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Morbidity and Mortality U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Prepared by the COMMUNICABLE DISEASE ' Ear rp..ln.. Apr 2-, 19i64 ATLANTA, GEORGIA 30333 Vol. 13. No. 16 PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN TFATES AND ON DEATHS IN SELECTED CITIES FOR WEEK ENDED APRIL BRUCELLOSIS Fifteen cases of brucellosis were reported for the compare with re 2(6 ,1A t1giport rr comparable week ended April 18, thus bringing to 120 the cumulative periods of 196 2, and 1961, res ly. Iowa ac- total for 1964. Iowa reported 12 cases this week; single counted for 40 pe ent f the Nation's 9 roal. cases were reported from Illinois, Kentucky, and North For rhe c omp' ble d le jago, 106 cases Dakota. were reported through e Uni rates. The annual Of Iowa's 12 cases, 7 were delayed reports from the total for the country has ec tied from the 6,321 cases one county which annually reports the greatest number of reported in 194' to the 381 cases reported last year. that State's cases. Thus far in 1964, this county has Nationally, packing house workers comprise 50 per- accounted for 20 of Iowa's 39 cases of brucellosis. All of cent of the patients with brucellosis, contrasted with 25 this county's cases were industrially acquired, from swine percent in 1958. Whereas swine were the source for about at a single packing house. 10 percent of brucellosis 6 years ago, they accounted for This year's 120 cases represent reports from 31 about -10 percent in 1963. Most of the industrially acquired States. Iowa's 39 cases are the highest for any State and brucellosis is of swine origin. Table I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES (Cumulative totals include revised and delayed reports through previous weeks) 16th Week Ended Cumulative. First 16 Weeks Disease April 18, April 20, Median Median 1964 1963 1959 1963 1964 1963 1959 1963 Aseptic meningitis ................ 29 18 --- 439 351 Brucellosis ....................... 15 13 11 120 106 167 Diphtheria ........................ 10 1 8 65 100 230 Encephalitis, primary infectious.. 38 -28 -- 514 ~ 412 Encephalitis, post-infectious ..... 27 --- 221 J1- Hepatitis, infectious including serum hepatitis ............... 825 845 845 14,566 16,334 16,334 Measles............................ 29,671 17,460 17,630 196,961 195,705 201,668 Meningococcal infections .......... 69 46 46 970 944 900 Poliomyelitis, Total ........... 3 1 6 22 44 127 Paralytic ...................... 3 1 6 16 39 82 Nonparalytic ................... --- 5 2 --- Unspecified .................... --- 1 3 Streptococcal Sore Throat and Scarlet fever .................. 10,452 7,408 --- 172,981 154,383 --- Tetanus .......................... 5 5 --- 60 55 Tularemia ........................ 2 3 --- 78 61 Typhoid fever .................. 8 7 10 103 113 152 Rabies In Animals ................. 111 94 81 1,361 1,150 1,289 Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY Cum. Cum. Anthrax: 2 Psittacosis: 13 Botulism: 6 Rabies in Man: Leptospirosis: Pa.-l 7 Smallpox: Malaria: N.J.-1, Ga.-1 29 Typhus- Plague: Marine: Mo.-1 3 SRky Mt. Spotted: Va.-I 7 634-S131 F7 2.60/4:13/1l Morlidity and Mortality ~ ikly Rrport EPIDEMIOLOGICAL REPORTS PLAGUE Arizona A detailed clinical account is presented of the fatal case of plague reported on page 121, of Vol. 12 of the M MTWR. The victim was a 28-\ear-old, unmarried, Navajo sheep herder who lircd 5 miles north of louck, Arizona, which is located on U. lligh ay 66. On December 1, he drove his sheep to a pasture where thev grazed through IDccumber 5. On December 5, he experienced the abrupt onset of chills, headache, abdominal pains, green, waerry diarrhea, and frequent expulsion of blood-tinged vomitus. He also complained of pain under his left arm. His symptoms per- sisted and he was driven to the Gallup, New Mexico, Indian Hospital. December 7. At 11 a.m., he was seen in the out-patient department. His vital signs were: temperature %.8"F., blood pressure 1L2 88, and pulse 130. Positive physical findings in- cluded subjective abdominal tenderness, moderate guard- ing without rebound, and decreased bowel sounds. The initial clinical impression was gastroenteritis, with the possibility of surgical abdomen. On the surgical ward at 2:30 p.m., his vital signs were: temperature 98.80F., blood pressure 80 "60, pulse 14if. and respirations 36. He was described as alert, restless, and dvspneic. He stated he had difficulty breath- ing. oxygen was administered. A large, painful, solitary node in the left axilla was noted on repeat physical ex- amination. The overlying tissues were indurated without pitting or eryrhema. Repeat abdominal examination re- vealed increased guarding on the right. His initial laboratory tests were: hemoglobin 16.6, hematocrit 50, white count 105,000, differential poly- morphs 64, bands 22, lymphs 13, and monocytes 1. Nu- merous bacteria (5 per white blood cell) were noted on the peripheral blood smear. Gram stain of the peripheral blood revealed numerous pleomorphic gram negative rods. His chest X-ray was interpreted as normal, his abdominal film showed less than normal gas, an electrocardiogram showed sinus rachvcardia, and his electrolytes were: CO- 28.6, Na 134, C1 87, and K 5.2. At 1:45 p.m., his temperature rose to 104.6"F. It was learned at this time that he frequently killed rabbits for food; he reported having killed and torn apart cottontail rabbits for his dog 3 days prior to onset. Diagnosis of gram negative septicemia,probably Pasteurella tularensis, was made. At 6 p.m., his temperature rose to 106.2"; his vital signs were: blood pressure "6 '0, pulse 120, and respira- tions 40. Despite treatment with streptomycin and chloro- mvcetin. he expired 8 hours after he was first seen in the out-patient department. At post-mortem examination, the only skin lesions present were a scratch on the lateral aspect of the left arm and an abrasion of the right thumb. Positive autopsy finding. included bilateral pleural effusions, heavily congested lungs, gra Irothy fluid within the trachea and bronchi, which had iniccied mucosa, submucosal gastric pLrechiae. and black, liquid stool in the rectum. Lymph nodes from the left axilla measured 2x2 centimeters and were hemorrhagic and necrotic. Pre-morrem blood cultures and bone marrow revealed Pasteurtila prstrs and pn, imooccus type VI. Post- mortem cultures of 1 mph node, liver, and spleen also demonstrated both organisms. A bone marrow smear was interpreted as demonstrating a leukemoid response. Hospital and family contacts were treated prophylac- tically with streptomycin and sulfonamide. No further cases have been suspect or diagnosed. (Reported b\ Robert L. HRrrschr. 11.D.. Medical Officer in Charge. Indian ilcalrl Hospital. Gallup. \'eu Mexico. Dr. Lloyd M. Farner. (.ummissionc, of I'ublic Health. Art:ona State De- partment o Health, and a tearm tirom the Communicable Disease Center). Editor's .ote. The co-existence of another organism with P. pestus, in thts case pneumococci Type VI, is an in- teresting phenomena which has been observed in at least one previous case of plague and which may mask the diagnosis of plague. In 1961, when 3 cases of plague were reported, post-mortem bacteriologic studies in one of the 2 fatal cases revealed the presence of hemolyric streptococcus Group A in addition to P. pests. MUSHROOM POISONING Colifomin Two San Joaquin County children experienced mus- carine poisoning within I hours after ingesting dried mush- rooms. Between 2 and I hours after eating the dried mush- rooms, which had been added to freshly opened tomato soup, a 16-year-old boy and his 3-year-old sister became acutely ill. They experienced vomiting, diarrhea, hema- temesis, melena, abdominal cramps, fever, vasomotor flush, bradycardia, and hyporension. They were hospitalized and treated with atropine; both children recovered within 48 hours. The suspect mushrooms were part of a larger non- commercial stock picked locally and used by the family during the past year without known ill effects. A sample of remaining mushroom was described as a member of the Roletus genus; further identification was not possible because of the condition of rhe sample. Certain species of the Boulrts genus have been incriminated in previous mushroom poisonings. 'Reported b\ ]ack J ili arr.s. M.D.. District Health Officer. and Philip fBearg. s I.D.. assistantt District Health Officer. San Joaquin Local Health District. Stockton. Caliornia; Philip K rCondit .1.. Chriet. Bureau of Communicable Diseases. California rate Department of Publir HealrbL. ____________A 13 Morbidity and Mortality Weekly Report SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS MARCH 1964 MARCH 1963 135 CASES OF PRIMARY AID SECONDARY SYPHILIS: By Reporting Area March 1964 and March 1963 Provisional Cumulative Cumulative Reporting Area March, Jan Mar Reporting Area March, Jan Mar 1964 1963 196' 1963 1964 16 196964 1963 NEW ENGLAND............... 43 28 125 97 EAST SOUTH CENTRAL.......... 139 134 376 353 Maine................... I I 1 2 Kentucky................. 11 3 30 24 New Hampshire ............ 1 4 2 Tennessee................ 36 46 108 116 Vermont ................. I I I 1 Alabama.................. 74 53 194 153 Massachusetts............ 25 12 78 49 MississippLi.............. 18 32 44 60 Rhode Island.............. 1 2 5 5 Connecticut............. 14 12 36 38 WEST SOUTH CENTRAL........ 202 227 612 687 Arkansas.................. 1. 18 46 48 MIDDLE ATLANTIC.......... 517 526 1,398 1,501 Louisiana ................ 46 43 145 146 Upstate New York......... 69 52 181 136 Oklahoma..... ............. 18 13 35 50 New York City............ 320 297 824 874 Texas.................... 124 153 386 443 Pa. (Excl. Phila.)....... 12 13 35 36 Philadelphia ............. 31 76 87 202 MOUNTAIN .................. 40 31 136 116 New Jersey............... 85 88 271 253 Montana.................. 2 3 - Idaho .................... - EAST NORTH CENTRAL ........ 177 181 561 492 Wyoming .................. 1 6 2 Ohio..................... 30 33 137 97 Colorado................. 3 3 4 15 Indiana............. .... ...... 3 3 18 12 Nei Mexico............... 20 8 70 22 Downstate Illinois....... 7 12 33 31 Arizona.................. 12 14 37 54 Chicago.................. 78 77 215 231 Utah ..................... 4 4 8 Michigan................. 53 49 144 105 Nevada ................... 2 2 8 15 Wisconsin................ 6 7 14 16 PACIFIC.................... 181 172 630 524 WEST NORTH CENTRAL......... 47 44 162 108 Washington............... 1 12 12 42 Minnesota ................ 10 9 34 21 Oregon ................... 8 3 25 10 Iowa ................... .. 2 4 8 7 California .......... ..... 171 156 585 465 Missouri .... ............. 25 19 77 42 Alaska ................... 3 2 North Dakota ..... ....... Hawaii..................... I 5 5 South Dakota.............. 2 15 5 Nebraska................. 4 6 19 16 U. S. TOTAL................ 1,870 1,962 5,637 5,.30 Kansas................... .. 6 9 17 TERRITORIES............... 63 70 196 178 SOUTH ATLANTIC............ 52' 619 1,637 1,552 Puerto Rico.............. 62 69 191 174 Delaware ................. 6 2 27 15 Virgin Islands........... 1 5 4 Maryland............. .. 62 40 142 129 District of Columbia..... 36 72 131 187 Virginia .................. 18 28 69 79 West Virginia............ 6 9 10 15 North Carolina........... 78 92 239 228 Note: Cumulative Totals include revised and delayed reports South Carolina........... 80 68 226 181 through previous months. Georgia................... 94 108 279 263 Florida................... 144 200 514 55 SUMMARY OF DEATHS AMONG PERSONS 65 YEARS AND OVER IN 108 U.S. CITIES The weekly average number of deaths among persons 65 years and over in 108 cities for the four-week period ending April 18 was 6,"06 as compared with an expected weekly average of 6,914. Week Ending 4 Week Weekly 3 28 4'4 411 4. 18 Total Average Observed 6,476 6,952 6,836 6,560 26,824 6,706 Expected 6,991 6,943 6,890 6,831 27,655 6,914 Excess -515 9 54 -271 -831 -208 NUMBER or arwo EATHS 8000 DEATHS or AGE 65 and OVER in 108 U.S CITIES 4.ero-- Nubwe Dc ee* 0. Our Hi eeh P-..os- I 4 --- t i-..oo No -. .. ? *. i. .- .." '.- .* r. .- "-c (Sce tab!c, page 119) 136 1lorbiditi and Mortality Weekl Report 1 ahlc (:ASES OF SPECIFIC) NOTIFIABLE DISEASES UNITED STATES FOR WEEKS ENDED APRIL IN. 196( AND APRIL 20. 1965 ( 16ih WEEK) Encephalitis Aseptic Meningitis Primary Post-lnf. Puliomyelitis, Total Cases Poliomyelltai, Paralytic Area Cumulative Cumulative 1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 1963 UNITED STATES... 29 18 38 27 3 1 22 44 3 1 16 39 NEW ENGLAND.......... 1 1 2 - Maine.............. - New Hampshire ...... - Vermont ............- - Massachusetts...... - Rhode Island....... 1 2 - Connecticut........ - MIDDLE ATLANTIC...... 10 9 5 4 5 4 5 New York City...... I 1 1 - New York, Up-State. 2 1 1 2 4 2 4 New Jersey ......... 6 5 1 1 - Pennsylvania....... 2 2 4 1 1 EAST NORTH CENTRAL... 5 1 7 12 1 2 12 1 2 10 Ohio ............... 1 2 1 1 1 4 1 1 3 Indiana............ 2 - Illinois........... 3 9 1 6 1 5 Michigan........... 2 3 2 2 2 Wiscons n......... - WEST NORTH CENTRAL... 2 2 8 1 - Minnesota.......... 2 2 3 1 - Iowa ............... - Missouri........... - North Dakota....... - South Dakota...... - Nebraska............ - Kansas............. 4 - SOUTH ATLANTIC....... I 5 2 1 11 4 1 8 3 Delaware.......... - Maryland........... - Dist. of Columbia.. - Virginia ........... -- West Virginia...... I I I 1 North Carolina..... I 5 2 I 2 2 South Carolina.... 1 1 Georgia............ 1 1 1 - Florida............ 1 4 3 1 EAST SOUTH CENTRAL... 1 3 1 3 2 Kentucky........... 2 - Tennessee .......... 1 1 1 1 Alabama............ I 2 1 - Mississipp ........ ... - WEST SOUTH CENTRAL... 1 2 3 2 9 1 9 Arkansas........... I - Louisiana.......... 1 8- 8 Oklahoma............ . Texas.............. 2 2 2 1 1 1 MOUNTAIN.............. 1 1 1 2 1 1 1 Montana............ . Idaho............... 1 Wyoming.............. . Colorado ............ 1 .- .. l - New Mexico......... . Arizona............. . Utah............... - Nevada............... . PACIFIC ............. 7 8 4 9 9 8 Washington.......... 1 2 3 1 1 Oregon............ I l 1 California......... 5 5 1 9 7 6 Alaska. ............ . Hawaii............. - Puerto Rico 2 2 Morbidity and Mortality Weekly Report 137 Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES FOR WEEKS ENDED APRIL 18, 1964 AND APRIL 20. 1963 ( 16Ih WEEK) Coniinued Infectious Hepatitis Brucellosis Diphtheria including Serum Hepatitis Typhoid Fever Area Under 20 years Age Cum. Cum. Total 20 years and over Unknown Cumulative Cum. 1964 1964 1964 1964 1964 1964 1964 1964 1964 1963 1964 1964 UNITED STATES... 15 120 10 65 825 386 371 68 14,566 16,334 8 103 NEW ENGLAND............ 1 4 74 30 40 4 1,563 1,942 7 Maine.............. 1 27 12 13 2 553 900 New Hampshire...... 2 1 123 134 Vermont ............ 10 9 1 193 27 - Massachusetts....... 1 3 20 4 15 I 310 570 4 Rhode Island....... 1 1 69 48 3 Connecticut........ .- 14 3 10 1 315 263 - MIDDLE ATLANTIC...... 2 4 223 92 131 3,315 3,170 1 18 New York City..... 1 33 11 22 472 400 1 6 New York, Up-State. I 82 46 36 1,466 1,422 4 New Jersey........ 2 40 9 31 600 491 - Pennsylvania........ 1 68 26 42 777 857 8 EAST NORTH CENTRAL... I 16 6 124 70 44 10 2,176 2,582 1 22 Ohio............... 43 26 14 3 589 766 1 15 Indiana............1 15 9 5 1 184 229 3 Illinois........... 1 11 6 14 5 9 336 558 3 Michigan.......... 2 35 21 14 928 894 1 Wisconsin.......... 2 17 9 2 6 139 135 - WEST NORTH CENTRAL... 13 68 1 10 39 18 10 11 855 720 1 10 Minnesota.......... 2 2 3 3 68 118 - Iowa................ 12 39 5 1 4 124 121 3 Missouri........... 4 8 4 3 1 208 298 1 3 North Dakota....... 1 2 1 36 19 - South Dakota....... 10 1 86 26 - Nebraska........... 10 18 56 Kansas ............. .- 1 7 22 12 10 315 82 3 SOUTH ATLANTIC....... 6 6 17 90 44 44 2 1,444 1,746 4 24 Delaware............ 1 31 25 - Maryland........... 12 5 7 272 193 1 1 Dist. of Columbia.. 26 57 Virginia........... 2 11 8 2 216 389 1 5 West Virginia...... 19 12 7 256 254 - North Carolina..... I 25 16 9 274 471 9 South Carolina..... 3 7 4 3 49 76 2 Georgia............. 2 6 12 2 1 1 33 70 1 I Florida ....... .... I 2 13 5 8 287 211 1 6 EAST SOUTH CENTRAL... 1 6 4 45 36 9 1,012 1,674 1 11 Kentucky............ 1 2 15 14 1 444 504 1 6 Tennessee.......... 1 18 14 4 348 656 4 Alabama............ 3 2 8 4 4 141 250 1 Mississippi........ 1 1 4 4 79 264 - WEST SOUTH CENTRAL.. 5 3 13 54 32 17 5 1,046 1,110 6 Arkansas........... I 6 5 1 121 133 3 Louisiana........... 1 1 3 13 8 5 216 206 - Oklahoma............ I 5 5 67 61 3 Texas.............. 2 2 10 30 14 11 5 642 710 MOUNTAIN............. 10 1 51 13 5 33 971 1,145 Montana............. 6 1 1 4 91 172 - Idaho.............. 5 5 73 164 - Wyoming............. 1 1 33 19 - Colorado........... 21 5 16 303 242 - New Mexico......... I 1 8 5 3 154 139 - Arizona............. I 8 8 205 255 - Utah............... 7 2 2 84 145 Nevada............... 1 28 9 PACIFIC............... 6 6 125 51 71 3 2,184 2,245 5 Washington......... 6 17 8 7 2 229 378 1 Oregon............. 1 20 14 5 1 235 321 California........ 5 85 27 58 1,605 1,484 4 Alaska............. -2 2 67 49 - Hawaii............. 1 48 11 - Puerto Rico 3 18 12 6 212 219 1 6 138 1Morbidity and MorIality 'eekly Report Tjhlr 3 CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES FOR WEEKS ENDED APRIL IS. 1964 AND APRIL 20. 1964 ( 16rh WEEK) Conrinued Streptococcal Meningococcal Sore Throat and Rabies in HMailesIf Meningitis Scarlet Fever Tetanus Tularemia Animala Cumulative Cum. Cum. Cum. _1961 9l6 1964 1963 1964 1963 1964 1 196 1964 1964 1964 1964 UNITED STATES... 29,671 69 970 944 10,452 7,408 5 60 2 78 111 1,361 NEW ENGLAND........... 801 3 29 67 1,185 969 3 7 Malne.............. 13* 2 10 46 10 3 5 Ntw Hampshirr...... 7 2 3 10 1 Vermont .............. 88 I 2 3 I I MassachuseEtts ...... 254 13 31 242 119 - Rh.odr Island ....... 139 2 6 127 70 - C.nnecticut ........ 179 3 11 16 764 759 - MIDDLE ATLANTIC...... 2,980 3 93 120 542 443 2 3 4 29 New Y'rk City...... 819 17 15 27 51 - Neu Nork, Up-State. 464 I 34 39 250 200 4 28 New Jersey......... 871 14 21 104 126 2 2 - Pennsylvania....... 826 2 28 45 161 66 1 1 EAST NORTH CENTRAL... 6,671 11 154 155 1,650 1,118 5 8 12 142 Ohio............... 1,637 3 48 45 384 113 1 1 68 Indiana ............ 1,785 3 28 18 318 144 1 8 Illinois........... 853 2 31 25 192 256 2 5 9 33 Michigan........... 1,441 2 34 48 472 379 I 1 12 Wisconsin.......... 955 1 13 19 284 226 1 3 21 WEST NORTH CENTRAL... 4,274 5 55 58 488 300 3 21 36 438 Minnesota.......... 24 10 10 25 23 1 11 131 lowa................. 3,740 1 3 2 221 50 I 1 13 152 Missouri........... 194 4 30 25 15 15 2 13 3 79 North Dakota....... 234 3 1 156 151 20 South Dakota....... 3 4 2 39 Nebraska........... 82 4 14 2 1 9 Kansas............. NN 5 3 65 59 6 3 8 SOLTH ATLANTIC....... 2,828 23 220 192 1,218 584 2 24 1 14 18 214 Delaware ........... 34 2 1 11 10 - Maryland........... 144 2 17 27 184 41 1 2 - Dist. of Columbia.. 15 7 3 8 - Virginia........... 970 22 49 308 178 2 3 9 149 West Virginia...... 515 1 17 10 392 145 3 11 North Carolina ..... 193 37 30 77 63 7 1 4 2 South Carolina..... 302 5 34 12 42 13 3 - Georgia ............ 5 1 18 11 13 1 1 7 5 26 Florida ............ 650 b 66 .9 183 133 1 9 1 26 EAST SOUTH CENTRAL... 2,780 4 99 79 1,657 1,156 1 9 16 23 214 Kentucky............ 869 31 20 161 147 1 1 3 28 Tennessee.......... 1,394 2 36 34 1,383 978 1 4 II 18 178 Alabama............ 373 17 12 13 13 3 3 2 8 Mississippi........ 144 2 15 13 100 18 1 1 - WEST SOUTH CENTRAL... 5,264 10 87 105 758 684 8 1 15 11 214 Arkansas............ 63 1 8 5 11 1 2 3 7 53 Louisiana.......... 3 6 71 46 1 3 3 2 22 Oklahoma............ 94 3 19 50 86 1 11 2 24 Texas.............. 5,104 3 5 35 696 594 3 I 115 MOUNTAIN ............. 901 1 37 32 1,576 1,130 2 4 50 Montana............ 92 1 130 92 1 Idaho.............. 66 1 1 159 161 - Wyoming............. 24 I 1 5 14 1 1 - Colorado............ 163 1 8 7 622 390 - New Mexico......... 39 18 2 235 238 1 25 Arizona............. 372 2 6 171 147 25 Utah............... 102 1 11 254 87 2 - Nevada............. 43 6 3 I - PACIFIC ......... ...3,172 9 196 136 1,378 1,024 6 4 53 Washington......... 1,263 16 12 428 371 - Oregon ............. 365 1 12 6 45 28 - California.......... 1,507 7 157 112 798 536 6 4 53 Alaska............. 1 I 6 4 7 54 - Hawaii.............. 36 5 2 100 35 - Puerto Rico 238 1 12 4 7 34 1 20 6 Morbidity and Mortalily U iklv Iy Rporl 139 1.ihk l (D) TOTAL DI A1Hs AM()N( PE H()NS 65 I AR. AN) ()\VI IN RI P()TIN(, I I (Tables 4(A), 4(B), 4(Ci, and '(D) will be published in sequence covering a fuur-wit l period.)" Art For weeks ending Fo r Weeks ending 3/28 1 /4 4/11 4/18 3/28 .-/II 11 4/18 NEW ENGLAND: Boston, Mass ............. Bridgeport, Conn........... Cambridge, Mass........... Fall River, Mass......... Hartford, Conn............ Lowell, Mass .............. Lynn, Mass................ New Bedford, Mass......... New Haven, Conn........... Providence, R.I........... Somerville, Mass.......... Springfield, Mass......... Waterbury, Conn ........... Worcester, Mass........... MIDDLE ATLANTIC: Albany, N.Y............... Allentown, Pa ............ Buffalo, N.Y............... Camden, N.J ............... Elizabeth, N.J............ Erie, Pa.................. Jersey City, l.J .......... Newark, N.J ............... New York Cit/, N.Y........ Paterson, N.J............. Philadelphia, Pa.......... Pittsburgh, Pa............ Reading, Pa............... Rochester, N. ............ Schenectady, N.Y. ......... Scranton, Pa ............. Syracuse, N.Y............. Trenton, N.J.............. Utica, N.Y ................ Yonkers, N.Y.............. EAST NORTH CENTRAL: Akron, Ohio ............... Canton, Ohio............... Chicago, Ill.............. Cincinnati, Ohio........... Cleveland, Ohio............ Columbus, Ohio............ Dayton, Ohio.............. Detroit, Mich............. Evansville, Ind ........... Flint, Mich............... Fort Watne, Ind.......... Cary, Ind................. Grand Rapids, Mich....... Indianapolis, Ind......... Madison, W ;s.............. Milwaukee, WL ............ Peoria, Ill............ ... Rockford, Ill ............ South Bend, Ind............ Toledo, Ohi .o.............. Youngstown, Ohio.......... WEST NORTH CENTRAL: Des Moines, iowa ......... Duluth, Minn............. Kansas City, Kans........ Kansas City, M ........... Lincoln, Nebr............ Minneapolis, Mann........ Omaha, Nebr.............. St. Louis, Mo............ St. Paul, Minn........... Wichita, Kan ............ 103 21 13 24 29 25 12 25 20 46 7 26 14 33 27 20 80 19 15 32 37 52 923 14 234 109 38 57 15 22 25 23 19 25 24 21 349 100 106 60 57 207 18 24 18 12 31 89 13 56 18 22 12 66 32 28 12 28 72 16 82 54 159 45 23 172 210 27 26 33 9 14 18 30 39 8 43 22 33 25 25 95 26 17 37 42 47 928 26 354 88 47 68 36 21 35 32 9 25 33 25 473 122 116 65 52 202 21 19 27 23 19 82 18 77 14 21 30 67 34 40 10 14 74 31 113 47 140 62 26 155 25 20 21 31 22 22 15 26 .2 9 22 16 41 27 24 90 21 23 22 48 50 1097 25 325 84 30 54 21 18 40 27 18 29 34 20 400 92 132 80 53 197 32 22 30 10 40 93 12 67 24 25 27 69 40 37 18 15 87 17 84 34 127 68 39 156 28 17 16 35 14 19 25 39 38 10 23 19 35 27 13 92 34 24 25 42 .8 950 3' 287 100 38 64 12 26 44 25 29 16 25 22 344 92 132 59 36 181 31 25 28 19 29 77 30 73 16 16 24 55 42 38 29 19 53 17 92 44 135 46 31 SOUTH ATLAWNIC: Atlanta, Ga............... Balt im:or ld ............ Charlorce, N.i ........... Ja ck onv.'llE, Fla ........ Il m i, Fla ............... Norfolk, Va.............. Rics c.nd, Va............. Savannah, Ca............. St. Petersburg, Fla...... Tampa, Fla............... Washington, D.C.......... Wilminbir n, Del.......... EAST SOUTH CEirTPAL: Bir li ngham, Ala.......... Chat tanooga, Tenn....... Knoxville, T nn.......... Lco'uiville, Ky ........... Memphis, Tinn............ Mobile, Ala .............. Muntgaiery, Ala.......... Nashville, nnr .......... WEST SOUTH CENTRAL: Austin, Tex.............. Bacon Ro.Vue, La ......... Corpus Christi, Tex...... Dallas, lex.............. El Paso, 7Te ............. Fort Worth, Tex.......... Houscon, Te ............. Little Rock, Ark......... New Or leans, La.......... Oklahoma Cit', Okla...... Ean AiC,'n.- Tex. ........ ShrE~po.rt, L. ........... Tulsa, Okla .............. MOUIflAIN: Albuquerqu-,, l. lex ...... Cul radio Rpring; Colo... Denver, C. 1 ............. Ogden, Utah.............. Phcenix, ArLZ ............ Pueblo, Coi ............. Salt LAsb Ct .., Uiah..... Tu >ce n, Ariz............. PACIFIC: BerKr l Calif .......... Fresno, Calif ............ Glendale, Calif.......... Honolulu, Hawar ......... Long BeEch, Calif........ Lo; Angele Cal if....... Oakland, Calif........... PasadErn C lif ........... P-rcland, Ore ........... Sacramenro, Calif........ San DicE'- L3 if ......... San Fran xc i o, Callf ..... San Jo,.; Cal f .......... Seattl Wash............ Spukane, Wash ............ Tacoma, Wash ............. 59 143 17 -2 45 23 49 17 69 33 101 25 48 19 24 54 56 20 6 40) 15 20 10 76 2'2 35 89 30 100 64 59 32 22 22 13 66 7 57 6 35 28 62 135 14 37 47 34 47 22 66 38 95 17 50 * 23 28 75 * 61 11 14 75 23 24 10 78 14 53 81 33 75 44 56 28 22 13 16 72 8 60 7 34 40 6 30 25 19 * 41 261 64 22 67 32 65 121 34 82 49 28 San Juar., P.R .............. .. 3 12 10 0Current Wek 1h rtality for 108 Select.J Citis 4(A) Total Mortality, all ags..................... 11,661 4(B) Pneumonia-Influenza Deaths, all ages........ 501 .(C) Total Deaths under 1 Year of Age ............ 670 4(D) Total Deaths, Persons 65 years and over..... 6,560 *Estimate based on average percent of divisional total. Totals for previous weeks include reported corrections. NOTE: 411 death by place o1 ccr..uace. I Morbidity and Morlality Weekly Report INTERNATIONAL NOTES QUARANTINE MEASURES Immuniration Informatirn for International Travel 19i6-64 edition I'bJ'i. Hl,,lilh r ,I rfr-r Publication No. 384 SECTION S EUROPE Netherlands, page 60 Insert: Smallpox And from all countries in Africa, Asia, and America except Canada and the Unired Stares of America I. All other information remains the same. Poland, page 60 Insert the information under REQUIRED: Smallpox-Except: (a) children under 3 months who have nor been in an infected local area during the 14 days preceding arrival; (b) travellers arriving directly from the following countries, provided they have been resident there for a period of 14 days, and these countries are free from smallpox: USSR (thewhole territory), all European countries, Canada and the United States of America. In addition to the established procedures for reporting morbidity and mortality, the Commun.cable Disease Center welcomes accounts of interesting outbreaks or cases. Such accounts should be addressed to Lawrence K. Altman. M.D., Editor Morbidity and Mortality Weekly Report Communicable Disease Center Atlanta, Georgia 30333 Notes Theie provisionol data ore based on weekly rolegramu o the Communl- cable Dsoease Center by the individual State heaolh depromenfs. Symbols- Data not available guanrtl) zero Procedures for construction of various mortally curves may be abtalned from Slatisics Section, Communicable Disease Center. Public Hedrh service, U. S. Departnnt of Health, Educatlon, ad Welfare. Atlanta. Gorglo 3033.. i9 * ml1 a Ir W N S~ The Morbidity and Mortality Weekly Report, with a circulation of 11,000 is published by the Communicable Disease Center. Atlanta, Georgia. Chief, Communicable Disease Center Chref. Epidemiology Branch Chief, Statstrics Section Asst. Chief, Statistics Section Chief. Surveillance Section Ed tor, MMWR James L. Goddard. M.D. A D. Langmuir, M.D. R. E. Serfling, Ph.D. I. L. Sherman, M.S. D. A. Henderson, M.D. L. K. Airman, M.D. 1 40 UNIVERbITY OF FLORIDA IIIlll1111111111111 3 1262 08864 3167 e -3 Om ?11 'Ku" |
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