"As it is now definitely known to be a communicable germ disease, a large part of this sickness and mortality can and ought to be prevented. Careful and extended investigation and observation has demonstrated that the chief source of danger is from the sputum or expectorated matter of consumptives, which contains the germs or seed of the disease in countless numbers, and that such sputum is especially dangerous after it has dried. The germs may be constantly found in the air and dust from the carpets, walls and furnishings of rooms occupied by consumptives, where every precaution is not taken to collect and disinfect such sputum as fast as it is expectorated. Most patients constantly re-infect themselves by failing to destroy their own sputum, and other susceptible persons inhaling the air of such rooms are exposed to constant and serious danger. This is none the less true because the disease may not develop so that it can be recognized for months or even years. These dangers exist to a less extent also in public buildings and rooms frequented and infected by careless consumptives.

"Being confident that consumption could be practically exterminated if the medical profession and people could be made to realize the importance of destroying the sputum from every one afflicted with the disease, the following rules have been prepared with care, and should be disseminated, and, as occasion requires, observed by all afflicted persons and families, and all others interested in the public welfare.

"1. Every person who has an habitual cough and expectoration should have a microscopical examination of the sputum made to ascertain if it contains the germs of consumption.. Until this can be done, or if the germs are found, all of the sputum should be carefully and systematically collected and destroyed or disinfected for his own protection, as well as that of others.

"2. Every particle of the sputum should be received upon soft paper and promptly burned, or into cuspidors containing a solution of chloride of lime, four ounces to a gallon of water, or of equivalent strength, and such cuspidors should be washed daily in boiling water. Cuspidors in hotels, cars and other public places, used by consumptives, should have similar care.

"3. The room occupied by the afflicted person should be large and well ventilated, with an open fireplace if possible, and no other person should remain or sleep in the room, unless all of the sputum is collected and destroyed with great care. However, if this is carefully and intelligently done, others may share the room in safety.

"4. It is important that consumptives should live in the open air and sunlight as much as possible, and that they should be taught to spit upon small pieces of cloth or paper, or use a pocket cuspidor, and destroy the sputum at the first opportunity. They should especially

be taught not to spit upon the floor of any public or private building. "5. Weak and broken-down people are especially vulnerable to the germs of consumption. Much may be done to lessen the liability to it by attention to the general health, and by developing the lungs and chest, and keeping them strong and healthy. Exercise in the open air, fresh air in the bed-room, gymnastics, frequent sponge bathing and chest massage, proper clothing, everything, in short, which will promote physical and mental well-being, are important to all, and especially to those who have inherited or acquired weakness.

"6. Sanatoria for the isolation and humane care of consumptives who can not be properly and safely treated at home exist in several States, and are greatly to be desired. Contrary to the popular belief, a large per cent. of those attacked by the disease can and do recover under favorable circumstances. Until the disease can be eradicated, the means of proper treatment should be placed within the reach of all afflicted for their own benefit, as well as for the safety of the public. "7. No person should take a room previously occupied by a consumptive until it has been thoroughly disinfected with formaldehyde or by burning sulphur, three pounds moistened with alcohol for each 1,000 cubic feet of space, with all the flues and other apertures securely closed. Afterwards the room should be re-papered and all woodwork re-painted, or washed in strong soap and rinsed in a disinfecting solution. No amount of disinfection of rooms can lessen the importance of cleanliness, fresh air and sunlight at all times.

"8. Milk and meat from animals afflicted with tuberculosis should not be used, or, at least, the former should be boiled and the latter well-cooked. This is especially important as to milk for children.

"9. With proper precaution, consumptives may safely mingle with their families and the public, but for the purposes of information and education in these matters, physicians and heads of families should report all cases suspected to have the disease to the local health authorities and obtain instruction and assistance in preventing its spread. "Copies of this circular, and of similar ones in regard to the prevention of typhoid fever, diphtheria and scarlet fever, may be had for free distribution by any one upon application to the board at Bowling Green.

"By order of the board:

"J. M. MATHEWS, M. D., President. "J. N. McCORMACK, M. D., Secretary."

"PREVENTION OF DIPHTHERIA.

"Circular Issued by the State Board of Health of Kentucky.

"To the Health Officials, Physicians and People of Kentucky:

"The unusuai prevalence of diphtheria in many sections of the State makes it the duty of this board to again call attention to the best known methods of preventing the occurrence and spread of this dis

ease.

"1. Diphtheria is both contagious and infectious, and is distinctly a preventable disease, being easily limited to the first case or cases. When it gets away from the primary cases and makes its escape upon the community, somebody is to blame. The sooner we accept this as a sanitary maxim, the sooner we shall begin to do our duties as individuals and communities.

"2. On account of its frequency and fatality, this disease is of far more importance to the people of Kentucky than smallpox, yellow fever or cholera.

Germs of Diphtheria, magnified from Photomicrograph
from Sternberg's Bacteriology.

"3. When a child has sore throat, and especially if diphtheria is in the neighborhood, it should be immediately separated from other children until a competent physician has seen it and decided whether or not it is affected with a contagious disease.

"4. If diphtheria, strictly isolate the case at once, in an up-stairs room if possible, and disconnected as far as practicable from the living and sleeping apartments of other children. No one except the physician and nurses should enter the room, and they should take every precaution not to carry the infection to others.

"5. The board urges the hypodermatic use of a standard antitoxin, such as Alexander's or Mulford's, in at least 3,000-unit doses, as soon as the disease is recognized or seriously suspected, and that this dose should be repeated within twelve hours unless marked improvement has taken place; and it recommends that immunizing doses of 500 units

t

be used for all children, and especially for all inexperienced relatives acting as nurses, who have been seriously exposed.

"6. Placard the house, and keep all other children, all having the care of children, and all who go where children are, away from it. Notify the health officer of the town or county within twenty-four hours, as the law requires, and he will co-operate with the physician and family to keep the disease from spreading; and if the family is not able to purchase the antitoxin, he will get the county judge to buy it and he will use it.

"7. The discharges from the mouth and nose, which especially contain the germs of the disease, should be received on soft cloths and burned, and other discharges should be disinfected, and all refuse from the sick room burned. All utensils used in feeding the sick should be washed separately from other dishes, and should remain some time in boiling water.

"8. Disinfect all bed and body clothing, and other like things, as soon as removed, by immersion for at least six hours in a solution of chloride of lime, four ounces to the gallon of water. They may then be wrung out and put in the wash. Remember, however, that no disinfectant in the occupied sick room can do away with the necessity for abundant fresh air and sunlight.

"9. The isolation of the patient should continue for ten days after all trace of the disease has disappeared, and until he has had a disinfecting bath and been clad in garments which have not been in the sick room. No person from a house where there is diphtheria should be permitted to go into public assemblies, and no child from a house where this disease has prevailed should be allowed to attend school without a certificate from the health officer that it is safe to do so.

"10. After complete recovery, or death, always thoroughly disinfect the room and its contents, preferably with nascent formaldehyde, or, where this is not available, by burning three pounds of sulphur, moistened with alcohol, for each 1,000 cubic feet of space, previously stopping all openings, and dampening the floor, bedding and clothing, and leaving the room tightly closed for twelve hours. The room should then be thoroughly ventilated, and all ledges, woodwork, etc., washed with strong soap and rinsed with a disinfecting solution.

"11. In case of death, the body should be wrapped in a sheet saturated in a disinfecting solution and buried without public service. In giving notices of death, newspapers should state that it was from diphtheria, and that children and those having the care of children, should not attend the funeral.

"12. To be effective, the precautions herein suggested should be rigidly observed. Imperfect isolation and disinfection are worse than useless, giving rise only to false and misleading sense of security.

"13. County and municipal boards of. health have full authority under our laws to enforce these rules, and will fall short of their duty if they fail to do so.

"Copies of this circular, and of similar ones in regard to scarlet and typhoid fever and consumption, for free distribution, may be had upon application to the Board at Bowling Green.

"By order of the board:

"J. M. MATHEWS, M. D., President.

"J. N. McCORMACK, M. D., Secretary."

"PREVENTION OF SCARLET FEVER.

"Circular Issued by the State Board of Health of Kentucky. "To the Health Officials, Physicians and People of Kentucky: "Scarlet fever, scarlatina and scarlet rash are different names for one and the same disease. It is an infectious and dangerous disease, and the mildest case may spread the infection and cause the most malignant cases.

"Scarlet fever is essentially a disease of childhood, and always results from infection from a pre-existing case. Countries have been free from it for centuries till imported by commerce and trade. Owing to its frequency and fatality, it is of far more importance to the people of Kentucky than smallpox, cholera, or yellow fever. In view of these facts, the great importance of prompt isolation and thorough disinfection to prevent the spread of the disease is beyond question. "The following rules have been prepared with care and should be disseminated and, as occasion requires, observed by all interested in the welfare of children:

"1. When a child has sore throat and fever, and especially when scarlet fever is in the neighborhood, it should be immediately separated from others until a competent physician has seen it and fully determined that it is not affected with a contagious disease.

"2. If scarlet fever, maintain strict isolation, in an up-stairs room, if possible, however mild the case may be, until the shedding of the skin is complete and all branny scales disappear, and, afterwards, until the patient has been thoroughly bathed and clad in garments which have not been in the sick room during the illness. As a rule, in Kentucky children are released from quarantine and permitted to return to school or mingle with other children before it is safe for them to do so. In giving the disinfecting bath, the hairy scalp should receive special attention.

"3. Placard the house, and keep all children, all having the care of children, and all going where children are, away from it. It should be borne in mind that the poison of scarlet fever surpasses that of