. 9
23. o
4. 9
Naples________________________________
7
8.
6
24.
7
8.
_____________
__
_______________
Palermo
3. 3
11. 3
2. 8
Czechoslovakia : Prague___________________
2.1
7
9.
2.4
________
_______________
Austria: Vienna___
. 2- ~ - - 1 - .8All countries ________________________ - - 2 -


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Federal Reserve Bank of St. Louis

13.

10. 5

21.2
13. 7
10. 7

.6
.3
1.1

20. 8
18. 6
14. 8

18. 1
15. 2
26. 5
15.1

1.8
1. 6
4.3
.3

18. 2
15. 7
32. 2
6.3

29. 2
13. 1
15. 0
8.4
13. 6
20. 0
17. 3
7.1

1.6
.7
1. 4
.9
.8
.6
2.1
0

25.8
13. 8
15. 9
8.4
15.1
18. 7
15. 7
12. 9

21. 7
26. 3

.3
.3

21. 4
29. 0

13. 7
13. 5

.6
1. 3

16. 5
17. 5

24. 9
16. 7
24. 5
9. 7
8. 6
17. 2

6.2
4. 0
8.8
2. 5
2. 6

19. 5
16. 9
24. 6
12. 6
10.8
17.4

2. 3

187

PUBLIC HEALTH SERVICE
TABLE

•

21.-Num,ber and percentage of quota applicants who were notified; for
different clas8e8 of cti8abilitie31 from July 1, 1930, to June 30; 1931
Total
number
of quota
applicants examined

Country

Belgium. _______________________
England ___ _______ -_-- __ -- ______
Irish Free State ______ ___ _______
North Ireland __________________
Scotland ________________________
Germany _________ . _____________
Holland ___________ _____________
Poland. _________________________
Denmark _______________________
Norway ________________________
Sweden _________________________
Italy ___ -- - --------------- ______
Czechoslovakia __ _________ ______
Austria _______________________ ._

415
5,777
6,647
1,117
3,295
14,845
1,578
8,223
1,236
3,376
1,997
5,653
1,840
811

All countries __________ ____

56,810

Per cent of total examined
who were notified

Number notified
Class A
conditions

Class B
conditions

Total,
classes
AandB

Class A

Class B

1
33
103
37
15
158
9
136
2
17
23
285
35
20

47
1,028
1,076
338
331
2,612
318
1,512
116
862
274
2,128
228
88

48
1,0Sl
1,179
375
346
2,770
327
1,648
118
879
297
2,413
263
108

0.2
.5
1. 5
3. 3
.4
1.0
.5
1.6
.1
.5
1.1
5.0
1.8
2.4

11.3
17.8
16.1
30.2
10.1
17. 5
20.1
18.4
9.3
25. 5
13. 7
37.8
12.4
10. 9

874

10,958

11,832

1. 5

19. 3

:,

Total,
classes
AandB

--11. 5
18.3
17. 6
33. 510.5
18.5
20. 6
20.0
9. 4
26. 0
14. 8
42. 8
14. 2
13. 3
20.8

22.-Number and percentage of nonquota applicants w ho were notified
for different classes of disabilities from July 1, 1930, to June 30, 1931

TABLE

Total
Number notified
number
of nonquotaap- Class A Class B
Total,
plicants
condicondiclasses
examined tions
tions
A and B

Country

Belgium __ __ .. ________ ..... ----England ___ .. _. . __ . __ . ___ ._ ... _.
Irish Free State _____ ___ ____ __ ___
Northern Ireland __ _________ ____
Scotland _____ ____________ _______
Germany _____ ___ __ ______ ______ _
Holland. ________ __ __ - _- _- _-- - -Poland _____ __________ _________ __
Denmark ___ ___ ___ ___ __ --------Norway __ ____ ____ ____ ____ ___ ___
Sweden ____ ______ ____ -- - ___ - _- _Italy_------------------ -- -- --Czechoslovakia _____ ____________
Austria ______ _--- ---- --- -- --- --All countries ________ _____ _

194
1,254
438
117
632
1,586
162
1,925
241
361
329
11,525
968
270

0
2
6
3
2
25
0
45
0
1
3
606
44
6

20,002

743

Per cent of total examined
who were notified
Class A
conditions

Class B
conditions

13.4
15.4
22. 3
29. 9
6. 5
18. 5
18.5
9.1
12. 4
31. 3
23.4
10.4
9. 3
6. 3

13. 4
15. 5
23. 6
32. 4
6. 8
20. 0
18. 5
11. 4
12.4
31. 5
24. 3
15. 6
13. 8
8. 5

12. 0

15. 7

Total,
classes
A and B

- - - - - -- - - - - - - - 26
194
98
35
41
293
30
175
30
113
77
1,196
90
17

26
196
104
38
43
318
30
220
30
114
80
1,m,
23

0
.1
1.3
2. 5
.3
1. 5
0
2.3
0
.2
.9
5.2
4. 5
2. 2

2,415

3,158

3. 7

23.-Percentage distribution of total quota and nonquota applicants of
each sem who were notified for different classes of disabilities from July 1,
1930, to June 30, 1931

TABLE

Quota
Country

Belgium ___________
England _____ ______
Irish Free State ____
Northern Ireland __
Scotland ____ __ _____
Germany ___ _______
Holland _____ _______
Poland __ ___ ____ ____
Denmark ____ ___ ___
Norway _____ _______
Sweden ___ _________
Italy _______________
Czechoslovakia _____
Austria ____________
All countries_

Nonquota

Male

Female

Male

Female

Class Class Classes Class Class' Classes Glass ClasslClasses Cl ass Class Cl asse
A
B AandB
AandB A
B AandB A
B AandB
A I B
0. 4
.5
1. 2
1. 3
.5
.9
.5
1. 2
.2
.6
1. 4
4.8
l. 9
2.1

11. 9
15. 8
16.1
26.0
16. 5
17. 5
19. 9
18.1
7. 5
24. 3
11. 8
34. 9
9.1
9. 3

12. 3
16.3
17. 3
21. 3
17. 0
18. 4
20.4
19. 3
7. 7
24. 9
13. 2
39. 7
11. 0
11. 4

1. 2

17. 0

18.2


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

J

0
.4
1. 7
4. 3
.4
1.1
.5
2. 3
0
.4
.9
5.1
1.8
2. 8

1 32.4
6.6
I 17. 6
• 19. 1
I 18. 3
I 11. 6 ,
I 26. 4
I 15. 3
' 39. 8
15. 2 ·
I 10. 2

1. 5

I 18. 4

I

10. 2
19.2

I 16.1

1

10. 2
19. 6
17. 8
36. 7
7.0
18. 7
19. 6
20. 6
11. 6
26.8
16. 2
44. 9
17. 0
13. 0

0
.3
1.0
0
.3
1. 5
0
2. 8
0
.6
.5
4. 4
6. 2
2. 5

17.1
13.4
19.1
29. 7
9. 6
19. 5
20. 0
11. 6
4. 7
29. 0
23. 5
10.0
11. 1
5.8

17.1
13. 7
20.0
29. 7
9. 9
21.0
20. 0
14.4
4. 7
29. 6
24. 0
14. 4
17. 3
8. 3

0
0
1.6
4. 2
.3
1. 5
0
2. 0
0
0
1. 2
5. 7
3.4
1. 9

10.3
17. 4
24. 9
30. 0
3. 9
17. 6
16. 8
7. 5
18. 3
32. 6
23. 7
10. 5
8. 0
6. 6

10. 3
. 17. 4
26. 5
34. 2
4. 2
19.1
16. 8
9. 5
18. 3
32. 6
24. 9
16. 2
11. 4
8. 5

19. 9

1.4

16. 0

17.4

1. 5

16.3

17. 8

188

PUBLIC HEALTH SERVICE

24.-Number and percentage of total applicants who were refused visas
-on medioal notification for different classes Of disabilities from July ·1, 1~30,
to June 30, 1931

TABLE

Number of visas refused forCountry and consular office

Class A
conditions

Class B
conditions

14
10
11
48
61
40
17

I

Per cent of applicants examined who were refused for-

Total,
classes
AandB

Class A
conditions

2

3

0.1

0.3

0.4

332
204
45

346
214
56

.5
.2
1. 0

13.3
5.8
4.1

13.8
6.0
5.1

314
449
188
186

362
510
228
203

1.8
1. 4
3.2
.4

11. 3
10.3
15. 2
5. 7

13.1
11. 7
18.4
6.1

68
13
52
10
43
10
181
2

664
81
376
32
149
192
1,087
54

732
94
428
42
192
202
1,268
56

1. 6
.8
1.3
.8
.7
.6
1. 7
.1

16.0
5.5
10.0
2.6
2. 5
10.9
10. 7
3. 7

17.6
6.3
11.3
3.4
3.2
11. 5
12. 4
3.8

3
15

124
539

127
554

.3
.5

11. 3
20.4

11. 6
20.9

11

Class B Total,
condiclasses
tions
AandB
------

Belgium: Antwerp ________________________
England:
Liverpool. ____ ______ __________________
London _______________________________
Southampton _________________________
IrishCobb
Free____
State:
__________________ ___________
Dublin ______ ___ _________ ___ ___________
Belfast_____________ - ___
Northern Ireland:
Glasgow ________________________
Scotland:
Germany:
Berlin _________________________________
Bremen _______________________________
Cologne _______________________________
Hamburg __ _____ ________________ __ ____
Stuttgart ______________________________
Holland: Rotterdam ______________________
Poland: Warsaw __ ____ ______ ___.___________
Denmark: Copenhagen ___________________
Norway:
Bergen ________________________________
Oslo __________________________________
Sweden:
Goteborg ____ _____ _____________________
Stockholm ____________________________
Italy:
Genoa __
-----------------------------Naples
________________________________
Palermo _____________ ,. ___________ _____
Prague___ ________ ________
Czechoslovakia:
Austria:
Vienna __________ ________________

15

54
79

65
94

.9
1. 3

4.3
7.2

5. 2
8.5

168
378
345
80
26

68
378
7
145
42

236
756
352
225
68

6. 2
3. 5
8. 7
2.8
2.4

2. 5
3. 5
.2
5. 2
3.8

8. 7
7.0
8.9
8.0
6.2

All countries_. ______________________

1,622

5,791

7,413

2.1

7.5

9.6

25.-Percentage distribution of male and female applicwnts who were
refused visas on medical notification for different classes of disabilities from
July 1, 1930, to June 30, 1931

TABLE

Country and consular office

Belgium: Antwerp _______ _____ ____________
England:
Liverpool. ____________________________
London _____ -------------------___ • -Southampton.
______________ ________
__
Irish Free State:
Cobb ______
--------------------------____
Dublin
. ___________________________
Northern Ireland: Belfast. ________________
Glasgow
________________________
Scotland:
Germany:
Berlin ___ ._. ___________________________
Bremen ___ . _________ __________________
Cologne _______________________________
Hamburg __ --------------------------Iloll~:Jf
g:~\ter-dam=
=== ==== ::::: === ======
Poland: Warsaw
__________________________
Denmark: Copenhagen ___________________


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Per cent of males who were
refused visas for-

Per cent of females who were
refused visas for-

Class A
conditions

Class B
conditions

Total,
classes
AandB

Class A
conditions

0.3

0.3

o. 6

0.3

0.3

.5

.3
.9

15.1
6.1
3.6

15. 6
6.4
4. 5

.5
.3
1.1

12.0
5.6
4. 7

12.5
5. 9
5.8

1. 4
1.0
1.1
.5

12.2
11.2
13. 6
9. 8

13. 6
12. 2
14. 7
10.3

1. 8
1. 6
4.4
.3

10. 8
9. 9
16.1
1.9

12.6
11. 5
20. 5
2.2

1.6
.9
1.1
.6
.5
.5
1.4
.2

19.1
5. 7
9. 7
3.6
2.9
13.0
13.4
4.3

20. 7
6.6
10. 8
4.2
3.4
13. 5
14.8
4. 5

1. 6
.8
1. 4
.9
.8
.6
2. 2
0

13. 5
5. 2
10.3
1.6
2.3
8. 6
7. 2
2. 8

15.1
6. 0
11. 7
2. 5
3.1
9.2
9.4
2. 8

Class B
conditions

Total,
classes
AandB

--- ------

0

189

PUBLIC HEALTH SERVICE

25.-Peroentage <»istribution of male and female app,Ucants who were
refused visas on m.e dioal notification tar different classes of disabiUties from
July 1, 1930, to June 30, 1931-Continued

1.'.A.BLE

Per cent of males who were
refused visas for-

Per cent of females who were
refused visas for-

Country and consular office
Class A Class B
Total,
Class A Class B
Total,
condicondiclasses
condicondiclasses
tions
tions
AandB
tions
tions
A and B
- - - - - - - - - - - - - - -1 - - - - 1 - - - - - 1 - - - - - - - - - - - - - - - Norway:
Bergen_ _______________________________
9. 9
.1
.3
13.0
9. 6
13.1
.8
19. 2
20.0
.3
21.1
Oslo. __ ------------------------------21. 4
Sweden:
Goteborg___ ___________________________
4. 7
1. 2
.6
4. 6
4.1
5. 8
1. 4
7.3
8. 7
1. 3
7.1
. Stockholm __ -------------------------8. 4
Italy:
6.1
6. 2
4.4
1. 6
10. 5
Genoa ___ -------------------------- --7. 8
Naples ________________________________
5. 9
2. 9
4.0
8. 7
5.8
1. 9
Palermo_ _ _ ___________________________
8. 8
7.0
.1
7. 3
8. 7
.3
Czechoslovakia: Prague_____ ______________
6. 8
3. 3
2.4
6. 0
4. 4
9. 3
Austria: Vienna_ __________________________
5. 9
2. 2
4. 5
3. 3
6. 7
2. 6
All countries._______________________

i-------1-----1-----1----1------1----1.8

9.1

2. 3

10. 91

6.3

8. 6

26.- Percenta,ge of male and female applicants notified for class B disabilities w.ho were refused) visas on medical grownds from July 1, 1930, to June

TABLE

30, 1931
-

-

-

Country and consular office

Number of applicants
notified for class B
conditions

Number of applicants
who were refused for
class B conditions

Per cent of applicants
notified who were refused for class B conditions

Male Female Total

Male Female Total

Male Female Total
---

Belgium: Antwerp ________ __
England:
Liverpool.. _____ -- --- __- _
London ___________ _______
Southampton ____________
IrishCobb
Free________
State: ___ ___ ______
Dublin __________________
Northern Ireland: Belfast. __
Scotland: Glasgow __________
Germanr:
Berlln _________ __________
Bremen _________________
Cologne. ________________
Hamburg ________________
Stuttgart ___ __ _______ ---Holland: Rotterdam ________
Poland: Warsaw __________ __
Denmark: Copenhagen ______
Norway:
Bergen ___________ _______
Oslo ___ ____ ______________
Sweden:
Goteborg ________________
Stockholm _____________ __
Italy:
Genoa ____ ._---- _________
Naples _____________ ___ __
Palermo _________ ______ __
Czechoslovakia: Prague _____
Austria: Vienna _____________
All countries ___________

40

33

73

1

1

2

2. 5

3. 3

2. 7

212
211
59

301
360
79

513
571
138

158
94
20

174
110
25

332
204
45

74. 5
45. 5
34. 0

57. 8
30. 8
31.6

64. 9
35. 7
32.6

184
222
115
213

320
452
258
160

504
674
373
373

125
164
59
138

189
' 285
129
48

314
449
188
186

67. 9
73. 8
51. 3
64. 7

59. 0
63. 0
50. 0
30. 0

62. 3
66.6
50. 4
49. 8

551
87
249
52
325
189
978
56

581
113
333
52
526
151
709
90

1,132
200
582
104
851
340
1,687
146

360
38
161
22
69
123
759
34

304
43
215
10
80
69
328
20

664
81
376
32
149
192
1,087
54

65.6
43.6
64. 6
42.6
21. 2
65. 0
77. 6
61. 7

52.3
33. 6
64. 5
19. 2
15. 1
81. 4
46. 2
22. 2

58. 6
40. 5
64.6
30. 7
17. 5
56. 4
64.4
37. 0

119
275

118
463

237
738

71
201

53
338

124
539

59.6
73. 0

45. 7
73.0

52. 3
73. 0

80
67

98
106

178
173

27
36

27
43

54
79

33. 7
53. 7

27. 5
40. 5

30. 3
45.6

215
734
366
123
47

362
1,039
608
196
58

577
1,773
974
319
105

38
260
6
76
24

30
118
1
69
18

68
378
7
145

17.6
35. 4
1.6
61.8
51. 0

8. 3
ll. 3
.1
35. 2
31. 0

11. 7
21. 3
.7
45.4
40. 0

42

- - - - - - --- - - - - - - --- - - - ----43. 4
53.1
36. 0
2,727
5,791
3,064
5,769
7,566 13,335


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

190

PUBLIC HEALTH SERVICE

27.-Number a,n,d percentage of total quota a.p plicants examined who
were refused), visas on medncal notification for different classes of disabilities
from July 1, 1930, to June 30, 1931

TABLE

Country

Belgium ________________________
England _______________ --- -- __ -Irish Free State _________________
Northern Ireland _______________
Scotland.... ____________________
Germany _______________________
Holland. _____________ -------- -Poland____________________ -----'
Denmark _______________________
Norway___
______
------ -----------Sweden
___________________
___
Italy ____________ _______________
Czechoslovakia _________________
Austria _________________________
All countries ________________

Per cent of number examined
Number who were refused
Total
who were refused visas
visas
number
of quota
appliTotal,
Class A Class B
A Class B Total,
cants ex- Class
condiclasses
condiclasses
condicondiamined
tions
AandB
A and B
tions
tions
tions
----------415
5,777
6,647
1, 117
3,295
14,845
1,578
8,223
1,236
3,376
1,997
5,653
1,840
811

1
33
103
37
15
158
9
136
2
17
23
285
35
20

2
543
734
180
181
1,270
185
1,021
52
653
127
296
87
35

3
576
837
217
196
1,428
194
1,157
54
670
150
581
122
55

0.2
.5
1. 5
3.3
.4
1.0
.5
1. 6
.1
.5
1.1
5.0
1. 9
2.4

0.4
9.4
11.0
16.1
5.4
8.5
11. 7
12.4
4. 2
19. 3
6.3
5. 2
4. 7
4.3

0.6
9.9
12. 5
19.4
5.8
9. 5
12. 2
14. 0
4. 3
19. 8
7.4
10.2
6.6
6. 7

56,810

874

5,366

6,240

1. 5

9.4

10,9

28.-Number and peroentag:e of total nonq_uota applicants who were
refusetl visas on :medioaZ notifi,c,a tion for different cwsses of disabilities from
July 1, 1930, to June 30, 1931

TABLE

Country

Total
number
of nonquota
applicants examined

Class A
conditions

Belgium ________________________
England ________________________
Irish Free State _________________
Northern Ireland. ______________
Scotland ________________ ____ ___ _
Germany_______________________
Holland ______ ----- ------------Poland ______ ------------ _______
Denmark: _______________________
Norway ______ -- -------- ________
Sweden _________________________
Italy____________________________
Czechoslovakia _________________
Austria __ _____________ ______ ____

194
1,254
438
117
632
1,·586
162
1,925
241
361
329
11,525
968
270

0
45
0
1
3
606
44
6

All countries ____ ____ ______

20,002

743


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

I Per cent of number who were

Number who were refused
visas

0

2
6
3
2
25

refused visas

Total, Class A
Class B
condi- classes A conditions
and B
tions
- - - - -0

38
29
8
5
32
7
66
2
10

0

0

Class B
Total,
condi- classes A
tions
andB

-------0

0

157
58
7

40
35
11
7
57
7
111
2
11
9
763
102
13

.1
1. 3
2.5
.3
1. 5
0
2.3
0
.3
.9
5.2
4.5
2.2

3.0
6. 6
6.8
.8
2.0
4.3
3.4
.8
2. 7
1. 8
1. 3
6.0
2. 6

3.1
7. 9
9.3
1. 1
3. 5
4. 3
5. 7
.8
3.0
2. 7
6.5
10. 5
4.8

425

1,168

3. 7

2.1

5.8

6

191

PUBLIC HEALTH SERVICE

29.-Percenta ge distribution of the total quota applicant's notified; for
each class of disabilities who were refused visas on medical grounds from
July 1, 1930, to June 30, 1931

TABLE

Number notified
Country

Number refused visas

Per cent of notified refused visas

Total,
Total,
Total,
Class A ClassB classes Class A Class B classes Class A Class B classes
con- A and
concon- A and
con- A and conconditions !'litions
ditions ditions
ditions ditions
B
B
B
--- ------ -- ------

---

Belgium _____________________
England _____________________
Irish Free State ______________
Northern Ireland ____________
Scotland _____________________
Germany ____________________
Holland _______________ --- _-Poland ______________________
Denmark ____________________
Norway _____________________
Sweden _____________________
Italy ________________________
Czechoslovakia ______________
Austria ______________________
All countries ___________

1
33
103
37
15
158
9
136
2
17
23
285
35
20

47
1,028
1,076
338
331
2,612
318
1,512
116
862
274
2,128
228
88

48
1,061
1, 179
375
346
2,770
327
1,648
118
879
297
2,413
263
108

1
33
103
37
15
158
9
136
2
17
23
285
35
20

2
543
734
180
181
1,270
185
1,021
52
653
127
296
87
35

3
576
837
217
196
1,428
194
1,157
54
670
150
581
122
55

874

10,958

11,832

874

5,366

6,240

100. 0
100. 0
100.0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0
100. 0

2.0
52. 8
68. 2
53. 2
54.6
48.6
58.1
67. 5
4;4.8
75. 7
46. 3
13. 9
38.1
38. 6

6. 2
54. 2
70. 9
57.9
56.6
51. 5
59. 3
70. 2
45. 7
76. 2
50.5
24.0
46.3
50. 9

- - - - - --- - - - - - - - - - - - --- - - - -100.
52. 7
48. 9
0

30.-Percenta ge d'istribution of tof>al nonquota applicants notified for
each, class of disability who were refused visas on medica-l grounds from July
1, 1930, to June 30, 1931

TABLE

Number notified
Country

Number refused visas

Total, Class A Class B Total, Class A Class B Total,
Class A Class B classes
classes
classes
condi- condi- A and condi- condi- A and condi- condi- A and
tions
tions
tions
tions
tions
tions
B
B
B

Belgium _____________________
England _____________________
Irish Free State ______________
Northern Ireland ____________
Scotland _____________________
Germany ____________________
Holland _____________________
Poland _______________________
Denmark ____________________
Norway _____________________
Sweden ______________________
Italy _______ --- ______________
Czechoslovakia ______________
Austria ___________ • __________

0
2
6
3
2
25
0
45
0
1
3
606
44
6

26
194
98
35
41
293
30
175
30
113
77
1,196
90
17

26
196
104
38
43
318
30
220
30
114
80
1,802
134
23

0
2
6
3
2
25
0
45
0
1
3
606
44
6

All countries ___________

743

2,415

3,158

743


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Federal Reserve Bank of St. Louis

Per cent of notified refused visas

8
5
32
7
66
2
10
6
157
58
7

0
40
35
11
7
57
7
111
2
11
9
763
102
13

0
100.0
100.0
100.0
100.0
100.0
0
100. 0
0
100.0
100.0
100.0
100.0
100.0

13. 3
15.4
29. 5
22.8
12. 2
10.9
23.3
37. 7
6. 6
8.8
7. 7
13.1
48.8
41.1

13. 3
15. 6
33.6
28.9
16. 2
17. 9
23.3
50.4
6.6
9.6
11.2
42.3
76.1
56. 5

425

1,168

100. 0

17. 5

36.9

0
38
29

192

PUBLIC HEALTH . SERVICE

31.-Percen tage distribution ·of total quota and nonquota applican ts of
each sex examined who were refused visas on medJical notification from July
1, 1930, to June 30, 1931

TABLE

Quota
Male

Country

Belgium __ ____ _____

Nonquota
Female

Male

Female

Classes
Class Class Classes
Class Classes
Class Classes
Class A
A and Class
A and Class
A and Class
and
A
B
A
B
A
B
A
B
B
B
B
B
- - --- - - - - - - - - - - - - - - - - -

rrfsf.a#:!ia-state====
Northern Ireland ___
Scotland ______ _____
Germany __________
Holland ____ ________
Poland __ __ ____ ____ _
Denmark __________
Norway ___ ____ ___ _
Sweden _______ __ ___
Italy ___ ______ __ ____
Czechoslovakia ____
Austria __ ________ __

0.4
.5
1. 2
1. 2
.5
.9
.5
1. 2
.3
.6
1. 4
4. 8
1.9
2. 1

0.4
10.0
12. 0
14. 7
11. 9
9. 7
13. 8
14. 5
4. 8
18. 5
6. 4
7. 0
5. 4
4. 9

12. 4
10. 6
14. 3
15. 7
5.1
19.1
7. 8
11. 8
7. 3
7. 0

All countries_

1.8

9. 5

11. 3

0.8
10. 5

it~ i
I

0
.4
1. 7
4. 3
.4
1.0
.5
2. 3
0
.4
.9
5.1
1.8
2.8

0. 5
8.8
10. 5
16.8
2. 1
7. 6
.9
9. 3
3. 4
19. 9
6. 3
3. 7
4.4
3. 6

0. 5
9. 2
12. 2
21.1
2. 5
8. 6
1. 4
11. 6
3. 4
20. 3
7. 2
8.8
6. 2
6. 4

0
.1
1.0
0
.3
1. 5
0
2. 8
0
.6
.5
4. 4
.6
2. 5

0
3. 2
8.4
4. 2
1. 4
2. 7
4. 7
6. 3
.9
3. 9
2. 9
3.0
.8
2. 5

0
3. 3
9. 4
4. 2
1. 7
4. 2
4. 7
9.1
.9
4. 5
3. 4
7. 4
1.4
5.0

0
.1
1. 6
4. 3
.2
1. 5
0
2.0
0
0
1. 2
5. 6
.3
1. 9

.4
.4
2. 6

0
2.9
6.8
12.S
.5
2.9
3. 9
3. 6
.6
1.9
1.8
6. 0
.7
4. 5

1. 5

6. 9

8. 4

1.0

3. 2

4. 2

1.3

2.1

3. 4

0
2. 8
5. 2
8. 5
.3
1. 4
3. 9
1. 6
.6
1. 9

.6

32.-Percen tage distribution of to t al quota and nonquota applicants of
each sem noti fied w ho were re fws ed vis as on m edical grounds from July 1,
1930, to June 30, 1931

TABLE

Quota
Male

Country

Belgium ________ __ _
England ______ _____
Irish Free State ____
Northern Ireland __
Scotland ____ _____ __
Germany __ ____ ____
Holland ____ _____ ___
Poland _______ ____ __
Denmark __ _______ _
Norway __ ________ __
Sweden ___ ______ __ _
Itlay ____________ ___
Czechoslovakia _____
Austria __ ____ ______

-

Nonquota
Female

Male

Female

Class Class Classes Class Class Classes Class Class Classes Class Class Classes
A and
A and
A and
A and
A
B
A
B
A
B
A
B
B
B
B
B
--- -- - - --- ---- --- -- -- ---

--

100.0
100.0
100.0
100. 0
100.0
100.0
100.0
100. 0
ioo. o
100.0
100.0
100. 0
100.0
100.0

4.0
63. 3
73. 9
56. 4
72. 0
55. 5
69. 5
79.8
64. 7
76. 2
54. 2
20.0
55.0
52. 5

7. 6
64. 5
75. 8
58.4
72. 9
57. 8
70. 4
81.0
66. 0
76.8
59.2
30. 0
62.8
61.2

0
100. 0
100.0
100.0
100.0
100. 0
100. 0
100. 0
0
100. 0
100. 0
100.0
100.0
100.0

4. 5
46.1
65. 2
51.9
32.4
43.3
47.8
49. 7
29. 2
75.4
41. 3
9. 4
29.0
29.1

4.5
47. 7
68. 5
57. 6
36. 3
46. 7
49. 3
55. 3
29. 2
75. 8
44. 6
19.1
36. 7
42. 3

0
100.0
100. 0
0
100.0
100.0
0
100. 0
0
100.0
100. 0
100. 0
100.0
100.0

0
28.8
44.4
14. 2
14.8
13. 9
23. 5
54.1
20.0
13. 3
12. 5
29. 6
74.4
42. 8

0
24. 7
47.3
14. 2
17. 8
20. 4
23. 5
63.2
20. 0
15. 2
14. 6
51. 3
83. 5
60.0

0
100. 0
100. 0
100. 0
100. 0
100.0
0
100. 0
0
0
100.0
100.0
100. 0
100. 0

0
16. 3
20. 9
28. 5
7. 1
8. 2
23.1
22. 2
4.0
5.8
2. 7
4.2
55. 3
40.0

0
17. 1
25. 7
37. 5
13.1
15. 7
23.1
38.6
4. 0
5.8
7. 6
37. 9
68. 6
53. 8

43. 8 100. 0

27. 2

32.5 100. ·o

17. 0

24. 9

- - -- --- - - - ----- - - 56.9
60.3 100.0 39.

All countries _ 100..0


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Federal Reserve Bank of St. Louis

6

193

PUBLIC HEALTH SERVICE

33.-Number and percentage of quota and nonquota applicants of each
sew who were refused visas for mental conditions from JuZy 1, 1930, to June
30, 1931

TABLE

Nonquota

Quota
Country

Num- Num- Per Num- Num- Per Num- Num- Per Num- Num- Per
ber cent
ber
ber cent
ber
ber cent
ber
ber cent
ber
rereexamrereexamrereexamexamrereined fused fused ined fused fused ined fused fused ined fused fused

Belgium ___________
England ___________
Irish Free State ____
Northern Ireland __
Scotland ___ ________
Oermany __________
Holland ______ ______
Poland _____________
Denmark __________
Norway ______ ______
.Sweden ____________
Italy _______________
Czechoslovakia ____
Austria ____________

---- --- -- -- --- --

210
2,501
2,279
387
1,123
6,493
857
4,911
679
1,436
905
2,560
872
428

1
9
13
4
5
42
3
5
0
5
7
33
4
4

0.4
.3
.5
1.0
.4
.6
.3
.1
0
.3
.7
1.2
.4
.9

205
3,276
4,368
730
2, 172
8,352
721
3,312
557
1,940
1,092
3,093
968
383

0
9
62
21
9
58
2
16
0
3
5
58
4
8

All countries_ 25,641

135

.5

31,169

255

TABLE

Female

Male

Female

Male

88
623
189
47
280
696
85
730
105
153
170
4,170
385
119

0
0
2
0
1
6
0
6
0
0
0
31
6
1

0
0
1.0
0
.3
.8
0
.8
0
0
0
.7
1.5
.8

106
631
249
70
352
890
77
1,195
136
208
159
7,355
583
151

0
1
2
2
1
13
0
5
0
0
1
115
18
1

0

.2
1. 4
2.8
.4
.6
.2
.4
0
.1
.4
1.8
.4
2.0
.8

7,840

53

.6

12,162

159

1. 3

0

.1
.8
2.8
.2
1. 4
0
.4
0
0
.6
1. 5
3.0
.6

34.-Number arn,.d character o,f the more serious manclatoriZy ewcludable
condiitions notified) from July 1, 1930, to Jiine 30, 1931
Q)

~

Ul

Nature or defect

l
Q)

III

~

'iiD

~

A
f;i:l

-

cc

cc
al

J;l
cc

;:;

~

e

(l)
(l)

'C
A
ol

'C
A

;s z

A

cc

~0

~

I>,

'C
A

(l)

cc

'C
A

~

~

s

~
0

<:.)

0

cc

~

'C
A

sA

cc

'o
p._
A
-- (l)

I>,

cc
~

M
0

z

A
(l)
'C
(l)

~

1

35

cc

~
3 0"" -<::I
-- - I>,

.c:l

<:.)

(l)

3
0

8
-1
____ ____ _____ ____ _____ ____ ____ ____ _____ ____ ____

-- -

-

Ul

--

-

Ul

-

1
Alcoholism_____________________________
3 ____ _____ ____ ____ ____
Dementia Praecox______ __ ____ __ ____ ____ _____ ____ ____
1 ____ ____ _____ ____ _____ ____ ____ ____
Epilepsy____________________ ____ ___ 1
1 _____ ____ ____ ____
1
Favus____ ____ ______ ___ _____ ___ _ ____ ____ __ ___ ____ ____
3
1
7
4
1
4 ____ ____
1
Feeble-mindedness_____________ 1
1 ____ ____ ____
5 ____
1 ____ ____
Imbecility______________________ ______ __
2
____
4
1
1
1
1
_______
________
__
___
Insanity________
1 ____ ____ ____
Idiocy________________________________________________ ___ _____
2 ____ 40 ____ ____ ____
1 ____
4
Loathsome contagious diseases__________
8
85 ____ 21 ____ 4
70 21 14
Mentally defective_____ ___ _________ 8
1 ____ _____ ____ ____ ____
Mentally depressed___________________ _______________
3 __________ : __ : ___ ____
Mentally retarded__________________ 4 _____ ____ ____
Organic nervous diseases____________________________ _____ ___ __ __________ ______
1
2 ____ 2
1
18
1
5
4
Psychopathic inferiority ____________ 4
2 ____ _____ ____ ____ ____
1 ____ ____
Senile dementia________________________
78 ____________
1
3
3
5
Trachoma____ ___ _______________ ____ 5
5
4
25
2
28
6
16
Tuberculosis, pulmonary ___________ 10
1
1
3
6
Tuberculosis, other forms____________________ 2
7
5
2
1
24
1
1
Venereal diseases___________________ 1
Total_____________________

j

109

40

17

186

10

181

2

18

26

~

_____
_____
50
43
2
1
2
53
174
_____
_____
3
10
3
487
40
19
4
891

____ ____
____ ____

3
2

2

5

39
8

2
6
2
1

52
70
9
13
3
102
439
1
7
3
55
6
623
150
35
48

80

26

1,622

4

8
26
____ ____
____ ____

35.-Percentiage of decrease in the number ewamined at the different
stations during the y ear enavng June 30, 1931, as compa;red with the yewr
ending June 30, 1930

TABLE

Country
Belgium _______________________________ _
England. ______________________________ _
Irish Free State __________________ ____ __ _
Northern Ireland _______________________ _
Scotland _______________________________ _
______ -------------------------_
Germany
________________________________
Holland

Per cent
58. 55
65.42
64.88
86.87
82.17
43. 67
54. 51

Country
Poland _________________________________ _
__ -------------------------------_
Sweden
___________________________________
Italy
Czechoslovakia _________________________ _

9. 69
35.26
32.83
46. 75

All countries _____________________ _

50.87

Two countries report an increase, viz, Denmark, 11.30 per cent, and Norway, 25.67 per cent.


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Per cent

194

PUBLIC HEALTH SERVICE
IMMIGRATION ON THE WESTERN HEMISPHERE

OAN ADA., OUBA, AND MEXICO

The system of the medical examination of applicants for visas at
American consulates, similar to that in effect at European ports, was
inaugurated at certain ports in Canada and at Habana, Cuba, and
Mexico City, Mexico, during the fiscal year; and at the request of the
Department of State, medical officers of the Public Health Service
were detailed to American consulates at those ports to act as technical
advisers to the consuls. Following is a list of these ports, together
with the dates on which this work was inaugurated:. In Canada:
Hamilton, January 12, 1931; Ottawa, December 11, 1930; Quebec,
October, 1930; Toronto, February 2, 1931; Vancouver, October 1,
1930; Windsor, October 16, 1930; Winnipeg, November 1, 1930; Yarmouth, June 29, 1931. This system of the medical examination of
applicants for immigration visas had been inaugurated at Montreal
during the preceding fiscal year. In Cuba: Habana, January 12,
1931. In Mexico: Mexico City, December 1, 1930.
The total number of applicants examined by medical officers of the
Public Health Service attached to American consulates as technical
advisers since . the inauguration of this system was 24,020. Of this
number, 23,398 were examined at Canadian ports; 233 at Habana,
Cuba; and 389 at Mexico City, Mexico. Of the total applicants
examined 180 were notified to the consul as being afflicted with a
disease or defect listed under class A as mandatorily excludable ~
2,287 were reported as afflivted with a disease or condition listed
under class B, as liable to affect their ability to earn a living.
TABLE

36.-Distribution, according to clas,s, of apcplicari:t's for irnmigration vis as
who were medically ea:,a mined from July 1, 1930, to June 30, 1931

Total
applicants examined

Country and consular office

Number of applicants in
each class
Quota

Nonquota

Per cent of applicants in
each class

Non-immigrants

Quota

---

Nonquota

Non-immigrants
- - - ·- - -

Cuba: Habana __________________
Mexico: Mexico City ___________

233
389

46
140

164
249

23
0

19. 7
36. 0

70.4
64.0

9. 9
0

Canada:
Hamilton ___________________
Montreal. __________________
Ottawa _____________________
Quebec. ______________ ___ ___
Toronto. ___________________
Vancouver __________________
Windsor __ ___ ____ ________ ___
Winnipeg ___________________
Yarmouth. _________________

847
8,275
403
5,937
1,803
658
3,448
1,258
769

711
3,853
144
176
1,313
288
2,116
387
13

123
2,880
259
268
488
370
1,327
613
754

13
1,542
0
5,493
2
0
5
258
2

83. 9
46. 5
35. 7
3. 0
72.8
43.8
61. 3
30.8
1. 7

14. 5
34. 8
. 64. 3
4. 5
27. 1
56. 2
38. 6
48. 7
98. 0

1. 5
18. 7
0
92. 5
.1
0
.1
20. 5
.3

All Canadian _____________

23,398

9,001

7,082

7,315

38. 5

30. 3

31.2

All stations _______________

24,020

9,187

7,495

7,338

38. 3 1

31.2

30. 5

1


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Federal Reserve Bank of St. Louis

195

PUBLIC HEALTH SERVICE

31.-DistributiM, according to seaJ, of a,pplicants fo1· immigration 'Visas
who were medically ea;amined from July 1, 1930, to June 30, 1931

TABLE

Number of each sex
examined

Per cent of each sex
examined

Country and consular office
Male
Cuba: Habana ________________________________________ _
Mexico: Mexico City __ --------------------------------

Male

Female

Female

107
193

126
196

46.0
49. 6

54.0
50.4

~i~~f~~g
All Canadian _____ ______________________________ _

605
4,879
188
3,442
966
354
1,982
690
231

242
3,396
215
2,495
837
304
1,466
568
538

71.4
59. 0
46. 6
58.0
53. 5
53.8
57. 6
54. 7
30. 0

28. 6
41.0
53. 4
42. 0
46. 5
46.2
42. 4
45. 2
70. 3

13,337

10,061

57. 9

All stations __________ ------------------------ ___ _

13,637

10,383

58.1

1=====1=====1=====1= ===

Canada:
Hamilton _________________________________________ _
Montreal_ _________________________________________ _
Ottawa ______________ _____ __ ______________________ _
Quebec __ __________________________________________ _
Toronto _____________________ - _________ _____ -- -----Vancouver ________________ ________________________ _
__________________ _
Yarmouth=______________________
=== ===== == ===== ==== == == == == == == ==== ==== ==

'

43. 0

I

44.4

38.-Number and percentage of applicants medically examined; who were
notified for different class·es of disa,biUties July 1, 1930, to June 30, 1931

TABLE

Per cent of applicants examined notified for-

Number notified forCountry and consular office

Ouba: Habana _______ ____ ________________ _
Mexico: Mexico City ____________________ _
Canada:
--------------------------Hamilton
• _______________ _
____________
Montreal.••
Ottawa __ .---------------------------Quebec ________ ---- ______ ---- -- --- --- -Toronto ________ • _____________________ _
Vancouver._--- -----------------------

f51~Jt1i::=

Total,
Class A Class B
Total,
Class B
classes
condicondiclasses
conditions
A and B
tions
AandB
tions
---- ---- ---24.0
4. 3
28. 3
66
56
10

Class A
conditions

9

16

7
62
2
4
37
5
31
8
5
161

216
858
62
207
157
135
423
154
3
2,215

===== === === ==== ==== ==== ==
All Canadian_______________________
All stations _________________________ ~

~

4. 1

6.4

.8
25. 5
.7
10. 4
15. 4
.5
64
.1
3.0
211
8. 7
2.1
194
.8
25. 5
140
12. 3
.9
454
12. 2
.6
162
.7
.4
8
9. 5
.7
2,376
. 8- ---9-.
~ ---

26. 3
11. 1
15. 9
3. 5
10. 8
21. 3
13. 2
12. 8
1.1
10. 2

25

2. 3

223
920

2-1~

39._:_Percentage distribution of male and female applicants examined
noti;{ied; according to class of disability, from July 1, 1930, to June 30, 1931

TABLE

Per cent of appli- Per cent of males Per cent of females
who hadwho hadcants who hadCountry and consular office

Class A
conditions

Class B Class A Class B Class A ClassB
condicondicondicondiconditions
tions
tions
tions
tions
---- ---- ---- ---- ----

Cuba: Habana ___________________________ _
4.8
18. 2
30.8
24. 0
3. 7
4.3
Mexico: Mexico City ____________ _____ ___ _
2. 5
4.1
4. 1
2. 0
2. 3
4.1
!=====t:====!=====1===== 1====!=====
Canada:
20. 1
.9
76. 7
2. 2
96. 8
3. 2
Hamilton___ _________________ _________
5. 0
.3
6. 0
.5
10. 4
.7
Montreal_____ _________________________
13. 5
.5
17. 6
.5
15. 4
.5
Ottawa_______________________________
1. 6
.2
2. o
. 03
3. 4
.1
Quebec____ ________________ __ __________
3. 1
1. 1
5. 7
.9
8. 7
2. 1
Toronto________ __ _____________________
42.1
1.4
53. 6
2.1
96.4
3.6
Vancouver ______________ ______________

f1;~Jtt=

J

gj

j

~p

lj

~q

~==========================
8. 7
.7
·
10. 1
.7
9. 4
.7
All Canadian________________________
All stations _________________________ ---_-7- ---9.-5-----.7-----rf.3 - - - .7- ----8.-7


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196

PUBLIC HEALTH SERVICE

40.-Number and percentage of quota. appUcants examined who 'Were
notified, for different classes of d~abilitfea July 1, 1930, to June 30, 1931

TABLE

Country and consular office

Cuba: Habana _________________
Mexico: Mexico City___________
Canada:
Hamilton ___________________
MontreaL __________________
Ottawa _____________________
Quebec _____________________
Toronto __ ----- ________ --- __
Vancouver __________________

Number notified forTotal
number
quota
appliA Class B
Total,
cants ex- Class
classes
condicondiamined
AandB
tions
tions
---- ---46
140

Per cent of total examined
who were notified forClass A
conditions

15
8

19
14

8. 7
4.3

32. 7
5. 7

41. 4
10.0

0
27
4
22
1
0

186
424
24
20
106
54
271
67
0

192
466
25
20
133
58
293
68
0

.8
1. 1
.1
0
2.1
2.9
1. 0
.2
0

38.0
11.0
16. 7
11. 4
8.1
38. 6
12. 8
17. 3
0

38.9
12.1
17.4
11. 4
10.1
41. 4
13.8
17. 5
0

1.1

12.8

13. 9

12. 8

14.0

4

6

= ==
Yarmouth _____________
---===
__

711
3,853
144
176
1,313
288
2,116
387
13

All Canadian _____________

9,001

103

1,152

1,255

All stations _______________

9,187

113

1, 175

l,288~

~i~~fi~g--~~=== ====== =

Class B Total,
condiclasses
AandB
tions

6
42

1

41.-Number ood percentage of nonquota applicants ea:am,ined who were
notified for di;fferent classes of disabilities July 1, 1930, to June 30, 1931

TABLE

Country and consular office

Number notified forTotal
number
nonquota
appliA Class B Total,
cants ex- Class
condicondiclasses
amined
AandB
tions
tions

Per cent of total examined
who were notified forClass A
conditions

Class B
conditions

Total,
classes
A and B
I

Cuba: Habana ________________ _
Mexico: Mexico City ___________

164
249

6
3

36
8

42
11

3.6
1. 2

22.0
3. 2

25.6
4.4

Canada:
Hamilton ___________________
MontreaL ___ _______________
Ottawa. _______ _________ ____
Quebec _____________________
Toronto ____________ -- -- ____
Vancouver ______ ___ _________
Windsor____________________
Winnipeg ___________________
Yarmouth __________________

123
2,880
259
268
488
370
1,327
613
754

1
12
1
4
1
9
2
5

30
375
38
103
51
81
147
72
3

31
387
39
107
60
82
156
74
8

.08
.4
.4
1. 5
1. 8
.3
.7
.3
.7

24.4
13. 0
14. 7
38.4
10. 5
21.9
11.0
11.7
.4

24.5
13.4
15.1
40.0
12. 3
22. 2
11. 7
12.0
1.1

AH Canadian __ ___ ___ __ ___

7,082

44

900

944

.6

12. 7

All stations _______________

7,~95

53

944

997

.7

12.6


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

9

=

13. 3
13. 3

197

PUBLIC HEALTH SERVICE

42.-Peroentage distribution of total quota and nonquota appUoants of
each sem emamined who were notified for different classes of disabilities from
July 1, 1930, to June 30, 1931

TABLE

Nonquota

Quota
Male

Country and consular office

Female

Female

Male

Total, Class Class Total, Class Class Total, Class Class Total,Class Class classes
classes A
classes A
classes
B AandB
B AandB
B AandB A
A
B AandB

-Cuba: Habana ..•.. 12. 5 25. 0
Mexico: Mexico
City•...•••...... 2. 5 7.6
Canada:
Hamilton .•....
Montreal. .....
Ottawa ........
Quebec •..••.•.
Toronto ........
Vancouver .....
Windsor .......
Winnipeg ......
Yarmouth .•...

.5
1. 0
0
0

.9

1. 4
.8
.2
0

18. 5
10. 0
.2
0
5. 9
53. 6
14.1
10. 0
0

- - - - - - - - - - - ---

37. 5

4. 5

40. 9

45.4

1. 3

30.4

31. 7

5. 9

14.1

20. 0

10.1

3. 3

3. 3

6.6

1. 8

1. 8

3. 5

.8

4. 4

5. 2

19.0
11.0
.2
0
6. 9
55. 7
14. 9
10. 3
0

.2
1. 0
0
0
1.1
1. 4
1. 5
0
0

3. 4
13. 0
.1
0
2.1
16.4
10. 3
7. 2
0

3. 7
14. 0
.1
0
3.3
17. 9
11.8
7. 2
0

.1
.6
0
1. 1
.8
.7
.2
.1
.5

1. 7
16. 0
.2
4.8
4. 9
31.4
10. 8
6.2
0

1.8
17. 0
.2
5. 9
5. 7
32.1
11. 0
6. 3
.5

0
1.0
0
.3
1.0
0
1.1
.1
.1

1. 9
23. 0
.2
13. 4
5. 5
26. 4
11. 2
5. 5
.4

1. 9
23. 0
.2
13. 7
6. 6
26.4
12.3
5. 7
.5

All Canadian.

1.0

13.1

14. 1

1. 4

12. 2

13. 6

.7

14.1

14.8

.5

11. 7

12. 2

All stations._

1.0

13.5

14. 5

1. 5

12.2

13. 7

.8

14.1

14. 9

.6

11. 5

12.1

43.-Number and percentage of total applicaaits e:camined who wer&
refused visas on medical notifi,oation for d,i"fferent classe8' of disabilities from
July 1, 1930, to June SO, 1931

TABLE

Number of visas refused for-

Per cent of applicants examined who were refused
visas for-

Country and consular office

Cuba: Habana••....•••••••••••.••.•....••
Mexico: Mexico City .••••••••••••••••••..
Canada:
Hamilton......... ....................
Montreal..............................
Ottawa...............................
Quebec................................
Toronto...............................
Vancouver............ ................

~~~~fg~g.............................

Class A

Cla.55 B

10
9

6
2

7
62
2
0
37
5
31
8
5

187
539
50
49
106
67
69
2
0

Total,
classes
AandB

Total,
classes Class A
AandB

Class B

16
11

4.3
2. 3

2.6
.5

6.9
2.8

194
601
52
49
143
72
100
10
5

.8
.7
.5
0
2.1
3.6
0
.·6
.7

22.1
6. 5
12.4
.8
5.9
47. 7
2.0
.1
0

22. 9

l====l=====l====l===='.====::J====
7. 3

12. 9

.8
7. 9

51. 4

2: ~

.7
Yarmouth.·····················-··-·· ----1-----1-----1----+----•1 ----4.6
.7
1,226
1,069
157
5. 2
All Canadian.......................
All stations __ •••.........•.••••..•••


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1====1=====1====11====!====:.J====
4. 5
.7
5. 2
1,253
1,077
176

198

PUBLIC HEALTH SERVICE

44.-Percentage distribution of male and female applicants examined who
were refused visas on medical notification for different classes of disabiUties
from July 1, 1930, to June 30, 1931

TABLE

Percentage of males who were Percentage of females who
were refused visas forrefused visas forl!Jountry and consular office

Total,
classes
AandB

Class A

Class B

Total,
classes
AandB

Class A

Class B

3. 7
.6

4. 7
0

8.4
2. 0

4. 7
2. 7

0. 8
1.0

5. 5
3. 5

. 6.
.8
.5
0
.9
2.1
.7
.8
.5

18. 7
6. 2
16. 0
13. 1
4. 7
32. 1
.3
.1
0

19. 2
7.3
16. 5
13.1
5. 6
34. 3
1.0
1. 0
.5

.2
6. 0
.5
0
1. 1
1. 4
1. 3
.3
.1

3. 4
6. 5
9. 3
4. 8
1. 2
15. 7
.1
.1
0

3. 6
7.1
9. 8
4. 8
2. 3
17. 1
1
:
.1

-----------------------Cuba: Habana
____________________ _
City
Mexico____
Mexico:

l====l=====l====ll====l =====l====

Canada:
Hamilton_--- - -----------------------Montreal______________________________
Ottawa'_______________________________
Quebec______________ __________________
Toronto______ _________________________
Vancouver--- - ------------------------

============================
;{~~ig~g=
Yarmouth____________________________

i

r----+-----+-----lf-----1----+----

A ll Canadian_______________________
All stations_------------------------

.7

6. 9

7. 6

.7

4. 3

5. 0

.7

6. 8

7. 5

.8

4. 2

5. 0

1====1=====1====11====1 =====1====

TABLE

45.-Number and percentage of male and female applicarnts notified, for
class B disabilities who were refmed visas on medical grounas from July 1,
1930, to June SO, 1931

Country and consular
office

Number of applicants
notified for class B
condition

Number applicants refused visas for class
B conditions

Per cent of applicants
notified who were refused visas for class B

Male Female Total
Female Total Male Female Total
- - - - - - - - - - - - - - - - - - - - - - -10. 7
4. 3
15. 2
1
6
5
23
56
33
12. 5
25. 0
0
2
2
0
16
8
8

Male
Cuba: Habana ___ ____________
Mexico: Mexico City ____ ____
Canada:
Hamilton __ __________ ____
MontreaL ___ _____ ___ ____
Ottawa __ ____ ________ ____
Quebec __________________
Toronto _________________
Vancouver ______________

22
22
77
1
0

186
539
50
49
106
67
297
2
0

91. 8
68. 3
91. 0
24. 7
82.4
33. 3
84.3
1.1
0

64. 4
56. 8
.69. 0
21. 3
40. 0
16. 3
47. 5
1. 5
0

86.1
62. 8
81.0
23. 7
67. 5
42. 2
70.1
1. 3
0

890

406

1,296

66.4

46.4

58. 5

895

409

1,304

64.8

45.1

57. 0

45
394
29
61
55
60
162
66
3

216
858
62
207
157
135
423
154
3

157
317
30
36
84
45
220
1
0

29
222
20

;f~~fg~g---~=============
Yarmouth _______________

171
464
33
146
102
75
261
88
0

All Canadians _________

1,340

875

2,215

All ,stations ____ ;. _______

1,381

906

2,287


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

13

l99

PUBLIC HEALTH SERVICE

46.-Number and perc,entage of total ·quota appUcants examined who
were refused visas on medical notification for different classes of disabilities
from Juvy 1, 1930, to June 30, 1931

TABLE

Country and consular office

Number who were
Total
visas
number
of quota
applicants
examined Class A Class B

Per cent of number examined
who were refused visas

refused

Total,
Total,
Class A Class B
classes
classes
AandB
AandB
---- ---- ---- - - - - - - ----

Cuba: Havana _________________
Mexico: Mexico City ___________

46
140

4
6

3
0

7
6

Canada:
Hamilton ___________________
MontreaL __________________
Ottawa ____ _________________
Quebec ______________ - __ -- - Toronto _______________ ----Vancouver _________________
Windsor ____________________
Winnipeg ___________________
Yarmouth __________________

711
3,853
144
0
1,313
176
2,116
387
13

6
42
1
0
27
4
22
1
0

178
350
21
0
86
35
40
0
0

All Canadian _____________

8,713

103

710

All stations _______________

8,899

113

713

•

8.6
4. 3

6. 5
0

15. 2
4. 3

184
392
22
0
113
39
62
1
0

.84
1.1
.7
0
2.1
5. 6
1. 0
.2
0

25. 0
9.1
14. 6
0
6. 6
48. 6
2. 9
0
0

25. 0
10. 2
15. 3
0
8. 6
54. 2
3. 9
.2
0

813

1. 2

8. 3

9. 5

826

1. 3

8. 2

9. 5

47.-Number and percentage of total nonquota applicants examined who
were refused visas on medical notification for different classes of disabilities
from Juvy 1, 1930, to June 30, 1931

TABLE

Country and consular office

Number who were refused
Total
visas
number of
nonquota
appliTotal,
cants ex- Class A Class B
classes
amine:!
AandB

Per cent of number examined
who were refused visas

Total,
classes
AandB
---- ---- ---- ---- ---- ---Class A

Class B

Cuba: Havana _________________
Mexico: Mexico City ___________

164
249

6
3

3
2

9
5

3. 6
1.2

1.8
.8

5. 4
2.0

Canada:
Hamilton ___________________
Montreal_ ___________ -- --- -Ottawa _____________________
Quebec _____________________
Toronto ____________________
Vancouver ________________ -Windsor _____ ______ __ _______
Winnipeg ___ ________________
Yarmouth __________________

123
2,280
259
268
488
370
1,332
613
754

1
12
1
0
9
1
9
2
5

8
188
29
49
20
32
29
2
0

9
200
30
49
29
33
38
4
5

.1
.4
.3
0
1. 8
.3
.3
.7

6. 5
8. 4
11. 2
18. 2
4.1
8. 7
2. 2
.3
0

6. 6
!S.8
11. 5
18. 2
5. 9
9. 0
2. 9
.6
. 'i

All Canadian _____________

6,487

40

357

397

.6

6. 5

6.1

All stations _______________

6,900

49

362

411

.7

5. 3

6.1


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

. 'i

200

PUBLIC HEALTH SERVICE

TAULEJ 48.-Percentaue distribution of the total quota applicants notifi,ea for

eaoh, class of disabilities who were refused 'Visas on. medical ground)s froon

July 1, 1930, to June 30, 1931
Number refused visas

Number notified
Country and consular
office

Class
A

Per cent of notified cases
refused visas

Total, Class Class Total, Class Class Total,
Class classes
classes
classes
B
B
A
B
A
AandB
AandB
AandB
--- ------ ------ ------

Cuba: Habana ________ ______
Mexico: Mexico City ________

4
6

15
8

19
14

4
6

3
0

7
6

100.0
100.0

20.0
0

36.S
42.8

Canada:
Hamilton ________________
MontreaL __ • ____________
Ottawa_. ________________
Quebec ____ -----_--· _____
Toronto _________________
Vancouver _______________
Windsor _____________ • ___
Winnipeg ________________
Yarmouth _______________

6
42
1
0
27
4
22
1
0

186
424
24
0
106
54
271
67
0

192
466
25
0
133
58
293
68
0

6
42
1
0
27
4
22
1
0

178
350
21
0
86
35
226
0
0

184
392
22
0
113
39
248
1
0

100.0
100.0
100.0
0
100.0
100.0
100.0
100.0
0

95. 7
82. 5
87. 0
0
81.1
59.3
83.3
0
0

95. 8
84.0
88.0
0
85.0
66.1
84.0
1.4
0

All Canadian __________

103

1,132

1,235

103

896

999

100.0

79. 2

82.4

All stations ____________

113

1,155

1,268

113

899

1,012

100.0

77.1

80. 0

49.-Percentage distribution of the total non,quota appZicants, notified
for each class of iUsabilities who were refusea 'Visas on medical grounds from
July 1, 1930, to June SO, 1931

TABLE

Number refused visas

Number notified
Country and consular office
Class
A

Total, '·Class
Class classes
A
B
AandB

Total, Class
Class classes
A
B
AandB
---

Cuba: Habana ____ __________
Mexico: Mexico City ________

6
3

36
8

42

Canada:
Hamilton ___________ ___ __
Montreal. _______________
Ottawa __________ __ __ ____
Quebec__________ ___ __ ___
Toronto ___________ ______
Vancouver _________ _____ _
Windsor _________________
Winnipeg ________ ------ __
Yarmouth __. ____________

1
12
1
0
9
1
9
2
0

30
375
38
0
51
81
147
72
0

All Canadian __ _________ _

35

All stations _________ __ _______

44


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Per cent of notified cases
refused visas
Total,
Class classes
B
AandB

6
3

3
2

9
5

100.0
100.0

8. 3
25.0

21.4
45.5

31
387
39
0
60
82
156
74
0

1
12
1
0
9
1
9
0

8
188
29
0
20
32
29
2
0

9
200
30
0
29
33
38
4
0

100.0
100.0
100.0
0
100. 0
100.0
100.0
100. 0
0

26. 7
20.1
76.3
0
39. 2
39. 5
19.6
2. 7
0

29.0
51.8
76.3
0
48.3
40. 2
24. 4
5.4
0

794

829

35

308

343

100.0

38. 8

41. 4

838

882

44

313

357

100.0

37.4

40.5

11

2

201

PUBLIC HEALTH SERVICE

50.-Percentage d~trib'Ution of total quota and, nonq·uota applic(JIYl,tS of
each seaJ eaJamined, who were refused visas on medioal notification July 1,
1930, to June 30, 1931

TABLE

Quota
Female

Male

Country and consular office

Non quota
Male

Female

Total, Class Class Total, Class Class Total, Class Class Total,
Class Class classes
classes A
classes
classes A
B AandB
B AandB
B AandB
A
B AandB A
-- - - --- -- -- --- -- -- --Cuba: Habana _____ 12. 5
Mexico:
Mexico
City _______
______ 2.5
Canada:
Hamilton ______
MontreaL ____ __
Ottawa ____ ____
Quebec ______ ___
Toronto _____ ___
Vancouver _____
Windsor _______
Winnipeg ______
Yarmouth _____

.7
1.0
1. 2
0
1. 6
2.8

.8
.4
0

All Canadian_ 1. 6
All stations _______ _ 1. 1

20.8

4. 6

4. 6

9. 2

1. 3

3.8

5.1

5. 9

0

5. 9

0

2. 5

6. 5

0

6. 5

1. 7

0

1. 7

.7

1. 5

2. 2

27.8
8. 0
18. 5
0
9.3
34. 7
12. 6
0
0

28. 5
9.0
19. 7
0
10.9
37. 5
13.4
.4
0

1. 3
1.0
0
0
2. 7
2.8
1. 5
0
0

15. 6
1.0
9.0
0
2.8
13. 9
6. 9
0
0

16. 9
11.0
9.0
0
5.5
16. 7
8.4
0
0

2. 2
6. 0
0
0
1. 9
1.4
0
.3
.5

8. 9
9.0
14.0
19. 2
6.5
27.8
7. 2
.3
0

11.1
10.0
14. 0
19. 2
8.4
29.2
7.2
.6
.5

0
2.0
.7
0
1.8
0
.9
.3
.1

5. 1
5.0
9. 2
16. 0
2. 2
16. 7
3. 5
.3
0

5.1
5.0
9. 9
16. 0
4. 0
16. 7
4.4
.6
.1

11. 9

13. 5

1.4

8.4

9.8

.5

8.1

8.6

.5

3. 9

4. 4

11.8

12. 9

1.6

8. 2

9. 8

.6

7. 7

8.3

.6

3.8

4.4

8. 3

51.-Percentage distribution of total quota and nonquota applicants of
each seaJ notified! who were refused visas on medlical grounds from July 1,
1930, to June 30, 1931

TABLE

Quota
Male

Country and
consular office

Nonquota
Female

Male

Female

Total, Class Class Total, Class Class Total, Class Class Total,
Class Class classes
classes A
classes A
classes
B AandB A
B AandB
B AandB
A
B AandB.
-- --- ---- ------- -------

--

Cuba: Habana _____ 100.0
Mexico:
Mexico
City _____________
100.0
Canada:
Hamilton ______
Montreal _______
Ottawa ________
Quebec _________
Toronto ________
Vancouver _____
Windsor _______
Winnipeg ______
Yarmouth _____

33. 3

55.0 100.0

11.1

20.0 100.0

12. 5

16.0 100. 0

0

26. z.

0

25.0 100.0

0

66.6 100.0

0

50.0 100.0

33.3

42.9•

97.5
84.4
88. 2
0
89.8
80.6
89.3
0
0

97. 5
85.6
88.8
0
80.2
81.9
89.9
2.5
0

All Canadian ______ 1()().0

90.0

90. 7 100.0

All stations ________ 100.0

90.3

89. 7 100.0

100.0
100.0
100.0
0
100.0
100.0
100.0
100.0
0

80597-31-14


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Federal Reserve Bank of St. Louis

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202

PUBLIC HEALTH SERVICE

52.-Number and peroentage of quota and nonquota a;pplicoots of each
sea: who were refused; visas for mentai condiHons from July 1, 1930, to June
30, 1931

TABLE

Nonquota

Quota
Female

Male

Male

Female

Country and
consular office
Per Num- Num- Per Num- Num- Per Num- Num- Per
Num- Num- cent
ber cent ber ex- ber cent ber ex- ber cent
ber ex- ber
rerererererere- ber ex- reamined fused
fused amined fused fused amined fused fused amined fused fused

--- -- -- --- Cuba: Habana_____
Mexico
Mexico
City ___: ___
_______

All Canadian_
All stations __

0

0

85

1

1. 2

3. 3

114

0

0

135

0

0

1. 3
.8
0
0
2. 0
1. 6
1.0
0
0

45
1,142
107
155
214
188
586
297
226

0
1
0
2
2
1
6
0
4

0
.1
0
1. 3
.9
.5
1.0
0
1. 8

78
1,738
152
113
274
182
741
316
528

0
2
1
0
1
0
6
1
1

0
. 12
.7
0
.4
0
.8
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1. 0

2,960

16

.5

4,122

12

.3

1.1

3,153

16

4,342

13

.3

0

0

22

0

0

79

0

0

61

2

2 .4
1 . 04
1 1. 2
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13 1. 7
0 0
9
.6
1 .4
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160
1,341
63
74
563
122
721
152
9

2
11
0
0
11
2
7
0
0

27

.5

3,205

33

.5

3,288

35

Canada :
Hamilton _____ _
551
MontreaL ___ __ 2,512
Ottawa __ ___ ___
81
Quebec____ _____
102
Toronto __ ____ __
750
Vancouver ___ __
166
Windsor ___ ____ 1,395
Winnipeg _____ _
235
Yarmouth ____ _
4
5,796
5,899

27

-- --- -- --

79

24

.5

I

TABLE 53.-Number ood oharacter of the more serious moodatorily e{l]olu da ble

conditions noti"{ied from July 1, 1930, toi June 30, 1931
03

A
03
.0

Disease or defect

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- - - - - - - - --

-- - Alcoholism____ __ ___ ___ __ ____ ____ _______ ____
1 _____ ____ ____ ____ __ __ ____ ____ ____ ____ ____ ___ _
Favus ___ ____ _____ __ __________ ______ ___ ___ __ ___ __ ___ __ 1
2 ____ ___ _ 1 ____ ____ ____ __ __ ____
Feeble-mindedness____________ _______ ____ __
1 ____ _ 2 ___ _ 1
2 4 __ __ ____ ____ ____ 9
Mentally defective__ __ __________ ___________ ___ __
2 ____ ________ __ __ 21 _____ ___ ____ ____ 21
Nervous instability_______ ________ __ ____ __ __ ______ ___ _ __ __ 1 ____ ____ ____ ____ ___ _ ____ ____ 1
Psychopathic inferiority________ ___ ___ __ _____ ____ _____ 2 ___ _ ____ 1
2 ____ ____ 5 3 13
Senile dementia_____ ____ _____ ________ _____ _ ____ _ ___ __ ____ 1 ___ _ ____ __ __ ____ __ __ ____ ____ 1
Trachoma ____ ___ _________ __ _________ _______ 5
7 __ __ ____ ___ _ ___ _ 1
3 ____ 1 ___ _ 5
Tuberculosis, pulmonary __ _________ _______ _ 3 ____ _ __ __ 1
1 __ __ 5 1 ____ 1 ____ 9
Tuberculosis, other forms___ _________ ______ _ __ ___ ____ _ ____ 1 ___ _ ____ ____ 1 ____ ____ ____ 2
Venereal diseases:
3
Syphilis____ ________ ______________ _________ __ __ ___ ________ ____ 1 ____ ____ ___ _ 1
1 ___ __ ____ ____ ____ ____ 1 ____ ____ ___ _ ____ 1
Chancre_ ____________ ______ ____ _________
Gonorrhea_____ ________ ___________ ______________ __ 1
2 __ __ ____ 2 ____ ____ ____ ____ 5

1
4
10
23
1
13
1
17
12
2
3
2
5

REPORTS FROM IMMIGRATION STATIONS

New York (Ellis Island), N. Y.-Medical Director C. H. Lavinder in charge.
Post-office and telegraphic address, Ellis Island, N. Y.
The activities of the three administrative divisions, viz, boarding division,
line division, and hospital division, at this port have been conducted along the
same general lines as in former years. E-ach of the divisions is supervised by
an executive officer under the general supervision of the chief medical officer,
and close cooperation is maintained at all times between these three units.
The work of the boarding division is conducted from offices located in the
Barge Office Building at the Battery. Because of its central location it is
easily accessible to all piers in New York Harbor and other more or less distant
points where vessels may dock. Travel time, a most important item, to and


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from ships is thus reduced to a minimum, with the result that it is possible
to cover all the vessels entering the port without undue delay. The office is
on the same floor and contiguous to the suite occupied by the immigration inspector in charge, with whom the medical division must be in close contact
ut all times for the proper performance of the work. The number of aliens
arriving at Ellis Island during the past fiscal year showed c~nsiderable decrease as compared with previous years. The economic depression in the
United States is largely, if not wholly, responsible for this decreased immigration. Because of these conditions American consuls have exercised their
discretion in the granting of visas to only those aliens who could show that
they would not, under even extraordinary circumstances, become a public
charge after landing in the United States. Following the inauguration of the
conduct of the medical examination of prospective immigrants abroad, it became unnecessary to conduct at Ellis Island the medical examination of such
third-class or steerage passengers as have been examined abroad, and such
persons now receive a confirmatory medical examination on shipboard. Only
alien third-class or steerage passengers who have not been medically examined
abroad and alien passengers of first and second class who are suspected upon
arrival to be afflicted with a certifiable condition are now removed to I-Ollis
Island. The net result of this change in procedure has been to shift the major
part of the work from Ellis Island to shipboard, which is taken care of by the
boarding division. The hours of duty for medical officers are the same as
those fixed by the Commissioner of Immigration for the inspectors, which during
the summer months are from 7 a. m. to 9.30 p. m. Four hundred and fortynine passengers from all classes were remanded to Ellis Island for further
medical examination during the fiscal year. The total number of aliens inspected during this period was 205,712.
During the fiscal year, 546,374 alien seamen were medically examined. Of
this number, 205,847 were examined intensively in accordance with section
20 (a) of the immigration act of 1924. This examination is designated to detect
the mandatory excludable diseases only. Three hundred and fifty-four seamen
were remanded to Ellis Island as a result of the above examination. This represents a considerable decrease in the number of cases remanded for the mandatory
diseases during the fiscal year as compared with the preceding year. SirtCP,
the intensive examination of seamen was inaugurated several years ago, officials
of the various steamship companies have made every effort to exclude seamen
suffering from these diseases as members of their crew, as such seamen nre a
menace to other members of the ,crew and passengers and the cost in caring for
them in hospital bills and fines is quite a considerable item. Many companies
now require their surgeons to make an intensive examination of all crew before
they are signed on their vessel, and a similar examination the day before arrival
at a United States port.
The line division, situated on First Island, is one of the main administrative
divisions of the Public Health Service in its work at Ellis island. It is located
at the east end of the main building on the first floor and bas at its clispos,11
about 14 large rooms with the necessary lavatories, etc. The activities of the
line division are concerned largely with the medical examination of aliens who
were not given an examination abroad by officers of the Public Health Service
prior to embarkation; reexamination of aliens held for further medical examination ; reexamination of landed aliens, when requested by the immigration authorities ; serving on medical boards; giving medical testimony before hoards
of special inquiry; furnishing the Bureau of Immigration with medical opinion
regarding certain aliens, and other miscellaneous duties in connection with the
conduct of the medical inspection of aliens. Warrant aliens are brought to
Ellis Island for deportation from all parts of the United States. Most of these
cases are presented to the medical division for the purpose of determining
whether their physical condition is such as to require their detention in the
hospital at Ellis Island or in the detention rooms of the Immigration Service.
If afflicted with class A or serious class B conditions, they are sent to the hospital for detention prior to deportation; if they are mentally clear and free
from contagious diseases, they are sent to the immigration rooms for detention.
At the request of the Commissioner of Immigration this examination of warrant
cases has been conducted in one of the detention rooms of the Immigration
Service, and considerable inconvenience and delay has been avoided through
this procedure.
Since the inauguration of the conduct of the medical examination of intending
immigrants abroad, Public Health Service officers detailed for this work are


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given a final intensive course of training at Ellis Island prior to taking up
these duties abroad. This training has proved very beneficial, as the medical
officers not only review the laws and regulations in force pertaining to this
work, but also are afforded a better understanding of the problems actually
confronted by the medical officers on this side in connection with arriving aliens
who have . had preliminary medical examination abroad prior to securing visa.
Boston, Mass.-Surg. Carl Ramus in charge. Post-office and telegraphic
address, 287 Marginal Street, East Boston, Mass.
During the fiscal year, 1,111 vessels were boarded for medical inspection
purposes at the port of Boston, and of this number 433 were passenger carriers.
The number of aliens arriving on these ships and medically inspected totaled
60,795, including 54,655 seamen and 6,140 passengers. Certifications were issued in the cases of 271 alien passengers and 304 seamen. Seventy-five seamen
were certified for class A conditions. The number of alien passengers arriving at this port who had been preexamined totaled 1,697; a total of 4·,443alien passengers were medically inspected at this port who were not preexamined prior to embarkation.
Among the number arriving at this port who embarked at European ports.
were many alien domiciled residents of this country returning from a visit
to their old homes in Europe. These aliens were provided with reentry permits issued by the Immigration Bureau. A number of aliens from Halifax,.
Nova Scotia, and St. John's, Newfoundland, arrived at this port. None of
these aliens was preexamined before embarkation, and many were landed for·
permanent admission to this country. By far the largest proportion of aliens
arriving at this port are from the British Isles and from the Canadian ports
above mentioned, with a few from other northern Europea.n countries.
As in the past, alien passengers of all classes are examined at the port
of Boston after the steamers are alongside their docks. On large steamers
the first and second cabin passengers are inspected at suitably arranged places
on board ship, and the tourist and steerage alien passengers are inspected in
special rooms provided for this purpose on the docks. The present excellent
system of medical examination at foreign ports continues to expedite the
routine examination of those aliens who have been preexamined. Alien passengers detained for further medical or mental examination, regardless of
class, are sent to the immigration station and, if. found necessary, transferred
from there to suitable hospitals. All immigration cases sent to hospitals are
under the direct care of the physicians and surgeons on the staffs of such
hospitals, but progress and diagnosis are carefully followed and checked by
the medical officers at this station. Cases found to have mental symptoms
are thus doubly checked by State and Federal officers before certification.
During the past year 162 cases were admitted to the various hospitals in this
district.
In addition to the medical examination of alien passengers, the crews of
passenger steamers are medically examined when the ships are alongside
the wharves. For the larger passenger steamers, Boston is a port of call for
a few hours only, and in order to expedite the medical inspection work the
passengers and crews are examined simultaneously.
By special arrangement with the medical officer in charge of the Boston
quarantine station there has been this year, as in the past, a certain amount
of interchange of immigration and quarantine functions between the two stations. Freight boats, subject to quarantine inspection, when calling at this
port, are examined for immigration purposes in conjunction with the regular
quarantine inspection. Freight boats, not subject to quarantine inspection, are
boarded at the docks by the medical officers from this station and the crews
examined for immigration purposes. At the subports of Lynn, Salem, and
Beverly, Mass., the combined quarantine and immigration inspection is conducted by the medical officers from this station. This arrangement is not
only expeditious to service operations but also considerably facilitates the
passage of these vessels through quarantine and immigration, thus conserving
a great deal of time for the vessel.
Boston being a port of entry for Chinese, a considerable number of this
race are medically examined at the immigration station. In addition to the
routine physical examinations, stool examinations are made to ascertain the
presence or absence of hookworm and other intestinal parasites. The number
of warrant cases brought to the immigration station continues to increase.
All such cases receive preliminary medical inspection as soon as they arrive.
Any found to have communicable or mental disea!'les, or otherwise definitely
sick, are sent to appropriate hospitals and treated until recovered or deported ;

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any found sick or injured are treated at the station if found to have only
trivial conditions.
A.jo, A.riz.-Acting Asst. Surg. 0. B. Patton in charge. Post-office and
telegraphic address, Ajo., Ariz.
The number of aliens inspected at this station for the year was 242, a decrease of 13 as compared with the previous year. However, traffic between
this port and Mexico has increased considerably, 3,796 aliens and 3,992 United •
States citizens arrived during the year as compared with 2,800 alien arrivals
last year. These aliens for the most part are "local crossers," who enter for a
short visit to the United States or to make purchases. The country south
of Ajo is a farming country and is rather free from disease. Vaccination for smallpox has been strictly maintained, about 574 vaccinations
being performed during the year.
The medical officer detailed to t he immigration station for the purpose of
making the medical examination of arriving aliens has also been designated
to make the required inspection of arrivals by airplane. During the year
the total number of such passengers was 14, of which 3 were aliens. Two
-o f these aliens were Mexican officials and the other was a, British subject, the
latter being inspected and passed. The Mexican officials were regular crossers,
previously inspected. The total number of airplanes arriving was eight.
With the exception of the three aliens previously mentioned all were Ameri-can citizens returning to the United States after a few hours' visit to the Gulf
of California and Sonoyta, Sonora, Mexica, on the international line.
Anacortes, Wash.-Acting Asst .. Surg. S. G. Brooks in charge. Post-office
and telegraphic address, Anacortes, Wash.
Anacortes is the terminus and home port of an international ferry connecting Victoria,· British Columbia, with this port. Most of the persons passing
through are of the tourist class, but there are a few aliens who are presented
for examination. Of the 110 ships that entered this port carrying 1,561 seamen, about 25 per cent were of foreign registry. Of this number, 35 alien
-seamen were examined.
Blaine, Wash.-Acting Asst. Surg. M. A. Keyes in charge. Post-office and
telegraphic address, Blaine, Wash.
The total number of aliens entering this port during the year was 272,356,
-0f which 1,760 were aliens seeking permanent homes; 700 of this latter class
were inspected. These persons arrive at this port from Canada by trains,
auto ,stages, and by foot.
It is anticipated that the new customs-immigration building at this port
will be completed in the near future and the facilities available for making
the medical inspection of aliens will, as a r esult, be greatly improved.
Brownsville, Tew.-Surg. R. R. Tomlin in charge. Post-office and telegraphic
address, Brownsville, Tex.
During the fiscal year there were 13,655 aliens medically examined for immigration purposes at this port. Every alien entering the United States
through the port of Brownsville was examined at least once during the year.
Of those aliens, 1,977 were bona fide immigrants, 63 were statistical aliens
making temporary entry, and 11,615 were nonstatistical aliens, or local crossers.
The aliens examined at this port, were, with a few exceptions, practically
all of Mexican nationality. They are met by immigration officers as they
cross the bridges from Mexico and .are sent to the Public Health Service officers
for medical examination.
The medical officer detailed for duty at the immigration station has also
been designated to meet all airplanes arriving from foreign ports for the purpose of making the required inspections. During the year there were 807
airplanes from foreign countries, practically all coming from Central America
and Mexico. These planes carried 1,967 crew and 1,508 passengers. Among
the passengers and crew there were 1,161 aliens, all of whom were medically
examined at least once during the year for immigration purposes; nine class
B certificates and one class C certificate were issued. In addi'tion to the
regu\ar mail planes arriving at this port, carrying a crew of one with an
occasional passenger or two, the Pan American Airways have a plane which
arrives daily from Mexico City and Tampico or Vera Cruz and Tampico.
These planes have a crew of four and a carrying capacity of 10 passengers.
They are met by a Public Health Service officer on arrival at the airport
and the crew and passengers are examined for quarantine and immigration
purposes. The general type of alien passengers entering by airplane is very
high.


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Bwffalo, N"' Y.-Acting Asst. Surg. W. L. Savage in charge. Post-office and
telegraphic address, Buffalo, N. Y. Under the general supervision of Surg.
Floyd C. Turner.
The total number of aliens entering the port during the year was 810,546,
of which number 857 were examined medically. Of these aliens. 4,972 were
bona fide immigrants seeking permanent homes, and 411 of this number were
• examined by the medical officer of the Public Health Service. Of the 1,614
aliens crossing the border at this point for temporary entry, 436 were referred
for medical examination; likewise 10 nonstatistical aliens were referred for
medical examination by the immigration authorities.
Due to the fact that most of the ships examined at this port are freighters
and grain boats from Canada, there are very few alien passengers. Owing
to the quota law, the examination of immigrants abroad, and the granting
of visas for admission to the United States, the physical and mental condition of arriving aliens is of a much higher type than formerly. The medical
officer examines all aliens held by the immigration authorities at the Peace
Bridge and ferry which connect with Fort Erie across the Niagara River.
Taken as a whole, the physical condition of these people is good. Arriving
a irplanes from Canada carry mostly first class passengers who are passed
on primary inspection by the immigration inspector.
Calais, Me.-Acting Asst. Surg. S. R. Webber in charge. Post-office and
telegraphic address, Calais, Me.
The majority of aliens seeking entry at this port were Canadians from the
Maritime Provinces. They were, in general, in good medical condition. The
medical examinations are conducted chiefly at the immigration station, the
medical officer making routinely four daily calls at the immigration office for
this purpose.
The total number of aliens entering at this port during the year was ap,,
proximately 991,962; the number of bona fide immigrants making permanent
entry was 655, of which number 552 were referred to the medical officer by the
immigration authorities for examination.
Calexico, Oalif.-Acting Asst. Surg. A. L. Rice in charge. Post-office and
. telegraphic address, Calexico, Calif.
The majority of aliens seeking entry at this port are Mexicans, with a few
Canadians, Chinese, Japanese, and other nationalities. The medical examinations are made at the immigration office, the hours of duty for such work being
from 9 a. m. to 1 p. m. ; in addition, the medical officer is subject to call at any
other hour of the day if necessary.
During the year 9,799 aliens were inspected, with 155 certifications for
various causes. Of the number inspected, 364 were seeking permanent entry,
269 were making temporary entry, and 9,166 were "local crossers." Three
hundred and fifty-eight vaccinations were performed.
Detroit, Mioh.-Surg. J. H. Linson in charge. Post-office and telegraphic
address, Detroit, Mich.
The new Detroit and Canada tunnel was opened for traffic on November 3,
1930. The Detroit terminal of this tunnel is about one block from the Detroit
and Windsor Ferry Building, and the office assigned to the Public Health
Service is on the second floor of this building. Medical inspection is held at
the ferry building office from 9 to 10 a. m., and at the tunnel office from
10 to 11 a. m. Between the hours of 11 a. m. and 2 p. m. the officer engaged
in the medical inspection of aliens makes sick calls at the Wayne County Jail,
where an average of 150 prisoners are held by the Immigration Service. Outside calls for the medical inspection of aliens who are unable to report for
examination or who are confined in various private hospitals are made during
these hours. From 2 p. m. to 4.30 p. m. the officer is again on duty at the
ferry building and at the tunnel.
Because of the lower rates on the ferry, the greater number of aliens enter
by this route. During the last year more aliens of the working class have
been seen by the examining medical officer, in contrast to the large number of
tourists and visitors of the preceding year. These aliens come chiefly from
northern and southern Europe, including the United Kingdom of Great Britain,
with no particular country predominating. A total of Z76,573 aliens entered
this port during the year. Of this number 6,270 were classified as bona fide
immigrants making permanent entry, 1,889 of whom were referred by the
immigration authorities for medical examination. The number of aliens making
temporary entry at this port totaled 3,303 while the number of "local crossers"


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was 267,000; 3,213 of the former and 5,059 of the latter were medically
examined.
Duluth, Minn.-Acting Asst. Surg. E. L. Cheney in charge. Post-office and
telegraphic address, Duluth, Minn.
There has been a marked change in the number and type of aliens applying
for admission at this port. During the past fiscal year, . 38 passenger boats
arrived, carrying 6,072 passengers. Only 13 alien passengers were admitted
for permanent residence; 843 were making temporary entry. No certifications
for disease were made. Of the 319 alien seamen examined, only 2 were
certified.
Eastport, Me.-Acting Asst. Surg. J. E. Brooks in charge. Post-office and telegraphic address, Eastport, Me.
During the past year, 39,731 persons entered the United States through
this port, 5,279 ot whom made temporary entry for varying periods. Owing
to the curtailment of the canning industries of fish and blueberries and the
almost collapse of lumbering operations and pulpwood, immigration is almost
at a standstill.
A part of the international ferry service for automobiles has been in operation for some time. The connecting link between this city and the nearest
Canadian island will soon be in operation. This line will lessen the distance
between this port and St. John and Nova Scotia by about 50 miles and should
deflect a large proportion of the through traffic now entering the United States
by way of the international bridge at Calais.
Eastport, I daho.-Acting Asst. Surg. S. H. Hodgson in charge. Post-office and
telegraphic address, Eastport, Idaho.
.
Eastport is on the Canadian border, and transportation to this port is via
one railroad and one highway. The great majority of aliens arrive by automobile and a large proportion o.f these are in transit to Vancouver, British Columbia. The bulk of the traffic· is during the summer months, as very severe winters
are encountered here.
The total number of aliens entering this port was 15,160, of which number
840 were seeking permanent homes. During the year the border patrol, apprehended 53 warrant cases and all were examined and deported.
El Paso, Tea:.-Acting Asst. Surg. Irving McNeil in charge. Post-office and
telegraphic address, 321 Mills Building, El Paso, Tex.
During the past fiscal year the two new subparts, Newman School and
Fort Hancock, have been included under the general supervision) of this station. These new subpo-rts, together with Guadalupe and Ysleta, spread the
activities of the station over a distance of more than 60 miles. The medical
· officer makes regular routine weekly calls at the subports for the purpose of
making the medical immigration examinations.
Besides Mexican immigration, which naturally Q0nstitutes the bulk of
immigrants at this port, there is a small number of two other groups. One
includes the better class of Europeans, mostly British subjects, either to·u rists or
professional men residing in Mexico; the other consists of Asiatics, either
orientals or from the Near East, the last named often maintaining residence
in Mexico for two years or more with the object of eventually making a
home in the United States. It is among this class that a considerable proportion of the trachoma cases reported is found. Another fruitful source of
trachoma is found among a sect called Mennonites, of northern European origin,
but who have colonized in Mexico after a long residence in Canada. These
people frequently travel back and forth between the Mexican colony and the
Canadian colony. Illegal entrants have been greatly reduced, not only by the
vigilance of the border patrol, but because of the realization of the difficulty of
:finding employment in this country, due to the economic depression.
Transportation by airplane to this port from Mexico was :first inaugurated
during the past fl.seal year. These planes soon reached a daily schedule, and
that schedule has been maintained throughout the year. The passengers on
these planes have been generally of the better class, American citizens predominating. The planes reaching El Paso usually come only from Torreon, 460
'miles away, which is the center from:· which planes come from various points
and go to various destinations, passengers from the City of Mexico changing
planes there. The only scheduled stops betw·een Torreon and El Paso are
Parral, Chihuahua, and Juarez.
The total number of aliens arriving at quarantine during the year, not including "local crossers," was 14,687; 143 of this number arrived by plane and 2
were certified as having diseases or defects.


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Port Monroe, Va.-Medical Director J. W. Kerr in charge. Post-office and
telegraphic address, Fort Monroe, Va.
During the fiscal year, 167 passengers and 13,838 seamen were inspected.
A total of 32 seamen were certified as suffering from class A diseases and
three were certified for class B diseases or disabilities affecting ability to earn
a living. The bulk of these inspections were made at Fort Monroe in conjunction with the quarantine inspections aboard ship. In addition, 54 ships
not subject to quarantine inspection were boarded at Fort Monroe for medical
inspections under the immigration law.
Gloucester, Mass.-Acting Asst. Surg. E. B. Hallett in charge. Post-office and
telegraphic address, 139 Main Street, Gloucester, Mass.
For the most part the medical inspection of aliens at this station consists of
the examination of alien seamen, the majority of whom come from the British
Provinces. There are also a considerable number who come from European
ports in salt and coal ships. Upon the arrival at this port of a ship on which
there are aliens, the medical officer is notified by the immigration inspector
and immediately boards the ship and makes the medical immigration examinaton. During the fiscal year 162 alien seamen were inspected, 4 of whom were
certified as having disease or defects.
Halifax, Nova Scotia.-Acting Asst. Surg. F. V. Woodbury in charge. Postoffice and telegraphic address, Halifax, Nova Scotia.
During the year, 7,501 aliens of all classes applied for the privilege of entry
at this port, 1,751 of these received medical examination. All bona fide immigrants, numbering 1,247, were examined. Of the aliens examined by the
Public Health Service in European ports prior to embarkation and seeking
entry through this port, none were found to be suffering from disease or defect
requiring deportation.
The majority of immigration passing through t);lis port originates in the
Province of Nova Scotia and in northern Europe; the quality of immigration
is excellent. There has been noted during the past year a much more rigid
interpretation and application of the immigration laws.
Hidalgo, Te:v.-Acting Asst. Surg. Andrew W. Para in charge. Post-office
and telegraphic address, Hidalgo, Tex.
Immigration at this port is almost exclusively Mexican. During the year,
4,024 aliens were medically examined. Of this number, 424 were bona fide
immigrants seeking homes and were required by the immigration authorities
to undergo an intensive examination, 8 were making temporary entry, and
3,592 were "local crossers." The majority of aliens examined and making
-entry through this port were of the better class. Clandestine crossings have
decreased approximately 25 per cent, duf' to a great extent to the activities
of the border patrol forces.
Honolulu, Ha-ivaii.-Medical Director S. B. Grubbs in charge. Post-office and
telegraphic address, Honolulu, Hawaii.
The medical inspection of first and second class and of certain third-class
aliens is made aboard vessels while at quarantine anchorage. All alien steerage passengers from oriental ports are examined at the immigration station.
Foreign seamen are usually examined while vessels are at the quarantine
-anchorage or on the way to the wharf from the quarantine anchorage ; some
are given an intensive medical examination after the vessel has arrived at the
wharf. The majority of aliens passing through this port were resident orientals who had been to China and Japan and were returning to their homes.
There are practically no bona fide immigrants seeking permanent homes passing through this port. During the year 4,099 passengers were inspected. Of
this number, 1,359 were given :i,ntensive examinations, and 180 were certified for
disease or disability. A total of 28,130 seamen were inspected; 1,320 were
given intensive examinations, and 44 were certified for disease or defect.
Jaclcman, Me.-Acting Asst. Surg. E. D. Humphreys in charge. Post-office
and telegraphic address, Jackman, Me.
Immigration at this port consists for the most part of aliens arriving from
Canada, both by highway and by rail. A majority of these persons are farmers .
and other laboring classes who cross the border at this point for the purpose of
making purchases or for temporary visits. The total number of aliens entering
the port during the year was 93,934. Of this number, 183 were immigrants
seeking permanent entry and 93,751 were nonstatistical aliens making temporary entry. Of the total number of aliens entering the port, 283 were
referred to the medical officer by the immigration authorities for medical
-examination.


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Jacksonville, Fla.-Acting Asst. Surg. R. S. vVynn in charge. Post-office and
telegraphic address, Jacksonville, Fla.
Because of the fact that the foreign ships entering this port are, for the most
part, cargo vessels, the immigration work consists almost exclusively of the
examination of alien seamen. Two or three passenger vessels stopped at this
port (luring the year en route to New York. There were 120 alien passengers
disembarking at this port, out of which number 1 was certified for disease.
Eight aliens were bona fide immigrants seeking permanent homes. The general
type of these was well above the average class of immigrant, both as regards
intelligence and physical condition. The number of alien seamen examined
during the year totaled 2,578, of which number 4 were certified for disease or
defect.
Key West, Fla.-Acting Asst. Surg. J. Y. Porter, jr., in charge. Post-office
and telegraphic address, Key West, Fla.
During the year 5,825 alien passengers and 2,526 alien crew were inspected,
a slight decrease as compared with the preceding year. The class of alien is,
as a rule, high, the vast majority being tourists from Cuba, with a few from
Mexico, Central and South America, and a very small number from Europe and
Asia. The medical inspection of aliens is conducted in conjunction with the
quarantine activities at this port; however, during the year 15·7 vessels were
met and boarded solely for immigration medical inspection.
Lewiston, N. Y.-Acting Asst. Surg. R. H. Sherwood in charge. Post-office
and telegraphic address, Lewiston, N. Y. Under the general supervision of
Surg. Floyd C. Turner.
Aliens arrive at Lewiston from Toronto, Canada, via the Canadian ports of
Niagara on the Lake and Queenstown about five months out of the year ; very
severe weather is encountered th'e remainder of the year. Most of these aliens
are from England, Scotland, and Wales and they are, generally speaking, of a
very high type. Medical immigration examinations are also available at the
international bridge at Lewiston. During the year a total of 26,370 aliens entered through this port. Of this number, 25,835 were medically examined.
Malone, N. Y.-Acting Asst. Surg. P. F. Dalphin in charge. Post-office and
telegraphic address, Malone, N. Y.
The total number of aliens applying for admission to the United States
through the port of Malone during the fiscal year was 8,484, of which number
147 were accorded medical examination at the time of their arrival at this port;
a majority of these aliens, however, had been preexamined in Canada upon
the occasion of their applying for visa. In previous years a great percentage of
the immigrants applying for admission to the United States at this port, especially during the summer months, were composed of Canadian nonresident
laborers who heretofore had been in the habit of coming to th'e United States
and doing seasonal work in the lumber woods. During April and May of the
past year, over 90 per cent of the persons examined were this type of immigrant. Because of the economic depression in the United States and. the labou
conditions, th'e se people were stopped at the border and turned back. Since
that date this type of alien has almost ceased to apply for admission.
Mobile, Ala.-Passed Asst. Surg. R. E. Bodet in charge. Post-office and telegraphic address, Mobile, Ala.
The majority of alien passengers applying for admission at this port are from
Central American countries and the West Indies or Cayman Islands, coming
to the United States on short business or pleasure trips or to enroll as students
in the various colleges in this country.
Aliens presenting evidence of class A diseases and requiring further observation or laboratory confirmation prior to certification are usually referred by the
immigration authorities to the marine hospital in Mobile for such observation or
additional examination and certification.
During the year, 4,951 aliens were medically examined at this station. Of
these, 4,897 were alien seamen, 43 were alien passengers, and 11 were ali'en
stowaways.
Naco, Ariz.-Acting Asst. Surg. B. C. Tarbell in charge. Post-office and telegraphic address, Naco, Ariz.
The aliens encountered at this port are mostly of Mexican race and nationality, being of the laboring class and entering for business, pleasure, and in
transit. Aliens held for deportation proceedings are also accorded medical examination at this port. The majority of alien passengers arrive at this port
by automobile; there is a daily stage service between Cananea, Agua Prieta and
Naco, Sonora, Mexico. A small number also come from Cananea and Nogales.


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Sonora, Mexico, tri-weekly train service being maintained between these places
and Naco, Sonora, Mexico. During the year an average of approximately 16,650
automobiles entered the United States monthly through this port. Inspection
is maintained for 24 hours each day, but only United States citizens and aliens
previously lawfully admitted are allowed to enter the port from 5 p. m. to
9 a. m.

Approximately 542,108 aliens entered the United States at this port during
the year. Forty-two of this number were recorded as statistical arrivals and
a total of 3,801 were given medical examination. A total of 219 certifications
were made.
Economic conditions in the United States are responsible for the curtailment
of immigration for permanent residence, but the number of aliens entering for
temporary stay and for local crossing remains about the same. The serious
depression in the copper mines, Arizona's principal industry, has removed the
incentive which brings many aliens to the United States unlawfuUy and as a
consequence the work of the immigration border patrol bas shown less results
than in previous yea rs.
New Bedford, Mass.-A.cting Asst. Surg. E. F. Cody in charge. Post-office
and telegraphic address, New Bedford, Mass.
The amount of work performed at this port during the year was very small,
but 62 passengers and 117 seamen being inspected during this period. The
arrivals at this port are Cape Verdeans returning under temporary permits
from their native homes in the islands. The Cape Verdean is a good sanitary
type, the majority of those entering having lived in this country for years
under good surroundings.
New Orleans, La.-Surg. T. J. Liddell in charge. Post-office and telegraphic
address, Room 305 Customhouse, New Orleans, La.
·
The conduct of the medical examination of aliens at this port is performed
in. conjunction with quarantine inspection. Any alien requiring further examination or treatment is sent by the local immigration authorities either to the
immigration station at Algiers, La., or to the marine hospital, New Orleans;
aliens requiring intensive treatment are sent to the local United States marine
hospital. During the year there were 3,658 alien passengers examined upon
arrival who had not been examined abroad, and 4 who had been previously
examined abroad prior to embarkation. Out of this number, 3,640 were passed
and 22 certified for mental or physical defects. Practically 75 per cent of the
passengers arriving at this port are first class and come from Central and
South American countries.
In addition to the medical examination of alien passengers, the medical
officer in charge also examines alien crews on vessels arriving at this port.
During the year, 37,153 alien seamen were examined for immigration purposes
at this port, of which number 316 were certified for disease or defect.
Nia,g ara Falls, N. Y.-Acting Asst. Surg. Raymond Hensel in charge. Postoffice and telegraphic address, Niagara Falls, N. Y.
Entry at this port- is made via two vehicular and passenger bridges and two
railroad bridges. Medical examinations are conducted either at the bridges
or at the main immigration office, which is located near the railroad station.
During the year there bas been a decrease in the number of statistical aliens
admitted at this port. Most of the statistical aliens arriving are relatives
of legally admitted aliens or aliens who had been here illegally and were apprehended, and were not attempting to make legal entry. There has been a
marked increase in the number of illegal entries apprehended in this area
during the past year. It is necessary to examine medically these aliens and
to furnish medical treatment to any who might be in need of attention.
The total number of aliens applying for entry was 1,529,205, of which 5,571
were statistical aliens. Of this number, 1,845 were medically examined and
110 certified for physical or mental defects.
Nogales, Ariz.-Medical Director D. Moore in charge. Post-office and telegraphic address, Nogales, Ariz.
The majority of aliens entering this port are Mexicans, with occasional
Europeans, Canadians, and Asiatics. In addition to the medical examination
of immigrants applying for admission at this port, the medical officer visits,
as occasion demands, the substation at Lochiel, some 27 miles eastward, for
the purpose of making medical examinations of aliens.
During the year, 22,398 aliens entered the United States through this port.
Of these. 5,030 were classified as statistical aliens making permanent entry.


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5,860 were aliens making temporary visits, and 11,508 were "local crossers."
Noyes, Minn.-Acting Asst. Surg. George R. Waldren in charge. Post-office
and telegraphic address, Noyes, Minn.
The past year has seen a slight decrease in the number of a liens applying
for admission through the port of Noyes. This is la rgely due to the wave of
depression and the economical condition of the Prairie Provinces of Canada,
and especially the Province of Manitoba. Also, where at one time all automobile traffic was routed Yia one highway, now an additional highway has been
built. diverting part of this class of travel to another port. A great part of
the aliens who are referred to the medical officer at this port by the immigration authorities for medical examination are those seeking medical treatment
in this country; only a very small proportion of the aliens coming over for
temporary entry are referred for medical examination. The majority of statistical aliens seeking permanent entry were examined at Winnipeg. The total
number of aliens entering this p ert was 50,511, of which number 129 were
examined medically.
Ogdensburg, N. Y.-Acting Asst. Surg. R. L. Stacy in charge. Post-office and
telegraphic address, Ogdensburg, N. Y.
The great majority of aliens entering through the port of Ogdensburg were
either farmers or laborers, coming chiefly from Canada. England, Ireland, and
Scotland. These examinations are conducted either at the office of the medical
officer or at the immigration office. Practically all the arriYing foreign seamen
were examined on shipboard. During the fiscal year, 166,680 aliens entered
through this port. Of this number, 182 were bona fide immigrants seeking
permanent homes; 640 were making temporary entry. One hundred and
thirty-two of the former and 11 of the latter were given a medical examination.
P,ensacola, FZa.-Acting Asst. Surg. C. W. d' Alemberte in charge. Post-office
and telegraphic address, Pensacola, Fla.
Immigration operations at this station consist for the most part of the
examination of alien seamen, there being very little alien passenger traffic
encountered here. The type of immigrant seamen encountered varies greatly
in view of the fact that vessels of nearly all nationalities call here. During
the fiscal year there were examined 1,204 alien seamen and 8 workaways. Of
this number, only four were certified as being afflicted with disease or defect.
Philippine Islands.-Surg. R. W. Hart in charge. Post-office and telegraphic
address, P. 0. Box 424, Customhouse, Manila, P. I.
The medical inspection of arriving aliens at ports in the Philippine Islands
iR performed by the quarantine officers in conjunction with their quarantine
duties. The collectors of customs act as immigration officers and are charged
with the enforcement of the laws nnd regulations concerning immigration.
Provision is made at every port of entry in the islands for the medical inspec•
tion of arriving aliens.
A majority of aliens arriving at Philippine Island ports are Chinese from
Fukien and Canton who embark at the ports of Amoy and Hong Kong. Most
of these are returning resident aliens and minor children of resident aliens.
A small percentage of aliens examined under the immigration laws are .Japanese. The primary examination of arriving aliens is made on board incoming
vessels, since there has been no provision made for conducting such examinations on shore. Those individuals found suffering from disease at the time
of the primary examination are held for further detailed examination ashore,
this being performed at the out-patient office of the Public Health Service in
the customhouse. At present there are no facilities available for the hospitalization of diseased aliens who may require prolonged observation. However,
construction of an immigration station at the port of Manila has begun and
facilities will be provided there for the detention, observation, and treatment
of aliens.
About 98 per cent of aliens arriving in the Philippine Islands enter through
the port of Manila. The remaining 2 per cent enter through the ports of
Davao, Jolo, and Zamboanga. As only freight vessels arrive at the ports of
Cebu, Iloilo, Legaspi, Cavite, and Olongapo, practically no aliens are inspected
at these ports. During the year a total of 23,986 aliens were examined. Of
this number, 133 were certified in accordance with the immigration laws.
Port Huron, Mich.-Acting Asst. Surg. George M. Kesl in charge. Postoffice and telegraphic address, Port Huron, Mich.


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During the fiscal year ended June 30, 1931, 904,798 aliens entered the
United States at Port Huron. Of these, 1,412 signified their intention of
becoming permanent residents and 249 were referred for medical examination
by immigration authorities. In addition, 810 aliens sought admission at this
port for temporary visits, and there were 902,574 "local crossers"; 354 of the
former and 353 of the latter were referred to the medical officer by the immigration authorities for medical examination.
·
While the number of aliens made the subject of a medical examination
decreased in comparison with previous years, the percentage of those certified
as suffering with defect or disease reveals an increase. This is due to a more
intensive examinaEon now being given arriving aliens. Examinations are
conducted at the St. Clair Tunnel station if entry is made by railroad and at
the wharf office of the Immigration Service in case of arrival by ferryboat.
In addition, many aliens are brought by automobile to the out-patient dis•
pensary of the Public Health Service in the Federal Building where better
facilities enable a more satisfactory examination. The type of immigrant
applying for admission at this port is excellent. Approximately 80 per cent
are natives of Canada.
Porto Rico.-Surg. L. E. Hooper in charge. Post-office and telegraphic
a.::1.dress, San Juan,- P. R.
During the year 7,832 alien passengers and 21,580 alien seamen entered
the ports of Porto Rico. Of this number, 7,772 passengers and 19,274 seamen
were examined at San Juan and 60 passengers and 2,306 seamen at the nine
sub ports.
The routine medical examination of aliens arriving in Porto Rico is effected
aboard vessels in conjunction with the quarantine inspection. Suspicious or
doubtful cases are sent to the Public Health Service office for further examination. The majority of immigrants arriving at Porto Rican ports come from
the other islands of the West Indies or from Central or South America. A
few come from European countries. The type is generally good, many of them
traveling first class.
Presidio, Tea:.-Acting Asst. Surg. 0. M. Hatcher in charge. Post-office and
telegraphic address, Presidio, Tex.
The general type of immigrant e;xaminecl at this station is of the laboring
class; practically all are Mexicans and are very poor. Most of the immigrants
locate on near-by farms. During the year 21,304 aliens entered the United
States through this port. Of this number, 11 were bona fide immigrants making permanent entry and 13 were making temporary entry; the remainder
were nonstatistical aliens or "local crossers."
Providenoe, R. I.-Surg. H. G. Ebert in charge. Post-office and telegraphic
address, 403 Federal Building, Providence, R. I.
Alien passengers seeking entrance into the United States through the port
of Providence originate almost entirely in the countries bordering on the
Mediterranean and Black Seas, and from Portugal and its island possessions,
Madeira and the Azores. From a standpoint of personal cleanliness and free•
dom from major personal defects, it would appear that closer attention is
being paid to those applying for passage than was noted in previous years.
During the year 1,958 alien passengers were examined who had not been
given a previous medical examination abroad prior to embarking. Of this
number, 50 were certified under class B and 3 under class O diseases. Of
the 93 aliens who had been examined abroad prior to embarkation, 19 had been
certified under class B and 1 under class 0. These were again inspected at
this port and their condition noted on the medical certificates.
The total number of alien crews examined during the year was 5,344, of
which 1,458 were intensively examined. No disease or defect was noted among
these men.
Rio Ckande, Tea:.-Acting Asst. Surg. 0. J. Martin in charge. Post-office and
telegraphic address, Rio Grande, Tex.
During the last fiscal year there were 912 aliens medically examined for
immigration purposes at this port. Of this number, 5 were bona fide immigrants
seeking permanent homes, 1 was making temporary entry, and 906 were "local
crossers " corning for business and trade purposes. The port is open from 8.30
a. rn. to 4.30 p. m., and medical examinations are conducted during those hours.
The aliens examined are practically all of the Mexican race and belong to the
laboring classes. Clandestine crossing is decreasing somewhat, due to the
activities of the border patrol.


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St. Albans, Vt.-Acting Asst. Surg. G. C. Berkley in charge. Post-office and
telegraphic address, St. Albans, Vt.
The general type of immigrant passing through this port belongs to the French
Canadian class. Many aliens of this class with criminal records are apprehended here and are detained in the county jail. At the request of the immigration authorities these aliens are given a medical examination by the me<lical
officer in charge. The facilities at this port where medical examinations are
performed are very meager, but it is anticipated that a new Federal building
will be constructed in the future with much improved facilities for this purpose.
The total number of aliens passing through this port during the year was
30,298. Those seeking permanent homes totaled 716, of which number 67 were
required to undergo a medical examination; 1,341 made temporary entry, and
of this number 75 were referreG. for medical examination; 2S,241 were nonstatlstical aliens or "local crossers."
St. John, New Brunswick.-Acting Asst. Surg. D. C. Malcolm in chargt-~.
Post-office and telegraphic address, St. John, New Brunswick, Canada.
From December until April, 202 aliens were inspected at this port, these landing from 21 Canadian-Pacific steamships. British subjects predominated with
a scattering of Hebrews, Germans, Poles, Slavs, and Scandinavians. The port
of St. John is open all the year but most of its operations are carried ou in the
winter months, during which months the ports of Montreal and Quebec are
iceQound.
San Diego, Oalif.-Surg. J. W. T appen in charge. Post-offi:::e address, Point
Loma, Calif. ; telegraphic address, San Diego, Calif.
The greater part of the medical immigration examinations at this port is done
aboard arriving vessels at Point Loma, in conjunction with quarantine inspection. The majority of alien passengers arriving are of an exceptionally good
type, largely tourists from the east coast, as the vessels are, for\ the most part,
intercoastal from New York City, with ports of call in the West Indies and the
Canal Zone. Some few ships arrive also from Sweden, France, and England.
The type of alien of these vessels are also of the better class. During the year
a total of 983 alien passengers were inspected at this port, together with 6,765
alien crew. The latter is composed almost entirely of the crews of small fishing
vessels, Portuguese and Italians, unnaturalized residents of San Diego, who
pursue their occupation of fishermen in southern waters off the coast of Mexico.
There were no certifications among them.
The medical officer at San Diego also performs the medical immigration
examinations of aliens arriving at the port of San Ysidro, which is located at the
extreme southwestern corner of the United States. This is the principal port of
rntry from the large territory of Baja California, Mexico, and is rapidly assuming a position of consequence in interrepublic travel. The climate and fertile
soil of the neighboring country is attracting thousands to settle there permanently. Motor traffic through this port is composed mostly of returning United
Sta tes citizens, but the daily crowded procession of foot passengers is largely
alien. During the year, 542,597 aliens crossed the border at this point; of these,
11,690 were medically examined.
San Francisco, Oalif.-Surg. H. A. Spencer in charge. Post-office and telegraphic address, San Francisco, Calif.
The activities of the Public Health Service at this station may be described
under the following headings: (1) Examination on ship board, (2) station
examinations, (3) hospital, and ( 4) miscellaneous.
A total of 8,089 alien passengers were medically examined on ship board upon
arrival, of whom 2,157 were bona fide immigrants. The remainder, consisting
principally of first cabin, second cabin, and returning alien passengers, were
passed on inspection aboard ship. Any suspected of suffering from physical or
mental ailments or diseases are r eferred to the immigration station for further medical examination. Of the total number of aliens arriving at this
port and undergoing medical examination, 1,231 were referred to the station
for a further examination. The hospital is utilized for the detention of aliens
for observation; for the treatment of aliens; for the isolation of those suffering
from communicable diseases, etc. This hospital has a normal capacity of 60
beds, which may, in emergency, be increased to 80.
All orientals and others who have resided in the Orient for a considerable
period are subjected to a stool examination upon arrival at San Francisco.
Uncinariasis is the most important condition usually found. Of 1,318 stool


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examinations, 215 were found positive for hookworm, or approximately 16 per
cent. Applicant aliens certified for uncinariasis come to the hospital for trea.tment before being released. Since the fiscal year 1929, the number of hookworm
certificates issued have decreased from 256 to 99.
Passenger vessels, with rare exceptions, call at Honolulu previous to arrival
at San Francisco, and the medical examination of the crews on these vessels
is conducted at that port. During the year only 54 seamen were inspected at
this station for immigration purposes.
San Pedro, Oalif.-Surg. H. E. Trimble in charge. Post-office and telegraphic
address, 111 West Seventh Street, San Pedro, Calif.
Immigration medical inspections at the port of Los Angeles iS' combined with
the quarantine and medical relief work; the majority are made in conjunction
with the quarantine inspection made by the quarantine boarding officer.
The majority of alien passengers arriving at this.port and seeking permanent
entry were from the Orient (mainly from Japan), Mexico, South and Central
America, Norway, and Sweden, in the order named. A total of 50,381 alien
seamen and 7,463 alien passengers were examined during the year. Of this
number 118 were certified for disease or defect.
Sasabe, Ariz.-Acting Asst. Surg. John M. Hardy in charge. Post-office and
telegraphic address, Sasabe, Ariz.
During the past year there has been a decrease in all classes of alien a rrivals.
A total of approximately 3,000 aliens entered the port during the year; 431 of
these were medically examined. Of the latter, 6 were statistical aliens making
permanent entry; 3 statistical aliens making temporary entry; and 422 were
nonstatistical aliens crossing the border as " local crossers," for temporary
admission or as transits.
The general . class of aliens admitted through the port ,vere Mexicans of the
better class, constituting merchants, ranchers, miners, and government officials
entering to make purchases in the United States. The hours for conducting
medical inspections are from 9 a. m. to 5 p. m.
Sumas, Wash.-Acting Asst. Surg. E. S. Clark in charge. Post-office and
telegraphic address, Sum.a s, Wash.
While most of the aliens come direct from Canada, some arrive via Canada
from other countries. These entries comprise all known occupations-farmers,
laborers, skilled and unskilled mechanics, professional classes, and similar occupations. In addition, the medical officer is often called to make medical
examinations of aliens who have gained a surreptitious entry into the United
States and are apprehended by the border patrol. During the year, 212,489'
aliens entered the United States through this port; 198 of these were bona fide
immigrants seeking permanent homes.
Va,nceboro, :Me.-Acting Asst. Surg. Roy M. MacLean in charge. Post-officeand telegraphic address, Vanceboro, Me.
The greater part of immigration at this port is comprised of aliens from
Canada, conforming to the ordinary type of Canadians. There are, however.
a few from overseas countries, which are given a careful examination by the
medical officer in charge. Any aliens requiring examination are presented by
the immigration authorities at the immigration station, careful attention being
given to the hair, eyes, nose, throat, glands, heart, and examination for deformities and any other physical irregularities. Suspicious cases are held for more
thorough examination. During the year the total number of aliens entering the United States a t this point was 55,698, of which number l,·531 wero
referred for medical examination.
Winnipeg, Mamitoba, Oan ada.-Acting Asst. Surg. George B. Story in charge.
P ost-office and telegraphic address, Winnipeg, Manitoba, Canada.
During the year, 13,238 persons applied for admission to the United States
through the port of Winnipeg, of whom 3,534 were referred for medical examination. The number of statistical aliens who were found to be admissible a t
this port as bona fide immigrants seeking homes was 1,213; the number of
statistical aliens found admissible for temporary entry during the year was
2,175; the number of nonstatistical aliens who applied for permission to cross
the border was 9,280. Of the 3,534 applicants for admission who were referred
for medical examination, 817 were found to be afflicted with disease or defects.
Among the number certified, 518 were going to the United States for the relief
of medical or surgical conditions. Of the statistical immigrants in possession of
visas who presented themselves for entry into the United States at this port,


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none who had previously been examined by a Public Health Service medical
officer at a foreign port was found to differ physically or mentally from the
condition expressed in the opinion of the surgeon making the original
examination.
Compared with previous years, there has been a decided improvement in the
type of immigrants seeking to enter the United States for the purpose of establishing permanent homes. Applicants from Central Europe, a group which in
former years constituted a considerable percentage of the total number of
immigrants, have practically disappeared. During the past year there has been
a marked decrease in the number of all classes of immigrants seeking admission
to the United States through the port of Winnipeg, which may be accounted
for in part by the strict application of the immigration laws by the Department of State and also by conditions resulting from the economic depression.


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DIVISION OF SANITARY REPORTS AND STATISTICS
In charge of Asst. Surg. Gen. R. C.

WILLIAMS

The work 0£ the division during the fiscal year consisted 0£ (1)
the collection, tabulation, analysis, and publication 0£ current
(weekly), monthly, and annual morbidity and mortality data, with
special reference to the communicable diseases; (2) the compilation
and publication of laws, regulations, and ordinances relating to public
health; ( 3) the issuing of the weekly Public Health Reports, reprints, and supplements; ( 4) the distribution ,0£ Public Health Service publications; ( 5) the preparation of official news releases and
broadcasts; ( 6) corres_pondence in response to requests :for public
health information which can not be answered by printed material;
and (7) the notification of foreign governments 0£ the appearance
of quarantinable diseases in the Umted States and its possessions,
and the exchange o:f sanitary information.
Reports of the prevalence o:f diseases dangerous to the public
health were received throughout. the fiscal year by telegraph and
mail from all parts .o:f the United States and from :foreign countries. These reports came from State and local health officers, officers of the Public Health Service, American consuls, foreign governments, the health section of the Secretariat of the League of Nations, the International Office of Public Hygiene at Paris, the Pan
American Sanitary Bureau, and .o ther sources.
The obligations imposed upon our Government by international
sanitary conventions to notify :foreign governments of the appearance of quarantinable diseases, and of the prevalence of certain communicable diseases, were met during the fiscal year.
The telegraphic reports received weekly from State health officers
with regard to certain communicable diseases were summarized, and
mimeographed copies were sent to the State health officers. In this
way early notice is given of the prevalence 0£ diseases which health
officers are eager to guard against.
MORBIDITY AND MORTALITY R EPORTS

Without adequate reporting of the notifiable diseases, public
health authorities can not effectively prevent or control disease. For
several years efforts have been made to establish a morbidity reporting area, similar in manner of determination to the registration areas
.for births and deaths established by the Bureau of the Census. The
purpose of such an area is to secure more nearly complete and, in
general, better re_porting of communicable diseases. During the fiscal year this division :formulated a plan :for the establishment of a
morbidity reporting area. This plan was presented at the Conference of State and Territorial Health Officers which met in Washington, D. C., in April, 1931, and received the unanimous approval
0£ the conference. The plan is based on facilities of the health de216

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PUBLIC HEALTH SERVICE

partments for ·collecting reports of cases of notifiable diseases and
on the case fatality rates for certain diseases over a period of several
years. The basic requirements, in addition to achieving the required
case :fatality rates, were:
1. Inclusion in the registration area for deaths and births.
2. Adequate legislation to enforce reporting.
3. Machinery for securing reports and keeping records.
4. Sufficient clerical force to do the work required.
5. A willingness to cooperate in efforts to secure more adequate records of
morbidity.

An analysis of the morbidity reports received from the various State
health departments and tabulated in the division was made the
basis of the case fatality rates. The diseases used were diphtheria,
measles 1 scarlet fever, typhoid fever, and whooping cough. The
average fatality rate for each disease was computed for the entire
death registration area. States showing a general average of more
than 100 per cent-that is, having better reporting than the average, as indicated by the fatality rates-were graded as "standard,"
while those States falling below the average were classed as" below
.standard." It was encouraging to note that 24 States were above
the average number of cases reported for each death. Twenty-one
States were below the average, while for four States the data were
incomplete.
The computations were made on the numbers of cases and deaths
for each disease as reported to the Public Health Service, but the
figures for States which were near the dividing line were corrected
by using the deaths as published by the Bureau o:f the Census.
The average number o.f cases for each death for the three years
was as :follows :
Cases

Diphtheria _________________________________________________
Measles ____________________________________________________
Scarlet fever _______________________________________________
Typhoid fever_____________________________________________
~Vhooping cough ___________________________________________

11
106
78
5
26

The plan as outlined is by no means considered final or perfect,
but it establishes a definite basis :for constructive criticism and future
development. It appears :for the present to be the most practicable
plan that can be put into effect, and it is hoped that further development will stimulate health officers and physicians to cooperate in
promptly submitting reports of notifiable diseases. It is believed
that with some effort practically all States can soon reach the
required standard, be admitted into the morbidity reporting area,
and thus aid in achieving better reporting. Of course the Public
Health Service must do its part as a central agency in the collection,
tabulation, compilation, and distribution of the morbidity information; and the degree of effort, cooperation, and encouragement in the
work of the Public Health Service will depend on specific appropriation made for it by the Congress.
CURR,E NT PR.EVALEN CE OF COMMUNICABLE DISElASES

Reports of the current prevalence o:f communicable diseases in the
United States, received :from State and local health officers, and
reports of quarantinabl e and other diseases, received from various
1

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PUBLIC HEALTH SERVICE

sources, were promptly compiled and summaries of the data were
published currently in Public Health Reports. The current report3
for the United States consisted of (1) weekly telegraphic reports
received from the State health officers, and (2) weekly reports
received by post card from cities o:£ 10,000 or more population. In
addition to publishing these current data each week as received, every
month a 4-week summary has been published. For statistical reasons
these summaries are for 4-week periods rather than for the calendar
month. These current summaries are valuable in that they give a.
good cross-sectio~ _picture of conditions throughout the country with
regard to the incidence and geographic prevalence of the important
communicable diseases. When outbreaks of unusua~ incidence of
any of the diseases are occurring, these summaries are extended to
cover periods preceding the increased incidence, and comparisons aregiven by geographic areas with the occurrence during prior years.
These summaries, therefore, present briefly a survey of conditions
throughout the country, with regard to the communicable diseases
that are especially important from the health officers' standpoint~
information regarding localities where special control measures are
needed, and the results of efforts to prevent the spread of disease.
CURRENT STATE MORTALITY STATISTICS

The publication in Public Health Reports of monthly mortality
statistics from the States that could furnish the data to the Public
Health Service was continued throughout the year. The present
plan is to publlsh about three such summaries during the year, including, for those States which supplied the most recent information, the periods January to March, January to June, and January
to September, and later an entire summary for the whole year. The
rates are cumulative year-to-date rates, computed on an annual basis;
that is, they are rates that would obtain for the entire year if mortality conditions should remain the same for the remainder of the
year. Each summary includes not only data for the specific period
0£ the current calendar year, but also comparative rates for the corresponding periods of four preceding years. The death rates are
given by States and by causes. The purpose of :publishing this information is to make currently available to the var10us health authorities, and to other persons interested, mortality data from as many
States as possible and at as early a date as possible. As these rates
are computed from preliminary reports, it is not expected that they
shall be considered as final or that they will agree with the rates,
published later by the Public Health Service or those issued by the
Bureau of the Census. They are intended to, and do, serve only as,
a current index of mortality until final figures are issued by the
Bureau of the Census.
COLLABORATING AND ASSISTANT COLLABORATING EPIDEMIOLOGISTS

The appointment of officers of State and loca~ health departments
as officers of the Public Health Service to aid in securing reports of
outbreaks and current prevalence of diseases dangerous to the public


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health was continued during the fiscal year. These appointments are
made at the nominal salary of $1 per annum, and they aid materially
in the collection of morbidity information and in the improvement in
reporting throughout the United States.
The accompanying table shows the States in which these officers
were acting at the close of the fiscal year and the number of officers
in each State.
Oollaboratitng and a*istant collaborating epiderniologist,s as of June 30, 1931

State or possession

Alabama __ _____________ _____ _
Arizona ______________________ _
Arkansas ________________ ____ _
California ___________________ _
Colorado. ___________________ _
Connecticut. ________________ _
Delaware ____________________ _
Florida _____ -_-- __ -- -- --- -- - -Georgia ________________ _-- __ -Idaho
-- -- - - -- -- - _Illinois_____________
______________________
Indiana _____________________ _
Iowa
_________________________
----------------------_
Kansas

ii~~i~!r_-_:::
== ==== ==== == ====_
Maine _______________________
Maryland ___________________ _
Massachusetts _______________ _
Michigan ____ _____________ ___ _
Minnesota ___________________ •

~~:~~f_:~===================
Montana ____________________ _

Collabo- Assistant
rating
collaboepidemi- e~fJ~Jiologists
ologists
54

State or possession

Collabo- Assistant
collaborating
rating
epidemi- epidemiologists ologists

129

Nebraska ____________________ _
New Jersey__________________ _
New Mexico _________________ _
New York ___________________ _
North Carolina ________ ____ __ _
North Dakota ______ _________ _
Ohio ________________ ____ _____ _
Oklahoma ___________________ _
Oregon_------------Porto
Rico _______ ____--------___ ____ _
South Carolina ______________ _
South Dakota _______________ _
Tennessee. __________________ _
Texas ________________________ _
Utah.-------------•----------

75

~r::~~~=====================
Washington _________________ _

1~

;:i:Jo~ff~_~::::::::::::::::
Wyoming ___________________ _

1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

Tota]__ ________________ _

44

69

213
238
197
0
3
11
42
9

108
571
314
116

4:~

1
77

122
94

95
0
28;

l
100>
88,
16L
81
102'
3;
1463
41
305
41
10
33

4,559

55
76

236
33

TELEGRAPHIO REPORTS

It is important that the Public Health Service and the State health
officers receive prompt information regarding the occurrence or
outbreaks of communicable diseases dangerous to the public health.
Early knowledge of such outbreaks and of their geographic occurrence and movement permits of prompt preventive measures on the·
part of health officers; and prompt action before a communicable
disease has spread often prevents serious results.
Telegraphic reports of such outbreaks and of general occurrenceof certain important notifiable diseases in the United States are
received by this division from officers of the Public Health Service,.
from collaborating and assistant collaborating epidemiologists, and
from State and local health officers. These reports are promptly
compiled, are summarized and sent to health officers in mimeogTaphed'.
form, and are published in full in Public Health Reports.
Since 1918 regular weekly telegraphic reports of the prevalence
of the principal communicable diseases have been received from State
health officers. In 1919 this telegraphic information was received
from only 24 States, in 1924 from 37 States, and in 1931 it was
received from 47 States, Nevada being the only State unable to
supply these reports.


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MONTHLY STATE REPORTS

Monthly reports of the number of cases of notifiable diseases were
received during the fiscal year from the District of Columbia, Porto
Rico, Hawaii, and all States except Kentucky and Utah. These
monthly reports include more diseases than do the weekly telegraphic
reports, and they include cases which were reported to the State
health departments too late for inclusion in the weekly telegrams.
The following-named diseases are included in the monthly reports
from most of the States when such diseases are actually reported
:as occurring within the State.
.Anthrax in man.
-Ohicken pox.
·Cholera.
Dengue.
Diphtheria.
Dysentery.
Influenza.
Leprosy.
Lethargic encephalitis.
Malaria.
Measles.
Meningococcus meningitis.
Mumps.
Occupational diseases and disabilities.
Paratyphoid fever.
Pellagra.
Plague.
Pneumonia (all forms).

Poliomyelitis .
Rabies in animals.
Rabies in man ( developed cases) .
Rocky Mountain spotted or tick fever.
Scarlet fever.
Septic sore throat.
Smallpox.
Tuberculosis (pulmonary).
Tuberculosis ( all forms).
Tularaemia.
Typhoid fever.
Typhus fever.
Undulant fever.
Whooping cough.
Yellow fever.
Other diseases not notifiable in the
State, but reported.

Some of the States can not give inforn1ation for all of the diseases
listed, and some of them include reports of cases of diseases no't
given in the list.
ANNUAL STATE MORBIDITY REPORTS

Annual volumes presenting the compiled reports of the notifiable
diseases in States have been published each year since 1912. These
annual summaries have greatly improved in scope since the first
issue, especially with respect to the number of diseases, the number
of States, and the J?resentation of the information. The volume of
1930, prepared durmg the fiscal year, includes data from all of the
States, the District of Columbia, the Territory of Hawaii, the Philippine Islands, and Porto Rico.
.
W~KLY AND ANNUAL CI'I'Y REPORTS

Weekly reports of the number of cases of the principal communicable diseases and deaths therefrom were received during the
year from 575 cities having a population of 10,000 or over. For the
purpose of providing a current comparable index to the prevalence
of certain communicable diseases in cities and, to a certain extent,
in various geographic sections of the country, the weekly reports
from approximately 100 of these cities scattered throughout the country were tabulated by geographic areas, case and death rates were
computed, and these rates for 5-week periods were published together
with the corresponding rates for the preceding year. For some of
the diseases the estimated expectancy, based on reports from each


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221

city for the preceding nine years, was computed. These rates were
published currently in Public Health Reports.
Two annual summaries of the prevalence of notifiable diseases in
cities in 1930 were prepared for publication; one was :for cities of
over 100,000 population and one for cities having from 10,000 to
100,000 population.
INSANE, FEEBLE-MINDED, AND EPILEPTIOS

Monthly reports of new admissions to hospitals for the care and
treatment of the insane were received during the fiscal year. The
data include admissions by sex and diagnosis, the number of patients
in hospitals at the end of each month, and the number of patients
on parole.
Reports were also received monthly from hospitals for the care
of feeble-minded and epileptics. These reports show the number of
patients on the rolls of the institution, the number in hospital and
on parole, and the number of admissions, discharges, and deaths.
Owing to the lack of personnel available to tabulate and compile
the data received, the compilation and publishing of this information
currently has been temporarily suspended.
FOREIGN REPORTS

In the collection of reports from :foreign countries regarding the
prevalence of quarantinable diseases and other diseases dangerous to
the public health, this division received during the fiscal year report.s
from officers of the Public Health Service stationed abroad, from
American consular officers, from foreign governments, from the International Office of Public Hygiene, from the Pan American Sanitary Bureau, and from the health section of the League of Nations.
These reports were compiled, abstracted, or· tabulated, and published
in the weekly Public Health Reports for the information of Federal,
State, and local health officers and others interested. The figures
published currently are not represented as being final or complete,
either with reference to countries represented in the data or to the
actual figures themselves. The purpose is rather to show as far as
possible the localities of recent occurrence, especially of the quarantjnable diseases and of other diseases dangerous to the public health,
where the information is available.
INTERNATIONAL ExcHANGE OF SANITARY INFORMATION

In accordance with the international sanitary convention of June
21, 1926, telegraphic information of the first cases of quarantinable
diseases in :ports of the United States and of the insular possessions
has been given promptly by the Public Health Service, through
this di vi,sion, to the International Office of Public Hygiene at Paris
and also to representatives of the countries signatory to the convention, through the Department of State.
During the fiscal year there was a constant interchange of information relative to the prevalence of disease, both in the United
States and throughout the world, with the international health agen-


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PUBLIC HEALTH SERVICE

cjes-the International Office of Public Hygiene, the Pan American
Sanitary Bureau, and the health section of the League of Nations.
In addition to the interchange of current information by cable and
correspondence, the weekly Public Health Reports are mailed
promptly to these three international health organizations, and in
turn similar epidemiological publications are received promptly

fr~fu~

•

Regular weekly reports of the prevalence of communicable diseases were received from the Dominion of Canada during the fiscal
year, prepared and sent out by the Department of Pensions and
National Health of Canada. These reports were published currently
in Public Health Reports. In return that department was kept
currently informed as to conditions in the United States.
The development in recent years of current international interchange of information regarding the prevalence of disease has been
an important contribution to the advance in international health relations, and has had a salutary effect in stimulating better reporting
within the various countries and in encouraging a sense of national
responsibility in the matter of prompt notification of the occurrence
of quarantinable and other dangerous communicable diseases. With
modern developments in modes and rapidity of transportation, the
value of and necessity for prompt knowledge of health conditions in
other countries is at once evident when one realizes that the time of
transit by airplane from many of these countries to the United States
is much shorter than the incubation period of most 01f the infectious
communicable diseases.
PREVALENCE OF COMMUNICABLE DISEASES DURING CALENDAR YEAR

1930

Reports of the prevalence of communicable diseases received by the
division from State health officers indicate that the health record
for the United States for the calendar year 1930 was exceptionally
good. The record for the first half of the year 1931 was also generally good, although an epidemic of mild influenza during the early
months of 1931 increased the death rates for a time and gave the year
a bad start from the health standpoint. Subse'1uent lower death
rates, however, indicated that the cumulative death rate was being
reduced as the year advanced.
With regard to the quarantinable diseases, there were no cases of
cholera, plague, or yellow fever in the United States during the fiscal
year, although there was an outbreak of cholera in the Philippine
Islands which began in May, 1930, and continued throughout the
fiscal year, and six plague-infected ground squirrels were reported
from Monterey County, Calif., during the first six months of 1931,
and the presence of plague-infected rats was reported from the
Hamakua District in the island of Hawaii. Over 500 cases of endemic typhus fever and more than 48,000 cases of smallpox were
reported in the United States during the calendar year 1930.
Although the outbreak of cholera in the Philippine Islands continued throughout the fiscal year, the numbers of cases and deaths
during May and June, 1931, were comparatively small. During the
calendar year 1930, about 4,600 cases of cholera with about 2,700
deaths were reported in the Philippines.


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Cholera was more prevalent generally during the calendar year
1930 than it was in 1929, althou~h the disease was not reported outside of Asia and the adjacent islands. In India more than 360,000
cases were reported in 1930, as compared with 285,000 in 1929.
Plague was as widespread throughout the world in 1930 as it has
been in recent years, although the total number of reported cases was
smaller than in 1929.
Yellow fever was reported from Brazil, in South America, and
-from the Gold Coast and British Cameroons, in Africa. One case
was reported at Lagos, Nigeria, which was said to have been a laboratory infection.
The world prevalence 01f typhus fever has been decreasing since
the decline of the great epidemic which followed the World War.
The disease is still reported, however, from all the grand di visions 0£
the world, the largest number 0£ cases being reported by the Union
of Soviet Socialist Republics.
Smallpox was reported from most of the countries of the world in
1930, although the number of cases in the countries of western
Europe was comparatively small. In 1930 England and Wales reported more cases of smallpox than did all the countries of continental Europe, and the United States reported more cases than any
other country with the single exception of British India.
COMMUNICABLE DlSEASES IN THE UNITED STATES

The accompanying table gives a comparison of the number of cases
of the principal communicable diseases and deaths from these diseases
in the United States for the calendar years 1928, 1929, and 1930.
CASES

Disease

Number of
States1

Aggregate population (in
thousands)
1928

1929

1930

Cases per 100,000
population

Cases
1928

1929

1930

1928

1929

--------- ----- --

Chicken pox _______
Diphtheria _________
Influenza
•. _------Malaria ____________
Measles ____________
M eningococcus
meningitis _______
Mumps ____________
Pellagra ____________
Pneumonia
( a 11
forms) ___________
Poliomyelitis ______
:Scarlet fever _______
Smallpox __________
Tuberculosis ( a 11
forms) __ _________
Tuberculosis (re spiratory system)_
Typhoid fever _____
Whooping cough ___
1

115,497
117,469
117,469
117,469
117,469

117,118
119,112
119,112
119,112
119,112

118,738
120,753
120,753
120,753
120, 753

40
38
44

111,086
101,442
117,469

112,693
102. 857
119,112

114,298
104,273
120, 753

43
35
44
44

113,287
97,652
117,469
117,469

114,891
99,020
119,112
119,112

116,494
100,389
120, 753
120, 753

43

117,051

118,684

120,315

36
44
44

105,033
117,469
117,469

106,556
119,112
119,112

108,078
120, 753
120, 753

43
44
44
44
44

195,441
90,169

201,694
84,273

215,133
65,422

169. 2
76. 8

172.2
70. 8

181. 2
54. 2

553,998

362,298

394,884

471.6

304.2

-a21:o

5,252
126,352

9,584
95,463

7,747
113,005

4. 7
124. 6

8. 5
92. 8

6. 8
108.4

4,772
170,423
37,961

2,742
179,055
40,706

8,185
170,940
48,033

--------- --------- --------- ------- ------- ------

--------- ---- ----- ---- ----- ------- -- ----- ------

----i:f ---is- -·-s:2
145.1
32. 3

150. 3
34. 2

141. 6
39. 8

--------- --------- --------- ------- ------- -------------------- ---------- 19.
-----------------22.0
22,646
26,558
22. 7
0
26,636
156,844

192,556

157,540

133. 5

In addition to the number of States given, the District of Columbia is also included.


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1930

--

161. 7

130. 5

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PUBLIC HEALTH SERVICE
DEATHS
Deaths per 100,000 Cases reported for
each death registered
population

Deaths
Disease
1928
Chicken pox ________________________
130
8,401
Diphtheria_------------- -------- -Influenza
___________________________
Malaria ____________________________ 49,419
4,291
Measles __ ---- ---------- ____________
5,535
Meningococcus meningitis __________
2,306
77
Mumps __
-------------------------Pellagra
____
_____ ________ ___________
7,502
Pneumonia (all forms) ______________ 114,514
Poliomyelitis ____________________ __ _
1,165
Scarlet fever ________________________
2,135
Smallpox _________ . __________ • ______
139
Tuberculosis (all forms) ____________ 89,420
Tuberculosis (respiratory system) __ 71,949
Typhoid fever ______________________
5,909
Whooping cough ___________________
5,862

1929

1930

1928

1929

1930

1928

1929

1930

- -- - - - - - - - - - - - - 147
7,832
65,012
4,133
2,809
4,359
96
7,367
108,485
679
2,447
]39
86,712
70,400
5,117
6,815

118
5,904
22,596
3,422
3,358
3,414
69
7,086
96,861
1,092
2,186
170
82,468
66,313
5,998
5,327

0.1
7.2
42. 1
3. 7
4. 7
2.1
.1
6.4
101.1
1. 2
1.8
.1
76. 4
68. 5
5. 0
5. 0

0.1
6. 6
54. 6
3. 5
2.4
3. 9
.1
6. 2
94. 4
.7
2.1
.1
73.1
66.1
4. 3
5. 7

0.1
4. 9
18. 7
2. 8
2. 8
3. 0
.1
5. 9
83.1
1.1
1.8
.1
68. 5
61. 4
5. 0
4. 4

11

1,372
11

1,823
11

2
1,641

2
994

2
1,638

80
273

73
293

78
283

27

28

3

1,503

------- ------- --------iof 129 118
------- ------- ----------4- ·-----47
------- ------- ----------4
4
5

Diphtheria.-The case and death rates for diphtheria in 1930 were
the lowest ever recorded by the Public Health Service. The case rate
was 54.2 and the death rate was 4.9 .per 100,000 population. Ten
years ago, in 1920, the diphtheria case rate was 155 per 100,000 and
the death rate 15.3. In 10 years the case rate has been reduced approximately two-thirds and the death rate more than two-thirds.
lnfiuenza.-During the calendar year 1930 the incidence of influenza in the United States was unusually low. The death rate from
the disease was 18.7 per 100,000 population, as compared with 54.6
in 1929 and 42.1 in 1928. The death rates for influenza and pneumonia combined for the three years were as follows : 1930, 101.8;
1929, 149; 1928, 143.2.
Malaria.-ln 1930 the malaria rate continued its decline. The rate
for this disease in the United States has been decreasing for several
years. There was a break in this trend in 1928, which year showed
a considerable increase, especially in certain sections of the South.
The reports for 1930, which give a death rate for malaria of 2.8 as
compared with 3.7 per 100,000 in 1928, indicate a reduction in practically every section.
M easles.-The prevalence of measles during the calendar year
1930 increased slightly over that for the preceding year, 394,884
cases, as compared with 362,298 in 1929. In 1928 more than 550,000
cases of measles were reported to the Public Health Service.
M eningococcus meningitis.-Meningococcus meningitis ( cerebrospinal meningitis) has been increasing in prevalence in the United
States for several years. In 1924 the case rate per 100,000 was 1.9
and the death rate was 0.8, while in 1930 these rates were 6.8 and 3.0,
respectively.
Pellagra.-The death rate for pellagra declined slightly in 1930
as compared with 1928 and 1929, but was higher than for any of the
years during the period 1924-1927. The prevalence of this disease
has been somewhat high during the period 1928-1930, and incomplete reports indicate some increase during the first six months of
1931.
Poliornyelitis.-During the calendar year 1930, 8,185 cases of
poliomyelitis ( infantile paralysis) were reported to the Public


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225

Health Service by the State health departments, as compared with
2,742 cases in 1929, 4,7.72 in 1928, 81933 in 1927, and 2,438 in 1926.
During the latter part of the fiscal year it was noted that the number
of cases of poliomyelitis was increasing more rapidly than was to
be expected from a normal seasonal fluctuation. As was pointed
out in Public Health Reports, the far West and Mississippi Valley
were the areas chiefly affected in 1930, whereas toward the midyear
of 1931 the tendency of increased prevalence appeared in States
along the Atlantic coast and the East North Central group, with
very little rise in the Western States.
Scarlet fever.-In 1930 the prevalence of scarlet fever declined
slightly as compared with 1929. The death rate for the disease was
1.8 per 100,000 population, the same as in 1928, as compared with
2.1 in 1929.
·
Smallpox.-The prevalence of smallpox has been increasing in
parts of the United States for several years. In 1930, 48,033 cases
were reported to the Public Health Service by 44 States, as compared
with 40,706 cases in 1929. Fortunately the disease has been mild,
with very few deaths in comparison with the large number of cases
reported. The .prevalence of the mild form, however, creates indifference among the people regarding vaccination, and leaves a fertile
field for the virulent form of infection, which has disastrously
attacked certain communities in the United States during the last
decade. The increased incidence in 1930 was largely confined to
States which have had high case rates for many years, and a large
proportion of the cases reported were confined to a comparatively
few States.
'Tuberculosis.-The calendar year 1930 recorded a new minimum
death rate for tuberculosis, 68.5 per 100,000 population, superseding
the record low rate of 73.1 established in 1929. The record for
tuberculosis of the respiratory system, which causes approximately
90 per cent of the deaths attributed to all forms of tuberculous
disease, shows the same favorable decline, the death rate dropping
from 66.1 per 100,000 in 1929 to 61.4 in 1930. The rate in 1928 was
68.5 per 100,000. At the beginning of the present century the rate
was 200 per 100,000.
Typhoid fever.-Typhoid fever has been decreasing in prevalence
in the United States ever since comparable yearly statistics of cases
and deaths have been available, thanks to the modern science of
sanitation. During the calendar year 1930 a slight reaction was
shown by the reports. The case rate for 1930 was 22 per 100,- .
000 population, as compared with 19 per 100,000 in 1929. The
corresponding death rates were 5 and 4.3 per 100,000, respectively.
It is believed that the increase reported during the last six months
of 1930, in some States, at least, may have been due in part to the
drought, which resulted in pollution and the necessity for using
water from new sources.
lNQillRIES AS TO HEALTH CONDITIONS

Many letters of inquiry were received by the division regarding
health conditions and asking for the compilation of statistical data.
Many persons expecting to travel in the United States or abroad,


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or having relatives traveling away from home, requested in:formation regarding the prevalence of disease in certain States or countries. The information requested was supplied whenever the necessary data could be secured.
DIRECTORIES OF• HEALTH OFFICERS

During the fiscal year annual directories of State health officers,
o:f whole-time county health officers, and o:f city health officers were
compiled and issued by the division. The State directory gave information regarding the administrative organization o:f each State
department o:f health, the names o:f the bureaus and divisions and o:f
the heads o:f such units, the appropriations for the work o:f each
department, and the publications issued by the department. The
city directory gave the names, official titles, and addresses o:f all city
health officers in cities having over 10,000 populatio-n , and for a :few
o:f the larger cities the chie:fs o:f the bureaus and divisions were listed.
SURVEY OF HEALTH EnuoATION BY RADIO IN THE UNITED STATES

During the year· the division made a survey, by means o:f questionnaires, o:f health education by radio in the United States sponsored
by official State and local health authorities and by county medical
societies. It was shown by the information compiled from this
survey that 15 State health departments regularly issued broadcasts
on public health subjects, usually weekly or twice monthly, while
6 issued broadcasts at irregular intervals; 18 o:f the large cities broadcast public health information r·e gularly, usually weekly or twice a
month, and 17 at irregular intervals; and 42 county medical societies
prepare and broadcast regularly programs dealing with public and
personal health. The information secured in the survey was prepared for presentation to the Committee o:f the World Association
for Adult Education by Radio at the meeting to be held in Vienna
during August, 1931.
It is o:f interest to note here that the use of radio broadcasting in
the United States as a means o:f disseminating information relating
to public health and hygiene dates :from 1921, when the United States
Public Health Service first adopted this means of health education.
It was in the following year that State health departments began
to emulate the the Public Health Service and adopted radio broadcasting as a means of giving out health information.
RADIO LECTURES BY THE PUBLIC HEALTH SERVICE

The health information by radio service was continued :for the
tenth consecutive year. The lectures cover a wide range of health
subjects, among which may be mentioned the following: Indigestion,
psoriasis, climate and tuberculosis, rheumatism, psittacosis, hygienic
adjustment throughout life, proper food, care of the hair and scalp,
and goiter.
At the present time two lectures a month are mailed from Wash~
ington to approximately 250 radio stations throughout the country
that are cooperating with the Public Health Service in the dissemination of this radio health advice.

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In addition to the radio broadcasts a number of articles were prepared during the year, at the request of unofficial public health
organizations.
This material is prepared in nontechnical language, so that it will
be easily understood by the layman. A number of the cooperating
radio stations broadcast the lectures, then turn them over to local
newspapers :for reprinting. In this way the information reaches
a large number of interested persons.
LEGISLATION AND COURT DECISIONS RELATING TO PUBLIC HEALTH

State and Federal l{llU)s and regulations.-During the fiscal year
work was carried on in connection with the compiling of those State
and Federal public health laws and regulations which were adopted
during the year 1929. This compilation, which is one of a series
dating from 1911, was almost ready tv go to the printer at the close
of the fiscal year.
Another publication which was nearing completion at the end
of the year is one that will contain the existing State statutes and
regulations dealing with the reporting of morbidity, together with
an analysi.s of such legislation and a review of the court decisions on
the subject.
The State and Federal health laws and regulations adopted during l930 were also collected.
Municipal ordinances and reguiations.-For use in a compilation
of selected municipal health ordinances and regulations covering a
period of years, there were collected those ordinances and regulations affecting public health which were adopted during 1930 by
cities in the Umted States of 10,000 population or over. Such city
health ordinances and regulations have been compiled and published
by the Public Health Service since 1910.
Court decisions.-There was continued the abstracting and publication of current court decisions relating to public health. Such
decisions of State and Federal courts of last resort were obtained
by searching current digests, and abstracts of such decisions were·
prepared and published in the Public Health Reports. Work was
also done looking to the issuance of a digest of such decisions when
the number available warrants such issuance.
Comptroller General's decisions.-Those decisions of the Comptroller General of the United States which related directly to the
Public Health Service were abstracted and indexed throughout the
year.
Requests for information.-Many requests were received during
the year for information and data concerning health laws, regulations, and court decisions. These requests were complied with to
the fullest extent possible.
PUBLICATIONS ISSUED BY THE DIVISION

The Public Health Reports ( vol. 45, pt. 2, and vol. 46, pt. 1) was
issued by the division each week during the fiscal year. This publication was established in 1878 and has been issued regularly each
week since 1887. It contained current reports showing the prevalence of communicable diseases in the United States (some of the

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more important diseases being reported by weeks and other diseases
by months), reports of the quarantinable diseases occurring throughout the world,. articles presenting the results of research work conducted by the Public Health Service in the various fields of public
health, articles on public health administration, and abstracts of current court decisions relating to public health. The Public Health Reports is the official medium of the United States Public Health
Service for the publication of reports on current morbidity, current
research work, and other public health information for the collection
and dissemination of which the Public Health Service is authorized
by law.
The 52 issues of Public Health Reports printed during the year .
contained 3,285 pages, exclusive of title-pages and tables of contents,
as compared with 3,143 pages in 1930, 3,362 in 1929, 3,189 in 1928,
and 3,520 in 1927. The number of each issue at the close of the
fiscal year was 9,500 copies. The increase of about 1,000 copies as
compared with last year was principally due to a larger administrative distribution and to congressional requests.
Ninety-seven of the most important articles appearing in Public
Health Reports during the year were reprinted in pamphlet form,
as compared with 94 during the preceding year. The Public Health
Reports is being used to an increasing extent for the early publication of reports from the National Institute of Health, especially
those for which it is desirable to secure prompt publication and
those which are not of sufficient length to be printed as monographs.
Eleven supplements to Public Health Reports were prepared for
publication in the division during the fiscal year, most of which
were delivered from the printer. Of especial interest were the compilation of State laws relating to narcotic drug addiction and a
pamphlet on the rat proofing of vessels. The compilation of narcotic laws included a discussion of the evolution of such laws and of
the scope of the present laws on the subject. The laws themselves
were presented under three headings, viz: ( 1) Control of Narcotic
Drugs, (2) Treatment and Commitment of Drug Addicts, and (3)
Instruction in the Public Schools Regarding the Effects of Narcotics
upon the Human System. The supplement on the rat proofing of
vessels was a concise but comprehensive review of the development
of the work by the Public Health Service, with many representative
illustrations of corrected conditions aboard vessels and the general
detailed instructions promulgated by the American Standards
Committee.
The division also issued the National Negro Health Week Bulletin
and Poster for 1931, the bulletin containing the outline of the program for effective community effort directed to important health
problems and the poster containing stimulative suggestions for
health work on a year-round basis.
New editions were issued of 14 previously issued publications.
SECTION OF PUBLIC HEALTH EDUCATION

During the fiscal year ended June 30, 1931, 116 new service publications were distributed by the Section of Public Health Education, as compared with 127 during the preceding year. The total


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distribution of copies of these publications and of editions o:f previously published documents aggregated 528,257, as compared with
366,690 distributed during the preceding fiscal year. Out o:f the
528,257 copies distributed during the fiscal year 1931, 270,126 were
sent in response to individual requests for information. The other
copies were distributed to the various mailing lists maintained by
the Public Health Service for the distribution of its publications.
The figures given do not include the publications printed and distributed by the Division of Venereal Diseases, nor the service regulations and official service roster distributed by the chief clerk's
office.
During this fiscal year a total of 32 requests were received for
the loan of stereopticon slides. In response to these requests, a total
of 1,648 slides were lent. These slides were lent to universities,
health officers, public health lecturers, and others interested in the
use of stereopticon slides for visual education on health subjects.
As in previous years, it was not possible to supply all of the slides
requested, due to the fact that the work of the stereopticon library
has been somewhat handicapped during the past 12 years on account.
of the shortage of slides and the lack of funds for making new
slides and replacement of those that have been broken or lost from
time to time in shipment.
Each year a large number of requests are received by the Public
Health Service from State and local health authorities, scientifie
associations, colleges, schools, and various other organizations for
material that might be used for exhibit purposes in connection with
the promotion of the public health. For the past several years
compliance with these requests has not been possible,, due to the
lack of funds for the preparation of suitable exhibit material. An
appropriation for the preparation of exhibits designed to demonstrate the cause, prevalence, and methods of spread of diseases
dangerous to the public health and measures for preventing them
became available during this fiscal year. Several creditable exhibits
were prepared. Among the subjects covered were Rocky Mountain
spotted fever, leprosy, and milk sanitation. Exhibits on undulant
fever and tularaemia were presented at the meeting of the Dallas
Southern Clinical Society, held at Dallas, Tex., March 30 to April
3, 1931. Exhibits on silicosis and postvaccinal tetanus were prepared for display at the annual meeting of the American Medical
Association, which was held at Philadelphia, June 8 to 12, 1931. An
exhibit with regard to the progress made in the scientific investigations conducted by the service concerning the diseases of man was
also prepared for display at the Congress of Military Medicine and
Surgery, which was held at The Hague, Netherlands, near the close
of the fiscal year.
Several motion-picture films on malaria control were added to the
collection of films, which were of considerable value in connection
with the efforts now being made to eliminate this disease.
PUBLICATIONS DISTRIBUTED BY THE DIVISION

The following is a list of publications distributed by the division
during the fiscal year:


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REPRINT S FROM THE PUBLIC HEALTH REPORTS

1365. Seamen with Venereal Disease in t he Port of New York. A cooperative
study participated in by the American Social Hygiene Associa tion, the
New York Tuberculosis and Health Association, the Welfare Council
of New York City, and the United States Public Health Service. Prepared by Annabel M. Stewart. April 11, 18, and 25, 1930. 98 pages ; 2
plates.
'
1366. Psittacosis: Rickettsialike Inclusions in Man and in Experimental Animals. By R. D. Lillie. April 11, 1930. 6 pages.
1370. Effect of Radiant Energy on the Skin Temperatures of a Group of Steel
Workers. By J. J. Bloomfield, James E. Ives, and Rollo H. Britten.
l\{ay 2, 1930. 13 pages; 1 plate.
1371. Observations on the Possibility of Methyl Chloride Poisoning by Ingestion
with Food and Water. By W. P. Yant, H. W. Shoaf, and J. Chornyak.
May 9, 1930. 8 pages . .
1372. Extent of Rural Health Service in the Unit ed States 1926-1930. By L. L.
Lumsden. May 9, 1930. 17 pages.
1373. Hearing of School Children as Measured by the Audiometer and as Related to School Work. A study of 710 children in Washingt on, D. 0.,
and 1,150 in Hagerstown, Md. By E. Blanche Sterling and Elizabeth
Bell. May 16, 1930. 14 pages.
1374. The Type Distribution of Meningococci in the United States During 1928
and 1929. By Sara E. Branham, Clara E. Taft, and Sadie A. Carlin.
May 16, 1930. 6 pages.
1375. An Anemia of Dogs Produced by Feeding Onions. By W. H. Sebren.
May 23, 1930. 17 p ages.
1376. Public Health Administration. By Allan J. McLaughlin. May 23, 1930.
10 pages.
1377. Sickness Among Industrial Employees During the Last Three Months of
1929. By Dean K. Brundage. May 23, 1930. 3 pages.
1378. The Abusive Use of Narcotic Drugs in Egypt. A review. B y W. L.
Treadway. May 30, 1930. 4 pages.
1379. Acute Response of Guinea Pigs to Vapors of Some New Commercial
Organic Cdmpound,s. II. Ethyl Benzene. By W. P. Yant, H. H.
Schrenk, C. P. Waite, and F. A. Patty. May 30, 1930. 10 pages.
1380. Occupational Mortality as Indicated in Life-Insurance Records for the
Years 1915-1926. By Rollo H. Britten. May 30, 1930. 9 pages.
1381. A Study of the Blacktongue Preventive Value of Lard, Salt Pork, Dried
Green Peas, and Canned Haddock. By Joseph Goldberger, G. A.
Wheeler, L. M. Rogers, and W. H. Sebren. June 6, 1930. 12 pages.
1382. Ctenocephalides, New Genus of Fleas Type Pulex Ganis. By C. W. Stiles
and Benjamin J. Collins. June 6, 1930. 2 pages.
1383. Undulant Fever in Ware County, Ga. By George E. Atwood and H. E.
Hasseltine. June 13, 1930. 12 pages.
1384. The Visible Effect of Castor-Oil Soap on Certain Organisms. By R. R.
Spencer. June 13, 1930. 8 pages.
1385. Medical Service in Federal Prisons. By W. L. Treadway. June 13,
1930. 8 pages.
1386. Psittacosis Outbreak in a Department Store. By L. F. Badger. June 20,
1930. 6 pages.
1387. The National Institute of Health, successor to the Hygienic Laboratory.
June 20, 1930. 4 pages.
1388. Results of the Operation of the Standard Milk Ordinance in Mississippi.
By A. W. Fuchs and H. A. Kroeze. June 20, 1930. 9 pages.
1389. Acute Response of Guinea Pigs to Vapors of Some New Commercial
Organic Compounds. III. "Cellosolve" (Monoethyl Ester of Ethylene
Glycol). By C. P. Waite, F. A. Patty, and W. P. Yant. June 27, 1930.
8 pages.
1390. A Quantitative Colorimetric Reaction for the Ergot Alkaloids and its
Application in the Chemical Standardization of Ergot Preparations.
By Maurice I. Smith. June 27, 1930. 15 pages.
1391. Third Report on a Rat-Flea Survey of the City of San Juan, Porto Rico.
by A. L. Carri6n. July 4, 1930. 6 pages.
1392. Experimental Studies of Water Purification. IV. Observations on the
Effects of Certain Modifications in Coagulation-Sedimentation on the
Bacterial Efficiency of Preliminary Water Treatment in Connection


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l393.
1394.
1395.
1396.

1397.
1398.
1399.
1400.
1401.
1402.
1403.
1404.

1405.
1406.
1407.
1408.
1409.
1410.
1411.
1412.
1413.

1414.
1415.
1416.

231

with Rapid Sand Filtration. By H. W. Streeter. July 4 and 11, 1930.
42 pages.
A Public-Health Survey of Iowa. By A. J. McLaughlin. July 11, 1930.
25 pages.
The Prevalence and Trend of Meningococcus Meningitis in the United
States. By R. 0. Williams. July 18, 1930. 4 pages.
Recent Progress in Studies of Undulant Fever. By H. E. Hasseltine.
July 18, 1930. 7 pages.
Pharmacological and Chemical Studies of the Cause of So-called Ginger
Paralysis. A preliminary report. By :Maurice I. Smith and E. Elvove,
with the cooperation of P. J. Valaer, jr., William H. Frazier, and G. liJ.
Mallory. July 25, 1930. 14 pages.
Relation Between Trypanocidal and Spirocheticidal Activities of Neoarsphenamine. By T. F. Probey and G. W. McCoy. July 25, 1930.
12 pages.
Decrease of Hookworm Disease in the United States. By 0. W. Stiles.
August 1, 1930. 19 pages.
The Proposed Morbidity Reporting Area. By R. 0. Williams. August 1,
1930. 6 pages.
The Present Status of Streptococcus Biologic Products in the Prevention
and Treatment of Scarlet Fever. By M. V. Veldee. August 8, 1930.
5 pages.
Acute Response of Guinea Pigs to Vapors of Some New Commercial
Organic Compounds. IV. Ethylene Oxide. By 0. P. Waite, F. A.
Patty, and W. P . Yant. August 8, 1930. 12 pages.
The Immunizing Value of Diphtheria Toxin-Antitoxin Mixture and of
Diphtheria Toxoid. By W. T. Harrison. August 15, 1930. 6 pages.
Antirabic Vaccine Paralysis. Consideration of various vaccines. By
G. W. McCoy. August 15, 1930. 4 pages.
Physical Impairments and Occupational Class. Differential rates based
upon medical examinations of 100,924 native-born, adult white insured
males. By Edgar Sydenstricker and Rollo H. Britten. August 22,
1930. 36 pages.
Acute Response of Guinea Pigs to Vapors of Some New Commercial
Organic Compounds. V. Vinyl Chloride. By F. A. Patty, W. P. Yant,
and 0. P. Waite. August 22, 1930. 9 pages.
Psittacosis. Epidemiological Considerations with Reference to the 1929-30
Outbreak in the United States. By Charles Armstrong. August 29,
1930. 11 pages.
Acute Response of Guinea Pigs to Vapors of Some New Commercial
Organic Compounds. VI. Dioxan. By W. P. Yant, H. H. Schrenk,
F. A. Patty, and 0. P. Waite. August 29, 1930. 10 pages.
Public Health Service Publications. A list of publications issued during
the period July, 1929-June, 1930. August 29, 1930. 7 pages.
Chief Etiological Factors of Plague in Ecuador and the Antiplague
Campaign. By 0. R. Eskey. September 5 and 12, 1930. 64 pages.;
2 plates.
Biological Products. Establishments licensed for the propagation and
sale of viruses, serums, toxins, and analogous products. September
5, 1930. 5 pages.
Bacillus Psittacosis Nocard, 1893. Failure to find it in the 1929-30 epidemic in the United States. By Sara E. Branham, George W. McCoy,
and Charles Armstrong. September 12, 1930. 8 pages.
A College Course in Child Hygiene. By E. Blanche Sterling. September 12, 1930. 4 pages.
Electron Equilibria in Biological Systems. IV. An Adaptation of the
Glass Electrode to the Continuous Measurement of Hydrogen Ion Concentration of the Circulating Blood. By Carl Voegtlin, Floyd DeEds,
and H. Kahler. September 19, 1930. 10 pages.
The United States Public Health Service as a Career. Information for
persons desiring to enter the regular commissioned corps. September
19, 1930. 14 pages; 6 plates.
Mortality from Influenza and Pneumonia in 50 Large Cities of the United
States, 1910-1929. By Se~wyn D. Collins, W. H. Frost, Mary Gover,
and Edgar Sydenstricker. September 26, 1930. 52 pages.
The Training of Health Officers. By Joseph W. Mountin. October 3,
1930. 5 pages.


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1417. A Note on the "Zone Phenomenon" in Human Sera. A comparison of
antitularense with antiabortus sera. By R. R. Spencer, October 3,
1930. 4 pages.
1418. A Study of the Effect of Typhoid Vaccine when Given After Infection.
By J. H. Crouch. October 10, 1930. 4 pages.
1419. The Pharmacological Action of Certain Phenol Esters, with Special
Reference to the Etiology of So-called Ginger Paralysis. ( Second re-,
port.) By Maurice I. Smith, with the cooperation of E. Elvove and
W. H. Frazier. October 17, 1930. 16 pages.
1420. Sickness Among Industrial Employees in the First Half of 1930. October
24, 1930. 2 pages.
1421. Cooperative Rural Health Work of the Public Health Service in the
Fiscal Year 1930. By L. L. Lumsden. October 24, 1930. 21 pages.
1422. A Note on the Incidence of Endemic Goiter in Northern Ireland. By
Robert Olesen and Paul A. Neal. October 31, 1930. 4 pages.
1423. The Influence of the Size of the Explant Upon Cultures of Chick Fibroblasts in Vitro. By W. R. Earle and J. W. Thompson. October 31,
1930. 27 pages; 8 plates.
1424. The Essentials of Smallpox Vaccination. By James P. Leake and John
N. Force. November 14, 1930. 5 pages.
1425. State and Insular Health Authorities, 1930. Directory, with data a$
to appropriations and publications. November 14, 1930. 23 pages. ·
1426. City Health Officers, 1930. Directory of those in cities of 10,000 or more
population. November 14, 1930. 16 pages.
1427. An Unusually Mild Recurring Epidemic Simulating Food Infection. By
R. R. Spencer. November 21, 1930. 11 pages.
· 1428. Mottled Enamel in a Segregated Population. By Grover A. Kempf and
Frederick S. McKay. November 28, 1930. 18 pages; 3 plates.
1429. Trachoma. Some Facts About the Disease and Some Suggestions for
Trachoma Sufferers. By Paul D. Mossman. November 28, 1930. 5
pages ; 2 plates.
1430. Venereal Disease Among Coast Guard Enlisted Personnel During the
Fiscal Year 1929. By W. W. King. December 5, 1930. 16 pages.
1431. Miliary Lung Disease Due to Unkno'wn Cause. By R. R. Sayers and
F. V. Meriwether. December 5, 1930. 16 pages; 2 plates.
1432. The Chemistry of Cell Division. I. The Effect of Glutathione on Cell
Division in Amoeba Proteus. By Carl Voegtlin and H. W. Chalkley.
December 12, 1930. 23 pages.
1433. The Blacktongue Preventive Value of Minot's Liver Extract. By Joseph
Goldberger and W. H. Sebren. December 12, 19<30. 7 pages.
1434. Experimental Studies of Water Purification. V. Prechlorination in Relation to the Efficiency of Water Filtration Processes. By H. W.
Streeter and C. T. Wright. December 19, 1930. 24 pages.
1435. Consecutive Readings of Pulse Rate on a Small Group of Clerks. By
Rollo H. Britten and C. R. Wallace. December 19, 1930. 7 pages.
1436. Whole-Time County Health Officers, 1930. December 19, 1930. 8 pages.
1437. Summary of a Study of Health and Hospital Services in Alameda County,
Calif. By Joseph W. Mountin. December 26, 1930. 16 pages.
1438. Further Biochemical Studies on the Antineuritic Vitamin. By Atherton
Seidell and Maurice I. Smith. December 26, 1930. 12 pages.
1439. Studies on Leptospira Jcterohemorrhagiae. By J. R. Ridlon. January
2, 1931. 5 pages.
1440. The National Leper Home (United States Marine Hospital), Carville, La.
Review of the more important activities during the fiscal year ended
June 30, 1930. By E. 0. Denney. January 2, 1931. 8 pages; 2 plates.
1441. The Occurrence of Tularaemia in British Columbia. By R. R. Parker,
Eric Hearle, and E. A. Bruce. January 9, 1931. 2 pages.
1442. Effect on Life Insurance Mortality Rates of Rejection of Applicants on the
Basis of Medical Examination. By Rollo H. Britten. January 9, 1931.
17 pages.
1443. Age Incidence of Communicable Diseases in a Rural Population. By
Edgar Sydenstricker and Selwyn D. Collins. January 16, 1931. 14
pages.
1444. The Incidence of Influenza Among Persons of Different Economic Status
During the Epidemic of 1918. By Edgar Sydenstricker. January 23,
1931. 17 pages.
1445. The Stillbirth Problem in the United States. By E. Blanche Sterling.
January 30, 1931. 8 pages.


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1446. Public Health Service Publications. A list of publications issued during
the period July-December, 1930. January 30, 1931. 5 pages.
1447. The Work of the United States Public Health Service. February 6,
1931. 30 pages.
1448. Typhus Fever. A virus of the typhus type derived from fleas collected
from wild rats. By R. E. Dyer, A. Rumreich, and L. F. Badger. February 13, 1931. 5 pages.
1449. The Influence of Arsenicals and Crystalline Glutathione on the Oxygen
Consumption of Tissues. By Carl Voegtlin, Sanford M. Rosenthal, and
J. M. Johnson. February 13, 1931. 16 pages.
1450. Studies on the Biochemistry of Sulphur. IX. The Estimation of Cysteine
in the Presence of Glutathione. By M. X. Sullivan and Walter C.
Hess. February 20, 1931. 4 pages.
1451. Experimental Studies of Natural Purification in Polluted Waters. IV.
The Influence of the Plankton on the Biochemical Oxidation of Organic
Matter. By C. T. Butterfield, W. C. Purdy, and E. J. Theriault. February 20, 1931. 34 pages.
1452. An Infection of the Rocky Mountain Spotted Fever Type. Identification
in the Eastern part of the United States. By L. F. Badger, R. E.
Dyer, and A. Rumreich. February 27, 1931. 8 pages.
1453. The Typhus-Rocky Mountain Spotted Fever Group. An epidemiological
and clinical study in the Eastern and Southeastern States. By A. Rumreich, R. E. Dyer, and L. F. Badger. February 27, 1931. 12 pages.
1454. Note on an Outbreak of Malaria in a Railroad Camp, Rawson Switch,
Calif. By J. C. Geiger and J. P. Gray. March 6, 1931. 4 pages.
1455. Measurements for Jaeger's Test Types Used in Near Vision Tests. March
6, 1931. 4 pages.
1457. A Limited Rat-Flea Survey of Savannah, Ga. By Carroll Fox. March 13,
,
1931. 2 pages.
1458. A Public-Health Survey of Oklahoma. By A. J. McLaughlin. March 13,
1931. 24 pages.
1459. Conference on Medicinal and Scientific Requirements of Narcotic Drugs,
Washington, D. C., August 12, 1930. A summary of the proceedings.
October 3, 1930. 14 pages.
1460. The Fundamentals of Public Health Law. By James E. Bauman. March
20, 1931. 10 pages.
1462. Antigenic Value of Scarlet Fever Streptococcus Toxin Modified by the
Action of Formalin. By M. V. Veldee. March 27, 1931. 6 pages.
1464. Act Extending the Hours of Quarantine Inspection. March 27, 1931.
4 pages.
SUPPLEMENTS TO THE PUBLIC' HEALTH REPORTS

85. The Notifiable Diseases. Prevalence During 1929 in Cities of Over 100,000.
1930. 29 pages.
86. Studies on the Biochemistry of Sulphur. VII. The Cystine Content of
Purified Proteins. By M. X. Sullivan and W. C. Hess. 1930. 11 pages.
87. The Notifiable Diseases. Prevalence During 1929 in Cities of 10,000 to
100,000 Population. 1930. 83 pages.
88. The Notifiable Diseases. Prevalence During 1929 in States. 1931. 70
pages.
89. Studies on the Biochemistry of Sulphur. VIII. The Rate of Absorption of
Cystine from the Gastrointestinal Tract of the White Rat. By M. X.
Sullivan and W. C. Hess. 1931. 16 pages.
90. Detailed Instructions for the Performance of the Dissolved Oxygen and
Biochemical Oxygen Demand Tests. By Emery J. Theriault. 1931. 34
pages.
91. State Laws Relating to the Control of Narcotic Drugs and the Treatment of
Drug Addiction. 1931. 330 pages.
92; Studies on Oxidation-Reduction. XVI. The Oxazines; Nile Blue, Brilliant
Cresyl Blue, Methyl Capri Blue, and Ethyl Capri Blue. By Barnett
Cohen and Paul W. Preisler. 1931. 67 pages.
94. Studies on the Biochemistry of Sulphur. X. The Cystine Content of Meat
and Fish. By M. X. Sullivan and W. C. Hess. 1931. 13 pages.
95. A Nomogram for the Calculation of Dissolved Oxygen. By C. T. Wright and
Emery J. Theriault. 1931. 3 pages.

80597-31-16


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Federal Reserve Bank of St. Louis

234

PUBLIC HEALTH SERVICE
PUBLIC HEALTH BULLETINS

197. Studies in Illumination. III. A Study of the Loss of Light Due to Smoke
on Manhattan Island, New York City, During the Year 1927, Especially
in its Relation to the Nature of the Weather, the Relative Humidity of
the Air, and the Velocity and Direction of the Wind. By James E. Ives.
1930. 40 pages.
198. A Study of the Pollution and Natural Purification of the Illinois River.
II. The Plankton and Related Organisms. By W. 0. Purdy. 1930. 212
pages; 42 plates.
199. Studies in Physical Development and Posture. IV. Postural Relations
a s Noted in Twenty-two Hundred Boys and Men. By Louis Schwartz,
Rollo H. Britten, and Lewis R. Thompson. 1931. 54 pages; 16 plates.
NATIONAL INSTITUTE OF HEALTH BULLETINS 1

155. 1. Key Catalogue of Parasites Reported for Ohiroptera (bats) with Their
P ossible Public Health Importance. By C. W. Stiles and Mabelle Orleman Nolan. 2. The Confused Nomenclature of Nycteribia Latreille, 1796,
and Spinturnix Heyden, 1826. By Benjamin J. Collins. 1931. 187 pages.
156. The Pathology of Generalized Vaccinia in Rabbits. By Ralph D. Lillie and
Charles Armstrong. 1930. 9-5 pages; 65 plates.
157. Experimental Syphilis. Lymph gland transfer method of determining
human infection with Treponema pallidum. By G. C. Lake and K. K.
Bryant. 1930. 41 pages.
.
158. Undulant Fever. With special reference to a study of " Brucella " infection in Iowa. By A. V. Hardy, C. F. Jordan, I. H. Borts, and Grace
Campbell Hardy. 1931. 89 pages; 7 plates.
ANNUAL REPORT

Annual Report of the Surgeon General of the United States Public Health
Service for the Fiscal Year 1930. 358 pages.
MISCELLANEOUS PUBLICATIONS

11. Official List of Commissioned and Other Officers of the United States Public
Health Service; also, List of United States Marine Hospitals, Quarantine,
Immigration, Relief Stations, and Quarantine Vessels. October 1, 1930.
86 pages.
29. Manual of Hospital Management for United States Marine Hospitals. By
M. H. Foster. 303 pages; 1 plate.
UNNUMBERED PUBLICATIONS

National Negro Health Week Program. This pamphlet is published annually,
usually about the middle of March, for community leaders in an effort ro
suggest ways and means by which interested individuals and organizations
may be organized for a concerted and effective attack upon the community's
disease problems. Seventeenth annual observance. 1931. 16 pages. ( Out
of print.)
National Negro Health Week Poster. Seventeenth Annual Observance. 1931.
(Out of print.)
1 This series of publications was formerly issued under the title of "Hygienic Laboratory
Bulletins." The name of the Hygienic Laboratory was changed to National Institute of
Health by act of Congress approved May 26, 1930.


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Federal Reserve Bank of St. Louis

DIVISION OF MARINE HOSPITALS AND RELIEF
In charge of Asst. Surg. Gen. F. C. SMITH

Industrial depression and even a temporary decline in shipping
activities did not lessen the demands for medical treatment at marine
hospitals and other relief 'stations. There was, on the contrary, an
increase over the precedi11ig year of 3.3 per cent in the amount of hospital treatment and of 14 per cent in out-patient treatment furnished to
seamen fromAmerican merchant vessels. Beneficiaries took advantage
of a slack season to seek surgical operations long deferred and treatment for disabilities neglected in prosperous and busier times. Admission to hospital was requested by a considerable number of beneficiaries who in normal seasons could have been cared for as outpatients. Discharges from hospital were slightly retarded by the
reluctance of indigent convalescents to leave because of precarious
employment conditions. The temptation for unemployed former seamen to attempt to gain entrance to marine hospitals by the use of
out-dated or fraudulent master's certificates was increased. A total
of 363,129 persons applied for treatment, physical examination, or
other kind of medical service, and to legal beneficiaries of all classes,
an aggregate of 1,666,215 days and 910,466 out-patient treatments
were given. One thousand three hundred and four deaths occurred in
hospital. For purposes other than treatment, 94,487 physical examinations were also made at the request of the Steamboat Inspection
Service, Civil Service Commission, and other governmental agencies;
it was not possible fully to meet all demands when very large numbers of civil-service applicants presented themselves for temporary
seasonal appointments. In cooperation with the Bureau of Industrial
Alcohol, 7,332 certificates of medicinal need of liquors were issued to
vessels. For the various services rendered to the several classes of
beneficiaries in different ports see the following tabulated statements:
Transactions at each marine hospital and relief station, Table 2,
page 261.
Causes of admission and condition on discharge, Table 4, page 268.
Causes of death, Table 5, page 270.
Number of days in hospital for various disabilities, Table 7,
page 273.
Nativity of patients, Table 9, page 275.
American seamen and specified diseases and injuries, Table 11,
page 278.
235


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Federal Reserve Bank of St. Louis

236

PUBLIC HEALTH SERVICE

CLASSES OF BENEFICIARIES .AND AMOUNT .AND CHARACTER OF SERVICES
RENDERED

Summary of services by class of beneficiary
Physical
Out-patient examinations
treatments (not related
to treatment)
Per
Per
Per
cent Num- cent Num- cent
of
ber
of
of
ber
total
total
total

Hospital days
Class of beneficiary
Number
American merchant seamen.
Veterans___________________

--- --- - -

990,205 59.43 472,392 51. 88 13,605 14.40 Communicable diseases are re•
307, 185 18. 44

ported to local health officers.

4,354

• 48

1,321

1 40 Patients of the U. S. Veterans'

Lepers_____________________

116,279

U. S. Coast Guard personnel
Injured Federal employees_

86,829

5. 22187, 063 20. 54 11,964 12. 66

57,042

3. 42179, 029 19. 67 22,343 23. 66

Immigrants________________

40, 904

2. 45

6. 98

1 ------

2, 560

• 28

1 ------

732

• 77

Seamen, U. S. Engineer
154
.16
34,433 2. 07 10,250 1. 13
Corps and Army Transport Service.
Seamen from foreign ves7, 459
• 44
778
. 09
39 -----sels.
Seamen and keepers, U.S.
192
• 20
10,846
. 65 6,096
• 67
Lighthouse Service.
Alaska cannery workers _________ ______
418
. 04 6,674 7. 07
leaving
States. ____________________________
Pilots
andUnited
other licensees
_ _ 6,785 7.19
United States civil-service
applicants and emU.ployees.
S. Shipping Board______
All others entitled to treatment.

Remarks

Aministration.
National Leper Home, Carville,
La.
All medical services and supplies,
ashore and afloat.
Patients of the Employees' Compensation Commission.
Patients of the Bureau of Immigration.
Civilian employees on U. S.
Army vessels.
Pay patients.

Medical supplies also furnished
to lighthouse vessels.
Vaccinations and other preventive measures.
For the Steamboat Inspection
Service.
_: _______ __________________ _ 19,929 21.09 For the Civil Service Commission.
__________________ _ 2,436 2.59 To determine fitness for sea duty.
15,033
• 90 47, 525 5. 22 8,312 8.81 From Bureau of Fisheries, Army,
Navy, Mississippi River Com•
mission, Coast and Geodetic
Survey, etc.

Total ________________ 1, 666, 215 100. 00 910,466,100. 00 94, 487 100. 00
DENTAL TREATMENT

With slightly increa.sed dental personnel, 12,793 more patients
were treated than in the preceding year. Four full-time dental
officers are on duty with the Coast Guard-2 at the Academy in
New London, 1 at Staten Island, and 1 at Curtis Bay, Md. During
the summer months an additional dentist was assigned to the Coast
Guard cutter Northland and one to Unalaska.
The total cost of all dental service in marine hospitals and relief
stations, including the salaries of officers and assistants, and supplies
and overhead cost, amounted to $214,785.39. Had the total amount
of dental treatment been procured at authorized fees by employing
contract dentists instead of service dental officers, the total cost
would have been $570,597.25. The major items of treatment rendered by service dental officers were as follows:
Item
Number of patients treated._. __ ----------------------------- - _________________ _
Number of complete dental examinations ______________________________________ _
X-ray exposures ________________________________________________________________ _
Prophylactic
treatment
(hours) (hours)
___ --------------------------------------------Vincent's
stomatitis
treatment
_____________________________
____________ _
~if:!~t~~~~eatment (hours) ____ • _______________________________________________ _
Alloy fillings ________________ • __________________________________________________ _
Gold inlays ____________________________________________________________________ _
Porcelain crowns __________________________________________________________
_____ _

ii\i::::::;fil)_ - - - - - - - - --- - - -- - - - - - - - -- - - -- -

Total number of treatments rendered. ____ ----------------------------- ---------


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Federal Reserve Bank of St. Louis

1930
52,763
34,140
17,878
6,326
2,318
2,273
37,537
22,596
780
53
6,259
2,527
488
312
280,722

1931
65, 55&
37, 701
21,291
6,175
3,567
2,218
43,344
23, 518, 736
91
8,211
3,148
1,342'
538
335,214

237

PUBLIC HEALTH SERVICE

Senior Dental Surg. C. T. Messner is in charge 0£ all dental
3ctivities in the field and the bureau.
COAST GUARD

The average number 0£ Coast Guard beneficiaries was 13,020 on
active duty and retired. The character and comparative amounts
of medical service furnished in recent years are shown by the following table:
Numerical strength of Coast Guard and
· medical services given
Year

Number of
Coast
Guard
personnel

Hospital Out-patient Physical
examidays
treatments nations

Average amount of medical
service per person

Hospital
days

Outpatient
treatments

Physical
examinations

-----1923 .•.•
1924
___ • --____---------------- --- _____
1925 __ • _---------------1926 ______ -- -- ------ --- _
1927 _____ -- _-- ----- _-- -1928 ___ ----------------1929 ____ -------------- -1930 __ • _-- -- -- ---- -- - • -1931 ____ -- --- ___ -- --- _--

4,684
4,896
7,077
9,839
10,984
12,462
12,833
12,963
13,020

41,681
36,504
60,336
71,799
76,564
85,691
88,870
90,179
86,829

32,530
45,857
90,494
125,226
155,977
137,971
169,697
196,334
187,063

4,207
7,008
13,394
19,061
18, 787
17,220
17,748
14,382
8,262

8.9
7. 6
8. 5
7.3
6. 9
6. 9
6.9
6.9
6. 7

6. 7
9.4
12.8
12. 7
14. 2
11.0
13.2
15. 1
14.4

0.9
1.5
1. 9
1. 9
1. 7
1.4
1.4
1.1
.6

Twenty-two medical and dental officers are assigned exclusively to
Coast Guard duty and 108 local physicians under appointment as
acting assistant surgeons furnish medical and surgical relief and
make physical examinations of Coast Guard and Lighthouse Service
personnel at isolated units remote from any Public Health Service
relief station.
Medical officers have been assigned, as usual, to the cutters on the
international ice patrol and to those on the cadet practice cruise in
European waters. Medical officers have been assigned to the Bering
Sea patrol, and a dental officer was stationed at the patrol base at
Unalaska during the cruising season. A medical officer and a dental
officer are assigned to the N 0?1thland). on its annual Arctic cruise to
Point Barrow, Alaska. This cutter has a well-equipped dental unit
and a specially appointed sick bay. The medical and dental officers,
in addition to their care of Coast Guard personnel, extend medical,
surgical, and dental relief to a considerable number of Alaskan
natives and others to whom such relief is not otherwise available.
Valuable scientific observations have also been made of medical, sanitary, and dental conditions among the natives.
During the year a dental unit was installed at the Coast Guard
depot, Curtis Bay, Md., and a dental officer assigned to duty there.
This unit serves a large personnel of vessels undergoing repair in
addition to that of the depot. A dental unit has been installed also
at Coast Guard section base No. 2, Stapleton, N. Y., and operated
from the marine hospital, Stapleton, by a dental officer of the hospital staff. These dental units reach a large number of Coast Guard
patients, many of whom would not otherwise receive dental attention.
They relieve dental units at hospitals of much work and save a very
large amount of time of Coast Guard patients. In addition to the


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Federal Reserve Bank of St. Louis

238

PUBLIC HEALTH SERVICE

usual medical, dental, and surgical supplies furnished the Coast
Guard, four new cutters have been equipped. Additional new outfits for one cutter and several patrol boats will be required during th&
coming fiscal year.
·
The high standard of physical examination performed at marine·
hospitals and elsewhere in the field has been maintained. In view
of the benefits provided by law for disabilities incurred in service·
it is necessary to exclude persons having physical conditions that
may lead to early disability and claim for pensions. The present
system of making and keeping the individual medical records ha&
been found unsatisfactory for Coast Guard needs. Also the proJ?er
consideration of claims for pensions and compensation for physical
disability is hampered by lack of complete medical records. A joint
board of Coast Guard and Public Health Service officers has made
a detailed study of this subject and recommended a system of individual medical records, the adoption of which is now under consideration.
Special attention given to the control of venereal diseases has continued. There was a progressive decrease in the number of cases·
reported in 1928 and 1929 over those in 1927. The number of cases
increased somewhat in 1930, but again decreased in 1931. Every de-crease represents a very material saving in money and efficiency, but
it is felt that the greatest possible results have not yet been attained.
Medical Director W.W. King is assigned to duty at Coast Guard
headquarters as representative of the Surgeon General and chief of
the medical section.
EMPLOYEElS' COMPENSATION COMMISSION

When civil employees of the United States are injured while in
performance 0£ their duties they are entitled to reasonable medical
and hospital services and supplies needed as a result of the injury►
The law further provides that where practicable ·such services shall
be furnished by United States medical officers and hospitals. For
this purpose 25 hospitals and 118 dispensaries of the Public Health
Service are available without cost, and to a limited extent other Government hos:.pitals are also available. In localities where the PublicHealth Service has no medical facilities available, treatment is furnished through private physicians designated by the commission, of
which some 4,000 have been selected throughout the United States ►
The Public Health Service furnished service during the fiscal year
as follows: 57,042 hospital days, 179,029 out-patient treatments, and
22,343 complete medical surveys. This service would have cost the·
compensation fund well over $1,000,000 if obtained elsewhere.
Surg. E. C. Ernst is assigned to the United States Employees"
Compensation Commission as medical director.
EXAMINATION IN FIRST AID

Ship's officer's and candidates for licenses were instructed in first
aid and ship sanitation at 37 of the 46 stations designated upon the
request of the Steamboat Inspection Service, by whom proficiency
in first aid has been required of all licensees since July 1, 1922. Approximately 94 per cent of the candidates examined were successfuL


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Federal Reserve Bank of St. Louis

239

PUBLIC HEALTH SERVICE

The following table shows the amount of first-aid instruction given
and the results of examinations :
Instruction and ea:aminati-on in first aid, fiscal year 1931
"O

.E
~
~

Station

.E...

><
a;,

.0

~
.0

z

z

Q)

El
::,

Aberdeen, Wash ______________
0
Baltimore, Md _______________
67
Bangor, Me __________________
0
Boston, Mass _________________
0
Buffalo, N. y ________________
0
Charleston, s. c ______________
0
Chicago, Ill ________ ___________
ltl
Cleveland, Ohio ______________
90
Detroit, Mich ________________
6
Duluth, Minn ________________
0
Evansville, Ind _______________
0
Galveston, Tex _______________
18
Grand Haven, Mich __________
0
Jacksonville, Fla _____________
0
Juneau, Alaska _______________
8
Louisville, Ky ________________
4
Marine City, Mich ___________
35
Memphis, Tenn ______________
7
Milwaukee, Wis ______________
0
Mobile, Ala __________________
0
New Haven, Conn ___________
0
New London, Conn __________
7
New Orleans, La _____________
68
New York, N. y _____________ 377
Norfolk, Va __________________
0
Oswego, N. Y ________________
1
Philadelphia, Pa _____________
19
Pittsburgh, Pa _______________
0
Port Huron, Mich ____________
8
Portland, Oreg ___ ____________
16
Providence, R. L ____________
0
San Francisco, Calif_ _________ 196
San Pedro, Calif__ ___________ _
0
Savannah, Ga ________________
9
Seattle, Wash ________________
0
Tampa, Fla __________________
0
8
Toledo, Ohio_---------------TotaL __________________ 959

Number passed

"O
a;,
i:l

·s.e

"O

.E
0

El
::,

50
94
2
120
30
3
10
73
11
24
2
45
9
20
8
8
22
7
74
16
8
37
67
459
73
4
104
13
5
16
12
159
36

]

H

~

p

8

0
49
0
0
0
0
9

50
24
2
104

50
73
2
104

28

28

3
1

56
6
0
1

10

3
10
66
11

8

8
30
4
70
50
3
85
13
1
0
12
7
32
3
63
8
0

1,713

813

789

11

~

C

16

0

p

:3~

... 0

El..8
<:e'-"

::, ::,

...,..cl

]

a,'-"

0

i:l

8

-~ ~

><
rx"l

1
0

e
]
0

8

- - - - - - -H

0
5
0
16
2
0
0
6
0
0
0
4
1
0
0
0
0
0
0
0
0
0
0
12
23
0
2
0
0
0
0
3
4
0
2
0
0

0
21
0
16
2
0
0
7
0
0
0
4
1
0
0
0
0
0
0
0
0
0
1
22

63
8
8

0
16
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
10
0
0
1
0
0
1
0
1
0
0
0
0
0

0
3
0
0
1
0
4
4
0
2
0
0

0
141
0
0
0
0
35
24
6
0
0
10.5
0
0
13
3
30
82
0
0
0
12
34
250
0
1
19
0
20
48
0
177
0
17
0
0
14

1,602

31

80

111

1,031

24
2
41
8
20
8
8
22
7
74
16
8
37
66
437
50
4
101
13
5
15
12
155
32
11

i:l

....0 ,.,....
0

$

E .i:l~i:l

.E
0

E ]i:l

18
0
0
8
1
. 22
7
0
0
0
7
62
367
0
1
16
0
4
15
0
148
0
8
0
0
8

65
8

"O

Time consumed
i:l

"O

ie

5
24
1
23
8
20
0
7
0
0
74

Number rejected

23

50
242
2
63
30
3
12
39
9
13
2
47
9
20
11
8
12
14
74
17
8
27

50
383
2

63
30
3
47
63
15
13
2
152
9
20
24
11
42

42
8
12

96
74
17
8
39
62
696
93
5
119
13
25
64
11
270
19
40
42
8
26

1,625

2,656

28

446
93
4
100
13
5
16
11
93
19
23

OPERATING COSTS

The appropriation of $5,877,496 was augmented by reimbursements received from the Veterans' Administration amounting to
$1,172,889, making a total available for expenditure of $7,050,385.
According to the classification of the General Accounting Office,
the several items of expense were as follows :
01-Personal services _________________________________________ _ $3,753,891
0200-Janitor and laundry supplies, X-ray films, etc _____________ _
71,475
0210-Medical and hospital supplies _____________________________ _
293,772
0220-Scientific and educational supplies ________________________ _
5,914
0230-Fuel ( coal, wood, gas, and fuel oil) _______________________ _
169,877
0250-Forage __________________________________________________ _
56,251
0260-Provisions _______________________________________________ _
1,153,726
0280-Sundry supplies ( ice, hardware, etc.) ______________________ _
79,071
03-Subsistence and support of persons ( contract care) ________ _
577,493
04-Care of animals __________________________________________ _
61
0500--Telegraph _______________________________________________ _
990


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Federal Reserve Bank of St. Louis

240

PUBLIC HEALTH SERVICE

0510-Telephone__,
___1---------------- -------------------- -------_
06-Travel expense
___________________________________________
07-Transporta tion of things __________________________________ _
09-Advertising ______________________________________________ _
10-Furnishing heat, light, power, water (contract) ____________ _
1100-Rent of buildings and offices ______________________________ _
1110-Other rents ______________________________________________ _
1280--Repairs and parts, motor vehicles _________________________ _
12'90-Alterations and repairs, other equipment_ __________________ _
1373-Laundry service __________________________________________ _
1375--Ash and garbage removal _________________________________ _
1380--Miscellaneous services ____________________________________ _
2250--Burials __________________________________________________ _
3000--Motor vehicles ___________________________________________ _
3010-Furniture, furnishings, and fixtures _______________________ _
3030-Scientiflc and recreational equipment_ _____________________ _
3040-Livestock ________________________________________________ _
3050--Other equipment _________________________________________ _
Reserved for unknown encumbrances _____________________ _

$24,139
102,444
77,774
7

185,025
28,380
4,643
7,430
26,793
57,849
1,969
3,669
28,941
15,664.
124,864
112,068
3,842
52,539
7,020,561
29,824

7,050,385
01-The item of personal services covers salaries and wages of 532 physicians and dentists, 510 nurses, aides, and dietitians, and 1,773 other employees.
0200--F or soap, lye, starch, brooms, toilet paper, and other laundry supplies,
$39,251; X-ray films, $31,909; postage stamps, $194; etc.
0210--Gauze and cotton, $25,047; clothing for lepers, $13,319; anesthetics and
adhesive plaster, $5,931 ; catgut and other sutures, $2,257 ; artificial legs, arms,
bra ces, and other prosthetic appliances, $4,003 ; etc.
0220-The principal item under this heading was $3,126 for subscriptions
to medical journals.
0230--Coal, $81,417 ; wood, $15,206 ; fuel oil and gas, $73,255.
0260--This is the cost of food at $0.53 per day for patients and personnel
in marine hospitals.
0280-Ice, $13,087; electric-light bulbs, $2,341; gasoline, oil, and grease,
$6,996; p acking boxes and materials, $1,770, etc.
3000-Six passenger cars were purchased for $2,819 ; 2 ambulances for
$5,075; 10 trucks for $7,770.
3010-Pajamas, bath robes, sheets, pillow slips, and counterpanes, $27,660;
beds and mattresses, $11,489; china and glassware, $5,791; window shades,
$1,223; fl.ling cases and desks, $2,798; and $75-,903 for other hospital furniture
and furnishings, etc.
3020--X-ray machines and tubes, $29,732; mortuary, $1,400; clinical thermometers, $2,530; medical books, $2,949; anesthesia apparatus, $1,681; urological tables, $2,170; diathermy machines and wheel litters, $2,09-2; furniture,
$23,251; other scientific equipment, $44,141.
3040--Livestock for Carville and Fort Stanton, $3,842.
3050-Dish-washing machines, $5,222; food conveyors and refrigerators,
$9,844; patients' lockers, $1,666; typewriters and computing machines, $4,522;
k itchen and dining-room equipment, $15,324; laundry and other equipment,
$15,961.
ECONOMIES

Surplus property :from other Government departments valued at
$16,977.77 was acquired :for the use o:f marine hospitals and other
relief stations. Funds amounting to $1,377.50 and $166.20 were
realized :from the exchange value o:f old typewriters and automobiles,
respectively. Two passenger-carrying vehicles were purchased at a
very nominal cost at auction conducted by the General Supply
Committee. Whenever possible, patients were sent to Carville, La.,
in groups to diminish expense of attendants.


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Federal Reserve Bank of St. Louis

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Detroit 111ch
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1.34

$6,025,815,42

(a) In-Patient department of atation cloud

Average per diem cost of in-patient relief, United States Marine Hospitals, fiscal year 1931.


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Federal Reserve Bank of St. Louis

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Federal Reserve Bank of St. Louis

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PUBLIC HEALTH SERVICE

243

Navy contracts were used to purchase fuel, lubricating oils, and
furniture. Typhoid vaccine was purchased from the Army Medical
School. Commonly used hospital supplies were purchased semiannually and tires and tubes quarterly as definite quantity items.
Repairs of quantities of unserviceable quartz burners and X-ray
tubes were consolidated. Narcotics and alcoholic liquors were obtained gratis through the Bureau of Narcotics and the Chief Coordinator, respectively.
Soap was manufactured at various hospitals from waste grease,
used X-ray films were dissolved in acetone to make spinal braces,
and standard rather than proprietary drugs were purchased in packages of standard sizes. Before purchasing, all clinical thermometers
are tested through courtesy of the Bureau of Standards, and of
12,000 thermometers tested, 349 were rejected for defects.
ABSTRACTS OF REPORTS FROM MARINE HOSPITALS AND SELECTED RELIEF
STATIONS

Representative activities have been selected from the annual reports of these stations. A tabulation of all the transactions will be
found on pages 259-278.
Marine hospital, Baltimore, Md.-Medical Director R. H. Creel in charge.

Plans for the new hospital are in preparation and it is expected that construction will begin by fall. The building program contemplates a 6-story
fire-resistant hospital with an approximate capacity of 380 beds and auxiliary
services, arranged compactly with utilities centrally located. Plans have been
made for continuance of medical relief in the present institution, although this
will be difficult and the bed capacity will be curtailed.
At all times the hospital was taxed beyond its normal capacity of 167 beds,
the average census being in excess of 200 patients. Overcrowding rendered
station administration difficult both from a professional and custodial viewpoint. Whatever merits the 1-story pavilion type of hospital may have, economy
of operation is not one of them, and with a small orderly and maintenance
force the task is increasingly difficult. In a number of ways administration
has been facilitated by the addition of labor-saving devices, such as dish-washing machines, bread toaster, electric refrigerators, and egg timers. Treatment
has been improved by such items as oxygen-tent, metabolism machine, improved gas machine, and other similar equipment.
For the surgical service 73 beds were utilized, but this number was inadequate
for the needs of that department, and in order to meet the requirements
patients often had to be transferred or discharged before fu1ly recovered in
order to provide for those more urgently requiring care and treatment. During
the year 695 surgical cases were admitted, not including cases of a surgical
nature that were treated in the venereal waTd for concurrent venereal infection.
There were 1,307 operations performed in the general surgery section, this
excluding surgical procedure in the genito-urinary section, dental clinic, and
eye, ear, nose, and throat clinic. At the out-patient office 2,535 operations were
performed, mostly of a minor nature, including 1,452 venepunctures. The
major operative procedures included 98 appendectomies, 10 amputations, 63
treatment of fractures, 8 thoracoplasties, 9 cystostomies, 117 herniotomies, and
16 miscellaneous laparotomies. In the medical wards 617 patients were treated,
including 61 cases of pulmonary tuberculosis. Three insane patients were
transferred to State institutions and three to St. Elizabeths Hospital. One
tuberculous patient was sent to a State institution and one to a hospital of the
Veterans' Administration.
An ample staff of attending specialists and consultants of the highest professienal attainments, most of whom are connected with other city hospitals, in
conjunction with the services of the resident staff, has been productive of an
exceptionally efficient service. In the genito-urinary wards 550 patients were
treated, most of whom had venereal infection. There were administered 2,271
injections of neoarsphenamine to in-patients and 1,148 to out-patients; 2,324


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Federal Reserve Bank of St. Louis

244

PUBLIC HEALTH SERVICE

injections of bismuth to in-patients and 1,199 to out-patients. Seven cases of"
late syphilis were treated by malaria infection. Spinal puncture was performed
in 53 cases. The eye, ear, nose, and throat section gave 1,370 in-patients a total
of 7,494 treatments, and 934 out-patients a total of 1,795 treatments; 87 operations were performed, most of a minor character.
The dental officers gave 2,157 patients a total of 16,177 treatments; 565,
patients were X rayed, the number of exposures being 2,500; 61 dentures were
made, 22 alveolectomies performed. There were 2,218 extractions and 1,160
:fillings. Twelve patients with fractured mandibles were treated.
The physiotherapy aides gave 18,531 treatments, 14,705 to in-patients and
3,826 to out-patients. The roentgenologist made 6,678 exposures and 669'
fluoroscopic examinations.
The total expenditure amounted to $326,050.16.
Marilfl,e hospital, Boston Mass.-Medical Director A. D. Foster in charge.
There were 1,867 patients admitted to the hospital, classified as follows:
Merchant seamen ________________ 965 United States Public Health ServCoast Guard men ________________ 573
ice --------------------------- 4()
Immigrants and alien seamen ____ 103 Lighthouse Service______________ 19'
Employees' Compensation ComCoast and Geodetic Survey_______ 13mission_______________________ 85 Bureau of Fisheries_____________ l0i
Foreign seame~----------------- 52 All other beneficiaries___________
7
The average daily number of patients was 156. In the out-patient depart-ments 1,982 physical examinations were made and 1,767 permits were issued
for medicinal liquor to be used on board ship.
Of 11 insane beneficiaries, 6 were transferred to native State institutions,
1 was referred to the immigration authorities for disposition, and 4 were sent
to St. Elizabeths Hospital. There were 5,292 surgical operations. Rontgenological examinations of 1,972 patients were made, with a total of 5,036"
exposures, and 82 patients were given 210 treatments, the majority of the cases
being dermatological. In the physiotherapy department 488 patients were given
17,217 treatments. Educational talks on prevention of venereal disease and
other subjects pertaining to the health of the individual, illustrated by motion
pictures, were given at various times to the patients in the hospital.
The open porches have been inclosed on the first and third floors rear and thesecond floor side, and with heating and lighting equipment installed, very
pleasant recreation and smoking rooms were thus provided. The old isolation
ward was remodeled and enlarged into double quarters and is now occupied by
the chief pharmacist and administrative assistant. Work on the old cemetery
on the hospital reservation has been completed. Numerous trees have been.
planted and the ground has -been graded and grassed.
Several organizations interested in seamen have provided entertainment for·
the patients at various times. Capt. E. W. Scott, United States Navy chaplain,
has continued his work, visiting the patients at the bedside and holding services:
in the hospital building for them on Sunday afternoons.
Quarters for medical officers now housed off the reservation are needed in theinterest of efficiency and economy, and the construction of these quarters,
together with a garage for station cars, has been recommended for consideration
under the public buildings bill.
The total expenditure amounted to $247,732.
Marine hospital, Buffalo, N. Y.-Surg. Floyd C. Turner in charge.
This hospital has been kept filled to capacity but without overcrowding, the·
maximum number of patients being 90. About one-third of the patients are
from the Veterans' Administration. Contract hospital facilities are utilized for
patients with contagious disease; insane patients are referred to the city hospital for observation and committed from there as necessary. No patients were
in the hospital at the end of the year who required domiciliary care but not
hospital treatment. The facilities of the New York State Institute for the
Study of Malignant Diseases have been freely utilized. The State health
department performs Wassermann tests, and the State Hospital for the Oare
of the Insane has furnished malarial blood for the treatment of patients with
cerebrospinal syphilis.
Staff meetings were held weekly. Educational work for patients was continued, four talks being given a month, and literature was distributed.
There are no quarters on the reservation for any of the medical officers.
Nurses and attendants formerly quartered in the hospital building have been


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PUBLIC HEALTH SERVICE

245

removed to provide additional space and now live off the reservation. In the
interest of efficiency and economy, the construction of a nurses' home, quarters
for 3 medical officers and for 25 attendants, and a garage for station cars has
been recommended for consideration under the public buildings bill.
The total expenditure amounted to $150,513.
Marine h,ospital, Carville, La. (the National Leper Home) .-Surg. 0. E.
Denney in charge.
The number of voluntary admissions has increased and the number of
patients leaving without permission has diminished to an almost negligible
percentage. The average daily population was 322. The nativity of the 337
patients remaining in the hospital at the end of the year represented 22 States,
5 insular possessions, and 17 foreign countries. Louisiana, Texas, and Florida
led this list with an aggregate total of 146 patients. The nativity of the 63
patients admitted during the year represented 13 States and insular possessions
and 6 foreign countries. Although 23 patients died, 19 were discharged with
disease arrested, and the results of treatment are considered very encouraging.
Additional facilities are needed for the growing requirements. The construction of an infirmary building for 100 bedfast patients is required, as
there is no hospital building proper and the cottages are unsatisfactory substitutes. An infirmary building and quarters for officers and other employees
now housed in shacks built of salvaged war materials have therefore been recommended for consideration under the public buildings bill.
In view of the general interest in this hospital, the only one of its kind in
the United States, the annual report of the station will be published in full in
Public Health Reports.
The total expenditure amounted to $457,343.86.
Marine hospital, Chicago, JZl.-Medical Director J. W. Trask in charge.
The facilities of the hospital have been severely taxed to provide necessary
medical and surgical relief to service beneficiaries. The rated and normal bed
.capacity is 150, but there was a daily average of 161 patients, of whom 78 per
.cent were seamen from American merchant ships. The greatest number in the
hospital at one time was 180. In addition to the full-time officers, the hospital
has a staff of 15 attending specialists of recognized standing and experience in
-their various specialties, most of whom are connected with tlie local medical
;Schools and larger hospitals, and who are available at all times for unusually
-difficult or serious cases.
The pressing need for dental care of seamen is shown in part by the fact
-that the hospital dental service in 1929 gave 3,934 treatments; in 1930, 5,817
-treatments; and in 1931, 11,952 treatments. The aggregate number of laboratory examinations in 1929 was 8,089, in 1930, 8,827, and in 1931, 9,754. So
lmportant in the proper and early diagnosis of conditions has the X ray become
-that, like clinical laboratory work, it may be taken in a measure as an index
of the quality of service rendered. The constantly increasing use of the X ray
is shown in the fact that in 1929 there were 2,932 X-ray examinations, in 1930,
:3,705, and in 1931, 3,804. The volume of physiotherapy work is limited by the
personnel; there were 11,178 treatments this year.
Three insane beneficiaries were given temporary care and then transferred to
.the custody of the State of their legal residence for continued care in State
nospi tals for the insane.
By the act of March 4, 1931, $510,000 was appropriated for a new hospital
·wing to provide 100 beds, additions to nurses' home and attendants' quarters,
:and two double houses for medical officers, the construction of which will
'l)robably start in the fall.
The totjil expenditure amounted to $293,494.55.
Marine hospital, Cleveland, Ohio.-Medical Director L. P. H. Bahrenburg
in charge.
This report covers the first year's activities of the new hospital, which is
71.ocated on Fairmount Road, at East One hundred and twenty-fourth Street, on
a reservation of 10 acres. The main building is four stories, of steel and concrete construction, with terra-cotta brick facing. It has a capacity of 251 beds,
'ls splendidly arranged for the care of the sick, and is fully provided with
modern conveniences and equipment. Bounding a quadrangular court to the
·south of the hospital are the quarters for personnel and the garages and work:shops. The landscaping of the grounds has not yet been completed.
The number of patients has grown with the increased bed capacity. Although
rosually there is a leeway of about 8 per cent of vacant beds, the hospital has


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Federal Reserve Bank of St. Louis

246

PUBLIC HEALTH SERVICE

on several days been filled beyond capacity. The attending specialist in internal medicine holds instructive bedside clinical discussions twice weekly in the
wards for the staff, as do also the attending specialists in surgery and orthopedics. The dental unit, the importance and activity of which have greatly
increased in all lines, has four chairs of the latest type, with a dental surgeon
and two dental internes on duty. Prophylaxis is stressed. There were 2,362
extractions, 1,653 fillings, and 126 dentures made. Thirteen jaw fractures were
treated with excellent results. Hospital and out-patients are treated in approximately equal numbers.
The cafeteria for ambulant patients has proved satisfactory beyond expectations. The ration cost averaged 50-iifo- cents and ranged between 55-l-u-91r and
45r\91r cents.
In the clinical laboratory a total of 15,506 analyses, tests, etc., were made.
Many gastric, blood chemistry, and other special analyses have been requiredr
and tissue work (from operations to autopsies) has been done, partly in collaboration with the National Institute of Health for a check upon results. The
demands upon the laboratory have grown to the point of requiring a third
laboratorian. With an excellent post-mortem room available (in which is a
refrigerator with a capacity of four bodies) and an attending specialist in
pathology, a great impetus has been given to the securing of autopsies. There
were 74 deaths with 46 post-mortem examinations, a percentage of 62.16.
Reckoned from the date when the pathologist was appointed, the percentage is
68.3, due in large part to the interest aroused by his thorough examinations
and instructive discussion of the findings.
The physiotherapy section is in charge of a head nurse with special training
who is assisted by a male trained aide. The equipment has proved very satisfactory in type and quantity. The following table indicates the extent to which
it is utilized:

Treatment
Massage ____ __________ __________ ______ __------ __________ -- ------ -- ---- ---- -- -- -Electrotherapy __ ____ ____________ ________ ____________ ___________ _______ _________ _
Hydrotherapy ________________________ __________ ________ ______ ____ _____________ _
Thermotherapy ___ __ __ ______ ____ _______ _____ ___ __ ______________ ___________ -- ---Exercise _____ ___ _________ _______ __ ___ ________ ______ __ __________ ______ ___ --- -- -- __
TotaL __________ _____________________________________________ _______ _____ _

Number of Number of
patients treatments
• treated
given
131
91
72
412

35
741

2,096,

2,157
1,1~
9,381
890
15,653"

The X-ray laboratory, well equipped for radiography and fluoroscopy, is under
the supervision of the attending specialist in rontgenology, who also assists the
staff in reading plates. A total of 1,740 patients were examined and 5,198.
exposures made.
The out-patient office was continued downtown in overcrowded quarters in
the Parcel Post Building. Merchant seamen constituted 86 per cent and
patients of the Employees' Compensation Commission 10 per cent of the outpatient clientele, although in the hospital, patients of the Veterans' Administration outnumbered all others, as with the opening of the new hospital it became
possible to extend larger facilities to this class of patients. One hundred beds
were allocated for their use, and this number was later increased. The maximum number of veterans was 205 on June 27, 1931.
A number of patients with permanent disabilities (one insane) were discharged to the custody of their families, being no longer in need of hospital
care. Three tuberculous patients were transferred to Fort Stanton.
The total expenditure amounted to $329,412.21.
Marine hospital, Detroit, Mioh.-Surg. J. H. Linson in charge.
The new hospital at Windmill Pointe was kept filled to capacity during this
year, the first complete year of its operation, and during the winter months
it was necessary to put beds in ward aisles and to place several patients in
a contract hospital. The smallest number of patients in the hospital was 108
on March 8, and the greatest number was 148 on January 22, considerably
above the normal capacity. Slightly more than half the hospital patients and
78 per cent of the out-patients were merchant seamen; 40 per cent of the


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Annual Report of the Surgeon General, United States Public Health Service, 1931

UNITED STATES MARINE HOSPITAL , DETROIT , MICH ., COMPLETION OF WHICH WAS AUTHORIZED BY THE ACT O F JULY 3 , 1930


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Federal Reserve Bank of St. Louis

Annual Report of the Surgeon General, United States Public Health Service, 1931

UNITED STATES MARINE HOSPITAL FOR TUBERCULOUS PATIENTS , FORT STANTON , N . MEX.


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247

PUBLIC HEALTH SERVICE

hospital patients were veterans of the World War. There were 11,150 dental
treatments, of which 43 per cent were for out-patients; 2,325 injections were
given for treatment of syphilis and 21,924 physiotherapy treatments for general
medical and surgical cases. The hospital is handicapped by an insufficient number of private rooms for seriously ill patients.
A contract to draw plans for the additional wing, nurses' quarters, attendants' quarters, laundry, and medical officers' quarters has been awarded to a
local firm of architects. ( See cut of architects' sketch.) It is proposed to
increase the capacity to 250 patients. Negotiations for additional land for the
hospital grounds were carried on, but the owner refused to sell at the public
appraisal and condemnation proceedings were instituted by the district attorney.
The department of public works of the city of Detroit was permitted to fill in
the submerged area of the present reservation almost to the harbor line.
Two mildly insane patients were released to the custody of their relatives,
2 were assisted to enter the Wayne County Home for the Poor at Eloise,
Mich., 1 was sent to the State hospital at Ann Arbor, and 1, a veteran, was
transferred to the veterans' hospital at Camp Custer, Mich.
The total expenditure amounted to $200,380.47.
Marine hospital, Eilis Island, N. Y.-Medical Director C. H. Lavinder in
charge.
The capacity of the hospital was overtaxed during the winter months, necessitating a ward at Hoffman Island, where, with the cooperation of the quarantine station, a group of patients was maintained from January 24 to May 20,
1931. American seamen now greatly outnumber other classes, and only 793
immigrants, 1,251 warrant cases, and 431 alien seamen were treated this year.
The reimbursements deposited in the General Treasury for the care of aliens
amounted to a considerable sum. The increased demands on this hospital are
shown in the following comparative statement:

Year

1927 _. _. _. ___ • ___ _ . _ ·- . _ . _ . ___ ·- -- -- __ -- ________ . _ ·- -- -- ____ ·- . _ . _ . _ . _ -- . _ . _ ·- -1928_. _ -- . _ . _ . _ . _ . ___ -- ________ . ___ ·- ·- ·- . _ . _ . _____ -- __ -- ____ -- __ __ __ ____ _ __ ·- ·1929_ ·- -- ·- -- ·- ·- ·- ·- -- -- -- -- -- -- -- -- -- -- ---- -- ·- -- -- -- -- -- -- ·- ·- -- ·- -- ·- ·- -- -- -1930 ___ . _ . _ . _ . _ . _. _. _ -- . _. _____ . _ _ ·- ·- . _. _ . _. _. _ . _ . _ . _ . _ . _ . _ . _. _. _. _ . _. _. ______ _
1931 ___ ·- -- ·- -- ·- -- -- -- -- -- -- -- ------ -- ---- -- ----- - --- - ---- ----------------------

Daily averTotal num- age number of days' ber of patreatment tients in
hospital
121,793
128,950
141,076
144,244
163,779

333
352
386
395
448

Staff conferences are held at regular intervals and programs are presented
under the guidance of a committee. Educational work for beneficiaries was
also continued, and a weekly talk was given with moving pictures, the average
attendance at which was about 300. A cafeteria was installed with modern
equipment, particularly for genito-urinary patients, and a special X-ray and
fluoroscopic unit was purchased for the tuberculosis section, where there are
contsantly more than 100 patients; 410 pneumothorax treatments were given
here. The Immigration Service plans further improvements to the hospital,
and an expenditure of about $120,000 in renovating the electric light and power
service, exterior and interior painting, reconstruction of bridge between Islands
No. 2 and No. 3, and repairs to roofs and plumbing.
The social service department is coordinated with that of the marine hospital
on Hudson Street and is represented in the Welfare Council of New York City.
Funds were donated by the auxiliary composed of local citizens. Convalescent
care was secured for 135 seamen, whose discharge from hospital was thus
expedited; 9,.4 seamen were returned to home ports, permanent care was obtained for 10 patients, and the discharge of 25 other chronic patients was arranged; 235 patients were financially assisted and 152 other patients referred
to agencies providing temporary shelter, all in the interests of facilitating
discharge or avoiding the necessity of admitting seamen to hospital. Friendly
aid was given to 1,847 patients in matters of baggage, wages, and the like, and
clothing was furnished to 219 patients. A volunteer worker is in charge of
the library. Recreational facilities were provided, including motion-picture
shows once each week. Patients' visitors were received numbering 16,024 and
2,440 passes were issued under medical direction. The following is a partial


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Federal Reserve Bank of St. Louis

248

PUBLIC HEALTH SERVICE

list of agencies contributing to the recreational welfare of patients at this
hospital:
Roxy's Theater.
American Red Cross.
Immigration Social Service Workers.
New York Film Board of Trade.
Seamen's Church Institute.
Cheer Givers.
New York Plant and Flower Guild.
Toc-H-Men.
The following is a brief statistical summary of transactions of the year:
Patients treated______________ 5, 851 Dental treatments____________ 21, 854
Deaths_______________________
125 Physiotherapy treatments _____ 11, 058
Autopsies _____ _:______________
74 Occupational therapy treatAverage stay in hospital (days)_
28
men ts______________________ 3, 572
Average per diem cost________ 4. 55 X-ray exposures______________ 8,999
Average ration cost_ __________ $0. 567 Laboratory examinations----- 34,189
The total expenditure amounted to $748,614.33.
Mwrine hospita,l, Evansville, Ind.-Surg. K. E. Miller in charge.
The average number of patients in this hospital was 70, the minimum 61,
and the maximum 77. More than one-half were patients of the Veterans'
Administration. An additional hospital building is needed to increase the
capacity and improve the facilities, and to this end $100,000 was appropriated
by the act of March 4, 1931. The reservation of 10 acres is of ample size.
Plans for the new building are in course of preparation by the Supervising
Architect, and it is anticipated that construction will begin this fall.
The total expenditure amounted to $75,062.49.
Marine hospital for tuberculosis, Fort Stanton, N. Mex.-Surg. R. L. Allen in
charge.
Of 375 patients treated, 304 were merchant seamen, 20 Coast Guard men,
9 beneficiaries of the Employees' Compensation Commission, 10 civilians from
the United States Army Engineer Corps, and the remainder other classes of
beneficiaries. The daily average was 248 and the maximum number of patients
261. The average stay of patients discharged, including those who died, was 682
days. It is the policy to encourage all patients to remain until either restored
to working capacity or death ensues, but transfers to other marine hospitals are
made if necessary for the patients' comfort. There were 23 deaths from tuberculosis and 18 necropsies. One patient was murdered by another patient. Of
84 tuberculous patients who were discharged, 34 were not improved, 31 were
improved, and in 19 the disease was apparently arrested.
Phrenic surgery and pneumothorax treatments were continued, with good
results, 26 phrenicotomies and 970 fills and refills were done. A dental officer
and dental assistant gave 3,088 treatments, including 450 fillings, 279 extractions,
and 18 dentures. Nine hundred and seventy-one ultra-violet light treatments were
given, and natural heliotherapy was continued with good results. The X-ray
work continues to increase in importance. Systematic periodic X-ray examinations are made and compared with previous readings and physical examinations
to note the progress made. All pneumothorax cases are checked with :fluoroscopic and plate examination at frequent intervals. There were 661 films of the
chest and 125 :fluoroscopic examinations made.
One technician does the clinical laboratory work under the supervision of a
medical officer. Two student technicians from among the patients have served
without pay, either of whom could now carry on the routine laboratory work if
called upon to do so. The opinion expressed in last year's report of the value of
the erythrocyte sedimentation test has been strengthened. Butler and Kahn
tests are performed on all patients admitted to the hospital. A total of: 6,113
laboratory tests of all kinds were made.
The bakery has been rearranged and the oven rebuilt. Modern cafeteria
equipment was installed in the ambulant mess, and the system is working out
very satisfactorily; the ration cost has decreased slightly and the patients
receive warmer and more attractively served food than formerly. The purchase
of canned fruit and vegetables and potatoes in carload lots has also reduced the
cost of supplies.
The occupational therapy department employs three aides and a storekeeper.
The craft shop was painted and decorated by the patients. It has 1 large room,
which is used for weaving, leather work, and decorative art, 1 small room for
show card and sign painting, and 1 for wood and metal work. Ninety-five
patients took occupational therapy and 46 educational therapy, an aggregate
total of 16,882 hours. Much is done for patients besides the educational and


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occupational work, as patients, due to their prolonged illness and loneliness,
become discouraged. Magazines and books were contributed to the library, the
greatest source of diversion. All h ospital beds are equipped with earphones
and the radio program is continuous from 6 to 91 p. m. Tbe Trowel Club
employs a radio operator and furnishes diver:: ; ified enterta inment throughout
the year, such as plays and musical programs, and distributes cigarettes and
tobacco. The Seamen's Social Club has distributed cigarettes, tobacco, and
razor blades weekly to all patients, with funds contributed by various steamship
companies. The Seamen's Church Institute operates the Commuuity H ouse and
contributes generously to vvelfare activities. A good baseball team wa~ maintained. Two motion pictures are shown ench week, and musical programs, parties and picnics for patients have been well attended. A Catholic and a Protestant chaplain have been maintained on the station by their respective organizations and conduct religious services and administer to the spiritual needs of the
sick and dyin~.
The pipe line froze on two occasion, necessitating large emergency expenditures for labor to restore service and causing serious water shortage.
Plans for repair of the line are now being prepared by the Supervising
Architect's Office. Livestock water supply was greatly improved b the drilling of two deep wells in pasture remote from water. One in section No. 28
has been equipped with a windmill and pump and is providing a plentiful
supply of water. The other well, in section No. 33, will be in service early
in the next fiscal year. The dam constructed by the Southern Pacific Railroad Co., located approximately 16 miles above the station proper, was completed and filled in May, 1931. The effect of this dam upon station water
supply can not be determined at this time.
Production of milk in the daJry h as been ample for all requirements. All
beef and pork qsed was produced on the station.
Since the old Army hospital burned in 1905, the old cavalry barracks have
been used as an infirmary and these are unsatisfactory. A new hospital
building is needed and a number of 2-bed shacks are also required to reThe construction of an additional hospital
place dilapidated structures.
building of 50 beds, 30 two-bed frame shacks, a nurses' home, quarters for 4
medical officers, and a new power plant and laundry building, has been recommended.
The total expenditure amounted to $358,341.29.
Marine hospit'al, Key West,, FZa.-Surg. M. S. Lombard in charge.
It was necessary to restrict admissions to this hospital to prevent
overcrowding, and a waiting list was maintained for patients of the Veteran~' Administration, who constitute the majority of the clientele. During
fall and winter months, a large number of old-line beneficiaries come from considerable distances to apply for admission. The average number of patients in
hospital was 88, and the maximum was 98 on February 21, 1931. There were
329 major and 1,033 minor surgical operations, 3,520 &urgical dressings, 3,595
clinical laboratory examinations, and 1,542 X-ray exposures. Spinal anesthesia
was used for operations below the diaphragm, and local or ether anesthesia for
other work or at the request of patients.
Through the courtesy of the Navy the hospital communicated by radio with
38 ships, exchanged 107 messages, and admitted 14 patient's who were transferred from passing ships at sea to commercial boats sent out for the purpose and conveyed to this port. The Army and naval hospitals being closed,
several officer.s and enlisted men on duty in or near Key \Vest were given
medical care.
Although all rain water is saved and used, it was necessary to continue
to purchase distilled water from the navy yard, no other sources of fresh
water being available on the island. To the end of the fiscal year salt water
for flushing purposes was purchased from the city of Key West, but during
the month of June, 1931, the station's salt-water equipment, consisting of a
65-foot well, a 2,000-gallon tank, and three pumps, was reconditioned and
again placed in operation, and now supplies salt water for fire-control and
for flushing purposes. The triangular plot of land adjoining the hospital
was leased from the Navy Department and graded and planted with shrubs,
trees, and Bermuda grass, as was also the ground west of the marine hospital buildings that was acquired through the courtesy of the Navy. A tennis
court was built with station labor. A fence was erected along the newly
estab}Lshed boundary lines and incloses the entire reservation, the general

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appearance of which was thus greatly improved. The supervising architect
has completed plans for the addition to the hospital for which $25,000 was
appropriated by the act of July 3, 1930, and construction work will begin
shortly.
The total expenditure amounted to $129,285.30.
Marine hospi,t,al, Loois'Ville, Ky.-Surg. Joseph Bolten in charge.
This hospital, with a bed capacity of 83, cares for seamen of the Ohio and
tributary rivers, beneficiari~s of the Employees' Compensation Commission,
patients of the Veterans' Administration, and other beneficiaries. The outpatient office in the customhouse remained closed; all out-patients were cared
for at the hospital. A large number of patients, especially veterans, applied
for admission to the hospital. The maximum number under treatment was
99 on May 30, 1931. Nine attending specialists representing the various
specialties supplement the full-time hospital staff. The attending specialist
in surgery examined 679 patients and opera ted upon 162.
The hospital is indebted to the University of Kentucky for blood examinations; this arrangement is very satisfactory, the reports being returned three
days after the specimens are forwarded. Both the Wassermann and Kahn
precipitation tests are made from each specimen, of which there were 874.
The contract for X-ray work has been continued for difficult cases requiring
expert interpretation. Three patients have also been treated with radium by
contract, receiving 6,800 milligram-hours, and 9 patients were given 58 deep
X-ray therapy treatments during the year.
The city park commission planted eight shade trees and the grounds were
further beautified by the addition of a considerable amount of shrubbery
received from friends and by the planting of 250 coniferous trees.
The home service of the Louisville Chapter of the American Red Cross aids
the patients in many social problems. A religious service is conducted each
week by various ministers at the invitation of the Young Men's Christian
Association and recreation is provided for ambulatory patients by a number of
local agencies.
By the act of March 4, 1931, $460,000 was appropriated for a new hospital
building and conversion of the old building into quarters for officers, nurses,
and personnel. The architect is drawing the plans for this hospital and construction will probably start in the fall.
The total expenditure amounted to $113,633.90.
Ma.r ine hospital, MempMs, Tenn.-Surg. W. H. Slaughter in charge.
This hospital was kept filled beyond the normal bed capacity of 65 ; at one
time there were 85 patients and beds were placed on the porches and in corridors. The professional work continued to increase; 1,417 sugical operations
were performed, 1,721 clinical laboratory tests made, and 588 exposures were
made in the X-ray clinic. Wassermann tests were performed on all patients
admitted to the hospital. All tissue removed at operations was submitted as
a routine procedure to the National Institute of Health for histopathological
examination. One patient not in need of hospital treatment and requiring only
custodial care was diverted to a local public institution. The duties of dietitian
were performed by the acting chief nurse in addition to her other functions.
The out-patient office was operated at the hospital.
Considerable new equipment was installed during the year, including furniture for wards and nurses' quarters, a truck, and complete new X-ray apparatus. A new hospital building is urgently needed to replace the present dilapidated buildings, and an appropriation of $175,000 is available for this purpose.
The total expenditure amounted to $103,954.49.
Marine hospita,l, Mobile, .A.Za.-Surg. W. S. Bean in charge.
Although Mobile in common with other ports has felt the world-wide depression in shipping, only 773 vesse•ls having entered at the customhouse, the smallest number since 1924-25, when 737 entered, the hospital has been filled at
all times. There was a daily average of 94 patients, although the normal
capacity is only 90. Of the 849 patients treated in the hospital, 523 were
merchant seamen. As in other years, patients of the Veterans' Administration
were admitted only when the beds were not needed for seamen. There were 20
deaths and 11 autopsies.
As is customary, the bulk of the considerable surgery has been done by the
consultants in general and orthopedic surgery. The dental work has increased;
9,252 treatments were rendered. The physiotherapy aide gave 7,980 treatments.
Two of the nurses were operated upon for acute appendicitis, and one suffered
a severe injury, sustaining multiple fractures of the pelvis. The appendicitis
cases made prompt recoveries and the fracture case was greatly improved at the

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Annual Report of the Surgeon General, United States Public Health Service, 1931

UNITED STATES MARINE HOSPITAL , GALVESTON , TEX.


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Federal Reserve Bank of St. Louis

Annual R eport of the Surgeon General , United Statl's Public H ealth Service, 1931

UNITED STATES MARINE HOSPITAL , NEW ORLEANS , LA .

UNITED STATES

MARINE

HOSPITAL , SEATTLE , WASH ., TO
IN

BE COMPLETED

1932
250-2


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251

end of the year though not yet re,ady for return\ to duty. As in the past , the
dietetic service has been under the acting chief nurse with the immediate supervision of a housekeeper. The clinical laboratorian secured in March, 19'30, has
made 10,958 examinations. The laboratory can now do any ordinary type of
clinical work required. The work in the X-ray department under a part-time
laboratorian in rontgenology has incre-a sed greatly during the year, due largely
to the examination of Veterans' Administration claimants for compensability.
There were some additions to the equipment. A total of 1,541 exposures were
made on 745 patients. In the dispensary 1,891 prescriptions were filled for outpatients and 820 for hospital patients.
Brass water piping was installed. throughout the hospital building to replace
the galvanized pipes, which had become so occluded that at times it was practically impossible to get sufficient water to various parts of the building. There
is now an adequate supply of hot and cold water with sufficient pressure at all
times. A new closed passenger car was delivered to the station on August 21,
19'30, and a new truck was bought.
An act approved March 4, 19'31, appropriated $450,000 for new buildings.
The work authorized will enlarge the hospital to 190 beds and provide a heating plant, a garage, a home for '30 nurses, and quarters for 4 medical officers.
Plans are in preparation and construction will probably begin this fall.
The total expenditure amounted to $1'33,574.
Mari ne h,ospital, N ew Orleans, La-.-Surg. T. B. H. Anderson in charge.
This hospital has continued to function at maximum capacity during the past
year, and the standard of professional service was satisfactory in spite of administrative difficulties due to construction of the new hospital. Several buildings were moved by station labor without interference with the operation of
the hospital, to clear the site for the erection of quarters. Educational lectures
on hygiene, in most instances illustrated, have been given to ambulatory patients
weekly. Staff meetings have been held weekly. The Orleans Parish Medical
Society and the First and Second District Dental Societies again held a joint
meeting with the staff of this hospital. Twenty medical and four dental internes were given a thorough course of instruction. Of these eight of the
medical and two of the dental internes received commissions in the service.
The internes as a group gave very satisfactory service.
·
The out-patient office at the customhouse building was moved to larger and
better quarters in the same building.
Fourteen insane patients were discharged to State or city or Veterans' Administration hospitals and only one was sent to St. Elizabeths Hospital.
The following is a summary of transactions for the year:
Hospital patients treated___________________________________________
5-, 001
Hospital days ______________________________________________________ 141,497
123
Deaths_____________________________________________________________
74
Autopsies ( 62 per cent)--------------------------------------------Operations, surgical operating room_________________________________
819
Doses of salvarsan_________________________________________________ 3, 771
Spinal punctures___________________________________________________
225
Operative procedures (urological service)____________________________ 4, 815
Treatments ( eye, ear, nose, and throat clinic)________________________ 10, 077
Operations ( eye, ear, nose, and throat clinic)________________________
326
Refractions ( eye, ear, nose, and throat clinic)________________________
192
Treatments (dental clinic) __________________________________________ 40,619
Examinations ( dental clinic)--------------------------------------- 5, 632
Treatments (physiotherapy department) _____________________________ 11,460
Examinations ( clinical laboratory)---------------------------------- 52, 536
Exposures (rontgenology department)_______________________________
9,077
Treatments (rontgenology department)______________________________ 1,090
Consultations with consultants______________________________________ 3, 006
Out-patient treatments (customhouse) : Medical, 13,352; dental, 9,640__ 22, 992
Out-patient examinations___________________________________________
3, 977
178
Number of liquor permits issued_____________________________________
Number of ship crew examinations__________________________________ 1, 368
Construction of the new hospital was began in July, 1930, and it is thought
that the hospital will be ready for o·c cupancy by November, 1931. ( See cut of
architect's sketch.) Construction of quarters for personnel was begun in
March, 1931, and these will probably be completed by January, 1932.
The total expenditure amounted to $484,315.98.


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Marine hospital, New York, N. Y.-Surg. P. M. Stewart in charge.

In addition to the station at 67 Hudson Street, o·ut-patient offices are operated at the barge office and the main post-office building; medicinal liquor
permits for ships are also issued in the customhouse. A continued increase
in work was accomplished without increase in personnel. New equipment
included an X-ray machine of valve tube type rectificatio'n, a new electrotreatment machine in the skin clinic, a dental X-ray machine, additional deep
therapy lamps for physiotherapy, and a photoptometer for more rapid and
accurate refraction. A rearrangement of floor space adjoining the laboratory,
supplies an additional roo·m for physiotherapy. Space for dark field laboratory
work was obtained by inclosing a portion of the unused hallway. The coldwater pipes throughout the entire building were replaced with brass pipe and
improvements in the lavatory facilities were made. Specially designed wash-up
sinks for patients were installed in the genito-urinary clinic. To provide adequate co·mpressed air for the dental clinic the usual type dental air compressors
were replaced by a large-size commercial compressor.
The number of patients treated during the year and the treatments rendered
showed an increase over preceding years. 'I'he following is a summary and
comparative schedule of the work during the past two years:
1930

New cases admitted ________________________ --------------------------------- __ _
Physical examinations __ .----------------------------------------------------- __
i~if.~~ih~litic injections _______________________________________________________ _
Total number treatments ______________________________ ________________________ _
Maximum treatments in one day _______________________________________________ _
Average daily treatments _____________________________________________ ---------X-ray exposures _______________________________________________________________ ._
X-ray treatments ______________________________________________________________ _
Clinical laboratory examinations __ -------------------------------- _____________ _

20,318
20,186
4,256
12,997
170,062
771
566
26,846
530
14,069

1931
21,029
16,054
5,252
8,668
178,642
769
595
22,709
1,479
13,054

Two patients were assisted to obtain entrance to Sailors' Snug Harbor.
Marine hospital, Norfolk, Va.-Surg. S. L. Christian in charge.
The maximum amount of hospital care was provided and an increase can not
be effected until the new hospital is built. The rated capacity of the hospital,
217 beds, was frequently exceeded ; the greatest number of patients was 249,
on February 24, 1931. The principal beneficiaries were 1,284 merchant seamen,
206 Coast Guard men, 146 patients of the Employees' Compensation Commission, and 703 patients of the Veterans' Administration. There were 79 deaths
and 46 autopsies. Attendance at autopsies and weekly staff meetings is
required of all offi:cers. The staff again furnished a program for Public
Health Service night at the medical society, and in October and June gave
clinic programs at the hospital for the benefit of the Old Dominion Medical
Society; (colored) which were attended by about 75 members.
Of 4 insane patients, 3 were transferred as citizens to a State hospital and
only 1 to St. Elizabeths Hospital as a service obligation. Of 6 patients requiring domiciliary care but not in need of hospital treatment, 4 were sent to the
City Home in Norfolk and 2 to a national soldiers' home. Four tuberculous
patients with dual eligibility were transferred to a sanatorium of the Veterans'
Administration. There were 2,386 intravenous injections for syphilis, 13,936
clinical laboratory examinations, 28,251 physiotherapy treatments, and 7,062
X-ray exposures ; 583 in-patients and 937 out-patients were furnished an aggregate of 10,926 dental treatments. Additional oxygen-therapy apparatus, a gas
machine for the operating room, an X-ray beside unit, and a new ambulance were
purchased. An officer with special training in pathology and bacteriology was
added to the staff. The chaplain held devotional services, provided 20 entertainments, and continued to provide proper religious services and supervise
all interments.
All the hospital buildings were painted inside and out, all roads were
widened 4 feet, the bathrooms in the nurses' home and the hospital kitchen
and dining room were tiled, and additional fire escapes were erected. Plans
are in preparation for an additional wing designed to increase the capacity of
the hospital to 400 beds and for additional quarters for which an appropriaWm of $800,000 was made by the act of March 4, 1931 (second deficiency act).
It is anticipated that construction will be started late in the fall of 1931.
The total expenditure amounted to $374,567.18.

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Marine hospi tal, Pittsburgh, Pa.-Surg. Ralph E. Porter in charge.

Many physical improvements were made in this hospital. The street through
the reservation was closed and a fence is under construction between the
hospital property and Arsenal Park. The kitchen was furnished with modern
equipment. Two new verandas were completed and put into use ; the one on
the first floor is used as a ward, increasing the bed capacity of the hospital
from 82 to 92, and the one on the second floor is used as a recreation room. The
roof of the veranda is used as recreation space for the third floor. The
exterior wood and ironwork of the hospital has been painted. A nose and
throat room has been equipped on the first floor. Electric water coolers for the
second and third floors and furnishings for the verandas were presented by
local welfare organizations. A consulting ophthalmologist was added to the
staff. There were 3,825 dental treatments, 6,255 physiotherapy treatments,
and 3,222 surgical operations. Seventy per cent of the hospital patients are
Veterans' Administration beneficiaries.
There are no quarters on the reservation for any of the medical officers.
Nurses and attendants formerly housed in the hospital building have been
removed to provide additional ward space and are quartered off the reservation.
In the interest of efficiency and economy, the construction of a nurses' home
and quarters for 3 medical officers and 25 attendants has been recommended
for consideration under the public buildings bill.
The total expenditure amounted to $147,008.80.
Marine hospital, Portland, Me.-Senior Surg. J. R. Ridlon in charge.
The hospital was filled to capacity during the year. Fifty-five per cent of
the patients were beneficiaries of the Veterans' Administration, 23 per cent were
American merchant seamen, 14 per cent were Coast Guard personnel, and the
others represented other classes of beneficiaries. Competent consultants were
attached to the staff and freely used in their specialties. Including tho.,;e
remaining from the preceding year, 855 patients were furnished 26,715 days'
hospital relief. Out-patient treatments numbered 5,238, and out-patient examinations 390. There were 1,021 surgical operations, 5,643 physiotherapy treatments, 4,424 laboratory examinations, and 1,890 X-ray exposures.
New construction is needed to provide increased facilities for patients and
quarters for personnel, garage, power house, storage, and mortuary.
Numerous welfare and service organizations have furnished entertainments
and some luxuries to patients.
There are no quarters on this reservation for any of the medical officers.
Nurses and attendants formerly quartered in the hospital building have been
removed to provide additional ward space and are now housed off the reservation. In the interest of efficiency and economy, the construction of a nurses'
home and quarters for 3 medical officers and 15 attendants has been recommended for consideration under the public buildings bill. A new heating plant
and a garage for station cars are also included in these requirements.
The total expenditure amounted to $119,695.
Marine hospital, Port Townsend, Wash.-Surg. 0. H. Cox in charge.
Located 50 miles from Seattle whence all patients are received, this hospital
of 100 beds was kept constantly filled and an average of 12 patients maintained
in a contract hospital. Two tuberculous patients were transferred to Fort
Stanton. There were 26 deaths and 15 autopsies; 874 surgical operations were
performed, including 67 appendectomies, 107 for repair of hernia, 9 gastroenterostomies, 4 nephrectomies, and 99 tonsillectomies. Ether was used only
three times. For a quick general anesthetic, ethyl chloride was used thirty-five
times. For the other cases, spinal, caudal-sacral, regional, or local procah1e
injection was used according to the indications.
The total expenditure amounted to $123,777.59.
Marine hospital, St. Louis, Mo.-Medical Director ]~. H. McKeon in charge.
The need of a new marine hospital at St. Louis has become increasingly
apparent. The Veterans' Administration continues to avail itself of the 30 beds
allocated for the treatment of its beneficiaries. Patients of the Employees'
Compensation Commission are being treated in increasing numbers and the
number of old-line beneficiaries hospitalized becomes larger each year. There
were performed 1,205 surgical operations, an increase of 430 over the preceding
fiscal year; 1,359 X-ray examinations were made, an increase of 286, and the
clinical laboratory made 3,286 examinations, or 1,000 more than in 1930.
Complete new X-ray equipment, including a Bucky table, has been ini:ocalled,
and excellent work in all branches of radiology is done. The out-patient Qffice
was removed from the old customhouse to the hospital. The new arr.-angement
is highly satisfactory to all concerned.


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The number of days' relief furnished was 32,569, divided among the various
classes of beneficiaries as follows :
Merchant seamen _______ _____ ___________ ______ __________ _ 9,244
United States Engineer Corps ___ ________________________ _ 8,863
Mississippi River Commission ___________________________ _
365
Employees' Compensation Commission___________________ _ 3,021
Veterans' Administration _______ _______ _________________ _ 10,789
91
Miscellaneous --- ------ - -------------------------------- To improve facilities and reduce the alarming fire hazards, due to the use of
ward buildings of inflammable type, the construction of a ward building of 100
beds has been recommended for consideration under the public buildings bill.
The total expenditure amounted to $140,097.32.
Marine hospi tal, San Francisco, Oali/.-Medical Director M. J. White in charge.
Ground was broken for the new hospital on April 7, 1930, and the cornerstone
was laid October 23, 1930. On June 30, 1931, the builders expected to have the
new hospital building completed by August 15. Work was commenced on the
nurses' quarters on December 4, 1930, and that building was about 80 per cent
completed on June 30, 1931.
Four sailors were assisted in obtaining entrance to Sailors' Snug Harbor, and
there are no other pa tients in the hospital at present who are eligible for admission thereto. Of the chronic patients undergoing treatment, all are in need of
hospitalization, and there is none, requiring custodial care only. One chronic
patient was sent to the State institution for the blind and one to the Veterans'
Home. Ninety•eight tuberculous patients were admitted to hospital, of whom
thirteen were transferred to Fort Stanton. There were 94 deaths from all
causes and 46 autopsies.
Through Army courtesy the hospital has been supplied since September, 1930,
with water from the Presidio reservoir at a cost of about $160 per month,
whereas water formerly purchased from the city cost about $800 per month.
The Presidio wafer pressure is ample to supply the new hospital building with·
out the use of booster pumps.
The Seamen's Church Institute has continued its very helpful work for the
hospital.
The original act for the construction of the new hospital building was amended
by the act of March 4, 1931, to provide for the construction of additional officers'
quarters, a laboratory building, a recreation building, a storehouse, and a garage.
Plans for these buildings are now in course of preparation.
The total expenditure amounted to $502,647.53.
Marine hospital, Sav<11WY1,ah, Ga.-Medical Director J. T. Burkhalter in charge.
The following is a comparative table showing activities for the fiscal years
1930 and 1931 :
Item
Number of days relief furnished in•patients ••••.. .....•...•.•.•.• . •.•.•.......•..
Physical examinations ...•... •. ... . ....•.•••••.••. •..••••••••••. . •• •••••••••••••
Out.patient treatments . •.....• . •.. .•. •..•••...•• ••...••. ••..•••••...•. •••••.•• •.
Dental treatments and examinations .•...•.•.•.•.•.•.•••.•.•••...••••...........
Laboratory examinations ... •. ....•...••..•.•••••• •••••.•••.•.•••.• . .•• ••.. ••••••
X •ray examinations .. •. . . ..•.• . _••.• •• _. . .•... __ ..•• _...•• _•.• __ .. _. __ •... _•• •• _
Surgical operations . ..• .• .• •.••. .•..•..... •••.•.•••...• . •••.•.•...... _..•••.•.•..
Physiotherapy treatments ...•• -·-·- •.....•.•.•.•.•••.•.•••.•.•••. •.• •• ••.•.•.••.

1930
58,188
1,743
6,967
6,645
14,911
3,152
4,034
10,701

1931
59,190
2,202
8,834
10,977
20,561
4,421
5, 475
16,997

There were 46 deaths and 11 autopsies.
A considerable amount of new equipment was added, the most important of
which consisted of complete equipment for an eye, ear, nose, and throat clinic
at a cost of approximately $1,500; one high-frequency diathermy outfit and
one electric vibrator, professional model, mounted on floor stand, at a ~ost of
$355.50; and one motorless oxygen•therapy apparatus at a cost of $400.
The outstanding improvements to the building were the erection of three sun
porches on the south side of the hospital annex, painting the exterior of the
annex, changing casement type windows to double•hung sash windows in labora•
tory and main kitchen, installation of a new dumb•waiter for subsistence supplies
and patients' trays, and an additional toilet and bathroom for tuberculous pa•
tients. A contract was also awarded by the Supervising Architect's office in


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amount of $12,300 for enlarging and remodeling the hospital; this work includes
the enlarging of dental clinic and diet kitchen, provides three nurses' offices,
two privates rooms with bath, and tile wainscoting in the main kitchen.
The total expenditure amounted to $228,463.13.
Marine hospital, Stapleton, N. Y.-Medical Director M. H. Foster in charge.
Filled always to capacity, this hospital sends its overflow of patients to Ellis
Island and Hoffman Island, an unsatisfactory arrangement that must be continued until the new hospital is built.
Of the 3,785 in-patients, 2,813, or 74.5 per cent, were merchant seamen; 572,
or 15.4 per cent, members of the Coast Guard; and 137, or 3.6 per cent, beneficiaries of the Employees' Compensation Commission. Other classes of beneficiaries were admitted in smaller numbers. There were 3,129 surgical operations, which included 125 appendectomies and 441 inguinal herniotomies. Four
hundred and sixty-three patients received spinal anesthesia, 428 were given
nitrous oxide or ethylene, and 115 had ether. Sixteen individuals were operated upon under rectal ether, and 144 operations were performed under novo,caine. Approximately 72 per cent of all patients admitted to the hospital were
sent to the surgical wards, and 29 per cent of the deaths occurred in the surgical
section; 11 of these died from malignancy, 8 of whom were never operated upon.
There were in all 91 deaths and 38 necropsies. The professional facilities were
improved by new equipment, including a urological examining table with X-ray
generator, an electric cardiograph, a gas-oxygen apparatus, emergency lighting
system for the operating room, new fracture beds, a complete outfit of new
splints, and new bakers of the wire-,coil electrically heated type.
There were 3,802 dental examinations and 20,595 dental treatments, a large
number of whLch were furnished to the personnel of the Coast Guard. The
dental department also performed 1,741 extractions and attended 52 fractures
of the jaw. The physiotherapy department rendered 35,057 treatments to 1,116
patients. The X-ray department made 10,283 exposures, of which 922 were of
the chest and 432 of the gastrointestinal and uro-genital tracts; 579 superficial
and deep X-ray treatments were administered. A number of patients were
transferred from other stations to receive deep X-ray therapy. There were
22,620 clinical laboratory examinations, including 3,430 complement fixation
examinations for syphilis, 286 routine gastric analyses and 28 special gastric
analyses, 136 spinal Wassermann reactions, and 276 tissue examinations.
During the entire winter the station furnished a medical officer to make
evening sick call and weekly sanitary inspection on board the shelter ship
Broaa,wOIJI~ a floating home for destitute seamen which was maintained by
the Salvation Army and anchored near the hospital. Prisoners from the
Federal prison camp, Department of Justice, located at Fort Wadsworth,
Staten Island, have been receiving treatment at this station in line with
recent legislation. A dental office and laboratory were equipped by the Service at Coast Guard Base No. 2, located about one-half mile from the hospital
and a dental officer is detaiiled thereto. This saves a large amount of time
for Coast Guard personnel and is advantageous to all concerned. Animal
experimentation studies of syphilis were continued.
Title to the parcels of additional land needed for new construction has
been acquired, and the reservation now extends to Vanderbilt Avenue on the
south and Tompkins Avenue on the west. Plans for the new buildings are
well under way, and it is anticipated that construction will begin this fall . .
The total expenditure amounted to $452,189.58.
Marine hospital, Vineyard Haven, Mass.-Passed Asst. Surg. Frank F.
Thweatt, jr. in charge.
This general hospitai opened in 1879, has a capacity of 24 beds, but during
the past winter as many as 40 patumts were cared for on more than one
occasion. In addition to merchant seamen, patients are received from 1
Coast Guard base, 5 life-saving stations, 6 lighthouses, and ·4 light vessels, and
occasionally from the Employees' Compensation Commission and the Veterans'
Administration.
By a rearrangement of facilities and the purchase of new equipment the
hospital has been improved. Repairs and alterations were made to the first
and second floors of the hospital building, as a result of which a new 4-bed
ward for tuberculous patients and a new operating room were secured. The
latter is newly equipped with light and electrical sterilizers. A new combination truck and ambulance was received shortly before the end of the fiscal
year.
The total expenditure amounted to $43,301.37.


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Federal Reserve Bank of St. Louis

256

PUBLIC HEALTH SERVICE

ReUef station, Cairo, JU.-Acting Asst. Surg. R. E. Barrows in charge.

The marine hospital in this city remains closed. It was closed to patients
in 1914 and reopened in 1919 for about five months. Quarters are furnished
at the hospital to the medical officer in charge and the caretaker, without
expense to the Government for fuel, electricity, gas, or water. The hospital
grounds present a neat appearance, the grass is kept mowed, driveways free
from weeds, and trees and shrubbery trimmed.
During the year 266 merchant seamen, 103 patients · of the Engineer Corps of
the Army, and 90 beneficiaries of the Employees' Compensation Commission
were treated,, and 30 members of the Coast and Geodetic Survey party were
inoculated against typhoid fever.
Several barge lines are now operating on the Ohio River. The Federal
Barge Line has one of its largest terminals· at Cairo and during the winter
is the northern terminal on account of ice in the Mississippi River north of
Cairo.
Relief station, Galveston, Tem.-Acting Asst. Surg. E.M.F. Stephen in charge.
Five rooms in the customhouse are set apart for the out-patient office, where
medicinal liquor permits, narcotic permits, and port sanitary statements are
issued to vessels. Six hundred and seventy patients were treated in the
contract hospital and 2,973 as out-patients.
The marine hospital is nearing completion, equipment is arriving daily,
and the buildings will be ready for occupancy about September 15, 1931.
The hospital site consists of four city blocks near the center of the city, about
midway between the Gulf and the Bay. It is near the best residential section
of the city, the location giving assurance that no objectionable construction
from a hospital viewpoint is to be anticipated.
The original act for the construction of the new hospital was amended
by the act of March 4, 1931, to provide for the construction of additional
quarters and a recreation building, plans for which are now in course of
preparation.
Relief statio'YII, Honolulu,, Hawaii.-Medical Director S. B. Grubbs in charge.
Honolulu is the only place in the Hawaiian Islands where relief is furnished beneficiaries. Medical treatment is given by officers who are also on
quarantine and immigration duty. The out-patient office in the Federal
building is conveniently located near the wharves. Patients requiring hospitalization are cared for in contract institutions. Most of those who apply
for treatment are American merchant seamen. There are also some Coast
Guard members, Employees' Compensation Commission cases, and occasional
beneficiaries of other classes. A large number of applicants for civil-service
appointments are given physical examinations. During the year 297 patients
were given a total of 3 367 days' hospital treatment. At the out-patient office
907 patients were given 1,793 . treatments. Seven hundred and three physical
examinations were made, of which 53i2 were of applicants for civil-service
positions. Medical advice by radio was furnished to masters of three ships
at sea.
Relief station, Los Angeles, OaJlif .-Surg. R. H. Heterick in charge.
In addition to the usual out-patient and hospital care of legal beneficiaries,
of which a considerable number are patients of the Employees' Compensation Commission, services have been rendered to the following: Post Office
Department; Department of Agricultu;re, mainly- the Forest Service and
Food and Drug Administration ; Coast Guard ; Bureau of Industrial Alcohol ;
Immigration Service; Internal Revenue; Bureau of Animal Industry; Weather
Bureau; Department of Commerce, both the Radio Division and the Aeronautics Branch; Land Office; and Census Bureau.
The practice of having late office hours two nights a week is still continued.
Two seamen were assisted to enter Sailors' Snug Harbor.
Relief station, Manila, P. J.-Surg. R. W. Hart in charge.
Hospital relief was furnished in the Philippine Islands only at the port
of Manila by an officer assigned to duty at the hospital from the quarantine
office. A total of 218 patients were admitted and r eceived an aggregate of
4,925 hospital days. A total of 797 surgical operations were performed.
Out-patient offiq_es were maintained at the ports of l\Ianila, Cebu, and Iloilo.
A total of 1,588 beneficiaries were given 2,791 treatments.
Relief station, Milwaukee, Wis.-Acting Asst. Surg. Robert J. Bach in
charge.
During the year 157 patients were admitted to contract hospital for a
total of 2,042 days, an average of 13 days per patient. There were 41 surgi-


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Federal Reserve Bank of St. Louis

PUBLIC HEALTH SERVICE

257

cal operations performed by the medical officer in charge and 114 medical patients treated, which necessitated 379 calls and 461 hours of work at the
hospital. All in-patients requiring extensive hospital care but able to travel,
98 in number, were transferred to the marine hospital at Chicago.
Relief station, Philadelphia, Pa.-Medical Director Rupert Blue in charge.
The station was moved from 410 Chestnut Street to the new building at
225- Chestnut Street. New modern equipment was installed and a dental
clinic, laboratory, X ray, and physiotherapy facilities were supplied, with an
increased number of trained personnel. A marked improvement in the work
of the station is being effected.
New cases admitted to out-patient treatment numbered 5,342. Merchant
seamen received 60 per cent of the hospital treatment furnished, and patients of the Employees' Compensation Commission 26 per cent, the remainder
being divided between Coast Guard personnel and civilian employees from
vessels of the Engineer Corps of the Army.
Relief station, Port Arthur, Tea:.-Surg. W. A. Korn in charge.
This station serves the ports of Sabine, Port Arthur, Port Neches, Beaumont, and Orange, Tex.; also Lake Charles, La. American seamen were the
principal beneficiaries.
In May, 1930, five cases of typhoid fever were received from the U. S. dredge
Raymond. The crew was inoculated against typhoid fever and no further
cases occurred. As a precautionary measure, in April, 1931, the crews of
three United States dredges operating in the Sabine Neches Canal were inoculated against typhoid fever. Medical advice by radio to ships at sea was
furnished 28 times. Three hundred and eighty-six specimens of blood for
Wassermann test were sent t{l the marine hospital at New Orleans, of which
55 proved positive. Twenty-five patients were transferred to the marine hospital at New Orleans for further treatment.
Relief sta,t ion, Portland, Oreg.-Passed Asst. Surg. F. S. Fellows in charge.
Station activities have been affected only slightly by the nation-wide business depression. In vaccinating 145 applicants for admission to Citizens'
Military Training Camp it was observed that ·fully 75 per cent of those vaccinated for smallpox were primary vaccinations, resulting in about 98 per cent
takes. The camp is therefore of considerable value to this locality from a
public health standpoint.
An increasing number of Employees' Compensation Commi'ssion patients are
being referred to this station for treatment, many of whom came from a long
distance--from Southern Washington, various points in Oregan and occasionally from Alaska, Idaho and other States. During the year the average stay
of patients at the contract hospital was 13 7~ days.
Relief station, St. Thomas, Virgin Islands.-Passed Asst. Surg. E. H. Carnes
in charge.
The relief furnished by this station continues to increase but is still of small
amount. Out-patient relief was furnished 393 times, the largest number in
10 years. However, only 60 days of hospital relief were furnished in the
contract hospital. The out-patient office is amply equipped to treat the conditions usually met with among the beneficiaries served." The Municipal Hospital continues to furnish satisfactory contract care.
Relief station, San Pedro, Calif .-Surg. H. E. Trimble in charge.
The out-patient office is in rented quarters near the water front, combined
with the quarantine and immigration activities. It will eventually be removed to the new Federal building, for which plans have been prepared by
the Supervising Architect.
Merchant seamen and Coast Guard patients predominated. For out-patients
and in-patients a total of 597 antisyphilitic injections and 565 emergency dental
treatments were given; 1,886 laboratory examinations were made and 832
X rays taken. Vaccinations against smallpox and inoculations against typhoid
fever numbered 533. Two insane and several indigent senile and chronic cases
were turned over to the care of Los Angeles County. Spinal anesthesia was
used extensively in the operative work. Of the hospital cases, 75 were detained immigrants or deportees. It was necessary to transfer 178 hospital
patients to the marine hospital at San Francisco.
Twenty-four-hour radio service was maintained for the relief of sickness
occurring on board vessels at sea.
Relief station, Seattle, Wa-sh.-Medical Director L. D. Fricks in charge.
The number of patients hospitalized showed a small increase over the preceding year. Of 4,791 out-patients, 4,136 were merchant seamen.


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Federal Reserve Bank of St. Louis

258

PUBLIC HEALTH SERVICE

On July 22, 1931, construction was started on the new marine hospital,
which will be completed in the fall of 1932. (See cut of the architects' sketch.)
This institution of 300 beds or more is designed to serve ships from the entire
Puget Sound area and will also be used extensively by the Veterans'
Administration.
Relief stati on, Washington, D. 0.-Senior Surg. R. M. Grimm in charge.
Practically all classes of service beneficiaries were represented among the
patients treated. The great majority were beneficiaries of the Employees' Compensation Commission, securing treatment for injuries incurred in the performance of their duty. This group has prese:µted a great variety of surgical
conditions. They constituted 83 per cent of the total number of patients and
received 90 per cent of the total number of treatments.
The practice of referring to this office certain claimants under the District
of Columbia workmen's compensation act has been continued. These claimants
are referred to appropriate specialists for examination and report and the
vouchers for the bills are approved by this office. Several beneficiaries under
the "Act to provide for the vocational rehabilitation of disabled residents 9f
the District of Columbia, and for other purposes," have been cared for upon
the request of the local supervisor in charge.
Physical examinations of persons entitled thereto have constituted a large
percentage of the work of the station and have occupied the time of two and
sometimes three medical officers. The great bulk of these examinations has
been for applicants and employees in the civil service or applicants for retirement and reinstatement. These examinations are often time-consuming because
of the numerous diagnostic procedures required. The preparation of long
reports in these cases has taken up much of the time of the clerical force.
Patients requiring long periods of hospitalization have usually b~en transferred
to nearby marine hospitals; 37 patients were transferred to the Baltimore
Marine Hospital, 1 to Boston, and 7 to Norfolk.
Supply sta,t ion, Perry Poiiltit, Md.-Asst. Pharmacist R. D. Kinsey in charge.
Two large warehouses of tile and concrete construction and two sets of
quarters are provided here through the courtesy of the Veterans' Administration. Requisitions are filled for Coast Guard units, vessels of the Lighthouse
Service, and second and third class relief stations, for which purpose stock is
purchased semiannually. Certain articles appearing on requisitions from firstclass stations are also supplied from Perry Point, although commonly used
medicines, gauze, absorbent cotton, janitor and laundry supplies, and other
bulky articles are purchased twice a year for shipment direct from the contractors to the marine hospitals. Surplus stock received from the Army, Navy,
Veterans' Administration, and marine hospitals and quarantine stations is
stored here, reconditioned if the cost of the work is less than 40 per cent of its
value, and reissued. Considerable economies were effected by using secondhand furniture from the Government hotels in Washington. Supplies of whisky
and alcohol for medicinal use are obtained from the collector of customs and
large quantities of empty bottles from the Bureau of Industrial Alcohol. The
following table shows the chief issuing activities of the supply station, fiscal
year 1931:

Stations

Marine hospitals ____________________ . ______________ _
Relief stations ____________________ ____________ ____ .. _
j~:~~i:it~i!tf~!~~~-S---~==:::::::::::::::::::::::::::::
Scientific research stations ____________ _______________
Surgeon General's office __________________ ___________
Coast Guard _____________________ • _____ ____ ________ __
Liththouse Service. ___ ______________________________
Ot er Government stations (surplus only) ___ ___ _____
Penal institutions. _________________________________ .
Miscellaneous_ •• ____________________________________
Total ______ --- ----- --- ----- -- -- -- -- ---- ---- -- ••


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Federal Reserve Bank of St. Louis

Number
of packages
shipped

Weight

6,121
1,155
139
168
41
31
1,785
253
521
226
4

512,833
43, 631
15,262
6,666
714
1,700
60,072
1,766
71,395
21,683
10

10,444

735,732

Value of Value of
purchased surplus
stock
stock

Total
value
---

$74,267
5,417
265
3,954
40
21
9,374
197

---------978
6
94,519

$72,165
3, 649
4,708
1,631
235
856
7,514
210
43,213
5,109

----------

$146,432
9,066
4,973
5,586
275
877
16,888
407
43,213
6,087
6

139,290

233,809

259

PUBLIC HEALTH SERVICE

In the interest of economy some simple compounds were manufactured,
including:
Liniment ________________________________________ gallons__ 455
Sirup white pine compound _________________________ do____ 100
Liquor cresolis com:pound ___________________________ do____ 430
Liquor antisepticus ________________________________ do____
30
Tincture iodine ____________________________________ do____
20
Tincture opium camphorated ________________________ do____
35
Tincture nux vomica _______________________________ do__ __
15
Tincture hyoscyamus _______________________________ do____
15
First-aid kits ______________________________________ each__ 299
Surplus stock acquired shortly after the World War is rapidly becoming
exhausted, making it necessary to purchase many supplies formerly obtained
without cost. During the fiscal year 1930, 56 items formerl y carried in surplus
stock at Perry Point, and in 1931, 50 other items became exhausted a nd were
added to the list of purchased articles.
The supply station continues as in the past, to be the recipient of numerous
courtesies on the part of the local Veterans' Administration officials.
CONSOLIDATED AND DETAILED REPORTS

The following tables give the consolidated and detailed reports for
the marine hospitals and relief stations :
Oonsolidated X-ray report, marine hospitals and second-olas8' relief statio ns

Number of patients examined______________________________________
Number
exposures ( classified as follows) :
Chestof_________________________________________________________
_
Bone and joint ______________________________________________ ___
Dental ________________________________________________________ _
Gastro intestinal and urogenital tracts ____________________ _____ _
Miscellaneous------------------------~------------------------Total ________________________________________________________

47,042
13,054
42,112
23,289
17,440

7, 4.-62
103, 357

Consolidated laboratory report, marine hospitals and second-class relief statio_ns
BLOOD

URINE

C~~plement
fixation: Syph-_
ilis _____________________
57,394
Kahn test for syphilis ______ _ 7,725
Erythrocyte counts ___ _____ _ 9,489
Leucocyte counts __ ________ _ 12,836
8,763
Differential leucocyte counts_
Malaria __________________ _ 3,438
Typing ____________ _______ _
1,228
Blood cultures _____________ _
489
Chemical determinations:
Carbon dioxide (Van
Slyke or similar) _____ _
162
Creatinine _________ ___ _
302
nitrogen __ __
532
Incoagulable
Sugar ________________

Urinalyses _________________ 103,632
Renal function tests_________
1, 187
Quantitative sugar__________
4,228

Urea nitrogen _________ _
Uric-acid nitrogen _____ _
Total nitrogen _________ _
Hemoglobin ___________ _
Chlorides _____________ _
Unclassified ___________ _
Coagulation time __________ _


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Federal Reserve Bank of St. Louis

3,184
340
21
352
9,615
37
1,221
3,319

FECES

Parasites and ova __________ _
Dysentery _____ ___ ________ _
Metabolic examination _____ _
Occult blood ______________ _

8,000
318
64
1,708

SPUTUM

Tubercle bacillus __________ _
Pneun1ococcus _____________ _
Other organisms ______ _____ _

27,425
381
281

STOMACH OR DUODENAL CONTENTS

Routine _______________ ___ _
Special ___________________ _

2,695
98

260

PUBLIC HEALTH SERVICE
SPINAL FLUID

WATER ANALYSIS

Wassermann _______ .:. ______ _
Colloidal gold reaction _____ _
Globulin test ______________ _
Cell count ________________ _
Bacteriological examination __
Other examinations ________ _

1,646
927
1,629
1,513
165
256

ChemicaL ________________ _
Bacteriological ____________ _

27
108

MILK AN AL YSIS

ChemicaL ________________ _
BacteriologicaL ___________ _

28
74

ANIMAL INOCULATIONS
BACTERIOLOGICAL EXAMINATIONS

Pus ______________________ _
Exudates _________________ _
Transudates ______________ _
Discharges:
U rethraL _____________ _
Other ________________ _
T. pallidum:
Dark field ____________ _
Smear ________________ _
Throat smears _____________ _
Cultures:
Throat _______________ _
Other ________________
Bacteriological counts ______ _
~

3,784
269
251
22,831
1,872

239

For diagnosis_______________
PATHOLOGICAL EXAMINATIONS

Autopsies _________________ _
Tissue examinations ________ _

372
2,318

VACCINES

2,389
252
2,101

Autogenous________________

521
1,265
23

Otherwise unclassified ______ _

260

MISCELLANEOUS EXAMINATIONS

6,572

Total examinations ___ 322, 752

TYPHOID AND PARATYPHOID EXAMIN ATIONS

Agglutination tests__________
Feces_____________________
Urine_____________________

280
201
115

Oonsoliaated report or surgical procedures at marine hospita,Zs and other relief
stations
Amputation, all or in part __ _
Appendectomy ____________ _
Arthrectomy ______________ _
Arthroplasty ______________ _
Arthrotomy _______________ _
Aspiration ________________ _
Blood vessels, operations on __
Bone graft ________________ _
Cauterization _____________ _
Cholecystectomy __________ _
C~olecy~t?tomy ___________ _
C1rcumc1s10n ________ .: _____ _
Cystoscopy _______________ _
Dilatation of, unclassified ___ _
Excision of, unclassified ____ _
Exploratory incision _______ _
Extraction of teeth ________ _
Eye, operations on _________ _
Foreign body, removal oL __ _
Fracture, closed ___________ _
Fracture, open ____________ _
Hemorrhoids ______________ _
Hernia _______________ ~---Hydrocele ________________ _
Incision and drainage ______ _
Intestines, operations on ____ _
Joint dislocation ___________ _
Kidney and bladder, operations on ________________ _
Lymphadenectomy ________ _
Mastoid operations ________ _


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Federal Reserve Bank of St. Louis

285
1,315
1

14
22
1, 140
85
22
420
68
13
690
1,282
2,723
2,103
219
36,900
282
3,739
910

186
867
2,160
228
6,232
217
99
66
93
58

Nerves, operations on ______ _
Osteotomy ________________ _
Plastic repair_ ____________ _
Puncture of, unclassified ____ _
Repair of, unclassified ______ _
Resection of, unclassified ___ _
Sequestrotomy ____________ _
Sinusotomy _______________ _
Skin grafting ______________ _
Spinal puncture ___________ _
Stomach, operations on _____ _
Submucous resection _______ _
Suture of minor wounds ____ _
Tendons, operations on _____ _
Testicle, operations on _____ _
Thoracoplasty, thoracotomy,
tracheotomy ____________ _
Thyroidectomy ____________ _
Tonsillectomy _____________ _
Transfusions, blood ________ _
Turbinectomy _____________ _
Urethrotomy ______________ _

50
142
129
3,206
242
224
22
135
73
1,258
88
591
1,837
73
297

TotaL _____________ _
Miscellaneous _____________ _

74,340
1,572

Grand totaL ________ _

75,912

109

47
2,965
164
201
48

(The above does not include 49,806
injections of sal varsan, arsphenamine,
and kindred preparations.)

261

PUBLIC HEALTH SERVICE

TABLE 1.-Nitmber of patients treated annually, 1868 to 1931 1
Sick and
disabled
patients
furnished
relief

Fiscal year

Prior to reorganization:
1868_ ·- ·- ·- ·- ·- ·- ·- -- -- -- -- -- ·- -- ·- -1869 ___ _________ _____ ·- ·- ·- ·- .. ·- ·- ·1870 .... ·- ·- ·---- ----- --- ·---------- After reorganization:
1871 ___ -- -- -- -- ------ ·- ·- ·- -- ·- ·- -- -1872 _____ ·- ---------- ·- ·- ·- ·- ·- ·- ·--1873 ___ ·----- ·- ------ ---- -- ·- -- ---- -1874 ___ -- -- ---- ---- ·- ·- ·- -- ·--- ·- ·- ·1875 ___ -- ·- ·- ·- -- -- -- -------- -- -- -- -1876 _________ ·- ·- ·- -- ·- ·- .. ·- ·- -- -- -1877 _____ ---- -- ------ ·- -- -- -- -- -- -- -1878 ___________ ·- ·- ·- ·- ·- ·- ·- ·- ·- -- -1879 ___ -- -- -- -- -- -- -- __ -- ---- -- -- -- -1880 _____ ·- ·- ·- ·- ·- -- -- -- -- -- -- -- -- -1881 _. _. _. _. _______ . _ . _. _. _ . ___ . _. __ _
1882 ___ _____ _____ ·- ·- ·- -- ·- ·- -- ·- ·- -1883 _______________ - _ ·- ·- ·- ·- ·- ·- ·-

1884 ___ ·- -- -- -- -- -- -- -- -- -- -- ---- --- 1885 __ _________________ ·- ·- ·--- ·- ·- -1886 ___ -- -- -- -- -- ·- -- -- -- -- -- -- - -- -1887 ___ ·- ·- ·- ·--- -------------------1888_
·- ·- _____
-- ·- ·-___
·- __
-- __
-- ___
·- --____
-- --__
-- -1889 _____
·- -·- -·1890 _. _ . _ . _ . _ . _ . _ . _ . ______ ___ _______ _
1891 _
__. ____
·- ·- ·- ·- ·- __
·- .·-___
·- ___
·- ·-_
1892
. _.--_ .·-_.·-_.--___________
1893 _______________ ·- ·- ·- ·- ·- ·- -- -- -1894_ ·- -- ·- -- -- -- -- -- -- -- ·- -- -- -- --- 1895 _ - . - . - . - . - . - . - . - . - . - . _. _. - . _. _..
1896 ___ -- --- - ------ -- ·- ·- ·- -- ·- -- -- -1897 - ·- -- -- -- -- -- ---------- ·- ·- ·- ·- -1898 _. - . - . - . - . _- - . - . - . - . - . - . _ . _ . _ . _..
1899 ___ -------- ·- ·- -- ·- ·- -- ·- -- ·- -- --

Sick and
disabled
patients
furnished
relief

Fiscal year

After reorganization-Continued:
11,535
11,356
10,560

1900 ____ _ ·- ·- ·- ·- ·- ·- ·- -- · - -- -- -- ·- ·-

1901 ___ -- ·--------- ·- ·- ·- ·- ·- ·- ·- ·- ·1902 ___ -- ---- -- ·- -- ·- ·- ·- ·- -- -- ·- ·- -1903 ___ -------- ·- _ ·- ·- ·- ·- ·- -- -- ----

14,256
13,156
13,529
14,356
15, 009
16,808
15,175
18,223
20,922
24,860
32,613
36,184
40,195
44,761
41, 714
43,822
45, 314
48,203
49,518
50,671
52,992
53,610
53,317
52,803
52,643
53,804
54,477
52,709
55,489

1904 ___ -- -- -- -- -- ---- -- -- ---------- ..

1905_ ·- -- -- -- -- ·- .. ·- -- ·- ·- ·- ·- ·- -- -1906 .. - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -1907 __ _______ ·- ·- ----- - ·- ·- ·- ·- ·- .. ·1908_ ·- -- .. -- -- -- __ -- ·- .. ·- .... -- -- -1909 ___ -- -- -- -- -- -- ---- -- -- -- -- -- -- -1910 ___ -- -------- ·- .. ---- -- ·- ·- -- -- ·1911 _. _. _... _.. . _. _. _. _. _. _____ ... _ ..
1912 ___ -- .. -- -- -- -- .. ---- -- -- --- - ---1913 _____ ·- ·- -- .. ·- ·- ·- -- -- -- -- -----1914 _ . _ . _ . _ . _ . _ ... _ . _ . ____ .. _. _. _. _ . _
1915 ___ -- -- -- -- -- -- -- -- -- -- -- -- -- __ .__
1916 _______ __ -- -- -- ·- .. ·- ·- ·- ·- ·- -- -1917 ___ . _ . _ . ______ ___ . __ . __ . ________ _
1918 _. _ ... _ . _ ... _ . _ . - . - . - ... _. ___ . _..
1919 ___ -- ------ .. -- ·- .. ·- -- ·- -- -- -- -1920 ___ -- -- . _-- -- -- -- ---- -- -- . -- _--- _
1921_
- -------------- __
---..-------1922 _____
________
______
·- ---- ·---·-1923 2____ ·- - - -- ---- - ·- ·- •• ·- -- ·- -- -1924 ___ -- ·- -- -- -- -- -- -- ---- -- -- -- ·- ·1925_ ·- ·- ·- ·- ·- -- -- -- -- -- -- -- -- -- ---1926_ - ·-···- ···-·-·- ·· ·--· --·- ·-· ···
1927 ________ ____ _____ - ·- ·-· - ·- ·····1928_ ·- -- -- -- -- -- -- ------ ------ ·- ·- -1929 ___ -- ·- -- ·- -- -- -- ---- -- -- -- .. -- -1930 ____ ______ _________ __ . ·- ·- ·- ·- ·1931 _. _ . _ -- -- . _ . __ ... -- __ . _ -- __ -- __ --

56,355
58,381
56,310
58,573
58,556
57,013
54,363
55,129
54,301
53,704
51,443
52,209
51,078
50,604
53,226
55, 782
58,357
64,022
71,614
79,863
110,907
144,344
153,633
126,956
159,686
204,944
245,140
249,973
240,592
260,552
279,350
259,364

1 These figures do not include patients treated in connection with veterans' relief activities of the service
as follows: 1918, 192; 1919, 13,856; 1920, 279,036; 1921, 667,832; 1922, 242,379; 1923, 9,704; 1924, 3,414; 1925, 4,360;
1926, 3,749; 1927, 2,830; 1928, 3,448; 1929, 4,907; 1930, 6,817; and 1931, 9,278.
2 In this year the practice of recounting out-patients applying for treatment in more than one calendar
month was discontinued.

TABLE

2.-Transaotions at United States Marine hospitals an,a other ,·eliet
stations, fiscal year 1931
Number
Patients
Total Number
of pa- Number Num.of paremain- Number tients
of times ber of
number tients
ingin
of
days
office re- phyof pa- treated Died hospital relief in
furlief was sical extients
hosJune 30, hospital nished
aminafurtreated in
office
pitals
1931
tions
nished
relief
---

Grand totaL _______________ 268,642
FIRST-CLASS STATlONS
MARINE HOSPITALS

Baltimore, Md __ ________________ _

R~~~Id,
Carville,~~-L=============:====
La __________________ __ __

Chicago, IlL _____________________
Cleveland, Ohio ___ __ _____________
Detroit, Mich ____________________
Ellis I sland, N. y ________________
Evansville, Ind __________________
Fort Stanton, N. Mex ____________
Key West, Fla ___________________
Louisville, Ky ___________________
Memphis, Tfmn ___ _______ ________
Mobile, Ala __ ___________________ _
New Orleans, La _________________
New York, N. y _________________


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

-- --- ---- --- --- ---

4.7, 033 1,304

4,410 1,666,215

221,609

910,466

94,487

7,741
5,414
3,000
1,290
31,892
2,749
2,261
975
115
460
503
328
1,384
2,689
7,686
30,171

40,480
31,891
12,339
1,930
79,004
18,176
12,558
1,300
219
2,156
1,304
1,820
5,277
8,189
31,525
178,642

2,526
4,039
1,713

- - - - - - - - - - - - - - -- - - - - - ----2,023
9,764
65
7,4.08
1,994
47
3,974
974
30
1,679
23
389
33,059
1, 167
45
4,821
2,072
75
3,409
1, 148
48
6,823
125
5,848
578
4.63
23
836
376
26
l, 116
613
15
1,184
27
856
1,981
19
597
3,538
849
20
12,196
4,510
125
30, 171 - ---· ---- ------

199
153
72
337
153
248
123
443
69
235
76

s,1

67
96
377

75, 766
56,205
20,254
116,278
58, sos
76,281
47,817
163, 799
25,488
90,574
32,459
30,248
23,185
34,505
141,294

---------- ----------

-------1,160
1,206
1,945
289
112
106
103
1,253
1,375
2,033
3,974
16,045

262

PUBLIC HEALTH SERVICE

TABLE

2.-Trarvsac tions at United States Mwrine hospitals, eto.-Contin ued
Patients
Total Number
remainnumber f fe~f;
ing in
Died hospital
f {e~t treated
June 30,
d in hospitals
treate
1931

Number
of days
relief in
hospital

Number
ffe~f;
fur
nish;d
office
relief

Number
of times
office relief was
furrushed

Number of
physic~l exar;unations

--------------1--- - - - - - - - - ---- ---- ---- FIRST-CL.A.SB STATIONS
HOSPITALS-continued

MARINE

Norfolk, Va ... .••••.•.....••. .• .. 8,377
Pittsburgh, Pa ...........••.• .•. . 2,120
Portland, Me .......••..•.•. •••.. 1,719
Port Townsend, Wash .•..•.••... 1, 247
St. Louis, Mo ........•••••.• ..... 1,819
San Fra ncisco, Calif. .......•...•. 14,354
Savannah, Ga .... ....... .•.•.•.. . 4, 391
Stapleton, N. Y .• .....•••.••.... . 7,705
323
Vineyard Haven, Mass ......•.•.
216
Contract overflow hospitals • •.•..

2, 534
758
856
902
671
3,367
1,803
3,753
186
216

79
51
21
25
33
93
46
81
3
2

5,843
81,656
1,362
31,926
863
26, 715
345
35,663
1,148
32,479
10,987
103,010
2,588
58,816
3,952
105,222
137
11,133
19,206 - --------

207
96
68
94
94
247
150
258
24
35

- - - ----- -- - -

Total .•...•..••••.. .•..•... 164,808

38,925 1,147

4,005 1,507,787

125,883

23,653
6,156
5,238
1, 170
5,424
54,931
8,781
21, 890
350

1,884
585
390
59
1,424
2,721
2, 192
311
17

554,403

47,462

------- -· --------

SECOND, THIRD, AND FOURTH
CLASS STATIONS. ETC.
Aberdeen, Wash ....•.......... ..
Albany, N . Y . ............... . ...
Anacortes, Wash .••.•. • ..•• . .....
Apalachicola, Fla ••...•...•...• ..
Ashland, Wis .......••....•. .•...
Ashtabula, Ohio .••.•.•..•.•.• ...
Astoria, Oreg ......•...•.•.• ..... .
Balboa Heights, Canal Zone .. .• .
Bangor, Me . ••••••••.•••.• •••....
Bath, Me.·-----· - _______________
Bay City, Mich. · ----·-------·-- Beaufort, N . C .. ·-----··------- -·
Beaufort, S. C __ ----·---·------ -Bellingham, Wash •• ---·-·------Beloxi, Miss.-·-·-·--- ------·---·
Boothbay Harbor, Me·--········
Bridgeport, Conn.·····-· ········
Brunswick, Ga .... . .•••.••••••••.
Burlington, Iowa..... .•••••••••..
1

~0= :: ::: :::: =:::: ::: :: =: =
8:{~?s,
Cambridge, Md .... ...••••••.....
Cape May, . J _-···-·········· ·
Charleston, S. C .........•••••• ..
Chincoteagu\? a. ·····-·-·· •••..
Cincinnati, 0 io ..••.•.•••••.. ...
Cordova, Alaska ..••••••••.... ...
Corpus Christi, Tex .•••. - ..•.••..
Crisfield, Md ..•....•.•..•• .•....
Duluth, Minn •••••••••.. : .......
~ecs.~: ::::::::::::::: :
i~1t~~:
Elizabeth City, N. C-···········

El Paso, Tex .• •.• ··-· ••..•• • •.•..
Erie, Pa·-····· ·· ··········-···· ··
Escanab~ Mich.···- •.• ·- ..•. .. ..
Eureka, aliL .•.••......••. .....
Everett, Wash.·····-· ····· · ·····
Fall River, Mass ... . - ....••......
Gallipolis, Ohio ..•.•••.•..•.• ....
Galveston, 'l'ex .•....•••• ••••. ....
Gary, Ind ....... ..•••••••••••.• ..
Georgetown, S. C. ···-·····-····Gloucester, Mass·-······· --······
Grand Haven, Mich .•••.•.• ·-···
Green Bay, Wis •••••••••.••••• ...
Gulfport, Miss ...••••••• ••••.... •
Hancock, Mich .•••...•••.•••• •••
Hartford, Conn .•••••••..•••• .•..
Honolulu, T . H ..•• ·-············
Houston, Tex ....••... . .••.•••...
Indiana Harbor, Ind ..•••.•••.•..
Jacksonville, Fla·-········· ······
Juneau, Alaska ....• ·-· ·-····· · ...
Ketchikan, Alaska •••••••••••..• •
La Crosse, Wis ...•••••••••..• ••••
Leo Hall, Va .•.••••••••..•• •..••.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

322
135
272
49
143
278
500
737
44
17
71
684
3
284
586
38
21
61
29
639
2
89
977
828
165
160
170
157
1,141
689
27
36
128
142
462
24
191
266
97
105
4,626
68
112
596
104
93
31
43
9
948
1,564
139
879
310
1,160
62
1,821

24
17
22
11
12
48
68
219
5
1
4
110
18
35
6
9
5
20
149

.... i . .• • • 1
------ -------------- --------····3· --------.••••• 2

4
1

-·---- 1
----i- ------------- ----·-------i- -----------------

····r

.••. 1

1
10 ·- •
16 ····1· •
87
4
98
,. ________
42
46
49
16
68

1
3
2 .
1
1

200
223
136
126
208
670
629
3,321
58
3
30
1,396
169
242
58
93
16
202
1,715
191
497
806

----------------------1
1
733
2
1
1
1

3
2
•• 2

610
662
139
953

- ··------- ------ --------- ---------.

2
9
48
7
49
40
6
40
670

------ ---------------------1
2

------ --------2
1
13

1

2
41

17
385
496
83
619
491
47
640
12,389

-------- - ---------1 --------6
186
----- - --------1
74
172
2 --------- ________
11
----------------······s ----- - --------76
3,414
194
3
9

·······1

19
12
16
4

250
1
91
82
240
16

,..

1

14

1
7

1
7
1

------1- --------2

4,783
1
1,148
1,294
3,167
170

- ------- - ----- - -------- - ----------

298
118
250
38
131
230
432
518
39
16
67
574
3
266
551
32
12
56
9
490
2
73
890
730
165
118
124
108
1,125
621
27
36
126
133
414
17
142
226
91
65
3,956
68
111
577
92
77
27
43
1
754
1,314
138
788
228
929
46
1,821

184
524
261
547
53
559
1
93
87
243
31
521
313
1,143
620
······49
68
1
35
306 ------43
3,140
15
902 --·-·463
159
2,013
17
77
14
3
21
89
32 ····-·sg
1,278
17
9
4
234
174
2,472
262
2,004
26
370
236
293
8
265
54
174
9
2,230
196
953
7
73
6
78
57
520
110
1,233
581
1,753
2
35
23
286
35
472
12
177
1
260
1,952
12,062
29
241
8
207
116
1,475
46
194
129
13
2
43
16
56
3
1,793 ··-··103
101
3,094
256 .....4i7
2,252
44
272
38
1,878
91
63
77
2,441

263

PUBLIC HEALTH SERVICE
TABLE

2.-T1·arvsactions at United States Marine hospitals, etc.-Continued

Total
number
f
treated

fe~!;

- - - - - - - - - - - - -1---

Number Number
Patients
Number
remain- Number
e~t of times
ffe~!~
in
ing
days
of
offi._ce
furDied hospital relief in
~reated
rehe!
nished
June 30, hospital
office w~s furm_hosp1tals
1931
mshed
relief

if

Number of
physical examinations

- - - - - - - - - - - - ---- ---- - - -

SECOND, TIDRD, AND FOURTH
CLASS STATIONS, ETC.-con.

17
589
176
228
21 ______ _________
197
Lewes, Del.._ ____________________
824
9,426
1,104
8, 795
11
508
Los Angeles, Calif..______________ 1,612
10
410
140
173
2
14
154
Ludington, Mich_________________
10
43
24
_________ __________
24
Machias, Me ___ .__ _______________
487
2, 791
1,628
4,925
10
2
229
Manila, P. I.· ·------------------ 1,857
9
619
81
344
1
25
106
Manistee, Mich__________________
1
435
198
445
52 ______ ····--···
250
Manitowoc, Wis_________________
84
820
274
215
21
295
Marquette, Mich ...... --•··-·····
21
136
76
184
21
97
Marshfield, Oreg ....•.•.• _.......
36
197
60
17
2 .•.•.. ·······-62
Menominee, Mich_..............
271
1,024
562
618
2
2
69
631
Miami, Fla .........•.......•.••• _
540
2, 222
807
2, 046
5
1
158
965
Milwaukee, Wis.................
6
1,214
237
803
1
64
301
Morehead City, N. 0............
5
181
80
30
4 ...••• ······--84
Nantucket, Mass.................
86
143
59
75
4
63
Nashville, Tenn..................
34
699
219
1,285
66
285
Natchez, Miss ......•...•.•.•.•.. 21
63
19
19
3 .....• .••.•.•..
22
Newark, N. J. .. _.................
154
5Jl
285
183
2 ·······-21
306
New Bedford, Mass..............
38
244
156
851
..•.•....
1
78
234
New Bern, N. 0.................
123
276
126
197
1
1
13
139
New Haven, Conn...............
129
336
228
551
3
2
52
280
New London, Conn..............
Newport, Ark ...•..•....••..•.... ···--·-- ...•..........•..•••••.. ...........•••..... ····-···· ······-5
220
69
23
2 ••••.• •.•.•.••.
71
Newport, Oreg...................
47
443
253
479
1 ..•....••
40
293
Newport, R. !....................
56
367
245
.•••.•....
•.••..•.•
.•.•••
..
245 ..•.•..
Newport News, Va...............
76
21
116
L3 .•.••• ..••••...
34
Nome, Alaska........ . ...........
239
110
35
2 .••••• •.•.•••.•
61
112
Ogdensburg, N. Y ..•..••••••.•..
118
35
134
7 .••... ..•.....•
42
Olympia,_)Vash..................
438
154
72
••.••.•••
.•....
9
78
163
Oswego,~- Y............. .. ......
43
897
332
398
46 •.•... .••.••••.
378
Paducah, Ky ••..• ••······-·······
207
83
191
1 .••••••..
28
3
111
Panama City, Fla................
1, 272
395
1, 223
3
91
4
111
506
Pensacola, Fla................ . ...
101
ol
78
..•••
.•••
..••..
7
66
58
Perth Amboy, N. J...............
1,354
316
148
1
15
2
330
Petersburg, Alaska...............
26, 131
5, 670
7, 874
4,493
18
12
705
Philadelphia, Pa................. 6, 375
56
207
70
1, 177
3
1
00
130
Ponce, P.R ... ·-·······--········
303
44
161
159
30 .•.... -·-····o~191
Port Angeles, Wash......... . ....
3,274
1, 4"711
1, 792
133
6
103
Port Arthur, Tex................. 1,582
235
709
227
56
10 ····-· ····---· 237
Port Huron, Mich................
1,890
4,535
1,512
4,205
12
2
198
Portland Ore_···-···-·······- ---- 1,710
1
1
. •
1 .
Portsmouth, N. R........... . .•..
1,013
446
732
2
47
493
Providence, R. !.................
299
24
132
132 ······· · - ........•... . .. ··-·-···-·
Provincetown, Mass.............
988
438
4
438
Reedville, Va.....................
232
86
115
143
··-··--··
··
-·-·
19
134
Va...................
Richmond,
8,370
2,210
180
2,777
1 ..••.....
19
Rock Island, Ill.................. 2,229
32
10
10 .•..••... ..•..• ...•..•.. .•.•.•....
Saginaw, Mich...................
391
82
60
5
4 ..•... .•.••....
86
St. Thomas, Virgin Islands.......
1, 156
348
1, 277
4
924
2
51
399
San Diego, Calif..................
79
46
40
7 •••... ...•....•
15
53
Sandusky, Ohio_.................
2,493
663
3, 304
170
7
2
189
852
San Juan, P. R...................
11, 171
4, 198
5, 055
593
9
10
371
San Pedro, Calif.................. 4, 569
1, 568
895
1, 527
11
180
2
145
Sault Ste. Marie, Mich........... 1, 040
18,614
5,067
3,372
5
9
6,861
260
Seattle1 Wash.................... 5,327
342
167
912
7
1
2
71
238
Sewara, Alaska ....••••..•••••.• _.
140
66
32
2 ...•.. ..•.••••.
21
68
Sheboygan 1 Wis .•.•••••.•...•·. •..
175
86
64
7
3 ..•.•• .••••.•.•
89
Sitka, Alas.Ka.....................
5
2
4
4 .•.•••.....••••.••••.•.. ··-·-·····
Solomons, Md..... ..... . .........
93
34
51
11
8 •.••.• .•..•....
42
South Bend, Wash...............
714
486
893
7
73
85
571
Southport, N. 0..................
587
280
504
23
58 •••• .. •••••••..
338
Superior, Wis....................
583
261
618
144
3
43
304
Tacoma, Wash...................
813
455
642
1
217
52
507
Tampa, Fla......................
1,482
524
1, 279
221
6
5
100
624
Toledo, Ohio.....................
1,248
295
63
66
15 .••••• ••..•.•..
310
Vicksburg, Miss..................
26. 061
3,329
2,952
10,724
11
3
221
Washington, D. C................ 3,550
11,938
1,092
Washington, D. C. (dental clinic)- 1,092 .•..•.•.. .•••.• .•••••.•• .••..•...•
336
204
246
10
1 ....•.•••
26
230
Washington, N. C................
3,344
678
•
•
26
•
678 .
White Stone, Va.................
38
18
63
22
4 ...•.. ..•.•.•..
Wilmington, Del.................
1, 716
556
375
160
43
599 ·
Wilmington, N. 0...............
116
36
235
1
16
52
Wrangell, Alaska.................

·····aas


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

264

PUBLIC HEALTH SERVICE

TABLE

2.-Tranlsactions at United States Marine hospitals, eto.-Continued
Number Number NumPatients
Total Number
paof paremain- Number of
times ber of
number tients
tients ofoffice
ing in
of days
physiof paDied
furhospital relief in nished
relief
cal extients treated
in
hosJune
30,
hospital
was
furaminatreated pitals
office
1931
nished tions
relief

--- ---

-MISCELLANE OUS

Curtis Bay, Md __ ________________ 2,333
Fernandina, Fla ___________ ___ ____
20
St. Elizabeths Hospital, Washington, D. c ___________________
157
Special acting assistant surgeons
for U . S. Coast Guard and
Lighthouse Service __ ______ __ ___ 5,490
Guard vessels and
u.bases
s. Coast
___ ... ________ .. _______ __ __ 26,827
Emergency _______________________
51
Examinations abroad for U. s.
Veterans' Administration. _____ -------Total. _____ -- . - - -- -- -- . - -- -- 103, 834
Grand total. _______________ 1268, 642


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

--------- ------ ----------------- ------ --------- ---------157
159

7

138

47,474

2

5

1,352

2,333
20

14,740
154

5,331

17,007

-------------- ----------------- -- -- -- --------- -- -------- --------- --------93

1

157

47,033 1,304

1,596

953
131

26,734
32

112,099
56

3,702
1

158,428

95,726

356,063

47,025

4,410 1,666,215

221,609

910,466

94,487

19

8,108

583

---------------- --------- --------

405

2

TABLE

3.-Relief furnished at United States marine hospitals and other relief stations, fiscal year 1931, classified by beneficiary

er.

Total Number
of panumber
of patients
tients treated in
treated hospital

0

C)I

Beneficiary

~

Class of station

I

r
~

~

Patients
Number N b
W?1 er Number
remain- Numherof of paing in days' relief tie?ts g~~~r~~ of phyf'i:
hospital in hospital furmshed lief was cal e~am1June 30,
o.ff\?!{e- furnished nat10ns

Died

------

1931
____
,,_____ ,____ - - - - - - - -

8,478
American seamen ______________ -------------- First-class stations __ ---------- -- ----------____
93, 039
361,354
2,200
876,321
72,807
20,232
616
5,127
303
113,884
5,365
117
Other relief stations ___________________________ l-_4_5,_8_71-1-----1-----l----l-- - - 1 -40,506
- - - j l111,038
----+--TotaL __________________ __ _______________ 138,910
13,605
472,392
113,313
2,503
990,205
25,597
733

Foreign seamen ______________________________ First-class stations __ ---------- ---------------Other relief stations___________________________

523
103

303
52

8
2

14
1

6,480
979

220
51

692
86

4
35

39
778
271
7,459
15
10
355
TotaL _------------ ---------- -----------626
l====l====f====l====l=====l====l====I====
U. S. Coast Guard___________________________ First-class stations____________________________
8, 126
4,417
30,030
169
71,902
5,209
19
2,917
Other relief stations____ _____ __________________
8,096
2,261
28,209
23
7,319
12,513
777
6
1,583
Special acting assistant surgeons_______________
5, 362
16,684
1,345
5,206
5
156
2
Coast Guard vessels and bases________________
26,827
3,702
112,099
26,734
953
93
1
Emergency____________________________________
39
1
41
116
24
15 ---------- ---------1 - - - - J . - - - - l - - - - + - - - -l - - - - - i - - - - - l - - - - - l - - - -

11,964
44,492
187,063
28
197
86,829
3,958
Total_ ----------------------------------48,450
U.S. Bureau of Fisheries ____________________ First-class stations ____________________________ l===3=7=1====l=====l'====l=====~====l====J:====
25
287
12 ---------- ---------238
Other relief stations___________________________
23
4
34
33
19
4
1----+----+--TotaL ________________________________ • _
60
4
321
271
44
16
l====l=====l====i====l=====l:====l====J====
176
691
226
2
3
940
60
U .s. Army---------------------------- --- ___ First-class
---------------------286
Other reliefstations
stations______
____________
:,______________
105
95
191
93
92
13
----------

•

1-'d

q

t:,::j

~

a

~

t;l

>
t-4

1-3
~
U1

t;l

~
H

at;l

---------I - - - - J . - - - - 1 - - - - + - - - - - 1 - - - - - 1 - - - - - f - - - -~- - - TotsL- _________________ ---- _____ __ ____ __
391
271
2
1,033
882
3
73
318 I

U . S. Navy and Marine Corps _______________ First-class stations ___________________________ _
Other relief stations _________________________ _

144
53

47
17

2

3
1

567
137

97
36

484
70

20
7

Total. - ----- -- -• --- ---- -- ---- ------ ---- -Mississippi River Commission_______________ First-class stations __ -------------------------Other relief stations _________________________ •
TotaL ___________________________________

197

64

2

4

704

133

554

27

1
1
365
1
2
11 ---------- ---------29-+----+-----1-----1--- - -136
1 - - - - -181 - - - -22
-1-----

_ _ _

1

31

12

501

19

23

t....:>
O':>
Cl


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Federal Reserve Bank of St. Louis

TABLE

3.-Relief furnished at United States marine hospitals and other relief stations, fiscal year 1931, classified by beneficiary-Contd.

Beneficiary

•

Seamen, U. S. Engineer Corps and Army
transport service.

Class of station

First-class stations ____________________________
Other relief stations ___________________________

Total Number
of panumber
of patients
tients treated in
treated hospital
716

Died

1931

2,344
2,080

319

32
9

Total ______ ---------------------------- -U.S . Lighthouse Service ______ __ ____________ First-class stations ____________________________
Other relief stations _________________________ :_
Special acting assistant surgeons _______________
Emergency _________________________________ ---

4,424

1,035

1,002
1,065
128
8

261
125
3
4

Total-------------- _____________ . ________

2,203

393

U.S. Coast and Geodetic Survey __ __ ________ First-class stations __ -------------------------Other relief stations ___ _______ _______________ __
Emergency ______________________ ------------ -Total. _______________ ____________________

383

94

623
4

u. s.

sion.

Employees' Compensation Commis-

First-class
------ ------- - -- ------ ---Other reliefstations
stations_____________________________

Total. ___________ -- ------ ------ ---- ----- U.S. Veterans' Administration ___ _____ ______ First-class stations_. __________________________
Other relief stations ___________________________
Foreign _______________________________________
Total. _____________ ______________________
U . S. Immigration Service _____ ____ __ ________ First-class stations __ ------------ -------------Other relief stations ___________________________

U.S. Public Health Service officers and employees.


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Federal Reserve Bank of St. Louis

Patients
Number Number
remain- Number of o_f paof times Numb~r
ing in days' relief t1e!1ts office re- of phys17
hospital in hospital furnished lief was cal e~am1June 30,
otl\Y:{e- furnished nations

30,227
4,206

1,628
1,761

41

90

34,433

3,389

10,250

154

13
3

22

8,973
1,851
7
15

741
940
125

83
13

4

3,482
2,284
323
7

16

27

10,846

1,810

6,096

192

68

3
5

2,188
1,091

289
555
4

905
2,175
8

274
313

162 .

8

3,279

848

3,088

587

137
34

41,407
15,635

38,451
9,642

114,487
64,542

15,581
6,762

179,029

22,343

5

---------- ------------------- ----------

---------- ---------- ---------- ------------

1,010
40,039
10,554

5,463"
4,787

74
16

1,588
912

12
11

120
34

96

2,500

23

171

57,042

9,172
106

8,873
54

373
4

934
2

306,170
1,015

299
52

4,127
227

l, 196
123
2

9,278

8,927

377

936

307,185

351

4,354

I, 321

3,360
379

2,737
112

24

84
9

36,584
4,320

623
267

891
1,669

108
624

1

---------- ------------ ---------- ----------

b::l

~

0

48,093

50,593

"'d

q

Total. - ___ --- --- -- -- --- ------ -- ---- -- ----

3,739

2,849

2!

93

40,904

890

2,560

732

First-class
----- --------------------Other
reliefstations
stations_____________________________

5,590

15
1

22

1,080

657
7

8,614
71

4,933
l, 073

30,393
9,147

594
142

Total_. ______ ---- - ___ -- __ --- _____ --- --- --

6,670

664

16

22

8,685

6,006

39,540

736

~

t;l

~

8
~
rn
t;l

~
H

0

t;l

Lepers____________________________ ___________ First-class stations ___________________________ _
Other relief stations __________________________ _

390

I

390

23

337

----------i---------·

116,279 ___________

1 ---------- ---------- ---------- ------------

Total_. _________________________________ _

1

1

391 I
390
23
337
116, 219
Masters, mates, and pilots ___________________ First-class stations ___________________________________________________________________________________________________ _
Other relief stations _____________________________________ ---------- ---------- ---------- ------------ ---------- _________ _
Total. _____________________________________ ----- _-- ------- --- ----- -- --- ---------- -- --- - ------1---------Citizens' military training camps ____________ First-class stations____________________________
114 __________ __________ __________ _____ _____ __
114
Other relief stations_______ __ ____________ ___ ___
443 __________ __________ __________ ____________
443
TotaJ____________________________________
United States civil-service applicants and
and employees.

---------390

1,002

1

4,562
2,223
6,785
297
404

1---------+-----1----+-----:----......_----1----"~557 __________ ---------- __________

------------1

557

1,392

701

First-class stations __ -------------------------- ____________________ ---------- _________________________________________ _
Other relief stations __________________________________________________________________________________________________ _

7,835
12,094

Total. ___________________________________ -----------------------------------------------------------------------Postal employ~---------------------------- First-class stations ______________________________________________________________ _____________________________________ _
Other relief stations ___________________________ ---------- ---------- ---------- ---------- ------------ ---------- _________ _

19,929

Total. ___________________________________ ---------- ---------- ---------- ---------- ------------ ---------- ----------

886

595
291

Alaska cannery workers __ ---------- ~- ------- First-class stations __ -------------------------- _________________________________________________________________________________ _
Other relief stations___________________________
418 ___ _______ __________ __________ ____________
418
418
6,674

Total_-----------------------------------~====---------- ____________

418

418

U.S. Shipping Board, for crews _____ ____ ____ First-class stations ________________________________________________ ----------__________________________________________
Other relief stations __________________ ___ __________________________ ---------- ______ ____ __________ __ __________ __________

6,674
1,305
1, 131

Tota]_----------------------------------- ______________________________________________________________ - - - - ~
Applicants, U. S. Bureau of the Census______ First-clas.•i" stations __ -------------------------- _________________________________________________________________________________ _
Other relief stations___________________________ __________ __________ __________ __________ ____________ __________ __________
1,917

Total_----------------------------------- __________ __________ __________ __________ ____________ __________ __________
Miscellaneous __ ----------------------------- First-class stations ___________________________ _
Other relief stations __________________________ _
Total. _____________ -- -------------- _____ Total..________________________________ First-class stations __ -------------------------Other relief stations___________________________
Special acting assistant surgeons_______________
Coast Guard vessels and bases________________

t;l

~H

0
t;l

1,917

257
37
6
3
532
220
726
1, 804
437 _ _ _1_ _-_._--_-_--------1-_--_-_-_--_-_--_-_ _ _ _ _28_ I. ._ _ _
43_6
999
1, 378
1
1
694
as
o
3
560
ooo ~ ~

I

164,808
38,925
71,466
7,837
5,490
159
26,827
93
51 ________

1,147
154

268,642

1,304

Ew~~!r::Y------------------------------------ _______
Grand total______________________________

rn

2

4,005
400
5

1

1,507, 787
155,992
1,352
953

125,883
554,403
63,629
226,901
5,331
17,007
26, 734
112,099
32________ 56_

47,462
41, 724
1,596
3,702
1

221,609

94,487

19___________ __________________ 131________

47,033

4,410

1,666,215

J

910,466

2

t:v
0)

-l


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268

PUBLIC HEALTH SERVICE

4.-0ause of admission for discharged patients and condition on discharge, United States marine hospitals and other relief statwns, fi,scai year

TABLE

1931
Number having specified diseases 1
or injury

Condition on discharge of patients
for specified diseases or mjury

Total
number
of perDisease or condition
so.1:s
havmg Cured
eac~
specidg;~.,e
or
injury
- - - - - - - - - - - - 1-- - - - - - - - - - - - - - - - Abnormalities and congenital
malformations _____________ _
13
50 - ----- - - ---- -- - - - - --- - - -----Blood and blood-forming organs, diseases and injuries oL
77 ------- ------- ------- -------Bones and cartilages, diseases
and injuries oL ___________ __ 2,239 _______ ___ ____ __ _____ ________
269
Circulatory system, diseases
and injuries of:
Heart disease, valvular____
282
87
3
228
607
Varicose veins_____________
302
70
46
186
558 _
All others ____ _____________ 1,365 ____________________________
97
Communicable and infectious
diseases, not including tuberculosis and venereal:
Conjunctivitis, granular
trachomatous_. _________
20
2
3
25
2 -----·Dengue___________________
2
2
3
1 ------- ------Influenza__________________ 1,016
43
1,068
469
9
Malaria___________________
314
33
77
7
1
355
Rheumatic fever, acute____
89
11
10
2
107
6
Typhoid fever____________
63
43
2
7
72
All others_________________
775 ------- ------- ______________ _ 380
DentaL_______________________
279 4,167 2,203
46
6,654
Digestive system, diseases and
injuries of:
Appendicitis______________ 1,148
201
64
1,413
544
Gastritis __________________
352
65
15
9
441
70
Hemorrhoids___ ___________
803
356
131
2
1,292
282
All others _________________ 2,055 _______ _______ _______ ________
344
Ear, nose, and throat, diseases
and injuries of:
Deviationofnasalseptum_ 459
410
131
1,000
161
Otitis media__ ____________
248
195
87
2
532
32
Tonsillitis _________________ 2,696 1,083
344
4,123 1,209
All others_________________
955 ------- ------- _______ -------305
Endocrines, diseases and injuries of_______ ______________
294 ------- ______________ -------22
Eye and adnexa, diseases and
injuries of.______________ ____
588 ------- ------- ------- -------119
Genito-urinary system, diseases and injuries of (exclusive of venereal):
Nephritis___ ________ ______
212
162
79
2
455
7
All others _________________ 1,490 _______ _______ _______ ________
307
Hernia __________ ______________ 1,875
383
158
2,416
773
Joints and bursae, diseases and
injuries of:
Arthritis__________________
841
1,557
61
291
90
335
All others_________________
466 _________ ___________________ _
46
Leprosy_________ ___ ______ _____
51 ____ _________________________ ------Lymphatic system, diseases
and injuries of:
Lymphadenitis___________
312
21
202
58
593
73
All others_________________
37 ____________________________ _
6
Muscles, fasciae, tendons and
~e~d<?n
sheaths,
diseases
and
mJunes of. __________________ 1,233 _______ _______ _______ ________
208
M aj~r
copditwn
fo_r
whi~h
a~~12t-

Condition
second
in importance

Condition
third
in importance a

Sequelae
to
major
condition

Im~~ Died ~~~~r
proved proved
ditions

-- -

- -- - - - - --

26

10

50
1,219
192
201
797

1
6

9

15

39

705

41
3
171

46
51
294

iiiii

12
1 -----408
12 ----127
185 -----·- ··---52
55
1
22
6
11
3
281
2
20
92
170 ------- -----63
448
240
426
1,321

119

35
1
1
54

41
r94
334

232 ------- -----159
1
1
489
8

66
55
256
152

2
2

l, 230

25

187
320

6

114

2

55

854
809

3
2

26
10

609
265
20

34
300
281

8

158
152

23

8

166
19
689

59
143

73
11

1 ______

33 5

Except in the case of specific diseases, statistics are given only for the ma;or condition for which admitted.
2 Represents number of discharges for each condition.
a Where sequelae were given, no third diagnosis was recorded.
1


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Federal Reserve Bank of St. Louis

269

PUBLIC HEALTH SERVICE
TABLE 4.-0ause of adrnission,

etc.-Continued

Number having specified diseases
or inlury

Disease or condition

Maj~r Condi- Condico~di- tion
tion
tlon second third
fo_r in im- in import- portted
ance ance

:f~t

Condition on discharge of patients
for specified diseases or injury

Total
number
Seque- of perlae
so~s
to
havmg
ImDied ~J~:r
major eac~ Cured proved
proved
ditions
co~di- s~:~t10n disease
or
injury

~!

------------1--- --- --- --- --- --- --- --- - - --Nervous system, diseases and
injuries of:
Ep}lepsy
without psychosis _______________
____ ____
Neuritis
_____
-- --- --- -----All others _________________
gynecological
Obstetric
___________________
conditionsand
Parasitic diseases:
U ncinariasis _____ ----- -- --All others ___ ______________
Poisonings and intoxications:
Alcohol (ethyl) poisoning
acute _________ --- - _______
Alcoholism, chronic (with
out psychosis) ___________
All others _________________
Psychiatric diseases:
Drug addiction without
psychosis ________________
All others _________________
Respiratory system, diseases
and injuries of (exclusive of
tuberculosis):
Asthma _________________ __
Bronchitis ________________
Pleurisy _______ -----------Pneumonia _______________
All others _________________
Skin and its appendages, diseases and injuries oL ________
Tuberculosis:
Tuberculosis, pulmonary __
Tuberculosis (otherwise
unclassified) _____________
Tumors:
Carcinoma ________________
All others _________________
Venereal diseases:
Chancroidal infections ____
Gonococcus infections _____
Syphilis
__________________
---------------All
others
__
Inoculations ___________________
Under observation ____________
Miscellaneous:
Cellulitis __________________
All others _________________

48
295
556
29
19

159

11

93

2
25

13

61
426

------- ------- ------- -------------- ------- ------- -------47
12 ------78
----·-- ------- ----·-- --------

2
25
34

28
210
323

12

14

2
26

13
103

1
3
14

2
26

------- ------------ ------

17
55
159
3
4
29

226

14

5

245

63

110

47
159

25

7

79

-------- ------- -------- --------

5
41

32
63

------- ------

10
52

29
370

21
12 ------62
------- ------- ------- --------

1
30

9
155

------- -----7

19
171

8
123
44
149
5

184
388
145
112
33

231

526

5

267

72
328
115
71

18
98
36
66

111

44

72

27

10

290
412

39

20

94
260
844

13
39
195

236
634
231
443
49
924
1,077

664

TotaL __________________ 40,060

327
1,063
407
632

------- ------- ------- -------------- ------- ------- --------

------- --------

3,153
2,806
37 ------__ .., ____
6
695 ------214
3,192

1
3
25
52

55

1,233
32

__ ,.. ____
356
76

141

3

33

349

16
122

77
174

1,127
3,528
3,845

172
383
42
10

371
2,116
1,841
17

-------·

8
3

7

7
1
6
154
4
11

155

6

243

556

9

26

6
1

126
20

65
95

-----·-----2
3
6

66

------· ------- -------- -------- ------- ------- -----14

47

330

66
776

99
1,539

8,425 21,181

34
119
36
28
7

3
3

------- --------·----- ------------------ ------- -------- ------· ------- ------- ------

------- ------- ------- ----·--------- ------- ------- --------

45

121
649
851
10

6
695

2
30

47
842

107 1,285

9,062

5

N0TE.-Immigration patients at United States Marine Hospital, Ellis Island, N. Y., are not included
n this table.
.


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Federal Reserve Bank of St. Louis

270

PUBLIC HEALTH SERVICE

TABLE

5.-0auses of death in United States marine hospitals and other relief
stations during fiscal year 1931

International
List No.

1
5
11
16
17
18
20
24
25
27
29
31
32
33
34
35
36
37
38
40
41

43
44
45
46
49
50
52
54
06

o7

08
60
65
66
67

Cause of death

Number
of deaths

I. Epidemic, endemic, and infectious diseases
Typhoid and paratyphoid fever_ __________________________________________________ _
Malaria ___________________________________________________________________________ _
Influenza _________________________________________________________________ - _- ____ - -Dysentry __________ ---------------------------------------------------------------Plague ____________________________________ -- ______ -____ -- _-- - -- -- - -- --- - - -- - --- - -- Yellow fever ___________ -------------------------------------------------- ______ ---Leprosy ________ __ ______ __ _________________________________ --- - -- -- - -- --- -- -- -- - -- - Meningococcus
___ diseases
------------------------ --- ----------------- -------- -_
Other epidemic meningitis
and endemic
______________________________________________
Anthrax ______________________________________________________________________ -- - --Tetanus ____________________ -- -- _-__ - - - -- -- -- -- - -- -- - --- -- - -- -- --- -- - -- -- -- --- - ----Tuberculosis of the respiratory system ____ _______ ____ ________________ _____________ _
Tuberculosis of the meninges and central nervous system __________________________ _
Tuberculosis of the intestines and peritoneum _____________________________________ _
Tuberculosis of the vertebral column ______________________________________________ _
Tuberculosis of the joints __ _________ -- ------------------------------------ _________ _
Tuberculosis of other organs _______________________________________________________ _
Disseminated tuberculosis _______________________________________ -- - -- -- - --- - -- -- - -Syphilis _____________ ________ ___ _____________________________________ ----- -- - -- -- - -Gonococcus infection __________ ________________________________ _____ - _-- _--- - -- -- --Purulent infection, septicemia __________________________________________ -- __ - - --- - -JI. General dis.eases not incltided in Class I
Cancer and other malignant tumors of the buccal cavity __________________________ _
Cancer and other malignant tumors of the stomach and liver ______________________ _
Cancer and other malignant tumors of the peritoneum, intestines, and rectum _____ _
Cancer and other malignant tumors of the female genital organs ___________________ _
Cancer and other malignant tumors of other or unspecified organs _________________ _
Benign tumors and tumors not returned as malignant_ ____________________________ _
Osteoarthritis _______________________________________________ -__ -_-- -- -- -- -- -- -- -- - Pellagra ____ ________________ __________ --- _-- -- __ -- -- ---- - -- - -- - -- --- -- ---- --- - -- - --Rickets ___________________________________________________ - -- - -- -- - -- -- -- - ---- - --- Diabetes mellitus _______ __ ___ _____________________ --------------------------------Anemia or chlorosis ___________ ----------------------------------------------------Diseases ofand
the Hodgkin's
thyroid gland_----------------------------------------------------Leukemia
disease ____ ______________________________________________ _
Alcoholism, acute and chronic __ ___ ________________________________________________ _
Poisoning, chronic, by mineral substances ________ ___ _______________________ _______ _

11

1

12
1
1
1
22

3
1
1
1

235
0
4

2
2
4

9

63
2

12

7

ol

28
4

56
2
2
3

1
18
4
6
5
8

1

III.-Diseases of the nervom svstem and of the organs of special sense

~~ ~~~~~rH!is =::::::::: =::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

74 -Cerebral hemorrhage, apoplexy _____________________ __ _______ --- ----- ------- -- -----70 Paralysis without specified cause ___________________________________________ __ _____ _
76 General
paralysis
of thealienation
insane_---------------------------------------------------77
Other forms
of mental
__________________________________________________ _
78 Epilepsy
__________________________
- -- --- --- ------ -- - -- - --- - -- -- --- -- --- -- -------79
Convulsions
(non puerperal). ___________________________________________________
-- --84 Other diseases of the nervous system ______________________________________________ _
86 Diseases of the ear and of the mastoid process _____________________________________ _

4
11

20
9
3
2

1
1
3

4

IV.-Diseases of the circulatorv svstem
87
88
89
90
91
92

Pericarditis ______________________________________________ -- - --- -- ---- -- -- - --- -----Endocarditis and myocarditis (acute) ____________________________________________ _
Angina pectoris __________________________________________ -- ---- --- - -- -- -- - -- - -- ---Other diseases of the heart_ _______________________________________________________ _
Diseases of and
the arteries_-------------------------------------------- -----------_
Embolism
thrombosis (not cerebral)--______
,. ________ __ _________________________

93
95
96

Diseases
of the
veins __specified
------------------------------------------------------------Hemorrhage
without
cause _______________________________________________ _
Other diseases of the circulatory system ___________________________________________ _

97
98
100
101
102
104
105
107

Diseases of the nasal fossae and their adnexa ______________________________________ _
Diseases of the larynx ______ .____________________________ ___________________________ _
Bronchopneumonia _______________________________________________________________ Pneumonia ______________ ______________________________________________________ -- __
Pleurisy ____________________________________________________ - - --- - -- -- - - -- -- - -- ---- Gangrene
of the lung __ --------------------------------------- _____________________ __
Asthma
___________________________________________________________________________
Other diseases of the respiratory system ___________________________________________ _

1
11
4

133
32
10
2

4

a

V.-Diseases of the respirator11 svstem


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1
1
49
120
6

1
5
5

PUBLIC HEALTH SERVICE
TABLE

271

5.-0auses of <lea.th in United States marine hospitals, eto.-Continued

Interna•
tional
List No.

Cause of death

Number
of deaths

VI.-Diseases of the digestive s11stem
111 mcer of the stomach and duodenum •••.......•••.•.•.•...•.....•.....•...•.•..••.•
112 Other diseases of the stomach ••.•••••.••.••••••.••.•••...••....••...•.....•.•.•...•
114 Diarrhea and enteritis •••..•••••.•.•••.•••••.•.•.•.•••••••••••••••••.......•.•......
117 Appendicitis and typhlitis .••....•..........•.•••.•.•.•••••••.•........••••••..•••.
118 Hernia •....•.......................•..•....•....•.•••.•••••••••••.•.•.••••••••••••.
119 Other diseases of the intestines ....................•.•.•.•.•..••••.•.•••••••••••••••
120 Yellow atrophy of the liver (acute) •.•...•.•.•••.......••.••.•.......•••••••••••••••
122 Cirrhosis of the liver ••...•••.•••..•...•••••..•••••••••••••.••.......•...•.•.•..••••
124 Other diseases of the liver ••.•••.•••••..•••••.•••••••••••••••••.•........•...•••••..
125 Diseases of the pancreas •..•....••.....•••••••.•••.•••••••••••••••••..••.•••.•.•••..
126 Peritonitis without specified cause ..•...••........••..•.•.••••••••••.••..•••...•••.
127 Other diseases of the digestive system (cancer and tuberculosis excepted) ••••••••.••

13
1
3

31
13

5

1
10
1

3
g

13

VII.-Nonvenereal diseases of the genitourinar11 s11stem and adnexa
128
129
131
133
134
135

Nephritis, acute ........•......•........••..•.....•.....••.•..•......•••..••••••..•.
Nephritis, chronic . ....•.....................•......••••..................••..••.•••
Other diseases of the kidneys and adnexa...••...............••.....•..••.•.••••••••
Diseases of the bladder_ ...............••.•............••••••••.....••..•.••••.•••.•
Diseases of the urethra, urinary abscess, etc ..•..............•..•••.•••.•.•.•.••••.•
Diseases of the prostate .....•....••.•.••..•..•••.••..•• ~ •.....•.....••••••••••••••.

151
153
154

IX.-Diseases of the skin and of tke cellular tissue
Gangrene .•...................•...•.•.•.•.•.•••.•••..••••..•......•••..••.•••••••..
Abscess, acute .......•.••••......•..•••..•••••••.••.•••••.•••••.••..•..•••••.••••.••
Other diseases of the skin and adnexa ...••.......•••..••••••.••..••••.•..••••.••..•

155
156

Diseases of the bones (tuberculosis excepted) .........•....•.•••••••••.••••.••.••.••
Diseases of the joints (tuberculosis and rheumatism excepted) .•••...••••••••••••••.

4

55
2
5

3

10

2

1
4

X.-Diseases of the bones and of the organs of locomotion

XIV.-External .:auses
109 Suicide by drowning ....•••••.•.••••••..••..•.••..••••••••......••••.••.•••.••••••.
170 Suicide by firearms ....••...•.....•..•....•......•.••••••••.•.•....•.•••••.•..••..••
177 Other acute accidental poisonings (gas excepted) .•••••••••••.••....••••.••.•••.••••
178 Conflagration ........•..•.•.•.............•....•....•••...•..•.•...•.••.•••••••••••
179 Accidental burns (conflagration excepted) .•.•..••••..•.•.••.•..•••.••••••.•.•...•.•
183 Accidental traumatism by firearms ........•.....•.••••.•.....••••.•...•••••••.••.•.
185 Accidental traumatism by fall ...................••••••..........••..........•.•..•.
188 Accidental traumatism by other crushing (vehicles, railways, landslides, etc.) .••..•
194 Excessive heat ....•....••..•.•...........••.•••....••••••••••..•..•.•.•.••••..•....
197 Homicide by firearms_ .•.•..•..•..•...........•••.•••••••••••••••••.•••.•.•.•.•••..
201 Fracture (cause not specified) ..•..•.•.•.••........•••.•••••.•.••.•••.•...•..•••.••.

2

3

1
1
3

4
2

2
2
2
4

1

35

XV.-Ill-dejined diseases
205

Causes of death not specified or ill-defined ......•.....•..•.•..•..•.•.•.••••••••.•...

5

Total .......•.............•......•........••.•....•.••.••.....••...••..••••..
Causes of death of immigrants at U.S. Marine Hospital, Ellis Island, N. Y., not
included above ...••...............•.••......•..•••••••••••••••••••....•.•••••.•.•

1,285

Grand total ..••.......•..••...•••....••.•.•••.•••••••••••••••••••••••••.•••••

1,304

•


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

19

TABLE

6.-Number of each class of beneficiary discharged from United States marine hospitals and other relief stations during the fiscal year 1931

t...:>
-:J
t...:>

Class of beneficiary

Group
Total

American
seamen

Foreign
seamen

Seamen,
U.S.
Missis- Engineer
U.S.
U. S.
~b~ic I
sippi
u. s. Coast
ployees' VetU. S: Health
Corps
LightRiver
and
Comerans'
Imm1u. s.
S
•
L
and
house Geo- pensa- Admin- grati?n 0
epers
Guard Army Marine ComArmy Service
detic
tion
istraService
and
emCorps misTranssion
Survey
tion
ployees
port
Service

i~--

U.S.

~~ay

g~!i

i~~~•

n3i:~n

Miscellaneous

----------------1---- --- --- --- -- --- --- ---- --- --- --- --- --- --- --- --Abnormalities and congenital malformations ____________________________ -___ - -_
Blood and . ~lo~d-forming organs, diseases and mJunes oL _________ ---- ·-·--B<;>ne;s
cartilages, diseases and inJuries and
oL _____________________________
__
Circulatory system, diseases and injuries
oL _____ _________________ ------- - ------Communicable and infectious diseases,
not including tuberculosis and venereaL
Dental __________ __ _____ --- -- ---- -- - -- --- Digestive system, diseases and injuries oL
E!!-r,
_nose,
and __
throat,
and in- _
Juries
oL _____
________diseases
___ ____________
Endocrines, diseases and injuries oL ____ _
Eye and adnexa, diseases and injuries oL
Genito-urinary system, diseases and injuries of (exclusive of venereal) ________ _
Hernia ___________ -------- ____ --- - -- ----- Joints and bursre, diseases and injuries oL
Leprosy ____ ______ ___________ _____ ___ ____ _
Lymphatic
system, diseases and ______
injuries
of _____________________________
__ _
Muscles, fascire, tendons and tendon
sheathi, diseases and injuries oL ______ _
N ervous'"system, diseases and injuries oL
Obstetric and gynecological conditions __ _
Parasitic diseases ___________ ----- --- -----Poisonings and intoxications ____________ _
.Psychiatric diseases _____________________ _
Respiratory system, diseases and injuries
of (exclusive of tubrr~ulosis) ___________ _
Sli:i~ a?d its appendages, diseases and
mJur1es of_ _________ -- --------- ---------


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

50

31

77

46

2

2

5 ------ -------- --------

2,239

1,247

19

126

1,949

1,041

2

70

2,279
279
4,358

1,350
143
2,183

25
5
30

451
38
428

4,358
294

2,386
153
303

23
9

685
18
53

4
1
2

1,702
1,875
1,307
51

1,022
1,147
629

13
9
6

134
46
75

5

349

249

6

32

1,233
899
29
178
432

639
455
17
75
278
191

11
4

124
54

588

399

1,593

909

924

533

3

115

4

10

4

30

19

4

502

258

4

16

7

23

27

4

38

698

7

34

3

4

132
7
114

26
2
51

14
17

6
2
18

114
81
1,375

119
3
10

42

3
5

22
2
3

20
5
67

869
104
126

22

70
23
15

7
16
13

12
6
2

26
331
124

379
284
416

13
1

8

2

9

36

3

2 -------- --------

27
15
1
4
12
7

15
4

263
36

124
314
4
67
42
117

6
2
2
3

17
4
14 -------- --------

-------- ------------21
15
6

5

-------- -------2

1
2

------ -------2 -------- -------1

1

4

9 -------- -------- -------- --------

25

2

-------- ---- ----------- -------- ------ -------- -------21 ------ -------- -- -----2
2 -------26
3
49
-------- -------3 -------3
Ill
14
14

1 -------- --------

------ -------- -------- ---------- -------- --------

26
120
1 -------- -------- -------14
81
10
152

3

5
7

2

21

1-4

2
2

51 ------- -

2

-------- -------- -------1
3

6

2
3

35

12

7

21

8

2
57
21

5
3

7
3

9

454

5

27

36

172

7

10

t,:j

~
a

18 -------- -------8

UJ.

t,:j

Tuberculosis ____________________________ _
Tumors __ __ ____ _-- __________ __ --·-- __ ___ _
Venereal diseases ________________________ _
Inoculations_____________________________ _
Under observation ______________________ _
Miscellaneous ___________________________ _

1,149
702
6,660
6
695
3,406

745
414
4,655
273
1,933

8
37

TotaL _______ -------------- --------

40,060

23,048

314

7
4
61

1

40 ------ -------35
1
2
618
4
2
3
55
2 --~----12
4
348
3,762

68

57

71

----------------------

19
17
171

9
44

-------1

7
65

11
34

I

2
22

956

367

I

151

11

2
2
21

298
20
181
16
819
29
1 -------32
284
639
241
2,314

7,891

7
2
226

8
18

4
19
10
1
6
48

381

639

--------

5

2
4

56

45

NoTE.-lmmigration patients at United States Marine Hospital, Ellis Island, N. Y., not included in this table.
TABLE

7.-Number of days in hospital for patients discharged during fiscal year 1931 from United States marine hospitals and other relief
stations, by broad groups of conditions and class of beneficiary
1-tl

Class of beneficiary

q

td

Group
Total

American
seamen

Foreign
seamen

Seamen,
Missis- U.•S.
U. S · sippi Engineer
U.S. U. s. Navy River
Corps
Coast Army anq.
Comand
Marine misGuard
Army
Corps sion Transv<>rt
Service

U.S.
U.S. Coast
Light- and
house GeoService detic
Survey

U.S.
Employees
Compensation
Commission

U.S.
Veterans'
Administration

U. S.
Immigration
Service

U.S.
Public
Health
Service Lepers
officers
and
employees

ti
H

Q

Miscellaneous

p:f
trJ

~

8

- - - - - - - - - - - - - - - - ! - - - - - - - - -- 1- - - j f - - - - - l - - - - l - - - - - - - -1- - - -1- - - - + - - - I · - - - - - - - - - - - - - - Abnormalities and congenital malformations _______ -- ______ --- -- - -- -- - -- - -- -- -Blood
!>~d 1?lood-forming
organs, diseases _
and rn1ur1es
of_________________________
B<?ne:i
and
cartilages,
diseases
and in- _
Junes of_ ______________________________

tfJ

trJ

1,456

126

1,011

4,540

2,611

98

185

97,102

55,511

470

4,038

10 -------- --------

75

103

908

702

228

27

~
H

282

4

1,636

17,086

17,269

Circulatory system, diseases and injuries
oL ________ ___________________ --- --- ---- 102,146 65,193
3,394
1,858
854
59
543
84
19 -------Communicable and infectious diseases,
2,071
318
231
502
5,153
195
73
36,756 22,858
not including tuberculosis and venereaL
40 -------DentaL ____ -- _______ - __ -- __ -- -- ----- - -- -16
513
43
5 -------23
4,899
2,793
7,814
417
248
2,272
943
237
216
Digestive system, diseases and injuries oL 107,396 48,889
4b5
23
E~r,.
nose
and
throat,
diseases
and
in•
1ur1es oL ____ • ___________ ______________ _ 61,844 34,542
i94
8,448
277
431
16
29
36
1,251
484
Endocrines, diseases and injuries of _____ _ 17,444 9,944 -------574
64
533
414
94
8 -------- -------16
Eye and adnexa, diseases and injuries of__
146
74
824
12,111
83
608
6,671
31
3 -------Genito-urinary system, diseases and injuries of (exclusive of venereal) ________ _
29,008
209
2,877
65
7
14
2,950
118
150
872
Hernia ___________ __ _________ ________ ___ __ 51,410
50, 230 31,474
263
1,236 ------ -------11
970
320
196
7. 362
Joints and bursai, diseases and injuries oL
58,370 29, £48
45
1,849
333 -------- -------476
336
11
3,072
Leprosy • -------------------------------67,231 -------- -------- -------- ------ -------- -------- ---------- -------- -------- --------


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

p:f

-------33

6 -------- --------

580

99

29,292

88

737

25

3,925
1,478
44,329

390
28
248

963

37

1,086

219

15,051
5,753
3,559

235

831

19

4

60
88

4

14,546
294
300 -------- -------8,202
3
153 -------40
21, 788
35
733
44
-------- -------- -------- 67,231 --------

Q

trJ

TABLE

7.-Number of days in hospital for patients discharged during fiscal year 1931 from United States marine hospitals and other relief
stations, etc.-Continued
Class of beneficiary

Group
Total

Seamen,
U.S.
U . S.
u. s. Em- u. s.
Engineer U . S. Coast
U.S. Mississippi
ployees'
VetU.S.
Navy River
Corps Lightand
Com- erans'
Coast U . S. and
and
house Geo- pensa- AdminArmy
Guard Army Marine Comdetic
tion
istraCorps misTrans- Service Survey
Comsion
tion
port
mission
Service
--- --- --- ----- --- ---- --- ------ --American
seamen

Lymphatic system, diseases and injuries
11, 126
7,723
of.. -- -- --- -- - -- -- -- -- -- -- - - ---- -- - - -- -Muscles, fascire, tendons and tendon
sheaths, diseases and injuries of. ____ ___
22,943 11,089
Nervous system, diseases and injuries oL_
50,407 30,699
Obstetric and gynecological conditions ___
694
459
4,289
1,735
Parasitic diseases ___ ----- - -- -- --- - ----- --Poisonings and intoxications _____________
6,255
4,030
Psychiatric diseases ____ ____-- ____ ---- - __ _ 53,939 45,587
Respiratory system, diseases and injuries
of (exclusive of tuberculosis) ____________
50,992 31,940
Sk;in _and its appendages, diseases and in1u.nes of. _____________ ______ ____ ___ ___ __ 26,693 16,496
Tuberculosis ___________________________ __ 188,734 149,421
Tumors ____________________________ . ____ •
27,891 18,251
202,183
Venereal
diseases
----- --- ------------Inoculations
______..______
_____
___________
__ 276,485
21
5
Under observations _____ _____ __ __ ________
5,62&
2,046
Miscellaneous. _____ ____ _______ ________ ___
55,210 30,167
Total. •• ________ ------------------- 1,454,242 891,984

Foreign
seamen

-------129
17 -------1,670 ----g"
94
1,264
-------- ---- ----------------------- -------- -------405 -- ---- -------- -------65
14
155 -----32 -------3 ---- ------------------- 2,963
143

1,199

227

2,111

111
200
105
1,635

1,954
7,760
652
21,871
14
503
3,469

-------32
508
5,926

------

31

29

75 --------

303

64

11

142

372
727
4
37
127
120

151
174

13

5,547

843

-------- 1,224
-------- --------------11
36 -------1,030
3
10
121

141

475

825

108

78

17
435
76
7
-------794
69
-------------------- 4,372
811
167
25
5
11 -------2,551
44
6,905
533
25 -------------------- -------- ---------15 -------- -------28 --··100· ---·-·a·
186
14
10
1,269
477
59
67

81,269 1,327

697

101

30,938

9,763

N0TE.-lmmigration patients at United States -Marine Hospital, Ellis Island, N. Y .• are not included in this table.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

2,971

1,413

U.S.
Immigration
Service

U.S.
Public
Health
Service, Lepers
officers
and employees

52

47

223
367
51
49
46
44

13,968

62

697

112
192
24
7,301
480

97
108
575
225
1
25
354

10,070

8,446

57,992 284,407

1-"d

--- --- --- ---

3,530
153
15,830
20
158
22
1,913
38
808 -------4,280
205

998
6,308
5,199 20,619
533
6,732
859 32,353
1 ------- 595
1,703
10,514
7,682

Miseellaneous

-------51

-------- -------49
----------------------------- --------------- --------------- --------------- -------27
-------15
--------------- --------------- --------------- --------------- -------512
9
21
--------

67,743

608

q

td

~

a

!J::I
t_zj

~

f-3

!J::I
UJ.

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~
1-1

a

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TABLE

8.-Classification of out-patient treatments furnished at United States marine hospitals and other relief stations, fiscal year 1931
InoculaPhysioVeneral tions_and Arsenicals therapy
diseases v~fi~~aand x ray

General
medical

Dental

Eye, ear,
nose, and
throat

Neuropsychiatric

Tuberculosis

Surgical

Marine hospitals _________________________ ---------------------Other relief stations _____________________________________ ------- -·
Special acting assistant surgeons _______________________________ _
Coast Guard vessels and bases ____________________________ -----Emergency ______________________ ______ --- - - - - - - - - - - - - - -- - - - --- -

51,680
61,352
7,236
53,128
42

165,146
27,158
691
16,121
10

33,799
14,333
1,917
10,102

110
184
101
47

257
532
234
137

114,111
61,619
4,653
19,264

78,481
23,056
255
6,909

3,907
6,200
1, 791
4,518
4

Grand totaL ____ . __ ----------------------------- __________

173,438

209, 126

60,151

442

1,160

199,647

108, 701

16,420

TABLE

Total

14,691
6,569
88
410

92,221
25,898
41
1,463

554,403
226. 901
17,007
112,099
56

21,758

119,623

910,466

---------- ------ . ---

9.-Nativity of patients discharged from United States marine hospitals and other relief stations during the fiscal year 1931
Class of beneficiary

Nativity
Total

American

Foreign

men

men

sea-

sea-

Seamen,
U.S.
u. s.
u. s.
U.S.
Missis- Engineer
U.S. Public
sippi
U.S.
Coast ployees' VetCorps,
Com- erans' Immi- real_th
Light- and
River
U.S.
Lepers
and
house
Geo- pensa- Admin- gration ervice
Guard Army Marine ComArmy
tion
istra- Service officers
misService detic
Corps
TransC
t·
andemSurvey
sion
port
m~~;n
ion
ployees
Service

i;::

U.S.

g~t

N~''l

Miscellane-

ous

29,230

1~807

13

3,350

61

51

11

812

254

105

1, 918

7, 251

521

4

32

0

40

1 - - - - - f - ' - - - - f - - - - f - - - - - , 1 - - - t - - - - 1 - - - - - 1 - - - - - + - - - - t - - - - t - - - - t - - - - - t - - - -1-- -

Hawaii, Panama, Philippine Islands, and
Porto Rico ____________________________ _

25
22
2
8
999
763
2
126
29
8
7
1------+---+---+---t---+-----l----+-----l----+----l----+----1----+----1----1----

Armenia __ . _____________________________ _
<\.ustria _________________________________ _
Belgium ________________________________ _
Bohemia ________________________________ _
Bulgaria. _______________________________ _
Canada _________________________________ _
Central America ________________________ _
China ___________________________________ _
Cuba ___________________________________ _
Denmark ___ -----------------------------


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

9
198
50
11

--.5
850
41
78
36

335

4 -------- -------- -----146
2
3
1
35
4
2 -----7 -------- -------- -----3 -------- -------- -----671
6
33
2

34

41
32

261

1 -------- -----4
2 -----1 -----15
20 ------

----------------------- - -- ---

-------- ---------- -------- -------1
-------1 -------- -------13
-------- ---------- -------- -------- ------------- -- ---------- -------- ·------1

4
22
5
3

-------- -------- ---------- -------- -------- --------

2

1
-----------------------------

-------4
9
2
12
79
-------- ---------- ---- -- -- ---- ---- -------- --------------1
2
2 -------- --------------- ---------- -------- -------- -------3
----- --2
7
9

2
8 -------- -------4 -------- -------- --------

21
8
5 -------1 -------26 -------- -------- -------17

.

t:rj

t:d

<!
H

- - - - - - - - - - - - - - - - , - - - - - - - - - - - - - - - - - - ----1----1--- - - - - - - - - - - - - - - - - - - - - United States ___________________________ _

m

2 -------- --------

t:rj

TABLE

9.-Nativity of patients discharged from United Statea marine hospitals and other relief stations during the fiscal year 1931-Contd.
Class o! beneficiary
Seamen,

Group
'rotal

Amor•
ican
sea•
men

U.S.
Missis• Engineer
sippi

For•
eign
sea•
men

River
Com•
mis•
sion

Corps,
and
Army
Trans•
port
Service

U.S.
Em•
U.S.
U.S.
Light· C~t
house Geo- pensa•
tion
Service detic
Survey Com•
mission

P~r:•

U.S.
Public
U.S.
e;:~;, I~Ji. Hea!th
Admin· gration Service, Lepers
istra• Service officers
and emtion
ployees

Miscel·
lane•
ous

- - - - - - - - - - - - - - - ·! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Egypt .•. _.......... ..•.... . . . ....• . .....
England ......•... . . ....•.•.•.•...•......
Finland .......•.•........................
France ........•... ••..........•.. . .....••
Germany._ •. . .•....... . ..•.......•.... ..
Greece ..........••.. . ....................
Holland ...•.....•....•..... . .............
Hungary•...•...•.......•....•....•.•....
Indies, East...•...••....................•
Indies, West. ...•.•.•................•...
Ireland .....•............•.•.....•........
Italy•.........•.............•..........•.
Japan ........ . ......••........•..........
Mexico..•...••......••...................
Norway•..........•...........•..... .....
Poland .....•........•.•..................
Rumania .••......•......................
Russia .......••.•. . ........ •••...........
Scotland ••.......•..........•••.•.•....••
Serbia..•.....•.•.•••.••... . .....••..••.••
South Africa .........•.•...•.....•.••.•.•
Sou th America ..•.•..•..•..•.•••••••••...
Spain ••....••.•.•.••.....••.•.•.•••...•..
Sweden .••..•.•.•.•........•....•.•.....•
Switzerland .. .........................•..
Turkey .•....................•.....•.•...
.All others ....................•...••......

13
584
262
66
764
210
166
26
2
301
564
315
27
85
1,272
216
38
216
307
4
231
423
768
49
43
1,237

271
427
127
6
70
1,074
107
14
130
236
2
21
201
383
646
35
30
826

Total. ....•....•.......••.•....••..

40,060

23,048

29

11
424
232
41
600
182
135
13

1 ••••••••••••••••••••••••••.••.••

34
1
4
26
2
7
1
4
15
17
11
1
62

14
4 ........
9
1 .•.••••. ........
11
4
2
8 ........
9......................
4
.•.•.•.•
1
.......••.......••......•....
.
..
4
25
2
6
12
22 ·--··· ...••••• .......•
3
3 ..••.•.• ••··••··
2 .............. -··· · ··1
1 ........ ........
12 ...... .•...•.. .••..• . .
3
2 .••••• ·•·••••· •••••••• -········· .•••••.• ·•••·•··
········ ...........•............•........•....... ....... ········
2
3
1 ..•... •••.••.. .•.•••..
34
11
5
7 ••.••• .•••.... .......•
39
•........•.•••..............••••••
1
4

109

--------------3
1

2 ••••••••••••••••••••••.••••••••• -·······

1 .•••............ ······-·
31
11 ······· - --······
4
1 ········
5

40

10 ......•.••......

2

4 .•.•••.• ········

6

1 ···•·•·· •···•···
2

6
6

32

11

2

5

53

5 ······-·

11
9
5

8
82
13

2

9 • .., ••••

14

46

2

2

15

4 ··••··

23
1

15

7

2

24

3
30
J
2
3
1 ·•·•····
2
2
2
3
1 .......•
1 .•••••••.•........ ··••·•·· ..•...•.

1 .•....•• -·······

5

2 ••••••••••••••••••••••.•••••••••.•••••••

8

5 •••••••••••••• ••••••••

2 •••••••• ••••••••

4

4 •••••••••••••• ••••••··

7

1 ••.•••.. .••.••..
23
22
1 .•.•.•.. ...... ••.•••.. ........
3
24

71

314

3,762

2

68

57

11

3 ••••••••

9 .•.•..•.
14
2 .............•..
1
2
14
29
956

367

151

6

1
1
3

1
11
3
1
147
2,314

3
5
12
7
7
56

7,891

3 •••••• ·•

1 .•.....•
2 ••••••••
7 ·••·•••• •••••••• •••••• • •

7 ..••.. ···•·•·· ....... .

1

NOTE.-Immigration patients at United States Marine Hospital, Ellis Island, N. Y., not included in this table.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

45
1
7
21
12
3
8
I
7
25

3

1

1 ••··•·•• ...•••..
2

2

2 •••••••• ••••••••••••••••
9

639

~
H

a

1

15 ...•....
1 ········
6 ••••••••••••••.•
24
1
1
2
2
12
50
381

Ul
lzj

56

45

lzj

TABLE

10.-Nativity of patients who died in United States -Marine Hospitals and other relief stations during the fiscal year 1931
Class of beneficiary

Nativity

Total

Amer•
ican
sea•
men

For•
eign
sea•
men

Seamen,
Missis• U.S.
U.S.
sippi
u. s. Coast
Engineer
u. s. U.S. Navy River Corps, Light•
and
Coast Army
and
and
house GeoMarine Com•
Guard
Army Service detic
Corps mis•
Survey
sion transI_>ort
service

u. s.

U.S.
U.S.
Em•
u. s.
Public
ployees Vet•
U.S. Health
Com• erans' Immi• Service
pensa• Admin• gration officers Lepers
tion
istra- Service and
Com•
tion
em·
mission
ployees

Mis•
eel·
lane•
ous

---------------1---- --- --- --- -- --- --- - - - --- --- --- --- ·-- --- -----United States ______ ·-------·--· .• -·-··-··

856

399

Hawaii, Panama, Philippine Islands,
and Porto Rico·-·····---····-··-·----·-

23

17

A ustria .• _. ·- ·-·-·· ·-···-·· ....... ·-· ·-··

Belgium_-···-·-··--·-··············-····
Canada •..•.•.• ·-·-·-·· ..............••..
Central America.··-···-·-·······-·-··-··
China_···-.-·-··-·-·-··--·--- __ ·--·· ___ •.
Denmark __ - --·-·-·-----··-···- ......... .
England •• ··-·-· ···--·---·-·-··--·- .• ·-·.
Finland·--·-·.·--··-· .. ·-·-·-·.·-·-· .... _
France.··-·.·- .•.• ·-·-··---· •. ·-·.···-· __
Germany •• ·--·--·-·--·--···-·---·-·-····
Greece •• ·-·-·-·--·_.···-··--···-····.···Holland •.•• -. ·-·-·- ·- .•.• ·-·-·. ·-···· ·-·.
Hungary .. __ .• ·-· ..•.....• _•.•...•..... _
Indies, West. __ ···--······-···.········-·
Ireland .••.•. -.·--·-·-·-·. ___ .-· __ ·-·-·· ..
Italy·----···--- .• ·-·-·-···---·-·. ___ .·- __
Mexico...... _. ____ .. _...•. _.. __ ... _.. _.. .
Norway_ ... ·-··--.. -· .. ·-··_ •.• ·-_. __ ·--Poland•. _. ·-··-· ·-· ··--·-·-. ····-·-.. ·-·Roumania •••• ·---·-·-·-··-··-···-·-·-· ..
Russia .. ·-·-· •.• ·-·-·-····· ... ·-· ... -···Scotland ............ ·-·· ·-· ··- ·-· .. _. ·-··
South Africa.···-··-···········-·-·-·····
South America•.... ·-·-··········--····-·
Spain •• ·-··· ••.........• _-· ... -····-· ... .
Sweden .• ·-·-···-·-··-·-···-·---····· ... .
Switzerland.....•. _._ .•. _.... __ ........ _.
Turkey •. ········--··-·····--······-·····
All others_··-··-·-···--·-·········-······
Total.·--··-·-·-· •.•.. ·---··-· .. -··.

18

2

2 ···-·-·-

8 -·······

17

347

14

6

2 •••••• ·-···-·· ••••••••

5
4 ·····-·· -··-·-·- ·-·-·- --·-·--· ··--···· ···---···· -····-·- ·····-·· ···-····
1 ·---··-· --·-·-·· ·-·--··· ·-····-·
2 ·-·-···· -······· ·······- ··-·-· ·····-·· .•.....• --·····-·- ···--··· --····-· ···---··
1
1 -·····-· ··-··-·· ····-···
35
28
2 ···--·-- ·-·-·· ····-··- ···-···· -··-···-·· ···-·--- ·-·-···· ·-·--···
3 ·····-·· ·-···-··
1
1
2
1 -······· ·······- ···-·- ··--···· ·-·-···· -········· ··-··-·- -···-··· ·-·-·-·· -··-···- -······· ---·····
1 -····· · 7
6 --······ ........ ---··- ·-·-···· ·-··-··- --···-·-·1 ·-······ ··-·--·· ···-·-·· -······· ···•···· ····--·- ··-···-·
14
11
1 ·-··-· -······· ···-···· ·-·-····-1 ·-·---·- ·---····
1 ···-···· ········ ··-···-- ·-······
30
22 -·····-- ·-····-· ·-·-·· ·····--- ·-·---··
1 -···--·- -··-···· ·····-··
7 ·-····-· -····--· ····-··· ·-····-·
23
19
2 ···-·· ·····-·· ····-··1 ····-··· -·····-· -······· ·-······ ·-······
1 --·- ··-· -·······
8
6 ······-- -······· ·-···· ·····-·· •••••••• -········· •••••••• -······· ······-·
2 --····-- ····-··· -···-·-- ··-·····
18
12
1 ---·-··· .......•••••.. -··-····
1 --···-·· ·······3 ·· · ···-· -·····-· -·--···- ··-····8
8 -----·-· ·····-·· ······ -······· ···-···- -···-···-· ····-··· •..•...• ·······- ·-······ -···-··· -·····-- ·······- -···-· · ·
9
7
1 .•.... -······· -······· -···-····· ····-··· ·····-·· ··-····· ·····--- -····--1 ····-··· -····--·
1

13
25
6

1 ---··--· -·····-· ····-· ........ -·-·-··· ···-·····- ······-· ........................ -·····-· -···---· ........ ······-·

13 ····-··· -·-·····
19 -···-·-· ··-···-·
2 ........
2 -·····-· ··-·-·-·
54
3 .•......

···•·•
··-···
-·····
-···-·
1

-·····-····-·········.....•..
-·······

-·······
-·--····
........
-·····-·
-·······

···-·-···· ····-··· ••··•··• ·······- -·-·····
1
1
1 ······-·
2
····-····· .••••••. ···•···· ······-··-······· ····-·-· ····-··· ······-- ···········-··-··
2 ........ -······· ·····-·-

-···-··· -·-····· -······· ·-····-·
1 ·-······ -···-···
1 -·······
2 --······
........ -···-··1 -·······
-······· -··•···· ······-· ······-·

····-·--

3
60
5
3 •••••••• -······· ··-··· •••••••• -······· •••••••••• ·····-·· •••••••• -·······
2 ····-··· ••.•••.• ·····-·· ••••••••
1 ···•·•·· -·····-· ······-· ···•·· ................ •·•·•····· ·•·•···· ··•····· ········ ...•.... ........
1 ········ -·······

12

9
2
8

9 ······-· .............. ·-··-··· -···-··· ...•...... -······· ........ .•.••...
6
1 .............. --····-· ...•...•.•..••.•.. ·•···•·· ........ ·······-

7 -------- -------- ------ ·----·-14 -------- ---·---- -----· -------26
2 ------ -------1 ·------- -------- -·------ -·---- --·--·-4
4
46
33
1
2 ------ -----·-17

32

1,285

lf1
l:;j

~
H

0

l:;j

2 ---··--· -···-··1 ·····-··
1 ·----·-·
1 -------- --------

2 -------- -------- -··--- -------- -------· ---------- -------- -- - ----- -------- -·-·---- -------- -------- -------- --·-----

733

28

-------- --------·- ------· - ---·---- ----·--- -------1 ---·---- -------- ---·---·
---·----·-···-· -·--·--- -------- -------1 -----·-1 -·-·---·
-·-----1
2 -------- -·-----1 -·-·---- -------- -------- -----·-------·1 --·--··· -·------ -------- -------- -·-·-·-- ---···-- -------- -·-·---·
---·-·-- ----------

2 --------

NOTE.-Immigration patients (19) who died at Ellis Island Marine Hospital are not included.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

33

41

1

5

2

16

23

377

16

23

7

tv

-:i
-:i

278

PUBLIC HEALTH SERVICE
11.-Number of discharged .Amerwan seam,.en admitted 'U.iith specified
diseases or injuries as a major condition during the fiscal year 1931

TABLE

Diseases or condition

Abnormalities and congenital malformations .................•...•••.•.•.•....
Blood !l~d ~lood•forming organs, diseases
and miunes of. ••.•••..............••••
Bones and cartilages, diseases and injur•
ies of. •.....•.•.•......•••••• •·••·•····
Circulatory system, diseases and injuries
of:
Hea:t disea~e, valvular ••.•••..••....
Varicose vems.......••.•.....•....••
All others •.........•.•••.....•.•...•
Communicable and infectious diseases,
not including tuberculosis and venereal:
Conjunctivitis, granular trachoma•
tous ....•.......•......•••••••.....
Dengue ...••.•••••••••••.....••.••••
Influenza .••...••••••••..•.••....•..•
Malaria .......••••••..•..•.••..•.•••
Rheumatic fever, acute .•••.••..•.•••
Typhoid fever .••••••..••••••••••••.•
All others •••.•..••..•.•••••.••..••..
Dental. .............••••... .••··········
Digestive system, diseases and injuries
of:
Appendicitis •.••••.••••••••••••••••.
Gastritis ••••.•..••••.•••.••••••••••.
Hemorrhoids •.•••••.••••••..••.•••..
All others •.•.••..•..••.•••••.•.•...•
Ear, nose, and throat, diseasesandinjur•
ies of:
Deviation, nasal septum ••••••••••••
Otitis media •••••••••••••••••.••••••
Tonsillitis •••..•••••••••.••••••••••••
All others •.......•.•••.•••••••••••••
Endocrines, diseases and injuries of.. ••.•
Eye and adnexa, diseases and injuries of.
Genito-urinary system, diseases and in•
juries of (exclusive of venereal):
Nephritis ••••••••.•••••.••••.•••••••
All others .....••••.•••••.•••••••••••
Hernia .......•........•.••••...•.....•••
Joints and bursae, diseases and injuries
of:
Arthritis ••••••••••••••••••••••••••••
All others •.•.......•••..•••••••••••.
Lymphatic system, diseases and injuries
of:
Lymphadenitis .•.•.•••••.....••••••
All others ••••.••••••.•••••.•..••.••.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Number
discharged

31
46

1,247

171
181
689

4
2
603
207
63
44
427

143
557
191
376
1,059

306
122
1,512
446
153
303
91

931
1,147
383
246

225
24

Diseases or condition

Muscles, Fasciae, tendons, and tendon
sheaths, diseases and injuries oL ••••.•
Nervous system, diseases and injuries of:
Epilepsy without psychosis ....•.•••
N euntis .......•••..•.•••••.•.•......
All others .....•..............•.•....
Obstetric and gynecological conditions ..
Parasiti9 dis~~es:
U ncmanas1s ...•....•........••••••••
All others •..........•....•••.•.••••.
Poisonings and intoxications:
Alcohol (ethyl) poisoning, acute .•...
Alcoholism chronic (without psy•
chosis) •.•..•.•....••••••.••..•.•.•
All others ......•..•.....•.....•••••.
Psychiatric diseases:
Drug addiction without psychosis .••
All others •••.•..........•.•.•••.••••
Respiratory system, diseases and inju•
ries of (exclusive of tuberculosis):
Asthma ..•....•••••.••••..••..•••••.
Bronchitis •••.••••.•.•.••••••••••••.
Pleurisy •••••.......••••••••••••••.•.
Pneumonia ..••..........••.•••.••..
All others •..•••...•..........•.•.•..
Skin and its appendages, diseases and
injuries oL •••••••..•....•••••••.•••••.
Tuberculosis:
Tuberculosis, pulmonary •••••••••.•.
Tuberculosis (otherwise unclassi•
fled) ••••••••••••••••••••••••••••••
Tumors:
Carcinoma ••••••••••••.•.•••••••••••
All others •..•.•••••••••.••..•..••...
Venereal diseases:
Chancroidal infections •••••••••.•••.
Gonococcus infections .•••••••••••...

Number
dis•
charged

639

26
149
280
17
6
69

180
36

62
27
164

108
346
129
307

19
533
705
40

184
230
528

2,324
1,777
26
1
273

~£~!rs •••.••••••• ~ •••••••••••••••
Inoculations .•••••.•••••.•.••••••••••••••
Under observation ••.•••••••••.•••••••••
Miscellaneous:
Cellulitis •••••..•....••...••.••......
All others •.....••...••.••••••..•••.•

1,789

Total. ••••••....•••.•••..•......•.

23,048

i1f

144

DIVISION OF VENEREAL DISEASES
In charge of Asst. Surg. Gen.

TALIAFERRO CLARK

The work of this division during the past year more strongly than ·
ever emphasizes the growing importance of the venereal diseases as
a major public health problem, shows that many research problems
yet remain to be solved, and indicates the increasing menace of
venereal diseases to the health of the body politic.
In addition to cooperating with State and local health departments
in the control of these diseases, disseminating information on their
cause and prevention, carrying on more intensive research, and investigating the incidence and prevalence of syphilis and gonorrhea in a
number of widely separated areas, both rural and urban, it has been
possible for this division to extend more active cooperation to other
divisions of the service and other Federal bureaus and unofficial
agencies in venereal disease work.
SCIENTIFIC RESEARCH

In addition to the clinical and field stu•dies mentioned elsewhere in
this report, important research has been continued along the lines
followed last year, with such modification as the need therefor
developed.
STUDIES AT THE MARINE HOSPITAL, STAPLETON, N. Y.

A large series of latent Wassermann negative luetics have been
studied from the standpoint of potential carriers and, consequently,
disseminators of syphilis. The work with this group has been practically completed and will be made the subject of a special report.
This line of study will be followed by others with representative
cases of other classes of luetics.
The search for an efficient prophylactic method has been continued,
but as yet with inconclusive results. Some correlated work has been
added to this study with the object in view of determining the time
required for the Treponema pallidwm to penetrate the normal
mucosa of the rabbit to a depth sufficient for the organism to escape
the effect of externally applied spirocheticidal agents.
The possibility of extending to rural and remote districts the
advantages to be derived from the early diagnosis of syphilis by
the microscopic examination of serum from the primary lesion has
been worked out. Essentially, it comprises the use of very fine
capillary tubes for the collection of the serum and transportation
in suitable containers to a distant laboratory for microscopic examination. This method has been tested out by other observers and at
present is in operation in the health department of one State and is
under consideration by others.
279


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

280

PUBLIC HEALTH SERVICE

In view of the importance of securing a single spirochete from
indisputable syphilitic material for cultural and animal experimentation, an attempt toward single-cell work with the spirochete has
been made. This study has been made possible by the recent development of a dark field condensor so constructed as to permit the
introduction of a micromanipulator into a film containing the organism. This apparatus holds out the possibility of a study of
cultural methods free from the influence of gross contamination.
Further research on reticulo-endothelial block in relation to the
Wassermann titer in rabbits has been continued with some interesting developments. Unfortunately, it has become necessary to suspend the actual work on animals for the purpose of developing a
block solution which is as free from organic material, especially
proteins, as possible, in order to evaluate the mechanical effect of the
particulate substance uncomplicated by the presence of foreign
protein.
Some biologic work in gonorrhea has been undertaken for the
testing of the therapeutic potency of gonococcus. suspensions previously hydrolyzed at various pH levels. Considerable technical
difficulties have arisen in connection with this study, especially in
the use of indicators suitable for hydrogen ion determination in the
low-acid range.
Plans also have been worked out for study of the use of ultra highfrequency currents in experimental syphilis. Preliminary work
will be conducted along th~ lines of its influence on the course of the
disease in rabbits, the effect of radiation in vitro upon the infectivity
of the organism, and the influence of radiation on the serology
curve.
STUDIES AT CHICAGO, ILL.

The valuable research on the use of biologic products in the
diagnosis and treatment of gonorrhea was continued during the
year at Chicago, Ill., in coop~ration with the scientific staffs of the
John McCormick Institute for Infectious Diseases and the medical
department of the University of Illinois, with the advice and assistance of the consultant staff of Cook County Hospital and the University of Illinois dispensary. It is impracticable at this time to
attempt to anticipate the results of the studies now in progress.
In general these studies are directed along the lines of the biology
of the organism, the preparation of various biologic products, and
the clinical testing of these products. Although a review of the past
20 years in which biologic products have been used in the treatment
of this disease fails to disclose any marked progress in other than the
treatment of the metastatic manifestations of this disease, this fact
should not preclude further work in this field because of the many
avenues of research that have not yet been thoroughly explored.
Studies in the fractioning of the gonotoxin now under way should
lead to some definite knowledge with regard to the therapeutic values
of this toxin, which seems to differ materially from the toxin produced by the diphtheria and tetanus organisms. The effect of thci
various protien elements upon the human being, the refinement of
methods for their extraction, and more complete know ledge of the
factors which influence their production are results which can
reasonably be expected from these studies.


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The extraction of the carbohydrate fraction from gonotoxin and
its use in the diagnosis of gonorrhea through skin reactions has
been widely mentioned in medical literature. It is important that
the merit attributed to the use of this product be investigated by an
impartial group and that accurate clinical data be collected, as is
now being done.
Related studies dealing largely with the refinement of methods for
the extraction of the various protein and carbohydrate fractions from
the toxin are necessary, because of the limited amount of basic work
that has been done along these lines. Unfortunately, this feature
of these studies has been somewhat delayed, but a serious difficulty
has now been overcome and rapid progress may be reasonably
expected.
Other studies now in progress relate principally to the potency of
biologic products treated in various ways and the clinical observation
of their effect. These studies are carefully controlled.
Moreover, studies on the hydrogenion concentration of the renal
excretion during the course of gonorrhea are being carried out with
the object in view of surveying this field for a possible clue to more
intensive investigations.
MALARIA TREATMENT OF NEUROSYPHILIS

As a result of studies, carried on over a period of several yea.rs,
of the principle of specific and nonspecific trea ment of general
paralysis of the insane, Doctor Wagner-J auregg, of Vienna, Austria,
in 1917, inoculated nine cases of general paralysis of the insane with
the parasite of tertian malaria with favorable results. The publication of this experience stimulated world-wide interest in thjs treatment of a previously uniformly fatal disease, with the result that
the Public Health Service has received each year an increasing number of requests for infected material for inoculation purposes. Durjng the year investigations were made in cooperation with the
Scientific Research Division to determine the feasibility of supplying
the infection from a central depot established by the service, studying some of the problems as yet unsolve.d that have arisen in connection with this form of treatment and, incidentally, the treatment of
malaria. Briefly, these activities thus far have been as follows: Infecting mosquitoes by permitting them to bite malaria. patients, to
feed on drawn infected blood, to feed on a suspension of salivary
gland sporozoites; cultural longevity of the parasites in blood drawn
in citrated solution, in relation to the effect of time and manner of
handling in their transportation by mail; cultivating the malaria
parasite in artificial media; investigating the advantages or possible
disadvantages of malaria therapy of the inoculation of blood from
one patient to another; extending research studies to include the
transportation of live mosquitoes in chilled containers, at prevailing
temperatures, both in net cages and in glass containers; and the possibility of the use of material derived from the cultivation of mosquito tissue in artificial media for inoculation purposes.
The importance of these studies is emphasized by the fact that
of approximately 70,000 annual admissions to the hospitals for the
80597-31-19


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insane in this country, something over 11 per cent are cases of general
paralysis of the insane caused by syphilitic infection.
·
Prior to the introduction of this method or treatment the average·
duration of life of a general paralytic after admission to a hospital
was approximately four years. In a recent report submitted by a.
representative of the British ~inistry of Health who has made im-portant contributions to the knowledge of this form of treatment,.
more than 20 per cent of the total cases treated up to 1929 have been.
permitted to return to their homes, and over 12 per cent of them
are con.s idered as cured.
CLINIOAL RESEARCH
COOPERATIVE CLINICAL STUDIES

Important studies of the effect of treatment on early syphilis,.
made last year in cooperation with a special volunteer committee on
clinical research in syphilis, representing five of the leading venereal
disease clinics of the United States, were the continuation of a
previously arranged program. A report on the first of these studies,.
Cutaneous and Mucosal Relapse in Early Syphilis and Its Differentiation from Reinfection, was read by a member of the committee before the International Congress of Dermatology and Syphilology
which met at Copenhagen, Denmark, August 5 to 9, 1930. One of thepractical applications resulting from this study is in connection with
the menace of relapses in early syphilis. It is very generally agreed
that the cutaneous and mucosa! relapses in early syphilis are a
greater danger to the public health than the initial lesion, becausethese lesions are frequently overlooked by the patient and their in-·
fectious character not recognized.
In this study of 5,952 cases of early syphilis it was found that
360, or 6.05 per cent, developed mucocutaneous relapses. Moreover,_
of the relapsed patients, 35 per cent had received less than five doses.
of arsphenamine. Indeed, 81 per cent of relapsing patients had.
received less than 15 arsphenamine injections. These are most important determinations, because one of the major problems in thecontrol of syphilis yet to be solved is the securing of treatment of
early syphilis adequate to render cases permanently noninfectious ..
During the year complete data have been assembled on latent.
syphilis. These data on 2,000 cases have been so arranged as to•
measure the effectiveness of treatment in terms of serological and_
clinical reactions, showing the influence of sex, color, age of the·
patient, and duration of the infection. The complications of
arsenical treatment as well as the treatment failures have been
analyzed, information which should prove most valuable to those·
interested in patients admitted for the treatment of latent syphilis ..
Preliminary work was completed on a paper on cases of cardio-vaiscular syphilis treated in the UniveriSity of Michigan clinic.
These data will serve as a pilot paper to the preparation of a study
of cases of cardiovascular syphilis treated in the five cooperating
clinics.
,
The major expense of these studies was borne ·by a special grantmade by a philanthropist. At a meeting of the cooperative clinical.


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group held in New York City on May 6, 1931, it was resolved that
the cooperative group una.er the Committee on Research in Syphilis
be dissolved as of July 1, 1931, and be reassembled under the same
name, the studies to be carried out under the general direction of
the United States Public Health Service, with the promise of finan•
cial assistance fr:om and in cooperation with a large foundation.
STUDIES AT THE UNITED STATES MARINE HOSPITAL, ELLIS ISLAND, N. Y.

A clinical study of the biologic treatment of the complications
of gonorrhea was carried out at the United States marine hospital,
Ellis Island, N. Y., consisting of observation on the comparative
therapeutic effects of the following: Saline suspensions of gonococcal
vaccine; commercial antigonococcic serum; gonococcal vaccine sensitized with commercial antigonococcic serum; gonococcal-mixed vaccines, that is, gonococcus, staphylococcus albus and aureus, streptococcus, and colon bacilli; gonococcal-mixed vaccines sensitized with
normal human serum; gonococcal-mixed vaccines sensitized with
serum from patients convalescing from gonorrhea; and normal
human serum.
It was clearly demonstrated early in the course of this study that
the effects of these various products on gonorrheal urethritis were
generally disappointing and their use was promptly discontinued.
Moreover, it was soon demonstrated that but two of these -agentsthe mixed vaccine sensitized with commercial antigonococcal serum
and the mixed vaccine sensitized with serum from patients who are
convalescing from gonorrhea-gave promise of therapeutic effect on
the complications of gonorrhea, as epididymitis, prostatitis, arthritis,
and gonorrheal ophthalmia. The use of these products caused a
uniform and marked systemic reaction when injected intravenously,
manifested by chilly sensations, rise in temperature, and relief from
acute pain. In ge:m.eral, the results obtained are quite similar to
those produced by nonspecific protein treatment, such as typhoid
vaccine, milk injections, or similar treatment. The mixed vaccine
plus convales