The vaccination of passengers soon after they embark secures a two-fold result:

First. In case the disease develops during the voyage, all persons successfully vaccinated previous to its development will be protected thereby from the effects of the contagion.

Second. On arrival at Quarantine, if there has been any exposure of the well to the contagion from the sick through the neglect or mismanagement of the ship's medical officer, those who have been successfully vaccinated by him previous to the exposure, are allowed to proceed to their destination, thereby relieving the steamship company of great expense and the passengers from a vexatious detention at Quarantine.

The maritime sanitary authorities at the ports of entry in this country can not direct that passengers shall not be embarked at ports of departure in Europe without a certificate of successful vaccination, so recent as to afford satisfactory evidence that they are not infected with the contagion of the disease. But the federal or State authorities can direct that all emigrant passengers shall be inspected by a medical officer connected with the consular office at the port of departure, and that such as are not provided with such certificates of vaccination shall be reported to the medical officer at the port of entry in the United States, in connection with the consular bill of health, with power to detain such passengers until the full incubative period of the disease has elapsed from the time of the last exposure. This would enable the health officer at quarantine to exercise such supervision as would, with few exceptions, prevent the introduction of the latent contagion of the disease. There is but little doubt that by an earnest and united effort on the part of maritime, municipal, and State health authorities, aided by proper legislation, the contagion of small-pox could be so completely destroyed that the disease would be almost unknown. It is certain that this desirable result can not be realized while the forces of the disease are recruited from the pest-houses of the old world.

Fifteen hundred and thirty-eight persons have been removed from vessels to Hoffman and Swinburne islands for observation since the date of my last report. They were removed from the following named vessels on account of exposure to the infection or contagion of the diseases named, and were detained for periods varying from four to fourteen days.

Two deaths occurred among the immigrants while detained at the Quarantine of Observation. Martha Smith, a German, who arrived on the steamer Amsterdam, died of chronic diarrhoea, and a child of acute broncho-pneumonia, the sequel of measles.

YELLOW FEVER.

This disease has been very infrequent on vessels from ports subject to that disease for several years past, and less so the past season than in any during the present Health Officer's administration.

In the first three years of my adrustration, fifty-seven cases of yellow fever were received at Quarantine hospital. During the last three years but eight cases have been admitted, four of which were taken from United States war vessels, whose people had contracted the disease at Port au Prince, Hayti. Two other cases died on board such vessels at Quarantine. In the three years past, there have been but four cases of the disease found among the merchant marine. This difference is undoubtedly to be attributed to the greater care exercised by masters of vessels, to prevent their passengers and crews from going ashore at infected ports, and in anchoring their vessels, and receiving cargo by lighters at a considerable distance from infected wharves.

The inducement to officers, agents and owners of vessels to adopt such protective measures, and thus prevent the infection of their

vessels or the persons on board of them, is not alone the certainty of protecting the lives and health of those committed to their care, but the equal certainty of escaping vexatious delay and great expense at Quarantine. Until within a few years past vessels were compelled to discharge "in quarantine," if they received their cargoes at a yellow fever infected port, whether or not they had had cases of the disease during the voyage, or had them on arrival at Quarantine. There was, consequently, the inducement to masters of vessels, or their owners, which exemption from delay and expense at Quarantine offered, to exercise unusual care to prevent the infection of their vessels, or the persons on board of them.

In previous reports reference has been made to this change in the management of our Quarantine. It has not been repeated too frequently, if it prevents in the future a return to the old time system of compelling all vessels from yellow fever infected ports to discharge their cargoes "in quarantine," during the infected season, at a distance of three or four miles from the wharves of the city. The public health has been equally well protected during the years since the change, and the commercial interests of the merchants engaged in trade with ports subject to yellow fever have been relieved of a grievous burden of expense.

January 13, 1890, the steamer Colon, from Aspinwall, arrived at Quarantine with a second-class passenger who had died on board. The man had died only a few hours before arrival. The history of the case was so imperfect that the body was removed to the Quarantine hospital. An autopsy showed that the man died of congestion of the lungs. The remains were claimed by, and delivered to the friends of the deceased.

April 14, 1890, the steamer Alvo arrived from ports in the West Indies. E. Mattison, passenger, died on the steamer the same day. The remains were taken to the Swinburne Island Hospital where an autopsy, and such history of the case as could be obtained, showed that billious remittent fever of a congestive type was the cause of death.

Deaths on board vessels from ports subject to yellow fever generally have an unsatisfactory history, and, when they occur within the jurisdiction of the Quarantine, an autopsy is necessary to discover the cause of death. Few of the steamers plying between New York and ports in the West Indies are supplied with medical officers.

In several instances during the year past immigrants were removed to Swinburne Island for observation, after exposure to small-pox,

owing to the incomplete state of the improvements at Hoffman Island, and the presence there of a large number of workmen.

It is sometimes necessary to remove cases of sickness to the Quarantine hospital from vessels from ports where infectious or contagious diseases prevail until the symptoms are more carefully observed than they can be on the first visit. This was the case with a man (Charles Ellertsen) removed August twenty-ninth last from the steamer Fort Williams to Swinburne Island Hospital suffering from malarial fever, and transferred September fourth to the Long Island College hospital.

Wm. Conners, a fireman on the steamer Santiago of the Ward line, was received from the United States Marine Hospital at Stapleton, S. I., and taken to the Quarantine hospital October eighteenth. This case has created considerable interest, and deserves more than a brief mention. The Santiago arrived at Quarantine the sixteenth of October, from Cienfuegos October seventh, from Santiago de Cuba the eleventh, and Nassau the thirteenth. The steamer had a clean bill of health from the United States consul at each of those ports. There has been no consular report of yellow fever at Cienfuegos during the past season. There being no report or rumor that yellow fever existed at Cienfuegos, the captain of the steamer allowed the crew to go ashore. At Santiago de Cuba the vessel anchored two miles from the shore, and none of the crew went ashore. The evening of the day that the Santiago left Nassau (thirteenth), William Conners, Michael Coade and Patrick Rice were taken sick.

When the Santiago was inspected at Quarantine the sixteenth of October, every one of the crew passed the deputy health officer without complaint or evidence of sickness. The same day that the steamer reached her dock, the firemen named went to their homes in the city. Conners returned to the steamer the following day and was paid off. The man went to the Marine hospital the same afternoon, and the following day (nineteenth) was brought to the boarding station and was sent to Swinburne Island Hospital. The patient was able to give a history of his sickness; it was fully confirmed by the chief engineer of the steamer.

He said he was taken with a chill after leaving Nassau; "had chills several days in succession;" "was not confined to his bunk," but was "up and down during the voyage;" that "the captain sent for him when we arrived at Quarantine, and he passed the doctor." When the man was examined at the Quarantine hospital late in the day (the nineteenth), his pulse was ninety degrees, his temperature 101 degrees,

skin and sclerotic slightly jaundiced; answered questions hesitatingly; manner dull and stupid, but mind clear when fully aroused; tongue dry and glazed. There was no complaint or other evidence of nausea, and he did not vomit after admission; urinate freely, and in usual quantity. The urine contained about fifty per cent of albumen.

Treatment. The bowels were opened freely with Rochelle salts; milk, beef tea and brandy punch were ordered to be given as freely as the stomach would bear.

October twenty-ninth the nurse said that the patient seemed better after the operation of the saline. The secretion of urine continued, but it was still loaded with albumen. Early in the afternoon, the man had a severe convulsion, consciousness never returned; the patient continued comatose until he died the following morning.

Dr. George F. Kemp, of the Hoagland laboratory, who desired to make chemical and spectroscopical investigations in cases of tropical fevers, had been notified and kindly assisted in making the autopsy in this case, seven hours after death.

AUTOPSY.

The countenance of the cadaver was jaundiced somewhat, and mottled with capillary congestion; chest slightly jaundiced; grumous incrustations on lips from blood that came from the fisured tongue; many patches of capillary congestion of the surface of the chest. Cicatrices in cervical glands indicative of previous suppuration. Pleura of right chest firmly adherent. Pericardium thickened, containing percardial fluid 10 cc. Right auricle congested-heart otherwise normal; both lungs greatly congested; hypostatic congestion very marked. No portion of either lung was solidified. Gall bladder about one-third filled; liver showed marked capillary congestion of surface and biliary congestion throughout the organ. There was no striated or leather-like patches so strikingly characteristic of yellow fever.

The peritoneum was stained with bile pigment, and adherent to lesser curvature of stomach. The whole mucous surface was more or less congested. The spleen nearly normal, weight, nine and one-half ounces. Surface mottled, capsule of both kindeys adherent throughout internal structure congested. Weight of left kidney, six and one-half ounces, enlarged -pig-backed; connective tissue slightly tinged with bile; weight of right kindey, seven ounces.