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EFFICACY OF BOTULINUS ANTITOXIN.

Note on "Studies on Organisms Concerned as Causative Factors in Botulism'' (Hygienic Laboratory Bulletin No. 136).

The discrepancies in the literature regarding the identification of the organisms concerned in the production of botulism and the isolation of a new type by the aiithor prompted a more complete investigation of the so-called "botulinus" strains than has hitherto been attempted. The strains studied include representatives of different groups, particular attention being given to type C. The properties of toxin and antitoxin of organisms concerned in botulism are discussed at length, based on the author's experiments. As a result of these and prior investigations, an antitoxin has been elaborated and standardized. The author states that the curative effect of antitoxin in human cases has not been determined definitely, hut that it seems reasonably certain that the antitoxin is effective prophylactically as is tetanus antitoxin. As to the effects produced when administered after symptoms develop, no certain statements can be made, owing to the fact that spontaneous recoveries of patients showing definite symptoms of botulism have been recorded. The curative properties an; dependent upon the length of time elapsing between the consumption of the ford and the administration of the antitoxin, and also on the amount of toxin which has been ingested.

The most promising field for the use of the antitoxin is in outbreaks of botulism in which persons who have consumed food containing the toxin have not developed symptoms, or only slight symptoms. In any case, the use of antitoxin is indicated, since it is the only known specific remedy and the possibility always exists that the results may be favorable.

GENERAL HEALTH CONDITIONS AS REPORTED BY THE HEALTH SECTION OF THE LEAGUE OF NATIONS.

The following general summary of health conditions is taken from data in the monthly Epidemiological Report of the Health Section of the League of Nations issued November 1, 1923:

PLAGUE.

The following information on the plague situation in India is credited to the ''Epidemic diseases summary," issued by the British Health Commissioner with the Government of India for the weeks ended August 25 and September 1, 8, and 15:

"Bombay Presidency.—Freshly infected: Karachi district and west Khandesh; spreading in Sholapur, Satara, Poona, and Dharwar districts; prevalent in Belgaum and east Khandesh districts.

"Bihar and Orissa.—Gaya district freshly infected; steady in Mazaffarpur district.

'' Madras Presidency.—Nilgiris district freshly infected; spreading in Bellary and Ooimbatore districts; abating in Madura, Malabar, and Salem districts; south Kanara district declared free.

"Burma.—Spreading in Bassoin and Mandalay towns and Yamethin district; Thaton district reinfected; sporadic in Moulmein town and Tharrawaddy, Prome, Myaungyma, Thayetmyo, and Pyapon districts; abating in Rangoon town and Insein, Maubin, and Bassein districts.

"Central Provinces.—Spreading in Yeotmal town, Amraoti and Akola districts; abating in Puradsinga village (Nagpur) and Arvi town (Wardha); mild in Jubbulpore and Buldana districts; two imported cases with one death in Nagpur town.

"United Provinces.—Mild in Benares, Ghazipur, Basti, and Mecrut districts.

"Punjab.—Rohtak, Gurgaon, and Gujrat districts freshly infected; spreading in Jhelum and Rabalpindi districts.

''Northwest Frontier Province.—Spreading in Hazare district.

"Mysore State.—Present in all districts except Chitaldroog."

The plague situation in Siam, judging from reports for August, continues to improve, relatively few deaths being recorded.

For Madagascar, the decrease in the number of deaths from plague since March has continued.

The epidemic in Egypt, which began in March and reached its height in April and May, seems to have ended.

CHOLERA.

The renewed increase in cholera in certain sections of India reported in July was more marked during August.

SMALLPOX.

There is no evidence of any marked increase in smallpox in the reports received during October in any of the countries which furnish current information except Siam. During the first three months of the year only 10 cases were reported in Siam, and in the second quarter 137 cases with 59 deaths. In the seven weeks July 1 to August 18, however, 573 cases with 364 deaths were reported.

There has been a marked decrease of deaths from smallpox in India thus far during the third quarter of the year as compared with the second and iirst quarters.

In the European countries where the disease was unusually prevalent, especially in England and Wales, Spain, and Switzerland, the downward trend has continued, and no serious outbreaks were reported during the weeks immediately preceding the date of the report.

TYPHOID FEVER.

The seasonal increase in typhoid and paratyphoid fevers has occurred in most countries. In Uruguay the seasonal curve is peculiar. The peak was readied in March and April, and cases and deaths decreased in May and June.

The reports received during October show the situation of typhoid fever to be, with a few exceptions, favorable. In many countries there is no marked decrease over the corresponding period in 1922, but in these cases the reported incidence is relatively low. In some of the central European countries, where typhoid fever has been relatively prevalent for the past few years, the reports for the summer months of 1923 show a considerable decline. This is especially the case in Czechoslovakia, Poland, and Rumania. There is no marked change in Austria, but in Germany there is a significant increase over 1922.

DYSENTERY.

While the prevalence of dysentery is shown by the reports to be less this year than in 1922 in nearly all countries, the usual summer increase has occurred fairly generally. The diagnosis and the complot<>ncss of notilication of dysentery varies widely in the different countries and figures are useful only as a general indication of the trend.

In Germany, where a higher prevalence of dysentery in 1923 than in 1922 is suggested by the reports, the increase over the preceding year began in the latter part of July and continued through August and September.

INFLUENZA.

In two countries for which September reports were available, Denmark and Sweden, some increase in influenza is shown. The reports for August from other countries show no upward tendency. No marked prevalence is shown in the reports for countries outside Europe.

LETHARGIC ENCEPHALITIS.

The reports on lethargic encephalitis, which do not go beyond September for those countries in which the disease is notifiable, indicate a marked and continuous decrease from the relatively high number of cases reported in the first months of the present year.

DEATH RATES IN REGISTRATION AREA: 1922.

The Department of Commerce announces that compilations made by the Bureau of the Census show that the mortality rate for the registration area was 11.8 in 1922 per 100,000 population against 11.6 in 1921. Six States, Michigan, Mississippi, Ohio, Pennsylvania, Virginia, and Wisconsin, show lower mortality rates for 1922 than for 1921. The lowest 1922 State rate (8.1) is shown for Idaho and the highest (14.7) for Maine and Vermont each. For cities which at the last census had populations of 100,000 or more, the lowest rate (7.5) is shown for Akron and the highest (17.8) for Memphis.

Crude death rates by no means tell the whole story regarding the healthfulncss of different localities. Ilace stock, occupations of the inhabitants, the sex and age distribution of the population, and the relative number of deaths of nonresidents arc factors which must be considered before it can be determined that one city or State is more healthful th.m another. For example, adjustments simply for differences in the sex and age distribution of the population in the States give Nebraska the lowest adjusted rate (9.1), and in the cities of 100,000 population give Akron the lowest adjusted rate (9.2), while in the States the highest adjusted rate (13.5) is for Colorado and in the cities the highest adjusted rate (19.3) is for Memphis.

Death rates from all causes (exclusive of stillbirths) per 1,000 population.

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Albany

Atlanta

Halt iiimre

Birmingham

Bo Ion

Hri'ljteiiort

Bi II.lo

H. 3

17. 7 11 1 16.0 15.0 11.9 I t.o

9.1 l.l. s 11. 7 ll.l)

17 I

13.6 II. 3 13.1

It. 3 19.3 17). 1, 19.2 15.5 13.9 15.3

7 ■

15, 7

17.. 7
11,2

13.7
14.9
11.1
13.4

7.5 IV 1 14. S 13.8 14.6 13.5 105 12.6

i The adjusted rate makes allowance for the differencs in the age aud sex composition of the populations in did Tent Stitos. and shows wh it the delta raie woild b-. if all States had the same proportion olmsld and females and tin sun? prop irtion of th" total population in each age group.

2 The crud • rite is bas-'d on total population and all deaths occurring within the given are*.

* Hate not computed.

« Not addi'd to registration area until a later date.

« ForrigeFortsett »