ALASTRM. by W

PUBLIC HEALTH REPORTS VOL 36. DECEMBER 9, 1921 No. 49 ALASTRM. By W. C. Rucxz,xSurgeon, United States PublicHealth Service; ChiefQuarantine Officer, Panama Canal. INTRODUCTORY NOTE. An epidemic disease called "alastrim" was reported in the Carib- bean littoral, Canada, and England during 1920. The importance of this disease from a quarantine standpoint has led to the compilation of this article. Acknowledgment is made to Castellani and Chalmers, whose Third Edition of their Manual of Tropical Medicine has been freely consulted; to the Kingston (Jamaica) Board of Health, whose circular on alastrim has been used in the preparation of this article; and to Prof. W. G. McCallum, of Johns Hopkins University, whose personal letter has been liberally used. It should be borne in mind that while alastrim, from a scientific viewpoint, may possibly be a separate disease entity, it has all the publc health aspects of smallpox and, in the present state of our knowledge of its exact classification, should always be reported and combated as smallpox.

Synonyms.-Varioloid-varicella, amaas, Kaffir milk-pox, Sanaga smallpox, West Indian modified smallpox, pseudo smallpox, weisse pocken. Definition.-An acute febrile, easily communicable disease, closely resembling smallpox, as a mitigated aberrant form of which, from a public health standpoint, it must be regarded. Etiology.-The causative agent is not proved. Guarnieri bodies (Cytoryctes variola) have been described in pus from the lesions and in smears made from corneal lesions of rabbits, 60 hours after inocu- lation with this pus. With dark-field illumination, McCallum found "particles resembling exactly Prowazek's bodies, and these were also found in the Berkefeld filtrates." The disease is very infectious to'man; both sexes and all ages are attacked. No racial immunity has been observed. The disease is found in the West Indies, South and Central America, South Africa, the Mediterranean area, and, more recently, in Great Britain. It is probable that the so-called "Cuban itch" and "Philippine itch" observed after the War with Spain, the mild form of smallpox 76415-21-1 (3023) December 9, 1921. 3024 prevalent in America, and alastrim are identical. The disease is highly contagious, its causal organism being spread by both direct and indirect vection. Certain observers believe that the disease is largely sprad by the air; but when the enormous number of daily contacts with fellow man is considered, the assumption of this theory to account for the rapid spread and persistence of the disease seems scarcely warranted. Overcrowding and all those things which favor the interchange of human secretions and excretions help to spread the disease. The exact classification of alastrim is still the subject of considerable discussion. It may be, and probably is, merely a mitigated form of smallpox, which, in an environment of low racial immunity, incomplete vaccination, or lowered vitality, might regain its lost virulence. It may be that the parasite is a separate species of the parent type. The facts that the disease may occur rarely after recent successful vaccination, that more often vaccination may be successful after a prior attack of the disease, and that two attacks of the disease may rarely occur in the -same person, are true of both "alastrim" and classical smallpox. The infectious agent probably is resident in the nasal and buccal secretions from a very early stage. The dried crusts and desquamated epithelium are also believed to act as vehicles of transmission. In the absence of definite knowledge of the causative agent and its portals of entry and exit to and from the human body, the prevention and eradication of the disease mast be approached on the regular lines of a smallpox campaign. Smallpox, in the language of Sydenham, "-has its peculiar kinds, which take one form during one series of years, and another during another." One attack of alastrim seems to confer lasting immunity. Pathology.-Since the mortality from alastrim is very low, 0.5 to 1 -per cent, little is known of the post-mortem pathology of the disease. At'necropsy, in addition to the surface distribution of the pocks, pustules are seen. on the palate, in the fauces, throughout the trachea, and into the bronchi; When the rash is very heavy, a marked subcutaneous edema is seen. This may be so intense as to completely close the eyes. -The eruption first appears as papules, which become yellowish pustules and scabs. Desquamation is followed by little scarring, but by considerable pigmentation. - In severe cases, trauma by scratching, may produce denuded skin areas. Boils sometimes occur, and there. may be slight alopecia. Symptoms.-After an incubation period averaging 14 days, during which prodromal symptoms are rare, the disease is ushered in with malaise, fever (1000 to 1030 F.), generally accompanied by. -vomiting, mild headache and backache, and constipation. These synptoms are rarely severe and are suggestive of a mild gastric upset. The patient may vomit but once and the muscle and bone pains may be 3025 December 9, 1921. so mild as to be disclosed to the examiner only by close questioning. The pains may, however, be generalized as in the initial stages of influenza. There may be a prodromal urticarial or measly rash. The eruption occurs usually on the third day (occasionally as early as the second, or as late as the fifth day) as a few widely scattered, minute, red seed-like papules on the forehead, face, and forearm. Sometimes they are, even in the beginning, very numerous over the face and very small, being so closely set as to give.to the skin of the forehead the texture of fine shark-skin. Usually the eruption at first resembles acne, but later more closely resembles smallpox or chicken pox. Successive crops appear on the abdomen, back, extremities, and face. Coincident with the appearance of the eruption, the temperature falls and the patient feels practically well until maturation takes place, with consequent skin tension and pain, particularly where the skin is thick, as in the palms and soles. Sec- ondary fever does not often occur. The eruption itself is not hard or shotty. In black skins, the papules appear slightly translucent. On the chest they are nearly always discrete and widely separate at first; over the arms rather less so. In the earlier stage they are not umbilicated except in the r#re instances when they form about a hair. On the second or third day of the eruption they become unilocular vesicles, which contain a limpid, somewhat glutinous, fluid. The vesicles do not umbilicate. They become sharply defined, glistening, tense, bulging pustules surrounded by a red areola on the fifth (sometimes the sixth or seventh) day of the eruption. Usually they remain discrete, but in the more severe cases they may become confluent. In the late stages, after maturity, umbilication may occur when the pus has been dis- charged or inspissated. Drying and crusting usually begins on the sixth or seventh day,. proceeds rapidly, and, except in the more severe cases, desquamation of the face is complete by the tenth or twelfth day after the beginning of the eruption. Sometimes some of the pocks never become pustular but start to dry in the vesicular stage, especially if they have been injured. In many cases the pus never advances to the stage of being thick and yellow. The drying begins on the face and then on the upper arms, chest, back, forearms, and legs about in order named. The roofs of the pustules sink, and the whole dries into a crust which ultimately may be rutbbed off, leaving an area of central pigment atrophy, a thin line of scurry epithelium and a wider zone of deep purplish pigmentation. This pigmentation may persist for several months, but the skin is smooth, with scarcely a trace of pitting or scarring. The eruption is distributed much as it is in classical smallpox. The face and scalp are always attacked. Vesicles may be seen on the hard and soft palate and the fauces of the more severe cases. This December 9,1921. 3026 produces pai in the throat and enlargement of the glands at the angle of the jaw. Lesions have been observed on the eyelids, butxot upon the conjunctiva. They occur on the lips and nostrils, and over the nose-and cheeks, the interveDing skin frequently being so edema- tous as to be tightly stretched, the pocks looking as though they were stretched out upon a red drumhead. The eruption occurs on the extremities, the chest, and the upper part of the back. A few pocks can generally be found on the palms and sols. Throughout its oourse the disease is exceedingly mild, and, except for the pains of onset and maturation, the patient experinces relatively little discomfort. There is no delirium, and patients are not really very ill and retain their appetites Pocks in the hard ski of the palms and soles are painful. There is no itching, but rather a burning skin sensation which may interfere with -the patient's sleep- ing. Patients rarely complain of the feeling of skin tensio With the extreme development of the pocks they seem mehanically disabled. They lie quietly in bed, rather depressed mentally, and very unwilling to move. As the pocks become dry and inspissated, the patients lose the depression and move about freely. 'UsuaDly the progress of the disease is uneventful, without complications or sequehe. Diagnom.-From the viewpoint of public health, "alastrim" should always be diagnosed and reported as llpox. The gentle- ness of the stages of invasion and eruption, the absence or vaguenes of the umbilication, and the general absence of-destructive processes are al indicative of alastrim. The mildness of alastm, even in an extensive epidemic, is distinctive. In a warm climate, at least, "alastrim" runs true to form and does not seem to increase in. virulence. Epidemics of the classical form of smallpox or of chicken pox may occur simultaneously with "alastrimi" and might tend to obscure the diagnosis; but the mildness of the attack and absence of umbilication and pitting in alastrim distinguish it from classical smallpox, while the occurrence of pustules differentiates it from chick pox. Prognosis.-The mortality from astrim is surprisigly low. The disease is more severe in the unvaccinated and debilitated, and most of the deaths occur in pregnant wome and very weak infants. Economically, it is important by reason of the rapidity of its spread and the temporary disablement of large mbers of persons. Treatmen.-This is symptomatic and hygienic. Isolatio in hospital, suitable nursing, cleanliness, the relief of the early constip& tion, the evacuation of the contents of the pustules, which aids greatly in their heading and disappearance, the use of alkaline mouth washes and gagles, and the vaccination of all exposed persons and the general public, ae the chief indications. 3027 December 9, 1921. EDITOR'g NoTE.-Leake and Force, of the United States Public Health Service, in their studies on the immunological relationship of alastrim (1921), inoculated monkeys and rabbits, using crusts and pustule contents from alastrim patients in Jamaica and Haiti. They summarized the results of their experiments as follows: A vesico-papular eruption was produced in monkeys by inocula- tion both with crusts and with vesicle contents from alastrim patients. The animals were protected against reinoculation with alastrim and vaccine virus. Rabbits inoculated with alastrim showed no eruption, but were almost completely immune to vaccine virus. Rabbits previously inoculated with vaccine virus gave positive intracutaneous reactions to smallpox crusts. alastrim material, and vaccine virus, but remained negative to chicken pox crusts. The fact that definite immunity to vaccinia is produced by previous inocuiations with alastrim is additional evidence of the essen- tial identity of alastrim with smallpox. (Reprint No. 669 from the Public Health Reports, June 24, 1921, pp. 1437-1443.)

ARSENIC AS A LARVICIDE FOR ANOPHELINE LARVA3. By M. A. BARBER, Special Expert, aud T. B. HATS, Technical Assistant, United States Public Health Service.t Roubaud 2 has successfully. used trioxymethylene, or parafor- maldehyde, in poisoning anopheline larvee. This powder, undiluted or mixed with some inert dust, is simply strewn on the surface of the water, where it is eaten by the larvae. The poison acts on the nervous system of the insect; causing paralysis, and when eaten in sufficient quantity causes death within a few minutes. It is said to be harm- less to any animal, aquatic or otherwise, except the surface-feeding anopheline larvm. A sublethal dose is said by the author to confer on anopheline larve a degree of resistance to a subsequent dose. We have confirmed the work of Roubaud to the-extent that we have found trioxymethylene very toxic to anopheline larvie, both in laboratory and in field tests. It seemed worth while, however, to extend this line of investigation and to search for some substance cheaper and more poisonous to the larvte than trioxymethylene; since the use ofa fine powder which acts through ingestion would seem to be a very promising measure against anopheline larvie. These larva lie at the surface of the water, and in feeding turn the head halfway around into such a position that the feeding brushes carry to the mouth any particles lying on the surface-tension layer of the water. The larve swallow all floating substances that are small enough to I&ome ofthelater experiments In this work weredonie by Assistant Sanitary Engiueer W. H. W. Komp. I Roubaud, E.: Compt. Rend. des Wances de l'Acad. des Sci. Vol. 171, 1920, p. -L Ibid., Vol. 170, 190, p. 1521. December 9,1921. 3028 enter the mouth easily, and are quite indifferent as to whether these are food or poison. No bait of any kind is required- to make these larvae eat anything that is offered them. - Moreover, poisons in the form of afe powder are very conveniently distributed. The surfactension layer of the water affords a con- .venient support for the powder, whether it be heavier than water or not, and the floating particles are further distributed by currents of air after they reach the water. Again, the insect, in feeding, draws to it particles lying at some distance from the head. After a trial of a considerable number of substances, we found compounds contaning arsenic most promising, and of these, Paris green has proved most efficient.

LABORATORY EXPERIMENTS. A laboratory test was devised by which the toxicity of a substance for anopheline larvs could be quantitatively measured. The powder to be tested was strewn lightly upon the surface of water in a Petri or other convenient dish, a larva was pipetted imto this dish, and the time when the particles of powder began to be swept into the mouth was observed carefully under a hand lens. At the close of any desired feeding period, the feeding time being reckoned by the number of seconds during which particles were entering the mouth, the larva was pipetted out, washed in two waters in order to free it from any adhering poison, and then deposited in a second dish for subsequent observation. A number of larvae were thus fed on the substance to be tested, and the length of time of survival and the proportion surviving after a given dose gave a rough estimate of the toxicity of the substance. Highly soluble substances were mixed with pollen or some other inert powder before testing. In case we desired to ascer- tain the time of survival after the maximum dose merely, a number of larva, were placed in a dish, the poison was strewn over them, and the time of survival of each larva was noted. In most of our experiments the size of the larvee and the temperature of the water were also noted. A large series of laboratory experiments was carried out in which a number of substances were compared, including several of the commoner arsenic-containi compounds. One or two protocols, given in brief, will illustrate the method and results of these experiments. Ten anopheline larvas, the size of which varied from one-quarter grown to full-grown, were fed on trioxymethylene, and nine similar larvee on Paris green, the dosage varying from "minmum"-that i the ingestion, or apparent ingestion, of one or two particles-to a dose represented by three seconds' feeding. Of the larva fed on 3029 -December 9, 1921. trioxymethylene none was dead 16 hours after feeding, while 4 of the 9 fed on Paris green were dead within 3 hours, and a fifth in less than 5 hours. Since one could not always be sure that a larva taking the "minimum" dose had really swallowed the poison, the experiment was repeated, allowing doses of 3 to 5 seconds. Of 12 fed on Paris green 11 died within periods varying from 85 to 103 minutes, while of 12 fed on a similar dose of trioxymethylene 6 survived at least 41 hours. The 6 of this lot which died, however, showed a shorter average time of survival than that of the 11 which succumbed to Paris green; 62.5 minutes was the average survival time of the trioxymethylene and 90.7 of the Paris green. In another series trioxymethylene, lead arsenate, and Paris green were compared, the dosage of the first two poisons varying from 4 to 15 seconds and that of the Paris green from 2 to 10 seconds. All of the larvee fed on the trioxymethylene, 4 in number, died in less than 1 hour; of the Paris green series 9 out of 10 died within less than 2 hours and the tenth after about 7 hours; of the lead-arsenate series practically all survived until the next day or later. As is illustrated by the two protocols given above, the Paris green did not always cause a more rapid death than trioxymethylene, but the proportion surviving after a very small dose was always less in the case of Paris green than with any other poison tested, a point of considerable weight in favor of Paris green as a practical larvicide, since it is not always.possible to give the larger doses when treating a pond or stream. The extreme sensitiveness of anopheline larve3 to Paris green was impressed on us by several laboratory accidents in which the very slight amount of powder accidentally thrown into the air during the process of mixing or measuring the poison caused a high mortality among larva, kept in the stock pans on the same table. Paris green freed from the water-soluble portion by long treatment with water was still poisonous for larvee, so it is probable that certain of the digestive fluids of the larve act as solvents for the poison. Lead arsenate and arsenic trioxide ("white arsenic") were both much inferior to Paris green as larvicides for anopheline larva,, and powdered arsenopyrite seemed to be wholly inert. We have tested the calcium arsenate in common use for dusting cotton plants, both in the laboratory and in the field, and find it decidedly less effective than Paris green. We would not recommend its use in place of Paris green except in case of emergency. In one experiment we successfully treated about 1,200 square feet of Myriophyllum-covered water with about half a pound of calcium arsenate mixed with sand. In other field experiments where considerably less quantities were used the results were very unsatisfactory. D embr 8, 192.16

Y1ELm EIPSN a - In field experiments a sketch was usually made of the breedimg place to be treated, and before treatment a number of dips were made with a definite sized dipper over different parts of this area, the location of the dips being approximately indicated oathe sketch. In recordg the anophelines present before and after treatment, the number of the pups and the number and size of the larva) were recorded, the sizes being usually designated as full, three-fourths; one-half, one-fourth, and small. The reexamaination of the breeding place was usually done at least three and one-half hours after treatment, and often on the next day. A protocol of a field experiment will ilustrate the method and results: Tne breeding place was a pond covered with grass, the blades of which projected an inch or two above the surface of the water. The temperature of the water at the surface was 35.2° C. and at a depth of 25 centimeters (10 inches), 26° C. Approximately 370 square meters (4,000 square feet) were treated with 10 cubic centimeters of Paris green mixed with about a liter (quart) of fine sand. The dust was thrown into the air by hand, the main distrbution being ef- fected by the wid. The sum of 31 dips over the whole area before treatment was as follows: Pupea, I; full-grown larva, 12; three-fourths- grown larvse, 3; half-grown larva, 7; one-fourth-grown larva, 16; small larva), 124; total, 163. About 24 hours after treatment the sum of 31 dips over the same area was as follows: Pupa), 2; full- grown larvae, 0; three-fourths grown, 1; half grown, 0; one-fourth grown, 3; small, 6; totl, 12. In this experiment the amount of poison used was very small, and the grass formed a barrier to its -spread, but there was an almost complete destruction of the larger larva) and over 95 per cent of the smaller ones. Other experiments have been done where the numbers of larva were much larger and the percentage destroyed was much higher, and in some experiments no survivors could be found. The fo:lowing kinds of breeding places have been successfully treated: Impounded water with larv2a protected by floating wood; cold water-in a ditch immediately below a spring, the larva) being protected by thick water cress; gras-covered ponds and those covered by Myriophylum; ground below a spring and covered with a thin layer df water; wet pasture with breeding in cow traclk; an old ditch, the water of which was covered with duckweed and partly protected by overhanging weeds; various smal pools without any particular covering. In small pools a few pinches of the diluted Paris green sufficed to destroy the larva). The species of anpheline apparently makes no difference as regards their resistance to this poison. 3031. 0Deember 9, 1921.

QUANTITY AND METHOD OP USE OP PARIS GREEN. Paris green in antianopheline work should be diluted with a large proportion of inert dust. . Only very, small doses are necessary to poison larva, and the dilution enables one to spread a relatively small quantity of the poiso over a large surface. Further, any risk Of poisoning the operator or the water treated is minimized by the use of the diluted dust. As a diluent we have successfully used fine sand, rotten wood dust, and road dust. Road dust, preferably mixed with some fine clay, seems to be as effective as any. The addition of weight in the form of some coarser sand is helpful in enabling one to direct the dispersal of the lighter dust. Some of the diluting dust sinks on contact with the water, but most of the arsenic is left on the surface. Flowers of sulphur has not proved a suitable diluting dust, possibly because so large a proportion of it remains floating that it is ingested with the Paris green, which latter is then too much diluted. A dilution of about 1 part of the poison to 100 parts of the inert dust seems to be a favorable mixture. The quantity of Paris green to be used must depend somewhat on the character of the breeding place. Where there is much high grass, reeds, and the like, one would use somewhat greater quantities of the poison than where the surface of the water is clear or covered by low surface vegetation only. Since the poison is relatively inexpensive, and the danger of poisoning the water of the breeding place is small, quantities somewhat larger than those given in the protocol would seem to be advisable, possibly about 10 c. c. (approximately 12 grams, 0.43 ounces avoirdupois, 0.6 cubic inches, or two level teaspoonfuls) to 90 square meters (1,000 square feet). 'A slowly settling cloud of dust carried along by a light wind is apparently the best agent for the distribution of the dust, and the main thing is to start this cloud in the right place and direction. A single cloud may destroy larve over a wide area and at a considerable distance from the operator. We have tried certain mechanical means for distributing the dust, such as the dust-guns used in duasting arsenic on cotton plants, but thus far we have succeeded best by simplythrowmig the dust into the air by hand. The cloud can thuis be formed high or low, to the right or to the left, depending on the force d diretiou of the wind. The pole and bag method, sometimes used for dusting plants, has been found useful in treating a breeding place at the bottom of a deep ditch.

TDIE OF DAY FOR THE USE OF THE POWDER. The best results are to be expected on a'sunny day when the powder is spread after the sun is well up and the dew has disappeared from any vegetation covering the breeding place. December 9, 192L $032 FREQUENCY OF TREATMENT. The frequency of treatment of a breeding place must depend largely on the temperature of the water. In a recent experiment anopheline larvas were thoroughly destroyed over a given area. The place was kept under observation from day to day, and frequent collections, of larva were made. Eleven days after treatment fully grown larva and a few pupsf were found. In this breeding place, then, it would have been necessary to repeat the treatment within ten days. The weather was warm and the temperature of the water very high, and it is probable that in this pond the growth of the larve (larve of A. quadrimactditus) was nearly at its maximnum rate. COST. Paris green was recently quoted at 22 cents per pound, f. o. b. New York City, packed in 300-pound barrels. Small quantities may be purchased in drug stores for $1 per pound. At 25 cents per pound the amount sufficient for at least 1,000 square feet, 10 c. c., would cost about seven-tenths of a cent. The calcium arsenate in common use for dusting cotton plants may be purchased for about 15 to 20 cents per pound. The use of a powder instead of a liquid should greatly lower the cost of transportation. Usually a dust suitable for dilution can be found in the neighborhood of the breeding place, so that one has to transport only a pound or so of Paris green for the treatment of a large area.

DANGER OF POISONING THE OPERATOR OR THE WATER TREATED. The danger to persons engaged in distributing arsenic-containing dusts as larvicides would seem to be mainly through the possibility of inhalation of the poison or its absorption through the skin rather than through ingestion. In our search for information regarding the possible harm to men or domestic animals engaged in distributing arsenical dusts as insecticides, we sent letters of inquiry to 17 United States or State agricultural experiment stations in the cotton or toba.cco growingStates, in the hope that information mightbeobtained from those who have had much practical experience with these dusts and their possible harmful effects. In some States these arsenical dusts, calcium arsenate in particular, have been used by the ton in combating the boll weevil. Of the 16 stations replying to our inquiry, 14 of the correspondents had had experience in the use of arsenical dusts. Of these 14, about half had knowledge of some injury to man or domestic animals through the use of these arsenical dusts. The lesions reported were chiefly of the acute type and of a minor degree, such as sores on exposed parts of the body, irritation of the bronchial 3033' DecemberO, 1921. tubes, and sometimes intestinal disorders-lesions which usually heaed promptly. Some more serious cases of chronic poisoning were reported to us by Mr. B. R. Coad, in charge of the Delta Laboratory, U. S. Bureau of Entomology, at Tallulah, La., who kindly wrote us a full deseription of these cases. The cases were of the cumulative type of poisoning, and occurred exclusively among persons who had worked with the dusts in close quarters for several years. They occurred as the result of exposure to calcium arsenate as well as to other kinds of arsenical dusts. "The chronic types of poisoning are practically always accompanied by some dermatic disorder, the injury of which varies widely with the individual, and is somewhat recurrent. Furthermore, in extreme cases we find neuritis and occasionally some fairly pronounced heart symptoms. It has proved a very obnoxious ailment, and, furthermore, a very stubborn one. Apparently it is brought about by a saturation of the system with arsenic, and the Vctim is nearly always hypersensitive to arsenic exposure. In the case of constant exposure the mucous membranes of the nose and throat reach such a condition that they are exceedily sensitive to mechanical irritation by any form of dust, and a slight exposure to dust brings on an attack which very closely resembles hay fevar." It is to be remembered that these chronic cases followed a long and timate exposure to arsenic dusts. Mr. Coad was of the opin- ion that the amount of exposure incident to the antianopheline work we have described would probably not lead to any particular danger. It is significant that so little trouble is reported by experiment station workers and by other persons who have used arsenic dusts exten- sively for some years. Possibly their immunity has been due in part to the fact that they use principally the slightly water-soluble calcium arsenate, and that cotton-plant dusting extends over a com- paratively short period each year. However, in antianopheline work where such small quantities of highly diluted Paris green are used, and where the work is wholly out of doors, simple precautions should §uffice to protect the user, nor would a health officer anticipate any strenuous objections from the people of a comnmunity to the use of a substance so commonly employed as an insecticide. In our experiments we have used no precautions other than to stand to the windward of the dust cloud-the place where one would naturally stand in distributing the dust-and we have experienced no harmful results whatever. However, even with the small quantities used in larvicide work, it is well to remember that one is working with a poison and that some precautions should be taken, at least until the matter is further investigated. It is probably sufficient to keep to the windward of the dust clouds and to avoid inhaling the dust as far as. possible. In case a great deal of expos- December 9, 1921. -3034 ure is necessary, one should use some precaution to keep any large amount of Paris green from entering the clothing or accumulating anywhere on the skin. As regards the danger of poisoning the water treated, it should be emphasized that only a minute quantity of Paris green is dusted over a very large surface, and of that compound only a very small fraction is water-soluble. We have never observed any effect of the poison on culicine larvea or on any aquatic insect or animal, however delicate, other than the surface-feeding anopheline larva3. In particular, we have never observed any indication of harm to top-feeding minnows or to any other natural enemy of larvea. The danger to domestic animals through drinking treated water seems very remote. In order to meet any objections on the part of the owner of a breeding place, one might arrange to have the stock removed from the breeding place for a day or so, but the owner will hardly insist on this precaution when it is explained to him that the powder is the same as that commonly used against insects and that only a very small quantity of it is to be used on a large body of water. In sum, the possible advantages of arsenic dust used against anopheline larvae are- its cheapness, portability, ease of distribution by means of the wind, and the possibility of using it over areas difficult of treatment by methods now in use. The chief disadvantage is that its use is limited to anopheline larvi-ova and pupse of all kinds, and culicine larvie are apparently unaffected. It is believed, however, that this method will have a place in antimalarial work, especially in places not easily drained and so covered by.vegetation or other obstacles as to render them inaccessible to natural enemies of larvae, or to other methods of treatment.

DEATHS DURING W ENDED NOV. 26, 1921. Summary of information received by tekgraphfrom industrial insurance companies for week endd Nov. 26, 1921, and correspoing week, 1920. (From the Weekly Health Index, Nov. 29, 1921, issued by the Bureau of the Cen, Department of Commerce.) Week ended Coesnding Nov. 26, 192i. werekp, 920. Policies in force ...... 47,761,374 .45,212,203 Number of death claims ...... 7,1887,399 Death clai per 1,OC0 policies in force, annual rate 7.8 8.5 3035 December 9, 1921. Deaths from all causes in certain large cities of the United States during the week ended Nov. 26, 1921, infant mortaliy, annual death rate, and conparison with corresponding week of preceding years. (From the Weekly Health Index, Nov. 29, 1921, issued by the Bureau of the Census, Department of Commerce.)

Week ended Deaths under Infant Nov. 26, 1921. Average Ilyear. mor- Estimated annual ralte, t City. Total Death death We 1 121.Tota Deth rte er eded Previouswi deaths. rate.' 100' Nov. 26, ye or Nov. 26, 11921. years.2 1921.'

Akron, Ohio...... 229,196 21 4.8 45.5 4 4 3 38 Albany, N. Y...... 115,071 30 13.6 C 10.5 2 C 0 45 Atlanta, Ga ...... 207,473 60 15.1 C 13.9 5 C 9 .... Baltimore, Md...... 750,864 181 12.6 A 15.5 24 A 25.67

irnga,Ala...... 186,133 50 14.0 A 18.1 7 A 6 .... Boston, Mass ...... 757,634 212 .14.6 A 14.9 32 A 32.86 Bridgeport, Counn...... 149,967 28 9.7 A 14.7 2 25 A 6 Buffalo, N.Y...... 519,608 108 10.8 C 13.4 13 C50 22 Cambridge, Mass ...... 110,444 29 13.7 A 15.0 1 18A 4 Chicago,11 Il.2,780,655 540 10.1 A 12.7 73 AIOS .... Cicnai,Ohio.. 4013,418 98 12.7 C 11.4 8 C 6.53 Cleve]ad Obio...... 831,138 164 10.3 C 10.0 23 C 19 62 Columbus Ohio.. I245,358 58 12.3 C 54 5 C 1 58 Dlasp Tex...... 165,282 38 12.0 A 12.6 6 A 4 .... DayossOhlO6...... 158,119 32 10.6 C 8.8 4 C 3 66 Denver, Colo...... 263,152 67 13.3 A 14.6 11 ...... Detroit, Mich...... :...... 1070,450 178 8.7 C 10.5 32 C 50. 6 Fall River Mass.120,668 27 11.7 C 14.3 5 C75 8 Fort, Worth, Tx111,423 29 13.6...... 2...... Grad apds Mch...... 141,197 35 .12.9 C 12.0 C 5 . 34 Tex...... 144,340 23 83 C 9.3 5 C 3..... ndaaoIn, d32,632 97 15.5 C 10.7 11 Cli1 85 JesyCt 38,788 67 11.5 C 9.7 10 C 12 69 Kan-sasCit, Kans...... 103,884 26 13.1 C 13.8 I 24C 7 KansasCity M...... 336,157 102 15.8 C 14.6 11 C 11 .... Los An..eles...Cali... 611,921 171 14.6 A 12.7 19 A 9 . 9 LOUJisvdle(Ky. ...-236,083 68 15.0 C 14.4 5 58C' 10 Lowll,a...... 113,757 25 11.5 A 15.2 4 A 7 64 Memphis, Te-nn...... 165,656 62 1.4 . 7...... Miwaukee, Wis ...... 468,386 113 12.6 A 108 19 A 21.9 M Dneapsl Minn ...... 392,815 81 10.8 C 11.8 5 C 10 28 Nasvil eiTn. . 122,080 89 16.7 C 15.4 1 C 5 .... New Bedford Mas125,012 22 9.2 A 14.2 2 A 5.31 New Haven bon ...... 167,007 35 10.9 C 11.8 3 C 3 36 XewOrleans La ...... 394,657 105 13.9 A 19.7 9 A 18 .... NewYork R. Y. 5,751,867 1,184 10.7 C 10.7 1.58 C 154. 6 Newark, 31.3.424,885 67 8,2 C 11.9 16 C 22 71 7.7 ...... 3 ...... 53 NoafokVanOmakha, Caebr...... 226,472Ci...... 121,260 5918 136 A 12.1 5 A 4 63 Omha kb ...... 197,066 43 11 4.4 ...... 3. .... 35 Paesn N.JI...... 137,463 27 10.2 ...... 5 ...... 85 hiaephIa Pa.1,866,212 396 11.1 414.5 .36 4 70 43 Ptbui g11 a '6028,452 171 14.8 C '15.89 36 C 28 128 otan,reg. .264,869 62 12.2 C 9.8 4 C 6 40 Pviee,R.I...... 239,645 56 12.2 C 13.6 9 C 8 73 RtichMod Vs...... 175,686 47 13.9 C 11.2 7 C 6 85 68 11.6 C 9.1 7 C 3 54 StLusyf...... 306,229St.LaW...... 786,164 178 11.8 C 123 18 C 27 .... St. Paul, Min...... 237,781 50 11.0 C 10.4 6 C- 4.6 Salt Lake City, Utah...... 121,59 23 9.9 A 13.3 2...... 31 Son Francisco, Calif...... 30,546 152 15.2 C 13.1 13 C 7512 Seattle Wash...... 327,227 565 8.8 A 8.6 2 A 6 17 Sprlnghedmaw ...... 135,877 22 8.4 C 1I.5 0 0_C 6 Ya...... 177,265R. 48 14.1 CI10.8 C2 84 7 TreleoL,OWhio...... 253,69 44 9.0 A13.5 4 A 7 40 Trenton,N.JI...... 12760 34 14.4 A 20.1 7 A 7 106 Washlngton,D..C....454,....026 84 9.6 A 156 7 A 12 41 Wl...... t.n ..D... .113,....408 24 11.0 C 159 2 C 6 .... Yorkerst ..14972mkprsp~ ~ ~ 08324 1247 13.2(LI AiLS.C 152 25 AC 48. 5445 I'Annual rate per 1,0 2"' A" Indicates data foropainthe corresponding week of the years 1913 to 1917, inclusive. "1C"1indicates data for the -corres-ondlung WU-UK of the1 year 1920. ' DeatsudrIyarpr100brhsa nulrt based an deaths under 1 year for the week and estimated brhfo190Ciislfblnarnointeregistration area for births. ' Data based on statistics o 95 98 n 97 PREVALENCE OF DISEASE.

No health department, State or local, can effectively prevent or contol dieease without knowledge of when, where, and undr what condions case are occurring.

UNITED STATES.

CURRENT STATE SUMMARIES. Telegraphic Reports for Week Ended Dec. 3,1921. These reports are preiminary and the fgures are subject to change when later returns are received by the State health officers. CALIORNIA-ontinued. Cases. Diphtheria ...... 45 PoliomyeUtis: cas. Hookworm disea...... 22 Lemoore ...... 1 Pelaga ...... 6 Los Angeles ...... ; I Pneumonia ...... 6 San Francisco ...... 2 Scarlet fever ...... 13 San Joaquin County...... 1 Smalpox ...... 14 Stockton ...... 1 Tuberculosis ...... 14 Taft ...... 1 Typhoid fever ...... 11 Scarlet fever ...... 13) Smallpox Chicken pox...... 20 San Jose ...... 14 Santa Clara County ...... 15 Diphtheria ...... 28 Hookworm disease . .1...... Scattering ...... 23 fever Influenza ...... 14 Typhoid ...... 14 Malaria ...... 41 Typhus fever-Los Angeles...... - 3 Measles ...... 1 Peag ...... 6 COLORADO. Scarlet fever ...... 2 (Exclusive of Denver.) Sm.allpox...... 10 Tuberculosis ...... 8 Chicken pox...... 23 Typhoid fever ...... 12 Diphtheria ...... 48 Whooping cough...... 4 Influenza...... 1 Measles...... 6 CALMORMLL Mumps.;...... 3 Anthrax-Patterson ...... 1 Pneumonia...... 3 Cerebrospinal menintin Scarlet fever...... 47 Los Angeles ...... 1 Smapox...... 17 Merced ...... 1 Tuberculosis...... 24 SantaCrz ...... -1 Typhoid fever...... 15 Diphtheria ...... 323 Whooping cough...... 2 Influenza ...... 21 ILeprosy: CONNECllCUI. Fresno County ...... 1 hicken pox ...... 53 Los Ang ...... Diphtheria:

San Frncisco ...... _. 1 Bndgeport ...... 17 Lethargic encepbalitis: Hartford...... , 9 Berkeley ...... 4 New Haven ...... 12

Los Angeles ...... I Scattering ...... 45 San Francico...... 2 Impetigo contaglosa ...... ; 7 Meases ...... 11 Influenza ...... 4 (3036). 3037 December 9, 1921.

CoNNECl'CuT-ceetinued. ILNois-ceOtinued. Meaes: Cases. Diphtheria-Continued. Cases.

Chaplin...... 8 Decatur 16

ovoeC ntry ...... 35 Galesburg ..... 12 Hampton ...... n Joliet ... S

Lebanon ...... , 30 Mattoon ...... ,,12

Masfield ...... 19 10

Wludham ...... 25 Peoria .... 11

cattering ...... 37 Rockford ... 17

MuMps...... 8 Streator 8

Pneumonia (lobar) ...... 23 Scattering ... 269

Scarlet fever: Influenza ...... 21

Bridgeport ...... 10 Lethargic enephalitis-Chicago 1

Hartford ...... 8 Pneumonia 263

Scattering ...... 63 Poiomyelitis: Tuberculosis (pulmonary) ...... 20 Bond County-Mills Township 1

Whooping cough ...... 32 Carroll County-Mount Carroll Township.. 1 DELWAR Chicago ...... Henry County-Loraine Township ...... 1 4 Chicken pox ...... Livingston County-Newton Township... 1 Diphtheria ...... 4 Will County-Johet Township...... 1 Meas ...... Scarlet fever: Pneumonia...... 2 Chicago...... Sc t fever: Rocord...... 9 Wilmington ...... 17 Scattering ...... 179 10 Scttering ...... smalpox: Tuberosis ...... 5 Central City ...... , ...... 18

Typhoid fever ...... 3 Scattering ...... 14

...... 1 Whoopmg cough Typhoid fever ...... 29

cough ...... 32 FLORDA. Whooping Diphtheria ...... 23 INMIANA.

Inlunzw ...... 9 Diphtheria ...... 166

Malaria .... 11 Rabies in animals-Sullivan County ..1...... Paratyphoid fever ...... 1 Scarlet fever ...... 127 9 Pnemni ...... SaUpox ...... 34

Scearlet fever ...... 3 Typhoid fever ...... 11 2 Smapox...... IOWA. Typhoid fever ...... 10 Cerebrospinal meningitis:

GEORGiA Dyersville ...... Keokuk ...... 1 Cerebrospinal meningitis ...... 2 Diphtheria ...... 78 Chicken pox ...... 44 Poliomyelitis ...... 5 Diphtheria ...... 48 Scarlet fever ...... 134 Dysentery (baclllary) ...... Smallpox...... 28 Hookworm disease ...... 41

Influenz ...... 7 KNSAS.

malaria ...... 17 Cerebro3pinal meningitis .8...... 1 Mumps ...... Chicken pox ...... 79 Pneumonia 10 ...... Diphtheria ...... 342 16 Scarlet fever ...... GeIman measles ...... 2

Septic sore throat ...... 4 Influenza ...... 8

Smallpo' ...... 18 Measles ...... 7

Tuberculosis (pulmonary) ...... 8 Mumps ...... 63 Typhoid fever ...... 11 Pneumonia ...... 23 Whooping cough ...... 5 Scarlet fever 235 Smallpox 49 ILLNOLS. Trachoma ...... 1.... Cerebrospinal meningItis: Tuberculosis 59 2 hIkago...... Typhoid fever 4 Island Beek ...... 1 Whooping cough ...... 13 Tazewell County- LOUSINA. Malone Township ...... D lphtberl. Diphtheria ...... 2...... a0 13 Aur ...... 16 Influenza ......

Sca fever...... 19 DhI island 10...... - le

...... 2 Chicago ...... 225 Smallpox

fever ...... 14 Cicero. ...a ... 11 T-yphoid December 9, 1921. 3038

MAINE. Ca ;es, Cases. 155 I Chicken pox...... lE Diphtheria ...... , , 9,,,...... g Diphtheria...... 21 Scarlet fever ...... 17

German measles...... I Smallpox ...... 21 Measles ..... L Typhoid fever...... 18 Pneumonia...... Mumps. 11 Scarlet fever...... 21I Cerebrospinal meningitis ...... 1

Tuberculosis...... Chicken pox ...... 71 Typhoid fever...... I Diphtheria.;....., ...... ,.... 321 Epidemic sore throat ...... ,.,.. 38 MARYLAND.1 Influenza ...... ,,,...... 18 Cerebrospinal meningitis...... Measles ...... 7 Chicken pox...... 56 Mumps.. 12 Diphtheria...... 101 Ophthalmia neonatorun...... 5 Dysentery ...... 1 Poliomayelitis ...... 2,.,,,,,,...... ,, 2 German measles...... 2 Scarlet fever .171 Influenza ...... 10 Smallpox . 1 2 Malaria...... Tetanus ...... 3 Measles...... 124 Trachoma ...... 9 14 MUumps...... Tubrculosis .. 55 Paratyphoid fever...... 1 Typhoid fever...... ,. 56 Pneumonia (all forms)...... 53 Whooping cough ...... ,,,,,,....,,,.,,. 17 Poliomyelitis ...... 4 Scarlet fever...... 65 MONTANA. Septic sore throat...... 4 Diphtheria...... 19. Trachoma ...... 1 Scarlet fever...... 29 Tuberculosis...... 78 Smalpox...... 33 Typboid fever...... 24 Typhoid fever...... 5 Whooping cough...... 20 NEBRASKA. MAsCRUSrS. Chicken poX ...... 14 Cerebrospinal meningitis ...... -., 2 Diphtheria: Chicken pox...... 1 Beatrice ...... 8 Conjunctivitis (suppu rative) .13 Omaha Diphtheria .232 ...... 18 Sattering ...... 21 German measles ...... 5 German measles ...... , 2 Influenza ...... 17 Measles ...... 31 Lethargic encephalitis ...... ,2 Mumps ...... 3 Measles .127 Pneumonia ...... 1 Mumps 45 Poliomyelitis-Omaha...... Ophthalmia neoatorum. .19 Scarlet fever ...... 43 Pneumonia (lobar). 98 Smallpox: Poliomyeiis.. 4 Bluehill ...... 12

Scarlet fever ...... 139 Scattering ...... 32 throat septic sore .11 Tuberculosis ...... 1 - Tetanus -. 1 Typhoid fever ...... 3

Tr c o a ...... 2 Tuberculosis (all forms). 177 NEW- JERSEY. Typhoid fever .11 Cerebrospinal meningitis ...... 1

Whooping oUgh .41 Chicken pox ...... 253 MINSTA. Diphtheria ...... 236 Influenza ...... 12

Chicken po. 28 Measles ...... 117

Diphtheria: Pneumonia ...... 111

Minneapolis .48 Poliomyelitis ...... 2

Scattering .117 Scarlet fever...... 174

Measles. .16 Smalpox ...... 5 Pneumonia. 3 Typhoid fever ...... 19 2 Poliomyelits. Whooping cough ...... 48 Scarlet fever ...... 216 Smallpox ...... 62 NEW MEXICO. Tuberculosis. 9 Chicken pox...... 7

Typhoid fever .15 Diphtheria ...... 35

Whooping cough. 1 Influenza ...... 1 Week ended Friday. 3039 Dec-mber 9, 1921.

NEw mEXICo-onltinued. VEIMONT. Cases. Cau ;es. Measles ...... 2 Chicken poo...... 35 ...... Diphtheria...... 20 23 Pneumonia.3...... 3 Measles...... 2

Poliomyelitis ...... 1 Mumps...... 3

Scarlet fever~~~~~...... S 5 Pneumonia ...... 2 Smallpox...... 3 Scarlet fever...... 42 TubercuWosis ...... 38 Septic sore throat...... 3 Typhold fever ...... 11 Typhoid fever...... 3 Whooping cough ...... 4 Whooping cough...... 10

NEW YORK. VIRGI . (Exclusive of Now York City.) Smallpox: C Count-Several cases. meningitis ...... 1 Cerebdsfpinal WASHINGTON. Diphtheria ...... ' 298 Chicken pox...... 65 Inltenza ...... aD Diphtheria:

. 70 M.e ...... Seattle Pheumonia...... 166 ...... 12 Scattering ...... 14 Poiomyelitis ...... 8 Measles ...... s

Scarlet fever ...... 311 Mumps...... 21 Typhoid fever ...... 46 Poliomyelitis: Whooping cough ...... 115 Lincoln County ...... 1

NORTH CAROLIA. Tacoma ...... Scarlet fever: Cerebrospinal meningitis ...... 1 Spokane ...... 8 Chicken pox ...... 82 Scattering ...... 29 Diphtheria ...... 146 Smallpox: German measles ...... 3 Spokane ...... 8 Measles ...... , 4

Walla Walla ...... 15 Scarlet'fever ...... 93 Scattering ...... 61 Septic sore throat ...... 2 Tuberculosis ...... Smallpoxs ...... i Typhoid fever ...... 4 Typhoid fever ...... 24 Whooping cough ...... 13 Whooping cough ...... 42

VIRGINIA. OREGON. Diphtheria: Chicken pox ...... 9 Diphtheria: Wheeling ...... 13 Scattering ...... 35 Portland ...... 25 Scarlet fever: Scattering ...... 18 Fairmont.20 Impetigo contagiosa ...... 3 Scattering ...... 15 -Mease s... Smallpox ...... 3 Mumps...... 4 Typhoid fever ...... 2 Scabies ...... 5 Scarlet fever ...... 8 WISCONSIN. Smallpoxc: Milwaukee:

Portland ...... 21 Cerebrospinal meningitis ...... I Chicken S tting ...... 13 pox ...... : ,,74

Tuberculosis ...... Diphtheria...... 39

Typhoid fever ...... 2 Pneumonia ...... 24

Whooping cough ...... Scarlet fever ...... 14 SOUXTH DAKOTA. Smallpox ...... 2 Chicken poX 1 Tuberculosis ...... 14

Diphtheria ...... 23 Typhoid fever ...... 1

Pneumonia...... 1 Whooping cough ...... 12

Scarlet fever ...... 6 Scattering:

. 22 Chicken pox ...... 9

Tuberculosis ...... 9 Diphtheria ...... 144 Influenza 2 T=EA ...... ,.,

Chicken pox ...... 8 Measles ...... 7

Diphtheria ...... 132 Pneumonia ...... 2

Influenza ...... 7 Pollomyelitis ...... 3

Pdl ...... 5 Scalet fever...... 139

Pneumonia ...... 7 ......

Scar fever ...... 52 Tuberculosis ...... 17 fever s8bpx...... 1. Typhoid ...... 9

Typhoid fever ...... 13 Whooping cough ...... 36 7641 5°~-21 -2 .seen*" 9,1 01. ;oIo

-Deayed Reports for Week Ended N.v. 26, 1t. 'DM tM LMM.

Chbicken ...... 12 SI Mmd Inhn"¢ ~~~~~...... ----...... 2 .S~~~~~~~~~~~~~~~ ...... 21

Mu. .s...... I 2 PSt tpOI6ld6W 1 4koing.- ...... -...... 19 Rabies in man-Bay4CoaWn .1 Cerebrospinal meningitis-Jefferson Cot..'.. I s riet Seven Chicken pox....1 Jefferwn County...... ,.... ,,.....,.. 10 Diphtheria: .t .16

Chrislian ...... 26

Davies County .. 2 Tot...... 7 Jederee County .. 62 Ttadbbbk

McCraken County...... 8

Marion ...... 21 TflOW 15

Scattering.. 7 ~.j* g37 Whooing oU .. 2 SUmARY OP CASES REPORTED MONTHJT BY STATES. The following summary of monthly State repotts iS published weekyandsinaly thoee sas1km whv%pres xrereewied durtng tIe Ct week:

October, M..

Delaware...... 1 9 4 ...... 42 .28 New York ...... 29 W 141 . a . 280 1,269 1. 819 Ohio ...... 46 42 2.... 4 82 51 1,580 7n 778 Ol...n.W ' ...... 22 'I 1 4.44 .78* .4 27 Virginia . . 487 341 ..0, 12 16 *1. a 3 Washt ...... 19. 62 188 224 67

S-MALLPOXVEDEWrC. Kansas CiY, Mo.-Kansas City, Kans. Smalpox in malignant fom continues in K ss City, Mo., and a few scattering cases of the diseae have -appeared in various other parts of the State, with origin traceable to Kansa City. The follo#. ing is -taken from a telerm dated December 2, received from Dr. (ortez F. Enloe, State conuaissioner of ealtf ouri: Smallpox epidemic continues unabated Kansas .Cit Seep. tember 1, 290 vases have been reported; 103 aths. ast five -days, 24 new cases, 11 deaths. Maligna:t type of disease has spread; 30 known cases, 4 deaths m vious parts of State, origin tr to Kansas City.; actual total probably higher. A telegram, dated Decemiber 5, 1921., from an officer of the PTubhic Heath Service, gives the following information: Kansas 'City, Xans.-Week ended December 3, 1921: asesy, 1; deaths, 5. Julv 1 to Deember 3: Cases, 5; -deaths, 16. 3041 lDecember 9, 1921. Kansas City, Mo.-Week ended December 3, 1921: Cases, 40; deaths, 14. July 1 to December 3: Cases, 315; deaths, 108. TYPHUS FEVER. Athens, Ga. Information, dated December 6, 1921, reports one case of typhus fever at Athens, Ga. CMTY REPORTS FOR WEEK ENDED NOV. 19, 1921. ANTHAX.

City.

Delaware: Wilmington ...... "I'll

CEREBROSPINAL MENINGITIS. The column headed "Median for previous years" gives the median number of case3 reported during the correponding weeks of the years 1915 to 1920, inclusive. In instances in-which data for the full six years are incomplete, the median is that for the number of years for which information is available.

Weekt ended Week ended Median Nov. 19, 1921. Median Nov. 19, 1921. City. forviouspre-_ City. forviouspre- years. Cases. Deaths. years. Cases. Deaths.

California Missouri: . Los Angeles ...... 0 2 ...... St. Louis...... 1 2 Connecticut: - New Jersey: Hartford...... 0 1 1 Garfield ...... Meriden...... 0 1 ...... Ncw Brunswick-...... 0 1. Illinois: Pa e ...... s 1 0 1 ( °cago...... 3 2 ... New York:

Decatur ...... 1 Buffo...... 0 1 1 Peoria....O 1 1 1..... New York.2 3 2 -Iwa: Niagr Falls ...... 0 ...O 1 Burlington ...... O 2 1 North Carolina: tbsst: -Durtam...... O 1 1 Belmont...... Ohio: Beverly ...... O 1 ..... Cleveland ...... 0 .1 Boston .. O 2 1 Pennsylvania:

Norwood...... 1 1...... SouthLridge .. 0..1 Tanmaqua ...... I Michigan: Te:xa Detroit . . 0 ...... 1 Galveston...... 0 1 1 Hi4glandPark 0 1 1 Ironwood .. 0 1

DENGUE.

DIPHTHERIA. See p. 3047; also Telegraphic weekly reports from States, p. 3036, and Monthly summaries by States, p. 3040. Ien*m 9 1921. 302 CITY BEPORTS FOR WEE EIDED NOV. 19 1921n-CbutinUe

City. Cases. DeRS*& City. Cases. Deaths.

Alabama: M ri: Birminham ...... t Joseph...... Montgo.ery 1 M...... *._*. ArkcanSss: MtS..*_tantL: Litt'e Rock .. 1 ....Billi..... Califonia: Newlersey: Bakersfield ...... 1 ...... Atlantic City...... 1...... San Francisco 4...... R.f -4- ...... 1I ...... r. Connecticut: NOWork: Meriden . .1...... Albany...... 7 New Britain .. 2 .. MountVermon ...... District of Columbia: New York ...... 22 Was.ngton. ... 1 ...... RochzeRter ...... 2 Geoxpa NorthC(elina: Atlanta ...... 1 2 Charlotte......

Chicag ...... 13 ...... To'edo ...... Kentuck.y: ...... 1 Cov*aon ...... is...... 4 8 NewOrleans ...... 2 1 Provlence...... 2.... Marland: Baltimore ...... 12 1 Dallas ......

Bes - I. ... .jS 2, S .lUebian eh.<...... i*.L* Cambrdge...... Ro e ...... Fab *t vi ...... }Hohil,,,.2 ...... 2

LEITARGIC ]INC*P AL?.

GeolagI New York: gattall ...... r . I N...... M.a-usetts: Somwvle...... 1

MALAMA.

Arkansan T__Tennesw Fort Smith...... 7 ,Tna-...... -@- Mwhs...... 4_, Georgiw Texaq: Savoah ...... Dales...... Louisiana: o ...... New Orlea ...... lr--...... -Wah ond ......

MEASLIES See p. 3047; also Telegraphic weekly reports from States, p. 3036, and Monthly .mmazies by Sta, p. 3040. PZLLAGRA.

City. Cases. Deaths. City. Cases. Deaths.

Alabama South Carolina: ...... Charleston ...... 1 I Twmw ...... vanh ...... :..... Abilene...... 5 ...- Valdots ...... I...... North Carolina: Durham...... I...... I R .~~~...... tSU_...... ~~~~~1.. 3043 December 9, 1921. CITY REPORTS FOR WEEK ENDED NOV. 19, 1921-Continued. PNEUMONIA (ALL FORMS).

City. Cases. J Deaths. City. Cases. Deaths.

Alabama: Marylnd: Anniston ...... 4 Baltimore ...... 34 19 Birmingham...... Cumberland .1...... Mobile...... 4 Massachusetts: Arisona: Beverly...... 1 Tucson...... 2 Boston ...... 32 Arkansas: Brockton...... 3 13 ...... 1 LittleRockc...... Cambridge...... Califoria: Chelsea...... 2 1 Bakersfield...... 2 1 Clinton...... 1 Long Beah...... 3 Everett...... 2 Los Angeles...... 28 8 Fall River. . 11 ...... 1 Oakland...... S Haverhi... 2 ...... Pasadena...... 2 Holyoke...... 1 Riverside ...... 1 Leominster. . ,. 1 Sacramento..... 8 3 Lowell ...... ,.. 4 ...... 2 San Diego . .... I Lynn.. 1 San Franeisco...... 20 Maiden . 2 Stockton...... 3 2 New Bedford...... 5 Colorado: Newburyport. Denver ...... 11 Northampton ...... 3 Pueblo ...... Quincy .. Connecticut: SalemI ...... Bridgeport ...... 1 Somerville 1 Bristol ...... 1I Soutl.bridge . . 2..... Hartford ...... Springfi l..d 8 1..... Meriden ...... 1 Wakefield . .1...... 1 New Britain...... 3 Webster .. -New Haven ...... Winthrop.. 2 Norwalk ...... Worcester...... Delaware: Michigan: Wilmington...... i . District of Columbia: Detroit ...... 46 Flint ...... Washingtoll ...... Georgia: Hamtramck ...... 10 Atlanta...... 13 Highland Park 2 ...... Jackson ...... 3 Augusta ...... 2 lMacon ...... ,.1 Kalamazoo...... 15 Pontiac...... Savantnah ...... 2 Illinois: Minnesota: 21 Alton ...... 2 Austin ...... 16 Aurora ...... 2 Milneapolis. Blue Island ...... St. Pau .------15 Chicago...... 1 3313 1 Cicero...... 4 2 Missouri: Decatur.... . 1 Independenice ...... KansasCity ...... East St. Louis...... 1...... 2 Forest Park ...... St. Joseph ...... Galesburg...... 4 2 Montana: Jacksonville ...... 1 Anaconda ...... 1 16 Kewanee ...... 1 Billings ...... I Salle ...... 1 Missoula...... Mattoo ...... Nebraska: I ...... Oak Park Omaha ...... Rock Island ...... 2 1 Nevada: Springfield ...... Reno .. 2 Indiana:

...... New . . Jersey: Cay...... Ctifton ...... 1 ...... IndXnapoli...... 33 La Fayette...... East Orange ...... Elizabeth ...... ,,,.l., . 3 Marion ...... Iowa: 101 Englewood ...... 1 ...... Council IXluffs ...... Garfield ...... 1. Hackensack ...... Ifinsas: 1 Coffeyville ...... 1 Hoboken ...... 3 ...... Topera...... 3 Irvington Wichita ..... :...... 10 Jersey City . . 6 Kentucky: Kearn y...... Montclair .. 2 1 Covington ...... 1 Lexdngton...... Morristown ...... Louisville ...... :.. New Brunswick...... 1 Owensboro ...... 1 2 Newark .... 33 8 Louislan^: Ormnge ... 5 1 ...... 1 Baton Rouge ...... Passac ...... New Orleans...... Plainfield ...... 1 Summit 2 Maine: ...... 1 . 5 Auburn ..... , .I.,. Trentoni ..... 1 Lwistol... .. West Hoboken . I...... Portland.....,,,., , ...I We3t Orange ...... 1 - December 9,1921. 3044

CITY REPORTS FOR WI ENDED NOV. 19, MI-Continued. PNEUMONIA (ALL "ORMB)-Continued.

City. Casws. Deaths. City. f Cases. Deaths.

New York: Ohio-Continued. 21 Albany...... '...... Toledo...... 1 1 ...... _ Buffalo...... ,Yonstown 3 ...... i- *3 Oklahoma: Elmira...... Oklahema City. 2 Glens Falls...... Tt11>B ...... i ...... Horndl Orexon:- Little Falls...... 16. nd...... 3 Middletown... IPennslania: Monnt Vernon. Phfdel phia...... New Yorkl...... ,1 127 Rhode slang: 48 North-Tonawanda...... f ...... 3 Port Chester., Providence ...... 4 Rocester...... South C6rolina: ...-....-- Chahtat. 6 Saratogas inDgS...... Tennese: .i2 ...... Memphis . ... _ 3 ...... 4 N Vile ...... 5 ..enctd...... 1 Texas: Waertown...... Abine ...... 1 White Plains ...... 1 Beaamont. 1 Yonkers...... Da ...... 6 North Carolina: El Paso ...... 4 Chadotte Houston...... 3 Durham...... Waco ...... 1 Greeboro...... Utah: Ral ...... Salt Lake Ctty ...... 3 BaU Virginia: Wilmingtonl...... Ou...... 11 Alexndria 1...... Ohio: 11 Lynehbrg ..... AUcr ...... 4 Norfok...... 4 Canton...... 10 Portsmouth ...... 4 Chilliothe...... Richond ...... 2 Cincinnati...... Roanoke...... 2 2 1 Cleveland...... West V ia: Columbus...... 28.... 2 ...... 1 Daytton...... I...... Huntington ...... 5 ElyrlaW ...... 1 I Martinsburg ...... 1 ... ..1 ...... Wheeln ...... 2 Ironton...... I...... Wisoonsm: Mansfield...... Belot; ...... 1 Newark Milwaukee......

Niles Oshkosh ...... I Salemn...... ^...... Rane ...... Springfeld..

- POLIOMYWLrTI (INFANTILE PARALYSIS). The cumn headed "Mediani for previous r" 6lvs the inlian number of eases rerteI during the corresponding weekm of the years M1 to fInusive. Ininstancs ln which data iuli years are ncomplote, the median is th for the number of yes for which Information is able ^Medlan Nov.Week1%,ended110. . -.Nov.Week esafed pre- 1a2 City. for viotn City. fbu _ y'O~5. ~~~~~~~~~~~~~viol's Ceus. lDeaths. 3e5. Q Deaths.

Colorado: New Jersey: Denver. .0 1 EastOur. 0O 1...1 Connecticut: New York: NewHaven . 0 1 . New York. 2 6 2 Illnos: Whit P i ...... Cbicayo ...... 1 .... Ohio:

Gals ...... 0 1. Cincinnati I ...° 1 . . Iowa: Toledo . 1... Muscatin e . 0 1 Oregon: Kansas rortlsnd...... O 1 .... Topeka .0 1 PensylvanIa: Maryland: Philaelphia . 0 2 g. uialtimore ...... 0 2 ..... Texas: Michiran: Houston.0 1 Flint ...... O. 0 ..... Washingtoin: Minnesota: Tacoma..0...... 1 ..... St.Paw ...... 0 ...... 1 Missouri: Kansas Cy0 ...... 3045 December 9, 1921.

. yREPORTS FOR WEEK ENDED NOV. 19, 1921-Continued. IRABD IN MAN.

City.

New York: New York ......

SCARLET FEVER. See p. 3047; also Telegraphic weekly reports from States, p. 3036, and Monthly summaries by States, p. 3040. SMALLPOX. The coumn headed "Median for previous years" give3 the median number of case3 reported during the corresponding weeks of the years 1915 to 1920, indusive. In instance3 in which data for the full six years are incomplete, the median is that for the number of years for which information is available. Week ended Week Median Nov. 19, 1921. Median Nov. 19,ended1921. City. forviotispre- City. forviouspre- years. Cases. Deaths. years. Cases. Deaths.

Alabama: Montana: Montgomery ...... 0 1 GreatG Fals ...... 5 Arkansas: New York: --- LittleRock ...... 0 1 I NewYork...... 0 1 . Califonia: North Dakota: - Bakersfield ...... 0 14 I Fargo...... 1 1. Oaklland...... 0 1 .ran. G rd Forks...... 10 1...1 San Francisco ...... 0 2 ...I.Ohio: Colorado: Cincinnati ...... 0 2 . Denver ...... 12 7 2 Dayton. 0 2...... 2 Fremont .0 9 £11inois: 0 .. Centralia ...... 0 .4 Sandusky...... 1 Chicago ...... 0 2 ....-1.Oklahoma: Elgin ...... 0 1 .-. - Oklahoma City. 1 1. I attoon ...... 0 1 ...... lOregon: Indiana: Portland ...... 3 12 . -- Bloomington ...... 0 1 ...... Pennsylvania: Gar ...... O 5 . Coatesville ...... 0. 1 .. Marion...... 0 1 .Punxsutawney...... 1 . Terre Hautet.0 ...... 1 Tennessee: Iowa: Chattanooga...... 1...... 0 MMuscatine ...... 0 3 ...... Utah: Waterloo ...... 0 1 ...... Salt LakeCity ...... 2 13. Kansas: Washington: Hutchinson ...... 0 13 ..... Aberdeen ...... 2 7 . -Le,favenworth... 0 2 .....S.... eattle .... 3 1 . To ...... 0 2 . . Spokane...... 13 4 . Woichita ...... 0 1 ...... Taco ...... 16 . -Michigan: Walla Walla...... 0 O ...... -- Detroit ...... 3 1 ...... Yakima.. 0 1 Minnesota: WestVirgnia. Austn . .1...... BlueSld...... 0 1 . Dulutb ...0. O 2 . Wisconsin: Hibbing .0 2 ...... Milwaukee ...... 9 1 .. Mlnneao ds.7 2 ...... Superior...... 0.. 1 . St.Pal .10 10 ...... WestAllis ...... 2 -Missourl Independence. 0 3 . - KansasCity.I so 22

TETANUS.

City. Cases. Deaths. City. Casos. DeQtIs.

Maryland: Alabr~~~~~~~~~~~~~M"tilaltimore ...... Birmingham . 1. 1 Michigan:

San Francis.o .I...... Missouri: Georg: Springien d 1 rIlInol:avannah .2 2 Derki:..New York: Chicago...... I. Decemiber X9.191 CIY REPORTS FOB WE W V. 1% Im.-Oont .d.

See p. 3047; also Telegraphic weekly reports from States, p. 3036. TYPHOID FEVE The column heeded "Median for previous years" gives the median number of cas reputed du&g tho corrsponding weeks of the years 1915lStto OInclusive. IA ustnceauwhih.dat the siz years Incomplete the median is that for the number of years f whJch iaavAUWahL Week ended Wee 1%ended ~CCity.City. jMedianNor.aous e. 19W10.et . City. Xqjior0 -Novi.Cases. Dets.1521. yes Cam Deoty. YO. ceases II Now ioraay-Coatinued. Barmnhm...... I 1 *v***-oU PA*'fn...... 2 ...s._ Mobi...... 0 1 sv 1I ..._ Arkasas: New York: ywot &idth...... 2 1 sX@vos Alhum ...... 3 1 .._ North iAttle Bak. .. 0 1 *@*-@@o 1 4 ...... CaDfomia: Elmur...*..*..... 0 2 Lee 3 1 --@@@e- o.....om...... 0 3 ...... 1 1 e@@*oeto 28 14 3 crameto...... 0 3 P*@soww Roester...... 2 1 .. ws Bynm...... 0 ,'''''i Santa An...... 0 1 s*****s Wown. 0 ...._ Colorado: North Carolina: Colorado Sprngs..... -o 2 vs**..*Z 0 .*..._...... _ Conneeticut: Wilington...... 0 1 ...__ Ohlon Giwich...... -0 w.*-w*t New Haven...... 1 Buem...... 1 Qwj=tti...... Wimington...... 2 *ev**@- Cleand...... a 5 GCo I umbus...... 1 a ....,*_ &ange...... 1 0 oovvr Dq*on...... Maen...... 13 a a Kmore...... 1 Rme...... 2 osvv*vv 1 Savannah...... 1...... 2 **+Ze* -.--.....MaIn...... 1 3 ...... Arora...... I *****s** Yogstown...... 0 a s B ...... 0 *_ I ws @v 6 a 6...... 4 1 ...._ Ao.ow..^...... 1 ...... _ Cicero...... @****** 0 ,._ Decatur...... svvvvvo -1 Galebr...... 0 *vo*vos 0 2 Jacksonville...... *-vv-s modvl ...... Mttoon...... 1 @o*we*wl Bethlehem.lina . ,*. .. Indiana: ...... I totd...... 2 Z,-* Chwster...... 0 1 .ington...... ,_ I. Indianapolis...... 1 awun...... a ...... L 0 Fayette...... w*s**vs Nedville...... a .*...... 0 *s*sovs PhlAdphi...... 1 SthBend...... I lvale...... *...... ov*vos 0 I Kanas: I Wovdlawn...... e..^_ Wichita...... 0 Me=...... Yok...... **.... Kentucky: de sand: I Louiville...... 2 *o-Z@@@ Pawtucket...... -.--- Louisiaa: I Soth Carolina: New Orleans...... 5 r .ston...... 2 I Maine: 1 9 ...... ton...... I **@¢v*o Rieshis...... 2 Nashvile... I, **6l Baltimore...... 6 2 o@- Texcas: I0 Cumberland...... 1 1 @s*@@@@ Abtle...... *@*@@@ tts: 1 4 @ @@@ Boston ...... a 1 rst Wiorth." 2 I o-ss@ Danvers...... 03 1 @e-*@tv Galveston...... ~0 *o*- Fall River. 3 2 @@@.@@ Waco...... 0 @.* Webster,...... 0 1 wew*@v 1 Michian: Alexandria...... 0 *s Ann Arb...... 2 v@-wX **@@-@e Detroit...... 7 5 .*s..... Nofok...... I 1- *** Flnt...... 2 1 ...-...* Richmond...... * * @ @@ 0 Washington:Virgmin: 1 Jackson...... P@e@@ves F *o-** Missouri. Seattlie...... DauvClireo 2, KansasCity...... 2 3 1 West Virginia.Doikke ...... 0 St. Lus...... 9 4 s *eo w @ MounIsvllle..... New Jersey Puberturg..... a ee@si Wisconsisi I. Atlantic City...... @ @ @ e . . . e 0 East Orangp...... *--wZ-- * * * * * Jersey City...... 0 I1. @@o-eo Milwaukee...... 0 *s** Ii - |...___ trumi ~~~~December 9, 1921

cm! IUWE)WS" FOR WUK ENDED~NOT. 19, M 2-Continued. DIWHTUI&,R ME*SLW WAULET AN" TVDECUWOSJS.

.DApbtbwia~ Measles. Scarlet Tuber- PNpula- Total fever. eulosis. ci1ky.

aj1Z iron....

. U4-U~

1M7,73. .40 17 ...... S 60,151 20 2...... 4 43,404 2 2 11,996 . ~~~2...... or....i...... 2022 17 3 . ... 2881 4.... 1...... 4. 2 . J 62I. Mmt Little iok. 14,0 ...... Caliornia: Alameda...... 4 Jakersheld...... 18,6381 -......

LongBeech...... 55,5....1..5..2 ...... A a.... .%867$. 181 68 ...... 6 5 2.I 6ea 20 2,361 63$ 218 1 1 ...... ,... . 2 ...... Rie h ond...... m .... 4.0.. ... Rivm-sM& ...... 19,341 .....1 . 1 Sen Diqp------.69,55 23 14 ...... I. 4 San fterisnp...... 5El410 US 58 I 1 8 20: 10 SaIntaAna. 1 3481 4 2...... 12441 3.1.....2 4029 14 18 14 . ... Valeole...... 21,1017 3 41j ... .I...... Colorado: eob,rsdotSRpi ,ri...... 30r,108 .3)....120 1 Devveve-. 25,38 78. 21 1o . .... 10 Pueblo...... 42-,901 14 a....6...... 1 Connecticut

143,533 28 12' 1- 1 --- 121 11 6 3 20,631 4, 1...... I ...... 11,238 1.. ]Derby...... j 11,475i 2 ...... - .--- Greenwich (town) .).... KbAr ...... tfr ..... & 40. 18 1: 2 Manchester- (town)------WeuWde (tilty)...... 10,1934: 1. . . . Now Br*t# a ..... 258,3 lotII 2 I63...... New Land don...... 12,517. 38 .. ...41.....j... Nbrwiclt ...... (town)... 28i,665.1 4 3 ...... r: Wilminton...... 1018. 14 1 2&iL.....11... 407,571, 125w 38 1 3 24t...4 2 6

200,616...... M1 .... 7 1!2 Augustat...... BrWsw* s...... 04 41 ...... LaGrane... , 17 `31...... --- I km....n.: . .,. .. ,. & Rome;...... 4,9Is3 ...1.1.-- .-- 13,252- .. 1 - ...... 83:251 433 5 1...... Savannso .... Va1dbst% ...... I07W- 2...... Idaho; Boise ...... 25.69 2 1 ...... JIUnoix 24,682 7 1...... 38,Wl 13: 9 1 2. . I.... i1;424 & 20 ...... Cemtrsft ...... 2701;79 557.~248 16 24:....141 6. 252.4S Cie" ...... 4991 & 19 1..I . 4 . Doeeatu...... 0818 8 13 1 ...... 3. 7 79 10 7...... December 9, 1921. '3048

ClTY REPORTS FOR WEEK ENDED NOV. 19,-1921-Continued. DIPHTHERIA, MEASLES, SCARLET FEVER. AND TUBERCULOSIS-Continued.

Mesls scre Tuber- Popula- Total Drhtw fever. culosis. tion Janu- deaths City. ary 1, from subject all ..8 A correction, causes.

Illinois-Continued. Elgin...... 27,454 4 2 ...... Evanston...... 37,215 6 7 ...... Fort Park...... 10,768 1 2 ...... Galesbur...... 23,834 4 6 ...... Jakonvle ...... 15713 16. 12 ...... 2 Kewanee...... 16,026 3 2 2 ...... 2 ... La Salle 13 050 6 1 ...... Mattoon...... 13 552 2 17 ...... Oak Park...... * 39830 7 8 I 1 ...... Pen...... 12,086 ...... 8 S ''''i' ...... i Peoria ...... 76 121 18 4 . . 7 1..i ''''' Roekford...... 65,661 10 7 1. 10 Rock sland...... 36,177 10 ...... 2 ...... Springfield...... 59,183 23 ...... 1 Indiana: Bl ngton...... 11,595 6 ...... Crawfordsvlle...... 10,130 4 I...... i...... ,.1. Eash Chicago...... 35,967 7 1....0...... I. Elkhart...... 24,277 4 2 1 ...... , 1 1 Frankfort..... 11,585 6 ...... 2 ......

..... ,378 16 ...... 2 Hammond...... 36004 10 ...... 8 Huntington...... 14, 000 2 2 ...... 2 Indianapolis...... 314l94 68 48 8 14 1.2 Kokomo...... 30,067 ...... 1 1 2 La Fayette...... 2, 486 8 2 ...... 3 1,0asot...... 21 6 7 ...... 1...... Marion...... 21,747 10 8 ...... 4 1 2 1 1 Mishawakca...... 15, 195 3 ...... 1 36,2 9 4 ...... 2 Muncie...... 2,765 4 ...... ------...... Richmond....:::' ...... South Bend ..... 70,983 7 3 -- Terre Haute. 66083 17 a6 1 .. 1...... Iowa 11 Burlington...... 24,057 ...... Cedar rids...... 4%.566 ...... 3 1 s...... 36 162 5 7 Davenport...... 56,m ...... 1 ...... Dubuque...... 39,141 ...... 3 ...... Marshitown...... 1.i%731. 1 3; Mason City...... 20,065 4 ...... *11 ...... Muscatine...... 16,068 10 ...... Ottumwa...... 23,00 ...... Sioux City...... 71 227 ...... 10 41 Waterloo ...... 36;230 ...... 4 2 1 1... Kansas: 1... 2... Atcison...... 1%630 1 4 i- Co esle...... 13,452 2 8 31 11.-... 3. Hutdbin...... 23,298 ...... 9 1 .''I''' Lawrence...... 12 456 2 1 21 Leavenworth ...... 16,912..... 6 ...i-l21 Parons...... 16,028 5 1 Saina...... 14085 1 3 Topekca...... 50,022 14 60 91 W lFbita...... 72, 128 20 28 1 Kentucky: Covigton...... 57,121 12 5 ...... 31I 1 I Lexington...... 41,534 20 4 .... 1 Louisille...... 234,891 59 52 3 21. 2 1'''-'' Owensboro...... 17 424 ...... 16 ...... Paducah...... 24, 736 .. 2...... Louisiana Baton Rouge...... 21,782 12 2i...... 1 ....1 Monroe...... 12,675i 2 .'i'...... New Orleans...... 387,219 132 ...... 8I.....s 17 Maine: ...... Auburn...... 16,985 5 ...... 1 Bath...... 14 731 8 ...... Biddeford ...... ; . 1K 9 ...... Lewiston...... 31,791 6 Portland...... 272 31 10 ...... 2 Sanford...... 10, 61 0 ...... Watervie...... 13,31 ...... 3049 Decomber 9, 1921L

CITY REPORTS FOR WEEKIENED NOV. 19, 1921-Continued.

DIPHTHERUA, MEASLES, SCARLET FEVER, AND TUBERCULOSIS-Continued.

Scarlet .Tuber. Mese fever. Popula. Tota Diphtherii culosis. Jon Jauiu- deaths City. a ry 1,1920 from ;ubject to' all C1 err-ection. causes. Go

Marland: 826 32 36.. Bali'More ...... 73, 201 53 I 24 ,Cumberland ...... 29, 837 6 2 ...... 2 Nassachusetts: Adams...... 12,967 2...... 2 Amesbury...... 10,0M6 0...... Arlington ...... 18,665 2 11 1...... Attleboro...... 19731 6...... 10740 1 1 B3evely ...... 22561 2 1 Boston...... 748,060 206 74 I Braintree ...... 10, 580 1 1 Brockton.... 66,138 23 B3rookline... 37,748 7 2. i. 109,694 21 5. 2 Chelsea...... 43,184 13 .... 5 Citnton ...... 12, 979 4 -1. Panvers ...... 11,108 ..... 8... 2... Everett ...... 40,120 4 5. Fall River...... 120,485 39 0 ...... S. Framingham...... 17,068 1...... Gardner ...... 16,971 5...... Oreenfiedd...... 15,463 4...... 1 .. Haverhill...... Holyke ...... 14...... 1 1 Lraoinstger...... 184,744 6...... Lowell...... 112,479 20 7 1 - 7 99,145 23 10 ... 5 48,103 18 8 1 .... . Medford ...... 3.9,068 6 1 ...... *1. Melrose ...... 1s. 204 4 4 ]Methuen...... 13,169 5...... New Belford ...... 121,217 29 11 .1. Newburyport ...... 1s,618..... I -.. .1. Newton ...... 46,054 7 7 1 Northampton..... 21,951 15 4...... Norwood ...... 12,627 2...... :1... 2...... 2.... Pitsfietd ...... 41,751 16 5. *1 3 Plymouth ...... 13,045 4...... Qulucy ...... 47,876 9 10 1 ...... Salem ...... 42,529 6 2...... 1 ... Saugus...... 10,874 2....~~...... Somiervlle...... 95,091 15 7...... 14,24,5 5...... Southbridge ...... 129,53 28 18 1 2. f.. 4 37,137 6 1... 1 I.. ... 1...... 4 4.... I Wartertown ...... 21457 2 1.... 2 Webster...... 13258 1...... 1 West Springfield...... 3443 0...... 18A0 6...... I Winthrop. 13455 1...... Woburn...... 16574 0...... Worceter ...... 79,5 52 7 ......

Ann Arbor...... 18,516 11 5.... 2...... 62.... Battle Creek...... 39,184 8.... Denton HArbor...... 12,233 I.... I, Ntrolt.:...... 2D5 125 11 36 1 86 91,599 19 17 2

Grad Rtapids...... 137,634 83 10.... *2 ....14.... Hlmtrack ...... 48,615 9 2.... Higbhland Park...... 46,499 7...... 13,739 3...... 48,374 10 5 1 ... 1...... Kajmes...... 48,358 25 9 1 ...... 10'. . . ero uaette,...... 12718 4...... 34273 8 26 PortafUc a"94 6

10,118 3...... Thkth.., ..... Q6,917 14 6.... Hibbing ...... 13,089 1 .%...... I.... Mankato ...... 12, 469...... December 9,1921. 3050

CITY REPORITS FOR WAEE ENDED NOV.- 19, 1921-Continued.

DIPHTHERIA, MEASLES, SCARLET FEVER, AND TUBZRCULOSiS-ConUed.

Tetal Diphtheria. Mieasles. Scarletfever. lionPopula.Janu- deaths City. I iry 1, 1I20 from subject to' all 8 causes. 4±

Minnesota-Continued.

Minneapolis...... 83 58 38082 7...... 6 5 Rochester...... 13,722 10 ......

St. Cloud...... 15,87 ...... 5 ...... St. Paidl...... 234,595 87 16 1 28. S Winona...... 19,143 ...... 1. Missouri: . Independence...... ,686 7 7...... 4...... I ......

. Joplin...... 3 asasCity ...... 410 125 57 4 .1 ...i...... -. 35 5 St. Joseph...... 77,ag ... 10 3 Lous 807 181 2 St...... g9 21. 10 Springfield...... 91, ...... Montana: Ana a...... Bfll.n...... 15,100 4...... 11 Greatw-.a...... 24, 121 5 7. 1 Missoula...... 12,668 6...... Nebraska: dhvn...... 5954 10 2. 3. 2. 2 Omaha...... 49 18 Nevada: 191,601 1...... 5... 2 p Reno...... 12,016 2...... 11...... New H1[ampshire: 1 Be:lin...... 16,104 3...... 1 ...... 3 1 Concord...... 22, 1'67 12 1 . . . 3 . Dover......

11, ...... Keene...... 210 13 . Nashua...... 8...... Portsmouth...... New Jersey: 1......

Asbury Park...... 12,400 1.. . . City...... Atlantic . 50,682 9 1. 2...... Bayonne. 76,754.....1I...... 2...... Belleville... 15,660 ...1...... I2 .. .. Bloom eld...... 2 ..... 3...... Clif ...... 26,470a,56 ...... East Orange...... I...... I 50,710 12.4.-..9 3...... 2. Elizabeth ...... 2837 ... 223 3::: 1 1 . 95,68256 . 8...... Englewood...... 11,627 ....1.1 Garfild...... 19 381 2 2.2. -- - GloucesterCity...... 12,182 4 ... Hackensak...... 17,667 9...... $ ...... HarrIson...... 15,721 1...... i1..

Hoboken...... 68,166 ...... 9 1. Irvigton ...... 25,480 ...... 2...... 1 1 Jersey City...... 297,864 .1:..:.... :.... 10.... 13. 28810 2 aoteir...... 1 ...... NewMorristown... 12,548 7 ...... Bruniswicka...... 32,779 10 .. Newark...... 414,216 77 196 ...... 33, 268 Orange ...... 3 17 Passaic...... 63,824 Paterson...... 20 4...... 8 Philipsburg...... 16,923 .'T' ....i...... 31...... PlailiRd. 7 27,700 ...... Summit. .. 10,174 3 . ..-.-: . . . Trenton...... 119,289 32 14 1 ...... 2.... Union .. .2 West Hoboken...... 40,068 4 1.....1......

West NewYork. 29,926. 3 1.1...... West Orange...... 15,'573 2 1...... New Mexicko .s Albuquerque...... 15,157 9...... 2 3 New York: 2...... Auburn...... Albany...... 113,344...... 18...... 1I.... Bufao...... 36.192 111 9 2 ...... 506,775 116 37 3 ... . 15.... Cohoes...... 229871 8 2...... 3.... 1b Elmira...... 45,305! 19 10.... 6 1 3... Geneva...... 14,6481 4...... I::: ... J Glens Falls ...... 16,638 4...... I...... 3051 Pecemhe-rO, I69i. ClTY REPORTS FOR WEEK ZNDED NOV. 19, -tmCtiued. SWUTURRIA. YKASLU SCARLET FNYR, AND TU8ilRCULOSLW-oCntlAUe

. Scarlet Tuber- Popula- Total Diphtheria. Meesles. fever. culosis. tionJalau- deaths,; City. ary 1,1920, from subject to all A C ewre3UBnt a as . U, w s tI . 0z ;1 o3 New York-Continued. ruell.,...... 3. 2 ,...... Ithaca...... 4 1-.. 2 ...... 10 3. 4 Jamestown...... 38,917 2 ...... uttle 13 029 ...... LockpotV...n...... F~s...... 2I2308 2 ...... 1 ...... Newburte 2 ...... x ount Vernon...... 726 9 3f366 ff 2 .. . 1...... _ ...... 1...... 1, 229 IC 93 2 19B 2f1 Nizr . ... 14 1 i 4Z 4 .... NeT b ...... 14 1 .ai...... F...... 16,373 ...... 73 34 2: 1. 8 ochest ...... T Rome...w...... 7 2...... i; 5 I Saratg Sprin...... 13:181 ......

72& ...... i1 r 9 ...... 1,717 35 53 4 3 ...... 22 . . 2 2 3 RWaertwn...... ,28 White Plans..... 031 ...... 1 Yonkers...... !...... I1 North Caroina: 1 Charlotte...... 339 1 1...... Durham...... 7 ...... _, Greensboro...... 861 ...... Rtalegh...... 26,41K 5 ...... -...... ,.'.-... Rtcky unt ...... 741 4 alisbury...... if 2 t...... Wimnon...... 33, 371 23 *...... Winston-Saem...... 439 ...... North Dakota: 961 ...rg...... _ 21 ; 0t 1,1 . Grand Forks...... 16,010 ...... 2 ...... Ohio: 2 , 05 ...... Ako.....-...... 3 ...... Afiance...... 21,60 31 2 L.....2 -- Barberton...... 1 4 ...... i Buiyru ...... 10425 ,.2 1 IL ...... 21 30 Caton...... Ch .iicoshe...... 1 ncinnti...... 1,247 L14 44 a . 16 Clevand...... 836 64 16. 85 521' --. I 7 Iumb...... 2... . 2 Cshotn...... 10847 ...... Dayton...... :...... 1 . . . . .- _...... Eas Clevelnd...... 021 .... 61 2 ...... WVIl...... pidlay...... 7'93OR. 5ll------..- ...... Fremont ...... I35 ...... 13 21 1..2 EXamilten...... ------11 2 1 Ikotonto...... --- Eenmore...... 10 3.. 3 tO; ".--...... -- ...... ' Lakewoo...... i.....1 16 ...... 1246 ...... 10 1 ...... 1-4.2 .... e?m ...... Mansfd .. . 1- .._. ...1. 27 1 ...... Mrio...... i ...i8... 'il ...... Mddltow...... 3 5 ...... 2B,718 11 29 2 1 ..| Newark...... New P hileli...... 10 ns 4...... NUS...... 13080 ...... 4 ...... Norwood...... xgm *-1 -..-...... Piqua...... 15,044 4 ...... t ...... 10,30 22,897 ...... -- e ...... y 31 1 ...... 1...... S f d...... 12 2 ...... I...... be...... 28508 .1 _ ...... 14,375 tmn...... 4, ...... Toledo...... GI 41 .1 . Youngstown...; 1358 4 ...... Zanesvle...... 29, 569 ...... L. ..110 ...... l IPulmonary tuberculosis only. December 9,1921. 3052

CITY REPOIRTS FOR WEEK ENDED NOV. 19, 1921-Continued.

DIPHTHERIA, MEASL SCARLET FEVBR, AND TUBERCULOSIS-Continued.

Diphtheria. Measles. Scarlet Tuber- Popula- Total fever. culosis. A-ffiR tion Janu- 1 i"S--0 I City. ary 1,1920, from subject to all .2 A correction. causes. S A i i) i 4 C.) cz0 0 1 1- Oklahoma: 8 Oklahoma City...... 91,258 25 2 .....3...... I 2 Tulsa...... 72,075 ...... 8 ...... 2 ::::: Oregon: Portland...... 258, 288 65 22 ...... 3 ...... 6 PennAylvania: 2 AJentown...... 7.3,502 ...... 10 ,.-.--- 4 Altoona...... 60,331 ...... 3 ...... 3 Berwickl...... 12,181 ...... 1 ,...... 1 Bethehem...... 50,358 ...... 9 ,-.-.. 5 Braddock...... 2D:879 ...... 3 ,...... 4 Bradford...... 15 525 ...... 1 Bristol...... 10,273 ,...... Butler...... 23,778 ...... 1 ...... Canonsburg...... 10,C32 ...... 7 Carnee...... 11,516 ...... 1 Charleroi...... 11,516 ...... 1 Chester...... 58,020 ...... 2 Coatesville...... 14, 615 ...... 1 ...... Dickson City...... 11,049 ...... 2 ...... Dubois...... 18, (81 ...... 2 ...... i.. Duque ew...... 19,011 ...... 1. Erie ...... 93,372 ...... 8 1 Farrell...... 15,586 ...... 1 1 Greensburg...... 15,033 ...... 2 Harrisburg...... 75,917 ...... 1 2 Hasleton...... 32,277 ...... 2 I ... Jeannette...... 10,627 ...... i Johnstown...... 67'327 ...... 3 53 150 ...... 5 .... McKeeaport. 2 Lacatler...... 45,975 ...... 2 2 ...i MoKees Rcs 16,713 ...... 6 1 MWahanoy c:ity...... 15,599 ...... 1 ...... Meadville ...... 14,568 ...... *2 .... Nanticoke...... 22,614 ...... 3 ...i NewCtle...... 44,938 ...... New Kensington...... 11,027 ...... Norristown...... 32,319 ...... North Braddock ...... 14,928 ...... Oil City...... 21,274 ...... 1 i. 2 i 1...... 10,236 ...... Ph^...... 1 1,823,158 449 62 ...... 4 95) Pho ile .I ...... 10,4'1A 1 ...h. Pittsburgh ...... 588,102......

Pittston ...... 18,497 ...... 2i...... I Plymouth...... - 16,50O ...... 2, ......

Pottstowm...... 17, 431 ...... 3, Pottsville ...... 21,876 ...... 3, I...... Pu ta wney...... 10,311

ng...... 107,784 ...... 3 137,783 ...... 4. I...... 3 ' B a o...... 21,24 1. .... 1 Stetn...... 13,428 i. b...... 10,'08 ...... liamaqua...... 12,363 3 U...... 15,692 3 1 Warren...... 14,256 ...... 5 I Wanton...... 21,480 3 1 West Chester ...... 11,717 ...... 2 Wlkes-Barre...... 73,833. 2 Wilk ag ...... 24.403. 2 ...... Williamsport...... 36,198. I Woo t...... 12,495 1 ...... York...... 47,512 C ...... Rhode Idand: C nItn...... 29,407 ,...... l I ...... , ...... Rag Providence ( )..... 21,70 ...... Newrport...... 30 255 ...... :.... 4...... Pawtucket...... 64.248 18 ...... 2 ' i ...... Providece...... 237,595 63 13 ...... i'.. 2 ...... 5 South Carolina: Charleston...... 67,957 25 7 ...... 3.. Columbia...... 37,524 ...... 5 ...... 3053 rDecember 9, 1921. CITY REPORTS FOR WEEK ENDED NOV. 19, 1921-Continued. DIPHTHERIA, MEASLES, SCARLET FEVER, AND TUBERCULOSIS-Continued.

Diphtheria. Measles. Scarlet Tuber- fever. culosis. City. ary 1, 192, from.f su ectto an * .." . correctin. Omuan. I

Bouth Dakota: I I Sioux Falls... 2, 176 1.... 1 1 ...... Tennessee: Chattanooga...... 57,885 .....i.. 6 5 ...... *.....i 162,251 22 ..... Nashville...... 118,342 52 14 -III...1 4 ...... 2 3 Abln ...... 52 6 AbC ...... 10 274 I8 ...... 2 ...... 12 .i .. .0 ...... 40,422 4 ...... DatM4s ...._...... i1 10,522 3 ...... 1, ...... i 158,975 43 ...... El pao...... 77,543 28 10 ...... 16 ...... 9 ...... Fort Worth ...... -- 106,482 26 2 ...... 1 Galveston...... 44.255 15 I ...... Houston...... 138,076 40 21 16, ...... 1 Waco...... 38,500 16 1 ...... Utah: Salt LA*e Cty...... 118,110 21 3 ...... Vtermont: ...... 1 Barre ...... F 4 ...... 12 Burington...... 22,779 2 ..... Rutland...... 14,95 s ...... 1 1 Virgiia: ...... 1 Alexand ia...... 18 060 3 ...... 1 ...... Danville...... 3 ...... 10ii 2 ...... 1 Lynchburg...... 296 9 7 ...... 1 ...... 115,777 14 ...... 3 ..... 1 ...I..... 2 ...... 1 ...... Potmouth...... 54387 15 3 .... i.. 4 ...... 2 Rielund...... 171,67 32 2 9 ...... 1 ILoanoke I ...... 50,842 13 17 6 ...... 2 1 315,652 ...... 7 I 5 ...... 6 ai...... 10#,4,7 I...... 12 ...... 96,965 ...... 3 1 .b...... Wdla Wa. 3 ...... 1 ...6 Yakima...... 18,539 ...... Weslatirle.. 15,2 2 8 ...... Bluesvldl...... 39,0 ...... t7 5 Fairmoh ...... 17,851 ...... 60,17 2 2 ...... Xug...... 12,515 2 1 ...... *...... 2 Morat...... 12,127 ...... Moun sile...... 10,669 .4.. 1 ...... Parkersburg ...... 20,060 5 2 ...... i 9 54,322 15 6...... WiscMion ...... 4 Appnetono...... 19,561 ...... 2 .. Asnud ...... 11,334 1 ...... 4 21,184 '- ...... i...... 3 2Q88D0 ...... I...1 4 ...... I Mendau we...... - 23,42? -...... Green syPi.. 31,84 -26 "'i' 2 ie,m ...... l...... 48472 -z ...... Kemoshr...... _ __ ...... la loo ...... - 6 .6 *. I 1 ....i. Myig...... 38 378 ...... W 17 3 Mah toyoen...... 17,563 ...... Marinette ...... 13,610 W 1 MUwaukee...... 457 147 ...... 50 17 Oghkosh...... 16 3 1 ...... Racine ...... u 12 24 ...... Sheboygan...... 13,955 ...... 6 ...... 0 StevensPoili ...... 11,371 1 *. ..abi.4bbb;6%..4 17 ....1616 2 wu...... 1061 ...... I ...... I ......

Cheyemne...... 13,829 I . - ...... FOREIGN AND INSULAR.

CHOLERA ON VESEL. Stehp " C"-Meda, S tra-From Chin During the week ended October 6, 1921, 12 cases of cholera with 4 deaths were reported at-Medan, Sumatra, occurring in Chinese amved on the steamship van Cloon from ports in China. AUSRALIA. Plague-Sydney. During the period November 30 to December 5, 1921, two cases of plague with one death were reported at Sydney, Australia. AZORES. Plague-Fayal - St. Michael. Plague continues to be reported on the island of St. Michael, Azores. During the three weeks ended November 12, 1921, 24 cases with 18 deaths were reported at Ribeira Grande, a locality situated about nine miles from the port of Ponta Delgada. A total of 63 cases with 30 deaths, all occurring at localities in the vicinity of Ponta Delgada, has been reported for St. Michael Island from August 6 to November 12, 1921. During the week ended September 10, one case was reported at Horta, island of Fayal. BERMUDA. Measles epidemic. An increase in the number of cases of measles was reported in Bermuda during the three weeks ended October 29, 1921, 47 cases being reported for the week ended October 15, 1921, and 70 for the week ended October 22, 1921. On October 29 the disease was de- clared epidemic.-

Epidemic Smaflp.x-Corael-Lota. Epidemic smallpox was reported present in the ining towns of Coronel and Lota, in the nvcinity of Concepcion, Chile, during the two weeks ended October 16, 1921. (3054) 3055 Decemb-r 9, 1921. CUBA. Commuicable Dleases-Habana-Provlnces. Communicable diseases have been notified in Cuba as follows: Habana. NOVEMBER 1-10, 1921.

Remain- New Disease. Deaths. dertreat.ment Nov.1921.10,

...... 1 2 IcteChickenpox.s,grave...... 1 . '2. 21 Leprosy ...... 11 l l...... 2 ...... 4 '42 mlpox.1j ..... I ' 1 Fyphoid feer...... lo .3 29

' From abroad, 1. 4 From theinterior, 1. 2 From abroad. 6 From the interior, 19; from abroad, 2. I From the interior, 29; from abroad, 3. NOVEMBER 11-20, 1921.

Diphtheria ...... 1 1 Icteru , grave...... I ...... Malai...... 39...... 1 25211 Smapx...... Z 21 Typhoidfever ...... ' '.4: ' ' ' ''.'.'.'...... 4.2.. 'From the interior, 1. 5 From the interior, 1. 'From the interior, 31; from abroad, 4. 4 From the interior, 18; from abroad, 3. Provincas.

New cases reported, Nov. 1-10, 1921.

Province. . .0~~~~~~~~-.

Camaguey .. ...22..... 70...... Habana ...... 1 24I 2 2 1 17 Matans..as..1...... I 2 Oriente...... 2...... 2 ... 1 210 4 1...... 97 Pinar del Rio ...... 1 15 ...... 4 SantaClara ...... 7 .... 5 411 4, 6 6

Totl . 1 3 8 3 276 5 10 4j 41 174 36

HAM. Denge-Port an Prince.' Dengue continued to be reported unusually prevalent at Port au Pinfe, Haiti, from September 25 to November 12, 1921. .j pboli Halth Repors, Oct. 14,1921, p. 2577. 76416° 21--3 )ecember 9,192L 3056 JAMACA. Infectious Diseae or KaUr Po). New cases of alastrim or Kaflir pox in the island of Jam'iica have been reported as follows: Week ended November 5, 1921, 68 new cases; week ended November 12, 1921, 17 new cases. Typhoid Fee- and Vicinity. Typhoid fever has been reported in Kingston and vcinity as follows: Week ended November 5, 1921, Kingston, 3 cases, sur. rounding country, 23 cases; week ended November 12, 1921, Kings- ton, 2 cases, surrounding country, 27 cases. JAVA. Plaue-September, 1921. Plague was reported present in the six eastern provinces of Java during the month of September, 1921. MEXICO. Plague-Infected Rodents -Tampico. Five plague-infected rodents were reported found at Tampico, Mexico, during the period November 20 to 26, 1921, making a total of 308 infected rodents found at that place from January 1 to Novem- ber 26, 1921. PERU. Plau-October 3-1 1921. During the two-week period ended October 15, 1921, there were reported in Peru 22 cases of plague with 13 deaths, occurring in the following-named Departments: Ancachs, ArequiRa, Cajamarca, Cal- lao-Lima, Lambayeque, Libertad, and Piura.

CHOLEIRA PLAGUE, SMALLPOX, TYPHUS FEVER AND YELLOW FEVER, Reports Received Dwing Week Ended Dec. 9, 1921.1

Pace. Date. Cases Deaths. ..

Indi ...... 21t. 3, ip: Deaths, Calutta ...... Sept...... 8....2.1..14 Rangoon...... 1...... 1 lavia:aEast Java- ...... 25-Oct. 1.... 2 Philipa=eds Sept...... Oct. 9-15...... 4 . .. Sumatra: Medan .. Sept. 20-Oct.6....O 12 4 Chinese arrivg on board v. On vesd: Steamship van C''. Sept.20...... -t 12 AIt men

aFrom medal offmcers of the Publi Het Servie Ameian consws, and tbreu 3057 December 9, 1921. CHOLERA, PLGUE, SMALLPOX, TYPHUS FE AND YELLOW FEVER- Continued. Repors Reeived During Week Ended Dec. 9, 1921-Continued. * ; PLAGUJI

Plac. Date. Cases. Deaths. Remarks.

Australia: - Sydey...... Nov. 30-Dec. 5.... 2 1 Azores: St. Michael Island- Ribeira Grande...... Oct. 23-Nov. 12... 24 18 Ceylon: Colombo...... Oct. 9-15 ...... 1 One plague rodent. China: Amoy.. Oct. 18-22...... Present. Also rodent plague. Egy t ...... Jan. I-Nov. 3, 1921: Cases, 322; Citiyes- deaths, 136. Alexandria ...... Oct.21-31 ...... 3 1 Sues ...... Oct. 21-Nov. 3.... 5 1 India: Karachi ...... Oct. 16-22 ...... 1 1 Madras Preidency...... Oct. 16-22... . 199 121 Rangoon...... Oct.915 .... 16 14 Java .p. 1...... -...... S ept.13,1921: Reported pres ent inthe sixeastem Proviaccs. Mtesopotai: Sept. 1-30 1 1 Bagdad ...... Mexico: Tampico ...... Nov. 20-26, 1921: Fiveplague-infected rodents founa. Peru ...... Oct. 3-15,1921: Cases,22; deaths, Callao ..... Sept. 1-30 ...... 4 13; occurring in department,s as follows: Ancachs, Arequspa, Cajamarca, CallaoLima Lam- bayeque, Libertad, and iiura. Turkcey: Constantinople ...... Oct. 16-22...... 1 1 July 24-0, 1921: One case; omitted from previous reports.

SMALLPOX.

Brazil: Sao Paulo...... Sept. 26-Oct. 22...I...... 3 Canada: New Brunswick- Charlotte County. Nov. 13-19...... 1 ...... St. Stephen...... Nov. 20-26...... 4 ...... Madawaska County.... Nov. 13-19...... 6 ...... Ontario- Montreal...... Nov. 2D-26...... I I...... Ottawa...... 6 ...... Saskatchewan- Regina...... Oct. 16-22...... 1 Chile: Antagasta...... Sept. 18-24...... 5 Concepcion...... Oct. 3-15...... 3 Coronel...... do. 40 Mining town. Epidemic. Lot...... Oct. 9-15...... Do. Tacahuano...... Oct. 9-5. Valparalso...... Oct. 2-...... China: Amoy...... Oct. 16-22...... I...... Present. Mandiuria- Harbin...... Oct. 17-23. 1 Mukden.. Oct. 24-29...... Do. Nanking...... Oct. 16-22...... Do. Cuba...... Nov. 1-10, 1910: New cases, 174. Antifla...... Novr. 1319..... Province- Camaguey...... Nov. 1-10...... 70 Babana...... 1 Oriente...... 99 Santa Clara...... o...... 4 Dominican Republic: San Pedro de Maors...... Oct. 30-Nov. 12... 7 1 . 4oD_m~o...... Oet. 20-Nov. 14... 68 ...... 1. In surrounding country. 1 N tt m...... Oct. 9-Nov. 5. 5 ...... Tndifi: Calcatta...... Sept. 25-Oct. 1...' 2 Madr...... Oct. 16-22...... 5 December 9, 1921. - 3068 CHOLERFLAGUI, SMALLPOX, YPSER AN!) YIE0WE Continued. Repwot ReOived Durin Week Ended Dec. 9J 1921-Continued. SMAlLPX-ot3ned

Place. Date. Case Deaths. Remarks.

Java: West Java Buitenzorg...... Oct 7-13...... 12 Mr. Cornes ...... do...... 53 Pandeglang ...... do .1 3 Tangerang ...... d ...... 1 6 Portugal: Lisbon...... Oct. 1-29.8 2 Portuguese East Africa: Lourenco Marques...... Oct.28 ...... 1 . Spain: Barcelona ...... Oct. 226.0-...... 1 Straits Settlements: Singapore ...... Oct. 2-8 .... 211 Tunis: Tunis ..... bOct. 29-Nov. 4....1 Constantinople ...... Oct. 23-29 ...... 3 UJnion of South Afr*--a: Cape Provines ...... Oct. 2-15 ...... Outbreaks. Natal ...... do ...... Do. Buthern Rhodesia...... Oct. 6-12.21 3 Transvaal ..... Oct. 2-15...... Do. Jo.annesburg. Sept. 1-3 ... 14 .

TYPHUS rEVER

Algria:,g ...... Oct. 21-31 ...... 1....

Smyrna ...... Oct. 23-29 ...... 2 ...... District. Chile: Concepclon ...... Oct. 3-16...... 3 Coronel ...... do...... Prsent. Talcahuano ...... Oct. 9-15.....1. 1. lesMesappaama:a 1-30. 3 S...... Sept...... Turey: Constantinople ...... Oct. 16-28 ..... 13 . Union of South Afica: Natal . Oct.28....4...... Do. Ornge Free State ...... do ...... Do.

YELOW FEVER.

Mexico: Cordoba ...... Oct.2-8 ...... 1 .. StateofVeaCr. Cuian .do .I...... State of Sinaloa. Ga daajraOct. 1-31 ...... 1 1 State of Jalisco. Gutierrez Zamora. Oct. 2-8 ...... 1 .. State of Vea Crus. In vicinity, at Seata Roa ran; 2 ses.

Reports Received from July 2 to De. 2,1921. CHOLEA

Place. Date. Cases. Deaths. j Rarkm

China: Amoy...... July 3-Set. 10...... Honlgkong ...... Aug. ?2-pt.Dt 24... 11 Au. 3. Shanga...... Aug. 1-Oct. 8..... Inn ease, Aug. Swatow...... Aug. 14-20...... 1 1-c. 16, 1 : ~s ei Germany: 1 Chne, 149; _ ily East rrussla- veried K5nisberg...... Oct. 0.. S 3059 December 9, 1921.

CHOLER, PLAGUE,SMALLPOXTYPHU FEVER, AND YELLOW Continued. FEVER- Reports Received from July 2 to Dec. 2, 1921-Continued. CHOLERA-Continued.

Plac". Date. Cases; Death:S. Remarks.

- .~~~~~~~~~~~~~

Inia...... i...... Mar. 6-June 25, 1921: Deaths Bombay...... May 1-June 18.... 75,281. July 3-30, 1921: Deaths, Do...... June 26-Sept. 24.. .78 49 46,999. Aug. 14-20, 1921: Calcutta...... May 8-June 25.... 597 521 Deaths, 19,033. Aug. 31-Sept. Do...... June 26-ept. 24.. 182 158 13,1921: Deaths, 46,051. Karachi ...... July 10-Oct. 8..... 153 137 adras...... May 15-June 25... _3 2 Do...... June 26-Oct. 15.. . 14 6 18 Ran g.oon..... Apr. 24-June 25... 17 lDo ...... June 26-Oct. 1.... 22 15 Indo China...... Jan. 1-31 1921: Cases, 80; deaths, City- 15. iMay 29-June 12, 1921: Cholon...... Juno 6-12...... 4 Cases, 251;- deaths, 202. Saigon...... May 9-June 12.... 65 44 Do...... July 4-Sept. 17.... 105 96 Disseminated in neighboring Province- Provinces. Anam...... Jan. 1-31. 42 ...... In January, 1920: No cases. Cambodia...... do. 8 January, 1920: Cases, 27; deaths, 14.

Cochin-China...... do. 18 4 January, 1920: Cases, 13; deaths, 10. Tonkin...... :: ....do..... 12 January, 1920: No eases. Java: West Java- Lebak ...... Sept. 9-Oct. 6..... 18 14 Phili pneIs:ands: .4 22fal...... May 22-June 25...... Do...... July 3-Oct. 8..... 43 5 Province- Batangas...... June 12-18...... 2 Do...... July 3-23...... 7 Cavite...... July 10-Aug. 6.... 2 Cebu...... June 26July 2.... 1 3.... . Lagna...... June 1925. 1 Do...... July 3-9...... 1 Mindoro...... June 12-18...... 1 Pampanga...... June 511. 1 ...... Tarlsc...... June 19-25...... 1 Union...... June 26-Aug. 13... 3 Poland...... ---- I. Apr. 24-June 18, 1921: Cases, 5; deaths, 1. Baranowieze...... Aug. 18...... Present. Bialystok...... July 25...... **...... Do. Pnsk...... do...... Do. Russia...... - -.. Jan. 1-Aug. 10, 1921: Cases, Districts- ...... 78,011. City of Moscow, cases, Astrakan...... Jan. 1-Aug. 10..... 5,132 289. Black Sea...... do. 3, 152 . *...... From Jan. 1 to July 13, 1921: cases in Kazan...... Jan. 1-July 13..... 434 ...... 1718 reported Kuban Kharkov...... do 257 ...... 1lerritory. Kursk...... Jan. 1-Aug. 10."" 1,227 ...... Moscow...... Jan. 1-July 13... 296 ...... City, 192 cases. Orel...... Jan. 1-Aug. 10..:: 1,968 ...... Rjasan ...... Jan. 1-July 13..... 129 ...... Samara...... Jan. 1-Aug. 10..... 5,315 ...... Saratov...... do. 7,201 ...... Simbirsk ...... do...... Tambov...... do. 21:56'1 ...... Tzarityn...... do. 3,028 ...... UfaI ...... do 5,196 Voroneh ...... dz 3,621 ...... Petrograd...... July 6...... 1O8 Bbspdr...... Jan. 1-Aug. 10.... 1,038 Kigh.z...... do. 5,687 TaI ar...... do. 1,178 TchuvoD...... do. 233 Rostovr on-Don...... June 1...... 747 Present on Orenburg-Tashkent line, and at Cheljabinsk, Perm, Petropaviosk, Ufa, and in Smolensk and Vitebsk districts during period under report, Decmber 9,1921. 3060 C A, AGUEZ,SMLLPOX, TPHrUSPFEVERI AN YELOW FEVE-. Continued. Repw_s Receied from-ly 2 6* Dc. 2, 1921-Continued. CKOLERa-Cntlnue&

Place. -Date. Cases. Deaths.

Russia-Continued. Sib...... June 1...... 1,2B ...... Far Eastern Republo. Territories- aerbeida...... Jan. 1-Aug. 10 .....614 . D o ...... -. do . 2,006 ...... Turkwtan ...... do.... 5,5 .S8 ...... Ino Ukraine do . Vy prvent; ports Siam: ~~~~pletes Ban.gkokDok....::::,:::::: : JuneApr.26-Sept.24-Junell17...1... 7 24 Straits Settlements: . Singapore...... June 12-18...... 1 1

PLAGUZ.

Algeria...... July 1-31, 1921: Cases, 166; Ia Aug. I-Oct. 10.... .1 Aumled t.- Aumale district...... May 31-July 3..... 71 22 Native district about 140 kilo. Dotarllegnine...... May 31-Aug. 24... .97 metemairm Algier.' Oran...... Sept. 20-Qet. 20... 2 Asia Minor: June 19-25. 1 .....Diri Do...... July 3-Oct. 22.... 5 ...... I ..Do. Australia: New South Wales- Sydney...... Sept. 11-Oct.8....I...... plagueinfectecraft found w 1 from ve sel lbor Brisbane. 80P,t. 19-Oct. 5,1921: 17 p r found in quarantinearee. Oct.26-Nov. 1921: 2 rats ound at distane wbar. Queensland ...... I Sept. 17-24.... Pagrats fonmd, 28. Brisbane..... Aug.23 ...... - i' Employee in produce store. Kelvin Grove . I ep$. 2)... 1'''1 Oice cleaner at Brisbane; 1 plauerat. Townsvl.s. S.ept.21 ...... I. 2 plagues-L kEnd... Azores. Fayal Island- Herta...... Sept. 4-10...... 1 St. Midhael Island...... Oct. 2-22,1921: Cases,25 deaths; Aug. -12. 13. in. .knt -of }idrande. Aug. 8. 38 12 Pont at Degdm Ri- 8-Oct. Santo Brazil: Babia...... May 15-June 18. .. 3 3 Do...... July 31-OcL 1. 4 3 Ma ns...... June28...... 1 Pernambuco ...... -- Aug. 22-28...... 1 I PXo ...... Locality 200 miles wet of Bahia rbgeprtdepormi dur An uust, with 60 deaths. Sept. I-2. kpidemic. Villa Nova...... £ept. 11-Oct ...... I...... Epidemic. Britisn East Africa: Kenya Colonyw- Kisumu...... Apr. 2May. .... Present. Do...... June 25-Sept 1. ...I ... Present in vicinity.. Uganda...... Idar. I-June 30...... 133I..F101 Reports of natWe oia show 2,7)9 deaths durig same pe-

Do . I July 1-31. 41 Reportsofinspecta, &"ths,230 rep ol,d, 1, Cape Verde Islads: Y_.Vjmt...... Aug. 1218. 6' CeY-: ..I May 8-June i1.... 2 CD .. June 26-Oct. 1.... 7 June 25-Oct. 8, 1921: Plaguerat 10.

Antofagata. . Oct. 23-29, 1921: 1 plague ra Iquique.....::::::::::::::: Sept..ept...... 17....::::I.i...... found. 3061 December9, 19' 1. ZCHOLIUA PAGUE, SMALLPOX, TPHUS FEVEIR, AND YELLOW FEVER- Continued. ReportsgReeived from July 2 to Dec. 2, 1921-Continued. PLAGUE-Continued.

Place. Date. Casesa. Deaths. Remarks.

China: Amoy May.15-June 25.... 7 2. D . .July 3-Oct. 15 42 Sept. 11-Oct. 15: Present; also ...... rodent plague. Foochow. May 15-21...... i...... Present. Hosuong..:...... Apr. 21-June 25... 59 May 1-7, 1921: Plague rats found. Do...... June 28-Oct. 1..... 41 30 Macurha- Harbin...... May 3-22...... 46 Ecuador: May 1-June 15..... 10 1 July 30... 9 4 P1aue rats found: Aug. I-Sept. Eget...... 16-Sept. 30,1921,133. Egypt...... Jan. 1-Oct. 20, 1921: Cases, 312; * Do...... deaths, 131. Alendri...... May 21-June 24.... 10 3 Do...... July 1-Oct. 20..... 52 13 Port Bald...... June 16-27...... 4 2 * Do. July I-Sept. 30.... 18 7 May 20-June 30. .. 9 5 Do...... July 1-Oct. 19..... 8 6 Province- Assiout ...... May 21June 16.... 9 7 Do...... July 30...... 1 ...... BeniSouef....; July10...... 1 ...... Gharbieh...... June 2-25...... 7 ...... Do ...... July 9Sept. 1. 9 ...... airgeh. July 6-13...... 5 Minieh...... May 28-JUne 10... 2 1 Do...... July 13-Aug. 18... 7 3 Grewe: Iireua...... Sept.23....' 3 Hawaii: Honokaa...... Plague found Sept. 8, 1921. July 15-19...... ji' rat May 21...... 1 ...... India...Paa...u...... , ...... May 1-June 25, 1921:.Cases, 2,093; Bombay. May 1-June 25.... 201 deaths, 1,624. June 26-Sept. 3, -Do. June 26-Oct. 1..... 82 58 1921: Cases, 3,570; deaths, 2,572. Calcutta.... May 8June 18.... 11 11 Do...... July 21-Aug. 6.... 23 21 Central Provines.. Aug. 14-20...... 27 16 K wchi...... May 8June 25.... 18 14 Do...... June 26-Oct. 1..... 5 5 Madras...... Aug. 20-27...... 1 1 Madras Presdeney...... May 22-June 25. .. 112 72 Do...... June 26-Cct. 15.... 1,518 999 Ran.--...... Apr. 21June 25... 162 142 Do...... June 26-Oct. 8..... 550 473 ...... 1. Jan. 1-31, 1921: Cases, 57; deaths, Indo-China.....galgon...... May 23-June 12. .. 51. Do...... July 10-Oct. 1..... 23 16 Isolated cases in vicinity of Sai- gon. Sept. 11-24: Plague rats found, 4. Catania;, .. Oct. 21 1 ..... Naples.J...... 8pt. 4-Oct. 7 5 ...... 2 were workers in mill; plague- infected rat found on premises. Java: East Java- Surabaya...... July 10-ifept. 24... 16 14 -Wagasw Tananarive. June 20-July 24. .. 49 46 Pneumonia. Mauritius: Port Lous.. Aug. 24...... Present. TMesrtaamia. Apr. 1-May 31. 32 35 Do. o July 1-31...... 1 1 Mexico: Ciudad Victoria. June 7...... 1 In £tate of Tamaullpas. Case confirmed June 20, 1921. Progreso...... 1. Plague rat reported found Eept. June 11-0. 10, 1921. . .. July 1-Aug.21...21.... 21 Infected rodents found July 1- Nov. 19, 1921, 192. Total, Jan. 1 to Nov. 19, 1921, 301. Deember 9, 1921i. 3062 CHOLERA. PAGUE, SMALIPXv TVPHU ?E Z ADA ELlOWW Comtinued. eptos Recived frm July 2 b Dec. 2 lI-Contiamed PLAAeUJ-4oQtlnue

ac Date. Caml. D1 ths. Remars

Morocco: Spanish Zone. Repoted In epidemic form Sep. 9,"U't1921. Peru ...... I...... I....-.... Mar. 1-Apr. 30, 1921: Cases, 119; deaths, 4. June 1-2 1921' Caes, 4; deaths, 10. Jly-1, 1 Cses, 9; d 3. Sept. 1-30, 1921: Casea,6; , . Department- Ancachs...... Apr. 1-0...... 4 1 AtHuarmey. Areguipn...... Mar. 1-Apr. 30.. 5 3 At Molendo. O...... -.-.- July 1-15...... 2 ...... I. DO. Cajamarca...... Espt. 1-30...... I Preet. At BAmbamarca Ca3n m , and other . Callao.. ... Mar. 1-June 30.... 16 1 At Callao. Do...... July 1-Sept. 30O... 6 3 DO. Lambayequc...... Mar. 1-Apr. 30.... 3 2 At Chiclayo. Do. Sept. 1-30...... 2 ...... Do. LibertadDo ...... Mar. I-June 15.... 31 In5iocalities Do...... Sept. 1-30. 3 ...... At San Per Lima...... Mar. 1-June30.... 43 At Lima City: Cas, 28; deaths, 1& Do...... Julyl 1-Sept. 15.... 4 3 At Lima City. Do...... Sept. 1-30 ...... 16 4 At Huacho: Cases, 9; deaths, 1. ima City: Cas,s 2: deaths, 1. Country: Cas, 5;eah, 2. Piura .Ma. 1-June 15.... 31 29 In 4 lo alties. Do . Sept. 1-15. 19 15 Death securred at Sediur. Do. Sept.1-30. 17 At2echua. Poland...... - ...... In bwde provfice, Aug. 9, 192: Cases S'

Porto ...... Total I od rets found RicoI...... from begnning of outbrk tl July 9, Q1.92, 90.. Caguas ...I Aug. 7-20. 4 2 Sept. 42, 1921: To plge Fjrdo...... _ A.ug.28-,Sept.3, 1921: Oneplegue. Wwiseted tfound. Man ...... Ju 17-23 I 1 Martin Pena ...... July 3-9......

San Juan...... Sept.9, 1921. Portugal: 16 Lisbon...... July 29-Sept. 3.... Portuguese West Afriea: Angola- I ...... Loanda...... Apr. 24-June 18... Firt aseocurdAr 011 De ...... July 17-23...._.. Rhodes (Island)...... Sept. 20-Oct. 8.... 1 fata case caported late in

Russia: ...... Sil-eria- Vladivostok ...... Apr. 1-June30.... 252 Do...... July 1-31...... 4

.Dakar...... Mav 1-June 30.... 54 47 Do...... Julj 1-Aug. 31.... 117 .93 Siam: Bangkok ...... Apr. 24-June1 ... 7 lJO...... July 24-Sept. 3.... 16 12 Straits Settlements: 16 Sinapore...... May 8June 18.... 5 mo June 20-Set.24... 8 ,6 Syria: ...... Alexandretta...... July 10-Aug. 6.... 4 Beirt...... May 31-June30 ... 2 4 Do...... July 1-Oct. 8..... 24 ...... Tuirkey: Con..a...... July l-Oct. 15.... 6 Uno otl&t Afr...... ^.... J...ary-Aprl,_1011: Osses tietve, 2;det,. Occur. 1tlng th Oanfr State" 3063 December , 1021. COLEA AGE,S PX TYPHUS FEVER, AND YELLOW FEVER- Oontinued. Reports Revd frm July 2 to Dec. 2, 1921-Continued. PLAGUE Continue.

PIWODt. Cases. Deaths. Remarks.

On vessels...... Plague rats reprted, .e$. 21, 1921, on vesls from Brisbane, Australia, at Sydney and other

Steamship Kishonev...... May.2 ...... A foo, China. Plague death en route. Vessel sent to quar. antine, entuckylIsad,where to hay 6 a total of 16 deaths was reported. (Publie Health Re ,Jly1, 1921, p. 1534.) Steamship Oreland . . . At Genoa, Itliy, June 12, 1921; from La Argentina. Two fatal aesPlattplague in crew en route. Steamship Ralph Moller... June 8.4 1 At Cbefoo, China from Vladivos- tok, Siberia. Three fatal cases en route. One case with fatal termination removd at V'ladi- vostok. Steamship San Lulis ...... Sept. 9 ...... -..... In harbor, San Juan, Porto Rico, Sept. 9, 1921: 1 plague rat. Steamship Tenyo 31rn.... En route between Nagasakand Kobe, Japan, June 28, 1921: 1 fatal case.

SMALLPOX.

...... July 1-41, 1921: Cases, 156. Depanmet-- Alg...... May 1-June 30'.'.. 3 Do...... July 1-31...... 153 Constantine...... -..do ...... 2 Oran...... do. 1 Sept. 1-10: One case. Asia Minor: Smyrna .... May 22-28 ...... 1 On the steamship Nicholas. Do...... July 8..... 2 DistncL Australia: 24-Oct. Victoria- (leelong...... May 5-16...... 2 ...... Mild. Do...... July 12-29...... 2 Melbourne...... Apr. 923...... 4 Mild4pidemuc- Do...... Juy 17-23...... 1 1 Bolivia: Slight epidemic reported. La Paz ...... Apr. 1-30...... 5 4 Brazil: Bahia ...... Sept. 25-Oct. 1... a 2 Pernambuwco...... Mar. 28-May 22.... 28 Rio de Janeiro...... May 8-June 18.... 11 2 ...... June 26-Oct. 22.... 13 52 Sao Paulo...... May 23-June26... 7 2 Do...... June 27-Sept. 25... 16 2 British East Africa: Ken-a Colony- ...... zanzzar...... May 8-14.... 12 Origin, India. Do. Aug. 1-31...... 14 -6 Districts and towns Bulgra:. ons...... s May 15-31...... ,6 Canada: Alberta- Calgy...... May 26-June 18... 3 Bntish Columbia- Vancouver...... May 28-June 25.: ...... De.._...... Oct.30-Nov. 5.... Winipeg...... do . 6 Do...... June28-Oct. 3.... New Brunswk- ...... Charlotte County...... July 10-Nov. 5.... 12 Aug. 7-Nov.I2... 8 Restigouch ounty.... 1 WetmoelandCounty.... Juie 19-25...... t.8 p...... OcL 23-Nov. S.... 3 Jam 26July 2... 2 Nova Scotiay Sydney...... June 518. 2 Do...... June 26-July 2.... December 9, 1921. 3064

CHOLERA, PLAGUE,- SMALLPOX, TYPHUS FEVER; AND YELLOW FEVER- Continued. Reports Received from July 2 to Dec. 2, 92-CoDtinued.. SMALLPOX-Continued.

Place. Date.. Cases. Deaths. T Remarb.

Canada-Continued. ODt4rio- Cornwall...... Nov. 15-21...... 14 ...... Fort William and Port Aug. 7-27...... 2 ...... Arthur. Do...... Oct. 16-22...... 2 ...... Hamilton...... June 12-18...... 3 ...... Do. July 3-9...... ,1 ...... Kingaton. JuneS-1...... At 2localities in vicinity, 2 cases. Lonfon ...... June 5-25...... 2 ...... Montreal...... June 12-18. .... 1 Do...... July 17-Oct. 29. ... 6 ...... North Bay...... --- June 12-25...... 3 ...... Do...... June 2BJuly 9. . .. 2 ...... Ottawa...... June 12-25...... 21 ...... Do...... June 2-Nov. 19. .. 42 Toronto...... Aug. 28-Nov. 5.... 4 ...... Baskatchewan- ...... Moose Jaw...... Sept. 4-Oct. 15.... 3 ...... Saskatoon...... Bept. 26-Oct. 17... 12 Chile: ...... Antofagasta..... May 16-June 19. .. 228 Arica...... May 31...... 2 Concepcion...... Sert. 5-19...... 3 ...... Reported present in Chillan and ...... Mulchen. Meillones...... May 30-June 5.... Present; also at interior nitrate Talcahuano...... Sept. 1-30...... 2 plants. Valpa so...... June 26-Oct. 21.... 49 China: Amoy...... May 8Jun 4...... 4 June S-25: Present. Do...... June 26-Oct. 8..... 3 Sept. 11-Oct. 15: Present. Antung...... May 16-June 26. .. 2 Canton .... Apr. 1- -.--. - ...... Present. Chg g...... May 1-June 25...... Do. Do.o -..-. June 26-Oct. 8.... Do. Foochow...... May 8-June 25.... 12 ...... Do. Do...... June 26-Oct. 15.... Do. Hankow...... May 15-21...... Do...... July 10-16...... Hongkong...... Apr. 24-June 25... 84 Do...... July 24-Aug. 2.... 1 MWanchuria- Dairen...... May 9June 26.... 44 5 Do...... June 27-Oct. 9. 9 3 arbin...... May 16-June 13... 5 ...... Do ...... June 27-July 10. . . 2 ...... May 22-June Duoden...... 11...... Present. July 3-Aug. 2D.. Do...... Do. Nanking...... M-ay8June 25...... -. Do. Do...... June 26-Oct. 15...., Do. Thanghin...... June 20-26...... In Intemational Settlement. Do...... July 3-Oct. &..... 6 Do. May 8-une 25.... 31 Tintsin...... 1 Mission hospital. Do...... June 26-Aug. 20... 9 .Tsingtau...... May 9-June 12.... 4 Do...... July 25-31 ...... Chosen (Korea): Chemulpo...... May 1-June30.... 3 usan ...... do...... 12 3 Gensan. do...... 5 2

eo ...... do...... 3- ...... Colombia: Santa Marta...... June 5-25...... 1 Present. Do...... June 26-Aug. 27... 7..... Do. Cuba . I... '7.. :: Oct. 11-20, 1921: Cas, 198. Oct. Antilla...... Juzne 5-25...... _. 1...... :"I.... 21-31, 1921: Cases, 214. Do ...... June 26-Nov. 12... 74 ...... cienfugos...... June 26-Sept. 3.... 3 .... Matanas...... June 12-18...... 1 1 Do...... July 3-31...... 4 2 Nuevitas...... July 4-Nov. 6..... 17 . 6 of thoso reported Ibmd in Preston...... Oct. 2-15...... 4 . vicinty. Fantiago...... June 1-30...... 28 2' Do...... Ju y 1-Oct. 31..... 00 I 1I . 3065 Decembr 9,1921.

RLRA, PLAGUE, SMALLPOX TYPH FEVER AND YELOW FEVER- Continued.

Reports Reeied om Ju 2 to Dec. 2, 11-Continued.

SMALLI'OX-Uaued.

-Plac D 6e. Deaths.

Dominican Republic ...... In easterri Provinces, Aug. 1921, 2,000 cases, astbnMed. La Ramona...... I Aug.25 I...... cam San Pedro de Macoris ...... Aug. 19-Oct 29... On supr estates in same Prov. ince, about 400 cases, Aug. 19- 2L 5M caw in the Dkstriet of Maeoris 50 of which weme witwn city Rmiits. Santo Domingo...... Sept. 1-Oct. 19... 34 Prasent in surrotmding country. Ecuador...... Eloy Albro...... Aug. 1-15...... 1 Guapaquil...... May -June30...- 31 Djo...... July 1-Oct. 15..... 32 1 Egypt: Ciro...... Mar. 19-Apr. 29... 2 Port Said...... Apr. 2-May 20....- 10 ...... Finland...... may 1-15...... France: 18 I ...... Brest...t -. May Z2-June 4.. 1-3 Cherbourg...... Aug...... 'I I...... VarioW. pr&...... July 22-...... 2 1.. Rouen ...... May 1-29-n 4...... 2 ...... Apr. 24-May 28. 1921: Cafts, 12. Additional, Afpr. 17-M&Y 7s, 1921: C&ses, 57; doths, 7. Great Britain: Nottingham...... Br29-Jane 4., 1 Do...... Jly 3-4ept. 24.. 5S SbtW Aug. 17 to be eOdemic Queenstown...... July 3-.------1 and to hgve begun about 2 Southampton...... Jue26-July 2.. 1 mmths previous to date; 57 C&W reported - June 6-12...... 1 Haiti: Cape Haitien...... June 19-25...... 2 Do ...... June 2Oct. 22.... 226 so Port au Prince...... Sept U-Oct. 29...... Present. India ...... Mar. 2o,-may 21, int: Deathsj Bombay...... May 1-June25...... ;'i. 3,232, Jum f-23, IVA: Do ..... June 26-Oct. 1.... 45 9A July .3-9, IVA: Deaths, Calcutta...... May 4June 25... 8 8 Ady 24-ao, iggi, iis deaths. Do...... June 26-aept. 10.. 9 7 Aug. L4-2% ign: Deaths, W i W...... May 29-June 25... 25 17 June 26-July 30. 8 2 Udo...... May 8-June 25.... 33 11 DeDe...... June 26-Oct. 15"... 98 49 ..o...... Apr. 2-Jue 4.... 29 3 Be...... July 0-Au. 13.. 1 Indo.China...... jag. 1-gi, ign; Cases, 102; de-athss May 9-15...... 2 1 Do...... Aug. 21-Sept. 24.. 2 2 Province- 85 A ...... Jan. 1-31...... i. 19W. CAm,16; deaths,& Canbedis...... Vambedin ....do...... 21 1929.- Cases, 139; deaths. 19 12 Igge: Cmes, g-, deaths 1. Tonkin 27 ...... 19V. Cwes, 224; dat-"

Italy: Catania...... pnvism juns .6-20, 1921: caw, 5. Do...... July 18-Ag. 14... In prorWr. Cmwj, 7. 11 Genoa...... Apr. 1-May 31.... Do...... Sy4-10...... 12 Messina..' May 23-Jun 26. 2 1MI: Do... 1"7 ...... 1 In pVOvjnW. jWy 4-179 I& U4e 21 ...... 7 cwes. 9. Paleru.o...... a...... Do...... Japan: Kobe...... May 24-June 26.. Naasaki...... May 23-Jun 26... 6 I Taiwa Island...... Juy 1-10..... - December 9, 1921. 3066

CHOLERA, PLAGUE, SMALLPOX, TYPHU FEVR, AND YLLOW FEVER- Continued.

Reports Received from Ju 2 to Dec. 2, 1921-Continued.

SMA XCotn d.

Place. Date. J Cases. Deaths. Remarks.

Java: East Java- Surabaya...... Junl925..... 2 Do...... July 10-Aug. 20... 10 i West Java- Bandoeng... May 27-June 3.... 1 Do...... July 8-21...... 1 Batavia...... May 8-June 23- .. 17 11 Do...... July 1-Oct. 6..... 110 II Buitenzorg...... Apr. 29-June 23... 18 Do...... Jul 22-Oct. 8.... 50 i Garoet...... May -12...... 1 ...... Do...... July 8-Aug. 4.... 4 ...... Krwang...... Apr. 29-June 30... 33 Do...... July 22-Sept. 22... 16 I Lebak...... Apr. 29-May 20... 12 I randeglang...... Jne 3-30...... 2 I DJo.,,,...... July 8-Oct. 8...... 1 Tangerang...... Sept. 18-Oct. 6.... 7 Poekaboemi ...... Sept. 9-15...... 1 Jugoslavia...... Mar. 14-May 13 1921: Cases, 334 deaths 83. tune 27-July 10; 19Q1: Cases, 111; deaths, 27. Mesopotamia: Bagdad...... Apr. 1-May 31..... 3 Do...... Aug. 1-31...... 20 4I Mexico: Chi hua...... May 23-June 27 ... I Do...... Oct. 3-30...... I Guadaara...... lune 1-30...... 3 ...... Do...... July 1-Sept. 30.... 13 Mexico City ...... May l1June 25 ... 246 ...... Including mumicipalities in Fed- 2 eral District. Do. June 20-Oct. 23.... 270 ...... Do. San Luis Potosi. July 17-Oct. 15...... 2. Tampico. July 1-20...... *.....

Torreon. Sept.1- 0...... 2 ...... i VemCruz.. June 13-19...... Do. July 1-Sept.11... Newfoundland: Tlton}. Aug. 20-20...... 3 Panama...... Jan. 1-Sept. 19, 1921: Cases 208, Canal Zone. Apr. 1-May 31..... of wbich 33 were nonreients. colon...... Jan. 31..... 111 Sept. 20-Oct. 30 1921: Cases, 3; 1-May 1 &o Taboga aIslld, 2 from ...... interior of Panama. Do. Aug. 30...... 1 ...... From the interior. Panama. Feb. 1-June 30... 54 ...... Sept. 419; 1 from interior. Do. July 1-ept. 19.... 4 ...... Poland...... Mar. 1-Apr.30,1921: Cases 1,117, District- deaths, 142. Apr. 24-May 21 Balystok.. Mar. 1-Apr. 30.... 3 ...... 1921: 6ases, 77; deaths 148. Cracovia ...... do. 56 6 May 22-June 18, 1921: 6ses: Kielc ...... do...... d 180 28 404; deaths 74. Juine 19July

Le m : ...... do..... 16 16, 1921: ases 334* deaths, Lod ...... do. 72 9 38; statistics for ilr"stLtoLvsL Lubhn ...... 397 30 Mlinsk, and Vina not includ Posez ...... 20 2 Silesi ...... do...... 10 ...... In Teschen. Stanislawow ...... do...... 30 Tarnopol ...... do...... 150 31 Warsaw ...... -3 4 Warsaw city. ...do...... go 13 Portugal: 30 Isbon.. May 15-June 25.... I...... 34 Do. June2B-Oct. 1..... 5 Oporto. June 19-25...... 1 ...... Do. Sept. 11-Oct. 29.. 8 ...... Portuguese East Lourenco May 8-28...... 8 ...... Do. July lo-ePt. 10... 14 4 Rumania.. Disrict- Hotin. Apr. 1-30. 40 -Orthel. Kar. 1-31.... 40 ...... 3067 Decmber 9, 19214

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER- Continued. Reports Received from July 2 to Dec. 2, 1921-Continued. SMALLPOX-Continued.

Place. Date. LCass.- Deaths. Remarks. Russia: Province- hin...... Apr. 1-June 30.... 11 Do...... July 1-Sept. 30.... 55

Latvia ..... Apr. i-May 31.... 41 Do ...... July 1-Aug. 31.... 38 . Siberia- Vladivostok. June 1-30...... Serbia ...... Mar. 24-May 21: Cases, 205; Belgrade...... Aug. 7-20. 2 l''''''''i. deaths, 41. Senegal: Dakar...... May 1-31...... 1 1 Spain: Barcelona...... May 12-June 22... 13 Do...... July 7-Oct. 19...... i 12 Huelva ...... July 1-Aug. 31.... 3 June 1-30...... l Do...... Aug. 1-31...... Malaga...... May 1-June 30...... ''''7'''i'57 Do...... July I-Aug. 31.... 57 Seville...... Oct. 19-Nov. 1...... I.. Tarragona...... May 9-15...... 21 1 Valencia .....- May 22-28. ,, ...... Do. July 2-Aug. 20.... 9 2 June 12-18. 1 ...... Singpore...... Do...... July 10-Oct. 1.. 1 Switzerland: Basel...... Sept. 11-Oct. 1.... 5 i...... Zurich...... May 28-June 11... 10 ...... Do...... July 3-Spt. 2..... 4 ...... Syria: Aleppo...... Apr. 9-16....,.-.. Present. 10-30 Beirut...... May ...... 1 Do...... Aug. 14. 1 Tuni: Tunis...... Mav 30-June 17... 2 3 Do...... July 2-Oct. 21..... 15 12 Turkey: Conistantinople...... June 12-25..... 5 ......

Do ...... -.-- June 26-Oct. 15... 12 Union of South Africa January - April, 1921: Cases ..l (white), 18; deaths, 1. Cases (native), 192; deaths, 5. May 1-31,1921: Cases,65; deaths,3, all natives. June 1-30, 1921: Cases, 64, of which I white. July 1-31, 1921: Natives- Cases, 129; deaths, 2. White- 1 case. Aug. 28-Sept. 3, out^ breaks in Cape Province, Orange Free State, and Trans- vaal. Aug. 1-31, 1921: Cases, 79; deaths, 1. Cape Province...... Apr. 24-June25...... Fresh outbreaks. Do...... July 1-Aug. 27.... 118 ...... Aug. 27-Sept. 27: Outbreaks. Natal...... Apr. 24-June 25...... Fresh outbreaks. Do...... July 1-Aug. 27...... Sept. 4-10: Outbreaks. Durban...... Aug. 7-27...... 3 ...... Stated to have been imported. Orange Free State...... May 29-June 25...... Outbreaks. Do...... Aug. 21-Sept. 17...... ii...... Present. Southern Rhodesia...... July 14-Aug. 31... 19 Transvaal...... May 22-June 18...... Do- Do...... July 1-31...... i...... Aug. 27-Sept. 17: Outbreaks. Johannesburg...... do. 2 Do...... Sept. 1-10...... 32 I...... District. On vsseL: Steamship Craster HalL.... Arrived Mobile, Ala., Oct. 8, 1921, from Buenos Aires, Rio de Janeiro, and Barbados. One case in crew removed at Barbados,-Sept. 28, 1921. Stoamship Montaro 1...... Aug. 31. At Batavia, Java, from Singa- pore, Aug. 27. Vessl pro- ceeded from Batavia to Fort Darwin and Townsville. Niagara ...... I June 1. At Sydney, Australia from Van- ewiver via Fiji and New Zea- land. a I - I - December 9, 192L 3068 CHOLERA, PLACGUED, SIMALI1X, AND YELLOW Continued.TVHUS:FbVER FEVEIR- Reports Reeelved from July 2 to Dec. 2, 1921-Continued. TYPHUS FZEVR.

Place. Date. Cases. Deaths. Remar.

a lge...... ia...... July 1-31,1921: Cases, 528. Department- A lg iers...... May 1-June 30.... 109 25 Do...... July 1-31...... 146 ...... Constantine...... do. 251 ...... Military Division...... do. 3 ...... Or...... M2ay22-June30.... 35 Do..D ...... July 1-31...... 39 ...... Oran (City)...... Oct. 11-31..... :. 2 Southern Territory..... July 1-31...... 89 1-- Asia Minor: Smyrna...... June 12-18..... 1 ...... In district. Do...... Aug. 28-Oct. 22... 3 I...... Do. Bolivia: La Paz...... Apr. 1-June 30.... 50 51 Do...... Juy 1-31...... 19 3 Brazil: Bahia...... June 19-25...... 1 Do...... Aug. 7-13... 1 1 Porto Alegre...... June 1925...... 3 Do...... Aug. 7-13...... 1 Canary Islands: Teneriffe...... Aug. 14-Sept. 10...... 2 Chile: Concepcion...... Apr. 12-June 20. . 8 July 2S-Aug. 29,1921: In hospital, Do...... 12-Oet. 2..... 17 30 cases; in city, 4stiniated, 00 ..Ccases.... Los Angeles...... July 26-Aug. 8... Prevalent.. Talcahuano...... Sept. 1-30..... Val iso...... Mar. 27-May 28... 4 Do...... June 26-Oct. 22... 6 Cbina: .'. Antung...... May 30-June 5.... .From report of Japanese Settle- Do...... June 27-Oct. 23... 18 - ...' ment and Danish Mission Hanlow ...... May 22-June 11...... amonig Chinese. Manchuria- Harbin...... May 25-29...... 1 ...... Do...... July 4-1.0...... 1 ...... Chosen (Korea): Chamulpo;...... June 1-30...... 2 Fusan...... May 1-31...... 1 ...-I...... Gensan...... May I-June 30.... 4 !...... 8eouL ...... May 1-31...... 1 ...... Cuba: Matan s...... Oct. 4-10...... 1 ...... Czechosovakia: Prague...... June 5-2...... 5 2 Egypt:Alexandria.: ...... May 21-June 23. .. 21 8 Do...... June 24-Oct. 14... 49 29' Cairo...... Mar. 19-June 24... 255 107 Do...... June 24-Sept. 9.... 86 51 Port Said . Ayr 27-May 13.... 8 2 Fiand...... M,ay 14...... 5 ...... Germany...... Apr. 2-June 4, 1921: Cases,L. Hamburg...... lay 27-June 4...... rat Britain: Dublin..''D bi...... May 2Wune 4.... Do...... Oct. 9-15...... 11 :: Greece: SalonikL...... May 23-June26. .. 21 6 Do...... June27-Oct. 16.... 2 2 Guatemala: Guatemala City...... July 1-Sept. 30.... 2 Hungary...... Jan. 1-July 13 1921: Cases, n occurting in 4 cotunties. Italesina (Province)...... '... Aug. 29-Sept. 4. 2 I In 2 localities. Japan: ...... Na ...... May 23-June 5.... 7 2. Ju g oVi...... II ...... Jan. 30-May 14, 1921; Cas, 286; ...... May 1-14...... deaths 40. June 27-July 10, June 19-25. 3 ...... W. 1921: (ases, 25; deaths, 7. July 10.-Sept. 3.... 37 MosopoAa.1a: ad...... M -1.....;..... 14 1 3 .o...... Aug.1-31..... 1 ...... 3069 December 9, 1921. CHOLERA, PLAGUE, SMAILPOX, TYPHUS FEVER, AND YELLOW FEVER- Continued. 2 to Dec. 2, 1921-Continued. Reorb oedeivedTYPHUsyoFEVER-Continued. - Pace-. Date. Case. Deaths. Remarks. Mexico: Mexico City...... May 15-Jun 26. .. 02 Includingmunicipalities in Fed- Do...... June 26-Oct. 22... 231 eral District. satlo...... - Oct. 2-8...... Sean Luis Potosi...... July 31-Nov. 5.... I...... Present. Morocco: Spanish Zone...... Reported present in epidemic form Sept. 29, 1921. Polan...... ,...... Mar. 1-Apr. 30, 1921: Cases, District- 11,489; deaths, 1,131. Apr. 24- Bialystok...... Mar. 1-Apr.30.... 853 45 May 21, 1921: Cases, 5,460; Cracovia...... do. 603 deaths, 489. May 22-June 18, Kielce...... do. 848 62 1921: Cases, 3,300; deaths, 299. 2 Leoa.O' ...... do. 508 277 June 19July 16, 1921: Cases: ..... a. '521 53 1 500; deaths 96- statistics for Lublin...... do. 1 446 83Ss irestLitovsi,t 'MInsk and P03en...... do. '77 Vilna not included Slasia...... do . 26 ...... _:; In Teschen. Stanislawow...... do . 1,557 Tamopol...... do . 1' 855 194 Warsaw. 9'72 61 Warsaw City...... do . 223 29 Portugal: Oporto...... July 12-Oct. 29.... 3 Rumania. District- H1tn...... Apr. 1-30...... 107 10 Kishinev...... Apr. 1-June 30.... 89 ...... Do...... July 1-31...... 11 ...... Distriet. Orhe...... Mar. 1-May 30..... 146 ...... Russia: Province- Esthonia...... Apr. 1-June30.... 113 Do...... July 1-Sept. 30.... 79 Latia ..... a.. Apr. 1-June 30.... 599 Do.. July 1-Aug. 31.... 115 ...... Sept. 8-15...... 2 Siberia- Vladivestok. Mar. 1-June 30. ... 5 3 Do...... July 1-Aug. 31.... 22 3 SebiaSeba...... D ...... Mar. 24-May 21, 1921: Cases, 70; deaths, 7. Spaiw Madrid...... May 1-June 30.. 3 Do...... July I-Sept. 30. 4 Syria:. Beirut...... May 20-June 10. .. 1 1 Do...... Sept. 5-Oct. 8.... 1 ...... Tunis: Tunis...... June 11-17... 3 Do...... July 30-Sept. 9.... 2 Turkey: .-::::I

Constantinople...... May 22-June 18 ... 11 .....- - - Do...... June 26-Oct. 15.... 54 -- Union of South Africa...... January - April 1921: Cases (white), 34; deaths, 2. Cases (native) 3,376; deaths, 437; June 1i4o 1921: Cases, 738; deaths, 66. July 1-31 1921: Natives-cases, 858; deat6s,121. White-seS, 15; deaths, 2. Orange Free Stat and Natal: Cases, 25; deaths, 10. Aug. 1-311 I12: Cas, 50; 83 (whltecases, 17; deaths, 4; aind colored cas 833- deaths, 79). c P in ...... Apr. 24June 24, 1921: Outbrek, ...... May 1-31, 1921: Cases, 52 deaths, 51'. July 1-31, 1921: Caes, 3; deaths, 15. Aug. 28-Oct. 1: Outbreakcs. Cape Town...... asy 13-19...... 10 3 At native cantonment In vicin- East London...... May 22-Junie 18. .. 1 ity. 1 Do...... Aug. 21-27...-...... rP.ft zabeh.... Aug. 7-20...... 7 ...... u. ag...... July 10-Oct. 1...... Outbres. Ogo fte...... 4 ...... Apr. 24-May 28,11: Outbreaks. V.Fr...... July 10Sept. 17...... Outbreaks.

Jd -mfbebr...... Sept. -10...... I.. Outbreaks in surounding country. Demmber 9,1921. 3070

.CHOLERAt PLAGE, SMALLPO. TYPHUS FER,-AND YlELOW FVER-- Continued. . Rports I -from Jul 2 to Dec. 2, 1921-Continued. T S WR-Cntue&d. Place.- )Date. Cases. Deaths. Re . Venezuela: Maracaibo ...... June 21-27...... 1 On vesseL_ Steamship Norden...... Aug.18.1 .. At Mareus Hook Quarantine, Pa. from Tuo, Mexico, v.ia ue=vltas, Cu Mec YELLOW FEE. British Hondua: Belie...... Aug. 22-Oct. 1.. 17 8 tann Creek...... Nov. 13...... 1 ...... , 30 miles from Bellze. Modc Alamo...... June 1-30...... 10 ...... State of Vera Cruz. Do...... July 19...... 4 i Baw de Penn...... July 17-23...... 1 I Do. Ca'?am alcapam...... do. 3 t Do. El Dorado...... Oct. 7...... Present. Sept. 25-Oct. 2 1921, deaths, 40. Oct. 2, dea6s, 5. Manzanillo...... June -1- e 3tS0, 1921: Ca, 19 : deaths Do...... Oct. 9-15...... 1 . Oct. 7: sent. do. Mazatlan ...... i. . Present. Playa Obispo...... Auig. 23...... Territorv of Quintana Roo. Tampico...... July 11-17...... 3I i State of Tamaulipas. Tierra Blanca...... Sept. 19...... Case arrived at Vera Cruz on steamship Monterey, which sailed from Progreso, Mexico. Tiooalan...... -.....F .Present. Tuxpam...... Stateof Vera Cruz. Oct. 15: Sev. eral cases present In vicinity. Vera Cru...... June 13-27...... 7 . Do. Do...... July 25-Sept. 25.. 6 Do. ZapataL...... July 14...... 1 1 Do...... Peru ...... MMar. 1-Apr. 30, -11: Oaes, 172; deaths, 57. June 1-30 1921: Department- Cases, 25, deaths, 13. July 1- Callao-_ 15, 1921: Cases, 2. C CaDaso...... ala Apr. 1-30...... 1 At quarantine station. Prom Lambayeque- Chiclayo. Ck o...... Mar. 1-June 15.... 47 18 CMongollape.... Mar. 1-Apr. 30.... 12 3 Ferrenafe...... Mar. 1-31...... 1 Jayanca...... Apr. 1-30...... 2 Lambayeque...... Mar. 1-Apr. 30.... 20 7 Monsefu...... Mar. 1-June 15.... 29 9 Motupe...... Mar. 1-Apr. 30.... 46 12 OlmCs..Grne...... Apr. 1-30...... 2 4 Pacora...... Jine 1-15...... 1. Mar. 1-31..... 5 Vill Eten. Mar. 1-Apr. 30.... 7 1 Apr. 1-30...... 1...... Liberad- Ca...... Grande...... June 1-15...... I1...... On farm. a lue...... Apr. 1-30...... 2......

Montesaco...... July 16-31...... Pacanga...... Juie 1-30...... 2 Pacsayo..... July 1-15...... 1. Paijan...... Julie 1-30...... 13 7 Do...... July 1-15...... 1. PuebloNa o. Apr. 1-30...... 1 Apr. 1-Jlne 15.... 2 2 Country. On vesselsa Trujillo 1rge I. S. MeGaughy...... Oct. 6...... 1. At quarantine station, Pensa. cola, Fla., from Tampio Mex- ico Sept.'30. Steamshp Lurlne ...... Aug. 13-27. 2 1 At iiatln, Mexieo, from Man. sanlio, Meico (Pubic Health

Steamship Monterey...... S ept. 18. 1 ...... At V d:rel rUha ProgreWo, Mexico, SWt. IS, 1921. PatIent went to Tiarra Blanma. Steamship a...... Nov. 12.. ., 1 1 At New Orleans, La.fm Beli, Bridt HondAlra. Steamship Wasbington...... 'Aug.29 I ...... At Mazatlan, Meiem - - x