with the patient; cleanse his hands thoroughly, and disinfect his clothing before entering another house. (7) The character and duration of the isolation must be left to the Public Health Department. Thorough disinfection with formaldehyd, ten ounces to one thousand cubic feet, the germs having now been corralled, will destroy them and thus end the existence of the disease. TRANSACTIONS. DETROIT MEDICAL SOCIETY. STATED MEETING, NOVEMBER 13, 1901. DISCUSSION OF PAPERS. DOCTOR GUY L. KIEFER read a paper entitled "The Relation of the Medical Profession to the Department of Public Health." (See page 498.) DOCTOR JAMIESON: In regard to the free vaccination by the health board, I do not think that the general practicians made much objection to that. I believe that in times of epidemic the procedure that will effect the greater number of vaccinations quickly is the proper one to elect. I think that every six or seven years at least we ought to insist on a revaccination of all school children, but where on one or two occasions it has failed, then I think it is unnecessary, as I think there are persons who are nonsusceptible after one or two successful vaccinations. In regard to medical registration, I think the doctor's plan is correct. DOCTOR DAVID INGLIS: As long as the profession are willing to lower the standard by endeavoring to make it easy, endeavoring to make arrangements for some person who is more or less with an infected person to go to work, we cannot say much to the laity if they try to evade the isolation. At present quarantine is conducted with great injustice to the people quarantined. The whole purpose of the quarantine is to protect, not the people in the house, but those outside the house. It does not seem to me that quarantine will ever be based on absolutely correct principles until the people who are imprisoned are paid for being imprisoned. I think that if laboring men were paid wages for isolation service there are very few of them who would not be willing to remain in quarantine. DOCTOR THOMPSON: The sequela which follow scarlet fever are of a very serious nature, and should be considered in the treatment of this disease. Scarlet fever, of itself, is often regarded as not being a very serious disease, and, for that reason, very frequently the means employed to eradicate it are not rigidly enforced. The hospital, perhaps, is the greatest aid which the physician has in eradicating scarlet fever, simply because the isolation is perfect. There is no danger of spreading the disease to the surrounding district. There is a great deal of knowledge necessary to successfully cope with this disease, and this is not possessed by the laity in general; therefore, it is necessary in many cases to send the patient to the hospital. We find this trouble most frequent among the poorer classes, I think, simply because the isolation is less successful among them. As regards disinfection, not only the room, clothing, toys, books, letters, et cetera, should be disinfected, but it occurs to me that, perhaps, the house cat also might be a good thing to disinfect. The domestic animals are known to convey these germs as well as anything else. It also occurs to me that this disease, the same as bubonic plague, spreads by means of rats, and therefore, I would suggest plugging up all the rat holes in the room. The importance of this isolation has been brought to the attention of the laity by the doctor, but I do not think that the laity understand it—why it is that the patient cannot be about playing or attending to his duties, et cetera. It would seem that such a patient is hardly the one to keep isolated, but the laity should be taught that as long as such person is able to convey infection to other people the necessity for isolation should be made plain. DOCTOR CHITTICK: It seems to me that a great responsibility devolves upon the medical profession regarding the danger of contagion in all these contagious diseases. The laity, of course, are not supposed to act on their own accord, but we have that responsibility thrust upon us, because we are supposed to know. There is a great deal of hardship sometimes, among cases, and the physician may hesitate where, for instance, a man's business is apt to be entirely destroyed. If the man who is the breadearner were compensated, I think there would be more willingness on the part of the laity to obey. If a hardship be incurred by being isolated, then the cases should go to the hospital. DOCTOR SCHMALZRIEDT: The law provides that the health officer shall see that the quarantined do not suffer for the necessaries of life, and have nurses. Of course, that does not permit us to offer a man who has been quarantined his day's wages; it restricts us to the necessaries for people who are in need. It makes it very difficult at times to maintain a quarantine when we have put the wage-earner out of the house, a man who is earning a small wage, and compel him to pay board for himself and also to provide for his family. If we could possibly supply his family, or give him some compensation if he remained at home, the quarantine laws could be more effectively carried out, but this is a matter which cannot be remedied except by legislation. DOCTOR BENNETT: One point that I think might be discussed in connection with the relation of the Health Officer to the medical profession, and one means of preventing this disease, would be in aiding the general practician to make diagnoses of scarlet fever. I have seen the time when I would say, as for me I cannot make a diagnosis in some of the milder cases of scarlet fever positively. I would let it drop at that. After watching some of the very best men in the profession in the city I find that they are very many times at sea to know whether they have scarlet fever gerins, measles, or some other slight rash due to various causes. I know positively that there are many cases in which no man can make a positive diagnosis. A help to the general practician is the fact that the Health Officer can step in at this time and aid him with his better knowledge of the disease and help to clear up the diagnosis. I think we ought not to hesitate for a moment to call the Health Officer in consultation in these cases. I believe that many cases are not reported for the reason that there are physicians who hesitate to admit that they cannot make a diagnosis in obscure cases. Another point, in regard to the medical registration, brought out by DoCTOR JAMIESON. I believe we cannot make a success of medical registration until it is put entirely in the hands of the Health Officer. At the present time if we know of a "quack" in our locality the only way we can get at him is by calling the attention of the prosecuting attorney to him, and in this way we are exposing ourselves. Many times quacks have the sympathy of the legal profession, and many times they are too lenient with them and let them go. If we could simply report the case to a Health Officer, and let him investigate the matter for himself and then report it to the prosecuting attorney, I think we could obtain better results. DOCTOR WAGNER: I infer, from the report by DOCTOR KIEFER, that there is a lukewarm interest in the prosecuting attorney. If the family physician allows the patient to take the street car to go to the hospital, I do not think we can do very much to prevent scarlet fever from spreading. DOCTOR AMBERG: It seems to me that if a man is quarantined he endures punishment for which he should receive compensation. DOCTOR KIEFER Spoke of the relation of the medical profession to the Department of Public Health, and gave us some good advice. We have two of the medical profession in the Department of Public Health, and I think these. two gentlemen could do a good deal for the medical profession and the public if they would practically unite. If the health board controls the lying-in hospitals why should it not look after all other hospitals? DOCTOR WALKER: This matter of the State Board of Registration is one that will be brought to the attention of the profession of this city the coming year in regard to higher medical education. There is considerable correspondence going on now in regard to this matter, and there. unquestionably will be brought up additional amendments to the presen law regarding who shall enter the profession and who shall say that they shall enter the profession, both as to their literary qualifications previous to entering the college and after they get through, as to whether they are fit for practice. That subject is a very important one, and in its solution the State of Michigan should lend all practical aid to those gentlemen who comprise the State Board of Registration in Medicine. DOCTOR SHURLY: As a remedy for a large number of cases that cannot be quarantined, I should suggest the cottage system of isolation for this city. There are many cases that could be sent to the hospitals, of children, if the mother were allowed to go to the hospital with the child. The city could equip a few cottages with what is necessary and allow the child and mother to be taken to these hospitals, and allow them to live in isolation in that way. It seems we have not got the cooperation of the public in the matter of isolation. DOCTOR JENNINGS: The question of public vaccination seems to me to be one that the profession generally are agreed upon. The difficulty is not in smallpox; the community generally favors the restriction of smallpox by the most energetic efforts that the health department can put forward, but it is not educated up to the vigilance of equally severe restrictions in regard to some of the other contagious diseases. In regard to the question of scarlatina that has been brought up, and methods of transmission, particular stress was laid upon the communicability of the disease during the stage of desquamation. There can be no doubt that scarlatina. is equally contagious during the period of desquamation, but that is not the most contagious period. The most contagious period is during the height of the fever. During the height of the rash it is at its highest point; during the desquamation it diminishes very rapidly. Its striking distance is so short that it is one of the most easily controlled of the contagious conditions. I was on the committee, I think, from the Detroit Medical and Library Association, that urged upon the Board of Health the. necessity of adopting a regulation, and we reported, after a very thorough investigation of the subject, that a four weeks' quarantine was a wise thing in quarantining, and I think now that it is. There is no reason why quarantine should be prolonged three or four weeks, even though desquamation be repeated. I doubt if after this period a case of scarlet fever is contagious; that is, from the epidermal scales. DOCTOR MCGRAW: In the New York Sun a little while ago there was described an interview with the Health Officer of New York, showing just what a community will do under certain circumstances. There in New York a Health Officer stated in this interview, "Whoever had smallpox would have to go over to the island and go into public wards and be treated for smallpox." It did not matter how gentle a lady had been bred or what she was willing to pay for. What the city was willing to give in that last epidemic of smallpox here was perfectly shameful. DOCTOR FLINTERMANN: We ought to have a hospital for contagious diseases, and have it ready at all times, and have it absolutely complete and clean in every respect. Scarlet fever is one of the diseases which, by precautionary measures, could be prevented. In former years cases of scarlet fever were very frequent; cases wherein the diagnosis was correct. Since we have learned to operate without danger to the patients, learned to protect lying-in women, such cases of scarlet fever have become very rare. That would give us a clew to adopt measures in some ways as we would in cases whereln there are lying-in women. DOCTOR KIEFER: In regard to paying quarantined people, certainly I am very much in favor of it; I think it would be well if we could put a premium on the quarantined. All those questions that require money to carry out, public mediums and public health measures, can never be accomplished until the profession stand together; until the public in general, and legislators and politicians know that the profession, as a whole, are demanding these things. In regard to consultation with the Health Officer, I do not think that DOCTOR BENNETT's remarks were intended to cut off any paid consultations on the part of the doctors who were, perhaps, more efficient than the Health Officer to make diagnosis of this kind; general practicians, and possibly specialists, who make a specialty of this kind of work, but, rather, in cases of the poor, where they would change physicians; where, perhaps, they will have a case of scarlet fever and will employ another physician, who will say that it is not a case of scarlet fever. I think it is the duty of the Board of Public Health to take the information of the first physician who saw the case. In regard to vaccine virus, it has always been the custom in the past to charge a price for the vaccine virus, which I have thought that particular price was excessive. The doctor could get it cheaper at an ordinary store where they sell vaccine virus. I should be very much in favor of giving out this vaccine virus free of charge. In regard to the lying-in hospitals and general hospitals. The lying-in hospitals have a law, and it is now being acted upon. The law is now that every lying-in hospital shall have an attending physician in each case. In regard to the general hospitals that may not be in proper sanitary condition, if DOCTOR AMBERG, who made that remark, will make a formal report to the Board of Health, they will look after the matter. In regard to cottages, as mentioned by DOCTOR SHURLY, it is the old question, but a matter of expense. I was a little disappointed at not having a vigorous response in the matter of registering physicians. I am not particularly anxious to proceed against the quacks and men who are not registered. It seems to me that that is another one of those questions where the isolation is with the one who does the prosecuting. He must know that the profession in the city of Detroit want the man prosecuted. DOCTOR AMES: In reply to what DOCTOR INGLIS said, relative to compensating persons that were quarantined, I have been in the habit of trying to practice what I preach, and I introduced a bill into the legislature calling for compensation of three dollars a day for householders who were isolated. The legislature did not seem to think the same as I did. It |