SAN FRANCISCO, CAL.

During the fiscal year ending June 30, 1915, 16,956 immigrants were inspected by the medical officers of this station, this number representing practically the same amount of work as that performed last year. To be exact, there were 34 more this year than during the fiscal year 1914. Of this number, 7,316 were brought from the vessels upon which they arrived to the hospital on Angel Island for more extended examination, and of the number thus brought 1,080 were certified to the Commissioner of Immigration as being afflicted with some condition which, under the provisions of the immigration law, should be brought to his attention. This list includes 128 different affections, and ranges all the way from practically unimportant diseases, such, for instance, as pterygium, to dropsical beriberi, resulting in death.

The large number of persons undergoing hospital examination is attributable to the same routine as obtained last year, namely, that of detaining practically all second and third cabin aliens until a microscopical examination to determine the presence or absence of hookworm ova could be made. There have been a few exceptions made to this rule if unusual circumstances seemed, in the medical officers opinion, to justify such exceptions.

The smaller number of medical certificates issued this year, in comparison to the number in 1914, is partially due to the decreased number of persons certified as having uncinoriasis, there being 124 fewer cases of this disease during 1915, and this falling off is doubtless due to more efficient examination previous to embarkation, as the transportation companies continue to demand a hookworm-free certificate before selling the applicant a steamship ticket. Notwithstanding this decrease in numbers, the fact that 486 aliens were found to be infected with this disease upon arrival at this port establishes beyond question the necessity for the continuance of microscopical examination to determine the possible presence of this condition and illustrates the error that would result if hookworm-free certificates were accepted here at their face value.

The Pacific Mail Steamship Co. has discontinued the practice of treating hookworm disease on board their vessels en route to San Francisco from Hongkong and has thereby eliminated the necessity, which existed last year, for the application of a fine against the company provided the recipients of hookworm treatment were not cured upon their arrival at this port.

The greater number of certificates issued this year for trachoma— more than double the number issued in 1914-is attributable to two reasons, first, due to the presence of an additional medical officer for a portion of the year; the medical division was, during that time, enabled to examine the crews of all incoming vessels, a procedure which had hitherto been impossible and which resulted in the detection and certification of 46 cases of this disease among crew men; and second, the different system in vogue of examining departing aliens at the port of Hongkong, such examinations being now, according to statements received, taken out of the hands of the steamship surgeons. More venereal disease has been found this year than last, but, on the other hand, a smaller number of cases of pulmonary tuberculosis have been detected.

Generally speaking, the work of the medical division has run smoothly, and from a strictly medical standpoint the percentage of recoveries among those ill in hospital has been very gratifying. The hospital has at times been unduly crowded and its resources taxed beyond its physical limits. At this time it is reported that there are aliens detained in the detention sheds who are certified for some condition and who must pass through the hospital before finally landing, which fact illustrates that the station should be equipped with hospital facilities of sufficient size to handle without delay the maximum business of the station.

DOMESTIC (INTERSTATE) QUARANTINE.

Plague-suppressive measures were instituted at New Orleans on July 6, 1914. From the date of the recognition of the disease, June 27, 1914, to the end of the present fiscal year, 30 human and 244 rodent cases were diagnosed. The importance of the outbreak, the first in the history of the Atlantic seaboard, can only be estimated by those familiar with every aspect of the disease. Measures for the control of the disease have been continued throughout the year. At San Francisco and its environs, and at Seattle, Wash., plague-preventive measures have been conducted along the lines developed in former years. Rocky Mountain spotted fever, a disease peculiar to the Northwest, has been combatted in the Bitter Root Valley, where it is most virulent. Surveys to determine the prevalence of the infection, which is of great economic importance, have disclosed the fact that it is much more widespread than is commonly supposed. The interstate quarantine regulations and the amendments thereto, two of which were promulgated during the year, have been enforced, as in previous years. Revision of the existing regulations is now under way. The sanitary and relief work in Alaska, performed in cooperation with the Bureau of Education, has been continued. In compliance with Executive order, all Government buildings in the District of Columbia have been regularly inspected. An extensive exhibit has been installed at the Panama-Pacific International Exposition, and the sanitation of the buildings and grounds of the exposition, together with the care of sick and injured, has also devolved upon this division.

PLAGUE-SUPPRESSIVE MEASURES IN NEW ORLEANS.

The presence of bubonic plague in New Orleans was first officially made known to the public June 27, 1914. On this date Dr. Oscar Dowling, president of the Louisiana State Board of Health, sent a telegram to the Surgeon General, stating that Dr. W. T. O'Reilly, superintendent of public health, had reported one case of human plague. Acting upon this information, the Surgeon General proceeded to New Orleans, arriving July 1, 1914. An investigation was made, and the diagnosis of plague received service confirmation.

In response to requests from many organizations, the city board of health, and the State board of health, Surg. Gen. Blue was placed in charge of eradicative measures by the Secretary of the Treasury, and plans were consummated for the service to assume charge of the situation, with the cooperation and aid of the city and State authorities. On July 3, 1914, Asst. Surg. Gen. W. C. Rucker was ordered to New Orleans to take charge of the service forces, and shortly after his arrival the Surgeon General returned to Washington.

The service assumed charge of eradicative work on July 6, 1914. Additional officers were ordered to New Orleans, headquarters were secured, and a definite plan of campaign mapped out.

The service operations were conducted by Asst. Surg. Gen. Rucker up to December 18, 1914, when he was succeeded by Surg. G. M. Corput. Surg. Corput was relieved by Surg. R. H. Creel on March 17, 1915, who remained in charge until the end of the fiscal year.

INCEPTION OF THE EPIDEMIC.

When and how plague entered New Orleans is a matter of conjecture. Ships arrive at New Orleans from Cuba, Liverpool, and the Canary Islands, all known to have been infected at one time or another at comparatively recent dates.

The water front conditions of New Orleans were such that rodent infection could have been introduced, and for a limited period of time remain confined to the wharves till a rise of the river would drive the rats inland and across the city. The rapid extension of the infection into "clean" areas of the city during August and September rather militated against any probability that the infection had been present, though quiescent, for a long period of time.

The first case of human plague in New Orleans officially recognized was that of C. L., who died in the Charity Hospital on June 28, 1914. The onset of illness in this case was not definitely determined, but is recorded as occurring on the 19th of June. However, previous to this case an autopsy was performed, June 17, 1914, in the Charity Hospital, on the body of T. B., a young white man, 18 years of age, who had died of symptoms highly suggestive of bubonic plague. The onset of symptoms in this case dated back to June 13, and while it was never officially recognized as plague, the fact that he worked in the plague-infected district, at South Peters and Commerce Streets, together with the symptoms and autopsy findings, makes it rather certain that this was a case of plague. That there might have been earlier unrecognized cases of plague in New Orleans is open to speculation, since the case of T. B. would probably have gone unrecognized had an autopsy not been performed.

The second case of bubonic plague, officially recognized as such, occurred in the person of a fellow employee of C. L. This second case of plague was R. W. W., who sickened on June 26, and was confirmed as plague on June 29. He ultimately recovered. Both R. W. W. and C. L. lived in a large rooming house, 713 St. Joseph Street, managed by the "Volunteers of America." They lived on separate floors, in rooms quite distant one from the other. Both men, however, worked in a stable at 424 Notre Dame. This building was used in part as a stable and part as a storage warehouse for paper and rags collected by the benevolent association known as the "Volunteers of America." R. W. W. worked as a hostler and C. L. was employed about the place for the purpose of assorting the paper and rags. No infected rats were ever found at 713 St. Joseph nor evidence of infection at that place. While the infection was not actually demonstrated to exist at 424 Notre Dame, a large number of mummified carcasses was found in the place upon the removal of the floor. The building of 424 Notre Dame was located some three

or four blocks from the river, being nearer the wharves of the United Fruit Co. than to any other river-front property.

The epidemic progressed, human cases occurring at intervals until the 1st of October, the last human case being that of C. Y., a Chinaman, who sickened on September 30 and died on October 4. Thirty cases in all were recorded, 20 recovering and 10 dying. Table 1 gives a résumé of the various facts pertaining to human cases. The hospitalization and treatment of the cases was attended to by the city board of health.

Rodent plague was not discovered until several thousand rats had been examined. In the first week after the assumption of eradicative measures by the service a plague-infected rat was trapped, on July 11, at 1914 Magazine Street. The diagnosis of this rodent case was confirmed on July 16, on which date two other rodents, captured on July 12, were likewise proven positive.