FOOT-AND-MOUTH DISEASE.

A case of foot-and-mouth disease in man was notified at Ellsworth, Kans., November, 1915, and a case at Salina, Kans., in December.

INFLUENZA.

In November and December, 1915, a disease resembling influenza was reported epidemic in practically all parts of the United States. Outbreaks of this disease extended from the Atlantic seaboard to the Pacific coast and penetrated even to such localities as central New Mexico. The disease spread throughout the country with great rapidity. In San Francisco, one of the first localities in which the disease was reported, the outbreak was said to have been the most severe of any since 1891, and the bacillus of influenza was reported to have been isolated. In many localities "grip" was reported epidemic, in others pulmonary infections were said to be unusually prevalent. The increase in the number of deaths registered as due to pneumonia was an index of the prevalence of the disease. At the height of the epidemic in some localities the morbidity rate was so great that difficulty was experienced in many establishments in carrying on ordinary business, due to the illness of a large percentage of the personnel. In December it was estimated that there were 100,000 cases of griplike disease in the city of Detroit. The hospitals were crowded.

In many places the schools were partially depopulated because of the number of pupils at home sick.

The New York City Department of Health, where griplike infections were prevalent, made a bacteriological study of 50 cases diagnosed as grip. The streptococcus was found in 26 cases, the diplococcus lanceolatus in 19, the micrococcus catarrhalis in 18, and the bacillus of influenza in 9. Other organisms commonly present in sputum and nasal discharges were also found. As an interesting comparison a somewhat similar study made in New York City during a previous year showed the influenza bacillus present in only one specimen out of 20 examined. The presence of the influenza bacillus in 9 of the 50 cases examined suggests that influenza was a distinct factor in the outbreak in New York. The findings in the other cases suggest that other infections due to the streptococcus and to the micrococcus catarrhalis were probably as great factors, also that the pneumococcus undoubtedly played a part and frequently complicated the other infections.

The increase in the number of deaths registered as due to pneumonia during the period in which the griplike infection was prevalent is illustrated by the following table, giving by weeks the numbers of deaths registered as due to pneumonia in certain cities:

Deaths ascribed to pneumonia.

Week ended

23.

30.

Oct. Oct. Nov. Nov. Nov. Nov. Dec. Dec. Dec. Dec. Jan. 6. 13. 20. 27. 4.

11.

18. 25.

1.

5 Was a New York City case-treated by a Mount Vernon physician.

6 The commissioner of health states: "Unless the case is an open one with discharging lesions and the home conditions are not suitable for adequate medical and nursing care, aside from reporting and tabulating and occasional inspection," no consideration is given.

7 The commissioner of health states: "Cases desiring hospital treatment are referred to department of public charities and admitted to their several hospitals-not isolated. This city does not segregate such cases."

8 Patient died in March, 1915.

9 Detained on premises of municipal hospital from Aug. 14 to Sept. 27, 1915.

10 Case came from California and was returned to that State.

11 Was in Richmond from Dec. 20, 1915, but was not reported until Jan. 4, 1916.

12 Disposition of case not stated.

13 Patient was a Japanese who had not been in the United States 3 years and was deported after 1 month's isolation.

14 The health officer states: "In the city of Tampa there is only 1 case, and 2 cases outside of the city limits."

15 This is the same case which is listed in the State table as being located in the District of Columbia.

LEPROSY.

Special blanks were sent to the health departments of States and to cities having a population of over 10,000 at the time of the 1910 census asking for information regarding the known occurrence of leprosy in their respective jurisdictions during the calendar year 1915. The following table gives the information furnished in the blanks returned. It is probable that there were a few known cases in cities from which no reports were received. Undoubtedly there were also a number of cases which were not reported because their existence was unknown to the health departments.

1 The health officer estimates at least 15 cases in Michigan.

2 The health officer states: "In one sense, none; in another sense, all, because we advise how these cases shall be handled. All cases, however, are practically isolated at home or in some institution. One case is isolated on a county poor farm."

3 Patient died Oct. 7, 1915.

4 Estimated.

5 Some cases at Diamond Head, not under State control.

MALARIA.

Among the major public-health problems confronting the country is that of the control of malaria, one of the diseases taking the greatest toll of the community and at the same time one which can

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.