THE PUBLIC HEALTH LABORATORY.

BY DR. B. H. STONE.

So much has been written and spoken since Pettenkofer's great experiment at Munich regarding the usefulness of the public health laboratory, such practical as well as theoretical demonstrations of its intense importance to the community have been presented, that any general discussion along that line must be something of a repetition, yet possibly justifiable at the present time.

Springing from one of the smallest of these scientific workshops the seed, knowledge of bacteria, has blossomed into the splendid flower of modern medical and sanitary achievements.

This knowledge of the etiology of disease, coming from the research laboratory, has made necessary the laboratory for diagnosis and investigation. With this widening knowledge has come the demand for the specialist as the life of no man is long enough to gain proficiency in every branch and department of medical science.

The general practitioner, thank God, has not yet gone or ever will go, but he must seek advice more and more of the specialist. It is a necessary result of development. The public health laboratory is established to furnish him the advantage of technical knowledge and skill which he cannot acquire and which he has not time to use if he could master the details.

The first laboratories, established and maintained by private funds, were for research work alone. To these institutions humanity owes a debt which can never be repaid. The outgrowth of these, the diagnoses laboratory, is filling a position which, while not so spectacular and fascinating, is none the less useful.

The physician who treats his patient by guess and makes a diagnosis by watching the effect of medication alone can no longer hope to compete with the man who uses every means at his command to make an accurate diagnosis of his case and then treats it rationally. The first is like the bridge builder who builds a bridge by guess and tries it by driving heavy loads over it until he finds one heavy enough to go through. The other, like the modern engineer, knows to a pound the strength of every brace and bolt.

In the early diagnosis of diphtheria the physician should learn to rely more and more upon the bacteriological findings. A careful comparison of statistics shows that even the best of clinicians will make an error in early diagnosis in fully 25 per cent of cases; an error which on the one hand may cost a life, and on the other result in the waste of expensive treatment and the inconvenience of quarantine.

Many a time the knowledge of the presence of tuberculosis early may render cure possible; and the moral effect of a negative sputum examination

may result in a wonderful improvement in the individual of nervous temperament who lives in morbid dread of consumption.

Typhoid fever can often be diagnosed by a blood examination long before the clinical symptoms are conclusive. The advantages of early confirmatory laboratory diagnoses to the practitioner are sufficiently evident and require no more mention.

The Laboratory of Hygiene is essentially a part of the great health organization of the state. It is the workshop of the health officer, and should be to you what the shop is to the carpenter. The rough work can be done outside, but there is always enough fine cabinet work which must be done in the shop.

To the laboratory pioneers are directly traceable many of the brilliant accomplishments of modern sanitary science. The awful plagues which swept continents, devastating cities and towns, are no more; not because men of medical science have learned to cure these diseases, but because the knowledge of their cause has given a tangible method of combating their spread. Preventative medicine, yet in its infancy, has already done more since its inception to relieve human misery than all the drugs and nostrums administered to cure disease since the world began.

To you as health officers is given the duty of protecting the public, and with the duty is given the results of hundreds of scientific workers who have ascertained accurately the cause of the infectious and contagious diseases with the best means of prevention.

Dr. Briggs says: "The achievements of scientific preventative medicine have now placed at the disposal of the sanitary authorities such full knowledge as to the causation of so large a proportion of the diseases producing death and of the means by which they may be restricted or prevented that the determination of the average death rate is in your hands."

The modern health officer must possess a broad knowledge and a technical skill. He is required to make diagnoses upon obscure infectious diseases, to decide when these cases should be quarantined, to direct the details of quarantine, to decide when quarantine should be raised, and to disinfect the house after all is over. But not only that he must be a plumbing expert, must be able to intelligently pass judgment upon a water supply and trace an epidemic, and decide the cause of death in cases suspected of foul play. In short, the modern health officer must be a man of exceedingly broad sanitary training. An attempt is made to supply this training by these schools, but a certain amount of technical knowledge is beyond the ordinary health officer unless he spends a life time in the service. Here again we must call in the expert. Our State Board has obtained the service of an engineer to help you out in many places, and the state has generously supplied you with a laboratory as well equipped for its work as any in the country. How can the Laboratory be of use to you?

You are perhaps most often called upon to quarantine cases of diphtheria. Put them under provisional quarantine until you have sent cultures from the throat for examination. If you get a positive reply you have authority