SOUTHERN FEORIDA: A WINTER SANITARIUM. Read before the Philadelphia County Medical Society, February 24, 1886, BY WILLIAM A. EDWARDS, M.D., Instructor in Clinical Medicine, University of Pennsylvania Physieian to St. Joseph’s Hospital. [.REPRINTED FROM THE PHILADELPHIA MED- I CAL TIMES TOR MARCH 6, 1886.] SOUTHERN FLORIDA: A WINTER SANITARIUM. THE facilities now offered to Northern tourists and invalids for reaching far-southern climes are so well adapted to comfort and ease of travel that the physi- cian can feel justified in trusting the most delicate cases to the brief railway-journey necessary, which several years ago would have been wearing and fatiguing to the most robust. Indeed, a day and a night on a modern parlor- and sleeping-car is anything but an unpleasant experience, opening each moment new sights and, to the traveller from the North, odd customs of inhabitants of Southern States along the line of travel. The study of climatology and the selec- tion of sanitaria are of great importance to the physician ; but, unfortunately, they usually receive but little attention from the practitioner. How often is the advanced invalid sent far away from his home and all that is dear to him, to be surrounded by strange sights and faces in a strange land, where he has been ordered by a physi- 2 cain who had not taken the trouble to look sufficiently into the matter in order to qualify himself to decide the important question as to which particular climate or locality was the one best adapted to his pa- tient’s case ! This has been well stated in a recent address before the American Cli- matological Association by Dr. John M. Keating, whose personal experience in climatology, gleaned from the climes of all nations, is second to none among us. In considering the matter of a selection of climate, Dr. Keating remarks as follows: “ How often have I met cases of ad- vanced phthisis, away from all the com- forts of home and its surroundings, dying in a strange land, sustained only by hope and the fact that they were carrying out the physician’s order! I wish that my words could only be made sufficiently im- pressive to picture to you, as the subject comes up before me, the many sad cases I have witnessed. It is so very easy for the doctor, who possibly knows that all hope is ended and a fatal termination not very far distant, to say to his patient, ‘ Go to Algiers,’ ‘ Go to Egypt, Australia, or Cali- fornia.’ The poor, unfortunate patient is at once inspired with hope. His weakened frame is sustained by the nervous energy which is brought about by determination. The long journey before him is no ob- stacle. Its discomforts are discounted ; and yet he scarcely reaches his destination before nature gives way. The journey to a foreign land requires a degree of strength 3 that is often surprising even to a man in good health. The wear and tear, the vi- cissitudes of temperature, the character of the cooking, damp sheets, and the hard beds, are much more wearing thaa most of us imagine. Our Consul-General to Egypt some years ago told me that much of the business of the Consulate was the caring for the baggage of the consumptives who had been sent from home in the last stages of the disease, to run down more rapidly, and possibly die within two or three weeks of their arrival. One of the most shock- ing sights to the invalid travelling South is to run across the boxes with the death- certificate upon them waiting at the sta- tions for the Northern train. Although I have the greatest possible belief in the value of the change of air and the resi- dence in a suitable climate for those in the early stages of disease, or where predis- position exists, or during convalescence, I am strongly opposed to the method at present adopted of recommending places in a general way, regardless of their suita- bility and other matters as important as the climate itself. A physician should know thoroughly the place to which he is sending his patient,—be as familiar with it as with the drug he orders in his prescrip- tion. ' “ I met in a fog, on a ship in the China Sea, a young lady who had been recom- mended by her physician to New Zealand. When she reached there with her family, her condition was such that they deter- 4 mined to bring her home. They returned by way of China, and the dense fog they encountered increased the catarrhal phthi- sis, which was rapidly breaking down, until she was in a sorry condition. Had she been sent to Aiken or Thomasville, or possibly Bermuda or Santa Cruz, and sur- rounded by the comforts of life, in an equable climate, within a few hours of her own home, she certainly would have lived longer.” Among the many sanitaria which our varied climate brings within our com- mand, South Florida pre-eminently sug- gests itself to the medical man in search of a winter-resort with a climate suitable for patients in need of out-door existence and a superabundance of pure, “unpre- breathed” air. The characteristics of the climate of South Florida are mildness and equability; it lies nearer the equator than any other of the States, yet extremes of temperature are usually unknown, the difference between the maximum of heat and cold being less marked than in any other part of this country. This applies more particularly to the southern part of the State, where frost is seldom found. The usual average daily temperature, it is said, does not vary more than twenty-five degrees, year in and year out. There is probably no other region in the world where so many elements are present combining to make the climate mild and uniform as in South Central 5 Florida, with Orlando and Winter Park as a centre. Frosts do occur in Florida, and ice is sometimes found in the shallow waters which are much exposed ; but this does not occur every winter, the present season of 1886 being a most unusual experience. For the Floridian south of Lake George, ice and frost would indeed be an unusual sight. There is no clearly-defined “ frost-line but the twenty-ninth degree separates the region of damaging frosts from those that are extremely light. We should bear in mind the fact that at the 29th or 28th parallel we must not expect the mild winter, the warmth and the sun- shine of the tropics: for such we must either seek the tropics themselves or visit Southern California. Changes in temperature, rainy days and cloudy skies, will accompany the same conditions experienced in the North, though to a very much milder extent. These should be expected and prepared for. The absence of blinding snow, of heavy and continuous frosts, of biting winds, will enable the invalid to live in the open air. If a patient wish to spend the entire winter South, he should choose the well- heated and comfortable hotels of Aiken, Thomasville, or Jacksonville, and remain there until he can be comfortably accom- modated farther South. People do not expect cold weather in the far South, as it comes but rarely, and 6 when it does come the hotels are not pre- pared for it. Cyclones and hurricanes never visit the State, nor do earthquakes arise, such as might cause more nervous prostration to a delicate patient in a few short moments than therapeutic skill can undo in months. Nor do the dwellers along the larger streams have to fear an overflow. Natural reservoirs have been constructed for the receipt of the immediate rainfall and for the drainage of the surrounding counties: hence the rise and fall of the rivers are automatically arranged by Nature’s engi- neer. The water gathers in the lakes, these rise in their natural basins, and are again slowly reduced by the rivers. It must be borne in mind that the entire State is now undergoing a most wonderful upheaval and improvement; marshes are being drained and cultivated, and thou- sands of acres are yearly meeting the hus- bandman’s plough for the first time; yet, withal, fevers, especially malaria, are not at all frequent, except among those who systematically disobey all hygienic laws, drinking surface-water from creeks and living upon low and badly-drained lands, and continuing upon a basis of living and eating suitable only to cold climates. Some sections of the State are totally ex- empt from malaria, as those in the vicinity of the sea-shore, and also those in the high, dry pine-lands, with Orlando and its vi- cinity as an example. It is particularly in Orange County, of which Orlando is the 7 county-seat, that the highest point above the sea is reached on the peninsula. Here you may find the pine-forests and a cli- mate soft and even. This is the climate and the locality that I would particularly recommend for cases of phthisis,—in fact, for all thoracic affections; while for nerv- ous prostration and neurasthenia in the aged it is perhaps the spot par excellence. As an illustration of the mildness and equability of the climate of Orange County, I will quote from the report on meteorology: “In December, 1880, oc- curred the coldest weather known in Flor- ida for fifteen years. On the coldest day the mercury at St. Augustine fell to 160, at Jacksonville to 20°, at Palatka to 240; at Orlando the mercury fell no lower than to 300.” The writer has met many cases through- out Florida, but particularly in South Central Florida, healthy and vigorous, some of whom are physicians now enjoy- ing large and lucrative practice, who sev- eral years ago came to this region as a dernier ressort. It has also been my fortune to meet sev- eral men prominent in business and in public life, in fact shaping and giving character to the locality that we are con- sidering, who, some years ago, came to Orlando simply as a last refuge from death. The county is the most progressive re- gion of a very progressive State. Some years ago—about fifteen—it hardly existed, save as a cattle-range with a very sparse 8 population. Now it numbers 15,425 souls, —a gain since 1880 of 8807. In this portion of the State is situated the famous lake-plateau, numbering one hundred lakes, along the margins of which people live in perfect health and comfort. In Orange County no limestone is found; hence the drinking-water may be either supplied by wells or obtained from the clear, deep lakes. Thus the problem of drinking-water is again solved by nature. In some of the counties the residents must depend on rain-water collected in tanks for all their table uses. The next important step is to consider the personal comfort of our patients dur- ing their Southern journey and the crea- ture comforts that they will receive after their arrival. The months of February, March, and April, with us, are the most treacherous of the year; in Florida they are replete with all that is most conducive to the welfare of the invalid: this is the time when Florida is at its best. Everybody coming to Florida by rail must stop at Jacksonville, and I would suggest that this be made the midway point. Let your patient here remain until he has entirely recovered from the wear and tear of his day-and-a-half railway-ride. Here will be found most excellent hotels, good drug-stores and physicians, plenty of amusement and avenues for mental di- version,—a most important, indeed an almost essential, factor in seeking health. 9 After this temporary breathing-spell, our patient will be ready to proceed farther down the peninsula, either by rail or by steamboat up the St. John River. The latter is the most interesting and instruc- tive. The steamers are large, commodi- ous, and comfortable. Berths can be se- cured for those patients too weak to sit about the decks and enjoy the ever-chang- ing scenery. Many interesting towns are passed, and along the east bank of the river from Palatka to Little Lake George, a distance of twenty-five miles, fine resi- dences and magnificent orange-groves in excellent cultivation are to be noted. On the opposite side, which is much lower, wild tropical plants and trees grow in pro- fusion. On entering Lake Monroe the patient is almost at the end of his river-trip, the ter- minus of the line being Sandford and Enterprise. Here I would again advise another halt in the journey. At Enter- prise is to be found one of the best hotels in the South, where the invalid will find everything conducive to comfort. It is situated on one of the finest bluffs in the State; all tropical fruits are found in pro- fusion ; the hotel has a very fine orange- grove; indeed, the “Brock House Grove” is among the finest in this section of the State. The lands surrounding Enterprise are high, rolling, and well cultivated. From here coaches run to New Smyrna, Halifax River, and its prominent points, where good hunting and fishing grounds 10 are to be found; bear, deer, turkeys, snipe, ducks, and small game are found in profusion : so that our patient, if at all able to be about, will find plenty of amuse- ment, and become enabled to set afoot the beneficial changes that may be ex- pected to be derived from such an exist- ence. To continue his journey, he will be obliged to take train on the South Florida Railroad (the trunk-line of railway to Tampa) from Sandford, and after an hour and fifty minutes’ ride will arrive at Win- ter Park, two hundred and twenty miles down the peninsula from Jacksonville, at which station will be found a small tram- car waiting to carry weak and sick persons from the station to the hotel, the “Semi- nole,” a distance of about two and a half city squares. The patient now finds himself excel- lently located upon high land, between two beautiful lakes, the ground gently sloping to either shore. From the promenades about the hotel nine lakes can be seen, bordered by graceful swaying pines and fruitful orange-trees. Here, in the centre of tropical Florida, the invalid can sit and bask in the warm sunshine of Indian summer in our early spring, constantly breathing pure ocean air dried and impregnated with the odor of pine, drink pure, sweet water, and in fact find rest, comfort, health, and lux- ury. Many mental diversions are pro- vided, tennis, croquet, bowling-alleys, billiards, good riding and driving horses, row- and sail-boats, steam-yachts running from lake to lake, with delightful walks among the old pines and orange-groves. When we recall the fact that one-sev- enth of all deaths are annually attributed to phthisis in the United States, and that in Maine, for example, fifty per cent, of all deaths between the ages of twenty and forty years are due to this cause, the known failure of our therapeutic agents in this disease gives to the study of climatology renewed interest. That climate is a po- tent agent in the prevention of phthisis is demonstrated by the fact that certain re- gions show comparative immunity, con- sumption being extremely rare in the native population. Dr. Archibald Smith states, for example, that it is an exotic in the Peruvian Andes. Damp, ill-drained land, cold, humid air, sudden changes of temperature, lack of sunlight, and anti-hygienic surroundings, all contribute to depress the general health and to occasion the fearful prevalence of phthisis in low-lying districts and in large cities. For instance, in New York the annual precipitation of rain and melted snow is 42.70 inches, exhibiting at once one of the causes of large cities presenting such enormous phthisical mortalities. Constant excess in the humidity of the earth and air predisposes to phthisical af- fections. On the other hand, dryness of earth and air gives to the residents of the locality under consideration comparative 11 exemption from disorders of the respira- tory tract. Laennec mentions a locality where the dampness of the soil was of such a character that two-thirds of the resident population died of phthisis. When in search of a climate for the pre- vention or cure of consumption, dryness of air and soil and the invigorating influences of sunlight must be among the deciding factors. As we see, South Central Florida is the region which presents us the most even climate, the largest proportion of fair, clear days, a sandy and absorbent soil, and the minimum amount of atmospheric moisture,—all the factors requisite in a per- fect climate for the class of cases under consideration. 12 300 South Thirteenth Street, Philadelphia.