76 PUBLIC HEALTH 



Contrast such places with well-ordered isolation hospitals like 

 those maintained in some of our smaller eastern cities, notably 

 in New England, and the observer must realize that patients there 

 treated not only have far better chances for recovery than if kept 

 in the ordinary home, but that they cease to be a source of danger 

 to the community. 



Until such handling of contagion becomes general in our coun- 

 try, negligent communities will continue to nullify the efforts of 

 those which take proper care of their inhabitants. If the stimulus 

 to such action came as an order from a federal board, having juris- 

 diction and punitive powers throughout the country, the popular 

 knowledge on this subject would grow more rapidly, and the popular 

 conscience would be more quickly awakened. 



Discovery and development of the serum treatment for certain 

 infectious diseases, notably diphtheria, has in the last ten years 

 brought new problems to sanitary officers, both in practice and 

 research. It may safely be said that the labors of the bacteriologist 

 have in this time done more than any other one thing in the pre- 

 vention of infectious disease. Speaking as a layman, of course, 1 am 

 led to believe that preventive medicine will in the next genera- 

 tion make its greatest progress along the lines of bacteriological 

 research. We are on the eve of still more important discoveries in 

 this direction, and it would not be rash to predict that serums for 

 the successful treatment of tuberculosis, pneumonia, and scarlet 

 fever will be the next great steps. The importance of such results 

 it is impossible to exaggerate. 



Consider for a moment the beneficial effects already attained 

 by the anti-diphtheritic serum. I may cite the work of New York 

 City, where the work was first instituted in this country, and where 

 it has been most highly developed. In 1893, New York's case-fatal- 

 ity from diphtheria was 36.4 per cent, and in 1894 it was 29.7 per 

 cent. New York having in 1892 established the first bacteriolog- 

 ical laboratory under municipal control, the preparation of serum 

 for diphtheria treatment was begun in 1894, and in 1895 the distri- 

 bution of this serum was begun. It was given free to all public 

 institutions and to all persons who certified, through the attending 

 physicians, that they were too poor to pay the price charged for it, 

 which was fixed at a point only high enough to cover the cost of 

 manufacture and incidental expenses of the laboratory; a staff of 

 medical inspectors was also designated to administer the antitoxin 

 free upon request of an attending physician. 



In that year, due almost entirely, I am convinced, to the use of 

 this new remedy, the case-mortality fell to 19.1 per cent, and it 

 has steadily decreased until in 1903 it had fallen to 11.1 per cent. It 

 is now the practice also to administer immunizing doses of anti- 



