In planning campaign, the entire field of action, appraises its strong points and its weaknesses and then concentrates his efforts where the dangers seem greatest and the possibilities of success brightest. Let’s examine these and then direct our attention to those conditions which offer the greatest hope of improvement.
“Influenza” and “grippe” are terms used to designate acute infections of the respiratory tract in which constitutional symptoms are more pronounced than in the common cold. Although coryza frequently accompanies influenza and grippe, the latter conditions are characterized more particularly by headache, sudden onset, backache, fever, chills, prostration, sore throat, and cough. The fatality rate from influenza is low, most patients recovering in three to four days, but cough and weakness may persist for some time.
Just what is the relationship or the difference between grippe and influenza is not clear. The symptoms and physical findings are similar. In general, however, the term “grippe” is usually used to designate the relatively mild infections which occur with greater or less frequency almost every winter, while the term “influenza” is used for the more severe infections which occasionally occur in epidemic form.
Influenza, or grippe, is an acute infectious disease. At different times various germs have been considered its cause. Recent work of Andrewes, Laidlaw and Smith in England and Francis in this country has proved the cause to be a filterable virus. These workers, using filtered nasal secretions from patients with influenza, have succeeded in infecting ferrets, mice, and human volunteers. This is very important, but of even more immediate practical value is the vaccine which Francis has developed for the prevention of influenza. In general it seems to reduce the occurrence of influenza among vaccinated persons to about one-third the rate among the un-vaccinated. Unfortunately, however, the general usefulness of this vaccine is limited by the appearance of new strains of the virus against which the vaccine is ineffective.
Lacking a completely effective preventive vaccine, we must also utilize general measures to combat this disease. The virus of influenza is highly ineffective and is transmitted from person to person by means of discharges from the nose and mouth.
Measures to reduce contact with infected persons should be observed, despite the fact that they are not completely effective.
The great danger from influenza is not the disease itself but the pneumonia which so frequently complicates it. This may develop in spite of all precautions, but it is most frequent among persons who remain up and about while ill. Consequently, the most valuable advice which can be given to patients with influenza is “go to bed when you have any fever and remain there until thoroughly recovered.” Other measures are helpful but should be prescribed by a physician in accordance with the needs of the individual patients.
Pneumonia can hardly be considered a single disease, for it may be caused by various germs and it acts differently at different periods of life. Although always serious, pneumonia is rarely fatal to persons in the prime of life. In infancy and old age pneumonia is largely a terminal process; that is, it is the actual method by which death comes to a large number of individuals previously weakened by infectious disease, by injury, or by the lowered vitality characteristic of extreme youth or extreme age.
Pneumonia is an inflammatory process of the lungs which causes a portion of one or both lungs to be filled solidly with serum, red blood cells and leucocytes. The cause of pneumonia is a germ most commonly the pneumococcus, the streptococcus, or a virus, although the tubercle bacillus, the staphylococcus, etc., may occasionally be responsible.
Pneumonia caused by the streptococcus is usually secondary to some other disease, such as measles, whooping cough, or influenza, and produce small areas of inflammation scattered throughout the lungs. These areas of infection begin around small branches of the bronchi and are frequently spoken of as bronchopneumonia. The prevention of such pneumonia depends primarily upon the prevention or, failing that, the early and adequate care of the primary disease. The experience showed that the pneumonia rate with influenza was much higher among soldiers in field than among those who were promptly hospitalized. Children with measles or whooping cough should be carefully protected from all contact with persons who have colds and from conditions which will tend to lower their resistance. There is no specific serum treatment for streptococci pneumonia, but the new antibiotic drugs give excellent results in most cases. All pneumonia patients should have adequate medical and nursing care.
Pneumonia caused by the pneumococcus, of which there are a considerable number of different types, frequently involve one or two lobes of the lungs at a time and so are called “lobar pneumonia.” Bronco Pneumonia, however, also may be caused by the pneumococcus. This pneumococcic pneumonia is considered as primary pneumonia, although patients usually report having had a cold before the onset of the pneumonia. It seems that, even with virulent pneumococci present in the nose and throat, some temporary lowering of the resistance from fatigue, alcohol, chilling, malnutrition, or a cold is frequently necessary for an actual pneumonia to develop.
Pneumococci are disseminated with the nose and throat discharges of patients and of healthy carriers. In fact, during seasons of pneumonia prevalence there are many more healthy persons carrying pneumococci in their noses and throats than there are actual cases of the disease.
One attack of pneumonia does not confer a permanent immunity against subsequent attacks. On the contrary, there seems to be an increased susceptibility to the disease after one attack. Vaccines have been tried at various times for the prevention of pneumonia, but no definite value for them has as yet been established.
In the treatment of certain types of pneumococcic pneumonia, definite progress was made through the development of a specific serum treatment. If given early in the disease, this serum reduces the death rates of the particular type of pneumonia for which it is applicable by 20 to 30 per cent. Still better, however, are the results obtained with the sulfonamides, penicillin, and aureomycin. In large groups of patients these new drugs have reduced the fatality rate from pneumonia by as much as 80 to 90 per cent.
For the prevention of pneumonia one can suggest only general measures for the avoidance of anything which tends to reduce vitality, such as dissipation, loss of sleep, fatigue, overwork, worry, poor or insufficient food, alcohol, colds, and excesses of all kinds. More care than is usual should be given to acute minor respiratory infections such as colds, influenza, bronchitis and sore throats. Persons with these infections should be isolated in bed during the acute stage and stay there at least as long as there is fever. Pneumonia should be considered a communicable disease and patients with pneumonia should be isolated in order to reduce the spread of infection to others.
Cancer as a cause of death has a natural tendency to increase as more people reach the cancer age, but so rapidly have cancer deaths mounted that it seems that there may be an absolute as well as a relative increase in its rate. This increase, however, may be checked to a certain extent as more and more people present themselves for medical care at the first onset of symptoms such as the following which are, or could be, due to cancer:
1. A sore that does not heal normally, particularly about the tongue, mouth, or lips.
2. A lump or thickening, especially in the breast, lips, or tongue.
3. Bloody discharge from the nipple or abnormal bleeding from any of the body Openings.
4. Progressive change in the size or color of a mole or wart.
5. Persistent indigestion.
6. Persistent hoarseness, unexplained cough, or difficulty in swallowing.
7. Any pronounced change in usual bowel habits.
Improvements in cancer treatment are giving encouraging results. Surgery and in carefully selected cases, x-ray and radium are proving increasingly effective. Reliable clinics report that 20 to 30 per cent of the cancer cases which they treat are living and will after five years or more. In no disease is early diagnosis more vital to successful treatment.
A few years ago heart disease assumed first place as a cause of death for people of all ages, and in spite of better diagnosis and treatment it is still on the increase. This is discouraging but not quite as hopeless as it might appear on first thought. Approximately 35 per cent of heart disease is due to infections involving the heart muscles and valves, 45 per cent to degenerative processes, 10 per cent to syphilis, and 10 per cent to a variety of other causes.
Rheumatic Heart Disease
Rheumatic fever, or so-called “inflammatory rheumatism,” is an infectious disease of the body as a whole but with a tendency to affect most severely the joints and the heart. Rheumatic fever contracted in childhood is responsible for 25 per cent of deaths from heart disease up to the age of fifty years. It occurs only in humans, with first attacks most common in children between five and ten years of age. It is more frequent in cooler climates and in urban communities, more in whites than in Negroes, slightly more in females than in males. There seems also to be a definite familial susceptibility to rheumatic fever and a significant relationship between its occurrence and malnutrition and poor living conditions.
Surveys indicate that approximately 1 to 5 per cent of school children have rheumatic fever at some time or another and approximately 60 per cent of children infected give evidence of heart involvement, permanent damage being most frequent to the valves. Repeated attacks occur in about half of these who have had first attacks and about one-fourth of the patients, particularly girls, develop chorea, so-called “St. Vitus’s dance,” as a complication.
The cause of rheumatic fever is a type of streptococcus. The initial attack frequently is preceded by a cold, scarlet fever, tonsillitis, or some other acute respiratory infection. Transmission is from person to person either directly or indirectly by means of hands, drinking glasses, etc. Individual susceptibility varies greatly. The majority of persons are resistant to rheumatic fever even though they get throat infections with the strain of streptococcus that cause this disease.
Efforts to control this serious and widespread disease must depend, until our knowledge of its cause is more exact, upon general measures such as isolation, the adequate care of patients during the acute stages of the disease, a properly safeguarded and regulated convalescence, attention to problems of poor housing and malnutrition, and the discovery early in life of children whose hearts have been damaged. This means the widespread careful examination of school children. Existing damage to the heart cannot be repaired but the functional condition of the heart can be determined and the children’s future lives planned with intelligent consideration of the physical limits which their damaged hearts impose.
Valvular heart disease, other than rheumatic, usually occurs as a complication of some infection such as scarlet fever, tonsillitis, pneumonia, or abscesses at the roots of teeth. This type of heart disease can be reduced; in fact, it is being materially reduced by the prevention and better care of these infections.
Degenerative Heart Disease
Less encouraging is the outlook for the heart disease which, like apoplexy and certain types of kidney trouble, is an end result of the stress, strain, and degenerative processes which have been slowly undermining the circulatory system. Over many years our most useful measure in the treatment of these diseases has been rest-rest from the stress and strain of worry, of overeating, of physical activity rest which the individual failed to provide until his body’s reserves were exhausted. The hope for a reduction of these degenerative processes is not entirely a forlorn one, since the American people seem to be taking a more sane and intelligent attitude toward living. Many are beginning to ask themselves whether the mad race for material success and “keeping up with the Joneses” is worth the price. As more and more decide that it is not, they will get more joy out of living and will postpone senescence with its disintegration of vital tissues.
Acute Respiratory Infections
The acute respiratory infections are major causes of illness at all ages but take an exceptionally heavy toll of life in infancy, Pneumonia and colds have been considered. Influenza is still unsolved. Each of these diseases is especially serious in infants and presents problems of control distinct for this age period, Exposure to respiratory infections transmitted from one person to another through the air or by means of the bands can hardly be avoided by older children and adults, but not so with infants. Infections must be carried to them. This is usually done by well-meaning parents, brothers, sisters, or other relatives. If possible, persons with “colds” should not be permitted to go into the rooms of infants, nor should they prepare or handle their food or drink. The danger of infection can be reduced also by thorough washing of the hands with soap and hot water before touching the child or its food and, if one has a cold, by covering the nose and mouth with a piece of gauze, linen, or muslin.
Diarrhea and Enteritis
This so-called “summer complaint” of children, although greatly reduced in recent years, still remains a prominent cause of death of children under ten years of age. Food and drink are responsible for most of these infections. Hence, adequate care in the selection and preparation of foods and better sanitation in their handling are all that is necessary to eliminate them. If parents will only make use of available information concerning the preparation and care of infant foods, many children’s lives can be saved.
Measles, although frequently considered trivial, is a serious disease in infancy. In fact, the possibility of death from measles is seventeen times as great if contracted by a child less than one year of age as by a child of six. This difference points the way towards, which efforts to combat measles may be directed. Complete prevention of a disease which, own in its early stages, is highly communicable, is impossible unless a specific immunizing agent against it can be developed. But postponement of the disease until school age when it is relatively without danger should be attempted and in many cases can be achieved.
The cause of measles is a tiny germ spread by discharges from the nose and throat. Early symptoms resemble an ordinary cold. It is in this stage that measles is most highly contagious. Hence, measures for the protection of infants against acute respiratory infections in general will also reduce their exposure to measles.
In addition to such general procedures there is available a specific preventive measure which can be utilized by physicians for the protection of children known to have been exposed to measles. This is the injection of blood serum, whole blood, gamma globulin, or placental extract from one who has had measles some time in the past. Blood from one of the parents may be used for this purpose.
The principle involved is to give the infant some of the protective substances which have been present in the blood of persons who have recovered from measles. If such injections are given within five days after exposure, the disease is usually prevented; if given from the fifth to the eighth day, a mild form of measles may develop but complications are rare. Injections given after the eighth day following exposure usually have little or no effect upon the course of the disease.
If a child gets a mild attack of measles after such injections, a permanent immunity will result. On the other hand, complete protection is temporary, although usually long enough to safeguard a child during a current epidemic. The following year the child will again be susceptible, but each year that an attack of measles can be postponed means a material reduction in the danger to the child.
Whooping cough, which caused the death of almost as many American children as diphtheria, measles, and scarlet fever combined, is the most distressing as well as one of the most serious of the diseases which occur in infancy. It is caused by a known germ which is present in the secretions from the nose and throat.
The early symptoms and in some cases the only symptoms, are those of a common cold. Hence, infants can be protected against infection only if they are safeguarded against exposure to colds or acute respiratory infections. Although vaccination against whooping cough was tried for some years with questionable success, recent studies with new vaccine are giving very encouraging results. Many of the vaccinated children are completely protected and the majority of those who do contract Whooping cough after vaccination have it in a much milder form than un-vaccinated children. In addition, a hyper immune serum is proving valuable both for treatment and for temporary protection. These immunizations seem to other new hope of protecting our children against one of the most dread diseases of infancy.