house to eruptive hospital at once, dismissing after twenty-one days all who had not contracted the disease, and keeping the sick separate from the others. All were negroes but one.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $1,000. The estimated cost in loss of trade and interference with business has been nothing.

The chief difficulty in stamping out the disease has been the concealment of cases.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Diphtheria, twelve cases and no deaths; scarlet fever, 100 cases and five deaths. The city health officer is paid a salary of $500 per annum, and all of the other members serve gratuitously.

I have no record of consumption, typhoid fever, dysentery or cholera infantum, as these diseases are not recorded.

Very respectfully,

W. E. IRVIN, M. D., City Health Officer.

Princeton City Board of Health.

Princeton, 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 city, in the month of December, 1904, with a total of fifteen cases and no deaths.

The first case came from Christian county, and 100 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.

The population of this city, is 4,000. At the time o our last report two-thirds of our people had been vaccinated. Since that time it is estimated that four-fifths have procured vaccination, leaving one-fifth still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have one eruptive hospital, located one-half mile from the city, with a capacity for twenty-five patients. Our method of managing the disease was to vaccinate and isolate or keep in close observation of them and give them no chance to inoculaté others; put them in hospital at once when diagnosed with smallpox.

The total cost of managing the disease for the nine months, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $700.

The chief difficulty in stamping out the disease has been the fact that people didn't want to believe it smallpox.

The city health officer is paid a yearly salary of $300, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: I was appointed health officer on December 4, 1904. I had no records turned over to me. I suppose they made their reports to you when they went out of office. I am using all efforts to clean out our city and stop each and all outbreaks of disease at once when discovered. Very respectfully

ZACH. T. CUNNINGHAM, M. D., City Health Officer.

Princeton, Ky., August 24, 1905.

State Board of Health of Kentucky.

Gentlemen: I was elected health officer in December, 1904. No record was furnished me. I suppose that they made their report to you from the city, including the $700 for expense. We paid $250 for the city hospital, which is worth the money any day. I included $200 of my salary in the $700 expenses marked in report. The city board is trying very hard to educate our people to have a clean city, and anything known will be thankful for any information. I remain, as ever,

Yours,

ZACH. T. CUNNINGHAM, M. D., City Health Officer.

Richmond City Board of Health.

To the State Board of Health:

Richmond, Ky., August 31, 1905.

Since our last published report two years ago there have been two outbreaks of smallpox in this city, in the three precincts, with a total of 150 cases and no deaths.

The first case came from Covington, Ky., and twenty-five or thirty 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, 25 per cent. had been properly vaccinated; of these, none contracted the disease. Of the 7 per cent. exposed who had not been vaccinated, all took the disease and none died.

The population of this city is 6,000. At the time of our last report 25 per cent. had been vaccinated. Since that time it is estimated that 50 per cent. have procured vaccination, leaving 25 per cent. still unprotected, after nearly eight years of smallpox almost constantly in some section of the State.

We have an eruptive hospital within the city limits with a capacity for thirty-five patients. Our method of managing the disease was to quarantine the infected houses, guard them until the patients were well, then bathe in bichloride solution, change clothing, turn them out and fumigate the houses. This was continued for some time without success. The first of the year 1904, the city purchased a frame building, with eight rooms in it, and moved the patients in it as they were discovered.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $5,200. The estimated cost in loss of trade and interference with business has been $1,500.

The chief difficulties in stamping out the disease have been on account of its not being reported, and then trying to hide the true state of affairs for fear of being sent to the pest house or quarantined.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, fifty cases and fifty deaths; typhoid fever, fifty cases and seven deaths; diphtheria, eighteen cases and three deaths; scarlet fever, forty cases and four deaths; cholera infantum, forty cases and fifteen deaths; dysentery, twenty-five cases and five deaths. 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 $50, making a total loss to the county for the two years from diseases which might be prevented of $11,150. The city health officer is paid a salary of $200, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: I am firmly of the opinion that nothing but thorough vaccination will stop smallpox from invading every household in the Commonwealth. The disease is so mild that in some localities little or no attention is paid to it, and the result is they travel on the railroad trains and over the county generally with impunity. Negro excursions are a fruitful source of spreading the disease.

Very respectfully,

C. J. BALES, M. D., City Health Officer.

Yellow Fever, 1905.

The early appearance of yellow fever in New Orleans in the summer of 1905 caused much alarm over the entire State, especially in the Purchase, which suffered so greatly from the epidemic of this disease in 1878.

In the winter of 1904-5 Drs. Bailey and McCormack had been sent as delegates to the session of the American Public Health Association in Havana, Cuba, and while there, after painstaking personal study, they became firmly convinced that yellow fever is transferred from man to man only when the species of mosquito known as the stegomyia fasciata acts as the intermediary host. Knowing that Western and Southern Kentucky were within the habitat of this variety of mosquito, the board felt that it was necessary to take such steps as would prevent (1) the infection of our domestic stegomyia fasciata mosquitoes from persons from the South who might be taken sick within our borders, and (2) the ingress of infected mosquitoes from the South.

The following letter and reply are typical of dozens of others from the authorities of every section. As we had had no experience with yellow fever since the means of propagation had been discovered, it was perfectly proper that our local authorities should have the fear and horror of the disease which they inherited or remembered from 1878, and just here we feel that we should record a just tribute to the local health officials, who all but unanimously accepted the statement of this board as to the proper means for fighting this epidemic, and by their painstaking, self-sacrificing, and almost entirely unremunerated care, made the plan of campaign successful. This letter, then, is typical of the interest felt by the better class of local health authorities:

"Hickman, Ky., July 31, 1905.

"Dr. J. N. McCormack, Bowling Green, Ky.

"Dear Sir: I am president of the City Board of Health at Hickman, and would like to get your advice whether to quarantine or not should the yellow fever continue to spread in the South. I suppose you remember what a time Hickman had in 1878. It seems to me that Hickman should quarantine sooner than any other town in the

State, for two reasons: First, we are on the river, and boats from Southern towns land here almost every day; and second, because we had yellow fever here in 1878.

"The fever originated here in 1878 by some small boys going aboard a boat to sell apples. In a few days the boys developed fever. "I am going to get the town as clean as possible, and will also use coal oil on all ponds. Please answer at once and oblige. Yours truly,

"L. P. BALTZER."

"State Board of Health of Kentucky,

"Bowling Green, Ky., August 1, 1905.

"Dr. L. P. Baltzer, President City Board of Health, Hickman, Ky. "Dear Doctor: We are keeping in very close touch with the yellow fever situation, and will put an inspection service on upon even the appearance of danger to our State. If the fever spreads so as to require this, we will endeavor to take steps to know definitely and advise the local health authorities of every refugee coming into this State from the infected district who has not been officially detained before he arrives at our borders beyond the period of incubation. If it becomes necessary, we will also require the transhipment of all passengers and baggage from the South into clean cars at or beyond our borders. With the present knowledge that yellow fever is spread only by the mosquito, such methods should have far more protective value than a quarantine, and at the same time be much less hurtful to travel and commerce.

"I will be glad to hear from you further at any time, but would advise against a quarantine unless the emergency becomes far greater than at present and until we can confer fully in regard to the matter. "Very respectfully,

"J. N. McCORMACK, Secretary."

On August 3d, the simultaneous appearance of the disease at several points outside of Louisiana, in spite of "shotgun" quarantines, caused increased alarm in the State, and a meeting of the executive committee of the board was held in Louisville, where a report from Dr. W. H. Sanders, the distinguished State health officer of Alabama, was read, showing the exact danger of a widespread epidemic in the South. Representatives of the great transportation lines coming into Kentucky from the South were present, anxious to assist the board