4IO
��TEE SCIENTIFIC MONTHLY
��THE PEOGEESS OP SCIENCE
��THE CONTROL OF EPIDEMIC DIS- EASES AND THE CAUSES OF DEATH
The only redeeming feature of the terrible epidemic of infantile paralysis which began in Brooklyn and has spread as far as Philadelphia and Boston, is the attention which it has directed to the control of communicable disease. It may be that the attitude of the public and of certain health boards has been somewhat hysterical, but as a matter of fact it has only been so in certain direc- tions. Thus less than three per cent, of the cases occur in those over ten years of age, and except in so far as they may be carriers of the disease the risk is so small as scarcely to warrant any quarantine or the closing of a uni- versity such as Princeton. It is, how- ever, almost impossible to overestimate the importance of using even drastic measures to suppress epidemics. What has been accomplished with cholera, the plague and small -pox can be done in the case of other diseases.
There are here reproduced several diagrams from the United States Cen- sus Reports and the Report of the Eng- lish Registrar General which show the relative death-rates of different coun- tries and the death-rates from different diseases. It is an extraordinary fact that three times as many people should die in Chile as in New Zealand, twice as many in Hungary as in Sweden. These differences also represent the progress made by the more advanced nations. The death-rate in England, for example, has in the course of fifty years been re- duced from 22 to 13 per thousand. People live about twice as long as they did' a century ago and about four times as long as they did in the middle ages.
The curves for the principal causes of death in the United States show great changes even in the course of a period
��80 short as twelve years. The most satisfactory aspect of these curves is the decrease in tuberculosis, typhoid and diphtheria, due in the main to three different methods of control, the first to more hygienic conditions of living, the second to suppression of the sources of the epidemic, the last, in part at least, to the antitoxin treatment. There are greater variations in pneumonia and infantile diarrhea, they being in- fluenced by seasonal variations, but on the whole a satisfactory decrease is in- dicated.
The most unsatisfactory curves are those for the three children 's diseases — measles, scarlet fever and whooping cough. They are curiously equal in their incidence and have remained al- most constant in their fatality for twelve years. They are far mor^ dangerous than infantile paralysis has hitherto been; they should be regarded with the same dread and their sup- pression should be undertaken with the same vigor. This is especially indicated by the English figures, where the deaths from these diseases, especially scarlet fever, have greatly decreased. Fifty years ago the annual death-rate from scarlet fever was over 2,600 per million children and this has now been reduced' to 250. It is a curious fact that diph- theria since the use of the antitoxin treatment has decreased at only about the same rate as the other diseases, and that it is now as large a cause of death as fifty years ago, while deaths from scarlet fever have been reduced to one tenth.
The increase of the organic diseases of later life is marked. Thus the most striking feature in the American sta- tistics is the crossing of the curves for the two most fatal diseases, tuberculosis and heart disease. In 1900 the death rate from the former was 202 per hnn-
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