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done in the county since the first cases occurred, that 5,000 had beenpreviously vaccinated, out of a total population of 11,624, leaving 6,000 or 7,000 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 $250. The estimated cost to the county in loss of trade and interference of business has been $2,000.

Our chief difficulty in stamping out the disease was: The people refused to believe that it was smallpox, and had long neglected to bevaccinated. Although the disease was well marked, many of our good people still believe it was not smallpox, though none of them ever saw a case and could not be induced to see one.

Very respectfully,
J. C. DOUGLASS, M. D., Chairman.

Spencer County Board of Health: Dr. W. E. Shepherd, Dr. Wyley Rodgers, Dr. P. A. Hobbs.

Taylorsville, 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 district or precincts: Taylorsville and Elkcreek, with a total of 8 cases and no deaths. A hospital or pest house was provided near Taylorsville, and the following was our method of management: Best house for the first case; the remaining seven were in the same family and were quarantined in the house in which it broke out.

The disease was brought to this county first from Shelby county; it was promptly recognized. I estimate that 800 vaccinations have been done in the county since the first cases occurred; that 5,000 had been previously vaccinated, out of a total population of 7,604, possibly leaving 1,800 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 $300. The estimated cost to the county in loss of trade and interference of business has been nominal.

We had no trouble in stamping out the disease. Our fiscal court co-operated with us heartily.

Very respectfully,

W. E. SHEPHERD, M. D., Secretary.

Taylor County Board of Health: J. L. Atkinson, M. D., B. T. Block, M. D., O. M. Kelsay, M. D.

Campbellsville, 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: Mannsville and Feathersburg, with a total of 22 cases and no deaths. No hospital or pest house was provided, and the following was our method of management: Isolation of infected and exposed persons at their homes with quarantine against the infected districts.

The disease was brought to this county from Lebanon, Ky.; it was not promptly recognized. I estimate that 600 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 about 11,000, leaving 8,400, or over 75 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 $98. The estimated cost to the county in loss of trade and interference of business has been $500.

Our chief difficulty in stamping out tne disease was: The failure of the local physician at Mannsville to recognize the disease when it first appeared, and his obstinate refusal to admit the disease to be smallpox when it was properly diagnosed. The disease appearing in portions of the county remote from the regular lines of traffic made it much easier to control than if it had been otherwise.

Very respectfully,

J. L. ATKINSON, M. D., Chairman.

Todd County Board of Health: Dr. J. O. McReynolds, Dr. R. W. Frey, Dr. W. S. Petree, Dr. J. M. Robinson.

Guthrie, 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: Trenton, Guthrie and Allensville, with a total of 100 'cases and 10 deaths. Five hospitals or pest houses were provided near Elkton, Guthrie, Trenton and Allensville, and the following was our method of management: All cases of smallpox were promptly removed to pest house or were isolated as soon as discovered, and all suspects were immediately vaccinated and quarantined for a period of fifteen days.

The disease was brought to this county from Henderson, Ky., and

the State of Tennessee; it was recognized after 50 had been exposed. I estimate that 3,500 vaccinations have been done in the county since the first cases occurred; that 4,600 had been previously vaccinated, out of a total population of 18,000, leaving 9,900, or 55 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 $7,000. The estimated cost to the county in loss of trade and interference of business has been $75,000.

Our chief difficulty in stamping out the disease was: Nonco-operation of a few members of the medical profession and about 50 per cent, of the laity, who insisted that the disease was not smallpox. Very respectfully,

J. M. ROBINSON, M. D., Member.

Trimble County Board of Health: Dr. W. A. Wright, Dr. John Calvert, Dr. J. C. Hancock.

Bedford, 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 April, 1899, it appeared in the town -of Milton, at the house of Wm. Wright, his son James having contracted it in Madison, Ind. It was promptly recognized, a guard placed over the house and maintained both day and night. Two other members of this family contracted the disease, but no case spread to the outside. In the following May, two other cases developed in the county, 3 and 5 miles from Milton. A number of persons had been exposed to these cases before they were reported to this board; these houses were also quarantined, the exposed persons vaccinated and the disease spread no further. These cases were also contracted in Madison, Ind. I omitted to say that at the request of this board a general vaccination ordinance was passed by the board of trustees of the town of Milton and fairly well enforced. Three of these cases were mild, 2 severe and 1 of the latter of the confluent form.

The cost to the county of these cases, including the erection of a pest house, etc., etc., was $736.40. The estimated loss to business was small, a few hundred dollars.

In February, 1901, a case developed near the turnpike, midway between Bedford and Milton. This case was promptly recognized, the house quarantined, and no other case resulted from it. It was -contracted either in Madison or Indianapolis, Ind., and was a very mild case. The cost to the county will be $40 or $50. Loss to business, nothing.

In March, 1901, a Mr. W. F., living near Wise's Landing, on the Ohio river, attended a meeting of the Mormon Fraternity in Louisville and remained a number of days. A short time after his return home he developed a mild case of smallpox. No physician was called co see him, and his entire family (6 or 8 persons) had contracted the disease, and almost the entire community exposed before it was reported to this board. On April 1st, after hearing of the disease, I visited Wise's Landing, and in company with Dr. W. A. Wright (member of this board), saw 4 well-developed cases and 2 of the cpnfluent form. All of these cases in the most public portion of the town, Vere immediately quarantined, the usual flag displayed, and all exposed vaccinated as soon as found. But these exposed persons being so widely separated over the county, a great number escaped vaccination and about 25 cases developed from these exposed. They were separated by about 15 or 20 miles. Each infected house was quarantined and guards placed upon each road leading to Wise's Landing, and maintained until all danger had passed and general vaccination had been done. There were no more exposed after the disease was taken in hand by this board. In this outbreak there were 34 cases, very mild in the beginning, but more severe as the disease advanced; 10 or 12 cases were severe, 6 of the confluent form; no deaths.

The estimated loss to business, $3,500. The cost to the county can not be estimated, as it will depend upon the action of the fiscal court. The greatest difficulty encountered by this board in the suppression of these outbreaks were the mild form of the disease in the beginning; the want of co-operation of the county officials and the prejudice of the people against vaccination. Since the first outbreak I would estimate that 2,000 vaccinations had been done in the county, that 2,500 had been previously vaccinated, out of a population of over 7,000, leaving about 40 per cent, still unprotected.

This board desires to express appreciation and thanks to your honorable board for its prompt action, and to your efficient secretary for his presence and valuable assistance.

Very respectfully,

J. C. HANCOCK, Secretary.

Union Govntji Board of Health: Dr. T. J. Shoemaker, Dr. H. I* Marl, J. T. Clark, Esq.

Morganfield, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had one great outbreak of smallpox in this county in the following districts or precincts: Uniontown, Henshaw, Morganfield, Hitesville, Boxville, Bradley, Caseyville and Sturgis, with a total of 800 cases and several -deaths. A pest house was provided near Morganfield, Ky., and the following was our method of management: After the quarantine on. November 21, 1899, was ordered by the State Board of Health, and the pest house established a little later on, the smallpox was readily stamped out. Uniontown was quarantined entirely and strictly, and all smallpox houses in other towns guarded.

The disease was brought to this county from either Earlington, Ky., in February, 1899, or Evansville, Ind., in June, 1899; it was not recognized until hundreds had been exposed. I estimate that 2,000 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 31,326, leaving a large 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 $5,000. The estimated cost to the county in loss of trade and interference of business has been $25,000.

Our chief difficulty was: The failure of the fiscal court to provide funds to establish a pest house. The board of health of Union county was always ready and willing to do everything to stamp out the smallpox, but the county failed to provide money to carry out any plan to rid the county of the disease.

Very respectfully,

T. J. SHOEMAKER, M. D., Secretary.

Bowling Green City -Board of Health: Henry James, Esq., I. B. Cook,. Esq., R. F. Dulaney, Esq., Dr. S. W. Coombs, Health Officer.

Bowling Green, Ky., Aug. 2, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this city, in the following districts or precincts: Negro settlements, with a total of 42 cases and 3 deaths. Two hospitals or pest houses were provided near the city, and the following was our method of management: As soon as the health officer was convinced that it was smallpox the patient was sent to the pest house and premises from which taken quarantined; no one allowed to leave or enter; provisions furnished by city.

The disease was first brought to this city from Evansville, Ind., several times; it was recognized after a number had been exposed. I. estimate that 5,000 vaccinations have been done in the city since the first cases occurred; that 4,000 had been previously vaccinated, out of a total population of 10,000, leaving a very small per cent, now unprotected.

The total cost of management to the city, including hospital,, physicians, vaccinations, guards, nurses, food, etc., for all the cases

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