RELAPSING FEVER.

A case of relapsing fever was reported at Denver, Colo., July 24, 1915. Spirochetes were found in the patient's blood. From the history the disease was apparently contracted at a mountain camp 25 miles from the city. Three other persons resident at the camp had similar attacks of illness which were undoubtedly relapsing fever. The fifth case of illness in a person residing near the camp was also believed to be relapsing fever. The daughter of the first reported patient, who nursed her mother and had not been out of Denver, had an attack of the disease and spirochetes were also found in her blood. The original infection was believed to have been contracted from a band of gypsies which had stopped some hours at the mountain camp referred to.

Relapsing fever undoubtedly occurs from time to time in the United States. Cases of the disease are occasionally found in arriving immigrants, and while the infected in these instances are detained and cared for as long as they harbor the infection the probabilities are that infected persons occasionally pass the immigration inspector without detection. Physicians throughout the country should familiarize themselves with the symptoms of the disease and keep on the lookout for cases. Wherever suspected the diagnosis should be confirmed by blood examination.

SCARLET FEVER.

Scarlet fever is present throughout all parts of the country at some time during the year. The virulence of the disease varies in different outbreaks and in different localities. There is a general impression that the disease is milder in the Southern States than in the Northern.

The State reporting the greatest number of cases in proportion to the population was Nevada where, during the calendar year, 1915, 2.5 cases were reported per 1,000 inhabitants. The District of Columbia came second, with 2.2 cases per 1,000 inhabitants, and Ohio, third, with 1.8. It is probable that the disease was not more prevalent in these States than in some others, but simply that it was more completely reported. However, the disease must have been very common in Nevada to have had so many cases reported.

The indicated fatality rates derived by comparing the reported cases to the registered deaths were lowest in Vermont, with a fatality rate of 0.96 per 100 cases; the District of Columbia, with a rate of 1.01; and the State of Washington, with a rate of 1.03. This simply means that the numbers of cases of scarlet fever reported in these States for each death registered as due to the disease was large. It shows that the cases were relatively well reported.

Some of the larger cities gave rates of prevalence considerably higher than those of the States. This may have been due to more complete reporting of the cases. Dayton, Ohio, had an indicated case rate of 4.2 per 1,000 population; Boston, Mass., a rate of 3.7; and St. Paul, Minn., one of 3.5.

The indicated fatality rates in some of the cities was very low, the lowest being Richmond, Va., with a rate of 0.4 per 100 cases; the next lowest, Seattle, Wash., with a rate of 0.7; and Kansas City, Mo., with one of 0.8. Ordinarily the disease seems to have a fatality rate under 1 per cent.

SEVEN-DAY FEVER.

Cases of seven-day fever were reported in San Juan, Porto Rico, in October, 1915, by Asst. Surg. Gen. H. R. Carter.

SMALLPOX.

The mild type of smallpox continued prevalent throughout the United States during the calendar year 1915. It was especially prevalent in the Southern, Central, and Western States, and in this territory wherever reliable records were kept many cases were recorded. In Indiana there were over 3,000 recorded cases, with 10 deaths; in Kansas, 2,800 cases, with 8 deaths; in Ohio, 3,200 cases; Oklahoma, 3,700 cases; and Wisconsin, 1,800 cases.

In Texas both mild and virulent types of smallpox were present. The infection of virulent smallpox is repeatedly found in territory adjacent to the Mexican border. In Texas there were 2,037 reported cases, with 101 deaths. Outbreaks of the virulent type of the disease were reported at San Antonio, Brownsville, and El Paso. At El Paso there were 96 cases, with 27 deaths reported. At Laredo there was between January 1 and May 1 a total of 207 reported cases, with 32 deaths.

At New Orleans there were 72 cases during the year, with 5 deaths. The virulent type of the disease was present during the month of June.

In Massachusetts a virulent outbreak occurred at New Bedford during May, June, and July, 1915. During this time 23 cases of smallpox were reported, of which 10 terminated fatally, giving a fatality rate of 43.3 per cent. The disease was distinctly of the virulent type. The eruption in 11 of the cases was reported to have been confluent and in 4 hemorrhagic. The original source of the infection was not discovered.

At Chattanooga, Tenn., there were 73 cases reported, with 31 deaths.

PORTO RICO.

On May 4, 1916, the presence of smallpox in San Juan, P. R., was announced by the director of sanitation, and this announcement was soon followed by reports of cases from other places in Porto Rico, particularly Trujillo Alto, a small town about 12 miles eastward from San Juan. To June 17 the following cases had been reported, but it is now known that a considerable number of cases had occurred in San Juan prior to the above date.

The form of the disease was mild as a rule, so much so that it led some persons unfamiliar with the disease in its mild forms to raise the question of its being genuine smallpox.

The general vaccination under the early military government attempted to include the entire population of the island, but unquestionably thousands of persons managed to avoid it. During the succeeding years more or less vaccinations were done, sometimes many thousands, but the increase of population by birth and immigration has exceeded the number of vaccinations, hence there has been a varying but constant increase in the number of persons nonimmune to smallpox, which number has further been augmented by those whose immunity conferred by vaccination has gradually worn off.

1914

2,848, 275

.079

2,861

.905

.43

.760

1,847

.834

32

1,228

.299

.590

.47

25

.069

1,359, 474

1,450