3 For six months only.

LEPROSY.

Leprosy is of special interest, not because of its frequency, but because of its infrequency. It is a disease which offers special difficulties in its control because of the lack of knowledge as to the means by which it is contracted. The situation is further complicated by the great dread in which those afflicted with the disease are held by most people.

Seven cases of the disease were reported in California, 2 in the District of Columbia, 60 in Hawaii, 19 in Louisiana, 596 in the Philippine Islands, 9 in Porto Rico, 1 in South Carolina, 1 in Wisconsin, and 1 in Galveston County, Tex. These few reported cases probably represent only a small fraction of those which developed in this country, and without doubt they do not represent all of the recognized cases. So long as the public attitude toward cases of leprosy is what it is, and it will probably continue for some time, and so long as there is no institution or place where those who have been so unfortunate as to contract the disease can go and spend the remainder of their lives in peace and quiet and with such comfort as is possible, just so long will the tendency be for friends and relatives to conceal cases of leprosy and to do everything within their power to prevent the cases being reported to the authorities.

Only two or three States have made provision for the segregation and care of those afflicted with leprosy, and the provisions in those States are not such as to make it an inducement for one affected with the disease to seek their refuge, certainly not until the later and more mutilating stages of the malady have been reached.

Few States have a sufficient number of lepers to warrant any great expenditure for their care. The establishment of a Federal institution where lepers from all the States might be sent has been repeatedly suggested. It would seem that under such an arrangement a greater degree of comfort might be given to these persons and life relieved of many hardships which must otherwise be encountered.

The record of cities shows that one case was reported in Detroit; three in New York; one in Philadelphia; one in Oil City, Pa.; two in St. Louis; five in Los Angeles; two in San Francisco; one in San Diego, Cal.; one in Tacoma, Wash.; and two in Tampa, Fla.

MALARIA.

Malaria constitutes one of the largest and most important publichealth problems with which we are confronted. Few diseases will lower the efficiency or affect the prosperity of a community to so great a degree as will malaria. Fortunately the disease is one of those most readily controlled. The means by which the infection is carried is known, and the conditions under which the dissemination and spread of the disease occur have been worked out to a greater extent than is true as regards most other maladies. Naturally, the first step in the control of this disease is the securing of information as to where the disease is present.

At one time malaria was very prevalent in Michigan, Wisconsin, Canada, and the northern parts of Indiana and Illinois. When the

disease was present in these localities undoubtedly many cases of illness due to other causes were ascribed to malaria, ague, and chills and fever. Very probably in the localities to-day where malaria is present the same condition exists and many cases of illness not due to malaria are ascribed to this cause. However, there are probably in these localities an equal number of unrecognized cases of the disease.

No State seems to have made a serious effort to secure reports of the occurrence of malaria, or at least not to have been successful in the attempt, unless perhaps the States of Mississippi and Virginia may be considered to have done so. In California there were 331 cases of malaria reported and 70 deaths from the disease; in Kansas, 8 cases and 25 deaths; in Maryland, 96 cases and 9 deaths; in New Jersey, 718 cases and 10 deaths; in Porto Rico, 395 cases and 613 deaths. The fact that the numbers of deaths are too great for the numbers of cases in California, Kansas, and Maryland is apparent. The fault may be, however, and probably is, at least in part, due to the assignment of incorrect causes of deaths. In Mississippi there were 116,688 cases of malaria with 1,029 deaths registered. In Virginia there were 6,926 cases with 117 deaths registered. In the Philippine Islands there were 19,753 deaths registered.

In the cities there were cases reported as follows:

In Boston, 16; Cleveland, 8; Philadelphia, 20; Newark, N. J., 31; Jersey City, N. J., 3; Camden, N. J., 2; Paterson, N. J., 4; and Richmond, Va., 20.

In other cities deaths were recorded as follows: Baltimore, 6; Chicago, 5; Detroit, 1; New York, 20; St. Louis, 10; Cincinnati, 3; New Orleans, 32; San Francisco, 5; Washington, 3; Kansas City, Mo., 6; Louisville, 2; and Providence, R. I., 1.

MEASLES.

Measles at some time during the year is present in practically all parts of the country. It usually shows an increased local prevalence at intervals of two or three years, the interval being due, presumably, to the time necessary for the development of a new crop of susceptible material. The control of the disease is exceedingly difficult, due in part to the fact that it is frequently so mild that no physician is called, the case being treated at home and not reported, and further to the fact that the time when the disease is spread seems to be limited largely to the early stage, when the malady has the characteristics of a head cold and before its true nature is recognized. Fortunately the disease is relatively mild and the fatalities are comparatively few, although there are without doubt many more cases of bronchial pneumonia and pulmonary tuberculosis following this disease than are usually recognized or shown by the official records. As a rule it is difficult to get cases of this disease reported to the health department. It is being done successfully, however, in a number of States and cities.

The highest reported case rates for measles for the calendar year 1914 were those for the States of Mississippi, Montana, and Colorado, with rates of 9.44, 6.52, and 4.87, respectively, per 1,000 population. The lowest rates among the States reporting were those for New Jersey, Arizona, and the Philippine Islands.

Among the larger cities the rates in some instances were considerably higher than those reported for States, the highest rates for cities of over 100,000 population being those for Indianapolis, Ind., Newark, N. J., and Grand Rapids, Mich., with rates of 19.98, 14.96, and 11.76, respectively, per 1,000 population. The lowest rates, which may possibly mean nothing more than incomplete notification, were those for the cities of Tacoma, Wash., Cincinnati, Ohio, and Louisville, Ky.

In the smaller cities some unusual rates were reported. The rate for Holland, Mich., was 37, of Battle Creek, Mich., 29.8, and of Billings, Mont., 32.1, respectively, per 1,000 population.

Of special interest are the low fatality rates given for some States and cities. There were in the District of Columbia 947 cases, with but 1 registered death, due to the disease. In Utah there were 2,019 cases, with 8 deaths, giving a fatality rate of 0.4 per 100 cases. In Vermont there were 434 reported cases, with 2 deaths, giving a fatality rate of 0.46.

In the larger cities there were in Indianapolis 5,185 reported cases, with 6 registered deaths, giving a fatality rate of 0.12 per 100 cases; in Denver, Colo., 2,674 cases, with 5 deaths, giving a fatality rate of 0.19 per 100 cases. Syracuse, N. Y., had 1,533 reported cases, with 3 registered deaths, giving a fatality rate of 0.2 per 100 cases.

Of the smaller cities, Augusta, Ga., had 573 reported cases, with 1 registered death; East Orange, N. J., 900 reported cases, with but 1 registered death, and Montclair, N. J., 769 cases, with but 1 registered death.