the cases were imperfectly isolated in their homes and the management was far from ideal.

The disease was brought to this county from Taylor Mines and Owensboro; it was not promptly recognized until after many had been exposed. I estimate that 200 vaccinations have been done in the county since the first cases occurred, that 500 had been previously vaccinated, out of a total population of 20,000, leaving 19,000 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 $1,500. The estimated cost to the county in loss of trade and interference of business has been small.

Our chief difficulties in stamping out the disease were: Το convince the people and officials that they had smallpox to deal with, and get them to submit to vaccination, and take other necessary steps to get rid of it. Very respectfully,

W. S. CLARKE, M. D., Secretary.

Green County Board of Health: Dr. O. H. Shively, Dr. E. F. Taylor, Dr. W. V. Tucker.

To the State Board of Health:

Greensburg, Ky., July 16, 1901.

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this county, in the following districts or precincts: Donaldsburg, in November, 1899, and Gresham, in March, 1900, with a total of 100 cases and 1 death. No hospital or pest house was provided, and the following was our method of management: Each house where there was one or more cases of smallpox was quarantined; the infected and non-infected put in different rooms when practical, and the names of those who were known, by the parties quarantined, to have been exposed, were taken down and parties quarantined at their own homes or at the homes where they were infected.

The disease was brought to this county from Adair county; it was not recognized and reported until many had been exposed. I estimate that 50 vaccinations have been done in the county since the first cases occurred, that practically only old soldiers and parties carrying life insurance had been previously vaccinated, out of a total population of 12,255, leaving probably 12,000 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 $2,255. The estimated cost to the county in loss of trade and interference of business has been nothing.

4

Our chief difficulties in stamping out the disease were: Violations of quarantine notices, parties violating or disregarding quarantine orders claiming that the malady was not smallpox. Outside of the county seat parties, as a rule, were very much averse to vaccination. Very respectfully,

W. V. TUCKER, M. D., Secretary.

Hancock County Board of Health: Dr. J. W. Knox, Dr. J. W. Griffin, Dr. J. H. Heavrin, Dr. A. Griffin.

To the State Board of Health:

Utility, Ky., August 24, 1901.

Gentlemen: Within the last four years we have had 4 outbreaks of smallpox in this county, in the following districts or precincts: Lewisport, Patesville, and Pellville, with a total of 20 cases and 1 death. No hospital or pest house was provided, and the following was our method of management: In every outbreak the disease was very mild. All of the cases were treated at private expense; isolation in every instance.

The disease was brought to this county from Owensboro three times: and Henderson once; it was promptly recognized after few had been exposed. I estimate that 100 vaccinations have been done in the county since the first cases occurred, that 6,000 had been previously vaccinated, out of a total population of 12,000, leaving 6,000 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 The estimated cost to the county in loss of trade and interference of business has been very slight.

We had no difficulty in preventing its spread, but our trouble is in getting our people to vaccinate, largely due to indifference.

Very respectfully,

A. GRIFFIN, M. D., Secretary.

Hardin County Board of Health: Dr. F. P. Strickler, Dr. S. W. Willis, Dr. C. Z. Aud.

To the State Board of Health:

Cecilian, Ky., August 1, 1901.

Gentlemen: Within the past four years we have had 14 outbreaks: of smallpox in this county, with a total of 20 cases and 1 death. Eruptive hospital or pest house was provided near Cecilian, and the following was our method of management: All cases having symptoms of smallpox were reported by telephone to some member of the county

Board, and the secretary, C. Z. Aud, immediately visited and examined said case. If it proved to be smallpox the case was sent to the eruptive hospital, and all who were known to have been exposed were vaccinated. Not a case vaccinated by the Board had the disease. There was no spread of the disease in any outbreak, except in 4 who escaped vaccination.

The disease was brought to this county from Louisville and other points; it was always promptly recognized. I estimate that 1,000 vaccinations have been done in the county since the first cases occurred, that 10,000 had been previously vaccinated, out of a total population of over 23,000, leaving 12,000 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 $3,000.

We had but little trouble in stamping out the disease. Our county court answered every call made on them, and in no instance did the disease spread beyond the family or house in which the initial case occurred. Too much praise can not be given to our enlightened fiscal court.

Very respectfully,

C. Z. AUD. M. D., Secretary.

Harrison County Board of Health: Dr. H. McDowell, Dr. Joe. Martin, Dr. M. McDowell, Dr. N. W. Moore.

To the State Board of Health:

Cynthiana, Ky., July 22, 1901.

Gentlemen: Within the last four years we have had one outbreak of smallpox in this county, including the city of Cynthiana, in the following districts or precincts: Cynthiana, Sylvan Dell, Claysville, Rutland, with a total of 85 cases and no deaths. A hospital or pest house was provided near Cynthiana, and the following was our method of management: Epidemic in Cynthiana and suburbs was taken charge of by city board. In other parts of county by county board. County provided a pest house where patients were taken, who could not be quarantined at home. Suspects and persons exposed were vaccinated and quarantined until it was decided whether or not they would have smallpox. Infected houses were disinfected with formaldehyde or sulphur, and worthless plunder burned.

The disease was brought to this country from unknown sources. It was not recognized until after numerous negroes had been exposed. I estimate that 4,000 vaccinations have been done in the county since

the first cases occurred; that 12,000 had been previously vaccinated, -out of a total population of 20,000, leaving 4,000 now unprotected (unable to get exact figures.)

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 $5,000. The estimated -cost to the county in loss of trade and interference of business has been $25,000.

No great difficulties were encountered in stamping out the disease. City and county officials and the best citizens, as a rule, gave health boards hearty support. Anti-vaccination sentiment and belief that the disease was not true smallpox sometimes caused trouble, and there was Occasional rebellion against quarantine. These were usually overcome by threatening to send somebody to jail.

Very respectfully,

MARSHALL MCDOWELL, M. D., Secretary.

Hart County Board of Health: Dr. T. H. Garvin, Dr. J. J. Adams, Dr. John Mudd.

To the State Board of Health:

Horse Cave, Ky., July 10, 1901.

Dear Sir: I wish to submit our report of the 2 outbreaks of smallpox that have occurred in our county. We had 1 case in May, 1899, with only one case of varioloid. From that one we have had this year 9 cases in the Bonnieville precinct-the first case in 1899 was brought from Lebanon Junction, Ky., by an inmate of the pest house running away from there. The disease was brought to our county this year from Chicago, Ill., by a negro man, and the other cases belonged to his family. We quarantined them in their houses; had a man to see to their wants. We thoroughly vaccinated the parties that had been the least exposed and isolated them. We had every one to be vaccinated that had not been, or had not had smallpox. The disease never went out of the family of either of the cases.

Vaccination and isolation will stamp it out, there is not a doubt of it, but we have always some trouble to get the quarantine thoroughly done, the most trouble is from an ignorance of why you want these things done, but if your county officers, county judge, and county attorney are all right, you can soon manage all such outbreaks; will never have any trouble in Hart county as our county officers are all right, you can soon manage all such outbreaks; will be about $2,50.

We had no deaths; the cases were of the discrete variety of a very mild type. We kept them quarantined until there was no chance of carrying the disease away. I feel proud of the way we came out. Dr.

C. J. Walton, of Munfordsville, was the attending physician. I went with him to see the first case and to help him arrange the quarantine, etc., which he carried out thoroughly; our county officers stand by us always. We never feel uneasy about controlling an outbreak in our county. With best wishes,

T. H. GARVIN, M. D., County Health Officer.

Henderson City Board of Health: Dr. D. O. Hancock, City Health Officer.

To the State Board of Health:

Henderson, Ky., Aug. 17, 1901.

Gentlemen: Your inquiry under recent date relates to the city of Henderson proper, therefore, it is more simple to report. In the spring of 1899 we had 5 cases of smallpox and 1 death. These occasioned much alarm and great loss to business. A pest house had been provided and no delay was experienced in moving patients to pest house. A general vaccination was put on, and about 6,000 patients were treated. These cases occurred in March and April. A fair estimate of cost to city treasury is $5,000, and a loss to business of $10,000. In November, December, January and February following the foregoing outbreak we were again visited by smallpox. In the city we had 38 cases; no deaths. The number of cases and duration of this out、 break was the result of prevalence of smallpox in adjacent territory, more than 1,000 cases having occurred within 40 miles of Henderson. Corn shuckers returning home brought smallpox. Men engaged on public works at Slaughterville and in mines, etc., and at other places brought smallpox. No trouble was experienced in any given case to control it. But the continual coming home of people, whose families lived in Henderson, and especially the negroes, together with those coming on purpose for treatment in our pest house gave us continuous annoyance for several months. A vaccination was again put on, and about 2,000 vaccinations and re-vaccinations were made. A fair estimate of cost to city's treasury is $2,000; business, $5,000.

In spring of 1900, smallpox again visited us, the source of this outbreak being as in first outbreaks mainly our suburban town, Audubon. In the city proper, there occurred 30 cases, no deaths. A general vaccination was again entered upon, service of physicians this time being secured at $10 per day, instead of 25 cents per operation as in former canvasses. About 1,500 vaccinations and re-vaccinations were made. A fair estimate of cost to city's treasury is $2,000; business, $5,000.

Summing these estimates, which are approximately correct, we have total cost to city's treasury, $9,000; business, $20,000; total number vaccinated and re-vaccinated, 9,500.