II. Etiology in organic heart disease

Abstract

In the foregoing analysis of 1001 cases of organic heart disease among adults, we found that: 1. 1. There was a close resemblance among the histograms representing the three prominent types of heart disease for the clinic patient, private patient, and ward patient groups (Fig. 4). 2. 2. About one-fourth of the cases presented rheumatic heart disease, about two-fifths arteriosclerotic, about one-tenth syphilitic, and about one-tenth heart disease of unknown origin; other factors, such as sclarlet fever, hyperthyroidism, nephritis, etc., together, comprised less than one-tenth of the total sample. 3. 3. A comparison with the mortality curve led to the belief that the private and ward groups were more representative of organic heart disease, so far as age and etiology are concerned. 4. 4. Rheumatic heart disease was rare after fifty years of age; from 90 to 95 per cent of the cases of rheumatic heart disease occurred before the age of fifty years, more than half of which occurred before the age of thirty. About 50 per cent of the syphilitic cases occurred before the age of fifty, and 50 per cent after this age; the disease appeared to be rare before the age of forty and after the age of sixty. From 80 to 95 per cent of the cases of arteriosclerotic heart disease occurred after fifty years of age. Two-thirds of the cases of unknown etiology presented lesions typical of rheumatic heart disease, and occurred before the age of fifty. 5. 5. In about three-fourths of the cases of rheumatic heart disease rheumatic fever, either alone or in combination with other infections, was an etiological factor; tonsillitis, in one-fourth of the cases; chorea, in a little more than one-tenth of the cases, and growing or joint pains, in about one-twentieth of the cases. With the exception of chorea, which occurred twice as often among females as males, the relative frequencies of these infections was about equal for the sexes. 6. 6. Rheumatic heart disease seemed to be as common among males as among females. In syphilitic heart disease the ratio of males to females was about seven or eight to one; arteriosclerotic heart disease appeared to be much more common among males than among females. The reason for this is inexplicable since the mortality from heart disease is about equal for the sexes in the higher age groups. 7. 7. Foreign-born whites made up almost half of the total sample. Little could be learned about the predominance of race or nationality in any of the types of heart disease, both on account of the small number of cases, and because of the fact that age and etiology seem to be so closely related, and that the older immigrants, the Irish and the Germans, constitute the older age groups, and the newer immigrants, the Italians and the Hebrews, the younger age groups. With these points in mind, the rather large proportion of Irish found in the rheumatic group, the rather large proportion of Irish and colored, and the small proportion of Hebrews in the syphilitic group, and the relatively large proportion of Hebrews in the arteriosclerotic group suggest that a detailed study, comprising a larger number of cases, along this line is desirable. While it must be strongly emphasized that no conclusive deductions can be drawn from the foregoing analysis on account of the small number of cases, this study should, nevertheless, focus attention upon the following points: 1. 1. The available mortality statistics for organic heart disease are inadequate in any attempt to study the age incidence and duration of the disease, because they are based on deaths recorded in accordance with the International List of Causes of Death which is not so classified as to make it possible to distinguish between the infectious and degenerative varieties of the disease. 2. 2. By introducing into clinics a uniform system of records and organizing clinics in such a way as to facilitate the collection of facts for statistical purposes, reliable and important data concerning heart disease may be made available. 3. 3. It is only when heart disease is treated in special cardiac clinics or wards or by physicians who are specialists in heart disease, and when these agree upon uniform methods of seeking, describing, and recording the facts as they present themselves in individual cardiac cases, that sufficient data can be collected and any progress be made in understanding the problems with which this study deals.