Dr. Craig concludes his report as follows: The important lesson to be learned from a study of the literature of Malta fever occurring in the United States Army is that the conditions are not easily recognized clinically, and may be attributed to typhoid, malaria, or in the chronic stages to articular rheumatism. This being so, the great value of a microscopical examination of the blood and the performance of the serum test is at once proven. None of the cases observed by me were diagnosed as Malta fever, and in only one of them was there any suspicion of the occurrence of this disease. The two cases presenting the chronic symptoms would, in all probability, have been transferred to Hot Springs, Ark., for antirheumatic treatment, while in the two cases presenting the acute symptoms the patient would probably have been treated for either typhoid fever or malaria. In fact, in cases when, on account of finding malarial parasites at different times in the patient's blood, the treatment has been altogether that for malaria, and had a diagnosis of Malta fever been made more quickly much discomfort would probably have been saved the patient. The following conclusions may be drawn from the study of these cases: (1) There occurs in the Tropics a fever which may resemble in its acute stage either typhoid or malaria and in its chronic stage articular rheumatism, caused by the Micrococcus melitensis. (2) There is no pathognomonic symptom of Malta fever. The symptoms are so inconstant and confusing that no one of them can be said to be typical of the disease. (3) A differential diagnosis of this fever is almost impossible in the majority of cases without the aid of the microscope and the serum test. FIRST RESERVE HOSPITAL, MANILA, P. I. During the period July 1, 1901, to April 15, 1902, 2,999 cases were treated in this hospital, besides a large number examined and assigned elsewhere, this being the distributing hospital of Manila. Maj. William H. Arthur, surgeon, U. S. Army, was in command. The hospital buildings, 23 in number, are much in need of repair. An allotment of $2,600 was used during the year in fitting up a pathological laboratory and receiving ward, in remodeling kitchens and offices, building a new kitchen and porch for officers' ward, bathroom and water-closets for hospital corps quarters, and a covered passageway from the surgical ward to the operating room. The addition of a small receiving and observation ward at the main entrance has been very useful. Plague, Asiatic cholera, smallpox, measles, and mumps have been detected at different times in this ward, and proper disposition made of them without exposing the other patients in a crowded ward to risk of infection. It is small, bare, and easily disinfected. The laboratory was opened February 26, 1902, and from that time to April 15, 1902, 406 examinations were made, as follows: Blood. One hundred and sixteen examinations, of which 77 were found positive for malarial parasites and 39 negative. Stools. One hundred and thirty-six examinations with results as follows: Ameba, 37 cases; ascaris lumbricoides, 22 cases; ankylostomum duodenale, 1 case; larvæ, musca vomitoria, 1 case. Urine.-Eighty-three examinations with results as follows: Albumen, 13 cases; sugar, 17 cases; tubercle bacilli, 1 case; gonococci, 5 cases; normal, 47 cases. Sputum.-Thirty-six examinations for tubercle bacilli; 3 proved positive. Pus, liver.-One examination for amebæ; result, positive. Pus from eye.-Three examinations for gonococci, all proving positive. HOSPITAL NO. 3, MANILA, P. I. This hospital is situated in Ermita district, just beyond the city walls and about 300 yards from the bay. It consists of 7 one-story wooden buildings having a capacity of 225 beds. The locality is good but for an estero which runs through the grounds. The average number of patients daily for the year 1901 was 172.6. From June 30, 1901, to April 15, 1902, 1,698 patients were treated. Of these, 772 were returned to duty, 25 died, 40 were discharged for disability, and 629 transferred to transports en route to the United States. The main specialty of this hospital is the reception for observation and disposition of cases which have been recommended for discharge on certificates of disability. These cases are held until the military history of each man is found to be complete and correct. In all cases, particularly those of a doubtful character, repeated examinations are made by the staff of the hospital acting as a board. A small proportion of these cases recover under treatment and are returned to duty. When the board is of the opinion that the disability may not prove to be permanent, transfer to the United States for treatment is recommended. When the disability is considered permanent, the case is transferred to the General Hospital, Presidio of San Francisco, Cal., for final disposition. A camp for hospital corps casuals is connected with this hospital. The detachment is quartered in tents which are framed and floored. THE NOZALEDA HOSPITAL, MANILA, P. I. This hospital was established by Maj. R. W. Johnson, surgeon, U. S. Army, December 18, 1901, on the breaking up of the Santa Mesa Hospital. Surrounding it on all sides is the most beautiful garden in the city of Manila. The front rests on Nozaleda street for 420 feet and the rear on Louban street for 320 feet. The reservation is closed in by a high stone wall on three sides, the fourth side, the front, by an ornamental iron fence. The building is a two-story brick and stone structure, the first story taken up chiefly for administrative purposes, the second used as wards. The capacity is 125 beds; but in addition to this there is in one corner of the grounds an isolated camp of 20 beds in 6 hospital tents for patients suffering from turberculosis of the lungs. From the time of its installation to April 15, 1902, 444 patients were admitted, 325 suffering from various forms of venereal disease, 47 from consumption, and 72 from other causes. THE CONVALESCENT HOSPITAL, CORREGIDOR ISLAND, PHILIPPINE ISLANDS. Corregidor Island lies across the entrance of Manila Bay, 27 miles from the city of Manila. The island is 3 miles long and from onefourth to three-fourths of a mile wide. The greater part of it rises abruptly from the water, reaching an extreme elevation of 550 feet above the sea. Several plateaus of different sizes are formed on the higher points of the island. The hospital is situated on the shore of a small bay, on the north side of the island. It consists of four wooden pavilions elevated about 3 feet from the ground and with corrugated iron roofing. Sliding windows encircle the buildings and permit the wards to be thrown open, giving the most complete ventilation. Covered porches, 5 feet wide, extend round the buildings. The administration building is a structure of two stories, 50 feet square, the lower story used as offices, the upper as a dormitory for the detachment of the Hospital Corps. The kitchen, with three army ranges, and dining room are large and commodious buildings. The latter, accommodating 250 men, is the largest and most suitable building of the kind to any hospital in or near Manila. The last-mentioned buildings are built on the general plans of the pavilions. All of the buildings are painted white, inside and out, with green trimmings, and present a very neat appearance. Storerooms, operating rooms, and dispensary are in two adobe buildings constructed by the Spaniards. They were rekalsomined last January, and answer in every respect the purpose for which they are used. An ice and distilling plant is in operation, located in a building just outside the hospital grounds and formerly used as a school building. The plant is in excellent condition, having run throughout the year without a single day's stop and has greatly added to the comfort and health of the patients. The natural drainage is perfect. Open drains run throughout the grounds, carrying the surface water to the bay. All excreta, garbage, and débris of every kind are collected daily and carried in open boats out to the sea about half a mile from the shore and dumped. This work is done by four natives hired by the quartermaster department and are under the immediate charge of an acting hospital steward. By this method the grounds are kept thoroughly policed and in good sanitary condition. Water is supplied by piping from a dam built in a water course about three-quarters of a mile from the hospital. The dam leaks, and during the dry season the supply becomes low. This fact may in the future lead to a serious deficiency unless a larger dam is built. The erection of a proposed distilling plant would solve the problem to a great extent. During the rainy season the supply of water is abundant. Drinking water is distilled at the ice plant. The food is very satisfactory, though recently the scarcity and high price of chickens and eggs has embarrassed the diet kitchen. Owing to the character of the hospital-a place for convalescents-practically all of the patients are on special diet. This is carefully watched, well prepared, and thoroughly enjoyed. The appetite of nearly all patients recovering from wasting disease is stimulated by the cool salt breezes, and in many cases voracious. The allowance of 40 cents is none too great; 50 cents a day could be easily used, with no wastage or extravagance. As far as at present known, Corregidor Island is free from malaria, and such cases transferred here have done well. The water tanks, and all connections of water, however small, are covered with a layer of kerosene oil, and the few mosquitoes that would otherwise be present have disappeared. The sea air; delightfully cool breezes, almost constant; sea bathing, bright, cheerful wards, good food, and the faithful performance of their duty by the medical officers, Army Nurse Corps, and Hospital Corps, have restored to health many cases of debility, apparently chronic these good results being obtained, as a rule, rapidly, with little medical treatment. During the period July 1, 1901, to April 15, 1902, 1,039 cases were treated in this hospital. Of these, 658 were returned to duty, 292 cases were transferred to the United States, 25 were transferred to other hospitals, 9 died, and 55 remained under treatment. Most of the cases transferred to the United States were chronic cases of amebic dysentery for which a transfer to the United States appears to offer the only promise of recovery. Respectfully submitted, W. H. FORWOOD, Surgeon-General U. S. Army. |