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As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, twenty cases and fifteen deaths; typhoid fever, fifteen cases and four deaths; diphtheria, one case and one death; cholera infantum, five cases and three 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 $100, making a total loss to the county for the two years from diseases which might be prevented of $4,000, as against $12,079.77 paid for county, and $7,895.62 for State taxes. The county health cfficer 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: In the absence of any data, this report is very imperfect. Will try to have a more correct report in the future.

Very respectfully,

I. S. WESLEY, M. D., Secretary.

Christian County Board of Health.

Hopkinsville, 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 every district and precinct, with a total of 600 cases and twenty deaths.

The first came from Evansville, Ind., and St. Louis, Mo., and many 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, 8,000 had been properly vaccinated; of these, none contracted the disease. Of those exposed who had not been vaccinated, all took the disease and twenty died.

The population of this county is 39,000. At the time of our last report 20 per cent. had been vaccinated. Since that time it is estimated that 55 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 two eruptive hospitals, located one and five miles from Hopkinsville, with a capacity of 100 patients. Our method of managing the disease was to move all cases to the hospital after we found we had an epidemic to deal with.

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

has been $4,000. The estimated cost in loss of trade and interference with business has been $10,000.

The chief difficulties in stamping out the disease have been in getting the fiscal court to prepare a suitable hospital and getting the unvaccinated vaccinated.

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, 200 cases and fifty deaths; diphtheria, thirty cases and five deaths; scarlet fever, fifty cases and five deaths. The county health officer is paid a salary of $600, and all of the other members serve gratuitously.

The following additional facts will be of interest in connection with this report: November 24, 1904, there was not a district in the county that was not infected with smallpox. At that time the fiscal court agreed to furnish the board with a hospital in sixty days. We handled 350 cases in the hospitals, 315 being negroes, with only eight deaths in the hospital-all negroes. Within ninety days there was not a case in the county. When we first opened the eruptive hospital for the whites we met with some strong opposition, but as soon as we got a few of our best people to go, we had absolutely no trouble in getting any one to be moved to the hospital-in fact, the people living in the country would send for the health officer to send for them, and I have gone out to examine a case and finding it to be smallpox brought the patient with me in my buggy to the hospital. I estimate we vaccinated 20,000 people, and not a single one lost an arm or leg from the vaccination, nor did any one suffer any great bodily pain or great inconvenience.

Very respectfully,

J. B. JACKSON, M. D., Secretary.

Hopkinsville, Ky., November 26, 1904.

D J. N McCormack, Bowling Green, Ky.

Dear Mir: We did not write you the 24th, having occasion on that day to talk with Arthur, and made a verbal report at that time. We feel that our work is becoming systematized and moving along pretty Well at last.

the town of Gracey, and county immediately surrounding, is the most serious source of infection. We decided, on the 24th, that we could make an eruptive hospital out of some isolated buildings, in every house of which there is either now, or has been, a case of smallWo secured the services of Dr. Crow to look after vaccinating peace and surrounding country, transferal of the sick to the hosand a bequcuft disinfection of all the houses in that locality. we spent a portion of the day there, and by night twenty

(20) cases were quartered, and to-night all in the town and several from the county will be in the hospital. In every house in this region a number will be found without successful vaccination, and daily several new cases are developing.

In San Domingo, a negro settlement southeast of Hopkinsville, just outside of the corporate limits, we have found quite a number of cases. Evidently the whole section is thoroughly infected, and the disinfection will include nearly every house.

In Hopkinsville proper, things are in a better condition. The people are being vaccinated by the wholesale, and Dr. Woodard is able to send all the colored people to the pest house as fast as located.

Pembroke furnished one new case yesterday, and from different sections of the country cases are reported daily. We think most of these are old cases just discovered, rather than just developing. We have several men who will begin disinfecting to-morrow, and that par will be looked after with special interest, feeling that our work will be useless if the houses are left in an infected condition. As yet no disposition has been made of the white patients. They are left, when found, with houses placarded, yellow flags hung out, and a guard where inmates are not to be trusted. ine party occupying the workhouse, which we desired to use for this purpose, refused to vacate, and it may take several days to eject him. We do not think it advisable to use tents, as there is such strong prejudice against same here, or any exposure while in the febrile stage. If we find that the legal proceedings will occasion much delay, will insist either on tents or another location for pest houses for whites.

Twenty-seven patients have been placed in the pest house at Gracey, forty-nine in the original pest house here, and ten were dismissed to-day.

Very truly,

AUSTIN BELL.

J. B. JACKSON.

Hopkinsville, Ky., November 22, 1904.

Dear Doctor: The Board of Health of Christian county and the Fiscal Court have ordered a compulsory vaccination of all persons in Christian county, and have appointed all the regular practicing physicians residing in the county to carry out said order at once. The State Board of Health has ordered a quarantine for Christian county, and Dr. J. N. McCormack has suspended the order on the condition that compulsory vaccination be stringently and immediately enforced. The County Board of Health has assigned to you the following territory, including all persons, both white and colored, therein, and insists that you make a house-to-house canvass at once, vaccinating

all persons who have not been successfully vaccinated within the last three years, under the following rules, and on the following conditions:

1. You are hereby delegated full power and authority to apply at each residence and on each farm and vaccinate, then and there, without excuse or delay, all persons who do not present evidences of successful and recent vaccination. In case any person refuses to submit to vaccination, or is away from the premises at the time you make your visit, you shall serve on each and every such person by delivering to a member of the family, or by posting on the door, one of the vaccination notices furnished you, in which such person is summoned to appear at your office within twenty-four hours for vaccination, or to present you with a certificate that he or she has been vaccinated.

2. It is made your duty to report daily each and every person found who has smallpox, and the name of each and every person who refuses to be vaccinated. This should be done by letter, unless it be an urgent case, then the telephone should be used. You should also warn each person refusing to be vaccinated that a warrant will be issued immediately and they will be prosecuted under the law for such refusal.

3. You must keep an accurate list of each person vaccinateď and require them to call at your office in ten days for examination, so as to know whether the vaccination was successful. You will also make a bi-weekly report by mail of the names and location of each person vaccinated under this order. At the end of the ten days after vaccination, after inspection, should you find the vaccination successful, you must issue a certificate of successful vaccination on the form furnished you herewith, for that person, and mail same to this office, so that our records may show that every person in the county has been successfully vaccinated. In case the first vaccination does not take, re-vaccination must be made and reported, until certificate can be issued.

4. All vaccination done by you must be at the expense of the people receiving the vaccination, including your fee and the virus. Exwww that in cases of indigent persons, Christian county, by recent con of the fiscal court (as well as by statute law in such cases d) proposes to pay for all such persons twenty-five cents and of the virus for each successful vaccination. All persons y these fees, who are able to pay and who persistently reasonable time, should be warranted and made to pay legitimate debt, including costs.

of whatever age, race, circumstances, contracting bevatter be confined in the eruptive hospital provided This order from the State Board is impera

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tive, and it is made your duty under the law to immediately report such cases discovered by you to this board.

6. Should there be any houses now in your district which is infected with smallpox, and which have not been properly fumigated or disinfected, you should either serve in person or have served on the person owning said house, or the person in possession of same, one of the enclosed notices, and all persons refusing to disinfect their premises or buildings at once according to the terms of the notice should be reported to this board at once.

Your compliance with this order will do much toward stamping out an epidemic that threatens the lives of many of our citizens. Your territory by metes and bounds is attached hereto.

Done by order of the Board of Health of Christian county, this November 22, 1904.

Clark County Board of Health.

Winchester, Ky., August 31, 1905.

To the State Board of Health:

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

As nearly as can be ascertained, other cases of preventable diseases have occurred during the two years as follows: Consumption, quite a number of cases and deaths; typhoid fever, forty cases and six deaths; diphtheria, twelve cases and four deaths; scarlet fever, twenty-five cases and three deaths; cholera infantum, fifty cases and three deaths; dysentery, twenty cases and two 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 $40, making a total loss to the county for the two years from diseases which might be prevented of $7,880, against $92,000 paid for State taxes. The county health officer is paid no salary.

Very respectfully,

I. A. SHIRLEY, M. D., President.

Clay County Board of Health.

Manchester, Ky., August 31, 1905.

To the State Board of Health:

Since our last published report two years ago there have been two outbreaks of smallpox in this county, in the Manchester district, with a total of nineteen cases and no deaths.

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