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Middleburg, Ky., October 20, 1899. State Board of Health, Bowling Green, Ky.

Gentlemen: Small-pox prevailed in the western part of Casey county, near the lines of Marion, Taylor and Adair, from the latter part of July to September 15, 1899, when all quarantine restrictions were lifted and the infected premises disinfected.

A diagnosis of the disease was not made until August 10th, when the fourth person was so seriously ill that he demanded the close attention of a physician. As the different stages of the disease appeared a diagnosis was readily made and warning given to the surrounding community, and a notice sent to the chairman of the county Board of Health.

Steps were immediately taken to prevent the spread of the disease and to care for those infected. All who had been exposed were placed under quarantine restrictions. The disease was confined to three private residences, and the temporary pesthouse, which was erected in the infected district. However, seven families were represented in full or in part. The epidemic is justly believed to have originated at Lebanon, Ky. It was mild in character, and it was difficult to make the laity (who did not see the patients, but heard of the mortality), believe that it was really small-pox. This, with other erroneous hearsays as to the dangers of vaccinations, made it difficult, and, in fact, impracticable to comply with the order of the county Board of Health, general vaccination throughout the county. This was the only difficulty met with during our earnest but successful efforts to put down the dread malady.

The total number of cases was twenty-six, with but one death. This one, a child five years old, had the discrete hemorrhagic variety. Five cases were confluent; the others discrete or of the varioloid character. Three of the number had been successfully vaccinated in 1862. Two of these had varioloid; the other confluent small-pox.

The attending physician, Dr. Hood, who had never had a successful vaccination, inoculated himself and had the discrete variety, which run a more rapid course. Two had their vaccination to take effect with the disease, each successive stage was shortened and the disease was very mild.

Our experience goes to prove that the disease is far less contagious than generally supposed by the laity and doctors. The total cost to the county is about $1,000.

Very respectfully,
J. T. WESLEY, M. D.,

County Health Officer.

CHRISTIAN COUNTY.

Hopkinsville, Ky., May 21, 1898. State Board of Health, Bowling Green, Ky.

Gentlemen: Your inspector, Dr. Arthur T. McCormack, has doubtless reported to you the case he saw here yesterday in company with Dr. T. W. Blakey. Dr. McCormack was of the opinion that it was a case of small-pox, and, acting upon his suggestion, we have taken every step we could to prevent any further trouble. We placed a guard at once over the house and hung out the usual sign. The tents ordered have not arrived, otherwise we would have had the patient and those exposed removed to proper quarters.

In the morning we will have temporary buildings put up for them until the tents arrive.

The suspected case was located this evening, and I visited at 6 o'clock. His name is William Whitfield, colored, age, 16; works in tobacco factory and lives in same part of town as the other patient. He showed no evidence of sickness until yesterday at 9 a. m. At that time the eruption appeared upon arms, face, scalp and shoulders mostlyscarcely any eruption upon legs or abdomen. Says he has had no headache, backache, rigors or fever, and that he feels as well as he ever did. Pulse 72; temperature 98 1-2, and on inspection presents no evidence except the eruption of being a sick man. I think it is a case of varicella. Have reported the case to Drs. Blakey and Stites, and one of them will see it with me in the morning. I failed to say that I saw the girl with small-pox at 4 p. m., and I think she is much better. Pulse 100; tem perature 101, and has taken her food because she had a desire for it. We were very glad to have Dr. McCormack with us, and appreciate his coming so promptly. Of course, we recognize your right to direct us in this matter, and it is only necessary to say that we intend to make a very honest effort to carry out your instructions.

Yours very truly,
H. H. WALLACE, M. D.,

County Health Officer.

Hopkinsville, Ky., May, 24, 1898. State Board of Health, Bowling Green, Ky.

Gentlemen: The members of the Christian County Board of Health met this morning, and with them the mayor and county judge. It was agreed for the following reasons not to remove patient with small-pox, and those in the house with it, to camp until another case occurred, for the following reasons: Until to-day we have had heavy rains every day for several days. The patient's condition is such that her removal to a wet camp would lessen her chances of recovery; moving her would increase the danger of infecting others, and last, but not least, hoping that this will be the only case, the county and city will be saved much expense.

It was decided to continue a strict guard over the house until the period of danger was past, and, after properly attending to inmates to burn house and everything in it. Dr. Blakey visited the suspected case this morning, and states positively that it is not small-pox. The patient who has it is doing very well. The tents are here, and the Board returns its thanks for them, and if not used will return them. With kindest regards to Dr. and Mrs. Arthur McCormack, I am

Yours very truly,
H. H. WALLACE, M. D.,

County Health Officer.

THE 1899 SMALL-POX EPIDEMIC IN CHRISTIAN COUNTY.

Hopkinsville, Ky., November 4, 1899. State Board of Health, Bowling Green, Ky.

Gentlemen: On July 14, 1899, a case of small-pox was discovered on a farm 4 1-2 miles from Hopkinsville. I was appointed by the Board of Health and the county judge to take charge of the case. I called to see the case on the evening of July 14th, and found a typical case of variola.

Dr. McCormack, of Bowling Green, was telegraphed for, and he and myself began a series of investigations in the surrounding vicinity, and found four more cases existing. This was reported upon our return to the city, and upon the advice of Dr. McCormack we immediately took steps to establish a pesthouse.

Upon investigation I found that an eruptive disease had existed in a colored settlement close by for several weeks, which was undoubtedly small-pox. But as a majority of the cases had been vaccinated they, of course (that is, most of them), only had varioloid. All parties that had taken the disease were colored. This fact was the source of a great deal of annoyance, for many of the laity were inclined to believe that it was not small-pox, but some loathsome negro disease. Since, however, the disease originated with a colored man who came to the | county, the chances were that the disease would be confined to that

race, owing to their close association and intermixing, provided the whites took the proper precautions, which they gladly did.

Another difficulty encountered in endeavoring to check the epidemic was the small mortality rate. Since the mortality was so small the people were inclined to be a little less cautious than they should have been, especially the colored race. I lost no cases.

As I have already stated, we ordered tents and established a camp, thus bringing all the cases of small-pox in one place, and also a camp of detention for those that had been exposed to the disease. The immediate vicinity was also thrown under a rigid quarantine for a period of three weeks. We had two deputy sheriffs to patrol the exposed district and see that the quarantine was observed. We also had guards stationed at our camp.

Owing to the class of negroes I had to deal with, I found it very difficult to get the names of all persons exposed to the disease. Nearly all facts ascertained in this line was through detective methods, in which I was ably assisted by one of my guards. Other cases were discovered in the country later, which were immediately brought to camp, together with all the exposures. All persons in Hopkinsville were ordered vaccinated, and all in the vicinity of the epidemic were also ordered to be vaccinated. The vaccination in the country I attended to myself, as far as my time would permit.' The majority of the vaccinations were successful, especially where I used the tubes, nearly every tube vaccination being successful.

I had eight or ten cases of varioloid in camp, which were exceedingly mild in character. The cases of small-pox, between twenty and thirty in number, were typical in reference to eruption and symptoms, but the constitutional symptoms in majority of cases were not severe. The disease began with fever, headache, intense backache, sore throat, conjunctival injection, etc.; fever ranging from 102 to 105. These symptoms continued three days, when the eruption came out. The eruption then ran through its several stages of papulation, vesication, pustulation, desiccation, etc. After the eruptive stage the symptoms abated until stage of pustulation, when they again became severe. Complications during the disease were numerous, the most common being oedema of ankles and lower extremities. This complication was very common in those past middle age. I also encountered two abortions. The children, of course, were still-born, but both mothers survived and rapidly recovered. I anticipated, or rather feared, septic poisoning in both cases, but luckily escaped it. I had considerable hemorrhage in one case, owing to an adherent placenta. However, I managed to detach it, which was immediately followed by its expulsion, the contraction of the uterus and stoppage of the hemorrhage. I also had one case complicated with abscesses. This patient had about twenty-five or thirty abscesses; mostly on his lower extremities and arms, but also a few on his body and neck. I incised each one of these separately, which was followed by an immense outpour of pus. As the patients recovered they were given a corrosive sublimate bath, a change of clothing, a certificate of discharge and then turned out of camp.

All houses ever occupied by a small-pox case were either burned or thoroughly disinfected by me. I used strong corrosive sublimate wash for floors and walls and sulphur fumigation. All articles in the room that could not be thoroughly disinfected were destroyed, after being appraised. The negroes always endeavored to get more than the appraised value for their property destroyed.

The total cost to the county in this epidemic, extending over three months, was in the neighborhood of $5,000, including everything-physicians, guards, food, clothing, tents, bedding, etc. The cost from loss of business was very small, as it was in the country districts. I think $2,500 would cover it.

J. W. HARNED,

County Health Officer.

CLAY COUNTY.

Manchester, Ky., July 30, 1898. State Board of Health, Bowling Green, Ky.

Gentlemen: The situation has not changed much since you were here. Some of the suspects have contracted the disease. Most of the others are convalescing. I think we will be able to control it right away. Two of my cases, I think, will die--the old lady and the infant. It is pretty hard to make headway against so many fools and hard-headed people, and nothing less than a good case of small-pox with some of them will do any good. I have not been able to get the situation at Jackson lately or since you were here. I understand there were three more cases in northern part of Laurel county, quite remote from the original neighborhood of the previous breaking out. Will write you again shortly.

Yours truly,

J. R. BURCHELL.

Pigeon Roost, Ky., August 16, 1898. State Board of Health, Bowling Green, Ky.

Gentlemen: I am still looking after the small-pox here, and am pleased to let you know that the most of the cases are well on the road

to recovery, and I think by the middle of September I will have everything cleaned up. I have two new cases among the inevitables and inside of the boundary of the quarantine. I have had thirty-six cases up to this time outside of the suspects; some very interesting cases, from varioloid to several confluent forms. I have one very remarkable case a young man twenty-six years of age, who broke out in blisters from the size of a ten-cent piece to large ones eight or ten inches in diameter. These were filled with serum, and in these blisters were the pustules, well developed and approaching the confluent form. He is suffering a great deal from that burning sensation that follows the rupture of a large blister from a burn. I have gotten many a cursing behind my back from the people who taboo the idea of small-pox. Many, however, are being convinced of the genuineness of the disease, and have ceased to disturb me with their talk. One gentleman's idea of small-pox was that when a man had small-pox he was in a hell of a bad fix, and as no one had been in that condition, therefore there had been no smallpox. I will be glad to make a full report to you when I wind up.

Yours truly,

J. R. BURCHELL.

Manchester, Ky., August 8, 1899. State Board of Health:

Gentlemen: In accordance with your request I beg to transmit herewith a condensed report of the outbreak of the small-pox as it occurred in Clay county in 1898. Rumors of the prevalence of small-pox in some of the adjoining counties, and also at Richmond, Ky., reached us at different times, but being off from the railroad some distance, our people and authorities gave the matter very little attention until sometime in May. A young girl of bad reputation passed through the county, stopping at several places. So, soon after she left persons at whose houses she had stayed and come in contact with began to break out with chicken-pox, as they thought, until the disease began to spread to an alarming extent, developing some very bad cases, though no fatal ones; also the same state of affairs began to develop in Laurel county. The State Board of Health got information of the state of affairs, and sent Dr. Smock, of Louisville, to investigate and ascertain if there was any small-pox in Laurel and Clay, and also what was being done to stop it. That it was really small-pox was too true, and nothing had been done to stop it. A meeting of the county officials was called, arrangements were immediately made to check the spread of the disease and stamp it out if possible. I was appointed health officer to take complete control of affairs, and ordered to use my best judgment in managing the outbreak. This I did, and was on the ground near the center of infection July 14th, and found that twenty cases had already developed and were in different stages of the disease. My acquaintance with the people and their peculiarities aided me a great deal in controlling the disease. The epidemic was scattered over considerable territory, and the question of a pesthouse at one point I knew would be out of the question, and as the population was scattering, I simply kept each family and locality to itself, placing guards on the roads communicating with each neighborhood where the disease was, not so much to keep the people at home who were infected, but to keep others out. The guards were withdrawn after a short time, or when the people got to understand what I wanted them to do. In the care of an isolated case

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