CONTENTS. I. Members and Officers of the Board. II. General Report of Secretary-Typhoid Fever, Con- sumption, Diphtheria and Scarlet Fever. III. Reports from County Boards of Health. V. An Appeal for Salaries for County Health Officers. VI. Health Laws, Rules and Court Decisions. VII. Medical Law and Court Decisions. VIII. State Medical Directory, by Counties. GENERAL REPORT. This volume will be found to contain a brief outline of the public health work done in the State from April 1, 1901, to April 1, 1903; reports from health officers of counties and municipalities; the health laws, and certain court decisions construing and defining them; and the rules and regulations, prepared under authority of law for the guidance of health officials and others. On account of the almost constant epidemic prevalence of smallpox the time and attention of the health authorities have been taken up with a nearly continuous warfare against this disease, but the report also seeks to furnish at least some trustworthy information, which may be suggestive and helpful in the prevention and restriction of other communicable diseases, and especially of the dangerous domestic pestilences which are always present in Kentucky. Named in the order of their importance, as indicated by available sick and death rates, as well as by the consensus of medical opinion, these diseases are consumption, typhoid fever, diphtheria and scarlet fever. Any one of the diseases named causes more deaths in Ken tucky every year than smallpox, yellow fever and cholera combined have done in all the history of the State. Taking typhoid fever, one of the most easily prevented of these diseases, with several counties making no report for lack of data, it is found that we had a total of 13,305 cases with 1,579 deaths. Considered purely as economic problem, the feature of it least thought of by most people, probably, the importance of these figures can scarcely be overestimated. At the conservative estimates made by the various boards, some of them entirely too low, the cost of caring for those sick of typhoid fever, to say nothing of the loss of time, reached the enormous sum of $963,750. Then it is universally conceded that no State has any more valuable asset than that represented in its vigorous population. As this disease is prac tically 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. 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 mach higher class victims of typhoid fever in Kentucky, gives us a calculable and definite loss of $1,579,000. Adding this to the cost of caring for those sick of it, as above figured, we have a loss within the period named of $2,542,750. 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 are now as 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 impossible without the germs as a crop would be without the seed. Consumption is another communicable disease, with a still greater fatality, as to which essentially the same facts obtain. It causes one out of each seven deaths which occur in Kentucky every year. Diphtheria and scarlet fever are diseases of childhood largely, but are widely prevalent and cause a heavy and entirely preventable mortality every year. 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 re quires. 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. In this way this information has been repeatedly laid before nearly every family in the State which reads the newspapers. 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. Typhoid Fever Germs in the walls of the bowel, 13,305 cases of this disease and 1,579 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, fering and loss of life, for the year, is reported as being $963,750. suf 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. 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 careless attendants, or on soiled clothing, or indirectly, by using milk or other articles of uncooked food or drink from cans and vessels washed in infected water. Ice from infected water is also dangerous, as it has been proven that freezing does not kill the germs. A large volume of water may be infected from one case, and, if already polluted with organic matter, become a ready culture fluid for the multiplication of the germs. In the now noted epidemic at Plymouth, Pennsylvania, involving the sickness of 1,104 persons, and the death of 114, the outbreak was traced to the use of water from a stream infected by the discharges from one imported case. The recent disastrous epidemic at Ithaca, New York, causing many deaths, and requiring the suspension of Cornell University, was traced to the use of a public water supply similarly infected. On the other hand, in the distressing and fatal epidemic which clung to our military camps at Chickamauga, Camp Mead, Montauk Point, and other places, during the Spanish-American war, flies were found to be the principal carriers of the disease by the United States Commission appointed to investigate the origin of the outbreaks. By the use of white powder sprinkled over the discharges in the latrines, thousands of these pests were tracked direct from these and found covering the food, hands and utensils in the kitchens and mess rooms of the common soldiers. Cultures taken from the feet, legs, bills and intestines of these flies showed the germs of typhoid fever in countless numbers. The kitchens and mess rooms of the officers were screened, and they almost uniformly escaped the disease. Other facts no less convincing as to both water and flies being carriers of this disease might be multiplied indefinitely, if space permitted. In a smaller way, they must be common in the experience of most physicians in active practice. Based upon the teachings of the foregoing facts, the following rules have been prepared with care for the guidance of all persons interested in their own and the public health: 1. When it is known or suspected that a person has typhoid fever, |