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of $18,600, as against $42,500 paid for county, and $47,500 for State taxes each year. The county health officer is paid no salary, and all of the other members serve gratuitously.

Very respectfully,

W. C. McCAULEY, M. D., Secretary.

Ashland City Board of Health.

Ashland, Ky., August 31, 1905. To the State Board of Health:

Since our last published report two years ago there has been one outbreak of smallpox in this city, with a total of thirty-five cases and four deaths.

The first case came from Ceredo, W. Va.

The population of this city is 8,000. At the time of our last report 80 per cent. had been vaccinated. Since that time it is estimated that 15 per cent. have procured vaccination, leaving 5 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have an eruptive hospital, located one and one-half miles from Ashland, with a capacity for forty patients.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Diphtheria, iwo cases and no deaths; scarlet fever, fifteen cases and two deaths.

This city has never enforced the ordinance requiring physicians to report to health officer contagious and preventable diseases, consequently there has not been kept a systematic register. Steps are now being taken to enact and enforce an ordinance requiring physicians to report promptly all cases of contagious disease.

Very respectfully,

THOS. R. YOUNG, City Health Officer.

Ashland, Ky., August 22, 1905. J. N. McCormack, M. D.

Dear Sir: Please find herewith biennial report. I regret that the report is unavoidably imperfect. It has been impossible to procure data necessary to make even an approximate estimate of the definite cost of managing smallpox, much less of estimating the constructive cost in loss of trade, interference with business, etc. Our city has a good eruptive hospital, and as cases are promptly removed there, we suffered very little from disturbance of business relations, and also from our being well prepared there was no necessity of troublesome quarantines. I regret also that I am not able to return a definite report as to the number of cases and deaths from general contagions and preventable diseases, as explained in this report. Hope to be better prepared in future to supply such report. Can you send mo an old-time pamphiet copy of rules and regulations of health board? Would like to have also new literature (if there is any) on yellow fever. I am, sir,

Yours respectfully,

THOS. R. YOUNG, Health Officer.

Lexington City Board of Health.

Lexington, Ky., August 31, 1905. To the State Board of Health:

Since our last published report two years ago there have been four outbreaks of smallpox in this city, with a total of seven cases and no deaths.

The first case came from Madison county, and five persons had been exposed to the disease before its character was recognized and reported so that we could take steps to bring it under control.

The population of this city is 35,000. Since our last report it is estimated that 15,000 have procured vaccination, leaving a small per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have an eruptive hospital, located two miles from the city, with a capacity for forty patients. Our method of managing the disease was complete isolation, thorough fumigation with formaldehyde, good nursing and in fact everything that should and could be done to stamp it cut.

The city health officer is paid a yearly salary of $900, and all of the other members serve gratuitously.

Very respectfully,
A, R. SIMMONS, M. D., City Health Officer.

Louisville City Board of Health.

Louisville, Ky., August 31, 1905. To the State Board of Health:

Since our last published report two years ago there has been no special outbreak of smallpox in this city. We had a total of 224 cases and eighteen deaths.

The population of this city is 238,000. At the time of our last report 175,000 had been vaccinated. Since that time it is estimated that 13,000 have procured vaccination, leaving 21 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have one eruptive hospital, located five miles from Louisville. Our method of managing the disease was, all cases being immediately isolated by being sent to eruptive hospital, infected material destroyed by cremation, and houses fumigated with formaldehyde gas, and general vaccination and re-vaccination.

The chief difficulty in stamping out the disease has been the mild

ness of the disease, thus allowing those afflicted to go about their business with an unrecognized infection.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 210* cases reported and 1,103 deaths; typhoid fever, 281* cases reported and 225 deaths; diphtheria, 771 cases and seventy-two deaths; scarlet fever, 443 cases and nineteen deaths; cholera infantum, seventy-three deaths; dysentery, sixty-five deaths. The city health officer is paid an annual salary of $2,000, and all of the other members serve gratuitously.

*We evidently do not get anything like a reliable report of cases of tuberculosis and typhoid fever. Cases of cholera infantum and dysentery are not reported to this office.

Very respectfully,
M. K. ALLEN, M. D., City Health Officer.

By E. C. Laverty, Secretary.

Louisville, Ky., August 31, 1905. To the State Board of Health.

Gentlemen: I herewith hand you a detailed statement of the cases and deaths as occurring from certain contagious and infectious diseases during each of the fiscal years ending August 31, 1904, and August 31, 1905.

You will observe that the statement is not only given by months, but also the cases and deaths as occurring in sanitary districts. The city of Louisville has been divided by me into sanitary districts for the purpose of keeping well in hand conditions of a sanitary nature. This system has been accepted by the Census Department of the United States Government, and is used by them in compiling statistics from this city.

I believe I get a full report of all cases of scarlet fever, diphtheria and smallpox. In all cases of scarlet fever and diphtheria the houses where the cases are located are placarded, and the placard remains until ordered removed by the attending physician when the regula. tions of the health department are fully complied with. All cases of smallpox immediately after diagnosis are removed to the eruptive hospital, the house fumigated with formaldehyde, and the remaining members of the household protected by vaccination.

I am convinced that this department is not getting a full report of all cases as occurring from typhoid fever and tuberculosis, the latter being especially hard to obtain, because the tuberculous patient fre. quently is in the hands of a number of physicians during the run of the disease, and the doctor when consulted takes it for granted that the case has already been reported.

Number of cases of Scarlet Fever reported each month in sanitary

districts, for fiscal year ending August 31, 1904.

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Number of deaths from Scarlet Fever reported from each sanitary

district, for fiscal year ending August 31, 1904.

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