Excerpt from Medico-Legal Bulletin, Vol. 3: October 1904

Not only would I make a plea for more accurate and earler diagnosis by the use of the laboratory methods, but a postgraduate course in the clinical diagnosis of the more common communicable diseases should be offered to physicians. The Bureau of Health should have under its super vision a series of lectures and demonstrations by competent teachers, to Which the physicians should be invited to attend. This Would favor a more accurate and earlier diagnosis and fewer mistakes, and thereby lessen the spread of contagion. It may surprise one to know the large number of mistakes. In diagnosis in the infectious diseases. To within a 1 recent period there was little attempt to train the student of medicine in the prac tical recognition of these diseases. It is surprising that so little concern. Was given to this subject by medical colleges, When an error of diagnosis mav lfiect a Whole'fcommunity, while 111 the ordinary non-contagious diseasesit' affects an individual. At the present time it is optional ln all the five medical shcools of Philadelphia for the students to study the infectious diseases. And Dr. Welch informs me that the number of students Who attend the course at the Municipal Hospital numbers abou't onehthird of the classes. The remedy of this would seem to be of no small importance. It should be compulsory for every medical student of all colleges to attend lectures on the contagious diseases, and see cases in the city hospital. Also there should be given to each graduating class one or more lectures on the duties of a physician to the Bureau of Health, explaining what diseases to report, and the best methods of protecting the public.

On the diagnosticating of a contagious disease several things ln reference to the family, and the surroundings should be taken into consideration, in deciding Whether or not to treat the patient at home. The neighborhood being -a congested district; the dwelling being unsuitable for proper isolation; or small dependance being placed on the family being able to carry out strict instructions to safeguard the public. Such cases should be encouraged bythe' physician in attendance to be treated in the city hospital. It is fortunate that there is no longer a choice as to the keeping of cases of small pox at home. And the greatest boon to the prevention of the spread of contagious Will come When all cases of contagious disease Will -be required to' enter. A hospital for their treatment. With the completion of the new Municipal Hospital there Will be an institution Which Will not be equalled by any similar one in the country. It is to be modern, comfortable, and well equipped for the treating of all contagions. The establishing of private iooms for those able and desirous of paying, and wards and service Which Will be inviting to both rich and poor, should make it impossible for the best'home treatment to surpass it. With the opening of such an institution theprofession shofild give unstinted aid in overcoming all prejudice agianst a hospital for contagious diseases. When patients insist upon remaining at home the attending physician should work in conjunction with the Health Bureau to see that every precaution is taken to prevent the further spread of the disease. The case should always be isolated on the top floor, m a suitable room, away from the rest of the family._ It is not unusual for the medical inspector to'find a case in the parloror the dining room, and the rest of the family'going in and out of the same room, no attempt at isolation being made. The health department desires at no time to interfere With the instructions of a physician to a family; but if he entirely ignores instruction in the necessary precautions, it becomes the duty of the medical inspector. It is in these cases that the inspector is misjudged as interfering With the rights of the attending physician.