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October 27, 1923


JAMA. 1923;81(17):1423-1426. doi:10.1001/jama.1923.02650170021007

Health problems all over the United States are similar, but in different areas the magnitude of the problems vary to a considerable degree.

Malaria, for instance, a real problem in the South, is not one in the Northwest. Botulism, there almost an unknown disease, is the subject of continuous investigation in the West.

It is well known that the virulence of the ordinary communicable diseases varies in different sections, and it is possible that individuals living in a certain environment may have an increased resistance to these diseases that they would not possess if they lived elsewhere. I have been asked many times why the mortality rate in communicable diseases is so low in the Northwest. It is not because of acquired immunity, as the slums and excessive crowding of the East are not in evidence.

It is true that the Western people, having come largely from the older sections

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