GENERAL PAPERS 67 



lar system with special severity and is a great factor in the 

 mortality due to insufficiency of the aortic valves, aneurism, 

 arterio-sclerosis, certain groups of cases of angina pectoris, 

 and cerebral hemorrhage. Syphilis produces over 26 per cent 

 of still births and holds an important place as a cause of death 

 within the first year of life. Nearly 20 per cent of the first 

 entrances to the institutions for the insane are due to this dis- 

 ease. There is an increased mortality rate among syphilitics 

 of 70 per cent, which means a reduction of the average ex- 

 pectancy of life by five and a half years. 



In the presence of the ravages of this scourge of the human 

 race, the one thing that stands out most conspicuously is the 

 ability to prevent it. The moralist would attack the problem 

 of syphilis by clean living, the abolition of prostitution, by 

 instruction of the youth in regard to the danger of venereal 

 disease and would discourage the postponement of marriage. 

 These measures would be the happiest, the most efficient and 

 certainly the most desirable means of prevention, but, on ac- 

 count of the frailty of human nature and the strength of the 

 sexual instinct, are most difficult of general application. The 

 sanitarian would utilize the full force of ethics, but, in addi- 

 tion, would urge the establishment of hospitals for the early 

 diagnosis and prompt treatment of syphilis, would educate 

 the public in the means of prophylaxis, and would make it a 

 criminal offense for one individual to knowingly transmit the 

 disease to another. 



Pneumonia destroys annually 132,400 lives, is the most 

 prevalent and most fatal of all the acute communicable dis- 

 eases. Its occurrence has shown considerable reduction dur- 

 ing the last thirteen years, falling from 180.5 deaths per 100,- 

 000 population in 1900 to 132.4 in 1913. 



It occurs as a primary disease; as a secondary to measles, 

 scarlet fever, whooping cough, diphtheria, influenza, and ty- 

 phoid; at both extremes of life — causing the death of young 

 children and enabling elderly sufferers to easily exchange a 

 life of invalidism for a peaceful grave. 



Pneumonia is caused most frequently by the pneumococcus, 

 but it also may be due to other organisms. It was commonly 

 believed that pneumonia was an autogenic infection, for a 



