encampments and ask to have sent to them carbon copies of communicable disease reports filed by the medical officer with the commandant.

Prevalence of communicable diseases

GENERAL COMMENT

The control of communicable disease in the State, outside of New York City, has been particularly difficult during 1917, owing to the unsettled conditions and numerous changes in health officers incidental to the war. It is difficult to estimate to what extent the extensive and constant movement of troops from other states and from one part of the State to another has influenced the prevalence of these diseases, but it seems reasonable to assume that it has contributed in some degree to the prevalence of certain diseases notably measles, German measles, and epidemic meningitis, all of which have prevailed in most of the military camps, the first two to a very great extent.

Among the common communicable diseases there have been increases in total numbers of cases recorded upstate, over 1916, in several, notably in chickenpox, German measles, scarlet fever, whooping cough, epidemic cerebrospinal meningitis and smallpox. The number of cases of diphtheria was larger by 53 than in 1916, although the case rate per hundred thousand population remains. practically unchanged. There has been a slight decrease in the diphtheria death rate as compared with 1911-1915. Typhoid fever increased by 68 cases while there were 30 less cases of paratyphoid, the combined case rate remaining practically unchanged. On the other hand there has been a decrease in death. rate for typhoid fever of approximately .3, with a decrease of approximately 4.9 or 46.7 per cent over the five-year period 1911– 1915, inclusive. There were 312 more cases of bacillary dysentery recorded than in 1916.

In several of these diseases, increases have been to some extent apparent rather than real, and in typhoid fever there is every reason to believe that an actual decrease has occurred both over 1916 and the preceding five year period.

Local outbreaks of communicable discase are investigated from

time to time by sanitary supervisors, and of late, by epidemiol ogists. Not infrequently such investigations bring to light numerous undiscovered or unreported cases, which are, as a rule, enumerated in the special reports of the investigators. In the past, owing no doubt to the lack of technical assistance in the office of the Division and the pressure of administrative work, most of these cases have failed to make their appearance in the annual records. With the appointment of epidemiologists, one of whom has been available for service in this connection, reports of investigations have been studied much more carefully than was possible before, and many cases are included in our records for 1917 which otherwise would have been missed. This is true regarding scarlet fever and diphtheria, but applies particularly to typhoid fever and bacillary dysentery.

With reference to typhoid fever, the omission from the records of such cases occurring in one or two of the larger outbreaks alone would have brought the 1917 rate down to a point considerably below that for 1916. The decline in the death rate in itself would suggest that there have actually been less cases, but that a much larger percentage of existing cases have been recorded.

Referring to bacillary dysentery, in a special report of an investigation of one large epidemic in 1916, it is stated that 225 cases had occurred which were undoubtedly dysentery, yet to record for the year showed but 121 cases charged to the municipality. During 1917 a similar outbreak occurred in the same municipality, and all discovered cases are included in the total for the year.

During 1917 several outbreaks of intestinal disorder have been investigated, some of which, according to laboratory reports, have proven to be bacillary dysentery. Here, again, it is reasonable to assume that there are not actually more cases, but that the disease is receiving more attention and that a larger proportion of existing cases are reported.

In acute anterior poliomyelitis there has been a very marked decrease over 1916, both upstate and in New York City.

A decrease of 12,166 cases of measles upstate against an increase of 5,916 cases in New York City, gives a decrease of 6,250 for the State as a whole. Mumps decreased both upstate and in New

York City. There was a decrease of 1,854 in tuberculosis (all forms) for the State as a whole, with an increase of 24 upstate.

Acute anterior poliomyelitis

In view of the occurrence of an extensive epidemic of poliomyelitis in 1916, and the uncertainty as to what 1917 would bring forth, the incidence of the disease during the spring and summer was closely and constantly observed, and so far as practicable every reported ease was investigated by a member of our field staff. Amendments to the Sanitary Code placed the maximum period of incubation at two weeks and made three weeks the minimum period of isolation. Health officers asking for advice were urged to isolate for the two-week period all contacts, including adults who were at all likely to come in contact with children or to handle foods, and to permit adults to enter and leave quarantined households only when the isolation of patients was complete, and the possibility of contact with children or of handling of foods was precluded.

The disease occurred in epidemic form during the summer in northern Vermont, and to a smaller extent in one or two Canadian counties djacent to New York State. On account of the proximity on the officers' training camp at Plattsburg to the Vermont line, special restrictions were placed upon intercourse between the two states at this point. The prevalence of poliomyelitis in New York State, however, nowhere assumed epidemic proportions. The largest number of cases reported from any locality occurred in St. Lawrence County, from which 31 cases were reported between August 13 and November 16.

The following chart (No. 2) shows the incidence of the disease by months in New York City and in the rest of the State. New York City reported 139 cases, as compared with 9,009 in 1916, while upstate 156 cases were reported as compared with 4,214 in 1916. It will be noted that, as in 1916, the incidence curve reached its maximum height a few weeks earlier in New York City than upstate.

Aside from the prevalence of the disease in St. Lawrence county, where a number of cases occurred during the epidemic of