FLORIDA 
AS A 
HEALTH-RESORT. 
BY 
FREDERIC D. RENTE, A. M., M. D., 
REPRESENTATIVE FROM FLORIDA ON THE EXECUTIVE COMMITTEE OF THE CENTENNIAL 
MEDICAL COMMISSION ; MEMBER OF THE AMERICAN PUBLIC-HEALTH ASSOCIATION ; 
OF BOARD OF MANAGERS OF HUDSON RIVER STATE HOSPITAL ; OF THE 
AMERICAN NEUROLOGICAL ASSOCIATION: LATE PROFESSOR OF DISEASES 
OF WOMEN AND CHILDREN IN THE UNIVERSITY OF NEW YORK; 
HONORARY MEMBER OF NORTH CAROLINA STATE MEDICAL 
SOCIETY; CORRESPONDING MEMBER OF NEW YORK 
MEDICO-LEGAL SOCIETY ; VICE-PRESIDENT NEW 
YORK NEUROLOGICAL SOCIETY, ETC. 
[REPRINTED FROM THE NEWJYORK MEDICAL JOURNAL, NOV.i, 1876.] 
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1876. APPLETONS’ PERIODICALS. 
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D. APPLETON dr CO., Publishers, 549 65 551 Broadway, N. Y. FLORIDA 
AS A 
HEALTH-RESORT 
By 
FREDERIC D. RENTE, A. M., M. D., 
REPRESENTATIVE FROM FLORIDA ON THE EXECUTIVE COMMITTEE OF THE CENTENNIAL 
MEDICAL COMMISSION ; MEMBER OF THE AMERICAN PUBLIC-HEALTH ASSOCIATION ; 
OF BOARD OF MANAGERS OF HUDSON RIVER STATE HOSPITAL ; OF THE 
AMERICAN NEUROLOGICAL ASSOCIATION ; LATE PROFESSOR OF DISEASES 
OF WOMEN AND CHILDREN IN THE UNIVERSITY OF NEW YORK ; 
HONORARY MEMBER OF NORTH CAROLINA STATE MEDICAL 
SOCIETY ; CORRESPONDING MEMBER OF NEW YORK 
MEDICO-LEGAL SOCIETY ; VICE-PRESIDENT NEW 
YORK NEUROLOGICAL SOCIETY, ETC. 
[REPRINTED FROM THE NEW YORK NOV., 1876.] 
NEW YORK: 
D. APPLETON AND COMPANY, 
549 & 551 BROADWAY. 
1876. FLORIDA AS A HEALTH-RESORT.1 
For years the question, Where shall I spend the winter f 
of a phthisical or phthisically-inclined patient, has been an 
embarrassing one to the physician. Winter resorts, some of 
them entirely dissimilar in the characteristics of their climate, 
have risen or fallen in the estimation of the public, and, to 
some extent, among medical men, according to the prevalence 
or decline of a theory, or apparently even a fashion ; and we 
are still, to a great extent, at sea as to what is the most favor- 
able location for an invalid in winter or spring, or even 
whether any change is desirable. The cold and dry regions, 
e. g., Minnesota; the elevated regions, wTith their rarefied air, 
e. g., the Engadine in Europe, the mountains of Peru in South 
America, Laramie and Colorado in this country, have had their 
pilgrims, and neither theory nor fashion seems to sustain their 
reputation. The time-honored resorts of Italy, which, for so 
many years, absorbed almost the entire invalid travel, have 
lately fallen greatly in the estimation of intelligent people, 
who could not fail, after the charm of novelty and the haze of 
romance had been dispelled, to see on how unstable a founda- 
tion, in a climatic and hygienic point of view, her reputation 
had been based. Even Mentone, to which the name and ef- 
forts of Bennett, for a long series of years, gave a fictitious 
1 This paper was read, by abstract, before the American Public Health 
Association, at its annual meeting in Boston, October 6, 1876. prominence as a health-resort, and rendered it, for the English 
invalids at least, a medical Mecca, has failed to respond satis- 
factorily to the test of time and experience. One who wishes 
to get a thorough expose of the peculiarities of Italian climate, 
from a responsible source, should consult the entertaining book 
of Dr. James Johnson on “Change of Air.” The climate of 
Bermuda has lately been recalled into some prominence . 
through the efforts of a transportation company; but those 
who have remained there for a few wrecks have been more in- 
jured than benefited. Those who merely made the voyage, 
and remained but a week or two, have seemed to be somewhat 
improved in health. 
But little has been known among our people concerning 
the climate of Florida. Comparatively few had visited the 
State prior to the war. Many causes conspired to this : the 
long Seminole War; the unsettled state of affairs for many 
years after; the impossibility of securing any decent accommo- 
dation for invalids; then the civil war checked travel and immi- 
gration, and rendered the State still a terra incognita. Now, 
everything has changed. To one who has not paid a visit 
there, especially to the St. John’s River region, for three or 
four years, it is as if the magician’s wand had been waved over 
it. Not only those seeking health, but settlers, in the shape 
of farmers, of men of means, even of wealth, of education, and 
refinement, have been pouring in along the river counties; as 
many as twelve thousand have been estimated as the influx 
into Orange County alone in twelve months. Forests have 
been leveled. Orange-groves have taken their places. Schools 
and churches have sprung up, and refined and agreeable soci- 
ety can be found over a large extent of country, where but a 
few short years ago a howling wilderness existed. The tide 
of invalid travel having been diverted from its usual channels 
to this favored spot, the attention of the medical profession 
has naturally been attracted there also, and a growing desire 
has been manifested to secure reliable and definite information 
in place of the various conflicting reports which are constantly 
flooding the journals and magazines of the country. The 
writer had collected a large amount of valuable information 
and statistics, and had partially prepared for publication, at 5 
tlie suggestion of friends and physicians, a somewhat elaborate 
account of the climate, remarkable objects of interest, and re- 
sources of Florida, especially as a health-resort, when he found 
that he was overtaxing his available time and health, and now 
offers, as a poor substitute, such remarks and suggestions as 
he thinks may prove interesting or serviceable to the profes- 
sion, and for which he may be able to find room in the some- 
what restricted compass of a medical journal. 
The discussion of the broad question of climate, in its va- 
rious aspects and bearings, has always been a perplexing one. 
It is especially so when we, as physicians, come to consider it 
in its relations to any particular individual, or even any par- 
ticular disease. To analyze the mass of information with 
which we are confronted, to scrutinize the various conflicting 
statements of equally reliable observers, and to deduce any- 
thing like a definite and satisfactory conclusion, with regard 
to any particular locality or country, is a matter of no small 
difficulty. To this sort of investigation the writer has ad- 
dressed himself for the past two years, in the case of Florida; 
and indeed, for the most part, only to a small portion of the 
peninsula, that which is most accessible to invalids. For, un- 
til proper facilities for easy travel and proper accommodation 
are provided for those larger portions lying along the Indian 
River, and along the Gulf coast, south of Tampa, which are 
supposed by many to present attractions superior to the more 
northern portions, their relative merits may profitably be left 
out of the question. The great bulk of tourists and invalids 
have heretofore distributed themselves along the St. John’s 
River and at St. Augustine. A few go into the pine-regions 
of the interior to get away from the river. But, go where one 
will in Florida, it is difficult, owing to the peculiar conforma- 
tion of the country, to escape the influence of considerable 
bodies of water. With reference to Florida, “ almost without 
a metaphor,” says “ Chambers’s Encyclopaedia,” “it may be de- 
scribed as amphibious.” This, however, so far from being a 
disadvantage, constitutes, to a certain extent, its charm, and 
will, in the future, constitute a great source of its wealth—• 
these bodies of water being, for theTnost part, clear streams 6 
and crystal lakes. A study of most of tlie works on Florida, 
from that of Le Moyne, who visited the territory as artist to 
the French expedition under Laudonniere in 1564, and the 
Bartrams, who visited it as naturalists in 1772, to the latest 
publications, including periodicals, pamphlets, and newspa- 
pers ; access to all the records bearing upon the subject in the 
possession of the War Department, the library of the Surgeon- 
General, and other depositories in Washington; a careful col- 
lation of the various meteorological and other tables included 
in these records; personal interviews with distinguished medi- 
cal officers of the army, who have served in all parts of Flor- 
ida, and with many of the scientific and medical residents of 
the State, with some of her representatives in Congress; and, 
lastly, the opportunity for consulting a considerable number 
of the thousands of intelligent visitors and invalids, who 
passed through, or located for the season at the writer’s winter 
residence, have afforded him unusual facilities for unraveling' 
the intricacies of the subject so graphically described by 
Scoresby Jackson. The last source of information, as regards 
the relative merits of various climates, he considers of more 
value than all the others, more so than even an extended per- 
sonal observation. For invalids are by far the best judges of 
climate ; they are living barometers and hygrometers. Sere, 
you have the opportunity to question and cross-question the 
reporters, and not only thus to arrive at the truth, but, what 
the books seldom give, the whole truth. All of these indi- 
viduals were intelligent and educated people, most of them 
invalids who had traveled the world over in search of health, 
and tested its renowned sanitary resorts, some of them winter 
after winter. Few of them had any particular prejudice for 
or against any special locality, save from its actual effect, but 
were, from self-interest, in search of the best. 
The evidence of those who have tested the climate of Flor- 
ida by sufficient personal observation, or by a careful exami- 
nation of the data furnished by others, has been of the most 
favorable character. The opinion of those who have devoted 
a few weeks to roaming from one locality to another, or who 
have based their opinion on conversation with a few visitors, may be profitably neglected. From the very earliest discovery 
of tlie continent, the remarkable salubrity of the climate, and 
the extraordinary transparency and purity of the springs, gave 
origin to the tradition that a “ fountain of youth ” existed 
somewhere within the borders of the territory, and led to the 
expedition of the romantic and chivalric De Leon in search of 
it. The first impression of a visitor, who has been led to form 
a picture of Florida from the enthusiastic descriptions of 
writers, aided, perhaps, by a vivid imagination on his own 
part, is not unfrequently that of disappointment. But a 
longer acquaintance almost always leads to a revulsion of sen- 
timent, and a succession of visits to something of the enthusi- 
asm of the earlier historians. A reasonable amount of valu- 
able data with regard to the meteorology of Florida is sup- 
plied by the volumes of the “ Medical Statistics of the United 
States Army ; ” but if one undertakes to judge of a climate, in 
a sanitary point of view, or of the fitness of any particular 
country or district for invalids, by mere latitude or tempera- 
ture, or its variability or invariability, its dryness or humidity, 
he will fail to comprehend the philosophy of the subject. Its 
geography, especially its physical geography, must be studied, 
its position with regard to surrounding or neighboring seas or 
bodies of water, to great currents both of air and water, to its 
relation to storm-centres and tracks of storms, to mountain- 
ranges, not only within its own borders, but sometimes at a 
distance from them. Thus Florida has often been poetically 
described as “ the Italy of America,” yet the parallel which 
runs through the southern extremity of the peninsula is 25°, 
while the southern extremity of Italy is 38°. The Riviera is 
44°, and the Isle of Wight and Torquay nearly 51°; yet the 
winter climate of the latter is very pleasant, and highly recom- 
mended in England for consumptives. While one can usually 
live in perfect comfort in Florida, even away from the coast, 
if at rest in the shade, under a temperature of 95°, the same 
person, under a like temperature in Aew York or Canada, 
would probably be in a state of mental and physical discom- 
fort. It is the insular position of Florida, with the proximity 
of the Gulf Stream flo/wing north, and the cold arctic current 8 
flowing south, the comparatively narrow strip of country sepa- 
rating the Atlantic and the Gulf, and the numerous smaller 
bodies of water abundantly distributed over its surface, the 
prevailing winds alw'ays sweeping over wTater of a uniform 
temperature, which modifies the heat of summer and the cold 
of winter. “ The peculiar character of the climate,” says Dr. 
Robert Southgate (“United States Army Medical Report”), 
“consists less in the mean annual temperature than in the 
manner of its distribution throughout the year. Possessing 
an insular climate, the extremes of temperature are much 
modified ; although the winter at Fort Snelling, Minnesota, is 
47° 73' colder than at Tampa Bay, the summer at the latter 
place is only 8° 24' warmer. In the summer season, the mer- 
cury rises higher in any portion of the United States, and 
even in Canada, than it does along the coast of Florida.” 
“Within the period of six years,” says Forry, “the mercury 
at Key West wTas never known to rise higher than 90° Fahr., or 
lower than 44° Fahr.” The variability of the winter tempera- 
ture has frequently been noticed, and has been often alluded 
to, by those who have not had personal experience of the actual 
effects of these changes on the human system, or with the 
modifying influence on these changes of the peculiar constitu- 
tion and surroundings of the State, many of which have al- 
ready been pointed out, as greatly detracting from its value as 
a health-resort. A change in twelve hours, for instance, from 
70° to 60° or 50°, has a very different effect on the sick from 
a change of a like number of degrees in Boston, Kew York, 
or Chicago. Practically, these variations are of actual benefit 
to those invalids who are tolerably careful, and who take the 
precaution to change clothing with the change of temperature. 
A continuous temperature of from 75° to 80° at mid-day, for 
a number of consecutive days, is generally felt as a serious in- 
convenience, especially by the more advanced and debilitated 
cases of phthisis, and these generally longed for the cold 
changes, knowing by experience their tonic effect, whereas 
the steady heat of some tropical regions, though not exces- 
sively high, and very agreeable to most persons, is generally 
followed by increased debility in the spring in the case of in- valids. With regard to these variations of temperature, Dr. 
Southgate remarks, “ Rarely is the change so great as to im- 
press the individual in fair health, uncomfortably, and the in- 
valid .has invariably sufficient warning to guard against it.” 
Surgeon-General Lawson, United States Army, speaking from 
an extended personal experience, says: “ The climate of Flor- 
ida is remarkably equable, and proverbially agreeable, being- 
subject to fewer atmospheric variations, and its atmospheric 
ranges much less, than any other part of the United States 
except a portion of the coast of California.” With whatever 
faults it may have, the climate of Florida, in comparison with 
most others, stands preeminent. I have watched, with some 
anxiety, the cases of those in the more advanced stages of 
consumption, when the diurnal temperature ranged, as it did 
last winter, from December 5th to December 16tli, as follows : 
78°, 82°, 82°, 83°, 84°, 81°, 82°, 81°, 81°, 80°, as I heard them 
complaining from day to day, and was gratified, when the' 
mercury showed 69° at the same hours on the 16th, to hear 
their expressions of relief, and to see their entire change of. 
manner and appearance. This was an unusual series of days’ 
for Florida in winter; but a high temperature of shorter dura- 
tion is quite common, and the cool, sometimes cold, change 
which succeeds, so far from causing colds and pneumonic com- 
plications, common under like circumstances at the North,, 
generally acts like a cold shower-bath, and braces up the sys- 
tem. The occasional wood-fires, around which the invalids 
so cozily congregate on the cool days, are never unacceptable 
as a pleasant change, and contrast favorably with the more 
uniform and debilitating heat and monotony of more tropical 
climates. Nothing, in fact, is so distasteful and injurious to 
most invalids as monotony. The writer has always believed 
in the traditional idea that when phthisis had arrived at the 
stage of softening, a removal to a warm climate is not a bene- 
ficial change, that a sudden and rapid increase of the trouble 
is pretty sure to follow. A study of such cases last winter 
has not tended to establish the correctness of this idea. On 
the contrary, the progress of the disease was slower, if not en- 
tirely arrested, provided the patients were not moribund (as 10 
they sometimes are) on their arrival, even with the disadvan- 
tage of being deprived of the comforts of home, which they so 
much need. Every village and hamlet in Florida can prob- 
ably furnish its examples of people who have come there years 
ago, only, in the opinion of their friends, to die, and who are 
now doing well, some of them apparently in full health. It 
is impossible, of course, to say, without a physical examination, 
how many of these were cases of chronic bronchitis, or other 
affections simulating phthisis, but their history showed that 
they would almost certainly have died except for their change 
of climate. This little village, in which I have taken up my 
winter abode, can furnish several examples. It is very likely 
that the more uniform heat of tropical climates may furnish 
stronger evidence of the correctness of this commonly-received 
opinion among medical men. 
The temperature is similar to that of a typical May or 
September in Hew York, and is usually delightful. For a 
period of twenty years, it was at Jacksonville, on the St. 
John’s, for January, February, and March, 62° ; at St. Augus- 
tine, 59° ; at Pilatka, latitude 29° 34', it was, last winter, for 
January, February, March, and April, at 12 m., 63° 50b The 
average temperature, taken during these months every hour, 
from 12 at night until 6 a. m., wras 57° 40'. A slight film of 
ice is occasionally seen during the winter, and slight frosts are 
not rare north of the 25th parallel, but not often injurious to 
vegetation. Williams, in his history of Florida, speaks of a 
snow-storm which appeared in 1774, and extended over most 
of the State. “ The ancient inhabitants,” he writes, “ still 
speak of it as an extraordinary £ white rain.’” 
As regards hygrometric conditions, it is necessary to say a 
few words. The “dampness” of the climate has been much 
talked about by those who have regarded only the physical 
aspect of the State, the large proportion of water existing 
everywhere, without any knowledge of the actual condition 
of the air. The air is, during summer, very damp. Guns, 
surgical instruments, etc., rust in spite of all precautions. 
More rain falls during this season than all the others combined. 
During the winter the case is entirely different. I found no special precautions necessary to preserve my instruments from 
rust, and boots and shoes, long neglected, showed no mould. 
At some of the prominent resorts in Florida the invalid is con- 
scious of an unpleasant dampness after sunset, when out-of-doors 
and not in active motion. As a rule, these places are usually 
surrounded by large trees, with their usual funereal adorn- 
ments of Spanish moss, which may, in some measure, account 
for this. At Pilatka, and at other points farther up the river, 
it is not so. This village, with an elevation of twenty-five feet, 
has a natural drainage on three sides, a peculiar soil, and no 
large trees, only the wild-orange, and other tropical trees of 
slight elevation, simply for ornament. Here, when the air is 
not too cool, one may be out until ten or eleven o’clock at 
night with comfort, though it is not advisable for invalids to 
be exposed at this hour. The dews, usually heavy, do not 
commence to gather until twelve o’clock, the mercury then 
commencing /to fall, and falling steadily until five or six. 
Until 11 p. m., or later, last winter, a handkerchief could be 
swept over the grass—which is here, unlike other localities in 
the State, as green as in a Northern village in summer—with- 
out being moistened. When the mercury rises to 75° or 80° 
during the day, there are fogs; but the invalid rarely sees 
them, as they commence at midnight, or later, and are dissi- 
pated by the sun before their breakfast-hour. A great deal 
has been said, by those interested in other winter resorts, about 
the fogs and dampness along the river; but there is really no 
more dampness than is useful, indeed necessary, to prevent too 
rapid radiation of heat from the surface of the earth, and a 
consequent too rapid fall of temperature. Were it not for this 
provision of the climate, instead of a fall of ten or twelve de- 
grees, we should, perhaps, have one of thirty to forty. In the 
desert of Sahara, for example, where the dryness is absolute, 
and radiation at night unrestricted, the temperature falls to 
the freezing-point; and on our Western Plains the difference 
between the diurnal and nocturnal temperature is sometimes 
60°. Here, while the evaporation of moisture during the day 
tempers the heat, the condensation at night limits the cold. 
At Fort King, in the same section of the State as Pilatka, 12 
Forry gives the annual number of fair days as 309 for a series 
of years, and on the Northern Lakes 117. On the coast of 
Florida the number is 250. A moist climate is not necessarily 
bad for consumptives, though it is generally so. On the Nile, 
though most cases do well at Thebes and Cairo, others do 
better at Alexandria. The climate of Lima is very dry, yet 
consumption is very common, while on the mountains back of 
Lima the air is always damp and rain common, yet consump- 
tion is rare. Cold and moisture are always bad, but warmth 
and moisture may or may not be so. The question as to the 
influence of large bodies of water on the production and prog- 
ress of phthisis is so important, especially to those physicians 
contemplating the adoption of Florida as a winter residence 
for their patients, that, at the risk of extending the limits of 
this paper unduly, I quote a very instructive table from Forry,1 
with an abstract of his remarks on the same, and his prelimi- 
nary observations : 
“ Having already demonstrated that the regions of the 
United States, on the same parallels of latitude, present sys- 
tems of climate very diverse in character, viz.—1. The regions 
bordering on the ocean ; 2. Those under the influence of 
inland seas; and, 3. Those remote from such controlling 
powers—it will be seen that these laws of climate main- 
tain an intimate relation with the etiology of pulmonary 
diseases. It seems to be a well-established law that the 
prevalence of catarrh and influenza, in each system of cli- 
mate, increases and decreases in proportion as the seasons 
are contrasted, thus maintaining an unvarying relation with 
the extreme range of the thermometer as connected wdtli the 
seasons.” 
“ The following table presents, in a condensed form, 
so far as regards the catarrhal forms of pulmonic lesions, 
the results of the quarterly sick-reports of forty-five perma- 
nent ports, arranged in classes, comprising a period of ten 
years : 
1 “The Climate of the United States, and its Endemic Influences, based 
chiefly on the Records of the Medical Department and Adjutant-General’s 
Office, United States Army, 1842.” 13 
Divisions. 
SYSTEMS OF CLIMATE. 
Latitude. 
Difference between the 
Mean Temperature of 
Winter and Simmer, 
Ratio treated per 
1,000 Strength. 
First Quarter. 
Second Quarter. 
Third Quarter. 
Fourth Quarter. 
Annua] Result. 
g 
f lsf Class.—Posts on coast of N. England. 
43° 18' 
38° 61 
63 
49 30 
85 
233 
o 
j M Class— Posts on N. chain of lakes.. 
46° 27' 
43° 00 
90 
62 50 
96 
300 
o 
| 3d Class.—Posts remote from the ocean 
and inland seas 
44° 53' 
55° 84 
175 
120 80 
169 
552 
(lsf Class.—From Del. Bay to Savannah. 
37° 02' 
32° 99 
102 
45 23 
97 
271 
s 
(2d Class.—Southwestern stations 
35° 47' 
30° 83 
122 
61 1 33 
78 
290 
g 
(1st Class.—Posts on Lower Mississippi. 
30° 10' 
24° 39 
82 
34 26 
60 
218 
o 
CO 
( 2d Class.—Posts in peninsula of Florida. 
24° 33' 
11° 34 
45 
24 40 
33 
143 
Average 
98 
56, 42 
88 
287 
“ This table contains, besides the results of the permanent 
stations, those of the thirty-one temporary ports in Florida.” 
“ This table, which exhibits the annual and quarterly 
ratios of each system of climate, and serves to elucidate their 
relations and sequences, affords a beautiful illustration of the 
etiology of catarrhal affections as connected with the meteor- 
ological laws established. Take, for example, the Northern 
Division, consisting of the first three classes: On the New 
England coast, as the ocean modifies the atmospheric temper- 
ature, the annual ratio, treated per 1,000 of mean strength, is 
as low as 233 ; on the Great Lakes, where a similar modifying 
influence is in operation, it is 300; while the third class, char- 
acterized by the extreme range of the thermometer, has a 
ratio of 552. But let us follow more narrowly the isotheral 
and isocheimal lines (representing the mean temperature of 
summer and winter), which describe four curves within the 
same space, presenting alternately a mild and an excessive 
climate. As these lines, on the coast of the Atlantic, present 
comparatively little deviation from the terrestrial parallel, the 
ratio of catarrhal diseases is low; advancing into the interior, 14 
the line of equal summer rises, and that of winter sinks, and 
the ratio increases proportionally ; proceeding into the region 
of the Lakes, the lines again converge beneath the controlling 
power of the waters, and the ratio of catarrh and influenza is 
modified accordingly ; again advancing into the interior be- 
yond these ocean-lakes, the average rises in proportion as the 
isotheral and isoclieimal lines tend to opposite directions. In 
the other divisions the same law obtains. On the Atlantic 
coast, between the Delaware and Savannah Rivers, the annual 
ratio is 271, while the average of the interior posts of the 
Middle Division, notwithstanding this class lies somewhat far- 
ther south than the former, is 290. As most of the posts of 
the first class of the Southern Division are on the Lower Mis- 
sissippi, and are much under the influence of large bodies of 
water, the annual ratio is as low as 218; while the second 
class, which comprises the mild, insular climate of East Flor- 
ida, has an average of only 143.” We thus see that large 
bodies of water modify climate favorably, and that the ratio 
of pulmonary disease increases with the increase of the mean 
annual ranges of temperature as regards the seasons, rather 
than the prevalence of sudden or diurnal vicissitudes; and 
that the injurious effects of moisture, even in cold climates, are 
more than counterbalanced by the modification of the temper- 
ature of the air induced by the warmth of the water; while 
in warm climates, in winter, the moisture lias a positively 
beneficial effect in limiting the diurnal vicissitudes. 
As regards liability to disease in Florida, a careful exam- 
ination of the “ Medical Statistics of the Army,” extending 
through a long series of years, personal observation, and con- 
versation with medical officers engaged in the Seminole War, 
indicate a remarkable exemption, throughout the State, from 
malignant or even very serious diseases. “At all seasons, 
with the exception of the Northern Division,” says Forry, 
“ the mortality is lower in East Florida than in any other class 
of posts.” He ascribes this, in a great measure, to “ its being 
nearly wholly in a state of Nature.” Circumstances have 
changed since then, of course, and the clearing of the forests, 
especially the hammocks, has developed in the summer season 
a considerable increase of fever. JNotwithstanding the exces- sive exposure and fatigue endured by our troops in the Indian 
wars, in penetrating the swamps and Everglades in pursuit of 
the savages, the amount of serious disease developed was re- 
markably small, and the ratio of mortality, as Forry has shown, 
correspondingly so—only twenty-six per 1,000 ; while in other 
portions of the United States it was thirty-five. General 
Barnes, our present Surgeon-General, informs the writer that 
on one occasion he accompanied a boat-expedition through a 
portion of the Everglades, and, although they were almost 
constantly wet, making their way at night, and for a time 
eating uncooked food, being afraid to light fires for fear of 
alarming the enemy, no severe cases of fever or rheumatism 
were developed in the detachment. General Crane, the As- 
sistant Surgeon-General, gives similar testimony from his own 
experience. 
In the “ Statistical Keport of the Sickness and Mortality 
of the United States Army,” from 1855 to 1860, is a table, at 
page 163, which exhibits the sickness and mortality among the 
troops stationed at the interior Gulf posts, and embracing, 
especially as regards the former, the most unhealthy part of 
the peninsula. The number of cases for the whole year is 
19,312, the deaths 119, or 0.61 per cent. There were but four 
cases of congestive fever, none of which died. It could there- 
fore hardly have been of the severe character which is met 
with in other parts of the country. If we take into considera- 
tion the very unfavorable circumstances surrounding the small 
commands scattered over this area, the bad water, poor food, 
hard work, and continuous exposure of all kinds, the small per- 
centage of mortality is remarkable, and shows that, although 
the cases reported for treatment are very numerous, the dis- 
eases of all kinds were very amenable to treatment and rapid 
cure; as all the military operations went on successfully, not- 
withstanding this very large amount of sickness. The very 
small percentage of deaths from diseases of the respiratory 
organs is especially noteworthy—only thirteen cases among 
the 19,000 of all diseases treated. Notwithstanding the damp- 
ness, rain, and exposure, there were only thirty-three cases of 
pleuritis and twenty-five of pneumonia. “ I have served in 
Florida,” says Surgeon-General Lawson (letter to the Horn 16 
D. S. Yulee, United States Senate, October, 1855), “and have 
served also with an army on the Northern frontier, and, from 
my experience of the influence of climate and active opera- 
tions in the field on the health of soldiers, I have no hesitation 
in expressing the belief that, had the troops engaged in the 
Florida War been engaged for the same length of time in ac- 
tive operations, in winter and summer, on the frontiers of Can- 
ada, though the cases of disease might have been less numer- 
ous, the mortality would have been infinitely greater, than 
was experienced in Florida.” 
Tourists are industriously warned, by persons interested in 
other localities in Florida, against the malaria of the St. John’s 
Ri ver. It is undeniable that persons do occasionally suffer 
from it during the winter season. But it rarely gives trouble 
except to those who are unusually careless in exposing them- 
selves, or in drinking well instead of cistern water. 
The State abounds in springs of excellent water, but they 
are not always accessible. Rain-water, however, may always 
be had, even in the driest seasons, by providing large cisterns 
for storage. Lately, water has been procured by boring 
through the calcareous crust to the depth of sixty feet or more, 
and the water, when filtered, is pleasant to the taste. A quali- 
tative analysis of one of these wells in the yard of the Put- 
nam House, made by my friend Prof. Wittliaus, gives the fol- 
lowing result: Lime (carbonate and sulphate); magnesia (car- 
bonate) ; ammonia, soda, chlorine, carbonic acid, sulphuric acid- 
{traces); silicic acid ; organic matter ; the latter in small quan- 
tity. This water ought not to take the place of rain-water for 
drinking-purposes. The cases of intermittent fever which do 
occur in the winter, generally among those who are visiting 
different points of interest up and down the river, and more 
or less exposed at night, are very manageable. It is not fair, 
however, to attribute every case of fever, which occurs among 
Northern visitors, to the Florida climate, since the disease has 
been so very prevalent, almost over the whole of the Northern 
States during the last five years, botli in winter and summer, 
that it would be more rational to attribute the outbreak-to 
latent disease contracted at home, and developed, as is char- 
acteristic of the disease, by change. In my own case, I had suffered from it for more than eighteen months, had failed to 
get relief from a summer’s residence in Saratoga Springs, and 
have never had an attack since my arrival in Florida last De- 
cember, though I remained there until the 10th of May, and 
although the winter was an exceptionally favorable one for 
the development of malaria, owing to the drought. 
Dysentery and diarrhoea of a mild type, and easily man- 
aged, occasionally attack the winter visitor. Statistics, which 
I have not space to quote, show that phthisis gives fewer 
deaths than in any other portion of the United States. Yellow 
fever, even when it appears in other Southern States, rarely 
appears in Florida, except at Key West and Pensacola. It is 
almost unknown in East Florida. “ This is only the second 
time,” says Forry, alluding to St. Augustine, “ that yellow 
fever has prevailed in this city for twenty years; while, at 
Charleston, we are told by Prof. Dickson that in twenty-four 
years’ practice but three have passed without his knowing of 
the occurrence of yellow fever. As regards the essential cause 
of yellow fever, we still remain in the dark. It is manifest, 
however, that, to develop the cause, and to keep up its action, 
requires a high range of atmospheric temperature; and, as 
this condition seldom attains on the coast of Florida, it would 
seem to afford, in part, an explanation of its infrequent ap- 
pearance in this region.” 
Who should go to Florida f When one thinks of our cold 
weather at the ISTorth, extending from October almost into 
June, with the last three months of alternate freezing and 
thawing, cold and damp, wTith their attendant crops of colds, 
influenzas, diphtheria, pneumonia, etc., one is disposed to an- 
swer, “All who can afford it.” The mass of visitors, who 
now pour into the State to enjoy the winter, are not invalids 
in the strict sense of the term ; many of those who are in- 
valids are not perceptibly so to the general observer, and the 
average tourist is not therefore annoyed, as he feared he might 
be, by constant contact with sick and suffering people. Of 
course, of the invalid class, those afflicted or threatened with 
phthisis and its allied affections constitute the majority of the 
pilgrims to all southern climates. Although I do not coun- 
tenance the practice of banishing those in the last stage of 18 
the disease from friends and the comforts of home, yet, as has 
been before stated, not all of those die, and an apparently 
rash and hopeless determination of a patient, perhaps in oppo- 
sition to physician and friends, occasionally results in cure. 
Besides, a considerable margin ought to be left for a possible 
mistake in diagnosis. Our lirst-class diagnosticians would 
hardly require this margin, and many who do not come within 
this> category will doubtless resent this insinuation. But a 
winter’s experience in Florida among the invalid visitors 
would convince the most skeptical that modern diagnosis of 
pulmonary complaints, even among those who stand high in 
professional estimation, lias not arrived at the degree of per- 
fection usually accorded to it. Then there is a class of cases 
which would be greatly benefited by a winter’s residence 
here, which is not considered of sufficient gravity by many 
physicians to be banished from home : those who present some 
of the rational symptoms of phthisis without any physical 
signs—a condition not unfrequently, at the present day, con- 
founded with the effects of malaria—such cases as Dr. I. E. 
Pollock had in mind when he said, in his recent lectures on 
phthisis, a Here ”—that is, where we have “ a union of sub - 
■febrile symptoms with progressive waste of the body—is danger 
without any physical signs.” Incipient phthisis, pneumonic 
consolidation, laryngeal and pharyngeal diseases, have sought 
and obtained great and prompt relief from this climate, espe- 
cially if not hereditary. Many cases of throat-disease are, 
however, sent here for the local affection, who have the seal 
of consumption already stamped on the countenance, yet who 
are in ignorance of any constitutional disease, and who be- 
come sorely disappointed at the slow progress, and sometimes 
the hopeless nature, of the case. Of all thoracic diseases, 
chronic bronchitis, not rarely confounded with phthisis, is 
most certainly benefited by a Southern winter. Asthma is 
benefited, but to what extent, and in what particular localities, 
I am not able to say. It has been claimed by invalids that a 
locality back of Mellonville or Sanford, on the river, is particu- 
larly efficient. Forry states that the patient who is suffer- 
ing from pure spasmodic asthma, or that which is complicated 
with chronic bronchitis, or that which is symptomatic of pri- mary irritation in other viscera, is much benefited ; also asth- 
ma connected with affections of the heart. But he does not 
advise any particular locality. The earlier stages of Bright'18 
disease may be more successfully treated here than in the in- 
clement weather of Northern latitudes ; also persons, espe- 
cially those of a delicate constitution, convalescing from 
measles or scarlatina, particularly when the affection of the 
kidney or other sequelae are slow in passing away. Old age 
finds in Florida a congenial winter home. Aside from the 
dangers of thoracic disease, to which this period of life is so 
peculiarly liable in our Northern spring climate, the vitality 
is impaired by the long winter and lagging spring. Many of 
this class of the male sex are also suffering from vesical and 
prostatic disease; and the impairment of cutaneous action, 
induced by cold, causes much suffering, and hastens an unfa- 
vorable termination. Many cases also of the other sex, whose 
vitality has become impaired by chronic uterine disease, and 
whose local ailments have been relieved, as far as possible, by 
local treatment, find a no less invigorating tonic in this balmy 
air. lihewmatism and some forms of neuralgia are benefited. 
Certain forms of dyspepsia, particularly such as may be termed 
nervous dyspepsia, which is, like other nervous affections, be- 
coming more and more common—which is merely one of the 
many symptoms of modern “wear and tear,” and which is 
often relieved completely, for a time, by the bromides, when 
various other treatment has failed—are permanently relieved 
by a winter’s residence here. Lastly, Florida offers a haven 
of rest and quiet for that condition which is unfortunately 
becoming so prevalent among the restless, driving denizens of 
our Northern cities and towns, which comes under the com- 
prehensive designation of nervous prostration ; what Hand- 
field Jones terms cerebral paresis, and which was thus de- 
scribed by James Johnson nearly fifty years ago :1 “ There is 
a condition of body intermediate between sickness and health, 
but much nearer the former than the latter, to which I am 
unable to give a satisfactory name. It is daily and hourly 
1 “ Change of Air ; or, the Philosophy of Traveling,” by James John- 
son, Physician Extraordinary to the King. 20 
felt by tens of thousands in this metropolis and throughout 
the empire ; but I do not know that it has ever been described. 
It is not curable by physic, though I apprehend it makes much 
work for the doctors ultimately, if not for the undertakers. It 
is that weak and tear of the living machine, mental and 
corporeal, which results from over-strenuous labor or exertion 
of the intellectual faculties rather than of the corporeal pow- 
ers, conducted in anxiety of mind and in bad air.” For this 
cerebral consumption, as we may call it, Florida affords as 
soothing a balm as for the pulmonary variety. It is as un- 
satisfactory to treat the one as the other in the stimulating 
and exciting atmosphere of our Northern Babylons. There, 
everything is energy, hurry, and rush, at all times and at all 
seasons; when the body is at rest, the mind is not. Here, 
the tendency is always in the opposite direction. Here, the 
Northern blasts, as they approach our borders, are gradually 
hushed into whispers. There, the very streams seem to rush 
along their rocky beds as if afraid lest winter should congeal 
them before they reach their ocean-goal; here, the swiftest 
currents have not enough energy to form a ripple. All Na- 
ture wears so subdued and peaceful an aspect, as one floats on 
the broad and placid bosom of the St. John’s, that the most 
restless mind soon becomes attuned to the same measure of 
repose. Rest has come again to the wearied spirit, sleep to 
the fevered pillow. “ All that surrounds one in Florida,” says 
Ledyard, “ is suggestive of, and in unison with, rest; and noth- 
ing is more grateful.” 
When shall one go to Florida f This will depend on cir- 
cumstances, extrinsic and intrinsic, as regards the individual, 
and may be left to the judgment of the physician. But, if an 
invalid lias only a limited winter vacation, he bad better spend 
it at the end than the beginning or middle. “ When shall one 
leave Florida or the South ?” is a more important query. Many 
not only sacrifice all the benefit obtained by a winter residence 
in the South, by yielding to an impatient desire to get home 
too early in the spring, but are actually damaged to a greater 
extent than if they had remained at home. Even healthy 
persons, who go South merely to avoid a disagreeable winter, 
are rendered more sensitive to cold, and contract colds or catarrh, by going North too soon. One may commence getting 
homeward in April, if he tires of sameness; otherwise, lie 
need not move until May. But he should not get north of 
Virginia until the third week in May. If the climate of Flor- 
ida becomes oppressive in April, Aiken, or Beaufort, in South 
Carolina, affords a more bracing and, at both the beginning 
and end of winter, a delightful change. He should not arrive 
in the latitude of New York until the third week in May, 
better even the first of June, if he has actual pulmonary dis- 
ease. 
IIow shall one get to Florida f There are many routes, 
by land and by sea. The feeble invalid, if he takes the for- 
mer, should go by easy stages, and not rush. The latter part 
of the journey is so slow and tiresome that, unless he has an 
unusual repugnance to the sea, it would be better to take one 
of the very good steamers, of which there are several lines, 
the most popular being that which touches at Charleston, 
where a transfer takes place to the steamer which goes direct 
to Jacksonville and Pilatka. Being once aboard, all fatigue 
is at an end, and the four days of sea-voyage are generally 
beneficial to pulmonary and throat affections. The warnings 
of our excellent signal-service now render ocean-travel by 
steamer, on the coast, almost perfectly safe. Sea-sickness is 
the dread of many. There are several means by which this 
may be greatly alleviated, and frequently entirely prevented. 
First, one may take bromide of potassium in doses of twenty 
to thirty grains three times a day, for three days preceding 
embarkation. This deadens nervous impressions on the 
centres, and blunts reflex action. I was led to infer this 
powrer of the bromides from their efficacy in preventing the 
vomiting induced by anaesthetics. Then, the belt recommend- 
ed by Jobard, of Brussels, is, in many cases, a valuable pre- 
ventive. It is worn, as tightly as can be conveniently borne 
(which gives less trouble to females than males), around the 
waist, and should be shaped to fit well, and be provided with 
bones like corsets. I have had some made at Tiemann & 
Co.’s, 67 Chatham Street, after Jobard’s pattern. Ilis idea, 
that it acts by preventing friction of the viscera against the 
diaphragm, thus provoking it into action, is untenable. It 22 
may act by the support and compression afforded the great 
vessels in the abdomen, thus preventing or limiting the varia- 
tion in the blood-pressure in the brain; or the pressure may 
influence the semilunar ganglion. The former is the more 
probable explanation, since persons who have made several 
voyages have found that, by managing their respiration in a 
certain manner, the sickness may be prevented. That is, by ac- 
customing one’s self to take an inspiration as the ship descends 
with the wave, and making the expiration correspond, as far 
as possible, with the rise of the ship, this apparent sinking of 
the ship under the landsman being the motion most likely to 
induce the sickness. Yomiting and nausea, from a variety of 
causes, are frequently cured, after the failure of all ordinary 
means, by the use of electricity by faradization. The writer 
first called the attention of the profession to its remarkable 
effects in this respect, in an article in the first number of the 
Archives of Electrology. He has not had sufficient evi- 
dence yet to prove its value in sea-sickness, but such as he has 
had is favorable. A small Gaiffe battery, which is inexpen- 
sive and easily manipulated, can be readily managed by the 
patient or a friend, one wet electrode being kept on the epi- 
gastrium, the other over the spine, or rather just to either side 
of it, unless it is large enough to extend across, and then over, 
the seventh cervical vertebra. 
IIow shall one live in Florida f This question will not be 
fully answered here, as it will be again taken up. Those who 
have a fondness for out-door life, hunting, fishing, etc., and who 
have the vigor to endure a little hardship, may form a party, 
provide the necessary equipments, and, with Hallock’s “ Camp- 
Life in Florida” and similar books as a guide, may find abun- 
dance of novelty, adventure, and game. If they need any 
other advice, I have no doubt my friend Al-Fresco, Dr. C. J. 
Ken worthy, of Jacksonville, will kindly furnish it to any of 
his confreres of the profession. One may live in good board- 
ing houses at ten to twelve dollars per week, with good rooms 
in pleasant situations, but, if he can afford it, the hotels in most 
places of resort are far preferable on the score of food. This 
is especially the case on the St. John’s, where the hotels have 
an exceptionally good reputation. Good and well-cooked food is a sine qua non in the case of such diseases as those 
for the alleviation or cure of which people come to Florida. 
Full nutrition of the body is of the highest importance, and 
patients should never sacrifice to a desire for cheap board ; it 
is better to make almost any other sacrifice. Many failures, 
attributed to the climate are probably due to error in this re- 
spect. If appetite or digestion fail for lack of inviting or di- 
gestible food, and this cannot be obtained, the invalid had bet- 
ter go North and brave the cold, if he has a comfortable home. 
If possible, one should always secure a room into which the sun 
shines during a considerable portion of the day, especially the 
morning sun. Nothing is more cheering, and nothing is more 
beneficial to the chronic invalid than sunlight. No trees 
should be allowed to intercept the sun’s rays. If too hot, it 
can be moderated by awnings or blinds. A sickly plant is 
revivified by sunshine and light, and the invalid animal re- 
sponds equally, if not so apparently, to their stimulating in- 
fluence. We have banished the traditional heavy and dark- 
colored hangings which formerly adorned the bedsteads of the 
sick. Let us equally hanish them from the windows of the 
sick-chamber, and admit the glorious light and air of heaven 
to assist our tonics with what no artificial tonic can supply. 
Let us endeavor to cure our patients of a prejudice which 
James Johnson aptly terms phoebophobia. 
With regard to the clothing proper for the winter climate 
of Florida, it is seldom that the invalid will want that which 
we wear at the North in summer, but rather that suitable for a 
moderate winter or late fall. Moderately thick clothing will 
be sometimes a little oppressive in the middle of the day, but 
always pleasant in the morning and evening. A tolerably 
thick overcoat ox shawl, as the case may be, should alwrays 
be taken along when one goes to ride, or in a steamboat, as 
the rapid motion creates a draught through the saloons. Thin 
woolen clothes should be w7orn at all times. 
A most important desideratum for the invalid is occupa- 
tion—something to give employment to both mind and body. 
Want of it is the stumbling-block to the improvement and 
enjoyment of too many of our Florida visitors. Ennui is a 
dangerous enemy of the invalid. Ilis thoughts, when not 24 
employed upon something external, are sure to be turned 
upon his disease, whether imaginary or real, and usually to his 
detriment. “Employment, which Galen calls 4 Nature’s Phy- 
sician,’ is so essential to human happiness that indolence is 
considered the mother of misery.” 1 English soldiers in the 
West Indies, while idle, though kept out of the sun, and taken 
care of, were far more disposed to diseases, says Robert Jack- 
son, than when kept at moderate labor nearly all day long, 
building roads in a marshy district. Lanier, in his interesting 
little volume on Florida, himself an invalid, thoroughly ap- 
preciates the importance of this subject. He says: 44 Endeavor 
to tind some occupation consistent with your disease’s require- 
ments. Brooding kills. If you are near a Florida farm (e. g.)r 
interest yourself in something which is going on there, the 
orange-culture, the grape-culture, the banana, the fig, the 
early vegetables, the tine tobacco-culture and the like. The 
field of Florida in these matters is yet so new, so untried by 
the resources of modern agricultural improvement, as to be 
full as fascinating, if one should once get one’s interest aroused 
in it, as it was in the old days when the Spaniards believed it 
to be full of gold and pearls.” Many invalids came to this spot 
last winter, and, finding nothing to interest them, although 
acknowledging the superiority of the climate, wandered off 
in search of novelty. Many others, although remaining here 
for many weeks, found that there were objects of interest still 
unexamined when they left, although pretty industriously em- 
ployed all the time. The fault, in these cases, is generally in 
the individual, not in the place. Some seek out sources of in- 
terest and amusement for themselves wherever they go; others 
of different tastes, or less inquiring habits of mind, yield to 
the temptation of indolence. Those who have become blase 
from frequent visits to ordinary haunts of visitors may, if 
they possess the requisite strength and energy, strike out a 
new course, and explore almost untrodden regions, and without 
any particular danger or discomfort. 44 Of the tens of thou- 
sands,” says A. M. Conklin, 44 who, each winter, go to Florida 
in search of health and pleasure, few if any ever hear of this 
delightful interior country,” referring to the Kissimmee and 
1 Burton, “ Anatomy of Melancholy.” Okechobee region, “ whicli is as little known to the outoide 
world as Amazonian forests, East India jungles, or the lakes 
of equatorial Africa.” Besides the natural beauties and ob- 
jects of interest, there are some of the most interesting relics 
of the moundduilders to be found in the State. Their, location 
and peculiarities are described in the December (1875) number 
of the Forest and Stream, with a map. Visitors last winter 
found much to interest them in their visits to the mounds 
which are scattered along the St. John’s Biver above Pilatka, 
and their explorations therein. These remarkable works of 
ancient art scattered all over our country are still a mystery, 
to some extent, to our scientific authorities, and an examina- 
tion of the subject, as found discussed in the many interesting 
works by Baldwin, Jeffries Wyman, and others, in connec- 
tion with the explorations and examinations which they can 
prosecute themselves in Florida, will be found to afford agree- 
able and perhaps profitable diversion to body and mind for a 
considerable portion of the winter. 
Physicians, in sending their patients South, frequently ad- 
vise them by all means “ to avoid drugs and doctors.” The 
same advice, at home, might often be good for those who have 
a propensity for too much indulgence in these luxuries (?); and 
doubtless has, in some instances, saved invalids here from 
injudicious medication and advice. But, from my experience 
last winter, I judge that a much larger number have been 
directly injured by it, and, not unfrequently, it has cost them 
their lives, through neglect of the early treatment of serious 
complications. Any physician in large practice in Florida, or 
any boarding-house keeper, can furnish instances of this kind. 
There is no prominent resort in Florida where respectable 
medical advice cannot be had—advice which would certainly 
be far better than the usual plan of trusting to luck or Na- 
ture, or the advice of lady-friends, or the carefully-put-up bot- 
tles and packages brought from the North to meet all the 
indications for treatment which may chance to arise during a 
long winter. Unless the medical knowledge and diagnostic 
skill could also be bottled up to accompany these last, they 
will be likely to prove a delusion and a snare. For a delicate 
invalid, the risk of a faulty diagnosis, of mistaking the incep- tion of a serious complication, or of a disease, for some simple 
derangement, great, much greater than that of getting 
medical advice due inquiry is made for the best. 
Besides the local physicians, there are now, always in all fre- 
quented places, medical men from other portions of the coun- 
try, well known to the profession. The writer will refer to 
only one instance, in illustration, out of many which have 
fallen under his observation. A well-known physician of one 
of our largest Northern cities accompanied his patient to 
Jacksonville the»past winter, and introduced him to a promi- 
nent physician of that place. Subsequently, the latter was 
called in, and found that the gentleman had, from some impru- 
dence, taken a severe cold a few days before, and had been 
endeavoring to get along the best wa}7 he could without med- 
ical advice. He said, “ Doctor, I don’t know if I have done 
right in sending for you, for Dr. charged me not to send 
for a physician , unless it was absolutely necessary.” The 
disease proved to be capillary bronchitis, which is frequently 
irremediable even if taken at the onset. lie was in a hope- 
less condition, and died within twenty-four hours. Another, 
scarcely less serious, and even more prevalent error, in the 
writer’s opinion (one, indeed, to which we must all, to a cer- 
tain extent, plead guilty), is, concealing from the invalid, and 
even also from the friends or relatives, the true nature of the 
disease. This entails unpleasant consequences both on the 
profession and the patients. The true pathological condition 
not being stated, the different physicians who may be called 
in at different tunes to examine the case are not apt to hit, 
upon the same statement, and thus the public berate us for 
disagreeing, and the science of medicine is scandalized, or our 
honesty is impugned. One says to the invalid, “ Your lung 
is a little weak; ” another, “ There is a little pleuritis at the 
top of this lung;” another, “There is some consolidation at 
the apex ; ” or, “ The air does not enter quite as well in one 
lung as in the other; ” or, “There is a little bronchial diffi- 
culty ; ” “ The tubes are slightly affected.” Often “ chronic 
pneumonia” is diagnosed. If there has been haemorrhage, 
especially if it has been slight, the patient is always, in his 
anxiety to make out his case as favorable as possible, ready with his explanation to the physician that “ it is only from 
my throat. I suppose ? ” The doctor says, “ Possibly it is,” 
and fails to undeceive him when he finds, as he usually does, 
that it isn’t. Then the patient tells his second and liis third 
physician that his “ doctor ” says it is only in his throat, and 
the other physicians wonder, perhaps, how so eminent an au- 
thority could make so glaring a blunder. Now, all these asser- 
tions are literally true, but they are not the whole truth ; in 
fact, but a very small part of it. A medical man knows what 
a “little weakness in one lung ” signifies, but the patient does 
not; or “ a little pleurisy ” at the apex ; or “ a consolidation,” 
or “ the little bronchial difficulty,” etc. He knows it means’ 
in nineteen cases out of twenty, incipient phthisis—“con- 
sumption.” But the patient does not, and he is very sure not 
to cross-question the doctor too closely, if at all. He is only 
too glad to have his fears allayed so easily. Behind these 
comparatively trivial secondary affections, there is often 
tubercular deposit, or, if one prefers to call it so, permanent 
pneumonic consolidation, or softening; or, not unfrequently, 
already a cavity. Many patients come to Florida with exten- 
sive softening in one or both lungs, with the consent, if not 
the advice, of their physician, who dreads to tell the whole 
truth, and to crush the bright anticipations of cure, which 
they and their relatives have formed, through the instrumental- 
ity of the climate of this favored region, of which they have 
heard so much ; and, perhaps, hoping that, at least, a tempo- 
rary lull in the progress of the disease may be obtained. 
When an early death occurs, with none, perhaps, but strangers 
around, and the body is, according to custom, sent home by 
express, then the physician’s reputation suffers, or that of 
Florida. If he is right, Florida is wrong. But Florida can- 
not work miracles. It is true, the physician is often met at 
the threshold, by the friends of the invalid, with the cau- 
tion, and often quasi command, “ Don’t tell her she has con- 
sumption—it will kill her if you do ! ” One may well say, on 
the contrary, “ It will kill her if you don’t.” In the long-run, 
the effects of the deception are far worse than those of the 
truth. The former are far-reaching and continuous, ham 
pering other physicians in their management of the case 28 
while the latter are transient, though, no doubt, at times dis- 
tressing and severe. No matter how slight, then, the begin- 
nings of the disease may be, the moment we are certain, we 
should say to the patient, “ You have wliat will result in ‘ con- 
sumption ’ without proper management.” In fact, in most 
cases, we can say, “ You have the beginning of consumption.” 
If the announcement is made in a proper manner, which 
the physician’s tact will enable him to vary according to the 
idiosyncrasy of his patient, the shock is slight, and entirely 
neutralized, and the patient’s confidence reassured, by the fur- 
ther statement that, with due care, and proper hygienic and 
remedial measures, the disease can he cured just as certainly 
as many other diseases. It would be a waste of time, and a 
superfluous attempt, at this epoch of medical history, to un- 
dertake to prove this. Consumption has always been con- 
sidered one of the opprobria medicorum. But there is no 
reason for this. Consumption is as curable as any other 
chronic affection—more so than many of them, if we can 
command the conditions of cure, if the patient can avail 
himself of the proper remedies. Most diseases would be in- 
curable without a resort to the proper remedies. It so hap- 
pens, however, that most of the best remedies for this disease 
are unattainable by the majority of those afflicted by it; also, 
that most patients, influenced by the delusion which is so 
characteristic a symptom, and often by the concealment of 
physician and friends, delay treatment. Hence its great fatal- 
ity. The cure of phthisis will never be found in any drug or 
any combination of drugs, although these are valuable, and, 
indeed, in most cases, indispensable auxiliaries. There is no 
disease, in which skillful diagnosis, sound judgment, judicious 
advice as to habits, occupation, climate, all the minutiae which 
enter into individual daily life, are so well repaid by corre- 
sponding success as in this. Change is generally the key-note 
to our management of incipient phthisis—change of locality, 
of air, of almost all the habits, leaving off bad and adopting 
good ; ventilation, exercise (judiciously managed),food. Now, 
it would be mockery almost for us to say to the poor shoe- 
maker, or compositor, or tailor: “ Your only chance is change 
of climate, of occupation ; you must give up your close room with its confined and poisoned air. You must take to the 
sea or the farm, to out-door work and regular exercise, good 
food, sound wrine, fewer hours of work,” etc. We are driven 
to the only alternative. When we cannot get the proper 
remedies, we must do the best we can. We prescribe such 
hygienic rules as can be observed. We prescribe cod-liver oil, 
phosphorus and its compounds, palliatives for cough, etc., 
and we thus lengthen and render more tolerable the lives we 
cannot save. Sometimes, even under these untoward circum- 
stances, wre do save life. All do not die, by any means. The 
physician who, at this day, consigns his consumptive patient 
to the realms of despair even in the more advanced stages of 
the disease, without an effort to save him, scarcely appreciates 
his mission to its fullest extent. Suppose, then, that our inva- 
lid knows that he has incipient consumption, or that condition 
of lung, call it by whatever name you will, wdiicli under ordi- 
nary circumstances will almost surely result in actual con- 
sumption. He is cheered by the confident assurance that his 
chance for complete recovery is good (we are speaking of 
those able to avail themselves of our advice); that, at all 
events, if he does not completely recover, his life may be 
greatly prolonged. But, he also understands that his life 
is, so to speak, in his own hands; that he must, in a measure, 
work out his own salvation. He knows that he banishes him- 
self from home, perhaps from friends also, to make & fight for 
life. lie ought to know, likewise, that the fight is not to be 
a short one; that perseverance is necessary, and a patient ac- 
quiescence in all the minutiae of the advice of his physician, 
however much and often it may conflict with his wishes and 
his temporary pleasures. Without this knowledge, it is almost 
impossible to get the patient to avoid the most outrageous in- 
fractions of the most simple rules. The physician must see 
to it that his patient is not hampered by too much advice 
and too strict rules. Here, judgment and a study of individ- 
ual character come into play. Some patients may bear con- 
signment to the backwoods, to the interior pine-regions—no 
doubt, per se, the best place for many. But something more 
than dry air is needed. Many would almost as soon be bur- 
ied. Many qualities of climate and location, besides that of moisture or dryness, are to be considered in making a choice 
for individual patients — congeniality, amusements, occupa- 
tions, diversion of the thoughts from within, life, activity, 
facility of access to and from the outside world. 
But, suppose the disease is not incipient. Suppose it is 
advanced, that it involves a considerable portion of the lung, 
that softening has commenced, even an abscess exists. It may 
be asked, “ Would you still inform a patient of his condition ? ” 
To a certain extent, yes ! How far, would depend on the in- 
dividual. There are exceptions to all rules. Such conditions 
involve more stringent rules and advice than the milder 
cases; and few patients will be disposed to submit to them 
at all times if they are not impressed with the necessity, and 
they cannot be so impressed if they are told that nothing very 
serious exists. The general condition of many of these—the 
appearance, the figure, the muscular strength, the appetite, 
the sleep, the ability to sustain considerable fatigue—may be 
good, or quite fair; and it requires no small degree of confi- 
dence in a physician to convince such invalids that their con- 
dition is such as to demand so close an adherence to hygienic 
rules. Even if the usual debility, cough, emaciation, etc., 
exist, the delusion, which is an almost inseparable attendant 
on the disease, prevents the invalids from realizing the mean- 
ing of these symptoms. Being in ignorance of their condi- 
tion, they are constantly wondering why the cough cannot be 
u stopped ; ” why the hoarseness or soreness of throat cannot 
be arrested ; why the expectoration cannot be checked ; why 
they do not gain fiesh or strength more rapidly, like others 
whom they look upon as afflicted with the same form of dis- 
ease. If the physician has kept them in ignorance of their 
condition, he cannot explain himself satisfactorily; his appar- 
ent want of success impairs confidence, and they apply to 
some other; and, in going from one to another, and from one 
location to another, and thus undergoing a succession of ex- 
periments with various drugs and various climates, they lose 
the only hope, which is in a steady perseverance. 
Some of the reasons why invalids fail to secure the ad- 
vantages which they have a right to expect from a winter resi- 
dence here have just been incidentally considered : a want of proper appreciation of their condition, and of proper advice, 
leading to want of proper care. In fact, the extent of the 
recklessness and the want of common-sense exhibited by 
many invalids would not be believed by any one who had not 
observed it. Even the remonstrances of friends seem to in- 
fluence them but in a trifling degree. My friend Mrs. Alex- 
ander Mitchell, of \rilla Alexandria, near Jacksonville, can 
corroborate this statement, as almost any observing person 
here can. Her house and grounds affording, from their 
beauty and tasteful adornment, a source of pleasure to visit- 
ors, she is sometimes almost overwhelmed by them, and she 
related numerous instances of the temerity of invalids, ladies 
especially, in coming over in frail sail-boats in the most in- 
clement weather, and clad in the most unsuitable garments, 
sometimes arriving drenched with spray or rain. On one or 
two occasions she has had to send out her boats to rescue 
them. In fact, her experience teaches her that, if there is a 
particularly unsuitable day for visitors to venture on the 
water, she must expect a batch of invalids. Her kind re- 
monstrances seem to be entirely unheeded, the same invalids 
not unfrequently repeating the operation. Instead of getting 
the best advice as to location, and remaining there a reason- 
able length of time for testing it, they remain a day or twro, 
and, if the weather happens to be unpropitious, or the hotel- 
table not precisely what it should be, or the company not par- 
ticularly agreeable, or the evenings dull, off they go to try 
another experiment, thus traveling from one place to another 
all winter. Suppose they find a place which they cannot but 
acknowledge to be all they could expect as to climate, ac- 
commodation, fare, etc. One would suppose that any sane 
invalid would be glad to remain there. No! “ I am getting 
tired of this place.” “It is so dull.” Or, “My wife don’t 
like it,” or, “ My daughter don’t enjoy herself.” And off 
they go in search of variety and excitement. Life and health 
weigh lightly against matters of such magnitude as these! A 
party is made up, when the weather is line, to go to some 
lake or stream on an excursion. When the hour arrives, the 
wind has changed, and a cold, wintry blast is sweeping from 
the north. Of course, you would say, “ The invalids won’t 32 
tlii 11k of going.” Not so. They are usually among the first 
to protest against any postponement; asserting, without 
knowing anything about it, that the wind will soon change 
and the day be pleasant. And then they must see everything 
that is to be seen. They must stand in the forward part of 
the boat, where the view is best, and the draught is worst. 
Many, on the other hand, come to one locality, and, without 
any competent medical advice, do stay a whole winter, get- 
ting worse all the while. But they like the place, the room 
is good, the music is fair, there are frequent “ hops ” for the 
daughters, and they are hoping all the time to get better. 
Then, when spring comes, they go home, and condemn Florida, 
as if the whole State, like France, were represented by one 
city. 
For instance, Miss M., and a gentleman-friend suffering 
from lung-trouble, went to Sarasota Bay, then to Manatee, on 
the Gulf coast. They were out of the world and uncomfort- 
able, and getting rather worse than better. But they re- 
mained ; and, in order to get away in the spring, had to pro- 
ceed some miles in a small boat to the coast to await the 
uncertain arrival of the little steamer plying to Cedar Keys. 
And here they were exposed for two days; and both are 
naturally rather “disgusted with ‘Florida.’” Again, the in- 
valid, on the way down in the cars, takes a slight “ cold; ” 
nothing more likely. The cold is neglected, it gets worse; 
the cough increases, the nights are thus made restless and 
sleepless, the appetite fails, there is some fever. The husband 
or mother gets nervous. “ The climate don’t agree,” and per- 
haps they go home again, or go to St. Augustine, or to Aiken, 
or Jacksonville, or Pilatka, or somewhere else, anywhere ex- 
cept where they ought to go, that is, to a competent physician 
for advice, as to what they should do. A suitable change may 
be required, or perhaps only a simple cough-mixture, and a 
little judicious nursing is all that is required to give the cli- 
mate a “fair show.” Sometimes the change of water or 
climate causes a diarrhoea, or it may set in as one of the acci- 
dents of the disease. It is a simple matter if managed in the 
proper manner, and, in a healthy subject, would perhaps re- 
quire no treatment. But it continues. The invalid finally consults a friend. She has a specific, of course; this fails. 
Another is “sure.” This don’t succeed. Finally, perhaps 
after considerable damage is done, a physician is consulted as 
a dernier ressort. Loss of appetite is a not unfrequent com- 
plaint among this class of invalids. But this is endured, and 
worried about, and friends are again consulted, and “bitters” 
are recommended, and the winter is thus wasted to a consid- 
erable extent. It is a very common occurrence, and one of 
the greatest nuisances of Southern watering-places in winter, 
for patients to lose their sleep, night after night, for weeks 
sometimes, with a most severe and persistent cough, and 
seemingly not to be aware of it. At all events, they consult 
no physician ; and the distress and insomnia, and other 
troubles arising from it, sometimes completely counterbalance 
any good effect they might have derived from the climate. 
Hotels sometimes lose some of their best families in conse- 
quence of one person on a corridor coughing night after night. 
It would be tiresome to multiply these examples. One might 
adduce scores. They are mentioned as a hint to those who 
may be benefited by them. They are not, by any means, 
overdrawn. The writer is willing to risk the suspicion that 
he may have a selfish object. Those who know him will give 
him credit for a better motive. The following remarks, of a 
writer1 than whom no one is better qualified to give advice 
on this subject, are so appropriate in this connection, that they 
ought to be quoted at length: “Let,not the invalid, however, 
trust too much to a change of climate. Unfortunately for the 
character of the remedy, it has been recommended indis- 
criminately, and without proper consideration. It has been 
too often resorted to as a last resource or a forlorn hope; or, 
in cases susceptible of alleviation or permanent cure, it has 
been wholly misapplied. One person is hurried from his 
native land with the certainty of having his sufferings in- 
creased, and his life shortened, instead of being allowed to die 
in peace in his own family; while another, who might derive 
much advantage from the change, is sent abroad wholly un- 
instructed in regard to the selection of a proper residence, or 
ignorant of the various circumstances by which alone the most 
1 Forry, op. cit. suitable climate can be rendered beneficial. It is one of our 
most powerful remedial agents, and one too which, in many 
cases, will admit no substitute. But, much permanent ad- 
vantage will result neither from traveling nor change of cli- 
mate, nor their combined influence, unless the invalid adheres 
strictly to such regimen as his case may require. This rem- 
edy—change of climate—must be considered in the light of 
all other therapeutic means, and, to insure its proper action, it 
is requisite that the necessary conditions be observed. The 
patient should, in a measure, regard the change of climate as 
merely placing him in a situation more favorable for the 
operation of the remedies demanded by his disease.” These 
remedies, whether local or general, or both, though ineffective 
in a northern climate, may become curative when aided by 
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