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The chart shows the number of deaths reported for 108 major cities of the United States by week during the past year. For comparison, the chart shows both the maximum and minimum number of deaths reported for the corresponding weeks of the 5 previous years.

The provisional figures shown in tables 3 and 4 were compiled from reports of the number of death certificates received each week in the vital statistics office of each city. The weekly count included all certificates filed for deaths occurring in the area, regardless of the date of death and regardless of the residence of the deceased.

Figures compiled in this way, by week of receipt, usually approximate closely the number of deaths occurring during the week. Differences are to be expected because of variations in the interval between death and receipt of the certificate. Whenever a holiday falls on the last day of the work week, the number of death certificates received for that week is usually low,

while the number for the following week is high. The sharp fluctuations in October and November 1955 were caused when city vital statistics offices closed Friday October 12 (Columbus Day) and closed Thursday and Friday of Thanksgiving week.

When the data shown here are used to compare 2 cities or to compare 2 years for a certain city, consideration must be given to several factors. The number of deaths reported by a city generally varies with the size of its population, so that changes from year to year in the number of deaths may be due, in part, to population increases or decreases. In cities of the same size, the number of deaths may differ because of variations in the age, color, and sex composition of their populations. Some cities are hospital centers serving large numbers of persons from areas outside the city limits, and in some areas the hospitals serving the city are outside the city limits. See the first page for a summary of mortality in 1956.

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(By place of occurrence, and week of filing certificate. Exclusive of fetal deaths)

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the morning of the following day. No food samples were available for laboratory tests. However, washings of viscera cavities and samples of turkeys from the same lot and same plant are being tested.


Dr. Mason Romaine, Virginia State Department of Health, has reported an outbreak of gastro-enteritis in an elementary school. Of 168 pupils who ate lunch in the cafeteria, 99 became ill with nausea and vomiting from 2 to 4 hours later. Bacteriologic examination of foods served revealed the turkey salad to be contaminated with hemolytic Staphylococcus aureus. An investigation revealed the turkey had been received the middle of November and was kept in a deep freeze until boiled on December 13. After boiling, it was left overnight at room temperature and was deboned and made into salad the following day. Fresh homemade salad dressing was used.

Dr. E. A. Belden, Missouri Department of Public Health and Welfare, has reported an outbreak of gastro-enteritis following the ingestion of cream-filled doughnuts. Five persons in one family became ill from 2 to 4 hours after eating the food. The doughnuts were purchased from a bakery where the baker went home with a "virus" the morning the product was baked. Laboratory examination of the doughnuts revealed a nonhemolytic S. aureus. Illness was reported in another family of unknown size who ate doughnuts purchased from another store of the same chain.

Dr. S. B. Osgood, Oregon State Board of Health, has reported an outbreak of gastro-enteritis in a private residence. Three members of a family and their 4 guests became ill with abdominal cramps and diarrhea from 4 to 5 hours after an evening meal. In addition, 5 of the persons had nausea, vomiting, and prostration. Of 7 food items served, coagulase-positive, hemolytic S. aureus was isolated from both turkey and shrimp. The turkey was of a nationally known brand, individually packaged and frozen. The bird was allowed to thaw at room temperature for more than a day. Since both the turkey and the shrimp yielded the causative organism it is believed contamination took place in the home.

Dr. J. H. Paul, Hillsborough County (Florida) Health Department, has reported an outbreak of gastro-enteritis among 35 persons attending a lodge supper. Of these, 10 are known to have become ill with severe abdominal pain and diarrhea from 7 to 14 hours after ingestion of the meal. An investigation revealed the most probable vehicle of infection was swiss steak and a sauce prepared the morning of the outbreak. It had been left unrefrigerated during the day and served around 7:00 p.m. Bacteriologic examination of foods including the meat were negative for pathogens.

Dr. Loren Rosenbach, Palm Beach County (Florida) Health Department, has reported an outbreak of gastro-enteritis among 12 persons eating a catered meal. An unknown number became ill from 3 to 6 hours later. Food ingestion histories indicated that the macaroni and cheese dish was the vehicle of infection but none was available for bacteriologic examination.



CPO 40034 3

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Reported Incidence of Notifiable Diseases in the United States, 1956

Final figures for 1956 supplied by State and Territorial health officers are presented in this summary.

Trends in the incidence of diseases are shown in table 1. The numbers of cases by month, usually by month of report, are given in table 2. Data on age distribution for 7 diseases were collected for the first time in 1956 and are shown in table 3. Since comparisons with previous years cannot be made, no comments on these data are made in this report. Cases by State and those in noncontiguous areas are shown in subsequent tables. The numbers of reported cases of certain diseases not requested to be regularly reported to the Public Health Service are also shown in this report.

Decreases in incidence were reported for many of the notifiable diseases, including poliomyelitis which experienced a 48-percent reduction as compared with 1955. Cases of paralytic poliomyelitis decreased in about the same proportion. This is the second year in which a decrease (about 40 percent) occurred in infectious hepatitis after a period of increasing incidence over the previous 5 years. Decreases in other disease incidences were noted as follows: brucellosis, 10 percent; diphtheria, 21; malaria, 55; meningococcal infections, 21; shigellosis, 26; tuberculosis, 8; endemic typhus fever, 27; and whooping cough, 49.

One case of plague was reported, the first since January 1951. Other unfavorable conditions were reported, such as significant increases in the incidence of approximately a fourth of the notifiable diseases. Reported cases of syphilis have shown reduction for the past several years, although in 1956 there was an increase of 7 percent. Amebiasis had been decreasing since 1949 but increased this year by 10 percent. Streptococcal infections have been increasing since 1950, with a 20-percent rise for 1956 over 1955. Other increases, including that for psittacosis, are discussed in the following paragraphs.

Diseases of low incidence showed little change in 1956 from the 1955 figures. For instance, Rocky Mountain spotted fever incidence decreased by only 2 cases, from 295 in 1955 to 293 in 1956; trichiniasis, also by 2, from 264 to 262; and typhoid fever, by 4, from 1,704 in 1955 to 1,700 in 1956; while tetanus incidence increased from 462 in 1955 to 468 in 1956. Diphtheria

Although several outbreaks of diphtheria were reported during 1956, the number of cases associated with them was small compared with the experience during the latter part of 1955. In the summer of that year a temporary rise began in the incidence of the disease. This continued through the fall and winter months, extending into the first months of 1956. But after that time the downward trend was resumed.


Vol. 5, No. 53

Included in the category of encephalitis are several types having different etiologic agents. The several types cannot be distinguished from each other except by serologic tests. Postinfectious encephalitis, which often accompanies or follows measles, whooping cough, and certain other acute infectious diseases, occurs most frequently in the seasons when these diseases are prevalent. The arthropod-borne types are predominantly summer diseases since the vectors are most numerous and active in that season.

In 1956 there were several large outbreaks of arthropodborne encephalitis, including eastern equine, western equine, and the St. Louis type. In Massachusetts eastern equine infections were reported in horses and pheasants; and for the first time since 1938 there were multiple cases in man. As in 1938 the cases in man were severe and frequently fatal with the majority of them occurring in young children. Most of those who survived showed evidence of considerable damage to their central nervous systems. Two human cases were also reported in Maryland. Infections in animals were common in States along the eastern seaboard from Massachusetts to the gulf coast. Large epidemics of St. Louis encephalitis were reported in 2 areas in Kentucky and also in Texas. Western equine infections occurred mainly in sporadic form. Of 277 reports of laboratory confirmed cases of arthropod-borne encephalitis, 227 were of the St. Louis type, 37 western equine, and 13 eastern equine.


The incidence rate per 100,000 estimated population for poliomyelitis in 1956 was 9.1 or almost half the rate of 17.6 for 1955. In 1954 the rate was 23.9. For 1956 the highest incidence was in the Western States, lower in the North Central, about half as high in the Southern States, and less than a fourth as high in the Northeastern States. The incidence rates for 1955 and 1956 by States are shown in the chart.

The highest incidence of poliomyelitis in 1955 resulted from an outbreak of the disease in Boston with a rate of 82.8 for Massachusetts and 58.1 for the New England States. Although an outbreak occurred in Chicago during 1956, the rate for Illinois was only 20.7 for the year. Other States with incidence rates in excess of 15.0 for 1956 were Utah, 28.0; Iowa, 21.5; Louisiana, 20.2; Idaho, 17.6; California, 15.8; and Texas, 15.2. In 1956 the lowest rate was for Rhode Island, 1.1; while in 1955 it was for Alabama, 5.9.


Increases in the number of psittacosis cases were reported from all sections of the country. Substantial increases

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