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from the lungs and expectorated by those who have consumption. This matter, when it is spit out by consumptives upon the ground, floors, walls, or other places, becomes dried and pulverized, and is carried about in the air as dust and breathed into the lungs of other persons, causing the disease in them. The material thus coming from the

lungs of consumptives contains large numbers of these germs. Often millions are coughed up by one person in one day.

In a majority of cases, pulmonary tuberculosis is not fatal.

It is not necessarily dangerous to live in the same house with one who has consumption, provided proper precautions are taken by the person who has the disease.

The following rules should be rigidly followed:

1. All material which is coughed up must be destroyed. It should never be spit out upon the ground, street, sidewalks, floor, wall, or stove, or any other place except in receptacles especially prepared for it.

2. If in the house or other place where it is possible to do so, a vessel or cup should be used for spitting into. This must contain a sufficient quantity of 5 per cent. carbolic acid solution (six teaspoonfuls carbolic acid to one pint of water) to partially fill the vessel. This must be emptied into a sewer or other safe place (preferably bury it), at least twice in twenty-four hours, and the vessel washed with boiling water.

3. When going about away from home the patient should be provided with pieces of cloth or paper napkins to spit into, and these must be destroyed by burning as soon as possible after being used, and the material should never be allowed to remain on them long enough to become dried. If handkerchiefs are used, they must be boiled thoroughly for one-half hour before washing, and must be kept in water or a disinfectant solution from the time they are used until they are washed. If handkerchiefs or cloths are used, it is best not to carry them loose in the pocket, but to keep them in waterproof bags (tobacco pouch).

4. The best plan for disposing of this material is for the consumptive to be provided with spit-boxes or flasks, which can be procured. These can be carried in the pocket and used and afterwards destroyed by burning or disinfected by boiling.

5. When coughing or sneezing the patient must always hold a cloth or handkerchief before the nose and mouth to prevent particles of material from being scattered about.

6. Patients confined to bed who are too weak to spit into a cup should use moist cloths, which must be immediately burned.

7. A consumptive must never swallow the material which is coughed up.

8. Great care must be taken to keep the hands, face and clothing from being soiled by the sputum, and if it should occur they must be immediately washed with soap and hot water.

9. Men who have consumption should wear no beards, or only closely-trimmed mustaches.

10. A consumptive should never sleep with another person, but always sleep alone. If possible, he should have a room alone.

11. The room where the patient stays and sleeps must have an abundance of fresh air. Windows should be left open day and night. it is best not to have a carpet in the room, and the floors should be wiped with a damp cloth and not swept.

12. The patient's bel-clothing and under-clothing and other clothing which is washed should be handled as little as possible, and should be kept in water when soiled until washed.

13. Rooms which have been occupied by consumptives should be cleaned, scrubbed and painted, or papered or whitewashed, before being occupied by any one else.

14. Consumptives should be warned against the use of any advertised medicine for consumption. They are all useless and mostly frauds. The use of drinks or medicines containing alcohol are useless and injurious.

15.

Every case of consumption should be under the constant attention and advice of a physician.

16. The only curative measures of any value are fresh air, sunshine, out-of-door life, and nourishing food.

WILL MASON, M. D., Health Officer.

Carlisle County Board of Health.

Bardwell, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago there have been six outbreaks of smallpox in this county, in all the four magisterial districts, with a total of 166 cases and no death.

The first case came from McCracken county and Tennessee, and many 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 county is about 10,000. At the time of our last report 5,500 had been vaccinated. Since that time it is estimated that 200 have procured vaccination, leaving 43 per cent. still unpro

tected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. Our method of managing the disease was isolation by family, quarantine and thorough disinfection after cases are free from infection.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been about $2,000. The estimated cost in loss of trade and interference with business has been large.

The chief difficulties in stamping out the disease have been mildness of disease, people feeling no dread of same, and aversion or prejudice against vaccination.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, ninety-seven cases and thirty-six deaths; typhoid fever, eighty cases and five deaths; diphtheria, eighty-nine cases and ten deaths; scarlet fever, 35 cases and no deaths; cholera infantum, sixty-four cases and nine deaths; dysentery, 228 cases and twenty-one deaths. The average cost to our people for managing and treating a case of any of these diseases, including medical attention, nursing, loss of time and incidental expenses, is estimated to be $25 to $50, making a total loss to the county for the two years from diseases which might be prevented of $23,720, as against $19,000 for State taxes. The county health officer is paid no salary, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection. with this report: Only about six of our physicians make the legal reports of births and deaths, and these records are of little value, and I was assisted in this report by responses to letters addressed to the physicians of our county.

Very respectfully,

WM. L. MOSLEY, M. D., Chairman.

Carroll County Board of Health.

To the State Board of Health:

Since our last published report two years ago there has been no outbreak of smallpox in this county.

We have an eruptive hospital, located two miles from Carrollton, with a capacity for fifteen patients.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption,

nineteen deaths; typhoid fever, one case and one death; cholera infantum, three cases and three deaths. The average cost to our people for managing and treating a case of any of these diseases, including medical attention, nursing, loss of time and incidental expenses, is estimated to be $25. The county health officer is paid a yearly salary of $250, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: No data by which we can approximate the number sick with above diseases. The majority of those dying with consumption were negroes.

Very respectfully,

W. P. WHEELER, M. D., Secretary.
Per F. H. Gaines, Chairman.

Carter County Board of Health.

Grayson, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago there have been two outbreaks of smallpox in this county, in the Willard, Olive Hill and Grayson and other precincts, with a total of 460 cases and seven deaths.

The first case came from Lexington, Ky., and 450 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. Of those exposed, four had been properly vaccinated and none contracted the disease. Of the ones exposed who had not been vaccinated, all took the disease and none died.

The population of this county is 22,000. At the time of our last report 20 per cent. had been vaccinated. Since that time it is estimated that 25 per cent. have procured vaccination, leaving 55 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. Our method of managing the disease was strict isolation, vaccination and quarantine; very little medicine, fumigation; 90 per cent. was mild discrete, the other severe concrete; four hemorrhagic, all died; three confluent, all dieu.

The chief difficulties in stamping out the disease have been people refusing to be vaccinated and inert vaccine.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption,

twenty-five cases and five deaths; typhoid fever, few cases. The average cost to our people for managing and treating smallpox, including medical attention, nursing, loss of time and incidental expenses, is estimated to be $1,800 for the whole costs, as against $16,000 for State taxes. The county health officer is paid a salary of $250, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: The seven deaths occurred at Willard, this county. The party first came from West Virginia. Four of these cases were hemorrhagic and three confluent. The doctor thought it fever, hence a good many exposures, and the points were no good and we had to do our work all over. In this way the disease got a start. We had no epidemic except smallpox.

Very respectfully,

J. W. STROTHER, M. D., Secretary.

Casey County Board of Health

Liberty, 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 county, with a total of ten cases and no death.

The first case came from Missouri, and fifty 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. Of those exposed, none had been properly vaccinated; of these, ten contracted the disease and none died.

The population of this county is 15,144. At the time of our last report few had been vaccinated. Since that time it is estimated that 300 have procured vaccination, leaving 95 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. Our method of managing the disease was isolating those who had been exposed, and vaccinating.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $50. The estimated cost in loss of trade and interference with business has been nothing.

The chief difficulties in stamping out the disease have been ignorant doctors, who claim the disease is elephant itch, and the refusal to be vaccinated resulting from this.

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