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and want to ask you to take the time to get them up. I am sending you two copies and want to ask you to fill out one of the blanks and return it to me within the xt two days. This is an immense undertaking, and can only be successful if the board can have the co-operation of all the doctors in Kentucky.

"Sincerely,

"J. N. McCORMACK, Secretary. “To the Health Officer of

County: "I have carefully gone over my books for the two years beginning August 31, 1903, and ending August 31, 1905, and have the honor of reporting as follows: “I have treated cases of consumption, of which

have died. "I have treated cases of typhoid fever, of which

have died. “I have treated cases of diphtheria, of which

have died. “I have treated cases of scarlet fever, of which

have died. “I have treated

cases of cholera infantum, of which have died. “I have treated cases of dysentery, of which

have died. “I estimate that there are

families in my practice, and that the above-named diseases have cost them, all told, $

The average case of typhoid fever in my practice costs the patient, including doctor, nurse, drugs, extra food and loss of time, $From the inspection of my books, I estimate that

per cent. of my patrons have paid me nothing for my services in the past two years. This information is given with the understanding that it is strictly confidential, and that this blank will be destroyed as soon as the figures are taken from it.

“(Name)

“(P. O. Address). The response to these circulars was prompt and the interest manifested by the profession in the statistics has been well-nigh universal. About one-third of the best physicians in the State have taken the time to go carefully over their books, and from their statements we are able to place before our people the following deductions, which, though not absolutely accurate, are so nearly so as to be of incalculable value as pointing toward the possibilities before public health work.

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We feel that we are not only not exaggerating, but in the light of recent scientific research

within the facts when we insist wherever a case of consumption, typhoid fever, diphtheria, cholera infantum, dysentery or scarlet fever occurs that somebody is at fault. These diseases are entirely preventable, and when Kentuckians realize what a burden they are, a long step will be already taken in Kentucky at least toward preventing them.

Taking, first, typhoid fever, one of the most easily prevented of these diseases, 1,132 of the 3,304 doctors in Kentucky have sent in the reports in this disease, and using these as a basis for our calculation, we are brought to the conclusion that within the past two years there have been 45,024 cases of typhoid fever in this State, with 3,366 deaths, or an annual sick rate of 22,512 from this disease alone, and an annual death rate of 1,683.

Considered purely as an economic problem, the feature of disease least thought of by most people, the importance of these figures can hardly be overestimated. Averaging the entirely too conservative estimates made by the doctors, including medicine, nursing, doctors' bills and loss of time at $94.18 as the entire cash expense of each case, the total cost of cases in the State reach the enormous sum of $4,240,340.32. Further, it is universally conceded that no State has a more valuable asset than that represented in its vigorous population. As this disease is practically confined to persons in the prime of life, who can contribute most to the public wealth and prosperity, those who die of it constitute a direct, tangible and irreparable loss to the Commonwealth. Adam Smith and other political economists place a commercial value of $1,000 on each healthy immigrant who arrives upon our shores to make this country his home. Placing this value upon each of the much higher class victims of typhoid fever in Kentucky, gives us a calculable and definite loss of $3,366,000. Adding this to the cost of caring for those sick of it, as above figured, we have a loss within the period named of $7,606,340.32. This is a germ disease which does not spread except where the seed are sown. The condition and laws under which these and other germs multiply and are scattered have been so carefully studied that they well known to the scientific world as the methods of distributing the seeds of wheat, corn or weeds are to farmers, and the disease is as

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impossible without the germs as a crop would be without the seed. It is not a pleasant thought, but it is an eminently practical one and one that our people should know and must face that the only way in which any person can get typhoid fever into his or her system is to get some of the bowel discharge or some of the urine from another person sick with typhoid fever in their mouth and thence into the digestive system. How this may be done and how the disease may be prevented is shown later under the head of the "Prevention of Typhoid Fever.”

Possibly of even greater interest, because of the enormously greater number of deaths, is consumption, the "great white plague.” Our reports show that within the past two years there have been 23,958 cases of consumption under treatment by the doctors of Kentucky and that 12,876 deaths have occurred from this dread disease, the death rate being 53 per cent. Of more serious import is it that the 47 per cent. surviving will furnish the death lists for the next biennial report, unless the present propaganda on the subject shall produce some results.

Next in its death-dealing importance is cholera infantum, which has caused 32,634 cases of illness and 3,870 deaths among our children in the past two years, a mortality rate of 12 per cent. In the same period there have been 10,362 cases of diphtheria and 2,136 deaths. These figures indicate that the physicians are not using antitoxin early enough, or in large enough doses. In the present state of our knowl. edge it is almost criminal for a case of diphtheria to go for more than twenty-four hours after a doctor is called before at least 3,000 units of a standard antitoxin, such as Alexander's or Mulford's, has been used. The various health boards should arrange with their respective fiscal authorities that the health officer may purchase and administer antitoxin to paupers at public expense.

In the same period there were 44,766 cases of dysentery and 1,866 deaths, a mortality of only 12 of 1 per cent.

Scarlet fever caused 2,721 cases of illness and its prevailing mild type is shown by the small number of deaths—119, a death rate of 4 per cent.

In all, from these six forms of preventable disease, there were 173,070 cases of ness and a grand total of 24,828 deaths. figures would indicate that there are now 2,711,450 persons in Kentucky it seems that from these figures that one person in each fifteen

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of our population has passed through one of these forms of severe illness within the past two years, and that one in each 109 of the people of Kentucky has been needlessly sacrificed to these preventable diseases that are even now claiming their victims by the hundreds and barely a voice lifted to save them.

Our figures would indicate that $5,802,139.56 has been expended in Kentucky in cash in the past two years for the medicinal care, nurs. ing and drugs for persons sick with these diseases, and that 24,828 of our citizens have died with them. Again, placing the conservative valuation of $1,000 upon each one of our people who have been thus needlessly taken from us we find that these preventable diseases in Kentucky in the past two years have cost the enormous total of $30,630,139.56. This means that five times as much money is wasted in this State each year as it costs to run the State government, or expressing it another way, that each and every man, woman and child in this State contributes over $5.60 per year toward the needless drain on our best resources, to say nothing of the sorrow and suffering and death caused thereby.

With the view of preventing or restricting the spread of these diseases, the following series of circulars have been carefully prepared for gratuitous distribution. They have been revised from time to time in order that they might voice the latest authentic information, as scientific knowledge has advanced. An attempt has been made to couch all of them in plain terms, adapted to popular use. Copies of these circulars are distributed in every available way as occasion requires. Upon notice, officially or through the newspapers, that any of these diseases exist in a locality, the circulars are sent to the physicians, the postmaster, and to the families, if the names are given. Copies are also sent to the county newspapers with a request for their publication with such editorial comment as may seem pertinent, and this board can not express enough gratitude to the public-spirited editors of our county papers for their prompt and effective circulation of these health matters when occasion arises in their respective localities:

"PREVENTION OF TYPHOID FEVER. “Circular Issued by the State Board of Health of Kentucky. "To the Health Officials, Physicians and People of Kentucky:

“This board again feels it to be a duty to call the earnest attention of our health authorities and people to the increasing prevalence and mortality from typhoid fever and to the consequent growing importance of the constant use of the methods endorsed and confirmed by scientific research and observation for the prevention of the disease.

[graphic]

M.

Typhoid Fever Germs in the walls of the bowel,

magnified from Sternberg's Bacteriology. Twenty-two thousand one hundred and twelve cases of this disease and 1,633 deaths were reported in Kentucky last year, chiefly confined to people in the prime of life and usefulness. The cost of caring for those sick of it, to say nothing of the sorrow, suffering and loss of life, for the year, is reported as being $2,120,170.16.

"Typhoid fever is probably the most preventable of all diseases, not even excepting smallpox. It is now definitely known that, like cholera and dysentery, the germs of the disease are contained only in the discharges from the bowels and kidneys of those sick of it, and that it is necessary for a person to swallow some of such discharges, or things polluted by them, in some way, in order to contract the disease. It is not a very nice thing to say or think, but the only way that you, reader, can contract typhoid fever is by getting some of the bowel discharge or the urine of a person sick with typhoid fever in your mouth.

“They usually gain entrance to the system through infected water from wells or streams draining inhabited areas, and polluted by infected fecal matter, or such matter may be carried by flies and deposited on the food, utensils and hands in unscreened kitchens and dining rooms. The germs may also be carried on the hands of care.

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