USA > Florida > Florida, 1513-1913, past and future; four hundred years of wars and peace and industrial development > Part 9
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HEALTH IN THE TROPICS
That a semitropical, or so-called hot climate, is not an unhealthful one, that it may have a death rate as low as the lowest in other and colder sections, is established by the often quoted example of Panama, which lies almost beneath the equator. Under the regime established and maintained by United States engineers in charge of the con- struction of the canal, it has a death rate that compares favorably with that of the most healthful localities in the world. These engineers have not changed by a single degree nor by a single unit of humidity the climatic conditions that they found. They have simply removed the conditions that induced disease.
The great city of Havana, with its four hundred thousand inhab- itants, located in a tropical country amid surroundings most favorable to disease and epidemic, is one of the most charming and healthful in the world. During the five-year period from 1893 to 1897, inclusive, its deaths from yellow fever, malaria and small-pox aggre- gated sixteen per cent of its total deaths. During the five-year period, from 1903 to 1907, inclusive, the deaths from these diseases in the same city were seventy-two one-hundredths of one per cent of the total number of deaths.
Between these periods there was no change of climate, but in 1898 the Spanish-American war raged over the island and on its waters. When the clash of arms was ended and the Spanish had been dislodged from their last holdings in the Western Hemisphere, President McKinley placed in charge of reconstruction work a man of action and an educated physician, Gen. Leonard Wood. Profes- sionally he recognized immediately the fact that sanitation was the first and most important work to be donc. He summoned Col. William C. Gorgas, of the Medical Department of the United States Army. To him he gave the order to clean Havana.
Colonel Gorgas cleaned it. So thoroughly was it cleaned that yellow fever was wiped out. Mosquitoes were banished from the city. The accumulated filth was swept from the streets and alleys; the sewers were changed from surface ditches to tile drains, laid deep under the ground; avenues were paved and the magnificent Malecon, the hundred-foot wide drive along Havana's ocean front, was built. The death rate was reduced to about one-fourth of what it had been under Spanish domination. And what was done in Havana was repeated all over the island of Cuba.
When American occupation was ended the government of the
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new republic had the good sense to appreciate the value of the work accomplished by Colonel Gorgas and General Wood, and it placed in charge of the Department of Health of Cuba, Dr. John Guiteras. He was a Cuban citizen, educated in the United States and for some time a resident of this country. He has maintained the high stand- ards of scientific sanitation established by the American officers, and he has improved in many ways the system committed to his administration.
FLORIDA'S MAJOR DISEASES
The four major diseases in Florida, in the order of their import- ance to the health of the state, are tuberculosis, hookworm, malaria, and typhoid fever. The nation-wide movement to eradicate the great white plague is strongly represented in this state, and earnest and systematic efforts are active for its obliteration. Florida has the dis- advantage of having, not only its own tubercular patients to care for, but for years it has been the Mecca for those similarly affected from every part of the United States, coming here with the hope that the balmy atmosphere and the warm sea breezes will effect complete cures. The hope has been warranted in hundreds and thou- sands of cases where the disease had not progressed to the stage in which it would have been incurable anywhere. In many other instances the expected recovery failed of realization.
In the opinion of many of Florida's ablest physicians, the most serious menace to the general health of the state is malaria, but that it is generally prevalent throughout the state or that it has a strong hold in any locality, is a misapprehension of facts. The State Board of Health for many months has been working to solve the problem of its prevalence. The results from the first one thousand blood tests show an infection of about four per cent, a much lower rate than popular estimate would claim, and no greater than in other com- munities, where the disease is not considered to be unduly prevalent.
Not until recent years has the hookworm been recognized as a menace to public health and to the efficiency of labor. The infec- tion, according to medical authorities, is not difficult to combat and to overcome. The greater danger from it lies in the difficulty of discovering the infection, after which its subjugation is speedy and not uncertain.
This insidious parasite is an intestinal worker. It is introduced into the human system largely from infected soils by the patient
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going without shoes, thus inducing what is known in the south as "ground itch." The victims are usually children and adolescents, of the age that usually or frequently "go bare-foot" in rural commun- ities in the south, and the infection is much more common in the country than in the cities. Its effects are a general debility of the physical system and the tendency is toward a corresponding mental lethargy. The ultimate results are a large reduction of labor effi- ciency and of all effort, and a weakening of the physical system so that other diseases attacking the victim become more than twice as destructive in their effects, as in patients who have not been thus incapacitated to resist disease.
Although hookworm infection is sometimes given as the cause of death, it is the opinion of those who have studied it that it is never directly fatal. Its prevalence in Florida has been at least partially indicated by the investigations of the State Board of Health, which through its agents has examined six thousand children in the rural schools in the central part of the state. The result of this study showed an average infection of fifty-two in each one hundred of these pupils. The board has planned a systematic canvass and treatment of the cases that have been and will be discovered, which will largely reduce the extent of the malady and guard against reinfection. It is not among the probabilities that it will long threaten the general health of the state nor that of the south.
DEATH RATIOS
It is usual to summarize the healthfulness of a city, state or larger section by the statement of its death rate-the number of deaths occurring each year in each one thousand of its population. For Florida such a statement is impossible, exactly as it is in at least twenty-seven other states of the Union, and for the same reason -it has no reliable data upon which to base even approximately accurate figures.
Florida is not included in the registration area recognized by the United States Census Bureau, which accepts no figures regard- ing the vital statistics of any city or section which are not proven to be correct within ten per cent. It is provided that individual cities, located within states that are not included in the official registration area, may be excepted and their records accepted. Florida has two such cities- Jacksonville and Key West-which are in this area, although the state itself is not so listed.
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Of the forty-eight states in the Union, only eighteen, by the adop- tion of adequate registration laws, have qualified and have been in- cluded in this official list. They are California, Colorado, Connecticut, Indiana, Maine, Maryland, Massachusetts, Ohio, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, Wisconsin, and Michigan. Only one so-called southern state, Maryland, is included in the number. Virginia has recently adopted a health registration law, which after its efficiency shall have been tested to the satisfaction of the Federal health authori- ties, will qualify it for the honor roll.
GATHERING STATISTICS
Twenty-seven other states have failed to establish and maintain systematic provisions for recording, even within approximate accu- racy, their vital statistics. It is presumable that all of them have found difficulty in devising plans to secure reliable data. Florida's State Board of Health in its efforts to meet the problem, has discovered two elemental facts:
First, that these statistics can not be secured without paying for them.
Second, that whether paid or not, physicians can not be depended upon to furnish these records complete or accurate.
Acting upon these fundamental facts the Florida authorities have considered a plan to be enacted into law, by which one person shall be appointed in each county who shall be held responsible to gather these records; that such person shall be paid from state or county funds for each item reported; and that the refusal of a designated relative of a deceased person or of a new-born child, to furnish the required infor- mation at the request of the county agent, shall make him guilty of a misdemeanor and shall subject him to punishment accordingly. It is expected that a law embodying these features will soon have a place in Florida's statute books.
FLORIDA'S DEATH RATE
The records of vital statistics in the two Florida cities included in the registration arca are the only figures on health matters recog- nized in Florida by the federal health authorities as being reliable or correct. An estimate for the entire state based upon such figures would be manifestly unfair. Florida's population is essentially rural,
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seventy per cent of its permanent residents living upon farms and in towns of less than one thousand population. While certain diseases in this state, as in other states, are more prevalent and more serious in their results in the cities, their ravages are partially counterbalanced by other maladies that prevail in the rural districts. It is an accepted fact that the death rates in these country disctricts are higher than in the cities where medical skill and general sanitary conditions are more favorable to successful treatment, but the exact amount of this differ- ence is difficult, even impossible, to establish upon present knowledge of facts.
It is also evident that the general health of different cities must vary within somewhat wide margins, according to the varying loca- tions, whether on the seaboard or in the interior and according to dif- fering local conditions and the efficiency of local health boards, where such boards exist at all.
JACKSONVILLE'S DEATH RATE
The records of disease and death in Jacksonville, Florida's largest city, for the year 1912, are given as typical. to a large degrec, of the conditions that are met and combated in this and in other southern states, in the efforts to reduce the ravages of disease. They suggest, at least, the problems that may be peculiar to the south which the medical profession and scientific sanitarians encounter in this great section.
Two serious elements in these problems are that a rapid growth of the city has prevented the extension of the water and sewer systems into the newer residence districts, especially into those occupied by the poorer classes of citizens. This has necessitated the use of the open closet with all its attendant ills. And this condition is met in every southern city that has a large and rapidly increasing population.
Another cause of a high death rate is the ignorance of proper sanitation among the negro race, which constitutes about one-half of the population. The colored people are attended almost exclusively by physicians of their own race, who with rare exceptions are not highly educated in their profession. These physicians knowing some of the characteristics of the race, frequently refuse to answer profes- sional calls unless they receive their fees in advance. A result of this lack of credit is that nearly one-half of the deaths reported among the colored population of this city, occur without any attending medical adviser. The same statement applies generally throughout the state.
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The number of deaths recorded in Jacksonville during the year 1912 was 1,276, of which 234 were of non-residents, meaning those persons who had lived in the city less than six months immediately prior to death. The death rate indieated by these figures was 18.1 for each one thousand, or 14.8 for each one thousand of the resident popu- lation. This resident population was divided between 35,293 white and 34,901 eolored persons. The death rate for the whites, including non-residents, was 14.1, and for the negroes 22.2, for each one thou- sand, and this variance was a direct result of the varying sanitary conditions surrounding the two raees in their living places.
RELATION OF RACE TO DISEASE
The more important causes of death occurring in Jacksonville dur- ing the year 1912, and the relative mortality rate among the two races from these diseases for the five-pear period ending with 1912, are shown in the following tabulation.
Causes of Death.
Average Death Rate for Five- year period.
Number of Deathis in 1912. White. Colored. White. Colored.
Typhoid (resident)
1
2
6.45
5.42
Malaria
5
10
1.72
8.03
Measles
2
0
.59
.24
Whooping Cough
0
2
.32
1.48
Diphtheria
1
3
.77
.33
Influenza
2
8
.51
.59
Tuberculosis (lungs)
34
102
13.35
36.64
Venereal Diseases
1
31
1.06
6.91
Pneumonia
17
43
8.83
16.21
Diarrhoea, under 2 years
18
5.27
8.00
Diarrhoea, over 2 years
5
7
4.75
5.39
From this exhibit it will be noted that tuberculosis leads in the numbers and percentages of deaths. Under conditions existing in Jacksonville, and to some extent in other southern cities, they are charged with many deaths from this disease that do not properly belong to them and that increase largely the number of deaths oceur- ring within their respective jurisdictions. Every persons having lived in Jacksonville for half a year or more, is considered a resident in compiling the vital statistics. But many deaths from this eausc each
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year are of patients who having contracted the disease elsewhere, have come to this city to linger for months and finally to die here.
It will be noted also that fifteen deaths are charged to malaria. Leading physicians of the south contend that this disease is rarely, perhaps never, a direct cause of death and that claims to the con- trary are based upon faulty diagnosis. Investigations by the Jack- sonville Board of Health during the year 1912, have gone far toward establishing the fact. It was discovered by the city health officer, late in 1911, that many of the small companies in which negroes are insured for sickness and death benefits, refuse to pay these claims in cases in which the cause of death is given as tuberculosis. Consequently, many colored physicians, to protect the claims of their patients or of the surviving relatives against these companies, substitute some other disease, usually malaria, for tuberculosis in filling the required certifi- cates of death. Therefore, it would appear that in the tabulation given above, the number of deaths charged to tuberculosis should be increased and those in the column under malaria should be correspond- ingly reduced.
TYPHOID FEVERS
The fight against typhoid fever in Jacksonville has led to a deep study of the conditions that cause it. The city's water and milk sup- plies were eliminated from the list of possible or probable causes by a careful supervision, and it was found that the chief source of infec- tion was the open and unscreened closets in the poorer residence dis- tricts occupied largely by the negro population, although it must not be understood that the colored residents are settled exclusively in these unhealthful surroundings. A large portion of the race is housed in homes of comfort and healthfulness and has a death rate almost as low as that of the whites. A careful screening of these open closets in the poorer quarters of the city brought a reduction in the number of deaths from typhoid fever in Jacksonville from forty in 1911, to eighteen in 1912.
Of the ninety-four typhoid cases reported to the city board of health in 1912, forty-three originated in Jacksonville and fifty-one were brought to the city and developed pronounced symptoms of the disease within one week after their arrival.
SMALL-POX
Due to a remarkably strong opposition in many sections of the state, Florida has no compulsory vaccination law. The result has been
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a series of small-pox epidemies in the state, none of them of serious extent. This disease in epidemic proportions naturally alarms the people of any community to the necessity of this precaution, and in the course of a few months the disease exhausts itself and dies out for want of material to feed upon. Its ravages are forgotten until the infection is introduced again from some other section or state, when the experience is repeated. This eyele is not peculiar to Florida; it is common in other states, as was illustrated in New York City itself, when in 1910 small-pox was epidemic in the Bronx. Jacksonville passed through an epidemic of the disease early in 1911, but with no deaths.
From this recapitulation of conditions governing the health of Jacksonville, the conclusion may be fairly drawn that this eity is normally one of the healthful cities of the country. This is shown by the low death rate of the white population. That this low rate does not cover the entire population is properly attributable to two eauses: first, the rapid extension of the residence distriets has outpaced the possible extension of the water and sewer systems, and this condition is being remedied by the expenditure of large bond appropriations; and, second, the ignorance regarding sanitary conditions among the poorer classes and the laek of medical attendance have to an abnormal degree induced disease among them. A campaign of education and a foreed obedience to rigid rules of sanitation, where education and persuasion fail, have already brought mueh beneficial change.
KEY WEST HEALTH RECORDS
The city of Key West is not typical of Florida as to its health eonditions. The southernmost city in the United States, it is located on an island midway between the mainland of Florida and Cuba. Its climate is tropieal, although the Gulf of Mexico surrounding it and the mighty gulf stream sweeping majestieally by it, give a surprising coolness to the atmosphere and a remarkable uniformity of tempera- ture through the entire year.
Its population of about twenty-two thousand ineludes from one thousand to fifteen hundred white Americans, thirteen thousand to fifteen thousand Cubans, most of them engaged in eigar manufacture, and the remainder is divided about equally between Bahaman and American negroes.
Owing to the formation of the underlying rock foundation of the key, there are no wells or other natural sources of fresh water for
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drinking and domestic uses. The supply is secured by evaporation or is brought from other places. With this heterogeneous population, composed largely of peoples careless of sanitary principles, and with no natural water supply, it is not surprising that the mortality rate of Key West is large when compared with other more favorably located cities. The average rate for the five years from 1907 to 1911. inclusive, was 21.4 for each one thousand. Yet here as the result of clean living and observation of sanitary rules, is a death rate among the white residents, including Americans and the better class of Cubans, of 13.5 for each thousand. The rate among the negroes was slightly above 24 to the thousand. The general character of diseases and their proportionate distribution between the races differ little from the facts already given for Jacksonville. These two cities in this respect may be taken as entirely typical of Florida as an entirety. In the classes of diseases prevailing through the state, there seems to be hardly an appreciable variation between the cities and the rural sections. The relative mortality of these diseases departs but little from the constants taken from the records of the Jacksonville Board of Health.
INFANT WELFARE
Public attention has been directed almost universally in the United States to the importance of the child to the commonwealth. In its efforts to conserve the usefulness of the infant for the future, Florida is abreast of the best thought of the time. In several Florida cities organized effort is directed to a supervision of sanitary conditions in the public schools, and to the proper medical and surgical treatment of the defectives discovered.
The subject of child labor, as it is encountered in many other states, is not of large importance in Florida, inasmuch as the number of manufactories and employments in which children find places are not an important feature of industrial life here.
An appropriation of state funds was made in 1911 to establish a hospital for indigent crippled children in Florida, and a further appropriation was made for the maintenance of the institution. The hospital has not yet been erected and the patients are cared for else- where until this institution can be erected and equipped. The demand upon the maintenance funds has exceeded its capacity, but it has been generously supplemented by liberal private citizens and the useful work has not been curtailed.
STATE BOARD OF HEALTH
MAIN OFFICE AND LABORATORY OF STATE BOARD OF HEALTH AT JACKSONVILLE
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The state also maintains at St. Augustine a well equipped asylum for the deaf, dumb and blind children.
THE STATE BOARD OF HEALTH
No story of health conditions in Florida, indeed, no history of the state itself, would be complete without a recognition of the work that has been accomplished by the State Board of Health. Jacksonville was visited in 1888 by the scourge of yellow fever. One person in every four of the entire population was a victim of the disease. Two of the remaining three fled the city to escape the plague. One person of every ten who had the infection died from it.
The first official act of Gov. Francis P. Fleming, who came to the executive chair of Florida in January, 1889, was to call a special session of the Legislature to provide for the creation and maintenance of a state board or commission to have charge of health affairs. That board was duly organized and as its executive head, the health officer of Florida, Dr. Joseph Y. Porter was elected. He has filled the posi- tion for a quarter of a century and he has made the board one of the most practically efficient health organizations in the world.
For one hundred and forty years before the discovery, in 1900, by Dr. Walter Reed that the infection of yellow fever is mosquito-borne, Cuba and its capital city had stood as a constant peril to Florida and to the United States. For fifty years the average of deaths in Havana alone from the loathsome disease, had been two each day. Florida extends five hundred miles nearer to that city than any other part of the United States. It has constant and intimate commercial relations with it, and it was due to this circumstance that Florida had become the natural entryway for the disease into this country, certainly an important one.
Five years after Doctor Reed's discovery, the Florida State Board of Health had the opportunity to try out the management of yellow fever according to the new declarations of science and to give the final test to the theories that had led to the world's emancipation from the disease. When the time camc, Doctor Porter and his board demon- strated for the first time on American soil that the pestilence could be controlled and stamped out by the careful and scientific isolation of infected cases. The spread of the disease was prevented in threc threatened epidemics at later periods, and instead of continuing as a menace to the rest of the nation, Florida was made a bulwark of pro-
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tection against the infection from the West Indies and the South and Central American countries.
ARBITRARY AUTHORITY VESTED IN HEALTH BOARD
The law that created Florida's Board of Health gave it the sole power to establish and maintain quarantine. It gave to its rules the force of cnacted law, making its authority ultimate throughout the state in matters affecting health conditions. It is doubtful if any American state has ever before or elsewhere delegated such unlimited authority to any body of its own creation. Never has this power been abused, but on several occasions it has been exercised, even to the re- sistance of Federal authority interfering in matters that affected the welfare of the state.
The absence of such authority vested in a quickly-acting organiza- tion in other southern states, has left the establishment of quarantine in certain emergencies to the mob, which in times not far in the past, has enforced it with lawless and armed power, doing incredible harm to those communities and bringing vast harm to interstate commerce and intrastate communication, and in some instances defeating the purposes that it sought to accomplish.
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