HEALTH OF THE NAVY.

Health conditions as indicated by morbidity reports for July were satisfactory. The admission rate for all causes was 491.6 per 1.000 per annum as compared with 528.7 per 1,000, the correspond. ing five-year median rate for July. The admission rate for all diseases, exclusive of injuries and poisons, was 436.5, as compared with the median July rate for the preceding five years, 456.3 per 1,000 per annum.

The rate for accidental injuries was 55.15 per 1,000 per annum, a figure that is not remarkable.

Communicable diseases were not unduly prevalent during July. Mumps is more prevalent this summer than last year. The annual seasonal increase in the prevalence of malaria is beginning to be noticeable. There were 128 cases during the month of July. Eightyseven cases of measles were reported during the month as compared with 93 in June. This incidence is about three and one-half times greater than is to be expected from the median rate for July. Influenza was less prevalent than usual at this time of year so soon after a pandemic period. One hundred and twenty-five cases were reported.

It is noteworthy that while the admission rate for measles was three and one-half times greater than our median experience for July, the admission rate for pneumonia, all forms, was considerably below the median July rate for these infections. These figures are in agreement with the conclusion that measles complications are relatively infrequent during the summer months.

The admission rate for communicable diseases, exclusive of tonsillitis and common colds was 56.2 per 1,000 per annum as compared with 67.7, the median July rate for recent years. The rate for tonsillitis and common infections of the respiratory tract was 59.9 per 1.000 per annum. The July median rate for these affections is 76.2. Less than half of the measles cases occurred at naval training stations and only 20 per cent were reported from ships; the remaining cases were scattered among foreign stations and shore stations. in the United States.

Of the 150 cases of mumps reported, 63 cases occurred in the United States fleet, most of them in battleships and destroyers on both coasts of the United States. Only 12 cases occurred at training stations.

The following table shows annual admission rates per 1,000 per annum for certain communicable diseases, entire Navy, for the

month of July, 1923, in comparison with median rates for the same month, 1918 to 1922, inclusive:

EPIDEMIC JAUNDICE IN NEW YORK STATE, 1921-22.

The following epidemiological study and analysis of 700 cases was made by Huntington Williams, M. D., Dr. P. H., sanitary supervisor, New York State Department of Health, and published in Health News, May, 1923, issued by the division of public health education, New York State Department of Health.

During the winter of 1921-22 New York State was visited over a very wide area by so-called infectious or epidemic jaundice. This disease was present at the same time in other parts of the country. Previous to the epidemic localized outbreaks had been studied by the New York State Department of Health in the village of Philadelphia, Jefferson County, in the winter of 1915-16; at Berkshire, Tioga County, in March, 1920; and in Chenango County during February, 1921. The disease as it appeared at Cooperstown, N. Y., during the recent state-wide epidemic has already been described.

It may be noted that during 1896 there occurred at Albany a well-marked outbreak of epidemic jaundice. At Hudson, N. Y., a similar epidemic occurred a few years previously. Reports from practitioners indicate that at certain localities in Delaware County, Allegany County, and especially in St. Lawrence County, repeated outbreaks of epidemic jaundice have occurred at varying intervals during the last 30 years. Up to 100 cases appear in some of these reports, and nowhere were uncomplicated cases recorded which terminated fatally. Multiple cases in households and in schools were frequently found in these earlier outbreaks. This history is interesting as having a possible relation to the outbreaks of influenza in the early nineties and again in 1918.

A detailed study of 700 cases of epidemic jaundice was made by the State sanitary supervisors in accordance with plans drawn by Dr. Edward C. Godfrey, jr., director of the division of communicable diseases of the State department of health. These cases represent approximately half the known cases that occurred during the epi

demic in New York State (excluding New York City), and in addition there were many cases that were so mild that they were not seen by a physician or recorded in any way. The 700 cases here analyzed were reported from the 25 counties of Albany, Broome, Columbia, Delaware, Erie, Franklin, Genesee, Jefferson, Livingston, Madison, Monroe, Niagara, Ontario, Orange, Oswego, Otsego, St. Lawrence, Seneca, Steuben, Sullivan, Tioga, Ulster, Warren, Wayne, and Wyoming.

Symptomatology.-The disease appeared to be mild in character, although the gastrointestinal symptoms were often distressing. In typical cases there was a slight initial fever, with several days of anorexia, nausea, vomiting, abdominal pain, constipation, clay-colored stools, and bile-stained urine. After this period, which lasted usually from three days to a week, jaundice appeared and the abdominal symptoms decreased markedly in severity. The jaundice persisted for varying periods from several days to several weeks. It was sometimes observed only in the eyes, but in other cases it was widespread over the body and of a deep shade. Convalescence was almost invariably slow, and was marked by prostration very frequently of a severe type. In rare cases when seen in the prejaundice stage, there was noticed a faint rash on the arms and upper chest, together with a superficial tenderness and roughening of the skin in these parts. As a rule, however, no record was made of this symptom. The physician frequently considered the disease intestinal grippe, perhaps because the jaundice epidemic came fairly soon after the pandemic of influenza. In this connection it is of interest to note that there was a moderate leukocytosis present in half of the cases at Cooperstown, which were studied early in the disease, and in no case was there reported a leukopenia.

Fire atypical cases.-Throughout the epidemic there occurred only five known fatal cases, in each of which there were complications. Two of these were in infants born to mothers ill with jaundice at the time of delivery. One infant was born jaundiced and lived only 36 hours. The other was born with clear skin but on the second day after birth developed a yellow tint over the body. On the third day the baby began to bleed profusely from the bowel. This condition continued at intervals until the death of the child on the fourth day. The third fatal case was that of a girl, aged 5 years, who had very marked jaundice for two weeks, with constipation and elay-colored stools. The child had an irregular temperature during this time, with marked prostration, similar to that of influenza. There were signs of encephalitis, and the chemical test for bile was positive in the spinal fluid. The fluid was of clear color, and gave a low cell count. Another fatal case was that of a girl, aged 6 years, whose jaundice was complicated by existing renal disease due to

scarlet fever contracted a year previously. In this case the attending physician attributed death to acute nephritis. The remaining fatal case was that of a boy, aged 14 years. He developed jaundice, which cleared up after a week's duration. Two weeks after this the jaundice returned and became very marked. There developed typical symptoms of meningitis at this time, and the child died four days after the second appearance of the jaundice.

Epidemiology. It is of interest to note that (1) of the 700 cases studied the sex distribution is almost exactly equal (50.4 per cent males); (2) a little more than half (51.7 per cent) of the cases were in the school-age group, from 5 to 14 years, and outbreaks often centered in a school; (3) in more than half the cases the dates of onset were during the months of November and December, 1921, and (4) multiple cases in a houshold or a school were very common.

Dates of onset. Of the 700 cases, the dates of onset in 672 cases were between September 1, 1921, and March 2, 1922, and are recorded in Table 4. In addition, the onset in 17 cases occurred between March 1 and August 31, 1921, and in 11 cases there was no recorded date of onset.

Multiple cases in household or school. Of the cases, 421, or 60 per cent, were multiple-that is, more than one case occurred in a household. The maximum number in a home was eight. In 83 instances, there were 2 cases in a household; in 33, 3; in 20, 4; in 7, 5; in 3, 6; in 1 instance, 7; and in 2 instances, 8.

In one instance (at Cooperstown, N. Y.), 14 children in a one-room school of 36 pupils developed the disease, over a period of two and one-half months. In another school, all the pupils but two developed the disease. In a third school, the teacher and also the physician gave the information that nearly every child in the room had had an attack of jaundice, and in a fourth school district, in St. Lawrence County, every child but one had jaundice, and in connection with the school outbreak other children in the homes had secondary cases of the same disease. This apparent susceptibility to infectious jaundice among school children was also noted in an outbreak in St. Lawrence County which occurred about 25 years ago. In this connection attention is again called to the age distribution of the 700 cases here reported.

Laboratory investigations. Special investigations were made by the division of laboratories and research of the State department of health with the hope of discovering the specific etiologic agent in this disease. Blood, urine, feces, and throat cultures from patients with the epidemic disease were examined, and in no case were positive results obtained in isolating Leptospira icterohaemorrhagiae or any other organism of significance.