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Take a snapshot of U.S. health in the early 20th century. Epidemics of crippling polio are the summer dread. Millions of cases of small pox, chicken pox, measles, mumps and German measles occur each year. Meningitis epidemics from Haemophilus Influenza B occur regularly. The leading causes of child mortality are infectious diseases including diarrheal diseases, diphtheria, pneumonia and influenza, scarlet fever, tuberculosis, typhoid and whooping cough. Mothers die in childbirth and prematurity is a death sentence. Life expectancy at birth is barely 50 years. There are no car seats, or for that matter, there are no cars. People fall off horses. Pioneers die crossing the rapids. The rate for black infants was almost twice as high. In 1935, more than 500 maternal deaths occurred for every 100,000 births. In 1900, for children older than 1 year of age, 3% of children died between their first and 20th birthday. In our time, we have seen smallpox eradicated and polio in developed countries is nearly extinct. How did we get here and have we gone too far? At the beginning of the century, life was precarious. But gradual knowledge of micro-organisms and how they infect humans contributed to decreasing mortality from invading bacteria. Between 1900 and 1998, the percentage of child deaths attributable to infections declined from nearly 62% to 2%. In contrast, accidents accounted for 6.3% of child deaths in 1900 but 43.9% in 1998. As trauma has become the killer of children, efforts to further decrease risk have supplanted the search for the newest antibiotic and treatment of infection. The social cry for safety, both in health care as well as our daily lives, is louder than ever. Just as we may have conquered many micro-organisms, we are waging the battle against negligence, looking for heightened accountability for products and services. Even though accidents account for a high percentage of deaths in children, the overall death rate from accidents has declined over the century from 47 to 16 deaths per 100,000 children. What brought us to this place? The major declines in child mortality that occurred in the first third of the 20th century have been attributable to a combination of improved socioeconomic conditions and the public health strategies to protect the health of Americans. As the mysteries of micro-organisms have been uncovered and discoveries made, they have been applied to enhance our ability to protect people and to fight disease. State and local public health departments implemented water treatment, food safety, organized solid waste deposal and public education about hygienic practices. Vaccinations became widely used in the middle part of the century. While the improvements in the first part of the century were produced by global improvements, vaccinations targeted specific, life-threatening diseases. Deaths from vaccine-preventable diseases have been virtually eliminated. Cases of tetanus, diphtheria and polio are unheard of in the vaccinated population. Although dangerous at times and overuse is in question, the development of antibiotics to fight infection has even further reduced the mortality of children. There is no doubt that widespread use has some serious consequences. However, the 21st century has shown a more conservative and judicious use of aggressive antibiotics, thus avoiding resistance and super-infections. As we go through our daily lives, it is often helpful to step back and regain perspective. There are many people and groups who fight against the use of immunizations and there are points of controversy that need attention. However, a keen look at the last 100 years and the progress made since then cannot be overlooked. Would you rather live in the 21st century with a life expectancy of 77 or in the early 1900s under 50? A healthy respect for the diseases that no longer exist will enhance understanding and add credibility to the data. Society must ask the question: How many diseases do we want to prevent? Is it better for the body to get disease rather than develop immunity from a vaccine, especially if the disease can be treated in most children? How do we assess risk and what risks are we willing to take? These are questions that we must help answer in the next 100 years. Society will direct us to where we need to go. Science will help us but ethics will guide us. New challenges are ahead and I am confident we are up to the challenge. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita and Ladera Ranch and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children's Hospital of Orange County. He is a member of the American Academy of Pediatrics and the Memorial Care Physician Society. If you have any questions or comments for Dr. Wesp, you can e-mail him at askdrwesp@netscape.net. Letters:ocfamily.com. |
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