The Incidence of Illness in a General Population Group: General Results of a Morbidity Study from December 1, 1921, through March 31, 1924, in Hagerstown, Md.

The problems and aims of public health are still set forth alinost entirely in lethal terms whenever statistics are used. We speak of an unfavorable death rate and measure success in a lowered mortality. The best indices which have been available of the prevalence of nearly all diseases are the fatal cases only; and our epidemiology is limited, for the m6st part, to statistics of, deaths. The reasons for this condition are fairly clear to every vital statistician and will not be discussed lhere. Of greater pertinence is the result of a prolonged dependence upon mortality statistics. The effect has been to foster a fallacious premise for public health work, namely, that a low death rate indicates the presence of health. Obviously it does not. We know that, on the contrary, an exceedingly unhealthful region may exhibit a relatively low mortality, as,. for example, a heavily infested hookworm locality or a section abounding in malaria. Pellagra may be widely prevalent in a community without affecting .erceptibly its general death rate or even increasing materially the number of deaths from the disease itself. Instances of the same sort.could be multiplied. The ill health that is manifested in symptoms, in discomfort, in lessened vigor and efficiency, even in illness and suffering, is not reflected in the deatlh rate, except for certain diseases, for any purpose practicable in preventive work. What really matters more to the sanitarian, therefore, in his scientific searching for causes and conditions and in his preventive work is not deaths but ill health. Of far greater importance to him than the life table or the list of causes of death is a view of the health situation as depicted by records of the occurrence of sickness and its causes. If such a view were permitted him,. it will hardly be denied that the change in his perspective would lead him to modify considerably his scheme for resear.ch and his program of effort. Such a view of the health-as contrasted with the death situation is not an impossible dream. While their significance may not yet be