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General Report.

The contents of this volume comprises an outline of the operations of the Board from April 1, 1899, to April 1, 1901, reports from the health authorities of each county and city in the State where smallpox has prevailed during the present epidemics, the health laws and court decisions relating thereto, together with the rules and regulations carefully framed to guide this and the local Boards of Health in the discharge of their important and responsible duties.


As the time and attention of the Board have been almost entirely taken up with the management of smallpox a brief history of the origin and spread of the disease will be of interest. To this will be added a summary of the facts furnished in the reports from the county and city Boards, to which the reader is referred for detailed information.

Smallpox was imported from Honduras to Mobile early in the summer of 1897, and spread rapidly through the mining regions of Alabama and Tennessee. The disease was singularly mild in form, and as it was mainly confined to the colored race, appeared to attract but little attention from either the health authorities or people except in the larger cities.

The first case in Kentucky came to Middlesboro from Tennessee early in December, 1897. Shortly after, the disease broke out at Jellico, a State-line town, and two months later a negro who had contracted the disease at Knoxville came down with it at Richmond.

The character of the disease was recognized early at Middlesboro, but in the absence of any hospital or other preparations for dealing with it, and while the fiscal authorities of the town and county were higgling about meeting the expenses, hundreds of exposures had occurred, in a population almost entirely unprotected by vaccination. To add to the difficulties of the situation, although the disease was well marked in its diagnostic features, ignorant and designing persons spread the report that it was "Elephant Itch," “Cuban Itch," “African Itch," names which clung to the disease in this and other States, much to the confusion of the popular mind. The malady spread rapidly at this place, resulting in the most severe and expensive epidemic that has ever visited an interior town in this State.

A serious condition of affairs also developed at Jellico, but here the Health Board secured earlier financial support from the county, and by most efficient work, the disease was brought under control.

Recognizing that the State was called upon to face an emergency, not only from the epidemics already on at the places mentioned, but also from fresh importations from other States, this Board caused the following circular letter to be sent to the health and civil officials and physicians in every county, and to every newspaper in the State. With characteristic liberality, the circular was reproduced in nearly every newspaper, multiplying it by many thousands, and laying the desired information and warning before every newspaper-reading family in Kentucky.

State Board of Health,

Bowling Green, Ky., Feb. 15, 1898.
To the Health Officials, Physicians and People of Kentucky:

Smallpox is now widespread in Eastern Tennessee, North Carolina, Southwestern Virginia and Northern Alabama, and several cases exist in Middlesboro and near Jellico in this State. The epidemic appears to have originated in Mobile last summer, and to have been gradually extending northward since. It is chiefly prevalent amongst the negro population and manifests an unusual tendency everywhere to break over official control and assume an epidemic form.

This Board, therefore feels that it is its duty to warn the people that prompt action may prevent its further spread in this State. Fortunately prevention is as certain and safe as it is cheap and easy. Vaccination and re-vaccination, properly done, with reliable virus, is a certain preventive and is entirely free from danger. This is the conclusion of the health officers of the world after years of patent investigations, and is now an accepted truth in preventive medicine.

Notwithstanding these facts, about one-third of the people of Kentucky have never availed themselves of this protection. Our people should not await for orders from boards of health in the presence of an epidemic to force them to an evident duty. Every citizen should see to it that not only himself, but, every one for whom he is responsible is vaccinated at once. No child should be admitted to any public or private school who has not been vaccinated, and all factories, railroads and mines should make the same requirements. This is especially important in view of the threatened danger.

The operation should be done by a competent physician, under proper aseptic precautions, and he should see the person vaccinated from time to time so the result may be certain. Imperfect vaccination gives a false and often fatal sense of security. Reliable virus can be obtained from the National Vaccine Farm, Washington, D. C., or their agents, the Henry Drug Company, Louisville, Ky.

In addition it is urgently requested that all boards of health perfect their organization at once, if they have not done so, and take every precaution to prevent the entrance of the disease into their jurisdiction, or, failing in this, be ready to stamp it out by strictly isolating the first case, and vaccinating and re-vaccinating every person exposed to it. All funerals should be strictly private.

This Board holds itself ready to give any assistance in its power at any time. By order of the Board:

J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.

The case which developed at Richmond was not recognized as smallpox, and many exposures had occurred, and about fifteen had the disease, in a negro quarter in the heart of the town, before the Board of Health was notified and any efficient steps taken to arrest its spread. Although the conditions seemed so threatening, the call made by the health officials upon the mayor and county judge was so promptly responded to that the epidemic was readily controlled, with a minimum of injury to the business interests of the town.

Expert inspectors were sent to the assistance of the local boards at these places, and this practice has been continued up to the present time, in so far as our limited funds would permit, but recently it has been necessary for the afflicted counties to pay the inspectors. Such assistance has been highly useful in clearing up questions of diagnosis and in giving much needed practical advice in isolation and details in management.

Six weeks after the first warning was issued, as the danger seemed even greater, another circular was prepared and sent out as before. It follows:

Office of State Board of Health,

Bowling Green, Ky., March 25, 1898.
To the Officials, Physicians and People of Kentucky:

This Board again gives warning that our State is seriously threatened with an epidemic of smallpox. Grave conditions already exist in Bell, Whitley and Madison counties, and cases are reported in Knox and Mason counties. So far the disease has been almost exclusively confined to negroes, but this exemption of the white race can not long be hoped for if it continues to spread.

In spite of repeated and continued warnings from this and county and municipal boards, each community so far attacked was unprepared, a large per cent. of the population was unvaccinated, and dangerous and costly delays occurred before the character of the disease was recognized, and hospitals and other provisions could be made for the sick and exposed.

Under our laws this expense must be met by the counties and cities affected, and it can only be made small by proper preparation before a case appears. Had Middlesboro and Bell county been thus forehanded and ready to care for the first cases, thousands of dollars would have been saved in actual outlay, very many thousands in loss of business, and the officials and community the mortification of clamoring for outside aid to do what they were amply able to do for themselves.

In view of these facts, the Board advises that each town and city at once pass and enforce a compulsory vaccination ordinance, beginning with the colored race, but reaching everybody; that isolation hospitals or tents, and suitable ground for their location, be secured; that visiting and strange negroes be hunted out, vaccinated and kept under observation, and especially that physicians practicing amongst negroes be instructed as to the difficulty of recognizing mild cases of smallpox

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