disinfected, their baggage being again disinfected on the day of sailing. During the period of detention all these persons enjoyed perfect health with the exception of one case of varioloid (the contacts undergoing the measures prescribed by the United States Quarantine Regulations) and six cases of measles among the children.

By an arrangement between the Italian sanitary and emigration authorities all emigrants for foreign countries entering Italy from infected or suspected districts are collected in the Naples detention house. Before being permitted to embark, these emigrants must present an official document signed by the Italian naval officer in charge of the detention house, declaring that the bacteriological examination of the feces showed a negative result.

The presence of an acting assistant surgeon in Sicily, who regularly informs the Naples office concerning the health conditions of the island, which is in close proximity and direct communication with the Levant, is of great advantage in preventing any surprise from that quarter.

SHANGHAI, CHINA.

Acting Asst. Surg. S. A. Ransom reports as follows:

During the fiscal year ended June 30, 1916, the work at this station shows a slight decrease as compared with that done during the corresponding period 1914-15. There were, however, increases in some directions, as will be seen from the accompanying tables.

Disinfection or fumigation of vessels to kill vermin was carried out as heretofore in almost every instance with sulphur gas, generated by the pot method. In one instance, however, a Clayton apparatus installed on the steamship Merionethshire (for controlling fire) was used with remarkably satisfactory results, 72 dead rats having been found distributed throughout the ship at the conclusion of the operation, notwithstanding the fact that the ship was only one year old and this office was assured by the officers that there were no rats in her. This same assurance is frequently forthcoming from officers on any ship fumigated. There were fumigated this year 32 vessels, as compared with 15 last year, which increase is accounted for by the fact that many Japanese and a few other tramp steamers have been put on the run between the Orient and the Pacific coast to replace the tonnage taken off by the Pacific mail and by reason

of the war. In addition to the above there were fumigated with sulphur 348 lighters used for conveyance of cargo to ships bound for American ports.

Decreases were noted in the following items: In crew carried, 3,595; in passengers carried, 3,215; in number of persons bathed, 143; in packages of freight carried, 165,144; in pieces of freight disinfected, 791; all of which may be accounted for by the lack of tonnage available.

The number of bills of health issued decreased by four only, showing that it was more a lack of size than in the number of ships clearing from here which was accountable for the decreases above referred to.

No vaccination certificates were issued during the year by reason of the fact that the incidence of smallpox in Shanghai was so low that it was not thought necessary to enforce vaccination among the personnel of various vessels taking bills of health from this office.

During the period under consideration there were investigated 12 cases of illness which occurred on vessels taking bills of health from this office. One case of leprosy was reported as occurring in the person of a Chinese member of the crew of the U. S. gunboat Samar. There was also one case of typhus fever on the U. S. S. Brooklyn in June.

The inspection of cargo destined for United States ports and the disinfection and certification of same where necessary, including particularly bristles, human and animal hair, hides, and second-hand personal and household effects, has continued throughout the year as heretofore, and all cargo destined for American ports has been passed upon by this office before the same is loaded upon lighters to be conveyed to ships. Considerable uncertainty has arisen with regard to the treatment to be required for shipments of hides, owing to sudden changes as to the disinfection required, put into force at ports of arrival, particularly New York. It has heretofore been the rule, under instructions from the State Department, to pass without disinfection all hard sun-dried cowhides. Early in the year, however, information was received here through shippers that various consignments of this class of cargo accompanied by properly authenticated certificates had been refused entry at New York because of lack of disinfection. No official information of this action, or of the reason therefor, or of any change in the requirements was received here until about six weeks later, when it was learned that all cowhides of whatever description were to be disinfected with 1 to 1,000 solution of bichloride of mercury. This process has since been carried out.

There still seems to be no adequate measures provided for the prevention of the entry of anthrax, riderpest, foot-and-mouth disease, etc., into the United States through sheepskins, deerskins, goatskins, wool, etc.

Vessels bound for United States are, during their stay here, required to lie in stream to prevent rat invasion; to use ratguards on lines to all lighters (which latter are periodically fumigated), and to undergo general fumigation when empty. Loading by daylight is required as far as practicable. The total number of lighters fumigated between July 1, 1915, and June 30, 1916, was 348, and 138 dead rats were found upon completion of the treatment.

The

2

In this connection it may be stated that the Shanghai Disinfecting Co. has just completed a new floating disinfecting plant. boat is constructed of steel, is 98 feet in length by 20 feet beam, and draws 4 feet of water. She has a house which provides a pilot house, an office, an electric light plant, a plant for generating SO2 and another for CO, gas, with an experimental chamber to test on rats the toxicity of the gas being pumped into the space to be disinfected. In the middle of this house is provision for shower baths for about 30 men at a time, warm water being supplied from steamheated tanks overhead. Clothing removed by bathers is sent down a chute to the infected end of the boat and then disinfected in the jacketed steam chamber before delivery to their owners, who after bathing are sent below to a clean space into which the disinfecting chamber opens. This space has 11 feet head room and ample air ports and is fitted with removable bunks to accommodate 65 men for sleeping in case it is necessary for them to remain on the disinfector over night because of the fumigation of their quarters.

Many of the details for the construction of this plant were supplied by this office, and the plant has its approval as generally efficient. Vessels and personnel from Shanghai destined to American, Philippine, and Canal Zone ports are inspected as near as possible to the hour of sailing, and bills of health issued at the time of inspection. The health of the settlement, with regard to minor contagious diseases, remains about the same as during the previous year.

Smallpox showed a decided decrease during the year just closed, there being reported but 5 cases among foreigners and 4 deaths among natives, as compared with 59 and 182 last year.

Plague was responsible for the death of 1 native during the year just closed, as compared with 16 in 1914-15. This death occurred in the month of October.

Cholera was entirely absent from the mortality report for the year 1915-16.

There were 10 cases of tuberculosis reported among foreigners and 977 deaths from that disease among natives.

Dysentery showed an increase among foreigners from 80 to 110 cases. There was a decrease of 6 deaths from this disease among natives.

Rat plague continues to appear sporadically. Between November and May, out of 12,925 examined 7 rodents were found to be infected. Leprosy, typhus fever, relapsing fever, beriberi, rabies and diarrheal disease continue present as heretofore. During the fall of 1915 rinderpest and foot-and-mouth disease were very prevalent in this settlement and, as far as can be learned, throughout China. The municipal veterinarian advises that these diseases are never entirely absent. There were also said to have been a few cases of anthrax among horses and cattle in this settlement.

Table No. 2 appended shows the morbidity among foreigners and mortality among Chinese, as reported to the local health department. There continues to be no requirement compelling the report of contagious disease.

The water supply of Shanghai and for the shipping is secured, as heretofore, from the Whangpoo River, below the settlement. This water in its original state is very muddy and contains quantities of sewage. The impurities are removed to a large extent by means of

sedimentation and sand filtration, which renders the water usually clear and fairly free of bacteria. Bacilli of the colon group are, however, usually found present in 1 cubic centimeter quantities of water. This content fluctuates, however, with greater demand for water, when the process of filtration is possibly less thorough than when smaller quantities of water are required.

MEXICAN PORTS.

PROGRESO, MEXICO.

Acting Asst. Surg. H. E. Gimler reports as follows: There were 146 vessels examined, 87 being fumigated before departure.

PUERTO MEXICO, MEXICO.

Acting Asst. Surg. G. McG. Stewart reports as follows: The activities of the service representative at Puerto Mexico, Mexico, dated from April 29, 1916, upon his return from a sanitary inspection of the Tabasquenia and Filisola fruit plantations on the Uspanapa River, this being a special duty ordered by the Surgeon General. He was compelled to leave his post of duty, along with practically all other Americans, on June 21, 1916, because of the hostile attitude of the Mexican authorities and people.

During the period April 29 to June 21 there were the following quarantine transactions:

During the period stated the medical officer kept a close watch for the appearance of any quarantinable diseases in Puerto Mexico and its vicinity and, with the exception of smallpox, was unable to detect evidence that any other existed. The records of the civil judge were investigated weekly, the Federal health officer was interviewed weekly, any rumors relative to sanitary conditions were given ear to, and numerous persons known to the medical officer were consulted upon this subject, either directly or indirectly

TAMPICO, MEXICO.

Acting Asst. Surg. Oscar J. Mayer reports as follows:

The number of vessels clearing from the port of Tampico for United States ports during the three months of April, May, and June of the 1916 quarantine season embraced 7 passenger ships and 164 oil tankers and oil barges. One thousand nine hundred and fortyeight passengers, including over 1,200 refugees and 4,204 members of crew, were inspected. Eighty-five ships were fumigated with sulphur dioxide.

The extraordinary political conditions of the country have had some effect on the economic conditions of this port. Absolute shortage of food supplies, prevailing high prices, in many instances amounting to over 200 and 300 per cent increases, have had their

influence on public health, especially in the increase of gastro-intestinal disorders. The still prevailing old nomenclature of diagnosis and consequent classification of deaths do not always give a correct idea of health statistics, and the irregular, semiofficial notices, difficult to obtain from the local authorities on death rates and the causes of deaths, are somewhat confusing as well as misleading, giving cause to suspicions of attempts at concealment, even if such is not intended.

TUXPAM, MEXICO.

Acting Asst. Surg. L. M. Taylor reports as follows:

Health and sanitary conditions obtaining at the town of Tuxpam, 10 miles up the river from the shipping port, are most deplorable. No effort is made to clean the place except by the aid of a few prisoners unfit for military service.

A number of native medical men have been driven out on account of political opinions; the place is at present headquarters of the military commander of the State and concentrating point for a large body of diseased troops; shortage of food and almost no drug or surgical supplies; appalling indifference of the inhabitants toward their physical welfare and their apparent utter hopelessness are some of the conditions that have contributed to the present state of filth, disease, and abandonment.

Statistics as taken from the civil records and private sources of information are appended below. Infant mortality is very great and is not included therein. Several cases have been reported as being possibly yellow fever, but upon personal bedside investigation the suspicion in each case was proven unfounded.

Principal causes of death January 1-July 1, 1916.

In reviewing conditions at the port of Tuxpam a distinct difference should be made between the town proper and the shipping point. The latter is situated at the mouth of the river on two large islands owned by the companies exporting oil, at which place every effort is made to maintain a high standard of health.

On each island a gang of men is constantly employed to clean up, cut weeds, lime the few remaining cesspools, and frequently change their location, open drainage ditches, and wage warfare on the land crabs. A guard established last year during the smallpox epidemic has been made a permanent feature. The coconut grove has been further depleted this year, tank farms have been drained, dykes built to prevent high tide from overflowing the swamps, and it is proposed to fill in the latter with sand dredged from the river. A large area has been cleared of underbrush and a sewerage system has recently been completed. The population is 1,600. Diseases, principally malaria and dysentery. Only one case of typhoid and no smallpox has appeared during the period covered by this report, January 1 to July 1, 1916.

63887°-H. Doc. 1493, 64-2-13