REPORT OF DR. HIRAM BYRD

JACKSONVILLE, FLA., January 1, 1912. Dr. Joseph Y. Porter, State Health Officer, Jacksonville, Fla. Dear Doctor: I have the honor to hereby submit a brief report of my work for the year 1911.

The greater part of my time has been employed in the office, where I have assisted in answering routine correspondence and in the general conduct of the Executive Office work. I have also assisted in the editing of the Health Notes, and have prepared for publication special bulletin No. 88, "Typhoid Primer."

I have in addition to the office work, spent an average of one day a week in the field, serving in a variety of capacities, such as investigating smallpox, poliomyelitis, typhoid fever, malaria, alleged sanitary nuisances, lecturing, inspecting vessels, and, in the absence of the veterinarian, have even had the management of two outbreaks of glanders.

Dade County Isolation Hospital.

At the spring term of the circuit court the Dade County Grand Jury in its presentment arraigned the management of the Isolation Hospital of the Board of Health in that county, whereupon I was detailed to make an investigation, the result of which forms the subject of a special report herewith submitted.*

Typhoid Fever at Belleair and Tampa.

In the spring of 1911 a number of guests who had spent some time at the Belleview Hotel, Belleair, developed typhoid fever after returning to their various homes in the north and west, whereupon the management of the hotel engaged the services of Drs. Jordan and Irons of Chicago to investigate, with a view of determining the source of infection and correcting it. Dr. Irons, after spending some time at Belleair without determining the source of the infection there, got on the track of some cream that had been shipped by the Tampa Dairy Company to the hotel, whereupon he followed it to Tampa, and after investigating the situation there, arrived at the conclusion that a certain dairy in Tampa was responsible for the typhoid fever at The Belleview. This became known in Tampa and rumors became widespread there and throughout the

* See Appendix.

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state that there was a milk epidemic of typhoid fever in Tampa, whereupon I was detailed to make an investigation, the result of which forms the subject of a special report herewith submitted.* In this connection, I wish to call your attention to the following features:

First. I was unable to get a shred of epidemiological evidence to indicate that typhiod fever in Tampa was milk borne; and, Second. The evidence that it was fly-borne was overwhelming. I, therefore, had occasion to review the work of Drs. Jordan and Irons, and my conclusions were diametrically opposed to theirs. In as much as they have published their investigations under the caption: "Three Outbreaks of Typhoid Traced to Milk Infection, "** (this being cited as one), I would beg a careful reading of my report, of which theirs forms a part, that you may the better determine for yourself whether the evidence convicts or exonerates the milk as a causative factor in the epidemic of typhoid fever, both at Tampa and Belleair.

Prevalence of Malarial Fever:

The office is frequently asked about health conditions at various points in the state with special reference to malaria. From the number of inquiries of this kind, it would seem the impression is abroad that malaria is very prevalent in the State of Florida. In the absence of mortality and morbidity statistics, it is impossible to answer this question except in a more general way and without any adequate idea to base such statements upon.

Now it is found in malarial countries that a certain number of people carry latent malarial parasites in their blood. This is particularly true of children. The more malarial the community, the larger the percentage of the children in health who will be found to be carrying this parasite. Thus it happens that a series of blood examinations of native children to determine how many have latent malarial parasites, forms a fairly good malarial index of a community.

A year ago I undertook to make a series of such examinations. I have had to do this only at odd times and at such places as other duties chanced to take me; accordingly only a beginning has been made.

*See Appendix.

**Jour. Amer. Med. Assn., Chicago, Jan. 20, 1912, v. LVIII, pp. 169-172.

A preliminary report upon this work was presented to the State Medical Association,* to which report a few examinations have been added, and is herewith submitted as a special report.** Committee on Sanitation and Public Health.

Nearly a year ago the State Superintendent of Public Instruction appointed a Committee on Sanitation and Public Health for the schools of Florida, of which he did me the honor to make me Chairman. The results of investigations of this Committee have been largely incorporated in an address before the State Conference of Womans Clubs, and the recommendations in a special report to the State Educational Association, both of which are herewith submitted.†

Policies in the Management of Communicable Diseases.

In addition to these special reports it is pertinent that I should make some observations upon certain of the policies of the State Board of Health respecting the communicable diseases in general and certain diseases in particular.

Quarantine.

As office assistant it has been my province to meet face to face all the communicable diseases encountered in the state; to study their epidemiology; to try out the accepted theories as to management; and to explain the failures, which, I regret to say have been uncomfortably numerous.

It is my purpose to specify in this connection some of the failures, and the wherefores, with the view of, as far as possible, adjusting the machinery between expenditures and results, so that each dollar expended in the interest of the public health will be expended to best advantage; for it is a belief of this office that only one thing in the world justifies expenditures in the interest of public health, and that is results. It is a further belief that all public health moneys should be expended so as to produce maximum results. I want to elaborate this just a little for it is one feature that is perhaps most frequently lost sight of even by business men. Remember,, first of all, that the primary object of a health depart

*Preliminary Report on Latent Malaria Carriers, By Hiram Byrd, M. D., Jacksonville, Fla. Assistant State Health Officer. In Transactions of the Florida Medical Association for the year 1911. pp. 103-104.

** See Appendix.

+See Appendix.