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we have thought it well to insert cuts representing the various types and stages of the mild form of smallpox now prevailing. Frequently all of these types are found in the same house or locality. But for the expense these pictures might be multiplied indefinitely from photographs sent in by our officials from all sections of the State. Except Jn the aged and intemperate, little fatality occurs in the types of the disease here represented, and usually little pitting or other trace of the disease is left after a few weeks. Most of them would be confined to bed but a few days—the mildest not at all.
Our law plainly requires physicians and heads of families to report all cases of smahpox and other contagious diseases to their respective county and municipal boards of health within the first twenty-four hours, that they shall obey the rules and regulations of such boards relating thereto, proper penalties being provided for failure or refusal to comply with them. Under the recent decision of the Court of Appeals in the Covington case, such boards have full authority to remove any person affected with smallpox to a proper isolation hospital. Under the decision of the same court in the Henderson county case such boards are empowerd to provide hospitals, physicians, nurses, guards, and all necessary supplies in managing and stamping out the disease, and that the county must provide for all reasonable expense thus incurred. It is greatly to be desired in the interest of economy, as well as because it is a matter of common concern, that the health and fiscal authorities should work together hand-in-hand, but the former should be fully informed as to their rights in the matter, and, in the presence of a public danger, should not hesitate in exercising them.
When its true nature is recognized early, smallpox is the easiest of all contagious diseases to stamp out. When it spreads beyond the first case, or at most, beyond the first family, somebody has violated the law, and is seriously to be blamed. The case or cases should be immediately and rigidly isolated, in the county or municipal hospital if possible; every member of the household, and every other person who has been exposed to the disease, should be traced out, vaccinated in three places, and kept under observation for twenty-one days; and the house should be flagged or placarded until it has been thoroughly and systematically disinfected and officially released, from quarantine.
These measures appear simple enough on paper, but their effective enforcement among negroes and the class of whites who neglect vaccination, and consequently have a monopoly in smallpox, will fully test the tact, patience, and firmness of the most judicious health official. If these precautions could be rigidly enforced throughout Kentucky for six weeks we would have no smallpox. If successive generations were systematically vaccinated we would never have any more smallpox.
vaccinated those rendered immune by having had smallpox, less the deaths, leaves 1,335,039, or a little more than 62 per cent, of our total population unprotected by vaccination after nearly four years of smallpox about them. Of those vaccinated 340,000, or over 42 per cent, are residents of the cities and large towns, 175,000 of the city of Louisville.
The actual cash expenditure from the county and municipal treasuries on account of smallpox was $308,271. This is official and accurate. The reported loss from interference with business is $734,000. This is only an aggregate of estimates, many boards not reporting upon this point, and is given for what it is worth.
We are appalled at the indifference to vaccination found on nearly every hand. This applies equally to remote districts where the anti-vaccination craze was never heard of, and to the educated cranks upon whom facts and even demonstrations are lost. All of this epidemic, suffering and expense would have been prevented had all of our people been previously vaccinated. Under existing conditions other outbreaks, and even an epidemic, are probable at any time.
In this connection proper and full credit should be accorded to nearly every county and municipal board of health in the State for faithful, persistent and often unpaid labor in protecting their respective jurisdictions from this pestilence, frequently in the face of misrepresentation and abuse, sometimes reaching almost to personal violence. In most counties the health officer having actual personal charge of the cases has been reluctantly and stintingly paid, but his associates, who often shared the responsibility and danger, have usually served wholly without compensation. Credit is also due to the rank and file of the medical profession, especially all of the more intelligent classes of all schools for their efforts in support of the constituted authorities. Probably higher praise should be given to the fiscal authorities in many counties for their support of the health authorities