4. If diphtheria or membranous croup, strictly isolate the case at once, in an upstairs room if possible, and as disconnected 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, in at least 3,000-unit doses in the mildest cases when seen on the first day of the disease, and from 5,000 to 7,000 units if the case is severe, and in all cases which have been sick longer than one day, as soon as the disease is recognized or seriously suspected, and that the dose should be repeated or doubled every six hours until marked improvement has taken place; and it recommends that immunizing doses of 1.000 units 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.

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 20 minutes 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 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 open

ings, and dampening the floor, bedding and clothing, and leaving the room closed for twelve hours. The room should then be thoroughly ventilated, and all ledges, woodwork, etc., washed with strong soap and rinsed with 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 notice 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 a 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.

14. The board has constantly on hand at its office in Bowling Green, a large reserve supply of antitoxin, supplied by the Alexander laboratories, which may be distributed to the poor under the direction of county or city boards of health at prices of 50 cents per 1,000 unit syringes, $1.30 for 3,000 units, $1.90 for 5,000 units and $2.20 for 7,000 units. This makes it possible for counties or cities to cure or prevent this fatal disease at a reasonable expense.

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. G. SOUTH, 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 in every case to prevent the spread of the disease are 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 immediate separated from others until a competent physician has seen it and fully determined that it is not affected with a contagious disease.

2. In Scarlet Fever maintain strict isolation, in an upstairs room, if possible, however mild the case may be, until the shedding of the skin is complete and all branny scales disappear, usually thirteen weeks, and, afterwards, until patient has been thoroughly bathed and clad in garments which have not been in the sick room during the illness, and the room thoroughly disinfected. 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. The rule should be always to give the community the benefit of the doubt and to maintain the isolation until there is no possibility of danger. 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 any other eruptive disease in its tenacious attachment to clothing and other objects, even for years, and in its portability to other houses, or even distant localities.

4. Burn all discharges from the mouth and nose, and disinfect all other discharges from patient. Burn all refuse from the sickroom. All spoons, cups, glasses, etc., used in the sickroom should be washed separately from other dishes, after remaining some time in boiling water.

5. Disinfect all bed and body clothing, and everything else used in the sick room, before removing it therefrom, by immersion for 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 sickroom can do away with the necessity for abundant fresh air and sunlight.

6. After complete recovery, or death, carefully and thoroughly disinfect the room and its contents. To do this, stop all apertures well, dampen the floor and bedding, and use nascent formaldehyde, or burn three pounds of sulphur, dampened with alcohol, previously dampening the floor, bedding and clothing, for each 1,000 cubic feet of space, leaving the room closed for at least twelve hours. Afterwards the room should be thoroughly ventilated, and all ledges, woodwork and walls washed with strong soap, and rinsed with a strong disinfecting solution. This work should be done thoroughly; otherwise it will give only a false sense of security.

7. In case of death the body should be wrapped in a sheet saturated in disinfecting solution and buried as soon as practicable, without public funeral services. Newspapers in giving notice of death, should state that it was from Scarlet Fever, and that children, and persons having the care of children should not attend.

8. Physicians attending Scarlet Fever should use a robe, overalls or other protection for the clothing and person; should wash the hands and face before leaving the house, and take every other precaution to prevent carrying the disease to others.

9. The law requires that all cases of contagious diseases shall be reported to the city or county board of health, by the head of the family or physician, within twenty-four hours. This law should be observed in every case of Scarlet Fever.

Copies of this bulletin, and similar ones in regard to the prevention of diphtheria, typhoid fever and consumption, will be furnished for free distribution, upon application to the Board at Bowling Green.

By order of the Board,

J. G. SOUTH, M. D., President.

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

PREVENTION OF OPHTHALMIA NEONATORUM.

(Disease of Babies' Eyes Which Causes Blindness.)

Circular Issued by

THE STATE BOARD OF HEALTH

of Kentucky.

To the Health Officials, Physicians and People of Kentucky:

1. Ophthalmia Neonatorum is a purulent inflammation of the eyes of new-born babies. It generally begins from one to three days after birth. In exceptional cases it may appear when the infant is a week or two old or even later.

2. The cause of this disease is infection by a micro-organism. In severe cases this is nearly always the gonococcus which is illustrated in the accompanying figure. Occasionally other organisms, such as pneumococcus and streptococcus may cause purulent ophthalmia in infants.

3. The infection generally takes place from the vaginal discharge getting into the infant's eyes during birth. When the disease begins later than the fourth day it has been caused by lack of cleanliness on on the part of the attendants.

4. This disease is responsible for about one-fourth of the blindness in early life and about one-tenth of all the blind in the world.

5.

Blindness from this disease is the more disastrous because it means practically a whole life of blindness, whereas loss of sight from other causes oftener occurs in the decline of life when usefulness is already on the wane.

6. So great is the burden to the Commonwealth in the care of the blind and so great the calamity to the patient and his friends that many states have passed special laws in regard to Ophthalmia Neonatorum, laying a heavy penalty upon the midwife or attendant who fails to summon a physician on the first appearance of the disease.

7. Ophthalmia Neonatorum is practically a preventable disease by a simple method of prevention. This means of prevention is as follows: As soon as the child is born the eyes should be carefully cleansed with a saturated solution of boracic acid, wiped dry with a little absorbent cotton, the lids carefully opened and one or two drops of a two per cent

S. B. H.-2