Document oeeVNybzK0pMky6g1K75DvXE7

CAN ACCIDENTAL TRAUMA BE PREVENTED?* MGeetor rogpeoTlMhi t.iar dnWNewhLVeiiYafcetoel er-kIyPn,rsCeuMsirtiay.dDne.cn, et M.P.H. Company We are a l l aware of the rem arkable achievem ents in d isease therap y and p re vention in the p ast sev eral decades. Preventive medicine has become a p ra c tic a l r e a lity in jevery day p ra c tic e . Most in fe c tio u s d iseases have been co n tro lle d and some v ir tu a lly e lim in ate d . This has created a new o rd er in the causes of death and d is a b ility . New h e a lth problems command the a tte n tio n of the p ra c tic in g p hy sician as w ell as the m edical in v e s tig a to r. One of these is a c c id e n ta l traum a. V ita l s t a t i s t i c s show th a t in 1950 some 90,000 deaths in the U nited S ta te s were the re s u lt of accidents, a m o rtality ra te of 60 per 100,000 population. Only card io v ascu lar d isease and cancer deaths now exceed those due to a c c id e n ts. The number of accid en tal deaths la s t year was about 4$ tim es the to ta l number of Americans k ille d and m issing in actio n so fa r in Korea. I f we co n sid er a l l b a ttle c a s u a ltie s in World War I I , the number of those k ille d , wounded, and taken p r is oner combined were about one-eighth of the accidental in ju rie s la s t year in the United S tates. A ccidents are now the lead in g cause of death from ages 1 to 25; second to h e a rt d isease in the broad age group 25 to 44; and f i f t h among p ersons 45 and over. Expressed in another way, f a ta l accidents cut o ff more years from the work ing lif e of the American people than any other single cause of death. Like the v isib le portion of an iceberg, f a ta litie s te ll only a sm all fractio n of the story of so cial and economic lo ss. For the beneath-the-surface p ortio n, estim ates only can be made. For every fa ta l accident, there are probably 100 se rio u s enough to d isa b le the in d iv id u a l fo r a day o r more and many of th ese re quire medical atten tio n . Treatment of accidental trauma is an im portant p art of the average d octor's daily p ractice. Despite th is , physicians generally do not think of accident pre vention as a p a rt of preventive m edicine. Once the in ju ry has been tre a te d , the e ssen tial facts obtained to .sa tis fy the requirem ents of an insurance company, or the death c e rtific a te fille d out, the physician is apt to consider his responsi b ility at an end. However, since accidents are growing in importance as causes of death and d is a b ility , i t is necessary for physicians to determine th e ir re sponsibility for the prevention of accidents as well as for the treatm ent of in ju rie s .* * Presented at the Second General Session, Massachusetts Medical Society, Hotel Statler, Boston, May 23, 1951. 03 i----7 o6 . preschool ages, playing with matches and clothing ignited at open fire s contribute m aterially to the death to ll. Drowning i s one of the more frequent causes of accid en tal death in young c h ild re n , p a r tic u la rly among 1- and 2 -y e a r-o ld s. About 400 deaths in th ese two ages are rep o rted an n u ally . Many of these f a t a l i t i e s occur in ponds o r pools near the c h ild re n 's homes o r sometimes in th e ir own back yards. F a ta litie s due to choking are by no means ra re . Twenty-six deaths in 1946 to 1947 among boys and g i r l s 1 to 4 in our experience occurred from the a s p ira tio n or swallowing of foreign bodies. Poisoning accounts for about 5 percent of a ll fa ta l a c cid en ts to young c h ild re n . Many of th ese occur between ages 1 and 3, the in q u isitiv e and "hand-to-mouth" period. The incidence of child poisoning is inade quately represented by m ortality ra te s . For example, in a study of admissions to the C hildren's H ospital, Washington, D.C., covering a 4-year period, there were only two d eath s, but 250 c a se s3. Lead poisoning is not a prominent cause of m ortality in th is age group but since the Baltimore City Health Department4 has reported an increase in childhood plumbism in th a t c ity , more a tte n tio n is being given to i t s study and p reven tio n. This is a somewhat d iffe re n t category from most other accid en tal poisonings in children. I t does not have the dram atic or clearcut relationship between cause and e f f e c t. The d iag n o sis i s freq u en tly made w ithout adequate lab o ra to ry o r e p i dem iological study to verify that the child has ingested and absorbed lead. For example, a t the C hildren's Medical C enter, Boston, where Byers5 has been making a c a re fu l in v e stig a tio n of suspected lead poisoning cases of 33 ch ild ren re fe rre d because of lead poisoning in the past three years, the diagnosis has been con firm ed in 18 cases; the condition was not present in 8; and in 7 the diagnosis as y e t has n ot been determ ined. More knowledge i s needed about childhood plumbism. P h y sician s in New England can c o n trib u te by re fe rrin g suspected cases to the C h ild re n 's M edical C enter fo r stud y . E ffo rts are being made in B altim ore, C in cin n ati, and elsewhere to create special fa c ilitie s to aid physicians in the diag no sis of th is serio u s and freq u en tly ill-d e fin e d co n d itio n . The cause in young children is usually due to pica and the source of lead is u su ally lead -co n tain in g p a in t on window s i l l s , play yards, to y s, e tc ,, which have been rep ain ted by am ateurs. In sid e woodwork i s ra re ly painted w ith a lead-con tain in g paint by professional p ain ters and reputable toy and juvenile fu rn itu re m anufacturers do not use to x ic p ain ts on th e ir products. Prevention must be centered chiefly on educating parents about the danger of perm itting children to chew or suck on painted o b jects or su rfaces. -5- REFERENCES 1. Co fh iPldeCdHoimaeamtrloithcnws .Seaelrthv ices and P Fund, New ediatri York. c Educ 1949. atio n . R eport of the American Academy 2. AA crmc isdtAeronmnt egrP,icaDatntoenJranold.u r B ., nal and Cole, of Public W. Graham: P e rs is te n t H ealth, November 1949. Hazards in the Home 3. AR udbminitC,tehdMi litdlotroenHn 'osBs.pHiaotnasdlp. Recinos, J r ., Ad ital, Washington, rian: D.C. Report on Child Poisoning Cases 1949. 4. B altimCorreed iHt eLailnthesD, eApamretmriceannt JSotuudrny.a l of P ub lic H ealth , September 1949. 5. Byers, R.K ., C hildren's H ospital, Boston. Personal communication. 6. P re ssJ, oEudrnwaalrdo: f TAhmeerAiccacnidMenetdiPcraolbAlemss.o ciatio n , November 29, 1947. 7. K leinNscewhmYiodrtk, HS t.aEt.e: JoAucrcniadlenot fPMreevdeinctiinoen, AinugMusetdi1c5a,l P19r4a8c.tic e . 8. PDrieevt reJincothua ,br nlHea .la ror yf F .: Accidents-, Childhood's G reatest Physical Threat, American Medical A ssociation, December 2, 1950. Are to 10- - 1 03