BY DR. BERTRAND P. ALLINSON.
(From The Anti-Vivisection Journal).
THE text of the Registrar-Generals Statistical Review of England and Wales for 1933 has just appeared. It would be more helpful if this publication were to appear nearer the period to which it refers for we have already had the Statistical Review (Part I. Medical) for 1934 and the tables of this latter year as well as those of this Journal. In view of this we only propose to comment upon certain special aspects of this Review.
On page 30 in Table XXV we had a comparison between the deaths from various causes per million living at ages of 1-5 years in 1911-17 and 1932 and 1933.
The first four diseases are measles, scarlet fever, whooping cough and diphtheria. During that period the death-rate for measles has diminished by 75 per cent., that of scarlet fever by about 66 per cent., that of whooping cough by 60 per cent., and that of diphtheria by only 50 per cent. In view of the absence of specific treatment for measles, scarlet fever and whooping cough we may ask how it is that a greater reduction in mortality has occurred in each of these than in diphtheria for which a “certain cure” has been in use for the last forty years. If we turn to the Registrar-Generals notes on diphtheria we are interested to read the following:.
“Recent bacteriological research suggests that under present conditions the fatality rate of an outbreak of diphtheria is largely dependent upon the proportion of cases infected by particular strains of C. diphtheriae which may have a localized distribution”.
This is very curious, for how many medical men have stated recently that the fatality rate in diphtheria depended upon the early administration of adequate doses of diphtheria anti-toxin? Of course, we ourselves have never accepted this latter assertion taking it as propaganda on the one hand and blind assertion on the part of prejudiced medical men on the other.
Consequently, the Registrar-Generals argument is either correct or an attempt to explain away the persistence of a mortality in a disease whose conquest was said to have been completed so many years ago. Perhaps this is another example of the triumph of the vanquished over the victors which history tells us about. In any case the Registrar-Generals comment shows that there is a mortality which is apparently not due to medical malpractice or parental ignorance and neglect.
When dealing with erysipelas the Registrar-General draws attention to a very peculiar phenomenon, and this is the rise in the erysipelas mortality at ages under 5, to 10 per 100,000 living in 1933. This mortality was 9 in 1896-1900, 8 in 1901-55, 6 in 1906-10, 4 in 1915-20 and 3 in 1923. We suggest that the diminution in mortality here chronicled coincides with the gradual diminution in the percentage of vaccinations in that age period.
Is it possible that the growing use of inoculations may be responsible for the rise in 1933, and that we must anticipate a continued increase in this direction? We are aware that the principal immunizing effort against diphtheria occurs at a somewhat later age but this does not necessarily invalidate the suggestion.
In 1933 there were two deaths from smallpox one of which was also suffering from acute miliary tuberculosis which no doubt was the really fatal malady, but there were three admitted deaths from vaccinia. This is yet another year that the admitted vaccination mortality has exceeded the smallpox mortality.
Of the cancer mortality we could say much but we will restrict comments to one peculiar feature of the marked increase of cancer of the lung, especially in men, when we have been told that tobacco has nothing to do with cancer production.
We cannot pass over the question of diabetes without making comment. It has frequently been pointed out by us that in spite of the introduction of insulin, there has been a steady increase in the mortality of diabetes. This, however, the champions of insulin therapy ( of which the Registrar-General is very evidently one) explain away by dissecting the mortality into groups of age periods and by claiming that the reduction that it appears has occurred in the mortality in ages under 45 is definitely due to the introduction of insulin, whilst the increase in mortality at the more advanced ages, particularly over 65, represents the lives whose death has been postponed (by an average of eight years we are told) by the introduction of insulin.
That there has been a considerable drop in the mortality of diabetes since the time of the introduction of insulin in the ages under 45 is not to be denied, but even this appears to have reached its limit, and the mortality will either remain stationary or quite probably resume its rise. With respect to the ages over 65 the rise has been only very slightly checked in the first years, but has risen more steeply in most of the subsequent years.
In Diagram 4 facing page 82 are given four curves representing the course of the diabetes mortality from 1861 to 1933 in age groups0-45, 45-55, 55-65 and 65 years and over respectively. Each of these curves shows one very distinct feature which is far more arresting than the alteration in mortality subsequent to the introduction of insulin in 1923, this feature is the steep fall in mortality commencing in 1915 and continuing to the end of the war, attributed by the Registrar-General himself to the food restrictions of that period.
This fall is far more important and dramatic, taking all four curves together, than any other feature in them. It shows us quite definitely that our contention of the prevention of diabetes by scientific living is a concrete fact. It brings us back to our basic attitude towards disease in insisting that if the fundamental causes are first eliminated, then little will be left to deal with subsequently. Insulin will never conquer diabetes, but scientific living will, for it shows that in spite of the increased mental strain of the War years, that the restriction of luxury foods and drinks caused a dramatic reduction in this disease as it did in other diseases.
We would like to remind our readers of the impressive all round reduction in mortality that occurred in Denmark during the latter part of the War as the result of the enforced restriction of luxury foods and abolition of alcoholic beverages, and as equally impressive being the rise in mortality which followed the removal of these restrictions.
The possibilities for the human race of this kind of action appear to us immensely more important than the discovery of one specific treatment which draws upon the vitality of innumerable sub-human creatures and which may thus postpone the demise of a few miserable human beings a few years.
The story of pernicious anaemia differs little from that of diabetes except that it is a malady over 90 per cent. of whose mortality occurs above the age of 45 and nearly 80 per cent. above the age of 65– here the introduction of liver and hogs stomach treatment only claims to postpone death by 32 years, and the Registrar-General in quoting the resumption of upward trend in the mortality says:.
“This suggests that any absolute reduction in the fatality of pernicious anaemia brought about by the new remedies has been balanced by an increased incidence or recognition of the disease”.
It appears that with medical science pursuing its present inspiring course we must await another war to save us from the inexorable onward march of these diseases !.
It is most important to remember that, with the exception of tumours, practically all diseases of the are are due to trouble elsewhere.
In visiting a number of nursery schools last year I was especially struck by the difference between the children in the open air and indoor schools. Anything from 10 to 40 per cent. of the children shut in rooms, even though some windows were open, had running noses, whereas in the open-air schools I saw but one or two. It is not always understood that open-air schools need not be very cold even in winter if an efficient system of heating is installed.
Constant nose-breathing must be insisted upon. It is but little good to operate for tonsils and adenoids for the prevention or treatment of middle-ear deafness unless at the same time the child is taught to breathe constantly through the nose. I have seen cases in which tonsils and adenoids have been completely removed, but in which the habit of mouth breathing still remained, and in which deafness steadily progressed until this habit was got rid of. To cure children of mouth-breathing, deep breathing exercises are very helpful.– SOMERVILLE HASTINGS, “The Preventive Medicine of the Ear,” The British Medical Journal.