The prevalence, severity and high mortality of tick typhus (table 1) in the Eastern states are not generally appreciated. It is probable that the actual incidence is much higher than the number of cases would suggest. In our series of 27 patients in the pediatric age group there have been 7 deaths, a death rate of 26 per cent. Our series is probably made up largely of cases of unusual severity, since most of the patients were referred to our hospital because their condition was critical. During this same period (1943 to 1946) the national mortality rate for patients less than 39 years of age was 12 per cent. The mortality rate in North Carolina during the past two years was 31 per cent, a figure comparable to ours.
There are two possible explanations of the high death rate in North Carolina. The strain of the organism may be unusually