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and varioloid in this race, and of the importance of calling in experienced counsel in every doubtful or suspicious case. Those hav. ing this work in hand should deal firmly, but kindly, with every one, advising that this work is being done for their protection as well as that of the community.
Quarantines against infected places, the first resort of unprepared towns, do much actual harm by giving rise to a false sense of security, thus retarding the work of vaccination and preparation, and, if rigidly enforced, are much more expensive than the precautions herein advised, besides causing much financial loss by interference with travel and commerce. No quarantine can be legally established without the consent of this Board, and this will not be given unless the circumstances are very exceptional. Communities maintaining unauthorized quarantines are liable to persons suffering injuries or damages therefrom.
At this time every person in Kentucky should be vaccinated or revaccinated. If properly protected it will not take, and if it takes there is need of it. The vaccination should always be done in three places about an inch apart, by a competent physician, with clean hands and instruments, upon a well-cleaned arm, by scraping off the scarf skin without drawing blood, and should be allowed to dry thoroughly before the sleeve is put down, and should be protected for a few days with clean cloth or absorbent cotton. This will give the best chance for a successful result, with much less soreness and suffering.
Fresh, reliable virus may always be had from the National Vaccine Establishment, Washington City, or from its agents the Henry Drug Co., of Louisville. Vaccination from the arm of a child known to be healthy is equally reliable.
This Board holds itself in readiness to aid local boards to the full extent of its powers, but little aid will be needed from it if each community will intelligently prepare to take care of itself. By order of the Board:
J. M. MATHEWS, M. D., President. J. N. McCORMACK, Secretary.
As the disease continued to spread in certain of the mountain counties, the following was issued and widely circulated, especially in that section of the State:
SMALL-POX IN SOUTHEASTERN KENTUCKY.
State Board of Health.
Bowling Green, Ky., July 18, 1898. To the Health Officials, County Officials and People of Southeastern Kentucky:
Smallpox now exists in Laurel and Clay counties and it is widespread in Jackson county. Every class of the population is affected and the disease is in epidemic form.
If every man, woman and child in Southeastern Kentucky is vaccinated at once, danger of a serious epidemic will be removed. Every person remaining unvaccinated is a menace, not to themselves alone, but to the health and business welfare of their entire section. Children should be vaccinated when quite young, and older persons should be revaccinated every seventh year, at least. This method of prevention is as cheap as it is safe and easy, when properly done, with reliable virus. The operation should be done by a competent physician, under proper aseptic precautions. Reliable virus may be obtained from the Henry Drug Company, Louisville, Kentucky.
In addition it is earnestly requested that the boards of health for each county and town perfect their organization at once and
confer with their county courts so that arrangements may be made to stamp out the disease as soon as the first case appears. Physicians should be on the lookout for first cases. An especial watch should be kept over teamsters, tramps, and peddlers. Prompt and intelligent organization will save heavy expense to all the counties interested, as the cost of stamping out the disease must be borne by the county courts.
This Board holds itself in readiness to give you any assistance in its power at any time. By order of the Board:
J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.
In spite of these admonitions, supported as they were in a great measure by the local health officials everywhere, town after town and county after county were found unprepared to deal with the disease when it came to them, and thus it spread from place to place, or was fed by fresh importations from Cincinnati, Evansville, St. Louis and points in Tennessee, until nearly all the counties in the State have had more or less severe experience with it. Of course there were exceptions to this careless and time-serving course, in which wide-awake county judges and courts appreciated the wisdom and economy of being forehanded. In such instances first cases were recognized and isolated, all exposed persons were vaccinated without argument or ceremony, and kept under observation, thus protecting their own jurisdictions at small cost and risk, and by the same effort protecting adjacent territories.
Early in 1899 the Board found that it had not only exhausted the fund that it had been gradually accumulating for years, but that it was heavily overdrawn in bank. From this time on we could only send our inspectors to those counties whose fiscal authorities would agree in advance to bear the expense. Fresh importations from adjoining States were constantly occurring, especially from Tennessee, where little care against the spread of the disease appears to have been the rule from the beginning of the epidemic, and in many sections of the State an alarming prevalence existed. In all it was found that smallpox had reached 110 of the 119 counties.
In its war against the disease the Board found that its authority to place counties and towns whose authorities failed or refused to adopt proper precautions against the disease an indispensable weapon. This authority was exercised sparingly, but the knowledge that it would be used when necessary, when this was fully understood, had a most salutary effect on that large class of county officials, especially who constantly hampered the work of their health officials by refusing timely appropriations necessary for feeding, housing and nursing the indigent sick, and using this pretense of economy as a vote-making device for popu. larity and re-election to the then held or some higher office. The last exercise of this quarantine power was exercised in Greenup county, 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 delaved 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 the court had resolved to support its board of health in bringing the disease under control, when the quarantine was raised, having been in force but fifty-three hours. The proclamation was as follows:
Bowling Green, Ky., December 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 stituted Board of Health for the county, the fiscal court has perbistently 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 modied by this Board. By order of the Board.
J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.