that was alone I moved it to a house where there were other cases, and paid the family so much for care, etc. Under this plan I found that I could dispense with guards in a short time, and also solved the nurseand-board problem without any trouble and very little cost, as most of the cases were mild, and some of a family were always able to wait on the others. Most of the families had something to live upon, so I had but very little expense in that line; whereas, in a pesthouse we would have had all the expense of nursing and board and furnishing the house. The outbreak lasted until the 20th of September, 1898, when at that time all cases were well, houses were disinfected and cleaned up, old bedding and clothing burned, and every precaution had been taken to prevent it again breaking out. I had forty-two cases with two deaths in little, feeble children who had complications. I had six cases of a confluent form, one case of varioloid and the remainder were of a discrete character, some of them showing the form distinctly, and were most interesting cases to study, showing the different forms and stages most beautifully.

The total cost in managing this outbreak was $1,584.56. The estimated cost in loss of business would be hard for me to come at. I would say about $1,500. I put it at that amount, because some, or many of the people, had no business and would not have been engaged anyway. I vaccinated about three hundred people, and 90 per cent of them were successful.

In making this report I wish to acknowledge the assistance of Dr. J. N. McCormack, representing the State Board, and also my county officials, and Drs. Manning, Sandlin and Phillips, of this county.

State Board of Health, Bowling Green, Ky.

Gentlemen: Yours with inclosed from Auditor Stone received. As formerly stated to you, one case did occur in the county. The Health Board made report of it to fiscal court. After consultation the court turned the case over to the Board with full and absolute control. They immediately purchased an old house, moved the case into a tent within fifty yards of that house, put an immune nurse with him-those of his household with whom he had come in contact were removed to the old house adjoining the tent. Every article in the original house was burned, and thoroughly disinfected the walls, clean clothing supplied them. An old man, father of the patient, sister and two children, all were vaccinated and a guard stationed to completely isolate them. The patient is convalescent and will soon be well enough to clean up; but within nine or twelve days the father, the sister and one child had varioloid, and the other child is now a suspect. This constitutes the full report of the county. No other cases; no county excitement.

Now for the town. There has been but little doubt that for the past three weeks there have been cases of small-pox in the town. The case in the county was a town negro, servant of Judge Holt, lived in his family and slept in his house; was sick for a week, drove the carriage with the fever and headache and backache. Mrs. Holt said to judge:

"Tom is sick. I think he is going to have fever. Send him to his father's; don't want him sick here with a spell of fever.' He went to his father, and I have given you the rest. But that was Thursday, did go to his father, came back to town Saturday-the eruption was then well out-back to country and to a negro meeting on Sunday; back to town Monday, home in country Tuesday. The cry then raised and the fiscal court notified Wednesday, but not until the next second day was the case turned over to the Health Board with full power.

Now to Col. Stone's case. Monday was county court day. The negro was well broken out; had been sick for several days. He was on the streets all day; town full of country people. Saw and was close to numbers of country people and as many town people. On Tuesday morning he came out on the street. Was on Main street, near the courthouse. The magistrate saw him, ordered him off the street; made him sit down in the corner of yard, telephoned me. I took the doctor (Price), whom we have employed for the county patients. He pronounced it small-pox. Five other doctors saw it. All agreed with Price. I notified the mayor, and to accommodate the mayor I procured a room, then bought a pair of cheap blankets, poured over them a bottle of Platt's chloride. Price took them, wrapped the negro in them, and a policeman marched him to the room where a small-pox case was convalescing, and I had Price put up a yellow flag. While I was out another case was reported, and Price went to see that patient. He pronounced it smallpox, and put up another yellow flag. We returned to mayor's office. I notified him of what we had done. I called a meeting of the Health Board and they indorsed my action. This brings up to Tuesday noon. Wednesday noon I called on the mayor and told him that I gave him official notice that small-pox existed in the town, and unless some action was taken immediately I would telegraph the State Board. He said he would see his Health Committee. Afterward a council meeting was called. Dr. Hume and Dr. Chinn, the members of the Board of Health, met them, told them small-pox existed, and demanded immediate action. After much wrangling, in which the chairman of the Health Committee said there was no case of small-pox in the city (the county judge had said the same thing to the Board the morning of that day, and further said that no case was in the city or county, and had not been for five years); also another member of the council declared no case existed in the city. But after the committee, through one of its members, declared he would not serve on the committee without the aid of the Board, and the Board being present declared they would not assume control unless the council surrender the absolute and entire control to them. A resolution was passed satisfactory to Dr. Chinn and Dr. Hume, and that night (Thursday) the Board was placed in charge. Immediately began a most rigid effort to secure a location for small-pox hospital tent, and at the end of forty hours notified the council it was impossible to secure a place, and asked that legal measures be taken to secure such place. And now at this meeting, 3 p. m., Saturday 8th, we have been notified of no definite plan, but in few hours hope to be furnished suitable place. In the meantime we have examined all reported cases, and have flagged five points in the city. Three others will probably be flagged to-day. At each flag a special guard is placed day and night. All egress or ingress stopped.

One case was the child of a councilman, the chairman of the Health Committee, who opposed the Board and declared no case existed in Frankfort. The child was that moment broken out. Dr. Ely, Dr. Hume, Dr. Chinn and Dr. Duvall all saw it, pronounced it small-pox, ordered a flag put up. It was threatened by the councilman to pull it

down, but the flag was put up, and he was told at his peril to pull it down. It still waves and a policeman stands guard over it. We do not have the support of the county judge, not all the council, nor very many of the substantial citizens, but the case is assuming such proportions as the better class in large numbers are coming to our relief constantly, and within the next forty-eight hours we doubtless will have the disease in proper limits, all cases flagged and guarded. If hospital furnished us we will remove the cases to-night, and make this our official report to your honorable body up to 3 p. m., July 7, 1899.

W. V. WILLIAMS, M. D., Chairman,
E. E. HUME, M. D.,

G. W. CHINN, M. D.,

County and City Board of Health.

REPORT OF BOARD OF HEALTH.

Frankfort, Ky., October 2, 1899.

To the Hon. J. D. Moore, Judge of Franklin County Court:
To the Hon. W. S. Dehoney, Mayor of the City of Frankfort:
To the Honorable the Fiscal Court of Franklin County:
And to the Honorable the Common Council of the City of Frankfort.

Sirs: The undersigned, the Franklin County Board of Health, appointed by, and auxiliary to, the State Board of Health, beg herewith to present to your honorable bodies, most respectfully, their report of the recent outbreak of small-pox in the county of Franklin and city of Frankfort. From the best information obtainable we are of opinion that the initial case was imported into the city and county by visitors from the military camp at Lexington during the occupancy of that city by Federal troops, during the summer of 1898. Occasional sporadic cases, at intervals for several months, appeared thereafter, which were overlooked because of error in diagnosis, mainly caused by the very mild type of the disease.

The first alarming case occurred on June 13, 1899, in the county, in the person of a negro employed in Frankfort, but whose parents resided in the county, who, becoming ill, was removed to the country home of his parents, from which place the first note of alarm was sounded. He, with his entire family, were isolated in a secluded locality, where all the family of five subsequently were affected, none of whom had been successfully vaccinated, four of the number had never been at all.

On July 4th, subsequently, the first pronounced case was publicly known in the city in the person of a negro man, who, when thoroughly broken out, had been on the street during county court day, and had endangered a very great number of persons. Up to this time the fiscal court had turned over the management of the situation to the County Board of Health, and within a few days thereafter the council of the city also requested the Board to take charge of the city's cases. soon as possible a location for an eruptive camp was leased and well supplied with tents, cots and all necessary appliances, and all cases were taken to the camp, and all suspects were removed to a detention A compulsory and general vaccination of the city was ordered and rigidly enforced, and all infected points in the county were likewise

camp.

As

vaccinated, which from that time was as faithfully observed in the county as was required in the city.

These and all other needed regulations were instituted, and the Board of Health desire to return their thanks to the fiscal court and common council for their hearty co-operation, courteous treatment and able assistance in so speedily stamping out the disease. Also the Board desire to especially return their thanks for, and appreciation of, the valuable services of Mr. James H. Graham, the executive officer, who volunteered as general manager of suspects and transportation of patients and suspects. We wish to acknowledge valuable services rendered the Board by Dr. Alvin Duval and Dr. John Graham, as city physicians, who were untiring and faithful in the performance of their duties, and to Mr. Lyman S. Graham, city inspector, for efficient work done as sanitary officer. Also to Mr. Morgan Brawner, who had charge of disinfection. He visited all premises in the city and made requisition of every detail necessary to put the city in a proper sanitary condition, which has been complied with, except such cases as have been reported to the mayor.

To the ladies of the King's Daughters too high praise can not be accorded. To them the city and county are largely indebted, pecuniarily for clothing furnished the 138 persons leaving the hospital. The Board would most earnestly recommend that, inasmuch as their resources have been entirely exhausted by their supplying so many needed articles, the city and county make them such allowance as may seem just and proper.

Also to Dr. John South, who was placed in charge of the hospital camp, and whose services were continuous, day and night, from the first day until the end was declared, embracing a period of sixty-three days and nights (never once leaving the camp), whose report of the details of the camp, made to the Board of Health, is hereby submitted and made a part of our report to your honorable bodies.

Every infected point in the city and county was thoroughly disinfected with formaldehyde, crude carbolic acid, sulphur and chlorides as were best suited to the requirements of each individual case-preference for formaldehyde, both for effectiveness and economy, as well as prevention. All clothing and bedding of patients were disinfected or burned, and no pains, care or expense was spared to make the work well up to the most improved methods.

On breaking camp a complete inventory of all belongings was made, which is also made a part of this report. Worthless articles were burned and all others were thoroughly disinfected and stored in a box house on the grounds, prepared for the purpose, the future disposition of which is for your honorable bodies to decide. The Board would suggest that the camp grounds and appliances be maintained for a suitable length of time to insure against a subsequent outbreak if such a condition should arise.

The Board of Health further most respectfully suggest that a committee from the fiscal court, and a like committee from the common council, be raised to act with the Board of Health to justly assess the amount of expense which should be charged up to the city and county, respectively.

All of which is most respectfully submitted by

U. V. WILLIAMS, M. D., A. M.,

Chairman Franklin County Health Board. E. E. HUME, M. D.,

GEO. W. CHINN, M. D.,

Secretary Franklin County Health Board.

Frankfort, Ky., September 24, 1899. To the Boards of Health of Frankfort and Franklin County-U. V. Williams, E. E. Hume, Geo. W. Chinn.

Gentlemen: Having been honored by you in being appointed as physician in charge of the eruptive hospital of the city and county, I now take pleasure in submitting to you the following report:

The grounds were secured by great efforts on the part of the mayor and members of the council, and the first two cases of small-pox were removed from the city on the night of July 10th. All others, who were so unfortunate as to have contracted this terrible and loathsome disease, were, by you and your valuable assistants' untiring efforts, speedily removed from the city and county to the eruptive camp. I think you will see the wisdom, from the appended statistics of the camp, of two things in particular that were done according to your advice. I refer to the compulsory vaccination in the city, and the removal to the camp of detention of all persons who had been exposed to the disease.

Number of cases that broke out in detention camp, white
Number of cases that broke out in detention camp, colored

Number persons with true small-pox who had never been vaccinated

51

Number persons with true small-pox who had been vaccinated, but showed no mark