Of the States included in the territory in which pellagra is prevalent, Mississippi has been making an especial effort during the last few months to ascertain the prevalence of the disease, and the occurrence of cases has, so far as known, been made a matter of record. The prevalence of the disease during the first six months of 1913, as indicated by the notification of cases, is shown by the following table:

Cases of pellagra reported in Mississippi during first 6 months of 1913.

Cases of pellagra reported in Mississippi during first 6 months of 1913—Continued.

Until recently rabies was limited to the territory east of the Rocky Mountains. It is only within the last few years that the disease has appeared on the Pacific coast. West of the Rockies cases were first found in California and later in Oregon and Washington. On April 23, 1913, cases of rabies were found in the city of Tacoma, Wash., and near-by portions of Pierce County. So far as the records show this is the first occurrence of rabies in the State of Washington west of the Cascade Mountains. The disease is supposed to have been imported into Tacoma in a dog brought from Arizona during the autumn of 1912. During March and April a considerable number of rabid dogs were killed in the city of Tacoma. On September 18, 1913, rabies was reported in a dog in Seattle, Wash. This is believed to be the first reported case of rabies in that city.

POLIOMYELITIS (INFANTILE PARALYSIS).

During the year ended June 30, 1913, there have been but few outbreaks of poliomyelitis of any size. The two most important outbreaks were those at Los Angeles, Cal., and Buffalo, N. Y.

LOS ANGELES, CAL.

In Los Angeles single cases of poliomyelitis were reported-1 in October and 1 in November, 1911, and 1 in March, 1912. In June, 1912, 19 cases with 4 deaths were reported and during the next two months the number was greater. From June 1 to September 7 there

were reported 249 cases. During the height of the outbreak from 20 to 40 cases were reported weekly. During the week ended September 7 only 5 cases in all were reported. The subsidence of the outbreak followed closely upon the establishment of a rigid quarantine of premises where cases existed, the closing of all schools, and the suppression of gatherings of large numbers of children.

Soon after the appearance of the disease in Los Angeles, in June, cases were noted at the beach resorts in the vicinity and later in neighboring counties and occasionally in those at a distance. Among the counties thus invaded were Riverside, Ventura, Merced, Sacramento, San Joaquin, and San Francisco.

BUFFALO, N. Y.

An outbreak of poliomyelitis occurred in Buffalo at about the same time as the one in Los Angeles. It had its beginning in June and reached its maximum during July and August. From June 1 to October 12, 326 cases were reported, of which 35 had terminated fatally. The outbreak terminated during the latter part of October. Cases of the disease also occurred in the surrounding counties in western New York and especially in Cattaraugus, Chautauqua, Erie, Genesee, Livingston, Niagara, Orleans, Wyoming, and Allegany Counties, in which 104 cases, with 16 deaths, were reported.

NEW YORK CITY.

From June 1 to September 28, 1912, there were notified in New York City 184 cases of poliomyelitis, with 26 deaths. The largest number of cases reported for any one week was 34 for the week ended September 14.

TEXARKANA AND VICINITY.

Poliomyelitis broke out in Texarkana in May, 1913. A case, however, had occurred as early as April 5. In all there were 143 cases, of which 50 occurred in Texarkana, or within a radius of 2 miles. The remaining cases occurred in neighboring towns and counties. The distribution of cases is shown by the following table:

Of the 143 cases, 124 had their onset between May 20 and June 18.

EPIDEMIC CEREBROSPINAL MENINGITIS.

During the year ended June 30, 1913, epidemic cerebrospinal meningitis has been present to some degree throughout the United States, cases having occurred in all parts of the country. For the most part the cases reported have been few in number and largely sporadic in character. Few outbreaks worthy of notice have occurred. The largest of these were reported from Arkansas, Tennessee, and the southern part of Illinois during January, 1913. Of this outbreak there is only a fragmentary record of the number of cases that occurred, as the notification of cases was exceedingly incomplete. In January, when the outbreak first began to attract unusual attention, in Arkansas there had been 25 cases, with 17 deaths, reported at Lepanto, Poinsett County. January 6 there had also been sporadic cases reported in other parts of the State.

In Tennessee, to January 13, there had been 108 cases, with 47 deaths, reported in Dyer County; 13 cases, with 9 deaths, in Lake County; and cases in Carroll County and in other parts of the State.

In southern Illinois, to January 10, there had been 11 cases, with 7 deaths, in Hamilton County; cases had also occurred at Cairo. The outbreak extended to the State of Kentucky.

It will be remembered that the year before there was an outbreak farther south which attracted considerable attention, and had its center and principal foci in Texas, from which it spread into Oklahoma and neighboring States. This year the center of the epidemic appeared to be in Arkansas, Tennessee, Kentucky, and southern Illinois.

The disease was also present in Texas this year. During the last week of December, 1912, 10 cases of epidemic cerebrospinal meningitis were reported in Eagle Pass. Of these 10 cases, 1 was mild and 9 were reported to be of the "fulminating" type, and the patients died in from 6 to 36 hours.

In Arizona 58 cases were notified from January 1 to May 8, 1913. In Los Angeles, Cal., there were 82 cases reported between January 1 and July 26, 1913.

A small outbreak occurred in Midville, Ga., during December, 1912. Surg. Carrington reported that during the year 1912 there had been 486 deaths in Missouri registered as due to cerebrospinal meningitis. This would indicate that the disease had been quite prevalent. How prevalent can not be known, as cases were not required to be notified in that State.

TRACHOMA.

Trachoma has been found to be widely prevalent in the mountain region of Kentucky. Out of approximately 4,000 people examined in this locality, 500, or 12 per cent, were found to have the disease. The examination of school children in the various mountain counties showed that from 3 per cent in some counties to 18 per cent in others were affected. It is evident that the disease has been present among these native-born Americans for many years. With trachoma so prevalent in the mountain districts of Kentucky it is quite likely that similar conditions will be found to exist in the contiguous mountain 2018014 -17