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REPORT OF PROCEEDINGS OF THE

STATE BOARD OF HEALTH.

REGULAR ANNUAL MEETING, OCTOBER 20, 1898.

At 3 p. m., Thursday, October 20, 1898, the Board met in regular annual session at the Galt House, Louisville. Present: Drs. Bailey, Samuel, J. H. Letcher, appointed to succeed Dr. Kinnaird, resigned, and Dr. McCormack. Absent: Dr. J. M. Mathews, recently appointed to succeed himself, and Dr. Geo. T. Fuller, appointed to succeed Dr. McReynolds whose term had expired. Dr. Bailey was elected president pro tempore, and presided.

The secretary read his annual report, including the annual financial statement, which was referred to an auditing committee composed of Drs. Samuel and Letcher, who, after an examination and comparison of same with the books and vouchers, reported that they were correct. The report is as follows:

REPORT OF THE SECRETARY.

The past year has been the most active and anxious one in the history of the Board. With yellow fever prevailing in the South during the past and present seasons in several sections which are a few hours from us by direct lines of travel, and with thousands of refugees flocking through and into our state, the danger of infection could not be overlooked. In addition we have had almost constantly on hand serious epidemics of small-fox in widely separated districts.

The danger from yellow fever was minimized this year by the late season at which it appeared, and by the fact that until recently it was confined to small towns and villages which were at once cordoned with local non-intercourse quarantines, which prevented train's from making infected points. Land quarantines are necessarily defective, but, as rigidly conducted by the panic-stricken communities of the South, they at least strain and keep back the greater and grosser opportunities for conveying infection.

An inspection service was maintained on all through lines of travel last year. This was so conducted as to offer the least interference with travel and commerce consistent with the proper protection of the public health. One of the railroad lines made continuous attempts to obstruct and evade our regulations, greatly increasing the labors and responsibilities of our officials, and, by the increased vigilance, caused the complaint to be made that the Board was discriminating against this particular road. In gratifying contrast with this, the other transportation lines gave us their cordial and prompt co-operation and instructed their employes to furnish every possible assistance to our inspectors.

For reasons previously stated, an inspection service was not put in operation this year, although constant watchfulness was maintained and things so organized that it could be put on at a day's notice. This will result in a saving of two or three thousand dollars to the state if frost comes before the disease gains a foothold, as is confidently expected. It is possible that cases will occur in some of the refugees who reach us with the disease still in their system, but it is not believed that it could spread here this late in the season. A report of the operations and expense of this service last year has already been submitted to the General Assembly, as required by law, and a copy thereof is now presented to you.

Small-pox was brought to Alabama from Central America in the early part of 1897. This disease had had no wide prevalence in the South for many years, and, in consequence, a large part of the population, and practically all the younger negroes, was un vaccinated. The disease spread rapidly to the mining regions of Alabama and Tennessee and reached Middlesboro and Jellico, in our state, in December, 1897. The County Board of Health attempted to restrict the disease at Middlesboro, but the parsimony and incapacity of the city and county officials made it impossible to prosecute this work at the opportune time, and the foundation of an epidemic was soon laid.

This Board was not notified of the condition of affairs until February 15th, 1898. This delay was mainly due to the mild character of the disease, and to the fact that it was confined to negroes during all the early part of the epidemic. I made several visits to the infected town, once accompanied by your President, and at the outset put four of our sanitary inspectors at work. Within three weeks over nineteen hundred people were vaccinated, and the disease was practically under control. At first the city authorities were disposed to render us assistance, but, receiving no aid or encouragement from the county court, which under our law is made responsible for the expense incurred in this work, soon refused any support, or even to feed those sick with the disease. Under legal advice, warrants were issued by the County Board of Health in payment for food and other necessary supplies for the sick and needy, but with the prospect of serious litigation to enforce their collection, the whole work was made both difficult and unpleasant.

In order to avoid all possibility of cost the local authorities finally induced the U. S. Marine Hospital Service to inject itself into the controversy. Our inspectors were at once withdrawn, whereupon it was found that this national service had no authority to enter upon or act within our jurisdiction except under the regulations and sanction of this Board. In the confusion resulting, a week of valuable time was lost, and much of the work required to be done over again. The epidemic was finally stamped out by the joint action of our own and the national authorities, after an actual outlay of thousands of dollars, and a loss of tens of thousands in the derangement of business and trade, all of which could and should have been saved had the first cases been properly isolated and cared for.

The experience at Jellico was in gratifying contrast to this. The disease had gained a strong foothold there when our inspectors got upon the ground, but the town and county authorities at once went to work in perfect harmony to isolate the sick and vaccinate the entire community, and the outbreak was brought under control at a very small cost. The good result here was largely due to the activity of Drs. Moss and Finley, of the County Board, and the mayor and county judge.

During this time a negro contracted small-pox at Knoxville and came to Richmond before he came down with the disease. As a rule sick negroes do not come under the care of the most competent physicians, and this case proved no exception to the rule. The diagnosis of "Elephant Itch” was made, and many curious, unbleached American citizens called in to swap opinions in regard to this new cutaneous decoration. Several other cases occurred, and very many more were exposed to the contagion, before the matter was brought to the attention of the authorities. County Judge Sullivan and Mayor Smith at once placed ample funds at the disposal of the local Boards of Health, employed one of our experienced inspectors to superintend the general work of stamping out the disease, erected sick and detention hospitals supplied with competent physicians and guards, with the result that the epidemic was eradicated almost without disturbance to business interests within a few weeks. The prompt and intelligent co-operation met on every hand here and at Jellico was indeed pleasant after the experience at Middlesboro.

In the early part of July small-pox was reported from Laurel and Clay counties. Upon the arrival of our inspector it was found that a strolling, half-witted woman from Jackson county, broken out with small-pox, had traveled the highways from near London to Manchester and back, resting at a number of houses on the way because she was ill, and exposing a large number of people to the contagion. Nearly sixty cases contracted the disease in the two counties. In both of these counties the action of the authorities was prompt and effective. Houses were hastily procured and fitted up, physicians and guards placed in charge, and the disease eradicated by the usual methods, with the smallest possible friction and disturbance of business and travel.

Our inspector followed the track of the disease back into Jackson county and found an alarming state of affairs existing there. This is one of the large and remote mountain counties, and small-pox had prevailed there for two or three months. Probably not more than one per cent of the population had been vaccinated, and no effort whatever had been made to prevent its spread, our inspector estimating that there were nearly a hundred cases in the county, including those already recovered. As the mortality had been very slight it had excited no public interest, persons convalescing and with abundant scabs on their persons going about pursuing their ordinary avocations. That there had not been a far greater spread of the contagion could only be accounted for by the sparseness and limited mixing of the population.

After a week's delay our inspector secured a meeting of the fiscal court, and, supported by Senator Clark and other leading citizens, made an earnest appeal for funds and assistance for stamping out the epidemic. A day was consumed by the court in considering the matter, when, by a unanimous vote, it refused to take any action. The county was at once placed in rigid quarantine, guards being placed on every road leading into it, stopping all travel and mail at the county line. I made a personal inspection of the entire district, visiting and conferring with the health and county officials in every adjoining county, in order that the quarantine might be made so effective as to confine the epidemic to the one county where the people did not object to it.

Within three weeks the court reconsidered its action, made appropriations for hospitals and guards, employed a physician suggested by this Board to take charge of this work, and soon had the outbreak under control. When fully assured of this the quarantine was promptly raised.

These repeated epidemics have made such a heavy drain upon our small annual appropriation that the Board is now almost without funds. Almost every General Assembly which has met since the Board was created has increased its duties and expenses, but no suggestion has yet been made by that body to increase our appropriation, which is the smallest in the United States. The limit along this line has been reached, and our future usefulness must be greatly curtailed unless supplied with funds with which to operate. We are now forced to decline many requests for assistance on this account, and are constantly subjected to adverse criticism in consequence.

Repeated outbreaks of diphtheria, scarlet fever and typhoid fever have been reported from nearly every section of the state, these domestic plagues never being entirely absent from our borders. Appropriate preventive circulars are at once sent to the local newspapers, as well as for free distribution in the community, and health officials, physicians and families are urged and instructed to take steps to stamp out the prevailing diseases. We consider this work of the greatest importance, as any one of these diseases causes more deaths in Kentucky every year than yellow fever, cholera and small-pox have caused in all the history of the state.

Texas fever in cattle and glanders in horses have appeared in a number of counties, and anthrax has recently prevailed to a considerable extent in a portion of Jefferson county. The state veterinarian is to be commended for his vigilance in looking after these interests under more than ordinary difficulties. He will present a report of this work during the meeting.

The routine work of the Board increases in amount and importance from year to year, and it is only a question of time when it will be necessary for your executive officer to devote his entire time to the duties of his office.

I herewith submit my financial statement for the past fiscal year, with a voucher for each item of expense.

FINANCIAL STATEMENT FROM APRIL 1, 1897, TO APRIL 1, 1898.

Debtor.
To balance on hand April 1, 1897..........

pril I, 1897.....................$2632 22 To annual appropriation....

................... 2500 00

Total ........

.$5132 22 Creditor. By payments as per itemized statement .........

em ..............$3544 20 By balance on hand April 1, 1898......

· 1588 02 Total

$5132 22

Itemized Statement.
Salary of the Secretary ......

. $1200 00
Printing . ........................................

739 00 Traveling expenses of members....

rs.....................

534 55 State Bacteriologist and Sanitary Inspectors..

435 35 Attorneys' fees and costs ...

193 30 Postage and telegrams ...........

166 91 Salary of typewriter........

150 00 Official supplies and furniture..........

.....

124 84

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Total . .

.......... $3544 20

The papers of Dr. Adaline Bell, a graduate of the American School of Osteopathy, who was examined July 5th and 6th, last, were carefully gone over by the full Board. It was found that this applicant had made a grade of 41 in anatomy, 50 in physiology, and 25 in pathology, the only branches in which she was required to be examined, 70 in each branch being the minimum grade required to pass. Upon motion a certificate was refused by a unanimous vote.

The papers of Dr. Thos. Hunt, of Allen county, were also examined, and as he had failed to show competency in any branch, a certificate was refused him.

After transacting some routine work with the epidemic of small-pox and the threatened epidemic of yellow fever, the Board adjourned to meet at 8 p. m.

The Board met pursuant to adjournment at 8 p. m. with President Mathews in the chair and all the other members attending the afternoon meeting in attendance. In response to notice 'had, Dr. G. N. Murphey, of Bowling Green, was present with his attorney, Mr. Zach Phelps, to answer charges previously preferred against him at the request of the Board of Regents of the Kentucky School of Medicine. After the reading of the minutes of the previous meeting relating to the matter, and the charges, Mr. Phelps asked for more specific charges and, after consultation, the Board decided that it considered the charges as preferred in the language of the statutes to fully meet the requirements of the law, but in order to

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