In the smaller towns of the interior it will be hopeless to think of any system of drainage except of a rudimentary sort. All that can be done at present is to enforce the proper care of such arrangements as are practicable, and to see that all garbage and excreta are removed to a safe distance. Cremation is, of course, the best of all methods for disposal of garbage, but it can not be economically carried out except on a large scale. It was hoped that a crematory would shortly be established in San Juan, plans for one having been submitted and approved, but I understand that the matter has been indefinitely postponed by the ayuntamiento. This is much to be regretted, for the present system of garbage disposal is most unsatisfactory and is a source of great complaint.

VETERINARY SANITATION.

For several months the work in this branch has been very heavy, and has been most ably performed under the supervision of Dr. Schirmer. Glanders was very prevalent, and little or no attention was paid to the matter by local authorities. A system of rigid inspection was instituted, all suspected animals were isolated, tested with mallein, and at once destroyed if the diagnosis of glanders was confirmed. A quarantine station for animals has been established near the city of San Juan, the ground being given by the ayuntamiento, and several animals have been destroyed there. By a strict inspection and separation of all infected animals, this terrible disease can soon be eradicated from the island, but we have one very serious difficulty to contend with, and that is the persistence with which certain ignorant persons claim to cure glanders.

The belief in the curability of glanders is common among the country people, and this being the case, they look on the radical measures of the board with mistrust, and try every means to conceal cases of disease. Time and education are necessary to overcome this obstacle, but in the meantime the board must continue in the exercise of its utmost powers to put an end to an alarming state of affairs. That success is rewarding our efforts is shown by the fact that for months past there has been no case of death by glanders in the human subject, whereas during the twelve months previous to June, 15 persons had lost their lives from this cause. It has not been possible with the limited means at our disposal to make a thorough investigation of other diseases of animals, but it is believed that anthrax prevails to a certain extent in some districts. This subject will be taken up in the coming year. No cases of rabies in man have been reported during the year, and but few cases in dogs.

LEPROSY.

Nine cases of leprosy have been sent to the colony on Cabras Island during the year, 2 have been discharged from there as nonlepers, and 2 have died. The present number in the colony is 23, of whom 14 are males and 9 females. The board is very anxious to collect all the lepers on the island, but the practical difficulty as to transportation is very great. Railroads and steamships will not take them at any price and in many cases the local authorities have pleaded absolute inability to pay the expense of having private transportation, thus nullifying the provisions of the charities act which impose on the ayuntamientos the duty of transferring lepers to the colony.

SMALLPOX.

From July to December, 1901, the island was practically free from smallpox, but in January, 1902, cases of varioloid began to be reported in many districts. The number of cases slowly but steadily increased, the chief centers of disease being Ponce, San Juan, Arecibo, Camuy, and Utuado. The disease was of a singularly mild type, only cases of confluent smallpox being reported, and no death occurred from disease contracted in the island. One death occurred in Arecibo, the patient having come from New Orleans and being, through an error, landed in a very critical state.

Upon the first appearance of the disease steps were taken to isolate all as far as possible, but the facilities for this were very limited in every place, and entirely absent in some. Application was made to the governor for funds to meet the emergency, and, as has always been the case, the appeal was at once responded to. One thousand dollars was placed in the hands of the board, and with this sum a hospital was built in Camuy, bedding and furniture purchased through the Woman's Aid Society, and the concern was in running order in a very short time. Arrangements were also made for extra medical assistance in Arecibo, and vaccination was pushed with all possible energy. It is only fair to make special acknowledgment

of the splendid work performed in Arecibo by Dr. L. Gastambide, who labored night and day with the true spirit of a conscientious public servant and to whom the board was unable to offer more than a nominal compensation. Few persons are aware of the immense difficulties attending a work such as is vaccination in Porto Rico. The people are, as a rule, indifferent, they live in a country where travel is often dangerous, if not impossible, and where evasion of official visits is particularly easy. In spite of all this the work has been pretty thoroughly done, and the board feels confident that the good results from it will be plainly seen in the future.

Similar work was undertaken in the other towns affected, and special attention was given to the schools. In these there was found a large number of children who had been either not vaccinated at all or else very imperfectly protected, and considerable laxity was shown to have existed in the granting of certificates of vaccination without the necessary inspection to prove the result of the operation. Such carelessness is of course almost criminal, but is partly excusable from the fact that the medical officers are overworked and ridiculously underpaid. No more important work can be done than that of vaccination, but unless the authorities, insular or local, provide the necessary funds, it can never be carried out as it ought to be, and the island will be annually exposed to great danger and expense. The public alarm is always apt to be exaggerated, and this year it assumed large proportions. A strict quarantine was established by the neighboring islands against Porto Rico and serious injury to trade and travel was the consequence. As a matter of fact, there was no sufficient reason for such measures, but it seemed as if the foreign authorities were influenced more by popular clamor than by the facts of the case, and the protests of the board were in every case disregarded. As no quarantine was enforced against New York, Boston, and other United States cities where true smallpox existed to a considerable extent, the injustice to Porto Rico was conspicuous. În a period of two and a half months ending March 7, 1902, the deaths from smallpox in the United States were 615, and yet trade was absolutely free from restriction, whereas in Porto Rico there was scarcely any true smallpox and no death therefrom.

In February, 1902, a number of cases of a disease locally known as "buba" were reported from Isabela. This is a disease characterized by severe ulcerations of the skin with great debility. A special investigation was at once made by Dr. Saldaña, and in accordance with his recommendations a temporary isolation hospital was constructed there and the needed medicines furnished. The funds for the purpose were supplied from a special appropriation of $250 promptly granted by the governor. Very quickly the disease was controlled and has since given no trouble.

Diphtheria has occurred in several towns on the island, but in no place has it assumed an epidemic form, and the type of disease has rarely been malignant. Treatment by antitoxin has been adopted in a few cases and with success, but the question of the value of this treatment being still a matter of dispute the board has not felt justified in incurring the heavy expense incident to a distribution of serum. The need of a bacteriological laboratory by the board is greatly felt in connection with this disease, for only by culture experiments is it possible to diagnose with certainty or to fix definitely the period at which the patient can be safely released from quarantine.

As in all other places, tuberculosis is the great and fatal scourge of Porto Rico, and under the peculiar conditions here the difficulties in the way of checking its ravages are very great. Sleeping in crowded rooms which are invariably sealed up at night against any possible entrance of air, the people expose themselves to every possible risk of contagion. The personal habits of the poorer classes are in favor of contagion through the dissemination of sputum, and attempts to change these habits are almost invariably a failure. However, the board is about to publish simple hints for general distribution on the subject, and some benefit is confidently expected from this I am happy to say that the practice of spitting in public places has been practically abolished, owing to the measures taken by the board, and that our public buildings, stores, and trolley cars no longer offend decency.

course.

EXAMINATIONS FOR LICENSES.

At the examination held in January there appeared 2 candidates for license as physicians. Of these 2 passed.

For license in pharmacy 5 presented themselves, of whom 4 passed.

For license as practicante 2 candidates appeared, 2 being successful.

At the examination held in June the result was as follows: For physicians 1 candidate, 1 passed; for pharmacists 4 candidates, 4 passed.

For this there appeared

In January, 1902, an examination in plumbing was held. 20 candidates for license as master plumbers, of whom 7 passed.

applied as journeymen, of whom 20 were passed. The standard of examination was kept low for obvious reasons, but on each succeeding examination it will be raised until it approximates that of the United States. The examination was oral, written, and practical, the latter being conducted in a temporary workshop rigged up on the premises of the board. Considerable intelligence was shown by some of the candidates, but the practical work was very naturally of poor quality, leadwork being an entirely new branch for them. Our inspector has always been ready to give every possible assistance, theoretical and practical, to those who apply for it, and his work is highly appreciated. Since his appointment in November, 1901, there has been a real boom in the sanitary business, and 185 houses in San Juan have been put in thorough repair and fitted with modern plumbing.

The condition of the patios and excessive overcrowding of the houses occupied by the poorer classes are matters with which the board has been unable to deal in a satisfactory way. Until accommodation is provided in the shape of more houses, overcrowding is inevitable, and until the city provides a public laundry the present abominable state of the patios must continue. Laundry work is almost the only industry of the poor, and for this the patio is the only available place. I see no good reason why a well-equipped public washhouse should not be provided by the city, or why such an establishment should not be at least self-supporting, if not a source of revenue, as is the case in hundreds of other cities.

The work of the medical inspectors of the board has been extremely arduous and has been performed in a most able manner. The results have been very marked in many towns, and in some it has been impossible to stir up the authorities to a sense of their duty by any means within the power of the board. Absolute poverty is put forward as the reason for inaction, but this is only an excuse in part, and can not justify the filthy conditions existing in many places.

Special attention has been given to slaughterhouses, bakeries, and other places in which food is prepared or sold, and the most drastic measures have been employed to enforce the orders of the inspectors. Scores of places have been closed until put in decent condition, and many tons of bad food have been destroyed. In one store upward of 15 tons of codfish were condemned and destroyed, and all over the island the quality of this article was found very inferior. Much of this fish being imported from British ports, a letter was sent to the British consul requesting him to notify the exporters that fish of inferior quality would be at once seized here and destroyed. Large quantities of hams were also destroyed as unfit for food, and this action led to some difficulty with one of the great packing houses in the United States. After a full investigation by the board, the action of the inspector was sustained, and the matter was finally settled by the withdrawal from the market of the particular brand which was found unsatisfactory.

Several instances of drug stores carried on in violation of law were found by the inspectors, and prompt measures were taken to enforce the laws.

The sale of drugs and medicines by general merchants has long been a cause of complaint by pharmacists. They are rigidly confined to the sale of medicines and allied articles, and were justified in claiming relief from a genuine hardship. After full discussion of the question on all sides, the board issued a circular forbidding after July 1, 1902, the trade in medicines by unqualified merchants. A few articles in common use, such as borax, olive oil, camphor, and the like were specified as legitimate objects of general trade, and the circular has been cheerfully accepted by all concerned.

Considerable progress has been made in the matter of cemeteries, but the scarcity of municipal funds has delayed the construction of many new ones which are badly needed. The apathy displayed in this matter is remarkable, and it seems almost impossible to arouse the public mind to the importance of providing safe and decent methods of interment. The board is most anxious to establish relief cemeteries in outlying barrios in large districts, but has been met with the practical objection that it is impossible to have the civil registry properly kept up by the municipal judge. This difficulty can, I think, be readily removed by executive or legislative authority, and a great benefit thus be conferred on the poor who are now compelled to carry their dead long distances to a central cemetery.

The water supply of the island is by no means as good as it ought to be, considering the ample sources available, but there is considerable activity being shown by some towns to improve existing conditions. Of course the cost of waterworks is very heavy, but I see no reason why any city whose credit is good can not by a special issue of water bonds become the owner of a good system and gain a fair revenue therefrom. A large portion of the loan recently obtained by San Juan is assigned to the extension and improvement of the works there, and the benefits to the city will be well worth the cost. The present intake is badly located, and the removal of this to a point farther upstream must be made if a good and clear supply is to be had.

The chemist of the board has made repeated analyses of the water, and reports it as being generally of fair quality, but by no means first class.

In Ponce the waterworks are of the most primitive kind, but the quality of the water is good, and the chief complaint made is of the muddiness. Yauco will soon have an admirable supply in quantity and quality. Arecibo is following the example, and other towns are merely waiting for loans in order to commence operations. But in order to obtain the best results the pollution of streams must be stopped, and this interference with ancient custom will be strongly opposed. Pollution of streams is well nigh universal, and even in the cases where the stream is not used for drinking serious nuisances arise from the discharge of refuse from distilleries, tanneries, and other factories. The refuse liquor from rum distilleries is horribly offensive, and is fatal to all fish; and in Ponce a serious loss has in this way been caused to the local fishermen. The board has been successful in several cases in persuading or compelling manufacturers to refrain from their former practice, and in time it is believed that every serious cause of complaint will disappear.

I desire to call attention to the report of Dr. Berkeley hereto annexed. (Appendix B.) His work has been most arduous and exacting, and has been carried on under difficulties which would long ago have discouraged a man of less enthusiasm and devotion to duty. The need of proper facilities for this work is urgent, the present premises used as a laboratory being utterly unfit for the purpose and absolutely forbidding the prosecution of certain classes of work. The rooms now occupied are in the custom-house, and as the Treasury claims this as its property the board of public works is not permitted to do anything in it. Meantime the Treasury Department refuses to make any improvement, although the chemist is often called upon to make investigations in cases pertaining to the customs department.

The subject of prostitution is one which the board has been unable to deal with, although much attention has been given to it. The objections to any system of inspection and registration of women are very great, and the attempt to carry out the plan in San Juan proved an entire failure. It is comparatively easy to control the avowedly professional class of women, but it is utterly impossible to regulate or prevent the traffic carried on by those who may be termed amateurs. All that seems practicable is the strict enforcement of police regulations to such a degree as to prevent public scandal, and to this end the restriction of residence to certain allotted districts in towns seems advisable. Laws and regulations of the most elaborate kind have failed in Habana and other cities to do more than to lessen the public display of the nuisance, and there is no reason to expect greater results in Porto Rico, even with a greater expenditure than is here possible.

Vital statistics is of course the true test by which the work of a board of health is estimated, and I am happy to say that the figures given in the annexed tables are of the most satisfactory sort and are full of encouragement for the future. For the benefit of those unwilling to study the matter in detail I append a brief résumé of the principal diseases of Porto Rico and their comparative mortality in this year and the preceding one. It will be seen that the total deaths in this year are 1,800 less than during last year, and there is every reason to believe that this splendid showing is chiefly due to the great sanitary reforms which have been carried out. Sanitary education is a plant of slow growth, even when nourished with golden showers, but the growth in Porto Rico is steady if slow, and will doubtless progress at a faster rate in future.

I regret to say that owing to insufficient funds and the consequently limited office staff it has been impossible to reciprocate the courtesies extended to us by the various States of the Union and foreign countries that have sent us their valuable reports, requesting the usual exchange of documents. This anomalous state of affairs will no longer exist, as the staff will be increased during the coming year, when Porto Rico will take her rightful place as the source of information of the most valuable kind. The vast mass of records of vaccination under the military government is in process of tabulation and the results of the largest work on record will soon be published. The value of such a report can not be exaggerated, and in this and other matters the board feels justified in expecting the liberal assistance of the legislature. The work of the board must be a constantly increasing one, and on its real results largely depend the health and lives of the community and consequently the productive capacity of the island.

A courteous invitation was sent by the American Public Health Association that the board be represented at the congress held at Buffalo in September, 1901, and the secretary was thereupon deputed as delegate of the board. He received also from the governor a special recognition as representative of the island in general, and was directed to investigate the methods in use in the health boards of Boston, Albany, New York, Buffalo, and Washington, with the view of introducing any useful features

INT 1902-MIS, PT 2——34

of their work in the office here. His reception at Buffalo and elsewhere was most cordial and flattering, every possible courtesy being extended to him, and great interest being shown in Porto Rico by all those be met. He read, by request, a paper before the congress, which was well received as an evidence of the progress of Porto Rico in sanitation, and was appointed on the executive committee as member for Porto Rico. Much valuable information was secured during his trip, and the benefits accruing to the office have been very great.

The board trusts that Porto Rico may in future be represented at all the meetings of this great association and that she will be found standing in the front rank of exponents of modern sanitation. Great are the powers of the board and very deeply does it feel the responsibilities laid upon it. Under the new organization which goes into effect on July 1, the board will be materially strengthened in its personnel, and even better results may be expected than those which I have the honor now to submit.

Accompanying this report are appended special reports from Dr. Berkeley, chemist to the board; Dr. Schirmer, veterinary inspector, and Mr. Spaven, inspector of plumbing. All of these are well worthy of serious consideration.

Very respectfully,

Hon. WILLIAM H. ELLIOTT,

R. M. HERNANDEZ, M. D., President Superior Board of Health, Porto Rico.

Commissioner of the Interior for Porto Rico.

Receipts and disbursements of the superior board of health of Porto Rico, fiscal year 1901–2.