TRACHOMA PROCLAMATION. Whereas, Trachoma, a highly contagious and infectious chronic eye disease, long a pestilence in the older countries, and usually spread by means of wash-basins, towels, pencils and other things used in common by children and families, and which, without prompt recognition and persistent treatment, results in serious and permanent impairment of vision or blindness in a large majority of cases, is officially reported by experts of the U. S. Public Health Service as widespread in the counties of Breathitt, Clay, Jackson, Lee, Leslie, Owsley, Perry and adjacent sections, with many cases in Jefferson and Clark Counties, and more or less spread into almost every other county in Kentucky, presenting to officials and people problems, both health, economic and humanitarian, demanding prompt and concerted action, especially by school authorities and others having the care of children, with whom the ravages of the disease seem most disastrous: Now, therefore, be it known, that the State Board of Health of Kentucky, in the exercise of authority vested in it by law, hereby forbids any person afflicted, or suspected to be afflicted, with trachoma, commonly known as "red sore eyes," to attend any school, public or private, in this Commonwealth, as teacher or pupil, and requests and instructs all physicians, teachers, school trustees, county and city boards of health and other officials and good citizens to assist and cooperate in preventing the further spread of this disease, otherwise likely to entail misery to individuals and a burden upon taxpayers almost beyond calculation, in the light of experience with it in other and older countries. It further instructs county and city boards of health, in co-operation with their respective city councils and fiscal courts, to inaugurate and execute and to require the heads of families and other persons to execute such sanitary regulations as such board may consider expedient to prevent the spread of trachoma, which is hereby declared to be an epidemic and communicable disease, and to this end they are requested to bring all persons infected with trachoma under prompt and proper treatment during premonitory or other stages of the disease. By order of the Board, at Bowling Green, this September 1, 1914. JOHN G. SOUTH, President. A. T. McCORMACK, Secretary. Bulletin of the State Board of Health of Kentucky THE TRACHOMA PROBLEM. One of the most serious economic questions that has ever been presented to the people of Kentucky will be made perfectly clear by the careful reading of every page of this Bulletin, with thoughtful inspection of the photographs. Practically all the figures are taken from actual investigation in Kentucky. All of the photographs were made in Kentucky. problem a more Trachoma. presents largely economic than any other in the whole field of preventive medicine. No one dies with this disease. Half of those who have it are eventually made blind. The economic usefulness of every single patient is greatly decreased. It would be conserva tive to say that the average earning capacity of persons having trachoma is less than one-fourth of the average earning capacity of well individuals. It is slowly but surely contagious, and spreads through families, schools, institutions, or communities when an initial case is introduced into either. Credit for bringing the attention of the State to the widespread prevalence in many sections is due to Dr. J. A. Stucky, of Lexington, and Miss Linda Neville, who has been for many years the representative of the State Federation of Woman's Clubs for the Conservation of Vision. Miss Neville's painstaking and wholly altruistic devotion to this work entitles her to the gratitude of every well-wisher of Kentucky. At the request of this Board, the Surgeon General of the United States Public Health Service detailed Surgeon John McMullen to make a survey as to the existence of trachoma in eastern Kentucky, in 1912. The details of Dr. McMullen's work have been heretofore presented, but in this Bulletin we take occasion to present a report from Dr. McMullen which will be read with interest by everyone. This Board feels that it should express for the people of the State the gratitude we feel to the United States Public Health Service for having placed Dr. McMullen in charge of the establishment of the trachoma hospitals in eastern Kentucky, and for his actual practical demonstrations that existing cases of trachoma can be cured and the spread of the disease prevented. Dr. McMullen has devoted. his whole energy to this work in such a way that he is now recognized as one of the leading authorities in the world on the subject of trachoma, and we believe that it is probable that no other man could have accomplished the remarkable results which he has. It is with pardonable pride that we record the fact that following the discovery of trachoma in the schools of Louisville and Jefferson county active steps were taken by the health authorities to eradicate the disease, with the results shown in the accompanying reports. In conclusion the Board desires to express its cordial appreciation of the successful efforts of United States Senator James and Congressmen Sherley and Cantrill in securing the Federal appropriation necessary for the work which has been done by the United States Public Health Service in Kentucky, and to all the authors of papers in this issue of the Bulletin. Copies of this Bulletin and of others on the prevention of disease can be obtained free by dropping a post card to the State Board of Health at Bowling Green. A. T. McCORMACK, Secretary. PREVENTION AND ERADICATION OF By JOHN MCMULLEN, M. D., Surgeon U. S. Public Health Service. Prior to the year 1912 there was but little known as to the amount of trachoma and its location in the United States, and we had been rather content to consider it an exotic disease. During the year 1912 the Congress passed a bill appropriating money to enable the Public Health Service to make examination as to the prevalence of trachoma and other communicable diseases in the United States. In May, 1912, an exten varying amounts. The heaviest infection, however, appeared to be in the neighborhood of the junction of Kentucky, Tennessee and the Virginias. The original survey of the eastern part of the State of Kentucky, which was made by the writer at the request of and with the hearty co-operation of the State Board of Health, in the summer of 1912, covered seven counties, in which 4,000 people were examined and 500 cases of trachoma found. A detailed survey has since been made in 16 other counties, a total of 23, several sections of each county being visited for the purpose of locating the most heavily in Both eyelids everted and the white spots indicate the location of the trachoma granules. sive survey was made in the State of Min- fected portions. While the disease has been found widely scattered, it is not evenly distributed, but exists in nests, so to speak, and some sections are comparatively free from it. A total of 18,016 persons were examined, and 1,280, or practically 7 per cent., were found to be suffering with trachoma. Of this number 16,696 were school children, and 1,324 were persons examined outside of the schools. The type of the disease found is severe and its mutilating effects are often seen. In order to fully appreciate the suffering among the victims of this disease one would have to actually see these |