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T HE increasing prevalence of smallpox in the United States and Canada led the Company early in 1921 to make an inquiry into the incidence rate of the disease in the principal cities. A questionnaire was sent to a large number of municipal health officers covering the number of cases and deaths which occurred in 1919 and 1920. Information was asked for also on the measures pursued by health departments in the prevention and control of the disease. Replies were received from the health officers of 243 cities in the United States and Canada. In 154, or 63.4 per cent of these cities, a total of 19,104 cases of smallpox were reported in 1920. In 1919, 140 of the cities, or 57.6 per cent, reported 14,335 cases of smallpox. Since the information was requested of all municipal health officers, without any particular fore-knowledge of the presence or absence of smallpox in any of the municipalities, our data should give a fairly representative indication 6f the prevalence of the disease in recent years, of the kind of municipal control, of the attitude of the public toward vaccination and of other factors which play a part in the campaign against smallpox. The highest smallpox incidence rates occurred in cities of the Rocky Mountain, West North Central, and Pacific Coast group of states and in Canada. A fairly high prevalence rate was reported also for cities of the West South Central states (Arkansas and Louisiana). The least incidence rates occurred in the New England, Middle Atlantic, and South Atlantic states. These areas also included most of the cities not reporting smallpox at all in 1920. Considering the cities according to individual states, the highest rates per 100,000 of population were observed in the cities located in the states of Washington, Minnesota, Nebraska, Colorado, Wisconsin, Montana, Iowa, and Louisiana, in order of decreasing incidence.

SMALLPOX INCIDENCE AND MEASURES OF CONTROL IN AMERICAN AND CANADIAN CITIES 1919 AND 1920