physician who reports that case, I go with him and look the case over, and we fix up the matters together, and we decide together what is best to be done with the bread-winner. If the case is reported to me by other than the family physician, I get the family physician and go with him just the same. As I understand the law, the health officer can take any number of physicians as council, but I have always observed the law of ethics, that the attending physician should always be present. Lately I have asked the family what their wishes were with regard to the physicians seeing the case. We have been having quite an epidemic of scarlet fever in Bennington. A teacher in one of our schools allowed a child having a distinct rash to sit in the schoolroom with the other pupils during examination week, the second week in June. Needless to say we had a great many cases develop from this exposure. We have had all the physicians in town see the cases. One physician diagnosed the case as positive rubeola; nothing else. Fortunately it was an old practitioner who had made that diagnosis. I presume I have seen five hundred cases of scarlet fever. Our law says-scarlatina. Every time I put up a placard scarlatina, I have had to answer numerous questions, such as these "Is that scarlet fever?" "Yes." "Why do you call it scarlatina?" "Because the card says so." "Then they are not very sick, are they?" I think scarlet fever should be called scarlet fever. I think a law should be passed at the next session of the legislature making it obligatory that scarlet fever should be quarantined as scarlet fever and not as scarlatina.

Health officers should have confidence in the practitioners of the town. When you are called upon to quarantine a case of contagious disease, take one, two or three physicians along with you to confirm the diagnosis made; at any rate take along as many as you need to satisfy the public the disease is diagnosed correctly and placarded accordingly.

Mr. Bates of Pownal asks the question, Has a layman the right to quarantine a family without the attendance of a practicing physician? My answer is, No.

Mr. Bates asks further, If the practicing physician notifies the health officer, but the physician is unable to attend to the placarding, is it right and lawful for the health officer, being a layman, to go ahead and placard the house for the disease given by the physician reporting the case to him? I have only put up three or four signs in the whole seventeen years in which I have been health officer. The physician puts up the card. The attending physician can placard the house without any friction. He is able to talk with the family and explain the necessity for placarding and the law is complied with without any hard feeling on the part of the party quarantined, and there is better satisfaction all around.

Dr. C. M. Ferrin, Essex Junction.

When you call in one or more physicians to confirm or make a diagnosis, who pays the bill?

H. L. Stillson, Bennington.

Whenever I call in a physician to see a case the town of Bennington pays the bill, and I think the town can be made to pay such bills.

S. W. Butterfield, Perkinsville.

My town is peculiarly situated. We have not a practicing physician in our town but have to depend upon five or six neighboring towns for medical attendance. In reporting to me, I have never found there has been a notice put up. What shall I do?

Dr. E. S. Albee, Bellows Falls.

I was called in consultation one Sunday night to see a case where the attending physician was uncertain as to diagnosis. He was not sure whether it was scarlet fever or diphtheria, or a combination of the two diseases. We sent a culture up to the laboratory at Burlington and the report came back-negative. Then, of course, they gave up the idea of its being diphtheria. There was some trouble between the family and the attending physician and another physician was called in to attend the case. At this time, it was a pretty old case to diagnose scarlet fever. We kept the man in until the end of two weeks. The last physician said there was no desquamation; what did they have? I said I didn't know. He said he was willing to let the man out as he thought it was safe. I said I should keep him there and if they wanted to appeal to the State Board of Health, they could. They did so appeal. Dr. Holton came up to Bellows Falls and examined the case and it was left with me, if they did not desquamate within four or five days, to let them out. I do not think I should be called upon in my official capacity as health officer, to diagnose the case. I do not consider it my duty to examine cases where I am called upon to placard the house in my official capacity as health officer. I quarantine the cases for the diseases as reported to me by the attending physician and do not consider it a part of the duties of the health officer to make a personal examination in order to confirm or disagree with the diagnosis made by the attending or family physician.

C. B. Kent, Dorset.

After listening to the remarks just made, I feel as though I was in the midst of a Methodist camp meeting. I haven't any advice to offer, but I have a little advice to ask. It seems to me during my office as health officer, only the most knotty questions have come to my attention. I am asked a great many times to quarantine a house for this thing and that, and sometimes I really don't know how far my official capacity carries me. Only last week I was asked to quarantine a boarding house which was infected with bedbugs. A man came to me and asked me to use my power of health officer in quarantining or disinfecting the boarding house. The

bedbugs were so thick there that you could scoop them off the walls. I wrote Dr. Holton asking him what should be done and he replied if he was in my place, he would write the proprietor of the boarding house rather than go. Perhaps some of you health officers can tell me something to do to remedy this trouble.

Dr. C. W. Peck, Brandon.

I think Dr. Albee is wrong. When I have a case reported to me, I go and examine it. They almost always seem very glad to let me in. Some little time ago I had a case of measles reported to me. I immediately went and examined the case and found instead a case of scarlet fever. What would have been the result if I had simply placarded that house for measles? Scarlet fever is no trivial affair to have floating around a community. We do not have it down our way; I choke it off. I never let it get started in my town. The health officer should stand squarely on his feet and be sure of the case before the house is placarded. I had a little trouble this last year. The streets were being sewered; one man thought he would take his own time in connecting his house with the city sewer. I served a notice on him, ordering him to connect his house within a specified time. He went out of the state, neglecting to comply with the request. I sent him registered letters asking him to connect his house with the sewer, but he would not accept the registered mail. I got all ready to put the sewer in myself and charge it up to him, when he decided that he could put it in cheaper than we could do it for him. I would suggest that every health officer stand squarely on his feet, be just, be positive, and do the right thing. I think Dr. Albee needs a little more spunk.

Dr. Henry D. Holton.

It seems to me a notice should be served on the proprietor of that boarding house that a nuisance existed in the presence of this vermin and the same should be abated. It is perfectly legitimate for the health officer to order the abatement of such a nuisance and also see that the order is carried out. The same thing is applicable to the subject of lice in our schools. Sometimes they think the State Board will not believe it. Some years ago a certain party in one of our school districts sent a bottle of them to the president of the State Board of Health. As soon as the rest of the members heard of it, we ordered him disinfected. It is a communicable condition and you should serve a written notice on the head of the family where such a nuisance exists, ordering the school children kept at home until rid of the lice. At the same time you should write to the secretary of the school board that you have prohibited them from attending school. This is, of course, necessary so the board will be aware of their absence from school as well as the cause for their absence.

Regarding the matter of the health officer going in and looking over a case prior to placarding a house for a contagious disease. It requires a good deal

of caution and wisdom. I have known serious trouble to come up because a health officer, a doctor, went into a house to see a patient who was being attended by a brother physician. The best and safest way is to write or telephone or call upon the attending physician and make some arrangements for a visit to the sick room in order to be sure of the correct placarding of the premises. As Dr. Peck has just said he does not prescribe, but goes in in order to be sure that the correct placard is placed upon the premises. If the health officer, a practicing physician, goes into a house where a contagious disease is and looks over the case, he may drop some word that is carried immediately to the family physician, which gives rise to discord, so you will see you should always go with the family physician when you visit a sick room in anticipation of placarding a house.

Not so very long ago a case of measles was reported in a certain town and the health officer quarantined the house. An old woman broke the quarantine and went into the house. She immediately said: "That is not a case of measles. It is canker rash." That information was reported to the health officer. Instead of taking another physician in consultation and going with the attending physician, he went there alone and changed the sign to scarlet fever. Of course, that caused a row at once. I was obliged to go up there to straighten out the business. The peeling process was going on nicely; there was an abscess in the ear, etc., so there was no question but that it was a case of scarlet fever. I saw the doctor who made the mistake and I said, "I am sorry, but I guess we shall have to call it scarlet fever." He felt very unpleasant about the matter for some time. Within six or eight months the health officer moved out of that town and this doctor who had made the mistake in diagnosis was appointed health officer. About a year from the time this case occurred, a case of scarlet fever developed and was reported. On his report he added: "This is in the house where we had a case of scarlet fever a year ago and I do not think it was properly fumigated." There is only one class of people who are as sensitive as physicians and they are musicians. With regard to the case Dr. Albee spoke of I might say the case had been running a little over two weeks and there was no evidence of desquamation. The patient was a man thirty years of age, and his wife said he had had no desquamation. She had scrubbed him every day. How much she had scrubbed off I do not know. I am not sure what he did have. One doctor described it so I diagnosed the case as scarlet fever, and another described it so I could not be certain just what it was, so I said if you do not see any signs of desquamation within a certain time, release the family.

Dr. E. F. Norcross, Island Pond.

Where the attending physician placards the house and does not call upon the services of the health officer, is the physician who does the placarding entitled to the pay?

Dr. Henry D. Holton, Brattleboro.

No, sir.

Dr. G. H. Branch, Grand Isle.

In defense of the young practitioners of the state of Vermont, let me state a little incident which occurred not so very many years ago in my

town.

An old man walked into my office one day and said he had a severe cough and loss of appetite and strength. I made a careful examination of the patient and asked him who had been doctoring him and he mentioned the name of an old doctor. After I completed my examination, I decided to send a specimen of his sputum down to the State Laboratory. The report came back-numerous tubercle bacilli. Now this old man who had been doctoring this fellow has been held up as an authority on tuberculosis for years past. I sent the man back home and he died within eighteen months of tuberculosis. I want to say that the old practitioners and often those who are supposed to be authority on the subject make mistakes in their diagnoses sometimes.

Dr. E. E. Whitaker, Newport.

I have been very much interested and pleased with the remarks of our secretary in regard to the duties of the health officer in making the diagnosis when these diseases are reported by the attending physician. I should consider that I had insulted a brother practitioner if I had gone in and made a diagnosis by myself, irrespective of the attending physician. If the attending physician is in doubt and wants my help or advice, he will call upon me, and I will give him the best I have got.

E. A. Graves, Sunderland.

How far has a health officer the authority to go into a family and clean out an infection of lice?

Dr. H. D. Holton, Brattleboro.

He would probably catch them if he went there. You can usually do the business by letter just as well.

H. C. Warren, Marlboro.

I had occasion last winter to put up a quarantine notice for scarlet fever. A day or two afterwards I called upon the family and saw the quarantine notice was taken down from the door. I inquired where it was. I found it was in the kitchen. I inquired who put it there but no one knew anything about it. None of the family had put it there and they apparently knew nothing about it. I notified the state's attorney of the county. He wrote back to me that in order to bring a prosecution, I