Dr. Campbell. The other day there was a drowning accident; I was called as the family physician to fill out the death certificate. The evidence all pointed to drowning; there was no question about it. Should I have refused to fill out any certificate and called in the health officer? Answer. No, simply tell the family to call in the health officer. Question. It was a New Hampshire health officer. Answer. Well, I presume they have the same laws-perhaps not exactly like. Carty. Where a health officer is called in shortly after a death takes place, should he issue a certificate? Answer. Yes, I think he should. Dr. Holton. I had this certificate of death reported me-reported to me by the town clerk: "Cause of death: Found dead in the road." I wonder if a physician thinks that is a proper statement as to the cause of the death. A good many people have been found in the road that were n't dead, but very much alive. Put it in a more definite form. A man was found dead in the road; it was supposed to be apoplexy; the doctor called it so. If he was satisfied, that is satisfactory, but why didn't he state it so? Question. I suspected a premature birth and death in the town-I not only suspected, but knew it. Have I the authority to inquire? Few people are willing to tell me all about it. They say, "It's none of your business; you have plenty of business, and this is none of your business." I have wondered if I could not make a few people understand that it is my business. Dr. Caverly. You have the state's attorney to prosecute them for not reporting a birth, and for burying a dead body without a permit-in case they did bury it. Are there any other questions or remarks to make? Dr. Fish. Mr. President:-There is a question that came up here yesterday, which seemed to me proper to be referred to among the medical-legal questions in the Question Box-in regard to the reporting of contagious diseases, and the question of the liability of the physician, whether or not they can be compelled, without fee, to report them? It came up upon the question of reporting cases of tuberculosis to the State Board of Health. Now, can a physician be compelled to report cases of tuberculosis to the State Board of Health, as directed by the Laws of 1902, without any remuneration for the physician, or can a physician be compelled to report cases of contagious diseases to health officers, because there is no fee attached? Those two questions we would all like to have answered. The same principle would govern either. Dr. Caverly. My answer to that would be that I don't think there is any question of contract involved in it at all The state has the right to compel a physician to do it, and the question whether he gets his pay for it, does n't make any difference. It is based upon the police power, as you see-that every citizen is required to do certain things for the protection of health, liberty, etc., of his fellow men-and they have to do that whether they get any fee or not. It is a part of their duty as physicians-a part of their profession to tell the State Board or the health officers what somebody died of. It is one of the requirements of the law of the state. If tuberculosis is a disease dangerous to public health, then the physician is just as much compelled to report that to the State Board of Health, as he would be a case of smallpox or scarlet fever, and it comes under the police power of the state to compel them to do certain things for the protection of the community. Question. I have a case of tuberculosis in my town; it has been in progress six or seven months, and is progressing toward a fatal end. The Laboratory decided several months ago that it was a case of tuberculosis, and I had no reason to question their findings. Have I any authority whatever to make directions in regard to the care of the sputum, etc.? She is allowed to have visitors at all times. The nature of the disease is well known, and visitors come there to see her every day. Now have I the authority to prevent their coming there? Answer. No, sir, I don't believe you can prevent their coming to see the lady, unless you quarantine the case, and they don't quarantine tuberculosis. Dr. Caverly. Health Officers, Doctors, and Laymen:-I want to thank you who are present, and assure you that the Board fully appreciates the sacrifices that most of you have made to attend the meeetings. I hope we may see you at the next meeting of Health Officers. ARE SMALL QUANTITIES OF PRESERVATIVES PERMISSIBLE? Dr. H. W. Wiley, chief of the Bureau of Chemistry, Department of Agriculture, Washington, D. C., has the following to say on this subject: It is admitted by all who have examined the subject in a critical way, even by the users of preservatives, that in certain maximum quantities the limit of toleration is reached in each individual, and positive injury is done. But it is also well recognized that many, if not all, of the usual foods when used in large excess produce injurious results. The many cases of disease produced by overeating, or by eating improperly prepared or poorly cooked foods, or by eating at unusual times, are illustrations of this fact. Upon this basis and upon the further statement that when used in extremely small quantities the preservatives in question can not be regarded as harmful, is founded the principal argument in favor of the use of the preservatives, aside from the fact that the foods themselves are kept in a better and more wholesome state. It is only proper to give to this argument full consideration and not to brush it aside as illogical and irrelevant. It is evident that any attempt to determine experimentally the effect of extremely minute quantities of any preservative, even when used continuously, would not be likely to lead to any definite result. In the foregoing data we have illustrations of the fact that even large quantities of the preservative employed-larger by far than would probably ever be found in any food product-do not always act in such a way as to permit of definite interpretation. The claim, therefore, that the use of such preservatives is justified when the amount is extremely small, and when even these small amounts are used only at intervals and not continuously, is worthy of careful consideration. An illustration which is pertinent may be taken from the particular preservatives with which the foregoing experiments have been made, namely, boric acid and borax. One of the food products' to which these preservatives are very commonly added is butter. This statement should not be taken to imply that in butter prepared for domestic use in this country borax is found to any considerable extent. When butter, however, is to be transported over long distances, and necessarily kept a long while, the addition of borax is very frequently practiced. The dietetic data which have been accumulated in the course of this experiment show that the quantity of butter consumed daily varies from thirty to seventy grams. Suppose, as a maximum, we say that the quantity of butter consumed in any one case daily is 100 grams, and that it contains one gram of boric acid or an amount of borax equivalent thereto. The maximum quantity of boric acid used in a day in this case would be one gram. In point of fact, however, it would rarely, if ever, reach this amount, but even in those cases where butter is eaten freely probably half a gram would be about the maximum quantity consumed. Further than this, one per cent of boric acid, or its equivalent in borax, in butter is a very large quantity. Probably, as a rule, not more than one half of one per cent is employed. In this case the quantity of boric acid likely to be consumed by any one individual in a day would be reduced to one quarter of a gram. In the case of meats preserved by borax, although larger quantities are eaten than of butter, it is not likely that any larger quantities of borax would be consumed. Thus it appears that those who habitually eat butter and meat preserved with borax might be consuming half a gram or a little more of boric acid per day. But preserved meats are not regularly eaten, and hence the quantity mentioned is likely to be overestimated. It would be unwise to affirm in a case of this kind, in the light of the data obtained by the experiments, that such a minimum consumption of borax, and especially when not a continuous one, would prove deleterious within any reasonable time of observation. The question then arises, Does the absence of such proof or the impracticability of obtaining it serve as a justifiable excuse for the use of this preservative? This question ought not to be decided alone, because the principle of the decision must stand, not only for boric acid and borax, but for every preservative used in foods. In other words, whatever principle is established for judgment as to the use of boric acid in small portions must also be applied to the use of every other preservative used in foods. The principle must also be still further extended so that whatever may be established as regards butter or meat must be admitted in respect of every other substance used in food. Hence before admitting the full force of the argument based on minimum quantities, the full significance of such admission must be considered and the practically unlimited extent of its application acknowledged. This leads to the discussion of the fact that in the majority of cases the labor of freeing the system from added preservatives falls principally upon the kidneys. In the method of life in vogue in this country the kidneys are already hard-worked organs. Americans probably eat more freely than the citizens of almost any other country, with the possible exception of England. Large quantities of nitrogenous foods are consumed. In the breaking down of the nitrogenous tissues the kidneys are the chief organs for the excretion of the débris. The addition of any further burden, therefore, no matter how minute, is to be deplored. If, however, the principle be admitted that injurious substances may be used in such small quantities as to be practically harmless, then we find the way open for loading upon the kidneys many different functions in addition to those which they now discharge. If they may be justly called upon to eliminate the small quantities of boric acid added in food, they cannot logically be freed from the necessity of eliminating also minute quantities of salicylic acid, saccharin, sulphurous acids and sulphites, together with the whole list of the remaining preservatives, which are eliminated principally through the kidneys. It would be useless to contend that the occasional consumption of small quantities of boric acid in a sausage, in butter, or in preserved meat would produce even upon delicate stomachs any continuing deleterious effect which could be detected by any of the means at our disposal, but naturally it seems that this admission does not in any way justify the indiscriminate use of this preservative in food products, implying, as it would, the equal right of all other preservatives of a like character to exist in food products without restriction. It appears, therefore, that there is no convincing force in the argument for the use of small quantities unless it can be established that there is only a single preservative used in foods, that this preservative is used in only a few foods, that it will be consumed in extremely minute quantities, and that the foods in which it is found are consumed at irregular intervals and in small quantities. On the other hand, the logical conclusion which seems to follow from the data at our disposal is that boric acid and equivalent amounts of borax in certain quantities should be restricted to those cases where the necessity therefor is clearly manifest, and where it is demonstrable that other methods of food preservation are not applicable and that without the use of such a preservative the deleterious effects produced by the foods themselves, by reason of decomposition, would be far greater than could possibly come from the use of the preservative in minimum quantities. In these cases it would also follow, apparently, as a matter of public information and especially for the protection of the young, the sick, and the debilitated, that each article of food should be plainly labeled and branded in regard to the character and quantity of the preservative employed. EFFECT OF BORIC ACID AND BORAX UPON GENERAL HEALTH. The most interesting of the observations which were made during the progress of the experiments was in the study of the direct effect of boric acid and borax, when administered in food, upon the health and digestion. When boric acid, or its equivalent in borax, is taken into the food in small quantities, not exceeding half a gram (seven and one half grains) a day, no notable effects are immediately produced. The medical symptoms of the cases in long-continued exhibitions of small doses or in large doses extending over a shorter period, show in many instances a manifest tendency to diminish the appetite and to produce a feeling of fullness and uneasiness in the stomach, which is some cases results in nausea, with a very general tendency to produce a sense of fullness in the head, which is often manifested as a dull and persistent headache. In addition to the uneasiness produced in the region of the stomach, there appear in some instances sharp and welllocated pains which, however, are not persistent. Although the depression in the weight of the body and some of the other symptoms produced persist in the after periods, there is a uniform tendency manifested after the withdrawal of the preservative toward the removal of the unpleasant sensations in the stomach and head above mentioned. The administration of boric acid to the amount of four or five grams per day, or borax equivalent thereto, continued for some time, results in most |