PUBLIC HEALTH WORK JORDAN. 607 



part in municipal health activities and is responsible for an important 

 share of the expense. In Boston, for example, in 1909 about one- 

 tenth of the annual appropriation was expended for disinfection. 

 One of the most experienced New England city health officers has 

 recently seriously questioned the value of such an expenditure. 1 

 After a study of the ratios of recurrences in certain diseases he con- 

 cludes that, "both theory and facts, so far as any data are available, 

 indicate that terminal disinfection after diphtheria and scarlet fever 

 is of no appreciable value." This view has met with strong support 

 from the experience of a number of English health officials, even if it 

 can not be regarded as conclusively proved. Every one now knows 

 that the large sums of money spent in measures of disinfection 

 directed against yellow fever gave little return in added safety. We 

 can hardly take for granted that any process of combating disease 

 is effectual simply because it is customary or traditional. It is 

 evident that the whole question of disinfection needs to be studied 

 afresh with a view to actual efficacy. It is not a subject for labora- 

 tory experimentation alone, but must be investigated as a problem 

 of practical public-health administration. 



Other instances of the application of energy and money to measures 

 apparently of slight or doubtful value might be cited, but those 

 already given are fairly typical. The question that should be asked 

 in every case is not whether a particular measure is entirely devoid 

 of value, but whether it is the most effective way of utilizing available 

 resources. As matters now stand, there are*a number of unques- 

 tionably valuable measures that can not be prosecuted with sufficient 

 vigor because of the enforced diversion of funds into other and less- 

 profitable channels. 



Efficacious measures may sometimes be distinguished from the 

 fruitless or relatively unprofitable by their direct and unmistakable 

 outcome in the saving of life and the prevention of disease. A few 

 illustrations may be noted. 



The importance of control and supervision of the sources of public 

 water supply has long been recognized, but the importance of con- 

 trolling the quality of the public milk supply, although frequently 

 urged by sanitarians, is not always appreciated. At the present 

 time in the great majority of American cities it is safe to say that for 

 every case- of infectious disease due to drinking-water ten cases are 

 caused by infected milk. It is difficult to secure adequate funds for 

 the sanitary control of the milk supply. By sanitary control of milk 

 is meant not the upholding of a rigorous standard of butter fat and 

 total solids, but the maintenance of proper standards of cleanliness 

 and health for dairy cows and especially the safeguarding the milk 



1 Chapin, Jour. Amer. Public Health Assoc, 1911, vol. 1, p. 32. 



