• TABLE OF CONTENTS
HIDE
 Front Cover
 Letter of transmittal
 Special agents' report
 Report of Dr. W.M. Stinson
 Dr. Hiram Byrd
 Cerebro-spinal fever
 E.W. Warren
 Dr. J. Frank Curtis
 Report of Dr. R.L. Cline
 Dr. W.T. Elmore
 Dr. Warren E. Anderson
 Dr. G.W. Lamar
 Dr. Chas W. Bartlett
 Dr. P.B. Wilson
 Dr. A.B. Harrison
 Dr. W.D. Bush
 Dr. R.T. Walker
 Report of Dr. J.N. Fogarty
 Dr. J.L. Horsey
 Dr. L.F. Henley
 Dr. J.M. Abbott
 Dr. Worth Lockey
 Dr. H.K. DuBois
 Dr. Bracken's letter
 The control of smallpox
 Report of bacteriologist
 Report of Dr. Chas F. Dawson,...
 Key West quarantine
 St. George's sound quarantine
 Cedar Key quarantine station
 Cumberland sound quarantine...
 Errata
 Current expenses
 Extraordinary expenses
 Laboratory department






Title: Annual report - State Board of Health, State of Florida
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 Material Information
Title: Annual report - State Board of Health, State of Florida
Series Title: Publication - Florida. State Board of Health
Physical Description: v. : ill., ports. ; 23-29 cm.
Language: English
Creator: Florida -- State Board of Health
Florida -- State Board of Health
Publisher: State Board of Health.
Place of Publication: Jacksonville Fla
Frequency: annual
regular
 Subjects
Subject: Public health -- Periodicals -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
 Notes
Dates or Sequential Designation: Ceased in 1968.
Numbering Peculiarities: Report year for 1893/94 ends Mar. 31; for 189<7>-1968, Dec. 31.
Numbering Peculiarities: Reports for 1923-32 combined in one issue.
General Note: Reports for 1910-<17> issued as its Publication.
 Record Information
Bibliographic ID: AM00000243
Volume ID: VID00001
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
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Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Front Cover
        Front Cover
    Letter of transmittal
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
    Special agents' report
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
    Report of Dr. W.M. Stinson
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
    Dr. Hiram Byrd
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
    Cerebro-spinal fever
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
    E.W. Warren
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
    Dr. J. Frank Curtis
        Page 82
    Report of Dr. R.L. Cline
        Page 83
    Dr. W.T. Elmore
        Page 84
    Dr. Warren E. Anderson
        Page 85
        Page 86
    Dr. G.W. Lamar
        Page 87
    Dr. Chas W. Bartlett
        Page 88
        Page 89
    Dr. P.B. Wilson
        Page 90
    Dr. A.B. Harrison
        Page 91
        Page 92
    Dr. W.D. Bush
        Page 93
    Dr. R.T. Walker
        Page 94
    Report of Dr. J.N. Fogarty
        Page 95
    Dr. J.L. Horsey
        Page 96
    Dr. L.F. Henley
        Page 96
    Dr. J.M. Abbott
        Page 97
    Dr. Worth Lockey
        Page 98
    Dr. H.K. DuBois
        Page 99
    Dr. Bracken's letter
        Page 100
    The control of smallpox
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
    Report of bacteriologist
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
    Report of Dr. Chas F. Dawson, veterinarian
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
        Page 141
        Page 142
    Key West quarantine
        Page 143
    St. George's sound quarantine
        Page 144
    Cedar Key quarantine station
        Page 145
    Cumberland sound quarantine station
        Page 146
    Errata
        Page 146
        Page 147
    Current expenses
        Page 148
    Extraordinary expenses
        Page 149
    Laboratory department
        Page 149
        Page 150
        Page 151
        Page 152
        Page 153
        Page 154
        Page 155
        Page 156
        Page 157
        Page 158
        Page 159
        Page 160
        Page 161
        Page 162
        Page 163
        Page 164
        Page 165
        Page 166
        Page 167
        Page 168
        Page 169
        Page 170
        Page 171
Full Text








Sixteenth Annual Report

~~~'. :^ "* ,l '"


OF THE


STATE BOARD OF HEALTH


OF FLORIDA









JACKSONVILLE, FLORIDA

FEBRUARY 15, 1905


The Drew Press. Jacksonville


A


1904


V


I'--~














LETTER OF TRANSMITTAL.


Jacksonville, Fla., Feb. 15, 1905.
T*o His Excellency, Napoleon B. Broward,
Governor of Florida,
Tallahassee, Fla.
DEAR SIR:-
SIt is with more than usual pleasure that I enclose
you the annual report of the State Health Officer for
1904; a gratification which my colleague wishes to
express with me by commending to your attention a most
excellent work done by the State Health Department, in
the personal health interests of the people, as also in a
Skillful and careful supervision of all contagious diseases
occurring in the State, in the hunian family and in the
) brute creation, which when unrestricted are always
Likely to cause uneasiness among the people, or to perhaps
interfere with business or commerce of the State. This
presentation of facts we feel will be acceptable to you,
S because having quite recently been a member of the State
S, Board of Health, you can the more keenly appreciate the
many difficulties which the Board has met with in the dis-
Scharge of its obligations to the people, as well as the eco-
nomical management which has marked its administra-
S tion. We are confident that the latter has been economical,
for while smallpox has been constantly introduced into
the State, especially into the northern border counties,
and the number of cases has been larger than in any pre-
vious year, yet the expense attending the care and treat-
ment of them has been smaller and the supervision as effi-
ciently made. While the number of ill persons in the State
seems to have been larger than in previous years, yet as
pointed out by the State Health Officer, this increase in
sickness has been altogether due to dengue, a distressing
and painful but never fatal disorder, and to smallpox,
which latter trouble can be prevented whenever the




b\^r-




2 SIXTEENTH ANNUAL REPORT

representatives of the people in their legislative capacity
see fit to enact measures to control it. Moreover, it is
pleasing to note that the mortality statistics received
by the Board do not show any increase in proportion to
ratio of population, which is constantly enlarging. We
concur in the timely suggestion of the State Health
Officer that the annual report of 1903, which was made
ad interim of the Legislature shall be submitted with his
report of this year, because it contains a detailed state-
ment of many important facts and recommendations in
furtherance of the progressive sanitary work of the Board
which must, if carefully read, create an interest in
measures of preventive medicine which the Board aims
to place in practical operation among the people, and
which if more than casually alluded to again would be
an unnecessary presentation of already discussed subjects.
Yet it would seem that propositions which have a decided
bearing upon disease prevention, and life saving, would
never be tiresome to consider and would ever command
and receive thoughtful attention. In preventing two of
the most dangerous and communicable diseases of conta-
gious type, the State Health Officer speaks of the wonder-
ful specific properties of antitoxin in both preventing
and curing diphtheria, and of vaccination as the only
means known at the present time to effectually provide
against smallpox, either in isolated cases or in epidemic
prevalence. We heartily concur in the opinion expressed
by the State Health Officer, that when the people generally
will learn to appreciate the value which the discovery
of these two remedies have been to the human race, and
will heed the advice of those whose experience and know-
ledge peculiarly fits them to offer, by cheerfully and
universally adopting their use, then there will be few
sorrowing mothers on account of diphtheria and no
disfigured men and women, because smallpox can be
made to be as obsolete a disease in the future as yellow
fever bids fair to be now. It does seem to be an unfair
burden of expense upon the State, that, because of a
prejudice which is as unreasonable as it is foolish and









OF THE STATE BOARD OF HEALTH.


against which statistics can be brought in convincing
array of facts and figures if objections can be overcome
by argument, an expenditure of public funds should be
made obligatory on the Board in caring for smallpox
cases, when vaccination will prevent an attack and stamp
out a threatened spread. This conclusion finds greater
force of argument when it is learned that fully ninety-five
per cent of the cases of smallpox which occurred in
Florida in 1904, were among the negro population, who,
migratory in character, contribute nothing to the revenue
of the State by acquiring property and from whom the
remaining five per cent of the whites contracted the
disease.
We not only thoroughly endorse the views of the
State Health Officer as to an existing necessity for a
compulsory vaccination law of limited proportions and
requirements, but earnestly request of your excellency
the influence of your own strong personality and office
to bring about such an enactment of law by which the
State may be rid of the pest, as an extended prevalence,
and the cases of smallpox reduced to a minimum number,
The disease, however, mild in character, creates uneasiness
among the whites whenever and wherever it appears,
from its loathsome nature and the disfigurement which
generally follows. Discomfort from any sickness with
attendant expense should not be permitted, much less
encouraged, by yielding to ignorance and prejudice.
We also approve of the suggestions of the State
Health Officer to confirm the rules and regulations of the
State Board of Health as statutory enactments, and we
agree with his reasoning that there will be less likelihood
of contention as to the legality of enforcement of these
rules and regulations if sanctioned by the Legislature.
They are but few in number as compared with the
regulations adopted at the organization of the Board
in 1889, and in their condensed form present the salient
features of conservative sanitary administration. They
contain nothing that might be objected to by the most
sensitive guardian of the personal liberty of the citizen,









SIXTEENTH ANNUAL REPORT


and on the contrary, it is thought, comprise useful
instruction in, and requirements for, healthful living and
profitable sanitation.
It is gratifying to confirm the opinions expressed
in the last annual report of the Board, respecting the
anticipated usefulness of the bacteriological laboratory.
This division of the Board's operations has been kept
actively engaged during the year, and has assisted the
physicians of the State, and through them, the people, in
early arriving at diagnosis of doubtful cases of disease, af-
fording an early opportunity to apply prompt remedies or
preventive measures. The report of Dr. Andrade, the bac-
teriologist of the Board, which is included in the report
of the State Health Officer shows a directorship of this
branch of the work intelligent in tone and scientific in
management. It is commended for careful reading and
study, being both interesting and instructive. There are
other topics connected with health matters, which are
referred to by the State Health Officer in detail in his
interesting account of the sanitary happenings of the
year, such as the care exercised over, and the treatment
of contagious disorders among domestic animals, and
especially of the management of outbreaks of glanders
among horses in different portions of the State by the
State Board of Health through the veterinary surgeon
of the Board, a position authorized at the annual meeting
of 1904; licensing persons to engage in the business of
embalming the dead for transportation who show a fair
degree of knowledge of the subject; seeking to control
pulmonary tuberculosis and to lessen the danger of
infection by prohibiting promiscuous expectoration on
sidewalks, floors and walls of public buildings, and in
public conveyances; looking after the sanitation of public
conveyances, and noting the construction of additional
isolation hospitals for seclusion and economical treat-
ment of smallpox, at Pensacola and Miami, which are
attractive subjects to speak on, but it is thought that the
State Health Officer has so entertainingly pointed out the
commendable qualities of each that I feel it to be merely









OF THE STATE BOARD OF HEALTH.


necessary to invite consideration of them to receive
proper and responsive attention.
With the ending of the present session of the Board,
my colleague and myself practically complete our term
of office for four years, for which we were appointed by
Governor Jennings. At present there are but two mem-
bers of the State Board of Health, as the vacancy caused
by your election as Governor has not as yet been filled.
In your elevation and election to the highest gift
at the hands of the people, of a soverign State, my
colleague, the State Health Officer and myself feel that
the State Board of Health has; been signally honored by
the people of Florida in having one of its members while
yet in active connection with the Board, preferred for the
office of Chief Executive of the State by a very flattering
vote of confidence. The election of Hon. James P.
Taliaferro for his first term as United States Senator
from Florida is another instance where a citizen of the
State and actively exercising the duties of membership
in the State Board of Health, has been selected by the
people to a high office in the administrative counsels of
the State.
In conclusion, it is gratifying, indeed, to note that
the people generally appreciate the efforts of the State
Board of Health in their behalf, especially and uniformly
showing perfect confidence in Dr. Joseph Y. Porter, the
executive officer of the Board.
Very respectfully,
E. M. HENDRY,
President State Board of Health.









SIXTEENTH ANNUAL REPORT


Jacksonville, Fla., Feb. 14, 1905.

To the President and Members of the State Board of
Health of Florida:

Herewith is presented for your consideration, and it
is hoped also for your approval, a brief and concise
statement of the transactions of the executive office of
the Board for 1904, together with a narrative of such
happenings in the sanitary work of the year as may be
interesting in general to the people of the State, and
explanatory as well of the objects sought to be attained
by the Board, in the prevention and suppression of
agencies and influences which when unheeded bring ill
health and disease both to the individual and to com-
munities.
Much which could be said with profit to all readers,
in behalf of preventive medicine, a subject which all
boards of health are teachers and exponents of, has
already been dwelt upon in previous reports, and while
the theme is pleasing to discuss and interesting and
profitable to consider, yet it is felt that if a report of
this character is read at all by the people and especially
by the legislative branch of the State Government,-and
it is the ear and attention of these representative citizens
of the State whom it is desired to reach-brevity and
conciseness must commend and bespeak attention, rather
than a discussion of subjects more particularly of interest
and concern to the sanitist; and yet, there should be no
leglislation contemplated or suggested, of more impor-
tance for Leglislators to consider than that which will
improve the health conditions of a people, suppress
disease, lessen sickness and prolong the usefulness of life
to at least the Biblical promise of three score and ten
years.









OF THE STATE BOARD OF HEALTH.


As the State Government begins with this year in a
new administration, with the inauguration of Governor
Broward as the State's Executive, and both branches
of the Legislative power have largely new members in
each body, perhaps unacquainted with the sanitary
requirements of the State, it may not be amiss nor will
it, it is thought, invite tiresome reading, to request of
those not familiar with the purposes of the State Board
of Health, and what it has accomplished, to acquaint
themselves with the Board's work in the past; by
scanning, if not by more closely studying, the annual
reports of the Board and especially the report of last
year, 1903, where several subjects bearing upon important
matters affecting the hygienic welfare of the people were
presented somewhat in detail.
The general health conditions of the State during General
I health
1904, can hardly be said to have attained that excellence conditions
which was enjoyed in the preceding years, although the
fatalities from all sources, sickness as well as accidents
is not increased over those reported in former years.
Dengue, smallpox and diphtheria contributed to an
increase in the sick rate, and although the mortality in
two-smallpox and diphtheria-were small, and none at
all in dengue, yet the number sick, with consequent ex-
pense, to say nothing of loss of time and absence from
daily vocations, conduced materially to the uneasiness of
the people and personal discomfort of the individual.
The record of the executive office for the year 1904, Birth and
gives the total number of births occurring in the State death rate
as 7,454, and deaths from all causes, as 3,898. A birth
rate per thousand of population of 14.10, and a death
rate of 7.42 for the same number. There were 8,465
marriages in 1904. An analysis of the vital statistical
tables, elsewhere given in this report, shows that of the
births reported, 4,533 were white and 2,921 were of the
African race and descent. Of the death returns obtained by
the Board, 2,257 were white and 1,641 were colored, 2,177
males and 1,721 females. In the tables alluded to may
be found the ages of the decedents, as well as the causes









SIXTEENTH ANNUAL REPORT


of death. These figures cannot be said to be indisputably
or entirely accurate, nor is it so contended, for the reason
that it is not presumed that every birth or every death
occurring in the State, especially in the rural districts,
has been reported to the Board; such a condition of
statistical accuracy does not occur in any State, but it
may be stated that a fair degree of correctness as regards
the life-wave of the State is represented, and that for
practical purposes in determining the healthfulness of
this section of the United States, the Board has obtained
all that can be reasonably expected in the way of vital
statistical recording, at least, until thorough, persistent
and unrelaxing efforts of educational teaching in this
direction, the importance of prompt and carefully pre-
pared reports of births and deaths, and of all other
matters relating to the collection of vital statistics is
fully appreciated and followed both by physicians and
others having management of institutions from which
such information is expected and desired.
vital At the last annual meeting of the Board a new
statistics system for collecting vital statistics, recommended by a
joint committee from the American Medical Association,
and the American Public Health Association, concurred
in, and approved of by the United States Census Bureau,
was authorized for Florida, by specific rules detailing the
methods to be followed, and the State Health Officer
immediately took steps to place the same in operation.
The delays incident to formulating and printing blank
forms, obtaining consent of physicians to act as registrars
in forwarding returns of births and deaths to the Board,
with other numerous difficulties encountered in the execu-
tion of the plan, all served to impede progress, and finally
as the year passed along and the system had not been
commenced, it was determined that the beginning of the
year 1905 should be set as the date when the machinery
of this new method for gathering into accurate record
the vital statistics of the State might be started, and then
it was hoped that the arrangements would be so nicely
perfected that each section and county of the State would









OF THE STATE BOARD OF HEALTH.


contribute evenly and correctly the births and deaths as
they might occur. The purpose is to have not only a
set of records-births and deaths-at the office of the
Board in Jacksonville, but also at each of the county
sites, for the convenience and possible use of the citizens
of the county from which such statistics are collected.
The Board will pay ten cents for each birth and death
reported, and will furnish free of charge, blanks and other
needful stationery upon which to make records. This
remuneration may appear small, but at the end of the
year, will amount to quite a respectable sum, and is as
much as the Board can afford at this time to offer, or
to assume the expense of, without further legislative
sanction. The success of the plan and of the value of
the reports obtained will depend entirely upon accurate
reports and the cooperation given by physicians, especially
in the country and sparsely settled communities, by
prompt and carefully prepared returns of every birth
and death, not only occurring in the practice of each,
but within their personal knowledge. There have always Physicians
been some physicians in the State who have observed et births
this obligation,-for it is a duty to the commonwealth,- and deaths
as religiously as they did any other important responsibi-
lity as a citizen, but there have also been others and,
it is mentioned with regret and reluctance, who have
opposed and antagonized every effort made in behalf of
this needed requirement to obtain information respecting
the growth of the State, and seemingly have defied the
State statute on the subject, by either' indifference or
determined opposition. The State Health Officer has
hitherto refused to advise prosecution for a negligence
of this character, although the opposition appeared to be
due to a perverse disposition and had not any reasonable
grounds for excuse, because of his unwillingness to have
the Board enter into judicial proceedings against any one
of his professional brethren, preferring that a patriotic
sense of citizenship should awaken and prompt a per-
formance of duty, which tended to secure valuable
knowledge for future generations, rather than to seek










SIXTEENTH ANNUAL REPORT


to obtain the information by the constraint of law,
particularly, when heretofore a service was requested
which was not compensated for. Now, however, as it is
proposed to pay for this service to the State, which
although small in amount, yet defrays any outlay of money
on the part of those making these reports, the legislature
will be asked to enact the rule of the Board respecting
vital statistics into a State statute and provide for a
proper observance of the same. However, unpleasant the
enforcement of the law may be, it is thought that pro-
fessional sentiment should no longer stand in the way
of a measure calculated to increase the reputation of the
State. Sanitarians everywhere, and those engaged in the
study of questions of social and political economy,
recognize more and more the value of accurate statistics
respecting the life, death, and general conditions of
health which effect the human family. State Boards of
Enforcement Health having a vital statistical bureau, which is care-
of rue ts fully administered and reports to which can be depended
report births
and deaths upon for correctness and reliability, are considered
progressive in thought and in sanitary work. They are
credited with being mindful of the needs of the people
in seeking to determine the movement of population as
well as the contributing causes of sickness and death, for,
from carefully compiled data of several years, conclu-
sions can be deduced, and better yet, measures may be
suggested for the betterment of the living and the
prolongation of life. Florida must be in the list of
Registration States of the Union, and the State Board
of Health will use every effort and energy to earn a
prominent position for correct and reliable statistical
returns. It is to be regretted that the executive office
has been unable to institute the system for collection of
morbidity statistics of the State which was authorized
by the Board at the February meeting of last year. The
importance of this measure was gone into quite in detail
in the last annual report from this office, and it was
confidently expected during the year to make an effort
in behalf of the system, but so much difficulty was









OF THE STATE BOARD OF HEALTH.


experienced in establishing the companion system-
vital statistics,--which really did not finally commence
operations until January of this year, that it was thought
if two systems, somewhat similar in purpose, were com-
menced at the same time, that confusion would result
and perhaps defeat the workings of both. So likewise
can be explained the failure to reestablish the "Florida
Health Notes," a publication previously edited by the
Board in years past in behalf of the sanitary interest of
the State. It was found that to properly and interest-
Florida
ingly present this pamphlet each month to the people of health notes
Florida, additional assistance in the way of clerical help
would be required, as the time of the other assistants in
the executive office, was well taken up in attending to
special duties which could not be laid aside even for a
day, and it was not deemed advisable to incur the expense
which another clerk would occasion. However, the two
subjects alluded to-morbidity statistics, and the "Florida
Health Notes"-may be considered as having been simply
deferred and not abandoned, for the importance of both
to the State has been widely argued and insisted upon,
to be altogether given up.
The following reports from special and county Reports of
special
sanitary agents, city physicians, and other friends of the agents
Board, who are interested in the work and cause of
sanitation in the State, gives an intelligent idea of the
health conditions existing in the different sections, during
the past year, with other pleasing and eventful data.
Especially are the reports from the special agents valuable
and instructive in matters relating to contagious diseases.









SIXTEENTH ANNUAL REPORT


SPECIAL AGENTS' REPORT.

DR. R. F. GODARD.

Special
Agent s I have the honor herewith to present an annual
report report of my work during 1904, which has been

principally, in dealing with smallpox, in the different
sections of the State. During the time I have been
connected with the State Board of Health I have been
directed to investigate twenty-one reports of smallpox
and two reports of diphtheria. As a result I found in
those several instances smallpox in seventeen different
sections and chickenpox in three. One other was for the
purpose of confirming my former diagnosis of chickenpox
at Mayo, Lafayette County, Fla.
I have also attended two epidemics of diphtheria
pursuant to instructions. By persistent work and at
times force, I have vaccinated about 1,450 persons during
this year. How many proved successful, I am not able
to say, but there is one fact in this connection I am
prepared to state positively, that I have not had a single
"bad arm" to follow these vaccinations.
I respectfully direct your attention to the following
tabulated table, which shows the counties in which I
have worked, the disease found, number of cases to
develop, source of infection, and fatalities:








NO. OF ORIGIN OR SOURCE

COUNTY. DISEASES. CASES. OF INFECTION.
Gadsden ............... Smallpox ......48...... Georgia ........
Leon .................. Chickenpox ...........................


DEATH.
. ..2 ...


.


Jackson ............... Smallpox ...... 9..... Georgia ......................
W alton ................ Smallpox ...... 1...... Alabama .....................
Washington ............ Smallpox ......27..... Georgia .....................
Gadsden ............... Smallpox ...... 4 ..... Georgia .....................
W ashington ........... Smallpox ..... 6 ......Georgia .....................
Columbia .............. Smallpox ......50 ...... Jacksonville ..................
Suwanee ............... Smallpox ............. Florida ............... 1 .....
Columbia .............. Smallpox ...... 1...... Florida ......................
LaFayette ............. Chickenpox .......................................
W alton ................ Smallpox ......13...... Florida ......................
L aF ayette .......................................... ....... .................
W alton ................ Smallpox ...... 1 .... Alabama .............. ......


Alachua .............. Diphtheria ..... 9......Not known .............................. ....
Hillsboro ........... Diphtheria .....21..... .Key W est .............1 .......................
Walton ................ Smallpox ...... 3...... Alabama .....................................
Jefferson .............. Smallpox ......50...... Georgia ...............2 ................... ....
Gadsden ............... Sm allpox ...... 1......Florida .......................................
Jackson ............... Smallpox ......95...... Dothan, Ala. .........2. .Under observation now.
Walton ................ Smallpox ......17...... Florala, Ala ..............Under observation now.
Gadsden ............... Chickenpox .................. ... ................ ..... .. ........
Jefferson ............. Smallpox ......47..... Georgia ...............1..Under observation now,


REMARKS.
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...............o..









SIXTEENTH ANNUAL REPORT


DSmallox and You will note that during the year, I have attended
Diphtheria
380 cases of smallpox, with a loss of 9 by death, also
that I have treated 30 cases of diphtheria of which
number I lost by death three. In the greater number
of instances the source of these several prevalences has
been brought from the adjoining States and have not had
their origin in Florida. Seven occurrences were traced
to Georgia, five to Alabama, and five out of the total
of 17 could not be traced. We stand sadly in need of
two important measures in our line of work in Florida.
One of these is the cooperation of adjoining States: the
other is a compulsory vaccination act in the State of
Sources of Florida. To a lack of the first we may safely attribute
infection
all the smallpox which I have had to contend with during
the year 1904. To a want of the second we have all
classes of laboring people, whites as well as blacks,
flocking from one public work to another of the State
carrying the infection of smallpox simply to avade a
possibility of being vaccinated by a health officer, we
cannot hope to successfully protect Florida from these
epidemics of smallpox when Georgia and Alabama treat
it so lightly and when we have no way of compelling
the laboring classes to be vaccinated.
Smallpox The following is a detailed account of the respective
County investigation which I have been directed to make during
the year: Gadsden County, February 23d, was directed
to take charge of the smallpox situation in Gadsden
County; after several days of long drives and very faith-
ful investigations I succeeding in locating the cases from
the rumors which were then prevalent in the county.
Smallpox was reported near Henson, Fla., a station on
the Georgia, Florida & Atlanta Railroad, and after
investigating I found four (4) cases all of whom were
negroes. The infection was directly imported from
Decatur County, Ga.
In visiting Concord, Fla., I found eighteen (18)
cases. All of these were in two colored families who
had brought the infection from Decatur County, Ga.
Within the next few days I investigated a report that









OF THE STATE BOARD OF HEALTH.


smallpox was prevalent in the vicinity north of Branch-
ville P. O. On investigation I found two colored, each
with smallpox. There were four (4) cases in one family,
one of whom had just died that morning of confluent
smallpox. This negro was a healthy man about fifty
years old and who had never been vaccinated, and in the
other family there were ten (10) to develop, one of whom
died. The one who died was an old negro man, eighty-
four years old, who had been successfully vaccinated
when a boy, and bore the scar at his death. In each of
the above foci the infected families were quarantined
and all neighboring families vaccinated.
On March 13th, 1904, a case of smallpox was found Sma"pox
Quincy
in Quincy, by Dr. J.- H. Wills. This case was the wife
of a negro preacher, who lived in a building in the most
thickly settled part of town known as "Rotton Row."
The front end of the building was occupied by a negro
who conducted a restaurant and general boarding house
for negroes and it was frequented by hundred of them
daily. At the time the case was found there was eleven
negroes residing in the building, none of whom had ever
been vaccinated, but who had been exposed to the case
daily for a week and a half. They were all quarantined
and vaccinated. As the vaccinations would "take" each
one was discharged after a thorough disinfection. There
was not a member of this number to develop smallpox,
although after as well as before vaccination they remained
in the house with the case. This infection was also
traced to Decatur County, Ga., as a source. During the
latter part of March, I was told of a few cases of small-
pox near Midway, a station on the Seaboard Air Line
Railroad, east of Quincy. On investigation I found two
(2) in a negro family, who had lately moved to that place
from Decatur County, Ga., at which place one of the
family had died of smallpox.
About the 4th of .-'-wil. Dr. B. F. Barnes, of Chat- Smallpox
tahoochee, Fla., reported a case of smallpox which he union
had found near River Junction. It was in the person
of a negro who had recently come from Fernandina, Fla.









SIXTEENTH ANNUAL REPORT


There were six other members of his family, all of whom
I vaccinated and was delighted on the sixth day to see
beautiful "take" in all except one. This one was the
negro's wife and who was then in the eruption stage of
smallpox. This suggests that vaccination will prevent
smallpox as a rule any time after exposure or during
exposure, provided it is done at least six days before the
initial fever of the eruption.
On April 24th, 1904, Dr. B. F. Barnes, of Chat-
tahoochee, Fla., again reported a case of smallpox near
River Junction, and I went down to look over the
situation, there were nine in the family, all of whom we
vaccinated; the vaccination proved successful in all but
three cases; these three (3) developed smallpox at once.
This infection was traced to the neighboring family who
had just been suffering of smallpox.
It will be seen that Gadsden County was not without
smallpox from January to May 26th, 1904, at which time
I discharged the last case in that county. On May 27th,
1904, I went to Concord again to investigate a rumor
of smallpox in that vicinity. I found that there had
been four (4) cases in a colored family, on Mr. Pat
Walsh's plantation, the negro who first erupted con-
traced the contagion in Decatur County, Ga. All of
these cases, his family, had completed the stage of
despuamation several days previous to my visit, so after
a thorough cleaning out and fumigating I discharged
the patients. From the above it will be noted that
Gadsden County, developed ten different foci of the
contagion, and each was traced to Decatur County, Ga.,
with one exception, which was from Fernandina, Fla.
In all there were forty-eight (48) cases of smallpox to
develop in this county during the five months.
smallpox Leon County, April 7th, 1904, I was directed to
Leon County
proceed to Tallahassee, and investigate a suspicious
eruptive disease. I found a case of chickenpox on Mr.
Thos. Hill's plantation twelve miles north of Tallahassee.
smallpox Jackson County, April 23, 1904, I was directed to
Jackson
county Marianna to investigate a reported case of smallpox. I









OF THE STATE BOARD OF HEALTH.


found two cases at Grand Ridge, a station on the Louis-
ville & Nashville Railroad, east of Marianna; these cases
were in one of the most respectable white families in
the town, and on account of the diagnosis being obscure
there were numerous exposures to this contagion. This
was an instance of smallpox, being called "complicated
malarial fever." I vaccinated all who had been exposed,
about thirty-five (35) in number and ordered strict
isolation. In this family where five children who
developed the contagion in regular order, two other
cases developed in another family who had been exposed,
but they were promptly isolated and prevented a further
spread. This infection was brought from South Georgia
by a negro who was employed by the white family who
first developed smallpox. This prevalence resulted in
nine (9) cases and I was able to discharge the situation
on May 26th, 1904.
In this connection I wish to mention the case of special
Mr. Walter S., who was vaccinated by me and on the
eighth day his vaccination gave or caused a considerable
rise of temperature, after two days, intermission he
developed another fever which rendered him unconscious
for two days and nights. On the fourth day of his last
rise of temperature he developed three papules one of
which was on the inner side of his left index finger, the
other two on his left hip. They developed normally into
the full grown smallpox pustules on the sixth day. This
seems to suggest that, although the vaccination did not
prevent the attack, it did absorb the eruption almost
entirely.
Walton County, April 27th, 1904, I was directed Smallpor
Wlton
to Freeport, Fla., to investigate a suspicious case of an County
eruptive nature. I found one case of smallpox in the
person of a negro who had contracted the contagion in
South Alabama, and had come home to Freeport to
suffer the consequences at his father's home. He had
been carefully isolated in an out house, and had not
been the means of exposing to any one except his family.
There were ten in the family, all of whom I vaccinated,









SIXTEENTH ANNUAL REPORT


and gave definite instructions as to the care for the cases,
and necessary disinfection afterwards. The instructions
were obeyed, and no other cases followed.
mallpox On May 21, 1904, I was directed to go to Vernon,
wasougtny Fla., eighteen miles south of Chipley, and investigate
a report of several cases of smallpox at that place.
I found that smallpox had been prevalent in the
town among the white people for sometime. It had
been imported from Southeast Georgia, during the
first week in February, 1904, by a white man. This
person was boarding at one of the hotels in Vernon, and
was attended by one of the local physicians, who
pronounced it "swinepox." There were nine cases to
develop in the hotel and from there it spread all over
town. It became general, and on account of the
physician above mentioned contending that it was not
variola it was no easy matter to suppress. After a
house to house vaccination I learned that there had been
twenty-seven (27) cases to develop in the town, two of
which was then in active progress. I vaccinated a
number of people, and ordered a thorough fumigation
of all the infected residences. After isolating the cases
then present and giving instructions as to the care of
them, I left the situation. At the urgent request of
Solicitor Walter Keho and Judge Parkhill, I notified the
court of the situation, and assured them that it would
be perfectly safe to hold court at Vernon at the regular
time appointed, which was nearly two weeks distant, and
as a result of the assurance of safety, court was held
at the regular time.
On January 9, 1904, I was directed to go to
Vernon again, and note the situation in regard to
smallpox. I found on my arrival that five (5) new
cases had developed from exposure to infected residences,
which had not been carefully fumigated the month
previous. All of these cases were isolated and being
cared for, so I instructed them as to vigilence and the
care which was necessary.









OF THE STATE BOARD OF HEALTH.


I wish to state in this connection that the only
infection remaining was "monopolized" by one of the
local physicians, who says that he came as near dying
of "smallpox" as he cares to. On this last trip to
Vernon, I vaccinated quite a number, of white people
and a few negroes. All of the cases at Vernon were
among the whites.
On June 15, 1904, I was directed to leaveJ Vernon, Smallpox
Columbia
and proceed to Benton, Fla., and take charge of county
a case of smallpox reported at that place by
Dr. D. Cone. On investigation I found that the case
mentioned was that of the superintendent of the East
Coast Lumber Company's Camp, which was located
about twenty-two miles north of Lake City, and five miles
north of Benton, Fla. I found that smallpox had been
imported into this; camp on December 26, 1903, from
Jacksonville, Fla., by a negro. About two hundred
employees were engaged in this camp, and among them
were about fifty (50) who had suffered of the contagion
since it had been imported. Quite a number had already
had it previous to this epidemic, and nearly all the whites
had been successfully vaccinated. At this time there
was only one case on hand which had begun to desqua-
mate, and four (4) others just well of it. I immediately
ordered sulphur from Lake City and began vaccinating
all who had not had smallpox. When the sulphur
arrived I had it issued out and had every house, car and
shanty fumigated. Through the courtesy of Mr. S. A.
Nixon, the superintendent, and his bookkeeper, Mr. King,
I had a cooperation in this camp that was extremely
gratifying. I had a pesthousee" set apart and the one
case was isolated in this until he recovered. Up to
January 26th, there had not been another case to develop,
therefore I had no hesitency in discharging the situation.
On June 30, 1904, I was ordered to Live Oak, Smallpox
and at that place I found that the cases which Suwanee
County
were creating the excitement were in the vicinity of
Hildrith, Fla., about thirty miles south of Live Oak. On
investigation I found two white families with smallpox









SIXTEENTH ANNUAL REPORT


living together, and numbering in all seven (7). They
were residing on the plantation of Mr. Collins, about two
miles south of Hildrith, Fla. Three of those were con-
valescing and all the rest were fully broken out from
four to six days previous to my visit. The last one to
develop the contagion was the youngest child of the
family, who was one and a half years old. The type
was extremely grave, not to be confluentt," and on the
eleventh day she died of the attack. The child's father
had contracted the infection in a negro camp near by at
a phosphate plant; in this camp a negro had died of it,
and it had been diagnosed by Dr. Hiram Byrd some
weeks previously. I finally discharged the situation on
January 13, 1904, after having attended the seven cases.
All were among whites.
On July 6, 1904, I investigated a report of small-
pox on Mr. D. H. Herlong's plantation, near Tolin P. O.
I found a negro suffering of smallpox, but had not
exposed any other except his wife. I vaccinated all the
negroes on the plantation and several white people after
quarantining the case with his wife. Later I saw the
negro, who reported no spread. His house was fumigated
and cleaned up later.
Smallpox On July 9, 1904, I was instructed to go from
LaFayette
county Fort White to Mayo, and investigate an "outbreak"
of a contagious nature at that place. After having
looked the situation over thoroughly and examined
the cases in question I found it to be chickenpox. From
here I immediately returned to Fort White.
Waltonand On July 15, 1904, pursuant to instructions I went
aaetteain t DeFuniak Springs to take charge of the occurrence
of smallpox at that pace. I found that smallpox
was prevalent in the east side of the town, and had not
been diagnosed until seen by the mayor, Dr. G. P.
Henry. It had been imported from Alabama, by way of
Dorcus, Fla., about May 1st, 1904. While here I
vaccinated quite a number and quarantined and attended
all five of the families who were suffering of smallpox.
For several weeks I had to furnish four families with all










OF THE STATE BOARD OF HEALTH.


the necessities of life, and as a result the care of these
cases was very expensive. On August 23, 1904, I finally
discharged the situation after having treated thirteen
(13) in all (all white), at DeFuniak Springs. I am
under obligations to the mayor, Dr. G. P. Henry, and
also Dr. C. A. Landrum for their energetic cooperation
and assistance while I was engaged in this work.
On July 23, 1904, pursuant to directions, I returned
to Mayo, Fla., in order that I might confirm my diagnosis.
On my return I found no cause to change my decision
in the matter, and I immediately returned to DeFuniak
Springs where I was engaged at that time.
On August 15, 1904, I went to Laurel Hill, Fla.,
eleven miles southwest of Florala, Ala., to investi-
gate a reported case of smallpox in that vicinity.
I ascertained that on July 27th a negro tramp came
into Gensburg's turpentine camp and died of confluent
smallpox on the night of the 28th of July, 1904. Mr.
Gensburg exercised exceptional judgment in having the
negro buried by the vaccinated men and the house in
which he died thoroughly cleaned out and fumigated,
thus preventing any further spread of the smallpox in
that vicinity.
On September 3, 1904, I was directed to go to Diphtheria.
Alachua
Gainesville, Fla., and take charge of diphtheria which county
was then prevalent in "Munteacha" settlement. In this
community I found four (4) families in which the
infection had gained a foothold. There were nine (9)
cases to develop, two (2) of which resulted fatally. It
would be unjust not to mention Dr. J. C. Colsons' able
management of the cases which recovered before my
arrival by the use of antitoxin with remarkable success.
Had the two fatal cases been seen by a physician and
treated earlier I am sure the result would have been
different. I adopted strict quarantine measures with
these families, and had no further spread of the infection.
On September 18, 1904, I was able to discharge the
situation after the recovery of all the cases, and a
thorough disinfection and fumigation of the infected










SIXTEENTH ANNUAL REPORT


residences. It was impossible to trace the source of this
infection.
Diphtheria On September 10, 1904, I was directed to go to
Hillsboro
County Tarpon Springs, and take charge of the diphtheria
situation in that town, which had at that time
assumed threatening proportion. On investigation I
found eight families in which the infection was prevalent.
In the eight families there were twenty-one (21) cases
of diphtheria at that time. I quarantined the residences
in which the infection was found and proceeded to treat
the cases. On the third day I had all under good control
except five (5) who appeared to be hopeless. Four of
them were white children, and one a colored child. In
the treatment of these I used antitoxin heretically, and
was successful in all except the case of the colored child.
On September 23, 1904, the situation was such that I
had no hesitation in discharging it after the proper
disinfection and fumigation of all residences. In this
occurrence it was plainly demonstrated to me that
without a thorough disinfection and fumigation after
cases of diphtheria it remains as dangerous as any
contagion or infection with which we have to deal. It
was easy to trace the source of this infection to Key
West, Fla., from which it had been imported early in
the spring. I cannot speak in terms too high of the able
management of this outbreak by Drs. J. E. Douglass and
A. P. Albough, of Tarpon Springs, Fla. I greatly
appreciated the cooperation and assistance rendered me
by them while in charge of the situation myself.
smallpox On September 28, 1904, I was instructed to go to
Alabama line
Florala, Ala., and investigate a reported "outbreak"
of smallpox at 'Paxton, Fla., which place is located
one and a half miles below the Alabama and Florida
line, opposite Florala, Ala. On investigation I found
that smallpox had been prevalent at Florala and
adjoining vicinity for several months, and that the infec-
tion had spread from there down and across the line into
Paxton, Fla. In the Florala Saw Mill Company's
quarters at Paxton, I found three (3) cases just complet-









OF THE STATE BOARD OF HEALTH.


ing the stage of desquamation and, as it had been over
two weeks since there had been a case to develop, I
disinfected all the infected residences and discharged the
situation. At this place all the negroes had either been
vaccinated or had suffered of the contagion, therefore it
was plain that new material had to be imported before
a new outbreak was imminent. Also that Florala could
furnish the infection for any new material. While here
I respectfully called the attention of the State Health
Officer of Alabama to the smallpox situation at Florala.
On October 3, 1904, I was directed to Monticello smauipo
to take charge of the smallpox situation in that county
county. It had been prevalent in Jefferson County
for several months, and at this time had assumed
immense proportions and had swept over the entire
northern part of the county. Negroes furnished the
principal number of the cases. While dealing with the
situation it was necessary to devote a great deal of time
to vaccinating ahead of the outbreak. This policy was
adopted immediately. While in attendance on this
situation I had exactly fifty (50) cases to develop in
three separate and distinct communities. Of this number
two (2) died of the confluent type. On November 21, 1904,
I discharged the situation, feeling safe in so doing on
account of having vaccinated about all the probable
smallpox material. The number vaccinated during this
epidemic was at least four hundred. The source of the
contagion was traced to Georgia.
On October 11, 1904, I was instructed to proceed
to Quincy, and assume charge of a case of small-
pox near that place. On my arrival I found one (1)
case of smallpox on one of the tobacco plantations five
miles north of the town. The negro had undoubtedly con-
tracted the contagion in Jefferson County, where he had
been some days previous to his initial symptoms. This
patient lived in one of the houses of a "quarter," number-
ing about fifty in all. He had freely associated with all
who had resided in the "quarters," therefore it was
necessary to vaccinate all who could be found. I spent










SIXTEENTH ANNUAL REPORT


several days at this work, keeping the patient guarded,
and expecting other cases to develop; especially did I
expect his wife to contract smallpox, but my vaccinations
were effective and prevented other cases developing. On
October 21, 1904, I discharged the situation, and have not
had any further trouble in that vicinity.
JS.c2s 'On October 20, 1904, I was directed to leave
county Quincy, and go to Marianna to take charge of the
smallpox situation prevailing in the northeastern part of
Jackson County. After investigation I found that the
infection had been brought from Doton, Ala., to this
vicinity by a white lady who contracted the contagion
in Alabama. This outbreak was confined to the whites
at first, but soon invaded the homes of three colored
families, a number of whom had been in attendance in
infected white families. My first step was to quarantine
all infected families, and to vaccinate all exposed persons
who could be found. By so doing I prevented the spread
of the disease, and limited the disease to three white and
three colored families. Among the whites there were
sixteen (16) cases to develop, and nine (9) among the
negroes. While in this community, I was able to
vaccinate quite a number of people in the neighborhood
and received the moral support of the best people of the
county. I am under obligations to Doctor Hill, of
Greenwood, Fla., for his valuable services and many
courtesies extended me while there. I discharged the
situation on December 12, 1904, after attending twenty-
five (25) cases in all. On November 3, 1904, Dr. W. R.
Booth, of Campbleton, reported a number of cases of
smallpox north of that place among the negroes. On
investigation I found a number of colored families
infected throughout a section covering several miles. The
source of the epidemic was Dothan, Ala. From which
place a negro had come and had spent several days and
nights in this community. He had not fully recovered
and, consequently, smallpox developed in every family
with which he spent a night.
At present, December 31, 1904, this prevalence of









OF THE STATE BOARD OF HEALTH.


smallpox is under control, and I am awaiting develop-
ments. There have been forty-four (44) cases to develop
up to the present and two deaths. The only way to
control this outbreak was to vaccinate every negro in
the adjoining communities to the families infected. This
I did, and during the time occupied in this work several
hundred had to be vaccinated. From the infected
district above Campbleton a negro boy came to a relative's
house, three miles below Campbleton. He had developed
smallpox and spread it in four families in that
vicinity before it could be checked. This is also under
observation at present, and seems quite under control
after one death, and twenty-six (26) cases. All of the walton
County
above seventy (70) cases have been among the negroes.
On November 26, 1904, I was directed to divide
my attention and investigate a report to the effect
that smallpox was prevalent at Paxton, Fla. I found
that the contagion had been imported from Florala,
Ala., and was well nigh epidemic at Paxton. It
is needless to state that Florala, Ala., is the constant
source from which West Florida can import any number
of cases of smallpox. On investigation at Paxton, I
found several cases and immediately determined to
vaccinate every person who had not suffered of smallpox
up to that time. With the assistance of Dr. J. P.
Phillips, I vaccinated every negro that could be reached,
and quite a number of whites. I quarantined all cases,
and vaccinated all exposed persons that could be found.
This infection is also under observation at present and
under satisfactory control. There have been seventeen
(17) cases to develop. Twelve of which are among the
white people.
On December 9, 1904, two cases of smallpox was Gadsden
County
reported by one of the physicians of Quincy, and
pursuant to instructions I investigated the situation.
It proved to be chickenpox. Therefore I immediately
proceeded to Jackson County to resume my work.
On December 18, 1904, the State Health Officer Jefferson
County
directed me to go to Monticello, and investigate reported










SIXTEENTH ANNUAL REPORT


cases of smallpox in Jefferson County. This I did, and
found two separate epidemics in different parts of the
county. One of these is in the vicinity of "Hamptons
Mill," nine miles northeast of Monticello. The other
is in the vicinity of "Wowman's Mill," about thirteen
miles west of Monticello. I have been vaccinating'
continually, and think I have one of the psuedo epidemics
under control. The other I have not been able as yet
to vaccinate ahead of, for lack of time. Both are now
under observation together with the situation in Jackson
and Walton Counties. Up to the present there have been
thirty-five (35) cases in all to develop in this county.
In addition to the above I have just located a house
in Monticello with eleven recovered cases in it, which
I have fumigated and cleaned up; from them there has
been one case to develop in one of the white families in
town. I fear no spread, however, from the present case.
In submitting the above report I wish to state that,
owing to overwork and incomplete notes, I have been
forced to omit many details that might have been of equal
importance and more interesting than those given herein.

REPORT OF DR. W. M. STINSON.

Jacksonville, Fla., Jan. 20, 1905.
smallpox During the past year, while occupying the position
of special agent of the State Board of Health, my work
in conjunction with other's, has been principally toward
the control and management of smallpox outbreaks as
they have arisen from time to time in different portions
of the State. In the great majority of these instances
there have been only a few cases, showing that there must
have been an importation of the disease from some outside
source. This source I think we have good reason to
believe to be from some of our neighboring States since
we have not had foci which were not practically under
the control of the State Health Department at all times,
and I believe it would well nigh be impossible for the
majority of these outbreaks to have originated in this









OF THE STATE BOARD OF HEALTH.


State. In the control and management of this disease, I
have visited more than twenty different portions of the
State, to investigate as many different outbreaks, and, iufecon
from the knowledge gained, I believe that the time is as
yet far distant when we may rest from our labors, not
from any fault in the management of these epidemics by
the State Health Department, because of lack of
cooperative movement on the part of our neighboring
States, in keeping down this disease, we cannot expect to
receive definite results in its total extermination. We
might be said to occupy a position similar to that of the
beligerent powers in the Far East; our State taking the
part of a smaller power fighting against seemingly over-
whelming odds and inexhaustible resources, which our
neighboring States seem to possess and to furnish in fresh
infection.
The floating negro population is the source from
which the majority of our outbreaks occur, as they pass
freely over the State line, and from the very hotbeds of mp"orta
the disease and, in some instances, they have the disease
developed upon them, on arrival. They mingle with their
own race at the border line of the State and start fresh
foci from which the disease may spread.
Under these conditions, and considering the disease
as it now exists in some of our neighboring States, I
think the State Board should be given more than usual
commendation for keeping the disease under control in
the manner it has. Just below our State border lines
on the North the fact is especially noticeable that the
disease is most frequent and most difficult to control,
altogether due, as has been said, to a freedom allowed
patients in some of our neighboring States, and condi-
tions of affairs, which is demoralizing to those who we
may find it necessary to control in parts of our State near
its northern boundary.
The prevailing mildness of the disease and the very mldness of
low mortality attached to same are making the prompt
control difficult among a certain class who seem to care
nothing for the esthetic or loathsome features of it. The










SIXTEENTH ANNUAL REPORT


fact also that successful inocculations with bovine virus
will prove a specific and prophylactic in all cases is not
known by the more ignorant class, and even in some of
the more intelligent, there is frequently violent objection
raised, and they sometimes bring forth the most peculiar
and absurd reasons for refusing. I have had some object
to vaccination because they say they have seen people
who have been vaccinated develop the disease. The
explanation of this apparent but not real condition has
been explained by inviting attention to the well known
fact that a person may be inoculated with vaccine virus
and yet not be vaccinated, also that unless the vaccination
be successful as shown by the resulting typical scar, no
immunity can be assured. It is a great mistake to
vaccinate a person, dismiss him and possibly give him a
vaccination certificate of vaccination without waiting to be assured
as to the successful result, but, how often is this not done?
This is one of the abuses of vaccination that the medical
profession are surely responsible for and should correct.
Another objection to vaccination I have found to
be a fear of sore arms and other annoying sequelae which
so often follows the operation when carelessly performed.
Many of these troubles are the result of secondary
infection, and it is not just to attribute the cause to
the vaccination per sc, for with pure virus, cleanly
methods and careful after treatment the dangers of
transmitting disease, or of contracting infection are
almost nothing. Sometimes after a successful vaccina-
tion and on or about the third or fourth day the tempera-
ture rises, and may persist until the eighth or ninth day.
There is marked leucocytosis. In children it is common
to have with the fever, restlessness, particularly at night,
and irritability, but as a rule these symptoms are slight.
If the vaccination is made on the arm the auxiliary glands
become sore; if on the leg, the iguinal glands.
As to the proper technique in vaccination, I follow
Technique
as near as compatible the following points:
The virus should be fresh and absolutely free from
contamination. The skin of the patient at the site chosen









OF THE STATE BOARD OF HEALTH.


for the operation should be sterilized as for any surgical
operation, having a surface free from any antiseptic
condition by washing well with soap and water, and
afterwards with alcohol, drying the skin with absorbent
cotton. The hands of the operator should be scrubbed
with soap and water, and then wet with alcohol or
corrosive sublimate. Use special scarifier, sterilize it by
passing through the flame of an alcohol lamp. Choose
a point near the insertion of the deltoid muscle if on the
arm, and if the leg be preferred, select a site just below
the head of the fibula. Avoid scar tissue. Afterward
protect with a celluloid shield which has been washed in
an antiseptic fluid and dried, but this must be removed
as soon as a special lesion has developed. The arm is
then dressed with boric acid ointment and covered with
aseptic gauze, bandaged so as to avoid compression.
Instruct patient to avoid all friction over the wound, and
on no consideration to handle the part, in other words,
let asepsis be the practice in this as in all surgical opera-
tions.
The following are a few facts which experience in
vaccinating has taught me.
Degree of immunity conferred. Immunity is said to
be acquired by the time the areola is at its height, that
is from eight to ten days after vaccination.
Vaccination in a pregnant woman does not protect
the child.
The duration of immunity is very variable and, in Immunity
the presence of an epidemic, revaccination should be
done to insure safe protection. A successful vaccination
within five years will probably prevent contracting the
disease, but will not be a certainty. It is conceded by
most authorities that the period of immunity is not only
extremely variable but is probably short in most cases.
The protection of vaccination is in direct proportion
to the excellence of the virus and the "take." The
completeness is shown by the resulting scar. Vaccina-
tion protects against smallpox as freely as does an attack
of the disease immunize against a subsequent attack.









SIXTEENTH ANNUAL REPORT


A large majority of those developing the disease,in
our State are among the more ignorant and, consequently,
our colored population. The disease in a great majority
of our outbreaks is extremely mild in character, and has
a mortality of less than one-half of one per centum, and
rarely leaves a permanent scar upon the person.
As illustrative of what might be done should we
ever succeed in getting a comparative compulsory vaccina-
tion law, or in other words, have all employers responsible
for the vaccination of their employees, I submit the
following in reference to the manner in which this condi-
tion was controlled in Porto Rico some years since:
"When the Spaniards left the island of Porto Rico
in 1898, smallpox was endemic; in December it was
epidemic; in January, 1899, it had honey-combed the
island and, by February, there were 3,000 recent cases,
and the disease was spreading at a gallop. In February
systematic compulsory vaccination was begun, with fairly
equal efficiency in all parts of the island.
Vigorous prosecution for four months, until July
1st, resulted in 860,000 vaccinations out of a population
of 960,000. The work then ceased, completed, and the
disease had practically disappeared. In two and half
years there have been but two per year as against a
former yearly average of 621."
The author well says:
Can any honest, intelligent person doubt, in the
face of these indisputable, easily verified facts, what
it was that in four months drove smallpox from its wide
and long-time reign on the island, and has since kept
it out? Vaccination alone did it, and will effectively,
wherever compulsory legislation properly enforced secures
its benefits to all.
Hyde states: "Vaccination, however, while probably
as near perfection as a preventive of smallpox as any
means can be, is still not absolutely perfect, and its
failures show most plainly in epidemics, when those
ordinarily resistant to vaccine become amenable and









OF THE STATE BOARD OF HEALTH.


vaccination may even apparently succeed after or during
the developed smallpox itself."
These exceptional facts, however, prove nothing
against the rule and the anti-vaccinationists overlook the
signal victories over smallpox of which the general
character of the present evidence is itself an evidence.
Hyde shows that were it necessary to appeal to statistics
at this late day to prove the value of vaccination, the
experience of Port Rico alone where smallpox has been
practically stamped out in two years would be sufficient.
She "bombarded us with a filthy germ, and in revenge we
made her clean."
His article concludes with the demand that "vaccina-
tion should be the seal on the passport of entrance to
the public schools, to the voters' booth, to the box of the
juryman, and to ever position of duty, privilege, profit
and honor in the gift of either the nation or State."
Personally I have found guard service of little use
in keeping infected persons in, except in especially selec-
ted instances.
One feature I would also like to mention as regards
the potency of vaccine virus. During the mid-summer
months I felt very much discouraged at the results I otencyof
obtained from vaccination, as in some instances I got less vaccine
than 15 per cent of successful "takes," while during the
cold months, and with perfectly fresh virus and that
which had been kept at a temperature not higher than
seventy-eight degrees I got seventy-five and even a higher
percentage of "takes." I would suggest that during
mid-summer months that all virus used should be
extremely fresh from the manufactory, or if found neces-
sary to be kept over for a time before using, to have same
placed in a refrigerator and to only send out sufficient
quantity which might be expected to be used within
twenty-four or forty-eight hours from the time it leaves
cold storage.
As a detailed synopsis from a geographical stand-
point, and other datd, I would ask your attention to the
following table:









DATE.
May 17............


TOWN. COUNTY. DISEASE. SOURCE.
Cedar Key ........ Levy .............. Impetigo Contageosa....... Unknown


May 30............MacClenny ........Baker .............Variola .


May
June
June
June
June
June
July
July
July
July
July
Aug.
Aug.
Aug.
Oct.
Oct.
Oct.
Oct.
Nov.
Nov.
Nov.
Dec.
Dec.


.Columbia Co. t3


26............ Lake City .........Columbia ......... ........ ....... Georgia
2...........Providence ........ Bradford .......... ... ..... ...... Georgia
4............ LaCrosse .......... Alachua .......... ...... .......... Florida
5............ .Hainesworth ...... Alachua .......... ................ Florida
16 ........... Fort W hite ........ Columbia ......... ... ... .... Unknown
17 ........... Tolan ............. Columbia ............... ....... ....... Florida
4........... Tallahassee ........Leon .............. ................ Columbia Co.
16.......... .Palatka ........... Putnam ........... Unknown
20............ W elaka .......... .Putnam ............ U ........... ...... Unknown
29............ Otter Creek .......Levy .............. .. I...... .. Florida
29............ .Newberry .........Alachua ........... ............... .. Georgia
16............ Marianna ......... Jackson ......... ...... Georgia
20............ Hastings .......... St. Johns ......... ...... ......... Palatka
20............St. Augustine .... St. Johns .........Secondary specific eruption.Florida
1............ Kissimmee ........Osceola ............Variola ......... ...... Florida
15............ Parrish ........... M anatee .......... ......... ... Unknown
25............ DeLand ........... Volusia ........... .... ......... Florida
28............ Lake H elen ........Volusia ........... .. ..... ........ Florida
1............ Kissimmee ........Osceola ........... ............... Unknown
4............ Lakqland ......... Polk .............. .............. Unknown
20............ Crystal River ...... Citrus ............ ............... .. Florida
12........... Newberry.......... Alachua .......... .................. Georgia
20........... Jennings...........Hamilton ......... .................. Georgia


5s










OF THE STATE BOARD OF HEALTH.


CASES. COLOR.
8........W white


NO. VAC. LOCAL SITU'N. DEATH.
........ 25....Town ............


3........ Colored ........ 45 ....Jail ...............


2........ "
11 .......
1........
2 ........
1........
10........
1........
49........
3 ........
6 ........
4 ........
1...... "
5....... "
2........White
1........Colored
3........ "
2....... .W hite .
2........ "
1....... .
7........Colored


........ .... Tow n .............
........100.. Country ..........1
........ 75.. .Country ..........
........ 15... Country ...........
........ 20....Town .............
........ 50... Country ...........
........ 35 ... .Jail ..............
........375....Town .............
........ 15 ... Tow n ............
........250.. M ill ..............
........ 150. M ine .............
........ 30... .Country ...........
........ 35 ....Town .............
........ ....Tow n .............
........ 25 ....Jail ...............
........ 75 ....Tow n .............
......... .... Tow n .............
........ 35....Town .............
........ 15... .Town .............
........300... Country ...........


14........ Both ...........150....Country ...........
1........ Colored ........175 ... Country ...........
3........W hite ..........250. ..Town .............


Giving a brief history of these outbreaks of small-
pox according to their dates, T submit the following:
On May 30th, in response to instructions relative Smalpox
Baker County
to report of suspicious case held in the county jail at
MacClenny, I left for that point to assume control and
charge of the situation should the case prove of a
quarantinable nature. I found three negroes in the jail
(all brothers. One was in the pustular stage of variola.
The three of them had been brought a few nights previous
from Columbia County for a supposed misdemeanor, and
the jailor at MacClenny had put them in jail, not know-
ing at the time that one of them had smallpox. The next









SIXTEENTH ANNUAL REPORT


morning there was considerable excitement in the town
when the jailor reported what he had in the jail, and
when I arrived the citizens and authorities were disposed
to let these darkies out and send them again to Columbia
County, thinking that Columbia County had simply used
this means of getting rid of an unwelcome situation.
After discussing the matter with them at some length, I
convinced the authorities that where the disease was it
would be best for it to remain, as. no one could be exposed
without the knowledge of the jailor and the cases could
be taken care of properly, and at the end of the disease
the jail could be thoroughly and properly cleaned. I
vaccinated the two brothers who did not have the disease,
but neither of the vaccinations were successful and both
men finally developed smallpox. All the cases were light
in character. After the last one had entirely recovered,
the jail was disinfected. There was very little cost to
the State in this instance as, being prisoners in the jail,
the county agreed to continue control of them as
prisoners and furnished provisions and other needful
articles, county health officer of Baker County looking
after their welfare.
sllpox On June 2d, in response to instructions from the
county State Health Officer that reports had been received from
Providence and LaCrosse relative to a smallpox outbreak
in both of these places,I left for Providence, Bradford
County, Fla., to look into the report of smallpox near
that place and assume charge of same should a disease
prove of a quarantinable nature. I found in a very
thinly settled section of the country, about six miles
from Providence, a small three-room cabin, and in it a
family of eleven negroes, four of whom had well developed
cases of smallpox. I gave them instructions as to
quarantine, stating penalty of breaking same, also
vaccinated all who did not have the disease. Regardless
of repeated vaccinations, not one of them "took." All
developed the disease, and one woman gave birth to a
babe while suffering from the disease, but child did not
have the disease. One child, seven years of age, died









OF THE STATE BOARD OF HEALTH.


from secondary pneumonia. These were the worst cases
I have seen during this smallpox prevalence. After
disinfecting the house and contents and superintending
also, a thorough cleansing of their bodies, I dismissed the
cases. I understand that the neighbors a few days
afterwards, after giving these negroes notice, burned the
house. There were no further developments in the
neighborhood from this source.
On June 4th, in accordance with instructions, I
visited LaCrosse, Alachua County, Fla., and arriving at
that place investigated the report. I found one case of
smallpox about two miles out of town in a very isolated
region, the case being about well at the time. I gave
instructions as to quarantine, vaccinated all in the
neighborhood and gave instructions also as to disinfect-
ing, and, as I had knowledge of other cases about five
miles from there, I went to this point (Hainesworth)
and investigating conditions there, found two cases. I
instructed them in regard to quarantine, vaccinated
others around here, and looking after these cases at
Providence, LaCrosse and Hainesworth until they were
entirely recovered, had the houses and contents disinfected
and dismissed the patients. There were no other cases
of smallpox following.
On June 16th I went to Fort White in response to
report from railroad authorities at that point. The
report had, for some reason, been delayed and I found
that the case of smallpox which they had given us know-
ledge of had entirely recovered and was at work as a
section hand. They had, themselves, disinfected the room
where this negro had been sick, so I contented myself by
vaccinating those in the community, and those who had
been exposed to the disease. I heard here that there
were cases at a place known as Tolan, about eight miles
from Fort White. I investigated this report and found
two families, one family in which all the inmates had
just completed the disease, and a near neighbor of this
family who, at the time, had the disease. I disinfected
and discharged the first case and quarantined the second









SIXTEENTH ANNUAL REPORT


family. This was a very isolated section of the country,
and there were very few whom I found it necessary to
vaccinate. There was no further spread of the disease
from these families, though I understood that there was
and had been at that time other cases at a phosphate
mine, about five miles distant, and I have no doubt that
the above mentioned families contracted the disease from
this source, though at the time I was unable to get any
information at all as to the source of infection.
On July 4th, in response to instructions, I went to
Smallpox
Leon County Tallahassee to assume control of the smallpox situation
which existed in the county jail. I found one case of
smallpox in a prisoner. There were nine other prisoners
in the jail, all having been exposed. I had the man with
the disease isolated in a cell as far as possible away from
the others. I vaccinated all the other prisoners and
continued to vaccinate them every second day. All who
did not have previous scar indicative of a past successful
vaccination, "took." I have often pursued this method
of revaccination, not waiting fully six days to know
positively whether or not the vaccination is successful,
but revaccinating at shorter intervals, about every forty-
eight hours, giving the virus an opportunity to thoroughly
get into the system, and it seems that even before the
typical pustule appears upon the arm the person may
have sufficient resistance to keep off the second vaccina-
tion. As I mentioned, not one of the other prisoners in
the jail who had not a previous scar failed to "take"
and, consequently, the outbreak was stopped at its very
inception.
Smallpox On July 16th, in response to instructions, I visited
County Palatka to investigate the smallpox situation then
existing at that point. There was a pest house being
used in the suburbs of the town and in one of the best
locations for such a house that I have ever yet seen as
it was on the banks of the river and surrounded entirely
landward by the most dense jungle of marsh, grass, vines
and undergrowth, and the only way that one might
escape from the place was by swimming, or in a boat.









OF THE STATE BOARD OF HEALTH.


I found about eight cases in this pest house. Smallpox
appeared to have existed in the town for some months.
I assumed control of the situation, and made a house to
house canvass in the town for cases, vaccinating all,
especially in the infected districts, and sent cases found
to the pest house and disinfected houses, clothing, etc.,
at the infected points. There were as many as twenty-
one cases in the pest house at one time. The chief of
police rendered me valuable assistance in the first day
or two of my crusade. After his very thorough canvass,
especially in the infected districts, I covered the sec-
tion about three times weekly. Only three other cases
developed. Since this outbreak closed Palatka has been
entirely free from smallpox so I learned from the chief
of police about a month or six weeks ago.
On July 20th and during my stay at Palatka, I visited
a small place about twenty miles from Palatka to
disinfect and release a case of smallpox then about
recovered. I vaccinated freely in the community, dis-
infected the house, and returned to Palatka.
On July 29th I received instructions to investigate Smallpox
a case of reported smallpox at Otter Creek in Levy Levy county
County. I went to this place and found two cases
existing in the negro quarter. I had them with their
families taken to a pest house located in the country.
I vaccinated the whole of the negro quarter of the town.
I also vaccinated those in the infected families
who had not already developed the disease.
Greatly to my surprise, no other cases developed in
the town, but in the families I sent to the pest house
there were two other cases. All of the cases were
extremely mild in character. I believe that the extreme
heat of the weather is to be given credit for our not
having a severe epidemic at this point. I know of 'no
other reason, if such may be considered a reason which
prevented it.
On or about August 1st, and while at Otter Creek, Smallpox
I had information of an outbreak of smallpox at New- county
berry in Alachua County. Arriving there I found that










SIXTEENTH ANNUAL REPORT


out about six miles from the town at a phosphate camp
four cases of smallpox were isolated in a small cabin
by Doctor Ruff. With the assistance of Doctor Ruff, I
vaccinated all the employees at this mine and instituted
a rigid quarantine, and having my hands full at Otter
Creek, I left the situation at Newberry with Doctor Ruff.
[ afterwards learned that there were no further develop-
ments.
Smallpox On August 16th I left Jacksonville for Marianna, in
cSount Jackson County, to investigate a report of suspicious
cases near that town. I found, about six miles from
Marianna, one case of smallpox which has entirely
recovered. This man had recently come from Georgia
and had the disease at the time he came. He was in a
cabin alone, being attended by his father who had had
the disease a number of years previously. I vaccinated
about fifty people in the community which was a very
thinly settled section of the country. After disinfecting
the house and contents I dismissed the man and returned
to Jacksonville.
mal On August 1st I investigated a report of smallpox
st. Jhyn at Hastings, in St. Johns County. I found one case in
County
the suburbs of this town in a negro who had recently
come from Palatka. He was in a house with a family
of five and, of course, all had been exposed to the disease.
I quarantined the house and vaccinated the inmates,
keeping a very strict and rigid quarantine as far as
possible without guards. I vaccinated very freely in
the community. The vaccinations, which were repeated
in the members of the family who had been exposed did
not take and two others developed smallpox. I then,
upon inquiry, found that the other members of the family
had previously had the disease in Palatka, and it had
been of such extreme mild character that, except upon
the very closest scrutiny, could this be detected, and I
had overlooked this upon my first examination. After
the recovery of the last case I disinfected the house and
discharged the patients. There were no other develop-
ments of the disease at this point.










OF THE STATE BOARD OF HEALTH.


On August 25th, while in charge of the situation at
Hastings, which is only a short distance from St. Augus-
tine on the East Coast Railroad, I received instructions
from Jacksonville to investigate a report of suspicious
cases at St. Augustine. There I found considerable
excitement in a certain section of the town where there
were a number of first-class boarding 'houses. The
suspicious cases were two young white boarders: one held
simply on suspicion, the other because there was a slight
rash over his body. They had both occupied a boarding
house by themselves, the other members having left,
fearing the possibility of smallpox. The young man with
the rash I diagnosed as being a secondary specific
eruption, and the other young man simply held as a
victim of circumstances, or in other words, being in bad
company. While here I was informed that there were
some cases in the pest house, and on investigation I found
two cases, but about well. As the situation was well
under control and there was no danger of spread, I
returned to Hastings.
On October 1st I received information that smallpox smaox
existed at Kissimmee, in Osceola County, and in the jail County
at that place, one case was found in a white man. There
were three other persons in the jail and all had been
exposed to the disease. The jail was located in the
basement of the fine county court house. One of the
prisoners had previously had the disease, and the other
two had been successfully vaccinated. I judged that the
case could stay where it was until such time as it would
be in a condition to be discharged, but there were some
objections raised by the county commissioners who held
a special meeting to discuss this proposition. They
wished the State Health Department to take all the
prisoners out and put them in a pesthouse and guard
them and feed them, until such time as the patient would
be well, or until I deemed it safe for him to return. Of
course I could not agree to any such proposition as I
did not consider the State Health Department should be
held responsible for feeding and guarding these prisoners









SIXTEENTH ANNUAL REPORT


as prisoners, and assume responsibility of their safe-
keeping. The commissioners finally compromised by agree
ing to build a pesthouse sufficiently strong to be a jail
and assume charge and part of expense of all prisoners,
the Health Department paying the sum of one dollar
a day for feeding and nursing patient. By the time
the pesthouse was built, patient had about recovered
and, of course, the other prisoners did not develop it.
I superintended disinfection of the jail by the prisoners
themselves and had same done in an especially careful
and thorough manner. As for the source of the disease
in this case I have reason to believe it to have been
contracted in the jail itself as there was rather authentic
data to the effect that a mild case had, some months pre-
viously, developed in the jail.
On October 15th I received instructions, which caused
me to visit Parrish, Manatee County, Fla. Reaching there
smaUpox I found one case of smallpox in a colored man living in
Mandate the section house of the railroad, also two other cases in
the suburbs of the town in a small cabin. I had the
case taken out into the country and put in an isolated
and comparatively worthless cabin, which was kindly
offered by the proprietor of an orange packing house, he
saying that one of his employees owned the shack and
that said employee was entirely willing for us to have
the use of this house as it was of comparatively no value,
and there were at the same time hints that the house
would probably be burned after the case weres discharged.
The houses in the suburbs of the town where cases had
been removed from were burned that night and, as
subsequently happened, the house in which patients were,
was also accidentally burned at about the time that
patients had completed their recovery, saving the citizens
this trouble. How the house caught fire no one seemed
to know. One of the negroes who was asleep in the
house came very near being cremated. I arranged a
small shack for the patients to stay in until entirely
recovered when I disinfected their persons and belongings
and discharged them. I succeeded in vaccinating only









OF THE STATE BOARD OF HEALTH.


about seventy-five of the inhabitants of the town. There
were no subsequent developments of the disease.
On October 28th I went to Lake Helen, in Volusia
County, to superintend the disinfection of a cottage in
the Chatauqua Camp at that place. I carefully and
thoroughly disinfected the house. The cases which had
been in this house and which had been removed to DeLand
I then saw, DeLand being about eight miles from Lake
Helen. I found the cases to be two white men who were
occupying the poor house as a pesthouse. These two
cases were entirely well so I disinfected and thoroughly
fumigated the house and belongings and person of the
inmates.
On November 1st I again visited Kissimmee, in
Osceola County, to investigate a smallpox situation. I
found one case in the new pesthouse which the county Osceola again
commissioners had previously built, and also satisfied
myself that this case did not originate from the previous
case they had which existed in the jail a month before.
This case was in a young white man, an orange packer
from the East Coast, and he was unable to give any
information as to where he might have contracted the
disease. While there I received instructions relative to
a smallpox outbreak at Carter's Mill. Leaving the
situation at Kissimmee in Doctor Hick's care, I went to
Carter's Mill near Lakeland. I found several cases
existing at a turpentine camp, about five miles from
Carter's Mill. I had these patients taken to an extremely
isolated spot, about five miles further into the pine
woods, to a small cabin which had been built to lock
tools in when the negroes were working the trees in that
section. I vaccinated the entire camp, also the mill
hands. In all I vaccinated about five hundred people.
No other cases developed.
On November 20th I visited Crystal River, in Citrus
County, investigating a smallpox report from that place.
I found in what was known as the Lacanto section, Citrus county
twelve cases. This section is about twelve miles from
Crystal River, and is in a thickly settled farming










SIXTEENTH ANNUAL REPORT


section. I preached vaccination to good success, as the
people were rather frightened. I isolated in their homes
those who had the disease. There were only two cases
developed, and the great majority of the vaccinations
"took." This is a positive demonstration of the manner
in which this disease may be controlled by the timely
administration of vaccine virus as a prophylactic; as
all of these cases had originated at about the same time
and from the same source.
Alachua On December 12th I visited Newberry, in Alachua
again
County, in response to a report of suspicious case by
Doctor Ruff of that place. I found one case, upon my
arrival, who had been already isolated by Doctor Ruff,
and being in the latter stage of the eruption. The
patient had rather a severe case, especially over the face
and exposed parts. I took the manager of the phosphate
camp where the negro was to see him and he was so
surprised and repulsed at the appearance of the man
that I had no trouble at all upon my return to the mine
in vaccinating all the employees. There were no further
developments. This man is one of the few who will
have permanent scars.
Smallpox On December 20th I received instructions to visit
Hamilton
county Jennings, in Hamilton County, to investigate a suspicious
eruption reported by Dr. J. M. Carswell of that place.
Arriving at Jennings, I found one case of smallpox
typically developed in a white man, one of the leading
citizens of the town. There had been considerable
discussion by the physicians and citizens in regard to the
case. The patient, himself, had not been confined to his
bed, and had during the first six or eight days of the
disease, freely exposed himself on the streets unmindful
of what the possible results might be should his ailment
prove to be smallpox, as he was told it was, by a number
of persons. He at last found it necessary to go to bed
on account of the severity of the attack, and when I
saw him he was quite ill. His family consisted of a
young wife and a nine weeks old baby, both, of course,
having been exposed. I recognized the case at once as










OF THE STATE BOARD OF HEALTH.


being variola and immediately there was great excite-
ment, both by this gentleman and his family and his
friends about town, resulting in a stampede to be
vaccinated. I vaccinated at least three hundred in a
very short while. One of our medical brethren who
doubted the character of the trouble, hesitating in his
mind about this condition to call it smallpox, unfor-
tunately contracted the disease later on. After I had
disinfected and discharged the patient and his family
who first contracted the disease I returned to Jackson-
ville, leaving everything quiet, as I thought, as all of
the citizens who had been directly exposed to infection
in the first place had been successfully vaccinated. To
my surprise, however, some few days, after my arrival in
Jacksonville, I received a telegram and again returned
to Jennings. Wondering as to the cause of the summons
when I arrived at Jennings and found my doubting
brother physician with a typical case of smallpox. He
made an accurate diagnosis of his condition this time
himself, deploring his former ignorance or opposition.
The wife and baby of my first patient, I should have
mentioned, contracted the disease also; on both of them
however vaccination took and went along with the small-
pox attack. Their cases though were of the very mildest
type, and should circumstances not have been as they
were, even an expert would probably have made a mistake
in their cases. Since these cases there have been no
further developments.


DR. HIRAM BYRD.

DR. JOSEPH Y. PORTER,
State Health Officer,
Jacksonville, Fla.
DEAR DOCTOR:-
I enclose herewith my annual report for the year 1904,
or rather that part of it in which I was associated with
the State Board of Health (till November 15th).









SIXTEENTH ANNUAL REPORT


During the year I have _traveled, in the interest of
the State Board of Health, about fifteen thousand miles;
have visited twenty-one of the forty-five counties in the
State; seen and reported two hundred and ninety-three
cases of cerebro-spinal fever, fourteen cases typhoid,
eight cases diphtheria. Have vaccinated about fourteen
hundred people; disinfected about fifty houses; collected
mosquitoes at the various points where my other duties
chanced to take, and have delivered a few addresses before
colleges and city councils on sanitary subjects.
But, by far, the greater part of my work relates to
smallpox, cerebro-spinal fever, and mosquitoes. I devote
therefore a separate section to each of these topics.
Very truly yours,
(Signed) HIRAM BYRD.

SMALLPOX.

r' report Type.-The type of this disease has not varied
appreciably from last year. It has been for the most
part mild. Of the 293 cases that came under my
observation, only one was fatal. Pitting occurs in about
20 per cent of the cases. It is usually worst about the
face, especially across the middle zone. I saw one mild
case in which a pustule occurred on the cornea, leaving
a permanent opacity. Have seen one case complicated
with pneumonia.
Incubation.-Most observers place the incubation
period of smallpox at ten or fourteen days. The late
Eugene Foster, however, gives it a wider range. He
places it from seven to twenty-one days. I have seen
several instances bearing this out. It is worth nothing
also that these cases, in which the incubation was long
drawn out, have been invariably mild. This, of course,
was to be expected.
Smallpox without Eruption.-There has been some
Smallpox
controversy as to whether we ever have smallpox without
eruption. In the light of that contention, the three cases
following are not without interest:









OF THE STATE BOARD OF HEALTH.


No. 1, Alex Thompson, colored, age 45, unvaccinated,
and his paramour were exposed to smallpox. On the
tenth day they both had a chill, followed by a rise of
temperature, headache, backache, both took to bed. On
the third day of the fever the woman developed the
eruption of smallpox and "felt better." The man's
temperature subsided but no eruption appeared. I sub-
sequently vaccinated him four times with fresh virus
(virus with which I was getting 90 per cent "takes"),
but it absolutely refused to take. He afterwards staid
at the pesthouse and waited on the patients six weeks
without developing smallpox.
No. 2 and No. 3, Lake City, in the family of Johnson
Lark, colored. The father first developed smallpox. He
had a severe case. Next the mother had somewhat
milder case. Subsequently the four children all developed
the prodormal symptoms, and one had a mild case of
smallpox, another had three pustules, and the other two
recovered without eruption. Vaccination would not take
in either case, showing that they were then immune.
Nor is there anything so remarkable in a case of
smallpox without eruption. It is estimated that a case
of semi-confluent variola has about three thousand
pustules. On the other hand, cases with only a dozen
pustules are very commonly met with. Indeed, I have
seen several well-defined cases with only two or three.
Since the number of pustles may very from three thou-
sand on the one hand to two or three on the other. I see
'no reason why it should not drop off even these two or
three. And I believe that the three cases above referred
to were cases of variola sine eruptione.
The public attitude toward smallpox has decidedly
changed during the past year. In most communities
now the presence of smallpox is regarded as a trivial
matter. In many instances it is not even reported. I
was in Jefferson County in August, and found seventy-
seven recent cases, all of which had recovered but five
or six and they were convalescing. I was in Orlando









SIXTEENTH ANNUAL REPORT


in July, and found several cases. It had evidently been
existing there for several months under the name of
chickenpox.
In some communities, however, where they have had
little or no experience with the disease, the announcement
of a case of smallpox still causes at least a general
uneasiness. Such was the case at Cocoa in June. Last
January a case developed in the Florida State College
in Tallahassee. It was in the person of one of the
professors, who had rooms in the girls' domitory. Had
it not been for the timely and cautious interference of
the State Board of Health, a panic would have ensued
with disastrous result to the college. Doctor Moor, of
Tallahassee, was the physician in attendance. As soon as
he recognized what he had to contend with he wired the
State Board of Health. Just then he learned that I
was in Tallahassee, and came at once to see me. I went
with him to see the case and confirmed his diagnosis.
We announced the situation to President Murphree, and
at once outlined a course of procedure. It was clear
that the patient must be taken from the dormitory and
his apartments disinfected, and the students vaccinated.
How to accomplish this without precipitating a panic
was the problem. There were perhaps 250 students in
school, a goodly number from a distance, and a large
per cent were young ladies. There was at the time a few
cases of smallpox, about eight miles out, and already
several anxious inquiries had been made as to whether
there would be any danger in remaining at Tallahassee,
and how far does smallpox travel through air, and will
white people take it from negroes, etc. Just a hint that
there was a case of smallpox in the dormitory would
have been all that was necessary to precipitate a panic.
We decided, therefore, to quietly move the patient to the
hospital without letting it be known what his real
trouble was. This we did and so effectively that the
patient was well and dismissed before it was known to
the public that he had smallpox. All danger was over









OF THE STATE BOARD OF HEALTH.


then, and no uneasiness was felt. No other cases
occurred.
Management of smallpox has not materially changed.
The essential procedure in all cases is: isolation of the
patient, vaccination of those exposed, and disinfection
of infected houses, fomites, etc. I have not had recourse
to guard service this year, but have in a few instances
had to employ a nurse. I have had to furnish groceries
where the patients were indigent. And I have always
endeavored to make the patients and others exposed feel
that the State Board of Health was their friend, and
have thereby gained their confidence and cooperation.
Nor do I know of an instance where groceries were
furnished in which the quarantine regulations have been
broken.
Isolation is a simple matter where there is a pest-
house, but where there is not it is sometimes quite a
problem. I have usually found it most expedient to
quarantine the patients in the house where found. If
there are other inmates in the house, of course, they are
to be vaccinated at once. They are then kept in another
part of the house if possible. In such cases, where
vaccination takes promptly, the individual may be con-
sidered safe if he escapes smallpox till the vaccination
pustule reaches maturity and begins to subside-usually
about the tenth day from the date of vaccination. People
rarely refuse to be vaccinated in the immediate presence
of smallpox.
Disinfection.--During the year it has fallen to my
lot to disinfect about fifty houses. They have presented
a diversity of conditions, so that I have had to meet
and overcome many difficulties attending practical dis-
infection. A great majority have been small open dirty
houses-huts in which fumigation is not to be thought
of. Sulphur and formaldehyde are worse than useless
where the fumes cannot be confined. In such cases I
have resorted to bichloride of mercury. I have found
the following formula quite useful:









SIXTEENTH ANNUAL REPORT


Bichloride of mercury............ 4 ounces.
Ammonium Chloride ............. 12 dramches.
Water enough to make ........... 8 ounces.

The above in sixteen gallons of water makes a
solution of bichloride of mercury 1 to 500 strong.

The solution has the advantage of being easily
carried, it can be had at any drugstore, is inexpensive,
can be used to wash the patient, bedding, clothing or
house, and can be relied upon.

vaccination Vaccination.-This subject has been threshed over
again and again till it seems that time spent on it is
useless, nor shall I have much to say about it. I merely
want to reiterate a few facts concerning smallpox and
vaccination, facts that may be easily substantiated, and
facts which every citizen ought to be familiar.

1. That smallpox, variola, varioloid, swinepox,
Cuban itch, elephant itch, Philippine itch, and the
"bumps" are one and the same thing.
2. That it is caused By a germ, or micro-organism,
or microbe, or "bug" if you please, and that only. It is
never caused by filth.
3. That it does not generate spontaneously but that
each case comes from some other case.
4. That it does not travel through the air, but that
in order to contract it one must come in direct contact
either with a case of smallpox or bedding, clothing, or
some material that has been in contact with the patient.
5. That a severe case may be contracted from a
mild one or conversely, a mild one may be contracted
from a severe one.
6. That both sexes, all ages, and all races are
susceptible to the disease.
7. That the eruption is usually worse in the face,
especially across the middle zone, so that when pitting
occurs it is apt to be there.









OF THE STATE BOARD OF HEALTH.


8. That there is no known way to prevent pitting
except to prevent the disease altogether.
9. That smallpox is a preventable disease-no man
woman or child need have it that choose not.
10. That vaccination is the only known safeguard
against it.
11. That vaccination does not merely make the
disease milder, but prevents it altogether.
12. That in a great majority of cases one attack
of smallpox or one successful vaccination renders the
individual immune for life.
13. That in a few cases, however, one attack of
smallpox or one successful vaccination produces only a
partial immunity, and that in such case, the individual
may subsequently contract smallpox or be successfully
vaccinated again.
14. That there are no natural immunes.
15. That the only way to know that you will never
have smallpox is to be vaccinated again and again till
it will no longer take. When thus immunized, one may
eat with it, sleep with it, or live with it, with absolute
safety.

The above terse statement will answer all ordinary
questions concerning smallpox and vaccination.
Virus.-With an experience covering about three
thousand vaccinations, and having used virus of all the
leading laboratories of America, I am convinced that it
loses its potency, in this climate, earlier than it is gen-
erally believed. This is especially true in summer. I have
repeatedly used a lot of virus getting 90 per cent takes
at first, but gradually lost its potency till it will not take
at all. In summer failures begin to be noticed six or
seven weeks prior to the time the virus is marked to
expire, and in two or three weeks more it is absolutely
unreliable. In winter it holds up from one to two weeks
longer. In summer therefore virus should be exchanged
for fresh at least five weeks before it is labeled to expire,
and in winter three or four weeks.









SIXTEENTH ANNUAL REPORT


Before I stumbled upon this fact, I vaccinated a great
many people, thinking I was using fresh virus, and
wondered why they did not take, when the truth was,
I was using virus already inert.

CEREBRO-SPINAL FEVER.

During the year I have seen only one outbreak of
cerebro-spinal fever reaching epidemic proportion. This
was at Madison. I read a paper on it before the State
Medical Association. This was a tolerably complete
report. I insert it in full:

CEREBRO-SPINAL FEVER.

(The epidemic at Madison.)

HIRAM BYRD, M. D., JACKSONVILLE, FLA.

(Special Agent, State Board of Health.)

From the literature ordinarily met, one who had
never seen an epidemic of cerebro-spinal fever would think
that it is a local lesion of the meninges of the brain
and spinal cord; and could hardly conceive of a. cause
occurring without pathological changes taking place there
and consequent cerebro-spinal symptoms.
Such however is not a case. But on the contrary,
it is a systemic infection. It may or may not be
accompanied by cerebro-spinal lesions. And this is the
central thought of the clinical side of this report. But
from the sanitary point of view, the manner of organ
and distribution will claim most of our attention.
And in presenting this report it is necessary that I
should preface it with a few explanitory remarks.
It is not my purpose to paint a complete clinical
picture of the disease (any good text book does that),
but merely to emphasize certain features of it which are,
by most writers, passed lightly by. What I shall
endeavor to do is:









OF THE STATE BOARD OF HEALTH.


1. To give a sanitary report of the epidemic.
2. To incorporate in it such clinical data as is
necessary in order to give a general idea of what the
epidemic was like, and
3. To use my own observations and those of others
to sustain certain conclusions, concerning the nature,
manner or origin, and distribution of the disease.
..I have drawn from every available source informa- Spotted fever
tion bearing on the subject. My own observation I
have supplemented with data kindly furnished by the
physicians of the vicinity and the families in which the
disease occurred. I have endeavored to give an accurate
report of the outbreak, unbiased by any erratic notions
previously acquired. I am free to confess that in many
instances it came far short of my conception of cerebro-
spinal, but I am forced to think that it was the conception
at fault and not the disease. I have interpreted freely
the phenomena observed without antagonism to any one.
My conclusions are my own only so far as they are
different from others. The plan I have elected to follow
is (1) to describe the leading symptoms of the disease
as encountered at Madison; (2) to discuss the mortality;
and (3) to discuss manner of origin and distribution.
And I hope that whatever of native charm this paper
may lack, will be supplemented by the unusual interest
attached to the subject.


SYMPTOMS.

Cerebro-spinal fever, as encountered at Madison,
usually began with a rise of temperature, accompanied
in about half of the case by a chill. In some instances
1he chill was severe and repeated. In some it was severe
but not repeated. In others it was less severe. And
in still others it was described as chilly sensation, while
in many, the chill was wanting altogether.
So far as I know, there was felbrile temperature in
every instance. But it did not conform to any special
type. Nor was its height any index to the patient's condi-










SIXTEENTH ANNUAL REPORT


tion. Death ensued with either high or low temperature.
Just before death in one instance the temperature reached
107 and two-fifths. In another 107. In some though,
it was just above the normal line, and in some it was
just below it. In one instance it advanced from 104 to
107 in about two hours, the patient having had an ice
pack in the intervening time. But as a rule the
temperature was not very high. Perhaps 100 to 102 was
the most common. In one instance a small boy developed
a high temperature in the afternoon. Next morning he
had typical eruption but his temperature was normal.
The second morning his eruption was fading, but his
temperature was 102. The third morning his eruption
was entirely gone, his temperature was 100, and he was
insisting that he was well. He went to an uneventful
recovery. It was not uncommon to find a temperature
of 100 to 101 or 102 during delirium. The duration of
of the temperature was as variable as its intensity. In
one case that was followed by an abcess of the brain,
the temperature lasted five weeks or more. In one
uncomplicated case the temperature lasted over three
weeks, subsiding by lysis. From this it could be traced
through a series of cases each of a little shorter duration
than the one next above till a limit of twenty-four or
thirty hours was reached and possibly that where
diagnosis was uncertain.
Headache, like fever, was a certain symptom. In
the worst cases it was severe and accompanied by
retraction of the head and rigidity of the cervical muscles.
In such cases, delirium soon supervened, lasting a vari-
able time and giving place to coma on the one hand or
stuper on the other. In the milder cases, headache was
correspondingly mild. In some well defined cases it was
hardly complained of at all. It was also uncertain as to
position, being in some instances occipital, and in others
frontal.
Backache was noted in the worst cases. Opistho-
tonos was reported in some of the fatal ones. From that
degree of severity, it too could be traced through cases









OF THE STATE BOARD OF HEALTH.


less severe till it finally faded out and was not present
at all in some of the endoubted cases.
Arthritis was noted as an occasional symptom. The
wrists, ankles and knees were most affected. In one
instance there was reported an effusion into the knee-
joint. In others there was swelling and tenderness and
in still others only pain on moving, while a majority of
all the causes had no joint symptoms.
Constipation was the rule. In only one instance
was diarrhoea reported and that was a negro who had
just been on a drunk prior to his attack.
Catarrhal symptoms were present in a few cases
but so seldom that I feel inclined to regard it as coin-
cidental.
The eruption was present in about seventy-five per
cent of the cases. It was two distinct types: petechial
and herpetic.
The petechial eruption appeared usually in twelve
to thirty-six hours after the onset of the disease. As a
diagnostic point, its absence means nothing but its
presence means a great deal. As ordinarily encountered,
it resembled flea-bites, consisting of red splotches, varying
in size from a pinhead to a dime, the edges not well
defined and shading off into the color of the skin. The
surface was rarely raised, though in the more marked
cases sufficiently so to be perceptible to the touch.
Occasionally there was a pin point place on the center
of deeper red than the rest of the splotches. And in
two instances, larger patches occurred dotted with minute
extravasations of blood. One of these was a fatal case
and died while these patches were still present. The
other recovered, and later the hemorrhagic patches took
on a jaundice appearance, peculiar to the reabsorption
of extravasated blood.
The eruption was usually confined to the fore arms
and legs, but the distribution was by no means constant.
In some cases it was not only abundant in these places,
but well sprinkled over the body and face, while in others
it was either sparsely localized or altogether wanting









SIXTEENTH ANNUAL REPORT


even in fatal cases. It was not observed in the negro in
any instance but I attributed it to the fact that it could
not be perceived through his pigment.
The eruption was as variable in its duration as the
disease itself, but usually lasted till convalescense was
established. In some cases though it faded during the
height of the disease. No desquamation followed it.
The herpetic eruption was about as constant as
the petechial. It had a predilection for the face-
especially the lips and chin. In one instance it was
noted in the mouth, and in two others on the hand, and
one on the foot. It is described as occurring on the body,
but I did not have the privilege of verifying this.
The mental state of those suffering from cerebro-
spinal fever is worth nothing. In some cases delirum
came on shortly after the onset and lasted from a few
to several hours. At such times the patient was kept
in bed with difficutly. Finally after varying intervals
the patient would pass into coma or stuper according as
the symptoms were growing worse or better. The
patient could be aroused from his stupor and would give
coherent answers if attention was held while he spoke.
It must be inferred from this that all or even a
majority of the cases suffering from any mental cloudi-
ness during the attack. This was confined to the worst
cases only, and that includes about half of those affected.
Eye symptoms were noted in eight cases. In seven
of these it was strabismus, and in the eighth ptosis. Six
of the seven cases of strabismis occurred during the
height of the attack and were divergent; the seventh
during convalescence and was convergent. Of the eight
cases, five died in thirty hours to one week from the on-
set. One developed abcess of the brain and died several
weeks afterwards. Four weeks from the onset one was
reported convalescing but subsequently died. Only one
of the eight recovered, and lie is still slightly affected
with strabismus.









OF THE STATE BOARD OF HEALTH.


DURATION.

The duration, like other phases of the disease, was
variable. Ten of the fatal cases only lived from thirty
hours to one week. The fifteen mildest cases recovered in
about the same time. But between these there was two
that died after several weeks, and three in which con-
valescence was long drawn out, lasting from three weeks
to more than a month.
Now if, and since, the individual symptoms may be
so variable, what may be expected of the disease itself?
How many combinations can be made of them? And what
a stretch from-that case in which all the severer symptoms
are present, to the one in which only a few of the milder
are? And yet this is what actually happens. In the
epidemic it is represented on the one hand by those
cases in which the individual is attacked in perfect
health and breathes his last in thirty hours, and on
the other hand by these who have an attack and recovers
almost as quickly. Yet great as such a difference is, it is
bridged by an unbroken series of cases passing through
such gradual transactions from one to another till even
division into types is at best but arbitrary. It is even
more variable and irregular than smallpox.
Now if we begin at the worst cases and pass down
the line, watching them grow milder till we reach a point,
beyond which diagnosis is impossible, have we a right to
stop and say that the process goes no further because
we are unable to trace it?

MORTALITY.

The exact mortality rate is difficult if not impossible
to determine. Just how many cases there were is not
known, for the reason that there were many that were
so mild that it was impossible to make a diagnosis of
cerebro-spinal fever, and yet we were at a loss to under-
stand them on any other hypothesis. Such doubtful
cases are not included in this report. Again just how
many deaths are attributed to cerebro-spinal fever is










SIXTEENTH ANNUAL REPORT


not certain. For instance, Doctor Mickler saw a case
just a few minutes before it died, and reported it as
showing evidence of "inflammation of the brain."
Further there were many cases reported as having had
certain symptoms, and recovered without being seen by
a doctor. So in all probability if the exact truth were
known there would be more than is now reported. This
report includes, however, only those cases which were
seen by a physician and in which a diagnosis was
established with a reasonable degree of certainty.
The first case reported developed on February 3d,
and from that time till the 17th, the disease was at its
height. During these two weeks, fifteen of the thirty
cases developed, and seven of the twelve deaths occurred.
During the next two weeks, from February 17th to
March 2d, nine cases developed and one death. During
the three weeks, dating from March 2d, four cases were
reported, and two deaths. Two that were reported con-
valescing subsequently died. This makes a total of
thirty cases and twelve deaths, or forty per cent mortality.
If we were to include in our diagnosis only those
cases in which cerebro-spinal fever symptoms were
pronounced, we would report fifteen cases of cerebro-
spinal fever, and twelve deaths, or a mortality of eighty
per cent.
Now let us suppose that this epidemic occurred in
some large city, say Baltimore, and what would have
been the result? There was eighteen families invaded.
There would in all probability, have called as many as
fifteen doctors, and so they would have seen an average
of some two cases each. They would have known noth-
ing of the other cases to help establish a diagnosis, and
none except those in which the cerebral symptoms were
pronounced would have been called cerebro-spinal fever.
Possibly fifteen cases would not have been reported,
twelve of which died and mortality statistics would
have been made up accordingly, showing a much higher
rate than actually existed.










OF THE STATE BOARD OF HEALTII.


If it had occurred in Baltimore, possibly a dozen
cases would have gone to the hospitals, and these
would have been studied with great care while living
would have gone to autopsy after death, and elabo-
rate reports made on the clinical and pathological
conditions, and others gather their data from such
reports to write textbook articles from. Such articles
will necessarily be misleading from the fact that they
do not take into account more than half the cases and
the worst half at that, while the other half is just as
important and infinitely harder to diagnose. I am
beginning to understand why the late Eugene Foster
defined a textbook on the practice of medicine as a book
that is made to mislead students and young practitioners.


CONTAGIOUSNESS.

It is the consensus of medical opinion that cerebro-
spinal fever is, if contagious at all, very mildly so; in
any event not exceeding tuberculosis. I see nothing
against that opinion. Certain features of it did at first
look as if it might be contracted one from another, e. g.
a man came to see Mr. C., and sat on the side of the bed
some ten minutes. Forty-eight hours later he developed
the disease himself. A cook was employed for the family
of Mr. C. She served just one week and developed the
fever. Again all of Mr. C.'s family, also a nephew that
was in the household, had it. But on the other hand,
his brother-in-law and wife and niece stayed in the house
with them all during their illness and did not contract
it. Again, of the eighteen families that it invaded,
there was twelve in which it originated without any
traceable history of exposure. And fourteen of the
eighteen had only single case, while only four had
multiple cases. From what I can learn I think that
at least two hundred people were exposed to it, and yet
only thirty developed it. And these thirty there is no
traceable history of exposure in more than half. Since
half the cases developed without having been exposed,









SIXTEENTH ANNUAL REPORT


it is highly probable that the fact of the other half having
been exposed was merely coincidental and that they
would have developed it any way.
I have said that it is a systemic infection. But
that has been said before. That grand old Master Wm.
Pepper concluded it systemic. Musser very properly
emphasizes that fact and places the disease among the
eruptive fevers. Nor could I conceive of a local lesion
producing such marked constitutional symptoms as
occurred in some cases without local manifestations. I
am referring now to some of the cases that had the
typical eruption, high temperature and athrists with
practically no headache, and without any cerebro-spinal
symptoms. Furthermore the specific cause has been
recovered not only from the cerebro-spinal fluid, but from
the blood, the spleen, effusion into the joints, pneumonic
areas of the lungs, and.from catarrhal mucous membrane
of the nose and throat. On the other hand the
evidence that it is a local infection is (1) that the
organism is found more abundantly there than elsewhere,
and (2) that the autopsy practically always gives
evidence of a local lesion. That the first should be so
even though it is a systemic infection is made clear
by the fact that the organism is known to have a pre-
dilection for the cerebral membranes, just as the organism
of diphtheria has a preference for the throat. And that
the autopsy should reveal such in due to the fact that
none of the milder cases, ever reach the autopsy table.
Indeed I doubt if those cases in which the cerebral
membranes are not involved are ever fatal.
That cerebro-spinal fever is due to the diplococcus
intracellularis, is now generally accepted. That the
pneumococcus, the streptococcus, the tphoid bacillus, and
the tubercle bacillus, may attack the cerebro-spinal
membranes and cause a true miningitis is well known.
So in a single isolated case all these possible causes must
be considered in making up a diagnosis. But in the
presence of an epidemic they are all eliminated, except
the diplococcus intracellularis, since it is the only known









OF THE STATE BOARD OF HEALTH.


organism they may cause an epidemic of cerebro-spinal
meningitis. (I wish to say just here, by way of paren-
thesis, that I use the term cerebro-spinal meningitis, as
referring to the conditions which may be brought about
by any of the above mentioned organisms; but the term
cerebro-spinal fever is used with reference to disease in
question, which is caused by the diplococcus intracellu-
laris, and that only.)
This organism is evidently widely distributed in
nature, for the disease has appeared from time to time
all over the world with the possible exception of the
tropics. And twice, since it was first described, if the
records may be trusted, it has disappeared from the
face of the earth for a period of years, after which it
returned again with all its former terrors. We have
plenty analogy for such universal distribution of spinal
organism. Take the mucous for example. All we have
to do to produce them is to leave a bit of damp bread
in the open air for a few hours and the molds promptly
appear. Again it is not an uncommon thing to find
the pneumococcus in the sputa of a healthy individual.
This also is true of the diphtheria bacillus. Upon such
grounds as these there is nothing preposterous in assum-
ing universal distribution of the diplococcus intracellu-
laris.
Now whether it is distributed through man's environ-
ment, or is harbored by his economy, is not quite clear.
The ponderance of evidence is that it is in his environ-
ment. That the disease is of such a local nature, bears
strong testimony to this. But on the other hand it has
been sought for in fifty healthy individuals and found
in two of them. One had been associated with the
disease though, and so we will discard that one and
still have its presence established in one in fifty. It is
a striking coincidence also that the number of cases in
the vicinity of Madison was to be the whole population
as one to fifty, there being a population of about 1,500.
But be that as it may-the next question to answer
is that if we accept universal distribution of the organism









SIXTEENTH ANNUAL REPORT


why don't we encounter these more frequently? The
answer is to be found in the laboratory. Bacteriologists
well know that organisms-say the diphtheria baccillus
for instance, grown under favorable conditions lose their
virulence. They became so attenuated that they are not
capable of over-coming to vital resistance encountered in
the throat of the healthy individual. And this is why
the diphtheria bacillus can be found in the healthy
throat, or rather it is why the throat can remain healthy
while harboring the germ. From this it would seem that
it is the attenuated state of the diplococcus intracellularis
and not its absence that accounts for the rarety of the
disease.
Why then do we have it at all if the germ is in
such an attenuated state? Again let the bacteriologist
answer. These same attenuated organisms may be grown
in successive cultures under optimus conditions, and
their virulence increases. And that is why we so
frequently encounter sporadic cases of diphtheria. Tbh
organism exists in the healthy throat which is not a
good environment for it. But let the individual become
weakened from exhaustion, cold, bronchitis, and he at
once becomes a good culture medium for the germ, which
now lights up in virulence and the individual has a case
of diphtheria. This is also true in a general way of
pneumonia. Why may it not be true of cerebro-spinal
fever?

CONCLUSIONS.
The only rational interpretation of the phenomena
observed that is consistent with all the facts, is embodied
in the following brief summary:
1. That cerebro-spinal meningitis may be caused
by sundry organisms, but that cerebro-spinal fever is
caused by the diphococcus intracellularis and that only.
2. That this organism has a preference for the
cerebral membranes, but does not necessarily attack
them; consequently in any given case of cerebro-spinal
fever, there may or may not be a cerebro-spinal lesion.









OF THE STATE BOARD OF HEALTH.


3. That the organism is widely distributed in
nature but in an attenuated state.
4. That under certain combinations of environ-
ments, its virulence till it is capable of causing a
sporadic case of cerebro-spinal fever.
5. That as this combination of environments extend
to a whole community, the result is an epidemic which
may be regarded as so many sporadic cases.
6. That it is not contagious, and when several cases
occur in the same family or community, they all come
from the same cause, and not from one another.
7. That in our present state of knowledge we have
no effective means of preventing it, but there is no doubt
that wholesome hygienic living will increase our vital
resistance and render us less easy prey to this fell disease.
Since delivering the above report I have met with
three more cases of cerebro-spinal meningitis. I have
also heard of a few cases occurring in other parts of the
State, about the same time of the outbreak at Madison.
I mention them because they have an important bearing
on the origin and distribution of the disease.
MOSQUITOES.
During the year I have collected mosquitoes at such
places as my other duties chanced to take me-altogether
at about sixty points. At some places I have spent
several weeks and collected all the commoner species.
At others I have spent only a few hours or a few days
and have accordingly made limited searches.
All doubtful specimens have been sent to Mr. L. O.
Howard, of the Bureau of Entomology, Washington,
D. C., for identification.
According to a list furnished me by Mr. Howard,
soon after I began collecting, there were nine species then
known in Florida. Since that time the Anopheles argyo-
tarsis has been found in Kew West. To these I have
added ten more, thus bringing the total number of species
now known in the State up to twenty. It is not unlikely
that other species will be found here from time to time.









SIXTEENTH ANNUAL REPORT


It must not be inferred, however, that these twenty
species are equally abundant, evenly distributed, or all
represented in any one community. The greatest number
that I have found in any one locality is nine, and in
many places have found only two or three. In some
places one, predominates and in others, another. Some
are pretty generally distributed over the State, while
others seem to be confined to very restricted and isolated
territories. I give the various species and their distri-
bution as I have found them, but. repeat that in many
places the search has been very limited.

DISEASE TRANSMITTERS.

1. Antopheies crucians (Weid.), Tallahassee, Live
Oak, Jasper, Cocoa, Kissimmee, Orlando, Fort White
and Oxford. Of the three species of anopheles now
known in Florida, this one seems to be, by odds, the
most abundant.
2. Anopheles maculipennis (Meig.), Kissimmee,
Orlando and Fort White.
3. Anopheles argyrotarsis (Theob.),Key West (sent
by Doctor Porter).
4. Stegomyia Fasciatus (Fabr.), Jacksonville, Lake
City, Monticello, Fort White, Crestview, Cedar Key,
Cocoa, Orlando and St. Augustine. I have also found
this mosquito at many farm houses. Probably, next to
the culex pipiens, it is the most uniformly distributed
species we have. The conditions under which it thrives
seem to be fulfilled in every part of the State. In
localities where it does not now exist there is every
reason to believe it would flourish if once introduced.
(It is to be remembered that this is the yellow fever
carrier.)

II. PESTS BY REASON OF THEIR ABUNDANCE AND FEROCITY.

5. Culex pipiens (Linn.), Jacksonville, Lake City,
Live Oak, Tallahassee, Jasper, Monticello, Cedar Key,
Crestview, Cocoa, St. Augustine, Palatka, Orlando,









OF THE STATE BOARD OF HEALTH.


Victoria, Oxford, Kissimmee, Gainesville, Ocala, and
many farm houses. This is commonly known as the
'house mosquito," and is the most generally distributed
specie we have.
6. Culxc Tcaniorhyncus (Desv.), Cocoa, Rockledge,
New Smyrna, Atlantic Beach and St. Augustine. This
is the mosquito that appears in such swarms along the
East Coast. It breads in salt and brackish marshes. It
may also bread in fresh water, according to Smith.
7. Culex solicitans (Walk.) ,Reported from St.
Augustine and Charlotte Harbor. This is also a salt
marsh broader.


III. TIE LESS IMPORTANT SPECIES ARE:

8. Culex consobrinus (Desv.), Daytona.
9. Culex perturbans (Walk.), Tallahassee, Lake
City, Monticello, Jacksonville and Oxford.
10. Culex triseriatus (Say.),On St. Johns River,
near Jacksonville.
11. Culex serratus (Theob.), on St. Johns River,
Jacksonville.
12. Culex nanus (Coq.).
13. Culex confirmatius (Arrib.), on Santa Fe River,
near Fort White.
14. Culex scholastious (Theob.), on Santa Fee River,
near Fort White. Found in West Indies, but not hitherto
reported in Florida.

DISTRIBUTION CONTINUED.

(Known in America.)

15. Culex imiger (Walk.), Cocoa and Crestview.
16. Janthinesoma music (Say.),found on the St.
Johns River, near Palatka and Jacksonville, and on the
Sante Fee River, near Fort White. This seems to be a
swamp species.
17. Psorophora ciliata (Fabr.), found in the woods
near Cocoa, Fort White, Tavares and Starke. This is the









SIXTEENTH ANNUAL REPORT


"gallinipper" with which it seems most people are more
or less familiar. He is the largest of our known species
and very handsome. He may be known by his size alone.
18. Megarhinus ratilus (Coq.), Georgia (Wm. Witt-
field).
19. Wyeomyia smithii (coq.).
20. Melanoconion status (Theob.), a small in-
significant species, found on the Santa Fee River, intere-
sting because it is the only specimen of this genus, so
far as I know, reported in America.

NOTD:-The insect popularly known as the "blind
mosquito" is found in the lake region of the State. It is
not a mosquito at all, though in looks it resembles one.
It does not bite but sometimes appears in such swarms
as to become a nuisance.
There are two hundred and fifty species of mosquitoes
in the British museum, collected from all parts of the
earth. More than fifty species are known in America.
New Jersey alone has thirty-five.

Preventable From the foregoing accounts of the sanitary status
diseases of the State, and from the tables, elsewhere given in this

report, it is learned that of the preventable disorders,
smallpox and diphtheria have given the State Board of
Health the most concern and worry to control and
suppress. The economic side of the question of manage-
ment, has also caused much disturbing thought and
serious deliberation, because both disease being prevent-
able-if measures offered by the Board are accepted and
used-additional cases after the initial case (generally
of importation), need never occur, and indeed, in the
matter of smallpox outbreaks, should not happen at all
if vaccination is accepted and successful performed.
Therefore, the State Board of Health finds itself
Honro confronted with a most difficult problem, in its efforts
to rid the State of two diseases of a typical contagious
type; either to continue the course followed heretofore
in the management of these disorders, which being









OF THE STATE BOARD OF HEALTH.


preventable to a great degree, seemingly cause a needless
expenditure of public funds, or in the matter of small-
pox extermination especially, to earnestly endeavor to
influence public sentiment and public legislation towards
measures compulsory in their methods and disposition,
which when faithfully carried out will assuredly bring
about satisfactory results both in a destruction of the
producing cause as well as in attendant expense of
treatment. Antidiphtheritic serum when administered diphthereti
serum as an
sufficiently early in diphtheria will prevent a fatal result, anidote of
so too will the remedy cause immunity against an attack diphtheria
to those exposed. The consensus of opinion of physicians
is that the administration of the antidote is a harmless
procedure, never causing ill results, and even in simple
sore throat (follicular tonsillitis), is productive of speedy
relief and quick return to health. It is not understood
therefore why any delay should occur in prescribing the
serum when symptoms of a doubtful nature manifest
themselves, or why a "wait" should be advised or per-
mitted until the laboratory makes an examination of the
specimens and decides the doubt. Oftentimes it is then
too late to arrest the course of disease, and the little
patient dies, while the profession is wrangling over the
diagnosis. The expression of surprise at any lagging in
giving the remedy is warrantable, when it is mentioned
that well-regulated drugstores everywhere in the State
constantly keep in stock the different antitoxins,
especially that of diphtheria, and that the State pays
for the serum on the attending physician's certificate
that the patient is indigent or unable to purchase such
a costly drug. Diphtheria antitoxin is considered a
specific when early given in the disease, and being ever
on hand, easily obtainable even by the poor, and harmless
in effect, it would seem to be almost criminal negligence
to omit its use when the slightest doubt exists as to the
true character of a throat trouble. Diphtheria next to
smallpox is the easiest of all the preventable diseases to
intercept and suppress in its spread. If experience
in dealing with contagious maladies has taught anything,









SIXTEENTH ANNUAL REPORT


it has certainly demonstrated two truths, and being
truths are indisputable facts that antidiphtheritic serum
early given cures and prevents diphtheria, and that
vaccination when successfully done, prevents smallpox.
Therefore it may be asked with pertinent reason, if these
statements are undeniably true, why the State should
not adopt, employ, and enforce measures which have
passed the stage of experiment and entered into the
authority of fact, against disease which yearly make
many sorrowful households, and to not a few, helpless
suffering, and invalidism, for future time.
In this connection, it is pleasing to recite that the
The Board by
donation of State Board of Health was able by a liberal donation of
anti-toxin
saves lives antidiphtheritic serum to save the lives of several
children in one family during the past year, which
although somewhat costly-$125-the money part of the
transaction sank into petty insignificance when compared
with the saving of life by a wonderful achievement of
science when discovering a remedy so potent against a
deadly disorder, and the still more beneficent provision
of the State, exercised through the instrumentality of an
institution purposely organized to supervise and care for
the health of the people.
The records of the office showr that there were 145
cases of diphtheria reported to the Board with 18 deaths.
Ages and sexes of decedents of this disease are given
in tables elsewhere in this report.
Number of cases of diphtheria reported from the
several counties respectively, with cost of diphtheritic
antitoxin:










OF THE STATE BOARD OF HEALTH. 67

COUNTY. CASES.

Alachua ........................................ 8
Brevard ........................................ 3
DeSoto ................................. ...... 3
Duval ........................................ 59
Escambia ...................................... 20
Hillsborough ................. .......... ...... 36
Leon ......................................... 7
Manatee ........................................ 4
Putnam ....................................... 3
Santa Rosa .................. .................. 2

T otal ...................................... 145

Cost of antitoxin distributed to indigent patients, $320.94.

Smallpox has caused the Board more worry, during
the past year, and uneasiness to treat or to manage than
any other of the preventable disease, or any unsanitary
conditions to quiet. It has been exceedingly mild in
type, producing but few deaths. The negro race has
suffered more in number of cases than the whites, and
the fatalities have occurred at the extremes of life, the
very old, or the very young. The very mildness of the
trouble has been the greatest danger and source of spread
of the disease, for its existence produced no alarm, nor
more than casual comment because of the very trivial
discomfort and almost non-enforced absence from daily
duties which its presence in a community occasioned.
Occasionally however, a confluent case happened, and
it was these severe occurrences which, as mentioned, were
rare, that created a "scare" leading to telegraphic informa-
tion to the Board.
During 1904 smallpox-has been reported from thirty Smallpox
counties in the State, and the number of cases to which
the attention of the Board has been invited is 973 with
7 deaths. This does not it is thought represent the total
sick from this cause during the year, for the disease was
so mild in character that it is quite probable that many









SIXTEENTH ANNUAL REPORT


suffered an attack and recovered who were never reported
or had any medical attention whatsoever. Indeed, time
and time again, when a more virulent type of the dis-
order manifested itself, especially among the whites, a
special agent of the Board investigating the case, would
find that smallpox had been generally prevalent among
the negroes of the community for some time previously,
but occasioned so little discomfort as to attract but
passing notice. Of the reported cases but 38 were white,
the remainder being negroes.
For many years, and in fact from the very inception
of sanitary work in Florida by the State Board of
Health, the importance of actively urging preventive and
protective measures against smallpox, its introduction
and spread, has been dwelt upon in the annual communca-
tions from this office and vaccination as the only certain
means of ridding the country of the pest, has continuously
been insisted upon. Repeating what was said in the last
annual report when speaking on this subject:
vaccination "Smallpox can be prevented by vaccination, properly
does prevent
smallpox and successfully done. This fact is so accepted as a truism,
that in times of danger from this disease, when prevailing
in any community, there are but few who will have the
temerity to refuse the protection which the operation
is known to give. But why some will wait for the loath-
some disorder to threaten an attack before protecting
themselves or their families is one of the puzzling enigmas
of indifferent domestic hygiene, and ignoring of measures
intended to prevent disease. So much has already been
said in previous reports of this nature, concerning the
protective quality of vaccination against smallpox and
the blessings of which the discovery of Jenner in 1798
conferred upon the human family, that possibly any
further discussion of the subject might be tiresome to
the reading public, but the opportunity cannot be
neglected whenever occasion offers to direct public
thought in this matter, for the duty of the sanitarian and
State Board of Health is to advise and instruct the
people upon sanitary and hygienic facts which have









OF THE STATE BOARD OF HEALTH.


been proven by long and patient experience. Statistics
obtained from smallpox hospitals, from physicians gen-
erally and of our own Board, very positively show that
persons with smallpox, either have never been vaccinated,
or have very imperfect and doubtful evidence of having
had the operation performed. Indeed, since the public
is incited to crime by information about the different
"pathies," how to produce a scar resembling vaccina-
tion," in order to deceive the public health officers, it is
to be wondered, as American Medicine very aptly
remarked in a recent editorial on the subject, "How much
of the vogue of heresy has been due to the falsified sta-
tistics and the spread of the disease through the makers
of scars resembling vaccination." Until the nation takes
this matter up and seriously considers it, by enacting
and rigidly enforcing a compulsory vaccination law,
smallpox will continue to exist in this country, and lives
be sacrificed to an unreasonable and foolish prejudice, to
say nothing of the unsightly faces which are multiplied
each year from this disease."
The opposition to vaccination evidently comes from opposition to
vaccination
ignorance, and self-opinionated prejudice, for it scarcely unreasonable
seems to be possible that any intelligent person who has
carefully studied the question from an earnest desire to
obtain the truth in regard to how much or how far vacci-
nation does actually protect or prevent smallpox, and
wishes to form an unbiased understanding and decision
on the subject, but will from the long array of facts and
instances presented, be asuredly convinced that when vac-
cination is successfully performed, the danger of contract-
ing smallpox is reduced to an inappreciable minimum,
and secondly, that when carefully done, heeding and pro-
viding against every possibly contingency of septic con-
tamination of the wound, the percentage of bad arms,
painful sores, and personal discomfort is insignificant to
the protective value and positive immunity obtained
against a most loathsome disorder.
The liberty of the citizens is attacked cries the poli-
tician, and the personal rights of the individual are in-









SIXTEENTH ANNUAL REPORT


vaded says the legislator, when vaccination is enforced,
(although in the protective interest of a whole commun-
ity), when each is appealed to for assistance in compul-
sory enactment of this character. Has the citizen the
liberty under the Constitution, to kill? And has the indi-
vidual a legal or moral right to be a contributory factor
in distributing disease and perhaps death to his neigh-
bor? Yet, by yielding to the fanatical demands of a pre-
judiced few, whose opposition has no sensible or reason-
able grounds for persistence, the law-makers of the
county, otherwise seemingly ever willing and eager to
offer protection to every industry, to commerce, and even
to the brute creation against disease, in fact, to every-
thing animate or inanimate, except the health of man, in-
differently treat the question of protection to the human
against smallpox, and passively dismisses the subject on
the ground of constitutional objection.
In speaking on this subject-smallpox and vaccina-
tion-before the last conference of State Boards of
Health with the Surgeon General of the Public Health
and Marine-Hospital Service, Dr. Herty, the able sec-
retary of the State Board of Health of Indiana, remarked
that the sanitarian of today had very little to hope for
in expectation of immediate eradication of smallpox from
the United States, because of rapid travel, unceasing
movement of the people, and the long period of incubation
of the disease after exposure, and that until the masses
are educated to the necessity for vaccination as a sure
prevention against smallpox, and the people impress that
belief upon the law-makers, with a demand for a compul-
sory requirement of this nature, smallpox will continue to
appear with more or less frequency and severity, depend-
ing entirely upon the immunity gained by successful or
repeated vaccination, or by an attack of the disease.
Large When smallpox became generally prevalent in the
industries in
State contri- United States, some years ago, Florida enjoyed a peculiar
buting factor
to spread of exemption for several seasons, due it was thought, to
vigilance and watchfulness, and in a great measure to
a persistent effort to vaccinate the population. One of









OF THE STATE BOARD OF HEALTH.


the first measures sought to be placed in operation, after
the State Board of Health was organized in 1889, was a
vaccination of school children and operatives in
factories and other institutions where a large number of
persons are employed. As soon as however the natural
advantages of the State to successfully carry on, various
industries was recognized, and large bodies of laborers
were introduced, from the States immediately to the
north of Florida, for phosphate mines, saw milling, na-
val stores and railroad construction, where smallpox pre-
vailed and where the disease was not cared for or res-
trained, it appeared in several counties and places in
the State, particularly at or near the site of phosphate
mines, or naval store camps. Almost in every instance
the disease was directly traced to an importation from
another State, and from the statements of Special
Agents who have been engaged in the management of
many outbreaks, it is learned that the majority of the
cases of smallpox occurring in Florida during 1904, could
be traced to importation by negro labor from Alabama or
Georgia. The large industrial plants, of phosphate and
naval stores, which have so materially contributed to the
commercial importance and prosperity of Florida, have
also furnished a large number of cases of smallpox for
the State Board to care for and manage. In several in-
stances where these plants have come into the State
from adjoining States, in their entirety, cases of smallpox
have developed astonishingly soon after locating here,
showing very clearly that the infection came with the
operatives and was not contracted after arrival. The
northern border line of the counties between Alabama
and Georgia have scarcely been free of smallpox infection
for several years. As soon as the disease is thought to
be stamped out and controlled, fresh infection crosses
the line and starts up another outbreak. From the Chat-
tahoochee river to the Perdido river at the extreme wes-
tern limit of the State, a Special Agent of the Board has
been kept constantly busy during the past year, both in
investigating rumors of smallpox and in actual manage-









SIXTEENTH ANNUAL REPORT


ment of cases which have been discovered. The planta-
tion counties in the middle and western part of the State,
with their large negro population, have incubated, it may
be truly said, over 450 cases during the past twelve
months. The infection introduced across the border line
by negroes from adjoining States, whose labor is invited
by the necessities of cotton growing, tobacco planting
and other equally as important industries, in the produc-
tion of which there is a constant demand for a large num-
ber of laborers, was kept concealed through the natural
secretive tendency of the negro, until the white people of
the neighborhood, becoming frightened at the general
prevalence of poch-marked faces, made telegraphic report
to the Board, and an investigation then brought out
startling facts of smallpox existence on the plantations
probably for several months, undisturbed, uncared for,
and indifferently thought of, because of the mildness of
the trouble.
Oppoaio to Co-operative assistance from the management of the
y oargeindus large industries already alluded to, has always been
trialplants given in isolating and caring for the sick of smallpox,
but when measures are recommended looking to the pro-
tection of the well, or to immunize those having had a
limited exposure, and vaccination of every one connected
with the plant or residing in the settlement is advised
and insisted upon, as being the only certain method to
stop a spread of the disease, an opposition too often
manifests itself, actuated solely by selfish motives; the
possible loss of time of the laborer from a sore arm, which
opposition oftentimes amounts to defiant resistance. An
instance of this character has quite recently been re-
ported by Dr. Diggett, a Special Agent of the Board,
who has been looking after an outbreak of smallpox in
Alachua County. He says, "I am meeting with a great
deal of opposition at that point (Williford), my princi-
pal opponent being a Mr. T., an ex-member of the Legis-
lature of 1901. He seems to be well informed about the
laws regarding vaccination, and as he employs some one
hundred negroes in his camp, and refuses to allow me to










OF THE STATE BOARD OF HEALTH.


vaccinate any one of them, the situation is a very difficult
one for me to handle. I also met this evening on my way
to Bell, a Mr. F., also from that town, who employs a num-
ber of men in his camp. He was very emphatic in his re-
fusal to allow me to vaccinate, and used some strong lan-
guage towards the State Board of Health; in fact, de-
fied me to vaccinate any of his crew, using threatening
language."
It can be understood, therefore, that the efforts to The'diffculty
to suppress
destroy smallpox infection in the State, or to at least con- smallpox
trol and limit the spread of the infection has not been
altogether encouraging, in fact, in many instances, are
very discouraging, because results do not seem to be ob-
tained such as might be expected from the strenuous
exertions put forth by the Board, and it is plain to see
that if smallpox is to be controlled in Florida and the
consequent expense lessened in the care and supervision
of the cases, additional legislation must be enacted,
whereby the management of the large industries which are
scattered over the State, shall be obliged to have their
employees vaccinated before employment and before be-
ing imported from other States, or be compelled, under
legal restraint to assume the expense under the manage-
ment and supervision of the State Board of Health, of
every case of smallpox occurring in their employ.
Considerable space has been given to the subject of
smallpox prevalence in the State during the past year,
and to vaccination as a protective measure, because of the
importance of the topic both from a public hygienic as
well as from a financial standpoint. It is a question of
paramount importance to the Board to consider at the
approaching annual meeting, when it is hoped that cer-
tain recommendations may be made to the Legislature
convening this year, to lessen an opportunity for small-
pox to occur and to spread, as well as to relieve a burden
of expense which under compulsory enactment of vacci-
nation could be very well lightened.
In the following tables may be found the number of
smallpox cases occurring in the several counties of the










SIXTEENTH ANNUAL REPORT


State for the year 1904, with the expense of each occur-
rence, and the cost of vaccine virus which has been sup-
plied without charge to any citizen or community making
request, viz:


Number of cases of smallpox occurring in the several
counties of the State during 1904, expenses of man-
agement in each county respectively, with cost of
vaccine virus:


Alachua ...... 7
Baker. ...... 3
Brevard ...... 11
Bradford ..... 11
Citrus. ...... 8
Columbia ..... 51
DeSoto .... .. 4
Duval........ 98


Escambia. .... 131
Gadsden ...... 53
Hamilton ..... 3
Hillsboro ..... 20
Jackson .... ..104
Jefferson ..... 97
Levy.. ...... 32
Leon........ 20


$ 109.10


(No expense.)

(No expense.)


(Including salary of guard
and nurse, $540)
(Includ'g sal. grd. $300)


(Incld'g sal. g'r'd $240


Monroe, (Salary of guard at hospital, no cases)
Marion ...... 15
Madison ...... 12
Manatee .... .. 4
Nassau ...... 56
Orange ...... 30
Osceola .... .. 4
Polk .......... 4
Putnam....... 30
St. Johns...... 11 (I'c'g Rainey claim, $200)
Suwannee. .... 10 (No expense)


112.10

24.20
43.25
37.90

1,169.51
427.96
16.00
11.00
533.75
7.00
53.70
36.88
202.34
120.00
146.45
36.40
10.25
966.55
11.30
16.00
38.00
86.15
235.60










OF THE STATE BOARD OF HEALTH.


Volusia...... 16 204.47
Walton...... 81 112.02
Washington 50 (No expense)

973 cases. $4,757.98
Cost of Vaccine Virus ............. .$ 978.11

$5,736.09


E. W. WARREN.

On the second day of January, I was directed to go
to Palatka and fumigate the office of the Selden Cypress
Door Company. Their former bookkeeper had died of
tuberculosis, something like a year before. Their first
assistant was then promoted, and had in a few months
contracted the disease, and at the time that I was there,
he was in Arizona seeking relief from the infection.
The management of the company came to the conclu-
sion that their offices were infected, and that the lives
of all who worked in or around the offices were in
jeopardy, so, they asked the State Board of Health to
fumigate.
On January 5th I received a communication from Typhoid fever
the office, directing me to Bartow, to investigate reports artow
of an epidemic of fever at that place. I had been at
Bartow in November and December of 1903, and when
I left there on December 8th, this fever was beginning to
appear. Mr. Warren Tyler had already contracted it
and died a few days later. On my arrival there on the
morning of the 6th of January, I interviewed the various
physicians and city authorities, and found 64 cases of
fever on hand by actual count; some had died before my
arrival and several had recovered. During the entire
epidemic there were 250 cases. I visited that day,
together with Drs. F. M. Wilson and J. A. Garrard, a
great many cases, and every case I saw was typhoid of
a pronounced type. There had been some difference of










SIXTEENTH ANNUAL REPORT


opinion among the public, owing to the fact that here
and there were cases of malaria along with the typhoid,
but a great many of the cases were typical typhoid.
The first problem that presented itself for our con-
sideration was to find where this fever came from, where
the infection existed; and of course, the first thought
contamin- was the water supply. A few thought it came from
tion work on certain streets which had been done in the
previous spring, nine months back, but the cases did not
confine themselves to the few streets that had been
worked; they were distributed in all quarters of the town
and in a few country families, and for that reason, the
infection could not have been confined to certain mains,
or from the carelessness of any one family in not dis-
water infecting its premises. Specimens of the water from the
supply
artesian well were sent to the laboratory of the State
Board of Health and thorough tests made. The bacterio-
logist did not find the baccillus of typhoid fever, but he
did find the baccillus coli communis, showing that the
water supply was contaminated by the contents of cess
pools, or waterclosets, or other such source, proving that
the infection came from the well and not from any of the
mains. Various school children who came in from the
country contracted the fever, and were carried home. No
other cases occurring in their families. Every person
who had the fever was known to have used the city water
beforehand.
On receiving the report from the bacteriologist on
the specimen of water, I conferred with the Mayor, Mr.
C. E. Baley, and asked that he issue a proclamation,
calling on all the citizens of the city to boil the drinking
water before using. He did so, and the people for the
most part observed the request of the mayor, and the
cases soon began to decrease, and with other minor
precautions, extended prevalence was controlled. Many
families fortunately had followed the advice of their
physicians and had been boiling their water all along,
and it is notable that not a case of fever occurred in those
families.









OF THE STATE BOARD OF HEALTH.


Another problem was, how did the infection reach the
well? A study of the topography of the city explains
that fully, I think, together with other existing condi-
tions. The city has not adequate sewerage, only surface
drainage. The well is situated a block north of the
business centre of the town, and is 180 feet deep, and has
a caisson extending down 80 feet. Just north of th?
well, 150 yards, is a kind of pond or lagoon into which
that section of the town is drained. In the southwestern
section is a low filthy meadow in the centre of which was
dug a cesspool or well forty feet deep to drain it. All
the water closets and stables after heavy rains would
be drained into this well. It emitted a very foul odor.
In the eastern part of the town is a sink hole into which
water often runs, pours and disappears. The epidemic
of fever made its appearance about two and a half months
after that fearful storm along the West Coast on
September 12th. During the storm the surface of the
town was literally washed off into these three depressions.
The well being situated between the three and constantly
drawing water almost without stopping at all, it is
perfectly reasonable to suppose that, being as shallow as
it was, the water from those places furnished a part of
its supply.
At my suggestion, the cesspool in that meadow was
filled up. As soon as it was determined that the water
supply was contaminated, the city authorities took steps
to have a new well dug which was to go two thousand
feet deep if necessary to get good water. This fever
was of a peculiarly malignant type. I saw few mild
cases, most of them were severe; typanites very pro-
nounced in all, fevers running high and holding on for
long times.
The death list amounted to eleven. The epidemic
lasted about two and half to three months.
On January 17th, Dr. J. P. Tomlinson, of Lake Fatalities
Butler, reported a case of suspicious character. I was
directed to go there, which I did and found it to be
chickenpox. I went from there to Omega, Fla., where









SIXTEENTH ANNUAL REPORT


Dr. R. M. Ware reported a case of smallpox at a
turpentine still. The patient had about recovered, but
had circulated pretty freely with the other laborers, so I
vaccinated all of them and left the case in charge of
Doctor Ware. Despite the exposure of all the other
hands at the mill, not another case occurred, owing to
the vaccination.
smallpox On January 22d, Dr. Wm. Griffith, of Dunnellon,
Marion
county Fla., reported a case of smallpox at a turpentine still.
I was detailed to look into it. I reached Dunnellon on
the 23d, and on the 24th, Doctor Griffith and I drove to
the turpentine place, twelve miles away, and found the
case to be semi-confluent. The case had already been
quarantined and a nurse placed with him by Doctor
Griffith, and the owner of the place had already taken the
precaution to vaccinate all but half a dozen or so of the
laborers; we finished them up that day. Doctor Griffith
is to be commended for the thorough way in which he
managed the situation, preventing any spread in a camp
where something like 120 negroes (laborers) were all
exposed to the case that was going around for several
days after the appearance of the eruption.
mallpox On arranging with Doctor Griffith for thee further
DeSoto
county management of this case, I went to Arcadia where Dr. R.
L. Cline had reported a case at a turpentine camp. The
management of this industry acted in an exceedingly
indifferent manner, refusing to allow Doctor Cline to
vaccinate their laborers and acting in rather an offensive
manner to me when I went to see the case, but agreed
for me to vaccinate if I thought it necessary. This, as
well as the case from Dunnellon, were imported one from
Georgia and the other from North Carolina. Note the
difference in the managers of the two camps; the one at
Dunnellon doing all he could to assist Doctor Griffith
to stamp it out, the one at Arcadia doing all he could
to prevent us from interfering with the case, notwith-
standing he had imported unvaccinated labor in violation
of the law.









OF THE STATE BOARD OF HEALTH.


From here I went to Punta Gorda, conferring with Snlpoxt
Dr. D. N. McQueen in regard to a case he reported in a
railroad construction camp, half way to Fort Myers.
This case had been carefully isolated and was very well-
cared for by the railroad people. I went on and found
the authorities at Fort Myers had quarantined against
the railroad people, thus causing some inconvenience.
I explained to the county commissioners and town
authorities that the situation was perfectly safe, and they
raised the quarantine immediately. I went back to
Arcadia and released the patient and fumigated the
house. The next day a telegram from the office advised
me to go to Lake Helen, which I did, and found one case
about recovered, in the camp of the E. W. Bond Lumber
Company. I found that prior to this there had been
about fifty cases in their camp that had not been reported.
I vaccinated about twenty or thirty of their laborers.
A telegram was awaiting me there, reporting a case smallpox
Volusia
of smallpox at Seville. I went there and found that Dr. County
J. C. Styles had a case on hand, and that he and County
Commissioner W. R. McBride had moved the patient and
entire family five miles out on Lake George, over the
worst possible roads. I remarked to Mr. McBride that
he had incurred unnecessary expense in moving him so
far away. Without taking any charge of the case what-
ever, I told Mr. McBride that I would go and see him
the next morning, which I did and found that he had
had a semi-confluent case, but was then recovered, only
needed to stay a few days longer to allow desquamation
to be completed. The family had been successfully
vaccinated. I saw no reason for the State Board of
Health to take hold of the case, as nothing was needed
to be done except to fumigate the house and clothing of
the family, and I explained to Dr. Styles how that could
be done with the expense of only ten pounds of sulphur,
by requiring the family to do the work. Mr. McBride
had promised to meet me on my return to Seville, but
he did not do so, so I wrote him stating what I had done.
Dr. Styles had been employed by the county. I report









SIXTEENTH ANNUAL REPORT


this case in minute detail, on account of a misunderstand-
ing later on, by which the county expected Dr. Styles'.
bill to be paid by the State Board of Health.
Smallpox While at Seville, I had a telegram, asking me to go
Duval
county to Wahoe, in Sumpter County, to investigate a report from
the postmaster, concerning some eruptive cases in that
vicinity, which on investigation turned out to be measles.
On February 16th smallpox was reported at New Berlin,
near the mouth of St. Johns River, among the crew of
the dredging company, which was building a jetty at
New Berlin. On account of the illness of Dr. J. N.
Cloud, the local agent of the Board for Duval County,
I was asked to look after it. I secured a tugboat and
visited the locality, and found three cases of smallpox
on the scow, on which were twenty-six laborers, all
negroes. I put them all into two yawls and took them
up to Phoenix Park, landed and took them across the
country to the hospital at the Sand Hills. They had
been previously vaccinated by Dr. Cloud.
Sma~fg On February 17th I went to St. Augustine in response
County to a report from Dr. DeWitt Webb, of smallpox at a
turpentine camp on Palicer Creek, eighteen miles south
of St. Augustine. When I reached the camp I found that
Mr. Mattox, the owner, had built two cabins half a mile
away and isolated his cases there, and was giving them
the best of attention. Only a few cases occurred at his
place.
Smallpox On the 19th of February I received a telegram from
Lake County the office, directing me to look after smallpox that had

broken out among the negroes at Eustis, Fla. I went
there and found only one case of any consequence, and
two very mild ones. Considerable excitement existed.
However, I quarantined the patients and vaccinated all
those living in the vicinity of them. On the 23d I
arranged for the management of those cases, and in
response to telegram, I went to Palatka. Dr. A. M. Steen
had reported a case, and when I got there, people were










OF THE STATE BOARD OF HEALTH.


much excited; nobody seemed inclined to take any steps
in the matter except to wire the State Board of Health
every few hours. It was a semi-confluent case in a
parturient woman (colored). She recovered nicely.
This case was on Lemon Street in a very thickly settled
section. I failed to get a place to move her to, so I
treated her 'where she developed, and no other cases
resulted. On the 29th I arranged for the temporary
management of this case, and went to Mount Dora, to
see a case reported by Dr. T. N. Lewis, but when I arrived
there the case was entirely well. I went on to Eustis,
finished my work there, then went to Minneola and
Clermont where there was some uneasiness about small-
pox, but I found none. In the meantime, the midwife,
who had delivered the woman in Palatka who had
smallpox, a few days prior to her attack, came down
with the disease. I returned and isolated her. I
remained at Palatka until March the 24th when I went
to Istachatta to look into reports of smallpox. The cases
had all recovered when I reached there. I returned to
Palatka, and on the 28th of March I went to Pomona. smallpox
and found one case of smallpox, which I left in charge coutagain
of Doctor Peck.
On the 29th of March I went to Dunnellon, to investi- Mad dog
gate a report of a sanitary nuisance, which I found to be Dunnenon
of little importance. On the 3d of April I went to Otter
Creek, where a mad dog had been creating considerable
disturbance. The excitement was all over when I got
there. Reports were varying: some excitable, others
calm; I think there had been little real danger. A few
dogs that had acted in a suspicious manner had been
killed.
On April 23d, Dr. A. M. Steen reported another case
at Palatka, this was in a white family and very mild.
The people there were now getting more accustomed to
smallpox reports, and the excitement was notably less.
I went to Kissimmee on the 29th of April to confer
with Dr. T. G. Thomas in regard to a case, but the trouble
had not been discovered until it reached the stage of










SIXTEENTH ANNUAL REPORT


desquamation, consequently he was entirely well when I
got there. I did, however, find one case at a turpentine
still, some twenty miles from Kissimmee, which I
arranged for.


DR. J. FRANK CURTIS.

Baker The general health of Baker County people for the
County .
past year has been good.
Contagious Diseases.-About the latter part of
April three prisoners were brought here and lodged in
the county jail, arriving about dark. The next morning
the sheriff called me to see them as he said they were
"broken out" with an eruption. I found two of them
well developed cases of discrete smallpox, and immedi-
ately communicated with the State Board of Health,
when a special agent was sent, and jail quarantined. The
third prisoner developed smallpox later, but there was
no other spread of the disease. All three were colored.
They were placed in jail to await trial before a justice
of the peace in another part of the county, and when the
time came for their trial they were taken from the jail
and carried before the justice of the peace before they
were released from quarantine, and returned to the jail
after being away all night. Special Agent Byrd was here
after they had left the jail and protested vigorously
against the act of the county officers in taking them away
before quarantine was off. Along those lines, I feel
that the Board of Health should make itself respected,
and if there is no law against State or county officers
interfering with quarantine, we should have such a law
passed and enforce it in every case where it is violated.
The cost of medical treatment for these three cases
(exclusive of the Board of Health Special Agent), was
$15.00, which the county paid.
Vital Statistics.-Is a step in the right direction,
and would suggest that in a county such as this one a
number of "Board of Health Rules" be distributed and










OF THE STATE BOARD OF, HEALTH.


under the direction of the county registrar, for the
enlightenment of the people. I have generally found
that the people are willing to assist in such useful
measures, but they must be made to understand what is
wanted, and literature is far more valuable than verbal
instructions.



REPORT OF DR. R. L. CLINE.

While there has been much sickness throughout Desoto
County
DeSoto County during the year 1904, we have had no
widespread epidemics.
We had an unusual amount of fevers, more Typhoid
fever than ever before, and many severe cases, though
but few deaths.
So far as I know, we had only eight cases of
diphtheria. The cases were all mild; one death from
subsequent nephritis. Antitoxin used in one case with
good results.
I know of only a few cases of tuberculosis, and three
deaths.
During the latter part of 1903 we had a very wide
spread of epidemic of measles, that lapsed over into
this year. It was a mild type, though some complicated
with diarrhea and pneumonia.
Two cases of smallpox in negroes, one case coming
from Georgia; the other's source I do not know.
During the months of October, November and De-
cember, we had a few cases of whooping cough, with one
death in an infant.
After consulting other physicians, we have concluded
that 80 per cent to 90 per cent of the children of this
county have hookworm. We have treated a great many
cases with good results.











84 SIXTEENTH ANNUAL REPORT

DR. W. T. ELMORE.

county The general health of Duval County has been unusu-
ally good, with special reference to communicable diseases.
This may be attributed to the efficient work of the State
and City Boards of Health, and the cooperation of the
physicians with this body.
This city, which furnishes the greatest population
of Duval County, had been reconstructed in a measure,
since the fire of 1901, and the sanitary conditions much
improved, both in the structure of the buildings and a
more efficient sewerage system.
Pablo Beach has had its local sanitary inspector to
enforce the sanitary rules during the summer season.
The county ditches in the vicinity of Baldwin have
been deepened to effect more thorough drainage.
The State "hospital for white patients in Duval
County was commenced in 1903 and completed in 1904,
and will admit fifty patients suffering from contagious
diseases.

Below I submit a tabulated statement of the cases
of smallpox treated at the State hospital in Duval County
for the year 1904:

Number of patients admitted ................98
Number of patients discharged ............... 91
Deaths none.
Number of patients remaining in the hospital,
January 1, 1905 ......................... 7

98 98

Number of patients not vaccinated, who had smallpox.45
Number of patients vaccinated, who had smallpox....14
Number vaccinated, who had no smallpox ............ 39

98









OF THE STATE BOARD OF HEALTH.


The primary origin of the disease can be traced to
Georgia, having been brought into Florida through the
floating labor element, who work in the turpentine
camps.
Vaccination, we all know, unquestionably decreases
smallpox to a marked degree, and under aseptic technique,
septic constitutional symptoms are reduced to a minimum.
As we overcome the prejudice of bad results of vaccination
prevalent among the laity, and enforce vaccination
measures rigidly, it is only a question of time before the
disease will be eliminated altogether. It is more prevalent
among the negro race, and, from the history of cases, is
usually spread by actual contagion.
Tuberculosis has had its usual number of victims
and has existed with the negro race in the majority of
cases, the mortality being 75 per cent as compared with
the white race. The negro race seems to be peculiarly
susceptible to the disease, and they succumb more quickly.
This fact is due to their mode of living.
We have had no scarlet fever.
Few cases of measles have been reported, and so
many cases being mild, did not require the services of a
physician, hence were not reported.
We have had some diphtheria, but the disease has
been mild, death resulting in one or two cases only. I
Typhoid fever has been reduced on account of the
improved sanitary measures. The mortality has been
small.


DR. WARREN E. ANDERSON.

Health conditions in Escambia County have improved Escambia
somewhat during the past year. Malarial fever, measles
and whooping-cough have occurred in some portions of
the county, but have not been marked by any general
distribution or severity.
Typhoid Fever.-This disease prevailing principally
within the corporate line of the city of Pensacola, has









SIXTEENTH ANNUAL REPORT


shown a very decided decrease for the year. I believe
this is due not only to improved sanitation, but partly at
least to the greater efforts on the part of the medical
profession in instructing the people in matters of personal
hygiene and preventive medicine. Missionary work of
this kind is not however confined to this disease alone,
but the timely suggestion and intelligent advice of the
attending physician contributes largely to the abatement
of many of our acute diseases.
Pulmonary Tuberculosis.-A slight falling off in the
number of death from this cause is noted-about 12 per
cent; but it is probable that much of this apparent
decrease is due to inaccuracies in diagnosis, and a
growing aversion on the part of relatives of the afflicted
to having a certificate of death labelled "Consumption."
Against this feeling the attending physician is not always
able to contend. In the city of Pensacola, there were
thirty-two (32) deaths during 1904--equally divided as
to the cause.
Smallpox.-For several years in the immediate past
this county has been sorely punished by invasions of this
disease, but I am able to report that since the first of
September last, there has been only one case recorded.
It would appear from this that an exhaustion of material
has occurred at the centre of distribution-the adjoining
State of Alabama-either by vaccination, or a general
immuning of the population by an attack of the disease.
Since the first of January 1904, there have been 131 cases
reported in this county, with two deaths-both negroes-
one in the Isolation Hospital, and the other in the city.
Of the total number of cases, 33 were white and 98
colored; 30 were treated in the Isolation Hospital at an
expense of $80.56 for medicine and provisions. The
expense of investigating cases of this disease in this and
the adjoining county of Santa Rosa, was $42.60 for the
year just closed.
Diphtheria-Since the establishment of the bacterio-
logical laboratory by the State Board of Health the early
recognition of this disease has rendered it easily possible









OF THE STATE BOARD OF HEALTH.


to suppress each successive outbreak as it appeared.
The total number of cases (20) is about one-half as many
as for the year before, and the mortality, owing to the
early and free use of antitoxin, is still much less; there
was only one death reported-a negro boy-in a dying
condition when seen by the physician.
Scarlet Fever.-For some reason unknown to me,
there has been a great decrease in the number of cases
of this disease. Four only were reported for the entire
year. All were among white children and none were
fatal.
Disinfections.-During the year 1904, 83 dwellings,
9 box-cars were disinfected for smallpox, 20 rooms for
diphtheria, 4 for scarlet fever, and 14 for tuberculosis,
making a total of 130 disinfections of habitations at an
expense in material-sulphur and bi-chloride of mercury
of $32.55.
Transportation Permits.-Of these, 70 were issued
to undertakers during the year just closed.


DR. G. W. LAMAR.

Replying to yours of recent date that I give you Gadsden
a short account of what "has been" in Gadsden County County
during the past twelve months, would say that of
necessity my report must be short, for this county has
"been distressingly" healthy for sometime past. Nothing
of a contagious nature, except a few cases of smallpox,
which were well handled by your special agent, Dr. R. F.
Goddard.
The water supply has been everything except what
it should have been, but we hope ere another summer
comes to have that righted.
I find the people becoming more and more educated
daily along the line of sanitation and sanitary measures,
and stand ready at all times to aid the State Board of
Health in any matter pertaining to the health of a com-
mity.









SIXTEENTH ANNUAL REPORT


DR. CHAS. W. BARTLETT.

Eabotugh The prevalence of infectious and contagious diseases
in the County of Hillsborough, State of Florida, during
the year 1904, has been greater than in any. of the past
four years. During the year we have had scarlet fever,
diphtheria, smallpox, typhoid fever and dengue.
The number of cases of scarlet fever were few
compared with outbreaks of previous years. During the
early part of 1904 there were a few cases, and four cases
in November. Since then there has not been a single
case reported.
While we have not had an epidemic of diphtheria it
has prevailed somewhat throughout the county during
the greater part of the year. Where death has resulted
from this disease it has been due, in those cases which
have come to my knowledge, to a lack of the use of serum
or because antitoxin was employed too late in the disease.
The following case proves the benefit derived from the
administration of anti-diphtheritic serum by the State
Board of Health.
The agent was called to see a child, three years old,
when he arrived he found the patient in a preagonic
condition. This child had been sick eight days and its
parents had not summoned a physician because they
were not able to pay for the service. The anti-
diphtheritic serum was administered, but too late to do
any good and the child died. The sister of the child, a
little girl five years old, was in the fifth day of the
disease and in very bad condition. Large doses of the
serum were administered to her and she recovered. Were
it not for this medicine I am sure that the little girl
would have shared the fate of her brother.
Typhoid fever has also prevailed, to some extent, and
notwithstanding the fact that the public water supply of
the city of Tampa was contaminated with one of the
species of bacillus coli-communis, there was no marked
epidemic, and the cases were not limited to any one
section of the city. During the year, as in the year









OF THE STATE BOARD OF HEALTH.


preceding, the cases were better diagnosed, due to the
examination of blood for Widal reaction by the laboratory
of the State Board of Health. The agent for Hills-
borough County had a case which emphasizes the above
statement. I was called to see a lady, Mrs. P. W., at
Gary, Fla., and, having been under my treatment before,
I knew had tuberculosis, had been experiencing increased
temperature, and it looked as if the attack of fever from
which she was suffering was due to the tuberculosis,
which I am sure would have been the only diagnosis made
had it not been for the examination made for Widal
reaction, which proved a case of typhoid in a tuberculous
patient. The woman got well of the typhoid but the
slight fever continued, due to the tubercle bacillus. In
this case I could advise the family as to the precaution
necessary with stools, etc., and also assure them that if
*she recovered it would be but a question of a few weeks,
as typhoid fever was of shorter duration than tuber-
culosis. With the diagnosis of tuberculosis alone I doubt
that she would have gotten well, as the treatment would
have been directed to the tuberculosis, and had she died,
her death would have been attributed to the wrong
disease.
Smallpox has prevailed more generally in Hills-
borough County this year than any before during my
connection with the State Board of Health. The
majority of cases have come to my knowledge when they
were nearly well or completely cured, and after having
had the opportunity of infecting others. To this is due
the difficulty of preventing the disease in Tampa. The
most of the cases in this county have been at Pelot,
Turkey Creek and Valrico, and on account of the distance
of these places from the hospital, one being twenty-four
miles, and the way in which the negroes live at the
turpentine camps, and the failure to make prompt
reports, it was difficult and practically impossible to
suppress the disease at these places, and its care and
treatment also entailed an increased expense to the State
Board of Health.









SIXTEENTH ANNUAL REPORT


I am sorry to say that during this year there has
been a noted decrease in the number of persons applying
for vaccination.
During the summer and a few days after receiving
information from the State Health Officer that there was
an epidemic of dengue in Key West, this disease appeared
in Tampa, and it was the most general epidemic that
has occurred in this city during the eleven years of
my residence here. There were very few families which
escaped entirely without some member having it, but
fortunately, very few cases were of a severe character
and none died.
The deaths from tuberculosis in Tampa and vicinty
during the past year were seventy-five. It is too soon
yet to be able to tell what will be the influence of the
new rule of the State Board of Health against spitting
in public places, though I hope it will bear fruit in the
no distant future.
The expenses for the State Board of Health outside
of the salaries paid the agent and the man in charge of
the hospital, have been limited to anti-toxin serum for
two cases, groceries and medicine for the smallpox cases
at the hospital, sums paid for transportation of the sick,
and a small bill for plumbing and repairs to the hospital.



DR. P. B. WILSON.

cukson I submit with pleasure, a brief report upon the health
and sanitary conditions that existed in Jackson County
during 1904.
Beside the ordinary malarial fevers and summer
complaints endemic in this section, we have suffered
severely a malignant type of malarial and enteric fevers.
Possibly the long dry spell and its subsequent effect upon
the surface water, played largely in this disaster.
Smallpox prevailed a short while in the northern
portion of this county, but was promptly controlled by









OF THE STATE BOARD OF HEALTH.


Doctor Goddard, an efficient adjunct of the State Board,
who will give a detailed description of same elsewhere,
as well as a statement of expense attached thereto.
No diphtheria or scarlet fever appeared, nor have
we heard of any.
Several cases of consumption were treated, and in
nearly every instance, the cases were not of domestic
origin. From all accounts, proper precaution was
exercised. Most of these cases were negroes.
The present system of gathering vital statistics, as
yet, is hardly in operation and, as a result, the reports
of this county so far are far short of nominal. It is
earnestly hoped that the physicians shall give the Board
more attention touching vital statistics than ever, thus
enabling the reports of 1905 to be more near the nominal.
The sanitary condition of our county may be con-
sidered good, excepting a few of the smaller towns, and
these could be remedied by proper drainage and disposal
of excrement.


DR. A. B. HARRISON.

My annual report for the year ending December 31st, Jefferson
1904, has, necessarily, been delayed. county
Jefferson County was healthy during the year, as to
diseases usual to this section of the State. There were
ten or twelve cases of typhoid fever, of which four died;
two in town, origin of infection not traceable; one came
home from Bartow with the fever, and recovered after
long illness. Of the other cases in the county, the disease
was contracted in Georgia by father, who waited on his
son that died after his return home. He also had
typhoid fever, and later, five of his family. The father
and one of his children, after lingering illness, died.
Smallpox has continued to spread, in spite of all
efforts to stop it. There is now presumably a hundred
having it, and I think that I am safe on the side of
correct statement, that there have been fifteen hundred









SIXTEENTH ANNUAL REPORT


cases in the county during the past twelve months. The
contagious was under the management or supervision of
special agents most of the time, who will give a more
elaborate report.
My attention has been given principally to town,
except in the absence of a special agent, when called
upon to investigate cases of supposed smallpox in the
country, and wanted my services for protection.
On July 2d I made several visits, ten to twelve
miles in the country, to different settlements. On one
man's farm, I found thirty cases of smallpox. In some
houses I found both measles and smallpox, did sanitary
work, and vaccinated quite a number, but to little purpose
as to protection in preventing the fever, for reason that
it comes on before the virus could take effect.
Expense account for July, $17.80.
In September I was requested to visit a family
(white) in the country, ten miles from town, in which
it was thought children had smallpox, and the boarding
place of teacher of a school near by. Arriving at the
place, I found two children with symptoms of smallpox-
diagnosis not positive-but owing to fact a physician had
told me the family these children had before visited did
have smallpox in the spring, I deemed it my duty to
teacher and school to give them the doubt, and requested
suspension of the school until further developments. It
proved to be chickenpox, and the school was resumed
the following Monday.
Expenses, $7.45.
In September I found a negro man had been in town
for over a week with smallpox. He was moved to a
house in the country, where five others had it. I
vaccinated quite a number, and all I could find who had
been exposed, burned the bedding this man had used,
and all useless articles, and thoroughly fumigated the
building, then canvassed the town looking for other cases.
Expenses, $28.45.
In December we had our first case of smallpox in a
white family. Called to see little daughter of W. E.










OF THE STATE BOARD OF HEALTH.


Haile on December 29th. The cook had visited in the
country, contracted the disease, and when fever came on
she absented herself two or more weeks and resumed her
place as cook, and from her this child took the fever.
Cost of services December, $13.35.
If it be possible at all to stop the spread of small-
pox in this county, it necessarily, would be at consider-
able cost.
The best plan to pursue, perhaps, is to vaccinate freely
among those who have not been exposed, and this I am
doing as fast as possible, or as the people will give
consent, and I am glad to state more of them are willing
to be vaccinated than formerly, many coming to my
office for it. I am hoping to keep, and believe will be
able to prevent this loathsome disease from becoming
epidemic in our town.



DR. W. D. BUSH.

The health of Lake County during the year 1904, ke county
which has just passed, I am glad to report has been good.
Taking the conditions by seasons, in the spring
months some few colds, bronchitis, none of which were
severe. Summer months very healthy, scarcely any cases
of malarial fever, some few cases of typloid; I believe
three or four cases was all in the county.
Of the contagious and infectious diseases, only a
few cases of smallpox, which did not spread or cause any
alarm among the citizens. We have had recently a few
deaths due to consumption, which came here a few months
previous very nearly dead when they arrived, too late of
course, for a climate to do any good.
The winter is mild, and so far, not a single case of
pneumonia to report; one or two cases during our winter
season is generally the only cases we have, and then due
to exposure.
The sanitary conditions are good.










SIXTEENTH ANNUAL REPORT


DR. R. T. WALKER.


Levy County As agent for the State Board of Health in Levy
County, I have to report that during the year 1904, I
was not called on officially to treat or manage any cases
of contagious or infectious disease. Our county being
comparatively free from such troubles during the year.
In the month of May, there was an epidemic of variocella
in the town of Cedar Key. Some of the symptoms so
closely resembled those of variola, that I felt justified in
notifying the State Health Officer, and asking for an
investigation. Doctor Stinson, and afterwards Doctor
Byrd, were sent down and after a thorough investigation
pronounced it variocella. Several adults were real sick
with the trouble, and in the beginning it was hard to
give a clear and positive diagnosis.
As local registrar, I have selected a sub-registrar for
each precinct in the county, and have given them instruc-
tions according to the regulations in regard to filling out
the blanks and reporting the first of each month. It will
likely take some time for the new regulations to be fully
understood and carried out.
The health of our county for the year was good;
there were some malarial troubles, and a few typhoid
cases out in the country, but on the whole the health was
good. We had no dengue fever, which prevailed to
extensively in some parts of the State. During the
summer we had in the town of Cedar Key a peculiar
and unusually severe epidemic of summer colds. It
attacked both the old and the young. Many persons
were confined to their beds for days, and suffered severely
from an aggravating and harassing cough.
A short time ago I had occasion to call the atten-
tion of the managers of one of the oyster canning
factories here, to what was becoming an offensive
nuisance, on account of an accumulation of stale oyster










OF THE STATE BOARD OF HEALTH.


liquor under the steambox. I suggested a remedy and
they promised to correct it. I hope there will be no
more trouble about it.
The sanitary condition of the county is as good as
is usually found in this section.

REPORT OF DR. J. N. FOGARTY.

In making my report on the health of Monroe
Monroe
County, for the year 1904, I beg to state that it was a county
busy one for the doctors, though not resulting in many
fatalities.
Typhoid Fever.-Early in February we were visited
by an extended prevalence of typhoid that made many
victims though but few succumed. This may have resulted
more seriously had not the people of our community heeded
the advice of all members of the profession by previously
boiling all water before using it for drinking purposes.
The occurrence of a case here and there lasted up to
September, when no more was heard of it.
Dengue Fever.-During the month of June we were
visited by the mosquito. For five months the broken
bone made its rounds and crossed the threshold of almost
every dwelling in our town, though not resulting fatally
in a single case. As a fellow practitioner expressed it
to me, it made one feel as though death was near at hand.
In some households then a few were stricken down at
the same time, among adults the rash appeared in 90 per
cent of the cases, and in children 100 per cent. In some
cases the urine became scanty but no albumen was found.
All complained of extreme prostration after the fever
stage.
Pigs.-The statute applying to the keeping or herd-
ing of pigs was enforced during the year. At first we
were met by strong opposition both by the laity and the
profession, but after pigs and odor had disappeared from
their midst, they all agreed that it was a good thing.
I think I can now safely say that there are no pigs
herded in Key West.









SIXTEENTH ANNUAL REPORT


DR. J. L. HORSEY.

Nassau The general health and sanitary condition of Nassau
County
County, has been exceptionally good during the past
year, in fact so good that my annual report must neces-
sarily be very brief.
The only communicable, but preventable disease that
have occurred were diphtheria and smallpox. Of the
first, diphtheria, there were but three (3) cases, two (2)
white, and one colored. Antitoxin was used in all of
these cases, but too late and in too small doses, so that
two of the cases died; one white and one colored.
Smallpox first made its appearance at Fernandina
during the early part of February, the first case having
been brought in from Brunswick, Ga. The disease spread
very rapidly from the first focus of infection and in a
very short time assumed an epidemic proportion, this
in spite of prompt and very energetic measures which
were adopted. The disease continued to spread until
a total of fifty-six (56) cases developed, all of which
were taken care of by the State Board of Health.
Malarial fever was not very prevalent during 1904,
and the fact was quite noticeable notwithstanding the
fact that mosquitoes were very much in evidence during
the entire summer.
I would respectfully call your attention to the
urgent necessity for a better and larger hospital at
Fernandina, for the care of contagious diseases, during
the past year the present house was found to be entirely
too small for the purpose, and a recurrence of smallpox
might cause trouble.

DR. L. F. HENLEY.

Polk County I am pleased to say that Polk County has not had
any serious sickness during 1904. A few cases of typhoid
fever, measles and four or five cases of smallpox have
been the extent of the sickness, with the exception of
acute colds which have been general over the county.
The health is good and the outlook is promising.









SIXTEENTH ANNUAL REPORT


DR. J. L. HORSEY.

Nassau The general health and sanitary condition of Nassau
County
County, has been exceptionally good during the past
year, in fact so good that my annual report must neces-
sarily be very brief.
The only communicable, but preventable disease that
have occurred were diphtheria and smallpox. Of the
first, diphtheria, there were but three (3) cases, two (2)
white, and one colored. Antitoxin was used in all of
these cases, but too late and in too small doses, so that
two of the cases died; one white and one colored.
Smallpox first made its appearance at Fernandina
during the early part of February, the first case having
been brought in from Brunswick, Ga. The disease spread
very rapidly from the first focus of infection and in a
very short time assumed an epidemic proportion, this
in spite of prompt and very energetic measures which
were adopted. The disease continued to spread until
a total of fifty-six (56) cases developed, all of which
were taken care of by the State Board of Health.
Malarial fever was not very prevalent during 1904,
and the fact was quite noticeable notwithstanding the
fact that mosquitoes were very much in evidence during
the entire summer.
I would respectfully call your attention to the
urgent necessity for a better and larger hospital at
Fernandina, for the care of contagious diseases, during
the past year the present house was found to be entirely
too small for the purpose, and a recurrence of smallpox
might cause trouble.

DR. L. F. HENLEY.

Polk County I am pleased to say that Polk County has not had
any serious sickness during 1904. A few cases of typhoid
fever, measles and four or five cases of smallpox have
been the extent of the sickness, with the exception of
acute colds which have been general over the county.
The health is good and the outlook is promising.










OF THE STATE BOARD OF HEALTH.


DR. J. M. ABBOTT.

The undersigned would respectfully submit to you Pcst
his report for the year of 1904, of the county of Pasco.
I am pleased to say that while Pasco County has
generally noted for its health, the year 1904 has been an
exceptional one, not an epidemic of any kind has visited
us. As my practice includes a good portion of Hernando
County, in the eastern and southeastern portions I will
include that also in this report, as it is entitled to the
same report. If it were not for those who come to our
balmy and ozonized climate for the white plague, and
coining too late to reap the benefits there from our death
rate would be much lower. In addition the deaths by
violence, accidents, and the use of instruments in cases
of obstetrics and carelesness after delivery, our death
report would be so small that I fear it would excite the
envy of some of our sister States, who boasts of their
health record to such an extent that your able and efficient
secretary might lose some of his reputation of affability
in trying to answer the enquires received. If ever a
people should sing praises to a merciful ruler these of
the above named section should. I am pleased to report
the fact that our people are beginning to learn the
necessity of hygiene and the benefits derived therefrom.
While I am a great advocate of good schools I think that
there should be a good sum of money appropriated for
the printing of pamphlets showing how to keep in good
health, and how poor locations have been made healthy
and distributed, most especially through our turpentine
stills and phosphate mines to our colored population,
showing the necessity of vaccination and sanitation. I
am sorry to say that while I have had the pleasure of
improving the hygiene of our mills, turpentine stills,
mines etc., yet it seems utterly impossible to teach the
colored population to observe instructions. I reported to
you considerable trouble and fever at a certain camp, but
the chemist reported the water pure. I then had the
camp watched and found that rum and wine, made from










SIXTEENTH ANNUAL REPORT


plums and strawberries together, with the fact that fifty
or sixty persons would occupy a room 12 x 14, with the
doors and windows closed. I appealed to the manager,
and as soon as the rum and wines were abolished
and the necessary ventilation made, the health at
once became excellent throughout the camp. I had a
peculiar case to attend to on the 21st of December, an
Italian's baby was brought to my office from the
phosphate mine at Bay City for treatment for chills and
fever; upon examination it was startling to find the
tonsils, facues and back part of the mouth, tongue and
palate all contained apparently a diphtheretic coating. I
had treated a good many cases of diphtheria before
moving here, and this seemed to be a typical coating, yet
the baby had no other signs, and it had been having
chills and fever every other day for more than two
weeks, its parents said that it had considerable gastric
irritation. I sprayed its mouth with dioxide of hydrogen
and found that it removed a good deal of the coating.
and with a treatment of same it was up in five days. I
regret very much that owing to obstetris calls, and a
cold that settled on the wounded lung that I was unlucky
enough to get at Jonesboro, Ga., during the Civil war,
I have been delayed with this report. You will ex,'ise
this, as I have no time to recopy it, or to overlook the
errors. Trusting that 1905 will be as prosperous and
healthy.
DR. WORTH LOCKEY.
sumter The general health of Sumter County during the
county year 1904 has been remarkably good.
The general prevalence of malaria fever seems to be
lessening each year.
No infectious or contagious disease has been reported.
A few cases of pulmonary tuberculosis came from
other states and were under my supervision. The
climate seemed to benefit them more than medicine. I
must say that we have a grand climate for those suffer-
ing from pulmonary troubles,, be it tuberculosis or
bronchial.




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