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By John W. TRASK, Assistant Surgeon General, United States Public Health Service. The accomplishment of effective public health work depends largely upon the use of information obtained from the notification of cases of the preventable diseases. Adequate notification shows the occurrence, prevalence, and geographic distribution of these diseases, and without this knowledge attempts at their control are to varying degrees ineffective, and the proper protection of the health of the community is impossible.
Originally the duties of the health officer were very simple, and related only to the control of certain diseases associated with popular dread. As knowledge, however, of the causes of diseases and their means of spread has been acquired, the responsibilities of the health department have rapidly increased, so that at the present time the health department is properly the guardian of the community's health in so far as health can be conserved by the prevention or control of disease.
Only those diseases may be properly classed as preventable or controllable of which something is known of the cause or means of spread. Given this knowledge, the first and essential step in their prevention or control is the securing of information of the occurrence and location of the factors that produce disease and of the foci from which disease may spread. Of the communicable diseases a knowledge of the existence and location of cases is necessary, as each such case constitutes a focus from which the disease may spread. Of the diseases that are preventable but not communicable, a knowledge of the occurrence of cases and of the conditions under which they are occurring is necessary, as it shows the existence of the conditions which produce these diseases. This knowledge can be obtained only when the occurrence of cases is made known to some authority--that is, when cases are reported. Any attempt 1
at the prevention of disease will be at best incomplete and in large measure a makeshift unless it is based upon a knowledge of the occurrence and prevalence of disease.
The health department in a community is able to control disease in proportion to the completness and exactness of its knowledge of the occurrence of cases. With full information of existing cases it can work effectively; it can direct its efforts at prophylaxis against the disease itself; it can work in the light of knowledge of the situation. Without such information its attempts at control must be of a general nature, sometimes effective, more often not, for it is working in the darkness of ignorance of the location and prevalence of that which it is attempting to control-as well hunt birds by shooting into every green bush, a practice that would cost much in ammunition and yield but poor results. If they are not reported there may be hundreds of cases of typhoid fever, or infantile paralysis, or scarlet fever, or smallpox in a locality, and the health officer not be aware that there are any present.
Tuberculosis is a communicable disease. With the exception of the relatively small proportion of cases contracted through milk from diseased cows each case is contracted directly or indirectly from some preexisting human case. To control this disease effectively, it is necessary that each case be known to the health department so that it may ascertain that the patient is not unnecessarily exposing others to infection. Tuberculosis is usually chronic in nature, and those affected frequently remain for months and sometimes years a focus from which the infection may spread to others. To control this disease the health department should make sure that the patients understand how to so conduct themselves that others may not be infected and that those associated with the sick know the manner in which the disease is spread and how to protect themselves from it. Then, too, the health department should know of those suffering from tuberculosis, as those so affected, for the protection of the community, should not engage in certain occupations in which they would be especially apt to spread the disease.
Typhoid fever is another disease in which the health department should be informed of the occurrence of each case. Every case of typhoid fever has potential possibilities for harm to the community through the contamination of water, milk, or other food supply. A knowledge of all cases is necessary for the protection of others, for each case is a focus from which, under suitable conditions, an outbreak may arise. When there are a number of cases of this disease, there is usually some one or more sources from which it is being spread, and it is only when cases are reported that the health department can ascertain their relationship to each other or their common source of infection when such exists. It is only through the notifica