• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 State board of health of Flori...
 Table of Contents
 Letter of transmittal
 Report of Dr. W. H. Cox, state...
 Press service
 Health notes
 Names of district health offic...
 Distribution of rabies treatme...
 Distribution of typhoid vaccin...
 Distribution of smallpox vacci...
 Distribution of tetanus antito...
 Distribution of diphtheria...
 Financial report
 Expenditures classified
 Financial statement
 Reports of district health...
 Bureau of child welfare: Report...
 Orthopedic department: Report of...
 Bureau of venereal diseases: Report...
 Bureau of diagnostic laborator...
 Bureau of engineering
 Central bureau of vital statis...
 Index of annual report
 Back Cover














Title: Annual report - State Board of Health, State of Florida
ALL VOLUMES CITATION PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/AM00000243/00039
 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: VID00039
Source Institution: 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
        Title Page
    State board of health of Florida
        Unnumbered ( 3 )
    Table of Contents
        Table of Contents
    Letter of transmittal
        Unnumbered ( 5 )
    Report of Dr. W. H. Cox, state health officer
        Page 1
        Page 2
        Page 3
    Press service
        Page 4
        Page 5
        Page 6
    Health notes
        Page 7
        Page 8
        Page 9
        Page 10
    Names of district health officers
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
    Distribution of rabies treatments
        Page 20
    Distribution of typhoid vaccine
        Page 20
        Page 21
    Distribution of smallpox vaccine
        Page 22
    Distribution of tetanus antitoxin
        Page 23
    Distribution of diphtheria antitoxin
        Page 24
        Page 25
        Page 26
    Financial report
        Page 27
    Expenditures classified
        Page 28
    Financial statement
        Page 29
    Reports of district health officers
        Report of Dr. John Keely
            Page 30
            Page 31
            Page 32
            Page 33
            Page 34
            Page 35
        Report of Dr. Geo. A. Dame
            Page 36
            Page 37
            Page 38
            Page 39
            Page 40
            Page 41
        Report of Dr. F. L. Tatom
            Page 42
            Page 43
            Page 44
            Page 45
        Report of Dr. A. C. Hamblin
            Page 46
            Page 47
            Page 48
            Page 49
            Page 50
        Report of Dr. W. H. Bryan
            Page 51
            Page 52
            Page 53
            Page 54
            Page 55
        Report of Dr. L. T. Galphin
            Page 56
            Page 57
            Page 58
        Report of Dr. H. O. Snow
            Page 59
            Page 60
            Page 61
            Page 62
            Page 63
        Report of Dr. A. W. Underwood
            Page 64
            Page 65
        Report of Dr. William R. Warren
            Page 66
            Page 67
            Page 68
    Bureau of child welfare: Report of Dr. Grace Whitford
        Page 69
        Page 70
        Page 71
    Orthopedic department: Report of Dr. E. Van Hood
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
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        Page 109
        Page 110
        Page 111
        Page 112
    Bureau of venereal diseases: Report of Dr. H. O. Snow
        Page 113
        Page 114
        Page 115
    Bureau of diagnostic laboratories
        Page 116
        Report of Dr. B. L. Arms, chief bacteriologist
            Page 116
            Page 117
            Page 118
            Page 119
            Page 120
            Page 121
            Page 122
            Page 123
        Report of Dr. H. D. Venters, bacteriologist
            Page 124
            Page 125
            Page 126
            Page 127
        Report of Dr. F. A. Brink, bacteriologist
            Page 128
            Page 129
            Page 130
        Report of Dr. Harold H. Fox
            Page 131
            Page 132
            Page 133
            Page 134
    Bureau of engineering
        Page 135
        Report of George W. Simons
            Page 135
            Page 136
            Page 137
        Sanitary investigations
            Page 138
            Page 139
            Page 140
            Page 141
            Page 142
            Page 143
            Page 144
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            Page 156
            Page 157
            Page 158
            Page 159
            Page 160
            Page 161
        Water and sewage laboratory
            Page 162
            Page 163
            Page 164
            Page 165
            Page 166
            Page 167
            Page 168
            Page 169
            Page 170
    Central bureau of vital statistics
        Letter of transmittal
            Page 171
            Page 172
        Report of Stewart G. Thompson, D. P. H., director
            Page 173
            Part 1: Influenza
                Page 173
                Page 174
                Page 175
                Page 176
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                Page 183
                Page 184
            Part 2: Morbidity
                Page 185
                Page 186
            Part 3: Statistical report
                Page 187
                Page 188
                Page 189
                Page 190
                Page 191
                Page 192
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                Page 194
                Page 195
                Page 196
            Appendix to Part 3: Statistical tables - 1917
                Page 197
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    Index of annual report
        Page 533
        Page 534
        Page 535
    Back Cover
        Back Cover
Full Text






THIRTIETH


ANNUAL REPORT

OF THE


otate Boarb of iraalth

of Fiortba

1918




APPROVED BY THE BQARD IN ANNUAL SESSION


JACKSONVILLE, FLORIDA


I II


T~







THIRTIETH


ANNUAL REPORT
OF THE


State


Board of Health


of Florida
1918


APPROVED BY THE BOARD IN ANNUAL SESSION
FEBRUARY -, 1919


JACKSONVILLE, FLORIDA


j d II 1






















STATE BOARD OF HEALTH

OF

FLORIDA




HON. CHARLES T. FRECKER, President, Tampa
HON. ED. M. EARNEST Palatka
HON. J. E. GRAVES De Funlak Springs


DR. W. H. COX .Secretary and State Health Officer
DR. V. H. GWINN, .Assistant State Health Officer
ROY CAMPBELL . .. Chief Clerk


Bureau of Vital Statistics S. G. THOMPSON, D. P. H., Statistician
Bureau of Diagnostic Laboratories . DR. B. L. ARMS, Chief
Bureau of Engineering GEORGE W. SIMONS, JR., Chief Engineer
Bureau of Accounting . SAMUEL F. FLOOD
Bureau of Venereal Diseases . DR. H. 0. SNOW
Bureau of Education and Child Welfare DR. GRACE WHITFORD


OFFICE OF THE SECRETARY AND MAIN LABORATORY
STATE BOARD OF HEALTH BUILDING
Springfield Boulevard
Jacksonville.










TABLE OF CONTENTS


Page
Presidents Letter of T"ransmittal--------------------------
Report of Dr. W. H. Cox, State Health Officer---------------- 1
Press Service ------------------------------------------ 4
Health Notes ---------------------------------------- 7
Names of District Health Officers------------------------- 11
Distribution of Rabies Treatments----------------------- 20
Distribution of Typhoid Vaccine ---------------------------- 20
Distribution of Smallpox Vaccine---------------------------- 22
Distribution of Tetanus Antitoxin-------------------------- 23
Distribution of Diphtheria Antitoxin------------------------- 24
Financial Report--------------------------------------- 27
Expenditures Classified -------------------------------- 28
Financial Statement -------------------------------------- 29
REPORTS OF DISTRICT HEALTH OFFICERS
Report of Dr. John Keely ----------------------------30
Report of Dr. Geo. A. Dame------------------------------- 36
Report of Dr. F. L. Tatom -------------------------------- 42
Report of Dr. A. C. Hamblin------------------------------ 46
Report of Dr. W. H. Bryan------------ ---------------- 51
Report of Dr. L. T. Galphin ------------------------ 56
Report of Dr. H. O. Snow-------------------------------- 59
Report of Dr. A. W;. Underwood--------------------------- 64
Report of Dr. Wm. R. Warren--------------------------- 66
BUREAU OF CHILD WELFARE
Report of Dr. Grace Whitford ----------------------------- 69
ORTHOPEDIC DEPARTMENT
Report of Dr. E. Van Hood---------------------- ---------- 72
BUREAU OF VENEREAL DISEASES
Report of Dr. H. O. Show--------------------------------113
BUREAU OF DIAGNOSTIC LABORATORIES
Report of Dr. B. L. Arms, Chief Bacteriologist------- -------116
Report of Dr. H. D. Venters, Bacteriologist------------------124
Report of Dr. F. A. Brink, Bacteriologist ---------- ---128
Report of Dr. Harold H. Fox------------- ----------------131
BUREAU OF ENGINEERING
Report of Geo. W. Simons--------------------------------135
Sanitary Investigations-----------------------138
Water and Sewage Laboratory------------------ ----- 162
CENTRAL BUREAU OF VITAL STATISTICS
Letter of Transmittal-- -------------------------- 171
Report of Stewart G. Thompson, D. P. H., Director ----------- 173
Part 1-Influenza --------------------------------- --173
Part 2-Morbidity --_------- ----------------185
Part 3-Statistical Report----. -------------- --187
Appendix to Part 3-Statistical Tables-.-------------.. ---.._ 197





















LETTER OF TRANSMITTAL.

Tampa, Florida, July 1st, 1919.
HON. SIDNEY J. CATTS,
Governor of the State of Florida,
Tallahassee, Florida.
Dear Sir:

I. herewith transmit to you the Thirtieth Annual Report
of the State Board of Health of Florida.

Very respectfully,
(Signed): C. T. FRECKER,
President, State Board of Health.










REPORT OF THE STATE HEALTH OFFICER.

Jacksonville, February 28, 1919.
HON. C. T. FRECKER,
President, State Board of Health,
Tampa, Florida.
Dear Sir:
In order that you may comply with the requirements
of the Statutes which make it obligatory for you to prepare
for the Governor a report upon what has been done by the
State Board of Health of this State for the last year-with
such recommendations as may seem to you to be proper
and necessary-a detailed report for 1918, is herewith sub-
mitted for your consideration and that of the other mem-
bers of the State Board of Health.

INFLUENZA.
Only one severe epidemic has visited this State during
the past year, the so-called Spanish Influenza and it was
world-wide. This terrible epidemic with its complications
and devastation, was visited upon Florida, last October
and took its toll in sickness and death.
Jacksonville, being the gateway to this State, Influenza
apparently made its first entrance into this State through
this city. A telegraphic communication was received from
the Surgeon General of the United States Public Health
Service at Washington, October 8th, advising the dis-
continuing of all public gatherings throughout the State.
On receipt .of this telegram a hurried conference was held
with the City Health Officer of Jacksonville, which resulted
in the closing of all the schools and amusement places in
Jacksonville, and a telegram was sent out from this Office
advising all our District Health Officers as well as the
mayors and city health officers of various towns through-
out the State, to close all amusement places and schools








2 ANNUAL REPORT STATE BOARD OF HEALTH

on account of epidemic Influenza. These measures were
immediately carried out; city officials and county school
officials appeared eager to co-operate with the State Board
of Health in endeavoring to check or control the epidemic.
Our District Health Officers were released from their
duties of special soil pollution work and were advised to
devote all their time to combating Influenza, even going
so far as to help attend the sick. Very soon our District
Health Officers had more than they could do. Calls from
various parts of the State came to the State Health Officer
for assistance and relief, as there was a shortage of medical
men in the State at that time due to war conditions. An
appeal was made by the State Health Officer for volunteer
medical aid throughout the State, and this appeal was an-
swered nobly by more than a score of physicians who
volunteered their services. Thus fifteen (15) extra medical
men were made available and put on the active list, and
under the direction of the State Health Officer, were sent
out into parts of the State where assistance was most
needed.
This action had the approval and co-operation of the
United States Public Health Service, and these extra
physicians were paid jointly by the State Board of Health
and the -United States Piblic Health Service. By a special
Act of Congress an appropriation of One Million Dollars
($1,000,000.00) was made to combat this epidemic through-
out the United States, and Florida's share was used by the
United States Public Health Service. The United States
Public Health Service, acting through their Assistant
Surgeon located in Jacksonville, did valuable service, and
the State Health Officer appreciates this assistance and co-
operation coming at such an opportune time.
The Statistician of our Department was advised to com-
municate by wire with all the State Registrars, requesting
them to wire reports of all deaths due to Influenza and
Pneumonia. During this epidemic daily telegraphic








REPORT OF STATE HEALTH OFFICER


reports of the number of deaths occurring from Influenza
and Pneumonia were received by our Statistician, and this
information was wired each day to the United States
Public Health Service at Washington. We published in
our Health Notes for November a chart showing graphic-
ally the number of deaths from Influenza and Pneumonia
each day from October 5th to November 5th, 1918, as
compared with same period in 1917.
By comparing the mortality list of October 1917, with.
the month of October 1918 (this being the month of the
epidemic) it shows to what extent this disease (Influenza)
prevailed in this State, and its frightful toll of death. For
October 1917, nine hundred and eighty-one (981) deaths
were reported. For October 1918, three thousand five
hundred and seventy-seven (3,577) deaths were reported.

DIPHTHERIA.
The usual number of cases of Diphtheria did not
materialize in the fall 1918, as was expected; no epidemic
occurred during the year. Diphtheria usually prevails quite
extensively during the late fall and early winter.

SMALLPOX.:
Smallpox gave us less trouble than usual during the
past year, and appears to be on the decrease. More vac-
cinations should be done among the school children.
People are apt to forget about vaccination when there is
no smallpox.
HOOKWORM.
Hookworm disease prevails quite extensively through-
out this State. This disease should be combated at the
source, as well as the curative treatment given. It is a
well established fact that the source is soil pollution.
Children who are treated and cured may become re-in-
fected unless the sanitary conditions about the premises
are improved.








4 ANNUAL REPORT STATE BOARD OF HEALTH

Much time of our District Health Officers and Sanitary
Engineer has been devoted to the prevention of soil pollu-
tion. The soil pollution campaign started in June 1917,
and continued through 1918, with the exception of the time
devoted to the Influenza control work. The Influenza
epidemic interfered with the soil pollution work early in
October and has been troubling us ever since. Soil pollu-
tion work is the work which aims at the prevention of
more communicable diseases than any other one work,
namely, Hookworm, Typhoid fever and Dysentery.

TYPHOID FEVER.

Anti-typhoid inoculation is recommended and used by
all of our District Health Officers. We furnish gratis this
serum to any physician in the State. On another page a
list of the free distribution of biologicals is given, most
of them are furnished free by the State.
Our system of disbursing the biological products has
many commendable features in that it affords convenient
places for quick distribution by not having to send to the
Central Office for the preparations. It is a well known
fact that the success ih the use of these products is due
to the early administration. The manufacturer bears the
expense of sending out these products under our directions.
The distribution of our biologicals by months and counties
appear on another page of this report. The use of biolog-
icals is on the increase, and we have increased the number
of distributing depots.

PRESS SERVICE.

Our weekly press service has been continued as bul-
letins, but the newspapers are not publishing them as
regularly as we hoped they would. This weekly press
service is an important way of getting certain public
health matters before the reading public.








REPORT OF STATE HEALTH OFFICER


During the Influenza epidemic when the people were
looking for anything to read "about Influenza, we had
several weekly bulletins on Influenza, its control and how
it is transmitted; also how to treat or what to do until
the doctor arrived. We emphasized the fact that it was
contagious and spread by personal contact; that crowds
should be avoided and that the great'danger from Influenza
was its complications-especially Pneumonia. Every week
during the epidemic and frequently since, we have had our
press service on Influenza.
The State Board of Health was duly represented at the
American Public iHealth Association held in Chicago,
December 9th to 12th, 1918. The Influenza epidemic was
made the most important subject for discussion and more
was said about this subject than any other and by the
most prominent Public Health men of the United States.
Much was learned concerning the nature of Influenza, and
much remains to be determined.
On the basis of the best data available, it is estimated
that there were about four hundred thousand deaths from
epidemic Influenza in the United States during the months
of September, October and November 1918.
Among the points agreed upon by the best health
authorities and scientists who have devoted much time
and attention to this subject are the following:
Compulsory reporting, wide spread publicity and educa-
tion, recognized administrative procedures, closing and
prevention, or limitation of gatherings-or at least proper
restrictions-especially prohibiting non-essential gather-
ings. A committee was appointed and charged with the
duty of preparing a provisional working formula based
upon facts and opinions gathered from papers and dis-
cussions at the meeting. A brief outline of the Com-
mittees findings and their recommendations appeared in
one of our December bulletins.
We have also laid great stress in our bulletins on








6 ANNUAL REPORT STATE BOARD OF HEALTH

Typhoid fever, its prevention, immunization and how to
immunize with the Typhoid vaccine, and also that the
State Board of Health furnished this vaccine free.
Malaria and mosquitoes have been one of our chief
topics, also the prevention of hookworms and rabies fully
described.
In regard to Rabies a letter was sent from this Office
asking the sheriffs of the different counties to co-operate
with us in the control of this unnecessary and easily pre-
ventable disease by killing all worthless dogs running at
large, and notifying the owners of other dogs the necessity
of keeping them at home or under surveillance. Almost
all the, sheriffs responded-offering their assistance.
Smallpox is probably the oldest of all the historic
epidemic diseases, and we have endeavored to show to
the people through the press that smallpox can be abso-
lutely prevented by vaccination. Every child should be
vaccinated. It is surprising to know the number of children
not vaccinated, going to school. Universal vaccination
will banish Smallpox. Vaccination against Smallpox is
furnished free by the State.
One of our weekly bulletins dwelt quite extensively
on school examination and the importance of keeping
a child who is ill from any cause away from school until
it is definitely known that the sich child has not a com-
municable disease. School examinations are now being
made by our District Health Officer.

PELLAGRA.
We have had numerous inquiries about Pellagra, and
w,e have' tried to explain that Pellagra is not a communic-
able disease and that it is caused by an unbalanced diet.
Pellagra is really not a public health question. The im-
provement of sanitary conditions has no. effect upon
Pellagra.








REPORT OF STATE HEALTH OFFICER


HEALTH NOTES.
We have continued to issue Health Notes and en-
deavored to have them reach all the physicians of the
State, as well as many laymen. We furnish a copy to any
one requesting to be placed on our mailing list.
In the January 1918 Health Notes, Medical Inspection
of School Children was taken up in full and described in
detail, how to examine school children and what to look
for. In the February number there is a good article on the
Control of Venereal Diseases. In the May issue there are
several interesting articles, namely, "Saving More Babies,"
"Control of Communicable Diseases," "Bureau of Diag-
nostic Laboratories," etc. The August number contains
What the State of Florida Does Through Its State Board
of Health, Typhoid Prevention and Cooperation are em-
phasized. September number was devoted to reprint of
papers read at our Health Conference and known as Health
Conference Number. The November issue contains'art-
icles on Sanitary Engineering, State Laboratories, Vital
Statistics, Child Welfare, Communicable Diseases in
Schools, etc.
We are interested in our Health Notes, and our inten-
tion is to get up larger (full 32 pages) and even more in-
teresting numbers, issued less frequently, but making them
one of our educational features.
HOSPITAL FOR CRIPPLED CHILDREN.
The Legislature of 1911 added to the duties and respon-
sibilities of the State Board of Health by Statutes requir-
ing corrective treatment for the indigent crippled children
of this State.
This Hospital for Crippled Children is now located at
Ocala under the management of Dr. E. Van Hood. Dr.
Hood has done some brilliant orthopedic surgery and his
kindness in having these crippled children so well cared
for, and at times entertained, speaks well for his ability
in such work. Your attention is called to his report.








8 ANNUAL REPORT STATE BOARD OF HEALTH

NEW BUREAUS ESTABLISHED.
During the latter part of the year a Bureau of Venereal
Diseases was established, placing a competent medical
man at the head to organize and do special venereal disease
work in conjunction and co-operation with the United
States Public Health Service. The United States Con-
gress appropriated in 1918 a special fund for this work to
be carried on throughout the United States. This fund
was prorated to the different states according to popula-
tion and Florida received Eight Thousand One Hundred
and Eighty-three Dollars and Eleven cents ($8,183.11) for
her part in this special work. You, with other members
of the Board, realized that this amount wasnot sufficient
and very generously and properly added to this fund an
equal amount or an amount not to exceed Twelve Thous-
and Dollars ($12,000.00) per annum, in addition to the
allotment made by the United States.
The Board very 'wisely created a Bureau of Education
and Child Welfare, which is an innovation in Public health
work in Florida. This being a special Department and
only created during the latter part of the year (Sept. 8th)
not much has yet been done, but much is to be expected.
Dr. Grace Whitford heads this Department and she is
capable of accomplishing much good among the children.
While the chief feature of this Department is educational,
we think, however, that all the departments are more or
less educational.
Realizing that no department can succeed without the
sympathy and co-operation of the people, this office recom-
mended to county officials that a social worker, or visit-
ing nurse be appointed in each county to assist in the
examination of school children, and to do the follow up
work, The counties of Lake, Orange, Palm Beach, Pinel-
las, Hillsboro and Brevard have made such appointments.
We hope that in creating the Department of Child
Welfare and placing a competent woman physician at its








REPORT OF STATE HEALTH OFFICER


head, that it will be the means of helping this State to
reach her quota in saving the lives of one hundred thou-
sand children in the United States and that all children in
Florida will be benefited.

DISTRICT HEALTH OFFICERS.
We have eight full-time District Health Officers, and
one part-time District Health Officer, whose reports ap-
pear in this Annual, to which your attention is called.
These gentlemen have done excellent work and I believe
their work has been satisfactory. Owing to the peculiarity
of his work it is practically impossible for a District Health
Officer's report to make a showing comparable with, and
commensurate to his actual work in the field (district).
In any one district there are many obstacles to combat.
Often a District Health Officer has to overcome them
single handed and alone. Aside from the great amount of
technical knowledge involved in the successful performance
of this work, it requires at times the utmost tact and diplo-
macy. A District Health Officer must be ever alert, con-
stantly a watchman and at the same time a man of sufficient
force to inculcate his ideas into the minds of people of
various classes and stations in life. Judgment, diplomacy
and tact are prerequisites, for he must not make mistakes
and then have to reverse himself. Once on record he
should stand by his guns, but he should never go on record
until he is sure he is right. He must be equally capable
of discussing the neighbor's offensive back yard with some
irate house-wife and facing a mass meeting with an organ-
ized opposition to his plan of closing the school and picture
shows-much is expected of the District Health Officer.
It is not true, according to the popular idea, that physicians
(doing regular practice) are qualified to do public health
work. Public health work, as it is understood today, is
not taught in regular medical colleges. There are few
schools today such as Harvard, Universities of Michigan,
Minnesota, Wsconsin and Ohio-and these only in the








10 ANNUAL REPORT STATE BOARD OF HEALTH

last few years-that give a regular public health course
and this as special work. Thus you will see that a District
Health Officer, to be efficient, must be a specialist, or make
this work a special work. It is for this reason that District
Health Officers are required to give all their time and are
,not permitted to do private practice. This is also the
reason that a Board of Medical Examiners was appointed
to examine applicants for the position of District Health
Officer, hence a special examination was held to fill
vacancies.
These examinations have in part an objective-that is
the applicant taking the examination must know or soon
realize what he must familiarize himself with and become
informed upon certain subjects pertaining to public health
work. It should be realized more fully that public health
work is special work.
During the year we had three resignations, namely,
Dr. C. T. Young, Dr. J. E. Taylor and Dr. Hiram Byrd.
Dr. Young was acting Assistant to the State Health Officer
in the central or main office. Dr. V. H. Gwinn was called
from the Jacksonville District to fill this position. Dr. L.
T. Galphin was appointed District Health Officer, subject
to approval by the Board, to fill the Tallahassee District
made vacant by the resignation of Dr. Taylor. Dr. W. H.
Bryan was appointed to fill the Jacksonville District.
At a meeting of the Board held in June a resolution was
adopted compelling all applicants for District Health
Officers, to pass a satisfactory examination before an
examining board. The Medical Board of Examiners was
then created consisting of three physicians whose duties
were to examine all applicants for District Health Officers.
At specified times, the Examining Board-making its own
rulings and requirements-conducts examinations, and is
required to recommend to the State Health Officer, the
three applicants making the highest grades in examina-
tions. The members of this Board are Dr. C. T. Young,








REPORT OF STATE HEALTH OFFICER


Dr. W. M. Rowlett and Dr. V. H. Gwinn. It was thought
wise to have two members of this Board, physicians who
were not connected with the State Board of Health. After
adopting rules governing the examination, these rules
being that all applicants were required to pass a satis-
factory oral and written examination, and were also re-
quired to make an average of not less than 65 per cent, the
Examining 'Board held its first examination in Tampa,
August 30th and 31st. Dr. L. T. Galphin and Dr. John
Keely, after passing a satisfactory examination before
the Medical Examining Board, were recommended and
appointed, the Board confirming the appointments at a
meeting held September 6th.
The Miami District, made vacant in October by the
resignation of Dr. Hiram Byrd, has not yet been filled.
The District Health Officers are required to make in-
spection trips throughout their districts, visiting all in-
corporated towns at least once a year, ascertaining the
sanitary conditions and advising with the municipal
authorities as to the necessary corrective measures for the
protection and conservation of the public health. They
are also at all times subject to call for special work, and
detailed at any time, to any point in their district or else-
where in the State, whenever and wherever the exigencies
of the situation appear to require their services for the
prevention and control of any communicable disease.
The following named physicians constitute our field
force and were selected on account of their qualifications.
The counties composing their districts are listed after their
names:

DISTRICT HEALTH OFFICERS DISTRICTS BY COUNTIES.
Dr.A.W.Underwood HeadquartersDr. G. A. Dame Headquarters
Flagler St. Augustine Alachua Inverness
Clay Marion
Putnam LaFayette
St. Johns Levy
Volusia Citrus
Seminole .Taylor









12 ANNUAL REPORT STATE BOARD OF HEALTH


Dr. John Keely Headquarters
Hamilton Jacksonville
Duval
Columbia
Baker
Suwannee
Bradford
Nassau
Dr. L. T. Galphin Headquarters
Jackson Tallahassee
Gadsden
Franklin
Liberty
Wakulla
Jefferson
Madison
Leon
Calhoun
Dr. A. C. Hamblin Headquarters
Manatee Tampa
Hillsboro
DeSoto
Lee
Okeechobee
Pinellas


Dr. W. H. Bryan Headquarters
Pasco Dade City
Hernando
Sumter
Orange
Polk
Osceola
Lake


Dr. F. L. Tatom
Escambia
Walton
Washington
Santa Rosa
Holmes
Bay
Okaloosa

Dr. Hiram Byrd
St. Lucie
Palm Beach
Dade
Broward
Brevard


Headquarters
DeFuniak Springs






Headquarters
Princeton


(Part-time)
Dr. W. R. Warren
Monroe


Headquarters
Key West.


THE LABORATORIES.

In 1917 the Laboratories examined 144 specimens of
supposedly rabid animals, 76 were positive, 62 negative and
six were doubtful or decomposed. Treatment was sent
to 134, all of whom were reported as indigent, except
about 27. There was one death (Duval County).
In 1918 the Laboratory examined 92 specimens of
suspected rabid animals-43 were positive, 41 negative and
8 unfit for examination. Treatment was sent out to 78.
49 of these cases were indigent and 29 paid for their treat-
ments. There were no deaths.
The following table gives the distribution by months
and counties and the cost to the State and to the patients.
The treatment referred to is based on the Pasteur prophyl-
actic (preventive) treatment and is not used as a curative.








.REPORT OF STATE HEALTH OFFICER


When rabies once develops there is no known cure, there-
fore the proper management is prevention. The preven-
tion could easily be carried out if all ownerless and worth-
less dogs were killed and other dogs compelled to wear a
license tag, and also to wear a properly fitted protective
wire muzzle. This can only be done by legislation, and
not by any rules of the State Board of Health.
"Bacteriology is now an old-established science, but
despite the fact it has changed public health work even
more than it has changed medicine or surgery,-and both
of these it has completely revolutionized,-the public still
clings to the belief that public health is a curious profes-
sion, absorbedly interested in cutting weeds in vacant lots
("to prevent epidemics"), in burying dead animals and
suppressing noisome odors ("to prevent epidemics"), in
inspecting plumbing and collecting garbage ("to prevent
epidemics"). The "good" health officer according to the
popular standard, still too prevalent, is he who keeps the
streets clean and the back alleys neat, who falls into a
rapture over a newly whitewashed outhouse and into a
rampage if a pile of old bones is found under the cellar
steps. Yet many of those who know better let these ideas
alone, or even acquiesce in them, "to save trouble."
Nevertheless it is expected that the carefully uneducated,
or miseducated, public opinion will demand up-to-date
action! Is it any wonder that the public insists on think-
ing, acting, and legislation to suit the theories of twenty
years ago instead of the scientific knowledge of today?"
(Quotation from New Public Health.).

ENGINEERING DEPARTMENT.
Your attention is called to the report of our Sanitary
Engineer and his report on the Florida Tank Privy which
is described in detail in Health Notes for August 1918.
The following quotation from New Public Health may be
interesting: .








14 ANNUAL REPORT STATE BOARD OF HEALTH

"The Public Health Engineer is not therefore, or,
rather, should not be, merely what the popular imagina-
tion makes him, a man of sewer pipes and concrete; of
water-meters, manholes and pumps. The New Public
Health Engineer will be a man keen of eye to see those
features in all community construction work which may
conduce to greater exchange of discharges, a man who
knows just what is needed for prevention of disease in
such ways, and therefore can both provide adequate pre-
cautions and at the same time avoid unnecessary or ex-
cessive ones. The civil engineer has been defined as he who
can do for $1.00 what any fool can do for $4.00. He is a
physical economist. He insists on physical safety but
within that limit knows best how to achieve the needed
safety without undue expenditure. The Public Health
Engineer, dealing with water supplies, sewage, disposal,
etc., does just this thing. He guarantees sanitary safety,
and within that limit he guarantees it for less money than
the ordinary builder. Any keen student of infectious dis-
eases can generally see the grosser faults in a supply which
permit infection. The Public Health Engineer is a spec-
ialist. He sees these faults very much more quickly and
surely; if they are intricate he has the skill and knowledge
to disentangle them; and when he finds them, he knows
how to correct them.
The Public Health Engineer is, or should be, much
more than this, however., He is the only public health
worker whose initial professional training necessarily
makes of him a business man, in the sense of an administ-
rator of operations on schedule time, and with economy
of labor and expense. Those physicians who make good
administrators in this do so because they learn it in ad-
ministration, not because of initial professional training.
This training of the Public Health Engineer makes him
also the best man to supervise maintenance of public
utilities, as well as to construct and equip them. Further,








REPORT OF STATE HEALTH OFFICER


the absence of training in mechanism and machinery so
prominent in the training of most health officials, makes
of the Public Health Engineer the only public health man
who can deal properly with the many mechanical devices
of modern building of the public routes of infection, on the
perfection of which many lives often depend. The hypo-
chlorite plant, the mechanical filter, the pasteurizing device
are machines. However well a physician may understand
the underlying biological principals, he cannot figure the
pitch of a cog-wheel or find the reason of the filter 'loss
of head' without infinite and wasteful effort, if at all.
"The Public Health Engineer is in public health what
the surgeon is in medicine, the 'man of his hands,'-the
actual operator. Whatever the physician may discover as
surgically necessary to be done, it is the surgeon who must
bring his skill and knowledge to bear upon the doing of it.
So, although the epidemiologist, the vital statistician, the
laboratory man must usually determine the sources and
routes of disease, it is the Public Health Engineer to whom
all must turn'wherever and whenever those sources or
routes are to be put out of action by physical construction
or mechanical device, or when economic mal administra-
tion of public utilities is the real basis of the trouble, rather
than a physical condition."

VITAL STATISTICS.
Dr. F. L. Watkins who was appointed Statistician
March 1916, for this State, resigned March 23, 1918, and
Stewart G. Thompson, D. P. H. of Kansas was selected
to fill the vacancy, April 15th, 1918. Dr. Thompson was
highly recommended and has given entire satisfaction in
this work.
Mortality reports for 1918 are higher than 1917, the
main reason, no doubt, due to the great epidemic.
The following quotation is given as an illustration:
"A recently completed analysis of the statistics of over
ten million wage earners recently insured by the Metro-








16 ANNUAL REPORT STATE BOARD OF HEALTH

politan Life Insurance Company, shows that during 1918
the mortality was higher by more than thirty (30) per cent
than prevailed for 1917."
We believe that the time is not far off when this State
will be admitted to the registration area of the United
States and that the assertion that the healthfulness of Flor-
ida, at all seasons of the year is excellent, will be sub-
stantiated and maintained by statistical figures.
Your attention is called to the Statisticians report in
his Annual Report.
FAIR EXHIBIT.
At the State Fair held in Jacksonville during the latter
part of November, the State Board of Health had a very
interesting exhibit, well displayed. This exhibit brought
forth such favorable comment that we were requested to
send it complete to the Fair held later at Live Oak. This
we did, with the result that we were also asked to send it
on to Marianna to the Fair held at that place in December,
and since then it has also been sent to the Orlando Fair.
Thus the people of the State generally have had opportun-
ities to see our exhibit, and to become familiar with the
different disease bearing insects, also to see the best
methods of screening against flies, and the great import-
ance of this, and of the septic tanks, which so materially
aid modern sanitation in country districts.

HEALTH CONFERENCE.
In June 1918 an Annual Conference ot Health Officers
was held. This was a get together meeting of our District
Health Officers and heads of Departments of the State
Board of Health to outline and discuss the work laid out
for the following year. This is always an interesting meet-
ing and the second of its kind we have had.
During the latter part of July the City Health Officers
of the State were invited to meet our District Health
Officers here in Jacksonville at the State Board of Health








REPORT OF STATE HEALTH OFFICER


Building for a general conference August 1, 2, and 3. At
the same time our District Health Officers were notified
to be here at that time. The object of this meeting was
to get all public health workers acquainted with our
District Health Officers of the State and at the same time
to have the City Health Officers understand the object
and duties of State District Health Officers, and further-
more to get the sympathy and co-operation of all the City
Health Officers throughout the State.
It was a pleasure to note the presence of physicians
who were not public health officials, as well as a large
number of city health officials. It was the consensus of
opinion that this meeting was a success. Valuable papers
were read and discussed; these papers were printed in our
Health Notes of September issue known as Health Con-
ference number.
The State Health Officer takes this means of expressing
here to the various city health officials and physicians
attending, his appreciation in helping to make the Con-
ference a success.
RECOMMENDATIONS.
Permit me to suggest in this Report that some revised
methods of admissions of physicians or "doctors" to pract-
ice medicine-including especially chiropractors-should
come before the next Legislature. A most absurd ad-
vertisement appears in one of the local newspapers by a
chiropractor warning against vaccination for the preven-
tion of smallpox and typhoid, stating in plain English that:
"Chiropractors do not need to resort to such methods to
ward off disease, as they remove obstructions so NATURE
can do her duty and give the body power of resistance, and
if any of these diseases should get hold, chiropractics is
the surest and quickest way to get rid of it, because it
assist nature to throw off the poison. Come in and let
me explain it so plain that you can see the reasonableness
of it. Always go to a real Chiropractor, and not a Mixer,








18 ANNUAL REPORT STATE BOARD OF HEALTH

who does not know where to look for or find the cause of
your trouble."
The Florida State Board of Health and all state boards
of health in the United States; the United States Public
Health Service; the United States Army and Navy recom-
mend vaccination against smallpox and typhoid-in fact
the best medical brains of the world recommend vaccina-
tion for the prevention of smallpox and typhoid, and here
is a chiropractic advertisement that is allowed to mislead
the common people by advising against vaccination. We
should ask the Legislature to prevent such advertising.
The State Board of Health was created by the Legis-
lature and should be supported by the Legislature.
While the true function of the State Board of Health
is to advise the people, the responsibility for public health
conditions rests with the people. We feel that it is our
duty to prevent "quack" advertising, as we do against any
other public health menace.
The Press Service for February 26th, 1919, is inserted
here following Recommendations, for the purpose of show-
ing up "quack" advertising, in the hope that some legis-
lation might be enacted which would regulate such ad-
vertising as maybbe misleading to the people.
Three quarters of a century ago Disraeli said in the
British House of Commons: "Public health is the founda-
tion on which rests the happiness of the people and the
strength of the nation. The first duty of a statesman is the
care of the public health."
PRESS SERVICE-STATE BOARD OF HEALTH OF FLORIDA.
Released Wednesday Morning, February 26th, 1919.
QUACK ADVERTISING.
In one of our prominent newspapers there appears an advertise-
ment that condemns vaccination against smallpox and typhoid,
starting off with such headlines: "Is It Possible That Thinking,
Scientific People Would Do Such a Thing", and ending by stating:
"If any of those diseases should get hold, chiropractic is the surest
and quickest way to got rid of it."
This advertiment is so absurd that the State Health department
would not notice it if its attention had not been called to it; further-









REPORT OF STATE HEALTH OFFICER


more it attacks vaccination, which the Florida State Board of Health
recommends as do other state boards of health as well as the Army
and Navy.
Is it possible that a chiropractor or any one else of ordinary in-
telligence believes that smallpox can be cured; moreover is it possible
that any one, even if smallpox could be cured, believes it better to
have the disease than to prevent the disease? Smallpox can be pre-
vented and the prevention is vaccination. The Florida State Board
of Health advises vaccination and furnishes vaccine free. It is the
duty of Public Health officials to prevent epidemics if possible and'
it is possible to prevent epidemics of smallpox. Thinking people
will not be affected by a quack advertiment, but the unthinking and
uneducated may be. The State Board of Health is trying to bring
home to the people of this State certain educational features that will
be beneficial in the way of preventing diseases by improved sanita-
tion and right living. Improvements in sanitation affect or control
the spread of certain diseases, but this does not apply directly to
smallpox-hence vaccination is advised.
It has been asserted by eminent authorities that vaccinia (cow-
pox) confers a more lasting and complete immunity against small-
pox than does an attack of the disease itself, at any rate it represents
the nearest approach to a perfect prophylaxis of which in all medicine,
we have knowledge.
In the educational campaign of all state and city boards of
health, it should be recognized that the quack advertisers, with their
grotesque misrepresentations, are even as much of a menace to a
community as is disease itself. There is no subject upon which the
average man or woman is so ignorant as that pertaining to health
and disease, so that with the natural and inborn yearning of the
human soul in distress for some specific, some perfect cure, which
cannot be offered by the conscientious physician (because it does not
exist) they are easily led astray by the plausible Charlatan who
"having none of the virtues can best assume them all."
In concluding this condensed report of what has been
done in State Health work in Florida, during the past
year, the Executive Officer wishes to express his thanks
and appreciation to the President and other members of
the Board for the confidence shown in the management
of the Executive Office, and for the approval of his policies.
The State Health Officer desires to thank his co-workers
and express his appreciation for their support and co-
operation. Respectfully submitted,
W. H. COX, M. D.,
State Health Officer.










20 ANNUAL REPORT STATE BOARD OF HEALTH

DISTRIBUTION OF RABIES TREATMENTS BY MONTHS


January ---------- 9
February --------- 9
March -----------16
April ------ 22


May -----------. 7
June ---------- 3
July -------------3
August -------- 5


September -------
October ------
November --------
December--------


DISTRIBUTION OF RABIES TREATMENTS BY COUNTIES


Alachua --------- 4
Bay ------------- 0
Bradford ------- 0
Brevard ---------0
Broward ------- 0
Baker ------- 0
Calhoun ------- 0
Citrus----------- 2
Clay --------- 6
Columbia -------- 0
Dade ------------ 2
DeSot ----------- 1
Duval -----------36
Escambia -------- 0
Franklin -------- 0
Flagler ---------- 0
Gadsden ----------1
Hamilton 1-------
Hillsborough ------ 3


Holmes ---
Hernando .----_-
Jackson ---------
Jefferson ------
Lafayette -------
Lake ---------
Lee ---------
Leon ----
Levy --------
Liberty --------
Madison ---------
Monro ---------
Manatee_ _-----_
Marion -------
INassau---------
Okaloosa ----
Orange---------
Osceola -------
Okeechobee'------


Palm Beach ------ 0
Pasco---- --- 0
Pinellas ------ 0
Polk ------------- 0
Putnam _--------- 2
St. Johns --------- 1
St. Lucie ------ 0
Santa Rosa ----- 0
Seminole------ 1
Sumter----------- 0
Suwannee ------- 2
Taylor--------- 0
Volusia -------- 4
Wakulla -------- 0
Washington -----. 0
Walton ---------- 0

Total--------78


State paid for 49 treatments at cost of ---- $980.00
Patients paid for 29 treatments at cost of -- 580.00

Total--------------------- $1560.00




MONTHLY DISTRIBUTION OF TYPHOID-VACCINE
BY COUNTIES

Counties Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total


Alachua --- ---
Bay --- --
Bradford -- -
Calhoun ------
Citrus- --
Clay --- --
Columbia ---
Dade ------ --
DeSoto -- --
Duval ----- -
Escambia -- --
Franklin -- --


53 -------- 25
50 -- ---- 1900
50 ---- 2 165
25 --- ---
50 -------- ----
30 -- -- ---
50 ---- 200 .--.
20 -------- 12
100 10 6 ---
63 219 271 462
50 100 1500 1500
---- 12 12


S2 -- ---
50 ---- --


12 -- ---

170 7 6

24 _- ---


78
1950
219
75
50
30
318
56
191
2121
3650
60


--










20 ANNUAL REPORT STATE BOARD OF HEALTH

DISTRIBUTION OF RABIES TREATMENTS BY MONTHS


January ---------- 9
February --------- 9
March -----------16
April ------ 22


May -----------. 7
June ---------- 3
July -------------3
August -------- 5


September -------
October ------
November --------
December--------


DISTRIBUTION OF RABIES TREATMENTS BY COUNTIES


Alachua --------- 4
Bay ------------- 0
Bradford ------- 0
Brevard ---------0
Broward ------- 0
Baker ------- 0
Calhoun ------- 0
Citrus----------- 2
Clay --------- 6
Columbia -------- 0
Dade ------------ 2
DeSot ----------- 1
Duval -----------36
Escambia -------- 0
Franklin -------- 0
Flagler ---------- 0
Gadsden ----------1
Hamilton 1-------
Hillsborough ------ 3


Holmes ---
Hernando .----_-
Jackson ---------
Jefferson ------
Lafayette -------
Lake ---------
Lee ---------
Leon ----
Levy --------
Liberty --------
Madison ---------
Monro ---------
Manatee_ _-----_
Marion -------
INassau---------
Okaloosa ----
Orange---------
Osceola -------
Okeechobee'------


Palm Beach ------ 0
Pasco---- --- 0
Pinellas ------ 0
Polk ------------- 0
Putnam _--------- 2
St. Johns --------- 1
St. Lucie ------ 0
Santa Rosa ----- 0
Seminole------ 1
Sumter----------- 0
Suwannee ------- 2
Taylor--------- 0
Volusia -------- 4
Wakulla -------- 0
Washington -----. 0
Walton ---------- 0

Total--------78


State paid for 49 treatments at cost of ---- $980.00
Patients paid for 29 treatments at cost of -- 580.00

Total--------------------- $1560.00




MONTHLY DISTRIBUTION OF TYPHOID-VACCINE
BY COUNTIES

Counties Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total


Alachua --- ---
Bay --- --
Bradford -- -
Calhoun ------
Citrus- --
Clay --- --
Columbia ---
Dade ------ --
DeSoto -- --
Duval ----- -
Escambia -- --
Franklin -- --


53 -------- 25
50 -- ---- 1900
50 ---- 2 165
25 --- ---
50 -------- ----
30 -- -- ---
50 ---- 200 .--.
20 -------- 12
100 10 6 ---
63 219 271 462
50 100 1500 1500
---- 12 12


S2 -- ---
50 ---- --


12 -- ---

170 7 6

24 _- ---


78
1950
219
75
50
30
318
56
191
2121
3650
60


--











REPORT OF STATE HEALTH OFFICER 21

MONTHLY DISTRIBUTION OF TYPIOID-VACCINE BY COUNTIES
(Continued)


Counties Mar.
Flagler -------
Gadsden -- --
Hamilton -- ---
Hillsborough --
Holmes --- ---
Jackson ------
Lafayette -- -
Lake ----- ---
Lee ..---- ---
Leon -----
Levy ------ 11
Liberty --- ---
Madison -- ---
Manatee-- ---
Marion ---- ---
Monroe --- --
Nassau --- ---
Okaloosa -- --
Orange ---- ---
Osceola------
Okeechobee --
Palm Beach --
Pinellas -- --
Polk --- -
Putnam-- --
St. Johns __
St. Lucie- -
Seminole __
SSumter ------
Volusia ---- ---
Walton --- ---
Washington ---
Suwanee -- ---


April May June July Aug. Sept. Oct. Nov. Dec. Total
-- --- --- 5 74 -- --- --- 79


30 25 75
4 --- --
_-- 300 200 300
S 90 48 12
-- ---- --- 102
-- --- 208
--- ---- ---- 1
--- 50 10 --
33 50 6 ----
27 --- --
16 60 110 75
--- ---- ---- ----
--- --- 50 .--
5- 0 -- 200
S 50 --------
-- -- 61 77
90 5 10
50 --- 2
50 --------
-- 50 200 --.
__ 50 4 --
50 -.- ----
50 10 --
--- ---- ---- ----
25 50
-- 50 ---- --
1 2
6 12 _.-- --
30 -..- 50 ---
750 -- --
12 250 --- ---
75 .--- 37


50 50 -- ----
10 5 ----
---- ---- --- --- ----
-- - ----
12 -- -- ----
200 300 -- ---
--- ---- -- --- ----
--- ---- --- --- ----
25 20 12.-- ---
5 ---- --- -------
55 95 -- ----
2 _-- ----




50 46 -- ---- ----






--- 2 -- --- ---



1 -- ---- --- ---
50 46 -- --











24 200 1 --- ----

2 52 ---- ----


.-- 12- --- ---
-- 200 --- --- ----
------ --- --- ----







S---- 12 -- 50
1 --- --- 7- ----


--- ---- --- --- ----


--- ---- --- --- ----
12 ---2 --- ----
---- 200 ------
25 --- --- ----
50 ---- --- --- ----


208 2754 1159 3142 4543 2629 238 7 56 14749


Total.--.. 11













MONTHLY DISTRIBUTION OF SMALL POX VACCINE BY COUNTIES

County Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total
Bay-------- ---- -- ---- ---- -- ---- 190 ---- ---- -- .-- 190 Z
Bradford ------------ 70 ---- -- -- -- -- --- -- --- --- ---- ---- t
Brevard ------ ---- ---- -- --- ---- ---- ---- 10 .. ... 10
Columbia -------... ---- -- --- ---- ---- -- --- -- ---- ---- --- 10 10
Dade -- ---------- 42 ---- -- -- -- -- ---- --- --. 42
DeScto--......------. 20 200 .. .... .. ... 220
Duval -------------- 111 60 612 15 115 4 .... 50 750 10 10 .. 1737
Escambia ----- 50 50 100 --- ---. 50 -- 50 50 .- -. .... 350
Franklin_ --------- 10 -- -- --- ------ 10 50 -- --- --. 50 120
Flagler ---------------- -. 30 -- --- --- --- ---- ---- -- 30
Gadsden -------------- ---. 20 ....- -- 2000 150 460 -.. 200 ....- .- 2830
Hamilton------ ---- -- ----- -- -- -- ---- 10 .... .. 10
Hernando ----------- -- ----.-- ----- -- --- ---- ---- ---- 50 50 .
Hillsborough --------- ---- 700 300 -- 500 .. 100 200 --- --- -- 100 1900
Holmes ----- --... -- ---- 30 100 --. -- --. --- ---. ---- --. --- 130
Jackson ---------- 40 180 .--. --. 10 ---- .-- --- -- .--. --. 230
Lake...........---------- --- ---- ---- ---- ----- -- -- ---- --- -- ---- -120 120
Leon .--.-- ------ ---- 450 ... .. .... 10 ...... 10 20 ... 50 540
Liberty ..--------------- ---- -------- 20 ---- --------- ---- ---- ------ 20
Manatee------------- .--- ---- -- ---- 20 30 .--. -- --. 20 -.. 20 10 100
Marion--.. --- ...------. -- -- ---- 40 20 .-- .. -- --- --. 30 ... 90
Monroe------------- ---- 40 50 -. 40 ---- -- --. 60 -- .. .... 190
Nassau .------------------- 30 .. --..--. -- --- ---- ------ --- ---- 30
Orange .--------- --- ---- 230 ..- -- 20 20 10 -60 10 350
Osceola ------. ---- --- --- --- -- 20 .... ... 10 30
Okpecbobee --------....---- 150 ... 20 .. 10 ..--- -- -- 180
Palm Beach----.---- --- --- -- -- 10 --. --- -- -- ---- ---- --- 10
Pinellas .------ ----- 10 --. --. -- ------ ---- -- 10 --. 20
Polk ....-........---- ------ --------- ---- ---- 670 20 -- --.- ---. 690
Put oonam - 10 ---- 10
St. Johns -------- 260 E500 ---- -- ---- 320 500 --- 50 00 300 0 ---- -- 2390
t. ucie--------------- 20 -- ---- 100 10 ---- -------- 50 100 -- -- 280
Seminole ---------- --- -------- 60 10 -- 20 10 -- -- -- 100
Voli0si--------------- --- 70 10 80 -- 170 -- -- -- 10 --- 340 ,
Walton---------- -------- ---- ---------- 10 -- ..- 10-
WVashington .----- 60 --- ---- -- -- --- ---- -- -- --- 50 -- 110
Total ------------- 683 2290 1592 385 3075 924 590 1730 1520 150 190 410 13539









REPORT OF STATE HEALTH OFFICER 23

(TETANUS ANTITOXIN)
MONTHLY DISTRIBUTION OF TETANUS ANTITOXIN
BY COUNTIES

UNITS

1,500 5,000


February:
Marion County -- --------------1--- 0

March:
Citrus County ------------- 1------_ 0


April:
Hillsborough County ---_--1 ___- --1-__1
Levy County ----_-----------1 ---_- 0

June:
Hillsborough County ------------- --

July:
Dade County -------------- 15-----0

August:
Volusia County -------------------5---- 3
Duval County ------------7----- 17

September:
Nassau County -------1--------1- __0
Hillsborough County ----- ---0------6-
Dade County --------------------6- 0
Suwannee County -- --------0-----1-- -0
Duval County -------------- -2-_ 20

October:
Duval County ---------------- 1 0
Dade County -------------------3 0

November:
Dade County ----------------6 2
Duval County -----1--- ------1_-- __---

December:
Duval County ----------- -----1---
Dade County -----------_0----_____

Total-------- -------68 ___48









24 ANNUAL REPORT STATE BOARD OF HEALTH

MONTHLY DISTRIBUTION OF DIPHTHERIA ANTITOXIN
BY COUNTIES
UNITS
1,000 5,000 10,000
January: Name of County.
Santa Rosa ---------------- 6
Total------------------------------- 6

February: Name of County.
Alachua _----------------- 9 10 10
DeSoto -------------------- 12 6 6
Leon -------------------- 5 5 5
Franklin -------- --------- 5 5 5
Suwannee ------------------ 5 5 5
Marion ------------------ 5 10 10
Citrus -------------------- 5 10 10
Monroe ------------------- .5 10 10
Orange .------------------- 5 10 10
Okeechobee ---------------- 5 10 10
Bradford ------------------- 5 5 5
Escambia ------------------ 10 10 10
Dade ----------------------- 10 10 10
Hillsborough ---------------- 10 10 10
Pinellas -------------------- 5 5 5
Sumter ------------------ 5 -
Columbia ------------------- 5 5 5
Walton -------------------- 5 5 5
Duval -------------------- 1
Washington ----------------- 5 5 5
Bay ---------------------- 5 5 5
Total--------------------------- 126 141 148

March: Name of County.
St. Lucie -------------------- 5 5 5
Palm Beach--------------- 25 17 11
DeSoto --------------------- 5 5 5
Duval --- ---------- 1
Alachua -------------------- 5 -
Total------ ------------------------- 40 27 22

April: Name of County.
Okeechobee ---------------- 5 5 5
Citrus -------------------- 6 -
Lee ------------------------ 5 5 5

Total------- ------------------ 10 16 10











May:


REPORT OF STATE HEALTH OFFICER

Name of County.
Osceola ------------------- 5 5
DeSoto --------------------- 5 5


Total----------------------- 10 10 10

June: Name of County.
Manatee --------------- 5 5 5
Total --- --------------------- 5 5 5
July: Name of County.
Hillsborough ----------.---- 10
Duval ------------------ 3 --
Bay ----------------------- 10 10 10
DeSoto --------------- 5 10 -
Suvannee ------- ---- 5 5
Calhoun -------------2 3
Sumter -------------- ---12 -
Total --- ----------------------29 31 25
August Name of County.
Okeechobee -------------- 10 -
Sumter -- ------------- 3 -
Calhoun--- ----------- 6 -
Duval ----------------- 4 2 1
Bay -------------------- 10 10 10
Total--__-------------- ----- 17 28 11

September: Name of County.
Duval ----------------- -- 3
Washington ---------- 15 15 -
Hillsborough -- --------- -- 3 10
Bay ------------------------- 2 -
Levy --------------------- 3 2 2
Baker --- ----------- -- 7 7
Polk ---------- ------- 5 15
Seminole --------------- 5 5
Calhoun ------------...------ 3 10
Hamilton ----------------- 2
Total ------------------------ 18 42 63

October: Name of County.
Gadsden ------------------- 5
Duval ---------------------- 4
Bay ----------------------- 5 6
Hillsborough --------- 10 20

Total ------------------------ 15 35









26 ANNUAL REPORT STATE BOARD OF HEALTH

November: Name of County.
Escambia ----------------- 10 5
Palm Beach -------------- 5 5
Duval ------------------- 4 8 10
DeSoto -------------------- 5 5
Gadsden -------------------- 10 1 1
Dade -------------------- 6 -
Bay ---------------------- 5 5
Washington -----------------10 -

Total------------------------------- 30 34 31

December: Name of County.
Duval ------------------- 7
Escambia ------------------ 10 10 10
Palm Beach----------------- 11 1 -
Polk ----------------------- 5 5
Hillsborough ---------------- 15 15
Washington ---------------- 12 12
Dade --------------------- -- 6 -
Manatee ----------------- 5 5

Total__-------------------------- 21 54 54

Grand Total---------------- 306 403 420









REPORT OF STATE HEALTH OFFICER 27

FINANCIAL REPORT
Statement of Expenditures from January 1st to December 31st, 1918.
by Departments.
Administration:
Salaries ----------------------- $8,803.00
Traveling expense -----_ --- 2,562.99
General expense ----------- 2,324.90
Furniture and fixtures---.--.. _- 81.10 $13,771.99
Education:
Salaries --------------- $670.00
Books, publications, etc.------ 2,580.85
General expense ------------ 127.65 $3,378.50
Engineering:
Salaries ----------------------- $3,588.28
Traveling expense---1------------ 517.94
General expense..-- .----------. 1,117.37
Furniture and fixtures------------ 109.65 $5,333.24
Field Service:
Salaries ----------_------ $29,107.87
Extra doctors (Influenza)--------- 939.23
Small pox expense---- ------- 186.45
Traveling expense--------------- 10,752.25
General expense...----- --------. 376.56 $41,362.36
Laboratories:
Jacksonville:
Salaries ------------------- $9,243.91
Traveling expense .--.---------- 222.46
General expense ------------ 1,571.66
Supplies ---------------- 1,008.97
Instruments, etc. ---------------- 108.05
Furniture and fixtures------------- 44.47 $12,199.52
Tampa:
Salaries ------------ ------ $5,298.80
Traveling expense ------ ----- 33.68
General expense ---------- 720.75
Supplies ----------------- 474.05
Furniture and fixtures ----------- 1.76 $6,529.04
Miami:
Salaries ----- ------------ $2,591.94
Traveling expense---------- ---- 36.00
General expense ------- ------ 206.27
Supplies ------------------ 256.16
Furniture and fixtures----------- 34.60 $3,124.97









28 ANNUAL REPORT STATE BOARD OF HEALTH

Pensacola:
Salaries ------------------------ $2,719.92
General expense ---------------- 268.62
Supplies ----------------------- 115.00 $3,103.54
Child Welfare:
Salaries ------------------------ $2,138.87
Extra Doctors' fees------------- 260.00
Traveling expense --------------- 348.04
General expense ---------------- 573.30
Hospital expense --------------- 3,717.98 '$7,038.19
Vital Statistics:
Salaries ------------------------ $7,649.00
Registrars' fees------------------ 9,037.20
Traveling expense ----------- 55.65
General expense ----------------- 1,928.88
Furniture and fixtures----------- 209.93 $18,880.66

Venereal Diseases:
Salaries ------------------------ $1,056.64
Traveling expense -------------- 523.21
Drugs, etc.---------------------- 1,070.97
General expense ---------------- 294.93 $2,945.75

Protective inoculation:
Antitoxins, vaccines, etc.------- $7,542.80 $7,542.80

Grand total-------------------- $125,210.56 $125,210.56
NOTE:-The discrepancy between the State Comptroller and the
Auditor of the State Board of Health in reference to the amount of
expenditures during the year is occasioned by one covering the amount
of vouchers actually issued during the year against the Comptroller for
payment of bills and the other for drafts issued by the Comptroller on
the State Treasurer in payment for State Board of Health vouchers
reaching his office during the year.


EXPENDITURES CLASSIFIED.

Animals, for inoculation------------ $109.00
Animal food---------------------- 83.94
Books, periodicals and publications-- 2,667.65
Care and repair of buildings ------- 236.85
Charts, blue prints, maps, etc.------ 109.43
Containers for mailing use ------- 252.23
Drugs, chemicals, etc.-------------- 1,333.07
Freight, express and drayage..-----. 288.63









REPORT OF STATE HEALTH OFFICER


Furniture and fixtures------------ 481.51
General incidental expenses-------- 989.23
Heating fuel ---------------------- 213.00
Hospital expense, crippled children-- 3,756.48
Laboratory supplies --------------- 1.459.20
Laundering --------------------- 82.69
Lighting and power ------------ 567.62
Physicians' fees, influenza, small
pox, etc. ---------------------- 1,337.68
Postage and stamped envelopes----- 1,795.03
Printing and office supplies-------- 2,511.27
Registrars' fees ----------------- 9,070.95
Rental of machines ---------------- 698.24
Salaries ------------------------- 72,965.73
Instruments ---------------------- 149.43
Telegraph and telephone ---------- 1,034.40
Traveling expense -----------------15,052.22
Vaccines and serums-------------- 7,542.80
Water ---------------------------- 166.93
Ice ------------------------------- 255.35 $125,210.56



FINANCIAL STATEMENT
of the account of the State Board of Health as indicated by the
records of the State Comptroller.

January 1st, 1918, cash balance -------- $37,184.57
Receipts during year 1918--------------- 153,759.39

Disbursements during 1918------------------------ $127,358.90
Cash balance, December 31st, 1918--------------------- 63,585.06

$190,943.96 $190,943.96


NOTE:-The discrepancy between the State Comptroller and the
Auditor of the State Board of Health in reference to the amount of
expenditures during the year is occasioned by one covering the amount
of vouchers actually issued during the year against the Comptroller for
payment of bills and the other for drafts issued by the Comptroller on
the State Treasurer in payment for State Board of Health vouchers
reaching his office during the year.










REPORT OF JOHN KEELY,
District Health Officer.
Jacksonville, January 28, 1919.
HON. W. H. COX,
State Health Officer.
Dear Sir:
I have the honor to submit the following report of my
work:
I began my service with the State Board of Health on
September 6th, 1918-being assigned to the Jacksonville
District.
During these four months, I have been engaged in all
of the ordinary duties of a District Health Officer; from
the administration of Anti-typhoid vaccine, Diphtheria
antitoxin, Anti-Pneumococcic and Anti-teatanic serums,
Vaccine inoculations, and the actual treatment of disease;
to those other prophylactic measures which may be in-
cluded in "soil pollution" work and the examination of
water (with the determination of its source and dis-
position).
I have enforced the screening of houses against flies
and mosquitoes, and have superintended the eradication
of insects and vermin.
I have swabbed several hundred noses and throats in
my (often successful) quest of the "Klebs Loeffler"
bacillus.
These, and various and sundry other activities have
been assigned me, but by far the most important work that
I have encountered was during the recent and distressing
epidemic of Influenza; and with this I have been so inti-
mately associated from its very inception and until even
the present, that most of my time and energy have been
expended in an effort to alleviate conditions surrounding
this unprecedented local (and National) calamity.
It is unnecessary to dwell upon the numerical inade-
quacy of the practicing physicians throughout our State;








REPORT OF DISTRICT HEALTH OFFICERS


to refer to their magnificent battle against odds over-
whelming or to their self-sacrifices and disregard of
pecuniary gain when duty called. These things are mat-
ters of record and well known alike to laymen and to the
profession.
It is also unnecessary to speak of conditions, at this
time, in one locality as being better or worse than in an-
other for they were bad enough everywhere, but surely
the limit had been reached at "Hawthorn," when you
(Mr. Health Officer) and myself were called there to assist
the one local physician in covering an area of some thirty
miles and in treating over one hundred and fifty patients,
among whom were twenty-eight widely scattered pneu-
monia cases and all infected with a most virulent organism
and many in a dying condition.
During the epidemic I have treated sufferers in Lake
Butler, Macclenny, Live Oak, Branford, Lake City, Glen
St. Mary, East Port, Arlington, Loretta and Panama
Park, all within my own district; and at Burnett's Lake,
High Springs, Fort White, Hawthorn, Dade City, Sanford
and Jacksonville, without.
In every case, where it had not been done, I have closed
schools, picture shows, etc., and I have assisted the local
physicians in every way possible.
It has been my endeavor, and in this I have been greatly
aided by the untiring efforts of Dr. V. H. Gwinn, to keep
thoroughly abreast of the last word in the scientific world
concerning this disease; and being in touch with practic-
ally all of the other State and many City boards of health,
we have been able to impart their experiences and recom-
mendations to the tired, and often discouraged, practition-
ers who had neither the time nor the opportunity for
gaining such information.
I have tried to impress those physicians, who were dis-
heartened by the apparent futility of all treatment, in some
of these cases, with the fact that I stood back of them and








32 ANNUAL REPORT STATE BOARD OF HEALTH

shared their responsibilities, and that I did so without in-
curring the slightest obligation upon their part or upon
the part of the patient. This seemed invariably to have
been a source of gratification and comfort to them.
In Jacksonville I treated many cases, (almost invariably
pneumonias), the overflow of a number of the local phys-
icians; and was on call, day and night at St. Lukes, St. Vin-
cents and Riverside Hospitals. Was called in consultation
by several physicians within the city of Jacksonville and
by a great number without, and took care of five doctors
in Jacksonville and elsewhere who were ill of this disease.
In and around Macclenny I visited fifty cases, in and near
Fort White, High Springs and Burnetts Lake over one
hundred and fifty cases, in the neighborhood of Hawthorn
one hundred and twenty-five or more (and many of these
a number of times). At Lake Butler and Glen St. Mary
I saw a number of cases, also at Live Oak, Lake City and
Branford, and at East Port there were some fifty or sixty
sufferers.
In Loretta, I found twenty-two school children of
St. Joseph's Academy ill and in bed and advised with the
resident physician as to quarantine and treatment.
At Arlington I found a distressing condition, there
being about one hundred scattered cases and no physician
(except the occasional visit of one of the overworked Jack-
sonville doctors). Here I visited and prescribed for,
practically all of the sufferers and arranged for their future
welfare.
Altogether to date, and including those in Jacksonville,
I have visited no less than eleven hundred Influenza
patients including at least one hundred and fifty pneumonia
cases.
While there is much that we do not know concerning
the nature of this disease, still there is much that we posit-
ively do know, and unless we utilize these facts to the ut-
most, we shall fail utterly in accomplishing anything.








REPORT OF DISTRICT HEALTH OFFICERS


Probably next in importance to the Influenza epidemic
and certainly so in my district 'is the Hookworm problem.
In my examination of the school children in Baker
County I found an amazing number thus infected and the
condition obtains in all of my eight counties but to a lesser
extent.
I have brought this matter to your attention and am
familiar with your excellent plans for combating this great
evil, in the near future.
Diphtheria has not appeared in epidemic form any-
where within my district during my service, although at
Youngstown and Panama City (not in my district) I was
sent to investigate and found that there had been several
cases and with high mortality.
I have seen a few scattered cases from time to time at
various places, but usually it has been limited to one and
almost never more than two in any given neighborhood
and with few fatalities.
The same I can say of Typhoid fever. The cases have
been few and scattered and the mortality extremely low.
Scarlatina, Measles, Varicella, Pertussis and Parotitis
have appeared at various places, usually confined to one,
or more members of a household and never in serious
epidemic form and with practically no fatalities.
No actual cases of Rabies, Cerebro-spinal meningitis,
Infantile-paralysis or Variola have been brought to my
notice, although several of the latter have been so report-
ed, but in each of these cases I have been able to revise
the diagnosis.
Malaria and Tuberculosis (in its various forms) I have
not infrequently encountered, and I have given appropriate
treatment and advice in every case.
Real "Trachoma" is present in perhaps a very low per-
centage of the school children whose eyes have been exam-
ined, but the relative frequency of Follicular Conjunctivitis,
which cannot be distinguished from Trachoma (in its in-







34 ANNUAL REPORT STATE BOARD OF HEALTH
cipiency) has caused me to adopt the plan of sending all
cases of Conjunctivitis to a specialist and not allowing
those so affected to return without a certificate of discharge
from said specialist.
No cases of Dengue or Pellagra have been reported to
me although it is likely that some few of the latter do exist
within my territory.
I saw one case of Leprosy which was brought up from
Seminole County for diagnosis.
During my service with the State Board of Health I
have delivered in various localities eight public addresses,
and have directly caused the passage of seven city ordin-
ances in as many cities.
I have made a thorough examination of two hundred
school children in Baker Caunty and have checked up and
continued the excellent work of Dr. O. H. Cox (of the
United States Public Health Service) upon the thirty-five
hundred school children in Duval County (extra Jackson-
ville).
I would like to emphasize the imperative need of nurses
and assistants if this work is to be carried on properly.
In conclusion, I wish ot thank you and your entire staff
for the cordial manner in which I have been received into
your midst, and for the courtesy and encouragement that
you have invariably shown me. With Dr. V. H. Gwinn,
(Assistant State Health .Officer) I have been most inti-
mately associated in the routine of my duties, and his un-
ceasing devotion to his work,, his cheerful advice and
friendly criticism have been my constant inspiration.
Through you I wish to thank Dr. B. L. Arms and his
excellent staff of Laboratory workers for their many
courtesies, and to commend them for the accuracy, celerity
and general efficiency with which they have handled all
of the work entrusted to them by me.
To Mr. George W. Simons and the members of the
Sanitary Staff, I am indebted for their personal kindnesses








REPORT OF DISTRICT HEALTH OFFICERS 85

and efficient cooperation, and to Mr. S. G. Thompson,
whose accurate and perspicuous reports of Vital Statistics
have so greatly aided us all.
Respectfully submitted,
JOHN KEELY, M. D.
District Health Officer, Jacksonville District.










REPORT OF GEO. A. DAME,
District Health Officer.

Inverness, Florida, January 27th, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
My dear Doctor:
Herewith I beg to submit a report of my activities as
District Health Officer of the district composed of the
counties of Alachua, Citrus, Levy, Marion, La-Fayette and
Taylor for the year 1918.
I have devoted some of my time to each incorporated
town within my six counties and to nearly every village
and rural community. A very considerable part of the
year's work has been given toward arousing interest in
the rural districts, using the country schools as centers
from which to spread our health propaganda.
At the suggestion of the State Health Officer my
efforts for several months have been concentrated within
definite areas, and I wish to state that I am in thorough
accord wth this suggestion. I believe that the results
obtained conclusively prove that it is better to take the
work up by communities, do intensive work, complete the
work contemplated, arouse such a community spirit for im-
provement that the work will continue under its .own
momentum and move on to the next unit. But while doing
this intensive work I have not neglected other public health
work in the other sections of my district.
The duties of a District Health Officer are so various
and so extensive that it has not been possible always to
follow up any one line of duty without multitudinous in-
terruptions but insofar as possible my chief activities have
been devoted to:
Child Welfare, Control of Epidemics and
Intensive Sanitary Surveys, Educational Activities.








REPORT OF DISTRICT HEALTH OFFICERS


Minor activities have been: Abatement of nuisances,
enforcement of public health laws, attendance at public
meetings, conferences with city councils, promotion of a
spirit of confidence among physicians and others in the
activities of the Health Department and for several weeks
during the terrible influenza epidemic, devoting from
eighteen to twenty hours a day to the practice of medicine
in towns and communities that were without physicians
or nurses. This work, it is hardly necessary to say, was
done without fee and at the suggestion of the State Health
Officer at a time of great distress and panic among the
people generally.
CHILD WELFARE.
This work for the year 1918 was in a rather chaotic
condition in all sections of. the State with a very few ex-
ceptions. This was due to several causes. Being a radical
departure to most of our people and sometimes sadly mis-
understood, they have to be educated to a proper appre-
ciation of this work: What is to be done, how it is to be
done and why we are doing it. Arrangements have to be
made for proper follow-up work. The authorities of the
different counties have to be shown that there is a popular
demand for this work before they can be induced to in-
clude funds in their budgets for the payment of salaries
of visiting nurses or social workers. These budgets are
made in July, a time of the year when most school activ-
ities have ceased. I regret to state that I was unable to
get any county in my district aroused to the point of having
an officer of this kind appointed and as a consequence
there was no follow-up work of any kind accomplished.
The situation for the year 1919 seems much more
promising and I believe now that appropriations will be
made in at least half of my counties for this vital need.
However, I wish to report that the children in all the
schools, white and colored, in two counties were examined
last term. These counties being Marion and Citrus.








88 ANNUAL REPORT STATE BOARD OF HEALTH
INTENSIVE SANITARY SURVEY.
I consider this undertaking the most important and
most necessary work promoted by the State Board of
Health during the year. It strikes at the very foundation
of disease in this State. Let the surveys be made as con-
templated; let the data be collected and properly tabulated
and the results be published to the people; let the proper
laws then be passed as are indicated by the results of this
survey; and then let these laws be enforced by all awak-
ened and conscientious local authority -and the death-rate
from typhoid, hookworm, tuberculosis, malaria and in-
testinal diseases will show such a wonderful reduction that
this State will take front rank in health and our people
will never consent to drop back into their previous anti-
quated and indifferent methods and attitude.
There are no records in my office of the work accom-
plished in this survey previous to August 5th 1918. Briefly.
I will state that a large number of towns were investigated,
many health ordinances were passed, public addresses were
made, hundreds of inoculations against typhoid were given,
hundreds of sanitary privies were built and hundreds of
house survey cards completed. Many unsanitary premises
and other nuisances were condemned and several spec-
imens of water were taken and analyses secured.
Since August 5th my reports show that the following
results have been accomplished and this, notwithstanding
the great influenza epidemic and the performance of other
necessary work.
Towns visited----------_----- 8
Ordinances passed --------______ 2
Anti-typhoid inoculations given __ 675
Public addresses made ---_---- 18
Privy notifications served --------_452
Privies actually built --__________ 724
House survey cards completed ----584
Other condemnations ______ 54
Samples submitted to Laboratory___ 18








REPORT OF DISTRICT HEALTH OFFICERS


At the beginning of this survey one county in each
district was designated as a starting-point. In my district
Marion was selected and most of my survey work has been
done within that county. The people of Ocala and of
Marion county have taken a very intelligent and sym-
pathetic interest in this work and have co-operated very
freely. The city council of Ocala designated their sanitary
inspector, Mr. G. W. Akin, as my assistant. I wish to com-
mend him as one of the most efficient sanitary patrolmen
it has been my pleasure to know.
CONTROL OF EPIDEMICS.
During the year there have been three epidemics of
typhoid in this district, the worst of which was at and in
the vicinity of Oak in Marion county. The steps taken at
that place are indicative of those taken at other points.
I made a survey of the surroundings and made four definite
suggestions:
1. That each residence be furnished with a
sanitary privy.
2. That each residence be screened against
flies.
3. That their water-supply be analyzed for
possible contamination and properly safe-
guarded.
4. That the people be inoculated against
typhoid.
Mr. Logan and Mr. Arnold of the McDowell Crate
Company took the initiative in carrying out these sugges-
tions and at the present time nearly every house has been
screened and furnished with a sanitary privy. Arrange-
ments have been made for an abundant supply of pure
water and a very large majority of the people have been
inoculated. The neighborhood is clear of typhoid for the
first time in more than a year.
There have been other small epidemics of measles,








40 ANNUAL REPORT STATE BOARD OF HEALTH

mumps, dysentery, whooping-cough and scarlet fever but
none of these reached serious proportions and were soon
brought under control.
Then comes the great influenza epidemic and I feel my
inability to make a proper report. I must say, and let it
suffice, that I'devoted practically all my time and energies
for not'less than two months to the alleviation of sickness
and suffering and to the use of every means available for
controlling this disease.
At this time it is still very prevalent in my district but
is showing a gradual diminution of frequency and of
virulence.

EDUCATIONAL ACTIVITIES.

I have felt that one of my most important duties was in
getting the public aroused to a proper appreciation of the
efforts of the State Board of Health and in creating a
demand for more and more health work of every kind,
especially proper sanitation, child welfare and the control
of communicable disease.
Usually my efforts have taken the direction of using
newspapers for health articles; addresses to schools, city
councils and other public gatherings; and in co-operating
to the fullest extent with local organizations of public-
spirited women.
I have found the newspapers always willing to devote
their columns to the promotion of all good ideas for health
improvement. The city councils are usually responsive to
proper appeals to their patriotism and civic responsibility.
As to the women of my district, especially as represented
in their local clubs under whatever name, it gives me great
pleasure to acknowledge their very efficient and very in-
telligent assistance rendered freely and unselfishly toward
the establishment of proper ideals and agencies for the
conservation of life and health.








REPORT OF DISTRICT HEALTH OFFICERS 41

SI have received most loyal and enthusiastic assistance
from Superintendents of Public Instruction, school teach-
ers and principals of high schools.
Respectfully submitted,
(Signed): GEO. A. DAME,
District Health Officer.











REPORT OF F. L. TATOM,
District Health Officer.

DeFuniak Springs, Fla., January 1st, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
Dear Doctor:
I beg to submit herewith a brief resume of my activities
as District Health Officer for the western district of Flor-
ida, embracing the counties of Escambia, Santa Rosa,
Okaloosa, Walton, Holmes, Washington, and Bay for the
year ending December 31st, 1918. During the past year
I have visited fifty towns and communities in this district,
many of them were visited several times. On these visits
in addition to the regular routine work of inspections I
gave popular talks on Sanitation and Hygiene, whenever
the opportunity presented.
The first half of the year was devoted to soil pollution
work and a campaign for typhoid innoculaton, both of
which were highly successful and gratifying. Notwith-
standing the high cost of materials and the scarcity of
labor caused by the war, over four hundred sanitary privies
were built in Bay county alone, principally in the towns of
Panama City, Millville and Bay Harbor. The latter town
being at this time one hundred percent sanitary, as far
as privies are concerned. In the balance of the District
there were built approximately two hundred and fifty
privies, included in the number were thirty five sanitary
privies installed at rural schools, besides a large number of
sewer connections in towns having sewage systems. The
campaign was not pushed in several towns contemplating
sewerage projects for fear that it might operate against
these projects when submitted to the people. In these
towns frequent inspection and scavenger service was
urged.








REPORT OF DISTRICT HEALTH OFFICERS


The campaign for typhoid innoculation was also highly
successful, and I wish to extend my thanks to all of those
physicians of the district who so generously cooperated
in this work and contributed to its success. Practically
all of the physicians of the district volunteered their serv-
ices free of charge to administer the vaccine furnished
free by the State Board of Health. As a result qf this
campaign approximately seven thousand eight hundred
received this treatment free of cost, besides a large number
who were innoculated by the public Health Service, and
others, who paid for their vaccine and were innoculated
by their family physician.
During the past year I have met with the councils of
nine towns discussing with them matters of sanitation
affecting their communities. The following towns have
passed sanitary ordinances recommended by the State
Board of Health.
Chipley, Bonifay, DeFuniak Springs, Panama City,
Millville, St. Andrews, Lynn Haven and Pensacola. Among
several sanitary ordinances passed by the city commission
of Pensacola was one of great importance, viz.: the in-
stallation of sanitary privies by the city with adequate
provision for scavenger service.
At this writing bids are being advertised for the con-
struction of twenty-eight hundred of these privies.

COMMUNICABLE DISEASES-TYPHOID FEVER.
During the past year typhoid fever has occurred in
this District with its usual regularity but did not assume
epidemic proportions except at Pensacola where it was
quite prevalent during the months of May, June and July.
During these months there were approximately one hun-
dred and forty cases (only four cases reported by phys-
icians up to June 1st) with fourteen deaths. An investiga-
tion of this outbreak by Dr. Deriveaux of the U. S. Public
Health Service and myself failed to reveal any common








44 ANNUAL REPORT STATE BOARD OF HEALTH

cause for the epidemic, most of the cases seemingly being
caused by flies and personal contact.
The milk from one or two dairies were suspected of
having caused some of the cases and were investigated but
it was shown that no persons living in screened houses
under hygienic surroundings using this suspected milk
developed the disease.
Practically all of the cases were in the unsewered
sections of the city in unscreened houses surrounded by
open privies.
To combat this epidemic a house to house survey was
made getting case histories and giving instructions for the
proper disposal of the excreta, and information regarding
modes of infection and methods for protection urging on
the neighbors in the surrounding community the necessity
for inoculation. The mornings were spent in this work
and inoculations were given at the State Board of Health
Laboratory in the afternoons, eight weeks were thus spent
with the result that by the first of August, when the disease
is usually most prevalent there were very few cases in the
city. During this period more than five thousand persons
were inoculated in the city of Pensacola.

OTHER COMMUNICABLE DISEASES.
No outbreak of other communicable diseases except
Influenza has occurred in this district during the past year.
A few cases of Diphtheria have occurred from time to
time but there has beeh no spread of consequence. Four
cases of smallpox have been reported to me during the
year. These cases were promptly isolated and the contacts
vaccinated and there was no further spread of the disease.
Several "sporadic" cases of scarlet fever have been report-
ed but there was no spread to other members of the family
or others, in any instance.








REPORT OF DISTRICT HEALTH OFFICERS


INFLUENZA.
This district together with the balance of the country
has suffered severely from the dread scourge of influenza.
A few cases began to make their appearance during the
early part of September, but there was no spread of con-
sequence until about the first of October, when it began
to spread over the whole district like a prairie fire, leaving
death and devastation in its wake. As soon as the disease
began to assume serious proportions, I got in telegraphic
communication with all parts of the district, that I could
not reach personally and ordered the closing of all schools,
picture shows, churches, and public gatherings of every
description and I want to say that at those places where
these precautions ivere taken early, that the disease did
not assume nearly so serious proportions as it did at those
places where closing was delayed until it obtained a firm
foot hold. With these orders promulgated I threw off the
mantel of Health Officer and.assumed the role of general
practitioner and went to work to assist in relieving suffer-
ing in those communities which were most in need of
assistance, at which work I have been engaged since the
first of October. During this period I have administered
to more than five hundred cases of the disease, and have
myself been twice a victim to it, suffering an attack of
Pneumonia with the last attack.
At this writing Influenza is still prevalent all over the
district but is of a much milder type than prevailed in
October and November.
Respectfully submitted,
F. L. TATOM, M. D.
District Health Officer, Florida State Board of Health.











REPORT OF A. C. HAMBLIN,
District Health Officer.
Tampa, Florida.
Dr. W. H. COX,
State Health Officer, Florida State Board of Health.
Jacksonville, Florida.
Dear.Doctor:
In presenting this, my annual report for 1918, to the
Florida State Board of Health, I am constrained to enquire
the purpose of the District Health Officer and if I have
executed the functions of that office fairly as I have met
demands. Have I placed the proper value on my energies
and my accomplishments? Have I been faithful to the
trust in helping to build up a sturdier generation and
cutting down that 38 per cent of unfitss"?
A BUSINESS.
Public Health work that protects and builds up is a
business and does not differ in an economic or social way
materially from other enterprises which are run by
methods that yield dividends. The question of profit or
loss must always be considered in the endeavor, not in
dollars, so much, but in the accomplishment of an expected
benefit to the people of that center for the expenditure of
a certain amount of time and money.
METHODS.
All communities do not have common needs so our
first effort is in making a sanitary survey, learning the
Topography, Geography and Sanitary conditions existing.
Believing, hs I do, that publicity, advertising if you
please, to call it, is the method for early results in Public
Health Work, and by condemning things that should not
exist we sometimes arouse some of the people into dis-
cussion and exchanging ideas and forming opinions. This
I call the stage of quickening. We then meet with the








REPORT OF DISTRICT HEALTH OFFICERS


city officials and talk ordinances along sanitary lines;
then through commercial bodies, Womens clubs and
societies we present our claims and ask for co-operation
and financial support. Here the Press comes to our rescue
and lends a helping hand. These people are all with us
and prove to be our best friends. They all have my pro-
foundest respect and thanks for the interest shown.
We are educating the people along lines of conserva-
tion. It seems human to look upon subjects that are
being agitated as being the ones of prime importance,
therefore, matters pertaining to public health should never
be allowed to occupy a rear seat. I tell the people of
things I find that should not be and they, as citizens,
have the right to know, and the right to demand better
conditions, cleaner markets, Dairies, and all places where
food products are handled, and that those who handle these
products should be free from the diseases that are
communicable.
Today our people are having broader and clearer
visions along lines of Conservation of health than ever
before, and are demanding better conditions and higher
standards in Sanitation and Cleanliness. And these ex-
pressions help those in authority to produce proficiency.
I am very slow in trying to do work alone but through
the assistance of the people I have found much saving of
time and money by combining the strength of the various
organizations.
Mr. Kipling very aptly expressed this position when
he wrote:
"It aint the individual
Nor the army as a whole
But the everlasting team work
Of every blooming soul."
Some one has said that knowledge which tends directly
to preserve life is of most worth so I have wielded a strong
arm against contagious diseases with special force along








48 ANNUAL REPORT STATE BOARD OF HEALTH

lines of isolation and quarantine. We are passing through
the Dark Age and beginning to see the light. Thank God,
where people think children must have all the trunnel bed
diseases, many fail to see any necessity for such and are
taking their stand with us, demanding that children with
communicable diseases must be kept in isolation and not
be allowed to scatter broad-cast such disease.
The Medical Profession, I regret to admit, is our
greatest hindrance along this line. by their negligence in
reporting every thing at once to the Health Department.
Another very important and, I believe, the most sub-
stantial branch of our work is the examination and teach-
ing our teachers and school children. I have devoted as
much time as practical to such work; teaching the children
the danger of finger nails, teeth, drinking cups, towels,
pencils, sanitation and the mosquito and have been very
much gratified in some of my return calls to find a good
part of it has been remembered and much of it put in
practice.
In my old territory (and I have done but little in my
new) I had 28 incorporated cities and about the same num-
ber not incorporated. In all of these centers I have made
sanitary surveys. Have looked to the water supply, sewer
system, sewage and garbage disposal privies, stables,
dairies, cooling and bottling rooms, Soda fountains, res-
taurants, hotels, grocery stores, fruit stands and lunch
counters, giving copies.of State Laws and offering advise
and suggestions as to screening, cleanliness, sanitation and
sterilization.
In this work your Sanitary Engineer, Mr. Simons, has
been a great help to me in getting ordinances passed and
advice on water supply and sewage disposal matters.
I have seen cQmpleted and doing the work well in two of
our cities, incinerating plants caring for all the waste for
these cities. Have extended sewer lines and water mains
in four cities making about 300 house connection with








REPORT OF DISTRICT HEALTH OFFICERS


sanitary closets. I have one city with water and no sewer
completely connected by Septic Tanks in every house and
the city limits extend far out so as to take in the suburbs.
I have several cities completely cared for by sewer and
pit privies, some are entirely cared for by dry pit and
others by the can and bucket plan.

SCHOOLS.
I have met with all my school boards and Superintend-
ents of Public Instruction urging the building of fly-proof
pit privies at all rural schools and many have been built.
All our better school buildings are being supplied with
Septic Tanks. I have, during the year, seen completed
about 500 sanitary toilet connections with sewer, 700 Flor-
ida tank toilets built, about the same number of dry-pit
privies, and 100 Septic Tanks connected.
When the War Department selected Arcadia for
Aviation Fields without waiting to consult the Home
Office I at once began a survey of the city and suburbs
and by the help of your Engineer was able to have
ordinances passed caring for sanitary conditions, fly-
.breeding places, draining' of the lower lands, abolishing
stables that were unsanitary and governing restaurants
and lunch counters, obtained permit to buy material for
the extension of water mains and sewer system.
We established an extra Cantonment Zone including
in that district the neighboring towns. We soon found
that by this work other towns in all sections of my district
were stimulated to making their own conditions better.
We have seen a little leaven leaveneth a considerable
territory.
About our shipbuilding plants, we have done some
ditching, draining and oiling of the water in our fight
against the mosquito, in addition to fly and lunch counter
protection.








50 ANNUAL REPORT STATE BOARD OF HEALTH

FLY AND MOSQUITO.
In some of our cities we have sprayed with Fenole
solution for the killing of flies on streets, alleys, stables,
dumping grounds, about Hotels and Restaurants, but have
laid greater stress on the destruction of the breeding
places. I have not said so much about killing the mos-
quito, but have advocated the screening of water tanks
and barrels, cleaning ditches, draining ponds, oiling
.streams and stagnant water by the drop method and the
Knap Sack spray. I have not mentioned the treatment of
typhoid and hook worm disease but have preached in-
oculation and the building.of pit fly-proof privies as
preventive measures.
Respectfully yours,
A. C. HAMBLIN,
District Health Officer.











REPORT OF W. H. BRYAN,
District Health Officer.
Dade City, Fla., February 1st, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
Dear Sir:
I herewith submit'report of my work as District Health
Officer from April 15th, 1918, to date.
During the first month of my service I was engaged
in doing sanitary survey in the Lackawanna District of
Jacksonville and around the S. A. L. Shops where con-
ditions were simply abominable. This section being out-
side the city limits of Jacksonville an~d without police or.
sanitary attention from the City, and very low and flat
with open privies, was a constant source of infection for
hookworm, Typhoid fever and other filth born diseases.
The S. A. L. Shops with eight hundred to one thousand
workmen, were without toilet facilities other than two
large incinerators. These were as much as one-fourth
mile from many of the workmen's stations and the open
box cars and toilets in old unused passenger cars were
used by the men and as a consequence the tracks were,
in places, covered with filth, making it most unsanitary.
This condition had not been remedied when I left Jackson-
ville District in September. However, many of the private
homes in Lackawanna District had provided earth -toilets
of an approved type, and the S. A. L. officials had promised
to install an up-to-date sewer-system.
The month of May was spent in Hamilton County
doing sanitary survey at Jennings, Jasper and White
Springs. In these towns I found the same degree of care-
lessness and apathy among the citizens and officials in
regard to sanitary matters, notwithstanding there had








52 ANNUAL REPORT STATE BOARD OF HEALTH

been a serious epidemic of bacillary dysentery in the
Northern part of the County a few weeks prior to my
visit there and many children had died. I found the sewer-
system of Jasper distracting raw sewage into an open
stream.
The wet weather in Spring was favorable for con-
tamination of the wells in Hamilton County and can
easily account for the outbreak of dysentery. Screening
laws were being ignored in every town in Hamilton
County and flies had full liberty to spread any and all
sorts of infection. I had many places screened and some
closed.
The month of August and up to September 10th, was
spent doing sanitary survey in North-east Springfield,
Panama Park, Fernandina and Callahan. In these places
I found many people disregarding the .simplest rules of
sanitation and in Fernandina found two-hundred and fifty
open privies and eighteen cafes and boarding houses
unscreened.
Between May 15th and September 10th, when I left
the Jacksonville territory, I visited all incorporated towns
and several unincorporated villages in that District, meet-
ing officials and discussing sanitary and health matters,
personally and at meetings of City councils.
There were no serious epidemics in Jacksonville
District during my service there, except the outbreak of
bacillary dysentery in Hamilton County and a few cases
of typhoid fever in North-east Springfield section of
.Jacksonville and a few cases of fever at Stark. Diphtheria
was reported from Macclenny, where upon investigation
I obtained history of three cases in widely separated
homes. I also saw one case of Scarlet fever in Lackawanna
district of Jacksonville. I am sure that the prompt use of
anti-typhoid vaccine prevented serious outbreak of typhoid
fever in the North Springfield section as conditions there
were very favorable to the spread of the disease. Before








REPORT OF DISTRICT HEALTH OFFICERS 53
leaving this section however, we instituted and had accom-
plished very gratifying sanitary reforms.
Since September 15th, when I was transferred to the
District composed of Lake, Orange, Sumter, Osceola, Polk,
Pasco and Hernando Counties, I have with the assistance
of my patrolman, Mr. Andrew Law, made sanitary survey
of Dade City, Zephyrhills, Brooksville, Kissimmee -and
St. Cloud.
In Dade City I found one hundred and fifty-seven fam-
ilies using open privies and drinking water from open
wells. Among these one hundred and fifty-seven families
I obtained history of fifty-two cases of colitis and bacillary
dysentery and sixty cases of fevers, (malaria and typhoid).
Among one hundred and twenty-seven families drinking
hydrant water and using sewers or septic tanks, I obtained
history of five cases of colitis and nineteen cases of fevers.
In Brooksville the proportion of these diseases was about
the same as in Dade City, where open wells and open
toilets were used and is evidence to my mind that open
wells and open privies are largely responsible for the
prevalence of bowel troubles and certain types of fevers in
our State during the Spring and Summer months, as a
large per cent of open wells are contaminated with colon
bacillus. In this territory since September 15th, I have
visited all incorporated towns and have investigated diph-
theria reports from Fort Meade, Wildwood, Leesburg,
Winter Haven, Dade City and Winter Park. These were
all sporadic as far as I could learn and only one case, that
of a fourteen year old boy, at Fort Meade proved fatal.
I have seen one case of confluent smallpox at Eustis
of unknown origin. One case of typhoid fever at a saw-
mill settlement in Polk County.
On October 9th, influenza was reported at Kissimmee
and I saw the first five cases there, all of which were con-
tracted on railway passenger cars or at least gave history
of railway travel within sixty hours prior to onset of the
disease.








54 ANNUAL REPORT STATE BOARD OF HEALTH
On October 18th, I was ordered to Dade City to do
missionary work in the treatment of patients suffering
from influenza and treated about two hundred patients,
eight of whom developed pneumonia and one died. On
October 26th, I was attacked with influenza and disabled
to November 15th, when I resumed my duties as District
Health Officer.
Since coming into the service I have inspected the jails
in every county in the two Districts which I have served
and desire to call the attention of the State Board of Health
to the fact that many of these jails are without any means
of heating whatever and consequently are very unsanitary
as the inmates are obliged' to sit in damp cement floored
cells for days at a time. Often inadequately clothed and
they fall easy victims to pulmonary diseases. It is a
notorious fact that if influenza enters a jail a large major-
ity of the inmates contract it and many die of pneumonia.
Many jails and small convict camps are unscreened. The
jail at Kissimmee is in Basement of Courthouse, only
about four feet above water level and entirely devoid of
heating facilities.
Dairies are universally filthy and small towns have no
laws governing the sale of milk.
In many of the small country schools there are no
facilities whatever for the public to bathe their hands and
many have no source of water supply other than a neigh-
boring well or pump and I found one school in Hernando
County where the public were carrying water one mile.
Might not some rule be passed requiring the School Boards
to provide an adequate number of basins for these pupils
and a water supply on school grounds? I am often at a
loss how to handle these matters in the absence of any rule
or law, although I am asking Boards of Education to give
more attention to them when I have opportunity to meet
the Boards personally. Negro schools in most towns are
very insanitary and a menace to the health of the com-
munities in which located.








REPORT OF DISTRICT HEALTH OFFICERS


I find many of the railway stations without adequate
toilet facilities. Some have open toilets a long distance
away, others have nothing and I know of no rule or law
requiring them to provide such conveniences for passengers
and patrons. However, I have condemned many of the
open privies and refuse to accept any substitutes except a
flush toilet inside the depot.
Examination of school children over a limited area
of my District reveals many cases of hook-worm in-
fection and consequent loss of mental and physical vigoi
among the young people of our State. As a rule, however,
parents respond to our efforts to help them and only need
to be reminded that constant vigilance is necessary to the
eradication of these pests.
Respectfully submitted,
W. H. BRYAN,
District Health Officer.











REPORT OF L. T. GALPHIN,
District Health Officer.

Tallahassee, Fla., January 27, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
Dear Doctor:
I herewith submit my report for the year 1918, begin-
ning April 1st, when my duties as Health Officer began.
To familiarize myself with my District, I spent this
first month in visiting the larger towns, and when possible,
meeting the Mayors, Councilmen and Physicians in each.
During the latter part of May, I was called to Chatta-
hooche, as there was an outbreak of small pox at the
Hospital for the Insane. On arrival, I found one of the
Physicians, one colored attendant, and two colored patients
afflicted with the disease.
There being no isolation hospital there, it was several
days before one for the white, and one for the colored
patients, could be improvised. As this all happened at such
an inopportune time, the Superintendent and one of the
Physicians being away on official business, I remained at
the hospital until they returned.
The Hospital being a State Institution, was immedi-
ately placed under quarantine. Upon investigation, it was
found that the disease was introduced into the Institution,
by one, who, living some miles out in the country, and
being afflicted with the disease at the time, visiting his
brother, a colored attendant at the Hospital, while so
afflicted.
All patients and employees were immediately vaccinat-
ed, also the families of the employees, who reside in Chatta-
hooche, and so only one other case developed, all being of
moderate severity, with no fatalities.








REPORT OF DISTRICT HEALTH OFFICERS 57

In June, I attended the Annual meeting of the District
Health Officers, held in Jacksonville, and again in July,
I attended a meeting of the City Health Officers of the
State, also held in Jacksonville, and from the papers read
at each, and the discussions of same, gained information
that has been of great help to me in my work.
During the month of June, I began an intensive sanitary
survey of Jackson county and I am putting it mildly when
I say that it certainly needed it. At the beginning, I not
only received no co-operation, but considerable opposition,
but by repeated conferences with the Mayor, and members
of the City council, finally broke down that opposition,
and later, received a great deal of encouragement and
aid from all.
On account of the war, labor, and material for the con-
struction of sanitary work, were almost out of the question,
but finally the latter was secured through Government
aid, and had not the Spanish Influenza invaded the country
in such epidemic proportions just at this time, great
changes for the better would have been made throughout
the county along sanitary lines.
In the early part of October, the Influenza having
spread so extensively over my District, I was instructed
by the State Department to render such aid as I could, and
Quincy, in Gadsden county, being in my estimation, the
place mostly in need of help, went, and remained there
until the epidemic was over in that district.
On my arrival at Quincy, I found four of the five local
Physicians confined to bed with the "flu", and the remain-
ing one, almost exhausted, and with 1200 cases of "flu" in
town, and immediate vicinity.
Shortly after leaving Quincy, the only Physician at
Port St. Joe, having been stricken with the disease, leav-
ing the town without medical assistance, I was instructed
to go there, and took charge of him and his practice,
until such time as he was able to resume his duties, after








58 ANNUAL REPORT STATE BOARD OF HEALTH

which I was sent to Sneads to assist the Physician there,
as he had almost broken down from overwork, on account
of the large number of influenza cases in his neighbor-
hood requiring so much of his time.
During the Summer and Fall, I saw several cases of
small pox, typhoid fever, and diphtheria in Quincy and
vicinity, .a few cases of typhoid fever occurring in Jackson,
Leon, Walkulla, and Jefferson counties, also three cases
of scarlet fever in Gadsden county but as all precautions
were taken to prevent a spread of these diseases, none
occurred.
The Medical examination of the school children, for
obvious reasons, was late in beginning this year, and a
report on this important work, is not attempted, as it has
so recently begun.
Respectfully submitted,
L. T. GALPHIN, M. D.
District Health Officer.











REPORT OF H. O. SNOW,
District Health Officer.
Tampa, Florida, January 1st, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
Dear Doctor:
I am enclosing my report for eight months of 1918 as
per your request. Detailed reports of my activities as
District Health Officer are already on file in your office,
and this is a summary of the whole of them.
Respectfully,
H. O. SNOW.


Tampa, Florida, January 1st, 1919.

SCHOOL INSPECTION.
During the year I examined a number of school chil-
dren in each county in my District. This work extended
over quite a period of time and was done when the de-
mands of my work did not have me occupied otherwise.
One of the most glaring defects I found among the
children I examined, was defective or rather decayed and
neglected teeth. It- is truly pitiful to see the absolute dis-
regard of dental needs and to see children of school age
with their permanent teeth, in a great many instances,
decayed beyond repair. I would respectfully recommend
that some steps be taken to train teachers to teach oral
hygiene and to form tooth brush classes. This will at
least direct attention to these defects and will, in some in-
stances result in having needed dental work done, as well
as serve to prevent decay of the teeth. It seems to me
that something should be done to furnish dental service
where people cannot afford it.








60 ANNUAL REPORT STATE BOARD OF HEALTH

I found quite a few children with defective sight in one
or both eyes. Eyes were tested with Snellin's cards fur-
nished from your office. A number of cases of Follicular
Conjunctivitis and some cases of Trachoma or granulated
lids were found and treatment recommended. Some of
these cases were treated, but without some method of
follow-up work, very few cases of any kind, receive atten-
tion. When children have Trachoma, I think they should
be excluded from schools until effectually treated as I was
able, in some schools, to trace a family of children through
the different grades by this affection of their eyes, which
accentuates the fact of its infectiousness.
Adenoids and enlarged tonsils were found in a great
many of the children and proper treatment recommended.
In rural schools, the prevalence of hook-worm'infection
was very marked. From a clinical standpoint, the per cent
of th6se infected ranged from 60 to 100. I remember one
school particularly, in Lake county, where there were
about ninety children in it and from symptoms present,
am quite sure there was not a child there who was not a
victim of this infection.
The establishment of the Bureau of Child Welfare
will doubtless enable the Board to relieve a great deal of
these remedial defects and infections and will prove of
great benefit to the children of school as well as pre-school
age, in this State.
I was fortunate enough to get the School Boards in
several of the counties of my District, to see the need for
proper examination of school children and to agree to
employ school nurses to assist in the work and to follow up
cases and urge treatment for those who need it.
It was my privilege to attend and assist in Better
Babies Contests in Tampa, Ybor City, Plant City, Orlando
and Brooksville. This is undoubtedly great work and
should be encouraged in every way possible. I was able
to help in a number of these places and could readily see








REPORT OF DISTRICT HEALTH OFFICERS


the good accomplished. The interest of the general public
was very marked in most of these places, and resulted in
having a great many defects, which were minor in young
children, but would prove to be a very serious handicap in
later life, remedied.

SCHOOL SANITATION.
The sanitary conditions of a great many of the schools,
as to outhouses, was very bad. No effort seemed to have
been made to comply with the law requiring proper sewer-
age disposal. These defects were remedied, when pointed
out to the Trustees, in a majority of cases. One county,
Pinellas, having sanitary privies of the L. R. B. type in each
school in the county. Ventilation and lighting defects
were found in some instances and pointed out to the proper
authorities.
The crusade against the use of the common towel and
drinking cup.was carried on and in the urban schools, a
great many drinking fountains have been established.
These, of course, are out of the question for rural
schools.
MUNICIPAL SANITATION.
I visited practically all of the towns and cities in my
District and conferred with the Mayors and Councilmen
in reference to proper sewerage disposal and was success-
ful in having several hundred sanitary privies installed,
some of the L. R. S. and some of the pit and can types.
Garbage disposal was taken up through Mr. Geo. W.
Simons, Chief Engineer of the Board of Health, and he
took care of that and the problem of. water supply of
several cities in this District.

EPIDEMIOLOGY.
There were about 40 or 50 cases of small pox in my
District, most of them either sent to the isolation hospital,
or isolated in their homes. Several hundred of those ex-








62 ANNUAL REPORT STATE BOARD OF HEALTH

posed were vaccinated by me or at my suggestion. None
of the cases of small pox proved fatal, though several of
them were confluent in type. I would respectfully suggest
universal vaccination of school children and adults where
it can be done.
There were six cases of epidemic Cerebro-Spinal
Meningitis, diagnosis confirmed by spinal puncture, none
of whom died. The source of the infections could only be
surmised as they were rather isolated cases. One case, a
negro boy about fifteen years of age, developed it while
at work constructing one of the aviation camps, at Arcadia.
I immediately notified Dr. Hamblin, the D. H. 0. there.
All of these cases received Flexueis serum intra-spinously
as early as the first twenty-four hours, when practical,
but one case did not get his first dose until five days after
his initial symptoms, and had doubtless begun to form
anti-bodies for himself prior to its administration.
I saw two cases of Anterior Polio-Myelitis in 1918, both
of which recovered. Neither of these received serum, as
early diagnosis was not made, it being very difficult in
isolated cases to make a diagnosis prior to the paralysis.
I saw a number of cases of Diphtheria and had three
very persistent cases of carriers develop. Was, however,
enabled to assist their physicians in rendering them non-
infectious and after several negative swabs were sent to
the Laboratory, they were released.
There were quite a few cases of Typhoid Fever in my
District. I visited most of these cases and saw that proper
disposal was made of excreta and succeeded in having a
number of people immunized. In one instance, I succeeded
in tracing the source of infection, it being water bourne.
Had the wells closed and contamination of new water
supply guarded against by proper sewerage disposal.








REPORT OF DISTRICT HEALTH OFFICERS


DAIRY INSPECTION.
I inspected a number of dairies, the majority of which
were not managed in a sanitary manner, due, in the major-
ity of instances, to lack of knowledge.
I would respectfully suggest the needs of a Bureau of
Dairies under the supervision of this Board, or some other
one, as numbers of children lose their lives on account of
drinking contaminated milk, or become infected with Tu-
berculosis due to the lack of knowledge or the wilfull use
of milk from tubercular cows. The average dairyman
seems to have no conception of what sanitation means,
and some of them do not even use a sufficient amount of
clean water for utensils, hands, etc.

Respectfully submitted,
H. O. SNOW,
District Health Officer.










REPORT OF A. W. UNDERWOOD,
District Health Officer.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
My dear Doctor:
I have the honor to submit the following report of my
S activities during the past year.
I have attempted to continue during the past year the
same constructive program that was outlined during the
first six months of my employment by your board.
Realizing that it is a campaign of education and one
of slow growth, requiring persistent effort, I have striven
to accomplish the desired end by bringing into play all
the activities, that could be obtained to further my
aims.
To this end I have in so far as was possible worked in
and through the Municipal Authorities from whom I have
received the most hearty co-operation and assistance.
St. Augustine, through the advice and counsel of the
State Board of Health, has eliminated all open and un-
sanitary toilets and arranged to have all human excreta
disposed of in a sanitary manner.
Palatka has passed an ordinance covering the same
ground but owing to conditions arising from the war it was
impossible to have the provisions of same complied with,
but it is expected to have the improvements under way and
carried to completion at an early date.
The other portions of my district are awake to the
importance of the need of having sanitary surroundings.
and are extending every inducement to have same carried
out and giving of their time and counsel to bring same to.
a successful conclusion.
I have spent considerable time in the examination of
school children,.giving them counsel as to the best course
to pursue to overcome the deficiencies arising from phys-








REPORT OF DISTRICT HEALTH OFFICERS


ical defects and in all cases holding a conference with
those in control that it might prove to be of permanent
benefit.
The results have been so marked that it has encouraged
us to make greater efforts in the year to come.
There have been no serious outbreaks of disease in my
district during the past year other than Influenza which
fortunately has been rather mild in its manifestations.
The State Institution for the Deaf and Blind, being
situated in my home town, I at once on the first appear-
ance of the Influenza in our midst, assumed charge of the
institution and with the most careful attention prevented
its entrance into the school.
The coming year promises to be one full of hope and
I am looking forward to one of greater accomplishments
not only of, improved sanitary conditions but of greater
interest in sanitary living by our people.
Ever grateful for the assistance so i'eely given by your-
self and the other members of the Board and hoping for
a continuation of same in the year to come.
I remain Yours most Respectfully,
A. W. UNDERWOOD,
St. Augustine, Florida.










REPORT OF DR. WILLIAM R. WARREN,
District Health Officer.

Key West, Florida, February 10th, 1919.
Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
Dear Doctor Cox:
I have the honor to submit the following report of the
District Health Officer, for the islands of the Key West
Extension, for the year 1918.
During the past year Monroe County has been fortun-
ate in having few cases of communicable disease within its
boundaries, and but for the invasion of 'influenza, the
morbidity and mortality rates would have been remark-
ably low.
The increase of the population of Key West by the
addition of men in different branches of the United States
Service, together with the families of the men stationed
here, required watchfulness on the part of the health au-
thorities, and the necessity for vigilance was early appre-
ciated by the Government, State and Municipal officers.
As a result, those in a position to know, are .fully aware
of the improvement in both sanitary and moral conditions.
The Navy Department under the supervision of Ad-
miral Fletcher, Commandant of the Seventh Naval
District, ably assisted by his District Sanitation Officer,
Doctor G. M. Guiteras, have been alert in sanitary matters
and their efforts and cooperation have been productive of
results that are very evident.
Systematic inspection of the eiqtire city, with a view of
eliminating the sources of disease and nuisances, was in-
augurated and has been continued. The cooperation of
the State and City was requested and was given. The
City council passed ordinances requiring screening of all
water containers and cess pools, the daily collection of








REPORT OF DISTRICT HEALTH OFFICERS


garbage, and provided penalties for violation of the
ordinances.
Oiling of cisterns and other water containers, holding
mosquito larvae, was regularly and systematically carried
on by squads of men, which materially abated the
mosquito nuisance.
The vigilance so exercised is probably responsible for
the fact that there have been no fatalities among the en-
listed men stationed here, from communicable diseases,
other than influenza.
Influenza first made its appearance among the Navy
personnel at the Training Station and in the United States
Marine Hospital.
The disease was brought to the Training Station by
recruits from the North, and the cases at the Marine Hos-
pital were taken from passing merchant ships, the disease
having been contracted in north Atlantic ports.
Of the first twenty deaths occurring in Monroe County,
fourteen were among men in the service of the United
States Government and six were civilians.
There were seventy-nine deaths from influenza in
Monroe County during the year 1918. Of this number
forty-four were civilians and thirty-five were in the United
States Government Service. Sixty-nine died in the month
of October, nine died in November and one died in
December.
It is estimated that twenty per cent of the entire popu-
lation of Monroe County had influenza during October,
November and December.
Typhoid Fever:-Nine cases were reported during the
past year and there was no deaths.
Scarlet Fever:-Two cases reported, no deaths.
Small pox:-No cases reported.
Malaria.-Three cases were reported and one death as
a complication. All of the cases were imported.








68 ANNUAL REPORT STATE BOARD OF HEALTH

Measles:-Th'ere were about fifty cases reported dur-
ing the year, and there were no deaths.
German Measles, Wlhooping Cough and Mumps were
reported in mild form, with no fatalities.
Diphtheria:-Eight cases were reported during the year
with no deaths.
Leprosy:-There are nine cases of Leprosy on the
island of Key West, under the supervision of the State and
City Health Authorities. There was one death from
Leprosy during the past year.
Acute Poliomyelitis:-One case of this disease was
taken from a U. S. Patrol boat and immediately isolated
at the Marine Hospital, the patient recovered.
Tuberculosis:--There were forty-seven deaths from
tuberculosis during the past year. It seems almost un-
believable that fifteen per cent of deaths here should be
caused by a preventable and curable disease. In a city
that boasts of a climate unsurpassed, where sunshine is
a daily visitor, where all can spend their hours of recreation
and rest in the open, something should be done by the
City and State to educate the people and prevent such an
economic loss.
I take this opportunity of expressing my appreciation
of the aid and cooperation rendered me by the State Health
Officer and his assistants during the past year.
Respectfully submitted,
(Signed): W. R. WARREN,
District Health Officer.











REPORT OF GRACE WHITFORD, M. D.
District Health Officer.
Tampa, Florida, February 13th, 1919.
Dr. W. H. COX,
State .Health Officer,
Florida State Board of Health,
Jacksonville, Florida.
My dear Doctor Cox:
The Bureau of Education and Child Welfare has been
established slightly over five months. During that period
my duties have taken me into the following counties:
Leon, Escambia, Broward, Palm Beach, St. Lucie,Brevard,
Pinellas, Hernando, Hillsboro, Lake, Duval, Marion,
Orange, Volusia, Lee, Pntnam, Suwanee, and Seminole.
These counties have either needed my services most,
showed greatest interest and co-operation, or have had
workers employed who required direction. Few counties
in the state have failed to evidence an interest in the work
or to ask for the service of the Bureau.
We have had the honor of having with us two leaders
of national importance in the work for children: Mrs. Max
West, of the Federal Children's Bureau in Sepember, and
Dr. Jessica Peixotto, Professor of Social Economics in
the University of California, and Chief of Child Conserva-
tion, Field Division, National Counsel of Defense. Both
left inspiration and continue to give practical help. To
the organizations which they represent we are indebted for
much of the literature that we use.
Practically the whole state is districted with Child
Welfare chairmen, either from the Florida Federation of
Women's Clubs or women of the Field Division, Florida
Counsel of Defense, making possible work that this Bureau,
with its limitations, could not cover, even with a large
budget. We are greatly indebted to both bodies of
women.








70 ANNUAL REPORT STATE BOARD OF HEALTH

The pre-natal work of the Bureau is as yet largely con-
fined to the distribution of literature, newspaper publicity,
lecture work, and the attempt to interest communities in
the establishment of small maternity hospitals or maternity
wards in larger institutions. A plan for a registry for
expectant mothers, and for "birthday" letters for the first
five years of the Florida babies' lives, has been formulated,
but must await an adequate office equipment before being
put into operation. Education of the colored mid-wife is
a grave necessity; classes have been formed in several
centers for these women, and local registrars are showing
some remarkable figures as to their effectiveness. Nearly
every county shows good "follow-up" work succeeding
Spring or Summer pre-school age clinics. It has seemed
wise to postpone many of the second clinics scheduled for
six months after the first, because of Influenza. Lake
County has just finished her second examinations. One
half of the children had not been reached in the first clinics,
and one half of those who had attended the first examina-
tion, had had, or had attempted to have, corrections ad-
vised made. We now have one county completely dis-
tricted with infant welfare stations to which the visiting
nurse makes scheduled visits. Infant Welfare Stations
have been established in Tampa and Jacksonville with a
milk depot in connection with the latter. Several com-
mittees are supplying needy babies with free milk. Orange
County has just appointed a'social service worker and Hills-
boro, a visiting trained nurse. In addition, social service
workers have been employed for some months by Brevard,
Lake, Palm Beach counties, and a visiting nurse each by
Dade and Pinellas counties; seven in all. Other counties
are anxious for such a service, but will have to wait for
their County Boards to make up their annual budgets.
Some of our cities have whole or part time nurses. This
type of woman is, perhaps, our greatest need throughout
the state in every county.








REPORT OF BUREAU OF CHILD WELFARE


As you know, physical examinations for school chil-
dren are being held in each district of the state. The record
cards used are those devised by this Bureau, giving the
possibility of a record of twelve years for school life. There
were over 185,000 children in the public schools before
Christmas; several thousand have been added since
through the tourist population. It seems well to make a
complete inventory of our most valuable material in this
way; after that is once done a less time consuming method
can be substituted. Where the work is conscientiously
done, perfect co-operation is given by the school patrons
and authorities, and the teaching body. My own school
examination work has been in Leon and Pinellas counties.
I hope to finish'in the latter completely myself. Again,
the visiting nurse, or social service worker, is the great
factor in the "follow-up" work. The policy is to invite
these workers, after they have proved themselves with
some months of service, to become, on consent of their
employing boards, members of this -Bureau at a very nom-
inal addition to their.iegular salary.
Active co-operation from other departments of the
State Board of Health, particularly in laboratory work,
has been valuable. Doctor Arms' plan for holding hook-
worm clinics in the schools is splendid, and is making an
impression on communities visited.
Respectfully submitted,
GRACE WHITFORD, M. D.,
Chief, Bureau of Education and Child Welfare.











REPORT OF ORTHOPEDIC DEPARTMENT,
State Board of Health.

REPORT OF Dr. E. VAN HOOD.

Dr. W. H. COX,
State Health Officer,
Jacksonville, Florida.
My Dear Doctor:-
I herewith submit Annual Report of The Orthopedic
Department of The State Board of Health, located at Ocala
for the year ending December 31, 1918. It is better known
as the Hospital for Crippled Children.
The medical profession of Ocala have shown a con-
tinued and gratifying willingness to assist in any way with
the work and each is herewith tendered due appreciation.
The citizens who have taken the children to ride, the
dentists, druggists, barbers, story tellers, Christmas tree
makers, and especially Mr. Ed. Carmichael, who gives the
children freedom of Silver Springs as bathing and picnic
grounds, and all who have in any way contributed of their
time, patience, material or skill towards the welfare and
comfort of the little ones, have placed us under many
obligations.
We thank Professors Booie, Johnson and Blake for
much and'tedious labor in making the photographs. They
do it gratis.
Dr. Harry Walters gives special rates for the X-ray
work, Ocala Knitting Mills gives several'dollars' worth of
goods, Messrs. Geo. Pasteur Masters Company and O. K.
T. Pot Company furnish Ambulance Service, and The
Carnegie Library gives free use of its books. Each has
our thanks.
Miss O. Dilday, Supt. Marion County Hospital, has
cared for the children very acceptably. Generous Ed.
Bennett gives free tickets to the "movies."








REPORT OF ORTHOPEDIC DEPARTMENT


The Ocala Banner and Daily Ocala Star-especially the
Star-have our appreciation for outspoken interest.
A word of recognition is due the social workers, field
workers, teachers, nurses, etc., who are serving under Dr.
Grace Whitford in The Child's Welfare and Education
Department, recently organized by you, for their enthus-
iasm in cooperating with the Hospital for Crippled Chil-
dren. They are responsible for seven children having an
opportunity to get the benefit of the Fund and this new
department promises much in the way of getting rid of
the inertia that characterizes my patrons. This in-
formation is given you because it is not likely to be brought
otherwise to your attention. Please furnish me with the
name of each worker.
A local committee has been officially appointed to
watch over the interests of the children committed here.
This committee consists of Mr. Chas. Cullen, the local
representative of The State Children's Home Society
(Marcus Fagg, Supt.), Dr. Ed. Chace, Mayor of Ocala,
and Miss Nellie Stevens, Supt. Ocala Primary School.
A special word about outdoor or correspondence cases.
They are, as you know, quite numerous, and many live
more than two hundred miles away, so it has happened
that I have visited several at and in their homes, though
you have not as a rule asked me to do this. Once you
offered to pay me for this service "extra." The Child's
Education and Welfare Bureau will, I hope, help me to
solve this question as to transportation of the very poor
whose income is so often less than their expenses.
I am pleased to know that you are much interested in
this department, because you have so many times "dropped
in" to take a look at the children and The Crippled
Hospital, in the last twelve months. Your visits have
"done good" every time and are therefore very much
appreciated. Very Respectfully,
E. VAN HOOD.









74 ANNUAL REPORT STATE BOARD OF HEALTH

CASES SUCCESSFULLY TREATED.
Harvey Carey.-Bowlegs, double osteotomy, see photo and read
history.
A. McGeehee.-Club foot and paralysis leg. Forcible correction and
a brace for "loose" knee joint. See photo.
L. Godboldt.-See history and photos. His case is the "master-
piece" of this year's work.
H. Link, col.-An ancient burn left his arm and shoulder helpless
on account of the contractures. A "trick" operation was successful in
dealing with the "batwing" that held his arm to the side.
E. Graham.-Clubfoot and knock-knee was successfully treated by
operation, though the leg is shorter by nearly three inches. A steel
extension will be given her. See photo. She paid all expenses-cost-
ing State nothing.
C. Weatherly.-Bassini for ing. obliq. hernia.
C. Weatherly.-Readmitted for hypospadias. Both operations
were done and he is now practically normal. Hypospadias was
operated by Bevan's method. See photo.
R. Peebles.-Removing Tonsils and Adenoids, and hookworms.
H. Cheshire.-Imperforate anus, which was operated some months
ago but the boy was threatened with rectal stricture. It is being
kept open.
M. Sparkman.-School girl with appendicitis. Her father paid the
hospital fees and so the operation costs the State nothing.
W. Simmons.-Large adenoids and hookworms. He paid for
assistant and as the work was done at office, the State is out nothing
for this case.
E. Malpass.-School child, with uterine hemorrhage due to polyp
hanging from interior of uterus. Polyp and its base removed but
small bleeding persisted until uterine arteries were tied through
vagina. Patient costs State nothing.
B. Hendry.-Hydrocele with congenital hernia. Operation made
a cure.
H. Livingston.-Fracture of femur multiple associated with frag-
ilitas Ossium. Patient has had three of these fractures. A good
cast was applied and boy had had no fracture for 10 months. He is
taking medical treatment also.
S. Ullman.-School girl. Cancer breast. Halstead operation. No
return in 11 months. See photo. She paid all expenses-costing State
nothing.
N. Baker.-Sandspur in larynx. Removed through a tracheotomy
incision. He paid all fees for hospital and assistant. So costs
the State nothing.
M. Hines.-Hipjoint abscess. A cast with fenestra to drain away
the pus and thus keeping parts at rest and clean brought about a
"cure" in ten months. Three casts were applied. She costs the State
nothing but the plaster-being in the outdoor department. 'No
deformity.
C. Maloney.-Kyphos and all the other symptoms of Pott's. A
Bradford splint for a few weeks and then plaster jackets for a few
months effected a cure, with no deformity.
H. Mizell.-Was .a similar case plus multiple and extensive ab-
scesses on back, hip, thigh and knees. Same treatment effected a cure
The hip is stiff. A later operation may relieve that.
C. Jordan.-Paralysis of soleus and gastrocnemius treated by
Gallie's operation. Very much benefited. See photo. A more exten-
sive operation may be done if desired at a later date.
No deaths. (Signed): E. VAN HOOD, M. D.









REPORT OF ORTHOPEDIC DEPARTMENT


DETAILED REPORT OF CASES TREATED.
F. MATCHETT.
F. Matchett, aged 10 years, Citra. Paralysis leg.-In. Spi. Par.
Family refused treatment.
G. GOIN.
G. Goin, age 5 years, Ocala. Dr. Counts. Epilepsy traumatic.
Kicked by horse some months ago, has had one operation for removal
of crushed bone and parents object to further surgical work-am using
medical treatment.
P. DEAN.
P. Dean, col., age 20, Williston. Dr. Freeman. Arthritis of ankle.
T. B. Refused surgical treatment. X-ray taken, costs State nothing.
W. RANDALL.
W. Randall, age 12, Micanopy. Dr. Howell. Left inguinal
hernia-congenital, Bassini operation. Cured.
E. MALPASS.
E. Malpass, age 14, Hawthorne. Dr. Floyd. Uterine polyp. Ex-
cision of polyp with its base. Benefited greatly-but a second opera-
tion of tying the uterine arteries through the vagina was done.
Patient having very little trouble. This patient is a school girl-bright
and promising. State Health Officer gave special permission for this
operation. Father paid all hospital expenses. Case costing State
nothing.
B. HENDRY.
B. Hendry, age 4 years, Coleman. Dr. Mitchel. Hydrocele with
hernia.- Incision, drainage and pressure. Cured.
E. BAXLEY.
E. Baxley, 3 years, Hawthorne. Dr. Floyd. Hip abscess and Pott's
disease. T. B. Von Pirquet's test positive. This case was reported
last year. Patient remained in Hospital a few weeks, treated entirely
on an open porch, by Buck's extension. Family physician had prev-
iously employed the same satisfactory method. Before cure was com-
pleted the mother insisted upon having the child at home-under
protest-(purely a case of "over mother love"). Dr. Floyd is con-
tinuing the treatment under difficulties-child only holding her own-
has fever and several abscesses. She should have either plaster jacket
or a Bradford frame. We hope to have her soon in hospital again.
H. STEWART.
H. Stewart, aged 8 years, Groveland. Dr. Register. Hip abscess.
Osteomyelitis of ileum. The abscess is draining well. Ankylosis is
established and the boy doing so well that he is now treated entirely
in the "out door department" and so, costing the State nothing.
J. SEYMOUR.
J. Seymour, age 12 years, Micanopy. Dr. Withers. Club foot, ob-
jects to treatment. Hope to get hold of him later.
T. JAMES,
T. James, col., aged 3 years, Centralia. Dr. Coogler. Delayed gen.
development, used thyroid ex.









76 ANNUAL REPORT STATE BOARD OF HEALTH

O. RICKETTS.
O. Ricketts, age 2 years, Kissimmee. Dr. Winn. Delayed devel-
opment mind and body. Treatment, thyroid ex., noticeable im-
provement.
S. HUNTER.
S. Hunter, age 10 years, Ocala. Dr. J. W. Hood. General lack of
development physical. Treatment thyroid ex. Improvement slow.
N. CARTER,
N. Carter, age 5 years, Gainesville. Dr. Boring. Spastic paralysis
-shoulder and arm-hook worm-adenoids-enlarged glands neck.
T. B. Von Pirquet test positive. Patient remained in hospital for some
time under treatment. Some improvement, however the paralysed
condition will require months if not years to correct. A letter plainly
setting all this before the parents when the child was sent home was
written. -
H. BECK, NOMA.
H. Beck, Noma. Dr. Warren. Gun shot wound, ankle-Refused
treatment.
D. DENISON, HOBE SOUND.
D. Denison, 10 years, Hobe Sound. Dr. Conkling. Paralysis of
many parts of body, began when child was about 18 months old.
Parents say it was preceded by diphtheria. Use of muscles in general
is now fairly good with the exception of muscles of phonation and
deglutition. Difficulty of talking sometimes not noticeable. Miss
Bess Morehouse, Social Service worker of Palm Beach County, who
brought the child, was instructed to use massage, general treatment
and to report progress.
W. WALLIS.
W. Wallis, age 8 years. Dr. J. W. Hood. Adhesions clitoris and
bed wetting. Chloroform given while adhesions were broken up.
Cured.
C. McNATT, TAMPA.
C. McNatt, age 6 years, Tampa. Mr. Frecker. Spastic par. arm
and shoulder, hook worm infection. Patient given course muscle
training and sent home with definite instructions. Cases like this
should remain in the Institution and suitable apparatus used upon
them to give the limbs proper passive exercise. The hospital for
Cripples lacks equipment and these patients cannot be satisfactorily
treated until such apparatus is furnished.
A. VICKERS, OXFORD.
A. Vickers, age 12 years, Oxford. Dr. Wood. Myositis, ossificans of
shoulder and muscles of back. X-ray, medical treatment.-Not im-
proving. Case was reported to the State Med. Ass. 1918 in Tampa.
M. DIXON, RED LEVEL.
M. Dixon, age 18 years, Red Level. Dr. Irwin. Atax. spastica.
Medical treatment. Patient may improve more or less but such cases
are always unsatisfactory.
S. DIXON, RED LEVEL.
S. Dixon, age 16 years, Red Level. Dr. Irwin. Sister to M. Dixon.
Same history of affliction from birth. Medical treatment.
G. WICKER, MICANOPY.
G. Wicker, age 16 years, Micanopy. Hodgkin's disease. Medical
treatment-not improved.









REPORT OF ORTHOPEDIC DEPARTMENT


H. BAKER, OXFORD.
H. Baker, age 8 years, Oxford. Dr. Slaughter. Sand spur in
Larynx. Tracheotomy and removal. Cured. Cost State nothing.
Parents paying hospital fees and assistant.
E. TANNER, FRUITLAND PARK.
E. Tanner, Colored, age 10 years, Fruitland Park. Dr. Morrison.
Shot gun wound, hand, lost'two fingers and thumb. Plastic operation.
Cured. Cost State nothing.
S. ULLMAN, SHADY.
S. Ullman, Colored, age 14 years. Shady. School girl. Cancer
breast. Halstead's operation. Cured. Cost the State nothing.
M. HINES.
M. Hines, age 5 years. Hip joint abscess. Applied three jackets
plaster paris. Covering well the thigh leaving fenestra for access
to the open wound in the hip. Patient made uninterrupted recovery.
Now the picture of health.
C. MALONY, KEY WEST.
C. Malony, age 6 years, Key West. Dr. Warren. Pott's disease
spine. Patient's photo appears in report of 1917. He has since made
a perfect recovery.
H. MIZELL, BARTOW,
H. Mizell, age 6 years, Bartow. Pott's disease with extensive
abscesses-hips and both thighs. Patient appears in report of 1917.
For the past twelve months he has been well and growing rapidly. A
remarkable case. He was treated in 1917 also.
J. MOORE, MICANOPY.
J. Moore, Colored, age 10 years, Micanopy. Epilepsy and spas,
par. legs. Medical treatment. Improvement.
R. BEARD, LADY LAKE.
R. Beard, Colored, age 17 years, Lady Lake. Dr. W. H. Cox.
Cerebro spinal meningitis. Medical treatment. Recovered.
G. GRAVES, DUNNELLON.
G. Graves, age 12 years, Dunnellon. Dr. Baskin. Chorea. Medical
treatment. Recovery.
I. GRAVES, DUNNELLON.
I. Graves, age 14 years, Dunnellon. Dr. Griffith. Eye strain.
Medical treatment. Recovery.
E. MONTGOMERY, MICANOPY.
E. Montgomery, age 10 years, Micanopy. Hem~plegia spastic
from birth. Advice-improving.
L. SELLARS, OCKLAWAHA.
L. Sellars, age 2 years, Ocklawaha. Dr. -Henry. Microcephalus.
This is a tentative diagnosis. The child is being given thyroid
extract.
E. SMITH, MICANOPY.
E. Smith, age 10 years. Micanopy. Short foot and leg, congenital
otherwise normal, will be furnished with steel extension.
I. TOWNSEND, GROVELAND.
I. Townsend, age 15 years, Groveland. Dr. Register. Contracted
tendons of knee. Short foot and leg. Advised manipulations, etc.









78 ANNUAL REPORT STATE BOARD OF HEALTH

R. PEEBLES, OAK.
R. Peebles, age 5 years, Oak. Dr. J. W. Hood. Tonsils and
adenoids. Operation. Cured. Cost State nothing.
H. CHESHIRE, OCALA.
H. Cheshire, Ocala. Dr. Blitch. Imperforate Anus. Operation
done some months ago, at birth but patient threatened with stricture
of rectum. Now doing nicely.
J. TRULUCK, MORRISTON.
J. Truluck, age 18 years, Morriston. Dr. Willis. Mentally
defective. Advised to see Dr. Randolph.
L. CLAYTON, OCALA.
L. Clayton, age 12 years, Ocala. Pharyngitis from fish bone in
throat. Removed bone. Cured.
M. SPARKMAN, HAWTHORNE.
M. Sparkman, age 19 years, Hawthorne. Dr. Floyd. Appendicitis.
Operation. Cured. This patient cost State nothing.
W. SIMMONS, KENDRICK.
W. Simmons, age 15 years, Kendrick. Dr. J. W. Hood. Adenoids
and catarrh. Hook worms. Operation and medical treatment. Cured.
Cost to the State nothing.
J. EDWARDS, OCALA.
J. Edwards, Colored, age 20 years, Ocala. Epilepsy traumatic.
Shot in brain. Refused treatment.
A. KNIGHT, FORT PIERCE.
A. Knight, age 2 years, Ft. Pierce. Dr. Hardee. Delayed loco-
motion. Mus.-training "go cart"-and medical treatment. Im-
proving.
H. LIVINGSTONE, KENDRICK.
H. Livingstone, age 12 years, Kendrick. Dr. Peek. Multiple frac.
thigh. Fragilitas ossium. This patient has had three fractured
Femurs in three years. Casts and medical treatment. No Frac. for
twelve months.









REPORT OF ORTHOPEDIC DEPARTMENT-STATE BOARD OF HEALTH.

Year Ending December 31, 1918.


NAMES.









P. Callahan .....
A. Thigpen ------
H. Hewett --........
A. Conner -------
N. Alderman -------
M. Revell -----------
B. Mork -------..
M. Goss ---------
A. Ray -------------
L. Randall ----------
M. Morgan ---------
E. Hill (Colored)..
H. Moon ------------
E. Baxley -----------
.H. Stewart -----
H. Carey -----------
L. Sellars -------
T. Howze ------
A. McGeehee -------
L. Godboldt --------
L. Tooke -------
E. Smith -------
J. O. Eddy ----------
H. Link (Colored)__
I. Townsend --------


ia



a e:







~, cr
*-'l '-'







1





n


Date Disdharged
and Condition








------------------------
------------------------
------------------------
Readmit. out d. tr.
------------------------
------------------------
Improv. 12-20 ------

u-------ed 12---------------
Oured 12-20---------.
------------------------
------------------------
------------------------
------------------------
------------------------
------------------------
------------------------
-----------.------------
------------------------
------------------------
------------------------
------------------.-..-
------------------------


Diagnosis


Operating, Plaster Work,
Special Treatment, Etc.









Casts-Braces ------------
Excis. Tib. Thom. Splnt.
Excis. Tib. Thom. Splnt.
Accd. Fract. New Bone-.....
Astragalec Casts etc.--------
Tenotomy, Casts, etc.--------
Gymnastic.............
Braces-Musc. training ------
Casts Tenot. etc...............
Music. train., Shoe adjust.-_
Braces ------------
Bougies. -----------
Drainage, Hello their. -----
Drainage Extension Rest-----
Drain-Extension ------
Braces-Osteotomy ---------
Thyroid Extract ---------
Braces --- -------
Operation, Casts, etc.--------
Casts-Muse. train.------------
Oasts-and Minor Operation-
Steel-Extension ----------
Manipulation
Fasciotom., Skin graf. Splint
Manipulat. straps, etc. ----


Flail leg. left I. S. P...........--
Ost.-myelitis Tib. right T. B.-
Ost.-myelitis Tib. right T. B.__
Ost.-myel. Tib. rightT.B.Pl.Cst.
Tal e var&val Ex.Par.legsI.S.P.
Pes. plan. Pes. cavus. I. S. P.
Extreme Rickets..........
Genu val double I. S. P. Spastic
Tal e var double Initer Rotation
Tal var. Ex. par. legs I. S. Par.
Total Par. le" In Sp. Par.---..
'Stricture of Esophagus--.......
Hip Abscess Deformity T. B.__
Hip absc..etc. Pott's Dis. T. B.
Hip absc.-Osteo Myelit. Ileum
Genu var do. Hk w.etc.,Readm.
Microcephalus -------------
Genu valgus Double---..........
Tal e var left Tot.Par.leg I.S.P.
Tal e v. do. tot.par.hips&l. ISP.
Sp.Blf.occ.Tal.e.var.&Perf.ul.ft.
Short leg and foot-Congenital
Tal e var do. I. Rot., age 10 m.
Anc. Burn of B. s'h. a.&forearm
Cont. knee tend., short ft.&leg













REPORT OF ORTHOPEDIC DEPARTMENT-STATE BOARD OF HEALTH.

Year Ending December 31, 1918.

.... ___--- __ _ _


NAMES.








E. Graham (Color.)
J. Cliburn
C. Weatherly -
J. Matchett ---
N. Miller ------.........
J. Seymour --
T. James (Colored)
O. Ricketts
S. Hunter -------
N. Carter
H. Beck -----
D. Denison
R. Peebles ---
H. Oheshire
J. Trueluck
L. Clayton
M. Sparkman --- -
W. Simmons -
C. Weatherly -
J. Edwards (Color.)
A. Knight-..--...-
M. Abstein .....-
A. Thigpen --.----. .
G. Goin ------
P. Dean (Colored)-.
W. Randall .......--


Operating, Plaster Work,
Special Treatment, Etc.


Date Discharged
and Condition


0 C


Diagnosis


"C-


a~d a..-

eS' en

'0X

1
1
1





1~~





1



1


1.1


Tal e var-Genu valgus w. 22 fix.
Tal e var with Bowlegs, double
Hypospadias ..............
Par. hip and leg, I. S. P.----...
Hemiplegia at Birth...---.....
Club foot ..--..--....--...........
Delayed Development......--..
Delayed Development-......-...
Delayed Development .------...
Spas. Par. Arm & Sh. H.-W.
Old Gun Shot of Ankle--.....--.
Dysph. fr. ac. dis. Par. muscle.
Dis. Tonsil & Adenoids, H.-W.
Imperforate Anus. Congen..-..
Mentally Defective ---.........
Pharyngitis fishbone throat.--..
Appendicitis with complications
Adenoids-Nasal catarrh, H.-w.
Oblique Ing. Hernia 1. Congen.
Traumatic Epilepsy fr. shot br.
Delayed locomotion--............
Lordosis fr. Potts dis. dis. arr.
Typhoid Fever, Readmitted....
Epilepsy Traumat.-bl. o. head
Arthritis Ankle, T. B...........
Oblique Ing. Her. left. Congen.


Tenotomy-Casts, etc.-------- ..---- --------
Forced Correction, Casts ..---... .-L--------
Bevan's Oper. Hypospadias-. Cured -------
None. --.----.------..... ------ -Refused Treatment
Muscle Training. Advice.... Home Treatment.--
Objected to treatment-..--- ----------.... ---.-
Thyroid Extract -------.... ----...............
Thyroid Extract -------....... ------.------......
Thyroid Extract ...--.---- ---..............
Muscle Training, etc. --..-- I Improved.....-----...
None --------.. --------.----...- Refused Treatment
Massage, etc. -- .............. --...........
Operation ....--- .---.--------. Cured--........--....
Operation and dilating.....---.-- ---...
Advice ---------- ---------- Not improved--....
Removal, med. treatment--. Cured-....---........
Appendectomy .---..--.----. Cured-..-.....----..
Operation ...--.-----.. -------- Cured--......------..
Bassini ----......-------------- Cured ...---.........
'Medical Treatment ----------- Not improved..---..
Muse. Train. etc., "Go-cart" Improving ---.......
Corset -.----.------- --- ----.....................
Medical Treatment --....----- Recovery .---....--..
Medical Treatment -.---. ---I -------- .
Refused Treatment ---------- Not mproved.---...
Operation ------------. ----- Cured -----------







REPORT OF ORTHOPEDIC DEPARTMENT-STATE BOARD OF HEALTH.

Year Ending December 31, 1918.

-I --I I --------- _


E. Malpass ------
Louise Shelton ---
B. Hendry --------
Hugh Livingston.--
S. Ullman (Colored)
A. Vickers --------.
M. Dixon -----
B. Dixon -------
G. Wicker----.......
H. Baxer --------
E. Tanner (Colored)
M. Hines -----
Rosa Nelson (Col.)
C. Maloney --..-.-
H. Mizell -------
J. Moore (Colored)
A. Randall ..........
R. Beard (Colored)
G. Graves ---......-
I. Graves ........
F. Montgomery -...
A. Evans (Colored)
C. Jordan .........
W. Wallis ..........
O. McNatt ---.......
Total.----.....


S1


Operating, Plaster Work
Special Treatment, Etc.







Uterine Polyp, etc.--.........-
Teno plast. Cast. Train.......
Incision, Drain & Pressure.-
Casts, Extens. & med. treat.
Halstead's Operation --.......
Medical Treatment---.........
Medical Treatment--.........-
Medical Treatment-.----......
Medical Treatment------------
Tracheotomy ----
Operation--------------
Casts-Drain...............
Medical Treatment---..........
Bradford Splnt.-Cast ..-------
Bradford Spint.-Cast .........
Medical Treatment--...--------
Medical Treatment-..........
Medical Treatment.-...-.....
Medical Treatment--..........
Medical Treatment---.........
Advice ----
Nothing-Ran away--.....-.
Gallie's Operation ............
Break pre-put. adhes.........
Muscle Training.----------


Date Discharged
and Condition







Cured --------
Cured -......------
Cured --..--------..
Cured --------
Cured -----.. ------..
Not improved--....
Ataxia Spastica -..
Not improved--....-
Not improved--.....
Cured -.-------
Cured-----------
Cured------
Improved .-...-----.
Cured .--.....--..
Cured.- _----......
improved --....-----
Improved .....-----
Improved .---..--...
Improved ........---------
Improved ------...---..
Improved ---------
Not improved..--...
Cured ---- ----
Much improved ..--
Improved --.........


Diagnosis








Exc. & Tying uterine arteries
Tal. var. r., Par Peronei I. S. P.
Hydrocele with Hernia Cong.
Mult. Fract. Thigh-Fragil. Oss.
Carcinoma of Breast---.........
Myositis Ossificans of should's
Not improved -------------
Ataxia Spastica -------- ---
Hodgkin's Disease ----------
Sandspur In larynx --------
Shotgun wound, loss 2 fingers
Hipjoint Abscess, T. B..-....
Partial Paral. both legs--......
Pott's Disease Spin. ---------
Pott's Dis. Spin & Hip absc. ex.
Spas par legs, Epilensy--......
Scoliosis & par. legs I.iS.P.
Cerebro spinal Meningitis ----
Chorea --------.---------------
Eye-strain-------------------
Hemiplegia spastic .from birth
Tot. par. legs & part p. of 'hips
Tal. cal. val. r. p. per.&sol.ISP
Adhesions clit with bedweitting
Spas. par. Arm & should. H-W


--------










-f


.. .

















HARVEY CAREY-Before Operation. HARVEY CAREY-After Operation.
H. CAREY, age 7 years, Centralia. Double bow legs, hook worms, boils and adenoids.
Treatment begun in 1917 by use of braces because parents objected to operation.
Osteotomy at proper places on the tibiae. Plaster paris cast. Ad secundum artem has
made a new boy. See photo. Medical treatment and operation for adenoids played im-
portant part in the transformation.
,lI' "
,, ..
: ....
HARVEY CA1-Bfr prto, HRVY AE -AtrOeain
H.t CAEae7yas etai.Dul o es okwrs oln dnis











sr
.- '


L-, L *\


'^'E

*"y .-'-^ ^ *'



IP-^.
^!j,.


L. GODBOLDT. -1 L. GODBOLDT. -2 L. GODBOLDT. -3
L. GODBOLDT, age 7 years, Plant City. Dr .---_.. Total paralysis legs, hips and feet-I. S. P.-Has not
walked in five and a half years, but crawled on "all fours," going backward instead of head foremost. When brought
into the hospital he begged to not be MADE to walk and sat about in helplessness. The feet were talipes varus and the
condition of legs and hips were non-descript-bending in any direction. See photo. As soon as the legs and feet were
straightened by force and plaster casts bringing the foot fairly on the floor the boy was coaxed, rewarded and compelled
in a way to walk 100 steps to meals three times a day aided by the nurse holding one hand. As soon as he grasped the
fact that it was possible for him to walk he joyfully cooperated. The Hospital nurses and visiting physicians agree
that this case is the year's masterpiece. He will never be a normal man, but he is taken permanently off the floor and
manages his crutches with skill. He will use braces later and have legs massaged daily. See photos 1, 2, 3.
manages his crutches with skill. He will Use braces later and have legs massaged daily. See photos 1, 2, 3.





































A. McGEEHEE-Before Operation. A. McGEEHEE-After Operation.
A. McGEEHEE, age 9 years, Lowell. Dr. Van Engelkin. Talipes equino varus left.
Total paralysis leg. In. Sp. Par. All deformities in patient corrected by operation. Is
now wearing cast on knee only-so that it is unnecessary for her to use hand on thigh
while walking with the "flail" leg. Will soon be given brace for knee. See photo.



































JAMES CLAYBORN-Before Operation.


JAMES CLAYBORN-After Operation.


JAMES CLYBURN, age 2 years, Plant City. Dr._--____. Talipes equino varus
with internal rotation and bow legs. Treated by forcible correction and the E. L. Scott
method with plaster cast. Little patient's legs are practically straight, but on account
of "naughtiness" when accompanying photo was being snapped he refused to stand as
he does at other times. The inversion may require an oteotomy later on. If a prognosis
is allowed in these reports, it is safe to say, his legs will be well nigh perfect in a few
months.








































N. MILLER, Jacksonville,
Age 6 years.
Hemiplegia right from birth.

N. MILLER, age 6 years. Jackson-
ville, Dr. Gwinn. Hemiplegia right-"
from birth. This very bright boy

can accomplish. At birth both arm

being assisted upon his feet he walked
after eighteen months of age, because
he wanted to "get about." In this he
was encouraged but the arm remained
undeveloped for lack of use. See photo.
Speaking theoretically, if the arm
had had the same conditions thrust
upon it as the leg had in the begin-
ning, it might now be a more useful
arm.


A. EVANS,
Refused treatment, Could be much
improved.

A. EVANS, Colored, age 17 years,
Brooksville. Dr. Creekmore. Total
par. leg and partial par. foot. In. Spi.
Par. Although assured that no opera-
tion was pending, the boy ran away
from hospital. I had intended to put
on a plaster paris cast to hold legs in
straight position and in this way
determine what could be accomplished
by braces.







































CLIO JORDAN-Before Operation. CLIO JORDAN-Much Improved.
C. JORDAN, age 10 years. Talipes, caleaneo-valgus right. Par. peronei and soleus.
Inf. Spi. Par. Gallie's operation was done with much benefit.












If

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X-Ray Photo Before Removal of Bone. X-Ray Photo One Year After Removal
A. THIGPEN. of Tibia. No Bone Has Reformed.

A. THIGPEN, age 17 years, Ocala. This patient has been in hospitals or under the
care of specialists for twelve years. Began with osteomyelitis-T. B.
One year ago I removed the tibia by sub-periosteal excision. Progress for the better
has bean slow. X-ray shows no bone returning. Have curetted three times for focal in-
fection near head of tibia. Skin grafted extensively once. Intend transferring fibula
to place of tibia as soon as conditions are favorable. Though local conditions are some-
what unfavorable, yet the boy's growth, vigor, health, and strength make me hesitate to
amputate the limb, which I am advised to do by all doctors. See photo. Wrist and
neck show scars following large bone abscesses four years ago.




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