Proceedings of the quarter-centennial celebration of the establishment of the Michigan State Board of Health : held at Detroit, Michigan, August 9, 1898.

Michigan. State Board of Health

Date:: 1898

Credit: Proceedings of the quarter-centennial celebration of the establishment of the Michigan State Board of Health : held at Detroit, Michigan, August 9, 1898. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$^^'herever any grave infection readies the proportions of an epidemic, the State board of iiealth slionld coroperate on the spot with even the most competent local board, and each should clearly understand and dis- charge its own functions. To the local board jiroperlj belongs the actual domiciliary work in the front. The responsibility behind the tighting line should be borne b^' the State board. Particularly should the State Board secure to the local board the credit and confidence which the com- munity owes. In no other way can the necessary activities go on with- out expensive disturbance of the ordinary life of the place. As to all that threatens public health outside the local sanitary jurisdiction, the State board should exercise its paramount authority. These matters will relate chiefly to the disposal of dead bodies, and to the movements of persons and things believed or suspected to be capable of carrying infection. Immediate circumstantial information should be furnished to other local boards concerning eveiw suspicious person or thing that may be moving out of the infected area. The running history of every epidemic and of every outbreak, large or small, should be preserved. The management of infectious disease is the clinical work of State medicine, and without a case book one’s ex- perience can never be large or comijrehensive. The practice of the Michi- gan Board of Health, opening as it does an account Avith evei\y outbreak, and continuing item by item till the incident is closed, has amassed a col- lection of histories that any of us may honorably coA^et. The public, including the doctors, have not yet learned Avhat an epi- demic is, and local health boards are usually loth to use the term within their sanitary jurisdictions. This reluctance doubtless groAvs more out of the sensitiveness of large business communities, than out of the ]tro- fessional sensitiveness of local officers. In current use, epidemic means sim{)ly the prevalence of unusual or dangerous disease. Fifty cases of rabies Avould in Detroit seem an eiiidemic, and your newspapers would reverberate Avith the horror; but Avho ever heard of an epidemic of tuber- culosis anywhere? If the 100 deaths from typhoid fever Avhich occur here in a year should all hap])en in three months, you would refer to the 1,500 or so cases as an outbreak. If they all should fall in a month, you would have to admit the existence of an epidemic. The people need to know that in eA'ery city or state whose typhoid rate is year after year aboA’e tAvo per thousand, typhoid feA'er is annually epidemic. Typhoid fcA^er is as much the sanitary shame of America as yellow feA^er is the o])probium of the West Indies, or leprosy of HaAvaii. I suspect we shall remove both these latter motes from our neighbor’s eyes before Ave get the beam out of our own. We have been hearing much recently about the health of our soldiers at the military camps in our OAvn country, and in Cuba. At the home camps we have troops relatively immune to typhoid fever; at the front troops generally susceptible to yellow feA'cr. Sanitary discipline is perhaps not better at the front than at b.ome. Against typhoid fcA’cr Ave possess T)reventive measures of positiA'e and proven effectiveness; against yel- low fever our methods are yet on trial. The sanitary history of the war noAV happily closing will furnish us some A’aluable lessons. If as Ave may anticipate, the prevalence and the fatality of yellow fever among the troops in Cuba should not greatly exceed tliat of typhoid at Tampa, it slionld teach ns that our oavu familiar typhoid fcA'cr is to us a more formidable enemy than yelloAV fever can ever be. I donbt, hoAveA’cr, if$