should be read with pride by every progressive member of the profession in the state. Its salient features were, in brief, as follows: -Up to 1883, there was "medical free-trade" in Michigan, any person being allowed to assume the title of physician and to practice medicine without regard to qualifications. From 1883

to 1899 there was "legalized free-trade"-a medical registration law which was entirely inefficient. From 1899 to 1903, the Chandler Act enabled the State Board of Medical Examiners to put out of business 1,600 quacks. The new law of 1903 as carried out by the State Board provides the highest standard of requirements for admission to medical practice in this country and the Michigan law has already been approved by two national medical bodies as the best in use and has also been copied in other states. The law against obscene medical advertisements has not yet been enforced owing to legal delays, but has recently been held constitutional and steps for its enforcement will be taken immediately. Reference was made to the proceedings of the last legislature in medical matters, and attention was called to the influence of the profession in important

questions when well organized and united. Recommendations were made as follows: (1) That the Society make Detroit its permanent meeting place. (2) That there should be co-operation with the State Historical Society in recording facts regarding the pioneer physicians of the state. (3) That the Society appoint a committee to undertake active measures in combating the patent-medicine evil.

Dr. Stockwell, of Port Huron, reported that at his initiative the Michigan Congregational Society has passed a resolution censuring the publication in religious papers of advertisements of alcoholic remedies and secret and fraudulent nostrums

The committee on resolutions reported today the request of the Society that Dr. Wm. Beaumont, who as army surgeon a century ago, made the celebrated observations in the stomach of the wounded Alexis St. Martin, be nominated for a placein the Hall of Fame at New York.

The resolutions also demanded legislation to prevent quack advertising, the cutting of rates, and the buying of cases.

Officers for the following year were elected as follows:
President-Dr. David Inglis, of Detroit.

Vice-presidents-Arthur M. Hume, Owosso; A. W. Harmbogen, Marquette; Florence Huson, Detroit; W. M. McNeil, Hancock.

Councillors-M. Wilson, Port Huron; C. H. Baker, Bay City; A. H. Rockwell, Kalamazoo; R. H. Spencer, Grand Rapids.

Section Officers:

Medicine

Chairman-H. Ostrander, Kalamazoo.
Secretary-R. S. Rowland, Detroit.
Orator-B. H. McMullin, Cadillac.

Surgery

Chairman-E. C. Taylor, Jackson.
Secretary-F. J. Lee, Grand Rapids.
Orator A. W. Crane, Kalamazoo.
Obstetrics and Gynecology

Chairman-Florence Huson, Detroit.
Secretary-B. R. Schenck, Detroit.
Orator-E. G. Abrams, Dollar Bay.

Dr. Bovee, of Washington, was not able to attend, but there was an unusual number of excellent papers read. Among those provoking the most discussion was that of Dr. T. A. McGraw on Statistics of Cancer; Dr. Carrier on Venereal Prophylaxis; Dr. C. D. Aaron on Moveable Kidney; and Dr. Donald's demonstration of a new method of withdrawing pleural effusions.

The orations were delivered before large audiences and were well received. The stereopticon demonstrations by Drs. Warthin, Cowie, and Hickey were extremely interesting and important contributions to the general program.

THE DETROIT CONTAGIOUS DISEASE HOSPITAL.

(Reply from the Board of Health).

To the Honorable, the Common Council:

Gentlemen-The following is an answer to the petition of those persons who object to the erection of the proposed Contagious Disease Hospital upon the site selected by the Board of Health, bounded by Willis and Alexandrine avenues and Brush street, and which petition was presented to your honorable body on June 3, to discuss this matter, and also a statement of the reasons why, in, the opinion of the Board of Health, it is, from a scientific and medical point of view, an entirely proper, safe, accessible and suitable location for this hospital.

Following this are copies of legal opinions received from the office of the Corporation Counsel upon the same subject, and which are hereby made a part of this answer.

As to the necessity of a hospital for contagious diseases in this city. The law under which the Board of Health is constituted makes it the duty of that board "to procure suitable places for the reception of persons afflicted with malignant, contagious and infectious diseases, and in all cases where sick persons cannot be otherwise provided for, to procure for them medical and other attendance and

It

necessaries." The city maintains an isolation hospital for the care of smallpox on Hamilton Boulevard, which will meet all demands for many years to come. is not intended by the Board of Health to use the proposed Brush street hospital for the isolation and treatment of smallpox. This will be guaranteed to the future by the terms of the deed transferring the property to the city.

The proposed hospital is for the reception of patients suffering from scarlet fever, diphtheria, measles, chicken-pox, German measles, erysipelas, tonsilitis and such diseases as are communicated only by close association or actual contact with an infected person or object. Harper Hospital maintains a small isolation pavilion for the care of diphtheria and scarlet fever; with this exception, patients suffering from these diseases are not received in the general hospitals of the city. Acting on these facts, the Board of Health has for three years asked for an appropriation for the purpose of establishing a proper hospital, and each year the matter has been fully discussed before the Common Council and the Board of Estimates, and the reasons presented why such a hospital is a necessity.. It has been shown, for example, that of the cases of diphtheria treated outside of Harper Hospital the last fiscal year the motality rate was 10 per cent greater than of those treated at the hospital, while the cases of scarlet fever the difference in the mortality rate was 2 per cent. in favor of hospital treatment.

Inasmuch as there were 1,252 cases of diphtheria treated at home, it is fair to conclude that if it had been possible to treat all of these cases at a hospital, with no better facilities than there are at Harper's, the result would have been a saving of 125 human lives. Applying the same reasoning to scarlet fever gives us a saving of 2 per cent. of 508 cases, or 10 human lives, from this disease.

Last year there were reported in Detroit 1,433 cases of diphtheria, but only 181 were sent to Harper, and of the 575 cases of scarlet fever reported, only 67 went to the hospital. The principal reason why so small a number was cared for at Harper was lack of room, and it is a fact that, even with so small a proportion of our cases going to the only hospital in the city available for that purpose, that hospital was on several occasions during the year so overcrowded that it was forced to refuse patients, and during these periods of time there was no place whatever in the City of Detroit to which cases of scarlet fever and diphtheria could be taken for treatment. This congested condition was almost continuous from March 26 (on which date the Board of Health made application for admission of two cases of scarlet fever, which were refused) until about the middle of April. On the sixth day of that month Harper was filled with 19 cases of scarlet fever. In a small ward that should not receive more than three patients there were eight cases of scarlet fever, and they were so crowded that it was necessary to keep the eight children in five beds. These are a few of the arguments that have been advanced year after year by the Board of Health in favor of a contagious disease hospital. Following is the experience of some other cities:

In 1896 the City of Boston constructed, at the expense of $650,000, the South Department of the Boston City Hospital for the care of contagious diseases. This hospital has received the hearty support of the medical profession and the people of Boston, and is one of the most popular institutions of the city. The influence of this institution in the restriction of the spread of dphtheria and scarlet fever and the reduction of the mortality in these diseases has been so marked that the larger cities in the east are rapidly following the example of Boston. New York, Philadelphia, Montreal and Worcester have erected contagious disease hospitals during the past year. In New York city the sum of $7,000,000 has been granted to the Board of Health for the erection of a comprehensive system of hospitals in various parts of the city for the care of contagious diseases.

In Detroit, in 1894, there were reported to the board 2,008 cases of diphtheria and scarlet fever alone. The experience of Boston shows that over 60 per cent. of the reported cases of these diseases are cared for at the South Department. With a modern, well equipped and well administered hospital in Detroit the experience of Boston would probably be repeated. At the present time each quarantined house is a center of infection but feebly controlled by the Board of Health, and may remain so for months. The segregation in one well conducted hospital of 50 per cent, or more of the cases would be a most important factor in limiting the spread of these communicable and dangerous diseases. Without a hospital the efforts of the board must remain inefficient; with the hospital, all dangerous centers of infection can be abolished.

As the experience of other cities has proven, the hospital will be a safe and

welcome retreat for rich and poor alike, and the income derived from patients able to pay for their attendance will go far toward the support of those who must, in the interest of the safety of the community, be cared for at the city's expense.

As your committee has received some expressions of opinion as to the communicability of these diseases and their method of transmission, the board submits for your information the subject quotations from a few of the most prominent medical authorities of the United States and Europe. The quotations are all taken from the chapters on scarlet fever.

ANALYTICAL CYCLOPEDIA OF MEDICINE-Sajous; F. A. Davis Co., Philadelphia, 1905. Vol. V., p. 534. "The chief source of infection is the patient himself, but the area of contagion is limited to a few feet."

MEDICAL PRACTICE-Bain; Longmans, Green & Co., London, 1904, p. 834. "In the open the carrying distance must be very limited; at any rate, there is no special prevalence of the disease in the immediate neighborhood of isolation hospitals."

DISEASES OF CHILDREN-Meigs & Pepper; Blakiston, Philadelphia, 1882, p. 773. "The distance to which it may be carried by the air does not appear to exceed a few feet."

A SYSTEM OF MEDICINE-T. C. Allbutt; the McMillan Co., London, 1899, vol. 11, p. 129. "That scarlet fever is not spread to any distance by aerial convection is well shown by the negative experience derived without exception from certain large fever hospitals, whose walls are closely surrounded with small tenements for the most part crowded with young children.

DISEASES OF CHILDREN-J. Lewis Smith; Lea Bros., Philadelphia, 1896, p. 254. "The area of contagiousness of scarlet fever is small; it apparently embraces only a few feet."

THE ENCYCLOPEDIA MEDICA-Chalmers Watson; Longmans, Green & Co., London, 1902, Vol. X., p. 490. "The distance of conveyance by aerial convection is not great. This is emphasized from the fact that residents in the immediate vicinity of a fever hospital do not suffer in consequence."

TWENTIETH CENTURY PRACTICE OF MEDICINE-Stedman; Wm. Wood & Co., New York, 1898, Vol. XIV., p. 15. "In order that scarlatina can be transmitted immediately, the contact must be quite close, such as touching, kissing, inhaling the breath, etc."

ACUTE CONTAGIOUS DISEASES-Welsh & Schamberg; Lea Bros. & Co., Philadelphia, 1905, p. 357. "There is no evidence to indicate that scarlet fever contagion is disseminated by aerial transmission. The immediate vicinity of scarlet fever hospitals appears to be as free of the disease as other sections of the city. In this respect scarlet fever differs from smallpox, in which disease the territory immediately surrounding the hospital is apt to show a disproportionately large number of smallpox cases.

"The following figures are taken from the Medical and Surgical report of the Boston City Hospital, 1897.

Radius of 1-8 mile from scarlet fever hospital..

.00 cases

"It is seen from the above figures that no cases developed within the 1-8 mile limit about the hospital.

Our experience at the Municipal Hospital at Philadelphia led us to believe that the striking distance of scarlet fever is extremely limited. It has been exceedingly rare for families in the immediate vicinity of the hospital to become attacked with scarlet fever, although they have not escaped smallpox."

A practical study of this question by the board confirms the opinions expressed by the medical writers. Health authorities make no effort to isolate scarlet fever or diphtheria hospitals in unsettled parts of cities.

The South Department (contagious) of the Boston City Hospital, 300 beds, adjoins the grounds of the general hospital and is in one of the most thickly settled parts of the city.

The new Scarlet Fever Pavilion in New York, 400 beds, is built directly on the street on a small lot close to the Willard Parker Diphtheria Hospital and the Biological Laboratory and the Administration Building of the Health Depart

ment. This is one of the most thickly populated sections in New York. At a recent visit, two members of the Detroit Board of Health counted upwards of 300 children playing in one block near the hospital.

In both New York and Boston the conditions of the immediate neighborhood of these hospitals is most favorable to the spread of infection; still there is no evidence of the communication of the disease from them.

In

The experience in Detroit is the same. Harper Hospital, as is well known, maintains a small pavilion for the treatment of scarlet fever and diphtheria. This building is situated in the rear of the main building; about 90 feet from the south wing and about 60 feet from the abutting Brush street property. warm weather, during convalescence, the children play freely in the grounds around the pavilion. This pavilion has been maintained for a number of years, and the report of January 1, 1905, shows that there were treated in the hospital 274 cases of contagious disease during the year. No complaint has come to the Board of Health from the residents of Alexandrine avenue, John R. street, Martin Place, Woodward Avenue Terrace, Brush or Brady streets of the presence of this hospital and there is no evidence that disease has been communicated beyond the grounds.

Although the two departments of the pavilion are separated from each other only by a brick wall and the windows open within a few feet of each other there have been no cases of communication by aerial convection of either scarlet fever or diphtheria to the adjoining departments.

From the foregoing evidence the Board of Health can assure your committee that a hospital such as is proposed is no more a menace to the health of the vicinity than the three hospitals at present existing there.

To properly fulfill its object for the control of disease, such a hospital must be, above all, easily accessible to all parts of the city.

A hospital placed in a remote and unsettled part of the city would be feared and shunned; the apparent necessity for such remote isolation would condemn it and seriously impair its usefulness.

Transportation of patients would be difficult, and dangerous to delicate infants and children, who are the most frequent sufferers from the contagious diseases. The necessity of a long journey in the winter months, when diphtheria and scarlet fever are most prevalent, would often be an insurmountable difficulty in gaining the consent of parents to hospital isolation and treatment for their infected children.

To physicians and nurses easy accessibility is equally essential. The liberal policy pursued by Harper and Grace Hospitals toward the physicians of the city will be followed by the Board of Health. Any physician may bring his patients to the hospital for isolation and keep them under his care, subject only to the rules necessary to safeguard the community against personal convection of the disease. With the hospital centrally located and close to the hospital center of the city, physicians will more frequently recommend hospital treatment.

To the patients' relatives and friends, again, accessibility is essential. Mothers and fathers must visit their sick children and every facility should be given them, thus to soften the anxiety that separation entails, provided, of course, that all restrictions are observed to prevent the spread of contagion. It has been shown that a centrally located hospital is not a source of danger to its vicinity and it would be a cruelty on the part of the community to demand that the unfortunate subjects of contagious disease should be pushed unnecessarily into a remote and inaccessible part of the city.

Almost every act of the board which has for its object the safeguarding of the public health imposes upon the individual some monetary loss, inconvenience, or even hardship. While the board regrets that in the selection of a site for a hospital it has opposed the wishes of the property-holders of the neighborhood, it must be mindful of the interests of the community at large and of the comfort, health and lives of those from whom it demands the sacrifice of isolation in the interests of the public health.

In regard to the disturbance of property values in the neighborhood of the site, which seems to be the controlling factor in the opposition to the action of the board. That the unfortunate agitation of the subject during the last few weeks has disturbed property values is quite possible, but the past sustained values of the property in the immediate vicinity of the Harper Hospital contagious pavilion would show that when the present agitation subsides values will readjust themselves to their former point. That the proximity of the Harper Hospital contagious department has had little influence upon the value of sur