Urine, 91; Water, 61; Miscellaneous-Bacterin Test, 7; Malaria, 6; Rabies, 4; Pasteur Treatment, 3; Milk, 24; Human Milk, I; Pus, 4; Cream, 4; Tissue, I. Total, 301.

Town Water-Dover, Camden.

Milk Survey-Newark, Middletown, Camden.

September, 1914:-Sputum, 36; Typhoid, 76; Diphtheria, 32; Urine, 87; Water, 53; Miscellaneous-Bacterin Test, 7; Blood, Count, I; Malaria, 9; Rabies, 3; Pasteur Treatment, 4: Milk, 18; Pus, 8; Stomach Contents, I; Mucus, 1; Urine for T. B., 1; Paratyphoid, 1; Miscellaneous, 1. Total, 339.

October, 1914:—Sputum, 48; Typhoid, 52; Diphtheria, 49; Urine, 97; Water, 48; Miscellaneous-Basterin Test, 5; Blood Sount, 1; Malaria, 7; Rabies, 2; Pasteur Treatment, 4; Milk, 1; Pus, 9; Stomach Content, I; Tissue, I; Miscellaneous, I. Total, 326.

November, 1914:-Sputum, 26; Typhoid, 28; Diphtheria, 26; Urine, 80; Water, 18; Miscellaneous-Blood Count, 2; Malaria, 2: Milk, 3: Pus, 9; Tissue, 2; Miscellaneous, 3. Total, 209.

December, 1914:—Sputum, 24; Typhoid, 35; Diphtheria, 34; Urine, 89; Water, 22; Miscellaneous-Blood Count, 2; Malaria, I; Rabies, I; Pasteur Treatment, 2; Human Milk, 1; Pus, 14; Tissue, 2. Total, 227.

INSTRUCTION FOR USE OF THE DELAWARE STATE BOARD OF HEALTH LABORATORY, NEWARK,

DELAWARE.

The Laboratory occupies five rooms on the third floor of the east wing of the main building of Delaware College. These have been provided and newly fitted up by the Trustees of the College. They include, (1) an office and library; (2) a room for microscopic and pathological work; (3) a general clinical and bacteriological Laboratory; (4) a food and water laboratory, and (5) a storage and washroom.

1. THE GENERAL FUNCTIONS OF THE LABORATORY.

The general functions of the Laboratory are clearly set forth in the act (Chapter 240, Laws of Delaware) creating it.

The title of this act reads: "An Act to Prevent the Spread of Disease and to Establish a Pathological. and Bacteriological Laboratory for such Purposes at Delaware College."

Section I reads: "that in addition to the duties and powers with which the Board of Health of the State of Delaware is now invested by the Constitution and Laws of this State, it shall further be, and hereby is authorized and empowered to establish and supervise a Pathological and Bacteriological Laboratory at Delaware College, and to supplement the equipment already there with any additional appliance necessary to make it perfectly safe and reliable for the thorough use of any or all of these means of protecting the citizens of the State against the spread of disease."

Again in Section 4, we read: "That all physicians, dentists, veterinary surgeons, or others practicing medicine or surgery or any branch thereof under the laws of this State shall be required to give prompt notice to the local State Board of Health of any and all cases of contagious or infectious disease that may come under their professional notice, and shall have free access to the work of the Laboratory for the determination of the diagnosis of any doubtful or suspicious case by forwarding, prepaid, a sufficient sample of urine, blood, sputum, or other specimen of such case, to the said Pathologist and Bacteriologist at Newark for examination, who shall examine the substances so sent, and report to the physician, dentist, or others, as aforesaid sending the same, the result of said examination without any delay and without further charge; the said physician, dentist or others aforesaid shall report the result immediately as herein above required."

It is clear from the title of the act, and from the words. quoted from Sections 1 and 4, that the primary function of the Laboratory is the invesigation of those diseases which are known as infectious or contagious, for the purpose, first, "Of protecting the citizens of the State against the spread of disease," as stated · in the last line of Section I; and second, "In order that all physicians, dentists, veterinary surgeons or others practicing medicine or surgery or any branch thereof may give prompt notice to the local or State Board of Health of any or all cases of contagious or infectious disease that may come under their professional

notice, and that to this end they shall have free access to the work of the Laboratory for the diagnosis of any doubtful or suspicious case" as provided for in Section 4.

The reasons for making use of the Laboratory that the provisions of the Law may be fulfilled are stated in the preamble which reads: "Whereas, by miscroscopic and biological investigation the presence of these diseases can be made manifest when symptomatology fails, thus enabling the Board of Health to make timely provisions against the spread of the disease and by so doing save the health and the lives of many citizens, and whereas these investigations can only be safely made in a Laboratory fully equipped, etc."—

There can be therefor no doubt as to the purpose of the Laboratory and that its examination and investigations are for the benefit of the public health and the prevention of the spread of infectious diseases.

The physicions have the free use of the Laboratory for the examination of specimens from infectious cases, but in return are required to give prompt notice to the local or State Board of Health of the findings of the Laboratory.

In this way the work of the Laboratory has a direct bearing on the work of every Health Board of the State.

Take an example: Dr. A. sends a swab from the throat of Mary B., of Dover. Dr. A. received a report by wire that the case is one of Diphtheria; he at once notifies the Local Board of Health of the facts. The home is immediately quarantined, and every precaution taken to prevent its further spread. The child convalesces in due time, and if the local Board of Health does its duty it will insist that the quarantine be maintained until bacteriological examination of the throat shows the absence of Diphtheria germs.

The same working of the law could be applied to all the other contagious diseases, and would show the relation of the Laboratory to the control of infection among the people of the State.

The Laboratory, however, is only an instrument; it has no power to initiate or to execute; these rest with the Boards of Health, and their action is largely dependent upon the efforts of

the physicians in using the Laboratory for the diagnosis of infectious diseases, and in their prompt notification to the local Boards.

The Laboratory, furthermore, is a convenient source of authority. A physician suspects, and is himself quite certain, that he has a case of Diphtheria, but he hesitates, especially if the case be a mild one, to give a diagnosis which will necessitate a burdensome quarantine. He, therefore, refers the case to the Laboratory, reports its finding as he is required to do by law, and thus relieves himself of personality in the matter.

The entire text of the law up to the 15th line of Section 4 has reference exclusively to the investigation of infectious diseases. It, however, empowers the State Board of Health to make such provisions as it sees fit for the examination of samples from cases which are not of an infectious nature.

Section 4 further reads "Provided, however, that nothing in this Act shall be so construed as to prevent the Board of Health of the State from making full provision for the free use of the Laboratory for the examination of any matter or substance so as to determine the diagnosis of disease neither contagious nor infectious, and neither local nor constitutional, and for the examination of water or food supply for any citizen of the State."

The lives of individuals, citizens of the State, are sometimes jeopardized for the want of certain laboratory investigations which would throw valuable light on the cases under treatment. In that event the laboratory would not refuse to render any assistance in examination which may lie beyond the ability of the physician to perform, due to lack of skill or facilities in chemical or microscopic research. But the examination should be so restricted that it shall be evident that the real purpose of sending such specimens is to obtain information regarding the condition of the patient beyond that which can be obtained by the physician himself, rather than to save himself the trouble of doing what he can.

All physicians, for instance, have been and are capable of making their own qualitative examinations of urine. Hence, at a meeting of the State Board of Health in December, 1901, it was decided to limit the urine work to the more important examinations such as could not easily be performed in the physician's

office by himself, with ordinary facilities; and the decision was embodied in the following resolution:

Resolved, That hereafter physicians be requested to make their own examinations for the ascertainment of the specific gravity, presence of albumen or sugar in urine or such other matters so easily ascertained by themselves.

The other lines of pathological work are outlined in the pages which follow, under separate heads.

WHO CAN USE THE LABORATORY.

The facilities of the Laboratory within the lines set forth in this Bulletin are open to all physicians, dentists and veterinary surgeons practicing within the limits of the State. The Laboratory shall not be used for private purposes not connected with the health of the citizens of the State, viz.-no examination for insurance purposes or for citizens of other States, except as may be necessary by reason of immediate contact of residence. The Laboratory is open to the use of local Boards of Health for sanitary examinations of any kind. Individuals not physicians, dentists or veterinary surgeons, desiring examinations made, must submit with the sample the recommendation of some one duly authorized to use the Laboratory, to the effect that such an examination would be advisable.

(Note: Specimens submitted for examination which are not prepared in accordance with the directions given in those instructions will not be examined by the Laboratory).

Specimens improperly sent are a menace to the health of all who are compelled to handle them either en route or in the Laboratory, and may cause the United States Government to deprive that person of mailing privileges. Therefore, specimens must be sent in laboratory containers.

When samples are forwarded by express the charges must be prepaid.

By a special order of the Post Office Department authorized mailing packages shall be treated as letter mail, hence the Labcratory authorities will endeavor to demand from the mail service the prompt delivery of all packages.

The report sent to the physician states when the specimen