The first case came from Ohio (a tramp), and 15 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, 12 had been properly vaccinated; of these, none contracted the disease. Of the 15 exposed who had not been vaccinated none took the disease.

The population of this county is 22,000. At the time of our last report 70 per cent. had been vaccinated. Since that time it is estimated that 10 per cent. have procured vaccination, leaving 20 per cent. still unprotected after nearly eight years of smallpox almost constantly in some section of the State.

Our method of managing the disease: The case was isolated at once, guards placed over him, all exposed persons were vaccinated and kept under observation for twenty days.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $110. The estimated cost in loss of trade and interference with business has been none.

The chief diff.culties in stamping out the disease have been the want of eruptive hospital and failure of physicians to report the cases promptly to the board of health.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 40 cases and 25 deaths; typhoid fever, 140 cases and 14 deaths; diphtheria, 44 cases and 6 deaths; scarlet fever, 50 cases and 2 deaths; cholera infantum, 6 cases and 3 deaths; dysentery, 65 cases and 8 deaths, and yellow fever no cases. The county health officer is paid a salary of $100, and all of the other members serve gratuitously.

Very respectfully,

SILAS EVANS, M. D., Secretary.

Boyd County Board of Health.

To the State Board of Health:

Catlettsburg, Ky., August 31, 1905.

Since our last published report two years ago there have been no outbreaks of smallpox in this county, except one case in Catlettsburg of mild type, which was isolated at his residence and promptly recovered without any spread of the disease. It was impossible to learn the source of contagion.

We have no county eruptive hospital, but Catlettsburg and Ashland each have one located about one mile from corporate limits, each having a capacity of fifteen patients.

.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 100 cases and 65 deaths; typhoid fever, 250 cases and 25 deaths; diphtheria, 100 cases and 15 deaths; scarlet fever, 100 cases and 10 deaths; cholera infantum, 100 cases and 10 deaths; dysentery, 200 cases and 5 deaths, and yellow fever, no cases. 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 $20 to $100, owing to the disease, making a total loss to the county for the two years from diseases which might be prevented, of $30,000, as against $20,000 paid for county, and $20,000 for State, taxes. The county health officer is paid a salary of $300, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: The above estimate is based upon partial returns from the physicians of the county, and I think are somewhat misleading, especially with reference to typhoid fever and cholera infantum, owing to there being included under the former many cases which a close diagnosis would probably have eliminated, and under the latter various types of intestinal derangement.

Very respectfully,

J. W. KINCAID, M. D., Secretary.

Bracken County Board of Health.

Brooksville, 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 Milford or Santa Fe district, with a total of 24 cases and no deaths.

The first case came from Cincinnati, O., and 15 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, none had been properly vaccinated; of these, 15 contracted the disease and none died. Of the 24 exposed who had not been vaccinated, all took the disease and none died.

The population of this county is 13,000. At the time of our last report 20 per cent. had been vaccinated. Since that time it is estimated that 5,000 have procured vaccination, leaving 60 per cent. still unprotected after nearly eight years of smallpox almost constantly in some section of the State.

We have an eruptive hospital, located five miles from Brooksville,

with a capacity for ten patients. Our method of managing the disease was strict quarantine and vaccination when possible.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $300.

The chief difficulties in stamping out the disease have been its mildness and making people believe it was really smallpox.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 100 cases and 75 deaths; typhoid fever 75 cases and 12 deaths; diphtheria, 20 cases and 3 deaths; scarlet fever, none that I know of; cholera infantum, 30 cases and 8 deaths; dysentery, 20 cases and 7 deaths, and yellow fever, no cases. 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 $10,000, as against $32,000 for State taxes. The county health officer is paid no salary.

The following additional facts will be of interest in connection with this report: It is very hard to be accurate in a report of this kind. I have done the very best I can.

Very respectfully,

C. H. WALLIN, M. D., Secretary.

Breathitt County Board of Health.

To the State Board of Health:

Since our last published report two years ago there have been no outbreaks of smallpox in this county.

The population of this county was 18,705 in 1900.

We have had no smallpox or any other eruptive disease in this county in the last two years.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 50 cases and 50 deaths; typhoid fever 75 cases and 15 deaths; diphtheria. 3 cases and 3 deaths; scarlet fever, no cases; cholera infantum, 20 cases and 2 deaths; dysentery, 5 cases and no deaths, and yellow fever, no cases. The county health officer is paid a salary of $100, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: This report is for the whole county and not for those

treated by the county health officer alone. We are in comparative good health at this time; no epidemic disease of any kind, except a few cases of typhoid fever of a doubtful type mixed with malaria. Very respectfully,

J. M. KASH, M. D., Secretary.

Jackson, Ky., August 21, 1905.

Dr. J. N. McCormack:

Dear Sir:-I have made a hurried report as best I could as per your request. Will say we have no health officers in this county at this time. Myself with Dr. Boggs and Dr. Hogg were appointed by the trustees of the town very recently, and Boggs and Hogg refuse to act. I have been trying to act in that capacity some, but can't do anything without an appointment from the State Board of Health. I would be glad; if you wish it, for you to send me an appointment for Breathitt county. I have an appointment for the town. Then I will do the very best I can. Doctor, we still keep up our regular monthly meetings, and have the honor of being the banner county in this district; so says Dr. Shirley, of Winchester.

Very respectfully,

J. M. KASH.

Breckinridge County Board of Health.

Irvington, 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 sixth district, with a total of 10 cases and no deaths.

The first case came from Evansville, Ind., and 29 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, 20 had been properly vaccinated; of these, none contracted the disease. Of the 9 exposed who had not been vaccinated, all took the disease and none died.

The population of this county is 25,000. At the time of our last report 1,000 had been vaccinated. Since that time it is estimated that 1,000 havé procured vaccination, leaving about 90 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 to quarantine in some vacant house or to build a temporary shanty, in which were placed

those having the smallpox. Those exposed were vaccinated and quarantined for proper length of time.

The total cost of managing the disease for the two years, including hospital, physicians, vaccination, guards, nurses, food and medicine, has been $300. The estimated cost in loss of trade and interference with business has been $2,000.

The chief difficulty in stamping out the disease has been inability to get co-operation from county officials, who make such a fight that physicians refuse to attend cases.

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, 75 cases and 20 deaths; typhoid fever, 200 cases and 23 deaths; diphtheria, 30 cases and 5 deaths; scarlet fever, 20 cases and 3 deaths; cholera infantum, 75 cases and 15 deaths; dysentery, 100 cases and 20 deaths; yellow fever, no cases. 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 $25, making a total loss to the county for the two years from diseases which might be prevented, of $10,000, as against $36,000 paid for State taxes. The county health officer is paid a salary of $100, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: Until we can get a fiscal court that will recognize the importance of co-operation with the physician instead of continually fighting him, we can not hope to successfully handle these outbreaks. The physicians of county justly refuse to attend smallpox as court refuses just compensation and county health officer can not, for the fee of $100, afford to personally attend to cases over the county. Then the health officer should be paid a salary sufficient to enable him to personally take care of outbreaks.

Very respectfully,

L. B. MOREMEN, M. D., Secretary.

Bullitt County Board of Health.

Shepherdsville, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report of two years ago there has been one outbreak of smallpox in this county in Lebanon Junction, with a total of 6 cases and no deaths.

The first case came from Louisville, and 12 (?) 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.