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Flight of A. quadrimaculatus. In connection with studies of the relation of the artificial impounding of waters to malaria, the distance of flight of A. quadrimaculatus was studied by Sanitary Engineer Le Prince and Assistant Epidemiologist Griffitts. Attempts were made to recapture previously marked and liberated specimens. At Stephens Creek, S. C., of 1,543 Anopheles taken, 4 were identified; 3 of these were captured at distances of 5,565, 3,245, and 2,800 feet from the liberation station. At Fort Lawn, S. C., about 300 were liberated on the Catawba River and 3 retaken at a point 3,090 feet removed. These must have crossed the river (800 feet) at a single sustained flight.'

Breeding places of Anopheles punctipennis and quadrimaculatus.— Additional data have been collected during the year with reference to the preferential selection of various types of water for propagation places by A. punctipennis and A. quadrimaculatus.

Studies of screening materials. For the purpose of determining the relative lasting qualities of various screening materials, an experimental battery of screen frames has been installed on the grounds of the Marine Hospital at New Orleans.

MALARIA INDEX AND OTHER BLOOD EXAMINATIONS.

Blood examinations have been made in the laboratory as heretofore for determination of the endemic parasite index and for other special purposes. The following is a list of places from which series of specimens have been examined for index determination since July 1, 1916:

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Miscellaneous series of blood specimens collected at various places were also examined, the total number being 899, of which 36 (4 per cent) were found to be infected.

The total number of specimens examined from 1912 to June 30, 1917, was 26,238, of which 3,278 (12.49 per cent) were found to contain malaria parasites.

1 Brief report of this study published. (Reprint 396 from Public Health Reports.)

IMPOUNDED-WATER STUDIES.

The investigation of the influence of the artificial impounding of water on the prevalence of malaria, begun in 1914, has been carried on as heretofore under the direction of Asst. Surg. Gen. H. R. Carter. Surveys were made at Parr Shoals, S. C., Blairs, S. C., Talladega Springs, Ala., Badin, N. C., Catawba River, Yadkin River, Broad River, and Stevens Creek, S. C. These surveys included physical and biologic examination of the ponds and their collaterals, together with investigations in the surrounding country to ascertain the degree of prevalence of malaria.

RELATION OF RICE CULTURE TO PREVALENCE OF MALARIA.

Intensive studies of the relation of the culture of rice to Anopheles propagation and malaria prevalence were begun during the latter part of the fiscal year at Crowley and Lake Charles, La.

As in other countries thus far, it has been found that the culture of rice in the United States is attended by the production of enormous numbers of Anopheles, but to what extent malaria prevalence has been influenced has as yet not been accurately determined.

HEMOGLOBINURIA.

Reports of cases of hemoglobinuric fevers were received from physicians in the States of Alabama, Arkansas, Florida, Louisiana, North Carolina, South Carolina, Tennessee, and Texas, and two cases were seen by one of the members of the staff during field investigations in July of 1916. In general, it is believed that cases are becoming more occasional, probably due to early recognition and better treatment of malaria.

PELLAGRA,

At the close of the previous fiscal year the following field investigations of pellagra, under the direction of Surg. Joseph Goldberger, were under way:

1. A study of the preventability of pellagra by proper diet. 2. A study of the transmissibility of pellagra.

3. A study of factors influencing pellagra prevalence in selected cotton-mill villages in South Carolina.

PREVENTABILITY OF PELLAGRA BY PROPER DIET.

A study of the preventability of pellagra by proper diet was begun in 1914 at two orphanages and at an asylum for the insane. A preliminary report of these studies was published. (Reprint 307 from Public Health Reports.) Since the results of these studies afforded clear indications of the preventability of the disease by this means, it was found desirable to enlarge the scope of the investigation by including an additional ward at the asylum and by adding a third orphanage, located at Columbia, S. C.

The results obtained in the second year of this study, completed in the fall of 1916, were in strict harmony with those of the first year. In not a single one of the individuals under observation at the orphanages or the asylum did pellagra develop either as an initial or a recurrent attack, in spite of the fact that the disease had been highly prevalent at all of the institutions before the service operations were commenced. On September 1, 1916, the studies at the orphanages were discontinued. A final report, including full details, will be published subsequently.

By reason of the greater significance likely to be attached to the results of studies of pellagra in the insane, it was deemed wise to continue the study at the asylum (Georgia State Sanatorium) for at least another year. At the close of the past fiscal year, the indications were that the results of the third year's study at this institution would in no wise differ from the results observed during the previous two years, namely, no new cases and no recurrences. So far as concerns pellagra in the wards under control of the service, it may be stated that the disease has ceased to exist.

TRANSMISSIBILITY OF PELLAGRA.

As it is widely held that pellagra is a communicable disease, an attempt was made to infect a number of individuals who volunteered for the purpose by inoculating them with blood, nasopharyngeal secretions, scales, urine, and feces from cases of pellagra. Six groups of experiments were made between April 25, 1916, and June 13, 1916, in which 16 volunteers, including 1 woman, participated. Seventeen cases of pellagra of various types and of different grades of severity furnished one or more of the experimental material. The period of observation of the volunteers following the inoculations has continued through the fiscal year. None has developed the disease or any indication of it. A detailed preliminary report of this experiment was published. (Reprint 376 from Public Health Reports.)

RELATION OF CERTAIN ECONOMIC FACTORS TO PREVALENCE OF

PELLAGRA.

A study of factors influencing pellagra prevalence in selected cottonmill villages in South Carolina was begun early in the spring of 1916 with Asst. Surg. G. A. Wheeler in immediate charge.

The villages first selected were seven in number, with an aggregate population of about 4,000. The completion of the studies at the orphanages in the fall of 1916 made it possible in January, 1917, greatly to extend this investigation by including 17 additional villages, having a population of over 20,000. During the second part of the fiscal year there have, therefore, been under observation 24 mill villages with an aggregate population of nearly 25,000.

The selection of the villages has been such as to permit of the study of pellagra prevalence under a variety of contrasting sanitary and other conditions. The data being collected relate to pellagra prevalence, sanitation, economic status, food availability, and seasonal variation in food availability. It is planned to terminate the collec

tion of data by the end of December, 1917. Analyses of these will, it is believed, bring out fundamentally important facts bearing on the nature of the disease and will afford a basis for constructive recommendations for its control and eradication.

SPECIAL STUDIES OF PELLAGRA AT SPARTANBURG, S. C.

The special studies of pellagra which were begun in 1914 at the service hospital and laboratory at Spartanburg, S. C., have been continued during the year. Aside from a number of changes in personnel the general organization for clinical and laboratory studies has remained the same as described in the annual report for 1916. The laboratory investigations remained under the general supervision of Prof. Carl Voegtlin until September 28, 1916, and since that time have been carried on under the immediate supervision of Biochemist M. X. Sullivan. On January 5, 1917, the entire work of the station was placed under the general supervision of Surg. Joseph Goldberger, while Passed Asst. Surg. R. M. Grimm was continued in immediate charge of the clinical work and in immediate administrative charge of the station.

The clinical personnel of the station has consisted of Passed Asst. Surg. R. M. Grimm throughout the year; Asst. Surg. R. L. Allen until January 22, 1917; and Passed Asst. Surg. C. H. Waring since January 30, 1917. Passed Asst. Surg. M. H. Neill was on temporary duty at the station until September 15, 1916. Pharmacist L. G. Smith has been continued on duty at the station throughout the year. The laboratory personnel has consisted of Biochemist M. X. Sullivan and Food Analyst Kenneth K. Jones throughout the year; Asst. Biochemist Carl P. Sherwin and Organic Chemist George R. White until September 15, 1916; Asst. Biochemist Paul R. Dawson since June 13, 1917; and Physiological Chemist Ralph E. Stanton since June 11, 1917. Dietitian M. Maude Fauquier has been continued on duty at the station throughout the year. In addition to the above there have been employed 2 clerks, 6 female nurses, and 11 attendants.

Clinical studies.-Both hospital and out-patient treatment have been furnished at the station throughout the year. The treatment used has been almost exclusively dietary in character. Drugs have been used only to a very limited extent, and then, as a rule, only to meet complications.

In the treatment of hospital patients several diets are being tried out in order to determine the comparative therapeutic values of various articles of food in the treatment of pellagra. Quantitative records of the consumption of various dietary constituents are kept and become a part of the record of treatment. At the time of admission of each patient a clinical history is taken and a complete physical examination made, including examinations of the stools and urine. Careful semiweekly clinical notes, weekly weighings, and dynamometer tests are made by way of determining the progress of the cases. It is believed that such records in a large series of uncomplicated cases of pellagra will be of value in determining a diet or diets which may be of general use in the treatment of the disease.

The treatment of out-patients has consisted of serving to them at noon each day in the hospital dispensary a well-cooked, well-balanced meal, consisting of well-selected articles of food, presenting a considerable variety from day to day, served in generous quantities. For the most part these patients have presented mild types of the disease and have been able to continue at their work during the periods of their treatment. While this form of treatment can not be recommended as an exclusive therapeutic measure, it is found to have a certain limited value in this respect. It has also been found that the introduction of this one meal into the regular daily dietary of the patients treated in the out-patient clinic has had a very definite value in the prevention of recurrences of the disease and it is believed to have had considerable value in an educational way. The majority of the patients treated in the out-patient clinic have been from the families of cotton-mill workers living in the immediate vicinity of the hospital.

The following tables give the data relative to the patients treated and relative condition at the termination of treatment:

Hospital patients.

Under treatment at the beginning of the year.
Admitted to hospital during the year...
Former hospital patients readmitted during the year.
Total hospital patients treated during the year..
Discharged from hospital treatment during the year.
Remaining in hospital June 30, 1917...

Days hospital relief was furnished during the year....

Out-patients.

Under treatment at the beginning of the year.
Admitted to out-patient clinic during the year.
Former out-patients admitted during the year.
Total out-patients treated during the year..

Discharged from out-patient treatment during the year.
Remaining under treatment June 30, 1917..
Treatments (meals) furnished during the year.

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Number.

31

129

9

169

140

29

7,802

20

16

9

45

23

22

4, 688

Hospital Outpatients patients (number). (number).

124

12

4

140

23018

In addition to the patients treated in the hospital and out-patient clinic a small number who could not be treated at the hospital were treated at their homes. In the treatment of these patients special preparations prepared in the station laboratory by Prof. Voegtlin were used. The administration of these preparations constituted the entire treatment. The patients were allowed to follow their own inclinations with respect to their diet.

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