• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Florida state board of health
 Table of Contents
 List of Illustrations
 Letter of transmittal
 Executive department: Report of...
 Hydrophobia
 Reports of assistants to the State...
 Report of Dr. M.E. Heck
 Report of Dr. C.H. Dobbs
 Report of Dr. C.T. Young
 Report of Dr. James M. Jackson
 Report of Dr. D.G. Humphreys
 Report of Dr. Raymond C. Turck
 Report of board of Embalmers'...
 Bacteriological laboratories
 Veterinary department reports
 Report of veterinary departmen...
 Report of Dr. W.A. Munsell
 Report of Dr. J.W. DeMilley
 Index to annual report
 Back Cover






Title: Annual report - State Board of Health, State of Florida
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/AM00000243/00002
 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: VID00002
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
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
    Title Page
        Page i
    Florida state board of health
        Page ii
    Table of Contents
        Page iii
        Page iv
        Page v
        Page vi
        Page vii
    List of Illustrations
        Page viii
    Letter of transmittal
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
    Executive department: Report of the State Health Officer, Dr. Joseph Y. Porter
        Page 9
        Page 10
        Page 11
        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
        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
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
    Hydrophobia
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Plate
        Page 57
        Page 58
        Page 59
    Reports of assistants to the State Health Officer and agents of the State Board of Health
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
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        Page 73
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        Page 76
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        Page 84
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        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
    Report of Dr. M.E. Heck
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
    Report of Dr. C.H. Dobbs
        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 Dr. C.T. Young
        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
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
        Page 141
        Page 142
        Page 143
    Report of Dr. James M. Jackson
        Page 144
        Page 145
        Page 146
    Report of Dr. D.G. Humphreys
        Page 147
        Page 148
    Report of Dr. Raymond C. Turck
        Page 149
        Page 150
        Page 151
        Page 152
        Page 153
        Page 154
        Page 155
        Page 156
        Page 157
        Page 158
        158a
        158b
        158c
        158d
        158e
        158f
        158g
        158h
        158i
    Report of board of Embalmers' examiners
        Page 159
        Page 160
        Page 161
        Page 162
    Bacteriological laboratories
        Page 163
        Page 164
        Page 165
        Page 166
        Page 167
        Page 168
        Page 169
        Page 170
        Page 171
        Page 172
        Page 173
        Page 174
        Page 175
        Page 176
        Page 177
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        Page 183
        Page 184
        Page 185
        Page 186
        Page 187
        Page 188
        Page 189
        Page 190
    Veterinary department reports
        Page 191
    Report of veterinary department
        Page 192
        Page 193
        Page 194
        Page 195
        Page 196
        Page 197
        Page 198
        Page 199
        Page 200
        Page 201
        Page 202
        Page 203
        Page 204
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        Page 233
        Page 234
        Page 235
        Page 236
        Page 237
        Page 238
        Page 239
    Report of Dr. W.A. Munsell
        Page 240
        Page 241
        Page 242
        Page 243
        Page 244
    Report of Dr. J.W. DeMilley
        Page 245
        Page 246
        Page 247
    Index to annual report
        Page i
        Page ii
        Page iii
        Page iv
        Page v
        Page vi
        Page vii
    Back Cover
        Back Cover 1
        Back Cover 2
Full Text


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DUPLI CATR


'STATE BOARD OF HEALTH


OF FLORIDA


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S- PROVED BY THE BOARD IN ANNUAL
SSIONMACH 16,1915



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JACKSONVILLE, FLORIDA


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PUBLIC HEA L '4
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'.. .ANNUAL REPORT


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MARCH, 1915


STATE BOARD OF HEALTH OF FLORIDA


TWENTY-SIXTH

C-
ANNUAL REPORT

of the


STATE BOARD OF HEALTH


OF FLORIDA

1914




APPROVED BY THE BOARD IN ANNUAL SESSION, MARCH 16, 1915


JACKSONVILLE, FLORIDA



THE DREW PRESS
JACKSONVILLE
FLORIDA
1915


PUBLICATION 134






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FLORIDA STATE BOARD OF HEALTH


MEMBERS:
HON. FRANK J. FEARNSIDE, President ........... Palatka, Fla.
HoN. C. G. MEMMINGER .......................Lakeland, Fla.
HON. S. R. MALLORY KENNEDY, M. D......... Pensacola, Fla.


JOSEPH Y. PORTER, M. D.,
Secretary and State Health Officer.


EXECUTIVE OFFICE AND CENTRAL LABORATORY:
State Board of Health Building,
Springfield Boulevard,
Jacksonville.


BRANCH OFFICES:
ASSISTANTS TO THE STATE HEALTH
Key West,
Pensacola, Gainesville,
AGENTS
Miami, Fernandina.
BRANCH LABORATORIES
Pensacola,


OFFICER,
St. Augustine,
Ocala.




Key West,


Miami, Tallahassee.


Tampa,





Tampa,














TABLE OF CONTENTS

Page
President's Letter of Transmittal ............................. ..... 1
Introduction ......................... ....................... 1
General Health of the State........ ................ ..... 1
Death Rate for Four Largest Cities of State.................... 1
Referring to the State Health Officer's Report concerning Pre-
ventable Diseases.......... ...... ................... 1
Efforts of the State Board of Health to Educate the People in
Disease Prevention........ ......................... 2
Estimated Cost of Preventable Disease......................... 2
Taxpayers of the State called upon to Defray Expense of Pre-
ventable Disease... .................. .... .............. 2
Abolishing Quarantine .......................... .. ........... 2
Vaccination made Compulsory by the State under Certain Con-
dition s ...................... ......... ............... 3
The Isolation Hospitals of Dade, Duval, Escambia and Hills-
borough ............................................... 3
Abandoning the Isolation Hospitals........................... 3
Recommendations of the State Health Officer.................. 4
Passes for Employees of State Board of Health................. 4
The Law Concerning Distribution of Free Hog Cholera Serum.... 4
Recommendations of State Health Officer concerning Public
Schools of State and Screening all Places where Food is Served 4
Recommendations Concerning Vital Statistics................... 5
Crippled Indigent Children's Hospital................. ....... 5
Recommending a Special Building for Crippled Children......... 6
Receipts and Expenditures ................................... 6
Method of Paying Bills and Handling Funds of the Board..... 7
Report of Dr. Joseph Y. Porter, State Health Officer................ 9
Introduction ................................ ..... 10
Explanation of the Method and Plan of the Report............ 12
The General Health of the State ................................ 12
The Attempt to Procure Vital Statistics for Florida............. 12
Value of Accurate Vital Statistics................ ... ......... 13
Indifference to Teachings on Matters Concerning Health and
Sanitation .............................................. 13
Individual Responsibility....................... ............... 14
Wanting to do too Much in Times of Epidemic................. 14
Teaching Through the Eye rather than by the Ear.............. 15
The State Board of Health's Exhibit........................... 15
The Health Train of the Louisiana State Board of Health........ 16
Referring to the Legislature of Florida Giving Sanction for the
State Board of Health to Expend Funds for Health Train.... 16
Reports of Preventable Disease Obtained from the Laboratories
of the Board................................... ... ...... 17
Referring to the Prevalence of Preventable Disease as Shown by
Laboratory Reports..... ............................. 17
Morbidity Reports Each Week would Settle Question of Low
M orbidity Rate for Florida................................ 17
Preventable Disease being Sometimes so Mild as not to be
R recognized ............................................ 17
Showing the Mortality Rate for 1914 .......................... 18










TWENTY-SIXTH ANNUAL REPORT

Page
Why not Accept the Measures which Science Advocates for Pre-
venting Disease............................................. 18
The Failure to be Protected Against Smallpox a Misdemeanor.... 19
Any One Contracting Smallpox to Defray all Expenses.......... 19
Employers Should be Held Responsible Where a Large Number
of Men are Employed...................................... 19
Referring to the Prejudice of Some People Against Vaccination.. 20
Prevention of Disease........................................... 20
The Commercial Side of Protecting the Citizens of Florida Against
Smallpox .............................. ............ ....... 21
Cost of Preventable Disease.................................... 22
The use of Serums and Vaccines.............................. 22
The duties of a State Health Management...................... 23
Free Distribution of Hog Cholera Serum to the Farmers........ 23
Regarding the Intent of the Legislature Concerning this Act.... 24
Quoting the Letter of the Attorney General................... 24
Dr. Dawson's Opinion of Furnishing Hog Cholera Serum to the
Farmers of the State Free of Charge.................... 25
Tick Eradication and Building of Dipping Vats.................. 26
Interest in Escambia in Tick Eradication..................... 26
What Dade County is Doing in Tick Eradication............... 26
Quarantining Ticky Counties.................................. 27
An Inspector Needed for Dade County to Supervise the Dipping.. 28
Federal Authorities Raising Quarantine Against Dade County.... 28
Carriers of Disease............................................. 29
Habits Detrimental to the Health of School Children............ 30
Bacteriological Laboratories .................................... 30
Scope of Laboratory Work.................................... 31
Diphtheria Examinations for Determining the Prevalence of Diph-
theria in DeFuniak....: .............. .................. 32
Tuberculosis Work and Handling by the Visiting Nurse.......... 32
Divisions of the State into Districts for Work of Visiting Nurses 33
Plans to Enlarge the Scope of the Work and Obtain Better Results 34
Defectively .Constructed Surface Closets....................... 35
Rural Schools Unprovided with Surface Closets............... 35
Drinking W ater of the State ............................ ...... 36
Flies and Typhoid ................ ............................ 36
Office Routine and Matters .................................. 37
Receipts and Expenditures.................................... 37
The Expenditures in Detail .................................. 38
Receipts ................................... .................. 40
Free Transportation of State Board of Health Employees When
Traveling on Health Missions in the State.................. 41
Crippled Children............................................ 42
Work Accomplished for the Crippled Indigent Children........ 42
Building or Ward now Necessary to Care for Crippled Children.. 43
The State Health Officer Assumes all Responsibility for Statements
made in this Report.................. ..................... 44
Recommendations ............................................ 44
Screening Food Against Flies ............................... 44
Surface Closets Should be Fly-proof........................ 44
Recommendations Concerning Vital Statistics................ 45
Recommending Free Transportation be Allowed Employees of
the Board on State Business.............................. 45
Withdrawing Free Hog Cholera Serum.................... 45
Visiting Nurses for the State doing Tuberculosis Work...... 46
Hospital for Crippled Children ............................... 46
Hydrophobia, Treatment Administered for its Prevention by the
State Board of Health during 1914 (table)................ 48










STATE BOARD OF HEALTH OF FLORIDA V
Page
Explanatory Notes, anti-rabic treatment...................... 51
History of Animals Found Positive for Rabies by Microscopical
Examination ................ ............................ 51
Deaths from Hydrophobia, 1914 ............................... 53
Hydrophobia, Treatment Administered for its Prevention, Distribu-
tion of Cases by Counties and Towns..................... 54
Reported Cases of Smallpox in Florida, 1914 with Vaccinations
Done .......................... ......................... 56
Status of Water Supply in 13 Florida Municipalities............. 58
Status of Sewage Disposal in 13 Florida Municipalities.......... 59
Reports of Assistants to the State Health Officer and Agents of the
State Board of Health ............................................. 60
Report of Dr. Chas. W. Bartlett, Southwestern. District.......... 61
Hillsborough County, Smallpox ............................ 62
Diphtheria ............................................. 62
Scarlet Fever ............................. ............. 63
Typhoid Fever................... ..................... 63
Miscellaneous .......................................... 65
Polk County ............................................. 66
Pinellas County .......................................... 66
Manatee County ......................................... 66
DeSoto County.............................................. 66
Lee County ................................................. 66
Report of Investigations made During the Year in Tampa.... 68
Report of Dr. C. W. D'Alemberte, Western District............. 72
Report of Dr. Joseph Y. Porter, Jr., South Tropic District........ 74
Typhoid Fever .................. ........................... 75
Sm allpox ....................................... ... ........ 76
D iphtheria ................................... ..... ........ 76
Infantile Intestinal Diseases ................................. 77
Plague ................................................ 77
Report of Dr. W. P. Crigler, South Central District.............. 79
Report of Dr. J. E. Taylor...................................... 84
Typhoid Fever............................................... 87
Smallpox .................................................. 88
D iphtheria .................. ... .. ........................ 89
Scarlatina ................................................ 89
M alaria ..................................................... 90
Pellagra ................................................... 90
Vital Statistics............................................. 91
Sanitation ............................................... 91
General Health Conditions ................................... 92
Tallahassee ............................................. 92
Apalachicola ............................................ 93
Quincy ............................................... 93
DeFuniak Springs ....................................... 93
Greenville ........................................... 93
Perry ............................ .. .............. 93
Live Oak..................... .......... .............. 93
Lake City.............................................. .. 93
Gainesville .............................................. 93
Report of Dr. M. E. Heck, East Coast District................. 95
Conclusion .......................................... 99
Report of Dr. C. H. Dobbs ....................... ............ .. 102
Tabulated Summary of Anti-typhoid Inoculations Administered
at Free Dispensaries Operated by the State Board of Health,
July 30 to September 10, 1914 .......................... 117










Vi TWENTY-SIXTH ANNUAL REPORT
Page
Report of Dr. C. T. Young.................................... 118
The Hookworm Campaign in Marion County................. 118
The Plan................. ....... .. .......... ........... 118
The Results................................................ 119
Investigation of Kissimmee Septic Tank Problem ............ 120
The Examination....................................... 121
Septic Action............................................. 121
Odors ................................................. 123
Purification-Bacterial ................................... 123
Septic Efficiency........................................... 124
Investigation of Typhoid Fever at Orlando, Fla.............. 124
Time of Occurrence and Extent c.f Outbreak............. 125
Sex and Color............................................ 126
D iagnosis ........................ ................. 126
Discussion of Epidemiology, Milk, Ice Cream and Soft
Drinks, Ice and Flies ................................. 127
Contact .............................................. 128
Carrier Cases.............. ........................... 128
Sanitary Conditions ...................................... 128
Sewage ................................................. 129
Water Supply...................................... .... 129
Sewage Disposal.......................................... 131
C conclusions ................... ....................... 131
Diphtheria ................................................. 135
Cost of Antitoxin......................................... 135
Comparison of Tabulated Results, Cost of Antitoxin...... 136
Diagnosis ...... ....................................... 136
Size Dosage ............................................ 138
Schick R eaction..................... ....................... 138
Report of Dr. James M. Jackson, Agent of the State Board of Health.. 144
Report of Dr. D. G. Humphreys, Agent of the State Board of Health.. 147
Report of Dr. Raymond C. Turck, Surgeon in Charge of Work under
the "Crippled Children" Act .................................. 150
Cases not admitted because of lack of Equipmeht................ 151
Need for Orthopedic Ward in Hospital ....................... 151
School Work and Manual Training ............................ 152
Ward in Connection with St. Luke's Hospital .................. 152
Separate State Orthopedic Hospital ........................... 153
Care in St. Luke's Hospital..................................... 154
Case Histories ................................................. 154
Report of Board of Embalmers' Examiners ........................ 160
Bacteriological Laboratories:
Report of Dr. Henry Hanson, Senior Bacteriologist.............. 164
Details: Pellagra ............................................. 166
Miami Laboratory ........................................... 167
Plague ...................................................... 167
Leprosy ........................................... ...... 167
Laboratory Examinations.................. .................. 167
Diphtheria ................................................. 168
Diphtheria Specimens Delayed .............................. 170
Lactic Acid Bacilli and Diphtheria Carriers................. 171
Gonorrhea ................................................. 171
Malaria .................................................... 171
Typhoid ................................................ 172
Tuberculosis ............................................... 172
Rabies ................... .................. ... ..172
W ater ..................... .. ........................... 172
Pathological Specimens................................... 173
Equipm ent ............. .............. ..................... 173










STATE BOARD OF HEALTH OF FLORIDA Vii
Page
P personnel .................. ...................... 173
Statement of Specimens Examined in Central Laboratory, Jack-
sonville, 1914 (table) .................. ................. 175
Distribution of Communicable Diseases as Diagnosed by the
Laboratories of the State Board of Health, 1914............ 177
Report of Dr. H. R. Mills, Bacteriologist, Tampa Laboratory.... 182
Statement of Specimens Examined in Tampa Laboratory, 1914.. 185
Table of Positive Specimens Examined in Tampa Laboratory,
1914, Showing Number Received from Various Towns of
the State ............................................... 187
Report of Dr. F. A. Brink, Bacteriologist, Pensacola Laboratory.. 188
Report of Specimens, Pensacola Laboratory, 1914 (table)..... 189
Veterinary Department:
Report of Dr. Chas. F. Dawson, Veterinarian.................. 192
Organization of the Veterinary Division .................... 193
V eterinary Inspectors ....................................... 193
Live Stock Agents........................................... 193
County Farm Demonstration Agents. Also Hog Cholera Agents
giving Free Service...................................... 193
List of Unofficial Hog Cholera Agents Whose Services may be
Engaged to Treat Hogs for Cholera, for a Fee............ 194
H og Cholera ............................................... 196
More trained Men needed to o Hog Cholera Serum Work.... 196
Methods of Employing the Serum ......................... 198
Resolutions of Federal and State Veterinarians............... 199
Hog Cholera Statistics...................................... 202
Loss per Thousand from Cholera.......................... 202
Florida's Loss from Cholera, 1913 .......................... 202
Florida as a Hog Raising State ........................... 202
Comparison of Southern States ........................... 202
Hog Cholera Sanitation..................................... 202
Prescription for Worms in Hogs ........................... 203
Transmission of Hog Cholera by Buzzards ................. 204
Hog Cholera Serum Statistics ............................... 206
Distribution of Hog Cholera Serum and Virus in Florida in
1914 .................................................. 207
Tick Eradication Movement................................ 208
Vat Construction......................................... 209
Constitution ................ ........................... 210
Object ................................. .............. 210
M ethods ..................... ...................... 210
Officers
M em bership .................. ....................... 211
M meetings ........................................... 211
By-Laws ......................................... 211
Glanders .................................................. 212
Cases of Glanders during the Year 1914 .................... 213
Hookworm in Dogs......................................... 213
Symptoms ................. ............................. 214
Treatment ............................... .............. 215
After-treatment .............. ..................... ... 216
Mad Itch in Domestic Animals ............................ 216
Regulations Governing the Entry of Domestic Animals into
Florida ................................................ 219
Veterinary Inspectors......................................... 222
Movement of Certified Animals into and out of the State of
Florida, last Quarter, 1914................................ 226
Florida Live Stock Estimates for Five Past Years............ 226










Vlll TWENTY-SIXTH ANNUAL REPORT
Page
Miami Dairy Ordinances. Rules and Regulations. Ordi-
nance 157............................................ 228
Production and Handling of Milk in Miami ................. 235
Cows ................................................... 235
Stables, Barns, Milking Sheds, Barnyards, Feeding Lots,
Corrals and Pastures .................................. 236
Milk Room or Dairy Building .......................... 236
Utensils ............................ ................ 236
Methods ............................................... 237
Health of Employees....... ............................. 238
Report of Dr. W. A. Munsell, Assistant Veterinarian ........... 240
Data on Glanders Cases ................................ 240
Cattle Certified for Interstate Shipment .................... 241
Detail of Work on Hog Cholera.......................... 241
Tick Eradication and Vat Construction .................... 241
Special Cases............................................... 242
Infectious Anemia, or Swamp Fever in Horses and Mules...... 242
Symptoms .............................................. 243
Diagnosis ............................................. 243
Treatment ........................................... 243
Report of Dr. J. W. DeMilly, Assistant Veterinarian ........... 245












ILLUSTRATIONS

Smallpox Tides ..................................,......preceding 57
Crippled Children Photographs, Figures 1 to 20............following 158












LETTER OF TRANSMITTAL


Palatka, Fla., March 16, 1915.
HON. PARK TRAMMELL,
Governor of the State of Florida, Tallahassee, Fla.
DEAR SIR:-I take pleasure in handing you the annual Introduction
report of the State Health Officer for the year 1914, which
embraces a recital of the activities of the Board during the
year as well as a detailed statement of the expenditures in the
maintenance of health management and health protection of
the people of Florida.
I am exceedingly happy to be able to say to you that the General health of
general health of the State for the year 1914 has been remark- the State
ably good.
From the four largest, cities of the State, three of which Death rate for
four largest cities
are in the registration area for deaths, of the U. S. Bureau of of Stae te.
the Census, the record shows a combined crude death rate
during the past year of 17.5 per one thousand population, of
which the white rate was 14.5 and the colored 22.1. Elimina-
ting deaths of reported non-residents (those of less than six
months residence at place of death) the combined rates are:
For white residents 12.3, colored residents, 20.6, all residents
15.6. The estimated population of these four cities is 165,691.
A large proportion of the State Health Officer's report is Referring to the
State HIealth
devoted to preventable diseases, their causes and their hinder- Officer's report
ance, and his arguments as to why the people of the State prventable
should not take advantage of the measures which science in diseases.
its progressive advance has clearly demonstrated to be useful
agents in keeping well, and in warding off many illnesses
which heretofore have been thought to be necessary to run a
specified course, are tersely and concisely put forth.
I heartily concur in the opinion expressed by the State
Health Officer in his conclusions in regard to this subject.
I trust that you may find it convenient to give your atten-
tion to what he has said thereon, and will make mention in an
approving way of the salient points of the report in your next
message to the Legislature.









TWENTY-SIXTH ANNUAL REPORT


Efforts of the
State Board of
Health to educate
the people in
disease prevention.














Estimated cost of
preventable
disease.









Taxpayers of the
State called upon
to defray expense
of preventable
disease.




Abolishing
quarantine.


It is to be regretted that indifference to the subject of pre-
ventable disease and the remedies which have been brought
forth of late to interrupt such illnesses as well as to adopt
measures to prevent the same should not have been more closely
heeded by the people of the State. If followed the people
would have enjoyed health and been better off financially.
Certainly the State Board of Health has made persistent
endeavor in this direction to educate those who could read, by
pamphlets, press articles, and monthly publications, so that it
would seem that there cannot be any reasonable excuse for
any adult in the State not being thoroughly informed on the
proper remedial preventive against the four principal pre-
ventable diseases: smallpox, typhoid fever, diphtheria and
malaria.
The State Health Officer gives an estimate of ten thousand
dollars which it has cost to care for the indigent smallpox
patients alone. The taxpayers of the State should not have
had to spend this amount if vaccination had been accepted and
practiced and it seems unjust to those who heed advice and
take advantage of counsel in this respect, to be compelled to
bear the burden for the neglect, indifference or perverse opposi-
tion by those who refuse to protect themselves by this simple
means. It has been estimated that it has cost the State at
least $75,000 to care for all the preventable diseases occurring
during the past year in investigating source, determining the
character of special ailments, and in a hundred other ways
connected with the management, have the taxpayers of the
State been called upon to defray an expense due entirely to
disregard, ignorance or perverse opposition.
I am in favor of abolishing all civic or domestic quaran-
tine measures in regard to smallpox and in fact, I believe that
the term "isolation" or "segregation" would be the better one
.to apply to other contagious disorders. I am convinced, as the
State Health Officer says, that when the State furnishes an
insurance to its people free of cost, by vaccination against
smallpox, and the people refuse, then those who are bearing
the penalty of their neglect or refusal to accept this gift of the
State, should be required to defray all expenses connected with









STATE BOARD OF HEALTH OF FLORIDA


their sickness. A warning card to the public that smallpox Vaccination made
compulsory by the
exists on the premises and that unvaccinated persons should State under certain
"keep out," is all I think should be necessary to inform, caution conditions,
and protect the public. Neither am I forgetting that there is
a class of indigents living from hand to mouth, who, if attacked
with this sickness, must be looked after. But I am also of the
opinion that to remedy this, vaccination among this class
should be made compulsory by the State. I would go a step
further and insist by legislative action, that large bodies of
men should not be permitted to be brought into or employed
in the various industrial plants of the State unless they are
individually, successfully vaccinated, or unless the employers
agree to defray all expenses attendant upon the occurrence of
cases of smallpox in their camps.
Several years ago the Board of County Commissioners in The isolation
Dade, Duval, Escambia and Hillsborough donated tracts of rSaloDade
land to the State Board of Health with the specific under- Escambia.
standing that the Board would erect thereon isolation hospi-
tals for the care of smallpox cases. There was a further
understanding in the covenant between the State Board of
Health and the County Commissioners that when the land
ceased to be operated for the purpose set forth in the instru-
ment of conveyance, then the land would revert, with the
appurtenances there, to the several counties. making the dona-
tion. It is a matter, I think seriously to be considered, whether
it would not be better business management and as emphasizing
the policy of the Board in its main reliance against smallpox
by vaccination to cease to operate these hospitals and to per-
mit the land to revert to the several counties who generously
donated it in the past, when hospital management was
thought to be the only means of controlling smallpox; not
treating the disease, but controlling it. The buildings which
were erected some years ago are now in much need of repairs
and in one or two instances are not adequate for any large
demand which might be made upon these institutions. They
should be either rebuilt, repaired or pulled down, or the prop-
erty allowed to lapse to its former owner. Moreover the loca- Abandoning the
tion of these anti-vaccination homes for the indigently perverse isolation hospitals.
cases of smallpox, are rapidly becoming closer and closer to










TWENTY-SIXTH ANNUAL REPORT


settled portions of communities and contiguous to large popu-
lated centers as for instance: Jacksonville in Duval County and
Miami in Dade County. The hospital sites butt onto suburbs
of Jacksonville and Miami, which are rapidly being built up and
it will not be very many years before the County Commission-
ers on complaint of citizens will demand their removal and the
State Board of Health will be asked to either vacate or abandon
the property. I think, therefore, it would be a wise proposition
as a measure of economy as well as of common sense to think
over the question whether any more money should be expended
on these buildings, either in repair or in new structures.
Recommendations The recommendations of the State Health Officer all meet
of the State Health
Offtcer.He with my approval. I especially wish to urge upon you the
Passes for benefit to the State in economy and to the Board in efficiency
tte oard of and speedy management which would result from legislative
Health. permission to grant authority to the transportation companies
operating in Florida to issue passes to the employees of the
State Board of Health. The reason that the State Health
Officer gives for requesting this permission is convincing and
The law seems to me to be unanswerable. So, also do I approve of
distribion of the recommendations in regard to amending the law relating
free hog cholera
ser cholera to the free distribution of hog cholera serum. The protection
of the swine industry of the State is a commercial proposition
entirely and and one of dollars and cents to the producer, and
does not in any way affect the life or health of human beings.
It is as much a commercial measure as the question of eradicat-
ing the citrus canker would be to the citrus fruit growers, and
I do not think that the taxpayers of the State as a whole
should be asked to donate $20,000.00 to $30,000.00 a year,
which is one-third of the present income of the State Board
of Health; to enhance the value of an industry that is so clearly
a commercial and class consideration, to the manifest impair-
ment of a fund designed for the protection of human life.
Recommendations Too much stress cannot be laid upon the recommendation
of State Health
OffiScer concening of the State Health Officer that the forthcoming legislature
public schools of
the State, and should enact measures looking to a better sanitary supervision
screening of all
places where food of the public schools of the State, especially in the rural dis-
is served. tricts. So too, do I advise that the present law which looks to
the protection of the citizens from insect-borne diseases by










STATE BOARD OF HEALTH OF FLORIDA


well screened kitchens, dining rooms, and "passageways lead-
ing thereto," be amended to include all other places in the State
where food or drink is served the traveling public, and which
may be contaminated by flies. The reasons given by the
State Health Officer are so clearly expressed that it is unneces-
sary, I think, to enter into any extended argument on the same.
Most particularly I endorse the recommendation that the
present vital statistics laws be remade into one comprehensive
measure to insure the accurate collection and greatest useful-
ness of data on all the life history of the people of the State,
and that these be properly and safely preserved as individual
records of those most concerned, as well as for the benefit
of the whole people to prove to the world that Florida is health-
ful; and to help guard against any lowering of that health-
fulness.
At the legislative session of 1911, a bill was passed direct-
ing the State Board of Health to erect and maintain a hospital
for crippled indigent children of the State and equip the same.
Twenty thousand dollars was provided for the purchase of
grounds, erection of buildings and all necessary equipment, and
ten thousand dollars a year for two years was mentioned as a
sum necessary for maintenance. Doubtless you are familiar
with the history of this measure. It was a pet project of
Governor Gilchrist who then occupied the Executive Chair of
the State, and a worthy impulse prompted, I have no doubt, the
proposition. He had seen, as I suppose you have, many times
when traveling about the State, a number of children who
were deformed in limb either through inheritance or by acci-
dent, and who from reason of poverty or straitened financial
circumstances of parents, had never been able to have their
deformity corrected, and who, as age progressed and their
natural supporters passed to the Beyond, would, unrelieved,
inevitably become a charge upon charity of communities or
of the Commonwealth. To have these children not become
wards of the State, Governor Gilchrist proposed the measure,
which was worthy of a great and generous Commonwealth.
But the bill was "turned down" in the Senate because of the
appropriation which it carried. At this juncture the Governor
called to his assistance the State Health Officer and accepted a


Recommendations
concerning vital
statistics.








Crippled indigent
children's hospital.









TWENTY-SIXTH ANNUAL REPORT


suggestion in the nature of a provision, "That until the num-
ber of indigent crippled children, citizens of the State of
Florida, shall be sufficient in number to warrant the State
Board of Health to erect and maintain an institution of this
character and nature, that the State Board of Health is author-
ized to arrange with any sanitarium or hospital in Florida to
care for and treat the indigent crippled and deformed children
of the State and to pay for such treatment out of the funds
of the State Board of Health not in excess of the amount
appropriated by this Act." This Proviso met with favorable
response from those in the legislature who had originally
opposed the measure and the bill passed. Accordingly the
State Health Officer has arranged with St. Luke's Hospital at
Jacksonville for the care of the white children and with the
Brewster hospital in the same city for the treatment of the
colored children, who are afflicted or deformed. Dr. Raymond
C. Turck of Jacksonville, a surgeon of orthopedic ability has
heretofore taken charge of these cases-both white and col-
ored-and has operated and relieved those whose condition
was such that an operation would benefit at no charge to the
State for his services. The Board has seen fit to give Dr.
Turck each year an honorarium as a slight token of apprecia-
tion of his generous donation of time and professional ability.
This is in no wise commensurate with the service given. Dr.
Turck, until this year, has not asked for compensation, but in
a recent letter to the Executive office he states that this work
takes up a great deal of his time, and he asks to be put on the
professional staff of the Executive Officer with adequate
Recommending a annual compensation. The increasing number of cases each
special building. year, seem now to warrant the Board in carrying out the terms
of the Act by constructing and maintaining a special building
for this purpose. Therefore I approve of the recommendation
of the State Health Officer that a building be constructed,
equipped and maintained in conformity with the provisions of
the Act, for the care and relief of the indigent crippled children
in the State, as soon as funds are available in the treasury of
the Board for this purpose.
Receipts and While the aggregate of expenditures during the year, as
Expenditures. itemized in the State Health Officer's statement, is apparently









STATE BOARD OF HEALTH OF FLORIDA


large, yet it should not be forgotten that the demands on the
.Board's treasury imposed by legislative enactments from time
to time, have likewise been heavy and exacting. Every
voucher is audited three times before it is paid. The Auditor
of the Board closely scrutinizes every item of the bill for
authority, before preparing the voucher. It then is placed
before the State Health Officer for his inspection and certifica-
tion that the "charges are just, equitable and according to
law." The voucher must then have my approval, and finally
that of the Comptroller of the State, who if he thinks it is
irregular or extravagant can "turn down" if he wishes any
schedule of expenditures sent him. The order in which these
audits are made is mentioned to show the exact course which
every cent of the State's money pertaining to the State Board
of Health funds, must take before it is spent. In this con-
nection I wish to invite your attention to a marked inconsist-
ency in the present Statutes in regard to the discharge of the
State's obligations when incurred by the State Board of Health.
Under the law, the State Health Officer is made the dis-
bursing officer of the Board, and he is placed under a ten-
thousand-dollar bond for the faithful and honest performance
of this duty, yet, he never has a cent of the State Board's funds
put in his possession or under his control until the contracted
debts are filed with the Comptroller. In other words every
creditor of the State Board of Health is expected and required
to receipt for the amount of his bill before any money is forth-
coming, and is compelled to wait for a remittance to the State
Health Officer from either the State Treasurer or from the
Comptroller before he is paid. It occurs to me that the Legis-
lature should either authorize a transfer of funds from the
State Treasurer to the State Health Officer, for the use of the
Board, on a regular, approved by the President of the State
Board of Health, requisition, equal in amount to his bond, or
else release the State Health Officer from the obligation of a
bond. As the method now prevails, .the State Health Officer in
order to conduct the affairs of his office in payment of petty
accounts, which business men usually class "petty cash," has
to advance various sums each month to meet express charges,
postage, drayage and such like small amounts, but which at


Method of paying
bills and handling
fLrnds of the Board









8 TWENTY-SIXTH ANNUAL REPORT

the end of the month and until a reimbursement can be made,
oftentimes amount to a respectable sum. For many years
after the organization of the Board in 1889, the plan of trans-
fer of sums not to exceed the amount of the State Health
Officer's bond, on requisitions approved by the President of
the Board, was followed, but under a subsequent administra-
tion was changed to the present method. At first, under the
present ruling the amount authorized by the statute which the
State Health Officer could make requisition for, was largely
in excess of the amount monthly expended, and the excess
was turned back into the general fund of the State Board of
Health held by the State Treasurer. Even then there was no
excess balance allowed for current expenses. At the present
time this amount is not sufficient to pay the current monthly
expenses of salaries alone, so I think that the Legislature
should provide some relief, by amending the present law
or enacting a new statute, in order that funds may always be
available for emergency use when required.
There are many other interesting features of the State
Health Officer's report, to which I might call your attention
and discuss, but to do so in a letter of transmittal of this kind,
would take up too much of your time, and I therefore ask that
you give a careful reading and consideration to the entire
report of the State Health Officer.
Very respectfully,
F. J. FEARNSIDE,
President State Board of Health.



























EXECUTIVE DEPARTMENT

REPORT OF THE
STATE HEALTH OFFICER,
DR. JOSEPH Y. PORTER.













REPORT OF THE STATE HEALTH OFFICER


To the President of the State Board of Health of Florida:
Herewith is transmitted to you for your consideration and
disposal the report for 1914 of the State Health Officer, who,
according to precedent as Executive Officer and Secretary of
the State Board of Health is expected to make a yearly report
of the transactions of his office in order that the President of
the Board after consultation with his colleagues may, accord-
ing to the language of the Statutes:
Introduction. "Make an annual report to the Governor of all expendi-
tures, in a clear and concise statement, together with any
special observations, and recommendations of facts that may
be conducive to the health and sanitary condition of the State,
* *,,
The report of the Executive Officer of the Board for this
year except in one or two instances, almost exclusively deals
with business matters and such questions as may affect adminis-
tration, with the hope and expectation, that what is told might
appeal to, and attract the thoughtful consideration of the
Legislature at their biennial gathering in April. Discussions
of scientific methods in preventive medicine, and the progress
attained in this direction has been and will continue to be found
from time to time in the monthly publication of the Board,
the HEALTH NOTES, and in the weekly press service.
Experience in writing reports which are mainly intended for
the eye of the average Legislator or business man, has taught
that attention is more likely to be gained by short and con-
cise statements of what has been accomplished and what is
recommended for future improvement, than a lengthy argu-
ment blended with instances and facts which, however interest-
ing to a sanitist or a student inquiring into special subjects
is apt to be considered dry reading by all others. Therefore the
following statements from the different divisions of the Health
Department comprise in a detailed manner what has happened
in each during the current year. It is hoped that what has
been attempted for the bettering of the health of the people of








STATE BOARD OF HEALTH OF FLORIDA


Florida by the Executive Officer, may meet with the approval
of the Board and that the recommendations for further
improvement may be accepted and concurred in.
At the end of the year all of the 29 cities of the State of
2,000 and over, by the Census of 1910 are actively collecting
records of births and deaths and nearly a third of the 50 odd
cities between 500 and 2,000 have passed the ordinance recom-
mended by this office and have started the work and over a
dozen of the smaller municipalities have taken the same steps.
Many of the other communities are interested and expecting
to pass the necessary legislation soon, and some even of the
counties desire to have rural as well as urban registration if
some plan can be formulated to allow this to be done.
This community interest and desire to preserve the indivi-
dual records of citizens and to show the true health conditions
of each locality is greatly to be commended and is a long step
towards the passage by the legislature of the Model Law now
in force generally throughout the registration area of this
country and which has in the past year been passed in Georgia
and South Carolina.
Florida cannot afford to be outstripped by any other State
in the South in this necessary index of her known but unproved
healthfulness, for there is no other State in the Union which
is more dependent upon an increasing influx of visitors and
settlers nor is there any state which offers them so .great oppor-
tunities. But the experience of the past year has shown the
need of unifying and correlating the work of collections in the
various communities, some of whose ordinances vary, and
especially of the importance of a central control, rather than
the control by the authorities in each municipality. Conse-
quently it is strongly recommended that an appeal be made to
the next legislature to pass the Model Law for the collection
of Vital Statistics in the most suitable form to suit conditions
in this State. Such a law would supplement local legislation
now in force and become effective where interest was slight
and ordinances unenforced and would eventually give all com-
munities reliable records.









TWENTY-SIXTH -ANNUAL REPORT


Explanation of
the method and
plan of the report.














The general health
of the State.











The attempt to
procure vital
Statistics for
Florida.


In explanation of this arrangement of work and recital of
events, it may be stated that the plan has been followed for
the past two years because it was desired in the first place to
show a due appreciation of the efforts of the sections, and.
secondly to have the several divisions tell in their own language
what has been accomplished during the year, the successes met
with as well as disappointments and difficulties incurred, and
for each to suggest means for the future improvement of their
institution. A careful reading of these reports as made to the
Executive Officer cannot fail to give a very clear and compre-
hensive idea of the extent and nature of the labor performed
by the different divisions, and which, when considered col-
lectively, make up the work of the State Board of Health of
Florida for the year 1914.
The general health of the State for the past year has been
exceedingly good; it might almost be said to have been
"excellent" were it not that the word "excellent" might unin-
tentionally mislead the reader, by suggesting that there had
been an absolute absence of all ills which might or do affect
mankind; a condition which can never be attained until the
human race shall have reached a state of ideal physical perfec-
tion. It can be authoritatively stated, however, that preventable
diseases have been less in frequency during 1914 than in
previous years, except possibly in typhoid fever and that there
has been an increasing development and interest in sanitary
activities on the part of the people, as is likewise shown by a
steadily decreasing morbidity. It is to be regretted that a broad
statement of this character cannot be supported by figures and
well worked out statistics, but as yet the Vital Statistics of
Florida have not been so tabulated that a positiveness can be
shown by tables and other collected data. A plan to procure this
most necessary information is being attempted by the Executive
Office, and has been in progress of acquiring for the.past year.
The movement, however, has been slow, not from a lack of
honest trial on the part of the executive office to stimulate pub-
lic opinion and individual interest, but because those who
should be most concerned could not be made to see the great
importance which well collected vital statistics would be to
communities singly and to the whole state, collectively. The








STATE BOARD OF HEALTH OF FLORIDA


Statistician of the Board tells in his report how far he has gone
in an effort to obtain information relative to mortality statistics
and the expectation for final accomplishing of this most desired
end. Unless tabulated vital statistics are accurate or within
ninety per cent of accuracy, a limited information of this
kind is worthless in studying the causes of sickness and for
working out methods to lessen the occurrence of disease and
lengthen the life of man. The value of vital statistics in health
work and general sanitary management is of incalculable
importance and those engaged in an effort to "keep people
well" realize this more than the average citizen, to whom vital
statistics present only an array of figures, and to the general
run of readers figures are always mystifying and uninteresting.
Educational measures along the line of improvement of the
human race are usually gradual and cannot be hastened faster
than the mental development of a people will accept and admit.
The importance of a subject has to be gone over and over,
and then some more, before facts are accepted and advice fol-
lowed. This hesitance to agree to propositions which acknowl-
edged teachers in certain callings are insisting upon comes not
so much from a spirit of antagonism as from a mental lethargy
and indifference-a "show me" disposition-in order to be
convinced.' Once convinced, the battle for health and health
allies is won, especially when it can be shown that commercially
the gain is one where dollars and cents counts equally or if
not more with comfort and contentment. Unfortunately this
unconcernedness about things pertaining to healthful living
applies with equal force and argument to the general subject
of personal hygiene and sanitation as it does to any particular
branch thereof, and it is only by persistent and insistent plead-
ing, coaxing and arguing and more particularly and especially
through educational means in public teaching, it can attain to
even- a fair degree of acceptance of worked out truths and
means and measures directed against preventable diseases.
Health is the greatest asset commercially as well as for house-
hold happiness-domestically-that a community, state or
nation can possess. The community which has the lowest
death rate or in which sickness is so diminished that it is an
almost negligible factor, is one that is prosperous in business,


Value of accurate
vital statistics.



















Indifference to
teachings on
matters concerning
health and
sanitation.








TWENTY-SIXTH ANNUAL REPORT


progressive in civic development and happy in domestic life,
for disease brings want and poverty and sickness entails suffer-
ing with all its attendant misery.
The efforts of the Executive Officer have been directed for
past years in an educational campaign to the value of general
Individual and individual hygiene. Individual responsibility in health
responsibility matters has been urged upon the people in press bulletins and
in other writings from the Executive Office so often that the.
expression has become the "slogan of the Board." As the
constant dropping of water will wear away flinty surfaces in
time, so it is hoped that the constant and insistent urging which
the Executive Officer is pressing upon the attention of the
people of Florida in a general conception of personal responsi-
bility in the manner of healthful living, may wear away that
indifference and apathy which too often comes and is allowed
to exist, in the absence of a general prevalence of some con-
Wanting to dotoo tagious disorder. The pendulum of alertness often swings
epidemic, then too far in the opposite direction, when fear takes the
place of reason, and "a wanting to do too much of an unneces-
sary character" supersedes rational action.
If the Executive Officer of the Board can convince each
citizen of the State that he or she should constitute himself or
herself the sanitary guardian and watchful warden of his or
her own household, to see that the tenets of hygiene and sani-
tary science are strictly followed in the care and management
of all that comes under their supervision and control, the
general tone of the State's health will not only be vastly
improved, but will be more than improved, will soon be raised
to the highest anticipation of possible perfection. Reference
has been made to the means adopted to convey this information
and the extent of exact knowledge of which, practical sani-
tarians possess on the subject. People must be taught that
indifference to Nature's requirements and an open violation
of the laws of health will assuredly meet with punishment.
Uncleanly habits and immoral practices which jeopardize
health-and all immorality tends to destruction of the natural
vital force of resistance to disease-will undoubtedly pay the
penalty of disregard, "even unto the third and fourth genera-
tion." This is Nature's law, and all natural laws, that is to









STATE BOARD OF HEALTH OF FLORIDA


say, those which pertain to human conduct in health or morals
are inexorable and unrelenting in their operation. Experience Teaching thro-gh
the eye rather than
has taught the Executive Officer that people learn quicker and by the ear.
remember longer that which is seen-that which is taught
through the eye-than what is told them by speech. The mind
seems to receive a more lasting impression by sight than by
words, and the picture thrown on the screen whether instruc-
tive or merely amusing is remembered longer, than a verbal
description would be, and while there has been an honest
endeavor to interest the reading public of the State in sanitary
subjects, by short terse articles on hygienic and allied topics
through the HEALTH NOTES and in weekly press bulle-
tins, and it is believed that the attempt at public instruction
in this direction is appreciated, yet it is felt that there is still
something lacking to round up or complete a system of instruc-
tion in sanitary schooling which will reach those who read
indifferently and who usually skip over articles of advice about
health, because they think that they are "too deep" for them
to understand or are lacking in sensational interest. Per-
haps this is true. If so, it then becomes the duty of those who
are charged with educating the public along health lines to
adopt other methods to reach an inattentive ear or a sluggish
brain. Appreciating the difficulties which lie in the way of
verbal or written instruction in educational measures of this
nature, it has been thought that the cause can be better served
by placing before the people plans, models and pictures illus-
trating the several methods by which health is conserved and
improved. An attempt of this kind was tried out at the meet-
ing of the American Public Health Association in December
of last year in Jacksonville. The results justify the Executive
Officer in enlarging the scope of informing the people in this
direction by adding to the "exhibit" many suggestive hints
to healthful living and to place the same "on the road" under
the control and direction of one of his Assistants and Sociologi-
cal Workers, that the people everywhere in the State may
receive useful instruction in methods and ways which experi-
ence and study has taught to be of practical advantage in
upbuilding the health of the home and community. There- The State Board of
fore commencing the early part of this month-February- Health's Exhibit.
fore commencing the early part of this month-February-









TWENTY-SIXTH ANNUAL REPORT


The Health Train
of The Louisiana
State Board of
Health.





















Referring to the
Legislature of
Florida giving
sanction for the
State Board of
Health to expend
funds for health
train.


the State Board of Health's "Educational Health Exhibit"
will be a prominent feature in teaching the principles and
fundamental doctrine of preventive medicine.
The plan for community education in health matters
adopted by Dr. Oscar Dowling the distinguished Health Officer
of Louisiana, by which he instructs the different sections of
his State through the agency of a health train equipped with
all needful means to demonstrate the subjects taught and the
lessons to be learned in personal and civic hygiene, is an ideal
one for popular teaching of the public in this direction, and
one which can be made effective through the State anywhere
that a rail line is operated or a side track exists. His health
train consists of three Pullman cars converted into exhibit
rooms, two for the purpose of demonstration and one for liv-
ing quarters for the attaches of the Doctor's office who are
necessary to operate and assist him in his lectures. The Rail-
road Commission of Louisiana allows the roads in the State
to haul this health train anywhere, and in fact the Inter-
state Commerce Commission of the United States has given
permission as an educational measure, for any railroad in the
United States to extend this courtesy if they wish to do so.
Realizing the importance of health instruction it is not known
that any railroad has ever refused Doctor Dowling's request
for free transportation of his exhibits. If the Legislature of
Florida would give its sanction to the State Board of Health
to expend some of the health funds in an educational measure
of this kind, or make a special appropriation for the purpose,
it is felt that a very noticeable improvement in the health and
personal hygiene in the rural districts of the State would soon
be noticed.
In the absence of exact and trustworthy information as
regards the nature and extent of preventable diseases in the
.State during the past year, and which, if vital statistical data
which could be depended upon, had been obtainable, which
the Board should have had-recourse must be made to the
reports of the different bacteriological laboratories to learn
the number and character of the specimens and cultures which
have been sent to them for examination and determination.










STATE BOARD OF HEALTH OF FLORIDA


These reports furnish probably the best index of the num-
ber and varied grouping of diseases of a preventable nature
which under existing conditions can be obtained. It must be
remembered, however, that the accompanying tables only show
approximately the cases and their number which have been
reported for it is unlikely that medical attendants have sought
from the laboratories information for all complex troubles
coming under their care or that each fever patient or one
affected with obscure throat symptoms has been reported to
either the local representative of the State Board of Health or
to the Executive Office.
In his report the Senior Bacteriologist, commenting upon
the prevalence of some of the "preventable diseases"-infor-
mation concerning which he has gathered from the reports of
the other laboratories-expresses the belief that in general there
has been a lesser occurrence of these disorders in 1914 than in
1913. Typhoid fever was the only disease showing a larger
number of specimens received and a higher percentage of posi-
tive examinations. This may be more apparent than real, be-
cause it is thought that physicians have made more use of the
laboratories during the past year than in previous years, a fact
which Dr. Hanson comments upon also. So it is just barely pos-
sible that the seeming increase of number of specimens and their
positiveness in typhoid has been altogether due to a more fre-
quent recourse to expert determination of the character of the
sickness, which a laboratory examination gives, than to a
greater degree of prevalence of this disorder. A dependable
morbidity report each week from the physicians of the State-
not of the names of the patients, but only the number of certain
illnesses coming under their observation and treatment-would
soon settle the question, which the Executive Officer has always
contended for, that Florida has a low morbidity rate as well
as a low mortality rate per thousand of population, but he has
never been able to prove the contention by figures, for they
were lacking.
Some of the diseases classed under the heading of pre-
ventable disorders are oftentimes so obscure in symptoms as to
be unrecognizable even to those who have had extended experi-
ence in treating them. For instance: Smallpox of late years


Reports of
preventable
diseases obtained
from the
laboratories of
the Board.










Referring to the
prevalence of
preventable
diseases as shown
by laboratory
reports.














Morbidity reports
each week would
settle the question
of a low morbidity
rate for Florida.








Preventable
diseases being
sometimes so mild
as not to be
recognized.









TWENTY-SIXTH ANNUAL REPORT


Showing the
mortality rate for
1914.









Why not accept
the measures
which science
advocates for
preventing
disease.


has been so exceedingly mild, causing so little constitutional
disturbance, that the true nature of the contagion has been
overlooked and not appreciated until perhaps a more violent
disturbance has called particular attention to the viciousness
of the eruption with more emphatic clinical manifesta-
tions. This reasoning is applicable to malaria and typhoid
fever, except however, that a differentiation is more easily,
obtained between these two diseases if the microscope is used,
or when, if that instrument of precision and diagnosis is not
available, a prompt reference is made to one of the laboratories
of the Board. It can be understood, therefore, that, with the
element of doubtful diagnosis, and mistaken clinical interpre-
tation, it is not an easy matter to be able to state the
exact number of preventable diseases occurring in any one
year, but it is believed that the morbidity rate as well as the
mortality rate in Florida for 1914 has been greatly lowered
over previous years. The statistics of mortality which the
Board has been enabled to obtain from the cities having a
population of 2,000 and over, where reports have been received
fully within ninety per cent of accuracy, seem to fully attest
the correctness of this belief, and would tend to the further
feeling of certainty that all manner of sickness which most
generally precedes mortality, has also been materially cut
down in extent of prevalence.
From the four largest cities in the State having an aggre-
gate population of 165,691, of which 101,186 are white and
64,505 colored, it is found that.the mortality rate for 1914 was
17.5 per thousand of population; 14.5 for whites and 22.1 for
colored, and excluding non-residents the rate was 15.6, for
white residents 12.3, and for colored 20.6; all other than
whites are included in the colored enumeration.
But with the knowledge which is so widespread, in regard
to preventive measures against special diseases, the question
can well be asked, "Why should people have smallpox, typhoid
fever, malaria, or diphtheria? Why should not the measures
which science in its multiform teaching asserts to be preventive,
be accepted, and why should sickness with loss of working
ability, which means loss in money, and all the attendant
expenses, worry, anxiety and discomfort, be preferred to








STATE BOARD OF HEALTH OF FLORIDA


health, vigor and mental activity and alertness, the possession
of which allows the individuals to enjoy the pleasurable things
of life? Can any sensible person give a reasonable objection
to accepting and adopting propositions for keeping well and
avoiding the sick bed? Yet the appalling statement is made
by statistics that over half a million of human beings die each
year from preventable disease; a sad commentary upon the
boasted intelligence of the twentieth century. Is not sympathy
wasted on a person who contracts smallpox or allows a mem-
ber of his family to be infected? Rather should not such a
perverse individual, after his physical punishment, be punished
by law for being a common nuisance, a stigma on intelligence
and a possible charge and a money imposition on the public
which his more provident neighbor must help to bear ? It would
be a righteous and even-minded act for the law-making power
of the State to declare that a failure to be protected against
smallpox is a misdemeanor on the part of a citizen, punishable
when so reported, and further because the disease is prevent-
able, that every one having smallpox should be required to
defray all expenses consequent upon such sickness. Where
large numbers of persons are employed in construction work or
in industrial plants, the employer should be made responsible
for all charges and bills of attendance, isolation and mainte-
nance of cases of smallpox occurring in their camps, plants of
construction work, of railroad building, phosphate mining or
other industrial institutions. It has been frequently said, but
the remark is worth repeating, "A man would be considered
either an idiot or a fool if he should refuse an insurance against
fire for his home free of any cost to himself." How many
men when a property consideration is concerned and a com-
mercial aspect is placed upon an offer of this kind, would
refuse? Yet daily the State is offering free insurance against
smallpox by vaccination; an insurance not only against a sick-
ness which is loathsome to the individual himself and repulsive
to family and friends, but an insurance against disfigurement
and perhaps death itself, and this offer is rejected. When it is
stated that there were 583 cases of smallpox in the State of
Florida in 1914 officially reported to the State Board of Health
and that these cases of preventable disease cost the taxpayers


The failure to be
protected against
smallpox a
misdemeanor.



Any one
contracting
smallpox to defray
all the expenses.




Employers should
be held responsible
where a large
number of men are
employed.








TWENTY-SIXTH ANNUAL REPORT


of the State over $10,000.00, is it a wonder that health authori-
ties cease to have patience and forbearance when dealing with
prejudiced individuals, who to maintain a foolish and unproven
contention against vaccination will endanger not only their
own lives but will sacrifice the lives of innocent and helpless
Referrien to the beings, the children under their charge? These individuals
vaccination could well be adjudged of unsound mind, for any human
being so mentally defective as not to be amenable to reason in
matters so vitally important as those affecting health are a
menace to any community by reason of a mental deficiency
and should be adjudged criminally responsible for his or her
acts; as much so as for seditious talk, or inciting a riot. A
burglar takes in money value what in time may be replaced.
He is a criminal nevertheless. Those who oppose preventive
measures against smallpox, typhoid fever and diphtheria are
in the opinion of the writer, criminals of the same class as the
midnight assassin or murderer. The only difference is one of
degree and in favor of the assassin, for the victim may have
an opportunity to defend his life, or escape, while in the other
case, innocent children are made to pay the penalty of vicious
perversity. Too strong language cannot be used in condemna-
tion of those who not only actively oppose preventive measures
for "keeping well' but likewise those who manifest an indif-
ference to the subject and who while acknowledging the teach-
ings of the State Board of Health as being correct, yet fail to
practice what they believe and are convinced of. When citizens
of the susceptible age to typhoid fever, between ten and fifty
years can be protected for less than one dollar, and when sta-
tistics show that about only one person in one hundred thous-
and, when protected contracts typhoid fever, and when further
statistics show that every case of typhoid fever is an expense
to some one of about five hundred dollars, is it not surprising
that aside from the "sick-bed" consideration, that prevention
does not appeal more strongly to every one who is susceptible
if only from purely a commercial standpoint? The same potent
argument may be used for all other of the preventable disor-
ders. Health means ability to work. Work means a capableness
to accumulate and acquire a comfortable competency which
e disentas means comfort and ease. It is only the stupid person who








STATE BOARD OF HEALTH OF FLORIDA


fails to see the advantages which prevention against disease will
bring to him. The Executive Officer trusts that the Board will
pardon the show of strong feeling on this subject of "Preven-
tion" against disease which has been indulged in, and with
which so much space in discussing the health affairs of the
State during the past year has been taken up. He feels how-
ever, that like strong remedies which sometimes are needed
to cure, strong and forcible language is required to awaken
the people to their own danger from a procrastinating indif-
ference in which a vast number have fallen. They need to
be aroused from a lethargy in which they are unconsciously
slumbering. It is the inherent right of every human to protect
his life. "Self preservation is the first law of Nature" reads
with as equal significance and force today as it did when placed
as a text at the top of a page of the old copy-writing book.
There seems to be a crazed desire by a large number of men
to carry a gun; for what? "To protect my life," is the answer.
And the occasion to use such a means of defending life does not
occur one one-thousandth times as often, as such an individual
meets up with from possible infection of typhoid fever when
traveling, or when visiting soft drink stands or eating in or
at unscreened dining rooms and lunch counters. This man
"with a gun" is willing to risk arrest, a fine, and perhaps
imprisonment for disobeying a statute of the State, which will
cost him money, besides deprive him of personal liberty, but
hesitates and is willing to take "a chance" against typhoid
fever although there is but little if any personal discomfort and
he can obtain the protection for less than a dollar. Tons of
literature have been written on this subject and tons of argu-
ment could still be printed. What the law-makers of Florida
might seriously and advantageously consider is the commercial
side of protection of the citizens of the State against small-
pox involving loss of time, which likewise means loss in reve-
nue, and more than all else imposing a burden in an equal
manner on the taxpayers, who are called upon to sustain this
expense because of a misguided and mistaken idea of "indi-
vidual right" which is thought to be granted to the prejudiced
and mulish, to do as they please, irrespective of the welfare of
others.


The commercial
side of protecting
the citizens of
Florida against
smallpox.








TWENTY-SIXTH ANNUAL REPORT


The following table compares the occurrence of those pre-
ventable diseases which the Board has gained information of
during the past year with those occurring in 1913. The com-
parison is favorable and shows a pleasing improvement.
Year Small- Typhoid Malaria Tuberculosis Diph- Rabies. Pasteur
pox Fever theria Treatment
1913 1,166 566 506 777 739 107
1914 583, 960 277 746 707 89
It is impossible to make any precise statement of the money
loss to the State which the occurrence of preventable sickness
has occasioned during the past year. Information of this
character would be interesting if it could be had, but because
of a lack of data and reported cases no estimate can be made.
Even an approximate estimate would be merely guess work
for many mild cases have been unrecognized, and this is par-
ticularly true as regards smallpox, and oftentimes through
indifference and carelessness the nature of fever cases is over-
looked. However as it has been the principal duty of the
Assistants to the State Health Office to ferret out, investigate
and trace the source of infection in the preventable maladies
to which the attention of the Executive Officer has been called,
it would seem perfectly fair that all expenses attending such
investigation should be charged against these disorders, and
therefore with the expense of the laboratories, whose opera-
tions have mainly been directed to determining and ascertain-
Cost of ing the nature of specimens for supposedly preventable sick-
preventable
disease. ness it can be stated within the limit of conservative estimate
that the preventable disorders, which should never have
occurred, have cost the Commonwealth of Florida in money
loss alone in the neighborhood of $75,000.00.
Much space has been taken up in discussing prevention of
disease as of primary importance in health management. The
subject of "Economic Value of Disease Prevention" was gone
into in a late "Press Service Bulletin" and need not be repeated
but it is believed that when a due appreciation is felt by the
people of the importance of this subject, then will morbidity
The use of be decreased in the State and mortality likewise. The advance
serums and
vaccines. made of late years in the discovery of vaccine and serums by
the use of which many illnesses can be avoided has enabled the
medical man to cut short attacks of sickness and in many









STATE BOARD OF HEALTH OF FLORIDA


instances prevent their occurrence. Vaccines made from the
dead cultures of the specific organisms of the individual suffer-
ing therefrom-known as autogenous vaccines-are now used
in warding off attacks of numerous disorders, not fatal but
annoying, that formerly were thought to have to run a specified
course. The protection as well as cure afforded the child by
early administration of diphtheria antitoxin with an immuniza-
tion protection given to members of the same family, the
prophylaxis that is the safeguarding of the individual when
bitten by a mad dog, by the Pasteur serum; the anticipation of
the action and preventing the same, of the tetanus germ, in
wounds by the anti-tetanic serum; the vaccination against
typhoid so well known; the inhibitive energy of quinine when
contesting with the malarial parasite, are all sheltering arms
which science has given to guard the human race against misery
and sickness. The first duty of a State Health management is The duties of a
State Health
to advise and recommend to the people measures which will management.
protect life, and secondly to urge the adoption of agencies
which will improve health and suppress sickness. Therefore
in discussing these subjects and presenting arguments for the
same, the Executive Officer feels that he is but following a
duty expected of him by the people of Florida.
As was remarked at the commencement of this narrative,
the happenings of the several divisions of State Health work
are told in separate reports submitted by each to the Executive
Officer of the Board and interesting accounts of the character
of labor performed is given therein. Except in a few instances
no comment need be made by the Executive Officer unless it
be to commend the efforts of the chiefs of the different sections
and to express his thanks for the diligence which they have
exercised in the trusts committed to them. There are, how-
ever, one or two matters connected with the Veterinary Depart-
ment of the Board and to laboratory and other management to
which it is desired to call your special attention.
First, the free distribution of hog cholera serum to the Free Distribution
farmers of the State, and the annoying features of free distribu- f hto h"era
tion, of the statute which was passed at the session of 1911. farmers.
It is not thought that the Legislature when passing this bill
contemplated what an enormous expense they were fastening










TWENTY-SIXTH ANNUAL REPORT


Regarding the
intent of the
Legislature
concerning
this Act.














Quoting the letter
of the Attorney
General.


upon the State nor what a drain upon the State Board of
Health's financial resources it was imposing. It is further
believed that the intention of the Legislature was-whether
so expressed or not-that only a moderate sum should be
expended by the State Board of Health under strict supervision
of the Veterinarian of the Board to demonstrate the usefulness
of the serum as a preventive of hog cholera and that if found
successful, then the farmers to purchase the product, which
would be a reasonable proposition, involving a commercial
aspect. It is not believed that it was ever contemplated by the
Legislature which enacted the law that one-third of the State
Board of Health's income should be expended in caring for the
health of a swine industry, the protection of which through
preventive measures was to enrich the producer or benefit the
exploiter.
The Attorney General of the State expresses this opinion
in almost the same tone, as his letter shows:
Tallahassee, Fla., September 25, 1914.
MY DEAR SIR:-Yours of the 16th inst., has been received. I note your
inquiry, as follows:
"The demand for free hog-cholera serum on the part of our farmers,
has reached such proportions that this Board must seek some means
of limiting the amount of serum which it will supply. At the present
rate of distribution of serum it will require probably one-fourth of the
income of this Board, this year. Will you be kind enough to express an
opinion upon the point as to whether the State Board of Health can,
under the present law, Chapter 6167, 1911, decide the amount it will supply
to an applicant."
The Statute on the subject, Chapter 6167, Acts of 1911, is as
follows:
"SECTION 1. The State Board of Health is hereby authorized and
empowered to establish, maintain and operate a plant for the protection
and distribution of hog cholera serum for the purpose of distribution to
the farmers of this State upon application therefore.
"No cost shall be charged by the State Board of Health for the hog
cholera serum so distributed."
Replying to your inquiry I will say that while the furnishing of hog
cholera serum to the farmers of this State is a matter of great public
importance, it is relatively of less importance than the protection and
preservation of the health of the people of the State, and, therefore, I
would say that the Legislature could hardly have intended that your
Board should use so much of its annual income in furnishing such
serum to the farmers as would interfere with the necessary work of the
Board in looking after the public health.
The necessary conclusion is that while as much of the fund as pos-
sible should be used for the first named purpose, this should not be
done to the disadvantage and neglect of the other, and my judgment is
that the law should be thus interpreted.
Respectfully, (Signed) T. F. WEST,
A ttorney-General.









STATE BOARD OF HEALTH OF FLORIDA


Illinois is the only other State in the Union which gives
away without cost hog cholera serum and in Illinois it is
understood that.only about twenty-five per cent of the requests
for the preventive is supplied to those soliciting this gratuity.
In consultation with the Veterinarian of the Board, Dr. Dawson,
he tells the Executive Officer, and his language is quoted as
nearly as can be remembered, that:
"As no Government can hope to furnish free serum ad Dr.Dawson's
opinion of
libitum and as no government is attempting it, it does not furnishing hog
cholera serum to
appear wise for Florida to do so. Yet a government has a the farmers of the
State free of
certain duty to perform in fostering its agricultural interests, charge.
It can profitably expend the taxpayer's money in demonstrating
the value of preventing and eradicating those animal diseases
that threaten the prosperity of the agricultural interests. In
the case of hog cholera, it could, with perfect propriety furnish
the farm demonstration agents now in the employ of the
State, with certain amounts of serum and virus to prevent out-
breaks of this disease. Florida is already a great hog raising
state, and will become a greater hog producing State if it can
be demonstrated that hogs can be protected from cholera. Not
only will the number be materially increased, but more import-
ant still, will be the fact that the breed will be improved,
because it costs little more to produce good breeds than it does
poor ones. In this way all agriculture will be improved. What
benefits the farmer benefits all, and the farmer should be given
the kind of help that will help himself. The Veterinarian or
his Assistants going to every farm and inoculating every hog
as fast as they are born should not be thought of. It is a never-
ending job, and also a thankless one. The plan that I would
recommend is to have a man in every section, a man of them-
selves to treat the hogs of a community, much in the same way
as certain men now do the castration work of a neighborhood.
Let the farmers' clubs get together and make it a community
affair. It would be very easy now.to effect such organizations,
as they already exist to a certain extent and only need being
put on a sounder basis. The State bought $21,160.78 worth
of serum in 1914. Had not a limit been put on the free distri-
bution, it is highly probable that the amount would have
reached $35,000.00."









TWENTY-SIXTH ANNUAL REPORT


Tick Eradication
and building of
dipping vats.
















Interest in
Escambia in tick
eradication.


What Dade County
is doing in tick
eradication.


Dr. Dawson thinks that $10,000.00 would be all the State
ought to expend another year in demonstrating the value of
serum, and that the expenditure ought to stop almost entirely
after the State has been thoroughly organized along the lines
which he suggests.
Second, as regards cattle tick eradication, provision for
which was made by the Legislature of 1913, Dr. Dawson gives
the information through his report that there are fifty dipping
vats in the State. These, with one exception, that at Gaines-
ville built for educational purposes, have been constructed by
private enterprise. There has been comparatively little interest
manifested in the subject during the year. Texas fever is
usually a chronic disease and like many other important diseases
even in the human being, creates little interest because it works
its damages slowly, has been here for years and therefore
creates little scare. The people who lose cattle from acute tick
fever are, in many instances, settlers and are told by natives it
is an acclimation fever and the cow did not have sufficient
constitution to stand it. If our native cattle actually died of
acute tick fever like our hogs do of cholera, we might expect the
same interest to be shown in tick fever as in hog cholera,
Two counties have shown some interest in tick eradication
during the year, Escambia and Dade counties. While it is not
known what Escambia county has done along the line of
actually getting ready to build vats and dip cattle, it is known
that the county commissioners of Dade County have voted a
sum of money sufficient, with the aid from the owners of the
cattle and from private sources, to build all the necessary vats
and hire inspectors to supervise the dipping, spraying and
hand picking of cattle every two weeks regularly for five
months, the time necessary to carry on this work of eradication
in order to completely rid Dade County of the tick. Dade
County is not a cattle county, that is, all its cattle are dairy
animals. She has nothing to ship out and therefore should be
the last county in the State that we should expect to eradicate
ticks. However Dade County is expecting to become a cattle
county and is, therefore, wise in fixing herself to begin the
business with the great advantage of not having to raise cat-
tle under conditions which the tick produces. The drainage









STATE BOARD OF HEALTH OF FLORIDA


of the Everglades has opened up vast tracts of excellent pasture
land, and now that citrus canker threatens the citrus industry,
her people are looking to other profitable means of gaining
a livelihood. This they can certainly find in the cattle business
under tick-free conditions, as these drained lands grow pasture
grass in profusion.
Dade County could, under tick-free conditions furnish all
the dairy products needed in that part of South Florida, and
even other less favored sections. There would be no deed for
canned milk and cream or for shipping milk and cream from
counties two hundred miles away, as is now the case. All the
dairymen are in the movement of clearing the county of ticks.
It is a very small job as all the cattle in the county are located
near Lemon City. A few are scattered here and there along
the railroad, one or two at a place. These are to be hand picked
free of ticks. At other places spraying will be resorted to.
There are no range cattle.
When the actual work of eradication begins it will be neces- Quarantining
sary for the Board to quarantine all the ticky area of the United ticky countries.
States. The same restrictions must be placed on ticky cattle
for everywhere as is now placed on Florida cattle going out
of the State. Those shipping cattle into Dade County from
any ticky country must furnish certificates to the transporta-
tion company and to the State Board of Health that the ani-
mals have been properly dipped for destroying ticks. This
quarantine will be as perpetual as the tick in the United States;
cannot be lifted while there is ticky territory in the United
States. When the present quarantine against Dade County
is lifted by the Federal Government the people there will be
permitted to ship to any part of the United States the beef
cattle they will probably be at that time producing.
Another advantage, the cattlemen from surrounding coun-
ties can dip their cattle and ship them into Dade County for
grazing under tick-free conditions.
Dade County has asked for nothing from the State Board
of Health up to the present time except information and moral
support. They have raised the money and probably have
enough to carry out the work. The State Board of Health
will be asked to protect their interests by declaring and main-










TWENTY-SIXTH ANNUAL REPORT


An Inspector
needed for Dade
County to
supervise the
dipping.





















Federal
authorities
raising quarantine
against Dade
County.


training a strict quarantine against other sections. All the
cattle to enter the county will be transported by the East Coast
Railroad and there is little doubt but that this company will
cooperate with the Board in carrying out quarantine measures.
One Company, the East Coast Cattle Company, does consider-
able business in the county shipping about three thousand
head of beef cattle into the county per annum. This consti-
tutes a considerable portion of the beef supply to the poorer
people of the county, and should be taken into consideration.
The Company should build their own vat and maintain the
same, but it seems good theory that the State Board of Health
should stand the expense of maintaining the quarantine against
this company. It could hardly be expected that the Company
would provide an inspector for doing the State's work, and
Dr. Dawson recommends the appointment of a man at Fort
Pierce to act as Live Stock Agent at that point. The salary
of such a man should be about $300.00 a year. His duties
would be to supervise the dipping and write certificates for
same. Possibly he might be taught to test the dip and see that
it was of proper strength.
It is highly important that the people take more interest
in the question. It does not seem fair to spend such large sums
of money on hogs and practically nothing on cattle. It is true
the people are not demanding the expenditure as in hog cholera,
but that is because those engaged in the cholera campaign can
more quickly produce results to satisfy the farmer, and justify
their appointment as agent, by talking "hog cholera." It takes
less than a year to produce a marketable hog, and three years to
produce a marketable steer; therefore the hog is a money crop
for the year. His feed is also more readily produced, and I
think upon the whole a more intelligent class of people are in
the hog business.
When Dade County is ready for actual work it will be
necessary for the State Board of Health to ask for Federal
cooperation.
This means an inspector will be sent to see that the actual
work is being done according to approved methods. The
county will never be freed of the tick quarantine unless the
Federal Government is invited to cooperate. This service will









STATE BOARD OF HEALTH OF FLORIDA


cost the State nothing, and will not be given except upon the
request of the official body in Florida having charge of animal
diseases.
Besides hog cholera and tick eradication-Texas Fever-
to which special attention is directed, there will be found much
other interesting matter touched upon and discussed in the
report of the Veterinarian of the Board. To those who are
especially concerned in the care of live stock and the diseases
of the lower animals, their protection against disease, and the
economic management of the industry, the deductions of Dr.
Dawson should be exceedingly entertaining and instructive.
A person is either sick or he is well. That is to say, if
the functions of life are being properly and healthfully per-
formed he is well, or if there is a condition existing which
deviates from the normal by actual visible symptoms, such a
person is sick. Now then if a certain organism, which is Carriers of
usually associated with a specific disease is found either in
the dejections or secretions or on the mucous surface of an
individual, and the individual does not show any clinical evi-
dence of the disease which that organism, when pathogenic,
is supposed to represent the type of, the question can be well
asked, "Is such an individual well or sick?" If well, what
particular damaging influence has the organism referred to,
being inert, on the health of another person with whom the
person harboring this class of bacteria unfortunately may
come in contact? Reference is especially had to supposed
"diphtheria carriers." The contention is not that there may
not be organisms resembling in form and shape the diphtheria
bacillus in the throats of school children, when examined indis-
criminately, but whether, when cases of clinical diphtheria
have not previously been found among children of a class room,
are these children, who are otherwise clinically healthy,
although showing the presence of the diphtheria bacillus in
their throats, a source of actual danger to other children in the
school?
The question is serious and deserves careful consideration
whether organisms, which the laboratories state to be of a
form and a character peculiarly denotive of a contagious dis-
order or infectious nature can remain inert, and take on a









TWENTY-SIXTH ANNUAL REPORT


virulent action only under conditions which lower the vitality
of the individual and his natural resistance to disease inroads,
or are always virulently pathogenic. For the practical value of
such determination and conclusion affect in a very important
Habits degree the action of public health officials. The habit which
helth of school children unfortunately have of exchanging pencils and wetting
children. the points, is not only an uncleanly one but a custom well
calculated to transmit many diseases, not only in those who may
be mildly clinically infected with diphtheria, but likewise with
the streptococcus infections; an infection which causes severe
constitutional disturbance. It can well be insisted upon, that it
should be the duty of the teacher in charge of a class room to
correct filthy habits of this kind as well as to prevent the inter-
change of fruit biting, gum swapping, or lunch eating, where
or when one child bites a portion and allows his or her "chum"
to do likewise. If "carrier cultures" could be tested out on
normal and perfectly healthy humans, the results would be
conclusive-one way or another, but who will permit this?
Certainly no parent, even if the health authorities wished to try
it out. The colon bacillus is constantly present in the intesti-
nal tract of the human and belongs to that group of bacteria
of which the typhoid bacillus is a kindred member. In
morphology and under the microscope there is a striking
resemblance one to the other. If, therefore, the colon bacillus
can remain constantly in the intestinal canal of the human
being, without harm or hazard to the individual harboring this
form of bacteria, or to others whom he comes in contact with,
why is it not possible that bacteria of similar shape-unless
maintained to be constantly virulent-lie dormant until a
lowered vital resistance occurs, which then makes it a virulent
organism ?
Bacteriological The bacteriological laboratories of the Board, of .which
laboratories there are six in number including the central laboratory at
Jacksonville, have done most efficient service during the past
year. From the reports of these useful aids to the people in
determining a speedy nature of sickness much valuable infor-
mation is gained.
The number of specimens examined have been 34,780 and
it is exceedingly interesting to learn the character of the








STATE BOARD OF HEALTH OF FLORIDA


examinations made. The tables which will be found elsewhere
give information that serves as an index as has been hereto-
fore referred to, of the health status of the State and the pre-
valence of certain disorders in the several sections of the
commonwealth. It will be noticed from a study of these tables
that other public health work, than what is usually followed in
laboratory routine, has occupied a large portion of the time
of these institutions. Bacteriological examination of drink-
ing water used in railroad coaches and in other methods of
public transportation of the people, which must be certified to
semi-annually by the Executive Officer of the Board and which
is required by the United States Public Health Service, take
up much of the time of the laboratories. Mention is made of
.this fact to direct attention to the extent and character of the
work done.
The Senior Bacteriologist, Dr. Hanson, discusses in the
report of the Central Laboratory, of which he is the head, the
subject of disease carriers. That is to say the existence of
certain pathogenic organisms in otherwise healthy persons,
who manifest no clinical evidence of the disease for which
the organism in question is supposed to be the type and equiva-
lent. The Executive Officer may be expressing very heterodox
opinions and may earn the reputation of being extremely radi-
cal in his views, but he cannot bring himself to believe that all
instances of so-called "carrier infections" when speaking of
outbreaks of certain of the infectious disorders, are really and
actually due to the presence of certain bacteria, which classed
as harmful may take on under certain unknown conditions, a
virulent action, are nevertheless unsupported epidemiologically
by clinical symptoms. While results obtained from experi-
ments of the transmissibility of disease of this nature on the
lower animals are fairly conclusive, yet, there will always exist
an element of doubt as to whether the same germ impress is
felt by them as would be the case in human inoculation. Here
objections are reasonable for it was not known until human test
cases were had in yellow fever transmission, that the virus
of yellow fever was only transmitted through a special species
of mosquitoes and that it was non-filterable. In a series of


Scope of
Laboratory work








TWENTY-SIXTH ANNUAL REPORT


Diphtheria examinations lately made in the Central Laboratory of the State
examinations for
determining the Board of Health, in over five hundred throat swabs sent in from
prevalence of
diphtheria in DeFuniak, less than two per cent showed the presence of the
DeFuniak.
diphtheria bacillus, but a great many did show a streptococcus
infection. There had been during the year quite a sprinkling
of cases of sore throat at DeFuniak which had been diagnosed
as diphtheria, and on request of one of the prominent phy-
sicians, a large number of outfits were supplied because he
thought that in no other way could it be determined whether
the continuance of the throat trouble was due to "carrier cases"
or not. The information is yet lacking of how many of the
specimens submitted for examination the symptoms bore out
the probable clinical diagnosis of diphtheria, and whether all
possible sources of infection transmission have been included in
the swabs collected. It is hoped that this information may be
had before this report goes to press or to the Governor, because
it may have a very decided bearing upon public health manage-
ment of this disease, and in connection with public health educa-
tion and a supervision of the health of the child in the public
schools. There are many good reasons for believing that in
the prevalence-limited or extended-of typhoid fever,
if it were possible to trace the source of the infection it would
be found that immediate or indirect "contact" played a more
important factor in distributing the contagion than did
"carriers," for in the study of the histories of several of the
outbreaks of typhoid fever attributable to carrier cases the
analysis made by rational reasoning show many vulnerable
points not in keeping with what is known as well established
facts in the etiology of this disease. More experience and
investigation is yet necessary both in the bacteriological labora-
tory and by the etiological clinician, before it can be said with-
out question that the "carrier" per se, without clinical support
is such an important factor in transmitting disease organisms.
Tuberculosis work At the March meeting of the Board in Key West, three
and handling by
the Visiting Nurse. sociological workers for special tuberculosis work were author-
ized. The State Health Officer desired to have at least 15 of
these "Tuberculosis Instructors," but the Board thought
differently, and with these three the work was started. The
"Visiting Nurse" for the Western District was appointed in









STATE BOARD OF HEALTH OF FLORIDA


April. The first month of her appointment she remained in
Pensacola, her resident town, the whole month visiting patients
in that vicinity.
In October the other two were appointed and started a sur-
vey of their territories, known as the Southern and Central
Districts. These districts comprise the following counties with
population for each district: Western District, Counties 17.
Bay, Calhoun, Escambia, Franklin, Gadsden, Holmes, Jack-
son, Jefferson, LaFayette, Leon, Liberty, Madison, Santa
Rosa, Taylor, Wakulla, Walton, Washington. Population
(1910) 238,902. Central District: Counties, 24. Alachua,
Baker, Bradford, Brevard, Citrus, Clay, Columbia, Duval,
Hamilton, Hernando, Lake, Levy, Marion, Nassau, Orange,
Osceola, Pasco, Putnam, St. John, St. Lucie, Seminole, Sumter,
Suwannee, Volusia. Population, (1910) 274,869. (Jackson-
ville is not included in this district as they have a city nurse.).
Southern District, Counties, 9. Dade, DeSoto, Hillsborough,
Lee, Manatee, Monroe, Palm Beach, Pinellas, Polk. Popula-
tion 171,639.
When it is considered that Florida has a population of
nearly a million, with an area of 54,861 square miles, it is
hardly fair to the work or the nurses, and the importance
attached to the same to attempt a report at this time. However
there were two hundred and seventy-one patients visited to
whom instructions were given. Of this number 207 were
white and 64 colored.
Many times owing to poor railroad facilities in some com-
munities, time is lost in getting about or a too hurried visit
to patients and physicians is unavoidably made. These workers
even against such odds have made good headway and show
what could be accomplished with a full working corps of intelli-
gent women. Many hardships are encountered, such as belated.
train schedules, poorly prepared food in out of the way places,
and uncomfortable sleeping conveniences, but they always
find the patient reported, even though it takes a long walk, or
drive or row boat trip combined, to reach the destination.
It can easily be seen that with such large territories to
cover, these workers cannot keep in the close touch with
patients that is necessary to make them earnest and helpful


Divisions of the
State into Districts
for work of
Visiting Nurses.








TWENTY-SIXTH ANNUAL REPORT


themselves. Then too, the nurse feels that she cannot devote
as much time to one community as is sometimes thought to be
necessary, in order to help the family over the first few days
of reorganized methods of living. Then too, a great many of
the patients will be dead before she can return, which will tend
to make the family lose confidence in the Home Treatment plan,
as there are from day to day little things that the family feel
that it can talk over with a nurse, rather than their physician
who is always to them a busy man. Unfortunately, many
times they have lost faith in the doctor because of his seeming
indifference to their particular case.
To perfect the plan of assisting the consumptives of the
State in better hygienic living, with the hope of improvement
and still further expectation of arresting the disease, the
Executive Officer should be permitted to enlist not less than
fifteen supervisors in this health work, so that it may be pos-
sible to get a more accurate history of the sick when discovered
and thus keep them under, it might be said, constant observa-
tion.
Sick people forget very easily even though they are inclined
to accept advice, and too often cases of consumption occur in
families where the bread problem is an all-absorbing one.
There is little time left from the multitudinous duties of the
mother-for the burden falls on her-to sit down and consider
seriously advice which the nurse left on her last visit. There-
fore, it can be understood how necessary it is that these
unfortunates should be seen frequently in order that their hope
may be stimulated and they may observe and fulfill directions
for their own care and the protection of their loved ones.
This corps of sociological workers would mean an annual
expenditure of $18,000.00 with added expense for traveling,
making an appropriation in all of about $30,000.00 for this
one purpose-the "Prevention of Tuberculosis"-which is not
an unreasonable sum for the State to expend in an effort to
lessen the number of cases as well as to hold out hope to those
already sick, of having their disease arrested.
This plan for an anti-tuberculosis campaign is a more feasi-
ble, rational and practical way of dealing with the disease than
by institutional treatment. In the latter only comparatively


Plans to enlarge
the scope of the
work and obtain
better results.








STATE BOARD OF HEALTH OF FLORIDA


few can be reached, and a great majority of whom there is no
accurate information, continue to sow germs of the disease,
which multiply cases, and thereby lessen the working capacity
of this state. Labor means production. Production a money
increase, therefore, everything that tends to decrease the work-
ing force of the citizen, likewise occasions a money loss.
In an address delivered to the Federation of Women's
Clubs of Florida at Lakeland, last December the State Health
Officer went quite minutely into the value and benefit of the
"home treatment" and by sociological workers as compared
with an institutional care of the unfortunates.
It will be noticed in the reports of the Assistants to the Defectively
State Health Officer, that reference is frequently made to surfc closets.
surface closets defective in construction, as being the propa-
gating cause of hookworm and of typhoid fever through fly
infection. It is a well established fact that in this State these
two diseases owe their existence, and it can well be said con-
tinuance to the storehouses of human filth, which are faultily
built and controlled. Perhaps it will not be putting the matter
too strongly, when it is said that there is a total absence of
those conveniences, so needful to health, in many rural homes.
An official high in the educational interests of the State Rural schools
is responsible for the statement, when inquiry was made, that unprovided with
surface closets.
over fifty per cent of the rural schools of the State are unpro-
vided with surface closets of any kind. Is it any wonder there-
fore that notwithstanding the vigorous campaign which the
State Board of Health carried on against hookworm, for sever-
al years, that the effort has resulted in so little permanent
benefit, when conditions are allowed to continue-soil pollution
-which is known to harbor the larvae which infect the feet of
barefoot children, and thus keep up the vicious cycle of hook-
worm contamination? Is it not about time that the Legisla-
ture should take cognizance of such neglect on the part of the
County School authorities and if there is no provision of law
by which surface toilets can be constructed and thoroughly
screened then to enact such a law and to make it an imperative
duty of every principal of school, rural or civic, to daily exer-
cise a supervision over these necessities for health, to see that
the interior of the buildings are kept clean and to punish








TWENTY-SIXTH ANNUAL REPORT


rigorously any defilement? The school trustees or supervisors
should be required to have the excreta from these buildings
disposed of in a sanitary manner and the grounds in and about
the buildings properly purified. If it is practicable, and there
is no sensible reason why it should not be a wise suggestion, a
legislative enactment might require that all privies or surface
closets when built without sewered areas, in any portion of the
State should be screened and made fly proof, for it is known
that typhoid fever and other of the intestinal disorders are
insect-borne and that the fly is mainly responsible for the propa-
Drinking water gation and spread of these diseases in Florida. The drinking
of the State.
waters of this State are pure; that is to say, are free from
intestinal contamination and can be safely used. It has only
occurred twice in the history of the Board that typhoid fever
has been traced to water used for drinking. When so detected
the use was forbidden and the prevalence quickly subsided.
Flies and Typhoid. Therefore, the Executive Officer is convinced in the opinion
that if the possible infection of the fly can be prevented, that
there would be a marked lessening of intestinal sickness in the
rural districts of the State and a rapid elimination of typhoid
fever. This wished for health betterment can be hastened by
compelling construction of surface privies or closets in such a
manner that flies cannot reach the wastes of the body, and carry
possible infection to food, for it is only through the digestive
tract that the poison multiplies and sickens.
During the year 6,000 letters have been received and
answered from the Executive Office in addition to which about
an equal number were answered by postals, besides much other
correspondence has been attended to, which did not call for
replies. In addition to this large mass of letter writing, 111,760
pieces of literature on sanitary subjects have been distributed
and mailed to those asking for the same. And not only to per-
sons asking for information of this kind has it been the pleas-
ure of the office to supply, but to every one who it might be
thought was at all interested in health matters, have pamphlets
been sent, on sanitary topics. The compilation of articles for
the HEALTH NOTES each month has taken up much time of
the Executive Office, and no little effort to prepare and make'








STATE BOARD OF HEALTH OF FLORIDA


interestingly readable and which together with the weekly office routine
and matters.
issue of the "press bulletin" demanded care in arranging. The
main effort however, of the Executive Office in an educational
way has been directed to imparting information to those who
seemed willing to be instructed or advised in sanitary or
hygienic matters, and therefore no opportunity has been lost
to assist any and every one seeking to be taught and set straight
on disputed questions relating to ways and manner of health-
ful living. No inquiry has ever been considered too insignifi-
cant to have prompt attention and a cheerful acknowledg-
ment. Nor has it been thought to be detracting from the
dignity of the office to say "I don't know" when only theoriz-
ing could offer an answer, and actual facts were not known.
The Executive Office has never approved of advising the peo-
ple along sanitary lines that well digested and proven out
facts could not sustain. Practical sanitation, which intelligent
people can understand and appreciate the value of, inspires
confidence: that which is based mainly on theory, is rejected
as doubtful, as being unsafe to accept.
With increased responsibilities requiring expenditures, Receipts and
placed upon the State Board of Health by each successive expenditures.
legislature and additional provisions of work and construc-
tion enacted by the Board itself at regular and called meetings,
the outlay of money from the Board's legitimate income, the
half mill tax on the assessable property of the State doubtless
appears to the average citizen to be large, but when it is taken
into consideration that the Florida State Board of Health has
a versatile field of operation not usually filled by other State
Boards of Health, and embraces within its scope of labors the
care of domestic animals as well as the human, and that the
legislatures have been particularly generous in the treatment
of the former, the maintenance of which charity to the com-
mercial interests of the State is all charged against the State
Board of Health fund, the Executive Officer does not think
that he can be justly accused of extravagance in spending
money for measures which are authorized by statute and by the
Board, because results have justified the cost and it is results
that the people of Florida are looking for; results which inspire
confidence in the ability of the State Board of Health to cope








TWENTY-SIXTH ANNUAL REPORT


with problems of health management-within the State and a
manifest capability to prevent by practical means and common
sense methods disease agencies from gaining admittance, with-
out at the same time disrupting business and causing needless
alarm and financial loss.
The accompanying table will show in minute detail the
different items of disbursement and for the purposes expended.
The State Health Officer has heard that it has been asked where
has such a large sum of money gone, and for what spent? as if
there was a wastefulness of the same. Those persons need
not, had they taken the trouble to read the annual reports of
the Board, have expressed such surprise because each year for
twenty-six years a table of this expenditure has been prepared
and submitted at each annual meeting of the Board and for-
warded to the Governor of the State. Not only so made pub-
lic, but the reports have been printed and freely distributed
for the asking. Each elected member of the Legislature, Cabi-
net Officers and prominent organizations of the State have
been supplied with a copy as well as those citizens who the
the Eecutive Officer has thought to be especially interested in
State sanitation and preventive medicine. If those charged
with the conduction of public affairs of the State will not
intelligently acquaint themselves with the movements of the
different departments of the State Government, by making
the inquiry, or by investigation, the failure to be informed,
should not be charged against the Executive Officers of the
several boards.

The Expenditures Per diem and mileage, members of the Board, Feb-
in Detail. ruary, March and July meetings ............. 602.40
Office equipment, traveling expenses and remuner-
ation account special details members of the
Board ....................................... 245.11 $ 847.51
Salaries and traveling expenses, Executive Depart-
ment:
Salary State Health Officer ................... $ 3,000.00
Traveling expenses, State Health Officer........ 1,919.58 $ 4,919.58
Salaries of eight Assistants to the State Health
Officer, and one Assistant resigned ............$ 17,666.32
Traveling expenses, Assistants to the State Health
Officer ........................... ........... 4,705.19 $ 22,371.51










STATE BOARD OF HEALTH OF FLORIDA


Salaries, two County Agents................. $ 1,200.00 $ 1,200.00

Salaries of Sanitary Patrolmen, Jacksonville,
Tampa, Pensacola and Key West............$ 4,800.00
Miscellaneous expenses, sanitary patrol service.. 192.30 $ 4,992.30

Salaries, three Tuberculosis District Nurses......$ 1,375.00
Travel expenses, Tuberculosis District Nurses... 603.05 $ 1,978.05

Salaries Veterinarian of the State Board of
Health, one Assistant and one Assistant re-
signed ...................................... .$ 4,099.92
Travel expenses, Veterinary Division........... 1,560.57 $ 5,660.49


Maintenance of Executive Office, Jacksonville:
Clerical Assistance: salaries of three clerks and
office boy, and special clerical service..........$
Vital Statistics: salary and traveling expenses
of Vital Statistician, office expenses and pay-
ments for reports............................ $
General office expenses, including postage, ex-
pressage and office fixtures...................
Printing, stationery, etc........................
Telephone and telegraph tolls..................
Insurance and miscellaneous items...............

Library: equipment and maintenance ..............
Administration Building: maintenance and fixtures
Grounds, Administration Building: maintenance
and laying of driveways ................. ...
County Isolation Hospitals, Equipment and Main-
tenance:
Dade County .................................. $
Duval County ............................. ....
Escambia County......... ...................
Hillsborough. County......... :: ................

Smallpox expense, unclassified....................
Vaccine (smallpox) ...............................
Diphtheria and tetanus antitoxin, and typhoid vac-
cine for the indigent..........................
Pasteur treatment for the indigent ...............
Expense incident to uncinariasis. unclassified......
Reimbursement for glandered animals.............
Hog cholera serum....... ........................
Crippled Children: hospital and incidental expense..
Sanitary engineering .............................
Exhibits and publicity ......................... .
Bacteriological Laboratories:
Jacksonville: Salaries, Senior Bacteriologist, two
assistants, stenographer and two orderlies .....$
Equipment and maintenance..................
Construction of animal house .................


4,439.96

2,442.39

1,974.00
4,145.72
680.46
803.74






180.00
2,460.72
852.23
1,006.55


14,486.27

1,039.95
1,066.38

920.03


$ 4,499.50

1,849.38
845.00

644.90
1,480.90
593.16
1,700.00
21,160.78
5,172.47
100.00
1,159.41


7,897.92
2,534.65
2.284.00 $ 12.716.57


Tampa: Salaries two bacteriologists, steno-
grapher and janitor.............. ........$ 4,171.60
Equipment and maintenance.................. 1,402.33 $ 5,573.93









TWENTY-SIXTH ANNUAL REPORT


Pensacola: Salaries of one bacteriologist and
office boy ....................................$ 2,229.92
Equipment and maintenance................. 864.49
Laboratory building......................... 6,145.56 $ 9,239.97

Miami: Salary one bacteriologist .............$ 333.32
Equipment and maintenance................... 1,386.78 $ 1,720.10
Tallahassee: Salary one bacteriologist ........$ 166.66
Equipment and maintenance.................. 395.91 $ 562.57
Key West: Equipment and maintenance ........$ 511.32 $ 511.32


Total expenditures, 1914 .......


$129,012.03


January .........
February ........
M arch ...........
A pril ............

M ay .............
June .............

June and July....
July .............
August ..........
September .......

October .........
November. ......

December .......


Regular
Requisition
$ 3,882.64
3,904.64
3,903.64
4,436.60
4,682.60
4,611.60

4,525.10
4,640.10
4,644.11

4,894.73
4,689.10
4,781.76


Special
Requisition
$ 3,271.83
4,060.86
3,634.59
869.65
3,891.34
5,667.52
1,932.12
4,706.60
750.00
2,946.13
4,030.32
4,076.33
5,451.98
750.00
4,323.68
1,370.74
6,375.62
4,234.41
3,658.80
750.00
79.31
3,349.22
2.788.97


Returned to


Co
$


mptroller Total
.... .... $ 7,154.47

... .... 11,600.09
.05 8,664.58
... .... 12,036.24
8.11 9,381.09

.... .... 8,307.73
... .... 4,030.32
8,601.43
8.60 10,083.48


21.06 11,067.47
... .... 11,270.35
... .... 12,582.31


2,483.21 ......... 14,232.47

Totals.......... $53,596.62 $75,453.23 $ 37.82 $129,012.03

Total Receipts, 1914......... ... ................... $129,049.85
Returned to Comptroller, 1914........................... 37.82
Total Amount Expended, 1914...........................$129,012.03

In view of the fact that the railroad companies operating
in the State have all expressed a willingness, and in one or
two instances a desire to extend to the employees of the State
Board of Health, the courtesy of free transportation over their
lines, it does not seem improper or inconsistent with either
the morals or rectitude of the State that such offer should not


Receipts.









STATE BOARD OF HEALTH OF FLORIDA


be accepted, particularly as a saving to the Board's treasury
would be effected each year of many thousand dollars. Accord-
ingly at the last session of the Legislature a bill was prepared
and introduced whereby the employees of the Board, when
traveling on the Board's business, would be permitted to accept
free transportation from the rail and steamboat companies in
the State, and the companies also be granted permission to
give the same. As there cannot be any virtuous obliquity in
this enactment, especially as sheriffs of the State who, by law,
are entitled to and do receive mileage fees when executing the Freetn
transportation of
mandates of a court, are given passes, and .further as State State Board of
.Health employees
Health Officials are performing a quasi-philanthropic duty in when travelling on
health missions in
an endeavor to promote and protect the health of Florida's the State.
citizens, it does not seem that there should be any opposition
on the part of the Legislature to grant this concession. While
the State Board of Health cannot be said to be a purely elee-
mosynary institution-and these are exempted from the restric-
tions against passes-yet, there is an element of charitable
work in the efforts put forth by the Board, which without any
great stretching of word construction could bring the employees
of the Board within the scope of the privilege and not violate
the spirit of the law. The "pass privilege" to employees of
State Board of Health is given in a great many States of the
Union, and in some no pass except the showing of a badge
is required when a representative of the Board is traveling on
public and official duty connected with the execution of health
statutes or to carry out the purposes of health management.
The bill prepared and introduced for the purpose of obtaining
the legislative consent to the measure requested by the State
Board of Health, while meeting, it is understood, with' the
approval of the majority of the legislative body individually,
yet failed to pass, because, it was disapproved of by the Rail-
road Commission. On what grounds this disapproval was
made is not apparent, nor is it known that any was given.
It is not believed that the purport of economy and efficiency
to the State which a measure of this kind would fulfill, could
have been thoroughly understood. Precedents have, been
established in this regard in other States, and the advantage in
quick action and frequent investigations, without having to









TWENTY-SIXTH ANNUAL REPORT


hesitate and weigh the cost of travel should certainly appeal
to the thoughtful citizen and to all who are deeply concerned
in the conservation of health with the greatest measure of
economy. If the Board will interest itself in bringing to the
attention of the Governor and lawmakers a provident pro-
vision of this kind, it is believed by the Executive Officer that
any untoward hostility would be overcome, especially when a
money saving, which the transportation companies are willing
to donate, could be plainly shown. The members of the State
Board of Health, who under the Statute have their traveling
expenses provided for by a specified mileage, are under the
Constitution, as Officers of the State, appointed by the Gover-
nor, forbidden to accept "free transportation" but the Execu-
tive Officer of the Board and his Assistants together with all
others connected with the executive office, are employees of
the Board and if the Legislature will permit cannot be
affected by any Constitutional restriction.
crippled This report would not be complete if due mention was
children. not made of the most excellent work accomplished during the
year under the provisions of the "Crippled Children" Act, a
measure which was passed by the Legislature of 1911. The
account of operations performed and results obtained is found
elsewhere in the very admirable report of Dr. Raymond C.
Turck, and is very interesting and instructive reading.
Since the passage of the bill authorizing this charity by the
State Board of Health, Dr. Turck has had full charge of the
surgical management of these cases in the correction of limb
deformities of indigent children of the State, who alone under
the conditions of law are the beneficiaries of the State's charity
in this respect.
Work The thanks of the Board should be extended to Dr. Turck
accomplished for
the crippled in the warmest manner of commendation, for the valuable and
indigent children, skillful service that he has given these helpless little ones, who,
without his expert professional knowledge so generously given,
would still be helpless and pitiable. The assistance which the
Statute permits to be given to children who are deformed in
limbor limbs, or.who through sickness, accident or at birth,
are unfortunately deprived of the use of any of-the extremi-
ties of. the body to .an .extent. which would prevent them from-,









STATE BOARD OF HEALTH OF FLORIDA


earning a living later on in life, is a praiseworthy effort on the
part of the State to provide an opportunity to transform a
helpless cripple into a useful self-sustaining citizen. The State
Board of Health appreciates the confidence shown by the
Legislature when it confided this care of suffering humanity to Building or ward
Snow necessary to
its supervision. As the number of crippled children applying care for crippled
children.
for relief, is increasing each year, the Board should consider
the necessity for providing for their care in a building owned
and operated by the State Board of Health in accordance with
the terms of the Act. The provision to board these indigent
children in hospitals or other institutions was to continue only
until the number requiring aid and help increased to such
proportion as would warrant the Board in erecting a hospital
of its own for the purpose.
Dr. Turck believes ,that this period has been reached and
that the Board should cast about for a fit location on which
to put up a suitable building, properly equipped for all pur-
poses which a corrective treatment of every manner of
deformity might demand. Possibly it is thought that the
St. Luke's Hospital Association might be induced to donate
sufficient space on its grounds to erect a ward to be operated by
the State Board of Health in connection with the management
of St. Luke's Hosiptal and the opinion has been advanced
that such construction along modern lines for a ward especially
designed for the correction of deformities could be completed
for twenty-five thousand dollars. The "up-keep" and main-
tenance of such a ward would depend largely on the number
of children admitted, but hardly appreciably more than is now
paid for the sustenance of the patients at St. Luke's and Brew-
ster Hospitals. This is a matter which deserves the earnest con-
sideration of the Board, and its importance should not be
overlooked.
From all that has been written and discussed in these pages
and the arguments submitted, what recommendations are
further necessary or thought to be, to increase the healthful-
ness of the people of Florida as a State, and to help individual
citizens thereof in keeping well and avoiding causes of sick-
ness it is imagined can be easily anticipated. Omitting for
the moment the third person in which style of writing reports









TWENTY-SIXTH ANNUAL REPORT


The State Health of this kind from the Executive Office have heretofore been
Officer assumes all
responsibility for made, and which is usually adopted, the State Health Officer
statements made
in this report. wishes to assume entire responsibility in opinions expressed
and is altogether answerable for any dogmas which may be
.considered dissenting and in opposition to customary or
accepted views of bacteriologists. This explanation is made
that the Board may not be embarrassed if entertaining different
views and opinions from those expressed by the State Health
Officer, and which might mislead the public if the Board held
contrariwise ideas. To further improve such conditions per-
taining to health, which will lessen sickness of all kinds, lower
the death rate of the State, and incite the people to a greater
activity in suppressing preventable diseases, the State Health
Officer submits the following recommendations:
Recommendations First. That the intention of the present State statute which
proposes to guard the health of the traveling public against
typhoid fever and allied disorders, by well screened kitchens,
Screening food dining rooms, and "hallways leading thereto" shall have its
against ies, protective powers enlarged by statute so that all meat shops,
butcher shops and markets, grocery stores, where food is sold
for consumption in the raw state, fruit stands, railroad lunch
counters, and other places where food is served to wayfarers
and itinerants, and all dining and buffet cars operated in the
State, shall be well screened by wire netting, with mesh
sufficiently close as not to admit flies. Not only shall these
places of food disposal be screened but it should be made the
duty of owner, occupant or operator to see that there are no
flies in the dining rooms, kitchens, dining or buffet cars, or
other mentioned places.
Surface closets Second. That by legislative enactment, all surface closets
should be fly-proof.
shole y-proofand privies used for the deposit of human excreta shall be fly
proof in construction, .and in conformity with plans recom-
mended and approved of by the State Board of Health. This
plan of building is easily erected and inexpensive to construct.
Third. That also by legislative enactment, all school
boards in this State shall be compelled to have every school
building provided with adequate facilities for Nature's Con-
veniences by either water carriage or surface closets, separate
for sexes, and in rural districts where sewerage systems do









STATE BOARD OF HEALTH OF FLORIDA


not exist, the surface closets to be of fly-proof construction.
That the trustees or supervisors of a school shall be held
strictly accountable for the cleanliness and good morals per-
taining to such buildings. The condition of these buildings
and the care exercised in keeping them in proper sanitary state
should be a matter of investigation and presentment by the
Grand Jury of a County at each term of a circuit court.
Fourth. That the Legislature be urged to vitalize the
statute of 1899, establishing the Bureau of Vital Statistics
under the supervision of the State Health Officer as Registrar
of said Bureau, by amendments providing for the practical pro-
visions found essential by other states; the statute to provide
for urban registration at first and later for complete state-
wide registration, rural as well as urban, when and as the
time is deemed ripe. And that all records and data relating
to the life and health of the people of the State now in posses-
sion of the Board and which can hereafter be collected, be
properly and safely housed, kept, indexed and published by
said Bureau, so as to be of the utmost use and value.
Also that all possible data of Morbidity, the statistics of
sickness, the most important of all vital statistics, be gathered
and made useful by the said Bureau, and that the above amend-
ing legislation make special provision for the Board to have
power to make rules and regulations of full force and effect as
law for the collection of such records.
Fifth. That the Legislature be requested and earnestly
petitioned to permit by enactment the transportation com-
panies operating in Florida to give passes to the employees
of the State Board of Health when traveling on official busi-
ness of the health department and in the interest of health con-
servation. The argument for such request, is economy to the
State and a more prompt and efficient service to the people.
Sixth. That the existing statute requiring the State Board
of Health to furnish hog cholera serum free to the agricultural
interests of the State be so amended as to direct that this pre-
ventive of disease to the swine of the State shall only be given
free for demonstration purposes; the free distribution to be
withdrawn when information in the use of the serum has been
gained by competent instructions. The argument for this


Recommendations
concerning Vital
Statistics.



















Recommending
free transportation
be allowed
employees of the
Board on State
business.




Withdrawing free
hog cholera serum.








TWENTY-SIXTH ANNUAL REPORT


recommendation is that to issue hog cholera serum as a gratuity
to any one for the asking would very soon bankrupt the. State
Board of Health's treasury, and it is not supposable that the
Legislature when passing this measure ever contemplated
embarrassing the operation of the State Board of Health in
its special charge of looking after the health of the people,
by imposing an obligation of so evidently an agricultural com-
mercial proposition, in detracting so much of the Board's
annual income from the really legitimate purpose called for by
the Constitution of the State, in Article Fifteen of that Instru-
ment.
isitingt ases 'Seventh. That legislative sanction shall be sought towards
oink tuberculosis improving the pulmonary tuberculous of the State, of whom it
is variously estimated there are about fifteen to twenty thou-
sand, by the home treatment of the disease under the care and
management of the State Board of Health, through a corps
of intelligent and trained sociological workers, who distributed
throughout the State in designated districts may frequently
visit the sick of this disease and give needful information
respecting individual treatment, by hygienic and sanitary
rules. This advice to be extended to the family that it too
may know how to avoid contracting the disease, and may
make surroundings of the sufferer more comfortable and
safer to other members. The argument and reasons for this
Recommendation are set forth in detail elsewhere in the text
of this report, and;
Hospital Eighth. That as soon as the funds of the State Board of
for Crippled
Children. Health will permit a hospital for crippled children shall be
erected and equipped in accordance with the terms of the Act
of 1911 providing for the same.
In conclusion, the State Health Officer wishes to express
his thanks and appreciation to every member of the Executive
Office, which includes the laboratory divisions, for the dili-
gence which has been shown in carrying out the duty and
apportionment of work which has been given to each to fulfill.
By a cheerful and willing cooperation my associates in health








STATE BOARD OF HEALTH OF FLORIDA 47

work have shown a deep interest in the welfare of the insti-
tution, which is greatly appreciated. To yourself and the
other members of the Board the State Health Officer expresses
his grateful acknowledgments for the generous support given
him in executing the policies of the Board.
Respectfully submitted,
JOSEPH Y. PORTER,
State Health Officer and Executive
Officer of the Board.










Treatment Administered for its


Jacksonville
Dowling Park
Ft. George
Newberry
Dowling Park
Dowling Park
Dowling Park
Dowling Park
Dowling Park
Newberry
Tampa
Jacksonville
Ocala
Live Oak
Ocala
Ocala
Ocala
Ocala
Live Oak
Jacksonville
Jacksonville
Jacksonville
Tampa
Tampa
Tampa
Tampa
Tampa
Tampa


Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Saliva
Saliva
Saliva
Bite
Bite
Bite
Bite
Bite
Bite


HYDROPHOBIA
Prevention, by the State Board of Health, During 1914


Lip
Hand
Thumb
Cheek
Leg
Buttock
Thumb
L. Thigh
Thigh
Hand
Head and Arm
Finger

Calf Leg
..............


Arm
Hands
Hands
Hand
Hand
Leg
Hand
R. Leg


Jan. 4

Jan. 5
Dec. 1
Jan. 17
Jan. 17
Jan. 17
Jan. 17
Jan. 17
Dec. 10

Feb. 17

Feb. 20




Mar. 11
Mar. 11
Mar. 11
Mar. 12
Mar. 16
Mar. 16
Mar. 16
Mar. 16


<

Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Rat
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog


*Io

Clinical
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies


Begun Ended

....... .......
Jan. 8 Jan. 28
Jan.11 Jan.31
Jan. 19 Feb. 8
Jan.20 Feb. 8
Jan.20 Feb. 8
Jan.20 Feb. 8
Jan.20 Feb. 8
Jan. 21 Feb. 9
Jan.23 Feb.12
Feb. 12 Mar. 3
Feb.20 Mar. 12
Feb. 25 Mar. 17
Feb. 26 Mar. 18
Feb.27 Mar. 19
Feb. 27 Mar. 19
Feb. 27 Mar. 19
Feb. 28 Mar. 20
Mar. 6 Mar. 26
Mar. 16 Apr. 5
Mar. 16 Apr. 5
Mar. 16 Apr. 5
Mar. 24 Apr. 13
Mar. 24 Apr. 13
Mar. 24 Apr. 13
Mar. 24 Apr. 13
Mar. 24 Apr. 13
Mar. 30 Apr. 19


.-



Indigent
Indigent
Indigent
Paid
Indigent
Indigent
Indigent
Indigent
Indigent
Paid
Indigent
Paid
Indigent
Unsettled
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent







470 45 M
471 11 M*
472 34 F
473 30 F-
474 5 F
475 33 M
476 57 M
477 Ad .
478 Ad F
479 Ad M
480 16 F
481 21 M
482 36 F
483 Ad M
484 26 F
485 9 M
486 9 F
487 25 M
488 33 F*
489 12 M*
490 6 M
491 45 F*
492 45 F
493 7 M*
494 7 M
495 .8 M
496 11 M
497 55 F*
498 20 M
499 4 F
500 Ad M
501 36 M
502 18 F
503 boy
504 31 M
505 42 M
506 10 M*
507 5 F


Tampa
Live Oak
Tampa
Newburn
Tampa
Tampa
Tampa
Jacksonville
Jacksonville
Jacksonville
Greenwood
Zephyrhills
Jacksonville
Jacksonville
Jacksonville
Tampa
Tampa
Jacksonville
Sneads
St. Augustine
Oklawaha
Oklawaha
Jacksonville
Micanopy
Green Cove Spgs.
Jacksonville
Jacksonville
Madison
Bartow
Jacksonville
Tampa
Cedar Keys
O'Brien
O'Brien
S. Jacksonville
Tampa
Hawthorne
Havana


Saliva
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Saliva
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite
Bite


Thumb
R. Hand
Finger
L. Leg -
Wrist
R. Thumb
Leg
.......Finger...
Finger
Finger
Hip
Thumb
Thumb
Finger
Hand and Legs
Leg
Thumb
Hand and Arm
Shoulder
R. Hand
Arm
Hand and Leg
R. Leg
Buttock
Leg
Thumb
Foot
Ankle
Leg
Leg
Thumbs
Leg
Leg
Finger
Hand and Foot
Leg
Hand


Apr. 8
Apr. 23
Apr. 27
Apr. 22
Mar. 31

Apr. 29
May 7
May 7
May 7
May 7
May 9
May 11

May 19


May 28
May 31
Jun. 8
Jun. 8
Jun. 12
Jun. 9
Jun. 14
Jun.13
Jun. 21

Jul. 11
Jul. 9
Jul. 24
Jul. 22
Jul. 23
Jul. 23
Aug. 6
Aug. 6
Aug. 14
Aug. 17


Cow
Dog
Dog
Dog
Cat
Dog
Dog
Dog
Dog
Dog
Dog
Hog
Cat
Cat
Cat
Cat
Cat
Dog
Dog
Dog
Dog
Dog
Dog
Cat
Dog
Dog
Cat
Cat
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog


Negri bodies
Negri bodies
Negri bodies
None
Inoc. Rabbit
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Clinical
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Clinical
Clinical
Clinical
Negri bodies
Negri bodies
Clinical
Clinical
Suggestive
Clinical
Clinical
Negri bodies
Clinical
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Clinical
Clinical
Negri bodies
Negri bodies


Apr. 14 May 4
Apr. 30 May 20
Apr. 30 May 20
May 1 May 21
May 2 May 22
May 4 May 27
May 5 May 25
May10 May30
Maay 1 May 30
May 10 May 30
May 12 Jun. 1
May 16 Jun. 5
May 16 Jun. 5
May 21 Jun. 10
May 21 Jun. 10
May28 Jun. 17
May 29 Jun. 18
May31 Jun.20
May 31 Jun. 20
Jun. 3 Jun. 20
Jun. 12 Jul. 2
Jun. 13 Jul. 3
Jun. 15 Jul. 5
Jun. 19 Jul. 7
Jun. 18 Jul. 6
Jun. 18 Jul. 6
Jun. 24 Jul. 14
Jul. 9 Jul. 29
Jul. 16 Aug. 11
Jul. 18 Aug. 9
Jul. 27 Aug. 16
Jul. 27 Aug. 16
Jul. 30 Aug. 19
Jul. 30 Aug. 19
Aug. 17 Sep. 6
Aug. 18 Sep. 7
Aug. 20 Sep. 9
Aug. 26 Sep. 15


Paid
Indigent
Paid
Paid
Paid
Paid
Indigent
Paid
Paid
Paid
Unsettled
Indigent
Indigent
Unsettled
Paid
Paid
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Paid
Indigent
Indigent
Indigent
Paid
Paid
Paid
Paid
Indigent
Indigent
Paid
Paid
Indigent
Paid











Treatment Administered


6





508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530


HYDROPHOBIA-Continued
for its Prevention, by the State B4


0


FU
F
M
M
M
M
M

F
F
M
M
M
M
M
M
M
M
F
F

M
M
*


.u 0




Havana Bite
Havana Bite
Havana Bite
Havana Bite
Live Oak Bite
Ocala Bite
Tampa Bite
Micanopy Bite
Perry Bite
Perry Bite
Perry Bite
Perry Bite
Perry Bite
Monticello Bite
Tampa Bite
Gainesville Bite
Tampa Bite
Dowling Park Bite
Newberry Bite
Lithia Bite
Tampa Bite
Lithia Scratch
St. Augustine Bite


board of Health, During 1914


-z
U


Foot
Foot
Foot
Fingers
R. Thumb
Abdomen
Arm
Toe
Ear and Face
L. Leg
Forearm
L. Elbow
L. Elbow
Head & Hands
L. Knee
Hand
Finger
Hand
Forearm
..............
Hand
r andL
Upper Lip


0-
o'



Aug. 17
Aug. 17
Aug. 17
Aug. 17
Aug. 18
Aug. 26
Sep. 1

Sep. 3
Sep. 3
Sep. 3
Sep. 1
Sep. 3
Sep. 10

Sep. 25

Oct. 1

Nov. 12
Nov. 25


4C

Begun Ended


Ca



Dog
Dog
Dog
Dog
Kitten

Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Dog
Cat
Dog
Dog
Dog
Dog
Dog
Dog
Dog


W -6
US




Negri bodies
Negri bodies
Negri bodies
Negri bodies
Clinical
Clinical
Clinical
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Negri bodies
Clinical
Negri bodies
Negri bodies
Clinical
Negri bodies
Clinical


Aug. 26
Aug. 26
Aug. 26
Aug. 26
Aug. 27
Aug. 31
Sep. 3
Sep. 9
Sep. 9
Sep. 9
Sep. 9
Sep. 12
Sep. 12
Sep. 14
Sep. 28
Sep. 30
Oct. 4
Oct. 26
Oct. 28
Nov.21
Nov. 29
Nov. 30


Sep. 15
Sep. 15
Sep. 15
Sep. 15
Sep. 16
Sep. 20
Sep. 23
Sep. 29
Sep. 29
Sep. 29
Sep. 29
Oct. 3
Oct. 3
Oct. 4
Oct. 18
Oct. 20
Oct. 24
Nov. 15
Nov. 17
Dec. 11
Dec. 19
Dec. 20


9
8
11
38
5
6
10
10
3
36
7
5
6
7
14
13
10
6
7
10
19
45,
8 mo.


Paid
Paid
Paid
Paid
Indigent
Indigent
Paid
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Indigent
Paid
Indigent
Paid
Indigent
Indigent
Paid
Paid
Paid
Indigent


*Colored


I I








STATE BOARD OF HEALTH OF FLORIDA


EXPLANATORY NOTES.

Case 442: Child could not be located when treatment
arrived. Treatment canceled.
Case 461: Patient had scratches on arm and was licked
by dog after showing symptoms of rabies.
Case 462: Patient had sores on hands and arms, sup-
posed to have been licked by rabid dog.
Case 463: Sores on hands of patient licked by dog hav-
ing symptoms of rabies.
Case 470: Patient had hand in cow's mouth. Crack in
skin on thumb supposed to have become infected.
Case 478: Abrasion on second finger of patient received
saliva of dog found to be rabid.
Case 493: Cat had been bitten by mad dog prior to biting
child.
Case 512: Animal had several convulsions morning of
biting boy. Was killed and head submitted to State Board of
Health. Found negative. Animal inoculation resulted in
death of inoculated animal, from unknown cause. There hav-
ing been a number of rabid animals in Live Oak some time
prior to the bite, treatment was considered advisable.
Case 525: Dog that bit child had what is known as "black
.tongue;" was killed and head carried to physician, who told
parents there was no danger, and threw head in river. Later
on a dog that had been bitten by this dog went mad. Treatment
was then ordered through another physician.
Case 528: Two dogs and pig bitten by dog same day as
patient, developed disease about November 26.
Case 530: Because of location of bite, treatment was
ordered immediately and dog held under observation. Dog
was found not to be rabid, and treatment was canceled.

HISTORY OF ANIMALS FOUND POSITIVE FOR
RABIES BY MICROSCOPICAL EXAMINATION

Case 444: Dog, family pet. Showed practically no symp-
toms of rabies previous to bite, except being a little peevish and
irritable. Child was playing with animal at time bitten.









TWENTY-SIXTH ANNUAL REPORT


Case 445: Pet dog. Had heavy cold. Neighbors
thought dog mad. Not known how infected. Ran a mild
course and died.
Cases 446, 447, 448, 449: Dog viciously attacked four
men, severely biting all of them. Escaped, but later found,
killed, and head submitted for examination.
Case 450: Bitten by same dog as in case 446 but at dif-
ferent time.
Case 451: Bull terrior. Had at first loss of appetite and
was gaunt and lazy, developing later an apparent pneumonia,
paroxysms of whining as if in severe pain which became more
frequent and more severe until death occurred.
Case 452: Dog bit child severely, as well as a number of
dogs in neighborhood.
Cases 455, 460: Parties instructed to shut dog up, which
had become vicious and wanted to snap and fight everything
it came in contact with. However, owner killed dog and
submitted its head for examination.
Cases 461, 462, 463: A bull puppy about eight months old
bitten by dog passing through at night. Gradually developed
pronounced symptoms of rabies. Killed and head sent to State
Board of Health laboratory for examination.
Case 470: Cow died, and head sent to laboratory for
examination.
Case 474: Pet cat. Head examined by microscope, but
no trace of Negri bodies found, March 31. Rabbit was then
inoculated, which died April 28, and upon microscopical
examination, showed presence of Negri bodies.
Case: 475: Pet French poodle. Showed practically no
symptoms.
Case 480: Dog. Was attacked several weeks before by
dog at night For several weeks before being killed would
notice no one.
Cases 483, 484: Cat attacked patient in yard. Patient did
not see cat, as it came up behind her. Cat was killed while
biting and scratching patient.
Case 499: Dog. Barking, biting, wandering from home.
Died of convulsions.
Case 500: Dog. Killed by police department.









STATE BOARD OF HEALTH OF FLORIDA


Case 501: Dog. First symptoms, July 12; distemper;
couldn't get up. Mad spasms of throat and legs; would not
eat or drink; had cough. Dog killed.
Cases 502, 503: Dog. Snapping and biting other animals.
Case 506: Strange dog from Johnson station reached
Hawthorn in morning and began traveling from one house
to another biting dogs and at one house bit colored baby.
Owner claims dog was seemingly in normal condition the
evening before, ate supper heartily, but attacked cows and
hogs that night, and then left home.
Cases 507, 508, 509, 510, 511: Symptoms not definite;
dog acted suspiciously for several days, dying in convulsions
soon after. Had been diseased with mange for some time, and
got to snapping at all children coming in contact with. On
fifth day after biting children, the dog drank water, had a fit
and died.
Cases 516, 517, 518, 519, 520: Pointer, 19 months old.
Began by acting restless, became cross, snapping everything
near. No appetite, very restless. Dog killed and head sent
to laboratory.
Case 521: Dog. Quiet and friendly until night before
patient was bitten. Was in fight with several dogs in owners'
yards that night and was not seen again until neighbor's child
was bitten next day.
Case 523: Boy helping to catch dog, which was running
about without muzzle, when dog bit him. Dog was playful and
ate after biting child. Dog presented almost no symptoms of
rabies.
Case 529: Dog. Foamed at mouth. Saliva and foam
covered patient's hands while holding dog. Received scratch
on palm of hand.

DEATHS FROM HYDROPHOBIA, 1914.
Ellaville, Madison County-N. H., aged negro, died No-
vember 8th. Walking to his home in country at night, and sat
down by roadside to rest. Dog passed by and growled. He
scolded it, and struck it with coat, when dog jumped at him
and bit him over the eye. The wound readily healed and noth-










54 TWENTY-SIXTH ANNUAL REPORT

ing more was thought of the matter until November 6th, when
patient had convulsion. These continued for forty-eight hours,
resulting in death November 8th. (From Suwannee Demo-
crat, November 12th issue.)

HYDROPHOBIA
Treatment Administered for its Prevention, by the State Board of
Health, During 1914
DISTRIBUTION OF CASES BY COUNTIES AND TOWNS
.. Total

County and Town .
- IS '= og t o


ALACHUA ........ 2 ...... 1 1 2 1 .... .. 7
Gainesville ......... .... ... .. .. 1.. .. 1
Hawthorn ........ .. .... .. .. .. .. .. .. 1
Micanopy ....... .. .. .. .. .. .. 2
Newberry ......... 2 .. .. .. .. .. 2.. 3
BAKER ............ .. .. .. ... .. ..
BA Y ....... .... .. .. .. ..
BRADFORD ................ ... .. ..
BREVARD ......... .. .. .. .. ...... .... .. ..
CALHOUN .............
CITRUS .............. .. .. .. .. .. ...
CLA Y .............. .. .. 1 .. .. .. .. ..
Green Cove Springs .... ...... 1 .. .. .. .. .. .. 1
COLUMBIA .............
D A D E ................ .. .. .. .. .. .... .. .. .. ..
DE SOTO........... .. .. .. .. .. .. .. ..
DUVAL ............ 2 1 .. 7 3 1 1 .. .... .. i8
Fort George....... 1 .... .. .. ... 1.
Jacksonville ....... .. 1 .. .. .. .. .. 16
South Jacksonville. .. .. .. .. .. .. 1
ESCAMBIA ....... .. .. .... .. .. .
FRANKLIN ... ... ...
GADSDEN .........5 .. .. .. .. 5
Havana ........... .. ..... .. .. 5
HAMILTON ........
HERNANDO ........... .. .. .. .. .. .. .. ..
HILLSBOROUGH.. 1 6 2 5 .. 1 2 1 3 .. .. 22
Lithia ............. .. . ...... 2 2
Tampa .............. 1 6 2 5 .. 1 1 2 1 1 .. 20
HOLMES .... ... ..
JACKSON .......... .. 2... .. .. .. .. 2
Greenwood ....... .. ... 1 . ...
Sneads .............. 1 .. .. ... 1
JEFFERSON ....... .. .. .. ... 1 ..
M onticello ........ .. .. .. .. .. 1 .... .. 1
LAFAYETTE
LAFAYETTE ....... .. .. .. .... .... .... .. ..
LA K E ................ .. .. .. .. ..
LEE .................. . ..................










STATE BOARD OF HEALTH OF FLORIDA 55

HYDROPHOBIA-Continued

Treatment Administered for its Prevention, by the State Board of
Health, During 1914
DISTRIBUTION OF CASES BY COUNTIES AND TOWNS


County and Town Z

_ _:) H U

LEON ............. .. .. .. .. ... .. .. .. .. .
LEVY ............. .. .. .... .. .. .. ....... .. 1
Cedar Keys ....... .. .. .. .. 1 .. .... .. 1
LIBERTY .......... ...... ............ .
M ADISON ......... .. .. .. .. .. .. 1 .. .. .. .. .. 1
M adison ......... .. ... .. .. .. 1 .. ... .. 1
MANATEE ......... .... .. ....... ..........
M ARION ........... .. 5 .. .. 2 .. 1 .. .. .. .. .. 8
O cala ............... 5 .. .. .. .. .. 1. .. .. .. .. 6
Oklawaha ......... .. ... .. .. 2 .. .. .. .. .. .. 2
MONROE .......... .... .. ...... .. .. .. .. .... ..
N A SSAU ............. .. .. .. .. .. .. .. .. .. .. ..
O RAN GE ............. .. .. .. .. .. .. .. .. .. .. ..
O SCEO LA ........... .. .. .. .. .. .. .. .. .. .. ..
PALM BEACH.......... ... .... .. .. .. .. ..
PASCO ............. .. .. .. .. 1 .. .. .. .. .. .. 1
Zephyrhills ........ .. .. .. .. 1 .. .. .. ... .. 1
PINELLAS .... ... ... .. .. .. .. .. .. .. ..
POLK .............. .. .. .... .. .. ... .. .. 1
Bartow ........... .. .. .. .... .. 1. .... . 1
PU TN A M ............ .. .. .. .. .. .. .. .. .. .. .
SANTA ROSA................. ... .... .... .
SEM INOLE ........ .. .. .. ... .. .. .. .. .. .. .
ST. JOHNS.......... ... 1 .. .. .... 1 .. 2
St. Augustine ......... .. .. .. 1 .. .. ... It 2
ST. LUCIE.......... .. .. ... .. .. .... .. ....
SUMTER.. .. ..
SUWANEE ........ 6 1 1 1 1.. 2 1 .. 1 .... .. 14
Dowling Park ...... 6 .. .. .. .. .. .... 1 .. .. 7
Live Oak...... .. 1 1 1 .. .. .. .. .. .. 4
Newburn ............. 1 .. .. .. .. .. .. 1
O'Brien ........... .. .. .. .. .. .. 2 .. .... 2
TAYLOR ........ .... .. .. .. ..5 .... 5
Perry ............. .. .. ...... .. .. 5 .. ..... 5
VOLUSIA........... ........ .. .....
W AKULLA .......... .. .. .. .. .. ....
WALTON ........ ...... ...... .. .. .
W ASHINGTON ...... ...... .. ...... ........


Total ............108 101 316 81 710110 3 3111 89 89
*Child could not be located when treatment arrived.
tDog.held under observation failed to develop rabies. Treatment
not given.'










56 TWENTY-SIXTH ANNUAL REPORT

REPORTED CASES OF SMALLPOX IN FLORIDA, 1914
(With Vaccinations Done*)



o U

4 V ) 0 9 o A V

Alachua ........ 33 34 6 2 1 .. .. .. .. .. .. 76 1,219
Baker ........ 1 .. .. .. .. .. .. .. .. .. .. 1 20
Bay .......... 10
Bradford ..... 1 2 .. 6 .... .. .. 3 14 250
Brevard ...... .. i 1 .. .. .... .. .. .. .. .... 2 50
Calhoun ...... .. .. 31 1 .... .... .. .. .... 32 70
Citrus........ ..1 .. 1 2 .. ..... .. ..... 4 70
Clay ......... ........ 1 1 .. .. .. .. ...... .. 2 40
Columbia ......... 2 6 .. .. 8 90
Dade .......... 2 .. .. .. .. .. ... .. .. .. .. 2 140
DeSoto ..... .. .. .. .. .. 1 .. .. .. .. .. .. 1 3
Duval ........ 20 4 13 14 6 2 .. .. ....... 59 904
Escambia .... .. 2 1 11 3 .. .... 1 .. .. .. 18 130
Franklin .. .. .. .. ..
Gadsden ...... .. i.1. .... .. .. 1 .. ... 2 600
Hamilton .... .. .... .. .. .. .. .. -.. .. .. 70
Hernando.... ...........
Hillsborough.. 1 19' 8 18 14 13. .. 1 .. .. 78 1,220
Holmes ...... ..... ........ ... ....
Jackson ...... .... 14 .. 1 ... .. .. .. 15 50
Jefferson ..... .. .. .. .. .. .... 35 11 46 360
Lafayette .... .. .. .. .. .. .. .. .. ..
Lake ......... .... .. 6 2 1 ... ..... .. 9 130
Lee ........... 3 2 .. .. .. .. ... .. .. .. 5 210
Leon ......... .. .. .. .. .. .. .. . ... .. 160
Levy ........ ... 2 2 .. .. .. .. 1 .. .. .. 5 480
Liberty ...... ...... .... ..........
Madison .... .. 1 1
Manatee ...... 1. .. ... ... .. .. .. .. 2 160
Marion ........ .. .. .. 2 ..... 1 .. .. .. .. 3 302
M onroe ...... 3 .. .. .. .. .. .. .. .. .. .. .. 3 60
Nassau ....... ... .. .. .. .. .. .. .. .. 2 .. 2 25
Orange ...... 20
Osceola ..... ...42 8 14 70
Palm Beach... .. .. .. .. .. .. .. .. .. .. .. .. .. 60
Pasco ........ .. .. .. .. .. .. .. ... .. .." 10
Pinellas ...... .. .. .. .. .. .. .. .. .. 1 50
Polk ......... .. .. 1 .. .. .. .. .. .. .. .. 2 110
Putnam ...... .. .. ...... 1 1 .. .. .. .. 3 72
Santa Rosa..... ...... 6 .. .. .. .. .... .... 6 20
Seminole .............. 2 .. .. .. .... .. .. ... 2 130
St. Johns...... 5 .. .. .. .. ..... 5 580
St. Lucie......... ...... ... .. .... .. .. .. .. .. 40
Sumter .. .............. .. .. ..... 20
Suwanee ... .. 2 .. .. .. .. .. 1 .. .. 6 18 130
Taylor ....... 1.. 4 1 .. .. .. .... .. 6 170
Volusia ...... ..33 31 68 1 1 .. 1 ..... .. 135 2,765










10 L- 0 -. a
0. 0. fft 0' 0 0) 0
( 03 0' B o 0.
-. -4 -4 -


8 X> 0f ,' w0 ff 0
o 0 0 0 0 -
C. 0. 6 I 0 6


- c .' .~
- .-. -
0o o~ O e


Soale of
Small p v
Ca soe
3200
3100
5000
2 900
2800
2700
2600
1600
2400
2300
2200
2 100

1900
1800
1700
1600
1500
1400
1300
1200
1100
1000
900
800
700
600
500
400
300
zoo
100
0


I I l ip


- -- -I I -

































Red lines represent number of vaccinations done, by years.


Scale of
Vaccine
Vsed
64000
62000
G0000
5800C
56000
54000
52000
50000
48000
46000
44000
42000
40000
38000
36000
34000
32000
30000
28000
26000
24000
'22000
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0










STATE BOARD OF HEALTH OF FLORIDA


REPORTED CASES OF SMALLPOX IN FLORIDA, 1914-Contd.
(With Vaccinations Done*)

a ,



Wakulla .....

aWalton ..... ... 1 60
-County = . =





W ashington .. .. .. .. .. .. .. .. .. 20
Vaccine points given o Assistants to State Health Officer for
general use. .. .. ..I ..I .. .. ..| .. .. .. ..I .. 1,497

Total .... 38104 133161 41 20 8 5 11 5 37 20 583 12,647

*Number of vaccinations is estimated by vaccine points distributed,
which are given out in small quantities at a time, as may be needed for
immediate use only. It is believed that nearly all vaccine points dis-
tributed are used, and that practically all vaccinations result in "takes."










TWENTY-SIXTH ANNUAL REPORT


STATUS OF WATER SUPPLY AND SEWAGE DISPOSAL IN
13 FLORIDA MUNICIPALITIES, 1914

WATER SUPPLY


Municipality



Eustis ..........


Source of
Municipal
Supply


3 drilled deep
non-flowing wells
(within 4" of
surface)


Gainesville ......Drilled deep well
and spring


Green Cove Spgs.

Kissimmee ......


Lake City.......


Leesburg .......


Live Oak........



Ocala ...........



Orlando ........



Palatka .........


2 drilled deep
flowing wells cased
2 drilled deep
flowing wells
8" and 12" casings
Deep drilled non-
flowing well

5 drilled deep
non-flowing wells
3 in service, 2
extra, all cased
2 deep drilled non-
flowing cased wells
(1 well condemned
by State Board of
Health, not used)
2 deep drilled non-
flowing cased wells
8" and 10" casings


Spring-fed lake 3-
mile in circumfer-
ence, 15 ft. average
depth
3 drilled deep flowing
cased wells


Pensacola ....... 13 driven flowing
cased wells


Sanford .........


Tampa ..........


3 deep drilled
flowing wells cased
8", 6", 3", to rock
20 deep drilled
flowing cased wells
From spring at
times


Depth
of
Wells


270' 6"
274' 6"
279' 6"
Casing
115'to
rock
365 ft.
Casing
185 ft.
735 ft.
650 ft.
379 ft.
418 ft.

400 ft.
Casing
110 ft.
Average
100 ft.
Casing
85-90 ft.
275 ft.
315 ft.
Cased
entire
depth
1220 ft.
350 ft.
Casings
300 ft.
250 ft.



178 to
190 ft.
each
Casings
80 ft.
135 ft.
Casings
135 ft.

265 ft.
275 ft.
140 ft.
165 ft. to
362 ft.
Casings
52-259 ft.


Average
Flow per
Minute
Gallons

Not
known



16,000


Not
known
Not
known
Artesian
500


500


1,000
1,200


274
258






545



950


Not
known

150


a. t

U 04
g8
no



75%




75%


40%

60%

50%


100%


60%
(All
White
Pop.)


Watershed


Inhabited ...........


Treatment


.......... None


Inhabited
Approx.
Pop. 3000


Inhabited
Septic
tanks
used
Inhabited
surface
privies
used

Inhabited
sewer for
sewage
disposal


Sedimen-
tation


Softening
by lime
and soda
ash


Spring
water
treated
with hypo-
chloride
of lime










STATE BOARD OF HEALTH OF FLORIDA


STATUS OF WATER SUPPLY AND SEWAGE DISPOSAL IN
13 FLORIDA MUNICIPALITIES, 1914



SEWAGE DISPOSAL


Municipality


Eustis ..........

Gainesville ... ..

Green Cove Spgs.



Kissimmee .....

Lake City.......

Leesburg .......

Live Oak........


O cala ...........

Orlando ........


Palatka .........



Pensacola .......






Sanford .........





Tampa ..........


Method of
Sewage
Treatment

None

Septic Tanks

Gravity system
into St. Johns
River


2 septic tanks

Septic tanks

None

Septic tanks


None

5 large, 1 small
Imhoff Tanks

Gravity system to
St. Johns River


Two cast iron out-
falls 20" and 24"
in diameter) distance
3,000 ft. from
shore into deep
water. Outer end
under 22 ft. water

Gravity system
to Lake Monroe




Imhoff Tanks
Gravity system


Year
Installed




1907

1911
Additions
in 1913


1910




1914



1913-1914


1908



1906-1908






1904
Later
added
to



1898to
present
time


Final
Disposition
of Sewage



Sweetwater Branch

St. Johns River



Lake Tohopekaliga

Lake Hamburg



Effluent from tank
runs into ground


Per Cent.
Incorporated
Area
Sewered



60 to 65%

25%
(Nearly half
population
of town)

About 50%

About 50%


Deep wells 70 %


St. Johns River



Carried away by
tidal flow in bay





Lake Monroe





Doubtful


75% of
inhabited
area

60%






Small
percentage of
incorporated
area. Thickly
settled part
of town

75%



















REPORTS OF


DR. CHAS. WM. BARTLETT,
DR. C. W. D'ALEMBERTE,
DR. J. Y. PORTER, JR.,
DR. W. P. CRIGLER,
DR. J. E. TAYLOR,
DR. M. E. HECK,
DR. C. H. DoBBs,
DR. C. T. YOUNG,
Assistants to the State Health Officer.



DR. JAS. M. JACKSON,
DR. D. G. HUMPHREYS,
Agents of the State Board of Health.










REPORT OF DR. CHAS. W. BARTLETT


SOUTHWESTERN DISTRICT

Tampa, Fla., January 1, 1915.
DR. JOSEPH Y. PORTER,
State Health Officer, Jacksonville, Fla.
DEAR DOCTOR:-Upon looking back over the records in
this office of the work done during the year 1914, for South
Florida, I find that the general condition of health has been
good.
The main two diseases in the counties of South Florida
have been typhoid fever and diphtheria; and in a general way,
the nuisances investigated and abated have been of the same
character, open closets and fly infection having played the lead-
ing part. Another source of many complaints has been the
unsanitary condition of filthy-kept butcher pens and manure
piles from stables. The unsanitary condition of private
premises has also been reported from time to time but as a
general rule, the condition has been more often due to animosity
of neighbors than really a nuisance in itself. In some of the
smaller towns and outskirts of large cities, the non-compliance
with the screening law by restaurants and hotel keepers has
been always investigated and abated. Another law coming
under the supervision of the State Board of Health, often
disregarded, is the keeping and herding of hogs within incorpo-
rated towns or cities, and this has always been ended immedi-
ately upon notification to this office, due to the fact that the
statute concerning this matter is very explicit. Information
often requested by citizens from different sections of South
Florida on hookworm infection, malaria, and water infection,
has always been cheerfully given in every case; and samples
of water supposed to be infected have always been collected
and examination made. Requests have also been made often
to this office by natives of this section of Florida now residing
in New York, for birth certificates needed for school attend-
ance, and same have been obtained and forwarded to them
whenever possible.








TWENTY-SIXTH ANNUAL REPORT


During the year we find that in incorporated towns the
sanitary condition has been good, but in all villages that we
have visited and in unincorporated towns, I find that there was
no provision whatsoever for the collection of night soil and
garbage.
As the work has progressed through the year, a special
and complete report has been made to the State Health Officer
on each and every investigation, giving full detail of the work
done, as well as to municipal and federal authorities when-
ever requested.
Before going into detail by county, it must be borne in
mind that Hillsborough being the largest county in population,
and this office being in Tampa, the center of population, we
are in closer contact with the Tampa physicians and the sur-
rounding districts; therefore, the report for this county is of
course more thorough and complete. The fact is, that the
number of scarlet fever, diphtheria and typhoid fever cases
reported by the physicians, covered nearly every case that
existed during the year in this section, which condition of
course does not prevail in the other counties.
Hillsborough At the close of the year 1913, we had two cases of small-
smalpox. pox at the isolation hospital, and during the year 1914, we had
altogether sixty-five cases of smallpox, which were divided
as follows: The highest number of cases prevailed during
April and May, there being sixteen cases in April and fourteen
cases in May. We had four months of the year without a
single case of smallpox, against two of the previous year. The
cases by months occurred as follows: January, 7; February,
12; March, 7; April, 16; May, 14; June, 6; July, 1; October,
2. Out of these 65 cases, nearly all were from the city of
Tampa; one case from Plant City; one case from Clearwater,
Pinellas County, although treated at the hospital here; three
cases came from Valrico, and one case from Jacksonville.
In connection with smallpox, vaccination for the prevention
of same has been carried on by this office throughout the year.
Diphtheria. Diphtheria has continued throughout the year, and in spite
of all precautions, such as fumigation, reporting of cases to
school teachers, keeping from school infected children, etc.. the
number of cases has been very large. We have received reports









STATE BOARD OF HEALTH OF FLORIDA


of diptheria cases from almost every section of the county. In
West Tampa and Tampa we have no less than 167 cases, the
highest month being December, forty cases, and the lowest num-
ber occurring in July and August, two cases each month. I
attribute this large number of diphtheria cases as partly due to
the reporting of all cases by the physician in attendance, this
year.
Now that our record for one year has been completed, it
has been proved that diphtheria is endemic in Tampa. The
death rate is nine for the whole year, of which September had
the largest rate, three, out of only twelve cases reported dur-
ing the month. On the other hand in the month of December
with forty cases of diphtheria reported, there was only one
death.
During the winter months, that is, from January to May, we Scarlet Fever.
had altogether ten cases of scarlet fever, of which number,
three were out of the city limits, in a close vicinity of Tampa.
From other sections of the county no cases were reported, and
although cases in town developed in the thickly populated parts,
there was no spreading of the cases. In each case the child
was isolated in his or her home, and the other children living
in the same house were removed to another building. All cases
were kept isolated for eight weeks, and were not allowed to
report to school until all signs of the disease had stopped.
Typhoid fever prevailed during the whole year, and we Typhoid Fever.
had a total of 185 cases. From the month of January up to
July, we had the largest number of cases, as follows: January
30, February 19, March 30, April 28, May 12, June 11, and July
12. Then there came a drop in the number of cases with a
slight raise again in December. There were only six cases in
August, four in September, nine in October, and five in Novem-
ber, increasing to nineteen in December.
It is well at this point to call attention to the fact that as
soon as fresh vegetables disappeared from the market, that is,
lettuce and celery, there is a considerable decrease in the num-
ber of typhoid cases, which increased again with the introduc-
tion of fresh vegetables into the market.
All cases of typhoid fever have been investigated as far as
the residence and surroundings and source of food supply are








TWENTY-SIXTH ANNUAL REPORT


concerned. Each and every case has been marked with a small
flag in the map of the city which is kept for this purpose in the
office; and here we are able to observe another remarkable
coincidence, and that is that in West Tampa, where there is
practically no connection with sewerage, the proportion of cases
according to population is less than in Tampa, there being only
thirteen cases for the whole year, while in Hyde Park we find
that in spite of having all the homes screened and connected with
sewerage, there have been no less than twenty cases. Upon
investigation, the only difference I find in the habits of the
people living on both sides of the river, is that in West Tampa
very few vegetables are consumed by the people and absolutely
no raw milk is taken by the majority of the residents there.
The fact is that in not a single case investigated by me was raw
milk taken; those not using condensed milk, had. their milk
supply boiled.
Another fact noticed is that there were no soda water
fountains in that section until the month of December, when a
new, modern, up-to-date soda water fountain was opened in
the corner of Howard and Main Streets, and coincident with
the opening of the soda water fountain and the consumption of
raw milk, we find that West Tampa had during the month of
December four cases of typhoid fever, out of the thirteen
reported for the year 1914 in West Tampa. Of course, one
single month is too early to reach any conclusion, but we shall
watch with care these developments.
Out of the 185 cases investigated we find that 32 patients
lived in screened houses; and out of these 32 cases only two
eat outside, while 11 of the patients contracted the disease
while traveling or outside of their screened homes, which leaves
only 19 cases having contracted typhoid fever in spite of living
in screened houses. Three of these last 19 cases had open
closets within 500 feet from their houses; and four other cases
that had to take raw milk out of their homes. We must also
bear in mind that a large number of people believe that by
simply screening their houses, they, are thoroughly protected
from flies, and therefore they fail to destroy the flies that get
into their premises; so that really instead of counting by
screened houses, we should count by fly-proof houses which








STATE BOARD OF HEALTH OF FLORIDA


undoubtedly would bring the number of those protected from
flies to a very small figure. It might as well be mentioned
here that although I laid stress on the fact that the people of
West Tampa were not using raw milk, we also find that those
cases using raw milk in Tampa, had not given us the name of
any given dairy often enough, to make me believe that the
milk taken was the source of infection. And in soda water
fountains, where raw milk is taken, it should not be regarded
as the only source of infection, as there is a possibility that
infection may also be transmitted by the lack of cleanliness in
the glasses furnished the customers. At the same time on two
occasions when water has been suspected of contamination, a
sample of the water supply has been collected and examination
carefully made, and no trace whatsoever found of infection in
the water.
Two new cases of leprosy were found during the year Miscellaneous.
1914. They were all advised to be kept away from public
places, and not to come in contact with other people.
There were also three cases of poliomyelitis or infantile
paralysis. These cases occurred among the Italian colony.
One case in the western part of the city of Tampa known as
Ellinger; another case on the southwestern part, and the third
case in the northeastern section of the city. There was no con-
nection between these families, and although there were several
children in each home, those mentioned were the only cases to
develop.
There were forty-one cases of chickenpox reported during
the year 1914 and they were all investigated for differential
diagnosis from smallpox.
Only one case of pellagra was reported from the county
throughout the year.
During the summer months intestinal infection among chil-
dren prevailed, but the acute milk infection or cholera infantum
was not reported, and I failed to see a single case during the
year, credit for which condition should be given to the inspec-








TWENTY-SIXTH ANNUAL REPORT


tion of dairies and milk examination carried out by the Pure
Food Department.
Polk County. The condition of health in Polk County has been good for
the year 1914. We had several cases of diphtheria reported
from Lakeland and Bartow. There were also a few cases of
typhoid fever reported. A nuisance was reported regarding
the unsanitary condition of a dumping ground used by the city
of Lakeland during the early part of the year. This was
immediately corrected by the Mayor of the city upon notifica-
tion. Also open closets surrounding public schools of which
attention was called to the Commissioner of School Board.
Examination of the ice plant of Lakeland, and investigation of
the sewerage system of Bartow were also made.
Pinellas County. Nuisances were reported on several occasions during the
year from this County, especially at Tarpon Springs, due to
the lack of sewerage connection of the Greek settlement and
butcher pens in filthy condition both at St. Petersburg and
Tarpon Springs. Several cases of typhoid fever were reported
also from St. Petersburg, Tarpon Springs and Clearwater.
Diphtheria also prevailed in the County during the year.
Manatee County. There were several cases of smallpox during the early part
of the year reported from Palmetto, and epidemic of amoebic
dysentery at Ellenton and Terra. Ceia during the latter part
of the year. Otherwise, the condition of. health was most
excellent.
DeSoto County. The health condition of DeSoto County has been good with
the exception of typhoid fever which prevailed at Wauchula,
Arcadia and quite an epidemic, considering the number of
people, at Fort Ogden. There were also a few cases of diph-
theria reported from different sections of this county during the
year.
Lee County. One case of smallpox was introduced at Fort Myers from
New York, and one case developed there. Several cases of
typhoid fever were reported from different sections of this
county. Otherwise the condition of this county wasexceeding-
ly good.










STATE BOARD OF HEALTH OF FLORIDA


Investigations of communicable diseases and sanitary nui-
sances performed outside of Tampa during the year were as
follows:


Date
Jan.. 4
Jan. 20
Jan. 31
Feb. 6
Feb. 28

Mar. 27
Mar. 29
Apr. 3
Apr. 14
Apr. 15
Apr. 27
Apr. 27
Apr. 29
Apr. 30
May 25
June 4
July 14
Aug. 17
Aug. 17
Sept. 11

Oct. 2
Oct. 5
Oct. 5
Oct. 20
Oct. 22
Nov. 1
Nov. 3
Nov. 11
Nov. 11
Nov. 11
Nov. 23

Nov. 23


Nov. 23 Dunedin


Place
Wimauma
Fort Myers
Valrico
Balm
Lakeland

Palmetto
Plant City
Frost Proof
Plant City
Tarpon Spring
Frost Proof
Avon Park
Haines City
St. Petersburg
St. Petersburg
Bartow
Tarpon Springs
Tarpon Springs
Clearwater
Tarpon Springs

St. Petersburg
Plant City
Knights Station
Tarpon Springs
Dunedin
Plant City
St. Petersburg
Ellenton
Bradentown
Manatee
Tarpon Springs

Clearwater


County Occupation
Hillsborough Smallpox
Lee Smallpox
Hillsborough Smallpox
Hillsborough Smallpox
Polk ice factory-collection water
samples for examination
Manatee Smallpox
Hillsborough Smallpox
Polk Smallpox
Hillsborough Smallpox
sPinellas Typhoid fever
Polk Typhoid fever
DeSoto Typhoid fever
Polk Smallpox and public nuisance
Pinellas Open drain
Pinellas Slaughter pen
Polk Sewage
Pinellas Oyster beds
Pinellas Sanitary- nuisance
Pinellas Sanitary nuisance
Pinellas Sewerage-sanitary nuisance,
vital statistics
Pinellas Underground drainage
Hillsborough Diphtheria
iHillsborough Diphtheria
Pinellas Sanitary nuisance-vital statistics
Pinellas Sanitary nuisance
Hillsborough Scarlet Fever
Pinellas Cesspool nuisance
Manatee Alleged epidemic
Manatee Interview with physicians
Manatee Interview with physicians
Pinellas Official trip with State Health
Officer
Pinellas Official trip with State Health
Officer
Pinellas Official trip with State Health
Officer










TWENTY-SIXTH ANNUAL REPORT


REPORT OF INVESTIGATIONS MADE DURING THE YEAR 1914
IN TAMPA.

January 1-Smallpox case Florida Avenue investigated and patient
removed to Isolation Hospital. Twelve vaccinations.
January 6-Death certificate of a German subject who was accidentally
killed at Port Tampa obtained from undertaker upon request
January 8-Smallpox case at Isolation Hospital which came from Clear-
water investigated. Nine vaccinations.
January 13-Interviewed Tampa physicians regarding their compliance
with the law reporting contagious diseases. Six vaccinations.
January 14-Interview with several of the Tampa physicians regarding
their lack of report on typhoid fever cases. Two vaccinations.
January 18-Smallpox case Estelle Street investigated and removed to
Isolation Hospital. Sixteen vaccinations.
January 22-Smallpox case Zack Street removed to Hospital.
January 26-Investigation of unsanitary condition private residence.
This matter referred to city of Tampa.
January 27-Typhoid fever condition *in Tampa investigated on
account of the large number of cases for the week ending January 13, 1914.
Report made of same.
January 30-Smallpox case inspected and removed to hospital at
Tampa, coming from Valrico, Florida. One more case on this date from
Valrico.
January 30-Another case of smallpox coming from Valrico removed
to hospital.
February 1-Smallpox case at North East Street and West 11th Ave.
investigated and removed to hospital. Two more cases on this same date
from same address investigated. Eight vaccinations.
February 2, 3, 4, 5, 6-Shell piles inspected at the Garrison, Tampa,
Florida, upon request made to abate nuisance. These cases brought
before the police court by Chief of the Sanitary Department, to whom
the case was referred. Nineteen vaccinations.
February 7-Smallpox case from City Stockade removed to hospital.
Another case from 17th Ave. and LaSalle St., West Tampa removed to
hospital on this date.
February 8-Smallpox case investigated Scott Street.
February 9-At 15th Street another case inspected and removed to
hospital.
February 9-Four more cases of smallpox in Tampa removed to
hospital.
February 10-Smallpox case, Jefferson Street investigated and removed
to hospital. Twenty-two vaccinations made.
February 23-Smallpox case, Maryland Avenue removed to hospital.
vMarch 6-Investigation of public nuisance on 25th Street, Tampa, Fla.
March 7-Stable inspected upon complaint of neighbors. Report
made to City Board of Health.
March 9-Smallpox case, 5th Avenue removed to hospital.
March 11-Smallpox case, Gilchrist Street removed to hospital.
March 13-Investigation of smallpox case at Port Tampa City.
March 16-Unsanitary condition reported on Morgan Street; investi-
gation made.









STATE BOARD OF HEALTH OF FLORIDA


March 17-Interview with Mayor of Tampa regarding the hydro-
phobic condition and the prevention of its spreading. Also with Mayor
of West Tampa on same subject. Three vaccinations made.
March 21-Smallpox case, 6th Avenue investigated.
March 26-Eight vaccinations made.
March 27-Smallpox case, 6th Avenue investigated.
March 27-Smallpox case, Tyler Street investigated and patient
removed to hospital. Twenty-three vaccinations.
March 28-Unsanitary condition at the Boulevard investigated.
March 28-At the request of Principal of the Hyde Park School, the
homes of nine pupils were inspected.
April 6-Case of smallpox investigated Washington Street.
April 10-Smallpox case Bell Street investigated and removed to
hospital.
April 11-Smallpox case at hospital inspected. Came from Plant City.
April 12-17th Street smallpox case found and removed to hospital.
April 15-Cass Street smallpox case found and removed to hospital.
April 16-Twelve vaccinations made.
April 16-Smallpox case Green Street investigated and case removed
to hospital.
April 17-Pierce Street smallpox case found and investigated.
April 18-Krause Street smallpox case reported and investigated.
April 19-Smallpox case Franklin Street removed to hospital.
April 20-Smallpox case Morgan Street removed to hospital.
April 23-Scott Street, case of smallpox investigated.
April 23-Another smallpox case found at same address.
May 1-Case from Morgan Street removed to hospital.
May 4-Case of smallpox on Tampa Street; removed to hospital.
May 6-Investigation at Ybor City of financial condition of patient
who tried to obtain free Pasteur treatment found to belong to the Circulo
Cubano Society and said Society made to pay for treatment.
May 8-Case of smallpox S. Nebraska Avenue investigated.
May 10-Two cases of smallpox removed to hospital from Scott Street.
May 14-Case from 21st Street removed to hospital.
May 13, 14, 15-Investigation of condition of typhoid fever in con-
nection with lack of consumption of fresh vegetables. Twenty-two vacci-
nations made.
May 15-Case of smallpox Zack Street investigated.
May 17-Case of smallpox India Street removed to hospital.
May 18-Case on Palmetto Alley investigated.
May 19-Five vaccinations made.
May 21-Investigation of Sanitarium premises due to a complaint
received regarding the unsanitary condition.
May 28-Inspection of excavation due to sewage at suggestion of local
newspaper. Three vaccinations.
.May 29-Investigation Kay Street for differential diagnosis between
chickenpox and smallpox.
May 29-Three other smallpox cases at 20th, Nebraska and Lemon
Streets, removed to hospital.
June 2-Inspection of City Stockade at request of State Health Officer.
Report made of same.









TWENTY-SIXTH ANNUAL REPORT


June 4-Two caess of smallpox at City Stockade and Highland Avenue
investigated and removed to hospital. Twenty-four vaccinations made.
June 13-Called on for differential diagnosis in a case of smallpox,
Whiting Street, Tampa. Six vaccinations made.
June 15-Smallpox case Nebraska Avenue removed to hospital.
June 18-Investigation of riot in Isolation Hospital caused by negro
patient and efforts made to arrest him. Whooping cough cases in Tampa
and West Tampa investigated.
June 19-Ten smallpox vaccinations.
July 10-Smallpox case Jefferson Street inspected and removed to
hospital. Seven vaccinations made.
July 13-Leprosy case inspected, and report of same made.
July 13-Twenty vaccinations.
July 15-Investigation of unsanitary condition at Grand Central
Avenue between Oregon and Orleans Streets. Investigation of pond at
the request of Mr. MacFarlane at Tampa Water Works, for drainage
purposes.
July 19-Two vaccinations.
July 20-Eleven vaccinations.
July 20-Interview with the wholesale houses of Tampa regarding
freight cars coming direct from New Orleans.
July 29-Steamers from New Orleans inspected by request of Mayor
MacKay.
July 30-Twelve vaccinations.
July 30-Interview with Mayor MacKay on extermination of rats for
prevention of bubonic plague. Three vaccinations on this date.
August 5-Investigation of smallpox at "Scrub" and removal of cases
to hospital. Two vaccinations made.
August 6-Eleven people vaccinated.
August 13-Investigation of freight cars arriving without posters.
August 14-Investigation of unsanitary cellar at private residence.
Inspection of cars going from Tampa to Port Tampa at the A. C. L.
Railroad. Thirty-six people vaccinated.
August 19-Interview with Mayor MacKay on extermination of rats.
August 19-Freight cars without certificate inspected.
September 20-Six vaccinations.
September 22-Investigation of diphtheria condition in Tampa at the
request of Mayor MacKay. Cases surrounding Michigan Avenue School.
Report of same made. Eight vaccinations made.
September 25-Tuberculosis infection in family inspected. Three peo-
ple vaccinated.
September 28-Interview to obtain list of Eclectic physicians, for
State Board of Health. Five vaccinations.
October 1-Inspection of Isolation Hospital.
October 6-Conference with committee St. Petersburg citizens regard-
ing slaughter house nuisance.
October 7-Inspection smallpox case on Estelle Street, and investiga-
tion diphtheria case reported by county physician.
October 8-Visit to Isolation Hospital.
October 10-Conference with Secretary of Examining Board con-
cerning list of Eclectic physicians.










STATE BOARD OF HEALTH OF FLORIDA


October 8-Investigation case smallpox on Estelle Street. Diagnosis
made.
October 12-Visit to Isolation Hospital.
October 14-Visit to Isolation Hospital.
October 15-Visit to Isolation Hospital.
October 17-Visit case of smallpox Marion Street: Diagnosis made.
October 18-Investigation case smallpox at Ballast Point.
October 19-Visit to Isolation Hospital.
October 21-Visit to Isolation Hospital.
October 23-Reinspection of underground water contamination at
Robles Point.
October 24-Visit to Isolation Hospital, and conference with city
authorities regarding drainage wells.
October 25-Conference with City Council and Mayor on diphtheria
situation. Conference regarding drainage wells.
October 27-Conference with school commissioners on diphtheria
situation Michigan Avenue school. Visit to hospital.
November 5-Inspection of Isolation Hospital.
November 9-Advice with St. Petersburg City Engineer on muddy
condition of water in reservoir:
November 10-Investigation of exhumation of body at Woodlawn
Cemetery for identification, and issue of permit.
November. 10-17-Examination of rats at Tampa laboratory.
November 13-Investigation of nuisance on Tampa Street. Matter
taken up with city sanitary department.
November 14-Visit to Isolation Hospital.
November 18-Conference with Tampa Times on Rat Guards.
November 19-With State Health Officer.
November 15-19-Statement to U. S. Port Collector. Twelve notifica-
tions to school teachers of diphtheria cases, by mail.
December 1-15-Routine work at office. Report of infectious and
contagious diseases for bill of health of out-going vessels, to custom
house officer.
December 5, 8, 9, 11, 15, 17, 30-Report of sixteen cases of diphtheria
to teachers.
December 27-Conference with councilmen on ordinances for rat
guards on in-coming steamers.
December 17-Investigation typhoid fever at Arlington Heights and
inspection of Purity Springs furnishing water to Arlington Heights and
other sections surrounding Tampa in connection with typhoid fever. Col-
lection of water from said Springs.
December 14-Investigation of water supply Hyde Park Avenue. Col-
lection of water samples.
December 26-Investigation water supply at Buffalo Avenue and sur-
rounding neighborhood at report of outbreak of typhoid fever. Collection
of water from two different sources.
December 30-Inspection of dairy premises based on public nuisance
Act at request of neighboring citizens.
December 12-26-Investigation reported cases smallpox 14th and 12th
Avenues.
Regular daily inspections by sanitary partolman made during the year.

Respectfully submitted,
CHAS. WM. BARTLETT,
Assistant to the State Health Officer.












REPORT OF DR. C. W. D'ALEMBERTE
WESTERN DISTRICT
Pensacola, Fla., Jan. 1, 1915.
DR. JOSEPH Y. PORTER,
State Health Officer, Jacksonville, Fla.
DEAR DOCTOR :-The number of cases of communicable
diseases reported to this office from January 1, 1914, to Decem-
ber 31, 1914, was as follows:
Sm allpox .................. .............................19
Tuberculosis ........................................51
Typhoid Fever....................................... 56
Dyphtheria ........................ ........................34*
Scarlet Fever ................... .........................14
M easles ............................................ 1
*Out of total cases of diphtheria, 18 were in and around
Century.
The number of fumigations by Sanitary Patrolman, from
January 1, 1914 to December 31, 1914, was 97.
The number of transit permits, Form 233, issued from
January 1, 1914, to December 31, 1914, was 85.
On March 20th, I visited Marianna to inspect conditions
of sewerage at the Florida Reform School. The sewerage
at that time was being emptied into a vacant lot about one
hundred yards from one of the main buildings. This has since
been corrected and is now carried off by pipes to sink hole sev-
eral thousand feet away from the premises.
April 10th, I visited Garnier's Fla., where there were sev-
eral cases of smallpox at Johnson's still. All persons that
had been exposed were vaccinated and no further cases
developed.
July 21st I was ordered to New Orleans, La., by the State
Health Officer, to report to Dr. W. C. Rucker, Assistant Sur-
geon-General of the United States Public Health Service, for
the purpose of studying the methods employed by this Govern-
ment in handling bubonic plague. By Dr. Rucker's permission
I was allowed to participate in the work commencing with the
trapping of the rats to following the complete laboratory pro-









STATE BOARD OF HEALTH OF FLORIDA


cedure to determine whether they were infected with the bacil-
lus pestis or not.
October 2d was detailed to Century, Fla., to assist the
physicians at that place in stamping out an epidemic of diph-
theria.
November 19th, I was detailed by the State Health Officer
to visit Graceville, Fla., to assist the authorities of that town
in stamping out diphtheria.
November 27th, I visited Chipley, Fla., to consult with the
physicians of that place regarding a case of diphtheria.
November 27th, I visited Marianna, to confer with the
Registrar of Vital Statistics.
During the year I have superintended the disinfection of
numerous quarters that have been occupied by persons having
contagious diseases. Have inspected in company with the
attending physician cases of a suspicious nature and super-
vised the inspection of freight cars coming into this city from
New Orleans, La., to determine if any rodents were harbored
therein.
It has been my pleasure and privilege to assist in a small
measure the educational work of the State Board of Health by
giving talks to various organizations upon health matters.
Respectfully submitted,
C. W. D'ALEMBERTE,
Assistant to the State Health Officer.












REPORT OF DR. JOSEPH Y. PORTER, JR.
SOUTH TROPIC DISTRICT.

Key West, Fla., January 1, 1915.
DR. JOSEPH Y. PORTER,
State Health Officer, Jacksonville, Fla.
DEAR DOCTOR :-Health conditions in the South Tropic
District for the past year have been excellent; very few of the
preventable diseases have occurred and in general the com-
munity has experienced one of the most healthful periods of
its existence.
This has been due to two factors: first, the screening laws
have been rigidly enforced, and secondly, a daily collection of
garbage. The latter plays a secondary role when it is con-
sidered that all garbage is, as a rule, deposited into coverless
cans, and that flies, which are chiefly to be considered in the
propagation of intestinal diseases, have been as plentiful in
number during 1914, as in former years. It is felt that a fur-
ther extension of the work against the fly such as a proper
regulation of all horse and mule stables, with all toilets made
fly proof, will result in a greater decrease in the above men-
tioned diseases. These matters' have been repeatedly taken
up with individual members of the City Council, also, the
Council itself, and it is hoped that shortly they may be enacted
into law.
The question of an incinerator was also brought to the
attention of the Council, and a committee was appointed,
which, after inspecting and witnessing the operation of all types
in the different cities between Key West and New York, in
a report recommended the purchase of a Nye Odorless Inciner-
ator; the matter is still under advisement, and it is hoped
that, within a short period, at least before the "typhoid season"
starts, it will be installed and in operation. At present
garbage is deposited on the outskirts of the city and an attempt
made to burn it; in dry weather this is fairly successful, but
in the rainy season it is a physical impossibility. The Council
has been repeatedly informed that this disposal of garbage is









STATE BOARD OF HEALTH OF FLORIDA


in violation of Rule 47 of the Rules and Regulations of the State
Board of Health.
During the past year an attempt was made to collect
morbidity statistics; printed post cards were furnished all
physicians; these post cards were so arranged that all neces-
sary to do was for the physician to fill in the name and address
with other such sociological data as race, sex, etc., and check
the disease from the list of printed diseases, and mail to this
office. Although assured of the support of each individual
physician, the number of reports became smaller and smaller,
and finally ceased. Another attempt is to be made shortly
along other lines, with greater promises of success.
The District outside of Key West was visited last May.
The several railroad camps, and other settlements along the
Florida Keys were found to be in good condition; the railroad
camps in particular were in a splendid sanitary condition, all
kitchens, dining rooms and sleeping quarters being thoroughly
screened, and both buildings and surroundings scrupulously
clean; nearly all toilets were placed over the water and thus
there was a minimum chance of spreading intestinal diseases.
In settlements there were primitive toilets, but no hookworm
infection was observed, possibly due to the lack of sandy soil.
Places visited were Big Coppitt, Chase, Little Pine Key, Boot
Key Camp, Marathon, Spanish Harbor Camp, and Bahia
Honda.
That there has been a marked decrease in this disease is Typhoid Fever.
not to be questioned. Owing to the lack of morbidity statistics,
commented upon elsewhere, it is impossible to state the exact
prevalence of this disease, but talking the matter over with
physicians, all agree that typhoid fever has prevailed to a
lesser degree than heretofore. Widal examination, and, in a
few cases, blood cultures have been performed for the phy-
sicians, but as a rule, they do not seem inclined to avail them-
selves of the aids to diagnoses. This office has also stated that
the State Board of Health is prepared to administer the typhoid
vaccine free to the indigent, but as yet, not one person has
availed himself of this opportunity. With the making of
all toilets fly proof I look for the typhoid rate to be still smaller,









TWENTY-SIXTH ANNUAL REPORT


for it is firmly believed that outside of a few contact cases
the disease here is mainly fly-borne.
Smallpox. Early in January a suspicious case was reported; after two
days' observation the patient was released from isolation, the
diagnosis not being confirmed. During the latter part of the
same month smallpox developed in a person who had but a few
days returned from Mexico. The diagnosis was promptly
confirmed; as the patient was removed from a steamer whose
destination was New York City, the Health Officer there was
notified by wire of the facts in the case.
All members of the patients' family were vaccinated, with
the exception of one young boy, who refused vaccination,
violated isolation instructions, and left the house. As this boy
had been in the same room with the patient prior to the rash
coming out, and was also said to have slept with him, a warrant
was obtained for his arrest, and as the County Commissioners
placed a small reward for his capture, he was promptly arrested.
A short talk convinced him of the error of his way and he
submitted to vaccination and later revaccination, which revacci-
nation gave a splendid take. The patient's mother later
developed a confluent case of smallpox and made an unevent-
ful recovery. Since then there have been no further cases.
In this connection, I might add that smallpox vaccinations have
in a small way been going steadily on; the School Board has
been urged to adopt a compulsory vaccination rule, fdr admit-
tance into the public schools of this county, but up to the
present they have not seen fit to follow this advice. As a result
there are growing up a large number of unprotected individuals,
who will be "fertile ground" should we be ever unfortunate
enough to have a mild unrecognized case of smallpox in the
community.
Diphtheria. There have been sporadic cases during the entire year,
developing at no time into epidemic proportions. All phy-
sicians have been repeatedly urged to submit throat smears to
this office, especially in mild sore throats, for it is only in this
way that we can hope to control the disease. During April
diphtheria developing in two school children, swabs and cul-
tures were made in all suspicious cases in the school room, in an
effort to determine the source, all proving negative.









STATE BOARD OF HEALTH OF FLORIDA


There has also been a decrease in these diseases, due no Infantile
Intestinal
doubt to the same causes as to the decrease in typhoid. A milk Diseases.
ordinance is now being drawn up to be presented to the Council
and it is hoped that they will see fit to speedily pass it.
Beginning with July anti-plague measures have steadily Plague.
proceeded. At my suggestion the city and county have placed
a bounty of ten cents on each rat delivered to the laboratory
here. Up to the present there have been examined 2,047, all
negative for plague. Rat proofing laws have been urged as
also the employment of a competent rat catcher, for so soon
as the fear and interest in plague began to die down, the daily
rat catch dropped to an average of from two to ten. Guinea
pig sentinels have been maintained in places along the water
front and in houses that receive goods direct from Cuba. When
first placed, a few deaths resulted, none suspicious of plague.
During October, New Orleans was visited for a period of ten
days, and the plague situation and anti-plague measures were
studied from every point of view. The experience gained
while working in the U. S. P. H. S. Laboratory, under Dr.
C. L. Williams, was invaluable, and I am indebted to him and
several other officers of this Service for many courtesies
received.
The campaign against the fly by means of "fly exhibits"
and fly posters has been persistently kept up, and I think is
beginning to bear fruit, judging by the interest the average
person now takes in this subject.
The public schools have been inspected. The School Board
has been urged to employ a "school nurse," who in addition to
her regular duties as such, can make simple tests for the acute-
ness of vision and hearing.
The matter of a dipping vat has been brought to the atten-
tion of the dairymen looking toward getting the island tick
free. When this is a fact, and the island released from quaran-
tine, blooded animals can be then imported and the milking
strain of the entire herd raised.
The mosquitoes on the island of Key West have been fre-
quently examined during the past year. No Anopheles have
been found.








78 TWENTY-SIXTH ANNUAL REPORT

In numerous examination of feces, no native hookworm
infection has been found. Occasionally, a few imported cases
have been encountered. The tricocephalus dispar has been
found to be a very common infection in children, almost fifty
per cent. of children showing the ova.
In my capacity as local surgeon for the. Florida East-Coast
Railway, I have recommended that all empolyees under forty,
excepting those who have had typhoid, be required to take the
typhoid vaccine.
The work' of the Sanitary Patrolman has been supervised
and systematized.
Respectfully submitted,
JOSEPH Y. PORTER, JR.,
Assistant to the State Health Officer.












REPORT OF DR. W. P. CRIGLER
.SOUTH CENTRAL DISTRICT.
SOcala, Fla., December 31, 1914.
DR. JOSEPH Y. PORTER,
State Health Officer, Jacksonville, Fla.
DEAR DOCTOR :-I have the honor to submit herewith my
report of the general health conditions in my district, during
the year 1914.
The district comprises the counties of Marion, Lake, Sum-
ter, Citrus, Hernando, Seminole, Orange, Osceola and Pasco.
The general health conditions have been good, with a
slight improvement over those of last year.
No epidemics of a serious nature occurred.
Typhoid fever was the most serious disease to contend with,
and, in some cases caused considerable alarm. In most all
cases the infection was fly-borne.
The open surface closet is a great menace to the health
of the state and until the people are educated concerning the
necessity of fly-proof closets, and septic tanks, the number
of cases will increase yearly. Work has been done along this
line by talks with the city authorities and private citizens, advis-
ing them of the benefits to be obtained by proper sewage dis-
posal and screening of residences. A number of cases of
typhoid existed in the cities of Ocala and Orlando during the
spring and summer; but at. no time reached a serious stage.
In these outbreaks the fly was the carrier of the infection.
Sporadic cases existed throughout the district, in the rural
as well as the urban parts.
Typhoid vaccine as a prophylactic was advised and a great
many people were protected with it.
Pellagra is causing considerable anxiety, owing to its
increase in the district. Cases are reported by all the physi-
cians, but at no place are there a great number of cases.
I found seven cases in one locality in Sumter County and
after investigating their etiology, found that the dietary theory
was upheld in all cases. The absence of a full diet of ani-
mal and leguminous proteids was noted in these cases.









TWENTY-SIXTH ANNUAL REPORT


As the treatment and prevention of this disease is now
better known we will be in a better position to fight it.
Malaria is still prevalent but not to such- an extent as for-
merly, becoming less and less every year. The people are
becoming better educated to the mosquito as the cause of the
disease, and are using means to protect themselves, both by
screening their houses and doing away with the breeding places
of the mosquito.
Two cases of Malaria Haemoglobinuria were reported from
Crystal River; both cases terminated fatally.
Hookworm disease prevails as usual in the rural parts, but
in the number of positive cases existing, few are so reduced
in health as to seek medical attention.
Here again we fall back on the open surface closet as the
cause in keeping up this disease, and until they are done away
with, the treatment of sufferers is of little avail as they readily
become reinfected.
The number of smallpox cases reported from this territory
was less than last year, reaching at no time an epidemic. Eight
cases occurred in a construction gang in the employ of the
Atlantic Coast Line Railroad Company. Two cases were at
first reported, but by the close association of the crew in the
same car, six others contracted the disease in spite of early
vaccination. These cases were isolated and no others followed.
A traveling vaudeville actor was put off the train by a
conductor at Williston last February, suffering with smallpox.
He was placed in my care for treatment. I had him isolated in
a tent outside the city limits and all expenses were paid by
the State Board of Health, as he was indigent.
No other cases followed this one. A small outbreak at a
sawmill near Umatilla was difficult to handle, owing to the
great opposition of the manager to vaccination.
A number of the town inhabitants were vaccinated and
the outbreak was confined to the mill.
The smallpox cases seen by me this year were all mild
and no deaths occurred. It isn't the severe cases that cause
the spread of the disease, but the mild and undiagnosed ones,
which are not confined to the house nor have medical aid, and
are thus free to wander around and spread the infection.









STATE BOARD OF HEALTH OF FLORIDA


Smallpox is made endemic by the negro who has no fear
of the 'disease, but is in horror of vaccination. They would far
rather have the "bumps" as they term smallpox, than be vacci-
nated; and veiy ingenious schemes have to be devised to get
them vaccinated.
The communicable diseases of childhood occur in the same
proportion as usual, but great good has been done in some
localities in their prevention by the medical inspection of
schools.
A child with a sore throat, cough, coryza or an eruption
is sent home and isolated, and, as these are in great part the
first symptoms and most contagious stage of the exanthemata,
great good is done in preventing their spread.
Diphtheria occurred in isolated cases in both town and
country, but no serious outbreaks resulted. An epidemic at an
orphanage at Enterprise was prevented by the administration
of immunizing doses of antitoxin to all the inmates. Only the
three original cases occurred.
No epidemic of dengue fever existed this year as is usual
in some localities.
No serious outbreaks of measles, scarlet fever and chicken-
pox were reported.
The sanitary conditions of the towns are improving, but
the municipal authorities are hard to wake up on this subject.
They generally wait until an epidemic of some kind breaks out
before starting to clean up.
Ocala has made great strides in matters pertaining to pub-
lic health and sanitation. A new health ordinance was passed
creating a new sanitary code and the office of city physician,
whose duties amongst many others, include the daily examina-
tion of school children, inspection of dairies, examination of
milk and its products; also inspection of meat markets and
bakeries. Already good results have been attained, as shown
by the absence of communicable diseases of childhood during
the school term. Only three cases of chickenpox were reported.
Ocala has under consideration a new sewerage system,
which is greatly needed. The majority of the sewage is dis-
posed of by the sewage well system.










TWENTY-SIXTH ANNUAL REPORT


Ocala has passed the model vital statistics ordinance and
is now in position to get full returns of births and deaths.
Orlando has this year completed a new sewerage system
of the Imhoff type. The city is also considering the passage
of a new health ordinance, with a provision for the appoint-
ment of a city physician. The city is in a good sanitary
condition.
Sanford has a good sewerage system and an excellent water
supply and is in a good sanitary condition. The health ordi-
nance is good and ably looked after by a city physician.
Kissimmee has lately increased the water supply, with a
new well and now has an abundance of good water. The town
is well sewered and is in a good sanitary condition.
In the small incorporated towns and those not incorporated,
the greatest need is the sewage disposal system and screening
of houses. In most places the open surface closet prevails and
is their greatest problem of sanitation.
The towns that have municipal water supply have good
water free from contamination, as in all cases the supply is from
deep cased wells.
The following is a summary of work and details during
the year 1914:


Place County
Longwood Seminole
Winter Park Orange
Kissimmee Osceola
Webster Sumter
Mt. Dora Lake
Mascotte Lake
Williston Levy
Morriston Levy
Kissimmee Osceola
Sanford Seminole
Kissimmee Osceola
Orlando Orange
Kissimmee Osceola
Umatilla Lake
............... M arion
Holder Citrus
Belleview Marion
Dunnellon Marion
McIntosh Marion
Citra Marion
Winter Garden Orange
Dunnellon Marion


Occupation
Diphtheria
Typhoid fever
Smallpox
Diphtheria
Sanitary inspection
Sanitary inspection
Smallpox
Smallpox
Smallpox
Vital statistics
Smallpox
Vital statistics
Smallpox
Smallpox
Smallpox
Smallpox
Hookworm campaign
Hookworm campaign
Hookworm campaign
Hookworm .campaign
Sanitary inspection
Hookworm campaign


Date
Jan. 3
Jan. 12
Feb. 3-13
Feb. 5
Feb. 16
Feb. 17
Feb. 19-30
Feb. 20
Mar. 21
Mar. 30
Apr. 1-7
Apr. 15
Apr. 17-27
Apr. 29
May 16
May 18-20
May 22
May 23
May 25
May 26
May 27
May 28











STATE BOARD OF HEALTH OF FLORIDA


Place County
Belleview Marion
Dunnellon Marion
Citra Marion
Oklawaha Marion
Sanford Seminole
Enterprise Vqlusia
Dunnellon Marion
Webster Sumter
Dunnellon Marion
Enterprise Volusia
Ocala Marion
Umatilla Lake
Sanford Seminole
Tavares Lake
Mt. Dora Lake
Orlando Orange
Zuba Marion
............... M arion


Occupation
Hookworm campaign
Chickenpox
Hookworm campaign
Rabies
Vital statistics
Diphtheria
Inspection of wells
Pellegra
Collecting water specimens
Diphtheria
Smallpox
Pellegra
Vital statistics
Sanitary conference
Typhoid fever
Sanitary inspection
Typhoid fever
Pellegra


Respectfully submitted,

W. P. CRIGLER,

Assistant to the State Health Officer.


Date
May 29
May 30
June 4
June 17
June 20
July 4
July 13
July 17
July 20
July 24-30
Aug. 4
Oct. 7
Oct. 23
Nov. 4
Nov. 13
Nov. 21
Dec. 5
Dec. 11














REPORT OF DR. J. E. TAYLOR
CENTRAL DISTRICT.


Gainesville, Florida, January 1st, 1915.
DR. JOSEPH Y. PORTER,


State Health Officer, Jacksonville.

DOCTOR :-I am attaching hereto my annual report


Date Place
Jan. 1-22 Jacksonville


Jan. 22-23 Winter Park

Jan. 24-25 Interlachen
Jan. 26-31 Jacksonville

Feb. 1-20 Jacksonville


Feb. 20-28 Tallahassee

Mar. 1-3 Tallahassee
Mar. 4 Tallahassee

Mar. 5-9 Tallahassee
Mar. 10-12 Chattahoochee


Mar. 12-31 Tallahassee


April 1-5 Tallahassee
April 6 Tallahassee


April 7-9
April 10-13
April 14-25
April 25-30

May 1-3
May 4-5
SMay 7


Tallahassee
Marianna
Tallahassee
Blountstown

Blountstown
Tallahassee
Chipley


Nature of Detail
Duty in executive office, investigation of
smallpox in Duval County, vaccination.
Investigation of diphtheria in So. Jack-
sonville.
Investigating an outbreak of typhoid among
the school children.
Investigating an outbreak of diphtheria.
Duty in executive office. Smallpox investi-
gation and vaccination in So. Jacksonville.
Duty in executive Office. Continuation of
smallpox work in the South Jacksonville
section of Duval County.
'Routine work of office of Assistant to the
State Health Officer.
Routine office work.
Investigation and isolation of diphtheria
case near Tallahassee.
Routine office work.
Visit to the Florida Insane Asylum and
conference with staff relative to sanitary
conditions.
Routine office work. Investigation of sani-
tary nuisance. Conference with local
physicians on pellagra.
Routine office work.
Suspicious eruption. Consultation. Diag-
nosed chickenpox. Isolation.
Routine office work.
Smallpox. Consultation.
Routine office work.
Suspected smallpox. Isolation. Vaccina-
tion.
(Detail of April 25th)
Routine office work.
Sanitary nuisance. Conference with prop-
erty owner and Mayor. Abatement.


DEAR
for 1914.











STATE BOARD OF HEALTH OF FLORIDA


May 8-18 Tallahassee Routine office work. Investigation of
alleged smallpox. Diagnosed chicken-
pox. Meeting of City Council. Ordi-
nance requiring registration of mid-
wives. Ordinance requiring manure bins.
Ordinance requiring the muzzling of
dogs. Conference with Womens Club.
Address to the Parents-Teachers Associa-
tion.
May 18-23 Greenville Investigation of outbreak of typhoid. Ex-
amination of drinking water. Conference
with Mayor and City Council. Visits to
-atients and talks to .nurses on necessity
of screening and proper disposition of
excreta.
May 23-26 Tallahassee Routine office work. Visits to typhoid
patients. Talks with nurses on necessity
of proper screens, disposition of excreta
and typhoid vaccination.
May 26-27 Greenville Further investigation of the tvnhoid out-
break. Re-examination of water.
May 27-31 Tallahassee Routine office work.
June 1-4 Tallahassee Routine office work. Further investigation
of typhoid Examination of water. In-
spection with recommendations of sur-
face privies.
June 4 Midway Investigation of two cases typhoid. Recom-
mendations regarding surface privies and
water supply. Talks as to the value of
screening and tyohoid vaccination.
June 5-8 Tallahassee Routine office work. Investigation of
typhoid outbreak continues. Examination
of milk.
June 8 Greenville Further work on typhoid.
June 9-12 Apalachicola Vital Statistics. Conference with local doc-
tors and City Council on sanitary con-
ditions. Address made the Civic League.
June 12 Woodville and Visited these towns in order to investigate
St. Marks conditions with especial reference to
typhoid. No typhoid found. Talked with
citizens as to proper measures to prevent
its appearance.
June 13 Chaires, Capitola Typhoid. Talks with citizens and patients
and Lloyds respecting the proper disposal of excreta,
the role flies play in scattering typhoid,
vaccination, screening, etc.
June 14 Tallahassee Further work on typhoid.
June 15 Midway Typhoid.
June 16 Tallahassee Typhoid.
June 17 Wakulla, St. Inspection with reference to the prevalence
Marks and of hookworm infection.
Woodville
June 17-20 Tallahassee Routine office work.
June 20-30 DeFuniak Springs Investigating an outbreak of diphtheria.
Isolation.











TWENTY-SIXTH ANNUAL REPORT


July 1-11 Tallahassee Routine office work.
July 11-18 DeFuniak Springs Further work on the diphtheria outbreak.
Isolation. Immunizing doses antitoxin.
July 18-27 Tallahassee Investigating an outbreak of sore throat.
Examination of milk. Inspection of with
recommendations to dairies.
July 27 Quincy Arranging for showing of Fly Reel under
auspices of Civic League.
July 28-31 Tallahassee Continuation of work on dairies. Demon-
stration of Organism in milk causing the
sore throat.
Aug. 1-3 Tallahassee Routine office work.
Aug. 4-7 Apalachicola and Inspection with reference to the possibility
Port St. Joe of landing rats from incoming ships and
lighters. Recommendations to city of-
ficials and stevedores as to rat-guards.
Aug. 7-18 Tallahassee Routine office work.
Aug. 18 Jacksonville Conference with Drs. Porter and Dobbs
relative to work in the Central District,
to which I had been transferred.
Aug. 19-27 Gainesville Routine office work.
Aug. 27-29 Lloyd Investigation of reported contaminated well.
Aug. 29-31 Perry Investigation and examination of city water
supply. Conference with and recom-
mendations to city officials.
Sept. 2-19 Gainesville Routine office work. Conference with
City Health Officer and City Board of
Health regarding health work in Gaines-
ville. Familiarizing myself with con-
ditions prevailing in this section of the
state.
Sept. 19 McIntosh Investigation of pellagra. Conference with
local physician.
Sept. 19-30 Gainesville Routine office work. Beginning medical in-
spection of school children.
Oct. 1-23 Gainesville Continuation of medical inspection of school
children of Gainesville.
Oct. 23-31 Gainesville Vaccinating school children. Routine office
work. Conferences with local physicians
on diphtheria and scarlatina.
Nov. 1-15 Gainesville Routine office work. Arranging for booth
at Alachua County Fair. Conferences
with local physicians on diphtheria, scarla-
tina and pellagra.
Nov. 16-19 Gainesville. Operating booth at county fair. Distribu-
tion of literature. Talks with visitors.
Nov. 19-20 Dowling Park Scarlatina. Isolation.
Nov. 20-30 Lamont Smallpox. Isolation. Vaccination.
Dec. 1-4 Jacksonville Attending meeting of the American Pub-
lic Health Association.
Dec. 4-8 Lamont Further work on smallpox. Wholesale
vaccination. Isolation.









STATE BOARD OF HEALTH OF FLORIDA


Dec. 8-19 Gainesville Routine office work. Conferences with local
physicians on diphtheria, scarlatina and
pellagra.
Dec. 19-22 Newburn Smallpox. Isolation. Vaccination.
Dec. 22-31 Annual vacation.

As can be seen from the above outline, my work for the
year 1914 has been diversified. During this period practically
all the public health problems a representative of the Board is
called to face have arisen and demanded attention. This makes
an extended report of details almost impossible, and with the
hope that my report will be clearer as well as more readable,
I shall outline the work under the different headings.
My first detail on account of typhoid was to Winter Park. Typhoid Fever.
Upon my arrival in this town, and after locating the cases, two
in number, as well as the former cases, I made an inspection
of what, in my opinion, were the only possible sources of
infection, to-wit: the water supply, the access of flies to human
excreta and the milk supply. Bacteriological examination of
the water and milk supplies eliminated these possible factors,
and practically convicted the fly. As all of the cases both
active and convalescent, were among the school children, an
inspection was made of the school premises where I found con-
ditions extremely bad. The toilet facilities were inadequate and
dirty. Flies had access to the excreta at all times, and as the
school rooms were not screened, could roam at will over the
hands and faces of the pupils. The installation of sanitary
closets promptly stopped the progress of the disease.
The next outbreak of typhoid I was called on to assist with
was scattered from Greenville to Midway on the Tallahassee
division of the Seaboard Railway. Two cases developed in
Midway, nine in Tallahassee, four in and around Chaires, one
in Lloyds and five in Greenville.
By bacteriological examinations, water and milk as pos-
sible causative agents were ruled out in Midway, Tallahassee
and Lloyds. Repeated examinations of the water supply of
Greenville proved a colon infection of all surface wells, and
while the typhoid organism was not found, I am not convinced
that the water supply did not have something to do with at
least some of the cases, especially as typhoid has been periodi-
cally present in and around Greenville for a number of years.









TWENTY-SIXTH ANNUAL REPORT


In the towns mentioned above, with the possible exception
of Greenville, the ordinary house fly was unquestionably the
agent by which the disease was spread. Screening of patients
and proper disposal of excreta, with, in Greenville, the addi-
tional precaution of using boiled water, all of which I person-
ally supervised, aborted what at the beginning appeared to
augur an unprecedented outbreak of this disease.
In the control of these cases, I vaccinated quite a number
of people who came in more or less intimate contact with the
patients, with the most satisfactory results; and should typhoid
break out again this year in Greenville, in addition to the con-
demnation of surface wells, I would advise general vaccination.
smallpox. During the year I have been detailed to handle outbreaks
of smallpox at DeLand, the South Jacksonville section of
Duval County, Marianna, Blountstown, Lamont and Newburn,
The number of cases seen were six, twenty to thirty, none,
none, twenty-three and four respectively. The diagnosis was
confirmed in Duval County, DeLand, Lamont and Newburn.
Control of the outbreaks was by isolation and vaccination.
Approximately 550 vaccinations were done.
The prevailing type of the disease was discreet; however, I
saw several confluent cases, and during the latter part of the
year, these severe confluent types seemed to be on the increase.
Vaccination has proven, as it always does, wonderfully effica-
cious. As an illustration of this fact, smallpox was scattered
over a large area in and around Lamont, among negroes,
where ordinarily few vaccinations could be done on account
of the prejudice against it among the colored people, but by
virtue of hard work practically the entire population was
vaccinated, and as a result the disease was stopped within the
short period of two weeks, and now, two months later, no new
cases have developed.
As a rule, the.people of my section of the state are satisfied
with our present method of handling smallpox, i. e., simple
isolation and vaccination; however, some few criticize this
method and think we should institute the obsolete shot-gun
quarantine. Usually a talk to such dissatisfied people will
show them the tremendous financial burden such quarantine








STATE BOARD OF HEALTH OF FLORIDA


would entail and the utter uselessness of it in view of the
ease, safety and preventive power of vaccination.
It appears to me that the people generally are becoming
more and more convinced of the safety and value of vaccina-
tion as it is now performed, and it is no Utopian dream to
think that, in the course of a very few years, smallpox will
cease to exist as a public health problem in Florida.
I have visited during 1914 South Jacksonville, Interlachen, Diphtheria
Tallahassee, DeFuniak Springs and Gainesville in connection
with diphtheria. In none of these towns has there been any-
thing like a definite epidemic, with the exception of Interlachen
and the nearby town of Kenwood where nine cases were
reported.
Control consisted in isolation and disinfection.
In diphtheria, as well as the other exanthemata, I have
almost decided that formaldehyde fumigation is useless, and
in fact causes harm in most cases on account of the faith
placed in it by the laity as. well as a good many doctors. In
lieu of fumigation, I boil everything that can be boiled, sun
for at least twelve hours every thing that can be sunned, and
wash with a one to one-thousand solution of bichloride of
mercury every thing else with -which the patient has come in
contact.
During the year, I have had to deal with scarlet fever in scarlatina.
Dowling Park and Gainesville. The cases at Dowling Park
were children of a boarding house keeper, and, consequently,
I could not definitely locate the origin, especially as neither of
the two cases had been away from home for a considerable
period of time prior to onset and had had no visitors. The
most probable hypothesis is an infection brought on the cloth-
ing of some boarder.
The situation in Gainesville has been rather difficult to
handle, and while there has been no serious outbreak, new
cases have developed from time to time during the past five
months. Practically all, if not all, of the patients have been
children from the third grade of the public schools. This fact
makes it seem probable that there is a scarlet fever "carrier" in
this grade, but on account of the little knowledge we have of








TWENTY-SIXTH ANNUAL REPORT


the etiological factors it appears impossible to establish this
theory or ascertain the origin of the contagion.
Whether it is the climate I am not in position to say, but
the fact remains that of the approximately 'twenty cases I
have seen, most have been very mild-in fact, in many of them
the diagnosis was impossible until typical desquamation began.
Control was by strict isolation.
Malaria. I have not had a single detail during the year on account
of malaria. I do not mean to intimate by this that there has
been absolutely no malaria in the districts in which I have
worked, but I do mean to say that malaria, as an epidemical
disease, has not been present. I have made it a point to talk
with the physicians of the different communities visited regard-
ing the prevalence of this disease, and have found that com-
munities which formerly had hundreds of cases, only had a
small number in 1914. The explanation of this fact is, in my
opinion, the wider use of screens and the almost universal
use of mosquito nets for beds. The knowledge that the
mosquito causes malaria has sifted down to even the most
ignorant negro, and this, as well as the discomfort of being
nibbled on all night, has brought about the more general use
of protecting materials.
Pellagra. I have been called in consultation on pellagra some twenty
to twenty-five times during the year. Whether or not this
disease is increasing is a question rather hard to decide, but
I have personally come in contact with many more cases than
formerly.
Until the etiology of pellagra is settled, it seems that
nothing can be done from the public health standpoint toward
its prevention; however, since the original report of Dr. Gold-
berger, of the U. S. Public Health Service, I have been
advising the dietary regime suggested by him, reinforced by
tonics. On account of the nature of pellagra, it is too early
yet, in my opinion, for too great hopes to be founded on this
method of treatment, but it is true that, for the time being at
least, the pellagrins are benefited.
Nothing I have seen would indicate that pellagra is at
all contagious or infectious.




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