JAMA Revisited February 23, 1918 It is, of course, readily admitted that infections may be food borne. The story of the part played by milk in the distribution of epidemic sore throat, typhoid fever, scarlet fever and tu- berculosis need not be rehearsed here as evidence. But Jordan, If it is true that public health is purchasable, it is also true that of the University of Chicago, in emphasizing the bacterio- limited expenditures will not procure unlimited talent or un- logic aspects of the subject points out that, after all, the cur- limited results. The upshot of this indisputable statement is rent methods for preventing food infection (which certainly that community health work ought to assume a pragmatic at- is not as innocuous as the most usual adulterations in the titude to the extent of undertaking foremost those proce- chemical sense) are not those of the simple inspection of dures which pay well from the standpoint of good returns in food products. The chief infections that are known to be due lives saved and disease prevented. The evolution of modern to food infected at its source, says Jordan, are those—mainly public health activities has been gradual; it is still far from a meat borne—caused by the group of paratyphoid-enteritidis complete or ideal stage. Progress in science has pointed year bacteria and those resulting from the use of infected milk. after year to the desirability of new measures in preventive For this reason it is questioned “whether the amount of dis- medicine; but it has also often directed attention to the inef- ease prevented by the ordinary methods of food inspection is ficacy of earlier procedures and given justification for their at all commensurate with the outlay.” modification or abandonment. Nevertheless, the prestige of It would be reckless, indeed, to abandon the careful an established custom, whether it is in trade, in diet, or in prac- supervision of our milk supplies in any detail that makes for tical hygiene, is not infrequently so firm that something more health, whether it be in the direction of examination of the than scientific argument is needed to uproot or replace it. persons handling this food or of effective pasteurization, or The history of household disinfection and room fumiga- of any other hygienic device that has justified itself. Even tion would furnish illustrations of what has just been con- harmless water may render milk of poor nutritive value to tended. The practice of the disinfection of habitations has children, and surely skimmed milk has lost a component of undergone great revision, not without a feeling of uncer- no little significance for the young. It may well be debated, tainty on the part of many as to loss of the supposed security on the other hand, whether much or even most of the cur- against recurrence of certain types of diseases for which rently practiced food inspection “pays” from the standpoint fumigation was once extensively carried out, after the of lives saved. From this standpoint clean streets may not removal of the patient…. This does not mean that household “pay,” and whitewashed barns may not prevent the loss of disinfection or school disinfection is to be entirely discarded, health. Nevertheless, modern civilization demands these and but rather that the value of specific procedures of the past are even more. Whether the campaigns for cleanliness in home, to be evaluated on the basis of epidemiologic evidence rather factory and outdoor premises ought to be directed from the than traditional assumption, as heretofore. office of the public health authorities or financed from their Two recent writers competent to discuss the values all too limited funds is a question for frank debate. But we of modern health work have raised the question, directly or cannot afford to give up the esthetic acquisitions of modern indirectly, as to the efficacy of much of the current work life. Nor are we to forget that, harmless though most fraudu- or propaganda in the domain of food hygiene. Dr. Chapin, lent adulterations are, they are not always safe. The Bureau the superintendent of health at Providence, R. I., in attempt- of Chemistry only recently saved us from the hidden dangers ing to combat the popular notion that the principal functions of poisonous beans imported by unscrupulous persons and of a city health department are sanitation and food control, ready to be unloaded on an unsuspecting public. Modern has remarked: food control has insisted on honesty and purity in matters “Another time-honored and popular means of promoting that concern our daily lives. We must retain this valuable the public health is control of the food supply. This control force intact in our public welfare organization—somewhere. naturally is divided into the prevention of adulteration and the promotion of cleanliness. Though there is much lurid lit- 1. Chapin,C.V.:TheRelativeValuesofPublicHealthProcedures,THEJOURNALA.M.A., July 14 1917, p. 90. erature on the dangers of impure food, as a general thing 2. Ptomain Poisoning versus Food-Borne Infection, editorial, THE JOURNAL A. M. A., adulterants are as likely to be healthful as unhealthful. Adul- Feb. 16, 1918, p. 462. teration, with rare exception, is an economic and not a health 3. Jordan, E. O.: Food-Borne Infections, Science, Jan. 25, 1918, p. 80. problem. There is almost as much nonsense written about ptomain poisoning as there is about adulteration. ...” JAMA. 1918;70(8):538-539. Editor’s Note: JAMA Revisited is transcribed verbatim from articles published Section Editor: Jennifer Reiling, Assistant Editor. previously, unless otherwise noted. jama.com (Reprinted) JAMA February 27, 2018 Volume 319, Number 8 835 © 2018 American Medical Association. All rights reserved.
JAMA – American Medical Association
Published: Feb 27, 2018
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