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This volume will be found to contain a brief outline of the public health work done in the State from April 1, 1903, to October 1, 1905; 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 still almost constant epidemic prevalence of smallpox in many counties, the time and attention of the health authorities have been taken up with nearly continuous warfare against this disease, but the report also seeks to furnish at least more trustworthy information than has heretofore been possible, which may be suggestive and helpful in the prevention and restriction of other preventable and 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, cholera infantum, typhoid fever, diphtheria, dysentery, and scarlet fever.
Feeling confident from the imperfect vital statistics heretofore collected, that any one of these diseases causes more deaths in Kentucky every year than smallpox, yellow fever and cholera have done in all the history of the State, the following letter and circular was sent to every doctor in the State, either directly in the larger counties, or through the health officers in the smaller ones:
“Dear Doctor:-We are very anxious to get up a fairly accurate report as to the morbidity and expense of preventable diseases in this State in the past two years. To get this we must have your hearty co-operation. We are convinced that with these figures we can do much to help the profession of the State.
"I am sending you a blank that I want to get filled out as accurately as possible. I am going to take the time to tabulate these reports,
and want to ask you to take the time to get them up. I am sending you two copies and want to ask you to fill out one of the blanks and return it to me within the next two days. This is an immense undertaking, and can only be successful if the board can have the co-operation of all the doctors in Kentucky.
“J. N. McCORMACK, Secretary. “To the Health Officer of —
County: "I have carefully gone over my books for the two years beginning August 31, 1903, and ending August 31, 1905, and have the honor of reporting as follows:
"I have treated --- cases of consumption, of which -- have died.
"I have treated — cases of typhoid fever, of which have: died. “I have treated
cases of diphtheria, of which - have died.
"I have treated - cases of scarlet fever, of which have died.
"I have treated --- cases of cholera infantum, of which have died.
“I have treated -- cases of dysentery, of which - have died.
"I estimate that there are — families in my practice, and that the above-named diseases have cost them, all told, $
- The average case of typhoid fever in my practice costs the patient, including doctor, nurse, drugs, extra food and loss of time, $From the inspection of my books, I estimate that per cent. of my patrons have paid me nothing for my services in the past two years. This information is given with the understanding that it is strictly confidential, and that this blank will be destroyed as soon as the figures are taken from it.
"(P. O. Address)The response to these circulars was prompt and the interest manifested by the profession in the statistics has been well-nigh universal, About one-third of the best physicians in the State have taken the time to go carefully over their books, and from their statements we are able to place before our people the following deductions, which, though not absolutely accurate, are so nearly so as to be of incalculable value as pointing toward the possibilities before public health work. We feel that we are not only not exaggerating, but in the light of re- . cent scientific research are within the facts when we insist wherever a case of consumption, typhoid fever, diphtheria, cholera infantum, dysentery or scarlet fever occurs that somebody is at fault. These diseases are entirely preventable, and when Kentuckians realize what a burden they are, a long step will be already taken in Kentucky at least toward preventing them.
Taking, first, typhoid fever, one of the most easily prevented of these diseases, 1,132 of the 3,304 doctors in Kentucky have sent in the reports in this disease, and using these as a basis for our calcu. lation, we are brought to the conclusion that within the past two years there have been 45,024 cases of typhoid fever in this State, with 3,366 deaths, or an annual sick rate of 22,512 from this disease alone, and an annual death rate of 1,683.
Considered purely as an economic problem, the feature of disease least thought of by most people, the importance of these figures can hardly be overestimated. Averaging the entirely too conservative estimates made by the doctors, including medicine, nursing, doctors' bills and loss of time at $94.18 as the entire cash expense of each case, the total cost of cases in the State reach the enormous sum of $4,240,340.32. Further, it is universally conceded that no State has a more valuable asset than that represented in its vigorous population. As this disease is practically 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. Adam Smith and other 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 much higher class victims of typhoid fever in Kentucky, gives us a calculable and definite loss of $3,366,000. Adding this to the cost of caring for those sick of it, as above figured, we have a loss within the period named of $7,606,340.32. 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. It
is not a pleasant thought, but it is an eminently practical one and one that our people should know and must face that the only way in which any person can get typhoid fever into his or her system is to get some of the bowel discharge or some of the urine from another person sick with typhoid fever in their mouth and thence into the digestive system. How this may be done and how the disease may be prevented is shown later under the head of the “Prevention of Typhoid Fever.”
Possibly of even greater interest, because of the enormously greater number of deaths, is consumption, the "great white plague." Our reports show that within the past two years there have been 23,958 cases of consumption under treatment by the doctors of Kentucky and that 12,876 deaths have occurred from this dread disease, the death rate being 53 per cent. Of more serious import is it that the 47 per cent. surviving will furnish the death lists for the next biennial report, unless the present propaganda on the subject shall produce some results.
Next in its death-dealing importance is cholera infantum, which has caused 32,634 cases of illness and 3,870 deaths among our children in the past two years, a mortality rate of 12 per cent. In the same period there have been 10,362 cases of diphtheria and 2,136 deaths. These figures indicate that the physicians are not using antitoxin early enough, or in large enough doses. In the present state of our knowledge it is almost criminal for a case of diphtheria to go for more than twenty-four hours after a doctor is called before at least 3,000 units of a standard antitoxin, such as Alexander's or Mulford's, has been used. The various health boards should arrange with their respective fiscal authorities that the health officer may purchase and administer antitoxin to paupers at public expense.
In the same period there were 44,766 cases of dysentery and 1,866 deaths, a mortality of only 1 of 1 per cent.
Scarlet fever caused 2,721 cases of illness and its prevailing mild type is shown by the small number of deaths-119, a death rate of 4 per cent.
In all, from these six forms of preventable disease, there were 173,070 cases of illness and a grand total of 24,828 deaths. As our figures would indicate that there are now 2,711,450 persons in Kentucky it seems that from these figures that one person in each fifteen
of our population has passed through one of these forms of severe illness within the past two years, and that one in each 109 of the people of Kentucky has been needlessly sacrificed to these preventable diseases that are even now claiming their victims by the hundreds and barely a voice lifted to save them.
Our figures would indicate that $5,802,139.56 has been expended in Kentucky in cash in the past two years for the medicinal care, nurs ing and drugs for persons sick with these diseases, and that 24,828 of our citizens have died with them. Again, placing the conservative valuation of $1,000 upon each one of our people who have been thus needlessly taken from us we find that these preventable diseases in Kentucky in the past two years have cost the enormous total of $30,630,139.56. This means that five times as much money is wasted in this State each year as it costs to run the State government, or expressing it another way, that each and every man, woman and child in this State contributes over $5.60 per year toward the needless drain on our best resources, to say nothing of the sorrow and suffering and death caused thereby.
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 requires. 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, and this board can not express enough gratitude to the public-spirited editors of our county papers for their prompt and effective circulation of these health inatters when occasion arises in their respective localities: