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mated cost to the county in loss of trade and interference of business has been nothing.

Our chief difficulties in stamping out the disease were: Ignorance and prejudice on the part of the laity and some of the physicians. The county officials generally supported us in our efforts to suppress the disease.

Very respectfully,

H. H. DULEY, M. D., Chairman.

Logan County Board of Health: Dr. M. E. Alderson, Dr. H. K. Rone,. Dr. T. O. Helm, James Cooksey, Esq.

Russellville, Ky., July 16, 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: Russellville, and in county, near town, with a total of 80 cases and -£ deaths. A tent hospital or pest house was provided near the town,, and the following was our method of management: The first cases in the county were guarded in their houses in the county. After the disease broke out in town tents were provided, a camp established, and all cases taken there. All exposed persons were vaccinated and this was enforced very generally in the town of Russellville.

The disease was brought to this county from Guthrie and from Tennessee; 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 15,000 had been previously vaccinated, out of a total population of 26,000, 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 $5,300. The estimated cost to the county in loss of trade and interference of business has been ?10,000.

Our chief difficulties in stamping out the disease were: The mild character of the disease caused a majority of the people and, at the outset, some"" of our physicians, to doubt that they had smallpox to deal with. After there were seven cases and deaths, and the diagnosis was confirmed by Dr. McCormack our difficulties were greatly lessened^ Very respectfully,

H. K. RONE, M. D., Secretary.

Lyon County Board of Health: A. D. Purdey, M. D., C.H. Linn, M. D., E. S. Wilford, M. D.

Kuttawa, Ky., July 16, 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: Cumberland River, Kuttawa and Eddyville, with a total of 128 cases and 2 deaths. No hospital or pest house was provided, and the following was our method of management: We procured cabins, isolated, and vaccinated. We used the Osburn treatment, viz.: 30 grs. bichloride mercury to 4 pints of water. Sponged each and every case, together with all who had been exposed. The two deaths were not treated by the Board. Many who were exposed never took the disease. We attribute this to the efficacy of the Osburn treatment and vaccination.

The disease was brought to this county from Tennessee and Illinois and Livingston and Crittenden counties; it was recognized after many families had been exposed. I estimate that 4,000 vaccinations have been done in the county since the first cases occurred; that 2,000 had been previously vaccinated, out of a total population of 9,319, leaving 3,319 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 $10,000.

Our chief difficulties in stamping out the disease were: On account of the contrariness of the fiscal court refusing to furnish the board with means sufficient to stamp out the disease, thereby allowing it to spread, and it was only with great difficulty that we got the county officials to make any appropriation. They (the court), denied its being smallpox, and took charge themselves, hired incompetent doctors and nurses when forced to act. Had the Board been allowed to act there would not have been more than one-fourth of the cases, . and the cost would not have exceeded $500.

A. D. PURDEY, M. D., Secretary.

Paducah, Ky., August 30, 1901.

To the State Board of Health:

Gentlemen: In reply to your request, I make the following statement to you, concerning our misfortunes, for the last four years as .shown from our books, viz.:

Cost of smallpox, care and vaccination, $8,267.55; approximate num"ber of persons vaccinated and re-vaccinated, including children in the public schools, 6,000.

The disease was first introduced from a colored man coming from Fulton, Ky., over the Illinois Central Railroad, and who was in full -development of a severe case. This man was caught on the street by Dr. Rivers, and escorted to the pest house by him. The annual outbreaks since that time have been from similar importations from surrounding cities and towns, coming both by river and railroads.

All cases, with few exceptions, have been treated at the city's pest louse; patients were carefully cared for by competent nurses, and supplied with best of food and change of raiment on departure therefrom. Few deaths have resulted, and most of these were from other -complications added to this contagion.

Careful isolation and quarantine of all persons known to be exposed, has been the invariable rule of its management in the city.

I enclose copy of circular letter found necessary last year to address to each of the physicians practicing in the city, which, we think, did much good.

The total number of cases detained at the pest house for the four years approximates about 320; cases isolated and treated at their .homes approximate 50; total, 370.

Very respectfully,

JAMES M. LANG, Mayor.

McLean County Board of Health: Dr. W. P. Miller, Dr. George Hillsman, Dr. H. W. Gates.

Calhoun, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had b outbreaks -of smallpox in this county, in the following districts or precincts: Livermore, Calhoun and Beech Grove, with a total of 50 cases and 1 death. No hospital or pest house was provided, and the following "was our method of management: Every case was isolated and when necessary a guard was placed on the premises, and all exposed persons and others, so far as they would be, were vaccinated.

The disease was brought to this county from Hopkins county, Ky.; it was recognized after many had been exposed. I estimate that 300 vaccinations have been done in the county since the first cases occurred, that 800 had been previously vaccinated, out of a total population of 12,448, leaving the balance 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 $5,000.

Our chief difficulties in stamping out the disease were: That the people were careless; they did not believe it was true smallpox, some of the physicians of the county contending it was not smallpox. We succeeded, however, in stamping it out each time, in spite of these obstacles.

Very respectfully,

H. W. GATES, M. D., Secretary.

Madison County Board of Health: Dr. J. M. Poyntz, Dr. W. M. Gibson, Dr. G. G. Perry, Dr. A. L. Hurst. ,

Richmond, Ky., July 16, 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: Richmond, College Hill, Peyton Town, Tate's Creek, Berea, Waco, Brassfield, Paint Lick, Bear Wallow, Red House, with a total of 183 cases and 6 deaths. One hospital or pest house was provided near Richmond, 1898, and the following was our method of management: Had no hospital or pest house in 1900. Managed cases at their home with guards. Isolation, cathartics, stimulants, tonics, cleanliness and general vaccination.

The disease was brought to this county from Knoxville, Tenn., in 1898, and from Cincinnati, Ohio, in 1900, by a journeyman tailor; it was recognized after many had been exposed. I estimate that 8,000 vaccinations have been done in the county since the first cases occurred, that many had been previously vaccinated, out of a total population of 25,607, leaving 60 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 $6,800. The estimated cost to the county in loss of trade and interference of business has been $25,000.

Our chief difficulty in stamping out the disease was: Resistance to the orders of health board, many good and reputable citizens refusing to aid us in resisting and combatting the loathsome disease.

Very respectfully,

J. M. POYNTZ, M. D., Chairman.

Magoffin County Board of Health: Dr. W. A. May, Dr. R. C. Adams, Dr. M. C. Kash.

Salyersville, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 1 outbreak of small-pox in this county, in the following district: West side of county, adjoining Breathitt, Morgan and Wolfe counties, with a total of 15 cases and no deaths. No hospital or pest house was provided, and the following was our method of management: The local board of health, with the assistance of the county judge, established a quarantine against the infested localities by placing flags and a sufficient number of guards on all the roads and near homes of all patients having the disease, until the period of incubation had passed for all those who had been exposed, tne board in the meantime vaccinating all who were willing.

The disease was brought to this county from the counties of Breathitt, Morgan and Wolfe; it was recognized after a few had been exposed. I estimate that 200 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 11,500 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 $150. The estimated cost to the county in loss of trade and interference of business has been comparatively nothing.'

Our chief difficulties in stamping out the disease were: Ignorance of the quarantine law, the old "hoodoo" negro-like scare, or dread of a sore arm from vaccination, by the less informed and superstitious, together with a failure on the part of the fiscal court to co-operate with the local board, on account of the indebtedness and distressing financial condition of the county at present.

Very respectfully,

M. C. KASH, M. D., Secretary.

Marion County Board of Health: Dr. R. T. Hodgin, Dr. Edward Kelly, Dr. R. C. McChord.

Lebanon, Ky., July 19, 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: Lebanon and Holy Cross, with a total of 25 cases and no deaths. No hospital or pest house was provided, and the following was our method of management: The first six cases were white waiting girls

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