GENERAL PAPERS 
65 
years following recovery, tuberculosis caused 39 per cent of 
the deaths and heart disease 14.8 per cent. Dublin estimates 
that 8,000 deaths occur in the United States each year among 
persons who have had their vitality so impaired by typhoid 
fever that they succumb within the first or second year after 
recovery. 
Twelve thousand persons die of measles in the United States 
annually, and ten thousand of whooping cough. Eighty-one 
per cent of the deaths due to measles and 95 per cent of those 
caused by whooping cough occur in children under 5 years of 
age. The failure of the mortality rates of measles and whoop- 
ing cough to show a reduction during the last fifteen years 
is due to the fact that they are highly communicable in their 
early stage, when diagnosis is most difficult and to the atti- 
tude of the public, which regard their presence as to be ex- 
pected and of little consequence to either the individual or to 
the community. 
Scarlet fever causes the loss of nearly nine thousand lives, 
82 per cent occurring before the tenth year of life. Scarla- 
tina is difficult to control, as its cause is unknown and mild 
cases may occur which are almost impossible of detection, but 
which serve as a focus for further spread of the disease. It 
is certain, however, that many unnecessary cases of scarlet 
fever are due to lack of care of the attendants upon patients; 
the non-pasteurization of milk; the failure to give thorough 
disinfection; the absence of adequate medical inspection of 
schools; and to imperfect isolation and too short quarantine. 
The deaths due to the failure to use effectively the well-recog- 
nized methods of prevention could and should be avoided. 
Diphtheria and croup are responsible for the death of 18,- 
000 people annually; 88 per cent within the first decade of life. 
The fatal cases of croup are usually the work of diphtheria 
bacillus. The number of deaths due to diphtheria have al- 
most uninterruptedly decreased during the last fifteen years 
and, at present, are less than one-half that of 1900. As strik- 
ing as this decrease may be, the mortality is much too high 
for a disease of known etiology, of well-recognized epidemiol- 
ogy, and one for which we possess a specific preventive and 
curative therapy. 
