PUBLIC HEALTH REPORTS

VOL. 40 APRIL 24, 1925 No. 17

VIABILITY OF B. TYPHOSUS IN STORED SHELL OYSTERS By CONRAD KINYOuN, Assistant Bacteriologist, hlygienic Laboratory, United Stztes Ptiblic Ilealti Serviee The object of this work was to determine whether oysters con- taminated with B. typhosuis and then stored unider uisual market conditions woul(l remain potentially infectious over a length of time sufficient to allow them to reach the consumer. Conflicting opinions are now current as to the length of time the causative agent of typhoid fever can remain viable in the oyster, and even as to whether the oyster can harbor the organisms at all. Obviouisly an oyster which harbors typhoidl organismns for as short a time as 24 hours becomes a potential infecting, agent for thlat time. Practi- cally it is of interest to know whether the time elapsing between the remov-al of the oyster from the bed and( actual consumption after passing through customary commercial channels is sufficient for oysters to rid themselves of possible infection. As early as 1603, oysters were incriminate(d in intestinal disor(lers, when suspicion was directed toward them by an illness of Henry IV of France (7). It was not uIntil the close of the nineteenth century, however, that oysters and shellfislh as agents of (lisease transmission receive(d particular attention. In October, 1894, Conn focused attention on the oyster by his investigation of the now famous Wesleyan outbreak, an(d thoughl only thlree outbreaks of typhoid fever were definitely traced to the oyster before 19,25, these stimulated wide interest and consequent study, with atten(lant epidemiological and bacteriological investigations. It is agreed that the medium of infection of oysters with B. ty- phosuis is water; but there is a wide (livergence of opinion uipon tlhe viability of the organisms in water. De Giaxa (12) fouind( numerous typhoid bacilli nine dtays after inoculation in ordinary sea water an(d 25 days after inoculation in steiilized sea water. I-le ma(le no ex- aminations later than thlese. Cassedebot, quoted by Frankland (1), foun(d the typlhoi(d organiisms (lestroyed in sterilize(d sea water within 48 houirs. Frankland (1) found 1 per cent and 3 per cent salt water prejui(licial to ty)hoid. Foote (2) conieludes that even in extremely cold weather, typlhoid bacilli will live in unsterilized brackish water (0.06 to 0.15 per cent salt) at least eight days, wlile in warnm(er 36275--25t-1 (819) April'24, 1925 8.120 water they rapi(dly (limiinish in numbers and can not be (letected after thlree weeks. Iler(linan and Boyce (3) conclude that typhoid bacilli w-ill not flourish in cleani salt water. Klein, quotedl by Reille (7), states that according to his experiments sea water is favorable to the survival of typhoid, an(l Reille (7) corroborates this finding. Burdoni et al., quoted by Conn (10), "proved the typhoid bacillus would live in sea wN-ater for 14 days." Dc Freytag, (11) found that the typhoid bacillus would live in concentrate(d salt anid gelatin solution for five months, buit not six months, at room temperature. To check the viability of the cultures used in tile present experi- nent, flasks containing 500 c. c. of 3.5 per (lent andl 30 per cent salt water were sterilized, then inoculated with a half slant eaclh of the Rawling and the Hopkinis strains of B. typhosus and kept at room temnperature. From day to (lay 0.1 c. c. from each flask was trans- ferred to Endo )lates and glucose brotlh fermentation tubes; and wlhen growth resulted, it was proved to be B. typhosus. This test slhowed that in 3.5 per cent sterilized salt water the organisms remained viable during the course of tile experiment-15 days- while in the 30 per cent salt B. typhosus was not proved after 24 hours. As to viability in the oyster itself, Harrington (13) cites the conclusion of Polak thlat during transportation the life processes of tlhe oyster have an inimical influence upon bacteria, diminishing their numiiber and, in certain cases, destroying them entirely; but Harrington states tiat this conclusion is opposed to that of others who liad found tilat the typlioid fever organisms live longer in the tissues and juice of the oyster than in the sea water. Field (6) cites experiments slhowing thlat mnany oysters are damaged and destroye(d during storage and trainsportation, thlus affording a favor- able mediunm for the multiplication of typhoid organisms. Previous laboratory work gives a range of infection lasting from eight days to six weeks. Foote (2) stated that, with oysters kept at a teulperatuire ranging from 500 to 65° F. (100 to 18.30 C.), the typhloid orgranismn lives longer in the stomiach and in the juice of the oyster thain it does in the water in whichi the oyster grows, and that if therc is an increase in organisms this increase takes place within the first two weeks, after whicil tilere is a decrease, but that the typhoid bacillus may be found even 30 (la-s after the date of in- fection. Boyce and lfcrdxnan (4) recovered typhoi(l organisms 14 days after infection; Fieldl (5, 6) 9 (lays after inf'ection, an(l from 4 to 6 weeks if oysters were cooled; Reille (7) froml 9 to 28 days; Klein fromn 7 to 11 (lays; Stiles (8) from 7 to 21 days. Park (14) states that infection is transitory and that oysters usuallv cleanse themnselves in lrom 6 to 8 davs. Gorham (9) gave an opinion, based on the seasonal counts, that oysters Iiiberniate. 81) April 24, 1:)25 Following this suggestion as to oyster hibernation, the New York City health departinent slhowed that infection (lid not occur in hibernating oysters whlen the surrounding wateI had 13O(M'() typhoid bacilli per c. c. Pease, *luoted by Patirk; (14), states that at 2.2° C. oysters close their slhells so tightly as to be im1pervious to particles of dyes in aqueous solution. The oysters use(l in the tests lhere reporte(l were of a large salt- water variety, tong(e(l fromi Tangier Sound(I in the Chesapeake Bay and broulgilt to Washington by power b)oat. By the tine they had reached Washington they had been out of water eihlt (lays. Two buslhels were purchiase(d oIn February 4, 1925, brought to the Ily- gienic Laboratory, and stored outdoor-s for the night. The followitng morning they were brought insi(le and cleaned roughly by scrubbing with brush an(l cold tap water. They were then placed in 6 large glass aquarium jars, each containing about 16 liters of sterilized tap water to whiclh 3.5 per cent sodijum chlloride C. P. had been ad(le(l. The amount of water was sufficient to cover the oysters generously. Air was passe(l througli this watet in a slow stream, allowingr ample aeration. After two lhours, when the temn- perature in tile jars ranged from 240 to 280 C., they were eaci inoculated withi two-thir(ds of a liter of 24-hour bouillon culture. The inoculum consisted of 2 liters each of Rawlings and(i Hopkins strains of B. typhossus. Previous to inoculation it was notice(d that the oysters had opened their shells. Six in each jar were tested for viability. On slight stimulation all closed their shells. During the night, air was passed through the water every two hours for 10 minutes. Cultural checks were made of the cultures used for inoculation. After 24 hours' feeding, the oysters were taken fromn thc aquariums, drained, and placed in galvanize&l-iron buckets. One portion was placed in a laboratory cold roomn, which is maintained at 100 C., and the other portion, covered with ice, was placed outtdoors. The, latter was re-ice(Idaily. During, thie test the mnean (laily outside temperature range(l from 27° F. to 580 F. (-2.80 C. to 14.40 C.), with an average of 430 F. (6.10 C.). From day to day individuals from each lot NweLre opened and cultured. Opening wtls preceded hy flaming the slhell thoroughly with a Bunsen buiner, pryina the shell apart witlh a flame(d oyster knife, and cutting the attachmneiit miiuscle of the right slhell. Cultures were obtained from the slhell liquidl with a pipette, anid from the stomnach by searing, dissecting, out anid opening the stomachl, and culturing with a loop, all un(ler aseptic conditions. The cultures were made on Endo plates, from which colonies were fislhed to Russell's double sugar me(liun, and to glucose brothl fer- mentation tubes. These presuimiptive tests were followed by testing April 24, 1925 8'22 motility, agglutinating power and indol production, action upon gela- tin, and fermentation reactions upon levulose, sorbitol, dulcitol, lactose, sailicin, iiositol, anI( dcxtrine. Unless an organism reacted typically to all these criteria, it was not considered to be B. typhos ts. Motility wtas observed from 24-hiour broth cultures, which were also used for aggcrlutinating tests. The latter were performed on microscopic slides by a(ldingr a (drop of culture to a dilution of monovalent seruni. Indol pro(luction was tested by moistening tile plugs of control tubes on eachl culture with a concentrated solution of oxalic acidl. Enlows' lne(liuln was use(d for the fermentation reactions. Adequate controls on a1llmedia and reactions were run. No atteinpt was made to estimate the nuimber of typhoid colonies otuantitatively on the plates from day to day. It was noticed, how- ever, that -from a very larg,e number at the first, there was no appre- ciable diminution until after thc eighthl day. On tile fifteenth day the typhoid-like colonies had decreased to approximately one-fourth flte original concentration. Of the total numler o-f colonies on the plates, it was noticed that the rate of re(duction in those froni the stooniach was faster than in those from the shell liquidl. In the 296 Endo plates made, colonies similar to those of B. (Coli were encountered in seveen instances. The experiinent was terminated on the fifteenth (lay of storage, because it was founcd tlhat some of the oysters stored at 100 C. were dyiing, or were in a (lamnaged state. Those iced, although in good con(lition, were b)ecoming bloated from drinking melted ice. Either of these cowaditions would cause oysters to be unmarketable; an(l as a considerable proportion of oysters are eaten witlhin 15 days after beingcdredged, it is believed that the results obtained are of practical value. The accompanying table gives a summary of the work done. It will be notice(1 that occasionally there is a plate which had no typhoid- like colonies upon it, and also that typhioid was not proved in every instance where a colony was fished. During, the latter part of the work, there was an increasing number of colonies which, although resembling typhioid on Endo medium, and not producing gas in glucose brothi, either failed to give characteristic fermentation reactions, or liquified gelatin. Tlle possibility of encountering such organisms led to placingf reliance not upon the presumptive tests but wholly upon the confirmatory tests. 823 April 24, 1923 Su?nmary of dai;ly tests

10° t. [- 2.8 .'C to 14.40 ('.1 Number of Nim- ~~~~~~Occur- Nir Oecu.r- Number of (,lays NSim- rence of I .,te Nouin-her roenl(- nlateys storedl Ntini- ber of Proved colon- uith Niimii- rer of Prvett (olfn- her fish- 13. ty- likeph-nold- er fish- hrIieTihl.0MB.tv-t- ike opened Inllogsts c(lonics like openeo 'id ingsts phosuspossclns:-likeCo)iloniies ( utile on colonies _a _ 1ceolote e

1 5 25 0 0 o 2- 5 21 21 -2 9 8 3-- 18 17 - 1 2 81 7- 1 4------4 15 5---- 1 2 C) 6 5-- 4 16 13 --- 2 8 8- - 6------4 16 16------2 8 8------7------4 16 !0 ------2 8 8 ------8------4 16r 10 ------21 8 7 10 -4 16 15 2 8 8 - 11 --4 15 129 2 6 2 1 2 13 --4 15 13 3 21 7 5 3 1 14-- -2 8 6 21 8 6 15 ------2 8 6 i------2 7 2 1----

SULMARY Oysters were arouse(I from hibernation, fed with B. typhos,us, and then stored. B. typhosus was being recovere(I 15 days after the oysters had been fed with the organism, whenl the tests were (lis- continued. BIBLIOGRAPHY (1) Frankland, G. C.: Oysters and Tvphoid. Nature (Lon(l.) 1894-5: p. 415. (2) Foote, Clias. J.: A Bacteriologie Studyv of Oysters, with Special Reference to Them as a Source of Typhoid Itlfection. Mledlical News (Pliila.) 1895, vol.66, p. 320. (3) Editorial: Oysters and Typlpoidl Fever. NMe(lical Record, 1895, vol. XLVIII: p. 557. (4) Bovee and Herdlman: On Oysters and Typhoid: An Experimental In- quiiry inito the Effect tupon the Oysters, of Various Exterinal Conditions, Inelludl- inig Pathogetlic Organisins. Report Brit. A. A. S. (Lonid.) 1896, vol. 65, p). 723. (5) Field, C. W: Medlical Recordl, 1904, vol. 65, p. 900. (6) : Proc. N. Y. Path. Soc., ti. s., vol. 3 (6), 1903, p. 161. (7) Reille, Paul: Huitres et Fievres Typhoides. Anni. ilyg. publ. et T'Med. Le'gale. Par. 4, ser. v. 8, 1907, 45. (8) Stiles, George WV. jr.: Sewvage-Pollutedl Oysters as a Cause of Typlloid Fever. U. S. Department of Agriculture, Buir. Chemii. Bu3ll. 156. 1912. (9) Gorlhain: SeasoInal Variations in the Bacterial Conitenit of Oystcrs. American Jour. Ptulb. Health, 1912, vol. 2, p. 24. (10) Conn: WXesleyan OuLtbreak. WVeekly Abstr.aets of Saniitar - Reports, 1894, vol. 9, No. 50, p. 1172. (11) De Freytag, C. J.: Uceber (lie Eiiwsirkuing conecntrirter Kochsalzl6sungen auf (ias Leben voni Bacterieni. Arehiiv. fUir Hygiene, 1890, vol. 2, p). 60. (12) De Giaxa: UIeher das Verhalten einiger patllogener Mikroorgaiuismen im Meerwasser. Zeitsclhrift ffir Hygiene, 1889, vol. 6, p. 162. (13) Harrington: Contributions oIi Tvphoid Fever. 13oston MIedical anid Surg. Jour., 1901, vol. 144, p). 439. (14) Park, WA"illiams, lxrunmwiede: Pathogenic Mlicroorganismns, 8th cl., .1924, p. 722. April 24, 1925 824 THE CLASSIFICATION OF CAUSES OF SICKNESS An informal committee was calle(l a few months ago by the Natioi)al Industrial ConferencIe Board, through Mr. Magnus W. Alexander, presidenit, to consider the question of a standard classi- fication of diseases whllich cause disabling sickness amnong, industrial work1ers. The rIesult of tlis work was a tentative list of (liseases ulhich is based upon tlle International List of Causes of l)eath. This list is being submnitted to var'ious orgalnizations and agencies inter- ested. 'T'hle fact that an incireasing, numi)er of industrial plants and1 other organizations a1'rerecording' the sickness which occurs aiilong the workers has, it is rcalized, nide desirable a greater UInfiformity in thL-e manner in whlihll the diseases are cltassified and(l made availa-Ible for genertal uise in studies of in(orbidity aind in(dustiial hlygiene. In- vestigations JiZive slhoxvn that eveni when relilble records of sickness aren leptk by indu1strial medical departments, in mlanTy instances theIe is nio comimon basis for comparison oll account of trie (iverse iiethods andl ractices emnployed in the classification of ailments causing disability. Tlis (quIestion has been discussed at severtal miieetings of various organizations intei'ested; and the comnmnittee, called together under the auspices of the National Industriall Conference Board, was informlndly coimpose(d of representatives of a nuiiiber of thesc organizations. The memibersliip was as follows: Mr. II. N. Dambnann, National Safety Council. Dr. William H-. Davis, Buireau of the Census. l)r. Louis I. Dublin, American Statistical Association. Dr. R. S. Quiniby, Amiiericani Association of Industrial Physicians aind Surgeons. Dr. F. L. Rectoir, Conference Board of Plhysicians in Inidustry. Mr. Edgar Sydenstricker, United States Public Health Service. Dr. Wade Wright, Industrial Hygiene Section, American Public Health Association. At its first meeting the committee was organized with Doctor Rector as secretary and Mr. Sydenstricker as clhairmiian. The fol- lowing subcommittee was appointed to prepare a tentative miiorbidity classification based on the intelnational List of the Causes of Death (tlirid revision): Mr. Dean K. Brundage, United States Public Healtlh Service, chairman. MIr. George II. V7an Buren, Meti'opolitan Life Insurance Co. Mr. J. 0. Spain, B-ureau of the Censtus. It will be noted that this list follows closely tlle terminology and the titles use(l in the International List and is, of course, subject to the same Criticisms. Its purpose, however, was not to revise the International List, but mnerely to specify under the various titles already used in the List those causes and conditions which are most 82.5 April 24, 1925 frequently encountered in the sickness experience of industrial em- ployees. The report of tlhc coummittee is )ublishe( lherewitlh as submitted for criticism and suogestions. The committee, lhaving accomlplishied tlhe preliminary work for which it was called, passed a resolution re(quiesting thliat the continua- tion of the work be under the Public Ilealth Service. In accordance witlh this request, the Statistical Office of the Public hlealtlh Service, in cooperation with otlhers wlho are inteiested, has becgun the prepara- tion of a mtanual of tlhe causes and(I conditions of disability andl will prepare reports from tiie to time oni tthe progress of the work. LIST OF DISEASES AND PATHOLOGICAL CONDITIONS FOR INDUSTRIAL MORBIDITY STATISTICS 1 I. EPIDEMIC, ENDEMIC, AND INF1ECTIOUS DISEASES: 1. Typhoid and paratyphoid fevers (1). 2. Malaria (5). 3. Influieniza (II). 4. Other epideilic and endemic diseases (2-4, 6-10, 12-25).2 5. Tuberculosis (all forms)- a. Tubercutlosis of thc respiratory system (31). b. Other forml-s of tutl)erculosis (32-37). 6. Venereal diseases- a. Syphilis- 1. Syphilis, so reported (38). 2. Locomrotor ataxia anti genieral paralysis of the insane (72 and 76). b. Chancroid (39). c. Gonorrhea (all forms) (40). 7. Pturuilent infection, septiceinia (41).3 8. Other infectiouis diseases, exclusive of those tinder 4- a. Antlhrax (27). b. Other diseases in this group (26, 28-30, 42).2 II. GENERAL DISEASES NOT INCLUDED IN CL-xSS I: 1. Cancer and otlier malignanit ttumiiors, all forms and sites (43-49). 2. Benigni ttumors and(I tumors not reportedl as malignant (50)-4 a. Nonmalignant. b. ITnquialified. 3. Rlleuiiimatism-5 a. Acuite rhetumatic fever (51). b. Chronic rhietumiatismii, osteoarthritis, gouit (52). 1 Figures in parentheses represent corresponding titl' numbers from the International List of (Cauises of Death, third revision, Pari:, 1120. 2 ShioulI any of the diseases ijicluded in this group indicate marked prevalence, they should be shown separately. 3 When not duie to an accident. 4 This title does not include tuimors of the female genital organs, ttumor of the bratin, tumor of the thyroid gland, tullior of the prostaLte, etc. (See " tuinor ' in inid'x of the Manual of the Interilationail List of Causes of Death, tliir( revision, 1). 292.) 6 Illness (Ille to rheuTiiatisnm is sub(livide(d into actite and chronic, in accordance with the detailed In- ternational L,ist of the Causes of Dealth. IProl)baly so -llny e-,ses wvill be reporte(l as (sIle to "rheumatism" without any qualification that it will be impracticab)le to determine which of the two conditions actually caused the illness; i)ut inasnmuch as acute rheumnatic fever, a disease whicili has epidemie prevalence, (lifters so markedly fr-om arthrit i dleforcnans, a disease of the joints of douibtful etiology, which ordinarily pursues a chronic course, it is felt that tihe subdivision should be maintained, an(d aIn effort imale to obtain thle in- forniation necessary for the proper classification of rlheumrnatisimi. If it is found to be i; srlcticable in certain instances to obtain this information, it is recommended that rheunatism, unqiuli.sii, be placed in Sub- division "a" (acuite rheimatisrn) in accordiince with the Interuatioali List. This title (loes not inc,ludo "inuscular rheunmatism." April '4, 11925 8236

II. GENERAL DISEASES NOT INCLUDED IN CLASS I-Cointinued. 4. Alcoholism, acute or chronIic (66). 5. Clhlrolic poisoning- a. Iniorganiic (67). b. Organic substances (68).0 6. Othier general diseases (.53-65, 69).7 III. DISEA.SES OF THE, NERVOUS ISYSTEM AND OF THE ORGANS OF SPECIAL SENSB: 1. Neuiralgia, neuiritis, hysteria (82)-8 a. Neuralgia. b. Neuritis. c. Sciatica. d. Migraine. e. Hysteria. f. Otlhers uind(ler this title. 2. Other (iiscases of the niervous system- a. FunctionalIiervouis (isorders, such as neurasthenia, nervous pros- tration, nervousness, etc. (84). b. Othiers uInI(der this title (70, 71, 73-75, 77-81, 83).9 3. Diseases of the eYe and aiinnexa (85)- a. Conjuietivitis. b. Eyestrain. c. Foi-eign1 body in the eye. d. Othlers uII(er this title.'0 4. Diseases of the ear (8)a)- a. Earache. b. Otitis mnedia. c. Othiers unclcr this title. 5. Diseases of thle miiastoid process (86b). IV. DISEASE,S; OF THE CIR&CULATORY SYSTEM: 1. Diseases of the heart (87-90). 2. Diseases of the arteries (91) a. Art-criosclerosis (911)). b. Others UInd1er this title (91a and 91c). 3. Diseases of the veinis (93)- a. Hemorrhoids. b. Phlebitis. c. Varicose veinls. d. Others Iunider this title. 4. Diseases of the lymphatic system (94)- a. Adenitis and swollen glands." b. Otliers unoer this title. 5. Hemiiorrhage without specified cause (95)- a. Epistaxis. b. Others uinder this title.

6 Iuselu(le(l un(ler this title arc all poisonings other than those of a sudden, accidental character. (See Intc-rnational List, titles 175-177 aind 1SI.) 7 Should any of the diseases included in this group indicate nmarked prevalence, they should be shown sel)prately. llysteri appears to he out of place in this title, but inasnmuch as it is inclulde(d with neuralgia and neuritis in the internatlioal list of the Catuses of Death, it was deemed advishble to keep it in the same place in this list, and to show the number of suich cases by provi(ding stubtitle "e". 9 Titles 72 and 761 in the International List (locomotor ataxia, and genieral paralysis of the insane) should be added to title 38 (syphilis). c Should trachoma or certain other diseases of the eye show marke(d prevalence, subdivisions should be adde(d for these diseases. 11 Include abscesses of the axilla, groin, cervical, and other lymnpbatic glands 827 April 24, 1923

IV. DISEASES OF THE CIRCULATORtY SYSTE M-CfltftiUUCd. 6. Other (liseases of the circulatory sy stein (92, 96)- a. 11igll-i)lood pressure (96'. b. Others unider this title (92, 96). V. DISEASE.S OF TPHE RESPIRATORIY SY sTEM: 1. Diseases of thle nasal fossae and(I ttheir annexa (97)- a. Corvza, rhinitis, and(i "cold"' (uinq(utalifiedl). b. Sin!usi t k. c. Others iuni(ler this title. 2. Diseali-ses of thle laryinx (98)- a. Laryngitis. b. Others uind(ler this title. 3. Broncelhitis (99) a. Acuite, excluLdinig cap)iliary bronchitis (see V4a). b. Chiroiici. C. llbspecified. 4. PIneumniaia (all forms) (100, 101)-- a. Broneho-pncuinonia, including caj)illary bronchitis (100). b. Lobar pneunionia (101a). c. Otlher for-Im1s of pnieuimoInia, incelud1ing pIeuIiioinia unispecified (1011)). 5. Pleuir-isy (102). 6. Asthma (105). 7. Otther dis8eases of the respiratory sy'stcm (tuberculosis exceptedC) a. PneuImoon'iosis (107a).2 b. Couigh, unqualified (107c). c. Hay fever (107c). d. Others iulnderl this title (103, 104, 106, 107). VI. DISEASES OF THE DIGESTIVE SYSTEMl: 1. Disea9ses of the 11ocutti and(1 anilnexa 108)- a. Toothache (unqualified). b. Abscessed tooth. c. PvIorrhca alveilairis. d. Other cond(litionis of the tectlh or gumlls. c. Canlker of nIoi:th (unqi:lified. f. Otlers under this title. 2. Disease.s of tile pi)aryxIV ati(t tonsils (109)- (l. Diseae.cs of tl)e )hlarynx-. b. iNsease., of the tonsil.;. c. I)re tlhroat (iniq( tialifiedc). d. Strptoecwcic soro thlroat. e. Others uill(ler this title. 3. Diseases of the stomlach (111, 112)- a. Gastric aind duodenal ulcer. b. Gastritis. c. Dyspepsia anld indigestion (unqualified). d. Nervous indigrestioll. c. Nausea, vomiiitinig. f. Stomach troIluble (unqualified). g. Others unider this title. 4. Diai rlrea and eniteiritis (114). 5. Appendicitis (117).

12 This includes fibrosis, silicosis, and other changes product'd by dust and other irritating ageDts. April 24, 1925 828808

VI. DISEASES OF THE DIGESTIVE SYSTEM-Continued. 6. Herinia, initestiinal obstruction (118)-13 a. Herniia. b. Intestinal obstruction (organic obstructions oinly). 7. Otlher diseases of the intestines- a. Constipation (119). b. Others uin(ler this title (115, 116, 119). 8. Diseases of the liver ani(i gall bladder- a. Jatiuildice (124). b. Cholecvstitis (124). c. Gallstones (123). d. Others unidler this title (120-124). 9. Peritonitis witlhotot specified caulse (126;). 10. Othier diseases of the (ligestive system (110, 125, 127)- a. " Craimps.'" 14 b. Others tuinder this title. VII. NONVENEREAL DISEA\SES OF THE' GENITO-URINARY SYSTEM AND ANNEXA: 1. Nephritis, acutte aIlCl chronic- a. Acuite (128). b. Chlronic, ineltuding unspecified (129). 2. Diseases of the bladder (133)- a. Cvstitis. b. Others uindler this title. 3. Nonpuerperal dliseases of the fem.ale genital or(rans- a. Menstrual disorders (140, 1411). b. Others tinder this title (137-141). 4. Otlher noivenereal diseases of the geiiito-uirillary system and annexa (130-132), 134-136, 142). VIII. THE PUERIPERAI, STATE (143-150). IX. DISEASES OF TIlE SKIN AND OF I'IHE CELLULAR TISSUE: 1. Fuirtuncle (152). 2. Abscess, uniiquahllific( (153). 3. Acne (154). 4. Derimiatitis venenLta (154). 5. Eczemwa (154). 6. Herl)es zoster (154). 7. Impetigo contagiosa (154). 8. Pruirituis (154). 9. tTrticaria (154). 10. UTlcer, iuniquialifiedl (151). 11. Othiers tinider this title (151, 153, 154). X. DISEASES OF THE BONES AND OF THE ORGA4.NS OF LOCOMOTION: 1. Diseases of the bones, tu'nerculosis excepted (155). 2. Diseases of the joints (tuiberculosis anid rheuimnatism excepted) (156). 3. Amiiptutations (157).

13 WVhen not dluce to an external cause. 4 A report of "cramps" ina male generally menans, it is believe1, some stomach or intistinal (listurbance which rightly belongs uinder diseases of the (ligestive systemz instead o tin(ler convullsions, as given in the International List. In fatal (c.ses, however, 'crarnps" shouldhe allocated to thc convulsions title. Cramps due to menstrual disor(leis should be classified under VII, 3a. 829 Api-il 24, 1925

X. DISEASES OF TIIE BONES AND OF THE ORGANS OF LOCOMOTION-COIntilnlied. 4. Other dliscases of tlhe organis of locomotion (158)- a. Bursitis. b. Flat foot. c. Lumbago. d. M1yalgia, includ(ling "stiff neck," etc. e. MIv ositis. f. Others undeier t'his title. XIV.'5 EXTERINAL CAUSES: A. Acci(dents, ocCl1)ational- 1. Acci(detetal l)1£rn3s, conflatgration. (178, 1719). 2. Accidental aslphyxiation by poisonous gas or vapor (181). 3. Accidenmtal euts or punctured{ wouny(IS (184). 4. Accidental falls (1S3). 5. Excessive cold (193). 6. Excessive heat (194). 7. Fractiires, sprituns, luxations (201). 8. Other exterin2al cautses: (1. Infey Ct(e wontid (202). b. Alt others (165-174, 177, 180, 182, 183, 186-192, 195-200, 202, 203). B. Accidents, Ie1nocClIpational or unquaiified- 1. Poi,aoning by food (175): a. Ptoniaii poisoning. b. Others iuin(der this title. 2. Other acute accidental poisoniings (gas exceptedI) (176, 177): a. Ivy poisoninig (177). b. Others unider this title (176, 177). 3. Acci(leintal burmis, conflagration (178, 179). 4. Accidental asl)hyxiation by poisonous gas or vapor (181). 5. Accidental cults or puncture(d wounds (184). 6. Accidental fall (185). 7. Excessivc coldk (193). 8. Exccssive hicat (194). 9. Fractuires, spirains, luxatiouns (201). 10. Other external cauises: a. Infected wouind (202). b. All others (165-174, 180, 182, 183, 186-192, 195-200, 202, 203). XV. ILL-DEFINED AND NT,'50KNOWN CAUSES (205): 1. Headache. 2. Exhaustion.'8 3. Backachle. 4. Biliousness. 5. Fever. 6. Fainting. 7. Dizzin1ess. 8. Otlher ill-defined. conlditions. 9. Cauise unknow;-n. XVI. ALL OTIER CAUSES (1 59-164, 20-4).

VGCroups XI andl XII are omnitte(i bec-use they are (tisemses an(d conditions of no industrial inmpor!ance. Group XIII is omitted because "(1(1 mge" is rarely reporte(lds a canii-F of disability on accounlt *frii, fact that there are very few really ol(d persons in ind:ulstry. It is felt that senility couldl just as vetl [be clissi- fie(d as "general debility" in the ill-b-Afine( grOiip. 1G Including debility, weakness, fatigue, ox- rs a-ork, general run-down condition, and(i the like April 24, 1925 830 CURRENT WORLD PREVALENCE OF DISEASE P.EVIEW OF THE MONTHLY EPIDEMIOLOGICAL REPORT FOR MARCH 15, 1925, ISSUED BY THE HEALTH SECTION OF THE LEAGUE OF NATIONS' SECRETARIATI Althougth inifluetnza outbreaks occurred in many countries during Januar;y and( February. "the type has usually b)een mil(l an(I the m )rtalitv inconsiderable," states tlhe Epidemiological Report issued March 15 at Geneva by the Health Section of the League of Nations' Secretariat. In addition to the considlerable prevalence of thie (liseaso in Western EuIrope, previouslv mentioned, outbreaks are reported from Moscow, Japan, an(d the I'nited States. All of these outbreaks hlave been mild andI there were no indications that more serious epidemics were (leveloping. Thie outbrea-k of epilemic hiccough in Denmark, referre(d to last month, continued in January, with 368 cases reported as compared with 344 cases in December. Reports from the city of Copenhagen shiow that the maximum occurred there in December, and( no case was reporte(d in the secon(d hlalf of February. Letharqic encephalitis.-A slight but gradual increase in the number of cases of lethargic enceplhalitis was indicated in the reports for Engiland and Wales (luring January and February; 231 cases were notified in February and 194 in the preceding four weeks. In Scot- land, the report for 16 towns gives 31 cases in the four weeks ended March 7 as compared with 17 cases in the preceding four weeks. Some cases were reported from a number of countries in Europe, notably Sweden, Deimark, the Netherlanids, Belgium, and Czecho- slovakia, where from 10 to 20 cases were notified in January. Plague.-The high prevalence of plague in the central provinces of Java has been mentioned in previous reports. A sharp increase in the number of reported (leatlis occurred in November and December. For the first three weeks of December the deaths from plague in Java numbered 2,091-about 1,000 more than had been recorded in any four-week period since the intro(luction of plague on the islancd in 1911. The Provinces of Soerakarta, Kedu, and Banjumas are tlle most severely affectedl. Deaths from plague in Java, July 15 to Decenmber 22, 1924

Number Number Four-week period of deaths Four-week period of (leaths

July 15-Aug. 11 -704 Oct. 7-Nov. 3 - 1,369 Aug. 12-Sept. 8 -844 Nov. 4-1)ec. 1------1,984 Sept. 9-Oct. 6 -1,187 DEc. 2-22 1------i 12,091

1 Three weeks only. Plague continued to increase in IIn(dia during Deceinber and tlle beginning of January; the total number of deaths reported was, however, approximately the same as at the corresponding date a I From thd Statistical O1lice, United States Public Health Servie. 831 8April'24,192"; year ago. Whlere in(lividual provinces are consi(lered, it is seen that while the disease was less prevaleint thani a year ago in Bombay, Bihar and Orissa, and( particularly Burma, it wasm ore prevalent in the Punjab and the United Provinces. The plague incidence in most of its endemic areas in Africa is low and on the decline. In the Union of Southi Africa, whier about the same number of caseslhave been reportted each month for several months, 26cases werenotified from February 1 to 25. No newcase of plague was reporte(l in January in the Goldi Coast and no case wasnotified in Egypt from January 22 to March 5. No country on the Mediterraneanreported a case of plagte(luring the month between the publicationl of the February and March Epidemiological Reports. Recent reports from Ecuador indicate an incriease in plague in Guayaquil. Cases of plaguie reportedi2n Gutayaqtuil, Ecuador Half-mionth of cmses Dec. 1-15 2 l)cc. 16-31 1 Jan. 1-15 -- 6 Jan. 16-1 11 Feb. 1 5 -- 14 C('holera.-The total number of cases of cholera reporte(l in Jn(lia at the beginn-ing, of January exceeded the ntumber reported at the same date a year ago. The excess was entirely due to the high prevalence in Mladras, wlhere over half of the cases occurred. The only other province with a hiigh prevalence was Bengal, wlhere it wasdecliniing and was less than in the previous year. "Arecrudes- cence of the diseasemalv be expected in March," states the Report. Tyj;hus a?id relapsin9 fever.-" The incidence of typhus in Eastern Europe" according to theIReport, "is lower than during any preced- ing winter since the war." Excepting Russia, Polandl has had the greatest ntunmber of cases, where in the first five weeks of 1925, 611 cases were notifiedl, as compare(d with 978 and 1,849 respectively, in the correspond(ling periods of 1924 and 1923. Cascs of typhuits adl relapsing ferer reported in Piussia, 1923-19214 fever . Tvphts- llesipsing MNonith 1923 1924 1923 1924 Jrrnnll::i-y - - ,56, 12:1 1 5, 675 69,401 7, 648 F-ehruary -- 46,157 1l, 950 47, 111 ,96iO MIarh -- 41, 1,56 20, 240 36,848 5,341 April -- 30, 598 17, 210 25,478 5,124 ay -- 25,451 15, 457 19,90 '3,949 June---- 11, 801 8, 150 12, C94 2, 684 July - - 6,268 4, 570 11,(0)9 3,049 Auguwst ----- 4,4,6 2,2931 10, s98 2, 653 Septenmber -- 3,517 2,347 7,5fi4 2,248 October-- 4, 28 11 944 7, 296 1 1 370 November -- 4,96i) 11, 77 5, 338 ,r83 D)eceiniber --- -- 7,882 1 4, 227 5, 169 1 776 I Incom1plete. April 24, 1'925 832 Smallpox.-Very few cases of smallpox were reported by most of the European countries for January or February. The disease con- tuiirned to spread in England and Wales, an(l during thie four weeks ei(ie(l February 21, 593 cases were reporte(d, compared with 416 cases the precedingf four weeks. A new outI)reak of smallpox was reported in Switzerlan(l, clhiefly in the Canton of Lucerne. During February, 78 cases were notifie(, and 26 in the preceding four weeks. In Spain a conisidlerable inlcriease in mortality from smallpox during the autumn and early winiter is slhown. In December, 252 deaths were reported, comparedl withi 59 deaths in December, 1923. Smallpox has been declining steadily in Russia, the number of cases in European Russia (exclusive of the Ukraine) declined from slightly over 2,800 per month in February and Marchl to 436 cases in August. The autumn recrudescence has been slight and only 624 cases were reported for November, though this figure is probably somewhat incomplete. Scarlet feter.-The prevalence of scarlet fever in most European couintries was somiewhat lower in January and February than in the montlhs of November and December. In Russia scarlet fever has been extensively prevalent, -with an incidence about twice that of 1923. In July the number of cases began increasing, and in October, 18,551 cases were notified in Euro- pean Russia exclusive of the Ukraine. In November and December the number seems to have declined somewhat, but returns were still incomplete. Jfeasles.-The incidence of measles was not high in most countries, and, indeed, was unusually low in several, as, for example, Denmark and the United States. On the othier hand, Hungary reported an increased incidence in January, when 4,696 cases were notified, in comparison with 1,977 cases in January, 1923. Also in France and Italy the disease was somewhat more prevalent than in the previous winter. The rather serious epidemic in Leningrad referred to in the p)revious report continued into February, with 775 cases and 64 (leaths in the three weeks ended February 14, antd 965 cases and 63 leaths the precedinog three weeks.

DIGEST OF CURRENT PUBLIC HEALTH COURT DECISIONS Interference with local health officer in performance of his duties.- (Oklahoma Criminal Court of Appeals.) A person was charged with obstructing a loctal lhealth officer in the performance of his duties regarding the control of rabies. The statute conferring autlhority on thle local healthi officer contained nothing specific relative to rabies conitrol, but by inference gave the State board of healtlh power to adopt 8323 April 24, 1'o25 regulations. It was niot alleged that the State boartl of health had promu!,gated any rules relative to animals afflictedI with rabies. Trhe court lheldl that in order to sustain the p)lrosecution the written accusation s'lould aver that the State botard of ihealtlh hadl rpomul- gate(d some rule concerninlg rabies an(d that the accused lhad inter- fered w-ith th? operationI of suclh rule sought to be enforce(d by the local lhealtlh officer. (Shilkett r. State, 232 Pac. 127.) Secerdlary (f c,ity `oard of healitli7 laid to occapy an "office."-(New tersey (Coiurt of Errarsan(l Appea!S.) Thle secretaly of the1 boar(d of health of tlhe city of IBayonne, an honorably (lischarge(l soldliei, Was remove(l from his oflice contrary to the provisions of a 1922 State law restrictinig the removal of an ex-service person holding a position or ofiice .under the Stato or municipal governmenit. The removed secretary brought a proceeding to determinie title to the office. It was contended arainst him that the position of secretary was not an office witthin the meaning of the act relating, to suich a, proceeding, as he had brougit, andI was Inot a position or office within thle meaning of the iaw restricting, the removal of ex-service Ipersons. The couirt held that the position of secretary was an office wlithiin the meaniing, of both acts an(l that the person remove(d waIs rightfully entitled to the office. (Brodmnian t. Rade, 127 Atl. 949.) Stat ate proh ibiting sale of n Pdetr-?Yiijlht cal7re.q con.striied.-(Massa- chusetts Supreme Judicial Court.) The defendant slaughtered and (dressed 1296 calv-es. The headl, hi(le, feet, and intestines were re- moVed fi';-: each careass, but the pluck (heart, liver, lungs, and wind- pipe), Sllins, sweetbread, and tail were retained. An inspector of the local board of health was presenit when the calves were slauigh- tered. Each careass was weiglhed and the inspector stampe(i each one with hils official stamp. Trvo days later thel carcasses were taken to another place, the pluck, shins, sw-eetbtread, an(d tail hlaving been rernove(l. Whlen delix-ere(l, 15 were founiid to weig,h less than 40 poilnds and we-re seized an(l conde-imned as being under-weighit. Sectioin 1 of1 chapt'Ver 329, Statutes of 1908 (Inow section 138 of chapter 94, General Laws-), prohibitedl "thie salle, offer or exposure for sale, or (lelivery for use as food, of the carcass, or any part or product thereof, * * * of any calf weighing less than 40 pounds wwhen dressed, with hea(l, feet. hide, aH(l entrails removed." The court held that the wor(ds "when (lresse(l' in the statute fixed a time rather than stated( a condlition and nmeant at the time at wlicll a calf is silaughtered. and(l dresse(l. The wordl " entrails" watis held to mean intestines and not to include the pluck and sweetbread. (Commiion- wealth v. Cohen, 146 N. E. 228.) April 24,19-25 834 DEATHS DURING WEEK ENDED APRIL 11, 1925 Summ2ary of iniformnation received by telegraph front ini(lustrial insuirance com- p~aniesjfor- week endled April 11, 1925"', and corresponding week of 192;,. (From the Weekdy Health Index, April 141, 191215, issued by the Buireaut of the Censuts, Departmncnt of C'omnmerce.) Week endeld Corresponding April 11, 1925 week, 1924 Policies in force------5935205 551,584, 062 Numiber of dieath claimns-- 11,270 11, 906 Death claimis per 1,000 p)olicies in force., annutal rate ------9. 911. 2 Deaths fromn all, causes in certain large cities of the United States duiring the week end(ed April 11, 1925, infant miortality, annual death rate, and compar-ison w'ith correspondinig wveek of 1924.1. (Fromt the WVeekly Health Index, April 14, 192.5, issued by the Bureaui of the Censuts, Department of Commerce)

Week endled Apr. Annual Deaths undler 1 11, 1925 deathi year Infant rate per ortality City ~~~~~~~~~~~~~~~~~~1,000 rate, (lity ~~~~~~~~~corre- Week CCorre- jweek Total Death spoinding ended sponding Aprdit deaths rate I week, Apr. 11, fweek, 1924 1925 1924 195

Total (64 cities) ------730 13.9 3 14.6 8301 3 954------Akron------33------16- 16.7---- 6 66 i - 368 15.3 8 10 Atihany'a------21.3 ----- Baltimore ------228 14. 9 15. 9 25 30 73 Birminghamn------82 20.8 17.1 6 7----- Bo0stonl------263 17. 5 17. 3 38 34 10j Bridgeport------2------4 4 64 BuiTalh------173 16.3 12.7 28 15 114 Camnhridge------43 191 9 13. 5 3 2 52 Camd(eti------30 12.2 20.2 2 8 33 Ciago 4------711 I 12.4 12.5 107 102 95 Cincinnati------118 15.0 16.1 9 10 53 Clevreland------223 12.4 11.7 21 41 52 Columibus ------8i3 15. 8 13.2 8 4 75 Dallas------55 14.8 13.6 10 4----- Dayton ------39 11. 8 10.5 0 5 0 Denver------102------lO0 9----- D)es MN'oine's------I 42 1.7 1. 0 Detroit-' 2.5.5 59 69 D)uluth------27 12-.7 9.1 ~~~~~~~41!4 5 85 Erie------26I------0 5 0 Fall River'-...... j 31 13.3 14.6 10 9 144 Flinit ------24----- 2I 11 33 Fort Worth -2------07 9. 2 14.4 2 3 Grand Rapids ------36 12.5 14.8 7 7 1-0-9 1otuston------50 ------6 3 Indlianap6fiS ------110 16).0 15.1 8 10 55 Jacksonville, Fla------30 14. 9 18.31 3 4 67 Jersey(City ------a_ 12.4 16.7 9 1 6 Kanisas City, Kans------35 14. 7 12.4 163 63 Kanisas City, 'Mo,------125 17. 7 16. 7 12 18------Lo ngeles-- 5 27 75 33 Louisville ------91 18. 3 16.5 8 6 70 Lowell------32 14.3 12.6 4 5~ 70 Lynn ------41 20.4 13.1 '5 3~ 133 Iemipliis ------i 76 , 22.7 14. 2 11 6 Milwaukee------140 14. 6 11. 1 12 22 55 NMshinnnpoi4 -126 15.4 16.2 10 21 5.3 Nashville' ------51 21. 4 16.5 5 3----- New lledford ------30 11. 6 11.8 7 6 116 New hlaven------43 12. 5 16.0 4 7 5 New Orleans------151 19. 0 16, 8 13 12.----- I Annui-l rate. per 1,000 popiulation. 2 Deathis uinder 1 year per l,l(X) births-an annual rate based on deaths under 1 year for the week andI Cstimnate(1 hirths for 1924. Cities left blank are niot in thec registration area for birthis. D1ata for 63 eities. 'Deaths for week endledI Fridaiy, Apr. 10, 1925. 833 April 24, 1925 Deaths from all catises int certain large cities of the United Sa'tts duilrinrg the week nde(le(l A pri'l 11, 1902-'5, ijfant nortality, ann (ul (katht rate, aitd cotmpar'ison wi'th corresponding week of 10J24-Continued

Week en(le(l Apr. A.~nnullal l)Deaths ulder 1 11, 1925 eanthialr Infant J rate per mortidity 1,01)0 rate, City corre- I-Veek C(orre- wk Total Death spon(ling ended sponding AeprndedI (leaths rate week, Apr. 11, week, 1125 1924 1923 1924 19

New York 1,494 12.8 14. 1 203 205" 81 Bronx Borouigh 157 9s. 1 12. 0 17 20 ,!9 Brooklyn Boroughi 527 12.3 13. 3 78 78 82 1Manhattan Borough'--631 14. 6, if,.0 83 94 83 Queens Borough 133 12. 1 11.1 19 9 94 Richmond Borough 46 17.9 19.5 6i 4 108 Newark, N. J 103 11.9 12.9 5 11 23 Norfolk 29 S.9 8.9' 4 3 71 Oakland 60 12.3 12.7 4 2 47 Oklahonma City 18 8.8 16.0 2 2 Omaha 65 16f.0 15.5 7 13 67 Pat.errson 30 12.2 2 5 34 Philadelphia 514 13. 5 1f). 0 53 68 67 Pittshurgh 187 15. 4 20.3 20 32 70 Portland, Oreg 76 14.0 15.t6 6 5 6)2 Providence 58 12. 3 20.1 6 14 48 Richmond 59 16. 5 16.2 10 7 121 Rochester 91 14.3 9- 71 St. Loiis 246 15.6 17. 0 13 41 St. Pau --l l 70 14. 8 14.3 5 9 43 Salt Lake City 4 30 12.0 l1.0 2 2 31 San Antonio 158 15. 3 19.6 9 15 San Francisco 142 13. 3 15.0 7 9 40 Schenectady 25 12.8 12.5 1 4 28 Seattle 62 8 8 82 Somerville 33 16.9 7.8 7 2 187 Spokane 40 3 5 65 Sprirgfield, Mass- 27 9.2 15.5 3 6 45 Syracuse 55 15.0 16. 9 8 8 101 Tacoma ------I 16 8.0 12. 1 0 3 0 Toledo 76 13. 8 13. 2 5 10 45 Trenton 40 15.8 14.9 2 6 32 Washington, D. C 142 14.9 13. 2 10 21 50 Waterbury ------23 1 4 22 Wilmington, Del 23 9.8 9.1 2 1 46 Worcester 58 15. 2 11. 2 6 3 69 Yonkers 26 12. 1 13. 8 3 1 6r) Youngstown 26 8. 5 15.8 3 6 38

4 Deaths for week ended Friday, Apr. 10, 1925. 362750-25t 2 - PREVALENCE OF DISEASE

No health department, State or local, can effectively prevent or control disease without knowledge of when, where, and under what conditions cases are occurring UNITED STATES

CURRENT WEEKLY STATE REPORTS These reports are preliminary, and the figures are subject to change when later returns are received by the State health officers Reports for Week Ended April 18, 1925 ALABAMA CALFORNIA C'.ases Cases Cerebrospinal meningitis - - 3 Cerebrospinal meningitis-Los Angeles Chicken pox. 79 County .------. 1 Dengue ------1 Diphtheria ------66 Diphtheria -- 8 Influenza -- 38 Dysentery -.-.-_ 4 Jaundice (epidemic)-San Francisco-.- 1 Influenza. 221 Leprosy-San Francisco 1 Malaria -- 27 Lethargic encephalitis: Measles ------12 Bakersfield. 1 Mumps ------48 Berkeley ------1 Ophthalmla neonatorum - - 1 San Diego - - 1 Pellagra:------14 Measles -- Pnelllnonin 129 Poliomyelitis-Alhambra - - Scarlet fever 21 Scarlet fever 80 Smallpox 97 Smallpox: Trachoma 3 Oakland Tuberculosis 40 San Diego - 29 Typlioi(I fever ------12 Sutter County 11 Whou)pilug couglh 20 Tulare C-ounty 15 ARIZONA Scattering - -- 44 Typhoid -- 10 Chicken pox ------6 feaver Diphtheria ------1 COLORADO Measles ------12 Mumps (Exclusive of Denver) Pneumonia 1 Anthrax -- 2 Scarlet fever 5 Cerebrospinal meningitis - - 1 Smallpox ------2 Chicken pox 7 Trachoma 2 Diphtheria 10 Tuiberculosis 50 Measles 1 Whooping cough - - 9 Mumps ------8 Pneumonia 15 ARKANSAS Scarlet fever 20 Chicken pox. 4 Tuberculosis -- 18 Diphtheria 4 Typhoid fever. 2 llookworm disease 3 Whooping cough - - 8 Influenza- 167 Malaria 167 CONNECTICUT iNfeasles 24 Cerebrospinal meningitis - - 1 Mtinmips 36 Chicken pox 70 Pellagra 13 Diphtheria -- 47 Scarlet fever 7 German measles. 43 Smallpox ------5 Influenza -- 12 Trachoma 1 Lethargic encephalitis - - 1 Tuberculosis -- 3 Measles 313 Whooping cough 12 Mumps 54 (836) 837 April 24, 192 CONNECTICUT-COntinued ILLINOiS -Colntinued C.ases Scarlet fever: Cases Paratyphoid fever .-- - Cook ('ounty - - 267 Pneumonia (all forms) - - 99 Jackson County -- 9 Poliomyelitis -- - I Kae County _-_-___--_ 8 Scarlet fever -100 MIcl,ean County- - 9 Septic sore throat -1 Mfadison County--13 Tuberculosis (all forns) -43 Scbuyler County--10 Whooping cough -124 Scatterig- -114 DELAWARE Smallpox: Alexan(der Couinty -___-_____-______12 C7hicken pox-2 MWIacon County --20 Malaria - -- 3 Union ('ounty - -17 Measles - - - 9 Scattering - -33 Mumps-2 Tubercutlosis- 256 Pneumonia-2 Typhoid fever -10 Scarlet fever- 2 WWhooping cough- - - 253 Tuiberculosis - - 5 Whooping cough --2 INDIANA FLORIDA Ch.cken pox- 58 Diphtheria __-- ___------______- 29 Chicken - 216i -ox - -19 Influenza Dip)htheria -- 10 Measles 10------1 InfluenZa - -2 MiiIil)s 1 Malaria ---- 20 Ophthalmia neonatortum - 1 - Measles ------921 Mumps - -127 Scarlet fever: Pneumonia ------lenC-oun-ty - 15 - Scarlet fever - - - 5 ('larl County -17 Smallpox-- 1 Del-a-are ('ounty .18 Tubercuilosis -26 Ell;h.rt County- -41 Typhoid fever - - 2. Lake ('ottnty - -18 Whooping cough -10 -I--r-on ('ou-tv ---12 GEORGIA Vermilion County- 9 Chicken pox - - 43 Scattering-94 Conjunctivitis (infectiotus)- 2 Smnallpox-56 rruber,,u!os,,s------45 Dengue 1---- -Tuber u-si- -6 Diphtheria - -13 Typhoid fever Dysenr^tery - - 10 Whooping cough-28 Ilookworiildisease - -2 IOWA Influenza ----- 40 Diphtheria ------10 Malaria ------4 Searlet fexer 31 MeaslesS-:-llp-ox-10 -- 9 Mumps --119 Pellagra - -16 KANSAS ---- 134 Pneumonia-- Cererospinal meningitis ------2 Scarlet fever -10 Ceerhipinentx i 93 Septic sore throat -16--Di1--th-i.- 17 Smallgox-1 Gernnan measles1- Tetanus -1 j1-n-ll-ena- 3S Tuberculosis.20 Lehri encphliis I ,ethuargic enee hlltist------I TyphloidITyptioid fevfe erer --esles -17 Whooping cough -481 Muinps ------237 iLl INOIS P~~~~~iict'iewrxiz ------78 fever .. 84 Cerebrospinal meningitis: Sr'itgcark(t- - fx-10 Lake ('ounty.1 -r(itlosis 60 Wooiford County ..-i--c-i- I Victs angina ------1 Diphtheria: X hooping cough -- - 39 Cook ('ounty - - (7 Scattering -- 2(0 L0t ISIANA Influenza-9 Diphtheria ---15 Lethargic encephalitis: Ilokwori disease . 21 _ Cook County ____--_---- ______---- I nfluenza ----37 Piatt Co-anty i- Llrosy- - - Measles- 1,326 M1alaria .-_-..-- 2 PneumoLia --- 386 Pellagra -- - 16 April 24, 1925 838

LOUISIANA-continued MINNESOTA-ontinued Dasos (lases Pneumonia ------47 Tuberculosis ------51 Scariet fever 7 Typhoid fever ------1 Smallpox 26 Whooping cough 13 Tuberculosis 29 MISSISSIPPI Typhoid fever - - 18 Cerebrospinal meningitis 1 Whooping cough - - 38 Diphtheria ----- 14 MARtYLAND I Smallpox 20 Cerebrospinal nineiiigitis - - Typhoid fever ------7 Chicken pox -- 89 MISSOU'RI Diphtheria 40 (Exclusive of Kansas City) Gerinan measles- 3 Cliciken pox ------85 Influenza ------4 I Diphtheria 48 Malaria ------1 Influenza ------46 Measles -- 34 Mfeasles 17 66 Mumps Mumps 83 Pneumonia (all forms) 108 Pneum-onia 69 Poliomyelitis 1 Scarlet fever 357 Scarlet fever 71 Smallpox ------12 Septic sore throat- 2 Tetanus 2 Smallpox 2 Trachoma 1 Tuberculosis 102 Tuberculosis Typhoid fever 4 Typhoid fever Whooping cough 81 Whooping cough 44 MASSACHUSETTS MONTANA Chicken pox 4 Cerebrospinal meningitis - - 4 Diphtheria 5 Chicken pox 134 German measles 31 Conjunctivitis (suppurative) 15 Measles 10 72 Diphtheria Mumps ---- 4 German measles 218 Rocky Mfountain spotted fever: Influenza -- 32 B3illings R. F. D 1 Lethargic encephalitis 1 Bonita 1 Measles 802 Bridger 1 MuInps 81 Fromberg I Ophthalmia neonatorum 29 Ismay------I Pneumonia (lobar) 141 Missoula R. F. D 3 Scarlet fever 226 Scarlet fever 25 Septic sore throat Smiallpox 3 Smallpox. 1 Tuberculosis 4 Tetanus - - 1 Typhoid fever- 1

Trachoma 14 Whooping coughl ------5 Tuberculosis (all forms) NEW JERSEY Typhoidi fever 12 Anthrax 1 Whooping cough ---- 131 Cerebrospinal meningitis Chicken pox MICHIGAN 50 Diphtheria 65 Diphtheria 87 Measles 222 Inflenza 43 Measles- Pneumonia 152 Pneumonia Scarlet fever 336 208 Scarlet fever 310 Smallpox -- 25 Tubercuilosis 83 Smallpox 3 Typhoid fever 8 Trachoma 1 Wliooping cough 151 Typhoid fever 5 Whooping coough 2497 MINNESOTA NEW MEXICO

Cerebrospinial meningitis .-2 Chicken pox 4 Chicken pox -100 Conjunctivitis S Diphtheria- 44 Influenza 2 Intlutenza 7 Measles 13 Lethargic encephalitis- 1 Mumps 7 Measles 29 Pneumonia 7 Pneumonia- 11 Scarlet fever 7 Poliomyelitis 1 Trachoma 1 Scarlet fever 210 Tuberculosis 31

Smallpox --- 22 Whooping cough . 12 1 Week ended Friday. 839 April 24, 1925

NEW YORK TEXAS C"'Iles (Exclusive of New York City) (Cerebrospinal nienili.,itiS 1 Cerebrospinal nmeningitis 3 Chicken pox ------21 Dip,htheria- S3 !)iphtheria ------21 Influeniza 12 l)ysentery (epidemic) _-_-_-_-_-_-.,-_-_-_ 4 Lethlargic encolphalitis- 2 Influenza -- 62 Measles ---- 49G MIeaslses 28 Pneumonia 323 Mutimips ------88 Poliomyelitis- I Ophthallrnia neanitoruni Seariet fever- 28, Pellagr- 3 Typhoid fever- Ii) Pneumonia -- 14 Whoopinig cough- 188 Polionivelitis 2 Scarlet fever 10 NORTIH CAROLINA Smpallpox 31 Chicken pox- 1 (4 Tuberculosis 79 Diphtheria 23 Tv phoi(l fev:er 15 Gerinan measles 8 Typlhuis fever 1 Measles- 26 W hoopiing cough 11 Scarlet fever -- 19 VERMONT Septic sorc throat- 5 Chicken pox 20 Smallpox -- 57 Diphthei-ia ------5 Typhoid fever- 4 AMe.sles ------3 Whooping cough- 113 MTumps 27 Scarlet fex-er 21 OKLAHOMA Typhoid fev er 2 (Exclusive of Oklahoma City and Tulsa) WN'hooping couigh 1 Chicken pox- 13 VIRGINIA Diphtheria- 3 Lethargic encephalitis-Chesterfield Cotunty 1 Inflenza-- 186 Smnallpox-Fairfax County 1 AMeasles -- 1 'WAS1I1NGTON Mumps- 71 Ccrehrospitnal meningitis: Piwcumonai- 3 Scarlet fever- 16 Spokane Smnallpox- 5 5Clarke Couinty - - 6 LewJis County - - Typhoid fever. 89 21 Chicken pox. Whooping cough- D)iphtheria-- 17 Gernian measles :13 OREGON ctasles ------4 Cerebrospinal meningitis 4 IMumnps 128 Chicken pox -- 14 Pnetumonia- 2 Diphtheria: Poliomyelitis-Whatcom County 1 Portland -- 11 Secarlet fever- 22 Scattering,-- 7 Smnallpox 30 Influenza- 85 Tuberculosis- 25 M4essles- 5 Typhoi(d fever- 3 16 iN'shooping couig}l ------120 Pneumonia--- 110 WEST I'IRiNiA Scarlet fever: Diphtheria.- P'ortland. 13 Scarlet feve.-. 19 Scattering -- 9 Smallpox 6 Smrallpox 2 Typhoid fever. 2 Tuberculosis -- 6 WISCONSIN Typhoid fever -- 1 Milwatikee: Whooping cough - is C'hioknn nrno 31 Dip)lltheria .. 19 SOUTH DAKOTA (.ermnan measles- 2013 Ch,ickucn pox-- 1 Influc,rza. 3

lufluenza. I casles ------202 Alsles ----- MuImnips 59 M umps ------PUcIZrlonia. 10.5 Pnei:ollnia. 17 S f.let fver .------.-.-- --- 22 S"c.ir'kt fex er 31 10

------17 Sn:.iipox -- 11 1 Whooping coughI 1 Dclhs. April 24, 1925 840

WISCONSIN-continued WYOMING Scattering: 7ases Cases

Chicken pox- 70 (Chicken pox ------5 Diphtheria 26 Measles ------24 Gernman measles 146 Mtnsps 13 Influenza- 444 Plneumonia ------2 AMeasles ------251 Rocky Mountain spotted fever--4 MIumps 289 Scarlet fever- 11 Pneumonia- 36 Whooping cough 7 Scarlet fever- 105 Smallpox 14 Tuherculosis 22 Typhoid fev-er- 4 Whooping cough 63 Reports for Week Ended April 11, 1925

DISTRICT OF COLUMBIA NORTII DAKOTA Cases Cases Cerebrospi-nal meningitis 2 Chicken pox- 8 Chicken pox- 13 Diphtheria 4 Diphtheria 11 IGerman measles- 1 Measles 37 Influenza -17 Phcumonia- 33 Mumps- 9 Scarlet fever. 18 Pneumonia- 5 Smallpox- B Scarlet fever- 47 Tuberculosis 24 Smallpox- 4 Typhoid fever 2 Tuberculos _--1 Whcoping cough- 20 Whooping cough -34 NEBRASKA Cerebrospinal meningitis OKLA!TOMA 11 Chicken pox- (Exclusive of Oklahoma City and Tulsa) Diphtheria- Measles- 2 Chicken pox -24 Mumilps -_------1 Diphtheria -17 Pneumonia 4 Intluensa -210 Poliomyelitis- 1 Pneumonia -89 Scarlet fever-- 12 Scarlet fever -35 Smallpox- 31 Smallpox- 12 Tuberculosis- 8 Typhoid fever- 9 Whooping cough 6i Whooping cough -20 SUMMARY OF MONTHLY REPORTS FROM STATES The following summary of monthly State reports is published weekly and covers only those States from which reports are received during the current week.

Cere- - bro- Poli Diph- Influ- Ma- Mea- Pella- Scarlet Small- Ty- gra nenin- theria enza laria sles elitis fever pox fever gitis n m f

Februtarg, 1925 IHawaii -24 10 47 - . 8 Afarch, 19.5

Arizona - - 1 14 154 -- 291 43 4 2 Louisina - - 2 78 799 33 5 19 0 83 141 47 Michigan - - 340 71 782 3 1,717 80 37 Missouri -- 6 305 377 5 59 2 1,226 75 23 Oklahoma 19 ---2,792 81 85 17 2 -- 176 43 Vermont- 8 ----51 --- 100 5 WVest, Virginiia - - 3 62 j 224 177 199 104 40 841 April 24, 1925 PLAGUE-ERADICATIVE MEASURES IN THE UNITED STATES The following items were taken from the reports of plague-eradi- cative measures from the cities named for the week ended April 4, 1925: Los Angeles, Calif. Week ended Apr. 4, 1925: Number of rats examined -_ 5, 290 Number of rats found to be plague-infected _- _-__-- - 10 Number of squirrels examined __-__-_-- 599 Number of squirrels found to be plague-infected - - - 0 Totals to Apr. 4, 1925: Number of rats examined -76, 481 Number of rats found to be plague-infected - - - 169 Number of squirrels examined - - - 6, 583 Number of squirrels found to be plague-infected - - - 9 Date of discovery of last plague-infected rodent, Apr. 20, 1925. Date of last human case, Jan. 15, 1925. Oakland, Calif. (Including otlher East Bay communities) Week ended Apr. 4, 1925: Number of rats trapped - - -2, 865 Number of rats found to be plague-infected - - - 0 Totals to Apr. 4, 1925: Number of rats trapped - - -32, 582 Number of rats found to be plague-infected - - - 21 Date of discovery of last plague-infected rat, Mar. 4, 1925. Date of last human case, Sept. 10, 1919. New Orleans, La. Week ended Apr. 4, 1925: Number of vessels inspected - 397 Number of inspections made - - 1, 187 Number of vessels fumigated with cyanide gas - - 29 Number of rodents examined for plague - -- 4, 847 Number of rodents found to be plague-inifected _-- 0 Totals to Apr. 4, 1925: Number of rodents examinedl for plague -- - -70, 511 Number of rodents found to be plague-iinfected -- - 12 Date of discovery of last plague-infected rat, Jan. 17, 1925. Date of last lhumnan case occurring in New Orleans, Aug. 20, 1920. GENERAL CURRENT SUMMARY AND WEEKLY REPORTS FROM CITIES Diphtheria.-Fo; the week ended April 4, 1925, 34 States reported 1,473 cases of diphtheria. For the week ended April 5, 1924, the same States reported 1,695 cases of this disease. One hundred anid three cities, situated in all parts of the country and having an aggre- gate population of nearly 28,700,000, reported 980 cases of diplhtheria for the week ended April 4, 1925. Last year for the correspondilln week they reported 1,034 cases. The estimated expectancy for these April 24, 1925 842 cities was 985 cases. The estimated expectancy is based on the experience of the last niiie years, excluding e)idemics. Aleales.-Twenty-nine States re)orted 4,686 cases of measles for the week ended April 4, 1925, anid 17,504 cases of this disease for the week enided April 5, 1924. OIne lhundred and three cities reported 3,084 cases of ineasles for thel week this year, and 6,029 cases last year. Scarlet Jever.-Scarlet fever was reported for the week as follows: 34 States-this year, 4,306 cases; last year, 3,914; 103 cities- this year, 2,260; last year, 1,735; estimated expectancy, 1,076 cases. Smnallpox.-For the week esrdcd April 4, 1925, 33 States reported 865 cases of smallpox. Last year, for the correspondinig week, they reported 1,407 cases. One huniidred and three cities reported small- pox for the week as follows; 1925, 308 cases; 1924, 543 cases; esti- mated expectancy, 107 cases. These cities reported 11 deaths from smallpox for the week this year. Typhoidjever.-Two hiundred and four cases of typhoid fever were re)orted for the week ended April 4, 1925, by 33 States. For the corresponding week of 1924 the saine States reported 245 cases. One huindred and three cities reported 44 cases of typhoid fever for the week this year, and 49 cases for the corresponding week last year. The estimated expectanev for these cities was 49 cases. Influenza and pneumonia.-Deaths from influenza and pneumoniia (combined) were reported for the week by 103 cities as follows: 1925, 1,277 deaths; 1924, 1,330 deaths. City reports for ueek ended April 4, 1925 The "estimated expectancy" given for diphtheria, poliomyelitis, scarlet fever, smallpox, and typhoid fever is the result of an attempt to ascertain from previouis occurTenice how many cases of the disease under consideration may be expected to occur during a certain week in the absence of epidemics. It is based on reports to the Puiblic hlealth Service during the past nine years. It is in most instances the median number of cases reporte(l in the corresponding week of the preceding years. When the reports include several epidemics, or when for other reasons the median is unsatisfactory, the epidemic periods are excluded and the estimated expectancy is the meaii number of cases reported for the week during noniepi- deinic years. If reports have not been received for the full nine years, data are used for as many years as possible, but no year earlier than 1915 is included. In obtaining the estimate(d expectancy, the figures are suloothed when necessary to avoid abrupt deviations from the usual trend. For some of the diseases given in the table the available data were not sufficient to im.ke it practicable to compute the estimated expectancy.

I ~~ ~ ~ Diplhtheria InIluenza Popula- Chick- Mea- Mu'sPneu- Division, State, and tion en pox, Cases sles, caMms monia, city July 1, cases C Cases cases re- deaths city ~~1923, re- erti-edest-' qzasesrae- rae- Deaths re,- r- re- estimated ported expect- r ported ed ted ported ancy

NEW ENGLAND Maine: Portland 73,129 9 2 0 2 0 0 23 2 New Hampshire: Concord -22,408 0 0 0 0 0 0 0 7 Manchester- 81,383 0 2 1 3 G 0 2 843 April 24, 1925 City reports for week ended April 4, 1.925 Conitinuied

D)iphtheria Illutienza Popul;a- Chicki- Pneu- Division, Staite, and July 1 , Cases ('s D )ths ( s': s vs m onia, ui1923. se esti- Cases (Case Deat - re- dleaths city r- mated re- re- re- ported re estinmated porte(d espct- porte ported 1oltC( ported ported anicy

NEW ENGLAND-Coltdl. Vermont: Barre - ' 10,008 1 0 0 0 0 O 0 0 Burlinigtoi - 23, 61:3 2 1 0 0 0 14 23 1 Massachusetts: Boston 770,400 29 cO 37 23 4 266 3' 39 Fall River '- L2, 912 7 3 0 5 2 0 0 8 Springfiel( -- - 144- 27 7 5 1 3 4 I 9 8 2 Worce-dert 191,927 22 5 9 3 0 2S 1 13 Rhode Island: Pawtucket 68.799 1 1 0 0 0 3 01 5 Providence 242,378 3 11 10 8 2 2 0l 10 Connect.icuit: Bridgeport '143, 55 0 1 51 O01 o I 2 Ilhartford l 138,t03f; 3 S 7 0 1 2 I 8 6 New Haven 172,967 8 4 0 1! 0 65: 0 7 MSIDDLE ATLANTIC New York: Buffalo ------'536,718 5 13 2 0 177, 10 2 New York 5,927,625 196 241 I 311 79 23 184 .36 230 Rochester 317,867 8 6 12 0 ) 34 25 14 SyracLse- - 184,-11 5 7 10 2 1 12 9: 6 New Jersey: (Camden 124,157 9 4 3 0 0 1I O 1 Newark 438,t699 20 18 17 14 0 34 13 17 Trentoni 127,390 0 5 1 4 1 6 0 4 Pennsylvania: Philadelphia 1,922,788 70 75 98 ------3 448 31 52 Pittsburgh 61:3,442 48 20 15 - 10 478 24 76 Reading 110,917 17 3 3 65 13 2 Scranton 140, 636 0 3 2 0 O0, 0 4 EAST NORTH CENTRAL I -, Ohiio: I~2 Cinci-nnati 406f,312 10 10 3 ------11 1 4 20 Cleveland - 888, 519 37 25 16 5 6 2 23 Coluinhbus- 261, 082 4 41 3 9 19 2; 18 Toledo 268,338 17 4 5 4,1 2 72 21 6 Indiana: I Fort Wayne 93,573 8 3 1 0 o1 0 Inidianapolis 342, 718 9 9 0 4 1 44 24 SouithlBeril - 76.709 0 1 0 0 0 2 0 4 'T'erre hlaute 68,939 0 1 0 0 0 8 0 2 Illinois: Cnicago -- 2, 886. 121 68 102 551 173 I 509 Is 96 Cicero 55,96S 5 2 2 9 0 Springfield - 61,833 10 1 2 2 o° 2 56i 3

Michligani: 41 Detroit - ..- 99,,6cm 30' 521 20 5 4 13 41 Flint - 117,96S 2 4 4 0 O 5 0 2 Grand Rapids 145,947 8 3 1 1 1 5 1 5 WiscoInsin: 1 0 I :Madison - 42,519 5 1 1 81 95 0 Mtilwatikee -- 484,.., 33 14 ' 14 1 1 2469 98 0 Racinle l-- 64:393 8 1 3 1 25 6 0 Superior -- - 1:9,716|1 1 0 0 0 0' 0 2 WEST NOP.T1I CENTRAL Minnesota: Duiltuth -101 6.289 4 1 0 0 0' o 0 2 Minneapolis 409, 125 56 14 2f |------13 25 St. Pauil 241,891 14 14 18 0 0 6 17 12 Iowa: Davenport- 61,262 0 1 0 0 2 0 ------Sioux City 7--.79662 1 2 0 0-01 10 Waterloo 39,6676 17 0 1 0 -2 1 Missouri: Kansas City-_ 351,819 9 8 3 8 8 4 14 23 St. Joseph - 78, 2'12 2 2 0 O1 1 1 5 St. Lotiis 803;853 33 391 49 -|--- 21 12 o10 I- __ 1 Population Jan. 1, 1920. April "4, 1925 844

City reports for week ended April 4, 1925-Continued

Diphtheria Influenza Popuila- Chick- AMea. mm Pneu- Division, State, and tion en pox, Cases, Css aessles,- uPS, moi, cases est Deaths cases cases deaths ~~~1923, re- Dets re- matedm d raes rae- re- re- estimated ported expect- ported portedprrred ported ported ported ancy

WEST NORTH CEN- TRAL-continued North Dakota: Fargo - 24,841 1 0 0 I3 11 0 Grand-Forks 14, 547 0 0 0 3 . I3 0 South Dakota: Aberdeen -15,829 1 0 I I 0 Sioux Falls-29, 206 1 1 I -o I 0 Nebraska: D Lincoln --8, 761 6 2 0 3 2 Omaha- 204,382 5 3 3 I 0 10 Kansas: 3 Topeka -52, 555 4 1 I 101 4 Wichita 79, 261 17 1 I A 2 7 SOUTH ATLANTIC Delaware: I, 0 Wilmington 117, 728 4 2 0 0 15 0 1 Maryland: Baltimore -7-7------8- 073 74 25 11 15 3D 9 65 49 Cumberland 32,361 1 1 0 0 Frederick 11,301 0 0 1 District of Columbia: Washington 1 437, 571 23 10 1E 02 1 42 22 Virginia: Lynchhurg-30, 277 3 0 0 0 22 2 Norfolk -15-,--- 089 23 I 0 0 4 58 3 Richmond 181,044 0 2 3 0 0 4 Roanioke -55, 502 2 1 0 0 1 0 2 West Virginia: Charleston- 45, 597 8 0 0 23 0 0 Ihtuntington 57. 918 0 0 0 0 Wheeling 56,208 4 2 4 0 North Carolina: Raleigh -29,171 8 0 0 0 22 3 Wilmnington 35, 719 2 0 0 2 Winston-Salem 56, 230 6 C 5 5 2 South Carolina: 1 0 Charleston -1, 245 0 0 0 2 Columbia -39,688 4 1 0 0 0 Greenville- 25, 789 0 0 0 2 Georgia: -I A tlanta -222, 963 0 2 3 0 2 9 Brunswick- 15, 937 1 2 0 0 Savannah-8-9,448 1 2 8 2 0i 11 1 Florida: 1 St. Petersburg 24,403 0 0 0 0 1 Tampa -56,050. EAST SOUTH CENTRAL -1 1. Kentucky: -----i- -1 Covington-57,877 0 4 0 0 9 3 Louisville -257, 671 3 2 3 6 0 0 0 8 Tennessee: 0 Memphis 170,067 1 . Nashville -121, 128 1 1 0 6 Alabama: Birmingham 195, 901 1 9 5 2 9 17 Mobile -63,858 0 1 0 0 0 1 Montgomery 45, 383 1 0 0 0 20 0O WEST SOUThI CENTRAL 9 Arkansas: Fort Smith -30, 6335 0 0 0 0 0 Little Rock 70,916 1 1 1 7 11 0 Louisiana: 0 New Orleans 404, r575 3 9 1 7 2 0 0 11 Shreveport-54, 590 5- 0 0 0 0 9 Oklahoma: Oklahoma-101,150 6 1 0 0 0 3 Texas: Dallas -177, 274 so 3 4 -- 4 8 4 Galveston- 46,877 0 0 0 0 0 0 0 Ihouston -14, 970 6 2 1 ^ 0 0 0 San Antonio 184,727 4 2 1 0 0 1 5 'Population Jan. 1, 1920. 845 April 24, 1925 City reports for week ended April 4, 1925-Continued Diphtheria Influenza

Popula- Chick- Mea- up Pneu- Division,Divsio,State,tat, andnd | Pojpu;-iCnwtionen p sles;-1Iumpe, monia, uly1, cass' Cases, cases c"e deaths city 1JUlyl - esti- Cases Cases Deaths re-re r- estimated ported ed ported portred ported ported ported ancy

MOTUNTAIN Montana: Billings- 16,927 3 0 1 0 0 O 11 O Oreat Fals-27,787 0 1 1 0 0 18 5 1 Helena - 12,037 0 0 0 0 0 0 0 1 Missoula- 112,668 0 1 2 0 0 0 0 0 Idaho: 3oise -22, 806 2 0 0 0 0 0 0 0 Colorado: Denver. -272,031 17 9 7 . 18 5 72 9 Pueblo -43,5i9 4 2 0 2 1 0 2 3 New Mexico: Albuquerque 16,648 0 1 0 0 0 1 4 3 Arizona: Phoenix -33,899 0 1 0 0 3 0 7 Utah: Salt Lake ity 126,241 16 2 2| 0 0 0 27 3 Nevada: Reno -12,429 0 0 0 0 O| 0 0 0

Washington: Seattle -1 315,685 44 5 8 0 9 65 Spokane -104,573 6 2 58 0 0° 0---° ------Tacoma -101,731 4 1 1 -- 1 0 6 6 Oregon: Portland -273,621 7 3 16 56 0 0 16 8 California: Los Angeles C66,853 55 40 41 28 4 50 31 17 Sacramento-69, 950 1 2 0 0 0 2 San Francisco 539,038 46 25 191 10 2 13 64 14

Scarlet fever Smallpox Typhoid fever ______. |Tuber- I Whoo¶>ing Division. State, Cases, Cases, c's's; Cases, cough, Detgths and city esti- Cases esti- Cases Deaths esti- Cases Deaths cases mated re- mated re- re- re- dmated re- re- re- causes expect- ported expect-'ported ported ported expect- ported, ported ported ancy ancy ancy

NEW ENGL.iND Maine: Portland 1 9 0 0 0 0 0 1 2 3 25 New Hampshire: Concord 1 0 0 0 0 1 0 0 0 0 1 Manchester 2 9 0 0 0 is Vermont: 0 0 0 0 0O Barre- 0 0 0 0 0 0 0 0 0 0 2 Burlington 1 0 0 0 5 Massachusetts: 0 0 (5 0 0 Boston 61 91 1 0 0 18 2 1 O 39 266 Fall River___- 3 6 0 0 0 1 0 0 O I 50 Springfield - 6 29 0 0 00 2 0 0 O 9 42 Worcester- - 8 18 0 0 3 0 0 O 7 63 Rhode Island: 0 Pawtucket - 1 2 0 2 2 0 o 0 0 17 Providence- 9 14 0 3 0 8 1 0 0 0 83 Connecticut: of0 Bridgeport- 6 13 0 0 3 1 0 0 2 32 Hartford 6 7 0 0 0 .0 0 0 0 7 39 New Haven 7 26 0 0 0 1 0 0 0 23 58 MIDDIE ATLANTIC 0 New York: Buffalo- 19 31 0 2 6 1 0 0 28 144 New York-- 215 390 1 1 0 2 110 8 3 0 158 1,506 Rochester_- - 13 77 0 0 0 3 0 0 0 10 83 Syracuse 15 5 0 0 01 1 0 0 0 1 42 XPopulation Jan. 1, 1920. X Pulnary tuberculosis only. April 24, 1925 846

City reports for week ended A pril 4, 1925 Continued

Scarlet fever Smallpos Typhoid fever Whoo . ~~~~~Tuber- ing Division, State, Cases, Cases, cuo',Cas, cougl3, Deaths, and city esti- Cases esti--Cases Deaths deaths sess, Cases Deaths case all matedi re- mated re- re- rc- mated re- re- re- causes expect- ported expect- ported rted ported expect- ported ported Poi ted ancy ancy ancy

MIDDLEATLANTIC- continued New Jersey:

Camden ---- 1 31 0 21 3 2 1 0 1O4 3 27 Newark-; 24 40 0 0 0 6 0 0 4C 8782 109 Trentoi- 3 2 0 0 0 3 0 1 1 O7 45 Pennsylvania: Plifladelphia- 72 176 t 17 47 C D 77 527 Pittsburgh - 19 78 iI 0 0 12 D4 ) 14 233 Reading 4 31 4 0 0 0 I 3 D 6i 36 Scranton 3 7 0 0 1 D4 I D 10 EAST NORTH CENTRAL a Ohio: ('incinnati- 11 16 I 0 4 1 I 2 158 Clevelaind 31 20 0 0 I15 2 0 24 205 Columbus --- 6 11 2 0 5 0 01 2 91 Toledo- 13 23 :4 0 0 6 1 11 14 74 Indiana: 0 I Fort Wayne 2 8 2 0 0 1 1 29 Indianapolis- 11 4 2 8 0 5 0 I 26 101 Souith Bend 3 15 0 1 0 1 0 13 Terre h1aute-. 2 3 0 1 0 0 0 C 0 32 Illinois: 0 I ('hicago- 84 286 3 I 51 2 c I2 138 806 Cicero 2 4 0 0 0 0 0 0 I2 2 8 Springfield__- 1 4 1 0 0 0 0 c I 0 23 Michigan: 0 0c 0 Detroit- 76 121 5 0 2o 2 c 58 305 Flint - 7 0 0 0 0 0 I 2 23 CTrand Rapids 8 75 1 2 0 1 0 3 1 34 Wisconsin: 0 0 Madison 4 1 0 0 0 0 0 2 4 Milwaukee - 32 15 17 0 1 0 55 134 Racine- 5 2 0 0 o 0 0 0 16 Superior 2 11 3 0 °l---ojll 1 1 0 6 0 WEST NORTH 0 CENTRAL 0o Minnesota: o Dutluth 5 24 2 0 °l 3 0 0 0 0 23 Minneapolis_ 2S 80 7 5 0 3 1 0 0 0 139 St. IPaul - 28 30 7 1 n 5 1 0 0 17 90 Iowa: o Davenport - 2 0 2 I 0 0 .0 Sioux City 2 O I 0 0 0 0 Waterloo 2 3 5 0 0 0 0 Missouri: 0°l Kansas City- 11 89 1 oj 6 0 0 8 118 St. Joseph- 2 7 i 0 -I0 0 0 0 32 0 0 0 St. L,ouis 34 112 0 7 3 2 0 8 268 North Dakota: 0 -I Fargo ------2 1 0 0 0 0 5 8 1 0 0 0 (rand Forks 0 0 0 0 I------0 South Dakota: 0 0 Aberdeen - . - 0 0 I------0 Sionx Falls--| 3 0 0 0 0 6- 0 Nebraska: 0 Lincoln 4 1 0 -----10 0 0 0 0 19 Omaha- 4 4 2 21 3 0 0 0 62 Kansas: 0 Toneka- 2 5 0 0 24 Wichita 3 0 4 0 1 0 0 0 30 40 SOUTH ATLANTIC Delaware: Wiliniington 2 2 0 0 1 2 0 0 28 Maryland: laltimore 35 50 0 20 3 3 0 65 266 Cullnlbrland..1 1 0 0 0 (I 0 11 1 11 Frederick. 1 0 0 0 0 0 0 0 3 847 April 24, 1925 City reports for week ended A pril 4, 1925-Continued

Scarlet fever Smallpox Typhoid fever 'iber- Whoop- eulosis, ing Division, State, Cases, Cases deat hs Cases,| cough, Deaths, and city esti- Cases esti- Cases Deaths re- esti- Cases! )eaths cases all mate(l re- matedl re- re- mated re- re- re - causes expect- ported expect .portedl ported porte(l expect- ported ported porte(l ancy ancy ancy

SOUTH ATLANTIC- continue(l District of Col.: Washington 20 26 1 2 14 0 15 144 Virgini=: 0 Lynchburg 1 0 1 0 0 0 0 0 0 8 11 Norfolk 1 0 0 0 0 3 0 0 0 17 Richmond 2 0 0 0 0 0 0 0 () 48 Roanoke-e 1 1 0 0 0 1 0 0 0 17 West Virginia: 1 0 Charleston. 0 1 0 0 0 0 0 1 0 2 8 hIluntington 0 5 1 0 0 0 WN'heeling 2 2 0 0 0 1 1 34 North Carolina: 0 0 Raleigh - 1 0 0 0 0 2 0 5 14 Wilminigton 0 0 0 0 0 0 3 12 XViiiston-n 0 Salem- -! 1 0 2 10 0 0 0 9 16 Soutlh C(n;roliiln-i 0 01 o 0 Charlestor - 0 0 0 0 0 0 1 35 Columbia- 0 0 0 0 2 0 o0 0 l 14 GTreenville -- 1 0 1 6 0 0 0 0I 9 Georgia: I 0 0 0 Atlanta 4 4 4 0 0 06 0 14 63 Brunswick ---I 0 0 0 0 1 0 6 Savannah_ 0_ 0 0 0 0 0 11 0 71 25 Florida: St. Peters- hurg - 4 0 1 0 0 0 0' 0 -0 13 0 0 °l-- Tampa -I1 1------0 ZA.ST SOUTH CENTRAL Kentucky: 0 Covington 1 2 0 0 0 0 1 0 0 15 Louiisville 5 16 1 1 0 10 1 0 3 94 Tennessee: I AMemphis -_1 3 2 I 0 Nashville-_H 2' 1 1 4 I- 5 -!°------0 1 61 Alabama: 1 I 0 Birmingham 1 22 1 .55 8 0 2 0 76 MIobile--- 1 0 1 0 0 0 0 I 0~- 17 MSfontgomery 0 0 1 3 0 0 0 0 I 4 15 WEST SOUTH 0 CENTRAL 0 Arkansas: 0 Fort Smith--- 1 0 0 0 0 0 2 Little llock.| l1 0 1 0 1--- - -i- 0 0 0 0 Louisiana: 0 New? Orleansr 41 7 5 0 0 11 2' 7 5 144 Shreveport - - I- 0 4 2 0 0 -I33 Oklahonml: 0 Oklahoomna - 31 2 5 0 0 0 4 21 Texas: 0 0 Dallas-- 2 4 4 1 2 0 0 0 5' Galveston - 0 0 0 0 0 3 1 0 (1 13 Ilouiston 1-l i 0 0 5 0 3 1 0 0 47 San.Antonio 1 0 0 0 0 IS 0i 0 0 0 59 0 MOUNTAIN 0 MontaLna: 0 0 B3illings 1 6 0 0 0 0 0 0 3 4 Great Falls-- 1 8 1 0 11 0 0 1 12 IHelena o 0 0 0 2 0 0 0 12 Missoula 1 0 1 0 00 0 0 0 0 0 5 Idaho: 0 Boise l-1 0 0 0 0 0 0 0 0 4 Colorado: I)enver-l-- 11 9 3 0 0 10 0 0 6 104 Pueblo ------01 O0 0 0 0 0 0 1 8 April 24, 192S 848 City reports for week ended A pril 4, 1925-Continued

Scarlet fever Smallpox Typhoid fever ~~~~~Tuber-_ Whloop- ing Deaths, Dix i'isfn, State, t~~iiS(5, Caxes,C ases, 1 (ulsisCas, ase Deth cough, and city e Lti Cas,.es: esti- CtasesCaseess-Deaths d(eaths esti-iCwes Deaths cases all natelt re- mat'^ re- re- mated re- re- re- causes ex )et- ported lexpect- ported ported pored expect- ported ported ported alley ancy ancy

MOUNTAIN-con. New MNlexico: Albuquer(lque 10 0 0 1 0 0 0 0 10 Ar0zo a: T'henix - 1 0 0 9 -- 0 0 2 29 IU tah: Salt Lake City 3 4 2 0 0 2 0 0 0 2 21 Nevada: 1 2 1 1 O 0 0 0 1 0 2 PACIFIC Washington: Seattle 9 14 `tpokane 4 2 2 0 Oregoni: Ilort lan(l - 6 12 (alifernia: LUs Angeles 16] 32 Sa(ramnento-I 21 2 San Francisco, 1 1 f16

Cerchrospi nal1 rrcningitis

Division, State, an(l city Cases Deaths

NEW ENGLAND

Afassachtisetts: 0 Boston I 0 I1 01 0 0 0 0 0 0 Springfield- 0 0 11 11 00 0 0 0 0 0 0 Connecticut: Bridgieport 1 ol °l °! °l 0 0 0 0 0 0 MIDDLE ATLANTIC New York: New York 4 2 8 4 0 0 0 0 1 0 New Jersey: Newark 0 0 2 1 0 0 0 0 0 0 0 Trenton 1 0 0 0 0 0 0 0 0 0 0 Penn.sylvania: 0 Philadelphia 0 0 1 1 1 0 0 0 0 EAST NORTH CENTRAL O 0 Ohiio: Columbus 0 0 0 1 0 0 0 0 0 0 Illinois: 0 Chicago 0 2 3 2 0 0 1 0 0 0 Michigan: 0 Detroit 1 0 2 0 0 0 0 1 0 0 WEST NORTH CENTRAL Minnesota: St. IPaul 1 0 0 0 0 North Dakota: °l~~~~~° °l ° Grand Fork-s i 0 0 0 0 0 0, O 1 ol o 0 849 April 24, 1925

City reports for week ended A pri 4, 19?2 Continuedl

Cerebrosp)inali Lethargic Pellagra lPolioimx ilitis(inran. fever nieiilitgitis encel)hilitis Tylplts

Division, State, and city kesti-Cases, r Cases Deaths Cases Deaths 'ases D)eaths liat edC (C'ase Dat lis ('Ca,ss Deatlis ex!Sxl)('t- ancy 1-

SOUTH ATLANTIC Maryland: Baltimore 1 1 2 1 0 0 0 0 0 0 District of Columbia: Washington O-- 0 1 1 n! nfu O 0 0 0 North Carolina: 1 WVinstoin-Saleni 0, 0 0 0 0 0 0 0 0 0 South Carolina: I 0 0 0 0 0 0 0 0 Charleston 0-O-O- 0 Columbial- 0 1 0 0 0 0 0 0 0 0 Georgia: 1 0 0 0 Atlanta ------0 0 0 0 0

EAST SOIUTlH CENTRAL Tennessee: Nashville- 0 0 0 0 0 0 0 Alabarma: 11irmiugham- 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 Montgomiiery 0 0 0 0 0, 1 WEST SOT'TH CENTRAL Arkansas: Little Rock- 0 0 0 0 0 0 0 0 0 0 Louisiana: Shreveport 0 0 0 0 0 0 0 0 0 Oklahoma: Oklahoma 0 0 0 1 0 0 0 0 0 Texas: .1houston 0 0 0 0 0 0 0 0~ 0 0 MOUNTAIN Nevada: Reno 0 1 0 0.0 0 0 0 0 1 PACIFIC O Waslhington: 0 Spokane- 3 0 0 0 0 Oregon: Portland 1 0 0 0 1 0 California: O 0 0 0 0 0 0 0 0 Los Angeles 0 Sacranietito 0 0 0 0 0 0; 0 0

The following table gives the rates per hiun(dre(d thousand popula- tion for 105 cities for the 10-week perio(d elide(d April 4, 1925. The population figures use(d in computing the rates were estimated as of July 1, 1923, as this is the latest date for which estimates are available. The 105 cities reporting cases lia(l ani estimate(d aggregrate population of nearly 29,000,000 tan( the 97 cities reporting deaths had more thcan 28,000,000 population. The number of cities in- cludedl in etich group and the acrgreg,ate p1opulations are showni in a separate table below. April 24, 1925 850

Summary of weekly reports from cities, January 25 to April 4, 1925--Annua! rates per 100,000 population I DiPhTIIhERIA CASE RATES

Week ended-

Jan. Feb. Feb. Feb. Feb. Mar. Mar. Mar. Mar. Apr. 31 7 14 21 28 7 14 21 28 4

Total - 2166| 317,5 3 16;8 149 4 169 162 6168 167 6168 7178

New England- 199 191 246 241 4 189 233 176 147 119 171 Mliddle Atlantic- 155 171 165 163 178 167 214 196 2.31 241 East North Central 2 135 145 132 123 119 114 128 134 112 93 West North Central 251 255 259 209 299 282 201 199 247 220 South Atlantic- 128 3 153 a 183 156 114 104 6 93 136 95 6 83 East South Central 97 63 69 80 51 63 40 69 57 8 28 West South Central 148 176 162 125 162 144 158 97 121 83 Mouintain -134 191 95 162 153 86 105 143 134 124 Pacific -- 293 270 180 165 25f8 235 197 249 t 179 374

MEASLES CASE RATES

Total 2 214 3 254 3 297 383 4 358 418| 6 449 506 6507 ' 561

New England- 484 576 661 720 585 656 542 725 755 957 Mliddle Atlantic -- 205 205 287 373 343 428 518 598 633 734 East North Central. 2 373 453 515 688 632 789 740 775 798 736 West Nor-th Central 21 17 31 27 73 68 75 93 89 77 South Atlantic 37 '49 3 98 110 81 100 '150 189 136 6214 Fq.st South Central 91 51 74 51 46 86 11 69 34 8 21 W(cst South Central 14 37 51 14 51 23 88 42 9 88 Mountain -286 782 153 620 916 29 763 573 38 219 Pacific -17 61 29 64 61 107 110 189 6 151 209

SCARLET FEVER CASE RATES

Total 2 364 3 412 3400 390 4 408 395 '432 427 6419 7411

New England- 534 614 564 606 4 558 584 534 544 604 534 Middle Atlantic 322 373 407 376 412 372 439 417 405 436 East North Central 2 379 426 397 432 434 433 497 498 483 442 West North Central.. 779 871 728 742 734 775 719 792 755 736 South Atlantic -- - 185 3 255 277 167 203 171 ' 224 146 167 | 179 East South Central. 217 97 212 223 183 194 355 286 286 8288 West South Central. 204 162 121 125 144 185 107 134 102 51 Mountain -258 334 382 248 315 286 200 429 248 277 Pacific --- 226 258 177 186 223 218 229 218 6222 191

SMALLPOX CASE RATES

Total 2 67 3 76 3 79 66 4 66 62 A 61 63 6 58 |7

New England- 0 0 0 0 4 0 0 0 0 0 12 Middle Atlantic 9 2 4 2 3 1 5 8 7 21 East North Central 2' 35 39 35 56 28 42 39 32 33 24 WVest North Central 195 145 193 126 120 114 124 o102 135 87 South Atlantic 45 3 62 3 98 67 43 51 ' 60 57 67 ' 50 East South Central 652 823 675 532 583 652 446 646 423 8450 West South Centrall 60 125 139 83 116 74 74 107 107 46 Mountain - 48 29 162 86 57 48 95 67 19 19 Pacific - 177 267 220 215 313 206 247 212 *191 255

' The figures given in this table are rates per 100,CC0 population, annual basis, and not the number of cases reported. Populations uised are estimated as of July 1, 1923. 2 Racine, Wis., not included. Report not received at time of going to press. 2 Wilmington, Del., not included. 'Ilartford, Conn., not included. 'Tamnpa, Fla., not included. ° Spokane, Wash., not included. 7 Tampa, Fla., and Memphis, Tenn., not included. I Memphis, Tenn., not included. 851 April 24, 1925 Sunmmary of weekly reports from cities, January .25 to April 4, 19235-Annual rates per 100,000 population-Continuied TYPIIOII) FEVER CASE RA,TrS

'Week ended-

Jan. Feb. Feb. Feb. Fel). MaI ;r. M1ar. Mar. Iar. Apr. 31 7 14 21 28 7 14 21 28 4 . Total 218 313 313 11 4 14 11 59 12 6 11 78 _ New England - 7 30 20 0 413 5 30 12 5 Middle Atlantic 19 13 6 10 8 10 5 8 7 4 East North Central 2 10 8 6 6 7 11 4 7 3 4 West North Central- 12 0 10 4 17 6 10 8 6 2 South Atlantic 37 3 17 3 34 8 20 8 '21 22 12 '23 East South Central 23 11 40 34 34 34 34 46 57 8 21 West South Central 60 23 46 42 42 2X 28 23 42 32 Mountaiin- 19 29 19 38 76 10 19 0 0 0 Pacific 3 17 12 23 9 15 15 0 6 28 20

INFLUENZA DEATII RATES Total 223 3 30 3 28 30 434 1 301 534 421 331 734 New England- 27 47 27 17 4 40 17 35 30 30 35 Middle Atlantic- 16 24 *22 21 20 15 24 29 22 21 East North Central - - 2 12 13 17 18 24 27 33 49 40 38 West North Central - 15 20 11 22 37 35S 33 42 46 39 South Atlantic 39 3 49 3 55 55 49 r3 5 29 53 12 3 29 East South Central- 74 69 63 74 126 103 91 120 86 8 77 West South Central - - 82 97 122 153 148 143 107 76 36 36 Mountain- 38 57 57 57 19 19 48 48 38 181 Pacific- 20 41 4 12 29 29 16 12 53 29

PNEIJMONIA DEATH RATES _

. 2206 3 225 3 216 4 201 205 5 222 217 206 205 Total 2221 !_ 7 Il ,~~~ _- New England 241 211 239 241 4 242 226 229 211 219 251 Middle Atlantic 230 253 231 216 185 210 214 217 199 215 East North ('entral 2145 164 168 184 171 195 241 222 214 182 West North Central - 118 134 131 131 166 140 175 173 166 193 South Atlantic 252 3 315 3 270 252 305 268 5241 290 252 233 East South Central- 303 326 320 320 292 269 366 286 269 18 253 West South Central - - 229 352 464 408 260 229 178 178 168 168 Mountain 315 191 277 219 267 162 210 172 200 162 Pacific 217 196 192 213 163 139 155 131 159 159

2 Racine, Wis., not included. Report not received at time of going to press. 3 Wilniington, 1)el., not included. 4 Hartford, Conn., not incluided. 5 Tamiipa, Fla., not included. 6 Spokane, Wash., not included. 7 Tampa, Fla., an(d Memphis, Tenn., not inclu(led. 8 Meinphis, Tenn., not iincluded. Number of cities included in summary of weekly reports and aggregate population of cities in each group, estilnate(1 as of Jutly 1, 1923

Number Number Aggregate Aggregate ofctiies ofcumiesCies populationi population Group of citiesGroupcitesof reportings r of cities of cities reporting reporting reporting reporting cases deaths cases deaths

Total- 10.5 97 28, 898, 350 28, 140, 934 New Enigland(I_------12 12 2,098,746 2,098, 746 Aliddlle Atlantic ------10 10 10,304,114 1o, 304, 114 East Northi Central 17 17 7 032. 533 7,032, 535 W'est Nortl (Central -- 14 it 2,515,330 2,381,454 Souths Atlantic-- 22 22 2,566,901 2, 566.),) 1 East South (Central 7 7 911,885. 911, 885 West Sotuth Central 8 6 1, 124, 564 1,02:1,013 Mlotintaiii ------9 9 546, 143 546, 445 Pacific 6 3 1,797, 830 1,275,381 362750-25t 3 FOREIGN AND INSULAR

CUBA Deratization of arriava from Tmnpico, Mexico.-Measures of derat- ization were oridered, April 7, 1925, to be enforced against arrivals from Tampico, Mlexico, on account of the occurrence of rodent plague at that port. INDIA Ep,idemiic mallpox-R an,goon .-Infornmation received undler date of February 20, 1925, shows the presence of smallpox in Rangoon, Burma, n(lia, in epidlemic form. During, the month of January, 1925, 199 cases were reported, of whlichl 26 were imiported. It was stated that all preventive measures wer-e being taken to check the spread of the disease, including appointment of atn extra staff of vaccinators, examination of infected aireas to discover and remove cases of smallpox, an(l an intensive campaign of vaccinaition and revac- cination of persons living in infected areas or employed in workshops, factories, and schools. Smallpox darinq the m?onth of Febrvary, 1.925.-ADuring, the week enided February 7, 1925. 91 cases of smallpox witlh 15 deaths, and dur- ing the two-week )erio(l endedl February 28, 217 cases with 49 deaths were reported at Ranigoon. Population, 356,556. MADAGASCAR Plaque Febr?uary 1-145, 1925.-During the period February 1 to 15, 1925, 95 cases of plague with 83 deaths were reported in the isiand of Madagascar. The types of the disease were stated to be bubonic and septicemic. For distribution according to locality, see page 854. MAURITIUS Plague-Ycar 1924.-During the year 1924, 161 cases of plague with 144 deaths were reported in the island of Mauritius, 101 cases with 92 deaths being reporte(I at Port Louis (population, 50,308). The period of greatest prevalence was for the months of October, November, and December, the greatest number of cases, viz, 44, with 40 deaths, being reported for the month of November. For further distribution accoriding to period and locality, see page 854. (852) 853 April 24, 1925 MEXICO Rodent plague-Tampico.-Rodent plague was reported April 6, 1925, at Tampico, Mexico, occurring in rats found in thiC vicinity of the Government wharf. PANAMA CANAL Communicable diseases-Februiary, 1925.-Duriing the month of February, 1925, comnmunicable diseases were reported in the Canal Zone and at ColonI and Panama, as follows:

Canal Zone Colon IPanailma Nonresident Total

se_ise ___ Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths

Chicken pox 4-I------4- ---- 31 ------3 ----- 42--- Diphtheria -1 6 --- 4 .-- 11 Dysentery ----- 2 2 3 Hookworm infection ------31 -- 4-- 40--- L po Y ------!--,--,--_-I Ma'ara- 55 4i 9 2 34 j 1 102 3 Measles -8 1 4 2- 15 Meninigitis - 1 1 1 3 3 1i-- --4 um ps------4 1- 2 i- Pneumnonia - 4 4 1 11 11 21 2 17 17 Polioiyelitis ---- 1------I Scarlet fever ---- - 1I-- 1 Tuberculosis --- 2 21 6' 5 26 22 5 1 39 30 Typhoid fever I------1 1 2 Whooping cough -- 4 9------13--

PARAGUAY Quarantine station established at Hu-mnaita.-Information received under date of March 6, 1925, shows the establishment of a quaranitine station at Ilumaita, Paraguay, at the junction of the Paraguav aind Parana Rivers, for tlle inspection of vessels enterinig Paraguavat waters, and for dlisinfection and quarantine when require(l, the object being, to guard against the, importation of plague. UNION OF SOUTH AFRICA Plague-Plag?te-infected rodents-February 15-2S, 1925. Plague has been reported in the Union of South Africa 11s follows: Week ended February 21, 1925-Cape Province: One fatal case, native, occurring, at a farm in Hanover District; infection was stated to exist in wild rodents on both sides the V'aal River, in a strip of country 10 miles wide and extendingf some miles east of Stand(ertoni; also in the Klip Rtiver valley, extendig, from neiear Rtoberts Drift to withiin about 10 miles from Volksrust. Week entde(d February 28, 1925- Orang,e Free State: Two fatal cases, in natives, on farms in Kroonstad District; in Senekal D)istrict, 1 fatal case, native, was reported, the case hiaving occurre(d on February 3, 1925, and having been iisad- verteiitly omitted from the report covering that date. Apri" 24, 1925 854 Smallpox Typh7us ferer Januiary, 1925.-During the month of January, 1925, smallpox and typhus fever were reported as follows in the Union of South Africa: Smallpox-4 cases occurring in the native populaltiotn. Tyh)lus fever-cases, 94; deaths, 12, occurring in the native population, with 2 cases in the white population. For distribution of occurrence according to locality, see paige 855.

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER The reports coiitaine(d in the following tables lntist not be considered as complete or final as regards either the lists of countries included or the figuires for the particular couintries for which retorts are giveil. Reports Received During Week Ended April 24, 1925 1 CHOLERA

Place D.te Cases Deaths Rermarks

Illid; -______- -- Feb. 8-14, 1925: Cases, 1,762; Calcutta - - M.ar. I-7 -- --1 19 iC) deaths, 1,081. Aladras ------AMar. 2-8 ------11

PLAGIIE

Brazil: tiahia Jan. 4-Feb. 28 4 3 British East Africa: Tanganyika- Jan. 18-24 17 11 Subject to correction. Uganda ------Dcc. 1-31- 37 32 Ceylon: Colomnbo- MIar. 1-7- China: Nanking ------Feb. 22-.Nlar. 7 - Present. India Feb. 8-14, 1925: Cases, 4,425; Bombay -- Feb. 22-28 - 3 3 (leatlis, 3,682. Madaga-scar- Feb. 1-15, 1925: Cases, 95; deaths, 83. Fort Dauphin (port) Feb. 1-15- 11 1 Bubonic. Itasy (province) do ------1 1 Do. Moramanga (province)_- - -do ----- Do. Tananarive (province)- 1! 1 Tananiarive (towii- --__ do I--21 2 Septicemic. Other localities do -- 901 - 78 Bubonic and septicemic. MiIauritius -3 Year 1924: Cases, 161; deaths, 144. District- Flacq - -- Dec. 1-31 5 4 PaTlIpleniousses -_- - do 1 1 Plaities Wilhemns --- Jan.-Dec --- .'14 47 Not present March, April, May. Port Louis Feb.-Dec ---- 101 92 Mexico: Tampico Apr.6, 1925: Plagueratfouindin vicinity of government wharf. Straits Settlements: Singapore Feb. 22-28- 5 4 Union of South Africa -.--- I- Feb. 15-21. 1925: 1 case, 1 death. Feb. 22-28, 1925: cases, 2. Ad- ditional case reported out of date. Cape Province- Hanover District Feb. 15-21 1 I Plague infection in wild rodents on both sides of Vaal River. Orange Free State- Kroonstad District;___ Feb. 22-28 2 2 Natives. Senekal District --- Feb. 3 1 Native. Delayed report. -I From miiedical officers of the Public Health Service, American consuls, and other sources. 85P Ap1r il 24, 1)25

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AN D YELLOW FEV ER-(C'oite l Reports Received During Week Ended April 24, 1925-Cuntltitlled SMALLPOX Plac" Date ('Ises l)eithil Ie:iiar ks Arabta: Aden -M\lar. 13-21 ____ 1-_____-__ Boliv a: F Ia Faw Fel).1 -- S 2 7 Bi azil: - flern a 'I o ------F!let) 15 ------Blul a- a S o a -M3a-. 12-18 ---- ario!od. Canal a, British ('oluriTiba- Vancouver -Mar. 21-30 -- 20 V'ictor a ---- 'aar.22 . pr.)l 4 4 Chiina - Aioy -lar.1-71 - -- 3 ery' preva!ent in district. Antunig -Tar. 2-S 3- Foochow -Fet). '2228 -- -- -'rs nt. 11(nk(n Feb. 22-Mar. 7 3 3 - N-an--n-- Feb. 28-Mlar. 7 ---- resnt. Colomt) a. Santa Ma;ta - NIar. 15-28 ---- Preset in mil(d form in localities i' Vicinity. n(laa- - - - - F-. S 14, 1923: Cases, 4,901, 985. Bonid ay -Fel). 22-28 513 29 dilcaths, CFa'cultta '- - - r. 1-7 280 200 Epidemic. Ka a-hi -ai-- S1------19 2 In(o-C(hina: Saigon - - Feb). S-21 -19 4 Includirg 100 sq. km. of sur- Iraq: rounding counitry. Ia('aa I - 1Mar. 1-7 1-- rounding Japan: Na a aki - Iar.8-22 -- 4 2 Jasva West Java- Cheribon Jan. 22-2S 1 Krawang. Jan. 15-21 1 Latvia - - - - - Jan. 1-31, 1925: Cases, 5. Nlexico:I DMxrango M-tlr. 1-31 ---- 6i San Luis Potosi i.r. 29-Apr. 4 ------1 Tampico Ilr. 21-31 8 2 Spain: Madri(- January - Febru- 13 Straits Settlenients: rvy. Singapore Fel). 22-2- 2 Tunis:l Tunis - Tar. 19-25 16 21 Unioni of South Africa ------Jan. 1-31, 1923: Cases, 4. N.ltive3 TYPHUS FEVER C(ile: Valparaiso --- - Mar. 1-7- ('hosen: (hemulpo-b e. 1-2 -- 1 S --oul- (10 2 1 MIexico: D)urango - - ir. 1;;-31 1 1 Mlexico City -Fe-Feb. 15-MIir. 21 9 24 Swedleni: Got,eborg - - Fe. 22-23 1 !---- Tuniis: Tuniis - -Nlar. 19-2.5 8 1 Tuirkey: Constantinople --- ar. 1- --- 1 UTnioni of South Africa------Jan. 1 -31, 1923: Cases, 94; d tlhis, 12; nitive. In white poplmla- tion, s(isss, 2. (ape IPlovince ------Jan------Ja. 1-31, 1923: Native. C:ises, 41:; dlo lis, 6. I) Feb. 22-28 -- l)-l k. Nat i- Jan--. 1 :31, 1925: C(mscs, 2S; deaths, 4. Native. D)o - Feb). 135-21------(Oithre-ks. OriangeM Free State'------Jlii. 1-31, 1123: (tascs, 16; d(Ic t i,,s 2. Nlitivk ,. )o - - Feb. 1321------u---t--rea- . Trisvial - J n 31, 1925 Cases, 9). Na,itiive. Yugovslalvial ------Nli.i SI 14, 1:i12.): (-tics. 1. April 24, 1925 856

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Cotitiitied Reports Received from December 27, 1924, to April 17, 19251 CHOLERA

Place Date CRSeS Deaths Remarks I~~~.~ Ceylon June 29-I)ec. 27, 1924: Cases, 14; Colonibo- Nov. 16-22- deaths 13. Do Jan. 11-24 . 2 2 India ------i O-ct. 19. 1921, to Jan. 3, 1925: Bombay Nov. 23-Dec. 20. 4 4 Cases, 27,164; deaths, l6,228. Do Jan1. 18-24-- 1 1 Janii. 4-Feb. 7, 1925: Cases, Calcutta Oft. 6-Jan. 3 - Fj9 51 12,35f6; deaths, 7,309. Do Jan. 4-Feb. 28- 143 115 Madras- No,v. 16-Jan. 3 619 40 Do Jan. 4-.MIar. 7. 137 Rangoon No-. 9-D)ee. 20..- 9 2 Do Jan. 4-Feb. 28- 11 8 Indo-China . ------Aug. l-Scpt. 30, 1924: Cases, 14; denths,i 10. Province- Anam Aug. 1-31 . Cambodia- Aug. I-Sept. 30 6 Cochin-China do 7 4 :Siam: Saigon Nov. 30-Dec. -__ 1 ------I Bangkok Nov. 9-29- 4 Do Jani. 18-Feb. 21 6 31

PLAGUE

Azores: Fayal Island- Castelo Branco Nov. 25 . Present witlh several cases. Feteira-- fo 1~ St. Michael Island - Nov. 2-Jan. 3. 30 13 Do -Jan. 18-24. 3 1 Brazil: Bahia -Feb. 15-Jan. 10-- 3 3 British East Africa: Tanganyika Territory- Nov. 23-Dec. 27 . 17 10 Uganda -Aug.-Nov., 1924.. 242 Canary Islands: 211 Las Palmas -Jan. 21-23 . 2 Stated to be endemic. Do------Fcb. 4 1 Stated to have been infected with plagure Sept. 30, 1924. Realejo Alto -Dec. 19 -.------Vicinity of Santa Cruz de Teie. rifle. Teneriffe- Santa Cm .- Jan. 3 -_ In vicinity. Celebes: MIacassar -Oct. 29 -I------IEpidemic. Ceyloni: ----- Colonibo -Nov. 9-Jan. 3. 12 9I Do - Jan. 4-Feb. 28. 9 11 I 5 plague rodents. China: Foochow- Dec. 28-Jan. 3. Present. Nanking -Nov. 23-Jan. 31 Do. Shing Ilsien -October, 1924------I d790 Ecuador: Chimborazo Province- Alausi District- Jan. 14 . 14 At 2 localities on Guayaquil & Quito Rtailway. Guayaquil -Nov. 16-Dec. 31 9 3 Rats taken, 27,004; found in- fected, 92. Do -Jan. 1-ar. 15-- 59 25 Rats taken, 45,027; rats found Naranjito - Feb. 16-Mar. 15... 1 - infected, 234. Yaguachi - Feb. 1-Mar. 15- 2 1i I From medical officetrs of the Public Health Service, American consuls, and other sources. 857 April 24, 1925 CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Cointiniuied Reports Received from December 27, 1924, to April 17, 1925-Cointinued PLAGUE-Continued

Place | Date Cases D)eaths Remiiarks

Egypt- Year 1924: Cases, 373. Jan. 1-23, 192.9: C(ases, 15. City- Alexandria-Year 1924 2 2 Last case, Nov. 26. Ismnailia --dlo 1 1 Last case, July 6f. IPort Said - do- 6 4 Last catse, D)ec. 7. Suez -od 20 13 Last case, D)ec. 20. Province- Dakhalia-- Jan. 1-S - - 1 1 Kalioubiah - - do- 3- Menoufieh- d---o- 7 3 Gold Coast !- - September-November, 1924: Deaths, 48. h1awaii: IlIoiokaa - Nov. 4 ------1 Plague-infected rodents found, D)ec. 9, 1924, aind Jan. 15, 1925. India - Oct. 19, 192$, to Jan. 3, 1925: Bombay --ov. 22-Jani. 3 4 3 (ases, 28,154; (leaths, 21,505. Do- Jan. 4-17 2 2 Jan. 4-Feb. 7, 192.5: Cases, Do------| Feb. 8-21 3 3 20,025; deaths, 16,761. Calcutt:a ---- - In.a 18-24 1 1 Karachi - - - Nov. 30-Dec. 6 2 1 Do - - Jan. 4-Feb). 2'1 12 11 Madras Presidency - - Nov. 23-Jani. 3 487 D)O ----- Jsan. 4-2 - 668 511 Ranigoo---- Oct- )-Jan. 3 2f6 25 Do - J--ai. 4-Fel). 28 ,__!79 69 Indo-Chiina --- Aug. 1-Sept. 30, 1924: Cases, 25; Provinice- deaths, 20. Aiiaii |- Atug. I-Sept. 30 41 4 Cambodia - dlo --- 18 15 Cochini-Chiria -- - do- 3 1 Saigo -I)ec. 25-31 1 1 Including 100 square kilometers of surrouiu(ling territory. Do- Jan. 11-17 2 1 Do. Iraq -June 29-L)ec. 13 1. 13 Japan- Aug. 10-Dec. 6 19' Java: East Java- Blitar ------Nov. 11-29 Province of Kediri; epidemic. Pare --- Nov. 29 - - -- Do. Sidoardjo --- - Jain. 2 Declare(l elpidermic, Province of Soerabaya-Nov. 16-Dec. 31 717 72 Soerabaya. )o -Jan. 1.-Feb). 7_____ 4 3 West Java- Cheribon -Oct. 14-Nov. 3 ------14 Do- Nov. 1-8Dec. 22 --- 80 -1--Do JanI. 1-14 ------44 ('heribon Provinice. Do - Jan. 30 ------Plresent. Pasoeroean ---- Dec. 27 --- -- Il-ovince. Epidemic in one lo- Pekalonigai ------Oct. 14-Nov. 3 l29 (cality. 1)o-- Nov. 18-Dec. 31_ 177 I)o J-.1;. 1-14 8I Pek.alongan Plrovince. Probalingga------1Dec. 27 ! I';rovin.i'ncllenlic. Tegal - Oct. 14- Dc. 31 2f; P'ekalongan Province.. 1) JanS1-. 1-14 37 Madag oscar: For-t Dauphin (port) - i-- Nov. 1-Dec. 15. 9 125 hasy Plrovinice --- Nov. 1-)ec. 15, 1924: Cast's, 4: Alajunga (port) - Nov. 1-30 1 1 deatlhs, 2. Morarmanga Province - - Nov. 1-Dec. 15, 1924: (Cases, 49; Tamnatave (port) ------Nov. 1-30-- - 1 1 deaiths, 31. Jan. 16-31, 1925: (ases, 4; (leaiths, 4. Taii.nanrive Prosince - O(ct. 1-Dee. 31, 1924: Cases, 298; deaths, 274. 1)o - Jan. 1-31: Cases, 135; (leatthl, 114. Tananarive (town) -Oct. 16-Nov. 30 8 7 Bulhoniie, pnteuionic, sepoti- D)o --- )ec. li-31 4 4 c,nttic. D)o Jani.1-1-S 1 1 Mauritius lslan(d - Sept. 7-Oct. 18, 1'9,21: Cases, CO; deaths, 53. Morocco- Marrakech - Feb. 9, 1925: Pre.sent in native (lularter of towni. Statell to his pneumnonic in formn and of hiigh mortality April 24, 1925 858 CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Cowstinueed Reports Received from December 27, 1924, to April 17, 1925-Continued PLAGUE-Contisiue(d

Place Date Cases Deaths Remarks

Nigeria - , .-- August-November, 1924: Cases, 387; deaths, 317. Palestine: Jerusalem - Mar. 3-9 I Peru -Fe-r uary, 1925 6 Siam: Bangkok -Dec. 28-Jan. 3_- -, I 1 Do - Jan. 25-Fel). 14____ 2 1 Siberia: T1ransbaikalia- Turga - - October, 1924 3 On Chita Railroad. Straits Settlernents: .1 Singapore - Nov. .-15 Do- Jn. 4--1eh. 28 8 Syria: 6 Beirut - Jan. 11-20- Turkey: Constantinople-JniJn. 9 15 - --- 5 5 UJnioni of South A-frica- Jan. 4-F'cb. 1 40 15 Native cases, 3; deaths, 1; white, 16 cases, 6 deathis. Cape Province- D)e Aar District Nov. 22-Jan. 3 4 Natixe. )o :- Jan. 4-10 . 2 Natives; on farms. Do -Jan. 25-31 1 Malay camnp. Dronfield ----- Dec. -13 __ 1 8 miles from Kimberley. Edenburg (town) ---- Jani. 25t-31 Plague infected house mouse. Kimberley -- 1)ee. . -2. 31 Do Fel). 1 , On farm. M\1araisburg DistrIct Nov. 22-Dec. 13 4 2 Bubonic, on (loedshoop Farm. Steynsburg District- Jani. 4-10 1 Native; on farm. Orange Free Stat- Bloemfontein )istrict_, Dec. 21-Jan. 3 5 2 Do- Jan. 11-17 1 Do. F;ckshutrg t)istrict Dce. 28-Jan. 3 1 2 lloolstad District- DI)ec. .-l3 1 On farm. Kroonista(l District Nov. 22-Jan. 3 2 3--1 Do Jan. 18-24 1 12 Native; on farm. Philippolbs District Dec. 21-27 1 V'redefort D)istrict-- De. .-'0 2 On fairms. Transvaal- Boshof District -- Dec. 7-Jan. 3 --- 3 On farin. Do - - Jan. 11-Feb. 14_.. 28 Native, 5 cases; white, 6 fatal cases. On farms. Siithfield -Jan. 11-17 . Winburg District - Fel). 8-14 . On farm. Native. Wodehouse DistricL Feb. 1-7 . 1 On farm. Wolmaransstad Dis- Nov. 22-29 . On Farm Wolverspruit, Vaal trict. River. Native. On vessel: S. S. Conde - At Marseille, France, Nov. 8, 1924. Plague rat found. Ves- sel left for Tamatave, Mada- gascar, Nov. 12,1924. Steamship -November, 1924- 1 At Majunga, Madagascar, from Djibuti, Red Sea port.

SMALLPOX

Algeria July 1-Dec. 31, 1924: Cases, 409. Algiers -.-.---- Jain. 1-Feb. 28_-- Jan. 1-20,1925: Cases, 107. Arabia: Aden . Jan. 25-Mar. 7 10 Bolivia: La Paz . Nov. 1-Dec. 3I1- 20 11 Do . Jani. 1-31 5 Brazil: Periiambuco . Nov. 9-Jan. 3- 100 27 Do . Jan. 4-Feb. I 78 35 British East Africa: Kenya- Mombasa . Jan. 18-24 Uganda- Entebbe .... (Oct. 1-31 __- 4 859 April24, 1925 CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Continuedl Reports Received from December 27, 1924, to April 17, 1925-Continued SMALLPOX-Continued

Place Date Cases Deaths Remarks 1 British South Africa: Northern Rhodesia. Oct. 28-Dec. 15 -- 57 2_ Do . Jan. 27-Feb. 2 -- 3 Natives. Southern Rhodesia- Jaii. 29-Feb. 4_ 1 I------Canada: Alberta- Calgary- Mar. 15-21- 1 Stated to have been contracted in Ontario. British Columbia- Oceani Falls- Mar. 7-27- 6 1- Very mild. Vancouver- Dec. 14-Jan. 3_- - 32 -- Do- Jan. 4-Mar. 21 268 Victoria- Jan. 18-Feb. 7 2 Manitoba- Winnipeg - Dec. 7-Jan. 3------14- Do- Jan. 4-Feb. 27----- 30. New BrunswicD - Bonaventurc and Gaspe Jan. 1-31- 1------Counties. Northumberland Feb. 8-14 -1 Couinty. Ontario- Nov. 30-Dee. 27, 1924: Cases, 33. Hamilton- Jani. 21-30 -1-- - D)ec. 28, 1924, to Mar. 28, 1925: Cases, 57; deaths, 1. Ceylon------1------July 27-Nov. 29, 1924: Cases, 27; Colombo- Jan. 18-Feb. 7----- 4--- (leaths, 1. China: Amoy- Nov. 9-Feb. 14 Present. Feb. 22-28, 1925- One Antung- Nov. 17-Dec. 28--- 5 . death. Do Jan. 5-Feb. 14 15 1 Foochow- Nov. 2-Feeb. 14 . Present. Hongkong- Nov. 9-Jan. 3 6 2 )o - Jan. 4-Feb. 7 9 7 Do- Feb. 15-21 2 2 Manchuria- Dairen- Jan. 19-Feb. 1I.. .. 2 Harbin- Jan. 15-Feb. 1i____ 5- Nanking- Jan. 4-21- Do. Sharghai Dec. 7-27 - - 1 2 Do- Jan. 18-Mar 7 8 Chosen: Seoul- Dec. 1-31- 1 Colombia: Buenaventura Feb. 15-28- 2 Czechoslovakia April-June, 1924: Cases, 1; occur- -~~~~~~ ring in Province of Moravia. Dominican Republic: Puerta Plata Mar. 8-21- 3 Ecuador: Guayaquil Nov. 16-Dec. 15i. 4 Egypt: Alexandria Nov. 12-Dec. 3I1__ 10 Do Jan. 8-28- 8 Do Feb. 26-Mar. 4.--- Esthonia Dec. 1-31, 1924: Cases, 2. France ------i- July-Decemilber, 1924: Cases, 81. Dunkirk- IMar. 2-8- From vessel. In quarantine. St. Malo Feb. 2-8 7 I------i- Believed to have been imported on steamship Ruyth from Sfax, Tunis. Germany June 29-Nov. 8, 1924: Cases, 7. Frankfort-on-Main. Jan. 1-10------Gibraltar Dec. 8-14------1-1 Gold Coast - July-September, 1924: Cases, 82; deaths, 1. Great Britain: England and Wales Nov. 23-Jan. 3 - -- 472 Do Jan. 4-Mar. 21 1, 477 Newcastle-onl-Tyne Jan. 18-Feb. 21.._ 9 Do Mar. 1-7- 1 Ureece-I January-June, 1924: Cases, 170; deaths, 27. Do------!------July-December, 1924: Cases, 38; deaths, 26. Saloniki------I Nov. 11-Dec. 22 |1 3 1------April 24, 1925 860

FEVER, AND CHOLERA, PLAGUE, SMALLPOX,FEVER-CoRtniitnued Reports Received from December 27, 1924, to April 17, 1925-Continued SMALLPOX Continued

'lace te CaseDCaes Deaths Remarks

| India Oct.Cases,19, 1924,12,564;to deaths,Jan. 3, 2,857,192.5 1925: Cases Jan. 4-Feb). 7,3,125. 30 13,88; deaths, Bombay ---- Nov. 2 Jan.n. 3 i3 Do ------Jan. 4-Feb. 21- 212 1 Calcutta ------Oct. 26Jan. 8 -- 307 170 )o ---- Jan. 4-Feb. 28___- 1, 347 901 Mar. 5, 1925. Epidemic. Karhi----- Nov.16-JJai. 3 - 1- 2 1) o -----Jan. 4-Feb. 14 -- 52 6 Do ---- Feb. 22-ar.77 21 9 Aadras ----Nov.16- an. 3-- 122 48 Do ----Jai.4--AMar. 7 - 552 212 Rangoon ------Oct.. 26-Jan. 3 - 86 28 Do - Jn. 4Feb.28- 504 98 Indo-China ------Ug. --Sept. 30, 192-4:Ca-ses, 223; deaths, 76. Province- Anam -Aug.-Sept1 30 49 11 (Cambodia - - do !- 40 9 Cochin-Chilla d to 115 49 Saigon ------Nov. 16:Jan. 3 17 5 Iiciluing10 1 sq. km. of sur- Do-- Jars. 410 - 3 1 rounding country. Do J Jan. 2-531 5 2 Do. Tonkini ------Atug. 1 Sept. 30 19-7 Iraq --Juile 29-)Dec. 13 137 66 Bagdad ---- Nov. 92Dec. 279 2 1 Italy-- - June 29-Dee. 27, 1924: Cases, 63. Jamx--aica I Nov. 30. 1921-Jan. 3, 1925: Cases, 50. Reported as alastrim. Do - - - - Jan. 4-31, 1925:(ases, 43. Re j ported asalastrini. Kingston -Nov. 30-De. 27_ 4 ------Reported as alastrini. Japan -- - - Aug.1-Nov. 15, 1924: Cases, 4. Nagasaki -Feb. -15 3 -- Taiwai - - Jan. 1-31 1-1- Java: East Java- Pasoeroean-Oct. 26-Nov. L 9 1 Do -Nov. 12- ) - - - Epidemic in 2 native villages. Soraba ------Oct. 19l)ec. 31 6685 212 Do ---- Jan. 15-Feb. 7 . 258 31 Wvest Java- Bata ---- Ot. 14-20 -- -| 2 Batavia ----Oct. 21-Nov. 14 , 2 - D)o )Dec. 20-Jan. 2 - 19i 4 Buitellzorg-______-----c.2331 _ 1 Batavia Residtency. C'heribon -- Oct. 14-Nov. 24 15 - Do Jan. 1- 7 - 2-- Cheribon Residency. Pekalongan --- Oct. 14-Nov. 24 - 22- D)o - Dec. 25-31 -- 3 --- Province. Penalang --- Jan. 8- 14 1 - PekalonganItesidency. Preanger ---- - Nov. 18 24 - - 1 _ - _ - Latvia ------Oct. 1-Nov. 30, 1924: Cases, 5. ------Jan. 1-31, 1925: Cases, 2. Mexico:Lithluiania Durango --- I ec. 1-31 -5I )o ---- Jan. 1-Fe').2e8 ______10 Guadalajara ----Dec. 23-212__ 1I Do -Jan. 23 4 AMexico City N-Nov.6-Mar.23-Dec. 2, 5 D)o- Jan. Ml-Iar.21 31 MIoniterey Jan. 21, 1925: Outbreak. Mar. -- Dec. 1-31 --1- 1- 1 14, 1925, prcsant. Salina Cruz D)o -FFeb. 22-N 2 Saltillo - - -- do 1 i-1- 11-31 5 4 TampicoDo - : Jan.1Dec. zIr.r20 51 16 V'erai ('rusz -,)ec. I-Jan. 3 10 o- Jan.5IIiar.29- - 37 Villa HterIosa ------Dec. 2-Jan. 10-o I---- Presenit.~~~~~~~ofTabamsco.Locality, capital, State Nigeria January-June, 1924: Cases, 357; Do d 87. Do !- July-Nove:nber,teallbs, 1924: Clases, 87; i ; deal'hs, 23. 861 April24, 1925

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Continued Reports Received from December 27, 1924, to April 17, 1925-Continued SMALLPOX-ContinUed

Place Date Cases Deaths Remarks

Persia: Teheran Sept. 23-Dec. 21, 124: Deaths, 12. Do Jal 1-31 10 Peru: Areqlipa- Nor. 24-30 _ Do Jan. 1-31 Poaad- Sept. 21-Dec. 28, 1924: Cases, 30; Portugal: deaths, 2. Lisbon- Dec. 7-Jan. 3 17 Do Jani. 4-Mar. 14.. 78 7 Oporto- Nov. 30-De 27- 3 2

Do JanIi. 1 1-Mar. 14 _ 3 Russia January-June, 1924: Cases, 9,683. July-September, 1924: Cases, 1,251. Siam: Bangkok Dec. 28-Jan. 3 1 1

Do Jan.1 -Feb. 21 19 Sierra L'on.e: Feo-wn ------Feb. 7-14 From S. S. Elmina. Spain: Bar. !o Nov. 27-Dec. 31 5

Cadiz-i Nov. I-Dec. 31 51 Jan. 1-31 9 Madrid Year 1924 40 Msalaga Nov. 23-Jan. 3 97 Do Jan. 4-Mar. 21 83 Valencia Nov. 30-Dcx. 6& De Feb. 15-MIar. 21--- 4 Switztand: Lucerne Nov. I-Dec. 31-- 19 Do Jan. 1-31- 24 Syria: Aleppo Nov. 23-Dec. 27- L3 Do Jan. 4-Feb. 28 71 18 Beirut ------Feb. 11-20-

Darn fscus ------J.an . 6-13-_ 2 D Feb. 11-20 22 rvsol: Tripoli July 14-Dec. 12 52 Tunis: Tunis Nov. 25-Dec. 29._ 42 15 Do lan. 1-Mar. 18____ 227 Turkey: Constantinople Dec. 13-19- 5 Nov. 1-Dec. 31, 1924: -Cases, 14. Union of Souith Africa _ ------Cape Proviince .. Fi1. 1-7 Outbreaks. De Aar District Jan. 25-31 ------Ottbreak at railway camp. Do Nov. 9-Jan. 17 Outbreaks. Orange Free State Nov. 2-8 -~~~~~~~------Do. Ladybrand District Jan. 15-31. Outbreak, on farm. Transvazal ------Nov. 0-Jan. 10 Do. Do Feb. 1-7- _ _ Outbreaks. Uruguay ----- January-June, 1924: Cases, 101, ddeaths, 2. Do ------I----I ----_ July-OWtober, 1924: Cases, 45; deaths, On vessel: S. S. Eklridge Mar. 23 -I At Port Townsend, from Yoko- hama an(l ports. S. S. labana I Feb. 18 --1------At Santiago de Guba, from Kingston, Jamaica. S. S. R uiyth |At St. Mlalo, France, January, 1921, frorm Sfax, Tunis; believed to lave inmported smallpox infection.

TYPHUS FEVER

Algeria July I-Dec. 20, 1924: Cases, 101; deaths, 14. Algiers -Nov. 1-Dec. 31 5 1 Do - . Jan. I-Mar. 10 _- 10 4 April 24, 1925 862

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER-Continued Reports Received from December 27, 1924, to April 17, 1925-Continued TYPHUS FEVER-Continued

Place Date Cacse Deatla Remarks

Argentina: Rosario- Jan. 1-31- 1 Bolivia: La Paz Nov. 1-Dec. 31l. 3 Do--- Jan. 1-31 2 Bulgaria- - Januiary-June, 1924: C-ases, 191; deaths, 28. Do- - July-October, 1924: Cases, 5. Chile: Concepcion -Nov. 25-Dee. 1 1 Do -Jaii. 6-12 2 Do -Jan. 27-Feb. 2. 1 Iquique -Nov. 25-Dec. 1 2 Do -Feb. 1-7 1 Talcahuano -Nov. 16-Dec. 20-. 5 Do-- Jan. 4-10- 1 Valparaiso -Nov. 25-I)ec. 7_-- 4 Do -Jan. 11-Feb. 21_.I 10 Chosen: Seoul Nov. 1-30 Czechoslovakia - December, 1924: Cases, 5. Egypt: Alexandria- Dec. 3-9- 1 Cairo Oct. 1-Dec. 23 13 8 Esthonia ------Dec. 1-31, 1924: Cases, 5.

Do- Jan. 1-31 4 France --.-- -- July-October 1924: Cases, 7. Gold Coast Oct. 1-31, 1924: 1 case. Gree(e - May-June, 1924: Cases, 116; deaths, 8. Do ------July-December, 1924: Cases, 40; I------!-- deaths, 4. Saloniki -Nov. 17-Dec. 15- 3 2 Do -Jan. 25-31. 1 .-- Japan- .-- Aug. 1-Nov. 15, 1924: Cases, 2. Latvia .------. .-- October-Decenmber, 1924: Cases, 30. Lithuania ------. Augtust-October, 1924: Cases, 15; deaths, 1. Do .--- Jan. 1-31, 1925: Cases, 27; deaths, :: 2. Mexico: 1- Durango Dec. 1-31- 1 G uadalajara Dec. 23-29 1 Mexico City Nov. 9-Jan. 3 80 Inclu(Iing municipalities in Fed- eral District. Do-- Jan. Il-Feb. 14.. 40 Do. Do -Mar. 8-14. 4 San Luis Potosi Mar. 8-14 Morocco- November, 1924: Cases, 5. Palestine. Nov. 12-Dec. 8, 1924: Cases, 7. Ekron -Dec. 23-29. 1 Jerusalem -do 2 I Do Jani. 20-26. !----- Mikveh Isreal-- io 1 3-- Rainleh Feb. 10-16- 1 Tiberias -Feb. 24-Mar. 2- 2 Peru: Arequipa -Nov. 24--Dec. 31 Poland -i------Sept. 28, 1924-Jan. 3, 1925: Cases, 751; deaths, 57. Portugal: Lisbon -Dec. 29-Jan. 4 2 Oporto- Jan. 4-Feb. 7 Rumania. Janu,ary-June, 1924: Cases, 2,906; deatlis, 328. Do Jtuly-August, 1924; Cases, 89; Constanza Dec. 1-10. (leaths. 12. Do Fel). 1-28 2- 2 1924: Rtussia -______Jan. 1-Juniie 30, Cases, Leciirngrai --Jun- e 29 Nov. 22- 12 92,000, July-September, 1924: Ca.ses, 5,225.

Spain: 3 Madrid Year 1924 Malaga --Dec. 21-27. 1 Swedew: Goteborg -Jan. 18-24- 1- 863 April 24, 1925 CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER--Continuiedi. Reports Received from December 27, 1924, to April 17, 1925-Continued TYPHUS FEVER-Continiued

Place. Date. Cases. Deaths. Remarlks.

Tunis - - -July 1-Dec. 20,11924: Cases, 40. Tunis -Mar. 5-11- 1 Turkey: Constantinople-o-Nov. 15-Dee. 19- 6 1 Do -__------_____- Jani. 2-Feb. 28 8 1 Union of South Africa --- - - Nov. 1-Dec. 31, 1924: Cases, 345; Cape Province - Nov. I.-Dec. 31 126 24 deaths, b. Do Feb.1 - - - Outbreaks. East London Nov. 16-22 1 Do --- Jani. 8-24- 1- Port Elizabeth :! Feb. 22-28 1 Natal -- NoV,. I-Dec. 31L. 130 50 Do - Jan. 18-24 -Do. Durban - Fel. 15-21 1 Orange Free State- Nov. I-Dec. 31- 59 8 Jan. 11-17,1925: Outbrcaks. Transvaal -do-30 5 Yugoslavia Nov. 24-Dec.- Aug. 3-Oct. 18, 1924: Cases, 17; Belgrade - Nov. 24-Dec. 28--- 5 -deaths, 2.

YELLOW FEVER

Gold Coast -October-Novemii- 4| 4 ber, 1924. Salvad(!(.r: San. Salvador -June-October, 1924 77 28 Last case, Oct. 22, 1924.

x