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Lawrence County Board of Health: Dr. M. G. Watson, Dr. J. D. Biggs, A. J. Garred.

Louisa, 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, in the following districts or precincts: Bear Creek and East Fork precincts, with a total of 97 cases and 2 deaths. No hospital or pest house was provided, and the following was our method of management: Quarantined each family when it first appeared, and we were notified of it. Placed guards over them, but found this method very unsatisfactory, and issued orders compelling vaccination in Bear Creek and East Fork precincts and town of Louisa, and by this method it was stamped out in 43 days after the origin of the last outbreak.

The disease was brought to this county from Boyd county, Ky.; it was not recognized until after many had been exposed. I estimate that 600 vaccinations have been done in the county since the first cases occurred; that 500 or 600 had been previously vaccinated, out of a total population of about 17,000, leaving 15,800 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 }1,800. The estimated cost to the county in loss of trade and interference of business has been $12,000.

Our chief difficulties in stamping out the disease were: Physicians and laity refusing to recognize it as smallpox and to be vaccinated, and getting the county authorities to co-operate with the Board of Health. Very respectfully,

J. D. BIGGS, M. D., Secretary.

Lee County Board of Health: Wm. Goosey, J. M. Beatty, Dr. J. H. Evans, Dr. M. F. Reed.

Beattyville, Ky., July 22, 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: Beattyville and Bear Creek, with a total of 45 cases and 5 deaths. One hospital or pest house was provided near Beattyville, and the following was our method of management: All developed cases, as well as the thoroughly exposed and too late to vaccinate, were removed, together with the bedding upon which the diseased had lain, to the eruptive hospital. Immune nurses were employed and the Tiospital visited daily by the local physicians. In two isolated places 10 to 15 cases were treated and cared for at their homes, the remainder taken to the hospital.

The disease was brought to this county from Caney, Ky., and from Bryant, Wis.; it was recognized after 10 to 15 had been exposed. I estimate that 1,500 vaccinations have been done in the county since the first cases occurred, that only a few had been previously vaccinated, out of a total population of 8,000, leaving 6,500, or 75 to 80 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, approximated). The estimated cost to the county in loss of trade and interference of business has been $15,000 to $30,000, approximately.

Our chief difficulties in stamping out the disease were: Getting the people vaccinated, many claiming the disease preferable to the effects of vaccination. Our first and most serious outbreak occurred in November, 1900, and during this epidemic our mortality occurred. This time the disease came from Caney, Ky. Since this outbreak the disease was again brought into the county from Bryant, Wis., and -while the disease was very mild from this importation, from 10 to 15 having taken it, and were treated at their homes. "Very few in the neighborhood of this later development have submitted to vaccination though any amount of persuasion has been used.

Very respectfully,

M. F. REED, M. D., Secretary.

Leslie County Board of Health: Dr. J. H. Lawrence, J. M. Walton, Abner Eversole.

Hyden, Ky., July 22, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had an outbreak of smallpox in this county, in districts or precincts scattered promiscuously over the county, with a total of 225 cases and no deaths. No hospital or pest house was provided for, and the following was our method of management: Each resident was guarded day and night -until the smallpox was wiped out, which lasted 79 days. No attempt was made to enforce compulsory vaccination. It would have caused 4i rebellion.

The disease was brought to this county from Whitley county; it was not promptly recognized until after many had been exposed. I -estimate that 50 vaccinations have been done in the county since the first cases occurred, that 20 had been previously vaccinated, out of a total population of 6,753, leaving 6,683 now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the case* 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 $1,000.

Our chief difficulties in stamping out the disease were: We found it most difficult to get the county officials to give us their assistance. The county board had it all to fight from start to finish, with but fe^r exceptions. You can readily understand what this means in this mountain country.

Very respectfully,

J. H. LAWRENCE, M. D., Secretary.

Letcher County Board of Health: Dr. John Collins, Dr. T. A. Cook, Dr.. J. N. McCreary.

Colson, 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, on Boone's Fork, with a total of 5 cases and no deaths. A hospital or pest house was provided near Baker Postoffice, and the following was our method of management: The first patient was isolated and placed in care of nurses, and a family whohad been exposed to this case were kept in their home under strict quarantine until all had recovered, when everything was thoroughly disinfected, etc.

The disease was brought to this county from Pike county, Ky.; it was promptly recognized after 4 had been exposed. I estimate that 100 vaccinations have been done in the county since the first cases occurred, that 400 had been previously vaccinated, out of a total population of 7,500, leaving 7,000, or 93 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 $60. The estimated cost to the county in loss of trade and interference of business has been nominal.

Our chief difficulties in stamping out the disease were: These cases occurred in a district Where a bitter feud was raging, and our doctors were loath to visit the district; but the people near, on first intimation of the trouble, instituted prompt means for confining and limiting the disease. We later gave attention to cases and had no spread. A man came in and lodged with a family, who, at once developed the disease, with result as above.

Very respectfully,

JOHN COLLINS, M. D., Secretary.

Lewis County Board of Health: Dr. T. S. Clark, A. H. Parker, Esq., Dr. W. T. Burdeck, Dr. 0. B. Adams.

Vanceburg, Ky., July 30, 1091.

To the State Board of Health:

Gentlemen: Within the last four years we have had four outbreaks of smallpox in this county, in the following districts or precincts: Fire Brick, Vanceburg, Laurel, Grassy and Esculapius, with a total of 301 cases and 4 deaths. A hospital or pesthouse was provided near Vanceburg, and the following was our method of managements. All cases that could be brought to pesthouse were done so, and it was under charge of the health officers of Lewis county. In other cases we had guards placed at the houses where persons were confined with the disease and best of care taken to prevent spread of the disease.

The disease was brought to this county from West Virginia, Ohio and Kansas; it was not recognized until many had been exposed. I estimate that 1,000 vaccinations have been done in the county since the first cases occurred, that one-tenth had been previously vaccinated, out of a total population of 17,868, leaving about 14,000 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 $2,300. The estimated cost to the county in loss of trade and interference of business has been $10,000.

We have also had 75 cases of scarlet fever in the past year reported to us in this county and 3 deaths, but we are glad to report we have not now a case of scarlet fever or smallpox in the county that is known to the board.

Very respectfully,
A. H. Parker, Member of the County Board of Health.

Lincoln County Board of Health: Dr. Steele Bailey, Dr. Hawkins Brown, Dr. J. F. Peyton, Dr. W. J. Edmiston.

Stanford, 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: Stanford and Crab Orchard, with a total of 48 cases and 1 death. A hospital or pest house was provided near Stanford, and the following was our method of management: Some of the cases were isolated and guarded in their homes, others, where they could be better managed, were taken to the isolation hospital. All exposed persons were vaccinated, as were all others who would voluntarily submit to it.

The disease was brought to this county from Columbus, Ohio, and 'Cincinnati, Ohio; it was promptly recognized. I estimate that 600 vaccinations have been done in the county since the first case occurred, that probably 8,000 had been previously vaccinated, out of a total population of 17,059, leaving about 50 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 interference of business 3s unknown.

We experienced no difficulties in stamping out the disease. The county officers piped unto us and were as anxious as we to see the disease stamped out. I have recently (July 1st) gotten rid of 5 cases (discrete), who were treated in the village. Had a day and night guard; no spreading. Negro buck came from the coal mines of Tennessee, brought the disease and communicated it to a huzzy and her three brothers. Everything O. K. now.

Very respectfully,

STEELE BAILEY, M. D., Chairman.

Livingston County Board of Health: H. H. Duley, M. D., Chairman. M. D., J. V. Hayden, M. D.

Smithland Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 5 outbreaks of smallpox in this county, in the following districts or precincts: Smithland, Hillsville and Grand Rivers, with a total of 20 cases and no deaths. A hospital or pest house was provided near Smithland, Ky., and the following was our method of management: Isolation, vaccination and cremation of infected clothing and household goods, which could not be satisfactorily disinfected. All patients were given a disinfectant bath.'

The disease was brought to this county from Evansville, Ind., Illinois, Crittenden county, Ky., and railroad hands, do not know from where; it was recognized after several had been exposed. I estimate Sthat 1,600 vaccinations have been done in the county since the first .cases occurred, that 1,200 had been previously vaccinated, put of a rtotal population of 11,000, leaving 8,200 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 $2,300. The esti

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