of the public health of the State and educates the public as to the necessity of sanitation and reveals the prevalence of diseases that go unnoticed. Such a law facilitates the efficient work of boards of health.

Where such laws have been in force the death-rate has decreased from 19.6 to 17.8, during the last census decade, and in cities the decrease has been more marked, especially among the infectious diseases. A local board of health law is necessary to the effective work of the State board of health.

The management of infectious diseases occupies the greater part of the field of sanitation and the most important of this class is tuberculosis. Modern investigation has done much to elucidate the nature, cause and manner ot propagation and the prevention of the disease. In cities where sanitary laws are more effective tuberculosis has shown a greater rate of decrease during the last census decade than in other sections where conditions are less favorable for the prevalence of the disease. It has been proved that 50 per cent. of the incipient cases can be cured. In Georgia during the year 1900 there were 2,651 deaths from tuberculosis, 981 occurring among the white, 1,671 among colored. The death-rate for the white is half that of New York State. The public should be taught that tuberculosis is a contagious disease where disinfection is lacking, and that every case is the result of some previous case. If recognized and reported early the number of deaths in Georgia ought to be greatly reduced.

There should be a law compelling the report of all cases of the disease and appropriation of sufficient means for disinfecting the premises of every fatal case and no house that has contained such a case should be offered for rent until disinfection has been certified to. While it would be more or less impracticable among the poor and colored, much could be accomplished in lessening the ravages of the dis

ease. The passage of such a law would educate the public to realize the nature of the disease and the importance of disinfection. Typhoid fever is next in the list of infectious diseases and in 1900 claimed 1,585 deaths in Georgia, 942 occurring in the white and 643 in the colored population. If what we eat and drink were pure, there would be no typhoid fever, and drinking-water is the great source of infection and that from wells furnishes the greater danger. I have observed 107 cases in which 89 drank well-water and 18 drank hydrant water, and in the locality where this observation was made, the greater part of the population is dependent on hydrant water for drinking purposes.

From a mercenary standpoint probably no disease involves as much expense for the care and management as typhoid fever. Estimating the mortality rate at 12 per cent. 12,670 cases may be assumed to occur in this State each year. Being a disease of early adult life, all cases may be assumed to be wage-earners at a low estimate of one dollar per day. The average loss of time would be about three months and the loss of wages would aggregate $142,650. Counting the same amount for nursing these cases would make a loss of $285,300. Estimating the cost of each funeral at $50.00 and the average loss of life at $1,000, it would amount to a total of $1,962,250. Adding the cost of medical attention and drugs would make in round numbers a per capita tax on each inhabitant certainly a small per cent. of this amount would insure the purity of drinking-water. The use of drinking-water from any publie supply well or spring that has been condemned by a local board of health should be prohibited by law.

Smallpox has increased in the United States during the last census decade 1,000 per cent., 3,454 deaths occurring in 1900. No disease interrupts public traffic more seriously than smallpox, and more stringent legislation is needed, especially in the management of ambulatory cases.

The greater prevalence is due to a large increase of an unvaccinated population. The benefit of vaccination needs no argument. Dr. Voight (New York Med. Rec., Oct. 17, 1903) director of vaccination at Hamburg, has observed 12 deaths occurring from complications after the operation of a half-million vaccinations, and some of these deaths were due to pre-existing complications. He concludes that vaccination partly prevents the development of other zvmotic diseases. During the recent Swansea epidemic, in 14,000 vaccinations none took smallpox, while there were 30 deaths in 300 cases of variola.

Vaccination should be made compulsory as a necessity and as an educational measure. Infantile diseases is a field of work needing the attention of the State. Nearly one-fourth of all deaths in Georgia occur during the first year of life, 2,720 in the white, 3,066 in the colored. In no other part of hygiene is the intelligent laity more ignorant as in the care of infants. Much educational legislation. could be effected. No servant who has any contagious or infectious disease should be permitted to assume the care of children. The sale of rubber tubes for nursing-bottles should be prohibited.

In 1900 there were 819 deaths in this State from diphtheria and croup, 144 from scarlet fever, 201 from measles and 222 from whooping cough. Reporting these should be made compulsory and proper means furnished for disinfection of same.

Hydrophobia should receive careful attention. The Georgia Pasteur Inst. and Lab. reports 76 cases for one year and untreated cases have a mortality rate of 25 per cent. The owner of a rabid animal, or one that has been bitten by a rabid animal, should be required to confine same, or else be responsible for the dangers arising therefrom.

The question of dealing with patent medicines is an open one. While not an unmixed evil, is one fraught with many

dangers. Venders of abortificient medicines advertised by another name should be punished by law. The law should provide a competent board of physicians, druggists and chemists to issue license to manufacturers of patent medicines and exercise censorship of all advertisements of this class. Many advertisements in the lay and even the religious press are immoral and render many sexual neuras. thenics melancholic.

The faith cure, so-called, does much to spread the danger of infectious diseases. No one can deny that such fads may benefit certain functional nervous disturbances and hysterical affections, but the treatment of contagious diseases by this method should be prohibited by law. Publie performances of hypnotism on minors is unlawful in Kansas and should be in other States.

The public exhibition of human monstrosities should be prevented; more means should be provided for the systematic investigation of unadulterated foods and drugs. Marriage among the defective classes does more to deteriorate the race than consanguineous unions would do, yet the latter is prevented by law.

The defectives should be defined by law and made to include the insane, the epileptic and the congenital deaf

mute.

All private maternity hospitals or any one boarding infants for pay should be compelled to register with the State board of health.

Medical attention and nursing in a private room should be provided for the insane after conviction instead of imprisonment with ordinary criminals. Many acute manias die in a cell for the lack of proper attention.

More sanitary regulations should be made to govern sleeping-cars and other public conveyances. I have seen cases of diphtheria develop shortly after a railroad jour

ney.

A PLEA FOR MORE THOROUGH EXAMINA

TION AND RATIONAL TREATMENT

OF NOSE AND THROAT

DISEASES.

BY DUNBAR ROY, M.D., ATLANTA.

Allow me in the very outset of this paper to say that I do not wish to leave the impression on any one that I am more expert or less free from errors in the treatment of nose and throat diseases than hundreds of others who daily practice this specialty; but the points which I do wish to mention are such as have been learned from what I conceived to have been my own errors in diagnosis and treat-ment, and which I believe will not be too unimportant to bring before this Association. Experience, while often a sad teacher, is nevertheless a highly important one. Through this source much information is acquired by thethoughtful physician which can never be obtained from books and periodicals.

Often have I gazed upon copies of that celebrated painting called "The Doctor," and marveled at the trueness to life therein depicted by the great artist. You all have seen it, the languishing child lying upon a couch of chairs. in a room which betokens poverty; the family doctor with. his chin upon his hands and his expression that of earnest and deep meditation over the illness of the little one whose feverish form lies before him and upon whose wan face falls the dull rays of light from the little shaded lamp upon the table; the mother's head buried in grief upon a near-by table while upon her shoulder rests the strong arm