An ulcer formed at the site of the bite and glands in the groin became swollen and painful. Agglutination reactions for Pasteurella tularensis were negative early after onset, but 9 days later tested positive in a dilution of 1:200.

Botulism

The California State Department of Public Health has supplied information on a case of botulism recently reported in the State. The patient's illness was characterized by nausea, vomiting, diarrhea, double vision, muscle weakness, and difficulty in seeing, swallowing, speaking, and breathing. The suspected vehicle of infection (unprocessed mushrooms) was not available for laboratory examination.

Streptococcal food infection

Dr. J. D. Martin, Louisiana State Department of Health, has reported an outbreak of illness involving 38 college students. Clinical symptoms compatible with those of food poisoning began about 9 hours after the students partook of a meal in the dining hall of the school. The meal consisted of roast bei, potatoes, peas, bread, and tea. None of the food was available for bacteriologic studies. Stool specimens obtained from

the patients were found to contain streptococcal organisms. Gastro-enteritis

The California State Department of Public Health has reported an outbreak of gastro-enteritis among 247 persons in a school. Of these about 87 became ill with nausea, vomiting, diarrhea, cramps, prostration, and chills from 9 to 15 hours after eating a noon meal in the cafeteria. The suspected vehicle of infection was meat loaf which was prepared during the morning. The meat loaf was made with powdered milk, fresh eggs, oatmeal filler, and baked with canned tomato sauce. None of the original meat loaf was available for laboratory tests. Specimens of the ground meat and powdered milk were negative for pathogens.

Also, the California State Department of Public Health has reported 3 outbreaks of gastro-enteritis in a farm labor group served by a single caterer. A total of 262 cases was reported, with many of the individuals being ill on the 3 occasions. Nausea, vomiting, and diarrhea began from 2 to 12 hours after the evening meals on the 3 different days. An investigation of the catering establishment revealed good food handling techniques Continued on page 8

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± 2√d, 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.