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San Francisco Quarantine, act June 11, 1896.

Balance July 1, 1897 -------------------------------------------------Expended to June 30, 1898-------------------------------------------

San Diego Quarantine, act June 11, 1896.

Balance July 1, 1897-------------------------------------------------Amount deposited to credit Treasurer United States------------------

Appropriations for quarantine stations, act June 4, 1897.

Delaware Breakwater---------------------- - - - - - - - - - - - - - - - - - - - - - - - - - Expended to June 30, 1898-------------------------------------------

Balance July 1, 1898------------------------------------------South Atlantic appropriation----------------------------------------Expended to June 30, 1898-------------------------------------------Balance July 1, 1898 a--------------------- * - - - - - - - - - - - - - - - - - -

Tortugas Quarantine Station appropriation--------------------------Expended to June 30, 1898-------------------------------------------

Balance July 1, 1898b------------------...-----------------------

a Expenditures authorized, $8,970.48.
b Reappropriated for fiscal year 1899, act July 1, 1898.

REPORTS OF FATAL CASES, WITH NECROPSIES.

REPORTS OF FATAL CASES, WITH NECROPSIES.

ENTERIC FEVER.
CASE 1.
Cerebro spinal meningitis.

F. G.; aged 29 years; born in Austria; admitted to marine ward, German Hospital, Philadelphia, Pa., March 8, 1898; died March 13, 1898.

Family history.—Negative. For past week has had feeling of general malaise, intense headache from beginning of attack. Bowels have not moved for past four days. Has had chills at irregular intervals since beginning of attack; were not followed by distinct fever or sweats. Headache is general in character but more severe in occipital region. Has had no epistaxis, cough, or expectoration. He felt sick enough from beginning of attack to be in bed. On admission temperature 38.2° C., pulse 98, good volume and compressible. Pupils about normal in size. Tongue heavily coated. Abdomen was scaphoid; no tenderness or gurgling in right iliac fossa. Area of splenic dullness enlarged. No eruption was noticed on any portion of body. Examination of heart was negative. Lungs normal except at left apex, at which point there was dullness on percussion and complete absence of breath sounds. Examination for malarial organisms was negative. Widal's reaction was positive both by city board of health and German Hospital laboratory. Three days after admission there was conjugate deviation. Urine showed trace of albumen, many leucocytes, hyaline, epithelial, and pale granular casts. Face cyanosed. On day of death, about twelve hours before his demise, there were physical signs of consolidation of greater portion of lower left lung. Opisthotonos present.

Autopsy.—Height about 1.73 meters. Post-mortem lividity very marked. Rigor mortis also very marked, and could only be broken up in arms, for instance by applying a great amount of force. General nourishment very good. Pupils equal and moderately dilated. The heart weighed, after opening, 430 grams. The mitral, aortic, tricuspid, and pulmonary valves were all found in good condition. The aortic and pulmonary were found competent by the hydrostatic test. The walls of the ventricles were normal macroscopically, and the usual proportion of 4 to 1 was maintained. The thoracic aorta was found clear and smooth throughout. The abdominal aorta also found clear and smooth, except where the bifurcation into the iliacs takes place there were a few specks of atheromatous change. The femoral and other arteries and veins, so far as observed, were found normal. The nares, larynx, and trachea presented no marked pathological changes. The left lung weighed 1030 grams. The pleural cavity was moistened by a serum-like fluid. Near the apex the cavity was nearly obliterated by many dense adhesions which were broken up with some difficulty. The entire lower lobe of the lung appeared to be consolidated, red in color, friable, and portions when placed in water sank at once, also did not crepitate when squeezed between the fingers, and gave sense of resistance when pressed upon, like a piece of liver for instance. The right lung weighed 820 grams. Nothing abnormal was noticed about pleural cavity, except at apex, where it was obliterated. The pleura was bound down in many places by adhesions to the pleural wall, which apparently were recent in character and readily broken up. The middle and lower lobes presented a normal appearance. In the greater portion of the upper lobe, but especially toward the apex, the lung showed evidences of consolidation. Near extreme apex and posteriorly there was a cavity about 5 cm. in diameter, in which there was a caseous material; many bronchi were bunched together, the lung structure apparently having been destroyed between them; the cavity was near the surface. Lower down there were several masses of fibrous tissue, encapsulated in the lung structure, very resistant on section, firm, and inelastic. The lung structure on section presented many tubercles about the size of a millet seed. The peribronchial glands were much enlarged and softened. On section they presented a caseous material, also some tubercles. The organs all bore the normal relationship to each other. The omentum was somewhat shortened. The peritoneum showed no pathological changes. Tongue was heavily coated with brownish-white fur. The pharynx was congested. The oesophagus showed no pathological change. The stomach contained a small amount of fluid which resembled curdled milk. Walls were coated with a tenacious slimy material. The diameter of the pylorus was 1.5 cm.; the diameter of the cardiac orifice 2.5 cm. The small intestine was congested. The ileum presented six oval ulcers in its lowest portion, opposite to the mesenteric attachment, their long axis in the long axis of the gut, their floor smooth and slimy, edges thickened and undermined. Mesenteric glands were enlarged, especially those in direct connection with that portion of the intestine in which the ulcers were found. Small areas of the large intestine were congested at points. The hepatic flexure and transverse colon were filled with hard fecal masses, which when mixed with water made a pea-soup material in appearance. Rectum was found, patulous and not altered from normal. The capsule of the liver was adherent, especially the diaphragmatic side; on attempting to strip it much difficulty was experienced, small bits of liver tissue being torn away. Macroscopically the condition presented a perihepatitis. The liver was chocolatered in color, weighing 1,600 grams, resistant to the touch and cut harder than normal, and on section presented the macroscopical appearance of an oncoming cirrhosis. The microscopical examination will be appended. The gall bladder was about half filled with bile. The ducts all found patulous, the walls somewhat thickened. Pancreas: Normal in appearance; weight, 115 grams. Left kidney weighed 150 grams. Appeared larger than normal; was congested. On section the cortical portion was found thickened; small areas of hemorrhagic change were found in medullary portion. Capsule stripped readily. Right kidney weighed 190 grams and presented the same general characteristics as the left. The pelvis contained a small amount of fluid which resembled cloudy serum. Pelvis and ureters: These parts appeared normal. The urethra had about the normal caliber throughout; on the introduction of the sound no strictures were observed. On longitudinal section the penile portion was somewhat congested; otherwise was normal. The prostate was palpated through the rectum and not found enlarged. On section no changes had taken place. The right and left suprarenal bodies showed no macroscopical changes, each weighing 10 grams. The general shape of the head had a tendency to squareness or box shape. The skull proper was of average thickness. The membranes of the brain were deeply congested. The veins and arteries were engorged. A large vein running in the membrane that covered the upper portion of the right occipital lobe had in its course an air or gaseous embolus, upon either side of which there was blood; no puncture in the vein could be observed. On the cortex there was much lymph, especially on either side of the longitudinal sinus. This lymph was immediately under the arachnoid and was of a yellowish

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