GENERAL SUMMARY BY THE SECRETARY.

In this report, beside other matters especially adapting it to the use of teachers and schools, will be found an outline of public health work done in the State for the two years ending April 1, 1909. It will include the health and medical laws; the rules and regulations prepared and adopted by this Board, and recommended for adoption by all county and city boards of health, for the information and guidance of health officials, physicians, teachers and the people in the matters to which they relate; and the proceedings of this Board at regular and called meetings, including the reports of its officers and committees. For the especial use of teachers, physicians and others, by special permission of the National Conservation Commission and the author, is included the Report on National Vitality, made to the Commission at its first session at Washington, by Prof. Irving Fisher, of Yale. Prof. Fisher has long been recognized as one of the world's greatest writers and teachers of political economy, and essential facts embraced in his report are of such vital interest that they should be so mastered by every physician and teacher as to reach and benefit every community and home in Kentucky where sufficient intelligent self and public interest can be developed to comprehend and appreciate their intense practical value.

Small Pox.

Entirely because vaccination had fallen into disuse and in a sense had become unfashionable, from 1898 until within the last three years, small pox was so constantly prevalent in almost every section of the State, so engrossed the attention of the heath officials and people, and was such a tax upon counties and municipalities, as to largely exclude other more important public health interests. After an expenditure of money by direct tax upon the people and interference with business of millions of dollars, to say nothing of the sickness, suffering and loss of life, covering a period of eight years, the extermination of the disease was made possible only through the self-sacrificing, though

usually misunderstood and cruelly misrepresented, labors of members of the local boards of health, 795 of whom served year after year absolutely without compensation, and most of the other fifty for such pitiful pay that they were not half rewarded for time and practice lost in the line of duty.

Vaccination.

Vaccination properly and thoroughly done is an absolute preventive of small pox, and is devoid of danger. The average expense of a successful vaccination done for the public is forty cents. The average expense of caring for a case of small pox is forty dollars. Vaccination has long been compulsory in Germany and every body complies with the law, with the result that for the last reported year there was but one imported case in their fifty-four millions of population. At the outset of our epidemic eleven years ago it was found that in spite of repeated warnings less than 30 per cent of the entire population, and in many counties less than 5 per cent, were protected by vaccination. Even then, with the prompt and intelligent co-operation of the county and city fiscal officials and people, every man, woman and child could have been easily and safely made immune, and the existence of the disease made impossible for one-tenth of what the epidemic cost, and still it is estimated that there was over a million unvaccinated people in the State. The health officials and medical profession in many counties agreed to provide this protection at actual cost, and in many instances free, and still many good people insisted that their motives were mercenary and refused.

Unreasonable and Unreasoning Opposition.

Instead of the co-operation and encouragement they had a right to expect in the performance of duties difficult and unpleasant enough at best, health officials and physicians, most of whom were serving gratuitously or for nominal compensation, as has been said, men too, of the highest personal and professional character and standing, were met with suspicion and criticism from fiscal officials, and often by open denunciation and threats of violence from people who were not only civil and intelligent about all other matters, but who had been the best friends. or even the patrons of these very physicians. This occurred over and

over again when they had made themselves personally responsible for food, medicines, clothing, nursing, guards and other necessities, for poor people afflicted with this most loathsome malady until the fiscal authority could meet, matters in which they had only the humanitarian and public interest inseparable from their calling, and many of them were almost beggared in purse and ruined in reputation and practice as the result. After careful inquiry it is seriously doubted if there is a physician in Kentucky who was benefitted permanently to the extent of one hundred dollars as the outcome of all the vaccination and small pox work of the nine years of the epidemic.

Our Every Day Household Pestilences.

With small pox practically out of the way, although likely to recur at any time in unvaccinated communities, just as fires may be looked for at any time where quantities of combustible material are carelessly permitted, it has been possible for health officials and physicians to give more attention to the prevention of the far more important every day domestic pestilences, tuberculosis, typhoid fever, diphtheria, the diarrheal diseases of infancy and childhood, scarlet fever, dysentery and similar diseases, which are a reproach to our civilization, and yet cause such a large sick and death rate in Kentucky, especially among young people just entered or soon to enter upon the most productive period of life, happiness and usefulness. A disease is important to a community, state or nation in proportion as it makes people sick, causes loss of time from productive labor, costs money for treatment and kills them. Measured by such standards these domestic pestilences, every day afflictions more or less of rich and poor alike, take the front rank in Kentucky, and cholera, yellow fever, bubonic plague and other exotic diseases of which there is so much dread, and at the mention of which people pale and tremble, sink into insignificance. The Importance of Systematically Collected Vital Statistics.

Vital statistics, the collection and tabulation of births, sickness and deaths, constitute the book-keeping of public health work, but, in spite of repeated efforts upon the part of the health officials for the necessary legislation, we have no provision for such a system in Kentucky worthy of the name. In order to do effective prevention we ought to know where every case of sickness and every death occurs and what caused it, and diagrams containing this information in easily

understood form should be hung in every school and home in the State, renewed and brought up to date each year. In the absence of such a comprehensive system, certainly as important as the facts in regard to crops and domestic animals, so carefully collected by both state and national governments regularly, the Board has been forced to rely upon such facts as could be gathered voluntarily from members of the medical profession. This year, as has been done biennially for several years, a circular letter of inquiry was sent to each of the 3,605 physicians, and a careful study of the replies, not so full and accurate as if made under the forms of law, while all the facts were fresh in the mind, enable us to make what may be considered fairly reliable estimates of sickness and mortality for an average year. A comparison with similar figures collected in the same way for other years will show that they have a value from which useful deductions may be made.

Useless Waste of Health and Life for an Average Year.

These returns indicate that during the last year, an average one except for diphtheria, there were 13,436 cases of tuberculosis under treatment, with 6,541 deaths; 18,387 cases and 1,818 deaths from typhoid fever; 10,980 cases and 2,336 deaths from diphtheria; 18,240 cases and 1,642 deaths from the diarrheal diseases of infancy and childhood; 19,624 cases and 840 deaths from dysentery and diarrhea in adults; 1,800 cases and 160 deaths from scarlet fever; 31,000 cases of gonorrhea and 16,250 cases of syphilis. Antitoxin was used in 4,516 cases of diphtheria, in many of them very late in the disease, with a death rate of 560. It was not used in 6,464 cases, with a death rate of 1,676. This gives a total of 129,717 cases and 13,337 deaths in one year, which is believed to be fairly typical of what is occurring every year, from these eight forms of preventable diseases. The sorrow and discomfort brought into homes and families as a result of this sickness. last year, and every year, all of which was practically preventable by the observance of precautions now well understood by the scientific world, is beyond human calculation, but there is a phase of the loss which can be measured in dollars and cents, and which ought to appeal to legislative bodies, fiscal courts, city councils and other officials, to business men and others having at heart the well being of the people.

The Money Cost of Sickness and Deaths.

Considered purely as an economic problem, the feature of disease least thought of by most people, the importance of the figures given above can hardly be overestimated. The estimate of our reporters of $94 for the medical care, drugs, nursing and loss of time for each case of sickness, certainly a very conservative one, shows that the total yearly tax upon our people from these diseases is $12,191,398, or nearly double the total annual revenue of the State. And this is not only as much of a tax as if paid into the county, city and State treasuries, but as these diseases were preventable and ought to have been prevented, it brought no benefit as other taxes do more or less, and was a waste which intelligence and foresight should first restrict and then entirely prevent. But the loss is far beyond this. It is the fashion to talk. about the conservation of resources. Unfortunately President Roosevelt restricted this to farms, factories, forests, mines, water powers and other like interests having recognized money value. Without men, women and children to operate and enjoy them these interests have only an abstract value, and hence political economists tell us the greatest asset of a state or nation is its people, its vigorous, healthy population. Anything which impairs the health or shortens the life. of the people, then, is making war upon the most valuable asset of the state. The value of a human life gradually rises from $90 in the first year to $4,200 at the age of 30, and then gradually declines as age advances until it becomes negative. Prof. Fisher places the average value of lives sacrificed by preventable diseases in the United States at $1,700. Taking this as a basis and applying it to the 13,337 deaths from this class of diseases in Kentucky last year gives the sum of $22,672,900. If this be added to the $12,191,398, which it cost in various ways to care for the sick from these diseases, it gives a total loss for the year of $34,864,298. Enormous as these figures seem they are believed to underestimate the saving which is entirely possible if all the people could and would observe the laws of health in their daily lives. It was this economic feature of the disease problem mainly, the senseless drain upon the material resources of their respective nations, an aspect of it which we have been able to induce few of our lawmakers to consider, which caused Gladstone, Disraeli, Bismark and others of like prominence in public affairs abroad to recognize as axiomatic and crystalize into laws and governmental policies the truth, that "The care of the public health is the first duty of the statesman."