Whooping cough

The death rate from whooping cough has shown practically no change during the past ten years, the fluctuations in the death rate being much less marked than for measles. The New York city rate has shown rather more pronounced fluctuations than the upstate rate, and throughout the ten-year period covered by table 1, page 203, has risen and fallen in alternate years. This regularity is not observed in the upstate rate, which, while it has been lower during the past three years than was formerly the case, has yet declined so slightly as hardly to be worthy of notice.

The death rate for 1917 was exactly equal to that of 1916, despite a considerable increase in the case rate. The case fatality rate has, however, shown a marked decline since the disease began to be reported in 1911, but it is probable that this is in part due to more complete reporting of the cases. The case fatality rate of New York city has been usually very much higher than the upstate rate, though neither of them indicates that the reporting of the disease is complete.

Pneumonia

Pneumonia was not included in the list of reportable diseases during 1917, and there are therefore no case records on file. There were 18,677 deaths recorded in the State as a whole, 6,665 of these from bronchopneumonia, and 12,012 from lobar pneumonia or unclassified. Of this number 2,859 deaths from bronchopneumonia and 4,741 from lobar pneumonia (or not classified) occurred in the State outside of New York city.

There is appended hereto an account by Dr. Charles W. Berry, sanitary supervisor, and Dr. H. T. Chickering of Rockefeller Institute for Medical Research (published in HEALTH NEWS) on an interesting group of pneumonia cases.

LOBAR PNEUMONIA OF UNUSUAL COMMUNICABILITY

On May 22, 1916, at the request of the local health officer of the village of W -, who had been notified of the facts by the family physician, an investigation was made by the Sanitary

Supervisor of some cases of obscure illness of a very severe nature occurring in one household. The symptoms were so ill defined, so severe, and of such sudden onset, that in the absence of definite clinical findings, typhus fever was suspected by the attending physician.

There were six patients all related and living in the same dwelling, all with the same type of infection and stricken down a few days apart with very severe symptoms. Their clinical histories were briefly as follows:

1 On May 13, 1916, Mrs. D., age 34, living in W., was taken suddenly ill with vomiting, high fever, delirium and dry coated tongue. The family physician was called in attendance, no positive diagnosis being made at that time. A few days later severe pains in the legs and right side developed and some symptoms of pulmonary congestion (cough and rapid respiration), but nothing very definite was to be made out. (Mrs. D. was six months pregnant.) Later a heart complication developed probably dilation

— and the patient died on May 24, 1916.

2 On May 14, Gertrude D., age 4 years, was taken ill in the same manner and was still in bed on May 27. There was no pain in this case except in the legs; there were vomiting, fever, delirium, rapid breathing, herpes about the mouth and some indefinite pulmonary rales.

3 On May 18, Mabel D., age 14 years, was taken ill and was still in bed on May 27. There was rapid onset with vomiting and delirium, severe pains in the legs and right side, a cough with bloody expectoration, indefinite chest symptoms, no herpes.

4 On May 19, Arthur D., age 6 years, came down; the same onset of symptoms as the others but no herpes or pains in the chest; leg and body pains severe. On May 27, in bed delirious.

5 On May 19, Fred. D., age 20 months, was taken with vomiting, fever, cough and expectoration, rales in chest; he had nearly recovered on the date of visit.

6 On May 22, Floyd D., age 11 years, was taken suddenly ill with the same symptoms. An examination by the Sanitary Supervisor showed consolidation of the right upper lobe with a few crepitant rales and slight dullness. Child appeared very ill with