be attacked with the greatest assurance of success and usually with moderate effort and expense. Comparatively little attention has been given to the control of this disease. Almost without exception health agencies have not even made an effort to ascertain the extent and nature of the problem within their respective jurisdictions.

As to the geographic distribution of malaria in the United States at the present time, there are three principal well-recognized endemic areas-one large area and two smaller ones. The large endemic area covers the whole southeastern portion of the United States, having for its southern boundary the Gulf of Mexico; for its western boundary, a line drawn from Eagle Pass on the Rio Grande to Leavenworth, Kans.; for its eastern boundary, the Atlantic seaboard; its northern boundary, a line drawn from Leavenworth, Kans., eastward some distance north of the Ohio River and to the Atlantic on a line with the northern boundary of Maryland. Of the two smaller endemic areas, one includes a section of the northern part of New Jersey, southeastern New York, Connecticut, Rhode Island, and part of the State of Massachusetts. The third recognized endemic area is in California, and includes the Sacramento and San Joaquin Valleys which occupy a large portion of the central part of the State. As indicated by reports received from State and city health departments, and the records of Army posts, there are endemic areas scattered here and there in many other States.

The community is prone to be interested in the unusual and little known, and to give small attention to the commonplaces of daily occurrence. In many sections of the country malaria constitutes the most common cause of sickness. Usually, however, it appears as a small factor in the mortality records. This may be the reason why the disease has aroused so little community effort. The absence of the disease from an important position in death records is as unfortunate as the conclusions drawn from it are fallacious. In areas where malaria is especially prevalent, it is probably the greatest of any of the mortality factors. Although it may not be the immediate cause of death, it injures and weakens those who contract it year after year or become chronically affected so that minor ailments, which would not be serious for a normal healthy individual, frequently cause death. Malaria shortens the average length of life. During the last four years systematic work was carried on by the late Surg. von Esdorf, at New Orleans, La., to collect data of the prevalence and geographic distribution of malaria in the Southern States. This was carried on by sending to practicing physicians every three months a reply postal card, asking for a statement of the number of new cases of malarial fevers occurring among their patients during each month of the preceding quarter, with a statement as to whether the diagnosis was confirmed by the use of the microscope.

During the calendar year 1915 and the first six months of 1916 circular cards were sent to the physicians of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, Tennessee, and eastern Texas. During this period 162,931 cards were sent to physicians and 20,526 replies received. The percentage of the number of replies to the number of cards sent out was 12.60. The number of cases of malaria reported in this way was 154,634. There were also reported 110 cases of hemoglobinuric fever,

There is appended a table showing the occurrence of malaria recorded in the several States through morbidity reports and death registration. There were 522 reported cases in California, with 49 deaths. This indicates an incomplete reporting of cases and some mistaken diagnoses in the recorded deaths. In Alabama the 80 recorded cases and 500 recorded deaths indicate very incomplete reporting of cases and either a very great prevalence of the disease or many mistaken diagnoses registered in death certificates. The 194 cases with 26 deaths in Kansas indicate incomplete reporting of cases and a considerable prevalence of the disease. The 1,132 deaths in Porto Rico in a population estimated to be a little more than a million indicates that the disease is a public health problem of importance. The same is indicated to a lesser degree by the 906 recorded cases and 447 registered deaths in South Carolina.

The 153,565 cases recorded in Mississippi and the 12,983 cases in Virginia probably serve mainly to show the practicing physicians' belief in the prevalence of the disease in these two States. In these States the data was collected by having the physicians report the first of each month the number of cases of the disease treated during the preceding month, the reports being made out in many instances undoubtedly from memory.

The table on page gives a summary of the numbers of cases of malaria reported during the year 1915, on reply postal cards sent to practicing physicians in the States included.

Malaria-Reported prevalence in certain States during 1915.

A case of Malta fever developed at the United States Immigration Station at Boston, Mass., in a boy, aged 13 years, a native of Sicily, who had come from Campobello and arrived at Boston August 6, 1915. A case was also reported, April, 1916, in a goat herder in the vicinity of Capitan, N. Mex.

MEASLES,

Measles is common in most countries and has come to be considered a necessary evil. The infection is so broadcast that few individuals attain adult life without being attacked. The infection, introduced into a community where there are a considerable number of children who have not had the disease, sweeps through the community, under favorable conditions, infecting all the susceptible individuals or so large a proportion of them that it dies out for sheer lack of material. This action may be likened to a forest fire which sweeps over a locality and becomes extinguished only when it has consumed all the inflammable material within its reach. These periods of prevalence of measles, frequently called outbreaks or epidemics, 63887°-H. Doc. 1493, 64-2—20