The Climate of South Central Florida, especially for the Pulmonary Diseases of Women and Children. BY J. M. KEATING, M. 1)., PHILADELPHIA, VISITING OBSTETRICIAN TOTHK PHIL A DEI. PH IA HOSPITAL, AND LECTURER ON DISEASES OF WOMEN AND CHILDREN ; SURGEON TO THE MATERNITY HOSPITAL ; PHYSICIAN to 8T. Joseph’s hospital; fellow of the college OF PHYSICIANS, ETC. REPRINTED FROM 2Tl)e >3>Id ¥orft ifttcDical .Journal for January 23, 18SG. Reprinted from the New York Medical Journal for January 23, 1886. -rr- TIIE CLIMATE OF SOUTH CENTRAL FLORIDA ESPECIALLY FOR THE PULMONARY DISEASES OF WOMEN AND CHILDREN* J. M. KEATING, M. D., Philadelphia, VISITING OBSTETRICIAN TO THE PHILADELPHIA HOSPITAL, AND LECTURER ON DISEASES OF WOMEN AND CHILDREN ; SURGEON TO THE MATERNITY HOS- PITAL ; PHYSICIAN TO ST. JOSEPH’S HOSPITAL; FELLOW OF THE COLLEGE OF PHYSICIANS, ETC. I have been requested to come before you with a short paper giving my experience upon one of the most important branches of the practice of medicine, and I regret that time will not permit of a more elaborate statement of the results of my travels in many lands and many climes on various occasions. I have seen enough to know that the study of climatology is one of the most important for the physician, and also—I say it with regret—I have learned that there is possibly no other branch that receives so little attention. How often have I met cases of advanced phthisis, away from all the comforts 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 impressive to picture to you, as the subject comes up before me, the many sad * Read before the American Climatological Association, May 28, 1885. 2 TIIE CLIMATE OF SOUTH CENTRAL FLORIDA. cases I have witnessed. It is so very easy for the doctor, who possibly knows that all hope is ended and a fatal ter- mination not very far distant, to say to his patient, “ Go to Algiers,” “ Go to Egypt, Australia, or California.” 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 be- fore him is no obstacle. 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 that is often surprising even to a man in good health. The wear and tear, the vicissitudes of temperature, the character of the cooking, damp sheets, and the hard beds, are much more wearing than 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 bag- gage 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 shocking sights to the invalid traveling South is to run across the boxes with the death certificate upon them waiting at the stations for the Northern train. Al- though I have the greatest possible belief in the value of the change of air and the residence in a suitable climate for those in the early stages of disease, or where predisposition exists, or during convalescence, I am strongly opposed to the method at present adopted of recommending places in a gen- eral way, regardless of their suitability, 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 pre- scription. I met, in a fog, on a ship in the China Sea, a young lady who had been recommended by her physician to New THE CLIMATE OF SOUTH CENTRAL FLORIDA. 3 Zealand. When she reached there with her family her con- dition was such that they determined to bring her home. They returned by way of China, and the dense fog they encountered increased the catarrhal phthisis, which was rapidly breaking down, until she was in a sorry condition. Had she been sent to Aiken or Thomasville, or possibly Ber- muda or Santa Cruz, and surrounded by the comforts of life, in an equable climate, within a few hours of her own home, she certainly would have lived longer. There are several things that are to be taken into consideration before a choice of residence is made. First, the possible prognosis, provided the patient remains where he is, judging from the stage of the disease and the rapidity of its progress, speaking, of course, of .pulmonary troubles. Then the temperament of the individual, whether he or she be one of active disposition, ready and willing to take exercise, improved usually by cold, dry weather; or, on the contrary, one of a nervous tempera- ment, or of sedentary tastes, whose improvement will be brought about by taking in the fresh air and with it sun- shine and warmth. Also, the financial condition of the pa- tients is a very important matter. Good food and plenty of it are as important a factor as fresh air. Unfortunately, these can only be found in very high-priced hotels, and many patients will be obliged to put up with inferior cook- ing and poor accommodations. It would be far better for such to remain at home. I would certainly make it a rule that, unless the individual is well enough off to obtain all necessary comforts and some luxuries, he or she had far better stay at home. Then, again, the place must be suited to the individual not only as regards climate, but pursuits. Invalids must be interested. If they have been used to com- forts, they should be surrounded by them. In fact, they must be placed in a position to take advantage in every way of everything that will be beneficial. I am speaking more 4 THE CLIMATE OF SOUTH CENTRAL FLORIDA. particularly in regard to the pulmonary diseases of women. Patients are often sent South too late in the course of the dis- ease. Those who would otherwise be improved remain away too short a time, and return home entirely too early in the season. We have undoubtedly in this part of the continent, close at hand, a choice of climates to suit every individual and every case—from the higher and more bracing air of the Adirondacks down to southern Georgia, through Florida, to Bermuda, St. Thomas, Santa Cruz, Jamaica, or the delightful Isle of Pines on the southern shore of Cuba, noted not only for its benefit in pulmonary troubles, but its great value, due possibly to the water, in chronic intestinal disorders. To- day I desire to call attention to south Florida—especially to the central southern portion, the backbone of the penin- sula ; and I feel that by simply outlining its general charac- teristics and pointing out the places that my own experience enables me to recommend, I will make my remarks more practical. It is scarcely necessary to speak of the value of Aiken, due to its sandy soil and pine forests; or of Thomasville, situated in southern Georgia, a spot where sun- shine is the rule, and where patients are surrounded by every comfort, at present, which they could wish for. But, for certain classes of cases, especially in the winter months, Aiken and Thomasville are both much too cold ; and it will be necessary for us to seek a spot below the heavy frost- line, which will combine the advantages of an inland climate with the soft, balmy air of the sub-tropics, and present the characteristics of soil and vegetation which have been found of advantage in phthisical troubles. Passing down through Gainesville, we reach the lower part of northern Florida, and, as we come to the 29th parallel, once more ascend in alti- tude until in Orange County we reach the highest point above the sea on the peninsula. We have here the sandy soil, the pine forests, and, in addition, a climate which is THE CLIMATE OF SOUTH CENTRAL FLORIDA. 5 insular in its softness and steadiness, but where the winds have been deprived of their moisture by being dried by pass- ing over large tracts of land. Florida is divisible into four parts: two geographical, into north and south Florida; two topographical, into the low land of the rivers and the sea-shore and the high and dry lands of the interior. The northwestern part of Flori- da—the old part—is so much like southern Georgia in all respects that we will give it no particular attention; the peninsula part is the most interesting in a sanitary point of view. North and south Florida are divided by the 29th parallel of latitude, and the climate of the southern part of the State is widely different from that of the northern. The climate of southern Florida is milder in winter than that of northern Florida, for obvious reasons. In the first place, during the heats of summer the winds generally blow from the Atlantic to the Gulf, and blow over sufficient land to heat them by radiation. The thermometer rarely reaches 98 degrees in mid-summer; breezes blow almost continually, and the nights are cool. The difference in the winter climate in the two sections is still more marked. During the winter the coldest winds blow from northwest by west, and can reach central Florida only by passing over the Gulf of Mexico. A little distance north of 29 degrees we have but purely land winds; conse- quently the temperature falls very rapidly in northern Florida and slowly in southern Florida. In December, 1880, occurred the coldest weather known there for fifteen years; on the coldest day the mercury at St. Augustine fell to 16 degrees; at Jacksonville to 20 degrees; at Palatka to 24 degrees; at Orlando, the principal town of south Florida and county-seat of Orange County, the mercury fell no lower than to 30 degrees. The climate of the western coast of Florida is colder than that of the interior; the cold winds THE CLIMATE OF SOUTH CENTRAL FLORIDA. 6 seem to precipitate themselves upon the coast, and to grow milder as they proceed eastward. The climate of Tampa is colder than the climate of the same latitude on the In- dian River. There is no clearly defined frost-line in Florida, hut 29 degrees separates as nearly as possible the regions of damaging frosts from frosts too light to injure orange-, lemon-, or lime-trees. Orange County lies south of 29 degrees, and Orlando is its county-seat, about thirty miles west of the Atlantic coast and about sixty miles east of the Gulf coast. The region about Orlando is most favorably known for its temperature; the country lying to the south- west of it, even in the interior, has colder spells of weather than the country in its vicinity. This county is one of the most progressive in the State, being second only to the county of Duval, in which is situated the city of Jackson- ville, in the assessable value of its property. Fifteen years ago it was little more than a cattle range. Seven years ago its population had grown to 6,000. At present the popu- lation has reached nearly 18,000. Five years ago the town of Orlando was a hamlet of about 200 people. Now it is a thriving, active town, with a population of over 2,500. It is situated on the backbone of the peninsula, 100 feet above the St. John’s River, upon the lake plateau, and from it the water flows toward all points of the compass. The country around it is undulating and often hilly, and entirely unlike the parts of Florida commonly seen by tourists. Nearly the whole lake plateau of Florida is covered with pine-tree for- ests, and is entirely free from malarial influences except near the marshy borders of a few of its many lakes. The soil of nearly all of south Florida is either a loamy sand or a sandy loam, and is very absorbent of the heavy rains that fall in the rainy season. The lakes of the famous lake plateau of Florida are 100 in number, are generally very deep, and always filled with THE CLIMATE OF SOUTH CENTRAL FLORIDA. 7 clear, cold water; groves are cultivated and houses built closq to their clear-cut margins, and people live there in perfect health. The counties lying to the west of Orange are Sump- ter and Hernando; they have rich soil, and are mostly underlaid with limestone. These are two of the richest counties in the State, but, owing to the rich land, they are not as healthy as the high ridge of Orange County. This distinction is widely recognized, for, although a large popu- lation is moving into Sumpter and Hernando Counties, the wealthier class of people, who desire health and comfort pri- marily, nearly all seek their homes in Orange County. In the districts underlaid with limestone the water is not drinkable, but in Orange County, where there is scarcely any limestone, most people depend upon lake water, or water from wells.* To the southwest of Orange is Polk County, one of the finest counties in the State. Its lakes are large and numerous and beautiful, the land good, and the country rapidly settling by immigration from all parts. The healthfulness of this county about equals that of Orange. * The importance of pure drinking-water can not be overestimated. Rain-water, collected in tanks that can easily be cleansed, should be the only water used in these resorts; this should be insisted upon until some means of drainage is established in these Southern places. So far as I know, no attempt has been made to drain these villages, and, as the population is increasing enormously, the numerous lakes attracting set- tlers to their vicinity, the tendency will be to make them receptacles of sewage. It is to be hoped that the great value of sewage as a fertilizer for orange-farms, groves, and truck-farms, will prevent its waste, and consequently the pollution of the water. Many hotels with most at- tractive surroundings are pest-holes as regards their sanitary arrange- ments. To seek health and return with typhoid fever is by no means an uncommon occurrence. If physicians would advocate this matter, their patients would be more particular, and hotel-owners would be obliged to secure the advantages of all the improvements given us by sanitary engineers. 8 T1IE CLIMATE OF SOUTH CENTRAL FLORIDA. The best hotels and boarding-houses in the State have naturally been established along the oldest routes of travel. Until within the last few years there have been few railroads built in Florida, and the St. John’s River was the principal and almost only highway; along its banks are the older towns, best hotels, and best facilities for living in comfort. Outside of St. Augustine, the best hotels in the State are now upon the St. John’s River. Northern enterprise and capital have recently entered the field there to compete with the river places. At Maitland a hotel was built about six years ago, and was the only hotel in the State upon the high land where reasonable comfort could be found. Within the last three years several hotels have been built at Orlan- do, and have been poorly kept; at present a large hotel is being built at Orlando, has been already leased to a White Mountain hotel-keeper, and will be conducted next winter as a first-class hotel. Orlando has good livery stables, is located in one of the best orange-growing regions in the center of the lake plateau, and surrounded with many hand- somely improved properties; possesses an ice factory, and has all the facilities for comfortable living. The drives about Orlando are numerous, and perhaps the most beautiful in the State. Five miles north of Orlando and two miles from Maitland is the beautiful settlement of Winter Park, and there a large hotel is also building, to be completed the coming winter.* At Altamonte, also on the South Florida Railroad, a few miles from Orlando, is a very good hotel, situated in the pine forests. The odor of pine in the air is most noticeable; the soil is sandy and absorbs the moisture. The hotel is very well kept, is comfortably furnished, and the climate is as fine as can be desired. On the northern shore of Lake Monroe, which is at the * This hotel, the Seminole, is, I think, now open. THE CLIMATE OF SOUTH CENTRAL FLORIDA. 9 head of the navigable waters of the St. John’s, is an excel- lent hotel, one of the most comfortable in Florida, sur- rounded by sunshine, and indeed in every way the most attractive spot for invalids and tourists; I speak of the Brock House at Enterprise.* The prevailing wind in winter is from the northwest, and, on this account, this body of water does not seem to affect the air. The upper shore of Lake Monroe has a mild winter climate; the country around is interesting. But for cases of incipient phthisis, or those with well-marked disease, I would insist upon the pine region. In the northwestern part of Orange County is a cluster of large lakes known as the Ocklawaha Lakes. There the country is bolder and more rolling, hills often rising to the height of sixty or eighty feet, but the hotel accommoda- tions are as yet but meager. Several important towns—Eustis, Taveres, Leesburg, and Mount Dora—are situated upon these lakes. At Gainesville and Ocalla, Marion County, and Leesburg, Sumpter County, there are good hotels, all on the line of the railroad whose terminus is at Orlando. Mount Dora has the most beautiful natural location of all the towns in Florida. The hilly char- acter of the interior of south Florida in entirely unknown to the great body of Florida tourists, and most people would be surprised to learn that immediately west of Lake Apopka, a lake upon the summit of Orange County, cover- ing fifty-six square miles, the land rises in several points to the height of five hundred feet above the ocean; these are barren sand-hills, too dry for profitable cultivation, but for south sanitaria can not be excelled. This region is as yet entirely undeveloped. * The hotel is supplied with rain-water for drinking purposes. All excrement is mixed with sand and frequently carted away. All hotels in the South should be obliged to adopt this plan. 10 THE CLIMATE OF SOUTH CENTRAL FLORIDA. Within two or three months from this time the places mentioned upon the high land of Orange County will be reached in a few hours directly from Jacksonville, or from the northwest through Gainesville, by rail. * After an inspection of the interior we will make a few remarks about the lower country along the coast, simply to condemn it as a place for invalids. The Indian River is but a long, straight estuary of the ocean, with only three narrow inlets connecting it with the ocean; consequently the water is always salt, and the rise and fall of the tide is but a few inches; on the east side it is separated from the ocean by a narrow strip of land too poor for cultivation, but on the west side there is a long, nar- row strip of rich land reaching nearly its entire length; at the lower end pineapples, bananas, and cocoanuts are being extensively cultivated ; the northern part is the most famous orange-growing region in the world. The most important settlement on the Indian River is Titusville, with two or three second-class hotels; about eight miles farther down is a passably comfortable hotel at Fort Capren; twenty miles south of Titusville a large hotel is now building at Rock- ledge. The Indian River lies entirely within south Florida, the whole of which throughout the summer months is upon the northern edge of the trade-winds. Attention has been already called to the western part, which is colder, and sub- ject to greater fluctuations of temperature. The summer climate of south Florida is little understood in the North, and is much cooler than is supposed. All the northern summer vegetation can be grown in winter. One peculiar- ity of south Florida is, that in winter sunshine is almost perpetual; I have been informed by a gentleman, who has spent eight consecutive winters there, that until last win- * Since this paper was read, the railroad has been completed, and the river journey is now avoided. THE CLIMATE OF SOUTH CENTRAL FLORIDA. 11 ter, which was exceptional, he had seen, in all that time, but one day in which the sun was not at some time visi- ble. March, April, and May are dry; the rainy season sets in in June and lasts to the end of September. During this period rain falls four or five times per week, the sky suddenly clouding and pouring down a volume of rain and then clearing. These frequent rains tend to keep the sum- mer days cool and pleasant. We may make a few remarks only in relation to invalids suffering from rheumatism, laryn- geal or pulmonary troubles. Invalids suffering from these troubles should avoid St. Augustine for several reasons. First, it is on the sea-coast. Secondly, it is subject to sudden violent changes of temperature, occasionally jumping from warm summer weather to frost, falls of 40° in a day not being uncommon. Thirdly, much dust is stirred up by the many carriages in the narrow streets. This dust is coquina- shells ground up under carriage-wheels, and is very irritating. This is the most particular feature in consideration of St. Augustine as a health resort. Unfortunately, it is not suffi- ciently understood by northern physicians; hut, looking at it on the other hand, we certainly have charming weather very many days in the winter. There all is life and gayety, the hotels are fine, amusements many, and the place itself for pleasure only is not equaled by any other place in Florida. Unfortunately, the winter population of St. Augus- tine is entirely too dense from a sanitary point of view for a Southern city. Jacksonville does not impress the physician favorably as a health resort; the greater number of invalids sent to Florida are sent to this place and never get below it. It appears to me to be damp, foggy, malarial, and, as far as phthisis is concerned, a place to be avoided on account of dust-storms, which are frequent in winter, and on account of the sudden changes of its temperature. 12 THE CLIMATE OF SOUTH CENTRAL FLORIDA. I can not but conclude this paper by stating that my own experience would warrant me in selecting southern Florida, and that portion of it situated along the South Florida Railroad, as the most suitable place to send our cases of pulmonary disease, especially if they be women and children, owing to the warm, soft, equable climate, which, nevertheless, is by no means depressing, but, on the contrary, is bracing and invites exercise; the sandy character of the soil; the large pine forests, which are certainly of great value ; the excellence of the accommodations, and the important fact that the journey is so short and easily made. It is a serious matter to send a lady to California or Colorado whose hus- band is obliged to attend to his business in the East; hence the development of Florida is a mere question of time, as such cases will naturally drift there. 1504 Walnut Street. The New York Medical Journal, A WEEKLY REVIEW OF MEDICINE. Published by 0. Appleton &. Co. Edited bt Frank P. Foster, M.D. The New York Medical Journal, now in the twenty-first year of its publication, is published every Saturday, each number containing twenty- eight large, double-columned pages of reading-matter. By reason of the condensed form in which the matter is arranged, it contains more reading- matter than any other journal of its class in the United States. It is also more freely illustrated, and its illustrations are generally better executed, than is the case with other weekly journals. 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