All vessels loading oil at the port remain in absolute quarantine; they are loaded slightly over 1 mile at sea through pipe lines; there is no communication with ship except by power surf boats owned by the loading companies, and it has been made a fixed rule to allow no member of crew or officer to come ashore. The service officer, in addition to his duties of inspecting the crews and fumigating all ships bound for southern ports, is employed by the companies to superintend the sanitation of the port as far possible in view of the intolerable conditions existing in Mexico.

Twenty-three vessels have been disinfected to date.

VERA CRUZ, MEXICO.

Acting Asst. Surg. L. B. Cooke reports as follows:

On account of the disruption of passenger service between southern ports of the United States and Mexico, service representative assigned to the port of Vera Cruz was delayed in reaching his post until April 29.

Upon arrival there he found conditions very unsatisfactory, sewage being inefficiently disposed of, the water supply inadequate, and the enforcement of sanitary measures in the hands of the military, who were apathetic toward all foreign interests.

Under these circumstances the service representative found it quite impossible to interest the local health authorities in the improvement of sanitation or in the erection of barriers for the purpose of preventing contagion from Mexico reaching the United States. Thus efforts looking toward the establishment of a station for the disinfection of passengers and their effects bound for the United States and suspected of harboring typhus carrying pediculi came to naught.

In order to avoid any danger from this source arrangements were made with the local steamship agencies by which all intermediate and steerage passengers for the United States were required to present themselves, and, if thought necessary, their baggage and effects also, for examination by the service representative previous to embarkation, and in case pediculi vestimenti were found they were refused passage.

With the advent of the rainy season no campaign was inaugurated directed toward draining storm sewers and gutters, oiling collections of water, or screening cisterns. With a considerable per cent of the population consisting of nonimmunes from the interior, and with more or less travel between Vera Cruz and other southern ports of Mexico, it would seem that an outbreak of yellow fever should not cause great surprise at any time. To prevent the infection reaching the United States, strict inspection of passengers and crews and the fumigation of vessels against mosquitoes was carried out.

The comparatively small number of deaths from smallpox occurring in Vera Cruz during the period April 29 to June 30, 1916, caused the service representative to consider it not necessary to institute any extra precautions against its introduction into the United States.

During the period between April 29, 1916, and June 30, 1916, 19 vessels were inspected, 2 vessels (naval vessels) were issued bills of health without inspection and 5 were fumigated for destruction of mosquitoes. There were 1,691 passengers and 1,291 crew inspected, no case of quarantinable or contagious disease being discovered.

At the time this report was made the political situation in Mexico was extremely critical, all Americans for the second time within a week being advised and strongly urged by the Secretary of State to leave Mexico at once. This was being done with expedition and it seemed that in a short time but few Americans would be left in the Republic. During this exodus it was impossible for the service representatives to inspect all refugees but, with the naval surgeon in charge, he saw some 312 refugees aboard the U. S. S. Nebraska, where one case of smallpox was discovered, which was promptly put ashore. No further cases appeared.

Mortality report of Vera Cruz, Mexico, from April 29 to June 30, 1916.

During the fiscal year ended June 30, 1916, there were examined by medical officers of the United States Public Health Service 481,270 immigrants, for the purpose of detecting physical or mental defects, when present, that would operate to the exclusion of the alien, in accordance with the United States immigration laws.

This number of aliens examined, as compared with 562,263 for the previous year, shows a reduction of 80,993. The number certified for physical or mental disabilities was 16,327, in contrast to 17,480 so certified during the preceding year.

The number of officers assigned to medical inspection has fluctuated during the year, but on an average 90 officers were exclusively engaged in this duty. Immigration examination, however, was performed to a greater or less degree by many service officers stationed at marine hospitals and quarantine stations.

Several officers stationed at consulates in foreign ports conducted examinations of intending immigrants. This procedure does not contemplate the issuance of a certificate, nor does it prevent the embarkation of the alien examined, even though he is found to be defective. It affords opportunity, however, for information from the medical examiner to the intending immigrant and to the steamship agent as to any defect that may operate to prevent the admission of such alien into the United States. To a very considerable extent this examination of aliens desirous of coming to America prevents loss of time and money to a number of them whose physical or mental condition would render them excludable as immigrants. A medical

officer stationed in a foreign port, therefore, acts merely in an advisory capacity, the official certification of deportable defects being made by service officers assigned to immigration stations in the United States, its possessions, and dependencies.

A marked reduction of immigration during the past two years has afforded opportunity to medical officers to conduct a more intensive examination of the mentality of arriving aliens. The increased efficiency in detecting mental defectives is shown by a comparison of the percentages of this class of cases during the past four years.

At the port of New York in 1913 the number of aliens certified as mentally defective was 50.8 per 100,000; in 1914, 96 per 100,000; in 1915, 135 per 100,000, and in 1916, 118 per 100,000. The chief medical officer at Ellis Island is of the opinion that the reduction in mentally defectives detected during 1916 was due to restricted immigration from certain countries in Europe, chiefly by reason of the European war. The generally increased proportion of mentally defective aliens certified, however, can not be attributed entirely to such temporary conditions as a diminution in the bulk of immigration and the relative increase in medical examiners. The policy of assigning to medical inspection an increasing proportion of officers specially trained in psychiatry has been a big factor in obtaining these results. More attention each year is being devoted to this phase of immigration inspection, and the increasing percentage of mentally abnormal immigrants discovered has demonstrated the value of the work.

The activity of the officers engaged in the mental examination of immigrants has not been confined alone to such examination, but has extended to valuable research and investigation along those lines. A notable contribution to the general knowledge of mental diseases has been Passed Asst. Surg. Mullan's study of the psychology of the arriving alien. Several standardized devices for determining feeblemindedness have been perfected by various service officers. A manual by the service officers stationed at Ellis Island for guidance in determining diseases has been in the course of preparation during the past two years. It is now near the stage of completion and promises to be of valuable assistance not only in the examination of immigrants but to the medical profession at large.

The general conduct of the medical inspection of immigrants during the past fiscal year has been along the lines evolved during the preceding year. In general, the examination consists of the preliminary or primary inspection for the purpose of detaining all those who are obviously defective, and also those presenting any condition or appearance suggestive of abnormality. A secondary and more rigid examination is made of those detained on primary inspection. This may embrace a thorough physical examination of the immigrant when stripped of clothing in a private room, and, when deemed advisable, it includes laboratory examination of the blood and all secretions, and continued observation in the immigration hospital.

It is believed that the number of officers now engaged in the medical examination of arriving aliens is sufficient to prevent the admission of physically defective persons, but the examination for detecting mental diseases requires such painstaking and tedious detail that additional officers for this kind of work are urgently needed in order that such examinations may be made with the necessary thoroughness

and efficiency, and at the same time with the dispatch demanded in routine immigration inspection.

The type of immigrant that will seek admission to the United States after the European war shall have ended is problematical. There seems to be no question that a very considerable exodus from Europe will occur. The economic reasons that have heretofore influenced immigration during the past 20 years will undoubtedly obtain in greater force at the termination of the war on account of the impoverished condition of the devastated countries. It seems assured that the number of physically disabled immigrants will be increased, and while the number of mental defectives may or may not relatively increase, the total number of these persons will undoubtedly be greatly raised. To accomplish the same painstaking mental examinations after the expected exodus from Europe takes place as is now being performed will require a much larger number of medical officers trained in the examination for detection of mental diseases.

As an index of the increasing efficiency of the medical examination of arriving aliens there are given in the following table the percentages of defectives, both mental and physical, recorded at all the immigration stations by officers of the Public Health Service in the period 1912-1916. While the increase in certifications has not been marked in any one year, the figures indicate, nevertheless, a steady and progressive increase in the number of alien defectives discovered by the medical examination during the period referred to.