As the Board publishes each month a pamphlet which deals with the health problems that arise, it is not thought necessary to engage your attention at this time in a re-discussion of such topics, which, always interesting and ever presenting new phases for consideration, would, nevertheless, take up too much space in a narrative report of this kind. The Notes, as the monthly pamphlet is termed in shortened speech, for the year 1911, will be bound with this communication and forms a part and parcel of one-half the edition of the Annual Report of the State Health Officer. The purpose of its editors is to talk in a plain way, omitting technical terms and theoretical suppositions, and to write for the people rather than for the profession, so that advice given or facts stated may be understood and thus prove of benefit, if accepted, to every person who will take time or have an interest in the all-important subject of health and health-producing agencies as well as in means and methods of preventing sickness, which latter, as has been before said, as an economic problem, entails expense as well as individual suffering and discomfort.

COMMUNICABLE DISEASES

Elsewhere in this report will be found in tabulated form the communicable diseases which have been reported to the executive office of the State Board of Health during 1911, with number and counties where occurring. The state statutes charge the State Board of Health with the supervision and care of only three of the communicable sicknesses-cholera, yellow fever and smallpox, all others to receive advisory management except when prevailing in an epidemic form.

SMALLPOX

Of these three, smallpox is the only disease which has caused concern or annoying supervision to the executive office. The northern border counties of the state, more than other localities, have continued to have cases crop up now and then, by reason of their proximity to states where it seems no provision is made or effort put forth to control its spread. The migratory negro, passing back and forth across the state line, as the demand for labor invites this class to seek work, has served to keep lighted the fires of contagion among those who have not been vaccinated and who refuse this protection.

The state statutes make it obligatory on the State Board of Health to take cognizance of and to employ such measures as the executive officer may think necessary to control and prevent its spread, but that protection that of all others, and it should be more emphatically expressed, which can alone stamp out smallpox and forever terminate it, the legislatures have refused to enact into statute law, and the Board, aware of the prejudice and antagonism, has avoided further recommendations in this direction, feeling confident that in due time the citizens of Florida will be convinced of the soundness of the advice which has been so frequently, persistently and emphatically given by the State Health Officer in these reports and in the Health Notes, and in righteous indignation against a sinful expenditure of state money for an easily prevented disease, demand a universal vaccination of the people of the state, especially of the laboring class who may be imported to work in large industrial plants.

MANAGEMENT OF SMALLPOX

Letters upon letters come to the State Health Officer asking "for protection against smallpox," as if he possessed some mysterious wand with which he could, by its wave, drive away the malady. Communities want to quarantine, and individuals wish to drive out the unfortunates, and it must be admitted, the ignorantly obstinate for if not obstinate they would be vaccinated and thus protected-who have contracted this loathsome disorder. The thought uppermost in the minds of most of these correspondents is quarantine, as if quarantine of smallpox ever did any good or could be made effective against the hundreds of cases which are so mild in character as to be unrecognizable except by the most expert authority, and oftentimes so mild and trivial then that cven one well versed in the detection of cases feels himself incompetent to make a decision.

It seems to be entirely forgotten-if the thought or consideration of the subject is ever seriously dwelt upon-that the communicable diseases vary in their severity according to latitude, and that such diseases have a far different potential significance in the northern portions of the United States than the same diseases in the southern states, and yet it is proposed that there shall be but one system and one plan carried out to control. Certain of the communicable diseases, such as scarlet fever, measles and smallpox,

seem to be more clearly accentuated, if such a term can be used, in the colder portions of the country than in the warmer latitudes. The facies of these particular diseases is recognized and detection is almost sure and easy. They are text-book cases; but it is entirely different with these diseases when happening in warm latitudes and countries. Here the symptoms are slight, occasioning but little discomfort and rarely confinement to bed, and it is not plain to see, in these mild cases where and when no physician is called in-for a physician's call means money going out—and without information to the health authorities, how such cases can be quarantined when even the parents or individuals themselves are ignorant of the nature of the sickness from which they are but slightly indisposed. How, then, would a quarantine of one such case be any protection to a community where many others unrecognized are running at large? This pertinent fact applies with greater force to smallpox than to the other communicable diseases, because against smallpox a protection has been discovered and when accepted is as sure in its sheltering care as is an asbestos house against the destructive force of fire.

The state statutes directing the reporting of cases of smallpox, to which reference has already been made, also prescribes what disposition shall be made of them and gives discretionary authority to the State Health Officer in the management; therefore, having tried quarantining smallpox and having found that such a method did not tend to abate the spread of the disease nor to lessen the number of cases, this system of management has been abandoned and is now replaced by caring for the indigent and by allowing a per diem for maintenance and such medical attention or nursing as the severe cases call for. Imperative instructions are given the sick to keep off the public highways and out of public places under penalty of arrest after recovery for violating the mandates of the State Health Officer approved by the State Board of Health. Guards for smallpox patients are not permitted nor is such a course of management sanctioned by municipal authorities, even if the municipality is willing to defray the expense, because, as already stated, all cases are not reported, neither recognized, and it is the unrecognized cases which keep the flame of contagion alive and spreading.

It is past all reasonable understanding why some people will persist in opposing vaccination by arguing against its protective

ability to prevent the spread of smallpox and in stamping out the disease in a community, state or nation. Facts are facts-they cannot be disputed, cannot be disproved, and more than once in the past year smallpox has been wiped out of a community in this state by no other means than by general vaccination. When everybody is immunized against smallpox, there is no more food for the disease to feed upon and it dies out.

The utter futility and, it can well be said, absurdity of trying to control the spread of smallpox by guards and even by isolation, except in towns and communities having a well organized police control and protection, is fully shown by the numerous incidents daily occurring where cases of smallpox, so mild as to escape detection of physicians and causing so trivial inconvenience as to incite no suspicion in the patients themselves, which walk the streets or pursue their usual work or business, thus coming in contact with many who are unprotected by vaccination. Not many months ago a negro porter of the pullman service came to the executive office asking for vaccination. On baring his arm for the operation it was discovered that he was then recovering from a well-marked but mild case of smallpox. For between two and three weeks this man had been traveling between New York and Jacksonville in the employ of the Pullman Company. If it were possible to obtain the information, it would be interesting to know the sequel of his exposure to unvaccinated passengers. In another instance a young lady from well-to-do family sought vaccination at the executive office of the Board, and, as in the case of the negro porter, it was discovered that she, too, was recovering from a mild case of smallpox. She had noticed the eruption, but her family physician had told her that she was suffering from a mild skin trouble, and, acting on this advice, she had not restricted her movements, as she did not feel sick, and had gone to and fro as she wished. She had visited moving picture shows, Sunda, School and, in fact, had not limited her intercourse with other members of the family or with her friends. But in due course of time the other members of the family, six in all, except a sister who had been vaccinated, all experienced the same eruption and in a marked degree of severity. It is needless to add that in both of these instances, that of the young lady and the negro porter, neither had been vaccinated.

Again there are instances where cases are deliberately concealed from the authorities and are only found after prolonged search.

Assistant State Health Officer Byrd on one occasion found a negro with smallpox hidden between mattresses, after a positive denial by the inmates of the house-friends of the patient-that there was any sickness in the house; and quite recently Assistant State Health Officer Young, reporting upon a case of smallpox, says: "This morning the chief of police came to me and reported that there was a case of smallpox in the colored section of the town. Investigating the rumor, I found a young mulatto man concealed in the upstairs of a dwelling in the center of the colored settlement, who was in the beginning pustular stage of a discreet type of the disease."

Assistant State Health Officer Diggett a few weeks ago stated in a report on smallpox: "I have to report three cases of smallpox on the Miles Johnson plantation, three miles out of town (Tallahassee); these cases have been isolated. Last year Dr. Moor and myself vaccinated Miles Johnson's negroes with the exception of the three cases reported above; they refused vaccination."

That a wave of smallpox would spread over the United States and that Florida would not escape has been told to the people of the state by the executive officer of this Board during the past ten or more years, in no doubtful or uncertain language, and the people have been urged time and time again to protect themselves against a disease most loathsome in its sickness, disfiguring in its sequences and destructive to life, by the only means known to mankind, and that is by vaccination. The warning has not been heeded and the crest of high water in this disease is being reached this year; on the other hand, the views of paranoics and persons utterly ignorant of the subject which they try to discuss and incompetent to express an opinion have been aired in direct opposition to the judgment of those who by experience and education are fully equipped to advise on all subjects relating to the care and preservation of the public health. Not only have the people been advised against accepting and following the earnest persuasion of the State Health Officer, but he and his assistants have been abused and villified because, having the courage of their convictions, they have continued to preach vaccination in season and out of season. Now that the prediction of the State Health Officer as to the increase of smallpox in the country and in this state is being fulfilled, the occasion cannot be lost to ask, "Who had the welfare of the people more at heart, the official who knew what he was talking about