Pneumonia

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Feb 24, 1916

TEN per cent of the deaths in the United States result from pneumonia. It is estimated that during the past thirty days this rate has been doubled in some sections. Tuberculosis and heart disease, each causing one ninth of all fatalities, are the only diseases which outrank pneumonia, and in certain cities pneumonia has even surpassed the mortality from tuberculosis. Seventy per cent of all cases occur between December and May. It is distinctly a cold-weather infection, seemingly brought by wintry blasts, but especially prevalent during the winter season only because its victims are rendered more susceptible at that time by exposure, debilitating influences, and the presence of predisposing infections.

Pneumonia principally affects those at the extremes of life, but no age is exempt. It is invariably a germ disease. The predisposing and exciting organisms are so numerous that it would be futile to attempt their enumeration. Many of them are constantly present in the mouths and throats of healthy persons, and it is only through the aid which we unwittingly extend to them that they are transformed from harmless organisms to one of man’s most powerful enemies.

The presence of other diseases is the great predisposing cause of pneumonia. They prepare the soil for invasion. Holding first rank in this category is influenza, the increased incidence of pneumonia at this time being largely due to the present epidemic of la grippe. Individuals suffering from this infection are peculiarly susceptible to respiratory complications, and should properly observe every hygienic rule. Inflammation of with the upper air passages, pharyngitis, bronchitis, and tonsillitis, often predispose to the development of the disease, particularly among the aged and infirm. The acute contagious diseases of childhood, more especially measles and whooping cough, frequently prepare the way for pneumonia. Any one who through neglect or carelessness permits the spread of these infections is therefore open to the severest condemnation. Exhausting disease, of whatever nature, is often sufficient so to reduce our resistance that we are unable to cope with organisms which should be easily overcome, and hence predisposes to the infection.

Debility, either temporary or chronic, developing from any cause, increases susceptibility. Because of this the disease most often attacks those at the extremes of life. Among debilitating influences must be mentioned cold, exposure to penetrating winds, and the chilling of body surfaces as a result of exposure to wet. The combination of lack of food and fatigue proves particularly disastrous during the winter season, and is a condition to be avoided whenever possible. Bad housing, mental or physical harassment, and overwork are alike the advance agents of the infection. Overcrowding, in street cars, halls, and other public places, is unquestionably in part responsible for the spread of pneumonia in cities, as far greater opportunity is thus offered for the dissemination of the predisposing diseases through indiscriminate coughing, etc., as well as the directly injurious effects which inevitably result from exposure to such environment. The overheating of rooms is also seemingly harmful. Promiscuous expectoration may be, and probably is, a factor in infection, and consequently should be avoided by every citizen. A remaining most important agent should be mentioned—alcohol. It is in truth the handmaiden of pneumonia, and there is none more certain or more sure of success, especially if liberally and continuously used.

While the foregoing facts constitute in part our knowledge of the reasons for the widespread dissemination of an infection which carries with it a mortality of from ten to thirty per cent, it should be remembered that our scientific data are not yet complete. There are problems connected with immunity, predisposition, and the occurrence of epidemics which are yet to be solved. It is known that pneumonia sometimes attacks those who are perfectly well, and who apparently have observed every hygienic rule. Whether this is due to the increased virulence of the organism or to other causes is unexplained. It is, however, recognized that avoidance of the factors so briefly enumerated will in large part diminish individual susceptibility and therefore the incidence of the disease.—United States Public Health Service, Jan. 24, 1916.