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two cases in such a short time, but from entirely different sources. Am preparing a report of the epidemic, which I hope to forward you soon. We sent to the pesthouse grounds eight persons who had been exposed to the two cases, and kept them 200 yards away from the cases. Three of these developed small-pox and three varioloid. The two others, by reason of a previous successful vaccination, will likely escape. There has been no death.
I have seen in the city two cases which in my judgment were varioloid. They had vaccinations in full bloom, but I could not trace any possible exposure to the cases of small-pox. There was another smuggled case in a wealthy family, which I did not see, but have abundant reason to believe was varioloid; in fact, the family telephoned their relatives that their child had varioloid. They must have gotten their idea from their physician, though he denied it to me. These three cases, ages 3, 4, and 16, were in widely separated localities. Herein is a “nut to crack.” Most authors think varioloid can not be directly caused by vaccination. This and previous experience compel me to doubt the theory. What is your opinion? Hoping the points given in this letter will excuse its length, and believing they may be of interest to you, I am
City Health Officer.
Ashland, Ky., Aug. 14th, '99. State Board of Health, Bowling Green, Ky.:
Gentlemen: In reply to your request for a report of the recent small-pox epidemic in this city, I would state that on Feby. 16th, '99, Hiram Kazee, white, was found with well-developed small-pox. He had been sick in his home for about a week before he was visited by Dr. A. G. Berry. There were about a dozen inmates in the same house, most of whom had been directly exposed, four of whom had escaped from the premises. All the rest were promptly removed to the city pesthouse, an enclosure of about twenty acres a mile from the city, where they were cared for by the county authorities under the management of Dr. A. G. Berry.
The patient was kept isolated from those exposed. Four of these in due time developed small-pox, the others, being vaccinated, developed varioloid. About a week after their removal to the pesthouse I visited Wm. Dawkins, colored, and found him with small-pox. He had come by rail from an entirely different region--Joliet, Illinois. He, too, was removed to the pesthouse. The family with whom he was boarding, six persons, were not removed, but vaccinated and rigidly quarantined in their home. None of these developed the disease, though one of them had slept with the patient. There were in all eight cases, five of whom had small-pox of severe type, and three had severe varioloid. There were no deaths. The treatment adopted was quite simple and entirely symptomatic and supportive, with scarcely any stimulation. The total cost of the epidemic was nearly $1,700, and was borne by the county. The prompt removal of the cases and those directly exposed, and the rigid quarantine observed, gave such complete control of the situation, the loss to business was practically nothing. The last cases were discharged April 15, sixty days after the first appearance of the disease. The City Council passed a compulsory vaccination ordinance,
which was thoroughly carried out. There was one singular circumstance happened during the epidemic-namely, I saw two cases (and there was one I did not see) of unmistakable varioloid, at different points in the city, and apparently entirely resulting from vaccination, as I could find nothing to awaken the slightest suspicion that either case had been exposed to any case of small-pox. These cases were also quarantined, for I considered them quite competent to convey true smallpox to unvaccinated persons. This opinion may be in conflict with accepted theories, but I was not willing to take the risk of that situation, and it is just in this way that I think small-pox has been sometimes perpetuated. But as it is not the province of this report to controvert present theories or to introduce new ones, I am content to dismiss the subject. If there are any late acts or decisions affecting the duties of Boards of Health I would be glad to have them.
Jackson, Ky., Aug. 8, 1898. State Board of Health, Bowling Green, Ky.:
Gentlemen: I was to-day called to see a man who is under the care of another physician that ten days ago came from Hot Springs, Ark. On the night of the 6th he had an eruption appear on his face, head, etc. To-day I find him without fever, but the forehead, face, nose, lips, soft palate, palms, etc., broke out with numerous papilla. No fever. Four or five days before this he says he felt lazy, languid, etc., having night sweats and a little chilly before the eruption took place; a little sick at the stomach at times. Throat a little sore now. Has never been vaccinated. The attending physician stated to him the trouble came from his stomach, and to me he made no statement of the cause when I called on him at his office. While in Hot Springs the patient states they had small-pox there. He also came via Little Rock, where they have it. I am not sure, as I have never seen a case, but I firmly believe he has small-pox. I would like for you to advise me about the matter or come up at once. Hoping to hear from you soon, I am
W. G. DAILEY, M. D., Member County Board of Health.
Jackson, Ky., Aug. 11, 1898. State Board of Health, Bowling Green, Ky.:
Gentlemen: I was more than sorry when you stated in your message to-day, "No one available or necessary. Isolate and vaccinate thoroughly.” There are a few people who yet say it is not small-pox, and if you will come or send some experienced man we can then end any dispute and stamp the disease in its infancy. The man was on the town up to Saturday, and broke out some on forehead and scalp Sat
urday night, and for three or four days previous to this guarded the jury. Now, are these jurors suspects, and are the people who he was with Friday and Saturday liable to acquire the disease? Outside of this we have about twelve who were with him Sunday; one of this number slept in the room with him Sunday night, and five others, or rather five out of the twelve are yet at the house in which he was taken. Myself and Dr. Redwine are added to the twelve above mentioned. I was last vaccinated in March of this year, and had only a little pustule; revaccinated myself as soon as I left the patient. Am I apt to be a victim or not? Should I go to the house of detention? How about the others I have mentioned? The county judge this evening 'most refused to build a place to hold the suspects, and if he should what can we do? His idea is to use the house in center of town where the first case occurred for a detention house, but my, it is in the center of town. Now, you say it is not necessary to come. I will ask you to please tell me why it is not. We are all inexperienced, and if you will come to our relief we can stamp the disease out at once. We are in distress and feel you are doing us an injustice in not coming. We, your officers here, are working in unity, but we are laboring under great difficulties, and unless we can get matters better arranged the whole county will be affected. I forgot to mention the Institute was also in session this week. Now, will you aid us with your appearance or some specialist, or shall we labor on under the difficulties and suffer the result? I hope it is your duty to come, and that as such you will do it. Let me hear from you at once.
W. G. DAILEY, M. D., Member County Board of Health.
Jackson, Ky., Aug. 10th, 1899. State Board of Health, Bowling Green, Ky.:
Gentlemen: In reply to your favor of the 8th, will say we had only one case of small-pox here. The eruption was complete. I visited him on 7th, 8th and 9th of August, '98; the eruption had been developed four or five days before he was isolated. It seemed to be a mild case. The actual cost to this county was about $100. Cost to patient about $100. Loss to business eight hundred or a thousand dollars. Something like two-thirds of the people here were vaccinated.
J. S. REDWINE, M. D.,
County Health Officer.
Early in March, 1899, a railroad employe whose run was between Lebanon Junction and Corbin contracted small-pox, probably in Louisville, where it had existed for months, and came down with it at his father's home in Williamsburg, his father being an undergraduate physician, practicing under the time limit and examination clause of the medical law. The disease was not recognized as small-pox, and, as soon as he was able to travel, after communicating the disease to his family, he returned to his brother's at Lebanon Junction, covered with scabs, bringing the disease to them, as well as to several of his fellowemployes.
As has been the case throughout the epidemic, most of the cases were mild, patients being quite ill usually until the eruption appeared, and then in a few days feeling well enough to walk about, having little if any secondary fever, many of the cases not even sending for a physician. Quite a number of cases occurred and the disease had been carried from this point to Horse Cave, Corbin and into Nelson county before this Board received information that anything suspicious was there.
One of our most experienced inspectors was sent at once, but he was unable to induce either the town or county authorities to take any interest in the matter, although he found a number of cases well marked, in the contagious stage on the street and lounging about the depot platform. As Lebanon Junction is the end of the Knoxville Division of the L. & N. Railroad, where many of the employes get their lay-off, and, as the principal boarding-houses were within thirty feet of the stopping place for many of the passenger trains, it is an important town from a small-pox standpoint. The executive officer went to the place in person, upon the failure of the inspector to interest the authorities or people, and he was equally unsuccessful, although he had learned in the meantime that the disease had already been carried from this point to Horse Cave, Corbin and into Nelson. He met one man on the street, starting off with a fishing party, who was covered with scabs; and found that others had been going about in the same manner, and that a majority of the people and officials could not be induced to adopt any efficient measures either to stamp out the disease in the town or for the protection of the traveling public, which was more or less constantly exposed while trains stood at the depot for the transfer of passengers.
Believing that the conditions existing there so seriously endangered a large portion of the state as to demand immediate action, this officer took the first train for Louisville, calling a meeting by wire, and the following was at once issued:
SMALL-POX AT LEBANON JUNCTION.
Proclamation by the State Board of Health.
Bowling Green, Ky., April 17, 1899. Whereas, It has come to the knowledge of this Board that smallpox is epidemic at Lebanon Junction, Bullitt county, Kentucky, that practically all the inhabitants and railroad employes at that place have been exposed to said disease, and that very many of them are not only unprotected by vaccination, but appear not to appreciate the importance of this and the other recognized precautions to be used against this disease, and,
Whereas. The conditions and railroad connections at this place are such as to endanger the health and business interests of a large portion of the state;
Now, therefore, Be it Known, That the State Board of Health, in the exercise of the authority vested in it by law, hereby declares the town and suburbs of Lebanon Junction, and each of the inhabitants thereof, temporary and permanent, to be in quarantine, and, under the pains and penalties of law, forbids any person to enter or leave said place, or to approach near any railroad train or depot ground, or the
reception or discharge at this place by any train of any passenger or employe, without a special permit from this Board, and forbids any person afflicted with this disease to go upon or near any street, alley or other public road or way. This quarantine to be in force from this date until raised. By order of the Board.
J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.
Louisville & Nashville Railroad Company,
Louisville, Ky., April 22, '99.
Bowling Green, Ky. Dear Sir: As per arrangements made while you were here April 17, we have run our Knoxville Division trains into and out of Louisville, required every employe at Lebanon Junction and on both main line and Knoxville Division to be vaccinated, and they are not allowed to go out on their run without showing certificate to this effect. Have special watchmen at Lebanon Junction to prevent the people at that point from coming in contact with trainmen and passengers, and we are not handling passengers to or from that station at all. The agent advises me this morning that there is only one case of small-pox now under treatment, the others having been dismissed from treatment by the doctors, but as an extra precaution they are kept in out of the way. When we run our train crews into Louisville, you know it paralyzes the business of Lebanon Junction, and on this account the people there have been very active since the quarantine was put in force to wipe out the disease and prevent its spread, and the fact that everybody has been vaccinated by your instructions is no doubt the cause of the present condition of affairs. Running the crews through to Louisville as at present is exceedingly expensive, and just at this particular time it is crippling us in another way; that is, causing a shortage of power to handle the business on the Knoxville Division on account of the time lost by the engines and crews coming on into Louisville with their trains, and then getting their trains to go back to the Knoxville Division with. Heretofore, we handled this additional freight on regular trains between these two points.
The C. N. 0. & T. P. have a bridge down on their line, and on this account are turning a number of trains over to us at Junction City to be handled to Jellico, and giving us others at Jellico to be handled to Junction City, and this extra business, coupled with the regular business, makes the power question a serious one.
As stated to you here in the office, we want to work hand in hand with you in getting rid of the contagious disease; in fact, we would not want to run any risk of spreading the disease even if there were no re. strictions placed around us by your proclamation, but, as explained in the beginning of my letter, so long as every one of the employes have been vaccinated and hold certificates to that effect, and as there is only one case reported under the care of a doctor at the Junction, do vou not think it would be entirely safe for us to resume turning our crews