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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 50 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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775 3,264 2, 424

812 848 514 794

741 3,512 2, 213

263 1,400

741 843 469 694

231 1,346

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Provisional Information on Selected Notifiable Diseases in the United States for

Week Ended March 21, 1953

week, 5 cases were reported in the southeastern part of the State. All were traceable to the Twin Falls area.

For the current week States reporting more than 1,000 cases of measles were: Wisconsin, 1,896; California, 1,396; and Ohio, 1,183. The report was not received from Texas where 2,786 cases were reported for the week ended March 14. Since the first of this year about half of the total cases have been reported in the East North Central and West South Central Divisions. However, during the last few weeks almost two-thirds were reported in these divisions.

The 8 cases of trichiniasis reported this week were in New York City.

For the current week a total of 61 cases of poliomyelitis was reported as compared with 70 for the corresponding week of last year. States which reported the disease by type, paralytic and nonparalytic, and those not specified were as follows:

Anthrax in animals

According to the February report from the Department of Agriculture no anthrax outbreaks occurred in 32 States and the District of Columbia. The report gives information on 22 outbreaks in 14 States and Puerto Rico. As a result of these outbreaks, 29 cattle and 16 swine were lost. The source of infection for 12 outbreaks was unknown, the remaining 10 were traced to infected soil. A supplemental report for January shows 4 outbreaks in 2 States. Ten hogs were lost in 1 outbreak and the losses were not given for the others.

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Infectious hepatitis

Dr. S. Finkelstein, Bureau of Indian Affairs Hospital, Cass Lake, Minnesota, gives additional information on the hepatitis being reported in the reservation. Preliminary information appeared in this report for the week ended February 21. Since that time 11 additional cases have been reported. Most of the 21 cases for January and February were observed in the outpatient clinics, only 3 were admitted as inpatients. Fifteen or two-thirds of the total were in persons under 16 years of age. The patients were scattered throughout the reservation and each had a private water well, so water seems unlikely to be the vehicle of infection.

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EPIDEMIOLOGICAL REPORTS

Smallpox

Dr. M. H. Mires, Vermont Department of Health, states that the case of smallpox reported for the week ended March 7 is erroneous, and was due to a typographical error.

Dr. F. T. Foard, North Carolina Board of Health, reports that the onset of the smallpox case reported previously was on February 28, but the State Board of Health was not notified until March 4. Medical personnel from Fort Bragg and Pope Air Base concurred with local health officers in the diagnosis. The patient was an adult male who had not been vaccinated since he was 6 years of age. He had not been away from his home in the southern part of the State. No source of infection could be found, and no secondary cases have been reported. Approximately 1,000 persons have been vaccinated in the area.

Shigellosis

Dr. Morris Greenberg, New York City Department of Health, reports an outbreak of shigellosis among a group of children in an institution which housed 76 children and 65 adults. A total of 27 cases has occurred since the 10th of March, 17 of which were among children 2 to 3 years of age. The symptoms were acute diarrhea with blood-streaked stools and mucus, fever, and some prostration. Preliminary samplings have thus far yielded Shigella sonnei from stools of the patients. The institution has been closed to new members. The suspected source of infection is a nursery maid who was ill with diarrhea just prior to the onset of the outbreak. This maid fed the 2-year olds. Her 2 children at home were also ill with diarrhea. Stool specimens are being obtained for verification.

Diphtheria

Mr. W. W. Benson, Idaho Department of Public Health, has given information on the outbreak of 46 cases of diphtheria in Twin Falls County during a 3-week period, February 15 to March 7. In addition to these cases, 16 carriers were found who had contact with these cases. All, except 1 case, were traced to a girl who developed the disease December 30, 1952. This girl had attended a wedding in Wyoming and was in direct contact with a child who had membranous croup and had a tracheotomy performed. Fifty-four percent of the cases were in children under 15 years of age. A full scale immunization program has been carried out and no new cases have been reported since the first week of March. However, during the following

Gastro-enteritis

Dr. Morris Greenberg reports an outbreak of 16 cases of gastro-enteritis in a private home in New York City. Roast beef was suspected to be the vehicle of infection. The beef was purchased February 26 and refrigerated until the following day, when it was roasted. During the cooling period of 4 1/2 hours, slices of the meat were removed for 2 persons for their evening meal. They became ill 5 and 13 hours later. A few days later 14 persons became ill from 4 to 20 hours after eating portions of this beef. Samples of the roast beef showed a large number of coliform organisms but no staphylococci or enterococci. Stool cultures were negative.

Influenza

The following reports were received by the Influenza Information Center, N. I. H., and the National Office of Vital Statistics.

Dr. E. H. Lennette, California Department of Public Health Laboratory, has reported serologic diagnoses of influenza A and A-prime in 15 individuals from scattered areas in California, having onsets from January 6 to February 24.

Dr. L. P. Kravis, Childrens Hospital, Philadelphia, reports the isolation and identification of influenza A-prime from 5 patients in the Philadelphia area, having onsets in the early part of February. Serologic diagnoses for influenza A were also reported for 39 cases in Pennsylvania, 11 in Wilmington, Delaware, 10 in New Jersey, and 3 in Tennessee.

of scarlet fever. Petechiae appeared after admission and he died the following day. The fourth person became ill on March 3 and developed a rash on March 7. Since the original 4 cases, the disease has been confirmed in the daughter of the cotton mill worker. Four suspected cases were admitted to the hospital on March 19, and all were members of the immediate families of the original cases.

The Ministry of Health considers that the disease will be contained in the present locality, and since a very strict surveillance procedure has been instituted the outbreak should be well under control. One unvaccinated contact is in Northern Ireland, and efforts are being made to locate her. It is thought that the infection was introduced in a consignment of raw cotton, but since the mill involved uses mixed cotton of the poorer grades, the country of origin may be either India, Egypt, or South America. Efforts are being made to determine the country of origin but success appears doubtful. This is the tenth episode reported since 1908 in which the disease was presumably carried by raw cotton. The mill involved has been closed voluntarily because 50 workers who were close contacts are under house surveillance.

Communicable diseases in other areas

Dr. A. S. Osborne, Science Attache, Science Office, Embassy, London, states that smallpox has been reported from Todmorden in the West Riding of Yorkshire, and in the neighboring town of Bacup, Lancashire. The original case seems to have been in a cotton mill worker who became ill on February 28. He developed a rash on March 4 which was thought at first to be chickenpox. He and his wife were admitted to a hospital on March 15. Another patient was admitted to the hospital on March 12 with a diagnosis

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

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

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4 367 773 230

July 1

297 512 181

2,954

(2)

1,786

137

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Anthrax--

-----062 13

1

1 (2) Botulism--049.1

(2) Brucellosis (undulant fever)-----044 28

32

12) Diphtheria--

-----055 25

36 137 Encephalitis, acute infectious ---082 11

28

17 (2)
Hepatitis, infectious,
and serum --
--092,1998.5 pt.

609
432

(2) Malaria ------

--110-117

3
24

(2)
Measles ------
---085 12,371 28,843 22,266

Sept. 1 Meningococcal infections

--057 147 157 94 Sept. 1 Poliomyelitis, acute----- ---080 61

70

61

Apr. 1 Rabies in man-

----094

1

(2) Rocky Mountain spotted fever----104A

1

(2) Scarlet fever and streptococcal sore throat------050,051 3,904

Aug. 1 Smallpox-----084

12) Trichiniasis-

--128

8

10 Tularemia ----

---059

7
9

15 (2) Typhoid fever

--040 22

28

28

Apr. 1 Typhus fever, endemic

--101

4

Apr. 1 Whooping cough-

----056 515

1,444 Oct. 1

12)

(2) 126, 345

2,870 57,689

(2) 12)

(2) (2) 283,840 184,026

2,503 2,004 28,547 28,547

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Reported in Pennsylvania.
2 Not computed.
Paddition: Alabama, week ended March 7, 17 cases.
"Deduction: Vermont, week ended March 7, i case,

5Additions: Indiana - January 10-February 21, 22 cases; week ended February 28, 1 case; week ended March 7, 8 cases; week ended March 14, 4 cases.

NOTE. No report for the current week has been received from Texas,

SOURCE AND NATURE OF DATA

These provisional data are based on reports from State and territorial health departments to the Public Health Service. They give the total number of cases of certain communicable diseases reported during the week usually ended the preceding

Saturday. When the diseases which rarely occur (cholera, dengue, plague, typhus fever-epidemic, and yellow fever) are reported, they will be noted under the table above.

: data not included

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

Table 2. CASES OF SPECIFIED DISEASES WITH COMPARATIVE DATA: UNITED STATES,

EACH DIVISION AND STATE FOR WEEK ENDED MARCH 21, 1953 (Humbers under diseases are category mmbers of the Sixth Revision of the International Lists, 1948)

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LW ENGLAND-
Maine----
New Hampshire--
Verzont----
Massachusette-
Rhode Island--
Connecticut--------

MIODIZ ATLANTIC-
Hev York---------
Hey Jersey---------
Pennsylvania-------

KAST NORTH CENTRALOnio-Indians-Mlinois------Michigan--------Wisconsin-------

WEST NORTE CENTRAL MinnesotaLove---Missouri--Horth Dakota---South Dakota-----Hebras ---------Kangas----------

SOUTE ATLANTIC DelawareMaryland---------District of ColumbiaVirginia---West Virginia---North Carolina-South Carolina--Georgia----Florida--

194 201 171

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Kentucky----
Tennessee--------
Alabama----------
Mississippi-------

BST SOUTH CENTRAL-
Arkansas--
Louisiang------
Oklahoma-
Texas----

MOUNTAIN
Montana-----
Idaho-----
Wyoming-------
Colorado------
lev Mexico-----
Arizona--------
Utah----------
levads------

PACIFIC--
Washington--
Oregon----
California-
Alaska--
Hevait
Puerto Rico----

2 4

68 67

7 335 188

60 227

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3 14 202 39 85 183 16

2 7 5 6

44 77 109 40 15 18 68

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