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. 



