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circulating among the citizens of the community in which they live, thereby endangering the health of said citizens, quarantine is hereby declared upon the residence of said Mr.

- and upon him and each member of his household; and it is hereby ordered that Frank Trader, constable, forthwith post a copy of this order on the front door of the residence of said Mr. —

— and serve a copy thereof on said Mr. - - -- in person; and it is further ordered that the said Frank Trader, constable, employ some person to guard said residence and confine therein the said Mr. and each member of his household until said quarantine is duly raised. And what the said Frank Trader, constable, does pursuant to this order, he shall forth with report in writing to the county health officer. Meeting adjourned.

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County Health Officer.

........................ Prosecuting Attorney of Wetzel County, W. Va. In addition to orders such as the above, the schools in the districts where the disease prevailed were closed, and where they were left open an order was issued excluding all unvaccinated children The Board of Health was so active in its efforts for the protection of the people that I thought it proper to send the following letter under date of January 9th, 1914:—

“Board of Health of Wetzel County,
Gentlemen:

I desire to congratulate you on your activity in efforts to limit the spread of small-pox in the county. By your wise and prompt action in issuing quarantine orders against families in which suspected cases exist, in closing the schools in badly infected localities, and in allowing no unvaccinated children to enter any school, you are pursuing a wise policy, limiting the spread of the disease, saving great trouble to families, as well as much expense to the county. Your orders thus far meet with my en. tire approval, and I urge that the order forbidding children un. vaccinated to enter the public schools be continued in force until your county is free from small-pox. In no other way can you safeguard the health of the community.

With thanks for your efforts in behalf of the public, and assuring you of my hearty support, I remain,

Sincerely yours,

S. L. JEPSON, Secretary State Board of Health."

The disease spread from Wetzel to Tyler county and by request of the county health officer of Tyler county, Dr. M. M. Reppard, I visited that county on January 12th, and again on the 20th. On the former of these occasions a public meeting had been announced at which I gave an address on public health problems. On the second visit I made three addresses to the school children of the town on small-pox and vaccination. I found one doctor in the county still calling the prevailing disease "chicken-pox” and I failed

county I had the following communication inserted in the Wetzel and Tyler county papers:

VACCINATION vs. SMALL-POX.

To the Editor:

A recent visit to Wetzel and Tyler counties has revealed an amount of prejudice against vaccination that is simply astounding. Nearly all of this can be traceâ to the most amazing false. hoods that I found in circulation in the rural district. One report was, that forty persons had recently come to Wheeling to have their arms amputated on account of the bad results of vaccination. Few people, I hope, credited this absurd report, for it is a reflection on one's intelligence for a moment to heed such nonsense. As a practitioner of medicine in Wheeling for over forty years, and a physician to one of the hospitals for twenty years, I can truthfully say that I have not seen nor heard of any worse result from a vaccination that a very sore arm, and where the arm is exceptionally sore it is not due to the vac cination, but to the poisoning that is permitted to occur at the point of vaccination by want of care and cleanliness in its management. There is no reason for the existence of small-pox. It is the one disease that can be banished from the world, did everybody resort to vaccination. Hear the Vermont Board of Health on this subject:

“We still have small-pox with us. There is no prospect that the mild form of this disease now prevailing will be arrested in the near future. Its very mildness is a serious obstacle to its suppression. We all know that there is only one effective preventive of small-pox, namely general vaccination. The disease can not exist in a well vaccinated community * * * It is the same loathsome disfiguring disease as of yore. It demoralizes the social and business interests of the community. Quarantine and disinfection are bungling and costly methods of dealing with it, and worst of all, in the absence of general vaccination are not effective. Several progressive states have abandoned quarantine in this disease and thrown the burden of its suppression on the public. The people are told in plain language that vaccination alone will prevent small-pox, and if they wish to avoid the disease they must be vaccinated. It is worthy of serious consideration, if the responsibility for this burden ought not to be placed where it rightly belongs, namely, on those who refuse vaccination, rather than on the general public who will have to pay the bills. Since vaccination is almost a perfect protective against the disease, it is absolutely inexcusable for any person to have it, and especially to spread it throughout a community, thus entailing great expense alike upon the vaccinated and the unvaccinated.”

Allow me to urge that the activity of the county boards of health be continued, that every child in the county within five miles of a case of small-pox be required to be vaccinated before entering school, and that this order stand until the county is free from the disease. If parents will prefer to deny to their children the advantages of the schools, rather than to save themselves from small-pox by a simple scratch of the arm, they should be allowed the privilege of doing so, but they should not be allowed by neglecting vaccination, to run the risk of contracting the disease and spreading it in the schools.

S. L. JEPSON. M. n.

Soon after the appearance of small-pox in the western part of the state the following bulletin on small-pox control was printed and widely distributed to health officials and others:

Small-pox Control.

For the past few months this disease has prevailed in so many parts of the state that it seems necessary to emphasize the importance of its early diagnosis and prompt sanitary control. The disease éxists in an extremely mild form, and has too often been mistaken for chicken-pox. We here venture two statements that are so nearly true that in the interest of the public health they should be taken as self-evident. I—When two or more physicians differ as to the diagnosis between chicken-pox and small-pox, the disease is small-pox. 2— Chicken-pox is a disease essentially of childhood, and when an eruptive disease resembling it occurs in an adult, it should be taken as smallpox, and controlled as such. If these two statements be accepted as true, there will be little trouble in controlling the spread of small-pox that now prevails in this state.

How Control Small-pox.

1. When called to a case of this disease isolate the patient in a room as free from furniture as possible.

2. At once vaccinate every member of the household.

3. Secure the names of every person who has been in any way exposed to the patient, search them out and vaccinate immediately, keeping them under observation for 16 days, and seeing them daily for the last six days of this period.

4. But one person should be admitted to the room of any patient, and that person should not be allowed to come in contact with any others:

5. If several cases occur in a community, by far the safest and most economical measure to stamp out the disease is, to put all in one building, if such can be found. In this way we avoid the infection of a number of houses with their contents, and the necessary destruction of much property that cannot be disinfected, such as pillows, etc. We also avoid the great expense entailed by having to support at public expense a number of quarantined families.

6. After the death or recovery of the patient securely close every crack and crevice in the room, and moisten the room with steam and fumigate with formaldehyde or sulphur. (a) place a metallic bucket in a tub of hot water in the middle of the room, put into the bucket not less than 10 ozs of powdered permangnate of potassium and pour onto this 20 ozs of formalin; (b) or crush 6 lbs. of stick sulphur, put in bucket as above, add a little alcohol and set fire to it. In either case close the door, stop from the outside all cracks and leave the room closed for 12 hours. Then open all doors and windows and have all woodwork and furniture in the room cleaned and body clothing that can be washed should be soaked in a bi

chloride solution 1/2000 and then boiled and washed. Destroy what cannot be disinfected.

We suggest that all physicians who receive this circular read the article on small-pox in the latest medical book they may have, and then remember that in many cases of the prevailing mild type, the common symptoms, such as headache, vomiting, backache, etc., if present at all, are in a very modified form.

Not all the county health officers have been as active as they should have been in the control of small-pox. I had reliable information that the disease was spreading in one of the central counties of the state and that the county health officer was not active in the adoption of measures for its suppression. On August 8th, 1913, a letter was sent to this official informing him as to his reported negligence, with specific instructions as to what should be done and a remuest for full information as to the existing situation. No answer to that communication was received until November 6th, and this was after the board had declined to confirm the reappointment of this oficial because of his apparent inefficiency. It became necessary later for a member of the state board of health to visit that county in the interest of the public health.

As this report is being prepared (Nov. 1914), we still hear of smallpox prevailing quite extensively in several parts of the state, and some physicians are still calling it chicken-pox, notwithstanding hundreds of the cases have been in the adult. So long as there are physicians who refuse to learn either from their own experience or that of others, and so long as an ignorant prejudice exists to the extent that it does in this state against vaccination, we can scarcely hope that small-pox will disappear from our borders until the supply of susceptible material is exhausted.

While we have made diligent effort to secure a full report as to the number of small-pox patients in the state during the last 18 months, we have not been able to do so. The figures here presented however, are as nearly accurate as we have been able to secure. Never, we believe, in the history of the state, have so many cases of this vile disease occurred. And yet this is the one disease that has no right to exist. It is the one disease that can absolutely be prevented by vaccination and revaccination. The statistics sent to us from some sections of the state demonstrate that almost every case of small-pox that has occurred was in an unvaccinated person, and that the very few cases in which vaccination had been previously done, it was performed many years ago. It would be impossible to calculate the enormous expense entailed upon the people of the state by the necessary expenses connected with the medical treatment of the cases, the loss of time of the patients, the guarding and feeding of quarantined families, the cleansing and disinfecting of infected houses and property, and the destruction of such property as could not be disinfected. All of this would have been saved had vaccination been universally adopted. tine and guarding of families infected with this disease should cease. Minnesota, Florida and one or two other states have adopted this policy and find it decidedly beneficial. Small-pox in recent years has assumed such an extremely mild form that a death from it is rarely heard of. There is not, therefore, the same reason, as in former years, for the rigid guarding of these cases. I have it from the Secretary of the Minnesota board that since the guarding of small-pox has been discontinued, and the people have been given to understand that they must either secure vaccination or run their chances of contracting the disease, the unreasonable prejudice against vaccination, based almost entirely upon erroneous reports as to its alleged evil results, has very greatly diminished, and after their more modern and greatly economical method of controlling small-pox, now tried for five years, there is no disposition to return to the former very expensive method. We hope that the West Virginia State Board of Health may soon adopt the new plan which we heartily endorse.

SUMMARY OF SMALL-POX CASES IN THE STATE IN THE PRESENT

EPIDEMIC.

The following table is believed to be approximately correct. The number of cases here presented is probably below the correct number We have learned of but nine deaths in the state. So far as we have been able to ascertain, we are of the opinion that not two per cent of the patients were ever at any time in their lives vaccinated successfully. Those who did claim a former vaccination had the operation done twenty to forty years prior to the attack of small-pox. The protective power of vaccination was never shown more conclusively than during the present outbreak of small-pox. And yet the most intense prejudice against this most beneficial measure is found throughout the rural regions of the state.

Cases

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Counties.

Cases Counties. · Cases Counties. Berkeley. .........137 Kanawha ..........857 Raleigh : Barbour ........... 84 Lewis ...... ..... 57 Ritchie ....... Boone. ... ... 24 Lincoln

69 Roane Braxton..... ....150 Logan ...... ....175 Summers .. Brooke ....

..... 1 Marion ...... ..... 36 Taylor. ... Cabell 11 .........

.....222 Marshall ...... 16 Tyler Clay .........:

36 Mason ..

.... 52 Tucker ........ Doddridge

.. 7 McDowell ..........143 Upshur. Fayette ..... ... 43 Mercer ..... .. 6 Webster ...... Grant ........ .. 18 Mineral .

90 Wood.. Greenbrier .. 1 Mingo

.. 77 Wyoming Hampshire .... ..108 Monroe ....... 22 Wayne ..... Hancock ...... .. 9 Nicholas

50 Wetzel .... Harrison .......... 64 Ohio .......

14 Jackson .....

....102 Pendleton ......... 20 Total

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50 ..329

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