GENERAL MEASURES OF DISEASE CONTROL I. Modern methods for the control of communicable disease require that the health authorities have a prompt knowledge of how, when, and where cases of these diseases are occurring. With this information efficient officials can secure results, without it their efforts are of little value. This information is secured from various sources among which the following may be men tioned: (a) Notification of cases by physicians.
(b) Laboratory reports.
(c) Reports by visiting nurses.
(d) School inspection.
(e) House to house searches.
() Reciprocal notification from other health authorities.
(g) Gossip and newspaper clippings.
(h) Carrier searches and searches among contacts.
(i) Householders and teachers reports.
The foregoing are listed very nearly in their importance as sources of information, the first of these being the most important.
2. Physicians Duties in the Reporting of duty is a legal one though the details of the obligation vary in dif ferent political units. In a general way one may say that the responsibility for the initiation and enforcement of control measures is one of the health authorities, while the responsi bilities of the physician relate to the care of the patient. In communities where health work is poorly organized the line of demarcation is indefinite. The physician is an important source of morbidity information to the health authorities. His re ports should give the following information: they should be in writing (for legal reasons), and state the name, age and sex of the patient, his address, place of residence, name of disease, occupation, place of employment or school attended, and the physician's signature. These are usually sent to the Health Officer. Reporting should be required as soon as a diagnosis is reached and doubtful cases should also be reported. A sepa rate report should be made for each case.
3. The Reportable Diseases.—The diseases whose notifica tion is required differ in various political units. They usually include a greater or less number of the diseases which are in cluded in the standard morbidity law, (though the inclusion of some is of doubtful importance from the standpoint of public health), namely: Actinomycosis Small-pox Acute infectious conjunctivitis Syphilis Anchylostomiasis (uncinaria- Tetanus sis) Mumps Anthrax Paratyphoid fever Cerebrospinal meningitis, Scarlet fever epidemic Plague Chicken pox Pneumonia, acute lobar Cholera Poliomyelitis Gonorrhea Rabies Leprosy Rocky Mountain Spotted Malaria Fever Measles Trachoma Dengue Trichiniasis Diphtheria Tuberculosis, pulmonary Dysentery, amoebic Tuberculosis, other than Dysentery, bacillary pulmonary Favus Typhoid fever German measles Typhus fever Glanders Whooping-cough Septic sore throat Yellow fever.
4. Prompt reporting, which is necessary, depends upon the following: (a) Realization by physicians of the necessity for reporting cases from a public health standpoint.
(b) Enforcement of statutes and ordinances, etc; requiring reporting.
(c) Provision of public and private facilities for the promo tion of early diagnosis. The clinical diagnosis of typical cases is fairly easy, but atypical cases, exotic diseases, or those whose clinical recognition may be delayed, will have to be diagnosed by means of laboratory assistance. Hence public laboratory service should be available for this purpose.
5. Estimates of the diseases prevalence are of value to the health officer for the purpose of checking the completeness of the morbidity reports. For this purpose the following may be employed: (a) Percentages or ratios secured from autopsy returns.
(b) The scrutiny of the mortality reports, to ascertain if the patients dying from the reportable diseases were previously reported during life as cases.
(c) Estimates based upon the mortality returns by the use of case-mortality ratios. Thus the mortality from typhoid fever is ordinarily considered to be to per cent. and if ro deaths occured during a given period, one would expect that in the same interval there had occured approximately TOO cases.