ore

 

 

  

 

 

 

 

 

 

   
     

MEMORANDUM
July 20th, 1931.

DOCTOR DUBLIN

- STATISTICIAN

‘ really do not know what to say about the significance of these corre-—
lations, nor about the desirability of further work along similar lines. Items

3 and 4 appear favorable. Has a diphtheria and heart disease relationship

been worked out with a positive lag of several years?

This observation occurs to me, if I interpret the tables correctly. For
the Registration Area, there is a marked decline running fairly consistently
throughout the entire period for scarlet fever, diphtheria, and rheumatic
fever. This is true of the period from 1910-18 as well as of the later years.
On the other hand, there was very little, if any, décline for heart disease
from 1910-18 inclusive. In fact, the 1918 rate is the highest in the series,
though I suppose that was partly influenza. Nevertheless, it might appear
that we had to experience a consistent decline in these other cayses for a
considerable period prior to the appearance of a parallel decline’ in heart
disease, The same general relationship seems to hold for our industrial pol-
ieyholder experience. Does that mean anything, and is it worth further inves-—
tigation?

In addition to the above inquiries, I am convinced, in the present more or
less hysterical state of the public and of the professional mind concerning
the apparent menace of heart disease, that there are several points that might
legitimately and advantageously be made: :

1) We are certain that “heart disease" is a complex of various etiological

factors and pathological conditions, most clearly understood when analyzed
by age groups. . r 3

#2) There is a younger age group in which heart disease is largely rheuxuatic
in origin, though probably in part related to other acute infections. Here
there has been a recent mortality decline, concomitant with and perhaps,
chronologically at least, subsequent to a decline in certain probable causa-
tive factors. You can best judge what stress, if any, might legitimately

“—~——____be_placed upon the apparent correlations. In any case, the situation with

reference to this segment of our heart disease problem, is reassuring and
hopeful.

3) There is a second middle age unit in which syphilis is the principal _
factor. Is it possible to determine the trend of mortality there? Apparent-— |
ly, the age limits should be approximately from thirty to eixty, according to}
Carr, Wyckoff, Lingg, Collins, Church, and others. Certainly, this phase of |[
the situation is not hopeless, as syphilis is surely to a large degree, with |
adequate resources, therapeutically, if not prophylactically, controllable.

 

4) There is, finally, an older age group, largely arterio-schlerotic, or
degenerative, where the rates are no doubt rapidly increasing -- an increase ©

  

 

 

  

 
ae is ineritenle because of the onton of the eepleticn. This increas

is also, in part, the logical sequela of successful disease preventive and

_ death deferring efforts at younger ages. It is, in fact, the reward of ac=

- complishment. Also, for many it furnishes a prompt and ‘painless exit, and

has, from this angle, a beneficent aspect. To some extent, the mortality

here may also be in part controllable or deferrable, through personal hygi
mental hygiene, the periodic health examination, and similar efforts at con
= servation, and the adjustment of ‘physical and emotional strain.

5) Finally, from a mortality point of iow, £ believe 1950, ie our a
ience, showed for the first time in several years, « turn downward in the
curve. 1931 apparently is going to approach 1920.pretty closely. Is there
any indication here that inspite of the inevitable accumrulation of cardiac/
- hazards in the older age group, the saving at younger ages may be going to
stabilize the picture, if not to start a. downward et A , ie

6) In any case, it is Jiportant to distinguish between these oe To
talk about heart disease as being the greatest cause of death, and being an =
increasing menace is misleading, because the observation hast necessarily be
based largely, if not entirely, upon this inevitable natural process reflect-
ed in the older age groups. The problem must be split so as more specifical
ly to indicate those phases which have a genuine public health ees rem :

_} and that reflect promising methods for more complete control, at see o*
greatest economic and social significance.

If we can decide what siestHicance to eles upon the statistics, can we
not develop something that would have timeliness’ and orientation value?

.

Denna. heeds: Me a
Fourth Ving roni dent”