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Louisville City Board of Health: Dr. M. K. Allen, Health Officer.

Louisville, Ky., July 17, 1901.

To the State Board of Health:

Gentlemen: Since December 4, 1898, we have had smallpox almost continuously, scattered throughout all the wards, with a total of 688 cases and 10 deaths. A hospital or pest house was provided five miles out, on large tract of land belonging to the city, and the following was our method of management: All cases immediately isolated by being sent to the Eruptive Hospital, destruction of infected material by cremation, fumigation of infected houses by means of formaldehyde gas, and general vaccination and re-vaccination.

The disease was brought to this city from Cincinnati in 1898, and Jeffersonville, in 1899. I estimate that 75,000 vaccinations have been done in the city since the first cases occurred, that 100,000 had been previously vaccinated, out of a total population of 205,000, leaving 25,000 now unprotected.

The total cost of management to the city, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $30,000. The estimated cost to the city in loss of trade and interference of business has been $100,000.

Our chief difficulties in stamping out the disease were: The mildness of the disease, permitting those afflicted with disease to go about .their business with an unrecognized infection.

Very respectfully,

M. K. ALLEN, M. D., Health Officer.

-Jessamine County Board of Health: Dr. W. H. Matthews, Dr. L. A. Penick, Dr. J. A. Vanarsdall.

Nicholasville, Ky., July 19, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 2 outbreaks of smallpox in this county in the following districts or precincts: Nicholasville No. 2, and Marble Creek, with a total of 25 cases and no deaths. A hospital or pest house was provided near Nicholasville, and the following was our method of management: Established strict quarantine over all cases and suspects; thorough vaccination of all citizens of the county; in each instance all who were exposed have been confined in house of detention under guard, or confined in their homes. In first epidemic all cases were treated in pest house; in .second all cases were quarantined and treated in their homes.

The disease was brought to this county from Cincinnati, O., and Fayette county, Ky.; it was not promptly recognized, and only after 65 had been exposed. I estimate that 4,000 vaccinations have been done in the county since the first cases occurred, that 4,000 had been previously vaccinated, out of a total population of 11,925, leaving 3,925, or 32 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $2,500. The estimated cost to the county in loss of trade and interference of business has been $8,000.

We have had but little difficulty in controlling the disease, the board of health has acted promptly in each instance and the disease has never spread beyond the families in which it originated, except in one instance it was not reported for several days, and some others were infected. The fiscal court gave us active support in everything. Very respectfully,

J. A. VANARSDALL, M. D., Sec'y.

Johnson County Board of Health: Dr. I. R. Turner, Dr. F. M. Wibben, Dr. W. H. Vaughan, Dr. P. P. Meade.

Paintsville, Ky., July 18, 1901.

To the State Board of Health:

Gentlemen': Within the last four years we have had 3 outbreaks of smallpox in this county, in the following districts or precincts: Low Gap, Big Gap and Paintsville, with a total of 31 cases and 1 death. No hospital or pest house was provided, and the following was our method of management: Patients were treated at their homes, isolated from balance of people, however. Outside of Paintsville no guards were employed. Out roads leading past infected houses were quarantined. Experienced nurses were employed, etc.

The disease was brought to this county from Elliott county to Low Gap; from parts unknown to Paintsville; from Ashland to Big Gap; it was very promptly recognized, after a few had been exposed. I estimate that 300 vaccinations have been done in the county since the first cases occurred; that 1,700 had been previously vaccinated, out of a total population of 11,000, leaving 9,000 now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases whch have occurred in the time named has been $1,200. The estimated cost to the county in loss of trade and interference of business has been $2,000.

Our chief difficulties in stamping out the disease were: Inexperience of majority of physicians, who claimed for some time that the disease was not smallpox.

I. R. TURNER, M. D., Chairman.

Kenton County Board of Health: J. R. Allen, C. R. Slater, Jno. F. .Lioomis, W. W. Ranshaw.

Independence, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 7 outbreaks of smallpox in the county outside of Covington, with a total of 127 -cases and 3 deaths. No hospital or pest house was provided, and the following was our method of management: Quarantined all cases and suspects and placed day and night guards over same. There is not an instance of its spreading after health board was notified. Our main obstacle to overcome was in getting families and also some few physicians to report the contagion in time.

The disease was brought to this county from Scott, Boone and -Campbell counties; it was generally recognized by physicians after some had been exposed. I estimate that 1,000 vaccinations nave been done in the county since the first cases occurred, that 8,000 had been previously vaccinated, out of a total population of 12,000, leaving 3,000, or 25 per cent, now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases Which have occurred in the time named has been $1,500. The estimated cost to the county in loss of trade and interference of business has been $1,000.

We had very little difficulty in controlling the disease after it was reported. If families afflicted would report at once to some competent physician, and he report to the Health Board, we would both save -suffering and money. Very respectfully,

JOHN F. LOOMIS, M. D., Secretary.

'Covington City Board of Health: Dr. C. W. Reynolds, Health Officer.

Covington, Ky., October 22, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have nad 2 outbreaks of smallpox in the entire city limits, with a total of 357 (detected) -cases and 4 deaths. A hospital or pest house was provided near this -city, and the following was our method of management: So far as practicable, patients were removed to the hospital as soon as the cases "were reported to the health department, but many cases had to be confined under guard in their homes.

The disease was brought to this city from Cincinnati; it was not promptly recognized, and only after many had been exposed. I estimate that 2,500 vaccinations have been done in the city since the first cases occurred, that 37,000 had been previously vaccinated, out of a total population of 42,000, leaving 2,500, or a very small per cent., now unprotected.

The total cost of management to the city, including hospital,physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $34,871.53. The estimated cost to the city in loss of trade and interference of business has been $8,000.

Our chief difficulties in stamping out the disease were: Although the eruption was typical and symptoms also, there was doubt among the physicians and laity as to the nature of the disease—the majority of the cases being very mild—though typical cases were prevalent; difficulty in enforcing vaccination and removal of infected to pest house.

Six hundred vaccinations were made in May, 1900, by Dr. Reynolds, the health officer, and his assistants. It is estimated that there wereat least 2,000 cases concealed (never reported to the health officer), in. the two years.

Very respectfully,
CHAS. W. REYNOLDS, M. D., Health Officer.

Knox Countj) Board of Health: Dr. J. W. Parker, Dr. W. E. Cecil, Dr. B. F. Herndon.

Barbourville, Ky. , July 19, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have had 1 outbreak of smallpox in this county, in the city of Barbourville, with a total of 9 cases and no deaths. No hospital or pest house was provided. Being unable to secure a pest house, the cases were quarantined in the residence in which the first case appeared, this consisted of a family of 7 and 2 boarders. All proper precautions were taken to confine it to this house. The residence was fumigated after all danger had passed.

The disease was brought to this county from College Hill, Madison county; it was promptly recognized, after the family had been exposed. I estimate that 250 vaccinations have been done in the county since the first cases occurred, that 150 had been previously vaccinated, out of a total population of 17,372, leaving about 17,000 now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the oases which have occurred in the time named has been $350. The estimated cost to the county in loss of trade and interference of business has been $10,000.

Our chief difficulties in stamping out the disease were: The stubborn resistance of the majority of the people to be vaccinated, and the doubt existing in the minds of many as to the genuineness of the disease, the slowness of the city and county officers to recognize the gravity of the situation.

Very respectfully,

B. F. HERNDON, M. D., Secretary.

Laurel County Board of Health: Dr. Jackson Givens, Dr. H. V. Pennington, Dr. R. T. Ramsey.

London, Ky., July 16, 1901.

To the State Board of Health:

Gentlemen: Within the last four years we have.had 2 outbreaks of smallpox in this county, in the following districts or precincts: Bush precinct in 1898, and Pittsburgh in 1899, with a total of 17 cases and 1 death. A pest house was provided near Bush and Pittsburgh, and the following was our method of management: In 1898 a vacant house was secured at Bush and four cheap rooms were added thereto and all 14 cases were taken there. Dr. Brock, residing at Bush, was the daily attending physician, and Dr. Ramsey, health officere of the county, had general supervision of the entire work. Two guards were in constant attendance. No infected house was burned but disinfected by sulphur fumigation and bichloride washing. In 1899 at Pittsburgh only one family had the disease and their home was isolated and no spread of the disease occurred. The husband and two children who had never been vaccinated had the disease. The wife, many years ago vaccinated, nursed the entire family without contracting smallpox.

The disease was brought to this county from Jackson county, Ky.; it was recognized after 30 or 40 had been exposed. I estimate that 300 vaccinations have been done in the county since the first cases occurred; that 7,000 had been previously vaccinated, out of a total population of 17,500, leaving 10,000 now unprotected.

The total cost of management to the county, including hospital, physicians, vaccinations, guards, nurses, food, etc., for all the cases which have occurred in the time named has been $1,500. The estimated cost to the county in loss of trade and interference of business was not great.

Our chief difficulties in stamping out the disease were: Many people did not believe it was smallpox. Many refused to be vaccinated, and objected to being taken from home to hospital or pest house. Co-operation of county fiscal court most difficult to secure and that offered the most serious difficulties.

Very respectfully,

R. T. RAMSEY, M. D., Secretary.

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