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To this letter a reply was received from the governor from which I quote as follows:

“Executive Department,

Charleston, July 26, 1913. Dear Dr. Jepson:--

I have your communication of the 24th of July and note that you have been at Hundred and that the smallpox epidemic there seems to be under control. I am indeed glad to know this. It is a good plan to impress upon the minds of citiens that each and every one should take upon himself the responsibility of a vigilant committeeman to see to it that proper precautions are taken so that no spread of this epidemic will occur. This is very much better than any guard system or any quarantine that you could adopt, especially if all who live in the neighborhood and who have been exposed in any way are properly vaccinated.

I am very glad to note that you believe this epidemic is under control and that there will be no further spread. It must be impressed upon the minds of those who have been contaminated that thorough fumigation is absolutely necessary after the infectious period.

I am glad you are going to give this matter publicity through the newspapers, and hope you will also keep me fully informed.

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Very sincerely yours,

H. D. Hatfield, Governor.

The above correspondence is given with the view of showing the state of public excitement that will arise in rural communities during the existence of smallpox. A letter came to me from Fairmont stating that the public there desired to quarantine against the towns of Hundred and Littleton. A writer in Burton continued to annoy the governor with long letters of complaint which were well nigh baseless, and which aroused a suspicion in the minds of some persons that they were written for commercial rather than sanitary purposes. The results show that the fears of the Burton people were not well founded, since not a single case of smallpox occurred in or near that town during the Hundred outbreak.

I may conclude the report of this local epidemic of this disease with the following letters. Having received a communication from the Governor, inclosing a letter from a Burton merchant with the usual complaints, I sent to the governor the following reply:

Wheeling, W. Va., Aug. 18, 1913
Hon. H. D. Hatfield,

Charleston, W. Va.
My dear Governor:-

Your letter (with Mr. Blank's inclosed) concerning the
smallpox at Hundred is received this morning. I at once sent
the following note to the Health Officer of that town:-
Dr. F. M. Kearns,

Health Officer,
Dear Sir:-

I am just informed that you have a number of new cases of smallpox. Please write to me today the exact condition. If more stringent measures are not adopted by your Health

some radical changes. Hoping that the report I have are exaggerated, I remain,

Sincerely yours,

S. L. Jepson, Sec'y,
State Board of Health.

The following reply is just received this P. M.:

‘Hundred, W. Va., August 18, 1913. Dr. S. L. Jepson,

Wheeling, W. Va.
Dear Sir:-

Your letter just received. The contents is not unexpected news, as we hear every day that the business men of Burton send, 'a list of new cases,' every day to the governor. They also say that he is going to send someone else to see the cases, as the Burton people have not confidence in you. Doctor, we have not had a new case since you were here, with the exception of one case in the Booth family where you were with me on two occasions. We have two cases that are about over the disease, and will be ready to let out, one tomorrow, the other about Wednesday. I will say that all cases have been kept in longer than you suggested, that was 16 days. I am keeping the suspected cases in for at least 21 days.

We have repeatedly asked the Burton people to send some of their best citizens down here to see for themselves just how things are, and how we are caring for the patients, but they will not come as they want this talk to continue for their own business advantage. If you can suggest any more radical means than we are already using, I know that I personally and the Board of Health collectively will be glad to adopt them. I will report as I told you, any new cases.

Respectfully, (Signed) F. M. Kearns, Health Officer.

I regret that you are annoyed by those Burton letters at a time when you have so much of greater importance on your hands. My large experience in the management of smallpox has taught me that an outbreak cannot be suddenly ended. An occasional case will crop up in spite of the most vigorous management. So I shall not be disappointed if, after the town is free from the disease for days, another case or two appear. But the epidemic is practically at an end, and the people of Burton and other nearby towns have no reason to be alarmed over the present situation, as you can see from Dr. Kearns' letter. * * * *

Yours sincerely,

S. L. Jepson, Sec’y,

State Board of Health.

To the above letter the following answer was received:

"Executive Department,

Charleston, Aug. 21, 1913.
Dr. S. L. Jepson,

Wheeling, W. Va.
My dear Doctor Jepson:

I have your communication of August 18th and note what you say relative to correspondence you have had with Dr. Kearns.

handled the smallpox situation at Hundred. I thought it was nothing more than right to send to you the correspondence that took place between Mr.- and myself. I am returning Mr. Throckmorton's letter which I have read with considerable interest. I take it that the smallpox scare will soon be over, etc., * * * *. With best wishes, believe me,

Yours very sincerely,

H. D. Hatfield, Governor.”

The following facts in connection with this outbreak of smallpox are of interest in this connection. According to Dr. Kearns, the Health Officer of Hundred, the first cases occurred in the country about three miles from Hundred. Two cases occurred in one family which were supposed to have originated in Marietta, Ohio, on or about the 15th day of May. Two additional cases occurred in this family. None of the four had ever been vaccinated. Three cases occurred in the family of a relative of the above; none of these had ever been vaccinated. Six additional cases occurred in the family of another relative. The parents were said to have been vaccinated 17 years previously but the four children, never. Five additional cases occurred in two families where there had been exposure. None of these five had ever been vaccinated. An elderly lady living with one of these families, and exposed during their entire illness, escaped the disease. She had been vaccinated in 1884. All of the above cases were in the country. In the town of Hundred there occurred 27 cases ranging in age from one to fifty-six years. Of these but one case had ever been vaccinated. One man who had been exposed and who had been vaccinated in 1865, escaped the disease. Thus we have in this outbreak, 45 cases of smallpox in persons but three of whom had ever been vaccinated, and two of these were vaccinated 17 years before and one 28 years before. Of the two exposed persons who escaped the disease, although freely exposed to it, one had been vaccinated in 1864 and one in 1865.

Four miles west of the town of Hundred is the town of Littleton on the B. & O. Railroad. In this town and the country around it, occurred 16 cases of smallpox, nearly all of which were quite mild. These were almost entirely in the care of Dr. A. B. Rinehart, who managed the outbreak well. No death occurred either in this group of cases or that at Hundred. I made one visit to Littleton and saw a number of the cases with Dr. Rinehart and found that they were well isolated, and fortunately, not in the thickly populated center of the town.

The smallpox seemed to extend gradually from the line of the B. & 0. Railroad Company southwest through Wetzel county, finally extending along the line of the Short Line Railroad between New Martinsville and Clarksburg. The cases continued to be very mild so that they escaped early attention. By invitation of Dr. Fankhauser, County Health Officer of Wetzel county, I visited Jacksonburg on November 5th, 1913, where I found that three cases, all adults, had occurred in one family, all passing through the entire course of the disease under the name of chickenpox, as the result of which error in diagnosis no curred in an employee of this family, and the fifth I found to exist in the person of the physician who had attended these four cases, and who now, on the seventh day of the eruption, was still calling it chickenpox. On the previous Sabbath, which was the fourth or fifth day of the eruption, he had attended church in the town and on the sixth day of the eruption attended a trial before a justice in the neighborhood and gave the disease to both the justice and the lawyer who tried the case. Invited by the principal of the school, I addressed the school children, with a number of parents who were quickly congregated, impressing the fact that the prevailing disease was not chicken pox but genuine smallpox. Learning that but about 5% of the 50 or more children congregated had ever been vaccinated, I impressed the importance of immediate vaccination and endeavored to disabuse the minds of those present, and through them the entire community, of the falsity of the reports in circulation as to the evil effects of vaccination. Vaccine points were immediately ordered and on the following day the county health officer vaccinated 95 children.

At this time about 20 cases of smallpox existed at Pinegrove, four miles west of Jacksonburg, nine of these in one house, and all well isolated and quarantined, and Dr. Fankhauser reported that the citizens were co-operating with him and Dr. A. E. McCuskey who had charge of the cases. Dr. Fankhauser, therefore, did not think it necessary for me to visit the town.

In this region, as along the main line of the B. & 0. Railroad Co., there had been so many exposures before this disease was recognized as smallpox, that cases sprang up in many different points in the county, but the county health officer and the prosecuting attorney were very active in their efforts to stamp out the disease which was a very difficult task. These two officials kept a close watch on the situation, consulting daily and issuing orders of quarantine wherever they found it necessary. They also employed local inspectors and guards as the situation seemed to require, and in this way I have no doubt they did the very best that was possible with the existing situation, and so far as possible limited the spread of the disease.

I visited New Martinsville several times to hold consultations with these officials and tendered advice as it seemed to be needed.

As a sample of the work of this Board, and as a guide to other Boards as to the proper method of procedure, we here print the following action of the sanitary officials at New Martinsville.

New Martinsville, W. Va., December 22, 1913.
At a joint meeting of the Local Board of Health of Wetzel County,
West Virginia, and of the Local Board of Health of the Town of New
Martinsville, West Virginia.

Present:
Dr. E. E. Fankhauser, County Health Officer;
Glen Snodgrass, Prosecuting Attorney of Wetzel County, W. Va.;
E. H. Yost, Mayor of the Town of New Martinsville, W. Va.;

Dr. F. E. Martin, City Health Officer of the Town of New Martinsville, The meeting was called to order by E. H. Yost, Mayor, and as such a member of the Board of Health of said Town.

On motion it is ordered that Glen Snodgrass act as secretary of this meeting.

On motion it is ordered that Jehu Morris be employed to act as guard at the Baltimore & Ohio R. R. depot, in the Town of New Martinsville, for the purpose of detaining, until they are examined by the county or city health officer, any persons coming into or going out of the Town of New Martinsville, who are suspected of having smallpox or of having been exposed thereto; and that the Mayor of the Town of New Martinsville be requested to appoint said Jehu Morris a special police officer of said Town for the purpose of enabling him to more effectually perform his duties under this order.

The members of these two boards having been advised by the secretary of the State Board of Health of West Virginia to prevent all public meetings within the Town of New Martinsville until danger of the further spread of smallpox is passed, it is on motion ordered that from and including this date until the further order of these boards, or until the said State Board of Health of West Virginia may order otherwise, all public gatherings of any kind are hereby prohibited within the corporate limits of said Town of New Martinsville.

On motion is is ordered that from and including this date all persons within the Town of New Martinsville who are known by either the city health officers or the county health officers to have been exposed to smallpox, and who are liable, in the opinion of either of said officers, to spread contagion, be and they are hereby required to submit to vaccination by some reputable physician, upon being notified so to do by either of said health officers. · On motion it is ordered that the city health officer be and he is hereby empowered, when in his opinion it is necessary so to do on account of the prevalence of smallpox, to establish quarantine at any house or at any premises within said Town of New Martinsville, either by oral proclamation, or by written or printed notices posted thereat; and that thereafter all persons who may be within said quarantined premises at the time the same are so quarantined shall remain therein until said quarantine is raised; and no other persons, other than the physician in charge or the city or county health officer, shall thereafter enter said premises unless he remain therein until said quarantine is raised; and no persons, other than the physician in charge or the city or county health officer, shall thereafter enter said premises unless he remain therein until said quarantine is duly raised. Meeting adjourned.

Dec. 29, 1913, At a meeting of the local Board of Health of Wetzel County, West Virginia, held in the town of New Martinsville, W. Va., Dec. 29, 1913.

Present—Dr. E. E. Fankhauser, county health officer; Glen Snodgrass, prosecuting attorney of Wetzel County, West Virginia.

It appearing to the board that Mr. and his family, have frequently been exposed to smallpox and that

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