apparent indifference that seems to pervade the minds of those who should strive to instruct the people in those important matters; with all the facts staring us in the face; the full knowledge that one in every six or seven of all deaths is from this disease; the bacteriological certainty of its communicability-all these facts are naught in staying the progress of this great white plague; "this pestilence that walketh in darkness and the destruction that wasteth at noonday." On it marches unobstructed and unimpeded, taking the fairest and best of the land as its victims, and we the custodians of the public health are doing so little. During the last year our worthy Secretary informs us that there were two hundred fewer deaths from this disease than during the previous year, but we as health officers cannot take any credit for that decrease in mortality, but rather ascribe it to the stringency in the money market, which compelled our Eastern friends to deny their sick the privilege of dying in California, the too much boasted and too highly lauded sanitarium for all tubercular patients. I do not wish to be considered a scold or a fault-finder, but if the public are not instructed in these matters by those who well know about it, whose fault is it? who are to be blamed?

With all due respect to my professional brethren, I say it reluctantly, that the fault lies with us. Much good has been accomplished by the efforts of sanitarians in bringing up the public mind to the point of demanding pure water by a better system of sewerage, of lessened mortality from diphtheria by establishing a more thorough plan of cleanliness, much diminished fatality in scarlet fever by rigidly quarantining even very slight cases. If these things can be and are done, why is it that in the very localities where all these flattering results have been accomplished tuberculosis has not only not decreased, but has actually increased in percentage of mortality? Who is responsible? My earnest desire is that this convention will express itself in no uncertain manner as to the duty of sanitarians in this matter.

Thanking you for your kind attention, I now, with much pleasure, will introduce to you your newly elected President, Dr. C. W. Nutting.

(Dr. Ruggles then introduced the newly elected President, C. W. Nutting, who spoke as follows:)

ADDRESS OF DR. C. W. NUTTING, PRESIDENT-ELECT.

Ladies and Gentlemen of the Third Sanitary Convention: The first thing that I desire to do is to thank you for the honor you have conferred upon me in selecting me to preside over this, the Third Sanitary Convention. We who are medical men and women know that it is not customary for the President of a Medical Association, or for the man who presides over medical deliberations, to make much of a speech on his installation into office. My friend, Dr. Ruggles, has just shown you that the time at which the President of a Sanitary Convention or the President of a Medical Convention is expected to address the body over which he presides, is at the end of his term of office. You will therefore excuse me to-day, and when my term of office has expired I will follow the precedent so ably set by my friend Dr. Ruggles.

I again thank you for the honor, and we will proceed with the business of the convention.

(It was moved and seconded that a Committee of three on Publication be appointed. On motion of Dr. J. R. Laine, the appointment of the Committee on Publication was deferred until the evening session.)

A PLEA FOR THE HOSPITAL AT HOME.

By SAMUEL O. L. POTTER, M.D., M.R.C.P.L., of San Francisco, Cal.

Nowadays we see many princely homes, in process of construction or already built, in which the designers have remembered every one who may cross the threshold in every and any capacity. The visitor finds therein his "guest-room," the caller her drawing-room and retiringroom; there are rooms set apart for smoking, billiards, cards, and music. The studiously-inclined finds a library for his use, however few may be the books therein. The lady of the house has her boudoir; the master, his "den"; the children, their nursery and play-room. The butler has his wine-room; the cook, her kitchen and pantry; the maid, her scullery; and the wash-lady, her laundry. The horse has his stable; the dog, his kennel; and the cat, her cushion. But if we ask for the sick-roomthe place provided for members of the family stricken with severe or contagious, perhaps fatal, disease-we will find that no architect has yet thought of designing in the palatial home a place for the illness which comes to almost every one at some time during existence, or for the final scene so certain to be the end of life for all.

While ordinary, middle-class folk are content, even glad, to go into one of our fine, modern hospitals, when ill, the very wealthy find that, with all their luxurious surroundings, they cannot in illness secure isolation at home from the disturbances of the family life, or from the racking noise of the city in which they dwell. It is obvious that, however perfect a house may be in other respects, it cannot be considered a complete home so long as it contains no special provision for the sickness which may come at any moment to even the healthiest of its inmates. Too often the so-called "spare-room," or "guest-chamber," is the only apartment available for use in sickness, which is neither hospitable to one's visitors, nor kind to our sick.

Every family physician, and householder of experience, knows well the discomfort of the ordinary family routine when disease enters the family circle. The bells are muffled, and the servants scolded for every slamming of a door; the older children wander around the house speaking with bated breath, in the all but vain effort to suppress the exuberant animal spirits of the younger ones. Playmates are forbidden the premises; guests take their departure; a trained nurse comes upon the scene to dominate the household and drive the servants to the verge of rebellion. The home, in fact, becomes the most uncomfortable place to all its healthy inmates, as a consequence of the sickness of some one therein. And then, if a contagious disease be prevalent, and suspected to have come into the family, how great the anxiety upon all, the depression on some, the terror on others-physical and mental conditions sufficient in themselves to so lower the vital resistance as to

invite disease on all who form that household. But if the disease prove to be the dreaded smallpox, how the hearts of the family are wrung at the thought of the inevitable removal of their dear one to the care of a public pesthouse!

So, also, when a member of the family is afflicted with that undoubtedly contagious disease, consumption, how necessary for the safety of others that the patient should live in partial isolation, and should sleep where no upholstery, or hangings, or papered walls, or carpets can retain the expired or expectorated germ of the disease, to dry and be inhaled as dust by healthy persons!

In our numerous hotels and boarding-houses, where nearly one half of our modern population dwells, the effect of sickness, especially if contagious, is a serious one to all concerned. The patient cannot obtain the necessary quiet, or the requisite articles of food; the other inmates feel themselves endangered by the proximity of disease, and begin to move away, while the proprietor is worried to death between the fear of disobliging a profitable patron and the desire of retaining his numerous guests. In the smaller cities and at the summer resorts there are no hospitals to which the sick one can be removed; and sickness in a hotel becomes a proverbial discomfort to the entire establishment.

Still greater is the difficulty when insanity, in acute or chronic type, makes its dreadful presence known in the home of a family, or in a hotel or boarding house. The maniac's yells are heard by the neighbors, and give rise to all sorts of rumors. There is no sleep for that household while the shrieks of one of its members can penetrate the stillness of the night. There are no means of securing the safety and isolation of the stricken one. The dreadful alternative, removal to an insane asylum, becomes necessary for the sake of all, even in cases of acute and curable mental derangement, with the consequent blight upon the future life of the one who has ever been incarcerated in a mad-house.

Every home of any pretentions should contain a suite of rooms, especially designed and arranged, and kept ready for the use of the sick members of the family and their attendants. Such a suite should be located, in a medium-sized house, on the warm upper floor, and in the southeast corner thereof, so as to obtain the best sunny exposure. It should be separated from other rooms on the same floor by halls with windows at their ends for free ventilation, and floors covered with a strip of heavy cocoa matting to deaden sound. It should be provided with a water-closet and a bathtub, emptying, not into the public sewer, but into a special receptacle, capable of being easily emptied and disinfected. In fact, a good earth-closet would be better than a watercloset, and equally efficient. There should be no feather-bed, no fancy cushions or upholstered furniture, no pictures, no wallpaper, no curtains or hangings, or only those of the cheapest kind, to be destroyed after every illness. All the furniture and other belongings should be plain and simple, capable of being easily cleansed and kept as aseptic as that of a hospital. The floor should be bare and painted, the walls and ceiling rough-finished and painted, with perhaps a dado of glazed ornamented tiles. There should be no sink, wash-basin, closet, or other contrivance connecting with the sewers. Opening off the sick-room there should be a sleeping-room for the nurse on duty, and also a small room furnished with a gas or electric stove, and the other requirements of a diet-kitchen. The entrance should be through a vestibule of good

size, so that the door of the sick-room would not open directly into the hall. In this vestibule should hang a large rubber coat to cover the clothing of the attending physician, and it should contain several pairs of felt slippers, large enough to go on over the boots of any one who may come in. There should also be a washstand in the vestibule, with toilet necessaries and disinfecting solutions, for the use of the physician before taking his departure. By such precautions the danger of his carrying infection to others would be minimized. The rooms should be provided with a well-lighted closet, containing everything requisite for nursing a case of typhoid fever, scarlet fever, variola, diphtheria, or other contagious disease, all arranged in order on shelves, and properly labeled. The necessary appliances for a surgical operation or a case of labor could be readily added when actually needed. The entire arrangement of this Home Hospital should be placed in the hands of the family physician, who will know exactly how to fit it up. When completely furnished it should be scrupulously respected, and never used for storing away empty trunks or broken furniture, but always kept clean and in order, ready for a patient at any moment.

The architectural arrangements should include provision for constant ventilation, independent of the windows, in case these should have to be kept closed. The latter should be guarded by heavy interior shutters, capable of being locked if necessary, so that a delirious or insane patient could not get access to the glass. Or, the sick-room need have no windows at all, light being admitted by an inaccessible skylight, properly shaded by horizontal blinds.

In the more pretentious houses and the palaces of our millionaires, where ground space and expense are practically unlimited, the home hospital might be in a separate structure, detached from the main building, but connected therewith on each floor by a light, lattice-inclosed, and covered bridge. The ground floor of this building would contain the necessary heating and laundry apparatus; the second floor would have on it the sick room, nurse's room, bath, closet, and diet-kitchen; while the upper floor would be arranged in two or three sleeping-rooms for the physician on duty, an extra nurse, and any member of the family who, in a case of contagious disease, might prefer isolation with the sick one to enforced absence.

So equipped, as I have tried to indicate by these suggestions, the members of a wealthy family would enjoy in sickness all the comfort and security now only attainable in the most modern hospitals, the public would secure increased protection from the spread of contagious disease, and the owner might safely defy the power of the health officer to remove the patient to a pesthouse. The latter may safely be assumed, for it could be shown to the satisfaction of any reasonable court that the interests of both the public and the patient are better guarded in this home hospital than they could possibly be in any public pesthouse ever yet erected and maintained by the servants of the body politic or the appointees of a political machine.

In a large hotel or boarding-house, such a hospital suite would be of incalculable benefit to every inmate, as well as to the sick. Instead of the usual panic, the routine of the establishment would go on undisturbed, even in presence of contagious disease; and the proprietor would feel as much pleasure in advertising and showing his home hospital as he does every other feature of the well-appointed hostelry.

While these suggestions are chiefly applicable to the homes of the rich, they may be modified with almost equal benefit for the dwellings of our great middle-class householders. Almost any owner of a home could set apart a quiet, sunny upper room or two, plainly and cleanly furnished, for the use of the sick. With an annual coat of paint, and a few simple articles such as any physician could suggest, the family sickroom would always be ready for illness of even a serious character. The danger lies in the temptation to use such a room for storage, or for the temporary accommodation of a visitor or a servant; which, if yielded to, would defeat the object aimed at.

As to my own share in the conception and promulgation of this idea, I may say that these suggestions were advanced by me several years ago in a faculty meeting at Cooper Medical College, as the subject of a popular lecture which I was asked to deliver. Another member of the faculty, however, having announced his intention of lecturing on hospitals during that season, I abandoned my intention and gave way to him. I published a brief synopsis of the matter in the last edition of my Handbook of Materia Medica, Pharmacy, and Therapeutics, under the title of "Sick Room," and also in the Pacific Medical Journal for September, 1894. The idea was original so far as I was concerned, and I had never previously seen anything on the subject in either medical or architectural literature; but I am aware that it has been partially carried out in some large boarding-schools for many years past.

Discussion of Paper Read by Dr. S. O. L. Potter.

DR. C. A. RUGGLES: I am very much pleased with the idea that after a paper has been read it is to be discussed, because much is to be gained by discussion, and I hope all papers will be thoroughly discussed. I have taken a great deal of interest and paid a great deal of attention to the reading of the paper, and particularly to that part which relates to missionaries, but that is outside of my range; however, the particular point is that the physician should protect himself from communicating disease to somebody else. It has been my privilege to be connected with health departments the most of my life. I state it here as a positive fact, in my mind at least, that disease has been carried by physicians from patients to healthy people, on account of the lack of the care that Dr. Potter suggests. Diseases like diphtheria, scarlatina, and smallpox are communicable. It seems to me as though the physician who is careless in visiting patients who have such diseases, and who neglects taking the proper care to prevent communication, should be indicted by the first grand jury that sits; that is my opinion. about it. I know that diseases such as smallpox and diphtheria have been carried about by careless doctors. You take a case, as they used to take diphtheria. I don't know how they do it with anti-toxine, but the way they used to do, was to swab out the child's throat, and the doctor got it on his coat and whiskers, and he went, perhaps, without having washed his hands, or without combing his whiskers, fifteen miles away probably, and communicated it to another child, and the wonder was how it came there. Some said that it was a visitation of Providence, but I say it was the carelessness of the doctor. I am glad to see that Dr. Potter has brought the subject up so positively in regard to the necessity of physicians not being the media of communication.