Through the kindness of Drs. T. J. Dimitry and J. A. Estopinal, 470 blood smears were secured from school children in St. Bernard Parish, La. These were examined by Passed Asst. Surg. R. A. Herring, who found only 4 positives, all of the tertian type.

Malaria index work. The microscopical examination of blood specimens secured for determining the malaria index in given places was continued. The malaria index was made during this year in the following-named places:

Alabama: Mobile, 884 examined; 44 infected; 4.97 per cent. Fulton, 402 examined; 20 infected; 4.97 per cent. Lanett, 646 examined; 1 infected; 0.15 per cent. Kaulton, 234 examined; 21 infected; 8.97 per cent. Holt, 305 examined; 9 infected; 2.95 per cent. Tuscaloosa, 767 examined; 35 infected; 4.56 per cent.

Missouri: Crystal City, 640 examined; 36 infected; 5.62 per cent. Louisiana St. Barnard Parish, 470 examined; 4 infected; 0.85 per cent.

Mississippi: Cedars, 119 examined; 40 infected; 33.6 per cent. Lucedale, 213 examined; 12 infected; 5.63 per cent.

North Carolina: Roanoke Rapids, 968 examined; 34 infected; 3.51 per cent.

From the beginning of 1912 to June 30, 1916, a total of 20,462 persons have been examined, of which number 2,561, or 12.51 per cent, were found to harbor parasites of malaria. These examinations were made among persons residing in the States of Alabama, Arkansas, Mississippi, Missouri, Louisiana, North Carolina, South Carolina, and Virginia.

On analyzing the records, the following interesting facts appear: 1. One of every eight persons examined was found to be a carrier. 2. The percentage of infection among whites was 8 per cent and that among the colored 20 per cent.

3. The percentage of carriers was highest among those 3 years of age and under. The extreme ages of persons found infected were 9 months and 85 years.

4. The tertian type was most prevalent, the proportion being practically 2 cases of tertian to 1 of estivo-autumnal.

5. The quartan type was extremely rare; only two pure quartans and 1 mixed quartan and tertian were found in a total of 2,561 infections.

6. The percentages of infection according to places varied from 1.7 per cent to 40.9 per cent.

7. Mississippi showed the highest percentage of infection among those examined.

8. About 1 of every 4 infected persons harbors the sexual (gametocyte) forms necessary for infecting a malaria-bearing mosquito. A report covering the malaria index work has been published in the Public Health Reports and issued as Reprint No. 331.

STUDIES OF RICE CULTURE IN RELATION TO MALARIA PREVALENCE.

Studies of anopheline mosquitoes in relation to malaria in regions where rice is cultivated are being continued at Stuttgart, Ark., and during this year like studies were begun at Crowley, La. Visits will be made to these places throughout the coming year, and as soon as

sufficient data are available, a report will be made dealing with the question as to whether rice culture has resulted in an increase of malaria.

HEMOGLOBINURIA.

Reports of cases of hemoglobinuria were received from physicians in the States of Arkansas, Florida, Georgia, Louisiana, North Carolina, Tennessee, and Texas. This disease occurs chiefly during the fall and winter months and is only reported at places where malaria prevails. Inquiry regarding this disease is invariably made at all places visited, where it is generally known as "blackwater," swamp fever," or "yellow jaundice." Physicians report that cases occur in the lowlands, and rarely in towns.

IMPOUNDED WATER.

99.66

The investigation of the effect of impounded water on the incidence of malaria, begun in 1914, was continued under the direction of Asst. Surg. Gen. H. R. Carter. During the calendar year 1915 surveys were made of the following bodies of water: The pool of Lock 12 on the Coosa River; the pool of Lock 17, Black Warrior River; the pond of the Parrs Shoals hydro-electric power plant; and the pond of the Georgia and Carolina hydro-electric power plant at Stevens Creek. The first two are in Alabama and the last two in South Carolina. In addition a brief survey was made of two ponds of water of the Tennessee Coal, Iron & Railroad Co., near Birmingham, Ala. Incidental to other work a survey was also made of three small ponds in Virginia. The results of these surveys are reported in a bulletin now in press. During the present calendar year surveys have been made at Colleton, S. C., and Whitney, N. C.

The investigations include the making of physical and biological surveys, the first to determine whether the physical conditions are such as to make the places examined suitable breeding places for mosquitoes, and the second to determine what places are actually breeding malaria-bearing mosquitoes. On the basis of information so far obtained in these investigations, definite recommendations are made to the authorities as to necessary steps to be taken for better sanitation as regards malaria. In order to reach more compre

hensive conclusions these studies will be continued for a number of years.

COOPERATION WITH BUREAU OF FISHERIES.

Beginning with the first of the year, the Bureau of Fisheries of the Department of Commerce has supplied certain species of mosquitoeating fishes within a radius of from 12 to 18 hours' railroad journey from its stations at Edenton, N. C., and San Marcos, Tex. The Bureau of Fisheries has announced its intention of extending this service to other stations in the near future after the solution of some problems in the economic distribution and transportation of the fish.

COOPERATION IN MOSQUITO CAMPAIGN AT BALTIMORE, MD.

On request of the mayor Sanitary Engineer William D. Wrightson was granted leave to direct the work of a mosquito commission

at Baltimore, Md., during the summer of 1915. The city was divided into four sanitary districts and a campaign of eradication carried out throughout the summer. At the end of the work Mr. Wrightson submitted a report, which included recommendations in regard to the details of conduct of similar work in 1916.

MALARIA STUDIES IN ANNE ARUNDEL COUNTY, MD.

During the course of rural sanitation studies in Anne Arundel County, Md., Asst. Surg. R. C. Derivaux was instructed to carry on simultaneous investigations of malaria. The work began in the previous fiscal year and continued through last summer. It was found that, while present to the extent of probably several hundred cases annually malarial fever does not represent a particularly urgent problem in Anne Arundel County. For this reason it was recommended that measures for its control on the part of individuals would be preferable to an extensive campaign to eradicate the mosquito, the cost of which would be out of all proportion to the results. to be gained. However, it was felt that antimosquito work was applicable in cities and towns. The one measure that would be productive of the greatest benefit would be a thorough campaign of education as to the nature of malaria, the mode of its transmission, and the methods for its prevention which can be applied by residents.

SURVEY AT TOLEDO, OHIO.

On request of the State and local boards of health, Surg. Carroll Fox was detailed to make a mosquito survey of Toledo, Ohio, in relation to disease prevalence. The survey lasted from June 21, 1915, to July 18, 1915. It was found that, although malaria was formerly a common disease in and around Toledo, with the growth of the city the greater part of the swamp land has been reclaimed and malaria has become an uncommon malady. The few cases reported to the health department in recent years have been imported into the city from outlying malarial sections.

PUBLICATIONS.

The following publications of the service during the past fiscal year relate to malaria.

REPRINTS FROM THE PUBLIC HEALTH REPORTS.

290. Anopheles as a Winter Carrier of Plasmodium. The mosquito as a prophylactic indicator. By M. Bruin Mitzmain. July 16, 1915.

324. Anopheles Punctipennis Say. Its relation to the transmission of malaria. Report of experimental data relative to subtertian malarial fever. By M. Bruin Mitzman. February 11, 1916.

328. Demonstrations of Malarial Control. By R. H. von Ezdorf. March 10, 1916. 331. Endemic Index of Malaria in the United States. By R. H. von Ezdorf. March 31, 1916.

337. Tertian Malarial Fever. Transmission experiments with anopheles punctipennis. By M. Bruin Mitzman. May 12, 1916.

PUBLIC HEALTH REPORTS.

May 19, 1916. The control of Malaria. Whirligig beetles (Dineutes) as a possible factor. R. C. Derivaux.

PELLAGRA.

Field investigations of pellagra have been conducted during the past fiscal year, under the direction of Surg. Joseph Goldberger, at three orphanages, two located in Jackson, Miss., and one in Columbia, S. C., at the Georgia State Sanitarium, Milledgeville, Ga., at the State prison farm near Jackson, Miss., and in seven mill villages in Spartanburg, Oconee, and Chester Counties, S. C. In addition, Dr. Goldberger has visited many localities, principally in the South, for the purpose of investigating peculiarities or eccentricities of pellagra prevalence. Studies of this character were made in Alabama, Arkansas, Louisiana, North Carolina, and Texas.

Special studies of pellagra have also been conducted at the laboratory of the United States Pellagra Hospital, Spartanburg, S. C., under the direction of Prof. Carl Voegtlin, the hospital work in that city being in charge of Passed Asst. Surg. R. M. Grimm.

Researches conducted during the past year serve to confirm the proposition that pellagra is due to the use of an unbalanced diet.

VALUE OF DIET IN TREATMENT.

A study of the value of diet in the prevention of pellagra at two orphanages and at an asylum for the insane was begun in 1914. The object of this study was to determine whether it was possible to prevent what has from the earliest history of the disease been. regarded as almost absolutely inevitable, namely, the recurrence of the attack in one who has had the disease the preceding season.

The two orphanages are located in Jackson, Miss. At both, cases of pellagra have been recognized annually for several years. During the spring and summer of 1914, up to September 15, a total of 209 cases of pellagra was observed in the children of these orphanages. Since about the middle of September, 1914, the diet at both orphanages has been modified in accordance with the instructions of the officer in charge of these investigations.

Through the courtesy and with the cooperation of the officers and staff of the Georgia State Sanitarium, two wards of pellagrins at that institution were made available for study in the fall of 1914.

A preliminary report of the results of the study at these institutions was made in October, 1915. (Reprint No. 307 from the Public Health Reports.) Of the 209 cases of pellagra observed at the two orphanages during the spring and summer of 1914 and up to September 15 of that year, not less than 172 completed at least the anniversary date of their attack under observation. In only 1 of these 172 pellagrins, following the change in diet, was there recognized during the year 1915 evidence justifying a diagnosis of a recurrence. Nor was there any new case in any of the nonpellagrin residents, 168 of whom were continuously under observation for at least one year. Recent admissions aside, during 1915 there was no pellagra at one and but a single case at the other of these institutions. Of the insane pellagrins studied at the Georgia State Sanitarium, 72 remained continuously under observation up to October 1, 1915, or at least until after the anniversary date of their attack of 1914. Not a single one of this group presented recognizable evidence of a recurrence of pellagra, although, of a group of 32 control pellagrins

not receiving the modified diet, 47 per cent had recurrences during the corresponding period.

These results very clearly indicated that pellagra could be prevented by an appropriate diet. The great importance, both theoretical and practical, of this result made it desirable to continue and to enlarge the scope of this investigation. Accordingly, the study at the two orphanages and at the Georgia State Sanitarium has been continued. At the latter the study was enlarged by including an additional ward about November 1, 1915. The scale of the investigation was also enlarged by including an orphanage located at Columbia, S. C. At this orphanage, in spite of various efforts made for its control, pellagra has occurred in varying degree from year to year since it was recognized there in about 1908. In 1915 there were recognized in all upward of 100 cases among the children.

The Public Health Service began its study at this institution on September 1, 1915, Asst. Surg. W. F. Tanner being detailed in local charge. Here, as at the other institutions, the diet was modified in accordance with the instructions of the officer in charge, the fresh animal protein foods and legumes were increased and the carbohydrate components of the ration reduced.

At the close of the fiscal year, June 30, 1916, there is every indication that the results of these continued and enlarged investigations of the second year will confirm the results of the first year's study, namely, that pellagra is preventable by an appropriate diet.

In connection with this study it was deemed highly desirable for the purpose of definitely establishing the character of various skin manifestations observed at the orphanage at Columbia, S. C., and at the Georgia State Sanitarium to obtain the expert services of Dr. John A. Fordyce, professor of dermatology at the College of Physicians and Surgeons, New York City. Prof. Fordyce visited these institutions for this purpose May 10-14, 1916.

Furthermore, by reason of the striking results in the elimination of pellagra among the groups of pellagrins studied, it seemed desirable that independent confirmation be had of the observations of the officers in charge. Accordingly, Passed Asst. Surg. R. M. Grimm was detailed to make an examination of the service patients at the orphanage at Columbia, S. C., and at the Georgia State Sanitarium, and Surg. C. H. Lavinder was detailed to examine these patients and also the patients at the orphanages at Jackson, Miss. These officers made their examinations during the last week of May, 1916, and reported no pellagra present in any person under observation.

EXPERIMENTAL PELLAGRA IN THE HUMAN SUBJECT.

A study of the possibilities of producing pellagra in the human subject by means of a faulty diet was begun in February, 1914, at the State prison farm near Jackson, Miss., with Asst. Surg. G. A. Wheeler in local charge. This study was made possible by the cooperation of Gov. Earl Brewer, who, by promising a pardon, obtained and placed at the disposal of the service 12 convict volunteers. This study was continued to November 1, 1915. At the end of this' period 6 of the 11 volunteers who remained throughout the test developed pellagra. A brief preliminary report of this experiment was published in the Public Health Reports and issued as Report No. 311.