Table 2. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES, EACH DIVISION AND STATE, ALASKA, HAWAII, AND PUERTO RICO, FOR WEEKS ENDED MAY 7, 1955 AND MAY 5, 1956-Continued (By place of occurrence. Numbers under diseases are category numbers of the Sixth Revision of the International Lists, 1948) 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. Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended May 12, 1956 Two suspect smallpox cases in southwest Missouri are un- Q fever (probable laboratory infection) der investigation. One is in a 12-year-old girl who had onset May 2; the other is in a 60-year-old woman who had onset May 4. There is no association between the 2 cases. Of the 383 cases of infectious hepatitis reported this week, 90 were in the Middle Atlantic States, 57 in the East North Central, and 68 in the Pacific. Since January 1,a total of 9,362 cases has been reported in the country as a whole compared with 16,241 for the same period last year. The number of poliomyelitis cases reported for the current week, disease year, and calendar year are shown below. The California State Department of Public Health has supplied epidemiological information on typhus fever in the Altadena-Pasadena area. Two cases of endemic typhus fever were reported in this area during February. Laboratory tests showed a positive Weil-Felix reaction with OX19 for both cases. For one case the titer was 1:320 and for the other, 1:1200. The complement fixation titer for one showed an eight-fold rise, but there was no complement fixation reaction for the other case. As a result of finding potential rat harborages while investigating the first case, it was decided to conduct a survey. During this survey, 6 rats were caught, yielding 1 flea. Blood specimens from several dogs and cats gave negative complement fixation reactions. Only 2 fleas were found on these dogs and cats. So far rodent trapping has been unsuccessful. The survey will be continued with changes in trapping techniques. An effort will be made to trap stray cats for laboratory tests. During the past 25 years, 22 cases of typhus fever (endemic -type) have occurred in the foothill area of Altadena, Pasadena, and Sierra Madre. Rats have been found to be natural habitants of that area. Investigations in recent years have indicated an association between the disease and pet cats in many instances. Blood specimens and ectoparasites submitted to the laboratory have been negative for typhus. In 1952, there were 11 laboratory confirmed cases of endemic typhus during October-December. At that time a survey was made of 94 homes. From 340 persons contacted, 175 blood specimens were collected, all of which were negative for typhus by complement fixation. During 1953 there were 3 cases in that area; in 1954 only 1 such case was reported. An endemic focus of typhus fever appears to exist in that foothill area. Although each episode was investigated by local and State health authorities, none of the investigations led to any identification of the sources. The California State Department of Public Health has given preliminary information on 5 cases of Q fever reported among employees of a biologics laboratory. One of the 5 was a maintainance man. Complement fixation tests with Q fever antigen were positive in dilutions ranging from 1:64 to 1:1024. These cases have been under investigation for several months, recently another possible case was found. Four persons of the original 5 worked with human placentas and with bovine and human blood. The placentas are no longer used in processing procedures of the laboratory. The recent suspect case was employed in the blood products unit. Psittacosis Dr. S. H. Osborn, Connecticut State Department of Health, has reported a case of psittacosis in a 50-year-old man. The clinical diagnosis was virus pneumonia. However, complement fixation tests on blood specimens showed an eight-fold rise in titer for psittacosis. The patient has owned 2 parakeets for several years, and the birds are in good health. He also owns numerous fowl, and blood specimens are being collected from a representative sample of each species. Anthrax Dr. E. J. Witte, Veterinarian, Pennsylvania Department of Health, has reported 3 cases of anthrax, 2 of which were associated with imported goat hair from Asia. Two of the patients worked in the same mill and lesion smears were positive for anthrax. Following a case of anthrax in this mill in January 1956, an inspection was made and air samples taken. The presence of anthrax spores was demonstrated. Recommendations for cleaning the plant and machinery were made at this time. Suggestions were also given regarding an employee educational program. When the last case was reported an official of the plant told the investigator that the company was working with public health officials on a control program. The other case was in a different mill, and the source of infection was not stated. Disease of unknown etiology Dr. James O. Bond, Florida State Board of Health, reports that in a small town a disease syndrome has been observed which resembles an occurrence in another part of the State in 1954. A total of 64 cases, all but one in adult females, has been seen during the past 10 weeks. Symptoms have been sharp, recurrent pains in the muscles of the neck, thorax, and shoulders; severe headache; disturbance in coordination; and some transient motor and sensory disturbances. Nystagmus and hyperactive reflexes have been found. Routine laboratory studies have shown no abnormalities, but special virological studies on 9 patients are being conducted. Malaria Dr. J. D. Martin, Louisiana State Department of Health, has reported a case of malaria in a man who recently returned from a 2-month hunting trip in Mexico. The onset of illness took place 7 days prior to date of his return, but he did not |