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Bath County Board of Health: A. W. Walden, M. D., J. W. Rutherford, M. D., J. M. Feland, M. D., J. J. Lacy, M. D.

Owingsville, Ky., July 15, 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: At Reynoldsville and Sharpsburg, with a total of twelve cases and no deaths. A tent was provided near Sharpsburg, and the following was our method of management: 1. To separate suspects from those affected. 2. To enforce vaccination in infected districts. 3. To give benign attention to the afflicted ones.

The disease was brought to this county from Montgomery and Nicholas counties; it was recognized, after about 100 people had been exposed. I estimate that 500 vaccinations have been done in the county since the first cases occurred, that 3,000 had been previously vaccinated, out of a total population of 15,000, leaving 12,000, about 75 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 $2,250. 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: 1. Our people were not sufficiently protected by vaccination. 2. We were not provided with quarters for patients and suspects, to meet the emergency. This, however, was readily supplied.

Very respectfully,

A. W. WALDEN, M. D., Chairman.

Bell County Board of Health: Dr. L. L. Robertson, Dr. T. H. Curd, Dr. W. D. Hodges.

Middlesboro>, Ky., July 17, 1901.

To the State Board of Health:

Gentlemen: Within the past four years we have had 3 outbreaks iOf smallpox in this county, in the following districts or precincts: Middlesboro, Ky., Pineville, and Wasiota, Ky., with a total of about .300 cases and 4 deaths. Three hospitals or pest houses were provided near Middlesboro, and the following was our method of management:

All smallpox cases were confined in the pest house and all suspects isolated. City authorities built a pest house wnich would accommodate about 60. This was never used on account of being inaccessible, but other houses were secured and all patients moved as soon as possible; then a house to house vaccination was commenced—suspects were quarantined to their houses.

'Khs disease .was brought to this county from refugee negro miner in Tennessee; it was soon promptly recognized, after aDout 15 had been exposed. I estimate that 3,000 vaccinations have been done in the county since the first cases occurred; that 500 had been previously vaccinated, out of a total population of 15,000, leaving about 75 per cent, now unprotected, chiefly in the county districts.

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 $6,800. The estimated cost to the county in loss of trade and interference of business has been $100,000.

Our chief difficulties in stamping out the disease were: The county authorities refusing to do anything and refused to pay any and all bills, consequently was very hard to get guards and people to help relieve the situation. We finally received help from marine hospital service under direction of the State Board of Health.

Very respectfully,

L. L. ROBERTSON, M. D. , Chairman.

Boone County Board of Health: J. F. Smith, M. D., J. M. Grant, M. D.,

W. A. Clore, M. D. Bullittsville, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 5 outbreaks of smallpox in this county, in the following districts or precincts: Walton. Verona, Bellevue. Burlington, and Bullittsville, with a total of 20 cases and no deaths. No hospital or pest house was provided, and -the following was our method of management:

Isolation of the sick and vaccination of all exposed persons. Two were sent to Covington pest house, and the rest were quarantined and taken care of at their homes.

The disease was brought to this county from Ohio and Indiana. It was recognized after 6 persons had been exposed. I estimate that 3,000 vaccinations have been done in the county since the first cases occurred, that 3,000 had been previously vaccinated, out of a total population of 12,000, leaving 6,000, 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 $415.92. The estimated cost to the county in loss of trade and interference of business lias been $6,000.

Our chief difficulties in stamping out the disease were: 1. The stub"born resistance of many people to vaccination. 2. The doubt existing 3n the minds of many as to the genuineness of the diseases.

Very respectfully,

W. A. CLORE, M. D., Secretary.

Boyd County Board of Health: Dr. J. W. Kincaid, Dr. J. D. Williams, Dr. M. L. Smiley, Dr. W. A. Patten, Dr. W. A. Berry, Dr. J. A. Prichard. >

Catlettsburg, Ky., July 31, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 4 outbreaksof smallpox in this county, in the following districts or precincts: Ashland, Catlettsburg, Durbin, and East Fork, with a total of 362 cases and 6 deaths. Two hospitals or pest houses were provided, one near Ashland and one near Catlettsburg, and the following was our method of management: Isolation of cases—some in the hospitals, but many in their homes. Vaccination was generally enforced in the cities of Catlettsburg and Ashland, but this was impracticable in most of the county districts. ,

The disease was brought to this county from a steamboat in 1898 and from Russell and Greenup counties, Kentucky, in 1900; it was not promptly recognized until many had been exposed. I estimate that 7,000vaccinations have been done in the county since the first cases occurred; number previously vaccinated, unknown.

The total cost of management to the county and city of Catlettsburg, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $3,735.69 for county; $3,159.28 for Catlettsburg. The estimated cost to the county in loss of trade and interference of business has been $15,000.

Our chief difficulties in stamping out the disease were: The mildness of the type, causing those who had it, as well as their friends to conceal it; the latter coming and going at will, thus multiplying the exposures. There were several cases in the city of Ashland, the cost of managing which is not included in this report, as Dr. Young, the health officer there, has failed to furnish me the information for which I wrote him. I estimate that there are yet from 2,000 to 3,000 unvaccinated persons in the county. Very respectfully,

J. W. KINCAID, M. D., Chairman.

Ashland City Board of Health: L. E. Veyssie, L. R. Putnam, Frank Friend, Thos. R. Young, M. D. , Health Officer.

Ashland, Ky., July 20, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 5 outbreaks of smallpox in this city, in the following districts or precincts; Wards 2, 3, and 4, with a total of 46 cases and no deaths. Ordinary hospital or pest house was provided near city of Ashland, and the following was our method of management: First outbreak, March 9th, though occurring in this city, the case and family exposed were promptly removed to pest house, and cared for by the county, a report of which will be supplied by Dr. W. A. Berry, who attended it. Second outbreak, May, 1900. Case found on street and taken forthwith to pest house and no other cases developed. Third outbreak, December 14, 1900, developed at six different points and was quarantined at three points. Thirty-three cases occurred. Fourth outbreak, March 6th, developed at two other points near by; was quarantined at those points and 11 cases resulted. Fifth outbreak, July 1st, quarantined at point and 2 cases occurred.

The disease was brought to this city from several sources, chiefly from Russell county; it was recognized after many had been exposed. I estimate that 2,200 vaccinations have been done in the city since the first cases occurred, that 4,300 had been previously vaccinated, out of a total population of 7,000, leaving 500, or 7 per cent, now unprotected.

The total cost of management to the city, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the oases which have occurred in the time named has been $2,250. The estimated cost to the city in loss of trade and interference of business has been . Hard to estimate amount of damage to business.

Our chief difficulties in stamping out the disease were: 1. Failure of city council to rigidly and fearlessly enforce ordinances for compulsory vaccination, and failure to ascertain that the vaccinations performed was really successful. 2d. Failure to remove original cases and all exposed persons to pest house, and failure to provide a suitable and respectable hospital in which to treat patients and other quarters, in which to detain suspects, or exposed persons. 3. Failure to provide adequate appropriation for guards, nurses, supplies, and medical services to patients and suspects.

Very respectfully,

THOS. R. YOUNG, M. D., Health Officer.

Boyle County Board of Health: Dr. Fayette Dunlap, Dr. John C. Bogle, Dr. B. T. Wood.

Danville, Ky. , July 30, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this county, in the following districts or precincts: One near Shelby City and another at Danville, with a total of 1 case and no deaths. No hospital or pest house was provided, and the following was our method of management: Isolation and vaccination.

The disease was brought to this county from Indian Territory; it was not promptly recognized until after 100 people had been exposed. I estimate that 300 vaccinations have been done in the county since the first cases occurred that—had been previously vaccinated, out of a total population of about 13,000, leaving about 40 per cent, now unprotected in the county.

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 $9.03. The estimated cost to the oounty in loss of trade and interference of business has been practically nothing.

We had little difficulty in management. As soon as recognized, authorities in the Shelby City magisterial district took charge, put up posters, fined 3 or 4 trespassers who had been warned to keep away. The young man, John' Laville, son of a doctor, attended a public sale after fever had begun; he broke out, but infected no one. Very respectfully,

FAYETTE DUNLAP, M. D., Secretary.

Bracken County Board of Health: Dr. W. A. McKinney, Dr. G. L. Plummer, Dr. C. H. Wallin.

Brooksville, Ky., July 17, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 3 outbreaks of smallpox in this county, in the following districts: Brooksville, Wellsburg and Johnsville, with a total of 32 cases and no deaths. A pest house was provided near the county infirmary, and the following was our method of management: To quarantine those who had the disease and to vaccinate those who had been exposed as soon as possible.

The disease was brought to this county from Gallipolis, Ohio, and West Virginia; it was recognized, after several had been exposed. I estimate that 1,200 vaccinations have been done in the county since the first cases occurred, that 1,800 had been previously vaccinated, out of a total population of 12,000, leaving 9,000, or about 68 per cent, now unprotected in the county.

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 $700. The estimated cost to the county in loss of trade and interference of business has been nominal.

Our chief difficulties in stamping out the disease were: It was in a very mild form, and the greatest trouble was to keep them quarantined and to get the people to appreciate the gravity of the situation.

Very respectfully,

C. H. WALLIN, M. D., Secretary.

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