The Citizen and the Public Health---the Individual’s Relation to the Health of the Community

s and Selections. The Citizen and the Public Health—-The Individual’s Relation to the Health of the Community.* *An address delivered at the National Conservation Exposition, Knox­ ville, Tenn., on Public Health Day, October 25, 1913. Reprint from Pub­ lic Health Reports, Vol. XXVIII, No. 45, November 7, 1913. BY JOHN W. TRASK, ASSISTANT SURGEON GENERAL, UNITED STATES PUBLIC HEALTH SERVICE. There are few things of so great importance to the individual as His health. Upon it depends largely his attitude toward life and his relationship to his fellow man. Generali speaking, those physically well are prosperous and efficient and the sick or dis­ eased unsuccessful and inefficient. The individual chronically poisoned by malaria or by hookworm infection finds his daily work onerous and the fruits of his labor give but little pleasure. The consumptive would gladly exchange his bank account for physical health. Who would not give his material wealth if by so doing he could bring back loved ones lost prematurely by fatal disease? The health of the community is the combined health of those living in it. The relation of the citizen to the health of the com­ munity is therefore his relation to the health of his neighbors and of those living in the same city or State. The health of the community should be of interest to every in­ dividual, for upon it depends the welfare of himself, of his family. and of his fellow citizens. Upon the health of the people depends the happiness and prosperity of the community. Without health there can be no real prosperity and such material success as may be attained is of little benefit. To the extent that the inhabitants of a community are sick the community itself is diseased. The community has health only in so far as the people are free from disease. To a community health is a valuable asset. It insures prosperity. It attracts people. It increases the value of the land. Many letters are received daily at the Public Health Bureau at Washington from people who are contemplating buying land or moving from one State to another asking about the health conditions of certain localities. They want to know whether there is much sickness in this or that lo­ cality, whether there is any malaria, much typhoid fever or tuber­ culosis, and whether there is a pure water supply. People are thinking in these days of their physical welfare, and have no desire to live in localities where insufficient, attention is given to the pre­ vention of disease and where there is more sickness than there should be. The community that has health has a distinct advan­ tage in the competition for economic prosperity over the sick com­ munity. The health of the community depends upon the health of the citizens, but the health of each individual also depends in some measure, often in large measure, upon that of the other members of the community. Health of the individual is therefore a con­ dition that, generally speaking, can be maintained only by a com­ bination of individual and community effort, and its importance is such that in the activities of the city and of the State it should hold a prominent place. The health of the community should be of greater concern than commercial prosperity, for it is essential to commercial prosperity. Necessary as are our courts, our fire and police departments, and our educational systems, the impor­ tance of the community’s attention to the citizen’s health is second to none. Each case of a communicable disease in a city threatens the welfare of every citizen. Every case of tuberculosis or of typhoid fever is to some degree a menace to every uninfected person. Mod­ ern civilization in its development has become more complex, and as a result of the many avenues of social and commercial inter­ course we are brought more frequently into contact with our fellow man and his life. Where the bread is baked in the home people are not exposed to the diseases of the bakers and of those who handle the bread in shops, but in cities most bread is not baked in the home. Today a number of cities properly require that no person afflicted with any communicable disease shall be employed in a bakeshop, and that bread and other articles made in bakeries shall be wrapped in paper before leaving the bake room. More than one State now has regulations requiring the wrapping of bread in this . way throughout the State. If we patronize barber shops, wcare liable to be exposed to cer­ tain diseases of the many patrons who have preceded us unless special precautions are taken. We are likewise exposed to the dis­ eases of our servants, and not only to their diseases, but to the diseases in the families and houses from which they come. We may be exposed to the diseases of those who send their clothes to the same laundry in which our clothes are washed unless there are proper supervision, and regulation, When there is a family co\y or a cow supplying a small neigh­ borhood the possibility of the milk carrying disease is compara­ tively limited. But in cities where milk dealers receive their milk, often from hundreds of farms, and after mixing it in large tanks distribute it to thousands of people, the danger from chance con­ tamination of the milk with disease germs is many times greater, for instead of one family handling the milk there may be hun­ dreds, and if the milk from any one farm is infected with typhoid or scarlet fever germs all the milk may become contaminated when it is mixed in the vat of the city distributor and hundreds of families thus exposed to infection. This is not merely proble­ matical. It is a thing of frequent occurrence. Epidemics of typhoid fever due to infected milk are common. Outbreaks in which there have been many hundreds of cases of scarlet fever or diphtheria have been caused by milk in a number of cities. Large outbreaks of septic sore throat,'spread by milk, have within the last two years occurred in Baltimore, Boston, Chicago, and elsewhere? In street cars we come into close contact with people from many homes. And there are still other means by which we are brought into contact with our fellow citizens and their diseases. The fly that breeds in garbage, decaying vegetation, and stable refuse and feeds on anything and everything, including the sputum of consumptives, the excretions of typhoid patients,, and the pus discharged from sore eyes and running ears, by'its sociable habit of going from one house to another may carry diseases to people who never see the sick. At church we come into more or less close contact with people from many houses, in some of which there may be persons sick with communicable diseases. At day school and in Sunday school children are associated with others and frequently contract dis­ ease, as is well known to all. The diseases of children are often spread in this way. It is onlyproper, therefore, that each house­ hold give special attention to the welfare of other households by keeping at home those sick with communicable diseases until all danger of spreading the diseases is past.’ This is especially true of the acute infectious diseases, such as measles, scarlet fever and diphtheria. When these are known to be present in the commun­ ity, parents should be watchful, for frequently children are sick for some time before the nature of the illnessis recognized, and, if during this time they mingle with others, the disease is likely to be spread, and no right-minded citizen wishes by lack of due care to be responsible for the occurrence of sickness in others, sickness that may deprive others of life. The common drinking cup, which until recently it was cus­ tomary to see at drinking fountains and in public places, brought individuals into almost personal contact. Every person who drank left a little of his saliva and a few of the germs from his mouth on the edge of the cup, and in using the cup not only quenched his thirst but sampled, as it were, the salivary contribu­ tions and the germs of his predecessors. •What is true of the common drinking cup is likewise true in some measure of cups, glasses, spoons, and forks in restaurants, hotels, and at soda water fountains, if they are not properly cleansed after being used. The possible danger in placing to our mouths cups or other vessels that have been used by persons of whose conditions of health we do not know will be readily appreciated if we consider tuberculosis. This disease is present through­ out the world. About one person in every hundred in our cities has it in a form in which it may be spread to others. A small proportion of the cases in man is contracted from milk from tuberculous cows. This is especially true of the disease in chil­ dren. With the exception of this comparatively small proportion, the disease is spread from person to person, and each afflicted in­ dividual owes his misfortune to the fact that he either unduly ex­ posed himself or was not properly protected from the disease in some one else. As the germ which causes tuberculosis is usually present in sputum and mouths of consumptives, the possible dan­ ger in using a common cup of any kind is readily apparent. The common towel and the common comb and brush of the waiting room or other public place all contribute to bring their users into very close relationship, a relationship “usually closer and more intimate than that of ordinary social intercourse with friends and acquaintances. Do what we will, our health depends not' only on how we live but also on how the other people of the community live. The danger of infection from the sick and diseased we never see is often greater than that from the sick we see. We can protect our­ selves from those we see and know of, but we are in large measure helpless to protect ourselves from those of whose existence we are unaware. Every case of a communicable disease in* a city is directly or indirectly a menace to every person. The safety of every inhabi­ tant depends upon the health