The Health bulletin [serial] - University of North Carolina at Chapel Hill

;
June, 1927 The Health Bulletin 23
There are two principal sources of infection
with the diphtheria bacillus,
namely clinical cases and carriers.
Practically all the studies have demonstrated
that 0.2 to 0.3 per cent of
healthy school children are carriers of
virulent diphtheria bacilli and 1 per
cent of the population as a whole. It
is natural to believe that diphtheria
carriers are the source of infection in
many cases. However diphtheria carriers
have been pursued for the last
twenty years, and many have been detected
and isolated, yet there is little
evidence that the incidence of diphtheria
has decreased in the country
until the last few years. There seems
to be good reason to believe that the
menace of diphtheria carriers has been
over emphasized. Certainly the detection
and quarantine of carriers is impractical
in rural health work and will
do more harm than good.
The immunization of children from
six months to twelve years with toxinantitoxin
has done more than anything
else to reduce the incidence of diphtheria.
We should push our immunization
work in the schools ; but at the
same time we must make a more determined
effort to immunize the thousands
of infants and pre-school children
in the homes. Isolation and quarantine,
education on diphtheria prevention and
immunization with toxin-antitoxin are
weapons to reduce the incidence of
diphtheria. This with constant warning
to parents as to danger of not calling
a doctor early and urging use of
antitoxin in large doses, intravenously
when necessary, will further reduce the
mortality, /
Heart Disease
Causes Most Deaths
From the standpoint of mortality, invalidism,
and economic loss, heart disease
stands at the top of the list in
this country and constitutes one of the
major public health problems of today.
Heart disease ranks as the principal
cause of death in the United States
for the year 1925, the total number of
deaths being 191,226 according to a
recent announcement made by the
United States Department of Commerce.
This disease causes from 10 to
15 per cent of the total deaths from all
causes and challenges our attention as
workers in the prevention field. No
doubt a campaign against tuberculosis
twenty-five years ago seemed almost
hopeless, as we knew little about the
disease, and yet tuberculosis has been
reduced from first to sixth place in
many States. This should give us
courage to initiate a similar campaign
for the education of the public on the
prevention of heart disease.
The uncertain nature of the etiology
of heart disease seems like an impassable
barrier at the very beginning. So
far as our present knowledge goes,
acut6 rheumatic fever, tonsilitis, chorea
and syphilis are among the more
prominent causes. Certain large hospital
clinics show that 50 per cent of
cardiac cases give a definite history
of acute rheumatic fever. Overwork
and abuse of the heart, causing a degeneration,
the same as degenerative
diseases of the kidney and other organs
of the body, is no doubt a factor in
the heart disease problem. However we
must bear in mind the fact that the
heart has to withstand the invasion of
all the infectious agents that enter the
blood stream. The fact that heart disease
is now taking top place in the
causes of death, brings home to us the
fact that these infections take place
with far greater frequency and far
more killing effect than the diphtheria
bacilli on the tonsils, or the typhoid
bacillus on Peyers patches.
We need more data on heart disease,
and the various infections and mechanical
factors that have to do with its incidence,
should be recorded somewhere
either in the home, the doctor's office,
the school or the local health department.
At the present time there is no
definite data as to the per cent of
heart disease that follows scarlet fever,
diphtheria, influenza, measles, syphilis,
tonsilitis, rheumatic fever, etc. After
the investigational phase of the work
has been carried on to the limit of
our present meager facilities we should
endeavor to educate the general public
as to the cause and importance of heart
disease. The public will have to be as
well informed on heart disease as it is
on tuberculosis before we can expect to
reduce the incidence of this disease as
tuberculosis has been reduced.