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pital or pest house was provided near Newport, and the following wasour method of management: When reported, house was immediately quarantined by placard, and in some cases yellow flag. Two guards were stationed, one day and one night guard. No one was allowed in or to come out, and all exposed were vaccinated.

The disease was brought to this city from near Ft. Thomas; it was promptly recognized, after few had been exposed. I estimate^ that about 600 vaccinations have been idone in the city since the first cases occurred, that 25,000 had been previously vaccinated, out of a total population of 29,000, leaving about 3,000 now unprotected.

The total cost of management to the city, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $1,100. The estimated cost to the city in loss of trade and interference of business has been not any, or very little.

Our chief difficulties in stamping out the disease were: The negligence in patients consulting a physician, owing to the disease being the mild form. Many could not be convinced that the u..lease was smallpox. About 75 per cent, of those having had the disease had never been vaccinated, the others having varioloid.

Very respectfully,

CHAS. J. KEHM, M. D., Health Officer.

Carlisle County Board of Health: Dr. Wm. L. Mosby, Dr. J. R. Owen^ Dr. J. M. Peck.

Bardwell, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 8 outbreaks of smallpox in this county, in the following districts or precincts: Arlington, Bardwell, and Cunningham, with a total of 24 cases and no deaths. A pest house was provided near Bardwell, and the following was our method of management: Eleven cases were detained and treated at pest house improvised in January, 1900. After convalescence, they were caused to bathe, change clothing and then dismissed. House scalded and fumigated, but was afterward burned by an incendiary.

The disease was brought to this county from itinerants, mostly negroes, from Tennessee and Missouri; it was always promptly recognized, after a few had been exposed. I estimate that 200 vaccinations have been done in the county since the first cases occurred, that about one-half had been previously vaccinated, out of a total population of 10,000, leaving 5,000 in the county now unprotected.

The total cost of management to the county, including hospital^ physicians, vaccinations, guards, nurses, food, etc., for all the caseswhich have occurred in the time named has been $1,100. The estimated cost to the county in loss of trade and interference of business has been comparatively nothing.

Our chief difficulties in stamping out the disease were: Fortunately we have had little trouble in controlling cases in our county, as we have invariably taken a firm stand both in positive diagnosis, and in the management, and'had the cordial support of the fiscal court.

Very respectfully,

W. L. MOSBY, M. D., Chairman.

Carroll County Board of Health: Dr. F. H. Gaines, Dr. B. F. Holmes, Dr. W. S. Golden.

Carrollton, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this county, both in Carrollton, with a total of 14 cases and 1 death. A hospital or pest house was provided near Carrollton, and the following was our method of management: Two of the families were promptly taken to the hospital. One of the others, being well isolated, was treated at home. All exposed persons vaccinated and kept under careful observation. We had some other cases later, which were managed on the same principles.

The disease was brought to this county either from Louisville or Cincinnati by boat; it was in each instance recognized, after a few families had been exposed.

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 $1,200. The estimated cost to the county in loss of trade and interference of business has been $5,000.

Our chief difficulties in stamping out the disease were: The lack of vaccination with our colored as well as with a large part of the white population, except the more intelligent classes in the towns. We had the sympathy and support of our fiscal court and county authorities. Very respectfully,

F. H. GAINES, M. D., Chairman.

Carter County Board of Health: Dr. C. L. Hudgins, Dr. H. K. Williams, Dr. F. W. Tyree.

Olive Hill, Ky., July 19, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had numerous outbreaks of smallpox in this county, in the following districts or precincts: Carter, Counts, Iron Hill, Stinson, E. K. Junction, Denton, Test, Woods, Limestone, Olive Hill, Enterprise, Lawton, with a total of 425 cases and 1 death. No hospital or pest house was provided near or in the county, and the following was our method of management:

^Quarantined each case wherever found. In some few instances we would send a new case to a house already infected. But it was in few

-«ases indeed that we could do so. All exposed persons were ordered vaccinated, very few of whom complied with the order.

The disease was brought to this county from West Virginia and Ohio; it was not promptly recognized, until after many had been exposed. I estimate that 1,000 vaccinations have been done in the county since the first cases occurred, that 2 per cent, had been previously vac

-cinated, out of a total population of 20,000, leaving 96 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 $1,000.

Our chief difficulties in stamping out the disease were: Utter disregard of the law in every way, especially manifested by refusing to obey quarantine instructions and to be vaccinated. This was largely caused by a number of physicians "so called," claiming that the disease was not smallpox.

Very respectfully,

C. L. HUDGINS, M. D., Secretary.

Casey County Board of Health: Dr. J. T. Wesley, Dr. David Beeler, Dr. James Wesley.

Middlesburg, Ky., Aug. 15, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 1 outbreak of smallpox in this county, in the following district or precinct: Casey Creek, with a total of 26 cases and 1 death. A hospital or pest house was provided near Clementsville, and the following was our method of management: We quarantined infected district; took those who had been exposed to pest house. Isolated suspects, etc.: had all the patients, as well as those who had been exposed or suspected placed under the care of a physician and nurses.

The disease was brought to this county from Lebanon, Ky.; it was - recognized, after 3 families had been exposed. I estimate that 2,000 vaccinations have been done in the county since the first cases oc. curred, that 1,000 had been previously vaccinated, out of a total population of 18,000, leaving 15,000 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 $1,000. The estimated, cost to the county in loss of trade and interference of business has been $500.

Our chief difficulties in stamping out the disease were: We met with no special difficulties in stamping out the disease, as no case occurred outside the district quarantined. The only difficulty encountered was in forcing our order for vaccination, quite a large percent, of the families refusing to have themselves and children vaccinated.

Very respectfully,

J. T. WESLEY, M. D., Chairman.

Christian County Board of Health: Dr. F. P. Thomas, Dr. Austin Bell, Dr. J. B. Jackson, Secretary.

Hopkinsville, Ky., July 16, 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: Hopkinsville and Crofton, with a total of 60 cases and 3 deaths. One pest house was provided near Hopkinsville, and the following was our method of management: In the first outbreak they were kept in tents. In this outbreak they cost the county $4,500. In the second outbreak we had 25 cases; these were provided with a good pest house and oared for at the cost of $2,300. Total cost to the county and town, $6,800.

The first outbreak of the disease was brought from Tennessee, and the second from Illinois; it was recognized after several had been exposed. I estimate that 60 per cent, 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 35,000, leaving 30 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 $68,000. The cost to the county in loss of trade and interference of business has not been estimated.

Our chief difficulties in stamping out the disease were in getting; our people to believe it was smallpox, and submitting to vaccination. Much of this had to be done by arresting the parties and bringing; them before the court; then our fiscal court was slow to co-operata with us in some instances.

Very respectfully,

J. B. JACKSON, M. D., Secretary.

Clark County Board of Health: Dr. I. A. Shirley, President, I. H. McKinley, Secretary, Dr. S. W. Willis, Dr. O. R. Venable.

Winchester, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 1 outbreak of smallpox in this county, in the following districts or precincts: City of Winchester and Renick precinct, with a total of 2 cases and no deaths. No hospital or pest house was provided near, and the follow ing was our method of management: Quarantined at their houses and rigidly guarded. All exposures vaccinated and isolated. First case occurred February 11th. Second, March 5, 1901.

The disease was brought to this county from Lexington in both cases; it was promptly recognized after 15 c r 18 had been exposed. I estimate that 2,000 vaccinations have been done in the county since the first case occurred, that 8,000 had been previously vaccinated, out of a total population of 16,000, leaving 6,000, or 33% 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 $700. The estimated cost to the county in loss of trade and interference of business has been small.

We had no difficulty in stamping out the disease. We jumped on it with both feet at once and in all doubtful cases the county was given the benefit of the doubt and they were quarantined .after vaccination. No cases were contracted from the first and there were only two cases. We had the prompt and constant support of .our county judge.

I. A. SHIRLEY, M. D., Chairman.

-Clay County Board of Health: Dr. I. S. Manning, Dr. W. F. Phillippe, Judge J. W. Wright, Dr. J. R. Burchell.

Manchester, Ky., July 17, 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: Pigeon Roost and Manchester, with a total of 57 cases and 3 deaths. No hospital or pest house was provided, and the following was our method of management: Those who were exposed were quarantined and separated; those who contracted the disease in isolated localities and/ not able to look after themselves, were removed to other families where the disease was already prevailing; a close guard kept to see that no .one came in or went out.

The disease was brought to this county first from Jackson county.

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