Montgomery, 9; Newton, 35; Owen, 6; Parke, 5; Perry, 4, 3 deaths; Pike, 5; Posey, 1; Spencer, 3; Sullivan, 6; Tippecanoe, 4; Tipton, 1; Vanderburgh, 5; Vermillion, 20, 1 death; Vigo, 30; Warrick, 4; Wayne, 1; Whitley, 14.

The greatest fatality occurred in Indianapolis, which was also the case last month. We have reports of more smallpox and one death following exposure to the late Senator Gibson, who, it will be remembered, died of black smallpox in Indianapolis on March 4th. The last report comes from Dr. H. H. Setser, Health Officer of Leavenworth, who tells that Mr. William Mode, an assistant doorkeeper of the State Senate, evidently got the contagion from Senator Gibson, and from whom his brother and sister-in-law took the disease, and also that Orrin Mode, seven years old, died after having high fever and hemorrhage. Dr. Setser is particular to announce that he does not say he died of smallpox, but that the symptoms named were the only symptoms that could have been attributed to smallpox. He further says: "But as the father has varioloid, the people are railing smallpox was the cause."

May. Five hundred and seventy-nine cases and 10 deaths were reported in May, from fifty-nine counties. In the same month last year there were 692 cases in sixty counties, with 1 death. Although we had fewer cases this May and had one less county invaded, yet it must be recorded that smallpox is worse because of the deaths being 10 to 0. The counties invaded were: Benton, 1; Boone, 4, 1 death; Brown, 8; Carroll, 2; Cass, 33; Clark, 7; Clay, 10; Crawford, 6; Daviess, 14, 2 deaths; Decatur, 10; Dekalb, 3; Delaware, 20; Floyd, 6; Fountain, 17; Fulton, 5; Gibson, 9; Grant, 20; Greene, 7, 1 death; Hendricks, 7; Howard, 12; Huntington, 1; Jackson, 1; Jasper, 30, 1 death; Jennings, 1; Johnson, 5; Knox, 9; Laporte, 30; Lawrence, 15; Madison, 44; Marion, 24; Martin, 20; Miami, 4; Monroe, 12; Montgomery, 1; Morgan, 1; Newton, 3; Noble, 1; Orange, 1; Owen, 4; Parke, 10; Perry, 2; Posey, 1; Pulaski, 4; Scott, 3; Spencer, 4; Sullivan, 11; Tippecanoe, 2; Vanderburgh, 6; Vermillion, 42; Vigo, 60, 1 death; Warren, 6; Warrick, 34; Wayne, 1; Whitley, 5.

June. Two hundred and fifty-two cases and 4 deaths, in fortynine counties, were reported. This is an improvement, for 579 cases, with 10 deaths, in fifty-nine counties, was the May report. It is also an improvement, excepting deaths, as compared with

June of 1902, when there were 570 cases and 1 death in sixty counties. The counties invaded were: Adams, 1; Allen, 8; Benton, 2; Blackford, 1; Boone, 2; Brown, 10; Cass, 11; Clark, 2; Crawford, 3; Daviess, 18, 1 death; Dearborn, 1; Decatur, 11; Delaware, 8; Fayette, 2; Floyd, 1; Franklin, 1; Fulton, 5; Gibson, 1; Grant, 15; Greene, 6, 1 death; Harrison, 5; Hendricks, 4; Howard, 1; Knox, 4; Lake, 10; Laporte, 1; Lawrence, 4; Madison, 33; Marion, 4; Miami, 10; Monroe, 14; Morgan, 1; Noble, 1; Orange, 5; Parke, 3; Pulaski, 1; Ripley, 1; Scott, 2; Starke, 6; Sullivan, 2, 1 death; Tippecanoe, 6; Tipton, 6; Vanderburgh, 2; Vermillion, 5; Vigo, 15; Warren, 2, 1 death; Wayne, 1; Wells, 4; White, 4; Whitley, 3.

July. One hundred and four cases and 4 deaths, in twenty-two counties, were reported for July. This is an improvement over the preceding month, so far as cases and area infected are concerned, but we have to record exactly the same number of smallpox deaths. In June there were 252 cases and 4 deaths, in fortynine counties. It is a splendid improvement as compared with the corresponding month last year, when there were reported 502 cases with 15 deaths, in forty-six counties. The counties infected were: Benton, 2; Brown, 1; Clark, 4; Crawford, 6; Daviess, 17, 2 deaths; Fayette, 2; Fountain, 2; Fulton, 5; Gibson, 2; Grant, 2; Laporte, 4, 1 death; Lawrence, 1; Marion, 1, 1 death; Marshall, 3; Miami, 1; Monroe, 4; Morgan, 2; Orange, 14; Parke, 3; Starke, 9; St. Joseph, 1; Tipton, 13; Vigo, 8.

August. One hundred and twenty-nine cases and 12 deaths, in twenty-four counties, were reported for August. In the same month last year there were reported 245 cases and 2 deaths, in thirty counties. In the preceding month 104 cases and 4 deaths, in twenty-two counties, were reported. Delaware county reported 2 cases and 2 deaths. If there is no error in the number of cases, this is a death rate of 100 per cent. The inability of a few physicians to diagnose typical smallpox should be again remarked, because a severe case, presenting every symptom of the disease and continuing three weeks, was returned as "a form of chickenpox." This happened at Mulberry, Clinton County. The counties infected in August were: Adams, 5, 1 death; Allen, 3; Benton, 1; Brown, 1; Clark, 5, 1 death; Clinton, 5; Daviess, 36, 8 deaths: Delaware, 2, 2 deaths; Dubois, 2; Fountain, 1; Fulton, 7; Gib

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son, 5; Grant, 2; Knox, 2; Lake, 1; Laporte, 4; Marshall, 2; Monroe, 5; Orange, 8; St. Joseph, 1; Tippecanoe, 2; Vigo, 5; White, 2.

September. Sixty-eight cases and 2 deaths, in sixteen counties, were reported in September. This is a decided drop as compared with the preceding month. In the same month last year there were 219 cases, with 3 deaths, in thirty-nine counties. It is most probable that all the cases were not reported, because in the first week following September there were found several cases in Brazil, where, on account of previous experience, the disease should have been correctly diagnosed.

October. Three hundred and twenty-four cases, with 1 death, in thirty-one counties, occurred in October. In the same month last year 298 cases, with 19 deaths, in thirty-five counties, were reported. In the preceding month the cases numbered 68, with 2 deaths, in sixteen counties. The counties invaded were: Allen, 1; Boone, 2; Carroll, 1; Clay, 75; Clinton, 1; Crawford, 3, 1 death; Daviess, 7; Dubois, 21; Floyd, 1; Fulton, 5; Gibson, 2; Grant, 7; Hamilton, 1; Laporte, 2; Madison, 2; Marion, 2; Marshall, 6; Martin, 3; Orange, 26; Parke, 1; Perry, 1; Putnam, 8; Shelby, 4; Tippecanoe, 68; Vanderburgh, 1; Vermillion, 1; Vigo, 65; Warren, 2; Warrick, 2; Whitley, 5.

At several points it was plain that the disease first appeared in atypical form in the schools, and afterward appeared among the parents and older brothers and sisters of the school children. At Fontanet, Vigo County, twenty-two children in a school numbering forty-seven were found affected with mild smallpox. In every instance the eruption was insignificant, but two or three days of more or less severe prodomal symptons existed. Parents would not believe the diagnosis and in instances actual abuse was poured against health officers for making a true diagnosis. In most of the instances the smallpox which appeared in the parents and older brothers and sisters was severe.

November. Three hundred and twenty-four cases of smallpox, with 1 death, in thirty-three counties, occurred in November. It is a singular coincidence that exactly the same number of cases were reported in October, and also the same number of deaths. The counties were not the same, two more counties reporting it present this month than last. In November, 1902, 441 cases of

9-Bd. of Health.

smallpox were reported, with 2 deaths, in forty counties. The counties invaded this month were: Allen, 8; Benton, 18; Carroll, 5; Clay, 26; Clinton, 1; Crawford, 2; Daviess, 20; Dekalb, 5; Fountain, 1; Fulton, 2; Grant, 4: Hancock, 4; Howard, 7; Jennings, 5; Lake, 2; Marshall, 23; Martin, 4; Monroe, 4; Montgomery, 2; Morgan, 5; Orange, 53; Parke, 8; Pike, 1; Shelby, 1; Tippecanoe, 34; Vigo, 34; Wabash, 1; Warren, 1; Warrick, 20; Wells, 1; White, 12; Whitley, 3. The one death occurred in Parke County.

As was the case in the preceding month, the disease appeared in atypical form in the schools at certain points, and afterward appeared among the parents and older brothers and sisters of the school children in typical form. In Benton County, at Templeton, quite an outbreak of smallpox appeared, and although the cases were typical and not mild, still they were called chickenpox by the attending physicians. A visit of the Secretary of the State Board, together with the Secretary of the County Board, was necessary to convince the people that they were visited by the loathsome smallpox, which might at any time cause great destruction.

December. Five hundred and twenty-three cases of smallpox, with 2 deaths, in forty counties, occurred in December. In the preceding month there were 324 cases, with 1 death, in thirtythree counties. In December, last year, there were 642 cases and 17 deaths, in forty-one counties. We have, therefore, to record an increase as compared with the preceding month, but a decided decrease as compared with the same month last year. The counties infected this month were: Allen, 37; Benton, 12; Carroll, 1; Clay, 212; Crawford, 2; Daviess, 49; Dearborn, 1; Dekalb, 7; Delaware, 1; Dubois, 3, 1 death; Fountain, 2; Fulton, 1; Grant, 28; Hancock, 1; Harrison, 1; Jasper, 3; Jennings, 3; Laporte, 2; Lawrence, 5; Madison, 1; Marion, 1; Marshall, 6; Martin, 10; Miami, 1; Orange, 22; Parke, 11; Perry, 1; Porter, 1; Pulaski, 5; Putnam, 1; Tippecanoe, 20; Vanderburgh, 9; Vigo, 28, 1 death; Wabash, 17; Warren, 1; Warrick, 8; Washington, 1; Wells, 1; White, 10; Whitley, 4.

From several of the counties we have received reports which plainly tell that smallpox is still frequently unrecognized. This occurs mostly in the rural districts. Nearly all of the physicians in the centers of population have now become more or less in

formed in regard to smallpox and mistakes are not so general in diagnosis. In last month's Bulletin we had an article which we headed "Very Sad." Under this heading we presented the fact that certain County Health Officers had reported smallpox as not present in their counties, and yet deaths from the disease had occurred within their jurisdictions. Their attention was called to this anomaly and they were told that more careful work would be expected of them in the future. We are glad to say that all of the counties have come to time this month with fuller and better reports.

SUMMARY OF SMALLPOX FOR THE YEAR 1903.

A decided increase in the number of cases, deaths and area invaded occurred in 1903, as compared with the preceding year. The following table, giving number of cases and deaths, and per cent. of increase in deaths, cases and area invaded, compared with the same months of 1902, shows the situation:

It is likely all of the smallpox deaths were reported, but probably not more than one-half of the cases. This was due to the fact that many cases were so mild as not to require a doctor, and also because many doctors do not know smallpox in mild form. Many instances might be detailed when even typical smallpox was not correctly diagnosed.

Indianapolis was the storm center for cases and deaths in 1903. The smallpox hospital was crowded for the first three months, and the disease did not abate until the city authorities provided free