Malarial Fever and its Prevention:

It is with much pleasure that your attention is invited to a work of immense importance, which, if continued, will be far-reaching in its benefit to the people of Florida. The Florida Medical Association, recognizing the momentous value which information respecting malaria, its distribution, as well as means necessary to prevent its spread, would be to the state, appointed a committee, of which Dr. Graham E. Henson of Crescent City is chairman, to study the subject and to present to the people in plain language useful and instructive facts in regard to a disease which has paralleled hookworm disease in invaliding a large proportion of the citizens of this state, and thereby as an economic problem, causes so much monetary loss to the commonwealth. This committee,

through its chairman, Dr. Henson, has prepared and furnished the press of the state articles on malaria which, if read, should carry not only conviction to the reader, but should prove useful and instructive aids to those whose lot in life brings them face to face with this preventable disorder. These articles have been compiled. printed and distributed by the State Board of Health under publication number 84, due credit being given to the authorship. While the committee of the Florida Medical Association has not finished its efforts in this direction, yet as an organization it has not the financial means to carry the investigation to as high a degree of scientific research as the subject demands. Therefore, appreciating the importance, the help to the people, and the possible rescuing of many lives from a state of prolonged anemia and feebleness as a sequence of malarial infection, the State Health Officer submits to the consideration of yourself and the other members of the State Board of Health the advisability as well as the natural demand in health work of pushing a campaign against malaria with the same aggressiveness as had characterized the earnestness with which the fight against hookworm disease has been prosecuted. Both of these diseases are preventable and it is apparent that as the State Board of Health is charged with the preservation of the health of the citizen against sickness which may attack from without, it is also obligated to reduce and minimize similar foes which within the state's border are destroying useful lives by impoverishing mental and physical vigor. To carry on in a systematic manner a work of this kind will require an organized force of trained investigators and considerable money, but the results will justify an expenditure

which will map out the districts which produce the Anopheles mosquito the malarial transmitter-and develop plans for its extermination. For this truism has long been accepted: No malarial mosquito, no malarial fever. With malarial and hookworm parasites subjugated and the people impressed with the teachings of the Board in this respect, mental and physical vigor of the people will increase proportionately. It is hoped, therefore, that the possibilities of improvement of the health of the people in this direction may so convince the Board that the suggestions herein made may have careful consideration.

Special Report on Typhoid Fever in Tampa, 1911:

Special attention is directed to a report of Dr. Byrd upon the prevalence of typhoid fever in Tampa. The situation there was closely studied, and all available evidence carefully considered. Dr. Byrd's conclusions were that the fly is the chief factor in the prevalence of the disease and he predicted that the high typhoid rate would of necessity continue until provision is made against the fly having easy access to open privies. That his conclusions are correct is shown by the fact that his predictions are fulfilled to the letter. The dairy that Drs. Jordans and Irons* endeavored to fasten suspicion upon was closed for a while, and then put in a sanitary condition, but typhoid still continued, and unabated except seasonal abatement. Tampa is opening the new year with the same general conditions that prevailed last year and may confidently expect a high typhoid rate in 1912.

Anti-Typhoid Vaccination:

Through the courteous regard of Surgeon-General Torney of the United States Army, in donating anti-typhoid vaccine from time to time from the Army Medical Laboratory, the executive

*In the spring of 1911 some ten of the guests of the Belleview Hotel at Belleair, developed typhoid fever, whereupon Drs. Jordan and Irons of Chicago undertook an investigation, resulting in the report that the infection came from one of the Tampa dairies. Their report is incorporated in its entirety in the report of Dr. Byrd, who arrived at diametrically opposite conclusions.

In view of the fact that all of Fisher's entire output from a herd of 68 cows (except an insignificant portion that might have reached the Belleview, even that doubtful) was distributed and consumed in Tampa; and in spite of that, the strong evidence that milk played no appreciable part in the typhoid prevalence in Tampa; and in view of the fact that Fisher's dairy was closed for a time and put in sanitary condition, and the alleged typhoid carrier dismissed; and still the fever continued; in view of all this, the correctness of Dr. Byrd's conclusions cannot for a moment be called into question.

office was enabled during the year 1911 to offer protection against typhoid fever to eighty-five persons, thus introducing the preventive, and stimulating a desire on the part of the citizens to avail themselves of a prophylaxis against a disease which by length of sickness entails much suffering, great anxiety on the part of family and friends, and an expense which oftentimes is burdensome and illy borne. While it is true that anti-typhoid vaccine may now be had from any druggist, because manufactured by the leading biological laboratories of the country, yet the cost of the product is not always within the reach of the poor or even those of moderate circumstances, and it is this class of citizenship who are to be protected against one another, in arresting such disease agencies which, if not restrained, tend to produce extended prevalence if not epidemics. It is not intended to convey the idea that the State Board of Health is designed principally to supervise or direct the health wave of the poorer classes, but because of indigency and want of financial means, certain preventive and curative means are costly and so are beyond the ability of those persons to procure, and in this way, when sick and not assisted, they become a menace to society. It is for this reason that the State Health Officer has perhaps stretched the authority vested in him in furnishing free to the indigent citizenship of the state such antitoxins and vaccines, when certified by the attending physician, as may be needful to save life or prevent further occurrence of the particular disease. This practice has been followed for diphtheria antitoxin, vaccine against smallpox, anti-rabic vaccine and tetanus antitoxin when used as a prophylactic against tetanus and administered immediately following a serious wound or injury. It is thought, therefore, that the Board should authorize a likewise free distribution of antityphoid vaccine, the same as is offered with the Jenner vaccine, and for this reason: experience has shown that human nature is prone to take chances, particularly where the cost in dollars and cents is a factor in determining whether the question of immunity against disease shall be entertained. As long as it was known that the executive office could supply anti-typhoid vaccine free, the applications did not lack in numbers, but when the supply obtained from the Army Medical Department was exhausted and applicants were told if the vaccine was bought from the druggist it would be applied without cost for the operation, there was a noticeable in

difference to the protection which, when free, was eagerly sought after.

Serum-therapy is so rapidly supplanting drug medication that as has already been pointed out, it will be but a few years before the biological laboratory will have discovered and placed before the medical profession sera and vaccines by which communicable and deadly diseases not only can be prevented in their occurrence but also mitigated and rendered less harmful in their course. Thus, and then, will the homely saying that "An ounce of prevention is worth a pound of cure" be the daily slogan of the scientific practitioner of medicine.

Prevalence of Typhoid Fever, Diphtheria, Measles and Scarlet Fever:

The examination of disease specimens by the several laboratories furnishes somewhat of an index of some of the communicable diseases. This is true especially of malaria, typhoid, diphtheria and tuberculosis, but to only a partial degree are these facts of any real value, because there are so many cases of each of these disorders that are not known of and not reported, neither are all blood smears and throat swabs sent to the laboratories for examination.

Information to the executive office for the year 1911 respecting the communicable diseases, places typhoid fever at 610 cases, and diphtheria 220 cases. For measles and scarlet fever the reports have been only spasmodic and meagre, and for the reason already given the mildness of seizures and the unrecognized cases. For diphtheria, typhoid fever and malaria, the chief dependence for information has been the laboratories, because cases occurring in the state can then be checked against by the laboratory findings.

In either and all of these there has been no extended prevalence nor has the usual serenity of the people been disturbed or confidence in the state health authorities been shaken.

Anterior Poliomyelitis :

Although opinions among some health authorities seem to be that anterior poliomyelitis is a highly contagious and infectious disorder, and should be placed in the list of restricted diseases (the word "restricted" is used because of the dislike of the term "quarantine," which really means nothing in the way of prevention), yet

it has not been the experience in Florida that this disease is of such an intensely communicable type as the writers in the northern sections of the country think that it is. Very frequently, more frequently than otherwise, cases of anterior poliomyelitis have occurred in households in this state having other children and only one child out of a large number in the family would be attacked. One or two outbreaks have been investigated in the state with this result, and the fact is not established that even the cases occurring in different localities had any connecion whatsoever with each other, and as no precautions were taken to keep the well children from the' sick, it is evident the contagious character of the disease is very low, else other child members of the same family would have contracted it from the sick one.

A tabulation of the cases reported in Florida in 1911 is as follows:

There is strong reason to believe that leprosy is also not as highly communicable as it has been supposed to be in the past. Experience with this disease has taught that the contagious principle is also very low, and that the prevalence of leprosy in a community need not occasion any more alarm and not so much as tuberculosis or syphilis, for lepers carry on their countenances the sign of the disease and can be avoided, but the others mentioned, more frequently than otherwise, can successfully hide their trouble to the ofttimes injury of the public, as in the case of syphilis in its various forms.

The Health Department of New York takes no cognizance of leprosy, and it has been a mooted question for many years by English observers whether the disease is as contagious or as communicable to the human family as has been generally supposed.