556 PATHOGENIC MICROORGANISMS 



are dropped into the eye at birth. It is extremely important that this 

 should be done properly and the entire conjunctival sac bathed in the 

 fluid. The method is so important that it is regarded as a matter of 

 very serious and inexcusable omission, if, under any circumstances, in 

 dealing with any class of the population, the physician managing a 

 childbirth fails to carry out this measure as soon as feasible after 

 birth. 



Another very important gonorrheal problem is the vulvovangitis 

 which occurs in children. In our own experience, this infection has oc- 

 curred most often in connection with the children's wards in hospitals. 

 The condition has, however, been observed in schools and in small family 

 groups where children were infected by sleeping in the same beds with 

 adults. In hospitals the disease may spread in epidemics, and from 

 bed to bed, with an ease that is astonishing when one considers the 

 delicate life of the gonococcus outside the body. It has often been 

 extre nely difficult to stop such bed to bed infection, in spite of the most 

 rigid precautions. Epidemics are so difficult to arrest, and the conse- 

 quences for the child so grave from many points of view, that it has 

 becone the custom in all well-managed hospitals to delay the admission 

 of female children to the general children's ward until vaginal smears 

 have been made and examined for gonococci. It is in our opinion 

 extremely important that when such smears are made, they should be 

 taken not only from the visible secretion, but should be taken from high 

 up in the vagina through a small Kelly speculum, with good illumina- 

 tion. When there is danger of spread and a case has been inadver- 

 tently admitted, only the greatest care in avoiding indirect contact from 

 bed to bed can stop it. As a matter of routine in children's wards, 

 there should be separate thermometers, unless all thermometers are very 

 carefully sterilized, thermometers should be kept in weak carbolic 

 solutions and washed with alcohol before use; the sterilization of diapers 

 and towels should be attended to, nurses handling cases with discharge 

 should wear gloves, and there should be no common use of towels and 

 washing utensils. Great attention should be given to the scouring of 

 bath tubs, and bed linen, night clothes, etc., should be sterilized by 

 boiling. 



Public Health Management of Venereal Diseases. During the 

 past ten years there has been a very wholesome increase of interest in 

 venereal disease prevention. There are certain general fundamental 

 principles which apply to all venereal diseases equally. In the first 

 place, it is necessary to look upon venereal infections as preventable 



