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under trying circumstances. This is notably true of such authorities of the counties of Warren, Webster, Woodford, Jefferson, Shelby, Mercer, Madison, Hardin, Christian, Harrison, Fayette, Mason, Boyd, Scott, Henry, Laurel, Breathitt, Clark, Barren, Livingston, Nelson, Clay, Owsley, Jessamine, Johnson, Monroe, and probably several others which did not come under the direct observation of the Board. Repeated outbreaks occurred in most of these counties, and in several instances the disease gained a strong hold, but the prompt and intelligent cooperation, moral and financial, of the fiscal officials with the health boards usually made it possible to bring the disease under rapid control.

Taking Warren county as an example, as it is located on the main lines of travel, and especially exposed, it will be seen that there were seven distinct importations of the disease into the territory outside of the city of Bowling Green, but the disease did not spread outside of the initial family in any but one outbreak, and that but twelve cases occurred in all. The total cost of this management, extending over four years and including 2,370 vaccinations was about $1,250, not including the annual salary of the county health officer. Such results would not have been possible without a wisely liberal fiscal -court to bolster up the health officials, and pay guards, nurses and other expenses as they are incurred. Similarly, Owsley county, located off from the lines of travel, but with smallpox in abundance in every adjoining county, kept the disease out entirely, not having a single case. Management -of the kinds mentioned is ideal.

SMALLPOX REPORTS FROM COUNTIES.

Adair County Board of Health: Dr. U. L. Taylor, Dr. W. T. Grissom, Dr. William Blair, Dr. Z. T. Gabbert .

Columbia, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had two outbreaks of smallpox in this cunty, in the following districts or precincts: Roley and Gradyville, with a total of one hundred and twenty-five cases and one death. No hospital or pest house was provided near the infected places, and the following was our method of management: All persons who had been exposed, were served with a written notice to remain on their own premises for twenty days, and the county attorney was directed to institute legal proceedings against any whowould violate it. In the Casey Creek outbreak the disease was confined to the two families in which it first made its appearance, but inthe Gradyville outbreak it was scattered all over that country before the Board of Health was notified, but it was suppressed in a short time, county since the first cases occurred, that four thousand has been previously vaccinated, out of a total population of fifteen thousand, leaving ten thousand now unprotected.

The disease was brought to this county from Marion county; it was in one case not promptly recognized until many had been exposed. I estimate that 1,000 vaccinations have been done in the county since the first case occurred, that 4,000 had been previously vaccinated, out of a total population of 15,000, leaving 10,000 now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $600. The estimated: cost to the county in loss of trade and interference of business has been $1,000.

Our chief difficulties in stamping out the disease were: Want of prompt co-operation by the county court, and everlasting talk and denial of the existence of smallpox by persons who had never seen a case, would not see a case, and if they had seen a case, could not have told it from a Belgian hare. Many smart people who were made to believe that some curious disease was abroad in the land, claiming it was "Cuban itch," "chickenpox," or anything in the world but smallpox. Very respectfully,

U. L. TAYLOR, M. D., Secretary.

Allen County Board of Health: Dr. A. L. Wagoner, Dr. W. B. Ray, Dr. Marcellus Whitney.

Scottsville, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had one outbreak -of smallpox in this county, in the following district: Alexandria, with a total of three cases and no deaths. No hospital or pest house was provided near the village, and the following was our method of management:

1st. Strict quarantine. 2d. By vaccinating all who had not been vaccinated within six years. Our county attorney gave us all the aid at his command. The fiscal court also wab ready and willing to give their help. The county judge was unruly and raised the quarantine before we disinfected.

The disease was brought to this county from Tennessee; it was promptly recognized, after only a few had been exposed. I estimate that 200 vaccinations have been done in the county since the first case occurred, that few had been previously vaccinated, out of a total population of 14,657, leaving about 95 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $300. The estimated -cost to the county in loss of trade and interference of business has been $1,000.

Our chief difficulties in stamping out the diseases were: Several physicians who claimed that it was not smallpox, who by their influence made vaccination difficult—and the lethargy of the people in general. Very respectfully,

A. L. WAGONER, M. D., Secretary.

Anderson County Board of Health: Dr. C. A. Leathers, Dr. G. E. Davis, Dr. F. B. Powers.

Lawrenceburg, Ky., July 15, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had four outbreaks of smallpox in this county, in the following districts or precincts: All in Lawrenceburg precincts, except one in Tyrone, with a total of nineteen cases and no deaths. One hospital or pest house was provided near Lawrenceburg, and the following was our method of management: That immediately upon discovering the malady was smallpox, we established, without any co-operation of county or city authorities a pest house, hospital, and house of detention, and placed a physician, nurses, guards, and attendants in charge. Four cases were first discovered, and out of house of detention ten cases subsequently developed.

The disease was brought to this county from Louisville by a negro boy; it was promptly recognized after a few had been exposed. I estimate that 2,000 vaccinations have been done in the county since the first cases occurred, that 4,000 had been previously vaccinated, out of a total population of 10,051, leaving 4,000, or about 40 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases, which have occurred in the time named has been $4,500. The estimated cost to the county in loss of trade and interference of business has been $10,000 or $12,000.

Our chief difficulties in stamping out the disease were: In not being prepared to meet the emergency, and not meeting at the first outbreak, with the hearty co-operation of the county officials. Since the courts have defined the duties of the Health Boards and the liability of citizens and counties, we have had the hearty co-operation of our county officials, and are now in shape to handle another outbreak, with much less expense to county.

C. A. LEATHERS, M. D., Secretary.

Ballard County Board of Health: Dr. N. L. Rogers, Dr. J. C. Dupoyster, Dr. W. T. White, Dr. J. A. Watwoods.

Wickliffe, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had four outbreaks of smallpox in this county, in the following districts or precincts: Woodville, Barlow, and Wickliffe, also Blandville, with a total of seventy-five cases and no deaths. One pest house was provided near Wickliffe, and the following was our method of management: Vaccination and isolation, and among the negroes and unruly whites guards to do patrol duty and keep suspects indoors.

The disease was brought to this county from Missouri and Illinois, or from boat people on river; it was promptly recognized, after a number had been exposed. I estimate that 300 vaccinations have been done in the county since the first cases occurred, that 4,700 had been previously vaccinated, out of a total population of 10,000, leaving 5,000, or 50 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $1,000. The estimated cost to the county in loss of trade and interference of business has been $5,000 to $10,000.

Our chief difficulties in stamping out the disease were: In getting the people to do what we wanted of them, a great many not believing it to be smallpox on account of mildness of disease. Our county judge rendered us very efficient service and spared no means to stamp it out. Very respectfully,

N. L. ROGERS, M. D., Secretary.

Barren County Board of Health: Dr. J. S. Leech, Dr. R. E. Garnet, Dr. F. J. Taylor.

Glasgow, Ky., July 19, 1901.

To the State Board of Health:

Gentlemen: "Within the last four years we have had two outbreaks of smallpox in this county, in the following districts or precincts: Glasgow in colored settlement, with a total of eleven cases and no deaths. No hospital or pest house was provided, but as the cases were nearly all in same family and had been infested before smallpox was discovered we "quarantined" them at home. This was in latter part of winter of 1899-1900.

The disease was brought to this county from Memphis, Tenn., by two negroes who had been working on the railroad; it was promptly recognized, after few had been exposed. I estimate that 1,500 vaccinations have been done in the county since the first cases occurred, that 600 had been previously vaccinated, out of a total population of 23,197, leaving 21,000, or about 91 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $500. The estimated cost to the county in loss of trade and interference of business has been $6,000.

Our chief difficulties in stamping out the disease were: Opposition to vaccination, unbelief of many people that smallpox oxistoi, owing to mildness of the disease.

We had another outbreak in December last, at Jennie, a small town in the northwestern portion of this (Barren) county with negroes: don't know whence it came, but it broke out in two or three families; very mild form; had much difficulty in establishing anl mainttCning quarantine regulations. Had one man, a negro, arrested, tried, and imprisoned for violating rules and regulations of Board of Health, but taken altogether, we managed our cases well and had the hearty cooperation of our county officials. Cost of smallpox at Jennie about $200, making a total of $700 all told for Barren county. Injury of trade at Jennie and Cave City, $500. Very respectfully,

F. J. TAYLOR, M. D., Secretary.

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