DISAPPEARING DISEASES

Evening Star, Issue 19271, 9 June 1926, Page 10

DISAPPEARING DISEASES

REAS&KS FOB DECLINE Certain infectious diseases seem io be dying out, according to a paper by Dr C. E. S. Flemming, of Bradford-on-Avon, England, printed in the ‘ British Medical Journal;’ Dr Flemming gives figures issued by' the British Ministry of Health, from which it appears that the decrease in the general British death rate from the period 18(1-80 to 1924 is 43 per cent., while individual diseases such as diphtheria, typhoid, scarlet fever, and tuberculosis have decreased 60 to 97 per cent. As for smallpox, its decrease is actually 100 per cent., not a single case having boon reported in the year last named . This, he thinks, is a striking record of the disappearance in varying degree of a group of widespread and serious maladies. In the defeat of ench, inedicine, curative and preventive, may justly claim to have nad a share, but general improvement in conditions of life must have had a large influence. He writes;

“ Except, perhaps, in the case of rabies, it is doubtful whether the medical profession can demand credit for the immediate, international, direct, end entire control of any one disease. Wo pride ourselves and our health administration, on the reduction in the death rate of phthisis: but figures for the years 1847 to 1924 show a long, steady decline. What influence had the Local Government Act of 1875? During the thirty years preceding it the rate per million had declined by 1,000, during the thirty years succeeding it the rate declined by 1,100. It does not appear that any decrease in the death rate followed the discovery of the infecting organism, or that any influence has been exerted by sanatorium treatment and the general campaign against tuberculosis which have been so actively carried on during the last twenty years. The only remarkable point is that the rate rushed up in a startling manner during the years oi the war, to fall immediately the war ceased. “ The infectious diseases already noticed naturally occurred to me as the most notable ‘of disappearing diseases, but there are others. Such, for instance, is gout. How rarely now, compared with forty years ago, does one see a classical case of acute gout! Is this decline due solely to dietetic reasons, chiefly to the greatly decreased consumption of port wine and beer, and so only one of the contingent results in tlie decrease in alcoholism? “ How seldom now, compared with thirty years ago, does one have to treat a serious case of acute rheumatism, socalled rheumatic fever. If this is not merely a personal experience, what is the explanation of the diminution in the number of these cases? “ In a list of disappearing diseases in ordinary surgery, I should be inclined to put first anemia; it seems not long since one was always attending not one, but several cases of chlorosis, chiefly, though by no means only, among girls of the servant or working class; now how comparatively rare these patients are. Better conditions of-?life, of home, and workshop, the stopping of child labor, shorter hours of work, better food, more sunlight and air, more rational dress, more outdoor recreation, and last, but by no means least, better teeth —all of these things have, I suppose, boon instrumental in this change; and with the decrease thero must have been a decrease in gastric ulcer, headache, heart failure, (vid phthisis. Also, I assume, due to tTie healthier and happier life is the decrease in the number of cases of hysteria, which not long ago were so frequent among the young women whose physical and mental energies wore unnaturally restricted. Another disease that is much less prevalent is rickets; this is due no doubt to better conditions of life. There are many conditions which are much less frequently met with now, which can, perhaps, hardly be described as dying diseases, because they are merely the result of the more effective treatment in an early stage of some disease or deformed conditions. Such, for instance, are strangulated hernia, daily becoming less frequent, for the obvious reason that hernias are cured before they become strangulated; peritonitis,, which thirty years ago was probably m pipe cases' out of ten neglected appendicitis: persistent headache, duo to errors of refraction. “ Lupus, which is now treated early ami successfully, and gastric ulcer, whicli is now actually cured in hospital bv the physician or, failing him, by ifie surgeon, may bo only apparently less frequent, for they, like many other conditions, have possibly, on account of their long duration, given rise to a false impression of their prevalence. “ Some conditions may appear to ho less frequent because it is no longer fashionable to look for them or to talk about them—such, for example, as movable kidney and displaced uterus, both at one time the delight of the pecker after sympathy. So, no doubt, in due time ‘ blood pressure 1 will become a less fashionable and loss prevalent complaint. “ Although it is nol a disease, T almost think that we might add to _the list, of disappearing diseases, senility; if it is not disappearing, there is much evdcnco that its onset is postponed by several vears.” There is little profit in merely registering the fact of the decline ol a disease unless at, the same time we can form some idea of the causes. Dr Flemming says on this point: “ Are we ever justified in concluding that any diseases naturally get less virulent and then disappear? What is the reason of the undoubted milder typo of some of the infectious diseases—such, for example, as smallpox? Is it due to vaccination and an inherited immunity? If so, why in the recent epidemic in Gloucester was there no difference in the character of the disease in the unvnccinated, whether they were the children of vaccinated parents, or of one or two generations of unvaccinated parents? Why is it that scarlet fever has become so much loss serious? There can he no question of artificial immunity, and one can hardly think that the mere isolation of some of the cases can account for this alteration. Although, judging by the analogy of diphtheria, it may be argued that isolation may have some influence in affecting virulence, the earlier cases in an epidemic of diphtheria are generally of a very mild type; as the epidemic increases the type becomes more virulent; if, however, the earliest cases are effectively treated and isolated, there is not the same increase in virulence.

" Is not the disappearance of an in- ' fectivo disease due to altered conditions , which render its continuance difficult® ; Given the old conditions, would it not i reappear P I “ Are wo to look forward to a time I when, having been freed from all I diseases, we shall, like the anti-vacci- ! nators, lulled into a false sense of secur- ; ity, forget the forces that drove them 1 out, and, relapsing into the old conditions—an unprepared, a non-immun-ised, and non-resisting community-bo attacked with devastating effect?”