The population of this county is 26,000. At the time of our last report, 9,600 had been vaccinated. Since that time it is estimated that 200 have procured vaccination, leaving 62% per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have one eruptive hospital, located one and one-half miles from Russellville, with a capacity for sixteen patients. Our method of managing the disease was to quarantine all cases and suspects in their homes; the suspects were vaccinated and placed under guard.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurse, food and medicine, has been $750. The estimated cost in loss of trade and interference with business has been $500 at Olmstead.

The chief difficulty in stamping out the disease has been the failure of negro families to call a physician until after a number of persons had been exposed.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, ten cases and eight deaths; typhoid fever, thirty-five cases and six deaths, diphtheria, five cases and two deaths; scarlet fever, six cases and no deaths; cholera infantum, four cases and three deaths; dysentery, eight cases and one death. The average cost to our people for managing and treating a case of any of these diseases, including medical attention, nursing, loss of time and incidental expenses, is estimated to be $150, making a total loss to the county for the two years from diseases which might be prevented of $10,200, as against $50,000 paid for State taxes. The county health officer is paid a salary of $250, and all of the other members serve gratuitously.

Very respectfully,

G. W. HILL, M. D., Secretary.

Lyon County Board of Health.

Kuttawa, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago there has been one outbreak of smallpox in this county, in the First Magisterial district, with a total of seven cases and no deaths.

The first case came from Trigg county, Ky., and fourteen persons had been exposed to the disease before its character was recognized and reported so that we could take steps to bring it under control. Of those exposed, seven had been properly vaccinated; of these, none

contracted the disease. Of the seven exposed who had not been vaccinated, seven took the disease and none died.

The population of this county is about 14,000. At the time of our last report 7,000 had been vaccinated. Since that time it is estimated that 2,000 have procured vaccination, leaving 40 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. Our method of managing the disease was isolating, quarantining, fumigation, etc.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurse, food and medicine, has been $300. The estimated cost in loss of trade and interference with business has been $500.

We have had no trouble to stamp out the disease.
Very respectfully,

E. S. WILFORD, M. D., Secretary.

McCracken County Board of Health.

To the State Board of Health:

Paducah, Ky., August 31, 1905.

Since our last published report two years ago there has been one outbreak of smallpox in this county, with a total of fifteen cases and no deaths.

The first case came from Paducah, Ky., and several persons had been exposed to the disease before its character was recognized and "eported so that we could take steps to bring it under control. Of the fourteen exposed who had not been vaccinated, fourteen took the disease and none died.

At

The population of this county is 25,000 outside of Paducah. the time of our last report few had been vaccinated. Since that time It is estimated that few have procured vaccination, leaving 50 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. (Paducah has an eruptive hospital, but the county has none.)

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurse, food and medicine, has been $700. The estimated cost in loss of trade and interference with business has been none.

We have experienced no difficulty in stamping out the disease. As nearly as can be ascertained, other cases of preventable dis

Scarlet fever,

eases have occurred during the two years as follows: thirteen cases and no deaths. The county health officer is paid a salary of $500, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: The above report is very incomplete, from the fact that there is kept no record of any diseases, deaths, etc., except reports of smallpox, scarlet fever, diphtheria, etc., as kept by the county health officer. Only a small percent of school children are vaccinated. Very respectfully,

P. H. STEWART, M. D., Secretary.

Paducah, Ky., May 28, 1905.

Dr. J. N. McCormack, Secretary State Board of Health, Bowling Green, Ky.

Dear Doctor: Following my report to you on January 17, 1905, I beg to say there is not one single case of smallpox in McCracken county outside the city of Paducah. There has developed but one case; that was sent to the city pest house, with the other members of the family who were exposed. Ohere are yet several cases in the city and in the city's pest house-in fact, Paducah has not been free from the disease within the past year, due, in my opinion, to lack of proper effort on the part of the city to stamp it out. Every case in both city and courty has recovered.

As health officer of the county I have, since my last report, abated two nuisances; both were keeping hogs penned too near the city limits and public highway. Nothing further to report. Yours sincerely,

P. H. STEWART, Health Officer McCracken County.

Paducah, Ky., November 14, 1905.

J. N. McCormack, M. D., Secretary State Board of Health, Bowling Green, Ky.

Dear Doctor: Since my last report to you as health officer of McCracken county, I beg to report to you one case of smallpox, with four exposures and no subsequent cases, all four being immediately vaccinated.

I have had eleven cases of scarlet fever reported to me, all of which were quarantined and the premises thoroughly fumigated following recovery; no death; one case now under observation. In one section a very mild epidemic existed for some weeks, so mild that the parents did not even suspicion scarlet fever until a case of some

severity developed. The public school was closed for two weeks, but is now open again with no new cases appearing.

Paducah has had a large number of cases within the past three months, and there are yet a goodly number on hands, but fortunately the death rate has been nothing. It appears as if the authorities in Paducah are inclined to be too lenient in quarantine rules and regulations, allowing exposed people too much freedom and removing quarantine restrictions too early after a case begins to improve. You will please not construe my observation as a kick or knock against the city health authorities, but this is also the criticism of other local physicians, as also the tardiness in establishing quarantine after cases have been reported by the attending physician. I suggest that you confer with Dr. H. T. Rivers and inquire as to these conditions. I merely write this with the view to spare no pains to suppress and exterminate the disease.

The citizens of the county co-operate heartily with the county board in its every effort, except as to vaccination. I do not believe that one-third of the school children in McCracken county are vaccinated. The board is unable to compel them to submit, as our county judge holds that the section of compulsory vaccination is illegal and unconstitutional, and refuses to decide with the board on this point. With proper care and attention, the prospects are bright for but few cases of contagious diseases the coming winter.

Yours sincerely,

P. H. STEWART, Health Officer McCracken County.

McLean County Board of Health.

Calhoun, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago, there has been one outbreak of smallpox in this county, in the Rumsey precinct, with a total of four cases and no deaths.

The first case came from Hindman, Ky., and three persons had been exposed to the disease before its character was recognized and reported so that we could take steps to bring it under control. Of the three exposed who had not been vaccinated, three took the disease and none died.

The population of this county is 12,000. At the time of our last report 20 per cent had been vaccinated. Since that time it is estimated that none have procured vaccination, leaving 80 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital. Our method of managing the disease was isolation and vaccination.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurse, food and medicine, has been $50. The estimated cost in loss of trade and interference with business has been none.

The county health officer is paid a salary of $100, and all of the other members serve gratuitously.

The following additional fact will be of interest in connection with this report, that the physicians do not make annual reports of births and deaths, so I can not form even an approximate estimate of the deaths from other diseases.

Very respectfully,

H. W. GATES, Health Officer.

Madison County Board of Health.

Richmond, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago there has been one outbreak of smallpox in this county, in the village of Berea, with a total of six cases and no deaths.

The first case came from Tennessee, and twenty persons had been exposed to the disease before its character was recognized and reported so that we could take steps to bring it under control. Of those exposed, fifteen had been properly vaccinated; of these, none contracted the disease. Of the five exposed who had not been vaccinated, all took the disease and none died.

The population of this county is 30,000. At the time of our last report 10,000 had been vaccinated. Since that time it is estimated that 5,000 have procured vaccination, leaving 50 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have no eruptive hospital in the county, but there is an excellent eruptive hospital in the city of Richmond, with a capacity for twenty-five patients. Our method of managing the disease was quarantine, isolation, guarding, with ichthyol locally and internally antiseptics. The county has no eruptive hospital; we use the city hospital in an emergency.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurse, food and medicine,