stock constantly on hand, and a supply will be sent at once to any board of health requesting it.

Arrangements have been made with the Lederle Antitoxin Laboratories of New York City to keep the board supplied with their concentrated antitoxin, which is manufactured on the same plans as that now being used so successfully in New York City and many other places. A specially low price has been made to boards of health. It comes in single packages put up in glass syringes ready for use, and will be kept in doses of 1000, 2000, 3000, 4000, and 5000 units. The price, including the syringe, to boards of health, is:

volving the larynx, if treatment is given on first day of disease, 2000 units will generally be found sufficient; if treatment is not given until the second or third day of the disease, it would be better to give 3000 units. If disease is severe, and in all cases of diphtheritic laryngitis, at least 4000 units should be administered, while 5000 to 10,000 units are often indicated. If favorable results do not follow within eight hours, the initial dose should be repeated or doubled. With refined and concentrated antitoxin, giving a maximum of strength in a minimum bulk, it is safer to give large doses than to risk the danger of an insufficient dosage.

The arrangements for its distribution by the State Board of Health are as follows: Upon the request of any local board of health, or of its health officer, we will at once send by mail or express, prepaid, the number of packages ordered, in the doses indicated. A statement will be sent to the person who orders the antitoxin and a duplicate statement will also be sent to the producer. The latter will collect the amount due for the antitoxin from the local board of health. The State Board of Health will not receive any money, and is simply acting as a distributing agent for the purpose of saving time.

Antitoxin will not be furnished to physicians except upon the order of the local board of health.

It may happen that an outbreak of diphtheria will occur where many persons have been slightly exposed, as in school, for example. The board of health may wish to have a small supply of antitoxin on hand for such an

emergency, but may not be called upon to make use of it. To meet such conditions a board of health may order as many as 20 immunizing doses and 10 curative doses, and have the privilege of returning to the State Board of Health within 30 days any unopened package, for which it will receive credit. The only extra expense, where this is done, will be the postage or expressage upon the packages returned.

In ordering antitoxin care should be taken to explicitly state the number of packages wanted and of what doses. The post office, or express office, if a large quantity is ordered, to which it is to be sent, must also be given. When antitoxin is received it should be kept in an ice chest, where possible, until needed.

It should be remembered that the success of antitoxin in the treatment of diphtheria depends largely upon its early use in sufficiently large doses. Each package of antitoxin will contain a blank for a report of the case in which it is used. Physicians who receive antitoxin from boards of health will be required to fill out this blank and return it to the State Board of Health. They must also certify that the antitoxin was used for a person in indigent circumstances.

Local boards of health are urged to make use of their authority and this arrangement for supplying antitoxin for the cure and převention of diphtheria. Physicians are frequently called to cases of diphtheria in poor families where the use of antitoxin would mean the saving of life, but where the family is too poor to purchase it. The physician should not be expected to furnish it at his expense. This should be borne by the public for the reason that to lessen the number of deaths from this disease, and the period of time during which those who recover must be quarantined, and also to protect those who are exposed from having the disease, is a public health measure for which the public can well afford to pay.

By order of the Board,

J. N. McCORMACK,

Secretary.

J. M. MATHEWS.

President.

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, Scarletina 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 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 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 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. 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 sick room. All spoons, cups, glasses, etc., used in the sick room should be washed separately from other dishes and should remain 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 sick room 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, for each 1,000 cubic feet of space, leaving the room closed for at least tweleve hours. Afterwards the room should be thoroughly ventilated, and all ledges, woodwork and walls washed with strong soap, and rinsed with the 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 his clothing and person; should wash his hands and face before leaving the house, and take every other precaution to prevent him from carrying the disease to others.

9. The law requires that all cases of contagious disease 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.

Copies of this circular, 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. N. McCORMACK, M. D., Secretary.

Prevention of Opthalmia Neonatorum.

The 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. Opthalmia Neonatorum is a purulent inflammation of the eyes of newborn 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 micro-organism. In severe cases this is nearly always the germ of gonnorhea 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 the part of the attendants.

4. This disease is responsible for about one-fourth of the blind 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 declining years of life when usefullness 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 on 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 the prompt use of a very simple method of prevention.

8. In Europe Lying-in hospitals the proportion of infants having this disease has been reduced from ten per cent to two tenths of one per cent by this preventive measure.

9. This means of prevention is as follows: As soon as a child is born the eyes should be carefully cleansed with a saturated solution of boracic acid,