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ty, whose fiscal court paralyzed its county board of health for months, until the disease became widespread, finally infecting and entailing thousands of dollars' expense on every county in that section of the State. It is now clear that the quarantine should have been imposed much earlier for the public good, but the board delayed action for several weeks in the hope that the court would take favorable action and save its people the hardships and annoyance of a quarantine. As a last resort an absolute quarantine against the county was promulgated. Within two days court had resolved to support its board of health in bringing the disease under control, when the quarań tine was raised, having been in force but fifty-three hours. The proclamation was as follows:

QUARANTINE PROCLAMATION.

OFFICE OF STATE BOARD OF HEALTH.

BOWLING GREEN, KY., Dec. 22, 1900.

Whereas, Official information has come to this Board that smallpox is prevailing in epidemic form in several portions of Greenup county and in a population almost entirely unprotected by vaccination, and

Whereas, After repeated notice and urging from the duly constituted Board of Health for the county, the fiscal court has persistently refused, and still refuses, to provide funds for the proper control of such disease, or for necessary nurses, guards, provisions, or even for the vaccination of those exposed to contagion, or in any other way to co-operate or take any of the steps required by law to prevent the spread of this highly contagious and loathsome disease, within said county, or to adjoining counties or States, until the County Board of Health has been forced to resign and leave their jurisdiction without even the semblance of protection, thus greatly endangering the health, lives and business interests of the people of the entire State, and of adjoining States.

Now, therefore, be it known, That the State Board of Health of Kentucky, in the exercise of authority vested in it by law, hereby declares Greenup county, Kentucky, and each of its inhabitants, to be in quarantine, and establishes a quarantine line along the entire boundary of said county, and forbids any person to enter or leave, except to pass through, and forbids any railroad, steamboat, or any other transportation company to make any stops, or to deliver any passengers

or freight to or from said county, without a permit from this Board, under the pains and penalties of law. The town of Russell, having an independent Board of Health, and having enforced compulsory vaccination, and complied with the other requirements of law for the suppression of smallpox, is hereby exempted from this quarantine.

Boards of Health and other officials of adjoining counties are requested and directed to enforce this order of quarantine at their respective county lines bordering on Greenup county, and to cause the prompt arrest, vaccination and prosecution of any and all persons violating the same.

This proclamation of quarantine will take effect and be in force from noon on Sunday, the 23d instant, until officially raised or modified by this Board.

By order of the Board:

J. M. MATHEWS, M. D., President.

J. N. MCCORMACK, M. D., Secretary.

As will be seen from the reports of the proceedings of this board, and the detailed reports from the county boards as to epidemics and their management within their respective jurisdictions, to follow, progress has been made in many counties, and in the State as a whole. Smallpox has been imported from adjoining and even distant States, and especially from Indiana, over and over again, but in most counties the experience of former years was of value to both the health and fiscal officials, and the ease and lessened cost of management were evident. As might be expected where important interests are involved, friction and clashing of authority and responsibility have occurred, but with less frequency, and in most instances they were more easily adjusted.

In nearly one-third of the counties our suggestion to put the county health officers upon an annual salary has been adopted with great satisfaction to all concerned. It has not only prevented misunderstandings about fees and greatly in creased the efficiency of the county boards, but has greatly lessened the expenses of management as a consequence. In such counties upon the appearance of the first case the re

sponsibility is upon the health officer alone, as it should be, and having nobody to consult, and no occasion or excuse for delay, the disease can usually be confined to the first case or family, and at only a nominal expense. In other counties where different ideas have prevailed, the health officer was hindered and embarrassed for funds for meeting actual ex penses for food, nurses and guards, and by the knowledge that he would have trouble in receiving compensation for his time and labor, and often so dreaded the contention and abuse incident and to follow the efficient discharge of his duties that they were avoided or neglected until the disease had gained a strong foothold, and an expensive and entirely avoidable epidemic had to be faced.

In this connection a summary of the facts contained in the reports from the county and municipal boards will be of inter est. Within the two years there was a total of 10,180 cases of smallpox reported in the State, and 116 deaths against 11,279 cases and 184 deaths in the two previous years. The 'total expense of management in the past two years was $195, 504 or $19.28 per case, as against $308,271, or $27.30 per case, in the two previous years. The health officers receive salaries in thirty of the 119 counties, and fifty-eight counties and cities have eruptive hospitals. Many other interesting and valuable facts are developed by the reports, and the reader is referred to them for details.

REPORTS FROM COUNTY AND CITY BOARDS OF HEALTH.

Adair County Board of Health: U. L. Taylor, M. D., Columbia, W. T. Grissom, M. D., Bliss, William Blair, M. D., Glens Fork.

To the State Board of Health:

COLUMBIA, KY., Aug. 10, 1903.

GENTLEMEN:-Supplementing our report of July 16, 1901, for the preceding four years, during the two years last passed, we have had two outbreaks of smallpox in the following districts or precincts: Milltown and Keltner, with a total of thirteen cases and no deaths. We have no eruptive hospital and our method of management was as follows: Isolation at home; all the members of the two families were exposed before I was notified. I was not at home at one time, and Dr. Grissom, the president of the local board, answered the call. There were six cases in one family and seven in the other. The disease did not spread beyond the first families.

The disease was brought to this county in two outbreaks from Green county; it was recognized after thirteen persons had been exposed altogether. A very small per cent. of our population is protected by vaccination, and an imported case in almost any section means an outbreak.

The total cost of managing the smallpox in the county, including hospital, physicians, vaccination, guards, nurses, food, etc., for all the cases which have occurred since my report in 1901, has been fifty dollars. The estimated cost to the county in loss of trade and interference with business has been nominal.

We had no difficulty in stamping out the disease, and have the support of our officials.

The health officer in this county receives an annual salary of $40. This is exclusive of smallpox. The health officer has never accepted this as full compensation.

It is impossible to tell the number of epidemic diseases which have occurred in the county in the past two years, as the doctors do not notify the health board as it should.

A few cases of typhoid fever have occurred in the county within the last two years, with some deaths. The chief cause has been want of proper sanitary conditions, stagnant ponds, marshes, and so on. The average cost of typhoid fever per case in this county is not reported.

I supplement the following additional facts which will be of general interest in this report: I have had no case of typhoid fever in the

last two years; there have been a few in the county. The Health Board has been so vigilant, that the disease has been almost stamped out. When I hear of any case, I go and look after the sanitary conditions, and set in order the things that are wanting.

Very respectfully,

U. L. TAYLOR, M. D., Secretary.

Allen County Board of Health: A. L. Wagoner, M. D., Scottsville, W. B. Ray, M. D., Scottsville, Marcellus Whitney, M. D., Gainesville. SCOTTSVILLE, KY., Aug. 12, 1903.

To the State Board of Health

GENTLEMEN:-Supplementing our report of July 18, 1901, for the preceding four years, during the two years last past, we have had four outbreaks of smallpox in the following districts or precincts: One at Trammel, in 1902, one at Alexander, one at Halfway and one at Halifax in 1903, with a total of thirty-six cases and no deaths.

We have no eruptive hospital and our method of management was as follows: All cases were in the country and small villages; we quarantined each and every person in their own premises and kept them there until they were released by some physician, and we also vaccinated all exposed.

The disease was brought to this county in three outbreaks from Warren county and one from Logan county. It was recognized after very few persons had been exposed. Only a very small per cent. of our population is protected by vaccination.

The total cost of managing the smallpox in the county, including hospitals, physicians, vaccination, guards, nurses, food, etc., for all the cases which have occurred since my report in 1901, has been $400. The estimated cost to the county in loss of trade and interference with business has been $2,000.

The chief difficulties in stamping out the disease have been: Refusing to be vaccinated; some physicians not co-operating, but opposed to stamping it out; indifference on the part of a great many people to the importance of the disease.

The health officer in this county does not receive a salary, but we are going to make an effort to have a fixed salary when the fiscal court meets.

I estimate that 200 cases of typhoid fever have occurred in the county within the last two years, with five deaths. The chief cause has been carelessness in disinfecting discharges and in sanitary affairs. The average cost of typhoid fever per case in this county is about $40.

I supplement the following additional facts which will be of general interest in this report: We have a good fiscal court to help the local board in all of its work. Very respectfully,

A. L. WAGONER, M. D., Secretary.

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