Contagious Diseases

The persistence of typhoid fever and smallpox in the U. S. is puzzling epidemiologists.

Too Much Typhoid. Last week the Journal of the American Medical Association published its annual survey of deaths from typhoid fever in U. S. cities of 100,000 or more population. In 1925 there were 77 such cities, 8 more than in 1920. Last year two such cities were entirely free from typhoid fever mortality--Lowell, Mass., and Scranton, Pa. The greatest mortality was in Memphis, Tenn.--28.6 per 100,000.

Study of these tables shows that the typhoid fever death rate has been steadily declining since 1910, except for 1913, 1921 and 1925, which have been designated as "typhoid years." Last year the rate was 3.43 per 100,000, an increase of 10% over the 3.09 of 1924.

The cause is still obscure. One influence may be the fading of the anti-typhoid vaccine given the War troops in 1917 and 1918. This vaccine was presumed to be efficacious for about seven years. Also an uninoculated group of males has grown up since the War. Then too early in 1925 there was a mild epidemic of this fever caused by infected oysters; this source was quickly shut off. The fever may be borne by water or milk; but in the large cities the water supplies seem to have been well guarded, the milk supplies too for the most part. Attributing the occasional welling up of typhoid fever to weather conditions seems a weak although favorite argument. On this point study over long periods is necessary. In fact, epidemiologists know they face an intricate problem.

Too Much Smallpox. Much less puzzling is the smallpox situation, covered for 1925 by the U. S. Public Health Reports, available last week for study. Formerly thousands died or were disfigured annually by smallpox. Now many a physician has never seen a case. Such improvement is certainly due to the efficacy of vaccination.* Yet in 1923 there were 21,233 smallpox cases reported; the next year 43,029 (103% increase); and last year 31,037 (decrease of 28% from 1924; increase of 46% from 1923). The analysis of this smallpox situation is extremely curt: the public has become lethargic to preventive activities, feels too secure in its present ignorance of smallpox ravages, should be completely vaccinated.

*Developed for smallpox by Edward Jenner (1749-1823). In all vaccinations the patient is deliberately given a mild attack of the particular disease he wants to guard against. The blood then develops certain properties which kill off the attacks of that disease, except in the very greatest concentrations.