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The chart shows the number of deaths reported for 106 major cities of the United States by week for the current year, and, for comparison, the median of the number of deaths reported for the corresponding weeks of the three previous calendar years. (The median is the central one of the three values arranged in order of magnitude.) If a report is not received from a city in time to be included in the total for the current week, an estimate is made to maintain comparability for graphic presentation.

The figures reported represent the number of death certificates received in the vital statistics offices during the week indicated, for deaths occurring in that city. Figures compiled in this way, by week of receipt, usually approximate closely the number of deaths occurring during the week. However, differences are to be expected because of variations in the interval

between death and receipt of the certificate.

While week-to-week changes in the total number of deaths reported for all major cities generally represent a change in mortality conditions, this may not be true for variations in weekly figures for each city. For example, in a city where 5C deaths are the weekly average, the number of deaths occurring in a week may be expected to vary by chance alone from 36 to 64 (d + 2Vd, where d represents the average number of deaths per week).

The number of deaths in cities of the same size may also differ because of variations in the age, race, and sex composition of their populations, and because some cities are hospital centers serving the surrounding areas. Changes from year to year in the number of deaths may be due in part to population increases or decreases.

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New England-
Middle Atlantic-----
Bast North Central.
West North Central
South Atlantic---
East South Central-
West South Central
Mountain---
Pacific--------

-(14 cities) -(17 cities) -(18 cities) -(9 cities) (9 cities) -(7 cities) -(12 cities)

-(7 cities) -(12 cities)

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250 1,076

188 1,156

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34 1

Morbidity and Mortality Weekly

[graphic]

August 14, 1953

Washington 25, D. C.

Vol. 2, No. 31

Provisional Information on Selected Notifiable Diseases in the United States for

Week Ended August 8, 1953

sweats, mild headache, backache, and aching of the extremities. High fever also occurred 2 or 3 times a day. The first specimen yielded a complement fixing titer of 1:8 and the second was positive for psittacosis in a dilution of 1:64. The patient had purchased a pet shop, including its stock, about 3 weeks prior to the onset of his illness. He had no information as to the source of the birds in stock. Shortly after purchasing the shop he sold the only love bird on hand to a party who later returned quite irate because the bird had died. No illnesses have been reported as a result of the sale of the love bird. The second psittacosis case occurred in a person who had an acute episode of coughing, fever, and chills over a 2-month period. Chest X-rays revealed infiltration of both lungs similar to virus pneumonia. The complement fixation test was positive for psittacosis in a titer of 1:256. The patient had been exposed to about 200 psittacine birds at a private aviary.

Malaria in civilians as well as in the military continues to be reported in numbers far below those for last year. On the other hand, infectious hepatitis exceeds the number reported last year. The number of cases reported so far in 1953 (20,161) is more than double the number (9,965) for the same period last year.

The number of cases of poliomyelitis reported for the current week is 1,883 which is about 14 percent in excess of the 1,630 for the previous week, but nearly 30 percent below that (2,642) for the same week last year. The cumulative total for the "disease year" is 10,231 as compared with 12,031 for the same period last year. The total number reported in 1953 is 11,745 which is below the figure 13,224 for the same period of 1952.

The cumulative number of cases reported since the seasonal low point about April 1 is in excess of last year's figures in all of the New England States, and in all except Massachusetts, the excess amounts to 50 per cent or more. Each of the Middle Atlantic States has also reported more cases than last year for the period from April 1 through the first week of August. Only Indiana, Minnesota, Missouri and North Dakota have reported more than last year in the North Central Divisions. In the South Atlantic Division, States reporting more than last year are Maryland, Virginia, North Carolina, South Carolina, and Georgia. In the South Central Divisions only Tennessee, Alabama, and Arkansas are in excess of the number for 1952. In the far western part of the country, Arizona, Utah, Nevada, and California have reported more cases.

Thus, the number of States including the District of Columbia reporting more and those reporting fewer cases for the disease year” as compared with last year is almost equal. The numbers are 25 and 24, respectively.

Thirty-four of the 125 cases reported in New York State were in the City of New York. In Ohio, except for 9 cases reported in Pike County, cases were concentrated in the large cities. In Illinois 37 of the 117 cases were in Cook County, and 6 were in Macon County where mass immunization with gamma globulin has been carried out. In Maryland, 23 of the 32 cases reported were in Baltimore (13) and Baltimore County (10). In North Carolina, a large majority of the cases were reported from counties in the western part of the State. Buncombe reported 5; Burke, 4; Caldwell, 9, Catawba, 1; and 7 in Wilkes. Avery County reported no cases. In Alabama, 2 of the 29 cases were in Montgomery County. In California, 65 of the 157 cases were in Los Angeles County, 23 in San Diego, and 13 in Kern. Orange County reported 7 as compared with 20 for the previous week.

A total of 23 deaths was reported: 5 in Ohio; 2 in Indiana; 7 in Illinois (1 each in Bureau, Cook, Lake, Marion, and Stark Counties, and 2 in Macon); 3 in Minnesota; 1 in Virginia; 3 in Arkansas (1 in each of 3 counties); and 4 in California, all in San Diego County. One of the latter was reported as military.

Typhoid fever

Dr. M. E. Ringe, Connecticut Department of Health, reports an outbreak of typhoid fever following a christening party attended by 22 persons, mostly members of one family. An illness of 2 brothers was diagnosed as typhoid fever. The disease was confirmed by stool cultures on one of the patients. Later a cousin of these boys became ill but a diagnosis of typhoid fever was not definitely made. However, a week later his 2 brother's became ill. One of these did not attend the party but had eaten some of the chicken salad which had been brought home. A blood culture on one of the latter mentioned brothers was found positive for S. typhosa. The same organism was found in stool specimens submitted by the grandmother who prepared the food in her home where the party was given. She gave a history of having had typhoid fever about 35 years ago.

Salmonellosis

Dr. Ceo. W. Cox, Health Officer, Texas Department of Health, reports an outbreak of 39 cases of salmonellosis among 42 persons who attended a chicken barbecue. Symptoms of vomiting, diarrhea, chills, fever, and abdominal pains occurred from 8 to 36 hours after the food was eaten. Salmonella chester was cultured from 13 stools of 14 patients and also from uncooked chicken livers. No barbecued chicken was available for laboratory testing.

Gastro-enteritis

Dr. Halverson reports 2 outbreaks of gastro-enteritis in California. The first outbreak occurred among 38 persons who ate in a restaurant. Of these, 29 became ill 4 to 12 hours later, Roast turkey was suspected to be the vehicle of infection. A 20pound turkey was roasted for 3 hours at 350° F. It was concluded that this may not have been sufficient to destroy bacteria. None of the meat was available for laboratory examination. Specimens taken from 6 food handlers and 4 patients were all negative. The other outbreak occurred among 284 persons in an institution. Sixty-three became ill with nausea, vomiting, severe stomach cramps, and diarrhea. The incubation period was not given because of the possibility of 2 meals being involved. It was stated that one batch of soup, which was added to day by day for several days, was boiled during the day and left during the night over a

EPIDEMIOLOGICAL REPORTS

Psittacosis

Dr. W. L. Halverson, Director, California Department of Public Health, reports 2 unrelated cases of psittacosis which occurred in different parts of the State. The first case was in a 40-year-old white man who developed symptoms of chills,

low gas flame. Reconstituted milk was made from milk powder which was stored in large bags. The preparation and the storing of the milk were below standard. Large numbers of pyocyaneus pseudomonas and colonies of staphylococcus were found in the meat stock, rice, reconstituted milk, and fresh sausage. Pyecyaneus pseudomonas was found in 6 stool specimens of the patients, and Staphylococcus aureus was found in cultures of specimens from 2 food handlers.

Dr. W. H. Y. Smith, Alabama Department of Public Health, reports an outbreak of gastro-enteritis in a church camp of about

400 persons. An investigation revealed that between 80 and 100 persons became ill. There is a possibility that the infection was transmitted through polluted water or by hamburgers at a sandwich stand. A mother handled food at the stand while caring for an infant with acute diarrhea. Laboratory examination revealed coli aerogens in water, and the hamburger was found to be positive for coliform bacteria, staphylococci and alpha hemolytic streptococci. It is possible that food other than that tested was the vehicle of infection. All stool specimens were negative.

Table 1. COMPARATIVE DATA FOR CASES OF SPECIFIED NOTIFIABLE DSEASES: UNITED STATES

(Numbers after diseases are category numbers of the Sixth Revision of the International Lists, 1948)

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Anthrax

---062 Botulism

-049.1 Brucellosis (undulant fever) -----044

38 Diphtheria-

-----055 23 Encephalitis, acute infectious ---082 21 Hepatitis, infectious, and serum-

---092,N998.5 pt. 524 Ma laria------

-110-117 53 Measles ----

---085 Meningococcal infections ----057

50 Poliomyelitis, acute

--080 1,883 Rabies in man----

---094 Rocky Mountain spotted fever----104A 9 Scarlet fever and streptococcal sore throat----

-050,051 | 1,140 Smallpox----

--084 Trichiniasis---

-128

5 Tularemia ----

-059 ll Typhoid fever

-040

88 Typhus fever, endemic

--101 11 Whooping cough

-056

239

331 1,475

64 2,642

1 16

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3,591

1,906

57 1,516

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Not computed.
2Deduction: Georgia, week ended July 25, 1 case.

SAdditions: Georgia and Indiana, week ended July 25, 3 and 1 cases, respectively. Deduction: South Carolina, week ended July 25, 3 cabes.

*Additions: Rhode Island and South Carolina, week ended July 25, I case each.
5Addition: South Carolina, week ended July 25, 1 case. Deduction: Indiana, week ended July 25, 1 case.
NOTE. Psittacos18: New Hampshire, 1 case.

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Symbols.–1 dash [-]: no cases reported; asterisk (*] : disease stated not notifiable; parentheses, [ ] in total; 3 dashes [---] : data not available.

: data not included Table 2. CASES OF SPECIFIED DISEASES WITH COMPARATIVE DATA: UNITED STATES,

EACH DIVISION AND STATE FOR WEEK ENDED AUGUST 8, 1953
(Members under diseases are category numbers of the Sixth Revision of the International Lists, 1948)

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Ma ine---
New Hampshire--
Vermont--
Massachusetts-
Rhode Island------
Connecticut-------

MIDDLE ATLANTIC----
New York---
New Jersey----
Pennsylvania--

EAST NORTH CENTRAL-
Obio--
Indiana-
Illinois----
Michigan--
Wisconsin--

WEST NORTH CENTRAL-
Minnesota-----
Iowa-------
Missouri-
North Dakota-
South Dakota-
Nebraska-
Kansa8-----

SOUTH ATLANTIC-
Delaware--
Maryland----
District of Columbia--
Virginia----
West Virginia--
North Carolina-
South Carolina--
Georgia---
Florida----

EAST SOUTH CENTRAL-
Kentucky----
Temessee-----
Alabams----
Mississippi---

WEST SOUTH CENTRAL

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