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The method of management: 1. When smallpox makes its appearance put on as nearly a general vaccination and re-vaccination as is posbla Enforce the law on this part. 2. Remove cases to pest house; burn infected effects; fumigate, send suspects in immediate family to pest house. 3. Have other suspects report every day. If they do not report send them to pest house. I find it much better to do this. If an effort to send all suspects to pest house is made, many will hide out, nor can the best detective find them. 4. In every subsequent case (there will be few if proper care is taken), vaccinate and re-vacoinate exposures and keep them under surveillance as above.

Difficulties in management: 1. General alarm is very difficult to manage. If possible, keep smallpox out of newspapers. Work instead of talk does most to counteract alarm. Never let the sun rise on a case within city limits. Get it to pest house. By time the public knows of a case, let them know also that it is in pest house. 2. Keep out of the courts is sometimes difficult. Paying officers often think the usual prices for fumigating and service is sufficient. On the other hand men and sometimes doctors have exaggerated notions of value at these times. To work in the happy mean is difficult for health authorities, and sometimes impossible. 3. The resignation of health officers and health authorities is another difficult problem. Many good officers in '".times of peace" will fail when work of this kind is to be done. "There are, however, always true men enough in every community and .a little patience will bring them to the rescue. Resignations may sometimes be justifiable, but even then they are unfortunate. 4. Henderson .experienced no trouble for lack of pest house. Our council had previously provided one. I might say, however, that but for this we would doubtless have suffered several times the loss by expense and : interference with business. 5. Supplies will cost more delivered than . at other times. If health authorities will keep close to their council .or fiscal court much trouble will be avoided. In two years of service .as member of Board of Health and acting health officer, no bill contracted by me was discounted by our city council. Nor did they fail me at any time on agreement for services of physicians to attend cases or to vaccinate. Health authorities should protect the city or county irom extortions and robbery, by refusing to employ persons who attempt to practice same. They will, however, do wrong to fail to be liberal to those who serve the public at these critical times. 6. The county should supply pest house for city as well as county. This we were after a time able to secure. The city will find it best, however, to manage all cases until they are in pest house. County organization .can not be so prompt as that of the city, therefore, the necessity for a city board of health in this management. 7. It will always be found difficult for the health officer to be pleasant and courteous throughout It all for

The croaker will croak because he is a croaker.
The scared will ask a thousand useless questions.
The fool will exhibit himself to his utmost.

The rascal will seek advantage and be mad if he is disappointed.
The liar will lie and continue to lie.

A thousand embryo lawyers will advise against his conduct.
Many will question his diagnosis—some his sense.
His private business will suffer.
He will want to swear.

Those whom he has always believed friends will seek to damage his business and reputation, and some will openly challenge his character.

Courage, wisdom, patience and perseverance are at a premium. It will sometimes be difficult to supply the demand.

Yours, etc.,

D. 0. HANCOCK, M. D., City Health Officer.

Henry County Board of Health: Dr. E. Bishop, Dr. W. A. Jemison, Dr. Geo. Oldham, Dr. C. L. Crawford, Dr. Geo. Jessie.

Eminence, 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 or precincts: Bethlehem, Pleasureville Depot and Eminence, with a total of 61 cases and no deaths. No hospital or pest house was provided; each treated at home, and the following was our method of management: Prompt isolation of those attacked and vaccination of all exposed parties. Each -case treated on its own merits.

The disease was brought to this county from Memphis via. Carrollton and from Frankfort; it was not in all cases promptly recognized until a number had been exposed. I estimate that 1,300 vaccinations have been done in the county since the first cases occurred, that many had not been previously vaccinated, out of a total population of 15,000, leaving 25 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 $3,000. The estimated cost to the county in loss of trade and interf erence of business has been $1,500.

Our chief difficulties in stamping out the disease were: Doubt in the minds of the laity and also of some physicians as to the disease being smallpox.

Very respectfully,

W. A. JEMISON, M. D., Secretary.

Hickman County Board of Health: W. W. Richmond, G. F. Beeler, JoeW. Smith.

Clinton, Ky., July 25, 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 or precincts: Columbus, Clinton and Moscow, with a total of 65 cases and 1 death. No hospital or pest house was provided, and the following was our method of management: Strict quarantine of all cases and isolating and vaccinating all persons exposed.

The disease was brought to this county from Tennessee and Mississippi; it was recognized after several had been exposed. I estimate that 9,500 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 11,745, leaving 2,245 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 $1,125. The estimated cost to the county in loss of trade and interference of businesshas been $3,000.

Our chief difficulties in stamping out the disease were: Lack of help from the county officials. Having no pest houses, we were forced to use old outhouses and tents, which were burned on discharge of cases. Have only had two cases in the county during the past year, and not a case in the county at present time.

Very respectfully,

W. W. RICHMOND, M. D., Chairman.

Hopkins County Board of Health: Thos. W. Gardiner, A. W. Davis, J. L. Dulin.

Madisonville, Ky., July 26, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 7 outbreaks of smallpox in this county, in the following districts or precincts: Earlington, Dawson, Mortons, and Madisonville, with a total of 300 cases and 3 deaths. A hospital or pest house was provided near each place, and the following was our method of management: Cases, as soon as reported, were isolated; all exposed persons were isolated, vaccinated and detained.

The disease was brought to this county from Union county, Ky., and Tennessee; it was not always recognized until after many had been exposed. I estimate that 1,500 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 25,000, leaving 13,000, or 50 per cent, or more, 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 $4,000. 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: Opposition to vaccination; inability to secure promptly sufficient money from fiscal court or towns; opposition to being sent to pest houses or detention; difference of opinion by physicians as to diagnosis.

Very respectfully,

J. L. DULIN, M. D., Chairman.

Jackson County Board of Health: Dr. W. T. Amyx, Dr. G. C. Goodman, Dr. C. H. Robinson.

Richmond, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years there has been 1 outbreak of smallpox in this county, well distributed, with a total of 67 cases and 9 deaths. A hospital or pest house was provided near McKee, and the following was our method of management: After I took charge for the State Board of Health the cases were collected and kept under guard as far as practicable, but some were treated at their home. Several deaths had occurred and many had recovered before my arrival. All were vaccinated who would submit to it whether exposed or not.

The disease was brought to this county by an escaped convalescent from the Richmond Smallpox Hospital; it was not recognized until many had been exposed. I estimate that 1,200 vaccinations have been done in the county since the first cases occurred, that very few had been previously vaccinated, out of a total population of 10,560, leaving practically the whole population 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 unknown to me. The estimated cost to the county in loss of trade and interference of business has been considerable, as entire county was in quarantine for some time.

Our chief difficulties in stamping out the disease were: Absolute refusal of the fiscal court or people to believe that it was smallpox, or to take any steps to prevent its spread until the county was placed in quarantine by your board, and I was sent to stamp out the disease. It was readily brought under control as soon as the confidence and co-operation of the officials were secured.

Very respectfully,

W. M. GIBSON, M. D., Sanitary Inspector for State Board of Health.

Jefferson County Board of Health: Dr. W. H. Wathen, Dr. G. W. Griffith, Dr. J. M. Krim, Dr. W. W. Hobson, Dr. B. W. Smock.

Louisville, Ky., July 15, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 6 outbreaks of smallpox in this county, in the following districts or precincts: Jefferson county, outside city, with a total of 59 cases and 2 deaths. A hospital was provided near city, and the following was our method of management: The eruptive cases were sent to the hospital, each and every member of the family remaining were vaccinated, and in some instances re-vaccinated. Bedding burned, rooms disinfected with formaldehyde gas. Infected houses inspected each day for new cases, and when found removed at once.

The disease was brought to this county from Louisville principally, Madison county, Rockcastle county, Indiana, Tennessee; it was recognized after others had been exposed. I estimate that 5,000 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 25,000, 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 $5,900. The estimated cost to the county in loss of trade and interference of business has not been great, owing to the promptness with which the first cases was found and removed immediately.

Am pleased to say we had no difficulty in stamping out the disease, owing to the fact that we have a most excellent county board, backed up with a more than excellent county judge and fiscal court, who, at all times, rendered the board all the moral and financial aid necessary. We have an annual appropriation of $1,000, and with this amount of money to pay an executive officer, we are always ready to meet any emergency.

Very respectfully,

B. W. SMOCK, M. D., Secretary.

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