MICHIGAN ACADEMY OF SCIENCE. 
139 
In order to reach the very mild cases that have probably not been under 
the care of a physician, there should be a careful systematic medical 
inspection of schools in each community. A competent medical ex¬ 
aminer should visit each school daily and personally examine all chil¬ 
dren who have been absent or who appear suspicious of being ill. In 
this way many otherwise undetected cases are discovered and may be 
isolated. In Detroit we are finding cases of diphtheria and scarlet fever 
in the schools continuously and they are, of course, promptly excluded 
and isolated. During the month of February fifty cases of whooping- 
cough were excluded from the Detroit public schools, and to this extent 
at least the danger of transmitting the disease was removed. 
By these various means it will be possible for us to get track of 
cases of communicable diseases. And now comes the question, how shall 
they be isolated? Is it safe practice to isolate cases of scarlet fever, 
diphtheria and smallpox in a private house? If so, should a general 
quarantine of all inmates be established or can the patient be isolated 
in one room or a suite of rooms and the rest of the family be given 
free ingress and egress? The last question should be answered in the 
negative. It may be theoretically possible to prevent the spread of 
these diseases by separating the patient off in a room, by handing dishes 
and food in at the door and having whatever comes out carefully dis¬ 
infected before it does leave the sick room, but practically such isolation 
is useless, and possibly worse than useless, because it gives a feeling 
of security which is always dangerous when it is not real. As to the 
question of establishing a general quarantine over the entire household 
in which the case is found. This may be done, but it would involve an 
unnecessary exposure to disease of all the other members of the family 
and would necessitate an unwarranted expense to the community. In 
the case of poor families it becomes the duty of the State to feed and 
provide for them when they are under quarantine, and more than that, 
in order to insure an effective quarantine, guards should be placed at 
the front and rear of the infected house day and night, involving an ex¬ 
pense of approximately twelve dollars per day per house. What then 
is the pi’oper way to isolate and by .means of isolation to prevent the 
spread of disease and protect the public health? The first requisite in 
every community for carrying into effect this general prophylactic meas¬ 
ure is a first-class, modern, well appointed hospital for the reception 
and treatment of communicable disease of various kinds. Such a hos¬ 
pital should be built on the pavilion style, having separate buildings for 
the different diseases, and should be under the control and supervision 
of the local board of health. If the proper kind of building were at 
hand, nearly every one would be willing to make use of it when the 
occasion demanded. All cases of contagious disease could then be re¬ 
moved promptly to the hospital, the house from which they were taken 
and its contents disinfected and the exposures kept under surveillance 
for a length of time equal to the period of incubation of the given 
disease. Any additional case that might develop would then be de¬ 
tected immediately and in turn removed to the hospital. At that in¬ 
stitution the isolation would be absolute and it could be controlled. No 
one would be allowed to enter or leave the hospital unless they care¬ 
fully obeyed all rules and regulations of the board of health as to pro- 
