probable that cases of typhus fever have occurred in various parts of the country and that undoubtedly there have been cases in all the larger cities. That for a number of years cases have occurred annually in New York City in considerable numbers is true, as the so-called "Brill's disease" has been ascertained to be identical with typhus fever. MEASLES. There was a measles outbreak of considerable size in Pittsburgh, where between November, 1912, and July 26, 1913, a total of 9,583 cases with 165 deaths had been reported. In Los Angeles, Cal., 6,444 cases of measles were notified to the health authorities between January 1 and July 19, 1913. In St. Louis, Mo., there were 4,281 cases of measles with 37 deaths reported between April 1, 1912, and March 1, 1913. During the year there was a considerable outbreak of measles in Richmond, Va., where between January 21 and April 26, 1913, there were 3,821 cases with 22 deaths notified to the health authorities. Other outbreaks have occurred in cities in various parts of the country. In some cases little or no attention was paid to the disease by the health authorities and little if any attempt made to ascertain the extent of existing epidemics. It will be noted that in Pittsburgh there were 61 cases reported for each death registered; in St. Louis, 115; and in Richmond, 173. Either the disease was milder in Richmond or the cases were much more completely reported than in St. Louis or Pittsburgh. BERIBERI. The occurrence of beriberi in this country is sufficiently infrequent to make outbreaks worthy of note. During the year there was an outbreak of beriberi in the State asylum at Austin, Tex. There were quite a number of cases, just how many is not known, as the details of the outbreak were not obtainable. SEVEN-DAYS FEVER. The occurrence in the Canal Zone during the summer of 1912 of a number of cases of what appears to have been the seven-days fever, previously reported only in India and the ports of southeastern Asia, adds one more disease to the list of those that the American physician should bear in mind in the consideration of continued fevers. This disease was differentiated from other fevers by Rogers in 1905-1908 as a sporadic fever occurring in the seaports of India. In India and Ceylon this fever has since been found in the cities and towns in low-lying regions, usually near the sea. In Calcutta and Colombo it occurs during the summer months, May to September. These are the months during which the disease was noted in the Canal Zone. Physicians in the southern ports of the United States should be on the lookout during the summer months for cases of this fever. The cause of the disease has not been found, and no fatal cases have been noted. Where present, however, it is a malady to be thought of in the differential diagnosis of malaria, typhoid fever, dengue, and other fevers. MALARIA. Malarial fever has been ascertained to be much more prevalent in the United States than has usually been believed. This excessive prevalence exists not only in the States south of the Ohio River, but also in certain localities farther north. South of the Ohio River malaria has been found to be present in practically all localities in which there are present suitable breeding places for the anopheline mosquitoes. The three types of the disease, the tertian, the quartan, and the estivo-autumnal are present. In many localities pernicious malaria is recognized as a not uncommon ailment by the practicing physicians. How prevalent the disease is has not been possible as yet to determine, due to the fact that cases are not required to be reported to the health authorities except in 4 States-Arizona, New Jersey, Pennsylvania, and Washington-and also to the fact that in many places there is much confusion in the diagnosis. Malaria is known to be present in central California and to some extent in Oregon and Washington. The disease has been found to be prevalent in certain localities in Connecticut. It undoubtedly prevails, unknown to the health authorities, also in many other localities in the Northern States. A map of the United States showing the prevalence and geographic distribution of this disease is greatly needed, and the data necessary for the making of such a map is now being collated. However, our information of the relative prevalence of the disease and its geographic distribution will continue to be incomplete and unsatisfactory until the disease has been made notifiable in all States. DENGUE. There was also an outbreak of dengue in Florida during October, 1912. The disease was present, especially in Tampa, Gainesville, Miami, and Key West. In October, 1913, the disease appeared in Savannah, Ga. The extent of this outbreak is not known, as the notification of cases was not required. MARINE HOSPITALS AND RELIEF. RELIEF STATIONS. During the year the service operated 23 marine hospitals, all of which are owned by the Government, and maintained 125 other relief stations where hospital and dispensary relief was furnished. Owing to the small amount of relief furnished, the relief station at Morgan City, La., was closed during the year. On account of a rearrangement of the customs districts, several customs offices where relief to sick seamen had formerly been furnished, were discontinued on July 1, 1913. The stations closed were Burlington, Iowa; Edenton, N. C.; Edgartown, Mass.; Sag Harbor, N. Y.; and Wheeling, W. Va. RELIEF TO SEAMEN. During the year 50,604 seamen were treated in the various marine hospitals and relief stations of the service. Of this number 14,097 were treated in hospitals a total of 405,944 days, and 36,507 were treated at the dispensaries a total of 60,699 times. During the year 430 seamen engaged on foreign vessels received hospital treatment a total of 5,612 days. The medical officers of the service made 9,971 physical examinations during the year. These examinations were made of applicants for original or renewal of license as master, mate, or pilot; applicants desiring to enter, or already engaged in the various branches of the Government service; examinations made of American seamen, foreign seamen, and persons contemplating service in the Philippine Islands. Medical officers of the service detailed for duty on board vessels of the United States Revenue-Cutter Service cruising in northern waters, furnished all possible medical relief to natives inhabiting both the mainland and the neighboring islands of Alaska. AID TO DIFFERENT BRANCHES OF THE GOVERNMENT SERVICE. Revenue-Cutter Service. Twelve hundred and eighty-six men were examined physically, of whom 200 were rejected. Steamboat-Inspection Service.-Five thousand nine hundred and four pilots were examined as to visual capacity, of which number 88 were rejected. Life-Saving Service.-One thousand three hundred and seventynine keepers and surfmen were physically examined, of which number 39 were rejected. Four hundred and fifty disability certificates referred to this bureau by the general superintendent of the Life-Saving Service were passed upon. These called for an expression of opinion on the medi cal evidence of disability submitted in claims for benefits under the act of Congress approved March 4, 1882; upon the physical fitness of keepers and surfmen for enlistment, promotion, and retention, and upon evidences of death submitted by widows or orphans in their claims for benefits. The services of 21 acting assistant surgeons were continued during the year for the physical examinations of keepers and surfmen at points not easily accessible to regular officers at stations of the service. In addition, 5 medical officers were detailed at the request of the general superintendent, to various points along the Atlantic coast to examine candidates for reenlistment. Coast and Geodetic Survey.-One hundred and two employees and applicants for appointment were examined, of which number 7 were rejected. Lighthouse Service.-Ninety-seven applicants for enlistment were examined, of which number 4 were rejected. Immigration Service. Two hundred and forty-five persons connected with the Immigration Service were physically examined; of this number 10 were rejected. Civil Service Commission.-One hundred and fifty-five applicants for appointment were physically examined; of this number 5 were rejected. Isthmian Canal Commission.-Six employees and applicants for appointment were physically examined; of this number 1 was rejected. PHYSICAL EXAMINATIONS OF MERCHANT SEAMEN. Physical examinations were made of 744 American seamen, of whom 20 were rejected, and 15 foreign seamen, of whom 7 were rejected. PHYSICAL EXAMINATIONS, PHILIPPINE ISLANDS. Physical examinations were made of 38 applicants in the United States to serve in the islands, of which number none were rejected. PURVEYING DEPOT. The following statistics show the transactions of the purveying depot during the fiscal year: |