LETTER OF TRANSMITTAL

TAMPA, FLORIDA, February 27, 1912.

To the Honorable A. W. Gilchrist,

Governor of Florida, Tallahassee:

SIR: I take pleasure in enclosing you a record of work of the State Board of Health for the past year, as compiled by the State Health Officer, a pleasure none the less agreeable because required by the statutes of the State.

I trust that you may have the time and may be sufficiently interested in the subject of the public health to give careful consideration to this report, because certain features are discussed which, arising in the state during the year, have brought more prominently into view circumstances relating to a rational and economical management of disease transmission and spread. . The whole subject, which has a wide range, is so concisely and clearly stated by Dr. Porter that I do not think it necessary for me to enter into a more detailed explanation except to say that with my colleagues I agree enurely in the policy which Dr. Porter recommends respecting the management of smallpox, as well as what should be the course pursued by the Board in conducting the affairs of the Health Department of the state. The desire of the Board is to educate the people in matters which will conserve their health, and to direct their thoughts in channels that will effect that purpose. We appreciate this fact, that patient effort and persistent reasoning and arguing will do more in the long run to convince the wayward and prejudiced than the employment of more forceful measures, such as haling before the courts of the state; yet where individuals, by their conduct and perverse actions, are likely to menace the health and perhaps the lives of their neighbors, we believe that due example should be made of such offenders. As long as pacific measures will accomplish the same object, the State Health Officer, acting for the Board, will follow such a course, which is a far pleasanter procedure to him.

Among other worthy subjects referred to by Dr. Porter and afterwards embraced in a recommendation, I think none better than his suggestion that the area of malarial infection in the state should be looked into and such measures taken by the Board as will limit the infection and lessen the disastrous sequences of this trouble. Undoubtedly, malarial and hookworm disease are impov

erishing factors which in this state as well as elsewhere diminish the earning capacity of the individual citizen, because the hookworm parasite in early life so depletes the mental and physical health of the child that it is a rare thing the system is able to throw off its pernicious effects and adult life is reached with a feeble mentality as well as a physical weakening. So, too, repeated attacks of malaria produce such a state of anemia, that is to say, reduces blood strength, that after a while an invalidism is caused which finally results in death. In both of these disorders the earning capacity of the individual is cut down, with a proportionate increase thereby in cost of living and maintenance. Thus it is reasonable to conclude that ill health from these causes as well as sickness from any cause tends to exhaust the financial resources of the commonwealth by adding ill afforded burdens. I believe, therefore, that the State Health Officer should be encouraged to pursue the line of investigation which he suggests, and that the expense thereof should be authorized. In discussing these and other matters connected with the administration of health affairs in the state, he tells me that he considers the principal enemies to good health in Florida, and against which an aggressive campaign should be waged, are hookworm, malaria, typhoid fever and tuberculosis. The first two he believes have been oftentimes confounded in the past, as well as the second. and third; and if people can be instructed to distinguish these diseases and promptly secure assistance, lives would be saved and much ill health prevented. I am in favor of affording every opportunity to the State Health Officer and his executive force of assistants to prosecute these investigations, believing that the state will reap a harvest of good health as a result of such work.

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Another point in the State Health Officer's report which I wish to allude to is this: unlimited discretionary authority in dealing with purely sanitary matters and such occurrences whch may not be specifically outlined by the statutes or made mention of in the rules and regulations of the Board. And right here and in this connection I wish to call your attention to another common-sense proposition. If the State Board of Health is charged under the Constitution with conserving and protecting the health of the citizens of Florida, then that which is necessary to accomplish this purpose should be followed and carried out by the executive officer, irrespective of any lack of specific authority which may be thought to

be limited by regulation or statute, and which, as the State Health Officer says, could not have been anticipated by the Legislature when framing the law, because all exigencies and emergencies likely to arise and affecting health can never be anticipated nor provided for. Year by year-most certainly has it been so since I have been presiding over the Board—the Board has increased in the confidence of the people until, at the present time, whenever any deviation from the normal condition of health occurs in any community, almost immediately an appeal is made to the Board to correct defects in sanitation or to place in operation such factors as will relieve anxiety and remove complaints. It is quite true that often complaints are ill-founded and unreasonable, and when such occur the complainants are so advised and reasoned with; but I believe that the people have a right to expect due attention and a relief from the Board whenever it is practicable and possible to afford it. This can hardly be effected if the Board and the State Health Officer, as executive officer of the Board, are held to a strict interpretation of the letter and not the spirit of the law.

After due consultation with the comptroller of the state, and after receiving from the city of Jacksonville a plat of land in a desirable section of the city, the Board has constructed this year a commodious building for executive offices and for the central bacteriological laboratory of the Board. The conditions of the gift were that the Board should erect a building which would be commensurate with the value of the gift by the city of Jacksonville, and it is believed that the Board has fulfilled its part of the compact.

Several measures respecting health management passed by the last legislature are capable of great good to the people if carried out and their requirements fulfilled, and of these the ordinance. requiring screening of kitchens, dining rooms, and walk ways thereto against flies, to my mind, is the most important of the measures passed, not only because keeping flies away from food will assuredly lessen the chances of sickness of a fly-borne character, but because the introduction of such a regulation into the state assembly, with a discussion which naturally follows, reflects a growing sentiment of confidence in the state in the State Board of Health and its counsel; for you will remember that something over a year ago at a called meeting of the Board at Tampa, on the advice of the State Health Officer, two rules relating to screening against flies and against mosquitoes were passed and promulgated. Of

course, there was the usual protest on the part of some that the Board was attempting to invade the sacred rights of personal privilege of the citizen, but the rule set in motion a step of sound thinking and reasoning on the part of the more thoughtful portion of the commonwealth, which the lawmakers executed as a result of that thinking.

The execution of laws pertaining to health administration is not, however, a part of the duty of the State Board of Health, nor is the executive officer charged with the functions of a prosecuting official of the state government. Unfortunately, too many of our citizens have this wrong impression, and when to their minds the health statutes in full or in part are being violated or ignored, it is difficult to make them undersand that the courts of the state should be appealed to to rectify or remedy these transgressions against public health, and not the executive officer of the Board.

It is pleasing to state to you that the bacteriological laboratories of the Board continue to afford the citizens assistance which is both mitigating as well as preventive in dealing with sicknesses when time and accuracy mean so much in arriving at a definite knowledge of the character of the ailments under treatment. It is believed from the commendatory mention of the work of these laboratories which has come to my attention in conversation with the lay public and in other ways, that the laboratory work of the Board is much appreciated by the people of the state and that there is no disposition to criticise the expense incurred in maintaining these very essential institutions.

The State Health Officer invites attention to the subject of reimbursement by the State Board of Health for animals killed in the state as a result of certain contagious diseases. He points out— but with no apparent intention of criticising the acts of the legislature the seeming injustice of paying for glandered animals which were killed under the law, at full appraised value in one instance, and being restricted by general statutes from doing so in all cases. As I understand the subject, glanders in animals is a disease which for all practical purposes is incurable, or, if curable at all, at great expense to the owner by reason of time required to effect the same; and further, that only a small portion of those treated ever recover. The law is that such animals shall be killed by order of the State Health Officer, after an appraisement has been made by the representative of the owner, a representative of the State Health Officer

and the veterinarian of the State Board of Health. But here is where there is always likely to arise confusion and misunderstanding. Notwithstanding the appraised value of each animal, the law specifically says that not more than $75.00 shall be paid for any one animal, and even then that payment cannot be made to one person for more than ten animals in any one year, and further provides that the animals shall have been in the state a year before payment or reimbursement can be considered. It is doubtful to my mind, as it seems to be to the State Officer, whether the funds. of the state should be used in payment to individual citizens for calamities of this kind. Losses of each and every kind are to be deplored, but I see no good reason why the state should pay for animals killed on account of glanders any more than it should reimburse the citizen for a destruction caused by frost, cyclone or fire. And this reasoning I consider especially sound when the general law is set aside to admit payment for glandered animals which had not been in the state the specified time, or where the infection seems to have been retained against the advice of the veterinary health authority of the state. A remodelling of this law seems to me to be greatly needed in order that discrimination may not be made in the future, and some confusing features eliminated.

The State Health Officer, in tables submitted, gives the number of specimens examined at the three laboratories as 20,233, and enumerates very interestingly the number studied at each. Not only are statistics of this nature given, but the cost per specimen examined is also stated, thus affording the reader an accurate idea how the funds of the state are expended for the benefit of the people. Eighty-one cents is a small sum of money compared with the value of informtion gained by the medical attendant as to whether his patient is suffering from malaria or from typhoid or from diphtheria or simple tonsilitis, in point of time, which means so much in the successful treatment of these disorders.

Continuing this line of thought, it is pertinent to say that, while the expenses of the Board have been greater for the past year, yet in the total amount of money expended by the Board, aside from the cost of erecting the building already alluded to, every cent has been devoted to the welfare of the people in providing measures for the suppression of disease, in an attempt to educate them in methods of health improvement and to a removal of causes