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the same renders unlawful all bills or charges for professional services in connection with the case.

Other States as Minnesota, New York, and Ohio have a similar requirement in their birth certificates. The following is the form of certificate used in New York:

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What preventive for ophthalmia neonatorum did Number of children born to this mother, including you use?....

If none, state the reason therefor..

present birth..

Number of children of this mother now living....



I hereby certify that I attended the birth of this child, who was born alive at .... stated.

.M., on the date above


(Physician, midwife, father, etc.)



Given name added from a supplemental Address report.. .19...... Filed Registrar.

The provisions of the laws confine themselves merely to requiring reports of cases in Connecticut, Idaho, Illinois, Maine, Maryland, Michigan, Missouri, Ohio, Rhode Island, South Carolina, Tennessee, and Texas. Health authorities must, when no physician is in charge, furnish remedial treatment in Indiana, Louisiana, Minnesota, New Jersey, and Wisconsin.

The State health authorities of Massachusetts, New Jersey, and Vermont are specifically authorized in law to furnish prophylactic outfits to physicians for use in their practice. Rhode Island was the first State, however, to introduce such outfits, which are distributed through diphtheria antitoxin stations and under general authority vested in the State board of health for the preservation of the public health. In New York also provision is made for the control and prevention of ophthalmia neanatorum, and in accordance there with

When there was no attending physician or midwife, then the father, householder, etc., should make this return.

sight, the importance of ophthalmia neonatorum as an economic factor becomes evident. Every child infected with the disease, if left untreated, eventually may become dependent upon the community for his support. His education will be more expensive, his power to earn a livelihood will be permanently impaired, and instead of becoming a useful member of society, he may, and through no fault of his, become a permanent public charge.

In the United States, the State of Massachusetts appropriated $40,000 in 1910 for the support of its blind asylums; the State of New York, $110,000; while the biennial appropriation for the State of Pennsylvania for its institutions of the same kind in 1909 amounted to $265,000. When we aggregate private expenses, amounts spent by States and cities, and also the estimate of the potential earning power of individuals thus disabled, the economic loss on account of ophthalmia neonatorum is enormous.



Notwithstanding this great economic loss to the State on account of ophthalmia neonatorum, it was not until 1881 that Credé gave to the world a prophylactic, thereby connecting forever his name with the prevention of the disease and the subsequent saving of the sight of infants. The effective and simple way in which he checked the infection by the use of silver salts, and the statistics compiled by him and others, gave substantial support to his theories, which have been gradually incorporated in the sanitary policy of all civilized countries. Legislative bodies both in this country and abroad having accordingly had impressed upon them the importance of the disease have adopted various legal measures for its control.

It is the object of this bulletin to present a comparative statement of the several measures adopted in the different States and to bring together copies of the laws in which they are contained. Brief mention is also made of measures that are required to be taken in certain countries abroad.


In France ophthalmia neonatorum is classed as one of the communicable diseases, must be reported, and is subject to disinfection. In Italy the regulations for midwives provide that the lids and conjunctivæ of infants must be washed after birth with a disinfecting solution, and that if an inflammation develops a physician must be called immediately.

In Belgium a physician must be called to attend all cases of ophthalmia neonatorum, while midwives, before bathing the infant, are required to wash its eyes with sterilized water. In Bavaria the midwife is required to carry with her a vial containing the nitrate

of silver solution with directions for its use. In Austria a penalty is provided for midwives failing to call a doctor in cases of ophthalmia neonatorum. Similar regulations are in force in Switzerland.

The Ophthalmic Society of Great Britain and Ireland has recommended that the following note be printed on all birth certificate forms: "If the eyelids are red and swollen, or form the site of a secretion some days after birth, the child should be taken to the physician without delaying one day. The disease is very dangerous; if not cured in time the sight of both eyes may be lost." The insertion of a similar statement in the birth certificates used in the different States would no doubt be productive of much good, and some benefit might also be expected from reserving in the certificate a space for the reporting of the condition of the eyes.


So far as known, the first legal steps taken by any State to control ophthalmia neonatorum in the United States were those of Maine in 1891, when its legislature enacted the first law relative to ophthalmia neonatorum in this country. In 1892 New York followed with an amendment to the law relative to midwives and nurses.

Subsequently, other States took legislative action. The dates of the respective laws are as follows:

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Repealed by chap. 108 Revised laws, 1905. Provisions now incorporated in regulations.
Since Jan. 4, 1910, a provision of the sanitary code.

immediately report such condition to the health commissioner or to some legally qualified physician in the city, county or town wherein the infant is cared for. Any person and persons violating the provisions of this act shall, on conviction, be punished by a fine not to exceed one hundred dollars, or by imprisonment in jail not to exceed six months, or by both fine and imprisonment.


(Revised Laws, 1902, chapter 75.)


Should one or both

SEC. 49 (as amended by chap. 269, acts of 1910). * eyes of an infant become inflamed, swollen and red, and show an unnatural discharge at any time within two weeks after its birth, it shall be the duty of the nurse, relative or other attendant having charge of such infant to report in writing within six hours thereafter, to the board of health of the city or town in which the parents of the infant reside, the fact that such inflammation, swelling and redness of the eyes and unnatural discharge exist. On receipt of such report, or of notice of the same symptoms given by a physician as provided by the following section, the board of health shall take such immediate action as it may deem necessary in order that blindness may be prevented. Whoever violates the provisions of this section shall be punished by a fine of not more than one hundred dollars * *


SEC. 50 (as amended by chap. 480, acts of 1907). * * If one or both eyes of an infant whom or whose mother he (a physician) is called to visit become inflamed, swollen and red, and show an unnatural discharge within two weeks after the birth of such infant, he shall immediately give notice thereof in writing over his own signature to the selectmen or board of health of the town; and if he refuses or neglects to give such notice, he shall forfeit not less than fifty nor more than two hundred dollars for each offense.

(Chapter 458, acts of 1910.)

SEC. 1. The State board of health shall furnish, free of cost, to physicians registered under the laws of the Commonwealth such prophylactic remedy as it may deem best for the prevention of ophthalmia neonatorum

SEC. 2. To carry out the provisions of this act there may be expended annually from the treasury of the Commonwealth a sum not exceeding twenty-five hundred dollars.

(Acts of 1911, chapter 643.)


The sums hereafter mentioned are appropriated * * for the salaries and expenses of the State board of health for the fiscal year ending on the 30th day of November, 1911, to wit:

For expenses in carrying out the provisions of the law relative to the prevention of ophthalmia neonatorum,1 a sum not exceeding two thousand five hundred dollars.


(Compiled Laws of 1897.)

SEC. 4475. Should one or both eyes of an infant become inflamed or swollen, or reddened, or should any pus or secretion form in the eyes or upon the edge of the lids, at any time within two weeks after birth, it shall be the duty of any midwife, nurse or other person having charge of such infant, to report in writing within six hours after discovery of such inflammation, redness or formation of pus, or secretion, to the local health officer or some legally qualified practitioner of medicine in the 1 Ophthalmia neonatorum made also notifiable by resolution of the State board of health on May 6, 1909

city, town or district in which such case shall occur, the fact that such inflammation, swelling or redness or accumulation in the eyes exists.

SEC. 4476. Any failure to comply with the provisions of this act shall be punished by a fine not to exceed one hundred dollars or imprisonment not to exceed six months, or both such fine and imprisonment in the discretion of the court.


(Regulations, State board of health.)

SEC. 80. Whenever one or both eyes of an infant become inflamed, reddened or diseased at any time within two months after its birth, it shall be the duty of any midwife, nurse, parent or other person having charge of such infant to report the facts of such affection in writing to the local health officer of the city, village or township in which the person having charge of said infant resides within 12 hours after ascertaining the fact.

SEC. 81. Any health officer to whom may have been reported any case of eye disease in a child under two months of age shall forthwith visit said child and provide immediate medical treatment unless said child is already under the charge of a competent medical practitioner.


(Revised Statutes, 1909.)

SEC. 8321. Should one or both lids of either eye or of both eyes of an infant become red or swollen, or should there be any discharge from either eye or from both eyes, at any time within three weeks after its birth, it shall be the duty of the midwife, nurse or other person having charge of said infant, at once, unless for good cause shown, to report the condition of said eyes to a legally qualified practitioner of medicine.

SEC. 8322. Every health officer shall furnish a copy of sections 8321 to 8323, inclusive, to each and every person who is known to him to act as midwife or nurse in the city or town from which such health officer is appointed, and the secretary of state shall cause a sufficient number of copies of said sections to be printed and shall supply the same to the health officers on application.

SEC. 8323. Any failure to comply with said provisions of sections 8321 and 8322 shall be a misdemeanor, and shall be punishable by a fine of not less than ten nor more than one hundred dollars, or by imprisonment not to exceed six months, or by both such fine and imprisonment.


[Regulations, State board of health.]

RULE 29. The disease ophthalmia neonatorum, prevalent only among newborn infants, is one of the most fruitful sources of blindness. All things considered, where there is the least suspicion of the prevalence of any gonorrhoeal infection, or a mucopurulent discharge from the vagina during birth the attending physician shall take precautionary measures at once to prevent this fearful disease. This consists in the instillation of two drops of a 2 per cent solution of nitrate of silver in the eyes of the newborn child after thoroughly cleansing the eyelids, then parting them and introducing the drug. When there is reason to suspect gonorrhoeal contagion this must be repeated the second day. It is the duty of physicians, nurses and direc


tors of public charities to disseminate among the poorer classes a knowledge of the dangers of this disease and the necessity for prompt treatment. Disinfection of the clothing of the patient, and burning of all cloths, etc., is essential, as there is great danger of contamination.

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