in 1898, and last from about Beattyville, Ky.; it was not promptly recognized in the first outbreak until many had been exposed. I estimate that 360 vaccinations have been done in the county since the first cases occurred, that 300 had been previously vaccinated, out of a total population of 12,000, leaving 11,000, or 90 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 $2,100. The estimated cost to the county in loss of trade and interference of business has been $3,000.

Our chief difficulties in stamping out the disease were: The mild character of the disease. The people thought it could not be smallpox unless it killed a great many. The free and easy going character of the mountain people who had not been used to any restraint of that character.

Very respectfully,

J. R. BURCHELL, M. D., Secretary.

Crittenden County Board of Health: Dr. T. A. Frazer, Dr. W. J. J. Paris, Hon. John W. Blue.

To the State Board of Health:

Marion, Ky., July 16, 1901.

Gentlemen: Within the last four years we have had 3 outbreaks of smallpox in this county, in the following districts or precincts: Marion, Dycusburgh and Ford's Ferry, with a total of about 300 cases and 4 deaths. One hospital or pest house was provided near Marion, and the following was our method of management: To confine all cases to pest house, placing a guard and furnishing supplies, etc., until such time as it was deemed safe to discharge them.

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The disease was brought to this county from Union county; it was recognized after many had been exposed. I estimate that cinations have been done in the county since the first cases occurred, that had been previously vaccinated, out of a total population of 13,000, leaving a large majority 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 $3,000 or more. The estimated cost to the county in loss of trade and interference of business has been very little.

Our chief difficulties in stamping out the disease were: A failure or refusal of officers to do their duty, and an idea promulgated among the people that the disease was not smallpox. I was not health officer at the time and I am indebted to Dr. J. R. Clark, my predecessor, for these data.

Very respectfully,

W. J. J. PARIS, M. D., Secretary.

Daviess County Board of Health: Dr. E. H. Luckett, Dr. C. H. Todd, Dr. L. G. Armendt.

To the State Board of Health:

Owensboro, Ky., July 30, 1901.

Gentlemen: Within the last four years we have had 6 outbreaks of smallpos in this county. Cases in every precinct in the county, with a total of 222 cases and 4 deaths. One hospital or pest house was provided near Owensboro, and the following was our method of management: As a rule the cases were quarantined in their houses and attended by the local physicians, and provisions furnished all the family by the county. In this way all exposed in the neighborhood were vaccinated by the local physicians, under direction of the county authorities.

The disease was brought to this county from Indiana, Louisiana and the counties of Henderson and Ohio; it was not promptly recognized in several instances. I estimate that very general vaccination has been

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done in the county since the first cases occurred, that had been previously vaccinated, out of a total population of 38,000, leaving a comparatively small 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 occurred in the time named has been $12,000. The estimated cost to the county in loss of trade and interference of business has been comparatively very little.

We had very little difficulty in management outside of negligence in regard to vaccination, owing largely to the fact that we had been so long free from the disease.

. Very respectfully,

C. H. TODD, M. D., Secretary.

Owensboro City Board of Health: Dr. C. C. Lewis, Chairman.

To the State Board of Health:

Owensboro, Ky., July 16, 1901.

Gentlemen: Within the last four years we have had 1 outbreak of smallpox in this city, in the following districts or precincts: Every ward, with a total of 500 cases and 2 deaths. A hospital or pest house was provided near the city, and the following was our method of management: Placing patient in pest house or in some cases guard at home.

The disease was brought to this city from St. Louis, Mo.; it was not promptly recognized until many had been exposed. I estimate that 4,000 vaccinations have been done in the city since the first cases occurred, that 6,000 had been previously vaccinated, out of a total population of 15,000, leaving 5,000, or 33 per cent. 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 $2,800. The estimated cost to the city in loss of trade and interference of business has beencan't say.

Our chief difficulties in stamping out the disease were: Failure of physicians to report cases promptly, and difficulty in enforcing vaccination, owing largely to the mild character of the disease.

Elliott County Board of Health: J. B. Hannah, Esq., Sanford Bailey, M. D., W. W. Johnson, M. D., S. G. Hunter, M. D.

To the State Board of Health:

Sandy Hook, Ky., July 18 1901.

Gentlemen: Within the last four years and since November 1, 1900, we have had 3 outbreaks of smallpox in this county, in the following districts or precincts. Six out of eight voting precincts, with a total of 165 cases and 3 deaths. Two hospitals or pest houses were provided near Isonville, and the following was our method of management: First, a general order by the Board directing all persons to be vaccinated over one year of age, who had not been successfully vaccinated within five years; followed by an order quarantining those who had been exposed. The secretary was then directed to take charge of the infected districts, prepare necessary hospitals—one for those who had been exposed and another for those who contracted the disease the secretary being directed to remain in the district and see those orders carried out.

The disease was brought to this county from Morgan county first, and, afterward, from Carter county and also from the State of Wisconsin; it was recognized after about 150 had been exposed. I estimate that 1,000 vaccinations have been done in the county since the first cases occurred, that 25 within five years had been previously vaccinated, out of a total population of 10,000, leaving 9,000, or 90 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 $725. 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: First, to convince the populace that the disease was smallpox. We wrote both the secretary and president of the State Board to send us some one

familiar with the disease to assist in convincing the people, but they failed to send any one. After they became convinced, they were not difficult to control. Second, the refusal of the people to procure their vaccination; the disease being so mild, they preferred to take the risk of the disease rather than the pain accompanying the vaccination.

Very respectfully,

SANFORD BAILEY, M. D., Secretary.

Fayette County Board of Health: David Barrow, M. D., J. W. Pryor, M. D., R. L. Willis, M. D.

To the State Board of Health:

Lexington, Ky., July 22, 1901.

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox. In the year 1899, it appeared in the county jail, the disease being brought here from Louisville. We had 9 cases in the jail, covering a period of four or five months. All were mild and no deaths. The criminal term of the circuit court had to be postponed on account of this smallpox. The prisoners had to be removed to barracks and extra guards appointed. Many of the prisoners had to be kept over several months who had been sentenced to the penitentiary. The care of these cases at the city eruptive hospital, the extra guards, building of barracks, food, clothing, medical bills, cleansing, disinfecting, and refurnishing jail was an expense to the county of $6,500.

The second outbreak of smallpox in this county was on or about the 15th of January, 1901. We have had about forty-five cases scattered throughout the county in eight precincts up to July 15th., with the exception of one case, which came to the county from Clay City, all other outbreaks were traceable to the city of Lexington, where there was quite an epidemic of smallpox. Ten of these cases were removed to the city eruptive hospital, the remainder were treated at their homes without guards. We had very little difficulty in the management of these cases. All were mild, except about 8, which were very severe of the mild type. There were no deaths. The expense of hospital, medical bills, vaccinations, disinfecting, clothing, and feeding was about $2,000. There was some loss of trade and interference of business, which did not amount to a great deal. There has been five or six thousand vaccinations in this county in the last eight months, but there still remains a large per cent. of our population unprotected by vaccination. Very respectfully,

R. L. WILLIS, M. D., County Health Officer.

Lexington City Board of Health: Dr. F. O. Young, Dr. A. H. Barkley, E. M. Winder, F. P. Anderson, H. T. Duncan.

To the State Board of Health:

Lexington, Ky., July 17, 1901.

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this city, in the following districts or precincts: First was in March, 1899, in county jail, with a total of 114 cases and 1 death. A pest house was provided near the city, and the following was our method of management: The patients during the outbreak .being entirely under the control of the law, the disease was early and thoroughly stamped out. The city was vaccinated at the cost of $300, and the care of the patients cost $493.66. The second outbreak occurred last November, appearing in different parts of the city. There was a total of 107 cases and 1 death; 16 persons were isolated on account of exposure. The disease has continued with us up to the present time, there being still one case with us.

The disease was brought to this city from Morgan and Wolfe counties; it was promptly recognized. I estimate that 2,703 vaccinations have been done in the city since the first cases occurred, that about same had been previously vaccinated, out of a total population of 30,000, leaving 22,594 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 $6,281. No estimate of the cost to the city in loss of trade and interference of business has been made.

Our chief difficulties in stamping out the disease were: 1st. Lack of early recognition on the part of the general practitioner. 2d. Failure of the general practitioner to report to proper authorities. 3d. Inability to at first send the patients to a pest house. 4th. Difficulties met with in enforcing vaccination.

Very respectfully,

F. O. YOUNG, M. D., President.

Fleming County Board of Health: Dr. C. R. Garr, Dr. C. W. Aitken, Dr. Lucien McDowell.

To the State Board of Health:

Flemingsburg, Ky., July 16, 1901.

Mt.

Gentlemen: Within the last four years we have had 3 outbreaks of smallpox in this county, in the following districts or precincts: Carmel, Muse, and Flemingsburg, with a total of 92 cases and no deaths. A hospital or pest house was provided near Flemingsburg, and the following was our method of management: All cases were promptly isolated under guard, and all persons who had been exposed