_Public Health Administration_
Unless one had had a wide experience in the administrative side of
public health matters, it would be useless for him to try to discuss the
details of handling any sort of an epidemic, and even then local
conditions vary so much in different cities and States that each
administrator’s experience must differ greatly. The difficulty with
reports of epidemics by public health officials is usually found in the
fact that the reports are impersonal compilations and convey no idea to
the reader, or rather to the student (for no mere reader is attracted to
them), of what situations were faced, of what difficulties were in the
way, of how the conditions were met, or what the administrator after due
reflection would advise doing next time under similar circumstances. In
the face of inexperience the writer ventures the following suggestions
for improvement, though no originality is claimed for the ideas.
The administrative powers should be centralized in one individual, or in
an executive officer acting for a competent board of advisers, who
should be endowed with the powers to carry out the measures which seem
best suited to meet the situation at hand, and who should be beyond the
pale of political interference and in position to prevent political
fiascos, built more or less directly on health regulations.
The United States Public Health Service should work toward standardizing
health laws and penalties for all States.
Thorough enforcement of ordinances requiring the reporting of all cases
and all deaths as now demanded by public health rulings should be
insisted upon. These reports are so important to a knowledge of the
progress of the epidemic that the section on preventive medicine of the
American Medical Association (51) has just advised the consideration of
eliminating from membership in the Association any physician who
willfully fails or refuses to comply with the regulations requiring the
reporting of communicable diseases. Additional information can be
obtained by daily canvasses of the schools, when open, of the large
industries, and of the daily admissions to hospitals. Data on the daily
facilities for the handling of additional cases in hospitals should be
on file in the office of the administrator of health.
Printed instructions giving in detail the proper procedures for
isolation of the patient and the protection of the family should be
supplied to physicians for distribution at the first visit to suspected
cases.
_Desirable Laws_
Some specific laws governing the following points would be of great
advantage during the progress of an epidemic: (a) A law providing for
the commandeering by boards of health of vaccines, sera or other
substances for which a sudden unusual demand may occur, and for the
distribution of such substances by the authorities to the public at the
prices ordinarily asked. (b) A law permitting the exclusion from the
daily papers by boards of health of advertisements containing obviously
false and fraudulent statements relative to the epidemic. (c) A law
permitting the health authorities to go into public eating places and
demand proper sterilization of dishes and eating utensils with the
alternative of closing the establishment. (d) A set of laws making the
penalties sufficient to prevent violations of the regulations.
_Education of the Public_
From the beginning to the end of an epidemic the health authorities,
aided by the medical profession, should take the public wholly into
their confidence. At the first news of the approach of the disease a
general bulletin should be issued giving all of the main facts that are
available. This was done in a way by the American Public Health Service,
but the bulletin reached only a small fraction of the people, and
although parts of it appeared later in the daily papers, it was pretty
generally missed. The papers should be used freely and the space paid
for when necessary, so that the news of the epidemic is featured
emphatically. The establishment of a question and answer department or a
bureau of information would take care of a great deal in the way of
denying misinformation. The public should be encouraged to report
helpful facts of all kinds, but with the understanding that no rumors
would be published without investigation and confirmation. In this way
it would be possible to prevent articles advising harmful and useless
remedies from reaching the press, and aid in suppressing some of the
“Sure Cures,” so many of which appeared to abuse the confidence of the
unwary during the 1918 epidemic. Several such cures have been most
interestingly discussed in a recent bulletin of the United States Public
Health Service. The bulletin divides the “Sure Cures” into three
different classes, as follows: “First comes the individual who has a
specific remedy, the formula of which he will sell for a price * * *;
next comes the person with a pseudo-scientific treatment, e. g.,
isotonic sea water, ‘orzono therapy,’ ‘harmonic vibrations.’ * * * Still
another type, who gives freely of his advice that humanity may be spared
from pestilence.” Among the latter are found advice for placing sulphur
in the shoes, wearing of amulets, inhaling of alcohol, chloroform, etc.,
as well as numerous religious and mental science treatments, etc. A
frank statement of facts and a discussion of the ridiculous side of many
of these claims would undoubtedly benefit the entire public. The
placarding of the cars and the warnings posted in conspicuous places no
doubt helped greatly, and this method undoubtedly should be continued.
As long as theatres are allowed to remain open, speakers may be used to
advantage to emphasize important points. The County Medical Societies
should be asked to appoint committees for supplying information or for
seeing that the information given to the public is authoritative. In
large cities committees may be organized among hospital superintendents,
so that the heartiest co-operation between health authorities and
hospitals will be available. The ever-ready aid of the Red Cross and of
every other auxiliary body should be employed to the fullest extent to
allay apprehension and relieve suffering.
_Summary_
The exact knowledge of the mode of transmission of epidemic influenza is
still wanting, but it is known to be spread by contact. Attention should
be directed toward every practical means of decreasing the number and
intimacy of contacts. Publicity campaigns and other educational measures
should be pushed strongly. Health Departments should adopt a policy of
preparedness during inter-epidemic times, should make every effort to
centralize and standardize their work, and should take steps to obtain
sufficient legal backing, so that upon the appearance of the epidemic
they can take the lead, speak with authority and enforce their
ordinances and measures. The physician’s duty is to inform himself on
the value of the various measures, and if he is at odds with the public
health methods, he should settle them between epidemics, so that when he
is called upon to carry out public health orders he can do it to the
letter and without criticism. Laymen should learn that quiet living
without violent exercise, the keeping of good hours, the avoidance of
public gatherings and of unnecessary exposure is the best policy to
pursue during influenza epidemics. They should strictly obey the orders
of those who have specialized in the control of epidemics, and all
business men must stand ready to help in every possible way and to make
their business interests subservient to the public good.