SANITARY REPORTS AND STATISTICS.

Through the Division of Sanitary Reports and Statistics, the Public Health Service keeps informed of the occurrence of outbreaks and epidemics and of the prevalence and geographic distribution of preventable diseases, makes disease maps, keeps cognizant of current sanitary legislation through the collection and compilation of State and municipal laws and regulations and court decisions on matters relating to the public health, and publishes weekly the Public Health Reports.

PREVALENCE OF DISEASE IN THE UNITED STATES.

During the year all available information of the prevalence and geographic distribution of communicable disease has been collected, as in previous years. This work, begun 39 years ago, pursuant to act of Congress, approved in 1878, has been continued with everincreasing scope. The agencies composing the intelligence system by means of which information of disease occurrence and prevalence is currently collected consist of the State health authorities, the health authorities of municipalities, counties, townships, towns, and boroughs, officers of the Public Health Service stationed throughout the country, and, for some diseases, the practicing physicians. These different agencies report with varied frequency, some when there exists an unusual disease prevalence, others regularly each week, and others monthly. In addition, the State and city authorities furnish annual statements of the prevalence of preventable diseases within their several jurisdictions. The system of reports has been developed until it now covers approximately 80 per cent of the population of the country. The States and cities from which reports are not received have undeveloped health organizations, and information of the occurrence of disease in their respective jurisdictions is not of record and therefore not obtainable through the usual channels.

Current reports.-Through the current reports received from the various cooperating officials, current information has been available at all times during the year of the outbreak of epidemics or the occurrence of unusual disease prevalence. This information has been made available from week to week to the health officials of the country and those engaged in public health work through the medium of the Public Health Reports.

Municipal weekly morbidity reports.-The cities having efficiently organized health departments have furnished each week statements

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of the prevalence of notifiable diseases in their respective jurisdictions. The cities able to furnish these reports have shown a constant increase in number. The quality and dependability of the reports have also improved.

These reports are made on franked postal-card forms which are supplied to the health officers of all the cities of over 50,000 population-128 cities—and to many of the smaller urban communities from which weekly reports have been received for a number of years. A reproduction of the report card follows:

Report for each week should be mailed not later than the following Tuesday.

Health Officer.

In June, 1916, 160 cities were forwarding these reports. At the end of June, 1917, the number reporting had been increased to over 200 per week. Many of the cities had reported promptly for every week of the year. Some cities failed to mail their reports promptly

and some others reported irregularly. The cities that reported with satisfactory regularity were:

The following are the cities that were either irregular in sending

their reports or frequently mailed them late:

Of the cities of 50,000 or more population, no reports were received from the following, due in most instances to the fact that the health departments did not have the necessary records from which to furnish the information:

Of the urban communities having populations between 10,000 and 50,000 many have not yet been able to furnish weekly reports because of having no health officers or because of lack of clerical force in. their health departments. In some instances their records were not so kept that the figures were readily available for making current reports.

Monthly State reports.-At the beginning of the year monthly reports of the occurrence and prevalence of notifiable diseases were received from 26 States and the District of Columbia, as follows: Arkansas, California, Connecticut, District of Columbia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, New Jersey, New York, North Dakota, Ohio, Oregon, South Carolina, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. The following States began reporting during the year: Alabama, Colorado, Maine, Nevada, New Hampshire, Pennsylvania, Rhode Island, and South Dakota. At the end of the year, therefore, current monthly reports were being received from 35 States having an aggregate estimated population of 72,398,112; representing 71 per cent of the entire population of the continental United States.

The following States were unable to furnish monthly reports: Arizona, Delaware, Florida, Georgia, Illinois, Kentucky, Missouri, Nebraska, New Mexico, North Carolina, Oklahoma, Tennessee, Texas, and Utah.

Annual State and city summaries.-For the last five years, beginning with the calendar year 1912, the Public Health Service has published annual statements of the prevalence of certain notifiable diseases in the States and cities that kept suitable records from which the data were available.

For the year 1912, 19 States, the District of Columbia, and the Territory of Hawaii, and about 260 cities were able to furnish the necessary data for these reports.

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For the calendar year 1916 the following States were included: Alabama, Arizona, Čalifornia, Colorado, Connecticut, the District of Columbia, the Territory of Hawaii, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, Washington, Wisconsin, and Wyoming.

The population of these 28 States, with the District of Columbia, was 67,348,100, representing 66 per cent of the inhabitants of the continental United States.

Annual statements for 1916 were not received from Arkansas, Delaware, Florida, Georgia, Idaho, Illinois, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Dakota, Tennessee, and Utah.

On succeeding pages of this report will be found analyses of these summary reports of States, compared with similar data for large cities. There will be found, also, tables showing for the calendar years 1915 and 1916 the numbers of cases and deaths reported, together with the indicated case rates per 1,000 population, fatality rates per 100 cases reported, and death rates per 1,000 population for diphtheria, measles, scarlet fever, tuberculosis, and typhoid fever.

For the calendar years 1912, 1913, 1914, 1915, and 1916, the Public Health Service, through the Division of Sanitary Reports and Statistics, has also compiled and published annual statements of the prevalence of certain notifiable diseases in cities of the United States having a population of 10,000 or more.

These summaries have covered the numbers of cases recorded, and of deaths registered, the indicated case rates per 1,000 population, the indicated fatality rates per 100 cases; and for the year 1916 in the cities of over 100,000 population the indicated death rates per 1,000 inhabitants for diphtheria, measles, scarlet fever, tuberculosis (pulmonary), tuberculosis (all forms), and typhoid fever.

Reports for the calendar year 1916 were received from all of the 66 cities of over 100,000 population, excepting Cambridge, Mass., and Memphis, Tenn. The reports represent 98.9 per cent of the aggregate population of the cities of this group. The cities of this group that reported, with their population as estimated for July 1, 1916, are: