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BELL COUNTY.

Bowling Green, Ky., July 1, 1898. Dr. J. N. McCormack, Secretary:

Dear Sir: I have the honor of submitting the following report on the small-pox epidemic at Middlesboro:

The disease was introduced into Middlesboro by a refugee negro miner from Birmingham, Ala., in the early part of November, 1897. The first cases occurred in a thickly settled negro district, were very mild in character, and the disease spread remarkably slowly. When Drs. Robertson and Curd, of the Bell County Board of Health, first saw and diagnosed the disease as small-pox there were some fifteen or sixteen cases in several different sections of the town and numerous exposures. The Bell county officials refused to furnish any money for the suppression of the epidemic, and the local Board very properly refused to act without funds. At last the city authorities were aroused to the gravity of the situation, and furnished some money. With this a pesthouse was built of sufficient capacity to accommodate about fifteen persons. When I first went to Middlesboro there were twenty-two negroes in the pesthouse. Of these two died afterward. Besides these there were some thirty cases in town. The city authorities then agreed to build a new pesthouse to accommodate sixty persons. This was built, but never used on account of its inaccessibility. It was at this time that I was ordered to return to Middlesboro with Assistant Inspectors Bell and Smock. The county health officer, Dr. Blair, also reported to Middlesboro, where he remained actively at work for a couple of months. The city authorities furnished police, inspectors, a medical vaccinating corps, guards, etc. Dr. Bell was made chief of the vaccinating corps, and to his painstaking and thorough work is due much of the success of our work. We secured a row of unoccupied houses and isolated and guarded all who showed symptoms of the disease. Suspects and those exposed were quarantined in their houses, and these were visited once or twice daily by Dr. Blair or Dr. Smock. During the time we had charge there were 169 cases and no deaths; 1,968 persons were vaccinated, and all of these were revisited and revaccinated when necessary. The town was strictly quarantined from the day of our arrival, and no sick person escaped during that time. All houses from which the infected had been removed were disinfected, or, where this was impossible, they were burned.

Under your orders of March 14th, Dr. Werten baker, of the Marine Hospital Service, was shown through the pesthouse, and reported to the surgeon-general that the situation was under control, and that he would leave on the next day, unless otherwise ordered. A number of citizens who had given us little or no aid during our hard work consulted and reconsulted the Service surgeon, and, inspired either by his talk or their dreams of government pelf, they kept the wires hot with messages appealing for government assistance. Under your order of the 14th of March we withdrew from Middlesboro. For several days after that the sick were without food or attention, owing to the lack of authority on the part of the government officers. On the 16th you wired acceptance of their offer to furnish men and money to control the epidemic under the direction of Dr. L. L. Robertson, chairman of the Bell County Board. In the meantime the epidemic had gained a foothold, which it took the government officials several weeks to overcome.

I append the report of the surgeons in charge of the work for the service, which takes up the history of the epidemic where I leave off, and the subsequent correspondence between the State Board and the surgeon-general of the Marine Hospital service in regard to the unauthorized acts of the latter and his assistants.

Respectfully submitted,
A. T. McCORMACK, M. D.,

Chief Sanitary Inspector.

REPORT ON WORK OF THE SERVICE IN SUPPRESSING THE

EPIDEMIC OF SMALL-POX AT MIDDLESBORO, KY. On March 10, 1898, I received a request from the Congressional representatives from Tennessee and Kentucky for aid in suppressing the outbreak of small-pox at and in the vicinity of Middlesboro, Ky. . As the State Board of Health had been in control of sanitary affairs up to this date, and as at a later date there was some dissatisfaction expressed by an officer of the State Board in regard to the Service attitude at Middlesboro, I publish herewith the entire correspondence on the subject:

House of Representatives,

Washington, D. C., March 10, 1898. Sir: Herewith I send you a telegram just received by me from John G. Fitzpatrick, Esq., mayor of Middlesboro, Bell county, Ky., as to the small-pox situation at said place. The situation is a very grave one. All Southeast Kentucky, East Tennessee, and Southwest Virginia are involved, or liable to be, and neither the municipal, county or state authorities are able to control the epidemic. I ask your immediate consideration and such assistance as you can extend. Middlesboro, Ky., seems to be the center of the district in which the disease is now raging.

Very respectfully,

DAVID G. COLSON, M. C. Surgeon General Marine Hospital, Washington, D. C.:

I fully concur in the above. Small-pox is spreading in my district. I ask for immediate action.

W. P. BROWNLOW, M. C.,

First Tennessee.

(Inclosure.)

Middlesboro, Ky., March 10, 1898. This telegram received from J. N. McCormack, Secretary State Board of Health: “Unless city or county can arrange, will be forced to release you and local Board from duty, stop all trains and advise adjoining counties to protect themselves.” County refuses aid; city has no funds. Can Federal aid be had? Ascertain and answer.

J. G. FITZPATRICK, Mayor. Hon. D. G. Colson, M. C.

In compliance with this request, P. A. Surg. C. P. Wertenbaker was ordered to proceed at once to Middlesboro, Ky., and report upon the situation at that place, and the following telegram was sent to the secretary of the State Board of Health of Kentucky:

Washington, D. C., March 11, 1898. Upon request of Kentucky and Tennessee Representatives, have ordered P. A. Surg. C. P. Wertenbaker to report on small-pox situation at Middlesboro, in its interstate aspect. Wire if Bureau can aid you.

WYMAN, Surgeon-General.

REPORT OF PASSED ASSISTANT SURGEON WERTENBAKER.

Middlesboro, Ky., March 14, 1898. Forty-nine cases variola here in pesthouse and twenty-three suspects; 400 suspects quarantined at their homes. Population, 4,200. One hundred and sixty-nine cases since February 28th. Two new cases yesterday. Disease declared epidemic in city March 4th. City quarantined; none allowed in or out. Dr. A. T. McCormack, chief state sanitary inspector, with four assistants in control, and states that State Board is able to control epidemic, expecting to force county to furnish funds. Citizens' Committee, headed by mayor, protest that city is without funds, and the county refuses to make appropriation. In meantime patients are without food. Citizens' Committee have wired Board of Health and governor asking that government be requested to render assistance, which chief inspector says Board will not do. Under circumstances do not see that Service can do anything. I will leave to-morrow morning,rejoining Wilmington, unless otherwise ordered.

WERTENBAKER. Surgeon-General Marine Hospital Service.

Washington, D. C., March 14, 1898. Are measures taken sufficient to protect Tennessee and Virginia ? Wish report on prevalence of disease in these two states in that general neighborhood. Answer and await instructions.

WYMAN, Surgeon-General. P. A. Surg. C. P. Wertenbaker, United States Marine-Hospital Service.

Middlesboro, Ky., March 14, 1898. The following telegram has been received by the Citizens' Committee: "J. R. Sampson and others: Your telegram received. After consultation with the Governor of Kentucky, I authorize Dr. Wertenbaker to take charge, if the Federal government will defray expenses. There is no money in our treasury and no law to appropriate any for this purpose. Signed, J. M. Mathews, President State Board of Health."

A telegram has just been received by the chief inspector from McCormack, Secretary of State Board, recalling all State Board officers. This will leave the situation absolutely unprotected. If authority in Mathews' telegram is sufficient, I recommend that I be authorized to take charge to-night, and request that camp equipage train be ordered to report to me at once. Please authorize necessary immediate expenditures for provisions, guards, etc. In Tennessee there are fiftynine cases at nineteen points. Albright, Secretary Tennessee Board of Health, authorizes statement that all are under control. Have heard of no cases in Virginia in this neighborhood.

WERTENBAKER. Surgeon-General Marine-Hospital Service.

Washington, D. C., March 14, 1898. Notify at once chief inspector, also Secretary McCormack; you have not been authorized to take control, and state officers should not be recalled. The government's interest is in protecting other states, and nowhere is the whole expense borne by the government. Every municipality should have enough pride in itself to suppress this ordinary contagious disease. In Alabama, where there were no municipal funds, the citizens raised funds. Will wire to-morrow. Keep me posted.

WYMAN, Surgeon-General. P. A. Surg. C. P. Werten baker, M. H. S.

Middlesboro, Ky., March 14, 1898. Wired McCormack on receipt of your message, as directed. Chief inspector and assistants left within an hour after receipt of orders, which directed them to leave at once, the message being doubtless sent by McCormack on receipt of copy of Mathews' message to Citizens' Committee. Local Board of Health in charge. County judge decided tonight that county had no funds and no law for appropriating funds for such purposes. Will keep you informed.

WERTENBAKER. Surgeon-General Marine-Hospital Service.

Frankfort, Ky., March 14, 1898. State Board of Health withdrawn from Middlesboro; county refuses to appropriate money; to-morrow last day of session, and doubtless no appropriation can be gotten through. Fitzpatrick telegraphs 70 cases; 400 suspects; nothing with which to feed them. Act of Congress not in library, and I do not know what the law allows. Am told Surgeon-General of the United States may be appealed to to take charge immediately. If such can be done, request him in my name to take charge.

W. O. BRADLEY, Governor. Hon. D. G. Colson, M. C.,

Washington, D. C.

Frankfort, Ky., March 15, 1899. I asked the legislature for appropriation, but it adjourned without action.

W. O. BRADLEY, Governor of Kentucky. Hon. D. G. Colson, M. C.,

Washington, D. C.

Middlesboro, Ky., March 15, 1898.
Middlesboro has 3,500 people dependent for support on wages of
working people...
People poor; business suspended; request your immediate assistance.

J. G. FITZPATRICK, Mayor.
Surgeon-General Marine-Hospital Service.

Washington, D. C., March 16, 1898. Request from governor through Representative Colson for Service to take charge. Assume that this is in accordance with Board's wishes; if not, advise. Will furnish medical officers, attendants, guards, inspectors, and attend to vaccination and disinfection. Will expect local authorities to care for poor not sick and furnish all subsistence so far as possible, funds having been raised, according to mayor.

WYMAN, Surgeon-General. J. M. Mathews,

President State Board of Health, Louisville, Ky.

Bowling Green Depot, Ky., March 16, 1898. Board asks you to aid and co-operate under our regulations. We accept heartily if this is your proposition.

McCORMACK,

Secretary State Board of Health. Surgeon-General Marine-Hospital Service.

Washington, D. C., March 17, 1898. Will render the aid mentioned in telegram to president of Board yesterday, as aid and co-operation under your regulations. All expenditures, however, must be supervised and accounted for by our own officer, who has been directed to confer with your representative and work in harmony.

WYMAN, Surgeon-General.. Secretary State Board of Health,

Bowling Green, Ky. As stated above, on the 10th of March, 1898, P. A. Surg. C. P. Wertenbaker was ordered to proceed from Wilmington, N. C., to Middlesboro, Ky., to investigate and report on the situation. The following is his report:

SMALL-POX AT MIDDLESBORO, KY.

Middlesboro, Ky., March 14, 1898. Sir: I have the honor to report that, in obedience to telegraphic orders, Surgeon-General's Office, March 10, 1898, I arrived here last evening at 8 o'clock. This morning, accompanied by Dr. A. T. Mc

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