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circular letter to be sent to the health and civil officials and physicians in every county, and to every newspaper in the state. With characteristic liberality, the circular was reproduced in nearly every newspaper, multiplying it by. many thousands, and laying the desired information and warning before every newspaper-reading family in Kentucky.

WARNING AGAINST SMALL-POX.

State Board of Health,

Bowling Green, Ky., Feby. 15, 1898. To the Health Officials, Physicians ånd People of Kentucky:

Small-pox is now widespread in Eastern Tennessee, North Carolina, Southwestern Virginia and Northern Alabama, and several cases exist in Middlesboro and near Jellico in this state. The epidemic appears to have originated in Mobile last summer, and to have been gradually extending northward since. It is chiefly prevalent amongst the negro population and manifests an unusual tendency everywhere to break over official control and assume an epidemic form.

This Board, therefore, feels that it is its duty to warn the people that prompt action may prevent its further spread in this state. Fortunately prevention is as certain and safe as it is cheap and easy. Vaccination and re-vaccination, properly done, with reliable virus, is a certain preventive and is entirely free from danger. This is the conclusion of the health officers of the world after years of patient investigations, and is now an accepted truth in preventive medicine.

Notwithstanding these facts, about one-third of the people of Kentucky have never availed themselves of this protection. Our people should not wait for orders from boards of health in the presence of an epidemic to force them to an evident duty. Every citizen should see to it that not only himself, but every one for whom he is responsible is vaccinated at once. No child should be admitted to any public or private school who has not been vaccinated, and all factories, railroads and mines should make the same requirement. This is especially important in view of the threatened danger.

The operation should be done by a competent physician, under proper aseptic precautions, and he should see the person vaccinated from time to time so the result may be certain. Imperfect vaccination gives a false and often fatal sense of security. Reliable virus can be obtained from the National Vaccine Farm, Washington, D. C., or their agents, the Henry Drug Company, Louisville, Ky.

In addition it is urgently requested that all boards of health perfect their organization at once, if they have not done so, and take every precaution to prevent the entrance of the disease into their jurisdiction, or, failing in this, be ready to stamp it out by strictly isolating the first case, and vaccinating and re-vaccinating every person exposed to it. All funerals should be strictly private.

This Board holds itself ready to give any assistance in its power at any time. By order of the Board :

J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.

The case which developed at Richmond was not recognized as small-pox, and many exposures had occurred, and about fifteen had the disease, in a negro quarter in the heart of the town, before the Board of Health was notified and any efficient steps taken to arrest its spread. Although the conditions seemed so threatening, the call made by the health officials upon the mayor and county judge was so promptly responded to that the epidemic was readily controlled, with a minimum of injury to the business interests of the town.

Expert inspectors were sent to the assistance of the local boards at these places, and this practice has been continued up to the present time, in so far as our limited funds would permit, but recently it has been necessary for the afflicted counties to pay the inspectors. Such assistance has been highly useful in clearing up questions of diagnosis and in giving much needed practical advice in isolation and details in management.

Six weeks after the first warning was issued, as the danger seemed even greater, another circular was prepared and sent out as before. It follows:

WARNING AGAINST SMALL-POX.
Office of State Board of Health,

Bowling Green, Ky., March 25, 1898. To the Officials, Physicians and People of Kentucky:

This Board again gives warning that our state is seriously threatened with an epidemic of small-pox. Grave conditions already exist in Bell, Whitley and Madison counties, and cases are reported in Knox and Mason counties. So far the disease has been almost exclusively confined to negroes, but this exemption of the white race can not long be hoped for if it continues to spread.

In spite of repeated and continued warnings from this and county and municipal boards, each community so far attacked was unprepared, a'large per cent of the population was unvaccinated, and dangerous and costly delays occurred before the character of the disease was recognized, and hospitals and other provisions could be made for the sick and exposed.

Under our laws this expense must be met by the counties and cities affected, and it can only be made small by proper preparation before a case appears. Had Middlesboro and Bell county been thus forehanded and ready to care for the first cases, thousands of dollars would have been saved in actual outlay, very many thousands in loss of business, and the officials and community the mortification of clamoring for outside aid to do what they were amply able to do for themselves.

In view of these facts, the Board advises that each town and city at once pass and enforce a compulsory vaccination ordinance, beginning with the colored race, but reaching everybody; that isolation hospitals or tents, and suitable ground for their location, be secured; that visiting and strange negroes be hunted out, vaccinated and kept under observation, and especially that physicians practicing amongst negroes be instructed as to the difficulty of recognizing mild cases of small-pox and varioloid in this race, and of the importance of calling in experienced counsel in every doubtful or suspicious case. Those having this work in hand should deal firmly, but kindly, with every one, advising that this work is being done for their protection as well as that of the community.

Quarantines against infected places, the first resort of unprepared towns, do much actual harm by giving rise to a false sense of security, thus retarding the work of vaccination and preparation, and, if rigidly enforced, are much more expensive than the precautions herein advised, besides causing much financial loss by interference with travel and commerce. No quarantine can be legally established without the consent of this Board, and this will not be given unless the circumstances are very exceptional. Communities maintaining unauthorized quarantines are liable to persons suffering injuries or damages therefrom.

At this time every person in Kentucky should be vaccinated or revaccinated. If properly protected it will not take, and if it takes there is need of it. The vaccination should always be done in three places about an inch apart, by a competent physician, with clean hands and instruments, upon a well-cleaned arm, by scraping off the scarf skin without drawing blood, and should be allowed to dry thoroughly before the sleeve is put down, and should be protected for a few days with a clean cloth or absorbent cotton. This will give the best chance for a successful result, with much less soreness and suffering.

Fresh, reliable virus may always be had from the National Vaccine Establishment, Washington City, or from its agents, The Henry Drug Co., of Louisville. Vaccination from the arm of a child known to be healthy is equally reliable.

This Board holds itself in readiness to aid local boards to the full extent of its powers, but little aid will be needed from it if each community will intelligently prepare to take care of itself. By order of the Board:

J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.

As the disease continued to spread in certain of the mountain counties, the following was issued and widely circulated, especially in that section of the state:

SMALL-POX IN SOUTHEASTERN KENTUCKY.

State Board of Health,

Bowling Green, Ky., July 18, 1898. To the Health Officials, County Officials and People of Southeastern

Kentucky:

Small-pox now exists in Laurel and Clay counties, and it is widespread in Jackson county. Every class of the population is affected and the disease is in epidemic form.

If every man, woman and child in Southeastern Kentucky is vaccinated at once, danger of a serious epidemic will be removed. Every person remaining unvaccinated is a menace, not to themselves alone, but to the health and business welfare of their entire section. Children should be vaccinated when quite young, and older persons should be revaccinated every seventh year, at least. This method of prevention is as cheap as it is safe and easy, when properly done, with reliable virus. The operation should be done by a competent physician, under proper aseptic precautions. Reliable virus may be obtained from the Henry Drug Company, Louisville, Kentucky.

In addition it is earnestly requested that the boards of health for each county and town perfect their organization at once and confer with their county courts so that arrangements may be made to stamp out the disease as soon as the first case appears. Physicians should be on the lookout for first cases. An especial watch should be kept over teamsters, tramps and peddlers. Prompt and intelligent organization will save heavy expense to all counties interested, as the cost of stamping out the disease must be borne by the county courts.

This Board holds itself in readiness to give you any assistance in its power at any time. By order of the Board:

J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.

In spite of these admonitions, supported as they were in a great measure by the local health officials everywhere, town after town and county after county were found unprepared to deal with the disease when it came to them, and thus it spread from place to place, or was fed by fresh importations from Cincinnati, Evansville, St. Louis and points in Tennessee, until nearly half the counties in the state have had more or less severe experience with it. Of course there were exceptions to this careless and time-serving course, in which wide-awake county judges and courts appreciated the wisdom and economy of being forehanded. In such instances first cases were recognized and isolated, all exposed persons were vaccinated without argument or ceremony, and kept under observation, thus protecting their own jurisdictions at small cost and risk, and by the same effort protecting adjacent territories.

Reports of these local outbreaks have been requested, and will be embraced in this publication, so far as received. An examination of these shows that a total of over 1,500 cases have been reported in the state; that the total cash cost for the afflicted municipalities and

counties was $57,000, and that the estimated cost from interference with business, commerce and travel to the towns and counties will foot up the enormous sum of $250,000, with many counties to hear from.

Of course it is well known that the entire epidemic was preventable and would have been prevented, had our reiterated admonitions been heeded. Vaccination of these communities would have made an epidemic of small-pox an impossibility. It is also confidently believed that most of the expense, to say nothing of the suffering and loss of life, could have been prevented had the funds been available for keeping our trained men in the field for the first two or three months, tracing out the suspects and exposed persons.

VITAL STATISTICS,

any civithe law is an the returns.

Attention is again called to the fact that our statute regulating the collection of births, marriages and deaths, important questions to any civilized people, is obsolete and wholly inoperative. Until the law is amended and vitalized, any compilation and publication of the returns would be worse than useless, as it would not only be unreliable but misleading.

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