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The chart shows the number of deaths reported for 108 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 3 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 with a weekly average of 50 deaths, 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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Table 4. DEATHS IN SELECTED CITIES FOR WEEK ENDED JANUARY 21, 1956
(By place of occurrence, and week of filing certificate.

Exclusive of fetal deaths)

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February 3, 1956

Washington 25, D. C..

Vol. 5, No. 4

Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended January 28, 1956

Infectious hepatitis cases reported this week total about 400 (42 percent) less than the number for the corresponding week of 1955. Of the current total (544), 114 cases were in the Middle Atlantic Division; 86 each in the East North Central and Pacific Divisions; and 62 in the Mountain.

Of the 47 cases of diphtheria, 8 were in Texas, 5 in Florida, and 4 each in North Carolina, Alabama, and Mississippi.

For the current week, Minnesota reported 7 cases of typhoid fever. Although the number is small, it is as many as was reported by the State for the entire year of 1955.

Poliomyelitis

EPIDEMIOLOGICAL REPORTS

Dr. C. G. Salsbury, Arizona Commissioner of Health, has reported a relatively high incidence of poliomyelitis during the 4-week period ended January 27, 1956. Of the 15 cases reported, 9 had signs of bulbar involvement, 4 were spinal paralytic, and 2 were nonparalytic. Twelve occurred in one county. The age distribution was as follows: 1 was under 1 year; 5 were 1 to 4 years; 5 were 5 to 9 years; 2 were 10 to 19 years; and 2 were over 20 years of age. There was 1 fatal case in an 8-year old child. One bulbar case, a 10-year-old girl, had received an injection of poliomyelitis vaccine 4 weeks prior to onset.

Diphtheria

The California Department of Public Health has supplied information on an investigation of diphtheria cases among approximately 750 persons in and around a farm labor camp. Fourteen cases are known to have occurred in the area between November 6 and December 12, 1955. Epidemiological evidence indicates that this camp served as a focus for the disease. The camp consists of a group of 318 small 1-room cabins, 49 houses, and 5 apartment buildings. The houses and apartment buildings have inside plumbing facilities. For every 3 to 4 cabins, there is one outside water faucet. Other facilities are provided in a large building for every group of 50 cabins. The inhabitants of this camp are primarily migrant laborers and change constantly, with a large family turnover during the latter part of the year, when diphtheria cases were occurring. School is provided on the camp grounds for children through the sixth grade, but older children attend a school 3 to 4 miles distant.

The first case occurred in a 7-year-old unimmunized girl who developed a cough and dyspnea. She improved under penicillin therapy, but later experienced exacerbation and a tracheotomy was subsequently performed. Throat cultures were found to be positive for diphtheria. The patient did not attend school, but was in contact with a boy who had similar symptoms. For the boy, no diagnosis of diphtheria was made. The second case was in a 4-year-old girl who lived several miles away. She developed a cough and respiratory distress, became progressively worse, and died about 5 days later while a tracheotomy was being performed. There was no post-mortem examination. The county health officer reported a positive culture but the virulence test was negative. Clinically, this case is compatible with diphtheria. The patient's infant sister had respiratory tract symptoms and a culture taken was reported positive by the county health department, but negative

by the State Department of Health. Investigation of the 4-yearold's contacts led to the decision to investigate the entire camp for diphtheria. Criteria were established for immunizations and 119 were given. Twenty-two cultures were taken on all those having colds, sore throats, and/or nasal discharges, and on patient contacts. Of these, 10 were positive, and 2 suspect cases later were proved positive. All these individuals had only mild symptoms of sore throat or other respiratory tract difficulties. They were treated with penicillin and all have recovered completely. No evidence of a common source of infection was found.

Anthrax in animals

According to the monthly report from the Department of Agriculture, only 2 outbreaks of animal anthrax occurred during December 1955. As a result, 13 sheep were lost in California, and a cow died in New Jersey. The source for both was infected soil. Information from 43 States, the District of Columbia, and Hawaii indicates they experienced no anthrax outbreaks during the month.

Monthly reports for 1955 show that a total of 122 outbreaks occurred in 20 States. During the year, 363 animals were lost, of which 216 were cattle. In one instance, contaminated feed resulted in the loss of 100 mink. While Louisiana reported 39 outbreaks during the year, there were no extensive outbreaks such as were reported during the summer of 1954. These extensive outbreaks which occurred in 2 States, Louisiana and Mississippi, accounted for approximately 2,000 animal losses in some 325 outbreaks.

Plague infection

Mr. Bertram Gross, Bureau of Rodent Control, Hawaii Department of Health, reports the finding of 2 plague infections within the endemic area of the Hamakua District on January 3, 1956. These infections were proved positive for P. pestis. The specimens (mass flea inoculations) were obtained from rodents trapped in District 1A, Kukuihaele area. The first specimen consisted of 1 male and 1 female X. cheopis from a female rat, R. alexandrinus. There were 1 male and 4 female L. segnis in the second specimen. They were collected from 3 mice and 1 rat, R. hawaiiensis.

Psittacosis

Dr. Mason Romaine, Virginia Department of Health, has supplied additional information on 2 of the psittacosis cases reported for the week ended January 7, 1956. Specimens collected from one patient showed an eight-fold rise in complement fixation titer between the acute and convalescent serums for psittacosis. The convalescent specimen from the other was positive in a dilution of 1:16 for the disease.

Acute pharyngo-tonsillitis

Dr. D. S. Fleming, Minnesota Department of Health, has reported an outbreak of approximately 46 cases of acute pharyngotonsillitis among college students. Most of those affected had beefy red throats, enlarged tonsils with exudate, fever, headache, and malaise. These were thought to be of streptococcal origin and the patients responded to penicillin therapy. It was

established that all the patients interviewed (except 1) had eaten at a snack bar on the campus a day or two earlier. Most of them had eaten egg salad sandwiches. The eggs had been boiled and made into salad the evening before. Sandwiches were made between 10:00 a.m. and 4:00 p.m. on the day they were eaten. There had been at least 2 persons with sore throats among food handlers at the snack bar.

Gastro-enteritis

Dr. Milton Feig, Wisconsin State Board of Health, has reported an outbreak of gastro-enteritis among 19 guests in a private household. About 5 hours after dinner was served, 2 children became ill with nausea and dizziness. At this time, potato salad and a "sea shell salad" were thought to be responsible for their illness, and the food was thrown out. Later it was found that more than half of the guests were stricken with similar symptoms. The next evening the family lunched on some of the cold baked ham that was left, and they became sick again. The ham was the only food eaten at this meal that had been served on the previous day. It was purchased from a local grocery store where meat is displayed in an open top refrigerated case. Almost immediately it was taken to a pastry shop where

it was to be baked. The ham was stored under refrigeration at the bakery until the following day, when it was baked. The meat was then taken home where it remained unrefrigerated for approximately 24 hours before being served. An investigation revealed no improper handling of meat at the grocery store. However, conditions at the bakery were poor and the uniforms of some of the help were badly soiled. Questionnaires sent to each guest revealed that 2 of the patients did not eat any potato salad but all had eaten ham. None of the salads were available for bacteriological examination and only the ham was tested. The laboratory report showed a heavy growth of gram positive, coagulase positive, staphylococci on a ham specimen. The meat was negative for salmonella and shigella organisms.

Dr. Carl. E. Weigele, New Jersey Department of Health, has reported an outbreak of gastro-enteritis among employees attending parties in 2 industrial plants. Of 178 persons who ate turkey dinners, 145 became ill from 10 to 24 hours later. The dinners had been prepared at a local diner and consisted of turkey, dressing (prepared separately), gravy, cranberry sauce, baked beans, mashed potatoes, and several kinds of pies. After carving the freshly prepared turkeys, the warm meat was placed Continued on page 8

Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: CONTINENTAL UNITED STATES (Numbers after diseases are category numbers of the Sixth Revision of the International Lists, 1948)

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