Showing the distribution of syphilis by nationality, as evidenced by positive Wassermann reaction as of June 30, 1929 Bureau of leprosy.-Work at Kalaupapa Settlement has progressed favorably during the year. Excellent work has been accomplished by the resident physician and his assistant. Individual records of the patients have been prepared and progress notes kept in each case. Regular clinics for the treatment of eye, nose, and throat cases have been instituted. There were 66 new cases reported during the fiscal year and 20 patients on temporary release were reexamined. A total of 2,416 injections were given during the fiscal year, including 123 patients on temporary release. Three times during the fiscal year patients (aggregating 40) have been transferred to the leprosarium. During the same period 1 patient and 13 children have been transferred therefrom. The 1 patient was transferred to Kalihi Hospital, 5 of the children to Kapiolani Girls' Home, and 8 to the Kalihi Boys' Home. There were 63 children of leprous parents in the Kalihi Boys' Home, Honolulu, and 71 in the Kalihi Girls' Home. Patient transferred from the leprosarium, Molokai.. Patient on temporary release recommitted for violating terms of release.. Number of patients reexamined and recommended for temporary release.. Number of deaths.. 3 49 Number of patients remaining in Kalihi Hospital June 30, 1929. 110 11235 40 1 5 72 67 177 Patients on temporary release reexamined and released not a leper.. Number of patients remaining in the leprosarium on June 30, 1929. Nativity of patients remaining in the leprosarium 174 496 40 2 2 坛 56 24 80 66 24 90 287 161 448 2 Average number receiving injections of ethyl esters... 73 3, 235 42 401 807 2, 689 8 5, 026 5, 602 30 793 184 The ethyl esters used in the treatment of the patients at the Kalihi receiving station were manufactured by the personnel of the station working at the University of Hawaii laboratories, and the Territorial board of health was furnished 7 liters for treatments of patients at the Kalaupapa leper settlement and for out-patients in outlying districts. Surg. N. E. Wayson, director of the leprosy investigation station, assisted by Passed Asst. Surg. L. F. Badger, both of the United States Public Health Service, have conducted the medical activities relating to the patients throughout the year. The cases have been individually observed and a greater individualization of their treatment has been effected. Treatment by the intramuscular injection of the esters of the acids of chaulmoogra oil has been continued. However, clinical evidence suggests that these esters are absorbed very slowly, if at all completely, when so injected, and efforts were made to detect their presence in the muscle by Röntgenology, if possible. Through the cooperation of the district medical officer of the United States Navy, a series of Röntgenograms was made on the group of patients. These were not productive, however, because of the very low percentage of iodine in the esters. The studies were pursued at the leprosy investigation station on small animals, and the findings obtained are confirmatory of the clinical observations. Further confirmation is suggested by the observations of other investigators on the nonabsorption of oily substances injected into human muscles. In order to further investigate the specific therapeutic value of this medicament, efforts have been made to develop a preparation of the esters which could be administered orally with less inconvenience and pain to the patient and which would be subject to the normal processes in the body for the absorption of oily substances. This has apparently been accomplished by the preparation of a cocoa emulsion, in which the esters are incorporated. A large pharmaceutical firm is experimenting toward improving the preparation and further eliminating its irritative qualities. No deductions can be drawn of its therapeutic value for some time. It has been determined that the washed esters are tolerated as well in the emulsion, as are the distilled esters. In view of the present evidence and accumulating opinion that the chaulmoogra esters are not specific, other treatments have been used to supplement it, and in those instances in which the patient grew worse while under the chaulmoogra treatment other methods and drugs have been substituted. Among these latter are to be included some of the salts of the heavy metals, esters of other fatty acids, and specific protein injections. The clinical records of the station for 10 years strongly suggest that those patients whose condition becomes arrested to a degree which permits of temporary release can be classified into a group exhibiting a certain type of clinical manifestations. These patients have a condition which tends to become self-arresting, especially when they are placed under proper hygiene, diet, and symptomatic treatment. Contrariwise, their relapse, often with a more intractable type, seems precipitated not only by the normal physiological functions of puberty, menstruation, and pregnancy, but by unfavorable economic circumstances and lack of proper medical care and supervision. The board of medical examiners reports that examinations were held on the second Monday of July and October, 1928, and January and April, 1929, with the following results: July, 1928: 6 candidates; 6 passed. October, 1928: 11 candidates; 11 passed. January, 1929: 5 candidates; 3 passed and 2 failed. One physician was licensed by virtue of his certificate from the National Board of Medical Examiners. On June 30, 1928, 204 physicians had been licensed; 22 physicians were licensed during the past year, 21 by examination and 1 by credentials, making a total of 226 to date. PRACTICE OF DENTISTRY There are 121 dentists practicing in the Territory, racially divided as follows: 40 Japanese, 45 American and European, 25 Chinese, 5 Hawaiian, 3 Korean, 2 part Hawaiian, and 1 part Japanese. Nineteen dentists were licensed by the board of dental examiners during the past year. There are 40 dental hygienists, 8 of whom were licensed during the past year. REGISTRATION OF NURSES The board of registration of nurses reports that examinations were held in July and October, 1928, and January and April, 1929, with the following results: July, 1928: 7 candidates; 7 passed. October, 1928: 5 candidates; 2 passed and 3 failed. January, 1929: 7 candidates; 7 passed. April, 1929: 2 candidates; 2 passed. Registered by examination, 18. Registered by reciprocity, 149. FEDERAL PUBLIC HEALTH SERVICE Only one quarantine station is maintained in Hawaii, at Honolulu. In addition, vessels are inspected at the following ports on other islands of the group: Hilo and Mahukona, Hawaii; Kahului and Lahaina, Maui; Ahukini and Koloa, Kauai. No case of quarantinable disease, as specified in paragraph 1 of the quarantine regulations, was found on vessels entering Hawaiian Island ports during the fiscal year. Cerebrospinal meningitis occurred on certain ships that arrived during the last part of the year, and these cases and contacts were detained at the quarantine station by the Territorial board of health, the Territory having no facilities for their isolation. A total of 1,015 persons were so detained. They were all in the steerage of vessels from the Orient, and were mostly Filipino laborers destined for Honolulu. The first ship from which meningitis contacts were taken to Quarantine Island was the steamship President Pierce, which arrived at this port March 14 with 15 cases among the Filipino steerage passengers. One case of meningitis had been put ashore at Yokohama and there had been 7 deaths en route, reported as pneumonia, but in all probability meningitis; 397 contacts were quarantined on the station, among whom 32 cases of meningitis subsequently developed. All cases were cared for in the Queen's Hospital, 16 terminating fatally. The next two vessels to arrive from Manila via China and Japan, had had no meningitis during the voyage. However, one case was reported afterwards on the island of Hawaii and two cases developed among the Filipinos while they were still at the Hawaiian Sugar Planters' barracks awaiting distribution to the plantations. On April 25 the steamship President Lincoln arrived with 13 Filipinos and one Chinese sick with meningitis. These were sent to the Queen's Hospital. There had been three deaths from meningitis en route. The entire Honolulu steerage, numbering 293 persons, and 20 steerage passengers for San Francisco who had temperatures, were taken to the quarantine station. Two cases developed among the detained Honolulu Filipinos. There was no meningitis on the steamship President Madison, which arrived from the Orient May 9. The next vessel, the steamship President Jackson, arriving May 23, had 13 cases of meningitis and one meningitis carrier. Nine deaths from meningitis had occurred en route to Honolulu, and there was one more death after the ship was tied up at the dock. Two hundred and seventy-nine Filipino and 26 Chinese steerage passengers were detained on the quarantine station. Nineteen cases of meningitis, all occurring among those detained, were cared for in the station hospital. The total number of cases from the President Jackson was 26, with five deaths. The period of detention for meningitis contacts from the first two vessels had been 10 days from the date of last possible exposure, but this was increased by the board of health to 14 days for contacts from the President Jackson. No further cases of meningitis occurred on vessels arriving from the Orient. Near the end of the year one case of meningitis and one suspected case arrived from San Francisco in the troop class of United States Army transports. With a single exception, all vessels fumigated were so treated at the request of the owners for the destruction of vermin, and were mostly small craft of the Army and Navy stationed here. As most of the vessels entering this port are en route to other ports, their usual stay being less than 24 hours, and as they are in cargo, they are not fumigated. WAIMANO HOME This home for feeble-minded is maintained under Territorial authorization. The inmates enrolled as of June 30, 1929, were 115 girls and 91 boys. The total of 206 is divided among the municipal divisions as follows: Oahu, 106; Hawaii, 50; Kauai, 24; Maui, 16; Molokai, 10. The predominating racial classification of patients |