the attendants, the apartment, and of all clothing and utensils used

in the room.

Food taken to the sick room should not be partaken of by any one excepting the sick one.

The minute particles which fly off from the patient during the period of desquamation must be imprisoned until they can be disinfected. This can be done by anointing the surface of the body, the scalp included, twice or more daily with carbolized or camphorated oil, cold cream or common lard. Handkerchiefs should be excluded, and cloths that may be speedily burned substituted for wiping away the discharges from the throat and nose.

The wearing apparel of the nurse and attendants should be of such material as can be easily washed, and as free as possible from tucks and folds, which serve as hiding places for the infecting material.

The several patients in the same family, so far as possible, should occupy different rooms, through fear that the poison might be aggravated and the type of the disease intensified.

3. The burying of all discharges from the body, and the disinfecting of all expectoration and nasal discharges.

The utensils used in the sick room should be kept constantly disinfected, while such articles as are of slight value, together with the sweepings of the room, should be burned. Such articles of clothes as cannot be baked or boiled had better be burned. A disinfecting sheet may be useful before the door or in the hall.

Some strong disinfecting fluid should always be kept in the sick room for the various occasions which may arise with reference to the discharges and utensils of the sick, and for the hands of the attendants.

4. The bathing and changing of clothes of physicians, nurses and clergymen who attend the sick, before visiting at any other house, and the exclusion from the public schools of all members of the family during the continuance of the disease in that family.

5. The compulsory report of the attending physician to the health officer of the town of all cases of scarlet fever, within twenty-four hours after learning of the existence of such disease, in any and every case under his care, and said health officer should see that the best sanitary regulations, in all cases, are enforced.

6. The occupants of all houses where scarlet fever exists, should

kindly prohibit the entrance of all persons, excepting necessary attendants, until the disease is past and the premises disinfected.

7. The thorough cleansing and disinfecting of the patient's body and clothing before being again allowed access to the public. This is effected by warm baths, with the free use of soap, taken on three or four successive days, until all roughness of the skin disappears. After this process, and with clean clothes, he may be deemed again safe for association. However slight may have been the attack, until this precaution has been observed, he must be regarded as unsafe to persons susceptible of scarlet fever.

8. The thorough cleansing, disinfecting and fumigating of all rooms and houses in which the disease has occurred, after the last case has been cured or buried.

9. The dead should be interred as soon as practicable. All funeral services should be conducted in a private manner, and never in a church. The attendants should be only the inmates of the family, and under no condition should there be any exhibition or exposure of the remains. Common customs and personal wishes must be subordinated to considerations of public safety. It is always to be remembered that the separation of the disease from the well is the most certain means of preventing its spread. Instances are numerous where infectious diseases have been spread through the exposure attendant upon public funerals.

Dr. Kirby Kitloe, of Grant county, Wisconsin, relates the case of a man who, against his most earnest protest, attended the funeral of a child in the family of a relative, sixteen miles distant, and brought the disease home to his own family, which proved fatal in the case of a favorite child.

"Dr. Goldie, the medical officer of health for Leeds, England, in his report to the local authority, states that every one of thirty people who attended the wake of an Irish girl who recently died in that town from typhus fever, were attacked by the same disease, and no fewer than nine of the cases ended fatally."

It is not too much to claim that if the foregoing precautions were observed, scarlet fever would scarcely pass beyond the bounds of the house where it first appeared. Certain it is that it would be robbed of much of its terror and kept effectually in abeyance.

Nor is it unlikely that under the more general diffusion of sanitary knowledge, and a better understanding of the laws of disease,

that the time may come when the common law, which guaranties protection to life as well as to property, will take cognizance of gross ignorance and great carelessness in regard to diseases dangerous to the public health, where such ignorance and carelessness jeopardize the health and life of the citizen.

The case recently noticed in an English medical journal, which, after two trials remains undisturbed, looks strongly in this direction. The case was one in which the owner of a lodging house brought an action against a gentleman who brought his children from London during convalescence from scarlet fever into the lodgings, without notifying the landlord of the danger to which his family were being exposed. Two of the children of the lodging house keeper took the fever and died. In the first trial the jury · awarded substantial damage; this verdict was sustained upon a second trial. (Am. Jour. Obst., 1873, p. 71.)

Where instruction and admonition shall prove powerless against ignorance, negligence, willfulness and a deficient sense of duty, the citizen may justly claim the protection of the state from the possibility of a great calamity.

If from the facts we have grouped, and the suggestions made, it appears that the public health may be preserved, and many young lives saved from a needless sacrifice, we would respectfully recommend to the health officers of every township, incorporated village and city in the state, the adoption of the following rules, or a modification of them to suit local conditions, for the better protection of the people against scarlet fever:

1. That all physicians or persons acting as such, be required to report every case of scarlet fever that may come under their care, whether mild or severe, to the health officer of the town, within twenty-four hours after discovering its existence; and that in case no physician is in attendance, the parents or guardian of the patient shall be required to make such a report.

2. That the sick person shall be isolated as much as possible from the other inmates of the house. If circumstances will permit, he should be placed in an upper room, previously prepared by the removal of all superfluous curtains, carpets, woolen articles, unnecessary clothing, bedding or furniture, likely to retain the infection.

3. That visitors to the sick room, except in the case of clergymen and medical men, should be peremptorily forbidden. All in

tercourse with the neighbors should be suspended excepting such as may be demanded by the necessities of the family and of the sick

one.

4. Special attention should be directed to the house and its surroundings. Any accumulation of filth or refuse of any kind should be at once removed and disinfectants freely used.

5. That the ventilation of the sick room shall be made as complete and perfect as possible, under the direction of the attending physician. A current of air may be established safely through the window in the following manner: Raise the lower sash of the window three or four inches, then procure a piece of board made to fit accurately into the lower opening, and place it there. By these means free outward and inward currents of air, without causing any draughts are obtained through the vacant space between the two sashes. 6. That where death from scarlet fever occurs, the body shall be wrapped in a clean sheet and placed in the coffin, being well sprinkled with some disinfecting fluid, such as strong carbolic solution, or dusted over with chloride of lime, and that it should be buried with the least possible delay. On no conditions should it remain in a room occupied by the living.

7. That during the existence of the disease, an adequate supply of disinfectants should be used; and if the family be too poor to obtain such, the Board of Health shall furnish them at the expense of the town.

8. That all houses where scarlatinous patients have been nursed shall be thoroughly cleansed; the ceilings and side walls of the sick room be lime washed, the wood work scrubbed with soap and water, and thorough ventilation allowed, after the patient last sick may have recovered or have been removed.

9. That no child having recovered from scarlet fever shall be admitted into the public school until six weeks after the day of first having been taken down with the disease; and that no child living in the same house shall attend the public school while the disease exists in that house. Nor even then, until such time as they furnish to the teacher of such school a written statement from the attending physician that the house and premises have been thoroughly disinfected, and that there is no longer any danger from contagion. 10. That patients dying of scarlet fever shall be buried in a private manner, as persons dying of small pox generally are.

Some of these recommendations may seem to be unnecessarily stringent, but when the welfare of the public and the great interests of human health and life are considered, we cannot recommend less.

Our duty to the living imperatively demands the enforcement of very stringent rules. We know of no other method of adequately dealing with this terrible destroyer of child life, and we believe that these methods, if faithfully adopted, will be followed by most happy results.