US.OFFICE OP STRATEGIC SERVICES Research and Analysis Branch R & A No. 1423 THE REGIONAL INCIDENCE OP DISEASE IN GERMANY A comparison of the incidence rates of diptheria, scarlet fever, dysentery, typhoid and rsratyphold fever for various regions of Gerrany. This document contains information affecting the national defense of the United States within the meaning of the Espionage Act, 50 U. S. C. 31 and 32, as amended. Its trans mission or the revelation of its contents in any manner to an unauthorized person is pro* hlblted by Jfew. 21 April 1944 Copy No. 11 Summary There Is no consistent pattern of uniform regional variations. Certain regions are more affected by specific diseases in a given year than others.. In another year, there may be sub- stantial changes. While the war years have produced such changes, it has not been possible to establish' any pattern of regional variation or wartime change. TABLE Of CONTENTS Page -) uratn ary e.............*.,,.<*lii I. Introduction . 1 II. Incidence Rates of Specific Diseases 3 A. Diptheria 3 B. Scarlet Fever 5 C. Dy s© nt ery c7 D. Typhoid Fever .......... 9 Paratyphoid Fever U III. The Rank of the Regions of Germany According to the Incidence of Specific Diseases 13 Table I. Cases of Dlptheria per 10,000 Inhabitants.,, 4 Table 2, Cases of Scarlet Fever per 10,000 Inhabitants,, 6 Table 3, Cases of Dysentery per 10,000 Inhabitants,.,,.* 8 Table I, Cases of Typhoid Fever per 10,000 Inhabitants,, 10 Table 5. Gases of Paratyphoid Fever per . 10,000 Inhabitants,,. 12 Table 6. Seventeen German Region:., Ransed According to Incidence of Disease, 1938, 1939, 1941, 1942. l4~l£ TABLED THE REGIONAL INCIDENGS OF DISEASE IK GERMANY I. INTRODUCTION The diseases selected include diptheria, scarlet fever, dysentery, typhoid, and paratyphoid, incidence rates of which are calculated per 10,000 inhabitants. Comparisons are presented for two pre-war years, 1938 and 1939, and two war years, 19H and 191.2. Tore complete information pertaining to these diseases will be found in the relevant parts of Health in Axis Kurope. R k A Ho. 10?0, 6 October 1913. The present study concerns one aspect not treated there, the question of whether there is a consistent pattern of uniform regional variations in disease throughout the years. The war has changed the previous regional distribution of disease incidence but the changes have been of an erratic nature, precluding the formulation of general statements as to the evolution of a new pattern; nor has it been possible to ascertain the extent to which the findings presented in the following pages should be modified in the light of such factors as deficient reporting of diseases, recent population movements, or the effects of air raids. The scale on which population movements 1 occurred in 1942 Is uncertain. It is also uncertain to what extent such movements are reflected in the population base of the rates and whether or not members of the armed forces are included. The statistical date with respect to the Incidence of the five diseases under study arc presented in the tables on the following pages. The figures, which have been taken in their entirety from the Reichs^esundheitablatt. the official publication of the Reich Health Office, are presented in two forms to illustrate different aspects of the problem. There la first presented a series of 5 tables indicating’ the incidence of the respective diseases per 11,000 inhabitants in the various regions, in order to give a quantitative picture of the prevalence of disease. Table 6, on the other hand, indicates the rank of the several regions of Germany according to the incidence of the diseases. The figures given are not of cases of disease, but show the rank of the given region among those of all Germany, Anhalt, which had the highest Incidence of diptheria in 1938# is assigned the numeral "1" under that year; by 1939 it had fallen to ninth place, and is assigned the numeral ”9". This table would reveal, should they exist, any fixed patterns in the i regional incidence of the diseases under study. IT. I&IDOKS RATS’S OF SPECIFIC DISEASES A. Dlptheria The data do aot reveal a conei.Uant regional pattern, During the wa,r year?, Be den, Saohson, tee Sudeten territory, Bayern, and certain parta of Prussia shea a rather high incidence* Of the regions, before the war, Bayern, Sachsen and Baden had a lover-fcnan-average incidence. There is thus a possibility that tne aore recent outbreaks have been heavier in those regions which in former years were less exposed to tiiia disease and thus nac acquired a lesser degree of 1mionization. Table 1 on the owing page indicates the number of cases of diptherla per L ' , ' 'r.i;‘-v- H’.i Table 1. CASES OF DIPTHSRIA PER 10. OOP INHABITANTS 1938 1939 1941 1942 Anhalt 49.0 Sudetenland 40.1 Hessen 34,8 ThCir Ingen 49,0 Bremen 38.6 Bremen 32.2 Baden 32.5 Baden 45,1 Preussen 26.2 Ostmark 27.8 Lippe 31,7 Sudetenland 44 >4 Oesterreioh 25.0 Hamburg 26.2 Sudeten! >29,9 Anhalt 43.6 Germany a 22.0 Lippe 25.6 Sachsen 26.4 Sachsen 38.6 Lippe 21.5 Preussen 24.0 Bayern 26,1 WCLrttemberg38.0 Hamburg 19.8 Germany 22.0 Sch. -Lippe 23,9 Bayern 35,9 ThttrIngen 19.2 Bayern 18.0 Preussen 23,7 Braunsoh- Braunschweig 18.5 Hessen 16,7 Germany 22,8 welg 35,2 Bayern 17.5 ThOrIngen 16.3 Hookleng.22,5 Weatmark 34,0 Hessen 17.0 Anhalt 16.2 Braunsoh, .21,6 Keoklenburg32 ,6 1'eoklenburg U.8 L'eoklenburg 15.2 Hamburg 21.4 Hessen 31,8 Sachsen 12.8 Sachsen 14,7 Ostmark 20.1 Preussen 31.4 Baden 12.3 Braunschweig 14,1 01denburgl8„6 Oldenburg 31*2 Saarland 12.1 Baden 13,8 Anhalt 18.1 Germany 31,2 Oldenburg 12.0 Schaumb-Llppe 8.5 ThUrlngenl7,l Lippe 27,2 Wdrttemberg 7,5 Oldenburg 8.2 Saarland 14,9 Hamburg 24,0 Schaumb-Lippe 2.2 Saarland 6.5 Wdrttemb, 14,1 A1 pen- and w&rttemberg 6.2 Danzig- Donau- Westpr. 13,7 Relohsgaue22.5 Warthel, 9,9 Bremen 21,5 Bremen 9,4 Danzig-*eat- preussen 13.4 *artheland 9,4 Schaumburg* Lippe 9,4 « - Excluding Auatrla. B, Scarlet Fever Llppe, Bremen, ITechlanburg, Hamburg, ThQringen, Anhalt, the Sudeten territories, and some parts of Prussia show a high incidence of this disease throughout the years. The incidence is lower for the southern parts of Germany. Rates for V/ttrtteo- burg, Baden and Bavaria are consistently below the average. Table 2 on the following page indicates cases of scarlet fever per 10,000 inhabitants. Vable C/SES OF SCAPXKP F/rviR ?KH 10.000 IKEABIT/1IT3 1938 1939 1941 1942 Bremen 51-8 Sudetealand 30.2 L'eaklecburg 68.1 Anhalt 84 5 I Llppe 1.5 Danzig-VJeat- Danzig-West~ 7,9 Oetterreloh 1 ,1 Mecklenburg 1,3 preueaen 4.0 preuasen Bremen .79 Bremen 1 1 Mecklenburg I;2 Mecklenburg 2 9 Braunscnwelg ,67 Anhalt .80 Sudetenland 1S1 Germany Anhalt ,51 Sudetenland ,74 Oataark 1.0 Sudetenland 1.8 Hreuanen ,50 Germany ,50 Anhalt ,93Breus«en 14 Saarland c46 ThQrIngen .45 Germany o 86Baden 1-4 tie mar, 7 a *43 Preuaaen .43 Preussen •68Anhalt 1 32 Thttr ixtgen ,38 Hessen 34 Braunschweig , 58Aip«n-and Dcnuu ,35 Braunschweig .33 Bremen .49Heiohagaue 1.2 Hamburg «30 Oldenburg ,31 Saarland ,28Braunaohweig 90 Sachsen ,25 Bayern ,26 Sachsen ,2601denburg 93 Bayern .23 Wttrttainberg ,26 Hessen ,24Bremen .71 Deden .23 Hamburg ,26 Thttringen ,23Bayern 44 Hessen ,23 Baden .19 Hamburg .23V»(trttemb*rg .40 Oldenburg ,21 Sachsen 16 Oldenburg .19Sohaunburg“ Sohauc.a.• Saarland .093WBrttemberg .18 Llppe 38 I ipr« .0 Schaumb,- Llppe. 0 Bayern ,l6Llppe 37 Llppe «l6Heseen 35 \ Baden • 1-3 earmark 34 Schaumb,-Llppe .0 Th&ringen - 30 Sachsen 62? Hamburg 22 a - Sxcl 41 tig Austria , Paratyphoid Fever Paratyphoid Incidence is high In Austria,, Oldenburg, Bremen, l!e Oldenburg end Hamburg. It is the Warthelend., Danzig and Western Prussia and Thttrlngen* Table 5 on the following page indicates the number of cases of paratyphoid fever per 10,000 inhabitants. Table 5 * CASKS OF PARATYPHOID FEVER PSR 13,000 INK4B IT ANTS 1938 1939 1941 WOrtteaberg 1,7 Oatmerk 1 .1 Oldenburg 2.2 Oesterrelch 1*3 Hessen .77 Sachsen 1.8 A]pen-and Dcnau* 1c 2 Saarland 1*2 Bremen .75 Bremen 1.0 Heiohsgaue Bremen 1.1 Baden .62 Ostmark .92 Oldenburg .95 Baden .62 Hamburg .60 Braunschweig .63 Preuseen «90 Bayern 52 Mecklenburg .53 Germany .54 Bremen .. 8*4 [Mecklenburg .51 »v8rttemberg .52 Hamburg • 52 Mecklenbuxj 77 Hamburg .50 Bayern .47 ThOrIngen .48 Lippe 75 Germany a Preussec .47 Germany .45 Preuseen 47 Anh*U 70 .4-3 Oldenburg .43 Bayern *44 Hamburg Thdr ingen 36 Preuseen .38 Sudetenland 42 Germany .M [Lippe ,33 Anhalt .34 Saarland .40 Braunschweig 67 [Sachsen 15 Saarland .32 Mecklenburg .29 Hessen a Braunschweig ,15 Lippe .27 Hessen .2? Baden . 60 llahalt ' .13 Braunschweig .18 Anhalt .23 ft&rttember# Sob.-Lippe .18 WflLrttemberg z? ■ ';" p it i' ,29 Sudotenlacd .17 Baden ..21 3i . Sachsen -15 Danzig-V.est- 3&chsen *23 Thtir ingen .13 preusaen Wartheland Lippe Sch,-Lippe ,063 Soh “Llppfe ,0 .0 DacifP-a.^ prbuaysen ■ WarthaissHl 2 ' .11 .10 L . Excluding Austria III. TTIg RANK OF THE REGIONS OF GgHKAMY ACCORDING TO THE INCIDENCE OF SPECIFIC DISEASES From the data given in the proceeding tables, it is possible to construct a table showing the pattern of the incidence of the five diseases in the various regions of the country. Table 6 on the following page presents this information. In the table a numeral indicating rank among all the regions Is assigned to each ' region for each of the four years, th* region of highest incidence being indicated by "I", the next highest by *2", and so on. It is *. thus possible to determine whether any part or parts of Germany have shown a uniformly high or low rani either with respect to one ot ucre diseases or with respect to ell Jseases over time, Study of the table fails to indicate any very consist rat pattern of uniform regional variations. T»bl« 6. SEVENTEEN GERMAN REGIONS« RANKED ACCORDING TO INCIDENCE OF DISEASE, i<0.9» l?4jL ,194*: A, Dlotheria B. 1938 1939 19U 194,2 ' . . ~?42_ Anhalt 1 9 13 3 Bremen n 1 2 Bremen 2 1 17 16 Llppe 2 9 3 Preuasen 3 5 7 11 Anhalt 3 B Oeaterreich a 4 2 11 15 Mecklenburg 4 Llppe 5 4 3 13 Preliseen 5 6 a Hamburg 6 3 10 14 Oesterrelch a 6 ? 16 Thhringen 7 8 14 1 Hamburg 7 1 6 Braunschweig 8 12 9 7 ThflrIngen S 10 5 n Bayern 9 6 5 6 Baden 9 11 Hessen 10 7 1 10 BraunschwelglO 4 U Mecklenburg 11 10 8 9 ’AQrttemberg 11 12 12 12 Sachsen 12 11 4 4 Hessen 12 15 7 Baden 13 13 2 2 Oldenburg : 5 1. Saarland b 14 16. 15 8 Sachaen 14 13 6 Oldenburg 15 15 12 12 Bayern 15 16 13 Wftrttemberg 16 17 16 5 Soh.-Llppe 16 U 17 Sch.-Llppe 17 14 6 17 Saarland b 17 17 14 « - 1939, 1911: >Ostmark; 1942: Alpen-and JXmau-Iioiohagaue b - 1942: weatoark 3 Djsenterr 5. Typhoid feter 1938 1939 19411942 .1228.122$ 1211 1212 Mecklenburg 1 2 1 Llppe 1 15 12 Hamburg 2 1 1 4 Mecklenburg 2 3 1 Bayern 3 5 7 Oeaterreioh a 3 5 Saarland b 4 15 11 15 Bremen 4 6 Preusson 5 5 8 5 Braunschweig 5 9 6 Oldenburg 6 - 4 6 Anhalt 6 4 Thilr Ingen ? 6 6 8 Freusaen 7 2 Bremen 8 13 7 2 Saarland b S 16 U • • 9 9 3 3 Thttringen 9 6 ,10 15 Sachsen 10 7 10 9 Wttrttemberg 10 12 13 10 . ■ 11 12 12 13 Hamburg 11 13 11 J7 Oesterreloh a 12 14 14. 12 Saohaen 12 15 8 16 Wttrtteiaberg 13 10 15 14 Bayern 13 11 14 9 Braunschweig 14 11 13 11 Baden 14 14 16 3 Lirpe 15 16 16 17 Hessen 15 8 9 13 Anhalt 16 8 9 10 Oldenburg 16 10 7 Sch -Lippe 17 17 17 16 Schauab.-Llppe 17 1? 17 11 % t m _ i H ft I ''I * K Att flK litffU' . iiht 1 Qi Qg yfUftrK § X • pcKt*afiu yODaU no4uJu«9^^U* B Paratyphoid 1936 1939 1941 1942 •Vflrttemberg 1 7 14 12 Oesterreioh 2 1 4 1 Saarland 3 12 10 15 Bremen 4 3 3 4 Baden 5 4 15 11 Bayern 6 8 9 13 Hecklonborg 7 6 11 5 Hamburg 8 5 6 8 Prouesen 9 10 6 3 ThOrlngen 10 17 7 17 Llppe 11 13 16 6 Sachsen 12 16 2 14 Braunsoh*aIg 13 14 5 9 Anhalt / 14 11 13 7 Hessen 0 2 I? 10 Oldenburg 0 9 1 2 Schaumburg-Llppe 0 15 17 16 c - Not reported