QUARANTINE INSTRUCTIONS.

AUGUST 4, 1913.

To medical officers in charge, acting assistant surgeons in charge, national quarantine stations, and others concerned:

This letter is intended to replace bureau letters of August 9, 1912, September 25, 1912, October 8, 1912, November 18, 1912, January 20, 1913, and February 15, 1913.

Vessels from the following ports are to be fumigated throughout for the destruction of rats upon their arrival at United States ports and the masters of said vessels are to be directed in writing to have all lines or hawsers leading to shore protected by rat guards, when such vessels are lying at United States ports, all gangplanks to be raised at night unless men be stationed near by to destroy escaping rats: 1. All ports in South America, including the river ports thereof. 2. All ports in Africa (including the Azores, Canary Islands, Cape Verde Islands, and Madeira).

3. All ports in Asia (including those of the Straits Settlements. Japan, the Philippine Islands, and Malay Archipelago).

Vessels from the following ports are to be fumigated throughout for the destruction of rats upon their arrival at United States ports. as often as once every four months, unless there are quarantine reasons where fumigation should be made more often:

1. West Indian ports, exclusive of Cuban and Porto Rican ports. The traffic from Porto Rican ports is subject to special outgoing quarantine regulations, which are frequently modified to meet existing sanitary conditions.

Until further notice vessels from Liverpool are exempt from routine restrictions, and are to be treated as indicated under general quarantine regulations.

Fumigation of vessels from ports in Australia may be limited to the provisions of paragraph 112, page 39, United States Quarantine Regulations of 1910, and the certificates of fumigation of the Australian quarantine officials may be accepted when presented in compliance with the above-mentioned paragraph.

SPECIAL OUTGOING QUARANTINE REGULATIONS FOR SAN JUAN, P. R., IN FORCE SINCE NOVEMBER 15, 1913.

1. Loading and unloading of freight permitted day and night, if from rat-proofed wharves under service supervision.

2. Stored fruit allowed shipped, provided the place of storage has been a rat-proof wharf or warehouse; fumigation of vessels limited to once every six months.

SPECIAL REGULATIONS IN EFFECT AT HABANA, CUBA.

1. All regular line vessels to be fumigated once every six months. 2. Ward Line vessels in the Mexico-Habana-New York trade will be fumigated in New York every six months, when empty, and must present a special certificate of fumigation.

3. No articles of merchandise so packed as to be liable to harbor rats may be allowed shipment, unless repacked or fumigated under medical supervision.

4. Vessels leaving Habana will be fumigated more often than once every six months if there be a quarantine necessity therefor, or else if inspection shows rat infestation.

NOTE.-Vessels carrying perishable cargoes, unless contraindicated by their general sanitary status, may be given provisional pratique and allowed to proceed to the wharf, there to remove said perishable cargo prior to the process of fumigation, the vessel, however, to be protected during the removal of such perishable cargo by the use of rat guards, and precautions, such as the raising of gangplanks, to prevent the escape of rats from the vessels.

Respectfully,

RUPERT BLUE,
Surgeon General.

PREVALENCE OF DISEASE.

No health department, State or local, can effectively prevent or control disease without knowledge of when, where, and under what conditions cases are occurring.

IN CERTAIN STATES AND CITIES.

SMALLPOX.

Indiana-Evansville.

Acting Asst. Surg. Neary, of the Public Health Service, reported by telegraph that during the week ended August 2, 1913, 2 cases of smallpox had been notified in Evansville, Ind., making a total of 849 cases reported since October 1, 1912.

Acting Asst. Surg. Neary, of the Public Health Service, reported by telegraph that during the week ended August 2, 1913, 23 cases of typhoid fever had been notified in Evansville, Ind., making a total of 171 cases reported since June 14, 1913.

St. Louis. Typhoid Fever Outbreak Due to Bacillus Carrier.

Surg. Carrington has reported the occurrence of an outbreak of typhoid fever in St. Mary's Orphanage Home, St. Louis. The outbreak was first notified to the city health department on July 17, when 35 cases of typhoid fever were notified as positively diagnosed and 25 additional cases as suspicious. Of these 25 suspicious cases 10 later proved to be typhoid fever. There had been up to July 31, 6 deaths. The first case was taken sick June 30, and within the succeeding 15 days 30 cases occurred. A definite diagnosis of the nature of the disease was not made until July 17. The orphanage has 250 inmates and 45 sisters and other employees, making the total population of the orphanage 295. Water and milk were eliminated as possible causes of the outbreak. Among the employees was found a girl 13 years of age who was employed in the kitchen and handled various articles of food. This girl had had typhoid fever three times, her last attack having been about 18 months ago. This girl was sent to the city hospital, where it was ascer tained by the city bacteriologist that she was a typhoid-bacillus

carrier.

CEREBROSPINAL MENINGITIS.

Cases and Deaths Reported by Cities for Week Ended July 19, 1913.