Cerebral Vascular Accidents in Patients over the Age of 60: I. General Considerations

I N THE REGISTRAR GENERAL'S returns, cerebral vascular disease is placed next to heart disease and cancer as the commonest cause of death: it is responsible for just over 13 per cent of deaths from all causes. The importance of these lesions as causes of disability is widely realised but is hardly reflected in the volume of research devoted to them. The prevailing attitude towards the therapeutic problem is passive: there is need for a more active approach. No concerted attack has been made on the social, economic and personal problems which are created by cerebral vascular disease. The circumstances seem to be entirely different from those which attend the study of cancer, tuberculosis, diabetes and even a disease as rare as myasthenia gravis. The statistics of the Registrar General show that in 1949 the crude death rate in England and Wales for cerebral haemorrhage was 737 deaths per million living persons. The number of deaths from vascular lesions of the nervous system in England and Wales increases yearly. In 1942 the number was 56,048, and in 1952 it was 69,388. In the United States in 1952, 170,000 people died of cerebral vascular accidents. This is over three times the number who died from tuberculosis and diabetes combined in the same year. It has been estimated that there are 1,800,000 victims of cerebral vascular disease in the United States today. Even allowing for errors in diagnosis, these figures reveal the magnitude of the problem. The statistics, however, fail to reveal the full