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TROPICAL AND EXOTIC DISEASES.
1844 ‘
from 1900 to the present year ; and in this report . vitamine" " found in the subpericarpal layers of it is shown that in a very large proportion of theibhe rice grain, set out their views fully ; and those cases a permanent cure of the lupus has been ’who also spoke included Dr. H. SCHAUMANN 1 in while others much has effected, improvement (Hamburg), Dr. S. SHIBAYAMA (Tokio), Professor F. occurred. Only in a very few cases has no benefltRHO (Rome), Dr. T. SHIMAZONO (Tokio), Dr. L. NATTANresulted. ;LARRIER (Paris), Dr. MALCOLM WATSON (British Malaya), Dr. J. TscIIUDNOwsKY (Paris), Dr. G. L. FINK (Burma), Dr. D. E. ANDERSON (London), Dr. TROPICAL AND EXOTIC DISEASES. Dr. L. SAMBON (London), Miss Tropical medicine still continues its triumphal IAGRAMONTE, MAY YATES (London), Mr. CANTLIE, Dr. E. DE march with the result that 1913 has seen much real FREITAS CRISSIUMA (Brazil), Dr. L. G. CHACINprogress in our knowledge of the origin, treatment,YTRIAGO (Venezuela), Dr. C. NOEL DAVIS (Shanghai), and prevention of the diseases most frequently met ‘and Sir PATRICK MANSON. The section passed with in the tropics. It is a matter of congratula‘a series of resolutions respecting the etiology tion that the London School of Tropical Medicine and prevention of the disease, embodying the views has already obtained nearly three-fourths of the inow generally held as to the danger of white rice sum of 100,000 required to place its operations ‘as a staple article of diet. on a better and more The substantial basis. The discussion on leis7mzania8is was opened great event of the year was the Seventeenth1by Professor A. LAVERAN (Paris), who read a International Congress of Medicine in London, this prepared by himself and Dr. C. NICOLLE being the first occasion on which a section has paper on Infantile Kala-azar. Sir WILLIAM B. (Tunis) been devoted exclusively to the subject of tropical LEISHMAN set out briefly the state of our The success of this medicine and hygiene. of the leishmania infection present knowledge section, which had for its president Others who took part in the ‘and its various forms. General Sir DAVID BRUCE, must have gratified its debate were Dr. Row, Dr. NATTAN-LARRIER, Dr. organisers. It more than justified its existence, CRISSIUMA, Dr. B. GONDER (Frankfort-am-Main), Dr. for its meetings were thronged at every sitting by AYRES KOPKE (Lisbon), Dr. A. SPLENDORE (Brazil), members from all parts of the world, some of whom Professor RHO, Dr. ANDERSON, Dr. L. P. PHILLIPS were among the " giants of tropical medicine " ; and i and last but not least, Sir PATRICK MANSON. these distinguished men, by taking part in the dis- (Cairo), The discussion on siocla
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1845 in Africa by Wild Animals columns of THE LANCET the notes of a case occurring The investigations of the Pellagra Com’in Ireland. and Insects. ]mission are being continued, and in this connexion The Secretary of State for the Colonies in August, Dr. SAMBON has recently visited the United States 1913, appointed a committee to report upon theIof America, where it is estimated some 30,000 present knowledge available as to the parts played persons are at present suffering from the disease. by wild animals and tsetse fiies in Africa in theiThe malady is reported to be prevalent, among maintenance and spread of trypanosome infections other places, at Porto Rico, the Panama Canal Zone, of man and stock; whether it is feasible to carry the Philippines, and the Sandwich Islands. The out an experiment with regard to game destruction difference of opinion as to whether this disease is in a localised area; whether it is advisable to due to a infection or a toxin, or is due to a .attempt the extermination of wild animals locally deficiencyspecific of some essential substance in the diet, or generally with a view of checking trypanosome has not been settled, though researches by Dr. diseases; and whether any other measures should SAMBON yet and other experts are in progress, as well be taken to obtain means for controlling these as investigations by an American Commission. A infections. The medical members of this committee recent report by Dr. HUGH S. STANNUS shows that ,comprise Dr. A. G. BAGSHAWE, Dr. ANDREW BALFOUR, is endemic in Nyasaland. SirJOHNROSEBRADFORD, Dr. W. A. CHAPPLE, M.P., Sir pellagra WILLIAM LEISHMAN, and Dr. C. J. MARTIN. Professor According to our custom we give a short summary R. NEWSTEAD and Dr. P. CHALMERS MITCHELL of the reported occurrences of the three exotic are also members of the committee, of which diseases, cholera, plague, and yellow fever, as well the Earl of DESART is the chairman. It may be as of small-pox in various parts of the world remembered that this subject was also raised in the during 1913 so far, at least, as the information has final report of the Luangwa Sleeping Sickness Com- been obtainable. mission by Dr. ALLEN KINGHORN and Dr. WARRINGTON Cholera in India and the Far East. YORKE. Cholera was prevalent in various provinces of Inquiry into the Nature and Frequency of West and so far as can be gathered from the India, African Coast Fever. limited amount of information available up to date, The Colonial Office, in view of the conflicting about 150,000 deaths were registered from the disease opinions expressed respecting the fevers occurring during the first nine months of the year. The on the West Coast of Africa, appointed in 1913 a worst sufferers were Bengal, the United Provinces small Commission of experts to study the nature of Agra and Oudh, the Madras Presidency, the and relative frequency of such fevers, and espe- Central Provinces, and the new province of Bihar cially as regards yellow fever and its possible minor and Orissa. The disease was continuously present manifestations among natives and others in West during the year in Calcutta, where about 1200 Africa; and to study the clinical course, pathology, deaths were recorded up to September. In Bombay and mode of infection of such fevers and the City cholera caused about 125 deaths in the same diseases for which they may be mistaken; the period. The malady appeared during 1913 at the nature of bilious remittent, malignant bilious re- Burmese ports of Rangoon, Bassein, and Moulmein, mittent, "inflammatory," endemial and "acclima- and at Madras and Negapatam in the Madras tising," and other forms of fever was to be investi- Presidency. In Ceylon 30 fatal cases occurred gated under the direction of this Commission, the at Colombo; and in the Straits Settlements at members of which are Sir JAMES KINGSTON FOWLER Singapore about 200 cases were reported. The (chairman), Sir RONALD Ross, Sir WILLIAM LEISHMAN, disease was reported to have occurred on the and Professor W. J. R. SIMPSON. west coast of the Malay Peninsula, and about 70 fatal cases were certified in Bangkok, the Special Investigation of Diseases in India. capital of Siam. Cholera was prevalent in Special investigations are now in progress in Indo-China, outbreaks being reported in Annam, India respecting the etiology, treatment, and pre- Cambodge, Cochin China, Laos, and Tonkin. The vention of a number of diseases, including Dutch East Indies suffered again from cholera in kala-azar, plague, cholera, relapsing fever, and 1913, the islands of Java, Sumatra, Borneo, and dysentery, the cost of which is defrayed, in whole Celebes being affected. In the Philippine Islands or in part, by the Indian Research Fund Associathe malady appeared in August at Manila, causing tion, which was founded in 1911. In this con- over 70 deaths up to November. In China cholera nexion we may refer to an article published was present in Amoy, Swatow, Canton, Hong-Kong, in Science Progress by Sir PARDEY LUKIS, which Foochow, Chuan-Chow, and elsewhere. Several shows how at present the practical application of prefectures in Japan were invaded by cholera scientific investigations is now being made use of during the year, and cases were notified at the in India with resulting great improvement in the ports of Kobe, Nagasaki, and Yokohama, as well as sanitary circumstances of the Indian people, accom- in the island of Formosa. panied by welcome developments in local sanitary Cholera in the Near East. administration. The Central Research Institute is located at Kasauli under the charge of Major S. R. Cholera was epidemic in Asia Minor and the CHRISTOPHERS, I.M.S. The Third All-India Sanitary Hedjaz up to the end of 1912, and in the early part Conference has not been held during 1913, but takes: of 1913 a few cases were heard of in these regions, the disease then seeming to disappear altogether. place in January, 1914. It was not until July that cholera once more broke Pellagra. out in Asia Minor at Smyrna, where up to September a L Pellagra, though not, strictly speaking, tropical about 300 persons had been attacked. The malady disease, is regarded by most people as an exotic,, also reappeared in August in the Red Sea provinces though lately Dr. L. SAMBON and others have re- of Turkey at the port of Hodeidah in Yemen, where ported some 40 cases in England, Scotland, and some 123 cases were notified up to September, Wales, while Dr. F. E. RAINSFORD sent to the; chiefly among the Turkish troops.
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1846 Cholera in Europe. Plague in the Far East. Plague was epidemic in Indo-China, including acutely epidemic at the end of 1912 in Constantinople and in its vicinity, especially at Annam, Cambodge, Cochin China, and Tonkin ; also Tchatalja, where the Turks made their final stand in the Quan-Tcheou-Wan leased territory, where It was fatally preto arrest the advance of the then victorious nearly 1500 deaths occurred. 1913 In the of news valent in the Dutch East came also Indies, especially early part Bulgarians. from Bulgaria and Macedonia that cholera had been in the island of Java, where more than 9000 cases. introduced by Turkish prisoners, and by the sick were recorded. In Siam there was an outbreak at and wounded soldiers sent home from the seat of Bangkok comprising some 60 fatal cases. Plague, When Adrianople capitulated in the was widely diffused over China, many cities, dis. war in Thrace. spring cholera broke out among the captive Turks, tricts, and ports being invaded by the infection. the infection extending also to the Bulgarian At Amoy about 300 deaths were recorded ; in Hongcaptors. The condition of the respective camps was Kong the annual epidemic included 335 fatal cases,. extremely insanitary, and we have the authority of and there was an epizootic among rats. Shanghai, the special correspondents of the London papers too, yielded cases both in man and in the rat; and for the statement that thousands of persons were at Canton in April and May plague caused 270, attacked and that many died ; how many will prob- deaths. Other places attacked were Swatow, Fungably never be definitely known. Cholera did not shan, Ampo, Kityang, Chao-Chow-fu, and Pakhoi;.;. become widely epidemic in the Balkan States until at this last-named port 2000 persons lost their lives the summer months ; up to ’ October 10,937 persons from plague. Chao-Yang was also invaded, and had been attacked in Bulgaria, of whom more than coincidently an unusual mortality was observed 3500 died; in Servia from July till October nearly among rats and mice. In Japan some cases occurred 7000 cases were reported, of which about 3000 proved in the latter part of the year at Yokohama, and there In the fatal; and in Roumania from August to October were 140 cases notified in Formosa. 5656 attacks were notified, 2908 of which had a fatal Philippine Islands the disease continued to crop up termination. Cholera broke out in Greece at the in sporadic fashion at Manila during the year, a few Piraeus among a batch of Bulgarian prisoners, and infected rats being also discovered. Scattered cases,. it was currently reported that the Greek army had too, came under notice in the Hawaiian Islands, also become involved. Cases, too, occurred in where also some plague-stricken rodents were in Salonica, whither many found. Macedonia, particularly had flocked and where many sick and Plague in the Near Eccst. refugees wounded had been sent. Cholera also appeared in The annual outbreak occurred at the Hedjaz port Bosnia and Herzegovina during the autumn, and of Jeddah early in the year, among the victims. the infection spread to Hungary (630 cases) and the registrar of the British Consulate. At being Croatia-Slavonia (494 cases), as well as to several Aden 80 cases and 58 deaths occurred, and the towns and districts in Austria, including Vienna, disease was also reported to be present in the Marienbad, and Prague, but there was no epidemic Sultanate of Oman. In the Persian Gulf plague in the last-named towns. In Russia some cases of appeared at the port of Bushire in April, and the cholera from Constantinople occurred at Odessa was epidemic in the two Persian provinces malady early in 1913, but the infection did not then spread. of Kermanshah and Khorassan from May to, During August, however, a number of places in the September. A few cases occurred at the port of government of Kherson were invaded by the Basra, probably imported from Bushire. In Asia malady, including the port of Kherson, where 40 Minor plague cases were reported at the ports of cases were notified. Some attacks also occurred in Adalia and Trebizond, and in the Lebanon district. Odessa in September, as well as in several localities Plague in Africa. situated in the governments of Poltava, Bessarabia, Taurida, Ekaterinoslav, and Kieff. At the close of In Egypt up to the end of November 649 plague 1913 the disease seems to be subsiding with the ’, cases had been notified, 95 being referred to. advent of wintry weather, but there is danger Alexandria and 25 to Port Said. At the Italian that in the coming year a recrudescence of cholera port of Massowah on the Red Sea coast of Erythrea in South-Eastern Europe may occur if sufficient an outbreak occurred in May comprising more than 50 cases. In British East Africa plague was preprecautions be not taken. valent during the first half of 1913, nearly 260’ Plague in India. cases being notified in Mombassa, Nairobi, Kisumu, Up to the end of October, 1913, more than and other many infected rats were also 200,000 cases of plague had been notified in India, and found. In places; the Muanza district of German East of these upwards of 171,000 had terminated fatally. Africa 236 fatal cases of plague were reported, and The provinces which had the highest plague there was a coincident epizootic among rats. On mortality during the ten months in question the island of Mauritius up to the end of November were the United Provinces of Agra and Oudh, with 280 cases of plague had been notified and about 400’ more than 88,000 deaths; the new province of infected rodents had been discovered. In Morocco Bihar and Orissa, with over 25,000 fatal cases ; the the disease occurred at Mehedia, Casablanca, at Punjab, with nearly 19,000; and the Presidency of Rabat, and El Arish. In Tripolitania cases Bombay, with not far short of 19,000. The epidemic were reported at Tripoli and Derna. Inplague the Canary of 1913 reached its height in March and April, and at Santa Cruz de Teneriffe some fatal cases to those two months more than 90,000 deaths from Islands, were registered during February. plague were referred. There is a great probability that the year 1913, when completed, will show a Plague in Europe. in There was very little plague in Europe during considerable reduction of the plague mortality India as compared with 1912, when 306,088 deaths 1913. In Russia about 30 cases were notified in the were registered from the disease, and 1911, when no territory of the Don Cossacks; and in the governfewer than 846,873 victims were certified to have ment of Astrachan, in a region said to be an endemic centre of plague, a number of casesperished from the malady. Cholera
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1847 among the residents, the origin of the infection not being traced to outside sources. Six deaths were certified up to October, and it is now feared that the endemicity of yellow fever may be re-established in Rio de Janeiro if care be not taken. Other places which suffered in Brazil were Bahia, where 70 cases were notified, among whom was the British chaplain, whose case proved fatal, and Manaos, where 40 deaths occurred. A few cases were also heard of at Pernambuco and Ceara, and a single ship-borne case at Para. In Venezuela some cases occurred at Caracas, and in the republic of Colombia the presence of the disease was reported discovered in November. In South America some at Carthagena, the infection having been brought 400 cases were reported in the State of Ecuador, from the interior. Ecuador suffered somewhat chiefly at the seaport town of Guayaquil, and later severely from yellow fever 1913, an epidemic reports’state that the disease was spreading into the occurring in Guayaquil andduring to Milagro, extending interior. The information available from Peru is Duran, Piedra, Naranjito, Bucay, Aqua Yaguachi, extremely meagre, but it is known that plague and Babahoyo. was prevalent, especially in the departments of Yellow Fever in Mexico and the West Indies. Lima, and Libertad, and that more Lambayeque, than 530 cases had been notified. The reports A few cases of yellow fever were reported during from Chili are also very scanty, but the disease 1913 in the province of Yucatan at Merida and was known to be prevailing in Iquique and other Maxcanu. The disease was also epidemic in the places. The government officials in the Argentine province of Campeachy, in the town of that name, do not publish newsrespecting exotic disease, but from May to October, and also in the port of consular reports show that plague had occurred Carmen in the same province. Some cases were at Rosario and in its vicinity, as well as at reported at Puerto, Mexico, in the province of Vera different places in the provinces of Tucuman, Cruz. The only reported occurrences of yellow fever Parana, Cordoba, and Entre Rios. In July it was in that was that have come to our knowledge in the West Montevideo, reported plague present the capital of Uruguay. cases occurred in Trinidad and in some cases Indies were Sporadic in Brazil at Rio de Janeiro, some 36 notifications Cuba; on two occasions a ship with infected being received up to October. About 20 attacks persons on board arrived at the port of were certified at Port Allegre. There was also an Habana. The first instance was in July, when the epidemic of plague at Bahia, about 150 cases being s.s. Hydra arrived from Manaos with the captain notified; and at Pernambuco about half a dozen ill, reporting also that four passengers had died fatal instances were certified. from yellow fever on the voyage. The second instance occurred in August, when the s.s. Morro Fever on Yellow the West Coast of Africa. During 1913 yellow fever appeared in Portuguese Castle arrived with a yellow fever case on boardWest Africa at Kiusembo, and there was a sharp namely, a passenger from the infected town of outbreak at Accra, in the Gold Coast, where cases Campeachy, who had shipped on board the vessel at continued to occur from March to October. Among the Mexican port of Progresso in Yucatan. the Europeans attacked at Accra were the wife of Small-pox in Europe. the Governor and his aide-de-camp; cases also An outbreak occurred in Sweden during April occurred in the Gold Coast colony at Quitta and and May at Stockholm, comprising 37 cases, the Cape Coast. In September the presence of the infection having been brought from Russia. As disease was reported in the German Protectorate of usual, the malady was very prevalent in European Togoland, at Lome, where cases had occurred during Russia, epidemics being reported in St. Petersburg, the previous year; also at Dakar in French Wes Moscow, and Warsaw, and in less degree in Odessa, Africa in November. In Southern Nigeria yellowt Batoum, Riga, and Libau. Small-pox often follows fever became prevalent at Lagos in March, the in the wake of armies in the field, and this was prevalence extending to other places in the colony, observed in the Balkans. At Constantinople the including Wari, Ibadu, Yoruba, Forcados, and malady was epidemic during most of the year and Abeocuta; a single ship-borne case was landed at also at Salonica, from which infection was carried Calabar in October. At the request of the Governor, by refugees on ships to the ports of Fiume and Dr. H. SEIDELIN, of the Liverpool Yellow Fever Trieste, where the infection spread. The occurBureau, was despatched to the colony to assist in rence of small-pox was reported in the Austrian making special researches with a view to the provinces of Galicia, Bohemia, Dalmatia, Moravia, discovery, if possible, of the specific parasite of the Carinthia, and the Tyrol, as well as in some parts disease and to make other investigations. Dr. of Hungary. Small-pox was severely epidemic in J. E. L. JOHNSTON and Dr. J. W. ScoTT MACFIE, in Eastern Servia and other parts of the Balkan THE LANCET, have reported the finding of the Peninsula and in Greece. In Italy cases were paraplasma flavigenum in the blood of cases, and notified in some of the large towns, including also in dogs at Lagos. Palermo, Naples, Turin, and Rome. There were Yellow Fever i-m South America. some serious epidemics in Spain, especially in Yellow fever, formerly endemic in Rio de Janeiro, Barcelona and Madrid, and in less amount in Cadiz, the capital of Brazil, has by means of modern pro- Almeria, Seville, Valencia, and Cordova. At Lisbon phylactic methods been completely banished from 123 cases were notified up to September, and a few the city except for occasional imported cases from instances were observed at Gibraltar and in Malta. infected ports. But recently in the absence of the ’, In Switzerland small-pox appeared in several disease the enforcement of the measures has gradu- cantons, including Argau, Lucerne, Ziirich, Basle, ally slackened. During 1913 some cases were Grisons, Vaud, and St. Gall. In Germany 84 cases
mostly of the pneumonic type were reported. During August 10 cases were registered in Greece at the Piraeus, the infection being traced to Egypt. Later the disease appeared in Athens, but did not spread. A single case was landed at the Austrian port of Trieste in November from the s.s. America. Plague in North and Sotcth America. In California, where the ground squirrels are known to be suffering from enzootic plague, two human cases, both fatal, were reported in 1913 ; and at Seattle, in the State of Washington near the Canadian boundary, nine plague-infected rats were
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1648 notified up to September, 35 being foreigners, in Japan were invaded, including Nagasaki, Yokomostly Russians. Berlin, Hamburg, Bremen, Breslau, hama, Kobe, Tokio, and Osaka. The presence of Kehl, and Strasburg furnished most of the cases. the disease was reported at Vladivostok and elseIn Luxemburg a few instances came under observa- where in the Russian Maritime Province. In Asia tion, and at Losser, in Holland, an outbreak com- Minor small-pox was epidemic in Beirut, Smyrna prising 34 cases was observed. During the first and Mersina ; and minor prevalences were observed half of 1913 there were 81 notifications of small- in Adana, Damascus, Tarsus, and Trebizond. There It is difficult to get precise was a limited outbreak in Arabia at Aden. pox in Belgium. information as to this disease in France, but it is Small-pox in Oceania. known that a fatal outbreak occurred in Marseilles, There was a small-pox epidemic of considerable and that cases were reported in Paris, Nice, Nantes, in New South Wales at Sydney, where proportions Limoges, and Toulon. over 1000 persons were attacked ; but the type was of the same mild character as that observed in Small-pox in Africa. North America, and this may be accounted for by In Egypt more than 2000 cases were recorded up the fact that the infection was introduced from to October, 91 of them being referred to Alexandria Vancouver. Cases were also notified in South and 89 to Cairo. Outbreaks were reported in and Queensland, while over 100 Australia, Victoria, Algeria, at Constantine and Oran. In South Africa were
The presence of cases occurred in New Zealand. the presence of the disease was noted at Durban in the Hawaiian Islands during the year small-pox and Johannesburg as well as in other places; and The infection was imported by ship was reported. outbreaks occurred in Zanzibar and in British East into Samoa from Hong-Kong, but the resulting outAfrica. Small-pox was epidemic in Somaliland and break did not assume any formidable dimensions. also in Abyssinia at the end of 1912, but no information concerning its occurrence in 1913 has been received as regards either of these countries. A PUBLIC HEALTH. severe epidemic occurred in Mauritius, comprising In noting, under the headings below, some of the more than 1000 cases, but not of a very severe type. outstanding features of the year to be included in a section on "Public Health," we are again forced to Smallpox in America. reflect on the continued expansion of the subjects Small-pox was epidemic in various parts of the which come before those who take part in public United States in a mild form, and some towns health and sanitary administration in this country. also suffered, including New York, Chicago, and The present year has given abundant evidence of Baltimore. In Canada the same mild type was this tendency; it has witnessed such new activities noted, outbreaks occurring in various provinces, on the of the State as the general introduction " including British Columbia, Manitoba, Ontario, of thepart local tuberculosis officer," the passing Quebec, and Nova Scotia. Cases were also reported through Parliament of the Mental Deficiency Act, in Newfoundland. In Mexico small-pox was widely the decision to make Exchequer contributions for epidemic, and its diffusion was no doubt facilitated general school medical service, the foundation of by the movements of the Federal and revolutionary a new organisation to spend nearly JE60,000 a year armies in the field, infection being at times carried on medical research, and the appointment of a by refugees across the Mexican frontier to Texas Royal Commission to advise as to public action for and other places in the United States; more than the repression of venereal diseases; while the 700 cases were noted in Mexico City. Cases of International Medical Congress itself conspicuously small-pox were reported in Honduras and Costa illustrated the growing demand which medical Rica. In Peru epidemics occurred in Ancon, Callao, science considers right to make for increased public Chancay, Huaco, and Lima; and in Chili at action in connexion with disease investigation and Santiago, Valparaiso, and Iquique, as well as else- prevention. Following the practice of previous where. In Argentina the presence of small-pox annual summaries, we have left to a separate was recorded at Buenos Aires, and a few cases were section the question of exotic and tropical diseases, reported in Uruguay at Montevideo. Brazil fre- in the control of which public health administraquently suffers from outbreaks of small-pox, and in tion based on modern research has produced such 1913 the disease was epidemic in Rio de Janeiro results in recent years. (355 cases up to September) and in Pernambuco, striking Acute Infectious Diseases. where 367 deaths were registered in nine months from the disease; also at Para, Bahia, and Manaos. The United Kingdom has been free during the In the West Indies scattered cases were certified year from any visitation of cholera or plague, save in Barbados, Grenada, and Trinidad. perhaps for an occasional case occurring at sea which has been dealt with at the port of arrival. Small-pox in Asia. The issue by the Local Government Board of the During the first half of 1913 upwards of 75,000 second annual return of the chief notifiable infecdeaths from small-pox were registered in India, the tious diseases for the whole of England and Wales, Punjab being the province that suffered most. together with available statistics of mortality, has Prevalences of the disease were reported in the enabled stock to be taken of the general prevalence cities of Bombay, Madras, and Calcutta, as well as of the acute infectious diseases during 1911 and at Karachi, Rangoon, and Moulmein. Cases occurred 1912 with satisfactory results, which appear to in the Straits Settlements, Siam, Indo-China, and have continued during 1913. Scarlet fever conthe Dutch East Indies, a severe epidemic being tinues to have a high rate of prevalence, and in the experienced in Java. Small-pox was widely pre- last few months has been conspicuously epidemic valent in China in the Eastern and Northern pro- in London, Birmingham, Manchester, and other vinces, where little or nothing was done to check large provincial cities, but its type remains Outbreaks were mild, in marked contrast to that with which the spread of the infection. observed in Hong-Kong, Amoy, Hankow, Nanking, physicians were familiar 20 or 30 years ago. Shanghai, and Chungking. Several ports and cities Reports which have reached us from medical
from 1900 to the present year ; and in this report . vitamine" " found in the subpericarpal layers of it is shown that in a very large proportion of theibhe rice grain, set out their views fully ; and those cases a permanent cure of the lupus has been ’who also spoke included Dr. H. SCHAUMANN 1 in while others much has effected, improvement (Hamburg), Dr. S. SHIBAYAMA (Tokio), Professor F. occurred. Only in a very few cases has no benefltRHO (Rome), Dr. T. SHIMAZONO (Tokio), Dr. L. NATTANresulted. ;LARRIER (Paris), Dr. MALCOLM WATSON (British Malaya), Dr. J. TscIIUDNOwsKY (Paris), Dr. G. L. FINK (Burma), Dr. D. E. ANDERSON (London), Dr. TROPICAL AND EXOTIC DISEASES. Dr. L. SAMBON (London), Miss Tropical medicine still continues its triumphal IAGRAMONTE, MAY YATES (London), Mr. CANTLIE, Dr. E. DE march with the result that 1913 has seen much real FREITAS CRISSIUMA (Brazil), Dr. L. G. CHACINprogress in our knowledge of the origin, treatment,YTRIAGO (Venezuela), Dr. C. NOEL DAVIS (Shanghai), and prevention of the diseases most frequently met ‘and Sir PATRICK MANSON. The section passed with in the tropics. It is a matter of congratula‘a series of resolutions respecting the etiology tion that the London School of Tropical Medicine and prevention of the disease, embodying the views has already obtained nearly three-fourths of the inow generally held as to the danger of white rice sum of 100,000 required to place its operations ‘as a staple article of diet. on a better and more The substantial basis. The discussion on leis7mzania8is was opened great event of the year was the Seventeenth1by Professor A. LAVERAN (Paris), who read a International Congress of Medicine in London, this prepared by himself and Dr. C. NICOLLE being the first occasion on which a section has paper on Infantile Kala-azar. Sir WILLIAM B. (Tunis) been devoted exclusively to the subject of tropical LEISHMAN set out briefly the state of our The success of this medicine and hygiene. of the leishmania infection present knowledge section, which had for its president Others who took part in the ‘and its various forms. General Sir DAVID BRUCE, must have gratified its debate were Dr. Row, Dr. NATTAN-LARRIER, Dr. organisers. It more than justified its existence, CRISSIUMA, Dr. B. GONDER (Frankfort-am-Main), Dr. for its meetings were thronged at every sitting by AYRES KOPKE (Lisbon), Dr. A. SPLENDORE (Brazil), members from all parts of the world, some of whom Professor RHO, Dr. ANDERSON, Dr. L. P. PHILLIPS were among the " giants of tropical medicine " ; and i and last but not least, Sir PATRICK MANSON. these distinguished men, by taking part in the dis- (Cairo), The discussion on siocla
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1845 in Africa by Wild Animals columns of THE LANCET the notes of a case occurring The investigations of the Pellagra Com’in Ireland. and Insects. ]mission are being continued, and in this connexion The Secretary of State for the Colonies in August, Dr. SAMBON has recently visited the United States 1913, appointed a committee to report upon theIof America, where it is estimated some 30,000 present knowledge available as to the parts played persons are at present suffering from the disease. by wild animals and tsetse fiies in Africa in theiThe malady is reported to be prevalent, among maintenance and spread of trypanosome infections other places, at Porto Rico, the Panama Canal Zone, of man and stock; whether it is feasible to carry the Philippines, and the Sandwich Islands. The out an experiment with regard to game destruction difference of opinion as to whether this disease is in a localised area; whether it is advisable to due to a infection or a toxin, or is due to a .attempt the extermination of wild animals locally deficiencyspecific of some essential substance in the diet, or generally with a view of checking trypanosome has not been settled, though researches by Dr. diseases; and whether any other measures should SAMBON yet and other experts are in progress, as well be taken to obtain means for controlling these as investigations by an American Commission. A infections. The medical members of this committee recent report by Dr. HUGH S. STANNUS shows that ,comprise Dr. A. G. BAGSHAWE, Dr. ANDREW BALFOUR, is endemic in Nyasaland. SirJOHNROSEBRADFORD, Dr. W. A. CHAPPLE, M.P., Sir pellagra WILLIAM LEISHMAN, and Dr. C. J. MARTIN. Professor According to our custom we give a short summary R. NEWSTEAD and Dr. P. CHALMERS MITCHELL of the reported occurrences of the three exotic are also members of the committee, of which diseases, cholera, plague, and yellow fever, as well the Earl of DESART is the chairman. It may be as of small-pox in various parts of the world remembered that this subject was also raised in the during 1913 so far, at least, as the information has final report of the Luangwa Sleeping Sickness Com- been obtainable. mission by Dr. ALLEN KINGHORN and Dr. WARRINGTON Cholera in India and the Far East. YORKE. Cholera was prevalent in various provinces of Inquiry into the Nature and Frequency of West and so far as can be gathered from the India, African Coast Fever. limited amount of information available up to date, The Colonial Office, in view of the conflicting about 150,000 deaths were registered from the disease opinions expressed respecting the fevers occurring during the first nine months of the year. The on the West Coast of Africa, appointed in 1913 a worst sufferers were Bengal, the United Provinces small Commission of experts to study the nature of Agra and Oudh, the Madras Presidency, the and relative frequency of such fevers, and espe- Central Provinces, and the new province of Bihar cially as regards yellow fever and its possible minor and Orissa. The disease was continuously present manifestations among natives and others in West during the year in Calcutta, where about 1200 Africa; and to study the clinical course, pathology, deaths were recorded up to September. In Bombay and mode of infection of such fevers and the City cholera caused about 125 deaths in the same diseases for which they may be mistaken; the period. The malady appeared during 1913 at the nature of bilious remittent, malignant bilious re- Burmese ports of Rangoon, Bassein, and Moulmein, mittent, "inflammatory," endemial and "acclima- and at Madras and Negapatam in the Madras tising," and other forms of fever was to be investi- Presidency. In Ceylon 30 fatal cases occurred gated under the direction of this Commission, the at Colombo; and in the Straits Settlements at members of which are Sir JAMES KINGSTON FOWLER Singapore about 200 cases were reported. The (chairman), Sir RONALD Ross, Sir WILLIAM LEISHMAN, disease was reported to have occurred on the and Professor W. J. R. SIMPSON. west coast of the Malay Peninsula, and about 70 fatal cases were certified in Bangkok, the Special Investigation of Diseases in India. capital of Siam. Cholera was prevalent in Special investigations are now in progress in Indo-China, outbreaks being reported in Annam, India respecting the etiology, treatment, and pre- Cambodge, Cochin China, Laos, and Tonkin. The vention of a number of diseases, including Dutch East Indies suffered again from cholera in kala-azar, plague, cholera, relapsing fever, and 1913, the islands of Java, Sumatra, Borneo, and dysentery, the cost of which is defrayed, in whole Celebes being affected. In the Philippine Islands or in part, by the Indian Research Fund Associathe malady appeared in August at Manila, causing tion, which was founded in 1911. In this con- over 70 deaths up to November. In China cholera nexion we may refer to an article published was present in Amoy, Swatow, Canton, Hong-Kong, in Science Progress by Sir PARDEY LUKIS, which Foochow, Chuan-Chow, and elsewhere. Several shows how at present the practical application of prefectures in Japan were invaded by cholera scientific investigations is now being made use of during the year, and cases were notified at the in India with resulting great improvement in the ports of Kobe, Nagasaki, and Yokohama, as well as sanitary circumstances of the Indian people, accom- in the island of Formosa. panied by welcome developments in local sanitary Cholera in the Near East. administration. The Central Research Institute is located at Kasauli under the charge of Major S. R. Cholera was epidemic in Asia Minor and the CHRISTOPHERS, I.M.S. The Third All-India Sanitary Hedjaz up to the end of 1912, and in the early part Conference has not been held during 1913, but takes: of 1913 a few cases were heard of in these regions, the disease then seeming to disappear altogether. place in January, 1914. It was not until July that cholera once more broke Pellagra. out in Asia Minor at Smyrna, where up to September a L Pellagra, though not, strictly speaking, tropical about 300 persons had been attacked. The malady disease, is regarded by most people as an exotic,, also reappeared in August in the Red Sea provinces though lately Dr. L. SAMBON and others have re- of Turkey at the port of Hodeidah in Yemen, where ported some 40 cases in England, Scotland, and some 123 cases were notified up to September, Wales, while Dr. F. E. RAINSFORD sent to the; chiefly among the Turkish troops.
The
Spread of Disease
.
1846 Cholera in Europe. Plague in the Far East. Plague was epidemic in Indo-China, including acutely epidemic at the end of 1912 in Constantinople and in its vicinity, especially at Annam, Cambodge, Cochin China, and Tonkin ; also Tchatalja, where the Turks made their final stand in the Quan-Tcheou-Wan leased territory, where It was fatally preto arrest the advance of the then victorious nearly 1500 deaths occurred. 1913 In the of news valent in the Dutch East came also Indies, especially early part Bulgarians. from Bulgaria and Macedonia that cholera had been in the island of Java, where more than 9000 cases. introduced by Turkish prisoners, and by the sick were recorded. In Siam there was an outbreak at and wounded soldiers sent home from the seat of Bangkok comprising some 60 fatal cases. Plague, When Adrianople capitulated in the was widely diffused over China, many cities, dis. war in Thrace. spring cholera broke out among the captive Turks, tricts, and ports being invaded by the infection. the infection extending also to the Bulgarian At Amoy about 300 deaths were recorded ; in Hongcaptors. The condition of the respective camps was Kong the annual epidemic included 335 fatal cases,. extremely insanitary, and we have the authority of and there was an epizootic among rats. Shanghai, the special correspondents of the London papers too, yielded cases both in man and in the rat; and for the statement that thousands of persons were at Canton in April and May plague caused 270, attacked and that many died ; how many will prob- deaths. Other places attacked were Swatow, Fungably never be definitely known. Cholera did not shan, Ampo, Kityang, Chao-Chow-fu, and Pakhoi;.;. become widely epidemic in the Balkan States until at this last-named port 2000 persons lost their lives the summer months ; up to ’ October 10,937 persons from plague. Chao-Yang was also invaded, and had been attacked in Bulgaria, of whom more than coincidently an unusual mortality was observed 3500 died; in Servia from July till October nearly among rats and mice. In Japan some cases occurred 7000 cases were reported, of which about 3000 proved in the latter part of the year at Yokohama, and there In the fatal; and in Roumania from August to October were 140 cases notified in Formosa. 5656 attacks were notified, 2908 of which had a fatal Philippine Islands the disease continued to crop up termination. Cholera broke out in Greece at the in sporadic fashion at Manila during the year, a few Piraeus among a batch of Bulgarian prisoners, and infected rats being also discovered. Scattered cases,. it was currently reported that the Greek army had too, came under notice in the Hawaiian Islands, also become involved. Cases, too, occurred in where also some plague-stricken rodents were in Salonica, whither many found. Macedonia, particularly had flocked and where many sick and Plague in the Near Eccst. refugees wounded had been sent. Cholera also appeared in The annual outbreak occurred at the Hedjaz port Bosnia and Herzegovina during the autumn, and of Jeddah early in the year, among the victims. the infection spread to Hungary (630 cases) and the registrar of the British Consulate. At being Croatia-Slavonia (494 cases), as well as to several Aden 80 cases and 58 deaths occurred, and the towns and districts in Austria, including Vienna, disease was also reported to be present in the Marienbad, and Prague, but there was no epidemic Sultanate of Oman. In the Persian Gulf plague in the last-named towns. In Russia some cases of appeared at the port of Bushire in April, and the cholera from Constantinople occurred at Odessa was epidemic in the two Persian provinces malady early in 1913, but the infection did not then spread. of Kermanshah and Khorassan from May to, During August, however, a number of places in the September. A few cases occurred at the port of government of Kherson were invaded by the Basra, probably imported from Bushire. In Asia malady, including the port of Kherson, where 40 Minor plague cases were reported at the ports of cases were notified. Some attacks also occurred in Adalia and Trebizond, and in the Lebanon district. Odessa in September, as well as in several localities Plague in Africa. situated in the governments of Poltava, Bessarabia, Taurida, Ekaterinoslav, and Kieff. At the close of In Egypt up to the end of November 649 plague 1913 the disease seems to be subsiding with the ’, cases had been notified, 95 being referred to. advent of wintry weather, but there is danger Alexandria and 25 to Port Said. At the Italian that in the coming year a recrudescence of cholera port of Massowah on the Red Sea coast of Erythrea in South-Eastern Europe may occur if sufficient an outbreak occurred in May comprising more than 50 cases. In British East Africa plague was preprecautions be not taken. valent during the first half of 1913, nearly 260’ Plague in India. cases being notified in Mombassa, Nairobi, Kisumu, Up to the end of October, 1913, more than and other many infected rats were also 200,000 cases of plague had been notified in India, and found. In places; the Muanza district of German East of these upwards of 171,000 had terminated fatally. Africa 236 fatal cases of plague were reported, and The provinces which had the highest plague there was a coincident epizootic among rats. On mortality during the ten months in question the island of Mauritius up to the end of November were the United Provinces of Agra and Oudh, with 280 cases of plague had been notified and about 400’ more than 88,000 deaths; the new province of infected rodents had been discovered. In Morocco Bihar and Orissa, with over 25,000 fatal cases ; the the disease occurred at Mehedia, Casablanca, at Punjab, with nearly 19,000; and the Presidency of Rabat, and El Arish. In Tripolitania cases Bombay, with not far short of 19,000. The epidemic were reported at Tripoli and Derna. Inplague the Canary of 1913 reached its height in March and April, and at Santa Cruz de Teneriffe some fatal cases to those two months more than 90,000 deaths from Islands, were registered during February. plague were referred. There is a great probability that the year 1913, when completed, will show a Plague in Europe. in There was very little plague in Europe during considerable reduction of the plague mortality India as compared with 1912, when 306,088 deaths 1913. In Russia about 30 cases were notified in the were registered from the disease, and 1911, when no territory of the Don Cossacks; and in the governfewer than 846,873 victims were certified to have ment of Astrachan, in a region said to be an endemic centre of plague, a number of casesperished from the malady. Cholera
was
1847 among the residents, the origin of the infection not being traced to outside sources. Six deaths were certified up to October, and it is now feared that the endemicity of yellow fever may be re-established in Rio de Janeiro if care be not taken. Other places which suffered in Brazil were Bahia, where 70 cases were notified, among whom was the British chaplain, whose case proved fatal, and Manaos, where 40 deaths occurred. A few cases were also heard of at Pernambuco and Ceara, and a single ship-borne case at Para. In Venezuela some cases occurred at Caracas, and in the republic of Colombia the presence of the disease was reported discovered in November. In South America some at Carthagena, the infection having been brought 400 cases were reported in the State of Ecuador, from the interior. Ecuador suffered somewhat chiefly at the seaport town of Guayaquil, and later severely from yellow fever 1913, an epidemic reports’state that the disease was spreading into the occurring in Guayaquil andduring to Milagro, extending interior. The information available from Peru is Duran, Piedra, Naranjito, Bucay, Aqua Yaguachi, extremely meagre, but it is known that plague and Babahoyo. was prevalent, especially in the departments of Yellow Fever in Mexico and the West Indies. Lima, and Libertad, and that more Lambayeque, than 530 cases had been notified. The reports A few cases of yellow fever were reported during from Chili are also very scanty, but the disease 1913 in the province of Yucatan at Merida and was known to be prevailing in Iquique and other Maxcanu. The disease was also epidemic in the places. The government officials in the Argentine province of Campeachy, in the town of that name, do not publish newsrespecting exotic disease, but from May to October, and also in the port of consular reports show that plague had occurred Carmen in the same province. Some cases were at Rosario and in its vicinity, as well as at reported at Puerto, Mexico, in the province of Vera different places in the provinces of Tucuman, Cruz. The only reported occurrences of yellow fever Parana, Cordoba, and Entre Rios. In July it was in that was that have come to our knowledge in the West Montevideo, reported plague present the capital of Uruguay. cases occurred in Trinidad and in some cases Indies were Sporadic in Brazil at Rio de Janeiro, some 36 notifications Cuba; on two occasions a ship with infected being received up to October. About 20 attacks persons on board arrived at the port of were certified at Port Allegre. There was also an Habana. The first instance was in July, when the epidemic of plague at Bahia, about 150 cases being s.s. Hydra arrived from Manaos with the captain notified; and at Pernambuco about half a dozen ill, reporting also that four passengers had died fatal instances were certified. from yellow fever on the voyage. The second instance occurred in August, when the s.s. Morro Fever on Yellow the West Coast of Africa. During 1913 yellow fever appeared in Portuguese Castle arrived with a yellow fever case on boardWest Africa at Kiusembo, and there was a sharp namely, a passenger from the infected town of outbreak at Accra, in the Gold Coast, where cases Campeachy, who had shipped on board the vessel at continued to occur from March to October. Among the Mexican port of Progresso in Yucatan. the Europeans attacked at Accra were the wife of Small-pox in Europe. the Governor and his aide-de-camp; cases also An outbreak occurred in Sweden during April occurred in the Gold Coast colony at Quitta and and May at Stockholm, comprising 37 cases, the Cape Coast. In September the presence of the infection having been brought from Russia. As disease was reported in the German Protectorate of usual, the malady was very prevalent in European Togoland, at Lome, where cases had occurred during Russia, epidemics being reported in St. Petersburg, the previous year; also at Dakar in French Wes Moscow, and Warsaw, and in less degree in Odessa, Africa in November. In Southern Nigeria yellowt Batoum, Riga, and Libau. Small-pox often follows fever became prevalent at Lagos in March, the in the wake of armies in the field, and this was prevalence extending to other places in the colony, observed in the Balkans. At Constantinople the including Wari, Ibadu, Yoruba, Forcados, and malady was epidemic during most of the year and Abeocuta; a single ship-borne case was landed at also at Salonica, from which infection was carried Calabar in October. At the request of the Governor, by refugees on ships to the ports of Fiume and Dr. H. SEIDELIN, of the Liverpool Yellow Fever Trieste, where the infection spread. The occurBureau, was despatched to the colony to assist in rence of small-pox was reported in the Austrian making special researches with a view to the provinces of Galicia, Bohemia, Dalmatia, Moravia, discovery, if possible, of the specific parasite of the Carinthia, and the Tyrol, as well as in some parts disease and to make other investigations. Dr. of Hungary. Small-pox was severely epidemic in J. E. L. JOHNSTON and Dr. J. W. ScoTT MACFIE, in Eastern Servia and other parts of the Balkan THE LANCET, have reported the finding of the Peninsula and in Greece. In Italy cases were paraplasma flavigenum in the blood of cases, and notified in some of the large towns, including also in dogs at Lagos. Palermo, Naples, Turin, and Rome. There were Yellow Fever i-m South America. some serious epidemics in Spain, especially in Yellow fever, formerly endemic in Rio de Janeiro, Barcelona and Madrid, and in less amount in Cadiz, the capital of Brazil, has by means of modern pro- Almeria, Seville, Valencia, and Cordova. At Lisbon phylactic methods been completely banished from 123 cases were notified up to September, and a few the city except for occasional imported cases from instances were observed at Gibraltar and in Malta. infected ports. But recently in the absence of the ’, In Switzerland small-pox appeared in several disease the enforcement of the measures has gradu- cantons, including Argau, Lucerne, Ziirich, Basle, ally slackened. During 1913 some cases were Grisons, Vaud, and St. Gall. In Germany 84 cases
mostly of the pneumonic type were reported. During August 10 cases were registered in Greece at the Piraeus, the infection being traced to Egypt. Later the disease appeared in Athens, but did not spread. A single case was landed at the Austrian port of Trieste in November from the s.s. America. Plague in North and Sotcth America. In California, where the ground squirrels are known to be suffering from enzootic plague, two human cases, both fatal, were reported in 1913 ; and at Seattle, in the State of Washington near the Canadian boundary, nine plague-infected rats were
reported
,
1648 notified up to September, 35 being foreigners, in Japan were invaded, including Nagasaki, Yokomostly Russians. Berlin, Hamburg, Bremen, Breslau, hama, Kobe, Tokio, and Osaka. The presence of Kehl, and Strasburg furnished most of the cases. the disease was reported at Vladivostok and elseIn Luxemburg a few instances came under observa- where in the Russian Maritime Province. In Asia tion, and at Losser, in Holland, an outbreak com- Minor small-pox was epidemic in Beirut, Smyrna prising 34 cases was observed. During the first and Mersina ; and minor prevalences were observed half of 1913 there were 81 notifications of small- in Adana, Damascus, Tarsus, and Trebizond. There It is difficult to get precise was a limited outbreak in Arabia at Aden. pox in Belgium. information as to this disease in France, but it is Small-pox in Oceania. known that a fatal outbreak occurred in Marseilles, There was a small-pox epidemic of considerable and that cases were reported in Paris, Nice, Nantes, in New South Wales at Sydney, where proportions Limoges, and Toulon. over 1000 persons were attacked ; but the type was of the same mild character as that observed in Small-pox in Africa. North America, and this may be accounted for by In Egypt more than 2000 cases were recorded up the fact that the infection was introduced from to October, 91 of them being referred to Alexandria Vancouver. Cases were also notified in South and 89 to Cairo. Outbreaks were reported in and Queensland, while over 100 Australia, Victoria, Algeria, at Constantine and Oran. In South Africa were
The presence of cases occurred in New Zealand. the presence of the disease was noted at Durban in the Hawaiian Islands during the year small-pox and Johannesburg as well as in other places; and The infection was imported by ship was reported. outbreaks occurred in Zanzibar and in British East into Samoa from Hong-Kong, but the resulting outAfrica. Small-pox was epidemic in Somaliland and break did not assume any formidable dimensions. also in Abyssinia at the end of 1912, but no information concerning its occurrence in 1913 has been received as regards either of these countries. A PUBLIC HEALTH. severe epidemic occurred in Mauritius, comprising In noting, under the headings below, some of the more than 1000 cases, but not of a very severe type. outstanding features of the year to be included in a section on "Public Health," we are again forced to Smallpox in America. reflect on the continued expansion of the subjects Small-pox was epidemic in various parts of the which come before those who take part in public United States in a mild form, and some towns health and sanitary administration in this country. also suffered, including New York, Chicago, and The present year has given abundant evidence of Baltimore. In Canada the same mild type was this tendency; it has witnessed such new activities noted, outbreaks occurring in various provinces, on the of the State as the general introduction " including British Columbia, Manitoba, Ontario, of thepart local tuberculosis officer," the passing Quebec, and Nova Scotia. Cases were also reported through Parliament of the Mental Deficiency Act, in Newfoundland. In Mexico small-pox was widely the decision to make Exchequer contributions for epidemic, and its diffusion was no doubt facilitated general school medical service, the foundation of by the movements of the Federal and revolutionary a new organisation to spend nearly JE60,000 a year armies in the field, infection being at times carried on medical research, and the appointment of a by refugees across the Mexican frontier to Texas Royal Commission to advise as to public action for and other places in the United States; more than the repression of venereal diseases; while the 700 cases were noted in Mexico City. Cases of International Medical Congress itself conspicuously small-pox were reported in Honduras and Costa illustrated the growing demand which medical Rica. In Peru epidemics occurred in Ancon, Callao, science considers right to make for increased public Chancay, Huaco, and Lima; and in Chili at action in connexion with disease investigation and Santiago, Valparaiso, and Iquique, as well as else- prevention. Following the practice of previous where. In Argentina the presence of small-pox annual summaries, we have left to a separate was recorded at Buenos Aires, and a few cases were section the question of exotic and tropical diseases, reported in Uruguay at Montevideo. Brazil fre- in the control of which public health administraquently suffers from outbreaks of small-pox, and in tion based on modern research has produced such 1913 the disease was epidemic in Rio de Janeiro results in recent years. (355 cases up to September) and in Pernambuco, striking Acute Infectious Diseases. where 367 deaths were registered in nine months from the disease; also at Para, Bahia, and Manaos. The United Kingdom has been free during the In the West Indies scattered cases were certified year from any visitation of cholera or plague, save in Barbados, Grenada, and Trinidad. perhaps for an occasional case occurring at sea which has been dealt with at the port of arrival. Small-pox in Asia. The issue by the Local Government Board of the During the first half of 1913 upwards of 75,000 second annual return of the chief notifiable infecdeaths from small-pox were registered in India, the tious diseases for the whole of England and Wales, Punjab being the province that suffered most. together with available statistics of mortality, has Prevalences of the disease were reported in the enabled stock to be taken of the general prevalence cities of Bombay, Madras, and Calcutta, as well as of the acute infectious diseases during 1911 and at Karachi, Rangoon, and Moulmein. Cases occurred 1912 with satisfactory results, which appear to in the Straits Settlements, Siam, Indo-China, and have continued during 1913. Scarlet fever conthe Dutch East Indies, a severe epidemic being tinues to have a high rate of prevalence, and in the experienced in Java. Small-pox was widely pre- last few months has been conspicuously epidemic valent in China in the Eastern and Northern pro- in London, Birmingham, Manchester, and other vinces, where little or nothing was done to check large provincial cities, but its type remains Outbreaks were mild, in marked contrast to that with which the spread of the infection. observed in Hong-Kong, Amoy, Hankow, Nanking, physicians were familiar 20 or 30 years ago. Shanghai, and Chungking. Several ports and cities Reports which have reached us from medical