(20) cases were quartered, and to-night all in the town and several from the county will be in the hospital. In every house in this region a number will be found without successful vaccination, and daily several new cases are developing.

In San Domingo, a negro settlement southeast of Hopkinsville, just outside of the corporate limits, we have found quite a number of cases. Evidently the whole section is thoroughly infected, and the disinfection will include nearly every house.

In Hopkinsville proper, things are in a better condition. The people are being vaccinated by the wholesale, and Dr. Woodard is able to send all the colored people to the pest house as fast as located.

Pembroke furnished one new case yesterday, and from different sections of the country cases are reported daily. We think most of these are old cases just discovered, rather than just developing. We have several men who will begin disinfecting to-morrow, and that part will be looked after with special interest, feeling that our work will be useless if the houses are left in an infected condition. As yet no disposition has been made of the white patients. They are left, when found, with houses placarded, yellow flags hung out, and a guard where inmates are not to be trusted. ine party occupying the workhouse, which we desired to use for this purpose, refused to vacate, and it may take several days to eject him. We do not think it advisable to use tents, as there is such strong prejudice against same here, or any exposure while in the febrile stage. If we find that the legal proceedings will occasion much delay, will insist either on tents or another location for pest houses for whites.

Twenty-seven patients have been placed in the pest house at Gracey, forty-nine in the original pest house here, and ten were dismissed to-day.

Very truly,

AUSTIN BELL.

J. B. JACKSON.

Hopkinsville, Ky., November 22, 1904.

Dear Doctor: The Board of Health of Christian county and the Fiscal Court have ordered a compulsory vaccination of all persons in Christian county, and have appointed all the regular practicing physicians residing in the county to carry out said order at once. The State Board of Health has ordered a quarantine for Christian county, and Dr. J. N. McCormack has suspended the order on the condition that compulsory vaccination be stringently and immediately enforced. The County Board of Health has assigned to you the following territory, including all persons, both white and colored, therein, and insists that you make a house-to-house canvass at once, vaccinating

all persons who have not been successfully vaccinated within the last three years, under the following rules, and on the following conditions:

1. You are hereby delegated full power and authority to apply at each residence and on each farm and vaccinate, then and there, without excuse or delay, all persons who do not present evidences of successful and recent vaccination. In case any person refuses to submit to vaccination, or is away from the premises at the time you make your visit, you shall serve on each and every such person by delivering to a member of the family, or by posting on the door, one of the vaccination notices furnished you, in which such person is summoned to appear at your office within twenty-four hours for vaccination, or to present you with a certificate that he or she has been vaccinated.

2. It is made your duty to report daily each and every person found who has smallpox, and the name of each and every person who refuses to be vaccinated. This should be done by letter, unless it be an urgent case, then the telephone should be used. You should also warn each person refusing to be vaccinated that a warrant will be issued immediately and they will be prosecuted under the law for such refusal.

3. You must keep an accurate list of each person vaccinated and require them to call at your office in ten days for examination, so as to know whether the vaccination was successful. You will also make a bi-weekly report by mail of the names and location of each person vaccinated under this order. At the end of the ten days after vaccination, after inspection, should you find the vaccination successful, you must issue a certificate of successful vaccination on the form furnished you herewith, for that person, and mail same to this office, so that our records may show that every person in the county has been successfully vaccinated. In case the first vaccination does not take, re-vaccination must be made and reported, until certificate can be issued.

4. All vaccination done by you must be at the expense of the people receiving the vaccination, including your fee and the virus. Except that in cases of indigent persons, Christian county, by recent action of the fiscal court (as well as by statute law in such cases provided), proposes to pay for all such persons twenty-five cents and the cost of the virus for each successful vaccination. All persons refusing to pay these fees, who are able to pay and who persistently refuse after reasonable time, should be warranted and made to pay like any other legitimate debt, including costs.

5. All persons of whatever age, race, circumstances, contracting smallpox, will hereafter be confined in the eruptive hospital provided by the county and city. This order from the State Board is impera

tive, and it is made your duty under the law to immediately report such cases discovered by you to this board.

6. Should there be any houses now in your district which is infected with smallpox, and which have not been properly fumigated or disinfected, you should either serve in person or have served on the person owning said house, or the person in possession of same, one of the enclosed notices, and all persons refusing to disinfect their premises or buildings at once according to the terms of the notice should be reported to this board at once.

Your compliance with this order will do much toward stamping out an epidemic that threatens the lives of many of our citizens. Your territory by metes and bounds is attached hereto.

Done by order of the Board of Health of Christian county, this November 22, 1904.

Clark County Board of Health.

Winchester, Ky., August 31, 1905.

To the State Board of Health:

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

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, quite a number of cases and deaths; typhoid fever, forty cases and six deaths; diphtheria, twelve cases and four deaths; scarlet fever, twenty-five cases and three deaths; cholera infantum, fifty cases and three deaths; dysentery, twenty cases and two 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 $40, making a total loss to the county for the two years from diseases which might be prevented of $7,880, against $92,000 paid for State taxes. The county health officer is paid no salary.

Very respectfully,

I. A. SHIRLEY, M. D., President.

Clay County Board of Health.

Manchester, 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 Manchester district, with a total of nineteen cases and no deaths.

The first case came from East Bernstadt, and forty persons have 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, twenty had been properly vaccinated; of these, none contracted the disease. Of the twenty exposed who had not been vaccinated, sixteen took the disease and none died.

The population of this county is 14,000. At the time of our last report 20 per cent. had been vaccinated. Since that time it is estimated that none have procured vaccination, leaving 80 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 isolation out of town and in out-of-the-way places, placing a deputy sheriff in charge.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $600. The estimated cost in loss of trade and interference with business has been nothing.

The chief difficulties in stamping out the disease have been the indifference of the people to the mild outbreaks and objection to vaccination, preferring the disease in its mild form to vaccination.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, twenty-five cases and twenty deaths; typhoid fever, twenty cases and two deaths; cholera infantum, fifty cases and five deaths; dysentery, fifty cases and two 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 $100, making a total loss to the county for the two years from diseases which might be prevented of $14,000, as against $16,000 paid for county and $18,000 for State taxes. The county health officer is paid $3 to $5 per day for time employed, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: There are a great many cases of consumption that are never reported, also of cholera infantum, and are never seen by any of the board nor by any physician.

Very respectfully,

J. R. BURCHELL, M. D., Secretary.

Crittenden County Board of Health.

To the State Board of Health:

Marion, Ky., August 31, 1905.

Since our last published report two years ago there have been near Levias, with a total of twenty-six cases and no deaths.

The first cases came from Hopkinsville, Gracey, and Evansville, Ind., and four 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 the four exposed who had not been vaccinated, all took the disease and none died.

The population of this county is 16,500. At the time of our last report 6,000 had been vaccinated. Since that time it is estimated that 500 have procured vaccination, leaving 60 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 to quarantine the persons infected in their homes and enforce vaccination. We have had but little trouble in controlling the disease for the past two years.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $950. The estimated cost in loss of trade and interference with business has been $2,000.

The chief difficulties in stamping out the disease have been locating and isolating mild cases and procuring vaccination.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, sixty-three cases and fifteen deaths; typhoid fever, ninety-seven cases and fifteen deaths; diphtheria, nineteen cases and seven deaths; scarlet fever, nine cases and no deaths; cholera infantum, twenty-seven cases and seven deaths; dysentery, sixty-eight cases and seven 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 $40, making a total loss to the county for the two years from diseases which might be prevented of $9,800, as against $34,000 paid for county, and $26,000 for State taxes. The county health officer is paid a salary of $200, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: We have had three separate outbreaks of smallpox within the last two years. The first case was from Hopkinsville, and the diagnosis was made early and it was confined to his family. The second was from Gracey, and the remainder of his family were pro