Copies of the special leprosy report schedules sent to health officers of States and of cities follow:

LEPROSY REPORT-CALENDAR YEAR 1916.

State of

Number of known cases in State, January 1, 1916,

Number of new cases reported during the calendar year 1916,
Number of cases that died or left the State during the year,
Number of known cases in the State, December 31, 1916,
Number of cases isolated under State control, December 31, 1916.
Number of cases isolated under local control, December 31, 1916,
Location of cases present in State, December 31, 1916.
Town or county-

Number of known cases in city, January 1, 1916,

Number of new cases reported during the calendar year 1916,

Number of cases that died or removed during the year,

Number of known cases in city, December 31, 1916,

Number of cases isolated under municipal control, December 31, 1916,
Remarks:

To the SURGEON GENERAL,

United States Public Health Service,

Washington, D. C.

(Date.)

(City Health Officer.)

MALARIA.

The Public Health Service has for the last four years circularized the physicians of most of the Southern States to ascertain as definitely as this means would allow the prevalence of malaria. To determine its geographic distribution elsewhere circular letters of inquiry were sent recently to the health departments of all the other

States and of cities of over 10,000 population. The records of the occurrence of malaria at Army posts were also consulted. The mortality records of the registration area for deaths were examined, but, naturally, gave little information of value, for the reason that malaria may be prevalent without appearing in the records of deaths. This is illustrated by the fact that between 1904 and 1914 there were in the Army in the continental United States, exclusive of Alaska, over 13,000 cases of malaria, while during this time there were only two deaths due to the disease. Between 1907 and 1914 there were over 7,000 cases without a death. Then, too, in civil life malaria frequently is given as a cause of death when the deceased was affected with some condition other than malaria. This is true both in ma

Endemic areas of malaria.-Shaded portions of map show endemic areas. Shaded circles represent localities in which cases of malaria occur and in which the disease is probably endemic.

larious localities and in localities where the disease does not exist. And as malaria appears comparatively infrequently in mortality records at most, it is impossible by this means to separate malarious from nonmalarious localities.

As to the geographic distribution of malaria in the United States at the present time, there are three principal well-recognized endemic areas-one large area and two smaller ones. The large endemic area covers the whole southeastern portion of the United States, having for its southern boundary the Gulf of Mexico; for its western boundary, a line drawn from Eagle Pass, on the Rio Grande, to Leavenworth, Kans. ; for its eastern boundary, the Atlantic seaboard; its northern boundary, a line drawn from Leavenworth, Kans., eastward some distance north of the Ohio River and extending to the Atlantic on a line with the northern boundary of Maryland. Of the two smaller endemic areas, one includes a section of the northern part of New Jersey, southeastern New York, Connecticut, Rhode Island, and part of the State of Massachusetts. The third recognized en

demic area is in California, and includes the Sacramento and San Joaquin Valleys, which occupy a large portion of the central part of the State. It is probable that the New England endemic area actually extends southward to the large southern area of which it is in reality a part.

As indicated by reports received from State and city health departments and the records of Army posts, there are lesser endemic areas scattered here and there in many other States. (See map.)

The records of the Army posts are not without interest. Fort Washington, Md., had for several years up to 1913 the highest malaria sick rate of any post in the United States. The admission rate varied from 736 to 1,000 mean strength in 1906 to 172 per 1,000 in 1912.

While the malaria rate in the Army has steadily declined during recent years, it is suggested that the causes are the improved conditions at the posts, better barracks, and greater attention to screening and drainage, also that the troops still suffer from the infection present in localities surrounding many of the posts.

In 1914 the highest malaria rate at any Army post in the United States was 73 per 1,000 mean strength at Washington Barracks in the District of Columbia. The second highest was at Fort Myer, Va., just outside of Washington, and the third highest at Leavenworth, Kans.

MEASLES.

Alaska. A considerable prevalence of measles was reported in Alaska. During the month of August, 1916, 23 cases occurred at Possession Point, and from December 15, 1916, to February 17, 1917, 87 cases were reported at Ketchikan. Reports indicated that the southeastern section of Alaska was quite generally affected, with high rates in many of the towns and villages. At Yakutat 128 cases occurred among a population of 145 persons.

Case rates. The highest case rates for measles reported by States for the calendar year 1916 were those of Virginia, Pennsylvania, and Washington, with 11.85, 11.67, and 11.03, respectively, per 1,000 population. The lowest case rates among the States reporting were those for Alabama, Arizona, and Mississippi, with 0.09, 0.37, and 0.87, respectively.

Of the cities of over 100,000 population the highest reported case rates per 1,000 were those of Richmond, Salt Lake City, and Youngstown, with rates of 43.30, 34.22, and 26.45, respectively. The lowest rates of 0.22, 0.39, and 0.59 for Oakland, Birmingham, and Cincinnati, respectively, probably indicate an incomplete notification of

cases.

Fatality rates.-The highest fatality rates per 100 reported cases were those of the Territory of Hawaii, Rhode Island, and Michigan, with rates of 8.12, 6.28, and 3.20, respectively. The lowest rates were 0.23, 0.32, and 0.33 in the District of Columbia, Louisiana, and Montana, respectively.

Among the large cities, the highest fatality rates were in Providence, Detroit, and Worcester, with rates of 7.86, 5.57, and 4.72, respectively, per 100 cases, while the lowest were in Denver, Seattle, Indianapolis, and Dayton, with rates of 0.11, 0.17, 0.20, and 0.20, respectively.

Death rates. Among the States from which deaths were reported the highest death rates per 1,000 population were in the Territory of Hawaii, Rhode Island, and Virginia, with rates of 0.61, 0.22, and 0.18, respectively. The lowest death rates were in Alabama, Louisiana, and Mississippi, with rates of 0.001, 0.007, and 0.007, per 1,000.

The highest death rates in cities of more than 100,000 population were rates per 1,000 residents of 0.39 in Youngstown, 0.36 in Toledo, and 0.34 in Hartford. The lowest rates were 0.005 in Cincinnati, 0.008 each in Denver and in Dallas.

Measles-Cases reported, and case and fatality rates, in States in which the prevalence of the disease is recorded, 1915 and 1916.

2 Not computed for 1915.

Deaths were not reported.