for quarantining too stringently and by others for not being stringent enough, but we are trying to act in accordance with law and as the best practice demands. Respectfully yours, F. M. Kearns, M. D., Health Officer. Under date of July 22nd, 1913, I received a letter from his Excellency Governor H. D. Hatfield, enclosing a sensational communication from a citizen of Burton in regard to the smallpox situation at Hundred. The governor suggested that I visit the town of Hundred, "and see whether the people are properly protected against the spread of smallpox." To this letter the following reply was sent: Hon. H. D. Hatfield, Charleston, W. Va. My dear Governor: "Wheeling, W. Va., July 23rd, 1913. Your letter with enclosures received. I have kept in close touch by telephone and letters with the smallpox situation at Hundred. I have official reports, written at my request, from both the Mayor, who is a very intelligent man, and from the Health Officer, assuring me that there are but three infected families in the town. Two of these have each two cases and the families had been already infected by former cases. The other is the family of the meat dealer (one case) referred to in the letter which you have received. Of this case the Mayor says; 'As soon as this case was reported to the health officer, the house was immediately quarantined. The report that the eruption in this case had appeared two or three days before Mr. H., left his place of business is false like many others in circulation. **** His place of business was thoroughly fumigated and his entire family put under strict quarantine. All those who had been exposed in his place of business were vaccinated or quarantined.' Some of these exaggerated reports have reached me, and are simply evidence of the panic apt to arise in small communities when smallpox prevails. The people of Littleton have complained to me of the situation at Hundred, when the fact is, that on my visit I found the situation at Littleton much worse than at Hundred. I have refused to permit a general quarantine against Hundred when so simple and certain a preventive as vaccination is at hand. This I have written to several communities. No sanitarian would now advocate a quarantine against a town where smallpox exists, unless, possibly, the grossest carelessness prevailed. While the Hundred outbreak was not, in its inception, controlled at it might have been, yet I found that on the whole the cases were well managed. I have been prevented from making a second visit by very serious illness in my family. Conditions are now improved, however, and I expect to go out tomorrow and will report my findings on my return. My refusal to quarantine against Hundred is perhaps the cause of the letters sent to you. Very sincerely, To the above a reply was received from Governor Hatfield who writes under date of July 24th, 1913. I quote as follows: “**** I think you are quite right relative to quarantine. It is quite expensive to quarantine a community. I think vaccination is a better plan to adopt. If the people in this section where smallpox is epidemic are properly vaccinated the suppression of this contagious disease is absolutely guaranteed and assured. With my very best wishes, believe me, sincerely yours, I made another visit to Hundred on July 24th and reported to the governor as follows: Hon. H. D. Hatfield, Charleston, W. Va. My Dear Governor: "Wheeling, W. Va., July 24th, 1913. This morning I made a visit to Hundred, went with the Health Officer to see the smallpox patients, except one family, too far away, and with this family communicated by telephone. The facts are as follows:-Ross family, already infected, has two cases, one nearly well; Taylor family, already infected, has two cases, one almost well; Booth family, already infected, has one recent case, very mild; Hinegardner family, not before infected, has one case, Mr. H., who will be dismissed on the 28th inst. Total families infected 4, total cases 6. Mr. Hinegardner is the meat dealer who was said to have an eruption three days in his store, selling meat all this time. He emphatically denies to me the charge and says he was quarantined promptly, just as soon as reported to the health officer by his physician. All the other families are shut in but no guards are employed. This seems not to be necessary, as every man and woman in the community is a self-constituted guard; and there seems to be no disposition for any of the quarantined families to disobey orders. Hundred is blessed with a Board of Health much above the average. It is composed of a dentist (the Mayor), a bank cashier, a carpenter-shut in by family infection—a lawyer (Hon. J. F. Throckmorton, whom you known) and the Health Officer. I am satisfied that all are trying to do their duty and that the reports that are in circulation are grossly exaggerated. My opinion is that the epidemic will soon be ended and that no further outside interference will be necessary, but I will continue to interest myself in the situation and render such service as seems necessary. The epidemic has continued so long because of the very mildness of the cases, and because it was at first taken to be varicella. What is most needed just now is, to properly inform the neighboring people as to the true situation, and thus quiet their fears which are so nearly groundless. With this view I shall give notice of my findings to the newspapers here. Sincerely yours, S. L. Jepson, Secretary. 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. 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: Hon. H. D. Hatfield, Charleston, W. Va. My dear Governor: Wheeling, W. Va., Aug. 18, 1913 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:- 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 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 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. & O. 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 |