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y 
 
 THE 
 
 CLIMATE AND DISEASES 
 
 OF THE 
 
 GULF COAST OF THE FLORIDA PENINSULA, 
 
 WITH REMARKS ON THE FORMER 
 
 IN RELATION TO PULMONARY TUBERCULOSIS. 
 
 / 
 By J. P. WALL, M. D. ; 
 
 TAMPA, FLA. 
 
 
 
 
 CHARLESTON, S. C. 
 PRINTED BY H. P. COOKE & CO. 
 
 52 BEOAD STREET. 
 
 1874. 
 
. 
 
 Y 
 
 
 <^o 
 
[From the Charleston Medical Journal and Review, July, 1874.] 
 
 ART. II.— The Climate and Diseases of the Gulf Coast of the 
 Florida Peninsula, with remarks on the former in relation to 
 Pulmonary Tuberculosis. By J.* P. Wall, M. D , Tampa, Fla. 
 
 By the " gulf coast," it is meant to include a distance of about 50 
 miles or more into the interior, where is found the natural water shed, 
 dividing the peninsula in its length into two nearly equal portions, 
 till the immediate vicinity/ the Everglades, is reached, in the extreme 
 southern portion. The gulf coast extends from Cedar Keys, 29° 07', 
 to Cape Sable, the extreme point on the main land, in latitude 25° N., 
 a distance of about 240 miles. North of the 28° of latitude, the 
 mean altitude immediately along the gulf coast is about 15 feet, with 
 some exceptional points of greater elevation. In the interior the 
 mean altitude is about 40 feet to below Fort Meade, and then 
 gradually declines to about 20 feet, with a still further decline in the 
 vicinity of the Everglades. North of Tampa Bay, on the coast, and 
 Fort Meade, in the interior, the country is more or less undulating, 
 with some considerable hills, and is peculiar in many places for its 
 subterranean drainage, most of the rain water escaping through sub- 
 terranean passages. South of Tampa Bay and Fort Meade the coun- 
 try is generally level, and, the rain water being got rid of only by sur- 
 face drainage, is subject to more or less inundation by the heavy rain- 
 fall of the summer. Many small rivers empty into the various bays 
 and harbors, with which the coast is frequently indented all along, 
 some of which rise as springs in a full volume^from the bowels of the 
 earth. These latter, however, are only found in those sections 
 abounding with subterranean vents for the rainfall, and consequently 
 none are found south of the 28° of latitude. 
 
 The character of the country is that of piney woods, interspersed 
 with hammocks, swamps, lakes, ponds, and prairies of variable extent, 
 respectively, from one to thousands of acres. The soil is moatly a 
 silicious sand, of a porus nature, on a substratum of clay, more rarely, 
 marl or rock. More or less vegetable debris in proportion to the 
 quantity and luxuriance of the forest growth, is found intimately 
 mixed with the surface soil. Lime rock is found generally, and in 
 many places crops out of the surface of the ground. In many locali- 
 ties the water is hard. Springs, impregnated with sulphur, and more 
 or less slightly, with other minerals, are quite common. 
 
 The natural growth is pretty much the same as that of Georgia 
 
2 Wall 071 Climate and. Diseases of Florida. 
 
 and the other Southern States, with the exception of the wild orange, 
 and, in the extreme Southern part, the palm and cocoa nut trees. 
 
 Meteorology. — Tampa, being nearly centrally situated on the gulf 
 coast, and some 30 miles interiorly from the gulf, at the head of 
 Hillsborough Bay, is selected as a fair medium locality for the fol- 
 lowing meteorological observations. These are taken from the statis- 
 tical report of the Surgeon General's office, published in 1856 : The 
 mean temperature for the faif seasons, and for the whole year, for 25 
 years, is, spring, 72°08 ; summer, 80°20 ; autumn, 71°04: winter, 
 62°35 ; whole year, 72°48. The mean rain-fall for the Jair seasons 
 and for the whole year, for 16 years, is, spring, 8.56 inches ; summer, 
 28.24 inches; autumn, 10.63 inches; winter, 8.04 inches f whole 
 year, 55.47 inches. The following summary of the weather is the 
 mean for 9 years : (the capitals indicate the direction of the wind, 
 and the figures the number of days from that direction.) N., 27 ; 
 N. E., 73 ; E., 60 ; S. E., 44 ; S., 40 ; S. W., 43 ; W., 43 ; N. W., 
 29; fair, 234; Cloudy, 143; rain, 98. 
 
 As regards the hygrometric condition of the atmosphere, it is to be 
 regreted that no observations have been made ; the same is also true 
 of the presence of ozone. The climate, however, may safely be class- 
 ed as a moderately dry one, at least ; and this conclusion is arrived at 
 from the 'coolness of the nights, causing universally and invariably, 
 except in very cloudy weather, no inconsiderable fall of dew, while 
 the thermometer usually falls from 10° to 20° below the maximum 
 range of the day. These facts indicate the great rapidity of radiation 
 from the earth ; it being well understood that saturation of the atmos- 
 phere, with aqueous vapor, is inimical to the radiation of heat. Prof. 
 John Tyndall says : " Wherever the air is dry, we are liable to daily 
 extremes of temperature. By day, in such places, the sun's heat 
 reaches the earth unimpeded, and renders the maximum highj; by 
 night, on the other hand, the earth's heat escapes unhindered into 
 space, and renders the minimum low. Hence the difference between 
 the maximum and minimum is greatest where the air is driest."* 
 
 The atmosphere is to a remarkable degree antiseptic, except during 
 the heavy rain-fall of summer, This is, no doubt, dependent on the 
 presence and oxydizing properties of ozone, together with the natural 
 dryness of the climate. The precipitation of moisture in the atmos- 
 phere, as fog, is extremely rare, only occurring occasionally, by no 
 means regularly, in the fall and spring. 
 
 The highest meridian range of the thermometer rarely reaches 96 6 , 
 and never exceeds it, even in the very hottest days of summer, while 
 more or less breeze, almost universally, day or night, is present. The 
 nights, even during the summer, are remarkably cool, and few trans- 
 pire in which some light covering in bed is not required, especially 
 from midnight till after sunrise. Continuous exposure to the night 
 air seldom fails to produce unpleasant, chilly sensations, when only 
 protected by the customary daily habiliments. 
 
 * Fragments of Science. Article— Radiation. 
 
Wall on Climate and Diseases of Florida. 3 
 
 Diseases.—- -The catalogue of endemic diseases of the gulf coast only 
 comprise those of malarial origin, viz, intermittent and remittent 
 fevers. Of these the types are, as a rule, mild, the pernicious varie- 
 ties being but exceptionally encountered. And for the last few years 
 the malarial fevers have been notably less common than before and a 
 few years subsequent to the late war. This may be accounted for, to 
 a great extent, by the abandonment of large plantations, where annu- 
 ally more or less new lands were prepared for cultivation by paring 
 the lands of the smaller growth, and killing the larger timber by gird- 
 ling it with the chops of an axe, from which naturally resulted no 
 inconsiderable amount of lignious decomposition, besides exposing the 
 new soil to the direct rays of the sun. In my experience hsematuria 
 has but rarely manifested itself as a complication, while some physi- 
 cians say they have never encountered it. At any rate, I have never 
 noticed it as a dangerous complication with the pathological phenome- 
 na described by the physicians of the other Southern States. It Was 
 simply a hsematuria, coming on in the hot stage, and disappearing in 
 the apyrexia ; the hemorrhage never assuming alarming proportions. 
 
 The treatment of the malarial fevers is generally that ordinarily 
 pursued ; the exhibition of an ordinary vegeto-mercurial purgative, 
 followed by quinine at short intervals during the intermission or re- 
 mission of the fever. Usually from twelve to twenty grains of qui- 
 nine, in divided doses, given in the course of eight or ten hours, suf- 
 fice to check the paroxysms of intermittent, and stop, or greatly miti- 
 gate, remittent fever. The hsematurial variety is generally treated in 
 the same manner, with the addition of a sinapism to the loins, and 
 sometimes the use of the warm bath. In the pernicious varieties, 
 commonly spoken of in Florida as congestive chills, the salvation of 
 the patient depends on early and rapid cinchonism. Once the chill 
 and congestion are thoroughly established, with extremities cold up 
 nearly to the body, the stomach becomes intolerant of stimulants and 
 medicines, or its functions are in abeyance to such a degree that no 
 absorption takes place, so that their administration proves futile. 
 Under such circumstances, in a few instances I have admistered twen- 
 ty or thirty grains of quinine, hypodermically, being compelled to use 
 some vegetable acid for its solution, through several different punctures, 
 with curative results. For hypodermic use the muriate of quinine, being 
 more soluble in water, is to be preferred to the sulphate. It is grati- 
 fying to state, however, that in a practice embracing a very large area 
 of territory, I have not met with nor heard of a case for several years. 
 
 The continued fevers, typhoid and typho-malarial, or any other 
 variety of continued fever, have never occurred within my experience 
 of fifteen years ; nor have I heard of any within the experience of 
 others. From these forms of fever this portion of the State is totally 
 exempt ; nor do I hear of them prevailing in other sections of the 
 State with denser populations. 
 
 Yellow fever and dengue are occasional visitants of the seaport 
 towns, and in a residence of three years in Tampa, I have seen an 
 
 *-# - 
 
 , 
 
 
 • - 
 
 - 
 
4 Wall on Climate and Diseases of Florida. 
 
 epidemic of each — yellow fever in 1871, and dengue in 1873. As 
 usual^ those attacked by yellow fever were recent residents, who 
 had never been exposed to its infection before. The geographical 
 position and commercial relations of the gulf ports will, no doubt, 
 always render them peculiarly obnoxious to the occasional epidemic 
 prevalence of yellow fever, and this latter will likely increase pari 
 passu, with their growth and commercial importance. In the epidem- 
 ic of 1871, it prevailed also at Cedar Keys, and from thence was car- 
 ried to Grainsville, a town a hundred miles from the Keys, in the 
 interior. In my observations of the epidemic in Tampa, it was 
 noted that a fever with a temperature of 106° F. and upwards inva- 
 riably proved fatal. At that .time I failed to appreciate the patho- 
 gnomonic significance of a gradually lowering pulse rate, contrasted 
 with a high temperature, so clearly pointed out since by Dr. Faget. 
 of New Orleans. 
 
 Idiophatic diseases of the liver — except the occasional occurrence of 
 jaundice — have never come under my observation, and I am inclined 
 to the opinion that they are very uncommon. Those histological 
 metamorphoses as phathological concomitants of the malarial fevers, 
 resulting in pigmentation, or bronzing of the organ, are probably com- 
 mon, but how much of structural or functional disease, if any, is de- 
 pendent on them, is as .yet an undetermined question. 
 
 Enlargement of the spleen is incidental to the malarial fevers, and 
 the malarial caohexia ; and in the latter the enlargement may be 
 more or less chronic in its nature. 
 
 Acute inflammatory affections of the respiratory organs — except an 
 occasional catarrh with some bronchitis — are extremely infrequent as 
 a rule j though here, as elsewhere, an epidemic influenza sometimes 
 prevails, during which serious pulmonary complications in some cases 
 are developed, taking their departure apparently from the epidemic 
 disease. But idiopathic pneumonia and pleurisy occur very rarely, 
 and are never so common as to be considered as even approximating 
 either an endemic or epidemic character. 
 
 Diarrhoea and dysentery only occur as sporadic diseases, and never 
 in an epidemic or malignant form. These diseases are generally mild, 
 and readily yield to treatment. 
 
 No case of acute rheumatism has ever come under my observation, 
 except when the patient was also suffering with a gonorrhoea! dis- 
 charge, more or less acute. I have noted three such cases ; one in a 
 negro man aged 22, where the knee joint was acutely inflamed ; one 
 in a white man aged 38, with the shoulder joint the seat of the rheu- 
 matism; and a negro woman aged 22, when the wrist was the joint 
 attacked. In all these cases my services were first sought in conse- 
 quence of the rheumatic disease, and the presence of gonorrhoea ad- 
 mitted in the course of the clinical examination. In the case of the 
 woman, her husband had but recently been under tieatment for gon- 
 orrhoea, and she complained of having the " whites. " 
 
Wall on Climate and Diseases of Florida. 5 
 
 Cerebrospinal meningitis, either as sporadic or epidemic has never 
 occurred in this section of the State south of Ocala, where it was said 
 to have prevailed in the winter of 1863-1864. Whether the diagno- 
 sis was merely made from the clinical history of the cases, or confirm- 
 ed by post-mortem examinations. I do not positively know, but am 
 inclined to the opinion that confirmatory evidence in anatomical lesions 
 was not sought for. During the same season a disease presenting 
 manv of the symptoms of cerebro-spinal meningitis, prevailed exten- 
 sively among the negro laborers employed on the fortifications at 
 Baldwin, and on the St. Mary's river, but unfortunately, on account 
 of the exigencies of the military situation then pending, the positive 
 character of the disease was not determined by autopsies. If this was 
 cerebro-spinal meningitis it is the only time that the disease has been 
 known to prevail in the State. At the time many of the medical 
 officers of the Confederate service were inclined to the opinion that 
 this disease was pernicious malarial fever of cerebral congestive type. 
 In the few cases which I saw at the time in Lake City, the subjects 
 being negroes, if there was any petechial eruption it escaped observa- 
 tion. 
 
 Trismus Nascentium is not more common in this section than is 
 general throughout the Southern States ; and while more common 
 among the negroes, it is by no means exclusively confined to that 
 class of our population. In my experience, however, trismus has not 
 been a very frequent disease. 
 
 Traumatic tetanus very rarely occurs after injuries and wounds or 
 surgical operations. In fact this disease is so extremely infrequent as 
 never to occasion the surgeon any apprehension of its being developed 
 as a complication. Among the wounded at the battle of Olustee, in 
 February, 1864, tetanus was much more common than had come under 
 my observation in a previous considerable service in the general mili- 
 tary hospitals of Richmond, Va. The night, following the battle in 
 the afternoon, was very cold for Florida, and the wounded were much 
 exposed, both in their transportation to Lake City that night and 
 after reaching there, in consequence of inadequate hospital accommo- 
 dations. The disease was on that occasion almost exclusively mani- 
 fested in connection with wounds of the foot and leg. 
 
 The frequent occurrence of small nascent pterygium, especially 
 among the males living on the coast, has appeared to me dependent 
 on the reflection of the white sand so common when the coast is not 
 margined by swamps. 
 
 So far this section has escaped diphtheria in either a sporadic or 
 epidemic form. There are not wanting those physicians, however, 
 here as elsewhere, who, either from ignorance or an unprofessional, 
 anxiety for reputation, call almost every affection of the throat diph- 
 theria. 
 
 Insolation or sunstroke never occurs in either town or country ; nor 
 have I heard of its occurrence in Key West. The heat is never so 
 excessive in this climate as either to cause disease or exercise an un- 
 
6 Wall on Climate and Diseases of Florida. 
 
 favorable influence on the sick. On the other hand convalescence is 
 always remarkably rapid as regards both diseases and surgical injuries. 
 
 ■Calculus affections of the urinary organs are never met with in ihis 
 section, nor as I know of in any other part of the State. From the 
 conditions favorable to the formation of verical calculi Florida ap- 
 pears to be peculiarly exempt. p 
 
 Of intestinal worms the most common varieties pre the ascaris lum- 
 bricoides and ascaris vermicidaris. The tape-worm in any of its va- 
 rieties is never met with ; nor do I believe that it is to be found in 
 any section of the State. 
 
 No instance of hydrophobia, in either animal or human, within the 
 State has come within my knowledge. 
 
 The mortality of this section is extremely low ; and that from ma- 
 larial fevers, for the last few years, has been nil. And so far as statistics 
 can be made available they show a less percentage of mortality for 
 Florida than any other State in the Union. The entire abscence of 
 many diseases more or less fatal in their character, and the greater 
 mildness of those of malarial origin cannot fail to demonstrate the 
 natural salubrity of the climate. Much of this exemption from the 
 graver forms of disease depends doubtless upon its greater freedom 
 from the extremes of temperature. 
 
 On account of the sparseness of population, and the considerable 
 distances between settlements, the eruptive • fevers have prevailed in 
 this section of the State only daring times of war, when the infection 
 was carried into communities by travelling, and returning soldiers. 
 Thus did rubiola prevail quite extensively during the Seminole dis- 
 turbances of 1856 and 1857 ; and the small pox more slightly in 
 isolated communities in 1863 and 1864. Scarlatina broke out on the 
 plantation, in Hernando County, of Hon. D. L. Yulee, in the spring 
 of 1861 among the negro children and those (white) of the overseer's 
 family. How the infection got there I was never able to discover ; 
 though the family of the Hon. Senator having but recently arrived 
 at the plantation from Washington, D. C., for a temporary sojourn, it 
 is but reasonable to infer that this very tenacious and subtle conta- 
 gious virus found its way there with them. The disease proved ex- 
 ceedingly mild, and was followed by no unpleasant sequelae, In all 
 there were thirty-five or forty cases and only one death, an infant 
 (negro) aged nine months, in which bronchitis and lobular pneumo- 
 nia were developed as intercurrent affections* Although throat affec- 
 tions, with more or less glandular swellings, were sufficiently common 
 to declare it of the anginose variety, yet upon the whole, the disease 
 was so mild as to require confinement to bed in only a few instances. 
 This is the only instance of the disease ever having been in this sec- 
 tion ; and has been alluded to in confirmation of what would be 
 naturally inferred in relation to the climate, the greater mildness of 
 the eruptive fevers here than in higher and damper latitudes. 
 
 Poisonous reptiles and insects are not more common and numerous 
 in this section than they are generally throughout the Southern 
 
WALL on Climate and Diseases of Florida. 7 
 
 States, and comprise only the same varieties. Mosquitoes, sand flies 
 and other insects are generally less troublesome in this section than 
 they are on the Atlantic and St. John's, or even in New Orleans. 
 Here they are usually found in certain localities only, being very 
 troublesome only in a few places, while in the greater portion of this 
 section the use of bed nets is never required. 
 
 Adaptability of the Climate to Consumptives. — As yet the influ- 
 ence of the meteorological conditions of different climates on disease 
 is not sufficiently understood as to enable us to determine, with any 
 accuracy, what meteorological combinations may be either inimical to, 
 or provocative of, disease. Up to within a recent period the tempera- 
 ture of a climate was considered the principal factor in the causation 
 of many diseases, and especially those of the respiratory organs. More 
 recent observations and experience, however, have pretty clearly 
 demonstrated that this belief or assumption can be predicated only to 
 a very limited extent, indeed, of nearly all diseases, and particularly 
 those of the respiratory organs. That ozone is only an allotropic 
 state of oxygen is conceded by the latest chemical authorities ; and 
 wether or not other allotropic conditions of the aerial elements, subtle 
 and as yet undelectable, may exist, and, by their action on the human 
 economy, cause disease, is a problem for future scientific elucidation. 
 The assumption of such a theory — bringing an idiosyncratic suscepti- 
 bility as an accessory factor — might go far towards the explanation 
 of causation in many diseases in lieu of the germ or cryptogamic doc- 
 trines. We are almost forced to such a conclusion to account for 
 the different effects on human health of various but remote climates, 
 similar in latitude, altitude and meteorological conditions. If this 
 ^L_pro^oxtion should be true of disease in general, it is but a reasonable 
 supposition that it may be true also of pulmonary tuberculosis ; and 
 until the ultimate laws of both biology and meteorological physics are 
 more fully comprehended, it is impossible to judge a priori what cli- 
 mates may prove beneficial, or otherwise, to consumptives. 
 
 To the earnest and patient investigation of climatic influence on 
 consumption, the conclusions arrived at by Dr. Manning Simons, of 
 Charleston, S. C, (American Journal of Medical Sciences, January 
 No,, 1872,)* may be taken as a fair expression of our present 
 knowledge on the subject *. 
 
 " 1. That phthisis occurs in every zone, and that its origin is not 
 rendered impossible by any conditions of climate, of which we have 
 any knowledge. 
 
 " 2. That the disease, contrary to a very generally received opinion, ■ 
 is not more frequent in cold regions, and that a great degree of cold 
 does not seem to favor its production. 
 
 " 3. That the same remark may be made in relation to heat. 
 
 " 4. That of all the influences which are favorable to its develop- 
 ment and progress, we must recognize moisture, especially combined 
 with heat. 
 
 " 5 That great variability in the qualities of heat, cold and 
 moisture are, however, to be recognized as most injurious. 
 
 
 .'■: 
 
 ; 
 
8 Wall on Climate and Diseases of Florida. 
 
 • : 6. That the most inimical influence to the origin and development 
 of the disease, is that exercised by the climatic conditions and habits 
 belonging to extreme altitudes. 
 
 "" 7. That consumption is, as a general rule, more frequently met 
 with on sea-shores, and diminishes to a certain extent in proportion 
 to the distances from these localities. 
 
 " To nearly all of these statements, however, there are exceptions, 
 In Madrid, according to Walshe, situated 2,000 feet above sea level, 
 phthisis is common. He further says, that if we try to explain the 
 rarity of phthisis in Algiers, and Egypt, and Syria, by the heat and 
 dryness of the air combined, we are met by the difficulty that the 
 East Indies enjoy a somewhat similar exemption, in spite of the mark- 
 ed moisture of the heated atmosphere. In Iceland, where variability 
 holds to a maximum degree, the disease is singularly rare.'* , 
 
 The question, however, is not so much what climatio conditions are 
 inimical to the development, as to the progress of pulmonary tubercu- 
 losis. If, as Dr. Wilks (London Lancet, Feb., 1874) and others hold, 
 rest is beneficial and exercise injurious in consumption, the adaptabili- 
 ty of high altitudes to lungs already involved, because of the greater 
 expansion required by the rarified air, appears questionable, and 
 might be expected to prove measurably detrimental in proportion to 
 the altitude. As regards sea coast, while no positive deductions can 
 be drawn, there is some evidence going to show that western sea 
 coasts are much more favorable for consumptives than eastern, as is 
 illustrated by those of Sweeden and Scotland. 
 
 As regards the beneficial efiects of warm climates in consumption, 
 Dr. C. T. Williams (London Lancet, Aug., 1872) " furnishes, from 
 the practice of Dr. C. J. B. Williams and himself, a statistical account 
 of 251 cases of consumption, who passed periods varying from one to 
 eleven winters in warm climates, out of the United Kingdom. 
 
 " * * The average of winters passed abroad by each patient was 
 2^ j and of 18 patients who took voyages, the average number of 
 *V voyages per patient was 2 $. 
 
 " The results of the climate on the general condition of these pa- 
 tients were that 65 per cent, were more or less improved, 6 per cent, 
 remained stationary, and 29 per cent became worse. The local effects 
 on the lungs were, that in 43 } per cent, cure or decrease of the dis- 
 ease took place, in 14 per cent, it remained stationary, and in 42 per 
 cent, it increased either in the way of advance, or extension, or of 
 both. 
 
 " The influence oi various groups of climates is next considered, 
 and from the results of a table, it is shown that the moist climates, 
 temperate or warm, yielded a percentage of " improved, " varying 
 from 50 to 55, of " stationary, " varying from 4$ to 141, and of 
 u worse," from 32 to 45 ; also that the dry climates yielded per cent- 
 age of*' improved," varying from 58 to 65, of u stationary/' from 20 
 to 25, and of *' worse," varying from 10 to 21 j and that of the pa- 
 tients who took sea voyages, 89 per cent, improved, 5 J per cent, 
 remained stationary, and 5 1 per cent, became worse. ****** 
 
 
Wall on Climate and Diseases of Florida. 9 
 
 " With reference to the question whether or no certain forms of 
 consumption deiive special benefit from any particular climate, the 
 author deduces from 55 cases of phthisis of inflammatory origin, who 
 wintered in various warm or temperate localities, that a dry climate 
 is more favorable than a moist one for the treatment of this form of 
 the disease ; and as regards phthisis of catarrhal origin, the deduction 
 from 41 patients is, that warmth and equability of climate are more 
 important than dryness for patients of this description. 
 
 " Forty of the climate cases died, and 202 were living at the last 
 report. Among the former the average duration of life was eight 
 years, and among the latter about nine years, which, when compared 
 with the average of life among patients who did not go abroad, show- 
 ed a slight extension of duration. The effect of cod liver oil in pro- 
 longing life is demonstrated by the instances of 13 patients, who, 
 though they had the full advantages of climate, either omitted oil or 
 took it irregularly. Among these, who are all dead, the average du- 
 ration was four years, eight months and a half." 
 
 Dr. C J. B. Williams, in concluding a series of papers on pukno- 
 nary consumption, (London Lancet, Nov., 1868,) says : 
 
 " Of far more importance in the treatment of consumption is 
 change of air and climate. It is of the greatest consequence to the 
 phthisical invalid that he should breathe as pure an air as possible, 
 and that the influence of this pure air on the blood and on the body 
 should be increased by such gentle and varied exercise in it, as his 
 strength and the condition of his organs will permit. This is the 
 great object of our sending him to a warm climate in winter, and to a 
 high and dry locality in the summer, that he may be as much as pos- 
 sible in the open air, with its exhilerating and vivifying accessories 
 of light, purity and freshness, without the chilling operation of cold 
 and wet in the winter, and the enervating and exhausting influence 
 of oppressive heat in the summer." 
 
 As regards the influence of the climate of the Florida Peninsula on 
 consumption, no reliable statistics have been collected, though the 
 U. S. census for 1870 gives, for the whole State, only one death in 
 1447. There is much reason for the opinion, however, that the 
 interior and western slope of the Florida peninsula is climatically bet- 
 ter adapted to those suffering with pulmonary tuberculosis than any 
 other section of the Union. 
 
 " The State is in the same latitude with the Des«rt of Sahara, 
 Southern China and Northern Mexico ; v but its comparative degree of 
 heat is not accurately indicated by its latitude, for it is isothemal with 
 the Bermudas, Egypt, Northern Hindostan, Southern California and 
 Louisiana." 
 
 Happily, while engaged in writing this paper, Dr.,C. W. Horsey's 
 (of Fernandina, Fla.,) article on the " climate of Florida," has appear- 
 ed in the April number, 1874, of the American Journal of Medical 
 Sciences ; and as an expression of the experience and the results of 
 observation of a resident physician on the Atlantic coaat, deserves at- 
 
10 Wall on Climate and Diseases of Florida. 
 
 tention, and the more especially as it is corroborative, to some extent, 
 of the facts and opinions which I am endeavoring to set forth. In 
 view also of its relieving myself of any appearance or accusation on 
 the part of the Faculty of the Atlantic or St. John's country, of 
 invidiousness or sectionalism, I am rejoiced at its opportune appear- 
 ance. Premising that the doctor is mistaken as regards the persist- 
 ent " humidity and frequent fogs " of this section — for I presume 
 that his personal observations have not extended south of Cedar Keys, 
 Micanopy and Ocala— I shall let him speak for the two sections ; 
 
 " Fernandina and St. Augustine present the same features of cli- 
 mate met with on the sea-board of semi-tropical countries elsewhere. 
 The atmospheric conditions of both are identical, being invariably 
 moist, especially at night and morning, and under the continued influ- 
 ence of the sea breeze and wind currents from the ocean. During 
 the winter months all points on the coast are exposed to the frequent- 
 ly prevalent northerly storms, which last at times for days, and whose 
 fierce and penetrating blasts are dimcult to be borne even by the 
 hardy. On the St. John's, but little difference is observed in the 
 atmosphere at the several places of resort on its banks. The country 
 along the river, for the greater part of its course, is flat, with little 
 elevation above the water level, and, as a rule, extensive swamps and 
 hammocks fringe its borders. The river presents a succession of ex- 
 pansions and contractions, conveying the idea of a continuous chain 
 of lakes, some of which are indeed immense surfaces of water, and it 
 is usually upon such expansions that the resorts are located. The 
 evaporation from the water necessarily causes a very considerable 
 amount of moisture in the air, which is so great that at morning and 
 evening perceptible mists hang over the river, and to a considerable 
 extent on either side, and not unfrequently heavy fogs prevail. It is 
 consequently at the begining and close of the day constantly damp 
 and chilly, or damp, warm and relaxing, as the temperature may hap- 
 pen to be at the time. This varies probably a very little less on the 
 river, for, lying further inland, it is more protected from the wind, 
 though the difference is slight. The climate on the gulf coast is 
 much milder, though the atmosphere is more or less humid, and fogs 
 are of frequent occurrence. It is apparently less subject to storms, 
 and the wind less penetrating than on the Atlantic. The mean win- 
 ter temperature of the Atlantic and St. John's may be set down at 
 between 55° and 60° ; the thermometer, however, often indicates 
 75° and 80°, and falls to 35° and 40°, and occasionally as low as 20°. 
 The mean is somewhat higher on the gulf, increasing as we go 
 South. 
 
 " In the interior of the State a very different atmosphere and cli- 
 mate are found, which present, also, however, considerable local 
 variation. The surface of the country ascends gradually from both 
 Atlantic and Gulf coasts, and reaches its highest altitude at very 
 nearly the centre of the eastern and penisula portion of the State, 
 forming a flattened ridge or table land, which traverses it in a direc- 
 
Wall on Climate and Diseases of Florida. 11 
 
 tion northwest and southeast, and extends to the southern extremity 
 of the peninsula. The soil throughout this region, which embraces 
 the largest area of the State, is generally sandy, the country flat and 
 covered with immense pine forrests, interspersed here and there with 
 savannahs or everglades. 
 
 " The topography of the middle and western portions is more undu- 
 lating and hilly, with greater prevalence of clay subsoil, and the vege- 
 tation and forest growth suited to such soil. The climate here is 
 more rugged and bleak than in any portion of the State, being the 
 only section in which a marked fall of snow has ever occured. The 
 highest elevation in the central section is about 300 feet, but varies 
 in different localities, the general average being from 150 to 200 feet. 
 The air here, as a rule, is always dry, and when changes in tempera- 
 ture occur, though at times sudden, provision or accommodation by 
 means of proper clothing, etc., can be made to meet such effects, 
 which is difficult, if not impossible, in humid atmospheres with high 
 barometric pressure." 
 
 In a recent article on Middle Florida by Dr. Randolph, of Talla- 
 hassee, published in the Floridian, a weekly newspaper, Dr. R. says 
 that the climate of that section is essentially moist instead of dry, as 
 Dr. H. has described it. Of these two contradictory statements I am 
 disposed to accept that of Dr. Randolph, for the reason that he has 
 lived and practiced physic in that section a great many years, and is 
 presumably the better capacitated to judge. 
 
 The following remarks of Dr. Horsey, extend to the northern por- 
 tion of that section to which it is my desire to call attention. He 
 says : " The section of country to which I especially desire to invite 
 and direct attention is the central pine land regions, of which the 
 towns of Gainesville, Micanopy, Ocala and Brooksville are the centres. 
 Situated as these points and their surroundings are upon the highest 
 and dryest section of the State, sufficiently removed from either coast 
 to be beyond the effects of dampness, they appear to me t® possess 
 peculiar fitness to merit all requirements of climate that are to be ob- 
 tained. We have here the healthful influence of that peculiar aromatic 
 element proverbial to the air of turpentine countries, which I regard 
 as not altogether mythical in its effects, for at least it is inviting for 
 out-door exercise and exertion, and thereby plays a very important 
 role in my idea of the requisites for improvement." 
 
 He further says : "I have thoroughly explored the country around 
 Gainesville for a considerable distance, and do not hesitate to recom- 
 mend this region, which embraces the counties of Alachua, Marion, 
 Sumpter, Wayne, and parts of Hernando, as in my opinion the most 
 eligible section of the State." 
 
 To this I give my hearty assent so far as it goes, but it should also 
 include the whole of Hernando, and the counties of Hillsborough, 
 Polk, Manater, and a portion of the very large county of Monroe. 
 These latter counties are peculiarly exempt from malarial fevers, much 
 more so than any others within my knowledge in the State, and their 
 
12 Wall on Climate and Diseases of Florida. 
 
 natural salubrity may be appreciated, when I state that these counties, 
 with an aggregate population of over 10,000 souls, do not average two 
 practicing physicians a piece. I do not include Key West, which, 
 although in Monroe, forms a distinct community of itself. 
 
 The following extract is taken from a report, written in 1853, from 
 near New Smyrna, by Assistant Surgeon Robert Southgate, to the 
 Surgeon-General : 
 
 " Lying mostly between two seas, Florida is, by position, entitled to 
 an equable climate ; and yet, on this coast, and in this latitude, equa- 
 bility can hardly be considered characteristic of it. During *the winter 
 and spring the atmospherical changes are often sudden and marked. 
 Even in this respect, however,. Florida, contrasted with other sections 
 of our country, can claim a superiority. Rarely is the change so 
 great as to impress an individual, in fair health, uncomfortably; and 
 the invalid has, generally, sufficient warning to guard against it. In 
 relation to general health, indeed, equability can hardly be considered 
 the most vital element of climate; the highest degree of physical 
 vigor being attained in climates of which variableness is a striking 
 quality. The human organism is constituted for such irritations ; 
 and were it subjected to the monotonous impression of a uniform tem- 
 perature for a length of time, its powers would, unquestionably, lan- 
 guish. Even in special cases, such as chronic diseases of the lungs, 
 the marked difference, during the summer, between the temperatures 
 of day and night so characteristic of the climate of the coast, would 
 probably be of service to the invalid. The refreshing sleep that may 
 be enjoyed during the cool nights of midsummer, with the ivigorating 
 sea-breezes of the day, must in his, as well as other cases, marked by 
 debility and irritation, promote the general health ; while the fact 
 that, during the winter, the temperature is rarely so depressed that 
 exercise in the open air may not be enjoyed, will render it a salutary 
 residence during that season of the year. Exercise in the open air, 
 by maintaining the vigor of digestion, and the appeasing the wearing 
 excitement of the heart and arteries, must economize the vital force 
 and save the integrity of the tissues ; and to the consumptive invalid 
 these considerations are of the very first importance." 
 
 What Dr. Southgate says in favor of the climate of Florida in rela- 
 tion to consumption, is peculiarly applicable to that of this section. 
 We have no such vast bodies of sluggish fresh waters, as is found 
 along the St. John's, continually exhaling moisture to be precipitated 
 as fogs and mists, by the air cooling through rapid terrestial radiation. 
 Nor are we troubled with storms or continuous northern blasts com- 
 mon on the Atlantic. The winds never eontinue long from an} r 
 direction, as may be noticed by reference to the meteorological tables 
 in the first part of this article, which, however, are not to be inter- 
 preted as meaning that the wind is continuously from the various 
 points of the compass, as there given. While breezes more or less 
 strong are common, the idea that the peninsula is traversed by them 
 alternately from Atlantic to Gulf, and vice versa, from Gulf to Atlan- 
 
Wall on Climate and Diseases of Florida. 13 
 
 tic, may be considered a mere poetical fancy, contrary to the known 
 general laws of air currents. 
 
 In this connection it may not be amiss to state also, that the inte- 
 rior pine land region spoken of by Dr. Horsey, is not altogether ae 
 level as might be inferred from his description ; while in places it is 
 so, much of it is undulating, even up to the Gulf beach in some places; 
 and some distance in the interior this undulating character extends so 
 far as Fort Meade, 46 miles southeast of Tampa, which is 80 feet 
 above sea level. I have given the mean altitude of this interior 
 region as about 40 feet above the sea-level, which may be a little less 
 than it actually is. My data are taken from the published statistics 
 of the Surgeon-G-eneraPs office, referred to in the topographical sketch. 
 Dr. Toner gives the altitude of Gainesville as 160 feet. The statistics 
 give the altitude of Fort King (near Ocala) as 50 feet; Fort Mica- 
 nopy (12 miles south of Gainesville) as 60 feet; Fort Brooke (at 
 Tampa) 30 feet. For cantonments, rather elevated spots were select- 
 ed by the officers. I have already referred to the distinet features of 
 surface drainage in the two sections divided by the 28° of latitude ; 
 that north being in many places subterranean, while that south is 
 entirely superficial by means of creeks and ravines, so that in the 
 rainy season the latter section is more or less inundated for short 
 periods at a time. 
 
 Cases of pulmonary tuberculosis, occurring in natives or old resi- 
 dents, are extremely infrequent. In a professional experience 
 in this section of 15 years, not more than half a dozen cases have 
 come under my observation, and the whole number occurring south of 
 Ocala, will probably not exceed a dozen or so for the same length of 
 time. Another fact to be borne in mind is, that in no instance where 
 the disease was so styled, was the diagnosis verified by a post mortem 
 examination ; so that in view of an advanced knowledge in pulmonic 
 pathology and diagnosis, and the lack of clinical experience in this 
 disease, to say nothing of professional inaptitude and false judgment 
 among the majority of ordinary practitioners of medicine, the correct- 
 ness of the diagnosis may reasonably be questioned in some cases. 
 
 In the majority of the cases the disease occurred in young men 
 with no marked family predisposition ; within my knowledge, never 
 in females or negroes. These facts are rather suggestive of the exci- 
 ting cause having been to some extent, at least, vicious practices, or 
 venereal excess, associated with other deleterious habits. ( Vidi Ac- 
 tion on Reproductive Organs, p. 117.) On the other hand, I know 
 several men who, as soldiers, being then young, in the western and 
 Virginia campaigns, were attacked with bronchorrhrgia, and having 
 been discharged in consequence, on their return to their homes, in 
 this section of the State, regained their health, and have continued 
 since in a robust, healthy condition. Some of these parties, as appli- 
 cants for life insurance, have been examined by me within the last 
 year or so, and in no instance was there any symptom or sign of pul- 
 monary disease. The companies, however, at the Home office, inva- 
 riably rejected them on account of the early hoemoptysis. 
 
14: Wall on Climate and Diseases of Florida. 
 
 Since the war but few invalids have visited Tampa, the St. John's 
 being their great thoroughfare, so that I have no personal experience 
 to offer in observing the effects of climate on them. What few I 
 have seen were generally expectant, if not sanguine, of great results 
 from climate alone, and discarded cod liver oil and alchohol as reme- 
 dies. Unfortunately, in a disease where death is the rule and cure 
 the exception, it will take long and persistent observation of a large 
 number of cases, whose clinical histories are to be followed year after 
 year, to determine anything positively as to the benefits to be derived 
 by resorting to any section or climate. American physicians have 
 not hitherto exhibited a zeal in this direction anything like equal to 
 that of the English. The result is that, from insufficient generaliza- 
 tion, or generalizing from an insignificant number of cases, many 
 places in various sections of the Union have acquired an ephemeral 
 reputation as a winter resort for consumptives. 
 
 In all cases the physician should endeavor to determine the stage 
 of the local disease in the lungs, and the character of its progress, 
 whether slow or rapid, and then conclude from these circumstances, 
 taken in connection with the general condition, whether or not a 
 change of climate is likely to prove beneficial. In selecting a climate 
 the course recommended by Dr. Austin Flint may be adopted. He 
 says : 
 
 11 The feelings and choice of the patient are to have considerable 
 weight. If, when in health, more vigor and enjoyment are habitually 
 experienced in summer than in winter, a warm climate will probably 
 be best, and, if the reverse be true, a cold climate is to be preferred. 
 The condition of the patient as regards feebleness is an essential point. 
 If he be so feeble as not to be able to live out of doors in cold weather, 
 or if the reaction from the impression of cold be slow and imperfect, a 
 warm climate is more suitable. It is rarely proper to send patients to 
 a cold climate if the disease be considerably advanced, and, as a rule, 
 a cold climate is better suited to male than to female patients." He 
 further &&y$> : " Places which are especially the resort of patients are 
 to be avoided ) the, moral effect of seeing daily examples of different 
 stages of the disease is unfavorable." 
 
 The employment of the mind in connection with out of door exer- 
 cise is, in the estimation of the author just quoted, of the greatest im- 
 portance. Here these requirements can be readily met, either in 
 hunting or fishing; or by establishing a more or less permanent home, 
 and engaging in orange growing, etc., both health and profit might be 
 the reward. 
 
 It is not my purpose to go into the treatment of consumption, but 
 it may not be inappropriate to say that, discarding the use of the well 
 known remedies, cod-liver oil and alcohol, and relying alone on chi- 
 matic conditions, however favorable,' will, in the majority of cases, end 
 in disappointment. That recovery, or at least great improvement, has 
 been the result of a more or less continued residence in this section, 
 indepently of medication, is vouched for by very reliable authority. 
 
WALLon Climate and Diseases of Florida. 15 
 
 In confirmation of this I shall take the liberty of introducing the fol- 
 lowing communication with cases from Dr. F. Branch, who has resid- 
 ed and practiced medicine in South Florida since 1848 ; 
 
 Dear Sir : In answer to your inquiry respecting the influence of 
 the climate, on the Gulf coast of South Florida, upon persons afflicted 
 with diseased lungs, I cheerfully furnish the following facts which 
 have transpired under my own observation : 
 
 " Case I. W. B., from Green County, Ala., came to Manater, a 
 settlement below Tampa, in the fall of 1851, laboring under a severe 
 cough, having a cavity in the right lung, from which was discharged 
 nearly half a pint of pus daily ; so enfeebled as to be unable to walk 
 fifty yards, and was greatly emaciated, having night sweats. He took 
 scarcely any medicine, depending upon gentle exercise in the open air, 
 and milk diet for recuperation. After about nine months residence 
 in Manater, his night sweats had disappeared, the pain had left his 
 lung, his expectoration had nearly subsided, and he was able to walk 
 a mile with but little fatigue. Before the expiration of another year 
 he deemed himself well, and decided to visit his home in Alabama. 
 I advised him to go in June, and return in August. He left in June, 
 and, remaining there, in October his cough returned, with all his for- 
 mer symptoms ; and he did not leave for Florida until the 10th of 
 December, and his case terminated fatally on the 10th of March. Had 
 he remained in South Florida, he might have lived for several years. 
 
 " Case II. A. G., a practicing attorney, from Memphis, Tenn. r 
 came to Manater, Fla., in the fall of 1849. He was extremely ema- 
 ciated, and had hectic symptoms, such as fever and night sweats. He 
 had copious expectoration, cavity in the right lung, loss of voice, so as 
 to be unable to speak above a whisper, and was unable to take any 
 exercise. He refused medication, not even submitting to counter-irri- 
 tants ; lived principally upon milk diet, eggs, fish and oysters ; spent 
 considerable time moving along the coast, sleeping in tents, and often 
 bathing in salt water, after he was sufficiently improved to bear the 
 fatigue. His improvement was gradual, but constant, and in three 
 years he had recovered his voice and his health, insomuch that he 
 delivered an oration with a full volume of voice, on the 4th day of 
 July, 1852. On the first day of June, 1853, he visited his home, 
 near Memphis. While at home, he contracted a severe cold, his 
 cough returned in an aggravated form, and in the following January 
 he returned to Manater only a few days before his death. We deem 
 it a legitimate conclusion that if he had remained upon the Gulf coast 
 of South Florida he might have lived for several years. 
 
 k£ Case III. M. C-, of Eufala, Ala., afilicted with diseased lungs, 
 was landed at Tampa, Hillsboroug Co., Fla., on the 10th day of June, 
 1847, being borne in a sheet to his boarding house, in consequence of 
 extreme emaciation and debility, with no prospect of living but a few 
 weeks. His progress in improvement was exceedingly slow ; but by 
 the following winter he was enabled to walk a hundred yards before 
 requiring rest. In about two years, he was so far recovered as to be 
 
16 Wall on Climate and Diseases of Florida, 
 
 elected to the office of Clerk of the Circuit Court, which office he 
 retained, performing all its functions, for thirteen years. 
 
 - Case IV. Dr. T. came to Tampa 7 from Vermont, in 1849, hope- 
 less of recovery, from diseased lungs. Resumed practice as physician, 
 and lived twenty-two years. Many similar cases might be mentioned. 
 Very respectfully yours, F. BRANCH, M. D." 
 
 From the foregoing it will be noticed that a permanent residence 
 in this section is of the greatest importance to the consumptive. And 
 to thousands of such the facilities for making a living by agriculture 
 and fruit growing, and of eventually acquiring independent incomes 
 from the latter, are not to be surpassed in any section of these broad 
 United States. 
 
 Before the war many more invalids visited this section than since 
 and now. The great' reason for this is entirely dependent on the 
 somewhat less accessibility of this section, compared to the Atlantic 
 and St. John's side. Moreover the facilities of travel and accommo- 
 dations for pleasure-seekers have hitherto been inadequate, because, as 
 yet, there has been no demand for such. These deficiencies can be 
 readily supplied by putting the Florida R. R., from Fernandina to 
 Cedar Keys, in the condition of a first-class road, with all the com- 
 forts of improved cars, etc., and placing more steamers on the line 
 between Cedar Keys and Tampa, touching at the other Gulf ports* 
 Capital would then soon supply hotel accommodations at all desirable 
 points. 
 
 In bringing this paper to a close, I will assure the reader that I 
 have been careful to avoid exaggeration, and have only set forth such 
 facts and opinions as are justified by experience, observation and 
 study. To thousands who annually visit the eastern portion of the 
 peninsula, the greater part of this section is a terra incognita, because 
 of its remoteness from the main lines of travel. The limited time 
 allowed for its preparation, and the interruptions occasioned by profes- 
 sional engagements, must be my excuse for any absence of methodical 
 detail, and lack of literary polish. 
 
 During the writing of this, tests for the presence of ozone in the 
 atmosphere have been repeatedly made, with positive results; its 
 presence being fully indicated at she expiration of three or four hours, 
 day or night. The method of testing was that given in the second 
 American edition of Brande and Taylor's Chemistry, and is thus pre- 
 pared : " One part of pure iodide of potassium (free from iodate,) is 
 dissolved in two hundred parts of distilled water ; ten parts of starch, 
 finely powdered, are mixed with the solution, and the liquid is gently 
 heated until it is thickened from the solution of the starch. White un- 
 sized or sized paper is soaked in the liquid ; the paper is dried, cut into 
 slips three inches long by three-quarters of an inch wide, and these are 
 preserved in a stoppered bottle. When intended for use, a slip of 
 ih.e prepared paper is exposed to a fail current of air in a spot shelter- 
 ed as much as much as possible from rain, light, and foul effluvia, for 
 a period varying from six to twenty-four hours." 
 
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