Fig. 1.-Shows proportion of "living" and "dead" July 1, 1910. Classified on admission. Frequently lay and medical visitors inquire, How many cures do you have? And they appear surprised when we tell them that all we can expect from the treatment here is an arrest of the disease, and the condition of "cure" can be vidual. Cards allow for name, address, club affiliation, and address of relative; also for ten reports. For convenience, different colors are used: pink for incipient cases; yellow for moderately advanced; and blue for far advanced. These are Fig. 2.-Shows the proportion of those working July 1, 1910. Classified on admission. is received from the first notice, another is sent, and then, if there is no response, the physician who sent the case to the institution is sought; and we have usually been able to locate the patient. The patient's lodge and church affiliations are also kept all strange when the number of persons who have been keeping the records is considered, for the early records of any institution are usually the most incomplete. The inquiry blank asks if the patient is at work, whether as well as when leav Fig. 3.-Shows proportion of those working, classified according to condition on discharge. hensive and complete report at hand was given at the Sixth International Congress by Brown, covering twenty-three years of the history of the Adirondack Cottage Sanatorium. We quote from his report: with disease arrested ten to five times that of the general population. We cannot give you such a complete report, but a study of the 195 cases discharged to July 1, 1910, including: DISCUSSION SECRETARY CROSBY: I would like to ask Dr. Pierce if he has trouble in finding room for all the patients that are sent there? I would like to ask also if some of them had to be placed on the waiting list: DR. E. B. PIERCE, Howell: A year ago the state had six new cottages built, which increased Our capacity from forty-six to eighty, but the appropriation for maintenance for that same year was not increased, so that while we had a capacity for eighty we were unable to use it, and we went through the year with an average of fifty-five cases. This year the legislature has given us a larger appropriation for maintenance, and we believe that we have sufficient funds to run the institution to its full capacity. I think by December we shall have as many as we can care for. Just now we are accepting every case that applies which appears at all favorable, as we have empty beds. A little later we shall have still more room, as we are using one of the cottages that we should use for patients to house the help. The other question asks to state the danger to the community of cases which do not cough or raise. I suppose that question covers the arrested cases as well. It seems to me that, with the proper training such as we endeavor to give our patients at Howell and with the knowledge of the disease that we try to instill into their minds, they ought to be safe when they return home, and therefore, not dangerous to the community. I say they ought nto to be, but you know as well as I do how hard it is for people to live up to what they know is right, and you all know that a man or woman who is on the street will cough and expectorate there rather than use the sputum box. One of our patients came to Detroit a while ago and got on a crowded street car. He was obliged to expectorate, so he used his box. He says that the car was emptied before it had gone another block, and, because of this incident, he used the street thereafter in the same manner as the rest of the public. It is hard for the individual to fight against the opinion that pervades the public, that is, that he is a dangerous individual, even though he knows that he is doing wrong by promiscuous spitting. A certain dentist asked the other day if I believed there was any danger to him in treating sanitarium patients. I told him that it seemed to me that the patients from the sanitarium were more safe than the patients from the village or farm because when they were obliged to cough, they let him know and did not cough in his face, while ill people from other sections are not careful and cough indiscriminately. There is no danger from the case which does not cough or raise, and there should be no danger from the arrested cases. In presenting this report to you today, we do not wish you to lose sight of the fact that we consider the institution to be of the greatest value as an educational factor. We are not attempting to "cure" people in the ordinary sense of the word, but we are chiefly attempting to teach them to take care of themselves so that when they go home they may be able to continue the treatment and not be a menace to the community. A LOCAL ISOLATION A. C. Haven, Lake Forest, Ill. (Journal A. M. A., January 27), says that every community should provide a hospital for contagious diseases, as treatment of such cases in private houses is very unsatisfactory. The location should be secluded and the building planned for the purpose, one story and fire-proof, adapted for isolating not only the sexes but different diseases, simultaneously, with accommodations for exchanging clothes for physicians, for disinfecting, cleansing, etc. The caretaker should occupy a separate cottage, which should contain in its basement the heat HOSPITAL ing plant for the entire hospital and every ward separately. Each ward should have its own dishes and outfit. The grounds should be attractively laid out, allowing for convalescents such outdoor privileges as can be permitted. The term "contagious" or "pest" house should be replaced by more euphonious terms. These are the ideals in substance which have inspired the trustees and architect of the Lake Forest Isolation Hospital, the elevations and plans of which are illustrated. It is the only hospital in the north shore suburbs of Chicago exclusively for contagious diseases. |