regulations, he so reports, and a certificate to that effect is issued to the vessel. In addition to these fumigations, the bills of health of some vessels recommend fumigation at the United States port of arrival, either on arriving at quarantine, on account of a violation of the regulations at Habana, or when empty, which means that the vessel had complied with the regulations here, except that the 30-day limit for fumigation had passed; and as the vessel was in transit with cargo (and possibly passengers), it was not advisable to fumigate it here, on account of the quantity or nature of the cargo. Many of these vessels were regular line steamers, with Habana as an intermediate port, where they stopped only a few hours, at most one day, and a fumigation here would seriously have affected their schedules. Permits for embarking crated fruit and other merchandise liable to harbor rats were issued after inspection throughout the fiscal year. Most of these permits were for fruit, especially pineapples, but_in this class was included also furniture, household goods, and other merchandise. Permits issued in 1915-16- Increase 2,938 2,904 34 These permits were for "lots," not for "pieces." Sometimes several thousand crates were included in one permit. When the merchandise required more than one lighter to take it alongside the steamer, the regular permit went with the first lighter, and each additional lighter received another and smaller permit. The driver of each wagon taking crated fruit, or other merchandise liable to harbor rats, that had been packed in the city in the presence of an inspector, received a small permit to take to the inspector on duty at the wharf where the merchandise was to be embarked, so that he would allow it to pass as soon as the large permit was presented, properly filled out for his approval. Inspection of railroad cars for shipping loaded to the United States was begun in February, 1915, and has continued steadily. In the present fiscal year it has reached the limit that the ferryboat Henry M. Flagler can carry. Its capacity is from 28 to 32 cars, according to their size. Railroad cars inspected in the 12 months ended June 30, 1916- Increase 5, 419 1, 492 3, 927 Of the sick and disabled seamen attended during the fiscal year, 9 were sent to a hospital and 26 were treated at the office or on board, making a total of 35 men attended to on American vessels. Some foreign seamen also were treated. PERSONNEL. On July 1, 1915, the personnel of this office included Acting Asst. Surg. Richard Wilson, in charge, Acting Asst. Surg. I. P. Agostini, and nine sanitary guards and inspectors. In compliance with department orders dated May 12, 1916, Surg. G. M. Guiteras came to Habana to inspect and report on sanitary conditions and to recommend changes in the regulations. He arrived on May 12 and, after completing the inspection, he returned to his station at Key West on May 26. During the early part of the fiscal year the quarantine office was moved from the previous location to quarters in the new Machina Building, which is used for administration purposes by the Cuban immigration and customs authorities. A large room has been set aside for the use of the United States Public Health Service through the courtesy of Dr. Frank Menocal, commissioner of immigration. 66 THE FERRYBOAT HENRY M. FLAGLER," ITS WHARF AND ENVIRONMENTS. In the last annual report considerable space was devoted to the steamship Henry M. Flagler and the arsenal wharf, where it ties up. The immediate surroundings of the wharf were then in very bad condition, being in great part newly filled ground. These have been improved gradually and are now in good condition, but the wharf is still situated between the San Jose wharf and the city dump-two rat-infested places. The ferryboat, which was an experiment last year, is a success this year. It has given such general satisfaction that a second ferryboat is being built, and a new wharf and a slip will be built in Regla. The place has been surveyed, but actual work has not yet begun. RESTRICTIONS AGAINST PASSENGERS FROM MEXICO. * * * The bureau, in its letter dated June 8, 1916, having directed that * * * "no passenger in transit from Mexico will be permitted to sail for a port in the United States south of the southern boundary of Maryland except such passenger shall have been six days from port of departure before arrival at a United States port," circular letters were issued to the agents of vessels that go to the southern ports of the United States and to those that bring passengers from Mexico to Habana giving instructions so that this provision would be enforced. This was begun on June 17. TRANSMISSIBLE DISEASES. In the last annual report mention was made that the quantity of water supplied to Habana by the Vento Springs was inadequate for the needs of a city as large as Habana had grown to be and that, to make up the quantity, water was taken from the Alemendares River, which was and still is very foul, and mixed with the Vento water. The result of this was evident in the increase in typhoid fever. During the present fiscal year this was discontinued, but the typhoid fever remained. Recently, on account of the retardation of the rainy season, the Vento water again became insufficient and again the Alemendares River has been used. Typhoid fever heads the list of communicable diseases during the past year with 400 cases, including 70 deaths. Of paratyphoid fever there were 41 cases, with 8 deaths. Diphtheria comes next with 308 cases, including 19 deaths. This shows a decided increase in the second semester. Measles and varicella occurred in the first semester, and with a very large increase in the second, giving a total for the year of 253 and 135, respectively. There were only 2 deaths from measles and none from varicella. Particularly deserving notice is a small epidemic of cerebrospinal meningitis in the second semester. There were 19 cases, including 16 deaths. This disease was almost unknown in Habana. In spite of these diseases the condition of Habana is good. The streets are in fairly good condition and are swept daily. The garbage is removed every night. There were 98 cases of malaria, with 5 deaths. All the cases were traced to the interior of the island. The number of cases of leprosy during the fiscal year varied from 240 to 250. Practically all of these were confined in the asylum at Habana, where they are sent from all over the island. BUBONIC PLAGUE. The beginning of this fiscal year saw the end of the third outbreak of bubonic plague in Habana. "On July 1, 1915, there remained three cases under treatment, convalescing. Two of these had been brought from Guanabacoa as soon as the diagnosis was made. All three recovered. On August 14, 1915, a man was taken sick with what was declared bubonic plague. The committee on infectious diseases saw him three times, the last time being August 27, when it was decided that the case was not plague. The last case of plague in Habana was confirmed July 5, 1915, and was discharged cured on July 19. He was one of those brought from Guanabacoa. After this date no more cases were reported in the island. No rat plague was reported. Although no plague was reported during the fiscal year the precautions were continued by this office. The local regulations of February 17, 1915, were enforced on vessels bound for the United States. The inspection of passengers for the United States was discontinued during the tourist season because it put an unnecessary hardship on them. In the end of May, 1916, the bureau revised the local outgoing quarantine regulations on account of plague, making them a little more severe. These were put into effect on June 7, 1916. These will be given in detail in another section. The Cuban sanitary department has continued the work of deratization throughout the fiscal year. The total number of rats caught was 56,045; the total number examined was 25.823. No plague-infected rat was found. For details of this work see Table No. 6, inclosure No. 2. The last plague-infected rat in Habana was found May 12, 1915. 66 SPECIAL REGULATIONS FOR THE S. S. HENRY M. FLAGLER." HABANA, CUBA, October 1, 1915. 1. All cars bound for the United States must be inspected before being put on board the steamship Henry M. Flagler. 2. As soon as inspected and passed, the cars will be closed, and the inspector will seal them. 3. All cars must be mechanically clean, whether empty or loaded. 4. Empty cars will not be allowed to go with straw, paper, or other waste packing material strewn in it. All this must be removed and the car must be swept clean. 5. No loaded car will be allowed to be put on board if the doors can not be closed properly or if the doors or any other parts are broken so as to permit the entrance of rats under favorable circumstances. 6. Empty cars in more or less damaged condition may be allowed to be embarked if they are clean and both doors are left wide open. Such cars must not be sealed. 7. Cars suspected of harboring rats will be unpacked and repacked in the presence of the inspector, or fumigated, according to circumstances. If fumigated, the material required will be supplied by the owner or the shipper of the merchandise, and in the absence of these by the transportation company. 8. Rat-proof cars coming from the interior of Cuba and not opened in Habana will be inspected and sealed at once. 9. The cargo put on board cars in Habana will be inspected for rats prior to loading, and if suspected of harboring rats will be (a) rejected; (b) unpacked and repacked in the presence of the inspector; (c) fumigated. 10. The cars to be inspected must be placed in a convenient place in the yards. 11. No car will be put on the ferryboat until it has been passed and sealed by the inspector. In case this rule is violated the inspector will refuse to seal such cars until they are put on land, where they must remain sufficiently long enough to enable him to do his work properly. 12. The inspector is directed to use the greatest care and attention in carrying out the above instructions, remembering that the prime object of his work is to prevent the possibility of rats being carried on the cars bound for the United States. 13. The officers and employees of the transportation companies are requested to give the inspector every possible assistance, bearing in mind that delay in inspection may mean retardation of the departure of the steamer. 14. These regulations replace all others heretofore issued. To the agents and consignees, etc.: (Signed) CIRCULAR LETTER. RICHARD WILSON, Acting Assistant Surgeon. HABANA, CUBA, June 1, 1916. The quarantine regulations for vessels leaving this port for points in the United States or its dependencies, issued under date of February 17, 1915, are hereby amended to read as follows: Quarantine regulations to be observed at the port of Habana by vessels bound for the United States ports. 1. All vessels must take the following precautions to prevent the ingress of rats: (a) Metallic rat guards not less than 3 feet in diameter must be used on all lines between the vessel and the wharf. (b) Vessels must fend off 8 feet from the wharf. (c) All planks and gangways must be removed at night, unless cargo is being shifted. (d) Lighters operating at wharf must be supplied with rat guards as above. 2. (a) Every vessel leaving Habana for United States ports must have been fumigated at least once within the 30 days preceding date of sailing, preferably when empty and at the port of Habana. (b) A duly executed certificate of fumigation from an officer of the United States Public Health Service, certifying that the vessel has been fumigated within one month prior to sailing will be accepted as evidence that the above provision has been complied with. No other certificate of fumigation will be accepted for this purpose. (c) The ferryboat Henry M. Flagler, on account of its rat-proof structure, will not require fumigation, but the cars carried on it will be inspected before loading and fumigated if necessary. Cars coming from outside of Habana direct to ship's side will be sealed without inspection. 3. Cargo liable to be rat infested must be inspected before embarkation. After inspection, it must not lie over night on the wharf unless placed within a rat-proof compound. 4. Loaded lighters, unless immediately towed to the steamers, must be pulled off 25 yards from the wharf without connecting lines to the wharf. 5. These regulations supersede all previous ones, which are hereby annulled. RICHARD WILSON, Acting Assistant Surgeon. (Signed) OPERATIONS OF THE SERVICE AT HONGKONG. Passed Asst. Surg. C. M. Fauntleroy, in charge, reports as follows: Bills of health were issued to 342 vessels carrying 5,971 cabin passengers, 11,999 steerage, and 29,951 crew. Eighty-nine vessels were fumigated under supervision of the service, and 256 rats were found dead after fumigations. During the year 253 vessels sailed for ports in the United States and the Philippine Islands without undergoing fumigation. The colonial government reports a total of 109,690 rats caught and 79 found to be plague infected. Acting Asst. Surg. W. J. S. Stewart reports as follows: This station is situated in the city of La Guaira, which lies within the confines of the Distrito Federal and which comprises three towns, one La Guaira proper and very old, being one of the first settlements made by the Spanish; Maiquitia, which lies on the railway connecting La Guaira and Caracas, distant about 1 mile; and the town or watering place of Venezuela, by name Macuto, also connected by electric railway with La Guaira itself. The last-named place is extremely pretty but damp and mosquito infested. It is by no means as healthful as Maiquitia and La Guaira, which for the greater part of the year are swept fairly clean by trade winds and kept freer from mosquitoes. The wharf is at La Guaira and so is the long breakwater pier (cement), where all foreign ships dock. The climate of La Guaira is hot and dry but, from the low humidity, the heat is not nearly so oppressive as in some places of higher latitude. There are a considerable number of transients in Macuto at the season of the year when the weather becomes cool in Caracas. The average calculated population is about 11,000 to 12,000. No one knows exactly, as there is no way of finding out, taking a census being out of the question. There is no way of ascertaining births or sickness or deaths amongst the poorest of the peon class. Some years ago when bubonic plague was in this port, as well as yellow fever, the conditions were apparently ideal in many ways for the spread of the disease and yet, for some reason, this did not occur. The city is plentifully supplied with rodents at present, dead rats lying in the street awaiting the scavenger cart being a common sight. All steamers come to the breakwater pier. This pier will accommodate three steamers of 500 feet and the most seaward of the three berths has a depth sufficient for any steamers that are likely to arrive for a long time to come As regards passenger service, La Guaira and Caracas are well served. One can go to New York via Colon, or direct by the Red |