spection in 32 cities and 321 towns, and 70 other cities in this country are doing the work more or less satisfactorily.

Public Health Buildings and Offices.

At present, outside of the large cities, no offices are furnished for carrying on health work, the health officer receives little or only nominal compensation for his services, and practically gives, and can afford to give little or no time to his duties except in the presence of small pox or similar diseases of no great importance to the people except as they interfere with travel and business. In most counties and cities it is probable that permanent accomodations for the offices, records and laboratories of the health department could be provided in the court house or city hall. Otherwise proper buildings should be erected, probably in connection with the hospital, which should be maintained at public expense in every city and county. It has been found that but one of every 100 citizens of this country ever have need for a court house except as a place to record their deeds, mortagages and other papers, while the benefits of a properly conducted health office would extend its benefactions to every hearthstone of the jurisdiction. It would be as reasonable, too, to ask lawyers to build and maintain court houses and jails, or teachers to construct and keep up school houses and serve without salaries, as to expect physicians to provide and maintain health offices, laboratories and hospitals at their own. expense. The legislatures and fiscal authorities in Kentucky, who no doubt fairly represent the wishes and intelligence of the people, are so far from realizing the need for anything more than a nominal health service, or at most, one to act in the emergency of an epidemic, and not to prevent epidemics as well as the more important household pestilences, that it is as worthy of serious thought if it would not be better for the members of all the imperfectly equipped boards of health to resign and thus kindly but forcibly and emphatically bring the officials and people face to face with the knowledge that they have no such protection for the health and lives of themselves and thier families, as is bounteously provided in other civilized countries, or is just as bounteously furnished for their hogs, cattle, sheep, mules, horses, crops and trees by our own National Government, if not by our State.

This Work of Doctors Obviously Unselfish.

As has been explained already, the medical profession of this State and Nation at great sacrifice of time, labor and money, has tried for years to secure the legislation which would bring these benefits to the people, but many of those in authority believed and often did not hesitate to say that the motives were sordid, were not made for the public good, not stopping to consider that in so far as doctors prevent disease they must diminish their own incomes. In fact, one is constantly impressed that it is largely because this reform is so purely unselfish that is so often misunderstood. Legislators found no other vocation systematically urging legislation antagonistic to its own interests and logically leading to its effacement and could not understand why medical men did it. It is mainly because ours is essentially a humanitarian calling, involving daily contact and devotion to the sick and suffering, and constantly facing the problems of protecting health and saving life, and has found that it is far easier and better to prevent than to try to cure many diseases that it has drifted into and developed this reform work, probably the greatest and most far reaching, and certainly the most unselfish that has ever been offered to a people. Doctors have taken up this work for the same reason that they do more actual Christian charity every day in every year than all the other people and organizations. Over a third of the people of Kentucky never paid a medical bill and never intended to, as is true in most other countries, but by reason of the systematic unheralded charity of the profession, as is so graphically portrayed in the life of Dr. William MacLure in the Bonny Briar Bush, no one of them in city or country ever suffers for the want of a doctor. Again, all other citizens may profit by their inventions or discoveries, but a doctor cannot, being forced by his vows to at once make public any discovery he may make without protecting it by patent, and thus give all sufferers the benefit without cost. In spite of all this, as will be seen by reference to the table of the principal appropriations made in Kentucky for an average year, published at the beginning of this report, money is poured out like water every year as a matter of routine for purposes, certainly no more important or meretorious, while that made for protecting the health and life of the people is hardly sufficient to pay the postage of such a department as these interests require.

Popular Education Needed.

To meet and overcome prejudices and objections which have so crippled the usefulness of the profession, and which have proven so disasterous to the best interests of the people in all the past, and are not only woven into the very fabric of the government, but into the habits of thought and life of the people whose protection is sought, is no ordinary problem. Legislation, however complete, and appropriations, however large, have little more than an educational value except as they are supported by an intelligent public sentiment. In order to develop and foster such a sentiment mainly, the medical profession of Kentucky and if the entire country, through a system of local societies extending into every country, and to which are cordially invited the doctors of every school of practice, has enlisted and, in a carefully planned and systematic way, begun a campaign of education with the view of enlisting the lay leaders of public opinion of every community in this altruistic reform. By means of a well devised post graduate course for county societies, with weekly meetings and attractive rewards for those who complete the four years work, outlined and furnished gratuitously to all who will accept, it is proposed to place the incentives and facilities for study within the reach of the profession of every county, with the purpose of placing a competent, up-to-date doctor within the reach of every family in Kentucky and in the United States.

Public Meetings Also.

In addition, it is advised that these county societies or schools hold frequent joint meetings with local organizations of teachers, editors, ministers, druggists, women's clubs, lawyers, farmers, laboring men and other similiar bodies which lead and mould public opinion, with the view of such a comparison of views, study and practical instruction as will shape and promote this reform. In time, through the co-operation of the teachers and others, by means of stereoptican and other demonstrations, it is hoped that every school, and ultimately every child and home, may be reached by this health and life-saving instruction. Such demonstrations should always include views of school houses and homes, humble and elaborate, which are models in location and grounds, architecture, ventilation, drainage, healing, lighting and water supply, as being no less important than the germs which are the direct

causes of the preventable diseases. If this is done for a few years it will be easy to have voters, legislators and executives in the next generation about whose active support and co-operation there will be no question.

Revolution in the Practice of Medicine.

As will be readily seen, what is here proposed means the same revolution in the practice of medicine which has gone on so rapidly in the practice of law in recent years. A generation ago lawyers were employed almost entirely in preparing for and in conducting litigation in the courts. Now, corporations and wise business men employ lawyers mainly to keep them out of the courts, and the number and character of the profession thus engaged is much higher year by year. In the same way it is only a question of time until a large part of the medical profession is to be employed as medical advisors for families to tell them how to live so as to keep well instead of the much more doubtful and difficult work, as family physicians, of trying to cure them after they are sick. All sickness cannot be prevented with present knowledge, but what are very properly known as the domestic pestilences, including those especially dangerous to children and young people, can and ought to be prevented, and this list should and will be constantly extended by such experimental research work and collective investigation as every State and the National Government will undertake, when a real wise statesmanship is substituted for the time-serving personal and political methods which were probably unavoidable in a new country like ours. It will require years of consecrated, unselfish labor upon the part of the medical profession and of such laymen as may be induced to enlist in it, often in the face of misrepresentation and derision from those to be most directly benefitted, before the success of the movement is assured. How doctors are to be compensated and supported, and whether as many will be needed under the new order of things, we have not stopped to inquire. They have the knowledge which not only qualifies them for, but which imposes the duty of leadership. It opens up a new field of usefulness, a field of unlimited possibilities, one which will make the profession of the future one hundred fold more important than that of today, and we only appeal for the popular and legislative support which will hasten its practical application to all communities and homes in Kentucky,

THE PREVENTIVE DISEASE CIRCULARS.

With the view of preventing or restricting the spread of the most common and fatal of the communicable diseases, the following circulars have been prepared for gratuitous distribution. They have been revised from time as scientific knowledge has advanced that they might voice the latest authentic information. They are couched in such plain terms as to adapt them to popular use. Upon notice, officially or through the newspapers, that one of these diseases exists in a county. or locality, the circulars giving information as to that disease are sent in quantities for popular distribution to the physicans, the postmasters, to the families if names are given, and to the newspapers with a request for their publication, with such editorial comment as may seem pertinent. In this way, while there is such interest in the subject as will cause them to be read they are placed in the hands of every family in the locality which takes a newspaper, and sometimes of those who do not, as the press has been generous beyond our words to express in its co-operation. The circulars follow:

PREVENTION OF CONSUMPTION.

Circular Issued by the State Board of Health of Kentucky. To the Health Officials, Physicians and People of Kentucky: Consumption is the most common and fatal disease with which the people of Kentucky are afflicted. It produces more than twice as many deaths as any other disease, causing one death out of every seven in this State. Our reports show that within the past two years there has been 26,872 cases of consumption under treatment by the doctors of Kentucky and that 13,082 deaths have occurred from this dread disease, the death rate being about 50 per cent. Of more serious import is it that the 50 per cent surviving will furnish the death lists for the next biennial report, unless the present propaganda on the subject shall produce some results.

As it is now definately known to be a communicable germ disease, a large part of this sickness and mortality can and ought to be prevented. Careful and extended investigation and observation has demonstrated that the chief source of danger is from the sputum or expectorated matter of consumptives, which contains the germs or seed of the disease in countless numbers, and that such sputum is es