4 Deaths were not reported.

SEPTIC SORE THROAT.

Eighteen cases of septic sore throat were reported in Maryland, 357 cases with 9 deaths in New York State, and 24 cases in South Carolina.

SMALLPOX.

During the last 15 years smallpox in the United States has practically entered the class of diseases having universal prevalence throughout the country, in which class are included such diseases as scarlet fever, diphtheria, and measles.

During the year 1914 the mild type of the disease has been the prevailing one. Only in a very few outbreaks was the infection of the virulent type. During the year 1914 there were reported in Arizona 7 deaths and 68 cases, in Indiana 7 deaths and over 4,000 cases, in Iowa 10 deaths and over 3,000 cases, in Maryland 5 deaths and 216 cases, in Minnesota 6 deaths and nearly 2,000 cases, in Mississippi 7 deaths and over 1,100 cases, in Montana 5 deaths and 1,200 cases, in the Philippine Islands 430 deaths, and in Virginia 18 deaths and over 3,000 cases. There are no satisfactory records available for the State of Texas, but it is known that there were outbreaks of the virulent type of the disease in the State during the year. The highest reported case rates were in Montana, Utah, and Virginia, with rates of 2.9, 2.7, and 1.5, respectively, per 1,000 population.

The highest fatality rates were in Arizona, New Jersey, and Maryland, with rates of 10.3, 4.3, and 2.3, respectively, per 100 cases. The lowest fatality rates were reported in Illinois, Wisconsin, and California, with rates of 0.05, 0.09, and 0.13, respectively, per 100 cases. Among the larger cities the highest reported case rates were in Nashville, Tenn., Salt Lake City, Utah, and Milwaukee, Wis., with rates of 3.22, 2.98, and 2.76, respectively, per 1,000 population.

Of the cities of less than 100,000 population the highest rates were reported in Waco, Tex., New Albany and Anderson, Ind., with rates of 13.41, 12.60, and 12.28, respectively, per 1,000 population. The highest fatality rates (not including Yonkers, N. Y., which had one fatal case) were reported at El Paso, Tex., where there were 191 cases, with 49 deaths, giving a fatality rate of 25.6 per 100 cases.

During the latter part of the year 1914 and the first part of 1915 there was an outbreak of virulent smallpox at Chattanooga, Tenn. The infection was imported by one M. L., who arrived at Chattanooga from El Paso, Tex., on November 9, 1914, suffering with a severe type of smallpox, from which he died. Subsequent to his arrival two other cases of confluent smallpox developed in the same house. The total number of reported cases from the original one in November to January 15 was 56, with 16 deaths, a fatality rate of 28.6 per 100 cases. During December there occurred 38 cases, of which 13 ended fatally. From January 1 to 15 there were 15 cases, with 2 deaths. Most of the fatal cases were of the hemorrhagic type. With the exception of the cases of varioloid, all were of the hemorrhagic or confluent types.

The wife of the patient in the first case stated that her husband had worked in a construction camp outside of El Paso before coming to Chattanooga, that he fell ill during the progress of his journey,

and stopped over a few hours at Montgomery and also at Birmingham. At the latter place he was feeling extremely ill, and was also very ill on arriving at Chattanooga, where the eruption was noticed the following morning.

The virulence of the disease was shown in a case which was reported on the afternoon of January 15. The patient had been sick three days, with initial symptoms of a chill, severe headache, and backache. The attending physician had treated him for influenza. On the morning of January 15, the third day of the disease, ecchymoses and petechia began to appear, and shortly afterwards he had severe hematuria and died at noon. The body presented no evidence of macular or papular eruption. It was very frankly a case of purpura variolosa.

Virulent smallpox has been present at Laredo, Tex., for some months. From January 1 to March 13, 1915, 124 cases of smallpox were reported at Laredo, of which a considerable number were fatal. Beginning in May, 1915, there was an outbreak of virulent smallpox at New Bedford, Mass. Between May 15 and July 3 there were 21 reported cases, with 9 deaths. The source of the infection could not be traced.

Wisconsin.

VACCINATION STATUS OF REPORTED CASES.

A number of State departments of health endeavor to ascertain the vaccination histories of all persons contracting smallpox. The following gives a summary of the vaccination status of such persons in these States for the calendar year 1914, and the available information for 1912 and 1913:

During the year the localities in which the presence of trachoma has been ascertained to exist were as follows:

An examination of the pupils of the graded schools of Versailles, Woodford County, Ky., revealed 9 cases of trachoma among 294 pupils.

An examination of the inmates of the Kentucky Houses of Reform at Greendale, Ky., revealed 21 cases of trachoma among 423 inmates.