vil/7 ANKYLOSTOMIASIS AND BILHARZIASIS IN THE MEDITERRANEAN BASIN (With 4 charts attached to the text). Translation prepared by: U.S. Fleet, u* S* Naval Forces, Germany, Technical Section (Meaical). VI1/7 I. Ankylostomiasis. The information on the occurrence of hookworm infections in the Mediterranean basin is very incomplete for some of the coun- tries concerned# There are no recent detailed investigations of Greece ana Turkey# A useful summarizing survey was published by W# HEINE (1938) which will be quoted several times in the following study# In Europe only Ankylostoma duoaenale occurs# In ell cases in which Necator americanus was found in southern Europe it occurred with remigrants from Brazil, etc# Necator does not occur in northern Africa; it is observed south of the Sahara only, in central Africa, where it has its proper origin# The cause of the considerable hookworm contamination in Egypt, according to KHALIL, (1924) are the ritual ablutions of the Mohammedan religion after defecating and urinating. AUGUSTINE, HELMY and NAZNI (1929) found that the frequency of hookworm infection in upper Egypt is 49 % while in the region of the Nile delta it amounts to 24*5 %• In both parts of the country, however, the number of hookworms found with the various patients, compared with the severity of the disease was said to be astonishingly small# According to these studies a- mong 75 % of the persons contaminated with ankylostoma in upper E>—- gypt less than 20 worms were found, and among only 2 $, 70 worms y and more. In lower Egypt 82 % of the patients have less than 20 worms and only 1 % 70 ana more. According to recent investigations of SCOTT (1937) 50 ~/o of the rural population of almost the whole of Egypt are carriers of hookworms (see Illustration 1)# A lower (20$ in the north of the delta) or a higher percentage (in some of the villages as much as 90 %) were observed in single places only# Al- together 5 million persons of the rural population of Egypt number- ing 12 million individuals was said to be contaminated with the hookworm. In Libya the hookworm disease does not seem to occur, as no endemic case was found during the last 20 years (GOETTSCHE 1942). According to PALAZZO (1936), however, there is the possibility that the disease might be imported from Egypt or other African terri- tories. In a certain borderline zone of the Bjebel which is lo- cated west of Lorna and south of Apallonia the annual precipitation amounts to more than 400 mm. ana according to other sources of in- formation even to more than mm. per year. The conditions for the occurrence of ankylostomiasis therefore seem to be present here. vii/7 In Tunisia the most important areas of the hookworm are located in the south of the country. Ihe oases of Gafsa, Tozeur, and Nefta are veLl known as foci. The inten- sively cultivated, continuously rigated soil protected from the sun by palms, is fertilized with human excretions. Thus, it offers the most favorable possibilities of development for the larvae of the hookworm. Contamination takes place principally auring the cul- tivation work which is carriea through with bare feet. In addi- tion it is made easy by the ritual ablutions of the Mohammedans, by drinking the contaminated water of the irrigation system, ano by eat- ing vegetables infected with larvae and fruit sullied with earth, or by eating the earth itself. In Gafsa 200 indigenous persons were examined for intestinal parasites by ESPIE (1937) and it was found that 51 of them (equal to 25 $)were contaminat- ed with hookworm (see Table I). The same author found among 300 indigenous persons in the coast- al town of Qabes 82 persons (equal to 27 %) contaminated with hookworms. Other foci of contamination of mi- nor importance are reported in the literature: These are the island of Djerba, the environments of Sfax, and the peninsula of Cape Bon in the north of the country with the local centers of Menzel bou zelfa, Haramam el Ghezaz, Beni Khaled, Nabeul, Dar Chaabane, soilman, and Gromhalia (ES- PIE 1930, BENYAMINe 1934). As in the remainder of North Af- rica foci of contamination were ob- served in Algeria in various places Illustration 1, Ankylostomiasis in Egypt, Ihe figures show the percentage of ankylostomiasis among the population (Acc.fco SCOTT 1937)*' vi i/7 with a thoroughly irrigated soil. The first cases were discovered by FERRIER (1906) in Mostaganem which is situated west of Oran on the coast. Furthermore, SERGENT and DE MOUZON (1910) observed hookworm eggs in the feces of indigenous Berbers in the Oasis of Mdoukal, in the mountain valley of Hodna. Later on more cases of infection were found in the same region, west and southwest of the Chett el Hodna. As local foci in this region Barika, Biskra, and foga were mentioned (BENYAMINE 1934, THIODET 1939). TABLE I. Intestinal worms of 200 indigenous persons of Gafsa (according to ESPIE). 1 time ankylostoma auodenale, 4 times ankylostoma ana ascaris, 6 times ankylostoma and trichuris, 33 times ankylostoma^ascaris and trichuris, 1 time ankylostuma, trichuris, and strongylus, 2 times ankylostoma, ascaris, trichuris, and strongylus, 1 time ankylostoma, ascaris, trichuris, and strongyloides stercoralis, 1 time ankylostoma, ascaris, trichuris, and hymenolepis nana. The information on the occurrence of hookworm infections in Morocco is scanty, but it is alleged that a certain number of cases is to be found among the population along the coast (CHANDLER 1929)* Isolated cases found in Casablanca anu Fez were not autochthonic, as they were imported from Cameroon ana other central African territories (NORMET 1922, VIALATTE 1932, BENYAMINE 1934). In Portugal the hookworm disease occurs as an endemic in the mines as as the farm workers (HEINE 1938) • In the coal mines of Pedro aa Cova locatea in the north in the vicinity of Porto, RICCO (1926) examined 116 coal miners and he found that 35 of them (47 %) were contaminated with Ankylostoma duodenale# This author also found that 98 out of 100 laborers examined in the mines of Gabo Mondego near Figueira da Fez were carriers of the hookworm* In Spain ankylostomiasis is among the miners as well as among the 'farming population. BAILEY and LANDAZURI (1920) estimated the number of the infected miners at However, 65 % of them harbored less than 23 worms* Clinical symptoms and an increase of the eosinophiles were almost always absent (M0LD0NAD0 1935)* The anemia of the miners is very frequent in the mining aistricts of Vll/7 Puertollano, Almaden, Sierra Morena, Horcajo (DE BUEN 1924)* HER- NANDEZ-PaCHECO (1928) gives the following percentages of infections in the Spanish mines: Linares 30, La Carolina 14, Ciudad Real 43* Cordoba 58, Sevilla 35* Baleares 61, Murcia 1, Huelva 0, Santander 0, and Vizcaya 0 The ankylostomiasis of the farm laborers was thoroughly in- vestigated by DERRIBA and CANOVAS (1933> 1934) in the Huerta of Murcia* This is an area locatuu in the valley of the Segura river which is 25 km. long and 14 km. wide with the town Murcia as its center. The first contamination with hookworm was found here in 1923* In 1934 the number of hookworm carriers in the district of La Raya amounted to 10.7 %• Men were more affected than women. The infections occur during farm work which is carried out with bare feet, particularly in the tomato culture and in the alfalfa fields. The aamage caused by the ankylostomae is generally small. In the province of Valencia numerous cases of ankylostomiasis were also observed (RODRIGUEZ-FORNOS 1926) among the rural population working in the vegetable ana rice fields. Similar data are avail- able for the provinces of Castellan de la Plana and Alicante, It is, however, likely that foci also occur in other parts of the country, particularly in the South (Cadiz, Ankylostomiasis of brick-yard workers was observed by LOPEZ NEYRA (1922) in Lachar near Granada ana by URBANO CASES (1928) in Navalmoral de la Mata (Caceres). In Italy ankylostomiasis is less frequent among the coal miners than among the farming population. While.the infections in the mines of Sicily ana Sardinia are few in number they are frequent through- out the rural communities* Annually several hundred new cases are found: 1925 to 1932 an annual average of 300 cases, 1933 552 cases, 1934 1258 cases, in 1935 697 cases (LUTRARIA,1LVENTO, and MAZZITELLI 1936)* Of the 94 Italian provinces, for the time being, only Luc- ania is entirely free from hookworm disease (VANHI 1938)* Through an oraer of the Ministry of Health in 1933 the disease has become a reportable oisease. Every case comes under treatment and all persons living together with the patients are examined together with them. Ankylostomiasis is particularly widespread in northern Italy, Liguria, around Modena, Milano anc Firenze. The southern parts of the country, particularly Sicily, are also considerably infected* The hookworms generally cause no persistent damages in Italy* They disturb, however, the normal condition of health by diminishing the natural defense forces of the organism, as is stressed by the vii/7 Italian authors. In Italy the exclusive parasite causing the hookworm disease is ankylostoma duodenale. Necator was found among a few remigrants from overseas. Now new infections with necator americanus occurred# V©ry little information is available on the part played by the infection with hookworm in southeastern Europe. In Greece the disease occurs in an endemic form in the southern parts of the country, in Arcadia, Euboea, on the islands of the Aegean Sea, and in Crete (HEINE 1936). In view of the conditions of climate it is probable that hookworm infections occur on the coasts of Turkey, and less pro- bably in the interior of the country# There is no information on the extent of the disease. In Trabzon and particularly in the province of Rise (Lhasistan) a considerable frequency of hook- worm infectioi was found by systematic investigations (CHANDLER 1929, ARAR 1935). II> Bilharziasis (Schistosomiasis), Bilharzia infection was observed in various countries of the Mediterranean basin* It is of the relatively greatest importance in Egypt, where the vesicular and the intestinal Bilharziasis is wide- spread among the population of the Nile delta region (see "Ankylosto- miasis and Bilharziasis in the Near East")* Outside of Egypt no large foci of intestinal Bilharziasis (Bilharzia Mansoni) exist, while numerous centers of infection are known of the vesicular Bilharziasis (Bilharzia hematobia)* In Libya there is no vesicular Bilharziasis in the territories of the country where there is no water; there are particularly no cases of Bilharzia in the Libyan table-land, which is 620 M above sea-level (PATANE 1924)* One of the centers of infection on the coast is Derna and its vicinity, where several cases have been ob- served# In this place, ZAVATTARI (1932) found ova with a terminal spine in the urine of 1*4 % out of 606 youthse There is also a small focus in Tauorga in the vicinity of Misurata on the coast# The dis- ease is more widespread in the southwest of the country throughout the territory of the Oasis Gat on the Algerian frontier and in Fezzan west of that place. In the villages El Barcat and El Feuat in the Oasis of Gat NASTASI (1936) found infections in about two thirds of the population examined. In Fezzan according to ZAVATTANI 10 to 15 % vil/7 of the adults and 60 to 70 % of the children suffered from Bil- harziasis. Similar figures were found by NASTASI, who observed 169 males, 19 females and 135 children suffering from Bilharzia- sis (see Illustration 2), Only 2 cases of intestinal Bilharzia- sis have been observed in Libya so far. They roused the suspicion that there is a focus of intestinal Bilharzia in Gat, all the more as Planorbis Pfeifferi was found there as the possible vector, Bullinus truncatus, the snail transmitting the vesicular Bilharzi- asis is widely distributed through- out Libya, It is found in Derna and its vicinity (Ouadi Derna,Ouadi El Atrum, Umerrezen, Ain Zara), in the Oasis of Ghadames and in numer- ous villages of the Fexzan area, • In Tunisia the occurrence of vesicular Bilharziasis has been known for a long time (BRAULT 1891, SONZINO 1893), The principal centers of in- fection are the Oasis of Gafsa and several places located around the salt swamps of the Chott Djerid (see Illustration 3)» According to GOBERT (1934) the population of Gafaa is in- fected with Bilharzia hematobia to more than 50 %c In 1932 5# % of 964 persons examined (including all school children) had ova with a terminal spine in their urine. The girls were in- fected more frequently than the boys, and the men more frequently than the women. In various snail villages in the environment of Gafsa (Sidi Man- sour, El Ksar, Lela) the indigenous population suffers from vesicular Bil- harziasis, likewise in the Chott Djer- id and particularly in the Oases of El Oudiane (Degache, Zaouiet, El Arab, Zorgane, Oulad Majed) numerous indigen- ous persons were infected; there is no Bilharziasis, however, in the Oases of Nefta and El Hamma, located in the neighborhood. In Tozeur, a big village south of El infection with Bilharziasis is rare. An important area of Bilharziasis is the region Illustration 2. Bilharziasis in Fezzan• In the underlined villages Bih- harzia patients and Bullinus snails were found simultaneously (according to NASTASI 1938)• VI i/7 of Nefzaoua with numerous villages contaminated, namely Kebili, Djemna, El Aouina (see Illustration 4). Finally some cases were found in other districts of Tunisia, for instance in Matmata in the southeast, in Kairouan in central Tunisia, in the region of Cape Bon (?) and of Tabarca in the north of the country* Bilharziasis in Tunisia* Vesicular Bilharziasis,si Intestinal Bilharziasis Bullinus xxx Plan^rbis vii/7 Illustration The distribution of Bilharziasis in the area of Nefzaoua (according to BOUSQUET 1930). In the underlined villages Bilharziasis and Bullinus snails are found simultaneously. vii/7 Particularly the children between 5 and 15 years are contamin- ated and in their urine blood containing ova with a terminal spine can be found. Even though the disease occasionally heals spontaneous- ly and with regard to its consequences cannot be compared with the Egyptian Bilharziasis, some of the adults, particularly males, suf- fer from its late consequences. Intestinal Bilharziasis (Bilharzia mansoni) dees not seem to be endemic in Tunisia, although 3 single cases were observed in Degache, Kebili, and Matmata (ANDERSON 19.23). Bullinus truncatus, the vector of Bilharzia hematobia, is widely spread. In the Oases of Gafsa and Nefzaoua snails are living in nu- merous water holes* In these places they are found in the spring-fed lakes with an abundant growth of plants and stagnating water and they can be traced on the bottom and particularly on the remnants of sus- pended parts of plants as on the underside of palm branches floating in the water. In the deeper springs with a smaller growth of plants and a considerable flow of water the Bullini are less frequent* They are entirely absent in the warm springs of Gafsa, as soon as the water temperature exceeds 28°Co In water holes, where other species of snails are frequent, Bullinus, as a rule, is found in small numbers only* plancrbis species do not occur in southern Tunisia, while Plan- orbis philippii subangulatus was found in some places of the north bet- ween 37°21*North and 36° 23* N (see illustration 3, ANDERSON 1923). In Algeria Bilharziasis has so far been found only in two placest in the southeast on the Libyan frontier 84 (45 %) out of 184 indigenous persons were infected in the Oasis Djanet in 1925* According to BERGE- R$T (1935)>who examined 204 indigenous persons in 3 villages of the Oa- sis Djanet 56 (27 %) persons excreted ova with a terminal spine through the urine* - The second Algerian focus of Bilharziasis is located in the north along the railroad track between Oran and Algiers* It is a small village, with 1729 inhabitants, located 9 Km* from Inkermann and 35 from Relizane in the valley of Cheliff in which there is an extensive system of irrigation canals* ALCAY, MARILL, MUS- SO and CASTRYK (1939) found hematobia ova in the urine of 42 persons out of 96 examined, while a total 52 suffered from hematuria* Bullinus snails occur in Algeria in the spring-fed lakes of the Oasis Djanet and in some places of the coastal region only: in the irrigation canals of Saint-Aime, in the canal of La Macta, in the out- let of lake Halloulaj in the swamps of Mirabeau, in the vicinity of Bougie, and in lake Oubeira not far from Bone (GAUTHIER 1934}• VII/7 Intestinal Bilharziasis was found once only in a young in- digenous person in Saint-Aime (MARILL, ALCAY, and MUSSO 1939). Planorbis snails, however, were nut found in the vicinity of this place, so that one does not know which is the intermediate car- rier. In Morocco vesicular Bilharziasis is widespread in the south only, although Bullinus truncatus and Planorbis dufouri are also frequent in the north, for instance in the zone of Tangier (REM- UNGER 1926), The cases found in northern Morocco among the Euro- peans and the indigenous population originate without exception from Fez (JOBARD 1924, RAYNAUD 1926). In the south since 1914, Marrakech has been well known as a focus of Bilharziasis# Carrosse (1930) had observed altogether 210 cases in this town and he reported that a- bout 5 to 6 % of the Bullini collected in Marrakech contained furco- cercariae. Moreover, thorough investigations in the focus of Bou Denib were made. Here, according to MEIDINGER (1931) 35 % of the indigenous population are infected on an average; in the garrison up to 80 % of some of the units were sick. Other centers of infection in southern Morocco are Ksar es soud (according to reports of the French health authorities), Erfoud (VIALaTTE 1932), the valleys of Oued Draa, and Oued Sous (B.JINE0UD 1931), Oued (BLANCARDI 1936), and Kari ben Aouda in Le Gharb (NAIN 1937). In Europe Bilharziasis foci are exclusively found in the south- west of the Iberian peninsula. According to BETTENCOURT and BORGES (1927) 3 centers of infection exist in the province of Algarve in southern Portugal; These are Tavira, Estoi, and the villages of Al~ portel. Alporuel is located 28 Km, northeast of Tavira. The trans- mitter of the disease is planorbis metidjensis var*dufouri. Con- tamination is promoted by the high mean .annual temperature which in this area is and by the occurrence of hot springs in which the infected snails live. It is possible that in Spain a focus of vesicular Bilharziasis exists which is located in Lorca in the province of Murcia (SANCHEZ COVISA 1922). According to GERMAIN and NEVEU-LEMAIRE (1926) Bullinus trun- catus (the same as B* contortus) -was found in France in the province Pyrenees-Orientales only. It also is frequent in Catalonia. In ad- dition the snail is found in Corsica, Sardinia, Sicily, and on the Italian mainland in the Campagna (ZAVATTARI 1929, BRUMPT 1930). There is, however, no endogenous Bilharziasis in southern Europe except for the Iberian peninsula (CARQSSE 1930). vii/7 Finally several cases of vesicular Bilharziasis in Cyprus are mentioned in the literature. The only focus is the small village of Syrianokhori in the vicinity of Morphou in the north of the is- land; it is known since 1902 (g,A, WILLIAMSON 1902, 1907)* Ac- cording to MCKINLEY (1935) 14 cases of Bilharziasis were observed in Syrianokhori during the year 1933; their focus was accurately delimited by LEIPER (1928), In Syrianokhori and its environments L2IPER found the following snails: Melanopsis, Linnaea, and less frequently Bullinus. Several cases of Bilharziasis were observed in Morphou itself, but they seemed to be caused by bathing and fishing in the pools of the dried out river bed of Syrianokhori during the summer months. In other parts of Cyprus no Bullinus snails were found by LEIPER, AH other areas of Bilharziasis in the Mediterranean basin (Palestine, Egypt) were discussed in detail in the section "Near Eastn• C. SCHLIEPER (Institute for Tropical Medicine and Hygiene of the Military Medical A- cadeiay)* VII/8 DISTRIBUTION 0? THE YELLOW FEVER MOSQUITO (ABDES AEGYPTI) AS VECTOR IN THE MEDITERRANEAN REGION (with 1 text-map) Translation prepared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) VII/8 The yellow fever mosquito (Aedes aegypti, former name: 'Stegomyia fasciata) is distributed throughout the Mediterranean region except the northern section of the Adriatic and parts of the French coast. It may be imported also into these regions by ships or airplanes and persist there in summer. In the area of the Black Sea, it occurs constantly only in the eastern section on the Georgian coast and in the eastern part of the coast of Asia Minor, while toward the west, only Istanbul is again a reported location. In summer, it can be found also on the Crimea. Its distribution is generally indi- cated by the 6° C. January isotherm (see map). Where summer temperatures remain low, however, such as in Brit- tany or on the Bay of Biscay, its boundary lies more southward. In ’’Encyclopedic entomologique”, vol. 1: Les moustiques (Paris 1942), SEGUY shows a map.of the probable constant distribution of the yellow fever mosquito in the Medi- terranean region and western Asia (see Illustration 1). southward. Illustration 1. Constant distribution of the yellow fever mosquito, (according to SEGUY 1942) • occasionally observed occurrence VII/8 This map is correct for the Mediterranean region but wrong for the Black Sea region where no constant occurrence is reported from the indicated area of the western coast. Also in the area of the southern Caspian Sea, nothing is known of any occurrence of the mosquito. The geographical distribution of the yellow fever mosquito in the countries with hot climates within the ring of the 6° C. January isotherms is generally deter- mined by the following behavior: The optimal temperatures for the yellow fever mos- quito lie between 2 and 32° C. Within these temperatures, it finds its best possibilities of development and living. In temperatures below 17° C., its eagerness to bite de- creases, though bites have been observed at temperatures of 14° and 15° C. Below 6° C. the mosquito perishes. The females live for 1-2 months and deposit around 750 eggs on an average. The eggs are deposited on water or above the water surface at the edge of the reservoirs. The larvae creep forth only at temperatures above 20° G. They may creep forth within a few days, but also only months afterwards under certain conditions. By such a "slow-hatching of the eggs", the yellow fever mosquito is capable of persisting through periods of unfavorable temperatures. Under the most favorable conditions, the development is achieved within 9-10 days. At temperatures below 17° G., the development is stopped. While the eggs are insensible to slight transitory effects of frost, the larvae perish. The mosquito may persist as adult insect in houses and stables through the winter in the Mediterranean region. Breeding places for the larvae are water reservoirs of every description, both in the open and in closed rooms, water casks, raintubs, cisterns, eaves, cans, flower-vases etc. The larvae do not live, however, in large pools or other stagnant waters. Under favorable conditions of temperature, the mosquitoes are extremely importunate, particularly when there is much moisture in the air and decreasing pressure of the air. They bite chiefly in the daytime, but also at night. Their flying range is inconsiderable (100 M.), only in exceptional cases it is around 1 Km. But the mosquito is frequently transported by all means of communication, VII/8 since it likes to sit in dark corners and nay also subsist several days without any nutrition of blood. In tho Mediterranean region, the yellow fever mosquito plays an inpcrtant role as a vector of the dengue fever. Pandemics repeatedly occurred there, in the course of which whole towns were suddenly affected with it. I remind you only of the great epidemics of 1889 and of the last in Athens in 1928. There is always the possi- bility of dengue epidemics .in towns, if more than 15 ah of the houses are populated with yellow fever mosquitoes. To control present epidemics or to remove the hazard of further spreading, the "Stegomyia index” must be reduced to 5 This is associated with the limited flying range of the mosquito. A particular hazard is also present if multitudes of yellow fever mosquitoes slip out immediately after the occurrence of the first few cases in period with rising temperatures of the air and simultaneous great moisture of the air. Even on the second day after biting a dengue patient, the mosquito becomes infectious and remains so up to the 27th'day, if not its whole life. Not even the lowest temperatures which the yollow fever * mosquito is barely capable to survive do any darnge to the dengue virus. According to a report of MOUTOUSSIS, the great pandemic in Athens in 1928 was preceded by several thousand cases during the months September - November 1927* These had been limited to a few districts of the city of Athens. The first few cases occurred in the environs of a family who had moved in from Alexandria. The disease is said to have spread at first slowly from the neighborhood of that house. In 1928, a few individual cases occurred as early as in spring after Easter. By the end of July and in all August the epidemic had spread in pandemic form over the whole city of Athens and the port of Piraeus, so that the number of cases is estimated to have been around 500,000 cases, i.e. around 80 % of the population of the infected districts. After tho middle of August 1928, the epidemic also has spread in most of the parts of Greece. The yellow fever mosquito is of particular importance as the vector of the yellow fever virus. Yellow fever, however, is not endemic in the Mediterranean region. VII/8 Only occasionally during the past centuries it has been imported by ships from West Africa and South America to the parts of the- southern coast of the Iberian peninsula and to Marseille. Seme importations have caused great epidemics, such as in Cadiz in 1800, 14,000 cases, and in Gibraltar in 1804, 15,000 cases with 5,700 fatal cases. The yellow fever cannot become endemic in these zones, since the yellow fever area is not exclusively determined by the ecological laws of the vector but rather by the living conditions of the yellow fever virus. In the middle of its development, the yellow fever virus requires a period for maturation which depends to a great extent on the temperature. The lower the outdoor temperature, the less prospect of survival exists for the virus in the mosquitoes. After infection, the yellow fever virus can be transferred afresh at high temperatures (higher than 31° C.) in 4-5 days, at 31° C. in 6 days, at 25d C. in 8, at 23° C. in 11, at 21° C. in only 18 days. At temperatures of 18° C., however, the infected mosquito is not yet infectious even 30 days afterwards. These data show why yellow fever does not become endemic in the Mediterranean region despite the presence of the vector. The epidemic imported to the Mediterranean region will always die out soon there due to the climatic conditions, particularly since the virus is not passed on from one mosquito-generation to the following. R. von BLUMENTHAL (Institute for Tropical Medicine and Hygiene of the Military Medical Academy) VII/9 DISTRIBUTION OF TICKS AS VECTORS OF DISEASES IN THE MEDITERRANEAN REGION (with 2 text-maps) Translation prepared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) VII/9 In the Mediterranean region, the distribution areas of two epidemics meet, which are determined by the occur- rence of ticks, because the transfer of these epidemics - the tick relapsing fever (see "Relapsing fever in the Mediterranean region" by Otto FISCHER) and the exanthe- matic tick fever or Marseille fever (see Map VII/10) - to man depends on the mediation of ticks. As contrasted to similar epidemics transferred by lice, tick relapsing fever and Marseille fever play only an insignificant role in the Mediterranean region. This is associated with the possibilities of infection. The transferring ticks are animal-parasites and infect man only occasionally, if man is in close contact with the host-animals of the ticks, and ectoparasites pass over to him, or if the usual host-animals of the ticks do not exist and the ticks try to-use man as a host. TixO occurrence of the transferring ticks seems to coincide largely with the occurrence of the host-animals. Rhipicephalus occurs everywhere, where dogs live or stayed. The north African species of Ornithodorus are largely adapted to rodents and live particularly in the burrows of the large and small desert-mouse (Meriones shawi Roz. and Gerbillus gerbillus 01.) and of the porcupine (Hystrix cristata L.). In addition, Mus rattus norvegicus is once mentioned as host-animal. .Other rodents occurring in North Africa are not mentioned in the literature, though it is probable that Ornithodorus is to be found in their burrows as well. If the rodents leave the burrows, the hungry ticks seek a new host and then occasionally get to man, to whom they transfer the spirochaetes of relapsing fever by biting him or by the coxal fluid. In districts where pigs are kept, the ticks are frequently parasites on the pigs which, however, are no virus reservoir. All species of Ornithodorus are animals active at night which hide in the daytime in fissures or between bricks like bugs, and seek their victims in the dark. The blood-sucking lasts about half an hour on an average. VII/9 The spirochaetes of relapsing fever as well as the rickettsiae of Marseille fever in the ticks are trans- ferred from one generation to the other in the eggs. It has not yet been positively proven that dogs may serve as a reservoir for Marseille fever. On the other hand, rodents can certainly be regarded as a virus re- servoir for the spirochaetes of relapsing fever. In addition, some other animals must be considered as re- servoirs (see following section). The following species of ticks can be vectors: I. Ixodines Rhipicephalus sanguineus Latreille must be regarded as the only vector. By its bite it transfers Marseille fever (Fievre boutonneuse), lives as a dog-tick on dogs, foxes and jackals, and is found in their living-places. Bites man occasionally. Geographical distribution: cosmopolitan, imported also to Germany, where it may be found in hotels. France: Toulon, Rognac, St. Marcel, Marseille, St. Cyr, La Giotat, Cannes, Nice, Sorgues, La Barque-Fuveau, Le Brusq, Ste. Maxime, Region de Gard; Tunisia: (no specific location); Algeria: Algiers, Chiffalo; Morocco: Tangier, Ain Mazi, Mers Sultan (Flateau near Casablanca), Rabat; Tripolitania: Tripoli; Greece: Piraeus, Vollo, Athens, Thessalonike, Mytilene, Thouria; Portugal: (no specific location); Crete: Rhetym- non; Italy: (no specific location); Serbia: Uskub; Bulgaria: (no specific location); Corsica: Bastia; southern Hungary: (no specific location); Roumania: Constanta; Asia Minor: (no specific location); Georgia: Poti; Egypt: Cairo; Palestine: Jerusalem. II. Argasines Several species of Ornithodorus are vectors of diseases. The important facts of their way of living have been mentioned before. VII/9 1. 0. erraticus Lucas ( = 0. maroccanus Velu)• Dis- tributed in southwestern Spain, northwest Africa (southern- most location Dakar), extends through Morocco, Algeria, Tunisia allegedly to Egypt, probably also to the Pelo- ponnesos. Cases of relapsing fever caused by an agent similar to Sp. hispanica, have been reported from there. Found in burrows of rodents and pigsties, principal vector of the Spanish relapsing fever. Illustration 1. Occurrence of ticks in Tunisia Ornithodorus erraticus Lucas Ornithodorus normandi Larroussei Morocco: Mansouria, Rabat, Doukkala, Douar Korlea Chouia, Oulad Fredj, Casablanca, region of Kenitra, region-of Tetuan, Constantine, 18 Km. north of Biskra, Forme Dufourg, Bou Znika, Bou Denib, Salsafat, Kenitra, Tetuan, Mazagan, Environ- ments of Goulimine, Douar Lamouitet (near Oualidia), Douar Regagda near Oualidia; Algeria: La Calle, Houbeira near La Calle, Nemours and environments, Algiers, Beni Ounif, Figig; Tunisia: Carthage, Tunis, Bizerte, Ferryville, Menzel-Temime, Bab-el- Allouche, Chaibine, Hcnchir-Zoutar; Oued-el-Khatef; Egypt; Asyut, el Hasaiba, Deirut; Spain: Acehuehe, Malpartida do Plasencia (Caceres), Talavera de la Reina (Toledo), Olivenza (Badajoz), Malaga, Fuento Ovejuna (Cordoba), Alcolea, Navamorcuonde, Huelva, vn/9 region between Aigueras de Vargas and Barcarota, Campillo de Salvafiera, Macotera, Aldehuela de la Boveda, Ciudad Rodrigo Boada, Cilleros el Hondo, Miranda de Azan, Monterrubio de las Sierra (all locations in the province of Salamanca), Navalmoral (Caceres), Sevilla, Cadiz, Jaen, Ciudad Real. A map on the distribution of relapsing fever in Spain was given by DE BUEN in 1926 (Distribucion Geographies de la Fiebre Recurrente en Espana. - Ann. Acad. Med. Quirurg. espan., XIII, p. 271, Madrid 1925/26). At that time, the transfer by ticks was still unknown. The map fully coincides with the distribution of the ticks, which has become known in the meantime. Illustration 2. Occurrence of relapsing fever in August 1922 in southwestern Spain (according to S. DE BEEN) • = 1 case VII/9 2. 0. normandi (Larrousse). Previously found only in rodent burrows in Tunisia, especially in the region of Cape Bon. Transfers the Spirochaeta normandi as described by ANDERSON and cooperators, perhaps Sp. his- panica as well. Tunisia: Carthage, La Marsa, Kef, Oued-el-Khatef, Henchir-ben-Abdelazis, Henchir-Zoutar, Si-Ali-Dahli, Henchir-Chabane (Mengoub), Gabes. 3. 0. foleyi Parrot ( - 0. franchini Rondelli). Similar to 0. lahorensis. Tripolitania, Libya, interior Sahara (Hoggart, Libyan Sahara). Host-animals: domestic animals, dromedary, gazelle, sometimes also man. Hides in daytime in sand, holes, fissures of stones etc. Called "Tebbia" by the natives in Ghadames, "Rhambda” in the Marmarica. According to the natives, it is a vector of tickbite fever (RONDELLI). Hoggar, Oulad Ighaghar, Ghadames, Tgutta (Tripoli- tania), Marmarica caves, Bardia, Cufra. 4. 0. delanoei Roubaud & Colas-Beloour. Morocco. In the burrows of porcupines. Role as a vector unknown. Morocco: region of Mazagan. 5. 0. papillipes Birula. The most important facts about this vector of Asiatic relapsing fever have been mentioned on map I1/3. In the Mediterranean region only in Alep. 6. 0. lahorensis Neumann. Is said to be a possible vector of tularemia in Asia Minor, in addition, is mentioned as a vector of Asiatic relapsing fever. Distribution see II/3. Asia Minor: Ankara, no other locations; Jerusalem. 7. 0. moubata Murray. Vector of African relapsing fever (Spirochaeta duttoni). Of no importance in northeast Africa. Egypt: Cairo, no other location; Cirenaica (without location^ R. von BLUMENTHAL (Institute for Tropical Medicine and Hygiene of the Military Medical Academy) VII/9 RELAPSING FEVER IN THE MEDITERRANEAN REGION (with 1 text-map) Translation prepared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) VII/9 I. The numbers of the various kinds of relapsing fever mentioned in the literature, whose agents have been through- out given particular names, are extraordinarily large and have been considerably increased recently. In addition to the variety of vectors, above all reactions of immunity but also in part a varying animal-pathogenity have been decisive for their differentiation. In the following list which is intended in the first place to give a general synopsis of all kinds of relapsing fever occurring on the globe, only the large‘groups have been mentioned which frequently overlap one another or even pervade each other, which is the case e.g. in the Mediterranean region (see section II). A. Europe 1. East European relapsing fever (RUTTY): Synonyms; Relapsing fever European Type (English), fievre recurrente mondiale (French), fievre recurrente a poux (French), Fiebre recurrente (Spanish), febbre ri- corrente (Italian). Agent: Spir. Obormoieri. Vector*. Lice, chiefly clothes-lice, but probably the head-louse as well. Occurrence: Eastern Europe, chiefly Russia, extending to Foland, Balkan (intensely distributed during the Balkan wars and during World War I). In western Europe, partic- ularly frequent in Ireland during the first centuries. 2. Spanish relapsing fever (SADI DE BUEN). Synonyms: Spirochetose hispano-africaine (French), Espiroquetosa hispano-africana (Spanish). Agent: Spir. hispanica. VII/9 Vectors: Ticks: Ornithodorus erraticus (Lucas) - 0. maroccanus (Velu) - 0. hispanicus, a pig-tick. Occurrence: The infection is chiefly found among swineherds in Spain (numerous provinces (see map VII/9), Portugal, Greece, also in western North Africa (see B lb). B. Africa 1. North African relapsing fever (ARNOULD): Two kinds have recently been differentiated (NICOLLE): a) the proper North African relapsing fever: Agent; Spir. berbera (SERGENT and FOLEY). Vectors: Lice. Occurrence: Morocco, Algeria, Tunisia (SERGENT, who brought experimental proof of' the transfer by lice in 1910) , Tripolis, Egypt (DREYER). b) the Spanish relapsing fever (cf. A.2): Agent: Spir. hispanica. Vectors: Ticks, chiefly 0. erraticus, and the species mentioned below. Occurrence: During the last few years, this form of * relapsing fever has been described in increasing numbers by various explorers from all regions of North Africa: Morocco (REMLINGER): As virus-reservoir, porcupine, jackal, jumping hare, and wildcat are mentioned. Algeria (SERGENT): Transfer also by Rhipicephalus sanguineus. Virus-reservoir: rats and dogs. Tunisia (NICOLLE): Vectors also 0. turicata and 0. normandi. Tripolis (FRANCHINI): Vector also 0. lahorensis. VII/9 2. Central African relapsing fever (LIVINGSTONE): Synonyms: Zeckenfieber (German), Tick fever (English), fievre recurrente a tiques (French). a) East African form: Agent; Spir. duttoni. Vector: 0. moubata (MURRAY). Occurrence: Starting from two old foci in German East Africa (Tanganyika) and on the Zambezi River, it extended along the lines of commerce in all directions up to southern Abyssinia, the Sudan, Somaliland, South Africa, and finally West Arr ica as well (see under b). Even in Madagascar, relapsing fever has been observed. b) West African form: Vectors: Ticks: 0.. moubata (MURRAY) , 0. erraticus (Lucas). Occurrence: Congo, Gold Coast, Senegal (endemic focus in Dakar): In Dakar, Spir. crocidurae (MATTHIS) must be mentioned as a special form, which is found in shrew-mice, and is transferred from them by ticks also to man. In West Africa mice, rats, weasels, squirrels, and young foxes are regarded as additional virus-reservoir. In addition, there is a relapsing fever in West Africa which is transferred by lice. C. Asia 1. Indian relapsing fever (CARTER): Synonyms: Bombay relapsing fever. Agent: Spir. carteri (MACKIE). Vectors: Lice, perhaps bugs as well. Occurrence: In all regions of India, chiefly in the northern provinces and their adjoining countries (Afghan- istan, Nepal), and on Ceylon. VII/9 2. Chinese relapsing fever (HILL): Vectors: Lice, perhaps bugs as well. Occurrence: In all regions of China, also in the former German protectorate of Kiaochow (U1HHMANN and FUERTH), in Tibet, Manchukuo, Korea, Siberia (Tobolsk), Japan, Indochina, Siam, Philippines, Netherlands Indies. In some of these countries, only infections imported from elsewhere exist, particularly if only a few indi- vidual cases have been described, such as in Siam and the Philippines. 3- Western Asiatic relapsing fever: Agent: Spir. persica among others. Vectors: In most cases ticks, chiefly 0. tholozani. In addition, there are reports of: 0. papillipes, 0. canestrini, 0. lahorensis, 0. asperus (BRUMFT in the ruins of Kish in Syria), and Argas persicus. In addition, lice are often mentioned, chiefly by German authors during World War I, when their importance as vectors of the disease has been concluded chiefly from the intense typhus occurring at the same time (MULHLENS, KUELZ) . Occurrence: Persia ('’Disease of Miana"), Turkestan, (salvarsan-proof), particularly Bukhara and Tashkent, Mesopotamia (among prisoners of war 1916 (KUELZ)), Syria (during the construction of the Baghdad railroad (SCHNEIDER)), Palestine: Tick fever of Palestine (CALWELL, iiDLER) beside lice-infections (MUEHLENS). D. America 1. North American relapsing fever: Agent: Spir. novyi (SCIIELLACK). Vector: There are varied data in the literature as regards the vectors. Lice are mentioned (1844, cases from Ireland in Philadelphia), then bugs and ticks: VII/9 0. hernsi (California), 0. turicata (Texas, Mexico). Occurrence: In many states of the U.S.A., in Mexico (in Yucatan), and Cuba. It is still a question whether some of the diseases have been only imported from Asia (by Chinese), or from Africa (by negro slaves). 2. Central and South American relapsing fever: Agent: Spir. neotropicalis. Vectors*. In most cases ticks, also lice in some regions. The following species of ticks are mentioned: 0. venezuelensis, 0. turicata, 0. talaje, 0. canestrini, and Argas anericanus. Occurrence: Panama, Colombia, Venezuela, Peru, Uruguay, Argentina (transferred by lice in the three last countries). Virus reservoir for the American relapsing fevers transferred by ticks: squirrels, chipmunks, and opossums. E. Australia and South Sea New Caledonia: Individual cases described by MORIN and GENVRAY 1925= Vector: Unknown. II Of the above mentioned forms of relapsing fever, the followin' forms occur in the Mediterranean region: 1. Eastern European relapsing fever (agent: Spir. Obermeieri - vectors: lice): Dalmatia, Bosnia (particularly 1902/04), Roumania, Serbia, Bulgaria, Macedonia, Albania, Greece (also in some islands), Turkey (particularly during the Balkan wars and World War I), in Italy and Sardinia. In western Asia, sporadic occurrence in Turkey, Syria, Iraq, Palestine. VII/9 East European Spanish North African West Asiatic relapsing fever Illustration 3- Relapsing fever in the Mediterranean region 2. Spanish relapsing fever (agent: Spir. hispanica - vector: ticks): In nun arous provinces of southern and central Spain (see Illustration 1, nap VII/9), Portugal, Greece. In North Africa: Morocco, Algeria, Tunisia, Tripoli. 3. North African relapsing fever (agent: Spir. berbera - vector: lice): All North Africa fr-on Morocco to Egypt, and to the south up to the Sudan and Abyssinia. A. West Asiatic relapsing fever (agent: Spir. persica - vector: ticks): Extends from Iran through Iraq to Syria and Palestine. VII/9 Table I. Relapsing Fever in the Mediterranean Region 1918 to 1930 (according to Rapport epidemiologique 145 (Hygiene-Section)) 1918 1919 1920 1921 1922 1923 Europe: "TtaTy • . . • • • Yugoslavia • . 23 69 21 13 Rounania • . 19,452 4,663 444 152 Greece • . • • m . Africa: French Morocco 0 • . . . . Algeria . . 2 18 5 4 Tunisia , . • . • 2 Jfeypt 12,642 3,272 2,876 1,217 172 39 Near East: Palestine • • • 51 25 8 Iraq * • • 3 0 1 1924 1925 1926 1927 1928 1929 1930 Europe: Italy • 338 289 195 214 153 • Yugoslavia 15 15 1 2 1 1 0 Rounania 56 34 6 5 0 0 0 Greece 91 1 0 4 3 7 0 Africa: French Morocco 0 0 0 51 1 10 8 Algeria 1 0 26 68 43 • • Tunisia 1 6 5 0 0 0 0 Egypt 5 3 0 2 0 0 0 Near East*. Palestine 11 22 11 25 28 19 20 Iraq 0 0 0 0 1 1 2 Note: . - no data available VII/9 Table I informs about the varied intensity of relapsing fever in the various regions. This table is an excerpt of the reports of the Hygiene section of the League of Nations. No differences have been made, however, between the various forms of relapsing fever. After World War I, considerable epidemics broke out in some regions, such as in Egypt 1918 with 12,6U2 cases. Even if the figure of the reported cases has considerably decreased meanwhile, Egypt must be called a principal focus of relapsing fever in the Mediterranean region. From Morocco, Algeria, and Tunisia, only sporadic cases of relapsing fever have been reported. In the south of these regions on the boundary of the desert, however, there are circumscribed foci, from which smaller or larger epidemics may start at any time. Even south of the Sahara, large epidemics of relapsing fever have been observed (1921-30). In this context, it is interesting that these large epidemics of louse-relapsing fever in Africa have not been asso- ciated with typhus epidemics. Otto FISCHER (Tropical Section of the Hygienic Institute of the University of Vienna - at present hospital annex Mariahilf - Munich) VIl/10 DISTRIBUTION OF RICKETTSIAL DISEASES THROUGHOUT THE MEDITERRANEAN BASIN Translation prepared by: U# S# Fleet, U* S» Naval Forces, Germany, Technical Section (Medical)• VIl/10 This group includes the acute infectious diseases which are caused by rickettsiae and usually communicated through certain ar- thropodes, Exanthematic typhus has been known to us for the longest period of time but the infrequent variations of this disease were not observed before the present century. Some of them are distributed throughout the entire world, others occur within a very restricted area only. In other parts of the world some of the latter occur as a closely related form, in addition it seems that there are local vari- ations with very slight differences from each other which are by no means *»f a decisive importance. Io EXANTHEMA.TIG TOPHUS (FRACASTORO 1546). Synonyms: Exanthematic Typhus, Spotted Fever, Famine Fever, Jail, Camp Fever, Epidemic Typhus, Louse Borne Typhus Fever, Tabar- dillo (the latter term being used for the genuine as well as for Murine Typhus)* ' ©rganism: Rickettsia prowazeki, da ROCHA LIMA 1916* Its virus reservoir is - as far as it is known - man suffering from typhus* Vector: Exanthematic typhus is almost exclusively communicated by the body louse (pediculus corporis, de GEER)* This usually is ef- fected through rubbing the excreta of the lice infected with rickett- siae into the bite or into small lesions of the skin, rarely by the dispersion and inhalation of the dried feces* Distribution: The principal territory of typhus incidence is eastern Europe and North Africa* However, it may occur in all other countries of Europe, Asia, and Africa* During the 19th and the 20th century typhus usually was intimately associated with war and in ad- dition to dysentery it is the most important war epidemic even in our days* It occurs in widely separated parts of Central and South Ameri- ca, as well as in North America and Australia* Its distribution throughout the Mediterranean countries and the adjacent territories varies* Greater Germany, Italy, and France are almost free from exanthe- matic typhus during normal times* However, numerous cases were imported during World War 1 to the Central European countries where they gave rise to the formation of epidemic groups* Formerly there was an endemic typhus focus in Brittany, France; with the French Army, however, no case of exanthematic typhus occurred* From 1939 on exanthematic typhus vii/io became inherent in Germany, as new territories were attached to Germany in the east. It remained confined there except for some isolated cases imported to the interior; but even in these eastern territories the number of cases is steadily dedreasing» In Czechoslovakia typhus was important only throughout the Carpatho-Ukrainian territory, while it was negligible in Bohemia, Moravia, and in Slovakia. In Italy typhus was rare after World War I, and after 1930 it had completely disappeared there. No cases of exanthematic typhus were observed in Switzerland. From the major part of Hungary only a sporadic typhus incidence is reported. However, there are several districts, principally in the south and the northeast of Hungary, where foci of typhus have been formed, such as in Borsod Abouj in 1931 to 1932, in the district of Csongrad in 1935-1936, and in other places in 1941* where the greatest morbidity rate occurred in the month of May. These foci apparently are connected with the great eastern European focus. In Roumania the typhus fever incidence was high during the war of 1914-1913. TKe retreat of the Roumanian Army was accompanied by a widespread epidemic during 1916 which was still present in 1919 (56,242 cases) and 1920 (i*.6,206 cases). Then it decreased rapidly to a certain moderate and constant frequency. The constancy was in- terrupted by a slight rise of the number of cases in 1936* Recently it is principally Bessarabia and adjacent areas of Roumania where typhus fever occurs in large numbers (Botosani, Iasi, Vaslui, and certain other areas). In the remaining parts of Roumania typhus fever usually occurs as isolated cases and foci are formed very rarely. The majority of the typhus cases is observed during the second quarter of the year. During the period from 1932 to 1935 the mortality varied between 9*5 and 10 In Bulgaria small foci sometimes occurred in sane of the districts principally throughout the province of Schumen, bordering on Roumania, but there was no particular accumulation of cases within any geographical area* Typhus generally occurs there as an isolated disease. The nwr- tality from typhus is about 10 %0 There was a big typhus epidemic within the boundaries of Yugo- slavia during the occupation in the course of ’world War I and during the retreat of the Serbian army, However, the morbidity rate dropped soon and from 1922 on to 1932 it maintained a certain moderate level* Recently the provinces of Vrbas, Drina, and Littoral are particularly affected. Typhus occurs there in the valleys of the mountains and in the small towns* 1934 a typhus epidemic broke out in almost all dis- tricts (except for Sava and Beograd). However, the number of cases was VII/10 diminished to one third during the following year. In 1935 the largest number of cases was observed during the first and the second quarter. The mortality from typhus for 1932 to 1935 is given as 7 to 8 %9 In Albania the typhus morbidity seems to be small. It was only in 1932 that 9 cases of typhus fever occurred, while no cases were reported for most of all the other years. In Greece typhus fever was endemic before World War I in Athens. About 40 to 7£> persons died annually from exanthematic typhus. During the Balkan wars the morbidity rate was principally increased in Mace- donia, In the Greek Army typhus was rare. A great epidemic, which was particularly widespread in 1923, broke out during the war between Turkey and Greece. But the typhus morbidity decreased rapidly in 1924* Typhus as a group disease was seen in the towns, such as Drama, Thes- salonika, Athens (1933 - 1935)* In other places typhus occurs only as a sporadic disease. Typhus is widespread throughout the Iberian peninsula. In Spain it was frequent before the 1st world War, Alter the last war only some few cases were recorded in the annual reports, except for 1919 - 1920, Between 1900 and 1936 the aspect was subject to changes by re- peated outbreaks in Madrid, Only during the period from 1917 to 1921 was typhus fever more frequent. Epidemic outbreaks of typhus repeated- ly occur in the southeastern parts of Spain Cadiz, Malaga, Granada, Algeria, Murcia)c During the civil war from 1936 to 1939 the areas occupied by the Franco troops were free from exanthematic typhus (QUINTANA)* The zone occupied by the government troops, contrary to that, suffered considerably from exanthematic typhus as it was frequent- ly imported by newcomers from Russia, Poland, French North Africa, and the Balkan countries. No figures are available. In 1939 a typhus epi- demic broke out in Madrid, which principally was imported from the south- eastern provinces. In these, typhus was observed in 1940 and particular- ly during the year 1941* For 1941 the following data were recorded: Madrid 2011 cases, Seville 583 cases, Malaga 868 cases, Granada 557 cases, Cadiz 531 cases. The highest typhus incidence was observed during the month of June. As regards typhus the southeastern provinces of Spain have to be considered as the most hazardous parts of the Iberian pen- insula . In Portugal exanthematic typhus also is frequent. After World War I, during the years 1913 to 1919 an increase of typhus was observed in the Portuguese-Army returning from the battlefields of France, In 1929 too, a small increase of the typhus morbidity was observed. After this time exanthematic typhus generally was not frequent. Sporadic cases and small VIl/10 foci, however, were sometimes observed. 1934 to 1935, 164 cases were reported, 32 of which had a fatal outcome; 20 of the fatal cases occurred in the province of Viseu, In 1941 a total of only 24 cases with 4 deaths occurred. From 1 January to 30 November 1942 no case of typhus was observed throughout all Portugal. In lUrkey small foci are also frequent. During the war bet- ween the Turks and the Greeks a considerable increase of the number of typhus cases occurred. This number, dropped soon. For the time being typhus in the European provinces of Turkey is usual- ly confined to Istanbul, while typhus was frequently observed in various districts of the Asiatic provinces, among them in the south in Konya and Seyhan during the period from 1933 to 1935, and in the west in Balikesir and Izmir (Smyrna). There was a slight increase of the number of new typhus cases in 1940 and 1941, the number of which was highest during the months of March to June. Generally the typhus morbidity is highest during the months of January to April. From 1933 to 1935 the mortality varied between 7 and 13 %. Throughout the eastern Mediterranean basin typhus usually is found in coastal areas and in the densely populated towns0 From 1934 to 1935 about 200 cases of exanthematic typhus occurred, 115 of them in Transjordan, and 81 in Palestine0 1936 and 1937 it was frequent throughout Palestine. From Syria typhus had almost entirely disappeared after the epidemic of Deir oz Zor in 1933» Typhus has occurred throughout Egypt since World War I, In 1929 1141 cases were observed, 214 of which had a fatal outcome. Then, there was a considerable decrease of the morbidity rate. It increased considerably again from 1932 on and it attained its climax in 1933 and 1934* From this time on the morbidity rate constantly maintains a moderate height. In 1940 and 1941 the morbidity rate was increased a- gain. The figures of the entire year of 1941 are not available, but during the week from 26 February to 1 March 1941 3$7 cases of exanthe- ma tic typhus were observed, 170 of them in Beheiza alone. The highest incidence was found throughout the Nile delta in lower Egypt with its towns and villages. Its course frequently used to be mild, although it is caused by the rickettsia Prowazeki (OTTO)• In upper Egypt, con- trary to that, usually only few persons and few groups of persons are involved with typhus fever. In 193# the months of April to June showed the highest morbidity from exanthematic typhus. The mortality rate ranged between 10 and 15 % (1932 it amounted to 12.4 %9 1933 to 14*9 %)* In Libya typhus ranges with the rare diseases and only occurs sporadically. Vll/io In Tunisia typhus occurs in almost all parts of the country. It is observed sporadically and in accordance with the density of population, principally in the north of the country, as small or large foci. Most of the typhus cases were observed in the period between the end of February and the end of May, It has been well known for a long time (CONSEIL 1939) that yphus is spread along the routes of the indigenous traffic and then becomes inherent in the big settlements and towns where it frequently reappears. Typhus recurred frequently in the following settlements: 1933 Kef, 192 cases, 1934 Kairouan 79 cases, Tunis 117* Souk-el-Arba 262, 1935 Beja 192, in Kof 158, in Medjes-el-Bab 95* in Mousse 86, and in Souk-el-Arba 79 cases. During the years 1939* 1940 and 1941 the morbidity rate of typhus was considerably increased: There were 1072 cases in Sdusse in 1941* 605 cases in Grombalia, 504 cases in Sfax, 430 cases in Kef, 424 in Kairouan. In Algeria exanthematic typhus also is particularly frequent in the northern parts of the country; none of the districts, how- ever, is entirely free from itc A particularly large number of cases was observed in 1937 and principally in 1941* In various years typhus occurred to an increased degree in the eastern parts of Algeria, and then a small number of cases occurs in every district. In 1933* 398 cases were observed in the aistrict of Batna in the vicinity of Tunisia, 229 in Constantine, 83 cases in Setif, In 1941 typhus was frequent, particularly in the north: in Algiers 4220, in Oran 4370, and in Constantine 3619 cases oc- curred, In 1938 the majority of cases was observed during the period from March to June, in 1941 during the period from May to June * In Morocco exanthematic typhus is also frequent. Foci are ob- served in tile north and northwest particularly. It is principally spread along the traffic routes, A high typhus incidence was ob- served in 1938, the morbidity rate being twelve times that of the average of the previous years. The new increase during the year 1941 is proportional to that of Tunisia and Algeria, and the ma- jority of cases was observed during the period from February to May* Typhus Areas: There are at least three typhus foci throughout the Mediterranean basin: 1. The eastern European focus having its center in the European parts of Russia and in Poland, in the south it extends as far as to the Black Sea involving Bess- arabia and the Carpatho-Ukraine in the westo VIl/10 2. The Egyptian focus in Lower Egypt which is con- fined to the Nile delta. 3* The North African focus in Tunisia, Algeria, and Morocco, where the traffic routes and junctions are involved in preference* 4* In addition there may be a typhus focus in the Balkans, throughout the territory of Yugoslavia, Sporadic cases of exanthematic typhus occur throughout the en- tire Balkan region, in Turkey, in the countries of the eastern Medi- terranean basin and finally in Spain and Portugal, Here one must count with the occasional formation of foci. Typhus is of little importance in Libya, Upper Egypt, Albania and throughout the major part of Hungary, No typhus occurs in Germany including the Protectorates of Bo- hemia and Moravia, in France, Italy, and in Switzerland. ' The area where typhus occurs, therefore, bus its northern boun- daries at a line separating France and Spain along the Pyrenees, con- tinuing through the Adriatic Sea between Sicily and Tunisia, around Italy, turning to the north at the frontier between Germany and Cro- atia, or Hungary and Germany, and delimiting in the east of Germany the eastern European foci from the wests n, ENDEivilC TYPHUS OF THE RATS (BRILL 1902). Synonyms are: Murine Typhus, Honeys Disease, Ship Typhus, Typhus Murin, Urban Tropical Typhus, Shop Typhus, X19 Tropical Typhus, Brill’s Disease which according to gftUMPT is n°t distinguishable from the Mu- rine Typhus* The causative organism is the rickettsia Mooseri (Monterio 1931J which is widely spread among all species of rodents® Vectors: Among the rodents Murine Typhus is communicated through the fleas and the lice* It is communicated to man through the fleas, probably also through the bugs and the ticks and it even may be dis- tributed through the body lice. VII/10 Heretofore the following vectors were found (BEUMPT): Fleas: Xenopsylla cheopis Rothsch, tropical rat flea, Nosopsyllus fasciatus Bose*, European rat flea, Ctenopsyllus segnis Schoenh. , mouse flea, Ctenocephalides canis Curtc, dog flea Ct, felis Bouche, cat flea, furthermore: Xenopsylla astia Rothsch ) Liponyssus bacoti Hirst ) Neither of them were found by MOOSER and CASTANEDA in 1932 Rat louse: Polyplax spinulosa Burm, Bed bug: Cimex lectularius L. Ticks: Dermacentor nitens Neuman D* Andersoni Spiles Amblyoma sp • Distribution: Murine Typhus is frequently observed in various parts of the world, particularly in the ports and in the big cities. Apparently it is a widespread epizootic of the rats, which occasional- ly may be communicated to man, ;,ith rats the organisms were found e- ven in places where no case of murine typhus was observed with man. In France in the year 1916 9 cases, in 1917 10 cases were ob- served in Faris (NETT&r ). BRUMFT found that the organism is dis- tributed endanically among the rats throughout Paris and he assumes that all rats are once in their lifetime infected with these rickett- siae. The proportion between the infected and the non-infected rats was 1:4* In Toulon mild typhus cases were repeatedly observed on board warships (MkRCANDIER and PIETROT 1932 and QUERANGAL DES ESSARTS 1934)• Some of these cases may have been imported. Most of them, however, were acquired on board the ships and the rickettsiae were also found in the rats of the ships and of the naval ports. In Tou- lon one rat out of three or four was infected (MARCANDIER and PIETROT)• In addition, one found the organisms of murine typhus in places in which no cases of man sick with murine typhus were observed, which happened in Bordeaux, Iyon, and even in Belgium, f0i, in Antwerp (Le CHUITON and MOUREAUX 1932, ROCHalX, SEDALLEIN,and BOUTNER 1932, MEIR— HAREGHE 1933). The mild cases reported from Italy seam to be cases of tick typhus and not of murine typhus (GUERRICCHIO)• Vll/io Greece, In Athens ana in the Piraeus the organisms were found in the animals and in man (LEPINE 1933)* Croatia, in Agram tick typhus was observed in 1935* In Koumania the examination of the rats had a negative result (COMBIESCO and POPESCO 1933)• Human cases of murine typhus were not observed. Throughout the eastern Mediterranean basin the virus was found in the rats, f, i, in Beyrouth '(p. LEFINE • Egypt. Murine typhus was observed in the rats of Alexandria, With these and with their fleas the organisms were found by PANAYO- TATOU 1932. In several cases it was carried away from here to other places by ships, Tunisia, The rickettsiae of murine typhus were found in the rats (NI COLDS and SPARROW 1934). Morocco, Murine typhus was found by G. BLANC, M, BALTHASARD, and FISCHER in' 1933. Outside the boundaries of the Mediterranean basin the organisms of murine typhus most likely were found in Great Britain (RANDIE and MARIAN 1928) and with certainty among the rats in Moscow (KRITSCHEWSKI and RUBINSTEIN 1933, SOLOVTOV 1934). The area where murine typhus occurs, therefore, is marked off in the north by a line going from the north to the south, east of Anvers and Paris, turning to the east on the southern side of the Alps, from here pointing to the southeastward airection and passing through Cro- atia between Agram and Belgrade, turning to the north in the south of Bucharest and ending in Moscow, Westward, southward, and eastward of this borderline one must take into account the occurrence of murine ty- phus in the rats and occasionally even in man. Ill* EXANTHEMA 11C TICK TYPHUS (CONOR AND BRUCH 1910). Synonyms: Fi&vre boutonneuse de Tunis (CONOR and BRUCH 1910), fievre exanthdmatique de Marseille;, fiSvre exanthematique de Maroc, fidvre exanthematique du littoral mediterranean, fievre ex- escarronodulaire (r. JORGE), Maladie de Conor, maladie febbre erritiva del Carducci, VII/10 Organism: Rickettsia Conori Brumpt 1932 (Syn. R. Blanci Camino- petros)* It seems to be widespread among the dogs of the hot countries. Vector: Its only vector is the dog-tick Rhipicephalus sanguineus Latr* (BRUITT). Seasonal distribution: In southern France 62 cases occurred bet- ween the months of May and September, with a particularly high number of cases in August, in Tunisia 33 cases occurred in the period between April and October with a particular frequency during the months of August and September (CONSEIL), in Portugal 30 cases occurred in the period between June and October with a particularly frequent incidence during the month of september (R. JORGE)o Distribution: This type of typhus is distributed throughout the countries around the Mediterranean, and in addition throughout the Su- dan, the Belgian Congo, the Kenya-and Tanganyika territory, southern Rhodesia, Union of South Africa* Portugal: Cases occurred in Lisbon, Geuveia and vicinity (30 cases in 1927), Alcobaca, Forto (R* JORGE). Spain; 1929, 8 cases were observed in Madrid, later on 6 more cases. 1 case occurred in Albacete 200 km. southeast of Madrid (R. JORGE)• 1 case was seen in the Balearic Islands (DURICH). Prance: In 1925 OLMER observed the first cases in Europe in Marseille, From this time on the disease was seen somewhat more fre- quently throughout the Mediterranean coasts In 1927 the number of cases was 38, in 1928 at least 60 (OLMER). Before 1928 159 cases were observed in the vicinity of the mouth of the Rhone river, 31 cases in the district of Vaucluse, 87 cases in the Maritime Alps, particularly in the vicinity of Cannes and Nice, 57 cases on the Var valley not far from Nice (CONSEIL). From this time on the dis- ease probably was increased in frequency. Italy; From 1910 to 1920 CARDUCCI collected 13 cases. More cases were found principally in the vicinity of Rome and in Luccania, but also along the entire western and eastern coast of Italy: In Naples, Palermo, Catania, Imola (east of Bologna), Genoa, Treviso (north of Venice), Fano (northwest of Ancona), Firenze (A* GUERRIC- CHIO), Messina* Greece. Cases of exanthematic tick typhus were observed in Athens SM''Volos* In addition contaminated dog ticks were found (BLAND and CAMINOPETROS)a vn/io Roumanian CONSElL observed 2 cases in 1911. In 1931, 34 cases were found in~Constanza. (COMBESCO ana ZOTTA)* Morocco; -The first 2 cases were seen in 1928 (DELONANORE). Later on 12 more cases occurred (BEROS and BALOZET). From this time on the tick typhus may have occurred more frequently, Algeria; several cases occurred in Algeria, Tunisia: The tick typhus was observed here in 1902 for the first time and a description was given in 1910 by CONOR and BRUCH, Before 1928, 36 cases had occurred (CONSElL). Libya: In Tripoli several cases were found (GABBI), in the Cyrenaica altogether 22 cases were observed during the period from 1914 to 1930. Egypt: A disease closely resembling tick typhus was found in Khartoum (1913, BALFOUR). Syria: several cases occurred in Beyrouth. Area; Ihe endemic tick typhus is exclusively found on and in the vicinity of the Mediterranean coast and it embraces the western parts of the Iberian peninsula. Sometimes cases of tick typhus oc- cur in the interior in the neighborhood of the littorals The borderline of this area crosses Egypt and North Africa, it embraces the Iberian peninsula and then runs along the ridge of the Pyrenees, From here it crosses the Languedoc and finally goes along the southern side of the Alps and ends on the northern coast of the Black Sea, The route of this line through Caucasia and Asia Minor is unknown. Within this area tick typhus is liable to occur. IV. VOLHYNIAN FEVER (WERNER 1916, HIS 1916). Synonyms: Trench Fever, Febris Quintana, Five Day Fever, Fievre des tranches, fievre tibialgique. Organism: The causative organism for trench fever is the rickett- sia quintana Schmincke 1917* Its synonym is rickettsia volhynia, It was seen for the first time by TOEPFER in 1916* The virus reservoir is not recognized as yet. 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 Number of inhabitants Year Europe . Germany 0 1 3 4 1 1 0 O’ t 0 1 558 66,030;000 1933 former Austria 1 0 • 9 } 6;758;000 1930 Italy 0 1 43;142;000 1938 France 2 0 • • • « • • 1 4 1 1 • • 3 6 41,980;000 1938 form. Czekoslovaida 30 127 328 171 439 92 14;730;000 1930 Hungary (+1; J) 0 6 78 45 29 20 22 • • 92 682 9,060;000 1938 Koumania 1857 1419 1801 1790 2296 2807 7093 4976 2255 7 34 2 1199 1880 19,750;000 1938 Bulgaria 292 219 359 178 285 77 207 160 91 86 2) 117 287 6;253,000 1938 form. v ugo sla vi a 154 12S 173 825 2210 680 775 942 686 • • 310 15;384;000 1938 Greece 63. 114 92 60 75 40 75 73 60 • • 49, 7;061;000 1938 Spain (+711] 5 9 10 27 3 5 10 8 • • 10861) 6857 25,493,000 1938 Portugal 57 19 34 6 121 43 9 67 37 26 • • 11 6,951,000 1938 Asia Minor . Turkey 259 182 93 194 272 422 401 667 450 3 8? 2) 816 950 16,15S;000 1935 Palestine 30 51 30 29 26 55 280 262 176 270 203 1,435,000 1938 Transjordan 0 30 19 68 60 55 35 15 • • • • 8 332,000 1935 Syria 0 7 2 467 2 1 2 1 16 7 2 3,600,000 1937 Africa Egypt 288 265 2298 7865 7536 3151 2757 2083 2811 4108 41842) 16,237,000 1938 Libya 0 0 1 2 0 . 6 1 88 • • • • isolated cases -840:000 1936 Tunisia 170 335 306 343 781 950 841 3778 2376 6016 6434' 7226 2;608;000 1936 Algeria 190 192 395 876 371 596 1168 3299 1564 2294 12892 7;235;000 1936 Morocco 170 403 256 451 303 431 173 1844 7437 • • 355 1594 6,296,000 1936 1) Deaths. - 2) No data for the last 4 weeks of the year, ► - 3: ) No data for January to March.- 4) incomplete figures for i 3 weeks. - No data: - Absolute figures of the reports of Typhus VII/10 Vll/io Vector: Volhynian fever is communicated only by the body louse (pediculus corporis de Geer)» Distribution: Trench fever is endemic throughout Poland, Vol- hynia, ana the neighboring territories* During world War I it prin- cipally occurred among the German troops, and it is likely that it was carried from here to the other theaters of the war* On the western theater it occurred on both sides (France, Meuse valley, Flanders), in Macedonia and in Mesopotamia* Several cases were also seen in Egypt# the yolhynian fever occurred in Spain during the civil war where it most probably was imported by the foreign troops recruited by the government. It is most remarkable that trench fever apparently did not per- sist outside the boundaries of its proper territory of origin, the white Rnthenian area, and that it disappeared again when the imported cases had subsided* Area: No details are known as to the area where Volhynian fever occurs. Of the countries belonging to the Mediterranean it is wide- spread only in the Ukraine, Bessarabia, and throughout the Caucasus# These territories are included in the original focus# It was not possible to find out whether or not trench fever also occurs in other countries# J. MRUGOWSKY (institute of Hygiene of the Waffen-SS Berlin)• "Vll/lOa EXAN THEMATIC TO HUS IN SPAIN. 1939 to 1942, Translation prepared by: U. S. Fleet, U» S* Naval Forces, Germany, Technical Section (Meoical), Vll/lOa Since the end of the civil war in Spain exanthematic typhus has been widely spread again throughout Spain. This disease which has been widely distributed there since ancient times showed a con- tinuous regression from the end of the last century on (cfo table I) and it occurred only sporadically in the Spanish capital, Madrid, and in the five southeastern littoral provinces (Sevilla, Malaga, Granada, Algeria, and Murcia - cf. map No. Vll/lOa)• luring the 2\ years of the civil war in Spain no cases of ex- anthema tic typhus occurred throughout the territory held by the Franco-troops, although there was a severe typhus epidemic in North Afsica at that time (9,000 typhus cases in French North Africa in 1937)* In the littoral provinces of Almeria and Murcia typhus was endemic during the civil war and it was spread among the population and the government troops which were contaminated with typhus through supplies from eastern Europe, Algeria, etc. From here the typhus epidemic was spread around by the shift of the population within the bounaaries of Spain beginning after the end of the civil war. The first extensive epidemic occurred in Madrid, the capital, immediately after the city was occupied by Franco*s troops. The first cases of typhus were observed here on April 8th, 1939. 23 out of the first 27 cases were imported from the southeastern provinces (cf. the lines on the maps), 57 cases were found in Madrid. Dur- ing the period from 1 May to 9 December 1939 72 cases more of typhus with 12 deaths were reported to the International Health Office in Paris. During the same year some small foci were found in Salamanca (epidemic among the prisoners), where 15 cases occurred, and in Vil- larobledo (province of Albacete), and in Valladolid* In May 1940 further small local outbreaks of exanthematic typhus occurred in Guaaix (province of Granada) with 40 cases and in Granada and Seville (50 cases). Towards the end of 1940 typhus broke out again in its old endemic area of Murcia and Almeria (no figures available), and in the beginning of January also in Madrid. By the end of March 1941 the daily morbidity rate for typhus was in- creased to 30 cases im Madrid which were observed throughout the en- tire area of the city. However, proper foci were not recognizable. The explanation for this is given by the Municipal Health Office of the city of i/Iaorid which observed an increase of the louse infesta- tion ©f the population attaining an average percentage of 35 % in 1941* From Madrid (city and rural communities) altogether 2011 cases were reported. According to the figures given by the General Vll/lOa Director of the Public Health Services of the International Health Office in Paris the mortality was 11.08 After Madrid, the number of cases was highest in Malaga with 868, Seville with 853, Granada with 557f end in Cadiz with 531 cases. Altogether 6857 typhus cases were observed throughout Spain in the year 1941, the mortali- ty being 13 % (after QUINTANA). Table 1* Mortality from Typhus in Spain (according to P.de la QUINTANA). 1901 - 1938. i 1 i Year Mortality (abs.figures) Year Mortality (abs, figures) 1901 128 1920 153 1902 55 1921 73 1903 184 1922 80 1904 400 1923 35 1905 138 1924 18 1906 120 1925 10 1907 91 1926 8 1908 58 1927 17 1909 671 1928 10 1910 301 1929 14 1911 134 1930 7 1912 102 1931 5 1913 243 1932 7 1914 82 1933 10 1915 51 1934 2 1916 52 1935 3 1917 68 193b 5 1918 13 1937 10 1919 227 1938 9 Ihis epidemic did not abate and it persisted during the first months of the following year (1942). During the period from 1 January tc 30 April 1942, 1193 cases of typhus occurred in Madrid. During the same period a new outbreak of typhus was observed in Barcelona with 761 cases. The other foci are in regress except for the province of Vll/lOa Cadiz (711 cases before April 30th, 1942)* However, in the course of 1942 typhus has become considerably more widespread than during the previous years so that for the time being the entire southeast of Spain must be considered as exposed to exanthematic typhus. More- over, sporadic cases of typhus also occurred in other Spanish prov- inces after the beginning of 1943* New cases were observed in the northern provinces of Barcelona, Navarra, Valencia, and Leon. H. J. JUSATZ. VIl/ll TYPHOID FEVER IN SPAIN AND PORTUGAL, Translation prepared by: U. S* Fleet, U* S* Naval Forces, Germany, Technical section (Medical)d VII/11 No geographical and medical investigations of the endemio oc- currence of the abdominal typhus and of the paratyphoid diseases in Spain and Portugal were made as yet. In spite of the wide dis- tribution of both diseases throughout the Iberian peninsula insuf- ficient material is available for the geomedical investigation of the epidemiology of the typhoid diseases. The following discussions, therefore, can only be an attempt to give a survey of the epidemio- logical situation in the course of one year of the last war (1941) as far as the material was available* The mortality rate of typhoid and paratyphoid fever in Spain was considerably increased by the disorders due to the civil war (cf. table Ij9 after it had been very small during the past decade. In 193& it amounted to almost 1 % of the total mortality rate. In contrast to France, which shows a continuous decrease, the typhoid mortality rate is still very high. While in 1930 the typhoid mor- tality in France was 4»0 % for 100,000 persons which dropped to 2.5 % before 1936, in Spain it was still as high as 11*2 % for 100,000 persons in 1935* Table 1* Mortality of Typhoid and Paratyphoid Fovei* in Spain* Year Number of j cases | Year Number of c&s a 0 1931 3599 1937 4671 1932 3114 193 B 4586 , 1933 3269 19391) 24711; 1934 3109 1940. * 1935 2804 1941^) 179C 1936 2601 ! » Footnotes: 1) For the first half of the year* 2) Except for the following weeks: 22/6 to 4/7> 10/8 to 16/8 7/9 to 27/9, 26/10 to 7/11 and 16/11 to 3l/l2 * - no data available. VIl/ll Table 2. Typhoid Fever in Spain. Provinces Cases Death 1941 calc.per 1000 inh* 1934 " mi Alav & • • • . • • . 116 1.1 6 6 Albacete . • . . . 81 0.24 46 15 ij] # • • • p 443 0.80 161 46 Algeria • 221 0.66 37 18 Av ila •••*••• 161 0.72 30 Badajoz ...... 981 1.36 103 61 Barcelona • • • . . 1520 0,78 362 224 Burgos, 62 0.17 40 5 Caceres •••••• 799 1.73 96 39 1 Cadiz ....... 1204 < 2.43 38 125 ! Castellon • * * , , 191 0.62 66 21 J Ciudad Real • • . , 267 0.52 77 12 Cordoba ...... 455 0,65 117 52 Coruna (La) . . . . 193 0.25 45 27 Cuenca . . .... 249 0.79 53 16 Gerona • «•«.. 276 0,85 58 19 Granada ...... 795 1.19 8L 101 Guadalajara .... 181 0.89 36 14 Guipuzcoa (s.Sebast). 156 0.50 29 11 Kuelva 476 1.32 45 35 Huesca ...... 159 0.66 46 6 Jaen ........ 892 1.27 117 96 lie on o ..... . 202 0.45 61 6 Lerida ...... 395 1.26 66 28 Logrono ...... 288 1.39 28 10 Lugo . « o » ... 135 0.29 34 14 Madrid . 931 0.63 98 58 Malaga3 ...... 1281 2e 04 63 133 Mercia * 490 0.76 77 43 Navarra ...... 403 1.15 33 31 Orease. . 414 0.96 43 ' 30 Cviedo . o . . « . 185 0.23 16 34 ..... 159 0.75 31 8 ntevedra. .... 600 lo04 65 40 Salamanca ..... 266 0.77 63 4 Santander • • • • . 509 1.36 24 ! 26 VII/11 Table 2 (cont»d). Province L.— - ■■ ■ Cases 'r Deaths j 1941 calc.per 1000 inh* 1934 1941 Segovia ...... 164 0.93 22 15 Seville ...... 689 0.83 103 82 Soria ....... 230 1.46 26 9 Tarragona ..... 435 1.39 55 49 Teruel* ...... 169 0.67 26 13 Toledo..... . . 134 0.27 59 9 Valencia. . . . » . 903 0.84 226 35 Valladolid. .... 255 0.83 28 15 Vizcaya •••••• 333 0.66 20 27 Zamora ...... 215 0.76 27 | 12 Zaragoza . . . .. 659 1.20 59 ; 1 > 39 Table 3. Mortality from Typhoid and paratyphoid Fever in Portugal. District _JL_2, 3.1 1 S 4 0 , number of cases calc. per 1000 inh. number of cases caXc.per 1000 inh. Aveiro 59 0,16 73 0,19 Beja 26 0.18 74 0.30 Braga 67 0,16 55 0.13 Braganca 63 0.34 75 0.40 Castelo Branco 45 0.17 126 0.47 Coimbra 53 0.20 74 0.19 p/C.ra 22 0.12 46 0.25 pa.vo 59 0.20 83 0.27 Guarda 50 0.19 92 0.34 Le.iria 50 0.16 116 0.37 Lissabon 174 0.19 166 0.18 Portalegre 13 0.08 33 0.20 Porto . 132 0.16 133 0.16 VII/11 Dis trict 19 3 3 . _ 19 4 0 number cases of calc, per 1000 inh. number of cases calc, per 1000 inh. Santarem 70 0.16 74 0.17 Setubal 61 0.26 30 0.13 Viana 17 0.07 24 0.13 Vila Real 33 0.13 75 0,30 Vi seu 61 0.14 67 0.15 Portugal . ( (Continent) 1 1108 0.17 1416 0.22 Table 3 (cont’d). The same disadvantageous conditions also exist in Portugal, where the typhoid mortality amounted to 16,1 % for 100;000 persons in 1935 j which was increased in 1940 to 22,4 %» The first survey on the geographical distribution of the typhoid and the paratyphoid fevers throughout the Iberian peninsula for the time being can only be given by the reproduction of the morbidity rate in the various provinces of Spain, The number of persons sick with typhoid fever in 1941 was calculated for 1,000 and the figures in- serted in the chart of the administrative districts. For Portugal the conditions of the year 1940 are taken as a base. H. J. JUSATZ (Institute of Hygiene of the University of Berlin and Institute for General and Military Hygiene of the Military Academy for Medical Officers)* VIl/12 TRACHOMA IN THE MEDITERRANEAN AREA. Translation prepared by: U. S. Fleet, U# S. Naval Forces, Germany, Technical Section (Medical). VII/12 Trachoma occurs everywhere on the globe. There is probably no country in which this disease is completely unknown. One must, however, make on principle a difference between its occasional oc- currence in individual cases, which have been chiefly carried in from so-called trachoma-countries, and its endemic spreading in large territories. Also here, there are differences in the fre- quency of occurrence. The "trachoma index" the percentage of the trachoma patients among the population, varies between 0,1 and nearly 100 %% An absolutely reliable representation of the geographical spreading of trachoma is opposed by insurmountable difficulties. They lie in the character of this disease. Trachoma is an in- fectious disease, the course of which extends over many years. In the beginning, it causes few complaints so that the greater part of the patients at first do not consult any doctor, partic- ularly with the less civilized peoples. By this fact, a number of cases is not officially ascertained, particularly since spon- taneous healings are quite frequent. Even in the countries where trachoma is one of the diseases liable to be reported (Germany, France, Italy, Switzerland, Soviet-Russia, Spain, Turkey, Hungary, Algeria, Morocco), not all cases are known. This is associated with the fact that the diagnosis of trachoma is difficult, par- ticularly in the beginning. Some cases are not recognized at all or diagnosed by mistake as harmless diseases of the coniunctiva tunica, e.g# follicular catarrh. Despite these difficulties, one has persisted in the endeavour to determine, at least approximately, the numbers of trachoma pa- tients of a certain region and to compare the trachoma indices of various countries with each other. One must calculate the trachoma index indirectly from other data of numbers. There are available as such data: 1. Official statistics in those countries, where trachoma is one of the diseases which must be reported, 2. the results of serial examinations of school-children 3. the reports of recruiting examinations 4* occasional serial examinations of single more or less characteristic groups of the population, 5* reports of ophthalmical clinics on the numbers of the treated trachoma-patients, as contrasted to the numbers VII/12 of other eye-patients, 6# the numbers of the trachoma patients known to practizing ophthalmological surgeons and general surgeons, 7. estimates of the numbers of the trachoma patients by surgeons well acquainted with the respective country, S. the proportion of the trachoma among the causes of blind- ness. Among these possibilities of computing the trachoma index, those are most reliable that are not based on chosen patients, such as the examinations of school-children ana recruits. The trachoma figures of the ophthalmological clinics (nr. 5 of the mentioned list) can be judged in the same way. Just here, we possess rather detailed data in the lit- erature. It must be considered, however, that the trachoma figures of the ophthalmological clinics depend on the conditions of civilization in so far as more patients with other diseases of the eyes and with re- fraction faults go to the ophthalmological clinics in a civilized coun- try. According to WIBAUT, who studied these problems thoroughly, one finds the percentage of the trachoma patients in the population (a) by dividing the percentage of the trachoma patients among the patients of the cphthalmological clinics (b) by 3 (a « 1/3 b). Everybody who has occupied himself practically with trachoma statistics knows that the trachoma figures resulting from the official reports according to the regulation for reporting trachoma infections, are too low. The present cartographic representation of the distribution of the trachoma is not based on only one source for all countries, but on the evaluation of the most varied possible data. The basis is the excellent critical elaboration of these problems by WIBAUT from the year 1929 (XIII Concilium ophthalmologicum 1929 Hollandia; Volume III). It is supplemented by data from recent literature. According to WIBAUTrs representation, the trachoma index is subdivided. The first group with the trachoma index 0 - 0,1 % comprises the territories which are practically free from endemic trachoma. The territories with a low trachoma index are subdivided more than those with a higher index, since in those, the data of numbers must be regarded as less reliable. On the whole, the distribution of trachoma does not depend on the po- litical boundaries but, overlapping these, is more determined by the landscape and by the social ana economic position of the population. W. ROHRSCHNEIDER (Ophthalmic Clinics of the Uni- versity in Koenigsberg/Prussia). Vll/I2a DISTRIBUTION OF TRACHOMA IN SPAIN. Translation prepared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) Vll/I2a According to the data of Prof. SORIA given at the XIII. Inter- national Congress of Ophthalmologists, 1929, a total of more than 55,000 trachoma patients has been counted in Spain. To control this national epidemic, a central trachoma control service (Servicio Antitracomatoso) was established in 192? by the Spanish Depart- ment of the Interior, Public Health Section. If one compares the above mentioned data with the official figures for 1933 (accord- ing to the statistical year-book for Spain) and for 1935 (ac- cording to the report of the League of Nations) with 31,333 cases and 11,024 cases respectively, a decrease of the figures of the trachoma patients in Spain is observed. No recent statistical material for the time after the Civil War is available, though it must be assumed, according to general epidemiological con- siderations, that the epidemic is still endemic in the provinces on the'Mediterranean coast, which have been most infected previous- ly, such as the provinces of Almeria and Murcia, Granada and Ali- cante, Valencia and Castellon de la Plana. Table 1 Distribution of Trachoma in Spain. Provinces According SORIA's ds Xlll.Ophtr 1929 absolute figures to Prof, ita at the lalm.Congr. per 1,000 inhabitants According Year-Book yea 3 absolute figures to the Statistic. XIX. Data for the - 1933 per 1,000 inhabitants. Albacete i 344 1,29 506 1.4 Alicante 2541 1 5.1 3284 5.9 Aimerfa 6702 17.77 8648 25.7 Badajoz 2006 3.33 336 0.49 ceres 126 0.3 255 0.6 Cadiz 316 0.67 528 l.©6 Castellbn de la Plana 2960 9.18 2318 7.4 Ja^n 555 1.05 554 0.79 Madrid 1785 2.03 270 0.18 Malaga 956 1.82 70 ' 0.11 Murcia 12492 20.11 6872 10.62 Palencia 2265 1.35 *) *) Taragona 472 1.39 *) *) Toledo 625 1.51 6 • Valencia 11303 12.7s 24 99 2.3 Zaragoza 7087 | 16.8 *) no data available. VIl/l2a Table 2. Trachoma Control Service in Spain. (New trachoma cases in 1933 *) Province . Advisory places in . Number of cases 1. Albacete Branch-center for Rural Hygiene in Hellin 506 Trachoma Control Institute of the capital of the province 247 Albatera 538 Altea 38 Aspe 312 Segura 369 Crevillente 248 Elche 16 S 2. Alicante Georgos 50 Orihuela 454 Villajovosa 307 Branch-center for Rural Hygiene in Alcoy 208 Inspection of schools, factories, work-shops, quarters of the poor, and coiiiimnities (pr®v. Trachoma Control Service) - 344 Tote 3284 * Data according to Anuario estadistico de Espana XIX ano 1934, Madrid 1935, page 319/20, Servicio Antitracomatoso: New cases of trachoma determined in 1933* VIl/l2a (Table 2) (Trachoma -Control Service in Spain) Province Advisory places in Number »f cases Capital of the Province 845 Adra 1436 Alb ox 2093 Canjayar 23 Carboneras 353 Almanzora 157 Huercal-Overa 52 3. Almeria Torres 367 Mo jacar 313 Nijar 137 Mar / 212 Vera 413 Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma Control Service) 2132 Total ”’8543 4. Badajoz Branch-center for Rural Hygiene in Merida 336 Capital of the Province 34 5. Caceres Branch-center for Rural Hygiene in Coria 117 Trujill© 104 Total 255 Capital of the Province (University Clinic) i 208 6. Cadiz Ch'iolana de la Front era San Fernando 130 Branch-center for Rural Hygiene in Algeciras 134 Tota 1 528 VIl/l2a (Table 2) (Trachoma Control Service in Spain) Province Advisory places in Number of cases Almazora 249 Benicarlo 174 Calig 104 Nules 26 Peniscola 131 Vail de Uxo 210 7. Castellcn Villarreal 203 de la Villavieja . 265 Plana Vinaroz 57 Capital of the Province Branch-center for Rural Hygiene 169 in Pozoblanco Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma 247 Control Service) 4B3 Total 23l£ Capital of the Province 1196 Albunol 134 Castell de Ferro 218 La Mamola 360 8. Granada La Rabita 431 Motril 1008 Tcrrcnueva 155 Ugijar Inspection cf schools, factories, work-shops, quarters of the poor, and communities ( Prov. Trachoma 67 Control Service) 1081 Total ~W5 VIl/l2a (Table 2) (Trachoma Control Service in Spain) Province Advisory places in Number of cases Provincial Institute for Hygiene 9 Control Service of the Red Cross 20 9. Huelva Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma Control Service) 20 Total “47 10. Huesea Branch-center for Rural Hygiene in Jaca 33 11. Jaen Capital of the Province Branch-center for Rural Hygiene in Linares 554 12. Madrid Ventas 175 University Clinic 95 Total 270 13. Malaga Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma Control Service) 70 Vll/I2a (Table 2) (Trachoma Control Service in Spain) Province Advisor places in Number of cases Provincial Institute for Hygiene 285 Institute for Youth Welfare 220 County Hospital 227 Aguilas 471 Albatalia 265 Algezares 3 S3 Cartagena 1114 Cieza 730 14. Murcia La Rava 128 La Union 361 Llano del Beal 125 Lorca 612 Mazarron 408 Puente Tecinos 159 San Anton 108 Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma Control Service) 1277 Total ”5873 15. Toledo Branch-center for Rural Hygiene in Talavera 6 Alcira 502 Cullera 118 Gandia 699 Sagunto 569 16. Valencia Sueca 52 Tabernes de Valldigna 178 Inspection of schools, factories, work-shops, quarters of the poor, and communities (Prov. Trachoma Control Service) 381 Total 2499 VIl/l2a (Table 2) (Trachoma Control Service in Spain) Spain Grand Total cf New Trachoma Cases in the year 1933 30,378 H. J. JUSATZ (Hygienic Institute of the University of Berlin and Institute for General and Military Hygiene of the Military Medical Academy)^ VIl/13 DISTRIBUTION OF POISONOUS SNAKES IN THE MEDITERRANEAN AREA. Translation prepared by: U* S* Fleet, U. S. Naval Forces, Germany, Technical Section (Medical). VIl/13 I, General Remarks, The fauna of poisonous snakes of the Mediterranean Basin is especially interesting in that the particular conditions of three continents are united in a relatively small space* The distribu- tion is in some instances in an apparent correlation with morpho- logic processes of past eras. In addition to several species of viperidae (adders), we also find a new representative of venomous vipers of which we only mention the dangerous proteoglyphous vipers (Elapinae), whereas the 6enerally harmless opisthoglyphous vipers of the family of the Dipsadomorphinae which include the widely distributed species of Coelopeltis, Tarbophis, Psammophis and others will not be considered further in this place, as is well known, poisonous snakes can only be distinguished from non-poisonous species by the presence of grooved (Elapinae) or pierced (viperidae) teeth. The color of poisonous snakes is subject to wide variation and hardly furnishes any clues, the more so, since the smooth body apart from a possible contrast of the head or tail or a particularly cornified epidermal covering does not offer any mark for distinction. The unexperienced observer will, therefore very easily confuse the different species or even consider the possi- bility of a new species. This explains the fact that the classification of European poisonous snakes is far from being clear. If one would go so far as to classify each local variety separately one would arrive at the grotesque result that the fauna of Southern Europe would boast of the greatest variety of poisonous snakes. The aistribution areas in Europe are determined with a con- siderably higher precision than is true for Asia and North Africa, where the possibility of exploration is not infrequently dependent on traffic conditions, A very dense network of observation in Eu- rope is opposed by a very sparse one in Asia and Africa. But even within the defined areas of distribution, the inci- dence of poisonous snakes is by no means uniform and is highly con- tingent on local conditions which must answer very definite require- ments, Although the expert will be able to recognize the ideal habitat even in a landscape of largely the same character it must be borne in mind that these conditions vary and are not known well enough to be defined with accuracy. Such factors as the thermal conauctibility of the soil which is a function of the geologic substructure in connection with the water permeability and storage capacity, sun radiation and the amount of sun VIl/13 during the summer months are of far greater importance to the Eu- ropean venomous snakes than for instance the intensity and dura- tion of winter cold. This is confirmed by the incidence of pelias berus up to 67°’ north latitude and in the high mountainouo regions of the Mediterranean Basin. The development of the young animals is contingent on the presence of a definite type of prey which a- gain require definite biologic conditions of their own. MERTENS and MUELLER (1928) distinguish seven European types of vipers, which are subdivided into numerous species. SCHWARZ (1936) establishes two major groups, the "berus-" and "lebetina-" groups. The group of "ammodytes" stands out so clearly in the former cate- gory even externally by the prominence of the lips, that it seems advisable to distinguish at least between three groups, namely the vip, berusv, vip. ammodytes- and vip. lebetina. Thus the vipera berus and ursinii belong to the "berus" group, vipera aspis and ammodytes to the "ammodytes” group and the species and subspecies of vipera lebetina to the "lebetina" group. The species which have advanced farthest northwards belong to the group of vipera berus, the distribution of which extends from the Atlantic Ocean through the North of Europe and Asia to the pa- cific $cean. South of this distribution area we observe a predom- inance of the vipera ammodytes family which is, roughly speaking, limited to the South of Europe. The distribution of the vipera lebe- tina group extends farthest to the south and east, from the North African coast of the Atlantic Ocean over the entire Mediterranean Basin to western Turkestan, Thus we have in the Mediterranean Basin to deal primarily with the ammodytes and lebetina families. The farmer is predominant in the north, the latter in the south and east of the Basin. The berus family appears only in sporadic inroads. The same is true for the re- presentatives of the Cerastes and Echis family, as well as for the pro- teoglyphous vipers Naja and Waiterinesia which are peculiar to the Airican snaxe fauna. Even representatives of the Bitis family were observed in the South of Morocco. The distribution limits are not in all cases well defined, especially in the south and east. Generally speaking poisonous snakes are only active at night and hide out in day time or lie quietly in the sun for many hours and they are often dug into the sand except for the head. Only a very few spe- cies go out for prey in day time. It my therefore justly be said that encountering a venomous snake is not a very common event even in VIl/13 hot countries where there are plenty of poisonous snakes. This will be quite understandable if one bears in mind that a quietly lying snake can hardly be distinguished in the contrast of glaring colors which is particular to the vegetation in hot countries. Relatively few species live in the immediate vicinity of cora- munities, among rubble at the fringe of the steppe. Representatives of these species sometimes do enter houses and apartments and are found betwen clothes, shoes or even hidden in the blankets of a bed. The majority of venomous snakes live far away from human settle- ments, so that only members of certain professions such as farmers, forest workers, plantation workers, hunters, etc. will be endangered. The conditions may work out much more unfavorably for troops. Camp- ing in the open air, combing of plantations and dense forests, combat in steppes and deserts definitely increase the likelihood of encounter- ing venomous snakes. The fact that snake bites are relatively a rare occurrence even in countries with an abundance of venomous snakes must be explained by the habitat of the animals, the majority of which will bite only if suddenly disturbed. In contrast to the venoms of the viperidae which cause hemotoxic effects and cell destruction, the venoms of the Colu- brides are complexes with neurotoxic effects. The vipera berus bos- niensis is an exception* though a representative of the viperidae family the neurotoxic action is prevalent in their venom. For clinical purposes it is always advantageous, though not im- perative, to know which type of venom is involved so that the proper anti-venom can be administered. But the polyvalent anti-venoms have shown good results especially in bites of European snakes the venoms of which are less potent than those of tropical or subtropical regions. As anti-venoms against the bites of European venomous snakes one can use; The Marburg Ammodytes-Serum (Behring-Werke) or the anti-venoms E R of the Pasteur Institute or Vienna Serotherapeutic Institute. Against the bites of African snakes in the Mediterranean Basin, the anti-venom A N of the Pasteur- Institute as well as monovalent anti-venoms such as the Marburg Bitis- or Maja-Serum have proved very successful. VIl/13 I!. The venomous Snakes of the Mediterranean Basin. (in consideration of the available space only the landscape where the snakes were encountered are mentioned in- stead of the exact localities. A detailed report on the incidence of European vipers is contained in the "Mitteilungen of the Behring Works", Vol. 7j 1936, which in many points have served as a guide. For the sake of a better legibility of the map and because of the uncertainty with regard to the distribution areas only the general distribution areas were presented in the map*) The fauna of poisonous snakes of the Mediterranean basin con- sists of the following species: Vipera, Cerastes, Echis, Bitis, Naja, and Walterinnesia with 26 representatives*. A.) Species of Viperidae. a) the Berus family includes: la Vipera berus berus L° 2a Vipera berus bosniensis Boettger 3<> Vipera seoanei La taste 4s Vipera ursinii ursinii Bonaparte 5« Vipera ursinii ma crops Mehely 6, Vipera ursinii renardi Christoph 7, Vipera ursinii Kaznakowi Nikolsky b) the Ammodytes family includes: 8, Vipera ammodytes aspis L* 9» Vipera ammodytes hugyi Schinz 10. Vipera ammodytes latastei Bosca llo Vipera ammodytes ammodytes La 12. Vipera ammodytes meridionalis Boulenger 13» Vipera ammodytes transcaucasiana Boulenger c) the Lebetina family includes: 14o Vipera lebetina lebetine L„ 15. Vipera lebetina xanthina Gray 16* Vipera lebetina mauritanica Guichenot 17o Vipera lebetina deserti Anderson 18. Vipera lebetina raddei Boettger VIl/13 By) Species of Cerastes. 19* Cerastes cornutus Forsk. 20, Cerastes vipera L* C. Species of Echis. 21• Echis carinatus Schn, 22. Echis coloratus Boulenger D. Species of Bitis. 23. Bitis arietans Merr, E«) Species of Naja. 24. Naja haje L* 25* Naja nigricollis Rhdt. F») Species of Walterinnesia. 26. Waiterinnesia aegyptiaca I. The distribution of the above species is not clearly defined and two and more of them not infrequently occur in the same area. Bastard types are observed in the area where Vipera berus and aspis live together. 1. Species of Viperidae, Group of vipera berus (common vipers). This group has a very wide distribution from the coasts of the Atlantic to the pacific and cannot be considered as a typical repre- sentative of the Mediterranean Basin,where its incidence is limited to numerous inroads which have developed special forms with special characteristics in well defined areas. We find for instance a variety which is especially adapted to the conditions of the steppe and which are encountered in moor and prairie land* The different distribution areas do not infrequently merge into each other and are in some in- stances superimposed. The moor- and prairie lana types prevail in Europe north of the Alps, in the post-glacial moraine lana as well as in the low and moor- lands of northern Europe, the foreland of the ice streams of the glacial VIl/13 era. From these main areas the vipers have spread to all regions which appealed to them and the species disappeared only in the most highly civilized areas. 1. Vipera berus berus L#> the common viper. In addition to the areas of distribution as mentioned above, this representative is alsb to be found in mountainous regions, sometimes even up to a con- siderable altitude as in the Alps, where places grown with alpine roses in the vicinity of alpine pastures and rocky ledges are the favoured habitat. These conditions are fulfilled in numerous valleys in Switzerland, especially in an eastward direction. On the other side of the Alp passes we find this species also in the valleys slop- ing to the s°uth and in Italy as far south as Padua and Ferrara. In Germany the common viper is widely distributed in the central mountain- ous districts, whereas it has completely disappeared in the densely populated Rhineland. In the eastern frontier region, the incidence is rather hish in certain places and we find them also in Tyrol, Styria, Kaernten and Krain. On the Balkan Peninsula the distribution even extends farther south to the Vitos and Rhodope Mountains and east- wards it includes the Bucowina and Moldavia. Although vipera berus _ is encountered in Macedonia, we do not find this viper in Thrace. This species is well known in France, apart from some areas in the southwest. 2. Vipera berus bosniensis Boettger. The Balkan viper invites special attention, the venom of this species develops mainly neuro- toxic effects which is in contrast to the venoms of all other viperi- dae. This fact has no special therapeutic importance since the am- modytes serum of the Behring Werke is also efxective against this venom. The distribution of the Balkan viper includes the northwest of the Balkan peninsula, from the rocky region of Croatia extending to Bosnia, Hercegovina, Slavonia and Albania. The limits of its distribu- tion are not yet well defined in all instances. The Morava-Wardar line seems to limit its distribution to the East. The limits to the South and Northwest are not yet defined. In the North the distribution area extends in some parts up to the Danube. 3# Vipera berus seoanei Lataste. The Iberian viper is only to be found on the Pyrenean Peninsula and only in the North and Northwest. It is mainly distributed in the Asturo-Cantabrian mountains, in the provinces of Asturias and Galicia and it is also known in Portugal. Distinct mountainous varieties are observed in altitudes of more than 800 M., above the timber line. Vll/13 The group of the vipera ursinii L« includes different varie- ties, namely the Steppe viper, the Meadow viper and the Caucasian viper. 4. Vipera ursinii ursinii Bonaparte, this representative which is named Wiesenotter in German, which means Meadow viper, is mainly distributed in the Hungarian lowlands and is to be found from the south bank of the Danube and as far westwards as Melk in the vi- cinity of Vienna. In the east the distribution is limited by the Theiss river and specimens were found in Siebenbuergen. Two isolated distribution areas were reported in the Abruzzo mountains and in the western part of the French Alps which muc t be interpreted as relicts indicating a formerly larger distribution of this species. 5. Vipera ursinii macrops Mehely, the Karst Viper. This re- presentative has roughly speaking the same distribution area as the Balkan Viper and is found in Bosnia, Hercegovina, Montenegro, North Albania and as far eastwards as to the area of Sofia (Lylin Moun- tains). The venom of this viper, as is the case with the Balkan Viper, has mainly a neurotoxic effect but this statement by REUSS still requires careful examination before far reaching conclusions may be drawn from this surprising resemblance of the effect of the venoms of these two representatives. 6. Vipera ursinii renardi Christoph, the Steppe viper, is distributed in north Bulgaria and in the west in Bessarabia, Crimea and area of the lower Volga including all the Russian steppes of central Asia up to the Altai. In the south the distribution extends to the Caucasus, to the plains of Aras and Kura including Armenia where this species was found as far south as Eriwan. It may, there- fore, be said that this species does not count among the more im- portant representatives of the Mediterranean Basin. 7* Vipera ursinii kaznakovi Nikolsky is distributed in the medium altitude regions of the Caucasus countries. In the East Cau- casus and in the plain of Kura, however, the species could not be proven. The incidence of this viper, as is the case with all vipers particular to the Caucasus, is thus limited to a relatively small area. Group of the Vipera ammodytes; This group is especially distributed in the areas bordering the Mediterranean Basin, The different representatives of this group are VIl/13 distributed as follows: 8, Vipera ammodytes aspis L., the "Viper" properly speaking is found throughout Italy and the distribution extends far to the north and northwest of the Apennine Peninsula, In an eastward di- rection the attribution does not go beyond the Isonzo river. In the northeast this species is found in the valleys of the Alps, es- pecially in Graubuenden and the incidence is on the increase the farther we go to the west. In one place at Thiengen it crosses the Rhine. It is rather frequent in the Jura and Vosges mountains up to the region of Metz in Lorraine, all over France, as far west as Abbeville, In southern France the species is distributed as far as the Gironde river and in the Vendee province as well as in the eastern foreland of the Pyrenees and northeastern part of Catalonia. In Catalonia this representative lives together with the Latastei family. In the Alps the species is found up to a- bout 2000 meters of altitude, 9, Vipera ammodytes hugyi Schinz, Hugy*s viper, has a rather confined area of distribution and it only occurs in southern Italy and Sicily, 10, Vipera ammodytes latastei Bosca, also called "Stuelpnasen- otter" because of the striking prominence of the upper lip, is dis- tributed all over the Iberian peninsula, furthermore in Algeria and Tunisia, where it is especially encountered in the shore districts, though it is also founa in many instances deep in the country. So, the species was observed in the area of Marrakesch in the Atlas Mountains at an altitude of more than 2500 Meters, The other representatives of the ammodytes family are not cha- racterized by this prominence of the lip, although a slight indica- tion of this particularity is present in some of them. 11. Vipera ammodytes L., also called the "Western Sand Viper" which is an absolute misnomer since the "sand vipers" never live in the sana. This species is characterized by an obliquely placed horn and a red tip of the tail. The main areas of distribution are the southeast district ofthe Alps, Dalmatia, Croatia, Bosnia and the Herce- govina. Representatives have also been observed in the mountainous districts of istria . In Kaernten the distribution area extends as far as Friesach in the north. The species was also found in the area of Laibach. Furthermore there is a little area near Bolzano which represents a relict. Farther eastwards we find this family as Vll/13 far as the Morava-Wardar line and in the north it was observed as far as the Transsylvanian Alps. It i s worthwhile mentioning that there exists a red mutant of this species. 12. Vipera ammodytes meridionalis Boulenger, characterized by a vertically placed horn is distributed in areas south and east of the distribution area of the vipera ammodytes L. In some districts, as for instance in the areas of Valona both species live side by side. This species is found in Greece as far north as the pello- Bulgaria, Macedonia, in the Aegean and Ionian Isles, far- ther east it occurs in Asia Minor, Turkey and Syria. 13* Vipera ammodytes transcaucasiana Boulenger, the Armenian Sand viper, has the smallest distribution of the three species. It is limited to the area of the Caucasus, where it is found particular- ly in medium altitudes. Group of Vipera lebetina: This group includes mountainous species of hot and tropical climates with a distribution extending from Northwest Africa to India• 14. Vipera lebetina L«, the Levant Viper. Of all the species of this group this representative has the widest distribution al- though the limits have not yet been established with certainty in all instances. The main distribution area is Iran and from there east- wards to Kashmir, northwards to west Turkestan and the areas of Amur- Darja and Syr-Darja. In the western extension the species was found in Transcaucasia as far as Batum. \ From Iran the distribution extends to Mesopotamia, where the species is known in the valley of the Orontes as far as Acre. In the southwestern section of Asia Minor the distri- bution area extends to 'Turkey as far as the area next to Adana. It is worthwhile mentioning that this species occurs on several islands of the Mediterranean Sea such as Cypros, Kimolos, Milos and Antimilos. 15* Vipera lebetina xanthina Gray, the Mountain Viper, is dis- tributed in Asia Minor. This species is well known in the Taurus Moun- tains, in the mountainous districts of Syria and Palestine as far as the region of Jaffa, in Lebanon and from there northwards to Aleppo, It is thus an inhabitant of the Lastern part of the Mediterranean basin. 16. Vipera lebetina mauritanica Guichenot is also a distinct mountainous form. The Atlas Viper is especially distributed in the VIl/13 northern part of the Atlas Mountains and the distribution area ex- tends from there almost to the Atlantic Ocean. In an eastward di- rection this species was found as far as in the area of Tunis. 17. Vipera lebetina deserti Anderson, the Sahara Viper, makes an exception in that it aoes not live in the mountains but in the plains. This species is distributed in the desert areas of South Algeria as far as the area of Ain Sefra, it occurs at the northern fringe of the Sahara as far east as Tripoli. It is likely to occur in the Cyrenacea in Lybia and certain reports seem to indicate that it is also dis- tributed in Egypt. 18. Vipera lebetina raaaei Boettger, the Armenian Mountain Viper, has as all the species of the Caucasus only a very small distribution. This species is found in the area of the Kura and Aras mountains. Since the distribution lies outside the map it could not be entered. 2. Species of Cerastes. 19• Cerastes cornutus Forsk, the Corn Viper, is one of the most generally distributed venomous vipers of North Africa which lives in the outskirts of the stony deserts. The distribution area extends from the northern outskirts of the Sahara from Algeria to the east by way of lybia as far as Egypt, It is found from Arabia to South Pale- stine and South Syria. 20. Cerastes vipera L., the Avicenna Viper is a small type ven- omous viper which lives in North Africa, in Algeria up to the Egyptian border in the deserts and sana dunes. It is also found in South Tunisia in the area of Douirat, in Tripoli, in the desert of Gizeh, in Egypt and also west of the Suez Canal. 3» Species of Echis, 21* Echis carinata Schn., the Rustling Sand Viper has this name because of the slight rustling noise made when gliding over the sand* This species is rather widely distributed in West Africa in a girdle with the width from Algeria to Togo including Egypt, Abyssinia, Somali- land, part of Arabia and Iran. We find it also in Transcaspian area and also in India. 22, Echis coloratus Boulenger strictly considered does not belong to the fauna of the Mediterranean basin. It is also mentioned in this vn/13 connection because specimens were found in southern Morocco in the area of Wadi Sous. 5« Species of Naja, 24. Naja haje L., the Aspis Viper (must not be confused with Vipera aspis) is one of the most dangerous venomous vipers which is encountered in the northern part of the Sahara from Morocco to Egypt, up the Nile as far as Mozambique, in Somaliland, furthermore in the south of Palestine and northwest Arabia* It is also found rather often in the district of Maryut, Giseh, Fayum, Tel el Amarna, Beni Hassan. 25. Naja nigricollis Rhdt. is distributed in the south, partic- ularly in Transvaal, Natal, Angola, Betschuanaland and all over west Africa, furthermore in upper Egypt where it was found at Assuan. 6. Species Walterinnesia. 26. Walterinnesia aegyptiaca which is closely related to the species of Naja is a very rare venomous viper which has been found so far in Egypt up to Iran. The number of venomous vipers to be met with in the Mediterranean thus appears to be rather important. As far as the different species in the European part of the Mediterranean Basin are concerned, it may be said that these belong to a few well defined families with a certain number of sub-families. A distinction of the different ven- oms made it possible to develop a specific therapy in each case. This distinction had to begin with a classification first of the local forms of snakes and then to extend the circle wider and wider. This con- sideration imparts some understanding for the importance of systematic zoologic classification even to the layman, It will become evident hew minute and seemingly unimportant observations fit into a general picture which one day will be viewed from an entirely different angle and gain considerable practical importance. F. ECKSTEIN Institute for General and Military Hy&i ene of the Medico-Military Ac- ademy, VII/14 PRECIPITATION AND ISOTHERMS IN THS MEDITERRANEAN BASIN Translation prepared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) VII/H The map of the precipitation and isotherms in the Mediterranean basin shows on tho same map the distri- bution of the precipitation throughout the entire Medi- terranean basin, some selected isotherms of the months of January and July, and through climograms the annual course of the precipitation, the temperature, and the relative humidity. This map was compiled on the basis of the information material studied and the latest maps available. The Mediterranean basin is a very homogeneous meteoro- logical area whose various parts show only certain varia- tions of the same type of climate, the so-called Medi- terranean climate. The term etesian which frequently is used to describe the Mediterranean climate originates from tho northwestern winds, the so-called etesians which predominate in tho eastern Mediterranean during the hot season, and the name of which was applied to the entire Mediterranean climate. The characteristic properties of the Mediterranean climate are a bright, dry summer, and a mild winter during which the maximum of the precipitation is observed. During winter the weather is rather unstable, about as unstable as in central Europe during summer. This climate which is so different during summer and winter is due to the shift of the subtropical Azores high. In summer the Mediterranean basin usually is under the influence of the subtropical high with its bright weather. During winter, however, when the subtropical high is shifted to the south, the Mediterranean basin comes under the influence of the central European west wind zone north of it and therefore shows the unstable character of weather. The proper Mediterranean climate with the maximum of precipitation in winter which is confined to the southern parts of tho Mediterranean area, that means to Africa and to the ooasts of the peninsulas suffers a certain modification towards the north and in the interior of the peninsulas by tho fact that there the maximum of rainf .11 occurs in the autumn and spring months. Thus a link is brought about to the central European meteorological area in the north with its summer rainfalls. As a consequence of the small amount of precipitation the coast of southern Tunis and Pale- stine have a steppe climate. VII/14 W. KOSITEN made an attempt to give a cartographical presentation of the various types of climate by recording the limit values of temperature and the types of precipi- tation (see Map VII/1, Undulant fever in the Mediterranean basin). According to this author the entire area consid- ered here is located between the isotherms of Id0 C. and -3° C. in the coldest month. In addition he distinguishes between the areas dry in summer and areas with the maximum of rainfall in the early summer or with rainfalls during all seasons and finally he defines the etesian climate through the 22° G. isotherm of that month which shows the highest temperatures. Hence, in the climate map available the course of the 22° C. duly isotherm shows the northern boundaries of the etesian climate. With the exception of Africa a duly temperature of 26° G. is found only in the southernmost coasts of Greece, Crete, and Turkey, and in Spain in the river basin of the Guadalquivir near Sevilla. A mild winter is characteristic for the entire Mediterra- nean basin. The January isotherm of 0° C. is exclusively found in the higher regions, while in the coastal areas the January temperature is above 6° 0. Tho annual amount of precipitation in the Medi- terranean basin differs considerably. Within very small areas very great differences are frequent, dependent on the location of tho areas in relation to the winds commonly bringing the rain. As the western winds usually bring the rain with them, the western and southern coasts of all peninsulas show the highest values of precipitation, while the interior is much more arid. Contrary to that in North Africa the northern coast facing the Mediter- ranean shows the highest number of rains. There are considerable contrasts in Spain where the precipitation in the northwest exceeds 1,500 mm., while in the eastern territories of Spain it only amounts to 300 mm. In addi- tion a region with more than 3,500 mm. precipitation is located on the eastern shores of the Adriatic, an area which is considered as the region with the greatest number of rain in Europe, while on the other hand southern Russia is one of the areas with the smallest amount of precipitation. VII/14 The olinograma on the margin of the map give a survey of the annual course of some of the meteorological elements (the names of the stations for which a climogram was given, are underlined). In the entire area studied (solid curve) the temperature conditions show the greatest homogeneousness during summer. The usually hot summer is followed by a warm autumn as a result of the heat storage in the Mediterranean. The winter of the borderline areas is mild while the tem- perature decreases towards the interior of the land areas. Spring is relatively cool, as due to the proximity of the cold water surface the rise of the temperatures is very slow. The annual course of the precipitation shows very different types. The etesian climate type with the dry summer and the maximum precipitation during winter is found in the stations of Alexandria and Palermo. Scutari is an example for the zone with a summer of little rain- fall and the maximum of precipitation during spring and autumn, while for instance Bucarest is characteristic for the northern territories with the principal preci- pitation period during summer. The annual course of the relative humidity is represented by a broken line. The stations in the immediate proximity of the Mediterranean, such as Livorno, Palermo, Alexandria show the smallest variations for the different months. In the stations which are located farther in the interior local conditions exercise some influence, so that variations of 30 to 40 % occur. Generally the minimum is observed during summer. leather Forecast Service (Air Force) VIII/1-3 YELLOW FEVER IN AFRICA Translation }. repared by: U. S. Fleet, U. S. Naval Forces, Germany, Technical Section (Medical) VIII/1-3 The reports on morbidity and mortality (see Table I) give only a vague idea of the distribution and frequency of yellow fever, because within endemic occurrence experience has shov/n that slight cases are far more frequent than typical ones but have such an uncharacteristic course that they cannot be recognized clinically. Thus, there are wide "mute regions of yellow fever" in which outbreaks of yellow fever arc possible under certain conditions, such as the sudden arrival of numerous non-immune and thus susceptible persons. These regions could be pre- cisely limited by serial examinations among the population, Table I Reported oases of yellow fever in Africa 1935-41 (A second figure in brackets indicates the fatal cases, if reported separately) 1935 1936 1937 1938 1939 1940 1941 French Colonies Senegal 1 12 36 2 - i j i Guinea - 1 - - -i i Ivory Coast 7 1 8 14 81 ! Togo 3 - - - i > 3(1) >49 Dahomey 2 4 1 1 - £L9 ■ | i t Sudan 1 5 3 4 - j i ! 1 * Niger 1 1 - - 3 j ! S 1 Equatorial Africa 2 - 2 2 4 2(2) 4 British Colonies Brit. Gambia 1 - - - - - - Nigeria 1 • 3 3 - 10(5) - - Sierra Leone 1 - 1 - - - Gold Coast 7 4 11 1 - 2(1) 1 Uganda - - 2 - - - 1 Sudan - - 2 - - 15 ,000(1, 660) ? Belgian Congo 1 2 Spanish Guinea 4 4 by means of the mouse protection test, which are available in large numbers for the years 1933-38* The map of the distribution of yellow fever immunity in Africa shows the results of these examinations, Table II gives the partic- ulars. It must be considered that, of course, the map VIII/1-3 shows only data of those places which have been examined, i.e. few entries such as in the region of the Ivory Coast do not mean that no yellow fever can occur there, or conversely numerous entries, such as in Nigeria, do not mean that yellow fever is distributed there more densely than in the regions which have been less well examined. With yellow fever, we are in the extremely favorable position of possessing, in the mouse protection test, a certain method of proving infection of yellow fever, since it does not only become positive after any infection of yellow fever (even after "occult immunization”), but also remains so during the whole lifetime of the respective person. Thus, negative reaction does not only mean that the respective person is susceptible to yellow fever, but also that with great probability he has never suffered from an infection of yellow fever in his life. Under these conditions, the systematic serial examinations with the mouse protection test have given an exact picture of the distribution of yellow fever virus at that time. The result shows that yellow fever is much farther distributed than suspected previously, particularly in the interior of the continent. After attention had been once awakened by these examinations, cases of yellow fever have been clinically and autoptically recognized in some mute zones, particularly in the Anglo-Egyptian Sudan, lust there, yellow fever has advanced recently toward the northeast, which had been already suspected on account of former immunity findings (see the last available reports about cases of 1940). Its future distribution cannot yet be estimated (cf. Sudan in table I). If the results of the nouse protection test among a population are subdivided into age groups, it can be seen whether yellow fever still exists, namely, if also the little children have positive reactions, or whether yellow fever is extinct in the respective region; for it must have been extinct for so many years that the most recent positive case is old (except possible positive persons immigrated in the meantime). Thus, the mouse protection test affords some - even if only limited - insight into the dynamics of the epidemic. On the present map and the respective table, differences have'*been made between groups above and below 15 years. VIII/1-3 During the mouse protection test, patient serum and virus containing mouse brain are mixed and after a first phase of binding, decreasingly diluted if necessary, intracerebrally injected to living mice (5-6 white mice per serum!). If the serum contains sufficient protective substance, the mouse remains healthy (positive), if it contains none, it dies within seven days at the most (negative). Table II Occurrence of Yellow Fever Immunity in Africa The figures in brackets behind the names of the regions indicate the source of the literature from, which the data have been . taken (see end of table). Tno figures before the places correspond to those on the map. Column A: Number of persons examined Column B: Percentage of juveniles younger than 15 years with positive mouse protection teat Cplunn C: Percentage of persons older than 15 years with positive mouse protection test No groups of age have been distinguished where the figures stand between B and C. ABC Morocco (3) 1. Casablanca 24-0 2. Fes 17-0 3. Rabat 45-0 Algeria (3) 1. Oran 28 - 0 Tunisia (3) 1. Tunis 25-0 Senegal (4) 1. Tivaouane 36 2. Pout 35 3. Fadioudyo 15 4. Sabaya 6 Guinea (4) 1. Kaukau 0 2. Kouroussa 0 3. Siguiri 10 4. Conakry 0 5. Boffa 0 6. Boke 0 ABC Sudan (4) 1• d. ayu. 15 2. Q,uio 20 3. Kiranga 37 4. SOX O'GO 0 5. Toukoto 0 6. Kayos 28 ?. Dingu.ii a 47 Sudan (1) 8. Ansongo 50 0 0 9 • Gao 80 0 0 Niger (1) 1. Agadez 86 2 0 2. Birnin NfKoni25 20 3- Dogondoutchi 25 36 4. Dosso 25 0 - 5• Gaya 50 64 92 6. Goure 30 3 7• Maradi 27 ‘0 8. Niamey 54 0 35 VIII/1-3 (Niger (1) ctd.) ABC 9. Tessaoua 51 50 52 10. Tillabery 25 0 - 11. Zindcr 83 0 44 Brit.Gambia(1)(8) 1. Bathurst 23 26 0 36 45 0 2. Basse 53 3.9 3. Georgetown 45 23 35 49 28 4* Korewan 38 32 5. Bakau 45 29 6. Brikama 44 2;' Sierra Leone (1) 1. Bo 15 0 2. Freetown 73 3 23 3. Makene 23 9 4* Moyamba 25 24 5. Sogbwena 13 - 8 Gold Coast (1) 1. Abetifi 20 5 2. Accra 25 8 - 3. Adeiso 24 27 4* Asamankese 25 40 5. Bawku 50 12 56 6. Bole 25 24 7* Cape Coast 24 29 8. Dodowa 26 24 9. Effiduase Town 25 0 County, 23 0 - 10. Yanasi 14 7 11. Kintampo 14 7 12. Korforidua 25 24 13. Kumasi Town 25 0 77 County23 0 I4 Larteh, TJpper27 30 15. Lov/er 25 0 16. Lawra 25 52 17. Mampeng (Akwapin) 20 0 (Northern Torritories)26 0 18. Mpraeso 8 0- 19. Navrongo 50 40 72 20. Nkawkaw 8 0- 21. Nkawatia 16 0 - 22. Obo 99- 23. Obomen 14 0 24. Salaga 38 26 ABC 25. Saltpond 25 4 26. Sekondi 25 4 27. Swedru (1930)25 0 (1932)25 16 23. Tamale 25 8 29. Tunu 25 16 30. Wa 50 32 60 31' ■ Yeyi 25 36 Nip:Glia (1) 1, Abe ok tit-a 122 5A 49 а. Abinsi 250- 3 - Ado 51 56 84 /-! - Agave 10 20 5. Aiyeto.vo 11 64 б. Akinnori 21 14 7. iiku.ro 50 0 8 8. Akwanga 25 0 30 9« Andaha 26 0 5 10- AX a Uxiga 50 0 24 11- Awe 19 5 - 12. Baoon; 62 8 36 13- BaracLogi 20 15 14- Baro-Koroko 17 0 20 150 Bida 40 68 7 16. Birnin Gwar.l 42 12 48 17* Birnin Kebbi 50 4 24 18. Bin. 25 12 19- Sudan 21 0 30 20. Calabar 24 13 21. Daladegum 18 11 44 22. Daura 52 4 29 23. Dinamari 5 20 24. Ede 25 28 25. Eggan 53 6 6 26. Snipata 30 23 25 27. Et sum-Mu tun 26 12 22 28. Forum 33 0 4 29= Gadau with small villagers 8 16 30. Garkida 25 28 31. Gowia 17 0 38 32. Gorgorun 98 0 7 33- Gurael 50 44 60 34* Gusau 23 4 - 35. Hadejia 78 39 28 36. Ibadan 524 42 61 37. Ifo 50 70 - 38. Ijebu Ode 26 15 39- Haro 50 48 VIIl/l-3 (Nigeria (1) ctd.JA B C 40. Ilesha 25 4 - 41. Ilorin 175 10 82 42. Iseyin 23 57 - 43. Iwo 25 20 44- Iyo 10 30 45. Janeta 25 0 - 46. Jarnari 6 16 47. Jebba 50 26 38 48. Jega 49 3 0 49- Jos ■ 79 8 23 50. Kaduna 50 2 51. Kakurc 11 100 52. Kano 125 7 20 53. Katagun 18 17 0 54* Katsena Ala 15 33 55. Katsina 75 0 17 56. Kazaure 56 4 7 57* Kontagora 26 6l 58. Koton Karife 37 13 13 59. Kujana 33 9 85 60. Kuru (Von) 300 61. Lagos 40 9 25 62. Lassa 25 29 18 63. Lokoja 76 12 45 64* Maiduguri 30 17 65 • Makawa 16 0 6 66. Makera * 27 4 67. Makintari 6 67 68. Malunri 4-50 69. Manfe 23 50 56 70. Manfe county, villages 121 18 34 71 • Mar ana 20 5 72. Me dachi 9 33 73. Meko 54 50 74* Menoko 17 0 25 75. Mkar 43 24 22 76. Muroji 50 12 20 77. Musunan 10 20 78. Muye 25 8 0 79* Numan 25 20 0 80. Ogbonosho 225 12 64 81. Ogudu 25 16 82. Okene 84 8 4 83- Oke Iho 27 48 84* Ondo 50 8 4 85. Onitsha 55 0 36 (Nigeria(l)ctd.) ABC 86. Oshogbo 50 60 87* Owerri- Okigwi 119 0 16 88. Cwo 50 0 12 89. Oyo 173 11 71 90. Pategi 62 8 91. Pctiskum 25 0 92. Rigachikun 47 5 32 93• Sabongari 36 14 82 94 Sansits 11 0 16 95. Ga.'wo 10 30 96. Shalfi 30 30 97. Shongo 44 27 82 98. Sok.obo 51 12 30 99. Sokwa 20 0 21 IOC, Takalafiya 57 27 67 101. TallataMafara50 0 102. Tanbawel 49 0 12 103. ParabbaGcngi 10 30 104. Tasbana 20 0 10 105. Tcshegua 10 50 106. Tinto(Manfe) 11 27 107. Toro 17 - 12 108. Tsakuwawa 50 38 46 109. Tula a. Wada 23 5 - 110. Yon 69 0 2 111. Wajagai 50 12 44 112. Wakar.10 25 24 113• Wallidizene 30 6 43 114. Wana 25 13 33 115. Warri 21 19 116. Wukari 15 13 117. Yabo 49 0 4 118. Yandev 56 33 36 119. Zareku 83 26 58 120. Zaria 154 1 9 121. Zuru 29 0 25 Liberia (1) 1. District 1 34 - 15 2. " 2 6-0 3. 37 15 4. Capo Palmas 24 0 5 . Ganta 25-0 Ivory Coast (4) 1. Benikoro 0 2. Darsalam 20 3. Dedougou 0 VIII/1-3 (Ivory Coast(4)) ABC 4« Dangouadougou 0 5. Gaoua 33 6. Gd.Possan 10 7* Kamalo 0 8. Kanpti 0 9. Kayo 10 10. Kirango 35 11. Kouara 0 12. Koutiala 30 13. Loo 15 14- Mbossoba 50 15. Mokby 60 16. Nounoudara 20 17. Onto 15 18. Ouagaladougou 110 19* Pabre 25 20. Po 0 21. Sabou 10 22. Sikasso 0 23. Tehini 0 24* Tenkodogo 10 Togo (4) 1. Paline 20 Dahoney (1) 1. Abonoy 40 60 93 2. Kandi 50 8 12 3. Parakou 25 8 - 4. Porto Novo 48 29 5. Save 25 24 French Congo (6) 1. Poto-Poto 39 12 36 2. Bacongo 34 40 26 3. Pointe Noire 47 46 35 4. Loango-D. 45 15 32 5. Bakouilou 5-0 6. Kayes 32 6 19 7* Tiena 6-0 8. Sine-Banba 18 0 25 9. Chilounga 27 10 0 10. N * Tina 24 8 17 Chad (6) 1. Abecho 16 0 7 2. Tinam 15 7 - 3. Abou-Deia 10 60 4. Mongo 18 44 5. Massenia 22 50 6. Melfi 9 55 (Chad(6)ctd.) ABC ?. Bousso 20 25 8. Bongor 19 0 Gaboan (6) 1. Port Gentil 45 19 27 2. Lanbarene 24 14 21 3- Vega 17 33 0 4* Bellevue 30 0 6 5. N’Sagha 16 25 8 6. Mayennie 500 7. Anioghes 9 0 0 8. Libreville 24 0 20 9- Abenelang 26 0 0 10. Zog *M?Bour 20 0 8 11. Coco Beach 29 36 28 12. K’Boue 10 - 10 13. Oyeui 5 - 20 14* Mcuila 5-0 15' Chibanga 5-0 16. Divenae 5 20 French Lquacorial (2) 1. Balhois 32 0 23 2. Banbari 50 28 60 3. Bangassou 50 20 44 4. Bangui 50 4 32 5. Berberati 49 8 21 6. Boda 49 12 72 7. Bouka 49 24 68 8. Bousso 50 12 56 9. Kinboalla 40 12 12 10. Jcko 20 5 - 11. Carnot 49 32 54 12. Dongou 50 0 8 13. Fort Archin- bault 26 19 14. Fort Larjy 48 2 15. Fort Sibut 50 12 36 16. Impfondo 47 18 24 17. Kinkala 50 0 24 18. Libreville 45 0 20 19* Liranga 50 8 12 20. Loudima 50 0 8 21. Loukolela 35 0 0 22. Loungba 25 52 23. Madingou 49 4 16 24. M'Baiki 50 0 24 25. Mindouli 25 4 - VIII/1-3 (French Equatorial Africa(2)ctd.) ABC 26. Mobaye 48 8 50 27. Moissala 50 0 12 28. Mossaka 32 0 - 29. Mouionzi 50 4 12 30. MTPouia 50 0 12 31. M'Vouti 49 0 3 32. N’Gabe 50 12 24 33= Ouango 50 0 24 34. Port Gentil 35 0 6 35. Rafai 44 24 53 36..Sibiti 50 0 4 37= Zenio 47 36 95 Caiaoroons (2) 1. Bafia 49 8 28 2. Batouri 50 4 16 3. Duala 50 0 0 4. Garua 50 0 5. Maroa 50 0 6. MTBanga 48 0 0 7. Nkongsanba 50 4 4 8. NfGoundere 50 9. Obala 99 0 1 Spanish Guinea(3) 1. Oveng 45 18 2. Machinda 36-3 3. Bimbongo 10-0 4. SpanishGuinca total 91 - 10 Belgian Congo(2) 1. Albertville 50 0 0 2. Banana 25 11 28 3- Banzyville 50 4 12 4. Basankusu "(Beige) 11-9 "(Benge) 15-7 " (Lilangi) 54 3 56 5. Basoko 50 - 16 6. Bona 50 0 24 "(Europeans) 12-0 7. Bondo 50 12 20 8. Buta 50 0 20 9= CoquilhatviHe 71 - 11 10. Dilolo 50 0 4 11. ElisabethviHe 50 0 0 12. Fradje 25 5 20 13. Kaiku-n-Zobe 32 3 - (Belgian Congo(2))A B C 14 • Kimpangu 46 0 0 15• Kisongo 24 . 0 5 16. Kongolo 50 0 4 17. Kinsuka 17 - 12 18. Leonoldville 56 0 6 19. r. (-j">>7iro:is 52 21 20. Libenge 51 0 12 21. Lisafe 72 0 15 22. Lisala 47 - 17 23. Longo 13 0 29 24* Luebo 50 0 0 25. Luluaburg 50 0 16 26. Luozi 46 - 15 27* Maduda 24 0 - 28. Matacli 58 15 42 29. Minkono 17 - 47 30. Niaii 16 0 31. Fort Francqui (Ilea) 22 - 18 32. "(Belgian) 21-0 33. Senge 13-0 34 = Soyo-Luadi 38 14 30 35. Stanleyville 83 - 10 36. Thysville 56 - 0 37= Tshela 27 4 - 38. Tshikapa 50 0 8 39= Usumbura 50 0 0 40. Vista 19 0 17 41. Yema 2-0 Angola (2) 1. Afiibris 50 0 0 2. Ambrisette 50 0 0 3. Benruela 50 0 0 4= Canabatela 50 0 0 5. Catumbela 50 0 8 6. Cateto 50 0 4 7. Caxito 49 0 0 8. Danoa 50 0 0 9. Dondo 50 0 0 10. Golungo Alto 50 4 0 11. Loanda 50 0 0 12. Malange 50 0 0 13* Maquela 50 0 0 14. Mossamedes 50 0 6 15. Muxima 50 0 8 16. pungo Adongo 50 0 0 17. Novo Redondo 50 0 0 18. Sao Salvador 50 4 4 VIII/1-3 (Angola(2)ctd.) ABC 19. St.Antonio de Zaire 50 8 4 Union of South Africa (3) 1. Cape Town 24-0 2. Durban 25-0 3. Tongaland 42 - 0 Bechuanaland (3) 1. Serowe 13 ( - 0 Southern Rhodesia (3) 1. District of Mtoko 22 - 0 Northern Rhodesia (3) 1. Barotseland 21-0 2. East Luangwa 25-4 3. Northwest District 25-0 4. West Luangwa 25-4 Madagascar (3) 1. Tananarivo 20-0 Zanzibar (3) 1. Zanzibar 62-0 Tanganyika (3) 1. Bukoba 23-3 2. Dar es Salam 25-0 3. Kigoma 25-0 4. Mpapwa 25 - 0 5. Mwanza 25-4 6. Tabora 23-0 7. Tinde 23-0 8. Uzinza 25-0 Kenya (3) 1. Fort Hall 26-0 2. Kakamega 55 - 0 3. Kisii 25 - 4 4. Kisumu 42-0 Uganda (3) 1. Ajumani 46 0 0 2. Aringa 51 0 0 3. Arua 92 0 6 4. Fort Portal 21 - 10 5. Gulu 51 0 0 6. Kaiso 19 0 0 7« Kigezi 24-8 8. Kitgum 50 0 10 9. Lira 54 0 3 (Uganda{3)ctd.) ABC 10. Masindi 50 4 0 11. Moyo 51 0 3 12. Mugwer 51 0 4 Anglo-Egyptian Sudan (3) 1. Anadi 36 0 11 2. Dilling 45 0 23 3. El Fasher 38 0 45 4. El Obeid 52 0 0 5. Geneida 38 0 8 6. Juba 52 14 7 7. Khartoum 32-0 8. Li Rangcu 31 0 25 9. Malaical 50 0 4 10. Rumbek 6l 4 46 11. Wau 55 13 26 12. Yirol 19 0 - 13. Yubo 37 0 25 14. Zalingi 30 0 13 Anglo-Egyptian Sudan (9) 15. Kau 38 42 87 16. Eliri 27 0 58 Anglo-Egyp^ion Sudan (9) 17. Lafufa 18 0 36 18. Nyaro 5 0 60 19* Heiban 31 0 7 20. Gulfan 99 0 18 Anglo-Egypt!an Sudan (7) 21. Malakal 114 18 19 Anglo-Egyptian Sudan (10) 22. Wadi Medani 3-0 23. Kosti 26-4 Egypt (3) 1. Aswan 28-0 2. Asyut 48-4 3. Luxor 51 - 0 4. Mansura 110 0 1 Abyssinia (3) 1. Addis Abeba 27-0 British Somali- land (3) 1. Borbera 10-0 2. Burao 19-0 3. Hatgeisa 15-0 VIII/1-3 (Note to Table II:) Source material (figures in brackets behind the names of regions): 1 = BEEUWKES and II.1AHAFFY, Transact. Roy. Soc. Trop. Med. a. Hyg. 28, 39 (1934). 2 -BEEUWKES, MAHAFFY, and PAUL, ibidem 28, 233 (1934). 3 = SAWYER and WHITEMAN, ibidem 29, 397 (1936). 4 = BOYE (Stefano- poulo). Bull. Off. Internat. Hyg. Publ. 25, 1015 (1933) and 26, 2106 (1934). 6 - STEFANOPOULO, "Rapport pre- liminaire sur les resultats du text de seroprotection en A.E.F. (1935-36)", in the files of the French Colonial Ministry. 7 = FINDLAY, Acta conventus III de tropicis morbis 1938, 314- 8 - JAMES, Bull. Off. Internat. Hyg. Publ. 27, 2354 (1935). 9 = KIRK, ibidem 28, 2343 (1936). 10 = JAMES, ibidem 26, 1043 (1934). The distribution of the principal vector, Aedes aegypti (Stegomyia), extends much farther than that of yellow fever, it practically occurs in the whole tropical and subtropical zone of the globe and even far in the temperate zone, espe- cially everywhere in the Mediterranean region, in the Near East and in all southern Asia, also on the East African coast (see map II/3 and VII/8). On the other hand, as far as one knows by now, one finds Aedes aegypti everywhere in Africa where immunity of yellow fever is found. The gnat is there by no means limited to the regions of the coast and of the large rivers, but it is found for instance in the whole of West Africa to the southern edge of the desert in nearly all denser human settlements, in the Congo in large numbers along the affluents up to Elisabethville; in the Sudan, it is found not so frequently, but not only an the Nile, but also in many oases, more fre- quently again in the settlements of Kenya and Tanganyika. It has been now experimentally proven that also other gnats (in part equally of the family of the Aedes, in part also Hemagogues, Sabethines, and perhaps others as well) may transfer the yellow fever virus, and for South America it has been positively proven that yellow fever occurs in regions free from Stegomyias. These are always districts of virgin forest in which individual cases or groups of cases of yellow fever (jungle fever) occurred, as has been proven, the infections took place in the virgin forest. Vectors are the mosquitoes living in the virgin forest. As known today, these infect themselves in monkeys suffering VIII/l-3 from yellow fever, with which fatal cases of yellow fever after natural infection are frequent, and with which even spontaneous yellow fever immunity can be occasionally found by means of the mouse protection test. It has not yet been proven, but it is highly probable that these conditions are equally true for Africa. \ In South America, jungle fever usually occurs limited to the seasons. It is not yet known where the virus exists in the season which is free from yellow fever. The monkeys susceptible to yellow fever cannot be this virus reservoir, since those, if infected, become either immune or die, like man; thus, they never become carriers of virus. The virus reservoir is probably in lower mammals (half-monkeys), per- haps even in cold-blooded animals. It is possible that the remarkable limitation of yellow fever distribution despite the by far larger distribution of the vectors and the pre- sence of multitudes of susceptible men, and particularly the humanity of the East African and Asiatic coastal dis- tricts is explained by the absence of the still unknown virus reservoir in these regions. This partial question excepted, one is today better informed of the distribution and dynamics, and thus of the danger, of yellow fever than of most of the other epidemics, as shown by the map. F. 0. HOERING (Institute for Tropical Medicine and Hygiene of the Military Medical Academy) VIIl/4 DENSITY OF FOIULITION IN IHE COUNTRIES OF THE ,.TL,S MOUNT.JNS Tr 'inslation prepared by: U. S. Fleet, U. S. Naval Forces, Geriaany, Technical Section (Medical) viiiA Through history and colonization the Atlas countries are the African foreland of Europe. The Atlas- mountains extending over a stretch of 2,200 Km. from the Atlantic Ocean to the straits between Tunisia and Sicily attracts the rainfalls and stores the water and thus it provides the basin of the rich culture of the thin northwestern strip of The pictures chiseled in stone, the dolmens, the mural paintings of the prehistoric era, as well as the magnificent Roman ruins give knowledge of the dense population of this territory and of the thousands of years old union of the Atlas countries with Europe which entered a new stage of development when the French set foot in Algeria in 1830, in Tunisia in 1881, and in Morocco in 1907. The presentation of the density of population was made according to the same principles as for map II/9 "Density of Population in tho Near and Middle East". The boundaries of the density of settlement exceeding 1 person, per 1 sq.Km. arc congruent with the borderline for the precipitation of 125 mm. per year, tho denser settlement exceeding 10 persons per 1 sq.Km. is associated to a high degree with tho precipitation value of 230 mm. I. Tunisia Among the Atlas countrios Tunisia, extending over an area of 135,130 sq.Km., is the smallest. The census of 8 March 1936 revealed a total population of 2.6 million inhabitants. The mean density of settlement amounts to 21 persons per 1 sq.Km. and it is higher than that of Morocco (15.6), but it is smaller than that of Algeria (31.4)* If one disregards the very thinly populated military area in the south (46,000 sq.Km.) a mean density of population of 20 persons per 1 sq.Km. was found in the northern territories under civil administration. The principal part of the population in the north is assembled in the area around Tunis, in the Medjer valley, and in the Sahel area between Sousse and Sfax. The three regions of Bizerta, Tunis, and Le Kef encompass only one sixth of the land area, but as the most important economic territory they harbor almost half of the total population. 24 °fa of the population are apportioned to the region of Sousse, 21 % to the region of Sfax, two fifth of this figure to the zone of olive cultivation. VIII/4 Fopulation of the va- E u rope a n s rious re- Total Moham- Total French Ital- Jews gions 1936 medans ians Total area 2,603,313 2,335,623 213,205 103,063 94,289 59,405 Bizerte 392,293 356,951 32,126 21,115 10,332 3,216 Tunis 541,323 364,031 143,161 63,027 72,398 34,636 Le Kef 306,409 296,203 0,079 5,170 3,386 1,322 Sousse 630,922 612,006 13,290 0,230 4,320 5,626 Sf ax 543,741 516,371 14,994 9,301 3,790 11,076 Southern Mili- tary area 193,120 139,556 735 595 55 2,009 In the steppe areas of central and southern Tunisia a denser population is found only in the vicinity of Kairouan, in the region of the phosphate mines near Gafsa and Tela, and in the fertile date palm oases among which that of Gafsa, Tozeur, Nefta, El-Human, Kebili, and Gabes, and the island of Djerba are the most important. In places where the irrigation system is sufficient, an intensive horticulture is maintained. The cultivation of the total areas is as follows; Cultivated land 2,934,000 hectare Permanent pasture 100,000 " Arborous and bush cultures (olives, wine) 630,000 " Woods and forests 1,016,000 " Not cultivated but cultivable land 4,320,000 t? Unproductive land 3,500,000 " The proportion of tho Europeans among the total population amounts to 0.2 cp (compared with 3-2 c/o in Morocco and 13.2 % in Algeria). To these 95,000 Jews must be added who, contrary to Algeria, were not granted French citizenship in Tunisia. The European population usually lives in the coastal districts and in the big towns. VIII/4 The population of Tunisia shows a continuous increase; Europeans popu- • lation Total Total French Ital- Malt- Mohammed- Jews in ians ese ans 1911 1,939,087 148,476 46,044 88,082 11,300 1,740,144 50,467 1921 2,093,939 156,115 54,476 84,799 13,520 1,889,308 48,436 1926 2,159,708 173,201 71,020 89,216 0,396 1,932,184 54,243 1931 2,410,692 195,293 91,427 91,178 3,643 2,159,151 56,248 1936 2,608,313 213,205 108,068 94,289 7,279 2,335,623 59,485 The crucial problem for the policy of population in Tunisia is the proportion of the French population to the Italians 11,200 of whom lived in the country as early as in 1880. As France was not successful in settling a sufficient number of French settlers in Tunisia it at first encouraged the Italian immigration. From 1923 on France made the attempt to correct the statistical facts con- cerning the population through extensive forced natura- lizations of the aliens born in Tunisia which applied particularly to the Italians. Before 1938 the number of the nationalized persons was 31,400, 18,151 of which were Italians. In Italian statistics of 1938 based on the ethnic origin the number of Italians and of Maltese to be counted with them was given as 127,000, that of the genuine French as 73,000 only. Above all attention must be paid to the fact that the Italian part of the population consists principally of peasants, fishermen, manufacturers, and industrial workers; without the Italian laborers the development of the Tunisian mining industry would have been unthinkable. Occupational classification of the French and Italians French Italians in 1933 Peasants and fishermen 9,241 19,750 Tradesmen and clerks 15,362 14,406 Manufacturers and workers 20,760 43,552 Transportation business 10,753 5,333 Independent occupations 4,057 2,331 Officials 21,350 541 Pensioners 6,157 1,033 VIII/4 More than three quarters of the Italians live in the district of Tunis. The city of Tunis itself has more Italian (50,000) than French (43,000) inhabitants even according to the French statistics (1936). II. Algeria While Tunisia and Morocco were under the administration of the Ministry of Foreign Affairs as French Protectorates, Algeria was considered as attached to France and was under the authority of the Ministry of the Interior. A large flow of farming settlers from southern France gave a French appearance to large stretches of the country. Including the southern territory extending through the Sahara to the border of the Sudan, Algeria covers a total area of 2,204,864 sq.Kni. with a total population of 7,234,684 persons (8 March 1936). In a narrower sense, Algeria conprises only the northern territories with 209,636 sq.Km. and a population of 6,592,033 inhabitants. The mean density of population is 31*4 persons per 1 sq.Km. and in Africa Algeria is only surpassed by the arable areas of Egypt and the Southafrican Union (34*9). Departement sq.Ka. Europeans Indig. Total 1 sqKm Algiers 54,701 365,504 1,875,407 2,270,911 41 Oran 67,352 399,674 1,223,682 1,623,356 24 Constantino 87,582 213,119 2,514,647 2,727,766 31 Northern areas 209,635 9784297 5,613,755' 6,592,033 31 Ain Sofra 650,151 5,393 107,954 193,347 0.3 Ghardja 143,712 2,134 169,232 166,366 1.2 Touggourt 134,865 865 242,498 243,363 1.0 Saham 1,066,500 563 39,012 39,573 0.03 Southern areas A 995,288 87955 633,696 642,651 0.3 Algeria total 2,204,863 987,252 6,247,432 7,234,684 3.3 VIII/4 By far the most densely populated area is the coastal zone of the Tell-Atlas. Between Algiers and Constantine the mean density of population is 50 to 100 persons per 1 sq.Km. This figure is increased in the Kabyl territory, the principal retreat of the Berbers, to high above 100 persons per sq.Km. The plateau located on that side of the Tell-Atlas, where no rain falls, has a width of 60 to 200 Km. This area has a steppe vegetation where halfa grass is cultivated and where cattle-breeding is highly developed. 6.2 million out of the total of 7*2 million inhabitants were indigenes’1 without full civic rights ("sujets francais" French subjects). The number of French citizens, including the native naturalized lows of Algiers and the aliens, amounted to 890,000; 791,000 of them were of French ethnic origin. In Algiers too the French administration made the attempt to keep the number of the aliens as low as possible through extensive naturalization; the high proportion of Spaniards is also worthy of note. Popu- Total French- Natural- Inligens (Sujets lation men ized {Tews francais) 1901 4,739,331 364,257 57,132 4,072,009 1906 5,231,050 449,420 64,645 4,447,149 1911 5,563,020 492,660 70,271 4,711,276 1921 5,004,275 520,642 73,967 4,090,756 1926 6,066,300 657,641 5,115,900 1931 6,553,451 733,242 5,540,236 1936 7,234,604 819,455 6,160,176 Popu- lation Tunisians All Moroccans o n s Spaniards Italians Others 1901 2,394 23,872 155,265 38,791 25,531 1906 3,083 25,277 117,475 33,153 17,849 1911 2,375 23,115 135,150 36,795 20,927 1921 1,700 27,345 144,315 31,927 15,904 1926 1,308 32,492 135,032 28,594 13,068 1931 2,918 33,840 109,821 26,136 15,705 1936 2,542 36,824 92,377 21,009 14,233 VIII/4 The considerable increase of the population which in the period between 1901 and 1936 annually amounted to 12 per mille of the mean figure for the population on an average, is principally due to a relatively high birth surplus. With a birth rate of about 34 per mille the mortality is only 15 per mille, so that there is an annual surplus of about 100,000 inhabitants. The total area of 220,406,410 hectare is distributed as follows: Cultivated land 5,766,475 hectare Arborous and bush cultures 635,159 " Woods and forests 3,517,277 ” Natural pastures 20,500,000 w Not cultivated and not cultivable land 210,533,147 ” Through an agricultural reform and through the expansion of the artificial irrigation (law of 10 April 1942) the control of the increasing surplus of the popu- lation was attempted. Great dams were planned to enable the irrigation of about 120,000 hectare of fertile soil. This land is to be colonized by new French settlers and indigenous tenants. In the principal cities of Algiers, Oran, and Constan- tine nearly 400,000 Europeans are living; 00 $ of all Europeans have their residence in the towns. In 1936 the total number of Jews was 116,000 (1.63 % of the total population and 14*9 % of the Europeans). Dopartement Jews Algiers 34,572 including town of Algiers with 25,474 Oran 50,452 including town of Oran n 25,753 Constantino 25,620 including town of Constantine " 12,961 Southern territory 6,140 VIII/4 The economic power and the population of Algeria was an important reserve for the home country with its low birth rate. Therefore the loss of Algeria is dis- tinctly noticed above all as regards the food supply. III. Morocco In 1936 the total population of Morocco amounted to 7,181,000 inhabitants. Of those 6,273,000 live in French Morocco and 908,000 in Spanish Morocco including the International Zone of Tangier. French Spanish Morocco Morocco Indigenes 6,057,000 845,000 including Mohammedans 5,896,000 811,000 (with 21,000 Mohammedan French subjects from Algeria) Jews 161,000 34,000 Europeans 216,000 163,000 A. Tangier Zone; The Zone of Tangier which since 1912 has been under international administration covers an area of 373,000 sq.Kn. and has about 60,000 inhabitants (1934)• Of those wore Mohammedans 36,500 Europeans 16,500 Jews' 7,000 The mean density of population which entirely depends on tho 46,270 inhabitants of the town of Tangier, amounted to 161 persons per sq.Km. B. Spanish Morocco; On an area of 20,000 sq.Km. 795,202 (1924) persons lived in Spanish Morocco. Of these there were: Europeans 44,400 Jews 12,900 The mean density of population was 28 persons per sq.Km. VIII/4 C. French Morocco; On an area of 415,000 sq.Km. the census of 8 March 1936 showed 6.3 million persons which is equal to 15 persons per sq.Km. The coastal plain spread along the foot of the Atlas mountains and forming the Sebu basin in the north, enjoys a sufficient number of rainfalls and a fertile black-earth soil; it represents the economic center. In tho east it borders on a steppe plateau where the halfa grass grows and which is principally an area of cattle breeding. At the foot of the Atlas mountains the soil gradually changes into a fertile red earth zone which is 30 to 40 Km. wide. Duo to the numerous rains in the High Atlas mountains this zone permits agriculture and fruit tree cultures. The northwest slopes of the Atlas mountains are populated by settled peasants whose grain cultures are extended to a considerable altitude. The foreland of the Atlas mountains with an area of about 190,000 sq.Km. is inhabited by 5*17 million persons, which is about 63 % of the total population. Here, the density of settlement amounts to 27 persons per sq.Km. on an average. The accumulation of the population is highest in the vicinity of Casablanca, Rabat, Mazzagan, Port-Lyautey, and Safi, where the density of settlement ranges between 30 and 50 persons per sq.Km. In Morocco the economic structure also is almost purely agricultural. The total area of 39,862,700 hectare is distributed as follows; Cultivated land 7,077,000 hectare Arborous and bush cultures 193,000 " Woods and forests 2,600,000 » Not cultivated arable land 10,250,000 " Not arable land 19,742,733 " Mining as the oauso of accumulations of the population is of no significanco. VIII/4 Population •j Not Moroccan population j Total I Frenchmen j Citizens Sujets et-. Aliens! proteges i ! ; Mor oc c an P opula tion Mohammedans Jews 1921 3,530,000 77,953 3,368,000 84,302 1926 4,229,146 66,223 8,335 30,154 4,016,882 107,552 1931 5,364,809 115,628 12,549 44,304 5,067,743 124,585 1936 civ.pop. mil. 6,242,706 139,131 53,430 15,111 16,438 6,369 50,937 8,616 5,874.888 23,334 161,312 VIII/4 The census of 1 March 1941 revealed a population of 7,983,473 persons. The increase of the population since 1936 amounts to about 1.7 million or to 27-6 it is considerably higher than the increase of the population during the period from 1931 to 1936 when the increase amounted to 0.9 million (16.5 %)• The Moroccan population was increased by about 1.6 million persons, the non- Moroccan population by about 143,000. The considerable increase of the population results in an increasingly embarrassing shortage of.land in the densely populated areas. 1.4 million persons are living in the towns which is almost one sixth (17.5 %) of the total population. Almost one quarter of the total increase of the population in Morocco is due to an increase of the urban population which since 1936 has increased by about 450,000 persons or 42.2 %. This means a proportionally considerably higher increase as compared with the rural population (plus 25*1 %). 1936 1941 Casablanca from 2577430 inhab. to 454,300 inhab. (76.5 $) Oujda from 34,523 to 63,381 » (83.6 %) Mogador from 15,166 " to 25,666 (69*2 $) The population of Marakech, however, was diminished by 0.5 which is a sign of the decreasing importance of the Sultan government. For Spain as woll as for France the Atlas countries range among the most valuable possessions. For Europe they are a necessary economic supplement and an important military glacis. H. HARMSEN (Institute for Hygiene of the Univer- sity of Berlin and Institute for General and Military Hygiene of the Military Medical .academy) GEOGRAPHIC INDEX TO THE ATLAS CF EPIDEMIOLOGY prepared by U.S. Fleet, U.S. Naval Forces, Germany, Technical Section (Medical) The Index is in alphabetical order, cross-references are made wherever doubt is possible. In case of colonies, protectorates, or dominions, the mother country is given in brackets and abbreviated, e.g. (Br.). The spelling was checked in accordance with Goode’s School Atlas (Hand McNally & Company, Chicago, 1939)* To give a brief survey of the countries treated in the Atlas of Epidemiology, on pages I & II preceding the Index the individual countries are grouped under the following headings: Europe Africa America Near & Middle East Asia & Pacific Ocean I The individual countries quoted are grouped into continents as follows: Europe Albania Austria Baltic Countries Belgium Bulgaria Czechoslovakia Denmark Estonia Finland Franco , Corsica Germany Gibraltar (Br.) Great Britain Greece , Crete Hungary Iceland Ireland Italy , Sardinia , Sicily; Latvia Lithuania Malta (Br.) Mediterranean Area Netherlands Norway Poland Portugal Romania Spain Sweden Switzerland Turkey see Near East Union of Sov.Soc.Rep. see Soviet Union spec, under Asia Yugoslavia Africa Algeria (Fr.) Anglo-Egyptian Sudan Angola (Port.) Boohuanaland (Br.) Belgian Congo Cameroons (Fr.) Egypt Eritrea (It.) Ethiopia French Equatorial Africa - - -, Chad - - -, Congo - - -, Gabon French West Africa - - -, Dahomey - - -, Guinea - - -, Ivory Coast - - -, Niger - - -, Senegal - - -, Sudan - - -, Togo Gambia (Br.) Gold Coast (Br.) Guinea, Spanish Kenya (Br.) Liberia Libya (It.), Cirenaica , Tripolitania Madagascar (Fr.) Morocco, French Morocco, Spanish Mozambique (Port.) Nigeria Rhodesia, Northern (Br.) Rhodesia, Southern (Br.) Sierra Leone (Br.) Somaliland, British Tanganyika Ter. (Br.) Tunisia (Fr.) Uganda (Br.) Union of South Africa (Br.) Zanzibar (Br.) II Near & Middle East Aden protectorate (Br.) Arabia Cyprus (Br.) Iran (Persia) Irao (Mesopotamia) Kuwait, Al (Br.) Oman Palestine Saudi Arabia - -, Asir - -, Hejaz - -, Nejd Syria (Fr.) , Lebanon Rep, Transjordan (Br.) Turkey Yemen America Argentina Colombia Cuba Mexico Panama Peru United States of America Uruguay Venezuela Asia & Pacific Ocean Afghanistan Ceylon (Br.) China , Hainan I. , Shanghai French Indochina - -, Kwangchowan Hongkong (Br.) India (Br.) , Baluchistan Japan Korea Kurdistan Manchukuo Nepal Netherlands Indies New Caledonia (Fr.) Philippine Is. Portuguese Macau Siam Soviet Union - -, Armenian S.S.R. - -, Azorbaidzhan S.S.R. - -, Bashkir A.S.S.R. - -, Caucasia - -, Daghestan A.S.S.R. - -, Georgian S.S.R. - -, Kalmyk Aut.Area - -, Kazakh S.S.R. - -, Kirghiz S.S.R. - -. Kuban Area - -, Siberian Area - Southeast Russia - -, Tadzhik S.S.R. - -, Transcaspian Region - Transcaucasia - Turkmen S.S.R. - -, Ukrainian S.S.R. - -, Ural Mountains - Uzbek S.S.R, " ”5 White Russian S.S.R. Tibet (China) GEOGRAPHIC INDEX 3/21/49 Abyssinia see Ethiopia Aden Protectorate (Br.) (S.Arabia) Il/l Plague, data of epidemics II/2 Anopheles distribution II/3 Arthropoda as vectors: Aedes aegypti, Phlebotomus minutus IIA Amebic dysentery, danger zone n/5 Leishmaniases, general occurrence of Kala-Azar assumed II/7 II Bilharziasis possibly endemic Afghanistan (Central Asia) 1/3 Indian cholera, epidemics since 1938, specific data Il/l Plague, general data II/2 Anopheles distribution, hypothesis II/3 Arthropods as vectors: Phlebotominae, Ixodidae II/7 I No ankylostomiasis due to scarce rainfalls II/9 Density of population, specific data Ill/I Malaria on the Turkestan border, extensive tropica foci VII/9-II Indian relapsing fever, general data VIl/13 Poisonous snakes, general data Albania 1/6 Paratyphoid A, endemic II/2 Anopheles distribution VII/A I General climate conditions, isotherms II Malaria and Anopheles, specific data VTl/4b Malaria and Anopheles, specific data, table VIl/6 Leprosy, no recent data available VII/9-II East European relapsing fever, general 'data VIl/10 I Epidemic typhus, rare incidence VIl/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions Algeria (Fr.) (N.Africa) i/l Plague focus of 2nd order, data for 1921 - 1940 1/6 Paratyphoid A, endemic l/8 Phlebotomus distribution VII/1 Mediterranean fever, general data VII/5 Leishmaniases, endemic ardas, specific data, charts VII/6 Leprosy, some data, general remarks VII/7 I Ankylostomiasis, specific data II Bilharziasis, specific data, ecology VII/9-I Distribution of ticks as vectors, specific data VII/9-II North African relapsing fever, specific data VII/10 Rickettsial diseases; I Epidemic typhus, endemic focus, frequent, specific data III Mediterranean exanthematous fever, cases observed in Algiers VIl/12 Trachoma,' general data VII/13 Poisonous snakes, general data VII/14 Precipitation and isotherms, general climate conditions VIIl/l-3 Yellow fever, specific data VIIl/4 Density of population, specific data, tables Anglo-Egyptian Sudan (E. Africa) Il/l Plague, no case since 1899 II/2 Anopheles distribution II/3 Arthropoda as vectors: Aedes aegypti, phlebotominae, Ixodidao II/4 .Amebic dysentery, danger zone II/5 Leishmaniases, general occurrence, chart II/7 II Bilharziasis is endemic, general distribution VII Yellow fever epidemic 1940 VII/9-II Central African relapsing fever, general data VII/10 hi Mediterranean exanthematous fever, general distribution VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data, table Angola (Port.) (S.Africa) VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data, table Arabia sea Saudi Arabia Argentina VII/9-II South American relapsing fever, general data Armenia see .Sovietollnion, Armenian S.S.R. Asia Minor see Turkey Asir see -'Saudi. Arabia, Asir Austria 1/2 Tularemia, some cases observed 1/6 Paratyphoid A, occasional slight epidemics VII/10 I Epidemic typhus, general data VII/13 Poisonous snakes, general data Azerbaidzhan see Soviet Union, Azerbaidzhan S.S.R. Baltic Countries (N.Europe) V/l Poliomyelitis epidemics, specific data, chart, tables V/2 Epidemic pleurodynia, general observations V/3 Leprosy, very specific data, charts, graph V/4 Precipitation and isotherms, general climate conditions V/5 Density of population, specific data, tables VT/1 Trachoma endemic, general remarks Baluchistan see India, Baluchistan Bashkir see Soviet Union, Bashkir A.S.S.R. Bechuanaland (Br.) (S.Africa) VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data Belgian Congo (Central Africa) i/l Plague, data for 1934 - 1940 VII/9-II Central African relapsing fever, general data VII/10 III Mediterranean exanthematous fever, general distribution. VIII/1-3 Yellow fever, specific data, table Belgium VI/1 Trachoma endemic, general remarks VII/10 II Murine typhus fever, causative organism observed Bulgaria 1/8 Phlebotomus distribution VII Cholera, severe epidemics, general remarks VII/4 I General climate conditions, isotherms II Malaria and Anopheles, specific data, chart VII/5 Leishmaniases, only superficial data VIl/6 Leprosy practically extinct, specific data VII/9-II East European relapsing fever, general data VII/10 I Epidemic typhus, general data VII/13 Poisonous snakes, general data VIl/14 General climate conditions Cnmeroons (Er.) (Equatorial Africa) VIII/1-3 Yellow fever, specific data, table Caucasia see Soviet Union, Caucasia Ceylon (Indian Ocean) VII/9-II Indian relapsing fever, general data Chad see French Equatorial Africa, Chad China 1/3 Indian cholera, epidemics since 1937 along the south coast 1/8 Phlebotomus distribution II/2 Anopheles distribution II/3 Arthropods as vectors: Phlebotominae III/2 Phlebotomus distribution VII/9-II Chinese relapsing fever, general data , Hainan I. 1/3 Indian cholera, epidemics since 1937 , Shanghai 1/3 Indian cholera, epidemics since 1937 Chosen see Korea Cirenaica see Libya, Cirenaica Colombia VII/9-II South American relapsing fever, general data Congo see Belgian Congo and French Equatorial Africa, Congo Corsica see France, Corsica Crete see Greece, Crete Cuba VII/9-II North relapsing fever, general data Cyprus (Br.) (Near East) II/3 .Arthropoda as vectors: aegypti, Fhlebotominae, Ixodidae II/5 Kala-Azar reported YIl/l Mediterranean fever, formerly frequent VII/5 Leishmaniases rare, general data VII/6 Leprosy, apparent increase, specific data VII/7 II Bilharziasis, one focus only, specific data VIl/13 Poisonous snakes, general data VIl/14 General climate conditions Czechoslovakia l/2 Moravian depression source of tularemia epidemics, table IV/4a Tularemia epidemics in Moravia, general remarks Vl/1 Trachoma endemic, general remarks VIl/10 I Epidemic typhus, specific data Daghestan see Soviet Union, Daghestan A.S.S.R. Dahomey see French West Africa, Dahomey Denmark 1/7 Paratyphoid C, no cases observed V/l Poliomyelitis epidemics, specific data, chart, table' V/2 Epidemic pleurodynia, general data V/3 Leprosy not endemic, imported cases V/4 Precipitation and isotherms, general 'climate conditions V/5 Density of population, specific data, tables Egypt 1/1 Plague, data for 1921 - 1940 1/8 Phlebotomus distribution, scarce data Il/l Nile valley as plague focus 2nd order, specific distribution II/2 Anopheles distribution II/3 Arthropoda as vectors: Aedes aegypti, phlebotominae, Ixodidae II/4 Amebic dysentery, frequent occurrence throughout the country II/5 Leishmaniases, general occurrence, chart II/6 Leprosy moderately frequent II/7 I Ankylostomiasis, very wide-spread II Bilharziasis, very frequent, specific data, chart, table II/9 Density of population, specific data VII Research work by geomedical scientists; Cholera, endemic foci in the Nile delta VII/5 Leishmaniases, additional remarks VII/6 Leprosy, high incidence, specific data VII/7 I Ankylostomiasis, specific data, chart II Bilharziasis, general remarks VIl/9-1 Distribution of ticks as vectors, specific data VII/9-II North African relapsing fever, specific data VII/10 Rickettsial diseases: I Epidemic typhus, focus in the Nile delta, specific data II Murine typhus fever, specific data III Mediterranean exanthematous fever, > similar disease observed IV Trench fever, some cases observed VII/13 Poisonous snakes, general data VII/14 General climate conditions, precipitation, isotherms VIII/1-3 Yellow fever, specific data, table 7 Equatorial Africa see French Equatorial Africa Eritrea (It.) (E.Africa) II/3 Arthropods as vectors: Aedes aegypti, Ixodidae Estonia (Baltic) IV/5 Epidemic typhus, specific data, table IV/10 Density of population, specific data V/l Poliomyelitis, only sporadic oases, chart V/3 Leprosy, specific data, charts V/4 General climate conditions V/5 Density of population, specific data Ethiopia (E. Africa) II/3 Arthropoda as vectors; Ixodidae VII/9-II Central .African relapsing fever, general data VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data Europe, Eastern Regions IV/4 Tularemia, epidemic spread, general data IV/5 Epidemic typhus, specific data, tables IV/9 Precipitation and isotherms, general climate conditions IV/10 Density of population, specific data Vl/l Trachoma, general remarks VII/10 I Epidemic typhus, focus centering in European Russia and Poland Finland 1/7 Paratyphoid C, no cases observed V/l Poliomyelitis epidemics, specific data, chart V/2 Epidemic pleurodynia, endemic distribution, specific data V/3 Leprosy endemic, gradually dying out, complete data V/4 Precipitation and isotherms, general climate conditions V/5 Density of population, specific data, tables France 1/6 Paratyphoid A, occurrence during World War I 1/8 Phlebotomus distribution Vl/1 Trachoma imported from Eastern Europe VIl/l Mediterranean fever, specific data, carriers VIl/5 Leishmaniases, first case 1918, no Oriental sore, specific data VIl/6 Leprosy imported increasingly, specific data VII/7 II Bullinus incidence, no endogenous Bilharziasis VII/9-I Distribution of ticks as vectors, specific data VIl/10 Rickettsial diseases: I Epidemic typhus, no cases II Murine typhus fever, specific data III Mediterranean exanthematous fever, specific data VIl/12 Trachoma, general remarks VII/13 Poisonous snakes, general data VTl/14 Precipitation and isotherms, general climate conditions , Corsica VIl/5 Leishmaniases, no Oriental sore, specific data VII/7 II Bullinus incidence, no endogenous Bilharziasis VII/9-I Distribution of ticks as vectors, specific data French Equatorial Africa VIIl/l-3 Yellow fever, specific data, table - - - , Chad VIIl/l-3 Yellow fever, specific data, table - - - , C6ngo VIIl/l-3 Yellow fever, specific data, table - - - , Gabon VIIl/l-3 Yellow fever, specific data, table French Indochina (S.Asia) 1/3 Indican cholera, epidemics, specific data VII/9-II Chinese relapsing fever, general data - - , Kwangchowan (S.China) 1/3 Indian cholera, epidemic 1937 French Morocco see Morocco, French French West Africa. 1/2 Tularemia, cases observed VII/9-II Central .JFriean relapsing fever, endemic VIIl/l-3 Yellow fever, specific data, table - - - , Dahomey VIIl/l-3 Yellow fever, specific data, table - - - , Guinea VIIl/l-3 Yellow fever, specific data, table - - , Ivory Coast VIIl/l-3 Yellow fever, specific data, table - - - , Niger : VIIl/l-3 Yellow fever, specific data, table - - - , Senegal 1/1 Plague focus of 2nd order, data for 1921 - 1940 VII/9-II Central African relapsing fever, endemic focus in Dakar VIIl/l-3 Yellow fever, specific data, table - - - , Sudan VIIl/l-3 Yellow fever, specific data, table , Togo VIII/1-3 Yellow fever, specific data Gabon see French Equatorial Africa, Gabon Gambia (Br.) (V. Africa) VIIl/1-3 Yellow fever, specific data, table Georgia see Soviet Union, Georgian S.S.R. Germany O&M Cholera in East Prussia 1831 O&M Poliomyelitis, Wuerttembehg 1937 - 1942 1/2 Tularemia observed in a hare 1939 1/6 Paratyphoid A, epidemics, data 1/7 Paratyphoid C, no cases, except one in Mecklenburg II/2 ,;nopheles distribution II/3 Ixcdidae as vectors of diseases IV/4 Tularemia in the northeast, general remarks V/l Poliomyelitis epidemics along the Baltic coast, chart V/2 Epidemic pleurodynia, specific data Vl/l Trachoma, endemic areas, specific data, chart of East Prussia, tables VII/9-I Distribution of ticks as vectors VII/10 I Epidemic typhus, no cases VII/12 Trachoma, general remarks VIl/13 Poisonous snakes, general data Gibraltar (Br.) VII Yellow fever, formerly principal focus, data of epidemics VIl/8 Yellow fever epidemic 1804,- no endemic Gold Coast (Br.) (V.Africa) VIl/9-II Central African relapsing fever, general data VIIl/1-3 Yellow fever, specific data, table Great Britain O&M Cholera map of 1848, general remarks on Greece 1/6 Paratyphoid A, endemic 1/8 Phlebotomus distribution II/2 Anopheles distribution II/3 Arthropods as vectors; • Aedes aegypti, phleobominae, Ixodidae IV/4a Tularemia in Thrace, general remarks VII Cholera, no epidemics VII/1 Mediterranean fever, endemic, general occurrence VIl/4 I General climate conditions, isotherms II Malaria and Anopheles, specific data, graph VIl/4a Malaria and Anopheles, specific data, graphs, tables VII/5 Leishmaniases, large endemic areas, specific data VIl/6 Leprosy, specific data, chart VII/7 I Ankylostomiasis, endemic occurrence, no data VIl/8 Aedes aegypti and dengue epidemics, specific data VII/9-I Distribution of ticks as vectors, specific data VII/9-II Spanish relapsing fever, specific data VII/10 Rickettsial diseases; I Epidemic typhus, specific data II Murine typhus fever, causative organism observed III Mediterranean exanthematous fever, general data IV Trench fever, general data VIl/13 Poisonous snakes, general data VII/14 Precipitation and isotherms, general climate conditions , Crete l/8 Phlebotomus distribution II/3 Arthropoda as vectors: Aedes aegypti, Phlebotominae, Ixodidae VIl/4 II Malaria and Anopheles, general data VII/5 Leishmaniases, very frequent, specific data, chart VIl/6 Leprosy, specific data, chart VII/7 I Ankylostomiasis, endemic occurrence VII/9-I Distribution of ticks as vectors, specific data VII/9-II East European and Spanish relapsing fever, specific data Guinea see French West Africa, Guinea Guinea, Spanish (W.Equatorial Africa, Rio Muni etc.) VIII/1-3 Yellow fever, specific data, table Hainan I. see China, Hainan I. Hojaz see Saudi Arabia, Hojaz Hongkong (Br.) (S.China) 1/3 Indian cholera, epidemics since 1937 Hungary VI/1 Trachoma endemic, general remarks VIl/5 Leishmaniases, recent occurrence, general data VII/9-I Distribution of ticks as vectors, specific data VIl/10 I Epidemic typhus, specific data VIl/12 Trachoma, general remarks VIl/13 Poisonous snakes, general data Iceland V/2 Epidemic pleurodynia reported before 1849 V/3 Leprosy, possibly endemic, graph India 1/3 Indian cholera, endemic focus in Bengal, data of epidemics 1/8 Phlebotomus distribution II/2 Anopheles distribution III/3 Leishmaniases in Bengal 1923 VII/9-II Indian relapsing fever, general data VIl/13 Poisonous snakes, general data , Baluchistan (N.W.India) II/2 Malaria, endemic foci II/7 No ankylostomiasis due to scarce rainfalls II/9 Density of population, specific data Indochina see French Indochina 13 Iran (Persia) i/l Plague, general remarks 1/3 Indian cholera, outbreaks 1939 and 1943 1/8 Phlebotomus distribution Il/l Plague, threat of; no recent data available II/2 Anopheles distribution, specific data, chart; malaria endemic II/3 Arthropods as vectors: Aedes aegypti, Phlebotominae, Ixodidae II/4 Amebic dysentery, some cases in Tehran II/5 Leishmaniases, Oriental sore wide-spread, no Kala-Azar II/6 Leprosy, distribution, general remarks and specific data II/7 I ankylostomiasis, recent occurrence II Bilharziasis endemic on the border to Iraq. II/9 Density of population, specific data IIl/l Malaria tropica, extensive foci observed III/2 Phlebotomus distribution IV/la Yellow sand mouse as plague reservoir LV/6 Leprosy focus in Northern Iran VII/1 Mediterranean fever, general remarks VII/9-II Aest Asiatic relapsing fever, general data VII/13 Poisonous snakes, general data Iraq (Mesopotamia) I/l Plague, endemic focus, data for 1921-1940 1/3 Indian cholera, outbreak 1943 Il/l Recent plague focus of 2nd order II/2 Anopheles distribution; malaria endemic II/3 Arthropoda as vectors: Aedes aegypti, Phlebotominae, Ixodidae II/4 Amebic dysentery, wide-spread II/5 Leishmaniases, mainly Oriental sore, general data II/7 I Infrequent cases of ankylostomiasis II Bilharziasis endemic, specific data II/9 Density of population, specific data VIl/6 Leprosy, general data VII/9-II Western Asiatic relapsing fever, specific data VII/10 IV Trench fever observed during World War I VII/13 Poisonous snakes, general data Ireland VII/9-II East European relapsing fever, frequent during last centuries Italy 1/2 Tularemia, no cases l/6 Paratyphoid A, endemic 1/8 Phlebotomus distribution II/3 Arthropods as vectors: Phlebotominae, Ixodidae ¥1/1 Trachoma endemic, general remarks VIl/1 Mediterranean fever, general distribution, carriers VII/2 Malaria, fatal cases, specific data VII/3 Malaria and Anopheles, specific data, chart, tables VIl/5 Leishmaniases, mostly in the south, specific data, charts VIl/6 Leprosy, specific data of endemic foci VII/7 I Ankylostomiasis, specific data II No cases of Bilharziasis VII/9-II East European relapsing fever, specific data VII/10 Rickettsial diseases: I Epidemic typhus, no cases II Mediterranean exanthematous fever, mild cases III Mediterranean exanthematous fever, gen/eral distribution VII/12 Trachoma, general remarks VII/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions , Sardinia VI1/3 Malaria and Anopheles, specific data, chart VIl/5 Leishmaniases relatively scarce, no pro- nounced foci, specific dqta, charts VIl/6 Leprosy very wide-spread, specific data, table VII/7 II Bullinus incidence, no endogenous Bilharziasis VTI/9-II East European relapsing fever, general data VIl/14 Precipitation and isotherms, general climate conditions , Sicily VIl/5 Leishmaniases, endemic areas, specific data, chart VIl/6 Leprosy, specific data, table VII/7 II Bullinus incidence, no endogenous Bilharziasis VII/13 Poisonous snakes* general data VII/1& Precipitation and isotherms, general climate conditions Ivory Coast see French West Africa, Ivory Coast I apan 1/3 Indian cholera, isolated cases, data for 1937 and 1938 II/2 Anopheles distribution VII/9-II Chinese relapsing fever, general data Kalmyk see Soviet Union, Kalmyk Aut.Area Kazakhstan see Soviet Union, Kazakh S.S.R. Kenya (Br.) (E. Af ric a) 1/1 Plague, data for 1921 - 1940 VII/10 III Mediterranean exanthematous fever, general distribution VIl/13 Poisonous snakes, general data VTII/1-3 Yellow fever, specific data, table Kirghizistan see Soviet Union, Kirghiz S.S.R. Korea (Chosen) (E.Asia) VII/9-II Chinese relapsing fever, general data Kurdistan (Turkey, Iran, Iraq) Il/l Plague data, persistent focus II/6 Leprosy, general data Kuwait, A1 (Br.) (Persian Gulf) II/l Plague, cases in 1940/41 VII/6 Leprosy, frequent occurrence Kwangchowan see French Indochina, Kwangchowan Latvia (Baltic) IV/5 Epidemic typhus, specific data, table IY/10 Density of population, specific data V/l Poliomyelitis epidemic, specific data, chart V/3 Leprosy, specific data, graph V/4 General climate conditions V/5 Density of population, specific data Lebanon Rep. see Syria, Lebanon Republic • Liberia (W. Africa) VIII/1-3 Yellow fever, specific data, table Libya, Cironaica (N.Africa) 1/8 Phlebotomus distribution VII/5 Leishmaniases infrequent, general data VII/6 Leprosy, rare incidence VII/7 I Ankylostomiasis, no endemic cases reported despite favorable climate conditions II Bilharziasis observed near Derna VII/9-I Distribution of ticks as vectors, general data VII/10 Rickettsial diseases: I Epidemic typhus, only sporadic incidence III Mediterranean exanthematous fever, specific data VII/13 Poisonous snakes, general data VIl/lA General climate conditions, isotherms , Tripolitania (N. Africa) 1/1 Plague, distribution 1930 - 1934 1/8 Phlebotomus distribution, scarce data VII/5 Leishmaniases infrequent, general data VII/6 Leprosy, no data available, allegedly no occurrence VII/7 I Ankylostomiasis, no cases II Bilharziasis, specific data, chart VII/9-I Distribution of ticks as vectors, general data VII/9-II North African relapsing fever, general data VII/10 Rickettsial diseases: I Epidemic typhus, only sporadic incidence III Mediterranean exanthematous fever, several cases observed VII/13 Poisonous snakes, general data VII/14 General climate conditions, isotherms Lithuania (Baltic) IV/4 Tularemia epidemics 1943/44 IV/5 Epidemic typhus, specific data,chart, tables IV/10 Density of population, specific data V/l Poliomyelitis, only sporadic oases, chart V/3 Leprosy, specific data, graph of the Kernel Territory endemic V/4 General climate conditions V/5 Density of population, specific data Vl/l Trachoma estimate; 10$ of the population Macau see Portuguese Macau Madagascar (Fr.) (Indian Ocean) VII/9-II Central African relapsing fever, general data VIIl/l-3 Yellow fever, specific data Malta (Br.) 1/8 Phlebotomus distribution II/3 Arthropoda as vectors: Phlebotominae, Ixodidae VII/1 Mediterranean fever, center of epidemic, ecology, general data of distribution VIl/5 Leishmaniases frequent, annual occurrence, specific data VII/6 Leprosy, specific data Manchukuo (E.Asia) VII/9-II Chinese relapsing fever, general data Mediterranean Area 1/6 Paratyphoid A, general data, tables VII Geomedical review, very detailed remarks VII/1 Mediterranean fever, general data of distribution VIl/5 Leishmaniases as characteristic "endeno- sporadic" diseases VII/6 Leprosy, numerous specific data, charts, tables VIl/7 I Ankylostomiasis, general distribution, specific data, chart, tables II Bilharziasis, general distribution, specific data, charts VII/8 Aedes aegypti and yellow fever, ecology, distribution, specific data, chart; dengue vector, data of epidemics VII/9-I Distribution of ticks, ecology, specific data, charts VII/9-II Relapsing fever, specific data, chart, table VIl/10 Rickettsial diseases; I Epidemic typhus, distribution, specific data, table II Murine typhus fever, vectors, specific data III Mediterranean exanthematous fever, distribution, specific data IV Trench fever, distribution, general remarks VII/12 Trachoma, general data VIl/13 Poisonous snakes, distribution, specific data Vll/l/f Precipitation and isotherms, etesian climate, specific data Mesopotamia see Iraq Mexico VII/9-II North American relapsing fever, general data Morocco, French (N.Africa) 1/1 Plague focus of 2nd order, data for 1921 - 1940 1/6 Paratyphoid A, endemic 1/8 Phlebotomus distribution Il/l Plague, occasional cases VII/1 Mediterranean fever, general data VII/5 Leishmaniases, endemic areas, general data VII/6 Leprosy, endemic foci, general data, chart VII/7 I Ankylostomiasis, scanty information, general data II Bilharziasis, endemic foci, specific data VII/9-I Distribution of ticks as vectors, specific data VII/9-II North African relapsing fever, specific data VIl/10 Rickettsial diseases: I Epidemic typhus, endemic focus, general data II Murine typhus fever, observed in Casablanca III Mediterranean exanthematous fever, specific data VIl/12 Trachoma, general remarks VIl/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions VIII/1-3 Yellow fever, specific data, table VIII/4 Density of population, specific data, table Morocco, Spanish (N.'jfrica) Il/l PI ague, occasional cases VII/5 Leishmaniases not frequent, general data VII/6 Leprosy, no cases reported VII/7 Ankylostomiasis and Bilharziasis, general data VII/9-1 Distribution of ticks as vectors, specific data VII/9-II North African relapsing fever, gereral data VIl/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions VIIl/4 Density of population, specific data Mozambique (Port.) (S.E.Africa) VII/13 Poisonous snakes, general data Nejd see Saudi Arabia, Nejd Nepal (N.India) VII/9-II Indian relapsing fever, general data Netherlands l/6 Paratyphoid A, occasional cases in ports Netherlands Indies (3.Indies) II/3 Phlebotomus distribution VII/9-II Chinese relapsing fever, general data New Caledonia (Fr.) (South Pacific Ocean) VII/9-II Relapsing fever, isolated cases Niger see French West Africa, Niger Nigeria (W. Africa) i/l Occurrence of plague 1921 - 1940, tablo VIII/1-3 Yellow' fov„r, specific data, table Norway 1/2 Tularemia, specific data 1/7 Paratyphoid C, no cases observed V/l Poliomyelitis epidemics, specific data, chart, table V/2 Epidemic pleurodynia, endemic focus in the southeast V/4 precipitation and isotherms, specific data, general climate conditions V/5 Density of population, specific data, table Oman (S .E. Arabia) II/2 Anopheles distribution II/4 Amebic dysentery, danger zone II/5 Leishmaniases, general occurrence VI1/6 Leprosy frequent occurrence, general 20 Palestine 1/8 Phlobotomus distribution 11/1 Plague, formerly frequent in ports 11/2 /jaophcles distribution, specific data*chart II/3 Arthropoda as vectors: Aedes aegypti, Fhlebotominao, Ixodidae 11/k Amebic dysentery, specific data, "one of the prevailing diseases" II/5 Leishmaniases, frequent occurrence, general distribution, chart II/7 I Ankylostomiasis, varying intensity of occurrence II Bilharziasis, various specific data II/9 Density of population, specific data VIl/l Mediterranean fever, formerly frequent VII/6 Leprosy, specific data of distribution VII/9-I Distribution of ticks as vectors, general data VII/9-II Relapsing (tick) fever, specific data VII/10 I Epidemic typhus, specific data VIl/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions Famirs see Soviet Union, Tadzhik S.S.R. Panama VII/9-II Central American relapsing fever, general data Persia see Iran Peru VII/9-II South American relapsing fever, general data Philippine Is. VII/9-II Chinese relapsing fever, isolated cases Poland IV/5 Epidemic typhus, specif ic-ddtd, chart, tables IV/9 East European relapsing fever, general data IV/10 Rickettsial diseases, general data; trench fever endemic VI/1 Trachoma endemic, general remarks VII/10 Rickettsial diseases,some of them endemic Portugal V/2 Epidemic pleurodynia obsorvod VIl/l Moditerranoan fever, general data VII/2 II Malaria and Anopheles, specific data, chart, tables VII/5 Leishmaniases, specific data, no Oriental sore, chart VIl/6 Leprosy increasing, specific data, chart VIl/7 I Ankylostomiasis endemic, specific data II Bilharziasis, foci in the south, spec.data VII/9-I Distribution of ticks as vectors,spec.data VII/9-II Spanish relapsing fever, general data VII/10 Rickettsial diseases: I Epidemic typhus, specific data III Mediterranean exanthematous fever,,gen.data VII/11 Typhoid fever, specific data, table VIl/13 Poisonous snakes, general data VII/14 Precipitation and isotherms, general climate conditions Portuguese Macau (S.China) 1/3 Indian cholera, epidemics since 1937 Rhodesia, Northern (Br.) (S.Africa) VIIl/l-3 Yellow fever, specific data, table Rhodesia, Southern (Br.) (S.Africa) VII/10 III Mediterranean exanthematous fever, general distribution VIIl/l-3 Yellow fever, specific data Romania 1/6 Paratyphoid A, occurrence during World War I 1/8 Phlebotomus distribution II/3 Phlebotomus distribution VI/1 Trachoma endemic, general remarks VII/L I General climate conditions, isotherms II Malaria and Anopheles, specific data,,chart VII/5 Leishmaniases not frequent, specific data VIl/6 Leprosy inconsiderable, general data VII/9-I Distribution of ticks as vectors,spec.data VII/9-II East European relapsing fever, spec.data VII/10 Rickettsial diseases: I Epidemic typhus, specific data II Murine typhus fever, no cases III Mediterranean exanthematous fever, spec.data Vll/13 Poisonous snakes, general data VII/14 Precipitation and isotherms, general climate conditions Sardinia soo Italy, Sardinia Saudi Arabia (see also following headings) II/2 Anopheles distribution II/3 Arthropoda as vector©: Aedes aegypti, Ixodidae II/4 Amebic dysentery, general data II/5 Leishmaniases, general occurrence of Kala-Azar assumed II/7 I No ankylostomiasis due to scarce rainfalls II Bilharziasis, endemic focus in Mecca II/9 Density of population, general data VIl/13 Poisonous snakes, general data - - , Asir 1/1 Endemic plague focus Il/l Endemic plague focus, recently only few cases II/9 Density of population, approximate data - - , Hejaz II/5 Leishmaniases, general occurrence of Kala-Azar assumed II/7 II Bilharziasis focus in Mecca II/9 Density of population, approximate data - - , Nejd II/9 Density of population, approximate data Senegal see French West Africa, Senegal Shanghai soe China, Shanghai Siam 1/3 Indian cholera increasing since 1936 VTI/9-II Chinese relapsing fever, isolated cases Siberia see Soviet Union, Siberian Area Sicily see Italy, Sicily Sierra Leone (w.Africa) VIIl/1-3 Yellow fever, specific data Somaliland, British (E.Africa) VII/9-II Central African relapsing fever, gen.data VIl/13 Poisonous snakes, general data VIIl/1-3 Yellow fever, specific data, table South Africa see Union of South Africa Soviet Union (seo also following headings) II/2 Anopheles distribution, general data Ill/I Malaria, specific data of occurrence IV/l plague, specific data, table TV/4 Tularemia epidemics, general data IV/5 Epidemic typhus, specific data, charts, graphs, tables IV/6 Leprosy extinct in central European Russia IV/9 Precipitation and isotherms, specific data IV/10 Density of population, specific data, tables VI/1 Trachoma endemic, general remarks VII/9-II East European relapsing fever, general occurrence VII/10 Rickettsial diseases, mostly endemic VII/12 Trachoma, general remarks VII/13 Poisonous snakes, general data - - , Armenian S.S.R. Il/l Plague, persistent focus II/3 Arthropods as vectors: Phlebotominae II/4 Amebic dysentery, endemic area II/5 Leishmaniases, Kala-Azar frequent II/9 Density of population, specific data III/4 Density of population, data of increase IV/2 Malaria and Anopheles,,forms of plasmodia IV/5 Epidemic typhus, specific data, tables IV/6 Leprosy focus, data for 1901 IV/8 Worm infestation, specific data, table IV/10 Population, fluctuations, spec.data,table VII/1 Mediterranean fever, general occurrence VII/13 Poisonous snakes, general data - - , Azerbaidzhan S.S.R. II/2 Malaria, endemic area II/3 Arthropods as vectors: Phlebotominae, Ixodidac II/4 Amebic dysentery, endemic area II/5 Leishmaniases, Kala-Azar frequent, chart II/6 Leprosy, imported from Iran II/7 I Ankylostomiasis frequent II/9 Density of population, specific data III/4 Density of population, data of increase Tv/2 Malaria and Anopheles, specific data, forms of plasmodia, tables IV/5 Epidemic typhus, specific data, tables IV/6 Leprosy, general observations IV/8 Worm infestation„spec.data, chart, tables IV/10 Population„fluctuations, spec*data, table VII/1 Mediterranean fever, general occurrence VII/13 Poisonous snakes, general data Soviet Union, Bashkir A.S.S.R. IV/4 Tularemia epidemics, general data IV/5 Epidemic typhus, specific data, tables IV/9 Precipitation and isotherms, specific data TV/10 Population, fluctuations, spec.data, table - - , Caucasia II/2 Anopheles distribution II/3 Ixodidae as vectors of diseases II/5 Leishmaniases, Kala-Azar frequent III/4 Density of population,data of increase,table IV/2 Malaria and Anopheles distribution, specific data, tables IV/5 Epidemic typhus, specific data, tables IV/6 Leprosy imported from Northern Iran, data for 1939 IV/8 Worm infestation, spec.data, charts, tables IV/10 Population, increase by migration VIl/l Mediterranean fever, general occurrence VIl/10 Rickettsial diseases, general data VIl/13 Poisonous snakes, general data - - , Daghestan A.S.S.R. IV/2 Malaria and Anopheles distribution IV/5 Epidemic typhus, spec.data, charts, tables IV/6 Leprosy focus, data for 1932 IV/8 Worm infestation, specific data, table VIl/13 Poisonous snakes, general data - - , Georgian S.S.R. II/3 Arthropoda as vectors: Aedes aegypti, . Phlcbotominae, Ixodidae II/4 Amebic dysentery, endemic area II/5 Leishmaniases, frequent occurrence of Kala-Azar and Dermal Leishmaniasis II/7 I Ankylostomiasis wide-spread, specific data II/9 Density of population, specific data III/2 Phlebotomus distribution and Oriental sore III/4 Density of population, data of increase IV/2 Malaria and Anopheles, occurrence, forms of pldsmodia. table IV/5 Epidemic typhus, specific data, tables IV/8 Worm infestation,spec.data, chart, tables IV/10 Population, fluctuations, spec.data, table VIl/1 Mediterranean fever, genera.l occurrence VII/9-I Distribution of ticks as vectors, gen.data VIl/13 Poisonous snakes, general data Soviet Union, Kalmyk Aut.Area 1/1 Plague, encLenic focus, data for 1921-1931 1/2 Tularemia epidemics, specific data, table 1/3 Indian cholera, outbreaks again 1942 1/8 phlebotonus distribution IV/l Plague, endemic occurrence, specific data, table PV/la Plague and ground-squirrels, specific zoologic data, table IY/2 Malaria and Anopheles, forms of plasmodia, tables IV/4 Tularemia, general distribution IV/4a Tularemia epidemics, specific data, graph, tables IV/5 Epidemic typhus, specific data, charts, tables IV/6 Leprosy, specific data, table 17/8 Worm infestation, specific data, tables IV/9 Precipitation and isotherms, general climate conditions IV/10 Density of population, fluctuations VII/1 Mediterranean fever, general remarks VII/13 Poisonous snakes, general data - - , Kazakh S.S.R. IIl/l II Malaria tropica, serious endemic foci in the Altai Mountains III/2 phlebotominae and Ixodidae, distribution III/3 Leishmaniases, occurrence III/4 Density of population, specific data, chart IV/l Plague, specific data, table IV/la Plague and ground-squirrels, specific zoologic data, table IV/4 Tularemia epizootic and epidemics, . general data IV/5 Epidemic typhus, specific data, charts, tables IV/9 Precipitation and isotherms, general climate conditions IV/10 Population, increase by deportation of Volga Germans VII/13 Poisonous snakes, general data Soviet Union, Kirghiz S.S.R. 1/1 Persistent plague focus, data for 1921 - 1931 IIl/l II Malaria endemic, establishment of nalaria stations III/2 Phlcbotoninae and Ixodidac, distribution, specific data, graph III/3 Leishmaniases, occurrence, chart III/4 Density of population, specific data,chart IV/1 PI ague endemic, specific data, table IV/la Plague and ground-squirrels, specific zoologic data, table IV/2 Malaria and Anopheles, forms of plasmod'ia, tables PV/4a Tularemia epidemics, specific data, graph tables IV/5 Epidemic typhus, specific data, charts, tables IV/10 Density of population, fluctuations VII/1 Mediterranean fever, general data - - , Kuban Area IV/2 Malaria and Anopheles, forms of plasmodia, tables IV/6 Leprosy focus, specific data, tables IV/8 Worm infestation, specific data, tables VIl/13 Poisonous snakes, general data - - , Prxrnir plateau see - - , Tadzhik S.S.R. - - , Siberian Area l/2 Tularemia epidemics, specific data, table III/4 population, density and distribution IV/10 population, increase by deportation VII/9-II Chinese relapsing fever, general data Soviet Union, Southeast Russia 1/1 Endemic plague focus, data for 1921-1931 1/2 Tularemia epidemics, specific data, table 1/3 Indian cholera, outbreaks again 1942 1/6 Paratyphoid A, cases 1/7 paratyphoid G, cases I/S Phlcbotomus distribution II/2 Anopheles distribution II/3 Arthropods as vectors; Aodes aegypti, Ihlebotominae, Ixodidae II/4 Amebic dysentery, endemic area II/5 Leishmaniases, frequent occurrence of Eala-Azar IV/l Plague, endemic occurrence, specific data, table IV/la plague and ground-squirrels, ecology, specific zoologic data, table IV/2- Malaria and Anopheles, distribution, specific data, tables PV/4 Tularemia, general distribution IV/4a Tularemia epidemics, ecology, specific dat a, graph, tables TV/5 Epidemic typhus, specific data, charts, graphs, tables 17/6 Leprosy endemic, specific data, table IV/8 Worn infestation, specific data, tables IV/9 Precipitation and isotherms, specific data IV/10 Density of population, specific data VII/1 Mediterranean fever, general distribution VIl/13 Poisonous snakes, general data VIl/14 General climate conditions, isotherms - - , Tadzhik S.S.R. II/2 Anopheles distribution IIl/l II Malaria tropica, serious endemic focus III/2 Phlebotominae and Ixodidae, distribution III/4 Density of population, specific data, chart IV/6 Leprosy, occasional occurrence 17/10 Population density, specific data, table Soviet Union, Transcaspian Region (Turkestan) II/2 Anopheles distribution II/3 Arthropoda as vectors: Phlebotominae III/1 I Precipitation and isotherms, climate conditions, chart II Malaria, endemic areas, specific data of epidemics III Anopheles distribution, specific data III/2 Phlebotominae and Ixodidae as vectors, specific data, graphs III/3 Leishmaniases, distribution, specific * data, charts III/1+ Density of population, specific data, chart, tables PV/l Plague, specific data, table IV/la Plague and ground-squirrels, specific zoologic data, table IV/6 Leprosy, specific data for various areas VIl/13 Poisonous snakes, general data - - , Transcaucasia 1/8 Phlebotomus distribution II/2 Anopheles distribution II/3 Arthropoda as vectors: Aedes aegypti, Phlebotominae, Ixodidae 11/k Amebic dysentery, endemic area II/5 Leishmaniases, frequent occurrence of Kala-Azar II/7 I Ankylostomiasis, general occurrence, table II/9 Density of population, specific data, table III/4 Density of population, data of increase, table VI/2 Malaria and Anopheles, specific data, tables IY/5 Epidemic typhus, specific data, charts, tables IV/6 Leprosy endemic, data for 1901 IV/8 Worm infestation, specific data, charts, tables IV/10 Population, increase by migration VII/1 Undulant fever, independent epidemic zone VIl/13 Poisonous snakes, general data - - , Turkestan see - - , Transcaspian Region Soviet Union, Turkmen S.S.R. II/2 Anopheles distribution IIl/l I Precipitation and isotherms, climate conditions, chart II Malaria endemic, children as reservoir,i general distribution III Anopheles distribution, specific data III/2 Phlebotominae and Ixodidae, ecology, distribution, graphs III/3 Leishmaniases, distribution, specAat a,, charts 111/1+ Density of population, specific data, chart 17/1 plague, specific data, table 17/6 Leprosy, data for 1928-1930 and 1939 7II/5 Leishmaniases, Phlebotomus, detailed ecology VII/9-II West Asiatic relapsing fever, general data 711/13 Poisonous snakes, general data - - , Ukrainian S.S.R. I7/la Ground-squirrel distribution 17/4 Tularemia epidemics, general data IV/4a Tularemia epidemics, ecology, specific data, graph, table 17/5 Epidemic typhus, spec.data, charts, tables 17/8 Worm infestation, specific data, table 17/9 Precipitation and isotherms, general climate conditions 17/10 Population density, specific data, table 711/10 Rickettsial diseases, general data 711/13 Poisonous snakes, general data - - , Ural Mountains 17/5 Epidemic typhus, specific data, tables 17/9 Precipitation and isotherms, general climate conditions 17/10 Density of population, specific data - - , Uzbek S.S.R. Il/2 Anopheles distribution IIl/l I Precipitation and isotherms, general climate conditions II Malaria endemic, most frequent of infectious diseases 111/2 Phlebotominae and Ixodidae, distribution III/3 Leishmaniases, occurrence, chart III/4 Density of population, specific data, chart 17/1 Plague, specific data, table 17/6 Leprosy, colonies, general remarks 17/10 Population density, specific data, table 711/13 Poisonous snakes, general data Soviet Union, White Russian S.S.R. IV/5 Epidemic typhus, spec, data, charts, tables IV/9 Precipitation and isotherms, general climate conditions IV/10 Population density, specific data, table V/l Poliomyelitis epidemics 1923 and 1925, some severe cases in 1941 Vl/l Trachoma endemic, general remarks VIl/10 Trench fover endemic Spain l/8 Phlebotomus distribution II/3 Arthropoda as vectors: Phlobotominae, Ixodidae VII Yellow various cases of occurrence VIl/l Mediterranean fever, endemic focus, general data VIl/2 I Malaria, specific data, chart, tables III Anopheles distribution, specific data VIl/5 Leishmaniases, mainly Kala-Azar, specific data, chart VII/6 Leprosy apparently increasing, specific data, chart VII/7 I Ankylostomiasis endemic, specifia data II Bilharziasis, possible focus VII/8 Yellow fever epidemic in 1800, no endemic VII/9-I Distribution of ticks, general data VII/9-II Spanish relapsing fever, spec.data, chart VII/10 Rickettsial diseases: I Epidemic typhus, specific data III Mediterranean exanthematous fever, specific data IV Trench fever observed in 1938 Vll/lOa Epidemic typhus, specific data, table VII/11 Typhoid fever, specific data, tables VII/12 Trachoma, general remarks VIl/12a Trachoma, specific data, tables VIl/13 Poisonous snakes, general data VII/14 Precipitation and isothe I*kio L/ n Q 1 c1imato c ondition s Spanish Guinea sec Guinea, Spanish Spanish Morocco see Morocco, Spanish Sudan see Anglo-Egyptian Sudan and Erench West Africa, Sudan 31 Sweden O&M Goiter, investigations on the incidence 1/2 Tularemia, specific data 1/7 Paratyphoid C, no cases observed IV/4a Tularemia epidemics, general remarks V/l Poliomyelitis epidemics, specific data, chart, table V/2 Epidemic pleurodynia, epidemic 1931,spec.data V/3 Leprosy, formerly endemic, dying out, complete data V/4 Precipitation and isotherms, specific data, general climate conditions V/5 Density of population, specific data, tables Switzerland O&M Goiter, investigations on the incidence 1/8 Phlobotomus distribution V/2 Epidemic pleurodynia, local epidemic VIl/6 Leprosy, rare incidence, no recent data VII/10 I Epidemic typhus, no cases VIl/12 Trachoma, general remarks VIl/13 Poisonous snakes, general data Syria 1/3 Indian cholera, epidemics, general data 1/6 Paratyphoid A, endemic 1/8 Phlobotomus distribution Il/l Plague, no cases except in Beyrouth II/2 Anopheles distribution II/3 Arthropods as vectors: Aodes aegypti, Phlebotominae, Ixodidae Il/A Amebic dysentery, endemic area II/5 Leishmaniases, general distribution II/7 I Ankylostomiasis, frequency increasing II/9 Density of population, specific data VIl/l Mediterranean fever, formerly frequent VIl/5 Leishmaniases, general occurrence VII/6 Leprosy, fairly frequent, general data VII/9-I Distribution of ticks as vectors,spec.data VII/9-II West Asiatic relapsing fever, general data VII/10 Rickettsial diseases: I Epidemic typhus, last epidemic 1933 II Murine typhus fever, causative organism observed III Mediterranean exanthematous fever, some cases in Beyrouth VIl/13 Poisonous snakes, general data VIl/14 precipitation and isotherms, general climate conditions Syria, Lebanon Republic Il/l Plague, no cases except in Beyrouth II/3 Arthropoda as vectors: Aedes aegypti, Fhlebotoninae, Ixodidae II/4 Aerobic dysentery, endemic area, particularly frequent II/5 Leishmaniases, general distribution II/7 I Ankylostomiasis, recently becoming frequent II/9 Density of population, specific data Tadzhikistan see Soviet Union, Tadzhik S.S.R. Tanganyika Ter. (Br.) (E. Africa) i/l Plague distribution from Uganda VII/9-II Central African relapsing fever, East Afri- can form, endemic focus, general data VII/10 III Mediterranean exanthematous fever, general distribution VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data, table Tibet (China) (Central Asia) VII/9-II Chinese relapsing fever, general data Togo see French West Africa, Togo Transcaspian Region see Soviet Union, Transcaspian Region Transcaucasia sec Soviet Union, Transcaucasia Transjordan (Br.) (Near East) II/3 Arthropoda as vectors: Phlebotominae II/4 Amebic dysentery, no data, presumably wide-spread II/5 Leishmaniases, general distribution II/9 Density of population, specific data VII/10 I Epidemic typhus, specific data VII/13 Poisonous snakes, general data Tripolitania see Libya, Tripolitania Tunisia (Fr .) (N.Africa) 1/1 Plague focus of the 2nd order; murine plague, data for 1937 1/2 Tularemia, cases, vectors 1/6 Paratyphoid A, endemic VII/1 Mediterranean fuver, general data VII/5 Leishmaniases, continuous increase, specific data, chart VII/6 Leprosy, no data available, allegedly no occurrence VIl/7 I Ankylostomiasis, specific data, table II Bilharziasis, general remarks, ecology,charts VII/9-I Distribution of ticks as vectors, specific data, chart VII/9-II North African relapsing fever, spec, data VII/10 Rickettsial diseases; I Epidemic typhus, endemic focus, wide-spread, specific data II Murine typhus fever, Rickettsia observed in rats III Mediterranean exanthematous fever, specific data VII/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions VIII/1-3 Yellow fever, specific data VIII/4 Density of population, specific data, tables Turkey l/l Mt, Ararat endemic plague focus 1/2 Tularemia, specific data l/8 Phlebotomus distribution, very few data available Il/l Mt. Ararat endemic plague focus, no epidemic since 1871 II/2 Anopheles distribution Il/2a Malaria and Anopheles in detail II/3 Arthropoda as vectors: Aedes aegypti, Ihlebot ominae, Ixodidae Il/A Amebic dysentery, general occurrence II/5 Leishmaniases, general distribution, few data available II/6 Leprosy moderately frequent II/7 I Ankylostomiasis, general data II/9 Density of population, specific data IV/Aa Tularemia in Thrace, general remarks VII Cholera epidemics, general remarks VII/1 Mediterranean fever, general data VII/5 Leishmaniases, general data (continued next page) Turkey (continued) VII/6 Leprosy, presumably increasing, gen.data VII/7 I Ankylostomiasis, general data VII/9-I Distribution of ticks as vectors, 'specific data VII/9-II East European relapsing fever, gen.data VII/10 I Epidemic typhus, specific data VII/12 Trachoma, general remarks VII/13 Poisonous snakes, general data VII/14 Precipitation and isotherms, general climate conditions Turkmenistan see Soviet Union, Turkmen S.S.R. Uganda (Br.) (E. Africa) i/l Endemic plague focus, data for 1921-1940 VIII/1-3 Yellow fever, specific data, table Ukraine see Soviet Union, Ukrainian S.S.R, Union of South Africa (Br.) VII No mention of cholera during the Boer War VII/9-II Central African relapsing fever, gen.data VII/10 III Mediterranean exanthematous fever, general distribution VII/13 Poisonous snakes, general data VIII/1-3 Yellow fever, specific data, table Union of Soviet Socialist Republics (U.S.S.R.) see Soviet Union United States of America 1/6 Paratyphoid A, regular occurrence VII/9-II North American relapsing fever, gen.data Uruguay VII/9-II South American relapsing fever, gen.data Uzbekistan see Soviet Union, Uzbek S.S.R. Venezuela VII/9-II South American relapsing fever, gen.data West Africa see French West Africa White Russia see Soviet Union, White Russian S.S.R. Yemen (S.Arabia) II/2 Anopheles distribution II/3 Arthropoda as vectors; Aedes aegypti, Ixodidae II/4 Amebic dysentery, danger zone II/5 Leishmaniases, general occurrence of Kala-Azar assumed II/7 II Bilharziasis, data of occurrence II/9 Density of population, various data and estimates Yugoslavia 1/6 Paratyphoid A, data for World War I, endemic * i/B Phlebotomus distribution II/2 Anopheles distribution II/3 Arthropoda as vectors; Aedes aegypti, Phle botominao Y/3 Epidemic pleurodynia observed VI/1 Trachoma endemic, general remarks VII/1 Mediterranean fever, general data VII/lv I General climate conditions, isotherms II Malaria and Anopheles, specific data, charts VIl/5 Leishmaniases, no Oriental sore, specific data, chart VII/6 Leprosy inconsiderable, general data VII/9-II East European relapsing fever, specific data VII/10 Rickettsial diseases; I Epidemic typhus, endemic focus, specific data II Murine typhus fever, general data VII/13 Poisonous snakes, general data VIl/14 Precipitation and isotherms, general climate conditions Zanzibar (Br.) (E.Africa) VIIl/l-3 Yellow fever, specific data GENERAL SUBJECT INDEX 3/31/1949 Aedcs acgypti 11/3:1, VII/8 Ankylostomiasis (hookworm disoaso) Il/7:I, VII/7':I, (map only: VIl/7a) * Anopheles 11/2, Il/2a, 111/1:111, IV/2:1, VII/3:II, VII/4, VII/4a, VII/4b ;.xthropod vectors of disoaso (oxcopt Anopheles) 1/8, II/3, III/2, VII/8, VII/9-I Bilharziasis (Schistosomiasis) Il/7:II, VII/7:II Bornholm disease (epidemic pleurodynia) V/2 Brill’s disease see Fever, murine typhus Cholera 1/3 Connor’s disease see Fever, Mediterranean exanthematous Dysentery, amebic II/4 Fever: Marseilles fever see Typhus, epidemic Mediterranean fever (Malta f.) VII/1 Mediterranean exanthematous f. (fi&vre boutonneuse) VII/10:III Murine typhus fever (endemic typhus) VII/10:II Relapsing fever VII/9-II Spotted fever see Typhus, epidemic Trench fever (Volhynian f., five-day f.) VII/10:IV Fever ctd: Typhoid fever (abdominal typhus) VII/11 Typhus fever, louse-borne see Typhus, epidemic Undulant fever see Fever, Mediterranean Yellow fever VIII/1-3 Fievro boutonnouse, f. oxanthematique sec Fever, Mediterranean exanthematous Ground-squirrels IV/la, (map only; iv/lb) Hookworm disease see Ankylostomiasis Isotherms IIl/l:I, IV/9, V/4, Yll/lk Ixodidae Il/3:IEI, III/2:II, VII/9-I Leishmaniases II/5 , III/3, VIl/5 Leprosy II/6, IV/6, V/3, VIl/6 (map only; VIl/6a-c) Malaria Il/2a, IIl/l;II, IV/2;2, VII/2, VII/3:I, , VI1/4, VII/4a, VIl/4b Mediterranean, geoitiodioal review VII Molitcnsis-Brucollosis see Mediterranean Mosquito vectors of disease II/2, Il/2a, 111/1:111, IV/2:1, VII/3:II, VII/4, VII/4a, VIlAb Myalgia, epidemic see Bornholm disoaso • Paratyphoid A 1/6 Paratyphoid C 1/7 Phlebotomus 1/8, 11/3:11, 111/2:1 Plague 1/1, II/1, IV/1, IV/la Pleurodynia, epidemic see Bornholm disease Poliomyelitis V/l Population II/9, III/4, IV/10, v/5, VIII/4 Precipitation Il/l:I, IV/9, V/4, VIl/14 (map only: Il/S) Rickettsial diseases ’ VIl/lO Sandflies see Phlebotomus Schistosomiasis see Bilharziasis Snakes, poisonous YII/13 Ticks see Ixodidao Trachoma VI/1, VII/12, VIl/12a Tularemia 1/2, IV A, IV/4a Typhoid fever (abdominal typhus) see Fever, typhoid Typhus: Epidemic typhus (exanthem- atic t., louse-borne t.) IV/5, VII/10;I, Vll/lOa Exanthematic tick typhus see Fever, Mediterranean exanthematous Floa typhus (murine t.) see Fever, murine typhus Urban typhus (shop t.) see Fever, murine typhus Volhynian fever see Fever, trench Worm infestation TV/8 Yellow fever see Fever, yellow AUTHOR INDEX 3/21/49 Bersin, Th., and Jusatz, H.J. IV/6 Leprosy in Southeast Russia and in the Transcaspian Area von Blumenthal, R. VII/8 Distribution of the Yellow Fever Mosquito (Aedes aegypti) as a Vector in the Mediterranean Region VII/9-I Distribution of Ticks as Vectors of Dis- eases in the Mediterranean Region , and Hennig V. II/3 Arthropoda as Vectors of Diseases (except Anopheles) in the Near East III/2 Sandflies and Ticks as Vectors of Dis- eases in the Transcaspian Region Donle, W. 1/6 Paratyphoid a in Europe. 1902 - 1939* Eckstein, F. VIl/13 Distribution of Poisonous Snakes in the Mediterranean Area Finger, G. V/l Epidemics of Acute Anterior Poliomyelitis in the Baltic Countries. 1930 - 1941* V/2 The Distribution of the Bornholm Disease (Myalgia acuta epidemica Sylvest) in the Region of the Baltic Sea Fischer, 0. VII/9-II Relapsing Fever in the Mediterranean Region Grell, K.G. TV/la Incidence of Plague and Distribution of Ground-squirrels West of the Lower Volga, the Significance of the Steppe Rodents of Southeastern Russia for the Epidemiology of the plague 2 Hr.bs, H. 1/7 Paratyphoid C throughout Europe and the Mediterranean fiMin VIl/l Mediterranean Fever (Melitensis-Brucellos- is) in the Mediterranean Region VIl/4 Occurrence of Malaria and Distribution of Anopheles in Italy VIl/4b Occurrence of Malaria in Albania Harmsen, H. II/9 Density of Population in the Near and Middle East III/4 Density of Population in the Transcaspian IV/10 Density of Population in the European East V/5 Density of Population in the Baltic Area VIIl/4 Density of Population in the Countries of the Atlas Mountains Hennig, W. (see also: von Blumenthal ,R.) 1/8 Distribution of Sandflies (Genus Phlebo- tomus) in Europe Hlisnikowski, 1. (see: Martini,E.) Hoering, F.O. VIIl/l-3 Yellow Fever in Africa Hue sing, 1. IY/2:1 Distribution of Anopheles in Caucasia Jusatz, H.J. (see also: Bersin,Th.; Martini,EOberdoerffer,M*) Objectives and-Methods of Medical Cartography X/l Plague Foci of 1st and 2nd Order in Europe, Near East, and North Africa. 1921-1941* 1/2 Epidemics of Tularemia in Europe, western Asia, and North Africa. 1921-1941* 1/3 Pandemic Distribution of Indian Cholera 1934 - 1943 Il/l Occurrence of Plague in the Near East 1917 - 1941 IV/4 Epidemic Distribution of Tularemia in the Area of Eastern Europe IV/4a Epidemics of Tularemia in Southeast Russia 1926 - 1942 VII/6 Leprosy in the Mediterranean Basin Vll/lOa Exanthematic Typhus in Spain. 1939-1942. VII/11 Typhoid Fever in Spain and Portugal VIl/12a Distribution of Trachoma in Spain Martini, E. II/2g Occurrence of Malaria and Distribution of Anopheles in Turkey VIl/3 Occurrence of Malaria and Distribution of Anopheles in Italy , and Hlisnikowski, J. II/2 Distribution of the Eever Mosquitoes in Western and Central Asia IIl/l Occurrence of Malaria and Distribution of Anopheles in the Transcaspian Region , and lusatz, H.JA VIl/2 Malaria in Spain and Portugal Mrugowsky, J. IV/2 Occurrence of Malaria and Distribution of Anopheles in Caucasia IV/5 Exanthematic Typhus in the Eastern Territories of Europe VIl/10 Distribution of Rickettsial Diseases throughout the Mediterranean Basin Oberdoerffer, M., and Jusatz, H.J. II/6 Leprosy in Iran Piekarski, G. II/4 Amebic Dysentery throughout the Near East II/5 Leishmaniases in the Near East III/3 Leishmaniases in the Transcaspian Territ. VII/5 Leishmaniases in the Mediterranean Basin Reichsamt fuer Wetterdienst IV/9 Precipitation and Isotherms in the Eastern European Territories V/4 Precipitation and Isotherms in the Baltic Area VIl/14 Precipitation and Isotherms in the Mediterranean Basin Rohrschncider, W. Vl/l Distribution of Trachoma in Central Europe VIl/12 Trachoma in the Mediterranean Area Ronnefoldt, F. VIl/4a Occurrence of Malaria and Distribution of Anopheles in Greece Schlieper, C. II/7 Ankylostomiasis and Bilharziasis in the Near East IV/8 Worm Infestation of the Population of Caucasia VII/7 Ankylostomiasis and Bilharziasis in the Mediterranean Basin Schreiber, W. (see: Zeiss,H.) Steiniger, F. V/3 Leprosy in the Baltic Countries Zeiss, H. VII Geomedioal Review of the Mediterranean Countries --- , and Schreiber, W. IV/1 Plague in Southeast Russia. 1877-1927. UNITED STATES FLEET UNITED STATES NAVAL FORCES, GERMANY SENIOR U. S. NAVAL LIAISON OFFICER ATTN.: TECHNICAL SECTION (MEDICAL) Room 111, Headquarters Fourth Medical Laboratory APO 403, U.S.Army, c/o PM. NY/NY. File: P 3—1(o) Serial: 260-Med 21 February 1949 From: U. S. Naval Forces, Germany, Office of the Senior U.S.Naval Liaison Officer, EUCOM HQ,., Attn.: Technical Section (Medical) APO 403 To: Chief of the Bureau of Medicine and Surgery, Department of the Navy Via: (1) Technical Officer, U.S.Naval Forces. Germany (2) Chief of Naval Operations (0p-32-F2) Subject: Missing Articles from Atlas of Epidemiology, Forwarding of Translations of. Reference: (a) Ltr. P 3-l(c), Serial 254-Med, dated 15 December 1948 from Senior U.S.Naval Liaison Officer, EUCOM, to Bureau of Medicine and Surgery, Navy Department. Enclosure: (A) Translations of three articles titled: Foreword by Dr. Handloser Introduction by Dr. Zeiss Medical Cartography and Control of Epidemics by Dr. Zeiss. 1. Forwarded herewith is a copy of Enclosure A which are articles missing from Folio I of the translation of the Atlas of Epidemiology which was forwarded previously by reference (a). A copy of Enclosure A will he forwarded directly to each recipient of reference (a) so it may be in- serted in the respective copies and the Atlas will then be complete in so far as it was published. 2. The German texts of these articles became a- vailable only recently. It is suggested that they be inserted in the Atlas as previously forwarded just behind the Index of the translation. Then this is done, the translation will be complete as it was published by the Medical Services of the German Armed Forces, and will be arranged in the order in which the articles appeared in the original text. 3# The preparation of these translations was done by the translators group of the Technical Section (Medical) which has lately been operating under the administrative su- pervision of the Senior U. S. Naval Liaison Officer, EUCOM HQ,. The editing of the translations is still being supervised by Commander Harry I. Alvis, MC., USN., who was formerly Head, Technical Section (Medical) but who has been in the United States since July 1948* / Ob / s / , • // ' O ' /P'.// sS' ■ /S' , y . *1. W. ABR.iH.iMS, Captain, U.S.N. Senior U.S.Naval Liaison Officer. co: (see page 2) Page 2 of letter P 3-l(c), Serial 260-Med, dated 20 February 1949 from U,S,Naval Forces, Germany, Office of the Senior U.S,Naval Liaison Officer to BUMED, Navy Dept. cc: ONA, OMGrTJS CNO (Op-32-F 2) BUMED (Publications Division) BUMED (Research Division) BUMED (Professional Division) BUMED (Preventive Medicine Division) U.S. Army Medical Library N.M.R.I. Bethesda, Naval Medical School, Bethesda /Department of Army Surgeon General, Medical Intelligence Section Department of Air Force, Air Intelligence Sect, Uk Si Public Health Service, Office of the Surgeon General U* S. Department of Commerce, Office of Technical Information.