CONTROL OF INFECTIOUS DISEASES 759 



disposal of discharges (spitting, etc.), should be part of the duties of 

 the health department. 



Finally, the strictest supervision of those concerned publicly and 

 officially in the handling of public utilities on a large scale (water sup- 

 plies, milk supplies, hotels, restaurants, food stores, etc.) should hold all 

 strictly accountable for the contamination of such supplies with dis- 

 charges whether these be normal or not. Hence official control of 

 infectious disease divides itself naturally as follows: 



1. The recognition and isolation of frank cases of the diseases in 

 question, at home or, better, in a proper hospital. 



2. The supervision of the attendants and immediate associates of 

 such frank cases. 



(a) To detect among them that one from whom the frank case, 

 already recognized, received his infection. 



(b) To detect at the earliest moment any other frank case about to 

 develop from among those associates who may have been infected at the 

 same time and from the same source as the frank case already found. 



v(c) To prevent further spread from any already infected associates 

 or those who may become infected by later association with the frank 

 case during its existence as such. 



(d) To discover mild, unrecognized, and concealed cases, and carriers. 



3. The exclusion of all infected persons, their infected non-immune 

 attendants, and immediate associates, from participation in public 

 life so long as danger continues and especially their exclusion from hav- 

 ing to do w r ith public utilities or public gatherings. Hence has arisen 

 the crude drastic but efficient (when consistently and uniformly 

 carried out in every case) system of isolation of the sick and quarantine 

 of his associates. 



Unfortunately quarantine has become a mere letter-of-the-law pro- 

 cedure, working great hardships on those who conscientiously sub- 

 mit to it and yet failing to achieve its objects because of the great 

 number of those who evade or escape it; moreover, because its provi- 

 sions are unintelligently enforced. Of what avail is rigid quarantine 

 of an infected family where milk continues to be sold from the same 

 premises? Why quarantine the honest man who has an honest 

 physician and whose case is reported, while his neighbor, having the 

 same disease in his family, calls no physician, or a dishonest one, and 

 therefore escapes official cognizance? 



