PAPERS OX ME AND PUBLIC HEALTH 



• 15 per cent of those examined. In th ma- 



jority $es the heart is of normal 



properly to ■ and j tolic and 



lie blood pressure will be found to be within 

 range of norm: 



tivit: - - : without inconvenience or without 



showing cardiac symptoms of any kind. group is 



carefully observed and repeatedly examined, it will 



"lit in most eases to discover anything more indica- 

 tive of heart abnormality than the murmur. Such 

 ditions are probably functional. 



There are. however, of all these examined from 2 to 4 

 per cent with definite organic heart disease. This latter 

 og a small incr - and un- 



doubtedly will eventually go to make up a part of the 

 increasing death rate from organic heart 

 middle life, unless meas re adopl their 



hearts. 



Heart disease is generally a reminder that entire re- 

 covery from infection is often only apparent. Th g 

 destruction of life caused by it is usually not the immed- 

 iate result of acute infection, but rather a slowly pro- 

 gressive failing of the cardio-vascular mechanism due to 

 injuries received originally from such d> as rheu- 



matism, chorea, tonsil:/ - sver, diphtheria, in- 



fluenza, or pneumonia. Dublin, in comparing the life 

 itancy of those who have had typhoid fever, for the 

 three years immediately following the disease, with those 

 who have not had the disease found the death rate in the 

 first group doubled as compared with those who have not 

 had typhoid. It was remarkable that l-4.S'~c of the deaths 

 were due to heart •; ~ - . showing that although recov- 

 ery was apparent the heart was so injured as to cause 

 death in a few years. Lues, of course, plays a £Teat role 

 in the production of heart disease in middle life but was 

 not an apparent factor in any of the cases that came 

 under our observation. 



The prevention of heart disease in youth is largely a 

 problem of the elimination of communicable disease. The 

 general adoption of the usual means for the control of 

 epidemic diseases whose complications are involvements 



