to proceed to Middlesboro and to report on the situation. On the 17th instant, at the request of the State Board of Health, Dr. Wertenbaker was directed by this Bureau to co-operate with the Board of Health, through its representative, Dr. L. L. Robertson, in stamping out the small-pox, and took charge of Government measures. There were then 89 cases of small-pox and 56 suspects. The number of cases that had occurred previous to this was estimated at 100 to 150; only 2 fatal cases had occurred. As rapidly as possible isolation of the suspects was accomplished. The small-pox cases were transferred to a large building that was secured for a hospital, and Dr. C. W. Duke, of Memphis, Tenn., who had been trained in Service methods in previous epidemic work, was made resident physician. A suspect camp was at once established, with Dr. W. N. Shoemaker, of Birmingham, Ala. (who was also familiar with Service methods), as resident physician. A disinfecting corps was organized, and the work of disinfection of all known infected houses was begun under the supervision of Acting Asst. Surg. Ira W. Porter. A thorough force of guards was organized to carry out the quarantine proclamation of the State Board of Health and to guard the small-pox hospital and suspect camp. A house-to-house inspection of the city was made and repeated until the epidemic was at an end. To facilitate the transaction of business with neighboring states, quarantine passes were given to those who were successfully vaccinated and were free of infection. After the Service took control 7 cases of small-pox in all were found (one of these occurred in the suspect camp) and 14 suspects were placed in camp. The last case developed on April 6. Previous to the separation in separate camps of suspects from small-pox cases 7 suspects were taken with small-pox. The infected houses, 97 in number, were disinfected by 1-800 solution of bichloride of mercury, and all clothing and household goods were soaked in solution of the same strength. Mattresses, pillows, and thick quilts were burned. Except in a few instances, it was impossible to disinfect with sulphur or formaldehyde, as the infected houses were not close enough for gaseous disinfection. As directed by telegraphic orders of the 2d instant, I relieved Passed Assistant Surgeon Wertenbaker on April 5. The methods already put in operation were continued. A final house-to-house inspection was made, of which the result is shown by Exhibit A. The detention camp was abolished on April 9, after discharge of the last suspect. The disinfection of the remaining infected houses was finished on April 11, and the quarantine was raised and guards dismissed on the same day. The schools, which had been closed for two months, were allowed to begin, after inspection of the children and revaccination when necessary. On April 14 the number of cases of small-pox had been reduced to 2. These were transferred to the county pesthouse, and on the following day, by order of the Bureau, the camp was broken up and the Service affairs brought to an end. The following tables are taken from the records of the small-pox hospital. Exhibit A shows the number of successful vaccinations in Valuable assistance was rendered by Acting Asst. Surg. Ira W. Porter, Drs. C. W. Duke, W. N. Shoemaker, Byron Dozier, J. W. Francisco, and J. G. Moss, and by Stewards F. R. Hanrath and F. H. Peck. The Service is indebted to Dr. L. L. Robertson, of Middlesboro, the representative of the State Board of Health, for his hearty co-operation and assistance. To the Mayor of Middlesboro, the city and county officials, and to the people of the city, the officers of the Service, whose pleasure it was to serve them, are greatly indebted for the uniform courtesy and active co-operation extended throughout the epidemic. Dear Doctor: I write to correct a misstatement made in the current number of your "Public Health Reports," to the effect that this Board, the Governor of Kentucky, or any one else having authority to do so, asked for national aid in suppressing small-pox at Middlesboro. The request was made by Representative Colson, who had no authority in the matter whatever, as you must have known. When your representative arrived the disease was under control and a speedy termination of the epidemic was confidently expected, as he reported to you when he asked to be relieved. You ordered him to stay, but, under his instructions, he refused to co-operate with us, or to do anything unless given absolute control, and by reckless statements made to certain citizens as to government funds available if he got this control, so confused our effort to get money from the county, which was amply able to raise it, that our Board withdrew, and the state was forced to accept a co-operation from you it had never sanctioned or needed. We hesitated to give you absolute control because of the ineffectual methods adopted by your Service in Alabama, which had permitted the present epidemic in Tennessee and Kentucky, and of its similar history in former years in dealing with yellow fever and small-pox. After our inspectors left, your representative found that he had no authority to assume charge. Our quarantine was continued in force to protect the balance of the state, but no one had charge in Middlesboro for almost a week, and the disease made such headway that it has required over a month to bring it under control to the same degree as when we left. With all due respect to you and your Service, we are satisfied that your interference was unauthorized and unwise, and ask that the correction be given a place in your next issue. J. N. McCORMACK, M. D., Secretary. In reply to your letter of April 9th, 1898, in which you request a correction of an alleged misstatement made in the current number of the Public Health Reports regarding small-pox epidemic in Middlesboro, I have to say that the statements in said Public Health Reports are verified by the records of this office, which show that not only the Governor of Kentucky, the President and Secretary of the State Board of Health of Kentucky, and a member of Congress from the district including Middlesboro, requested nation aid in suppressing the epidemic of small-pox at Middlesboro, but that a similar request was also received from the Mayor of Middlesboro; so that your request for a correction was evidently made under a misapprehension of the facts. Contrary to your assertion, no instructions were given to Dr. Wertenbaker to refuse to co-operate or do anything unless given absolute control. You are equally in error in regard to the success of the Service in the methods adopted for the suppression of the epidemic in Alabama, as the Service never assumed charge of small-pox throughout the state of Alabama, its operations being in Birmingham and vicinity. With regard to the history of this Service in dealing with yellow fever and small-pox in former years, it is only necessary to call your attention to the Annual Reports of the Service, as well as the Public Health Reports, to prove the incorrectness of your statement. Respectfully yours, WALTER WYMAN, Supervising Surgeon-General, M. H. S. Dictated. State Board of Health of Kentucky. Executive Office, Bowling Green, Ky., April 20, 1898. Dr. Walter Wyman, Surgeon-General U. S. Marine-Hospital Service, Dear Sir: Washington, D. C. I regret very much that you felt it necessary to make the statements contained in your letter. Your records can not show that the officers of this Board or the Governor of Kentucky asked you to send any one to Middlesboro, for the very simple reason that they did not do so. After Dr. Wertenbaker was sent without official invitation he reported to you that we had the epidemic under control; that no interstate question was involved, and asked to be relieved. You ordered him to remain for reasons best known to yourself, until his presence and your promise to furnish funds demoralized the local officials, who had from the first objected to bearing the expense properly imposed under our statutes. Under a gross misrepresentation of the facts the president of this Board and the governor were induced to ask your Service for aid, and I withdrew our inspectors, when it was found that Dr. Wertenbaker had no authority to do anything. Chaos reigned for several days, hundreds were exposed, and the epidemic was again on, and was only prevented from reaching serious proportions by the systematic vaccination done by us before your interference. I have no means of knowing what instructions you gave Dr. Wertenbaker, but he stated in a public meeting and often in private that he could only co-operate with us upon condition that he was given absolute control. As you refuse to make the correction, demanded alike by the facts and fair dealing, I will be forced to take my own methods of doing so. Respectfully, J. N. McCORMACK, Secretary. Editor of the Journal: In the April 1 number of "Health Reports," published by the U. S. Marine-Hospital Service, the statement was officially made that national aid was sent to this state at the request of this Board and of Governor Bradley, and that the representative of that Service found the methods of this Board inefficient. Upon receipt of the publication I at once wrote the Surgeon-General asking that the false and unjust statement be corrected. As he has declined to make the correction, and as this Bureau is the chief obstacle to the enactment of efficient national legislation for the protection of the public health interests of the country, I ask that the subjoined correspondence be given a place in your columns, that health officials and the profession may know what to expect at the hands of this Bureau should its persistent requests for increased power be granted. Very respectfully, J. N. McCORMACK, Secretary. To the Editor of the Journal of the Am. Med. Association, Chicago, Ill. BOYD COUNTY. Ashland, Ky., Feby. 22d, '99. State Board of Health, Bowling Green, Ky.: Gentlemen: I regret to report that a case of small-pox developed here 18th inst. The patient, a resident of this city, came off a steamboat. His family and several others in the same house had not beenbut are now-vaccinated. He was sick in the house about six days, then the county physician and another saw him and reported the case as small-pox. I was sick at the time and could not see the case to verify diagnosis. The patient and those exposed have been removed to the city pesthouse, a mile away, and are in charge of the county. A general vaccination is being performed. This county has no County Board of Health, and of course no health officer. Would it not be well for you to inform the county judge of the necessity of his organizing such a board, and of his informing you of the existence of the board? Is there a statute requiring county courts to appoint and perpetuate County Boards of Health? I ask for information. In the absence of such a board, is not the county judge authorized to take charge of a small-pox epidemic and incur a debt of expense in caring for the same? Will you please send me your latest book of Health Laws, and refer me to any acts later than the book, or not embodied in it, pertaining to health interests. Will be glad to receive any other papers, suggestions, instructions, etc. that may be of assistance in keeping well posted on all matters connected with the duties of the situation. Apologizing for this intrusion, and asking an early response, I am, sir, Yours respy., THOS. R. YOUNG, Ashland, Ky., March 14th, '99. State Board of Health, Bowling Green, Ky.: Gentlemen: In reply to yours of 11th, I would state that the first case of small-pox we had has his home and family here, but was running the river as deck-hand on a steamboat plying between Pittsburg and St. Louis. He had come off the boat several days before he broke out. About a week after that case had been taken to the pesthouse, I saw a negro with small-pox who had come from Joliet, Illinois. The doctor in attendance had diagnosed syphilis. I sent him to the pesthouse and it proved a highly typical case. Strange that we should have |