BEFORE CONSIDERING the possibility of eradicating tuberculosis, I will attempt forestall considerable unnecessary discussion by defining three terms used a great deal in the current literature on the question of abolishing communicable diseases-eradication, elimination, and as a public health problem. Eradicate, according Webster's, is derived from the Latin eradicatuts from e, meaning out, plus radix, meaning root, thus to pluck up by the roots. As Dr. Fred L. Soper has pointed out, it might be well if we had a term. which refers destroying seeds rather than pulling up roots; however, there seems be little point in trying introduce a new term at this time. I think we may assume that when we talk about pulling a disease out by the roots, we mean destroying the seeds of infection as well. Eliminate, according the same source, comes from elim,inat/s from e, out, plus limen meaning threshold, thus to expel, exclude (or throw out the door). At the 1959 Arden House Conference on Tuberculosis, the conferees originally agreed as the objective, but at the closing session changed the word elimination, implying that they were being slightly more conservative. I said at the time, and repeatedly since tlhen, that as far as I am concerned the two terms are synonymous. There is, however, a fine point of distinction, as emphasized by Dr. Anthony M. Payne, chairman of epidemiology and public health at the Yale University School of Medicine, in his address at the opening session of the 1962 annual meeting of the American Public Health Association. He pointed out that elimination, from its derivation, obviouisly implies a certain boundary line (threshold) beyond which one has excluded the item under consideration, whereas eradication per se does not. Thus, if you toss the cat out the door, you have eliminated it from the house, but since you didn't kill the cat you have not eradicated it, and it may crawl back in. However, this distinction between eradication and is not very helpful from a practical standpoint, since in using the term elimination you have mention the boundary lines that you have in mind. Hence, you might as well use the term begin with, plus the qualifyinig designation of the area in mind. Thus elimination of smallpox from the United States is the same as of smallpox from the United States. Similarly, if you eliminate smallpox virus from every geographic area in the entire world, then you have reached the stage of of smallpox on a global scale. Of some pertinence this entire consideration is the fact that a new committee oni disease eradication was established by the epidemiology section of the American Public Health Association and held its first meeting in Miami Beach in October 1962. At the initial organizing session the committee agreed unanimously that no communicable disease could be considered be eradicated until it is eradicated from the entire world. This means not merely the absence of clinical disease but the worldwide eradication of the specific etiological agent responsible for the communicable disease in question. As as a public health problem, this is a phrase used extensively indiDr. Perkins is managing director of the National Tuberculosis Association. This paper was presented at the Science Writers Seminar on Respiratory Diseases, Princeton, N.J., November 2, 1962.
Read full abstract