COMMUNICABLE DISEASES With an ever-changing knowledge and ever-accumulating experience, it sometimes becomes necessary to change policies in the management of communicable diseases, and to base the policies of the Board on practical and tried-out methods rather than on theoretical conclusions. For instance, with the advent of our knowledge that yellow fever is transmitted by mosquitoes, it was necessary to rearrange the entire scheme of management in accordance with that fact. Some of our information is based upon bacteriological investigation and some upon epidemiological studies, for very often the conclusions arrived at by bacteriological study and by epidemiological study greatly vary. For example, Dr. Flexner and others have found in the nose of a child suffering from infantile paralysis something which, when injected into a monkey, will produce symptoms of that disease, thus bactericlogically indicating that the disease is transmitted by nasal secretions and that it is transmissible. On the other hand, Lebredo and Recio* of Cuba studied 140 cases of infantile paralysis in the province of Santa Clara, Cuba, and in no instance did they find more than a single case in a family, notwithstanding the fact that the Cubans for the most part generally have large families and, further, notwithstanding the fact that no attempt was made to limit communication between the sick and the well. Similarly in the state of Washington 397 cases were studied by Kelly, Gellhorn and Manning,** and in only eight instances was it found that two cases occurred in a family, and in no instance more than two. These observations are in keeping with the observations generally made upon the occurrence of the disease in Florida. It is the policy of some boards of health to base management upon laboratory findings, and thus it happens that in New York City infantile paralysis is quarantined for a period of six weeks. In other boards it is the policy to give a little more weight to epi *Lebredo, Dr. Mario G. and Recio, Dr. Alberto, Acute anterior poliomyelitis, Cuban epidemic of 1909. In Sanidad y Beneficencia, Havana, Cuba, April, 1910, vol. iv (4), pp. 328-357. **Report of Infantile Paralysis in the State of Eugene R. Kelley, M. D., Assistant State Health horn, M. D., and John B. Manning, M. D. pp. 69. Washington during 1910, by demiological findings, particularly when they do not coincide with bacteriological findings, and this is the position assumed by this office, for, notwithstanding the bacteriological findings to the contrary, it would seem to the State Health Officer of Florida that he would be hardly justified in throwing any restrictions around the sufferer from infantile paralysis, especially since it is a rule of the disease, to which there have been but few exceptions, that but only one person in a family had suffered from it. It might be added that there is a growing unrest as to whether land quarantine is ever justifiable. It has certainly never justified itself as applied to measles or whooping cough, and has consequently been abolished almost everywhere where it has been instituted, with indifferent results as to whether quarantine is or is not maintained. The same thing is true of smallpox, particularly in the Southern United States where the disease often manifests itself in such mild form, and it might be said rarely manifests itself except in mild forms; and this is equally true of scarlet fever. On account of the very mildness of these diseases a great many, frequently the majority of the cases, are entirely overlooked, and no quarantine restrictions whatsoever thrown around them, and it is just such cases that keep the disease spreading regardless of quarantine. In other words, it is exceedingly problematical whether ̧ quarantining one-fourth to one-half of the cases of a disease (those cases which are reported to boards of health) and leaving the other three-fourths to one-half (mild, unrecognized cases) going unhampered and without any restrictions whatsoever, is justifiable, for it is doubtful if such quarantine restrictions have any restraining influence upon the spread of the disease. COMMON NUISANCES In the ordinary acceptation of the terms, there are two kinds of nuisances: common nuisances, which are nuisances that do not make people sick; and sanitary nuisances, which are nuisances that do make people sick. Unfortunately the statutes are a little confusing on these terms, but the Board has adhered to the advice of the attorney and confined its activities to sanitary nuisances, or those things that actually affect the public health. Common nuisances do not make people sick. They may be annoying in the extreme, but unless they actually affect the health of people they are not construed as sanitary nuisances, and do not come within the jurisdiction of the State Board of Health. For example, a glue factory gives rise to very foul smelling odors, but it does not make people sick. It does not cause smallpox, or typhoid fever, or yellow fever, or any disease in the whole catalog, however ill it may smell. People live as long, and enjoy as good health, working in a glue factory, or in a guano factory, as in a cologne factory. A common nuisance can be abated, however, under the Common Nuisance Act, Section 3680 of the General Statutes, 1906, which reads as follows: 3680. (Nuisances.) Indictment and removal.-All nuisances which tend to annoy the community or injure the health of the citizens in general, or to corrupt the public morals, shall be indictable and punishable by a fine not exceeding two hundred dollars, at the discretion of the court; and any nuisance which tends to the immediate annoyance of the citizens in general, or is manifestly injurious to the public health and safety, or tends greatly to corrupt the manners and morals of the people, may be removed and suppressed by the order of the justice of the peace of the district, founded upon the verdict of twelve householders of the same, who shall be summoned, sworn and impaneled for that purpose, which order shall be directed to and executed by any sheriff or constable of the county; and an indictment shall lie for the same. This is a fortunate separation of the actual public health work from the scavenger work of the state. Both are provided for by law, but by separate laws. In actual practice it usually falls out that the Board is appealed to first, and then in cases of common nuisances complainants are referred to appropriate statutes under which common nuisances are abated, reserving its own activities for sanitary nuisances proper. It might be added that many of the complaints partake more of the nature of personal disagreements than anything else, and in such cases the Board is called upon to pull some one's chestnuts out of the fire. People go so far as to write letters of complaint asking that their names be not mentioned, and even in some instances withhold their name entirely from the letter. Sometimes it is a matter of property values. For example, a certain man bought a tract very cheap because it was in the vacinity of where municipal garbage was disposed of. He then undertook to use the State Board of Health to get the municipal garbage disposed of elsewhere in order that his property value might increase. It is needless to say that it has been the policy of the Board to keep out of such squabbles, and that where the public health has not been directly concerned, it has held strictly aloof. 1911 MEETING OF THE STATE BOARD OF HEALTH During 1911 the State Board of Health was in session but once, the annual meeting, which was held on February 14th, 1911, in accordance with the statutes. An abstract of the transactions is as follows: Regular Annual Meeting: On Tuesday, February 14th, 1911, at 3:30 p. m., the State Board of Health of Florida met in annual session at the executive offices of the Board, Dyal-Upchurch Building, Jacksonville, Florida. Present: Hon. E. M. Hendry, president; Hon. John G. Christopher and Dr. H. L. Simpson, members of the Board; Dr. Joseph Y. Porter, State Health Officer; and Dr. Hiram Byrd, Assistant State Health Officer. The minutes of the two special meetings held in 1910 were read and approved. The Annual Report of the State Health Officer for the year 1910 was read and approved, as likewise the President's letter of transmittal, and the two documents were ordered forwarded to the Governor of the state. The desirability of further sanitary legislation, especially as regards the addition of a Division of Sanitary Engineering, was discussed, and the State Health Officer was instructed to prepare a measure with this object in view, to be presented to the 1911 legislature. The rules and regulations of the Board were revised, additions being made, as well as some rules being repealed, and the matter referred to the attorney of the Board for legal instructions. Mr. Christopher, member of the Building Committee of the State Board of Health, reported that satisfactory progress was being made in filling in with sand the lot recently donated to the Board by the city of Jacksonville, on which it was contemplated that the Board would erect a building for executive offices and central laboratory; and the Board, upon the representations of the member, increased the appropriation for the building to $40.000. |