• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Board members, directors and field...
 Table of Contents
 President's letter of transmit...
 State health officer's letter of...
 Report of Henry Hanson, state health...
 Orthopedic department, report...
 Library, report 1932
 Drug store inspection, report...
 Multigraph department, report...
 Division of accounting, report...
 Bureau of communicable diseases,...
 Bureau of communicable diseases,...
 Bureau of child welfare, report...
 Bureau of child hygiene and public...
 Division of public health nursing,...
 Division of malaria research,...
 Division of malaria control studies,...
 Bureau of laboratories, report...
 Bureau of engineering, report...
 Central bureau of vital statistics,...






Title: Annual report - State Board of Health, State of Florida
ALL VOLUMES CITATION PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/AM00000243/00003
 Material Information
Title: Annual report - State Board of Health, State of Florida
Series Title: Publication - Florida. State Board of Health
Physical Description: v. : ill., ports. ; 23-29 cm.
Language: English
Creator: Florida -- State Board of Health
Florida -- State Board of Health
Publisher: State Board of Health.
Place of Publication: Jacksonville Fla
Frequency: annual
regular
 Subjects
Subject: Public health -- Periodicals -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
 Notes
Dates or Sequential Designation: Ceased in 1968.
Numbering Peculiarities: Report year for 1893/94 ends Mar. 31; for 189<7>-1968, Dec. 31.
Numbering Peculiarities: Reports for 1923-32 combined in one issue.
General Note: Reports for 1910-<17> issued as its Publication.
 Record Information
Bibliographic ID: AM00000243
Volume ID: VID00003
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Front Cover
        Front Cover
    Title Page
        Title Page
    Board members, directors and field personnel
        Page i
        Page i-a
    Table of Contents
        Page ii
        Page iii
        Page iv
    President's letter of transmittal
        Page v
        Page vi
    State health officer's letter of transmittal
        Page vii
        Page viii
    Report of Henry Hanson, state health officer (decade in public health)
        Page 1
        1923-1932 Inc.
            Page 1
            Page 2
        Library, re-establishment
            Page 3
        Organization
            Page 4
        Research
            Page 4
        Malaria research
            Page 5
        Mortality rates during the decade
            Page 6
            Page 7
        Twenty leading causes of death, Florida, 1931
            Page 8
        Twenty leading causes of death, Florida, 1923
            Page 9
        Rabies
            Page 9
        Work of the state board of health in general
            Page 10
            Page 11
            Page 12
    Orthopedic department, report 1924-1931
        Page 13
    Library, report 1932
        Page 14
    Drug store inspection, report 1928-1932
        Page 15
    Multigraph department, report 1920-1932
        Page 16
    Division of accounting, report 1923-1932
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
    Bureau of communicable diseases, report 1923-1931
        Page 27
        Personnel
            Page 27
            Page 28
            Page 29
            Page 30
        Table of activities
            Page 31
            Page 32
            Page 33
            Page 34
    Bureau of communicable diseases, report 1932
        Page 35
        Page 36
        Motion pictures
            Page 37
        School children, physical examinations
            Page 38
        County units
            Page 39
        Tuberculosis division
            Page 40
            Page 41
            Page 42
        Taylor County health unit, report 1932
            Page 43
            Page 44
            Page 45
        Leon County health unit, report 1932
            Page 46
            Page 47
            Page 48
        Escambia County health unit, report 1932
            Page 49
            Page 50
            Page 51
    Bureau of child welfare, report 1923-1925
        Page 52
        Page 53
        Page 54
        Page 55
    Bureau of child hygiene and public health nursing, report 1926-1931
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Midwife survey
            Page 61
            Page 62
            Page 63
    Division of public health nursing, report 1932
        Page 64
        Work with midwives
            Page 65
            Page 66
            Page 67
            Page 68
            Page 69
            Page 70
    Division of malaria research, report
        Page 71
        Page 72
        Malaria field studies
            Page 73
        Induced malaria studies
            Page 74
            Page 75
            Page 76
        Malaria and physiography
            Page 77
    Division of malaria control studies, report
        Page 78
        Malaria blood index
            Page 79
            Page 80
            Page 81
    Bureau of laboratories, report 1923-1932
        Page 82
        Page 83
        Table, specimens examined
            Page 84
    Bureau of engineering, report 1923-1932
        Page 85
        Page 86
        Water supply
            Page 87
            Page 88
            Page 89
        Sewerage and sewage disposal
            Page 90
        School sanitation
            Page 91
        Institutional sanitary inspection
            Page 91
        Swimming pool sanitation
            Page 92
        Auto tourist camp sanitation
            Page 92
        Mosquito control
            Page 93
            Page 94
        Waste artesian water
            Page 95
        Cannery sanitation
            Page 95
        Rabies
            Page 96
        Drainage well sanitation
            Page 96
        Other camp sanitation
            Page 97
        County fair or carnival sanitation
            Page 97
        Garbage disposal
            Page 97
        Milk and milk sanitaion
            Page 98
            Page 99
        Shellfish sanitation
            Page 100
            Page 101
        Special reports of investigations
            Page 102
            Page 103
        Publications issued
            Page 104
    Central bureau of vital statistics, report 1923-1932
        Page 105
        Preamble
            Page 105
        Contents
            Page 105
        New laws
            Page 105
        Original records
            Page 105
            Page 106
        Mortality charts
            Page 107
            Typhoid fever
                Page 107
            Malaria fever
                Page 107
            Tuberculosis
                Page 108
            Diphtheria
                Page 108
            Pneumonia
                Page 109
            Influenza
                Page 109
            Infant mortality
                Page 110
            Puerperal rates
                Page 110
            Diarrhea and enteritis
                Page 111
            Automobile accidents
                Page 111
            Birth rates
                Page 112
            Death rates
                Page 112
        Tables (1931)
            Page 113
            Estimated population by color #1-2
                Page 113
                Page 114
                Page 115
            Births and birth rates #3-4
                Page 116
                Page 117
                Page 118
                Page 119
            Deaths and death rates #5-6
                Page 120
                Page 121
                Page 122
            Infant mortality #7-8
                Page 123
                Page 124
                Page 125
                Page 126
            Stillbirths and illegitimate births #9-10
                Page 127
                Page 128
                Page 129
            Marriages #11
                Page 130
            Divorces and annulments #12
                Page 131
        Tables (1927-1931)
            Page 132
            Deaths from typhoid fever #13
                Page 132
                Page 133
            Deaths from malaria #14
                Page 134
                Page 135
            Deaths from measles #15
                Page 136
            Deaths from whooping #16
                Page 137
                Page 138
            Deaths from diphtheria #17
                Page 139
                Page 140
            Deaths from influenza #18
                Page 141
                Page 142
            Deaths from tuberculosis #19
                Page 143
            Deaths from pellagra #20
                Page 144
                Page 145
            Deaths from pneumonia #21
                Page 146
                Page 147
            Deaths from diarrhea, enteritis, dysentery #22
                Page 148
                Page 149
            Deaths from puerperal state #23
                Page 150
                Page 151
        Tables (1923-1931)
            Page 152
            Births and birth rates, Deaths and death rates #24-25
                Page 152
            Infant mortality #26
                Page 153
            Deaths from typhoid fever and deaths from smallpox #27-28
                Page 153
        Tables (1923-1931)
            Page 154
            Deaths from scarlet fever, deaths from whooping cough #30-31
                Page 154
            Deaths from diphtheria #32
                Page 155
            Deaths from influenza, deaths from dysentery #33-34
                Page 155
            Deaths from epidemic cerebrospinal meningitis #35
                Page 156
            Deaths from rabies, deaths from tetanus #36-37
                Page 156
            Deaths from tuberculosis #38
                Page 157
            Deaths from syphilis, deaths from malaria #39-40
                Page 157
            Deaths from cancer #41
                Page 158
            Deaths from diabetes mellitus, deaths from pellagra #42-43
                Page 158
            Deaths from cerebral hemorrhage #44
                Page 159
            Deaths from pleurisy #47
                Page 160
            Deaths from appendicitis #50
                Page 161
            Deaths from nephritis, deaths from congenial malformations #54-55
                Page 161
            Deaths from diseases of early infancy #53
                Page 162
            Deaths from suicide, deaths from homicide
                Page 162
            Deaths from automobile accidents #56
                Page 163
            Illegitimate births, stillbirths #57-58
                Page 163
            Deaths from puerperal state #59
                Page 164
Full Text





STATE BOARD OF HEALTH
OF
FLORIDA


THIRTY-THIRD

REPORT





A
DECADE IN
PUBLIC HEALTH
1923-1932 INC.


up


LI I












STATE BOARD OF HEALTH

OF

FLORIDA


THIRTY-THIRD


REPORT\


\ 9 -


ADMINISTRATION OFFICE
JACKSONVILLE

BRANCH LABORATORIES
TAMPA
PENSACOLA
MIAMI
TALLAHASSEE


-a.


MO






I

BOARD MU MS RS, DIRECTS AND FIELD PIRSONNIL

BOARD MEMBERS

H. Mason Smith,M.D.,Pres. Henry E. Palmer, M.D. Edward M. L'EInge,M.D.
Tampa Tallahassee Jacksonville

STATE HEALTH OFFICER

Honry Hanson,M.D.
Also Executivo Officer and Secretary of Board

BUREAUS AT JACKSONVILLE
DIRECTORS

Laboratories ........................Paul Eaton,M.D., D.P.H.
*Vital Statistics .....................Stewart G. Thompson, D.P.H.
Communicablo Diseasos..................P. A. Brink, M.D.
lglnooring .........................Loua G. Lonert
Accounting.... .................... ... Wilson Baltzoll
Librarian........................... ... Elizabeth Bohnonborgor



*Registration Inspoctor.................Anna C. Emmons
Drug Storo Inspector ..................M. H. Doss
Assistant Drug Store Inspector.........Frank S. Castor

LABORATORIES

Jacksonvill.............. ..............Pearl Griffith, B.E.
Miami..................................E. R. Powoll
Ponsacola ................*............. Johnotte McCormick
Tallahassoo.... ............ .......... stollo Bryan
Tllpa ..................................H.D. Vontors, B. S.

MEDICAL OFFICES

Jacksonvillo ..........................T. E. Morgan, M.D.
Tallahassoo...................... .....H. A. McCluro, M.D.
Wost Palm Boach.......................C. W. Poaso, M.D.
Tampa..................................A. C. Hamblin
DoFuniak Springs.. .....................C. W. McDonald

TUBERCULOSIS AND EPIDEMIBOGY

Jacksonvillea..... .....................W. A. Claxton, M.D.

DISTRICT SANITARY OFFICERS

Jacksonville......................... Prod A. Safay
.mi...... ........... .................George B. Reed
Ocala.................................C. A. Holloway
Orlando................ ...............Russoll Broughman
Tallahosse............................C. N. Hobbs
Tampa................., .... ..*.D. H. Osburn

^tJO<^







MIK AMD DAI~ Y SPECIALIST


Ftoksonville............................. D. Macready

PUBLIC HEALTH NURSES

Jacksonville...........................Joyco Ely, R. N.
Jacksonvillo........,........ ..........Lalla Mary Goggans,R.N.
Ft. Pierco.........................Annie Gabriel, R. N.
Starko.. ............... ...... .... ,*Mary G. Dodd, R. N.
Tampa...........*......... ..*...,.....ule 00. Graves, R. N.

MALIA RESEARCH

Tallahassoo.. ................... ....... .MrkF. Boyd, M.D.
(Rockefeller Foundation)

MAlARIA CONTROL STUDIES

Jacksonvie...... .... ........... ..** T. H. D. Grifittbs, M.D.
(U.S. Publi oHealth Service)

CONSULTANT IN ENTOMOLOGY

Orlando................. .............W. V. King, Ph.D
(U.S4 Bhreau of Entomology)

DIRECTORS FULL TIME COUNTY HEALTH UNITS

Perry, Taylor County...................W. H. Y. Smith, M.D.
Tallahassoe, Leon County............*..L. J. Graves, M.D.
Pensacola, Escambia qounty.............W. A. McPhaul,M.D.






-


TABLE OF CONTMlTS



Page
Personnel.................................... *.....* 0.. ............... ...1I
Table of Contents ...............*..........*............. ....... .IIIII, IV
President's letter of tranamittal .......................*...............VVI
State Health Officer's letter of tranamittal ........................ VII* III

Report of Henry.Hanson, State Health Officer (Decade in Public Health.......1
Introduction ..........*...... .............. .................... 01
State Board of Health, ambers........ ..0.............................
4Abraryr re-establishment.................... ........... ...... 3
Organization. ., ....,.... .....q. ..0...........0................... ...4
Researhh...,......... ................................ ..................4
Malaria Resesrh .................... ......... .....................5
Mortality Rates During the Decade....................................6
Twenty Leading.Oauses of Death, Florida, 1931..........................8
Twenty Leading Causes of Death, Florida, 1925........................*.9
Rabies....... 0 0....... ...............................................09
Work of the State Board of Health in General...'*......,..,.......... 10
Orthopedic Department, report 1984-1951..................................1
4brary, report 1938,..,...................................................14
Drug Store Inspection, report 1988-19l......... ,... ..............15
l4tigraph Department, report 1920-1938............. ... ................16
Division of Accounting, report 1923-193.................e.................17
Bureau of Coamunicable Diseases, report 1983-1931........................27
eSum5ary.... .. .e o. 5 s00 ...oS .00s.... *e*.o.0.... .o **..**o. 0o.-0.207
Table of Activities. ...... ............... ...... ..... ........... ..31
Bureau of Commnicable Diseases, report 1938.. ............................35
pj:tiological Investigations... 5............................ 5
MItion Pictures...................s ..*... .................... ......37
School Children, physical examinations .......................60..... 38
County Units................... ,............................ ....... 39
Tuboroulosis Division ......e............... ......... .............40
Taylor County Health Unit, report 1932..................s...............43
Leon County Health Unit, report 1932..................................46
pocas~ba County Health Unit, report 1932.......e..... ................. 49
Bureau of Child Welfare, report 1983-198. ............. ....... .. .. .........52
Bureau of Child Hygiene and Public Health Nursing, report 1926-1931.........56
Midwife Survey...., .......................................... .....61
Division oftPublic Health Nursing, report 1932.............................64
Work with Midwives....................................................65
Division of Malaria Research, report....................................... 71
Malaria Field Studies......... ............................. ....... 73
ndueed MIlaria Studies,..................*...........................74
Mlearia and Physiegraphy................. .......................77
Division of Maleria Control Studies, repoz t....................... ......78
Malaria Blood Index.................................... ...............9
Bus a of Laboratories, report 1983-19...................................8
Table, specimens examined ...........,..... ....................... 84
Bureae of Engineering report 1983-1938...............................o
Water Supply.. e ........................ .......e......... .....** 87
Sewerage and Sewage Disposal..r....... ........................ .90






IIn


TABLE OF CONTENTS (Cont'd)

Page
Bureau of Engineering, report 1923-1952 (contd).....................
School Saiitation..................................................91
Institutional Sanitary Inspection...................................91
Swimming Pool Sanitation.... ....* ........* .................9.
Auto Tourist Camp Sanitation..........* ............................92
'Mosquito Control. ...........*...... .. .0.. .......*........*.. .95
Waste Artesian Water....................... .....................95
Cannery Sanitation...... ..-.... ... ......................95
Rabies......,.. ........................... ......................96
Drainage Well Sanita~ticnt....a............... .......................96
Other 'Camp Sanitation. .. .... .. a... ....*.... 6 ........ 0 ..0 .. 9.97
County Fair or Carnival Senitation.. ......*......97
Garbage Disposal9. .,.......... ...... ......................97
Milk and Milk Sanitation.... .................................... ....98
Shellfish Sanitation....o.................... .....................0100
Special Reporns of: Investigations.................... .............102
Publications Issued, ................................................104
Central Bureau of Vital Statistics, report 1923-1938.....................105
Preamble, etc.............................s.......................105
*Moritality Charts................J........;...;....<.....;...........
Typhoid Fever................................................107
Malaria..................................... ....................107
Tuberculosis.................* ................*...........*,.*..108
Diphtheria................ 0 0 0 000 ............................. 0 0000000 .....108
Pneumonia........................................... ..0....... 109
InfluenZa...................................... ...... .......109
Infant Mortality...... ........................................110'
Puerperal 1ates.;.... ;........................................110
Diarrhea and Enteritis......................................111
Automobile Accidents.....0............9...........111
Birth Rates.. ...*...... ......... ................. 0........112
Death Rates.............................................. .11
Tables (1931)
Population # 1-2.;.................... .............90...113-116
Births and birth rates #-3-4...............................116-119
Deaths and death rates # 5-6................................ 0-125
Infant Mortality # 7-8....................................123-126
Stillbirths and illegitimate births # 9-10.............1.1027--150
Marriages # 11....,............................ .........10-131
Divorces and Annulments # 12 ..............................131-132
Tables (1927-1931)
Deaths from Typhoid Fever # 13.............................138-184
Deaths from Malaria # 14........................154-135
Deaths from Measles # 15................................3.15-157
Deaths from Whooping # 16................................17-159
Deaths from Diphtheria # 17....,.........................159-141
Deaths from Influenza # 18.................... ..........141-14
Deaths from tuberculosis # 19...............9*.. ..........14-144
Deaths from Pellagra # 20 ...............................144-146
Deaths from Pneumonia # 21..................................146-148
Deaths from Diarrhea, Enteritis, Dysentery # 22......9......148-150
Deaths from Puerperal State # 23 ...........................150-452






- IV i-


T4BLI OF COCTUTS (CONTD)

Page
Central Bureau of Vital Statistics, report 1935-1932 (contd)
Tables (1923-1951)
Births and Birth rates # 84................... ..............,15
Deaths and Death Rates # 25.............................. .... .152
Infant Mortality # 86.......................... ..... 153
Deaths from Typhoid Fever...# 27................................153
Deaths from Smallpox # 28 ...... ........ ee..**..... *..... 153
Deaths from Measles # 29 ........ ......... ....... ............154
Tables (19g2-1931)
Deaths from Scarlet Fever # 30.,.............................154
Deaths from booping Cough # 31 ...................... s........154
Deaths from Diphtheria # 32......................................15
Deaths from Influenza # 33...................................55
Deaths from Dysentery # 34................................. ..155
Deaths from Epidemic Cerebrospinal Meningitis # 35.............156
Deaths from Rabies # 36........... ..... ..... ................ ..156
Deaths from Tetanas # 37..................., ............... ...156
Deaths from Tuberculosis # 38....... ...................... .157
Deaths froa Syphilis # 59................... .... ...........157
Deaths from Malaria # 40 ................................ ...157
Deaths from Cancer # 41.............c.. ................s ......158
Deaths from Diabetes Mellitus # 42......cc............ ......158
Deaths from Pellagra # 43 .......... .......... .................158
Deaths from Cerebral Hemorrhago # 44........ ..................159
Deaths from Heart Disease # 45................... ......... .. 159
Deaths from Pneumonia # 46............. ................ .....J.59
Deaths from Pleurisy # 47............................ ,,......160
Deaths from Asthma # 48................... ...160
Deaths from Diarrhea and Enteritis # 49.....................cO160
Deaths from Appendicitis # 50... .. ...........**..* ...* .....* 161
Deaths from Nephritis # 51...............se..................161
Deaths from Congenital Malformations # 52......................161
Deaths from Diseases of Early Infancy # 55.................... 162
Deaths from Suicido # 54.............. ........ ...............16
Deaths from Homicide # 55 .............. ........ ... ......... .162
Deaths from Automobilo Accidents # 56 ........................165
Illegitimate Births # 57....................................*..163
Stillbirths # 58.............................. ........ ....163
Deaths from Puerperal State # 59 ..............................164










January 1, 1933



To His Excellency
David Sholtz, Governor

Sir:

I have the honor to submit a report from the State Board of
Health covering a decade. For various reasons no annual report has been made
since the biennial report for 1921-1922. It is unfortunate that there has been
no readily available compilation of activities and statistics of the progress of
the general health of the state for the past ten years.

In the attached report of the State Health Officer you will note
that he opens with a discussion entitled "A Decade In Public Health" covering
the period 1923 to 1962 both inclusive. The report is of necessity brief and only
the leading features are discussed. It is an effort to tie up with the past
bringing as much of the material as possible up to d(te. Owing to the reduced
budget which cells for economy in every action the report has been mimeographed.
All the work has been done in the Multigraph Department with the assistance of
the mimeograph in the Bureau of Vital Statistics. There have been many calls for
the reports of the State Health Department, in fact so many that the State Health
Officer was embarrassed by the necessity of making repeated replies that no
report had been published since 1922.

The composition of the State Board of Health is shown on pages
1 and 2 of the State Health Officer's general discussion. On page 4 the various
branches of the organization are shown.

In 1931 a Division of Malaria Research was added. The high
character of work done in this Division has attracted visitors from all sections
of the United States and many from foreign lands. It has been the means of placing
Florida in the lime light as a research centre and high in the estimation of
scientific workers.

In 1932 the Board established a Division of Malaria Control Studies
and later it secured the active cooperation of the Department of Entomology of
the Federal Department of Agriculture, all without cost to the state. This largely
due to the national and international recognition of the State Health Officer.

The report owing to its brevity is so full of meat that it is in
itself a sumxmry which cannot readily be further summarized in a brief letter of
transmittal. I note, however, that the State Health Officer has failed to mention
Health Notes, a very important instrument for the dissemination of knowledge for
safeguarding of health. This is sent only to those who have expressed a desire to
have it. It is very useful as well as inexpensive. At present it costs the
Board less than $100.00 per month. It should be continued.

The 3o"rd has operated a moving picture truck equipped (on a Ford
sedan type) with a generator to show health films in the rural communities where
such information is most urgently needed.











One of the most serious setbacks which the State Board of Health
has experienced was on finding that there was not enough revenue to operate the
the budget authorized by the Legislature of 1931. It brought about the suspension
of the major part of the Bureau of Child Hygiene and Public Health Nursing. Only
three nurses were retained to carry on the work of the Bureau. Through economies
affected in administration a fourth nurse was put in service. To carry out the
many duties which normally belong to the nurse we should hrve a minimum of ten
nurses. One is doing parent education, one tuberculosis and two Pre at present
devoting their time to midwife control a very important part of the maternity and
infancy program, There ought to be at least five nurses constantly in the field
in addition to the chief of this work who has a great deal of office work in con-
nection with directing the activities. At present we have no nurses doing com-
municable disease control. It is hoped that the Legislature may find means to
permit restoration of this vital activity.

All bureaus have done praiseworthy work but time and space does
not permit me to comment on all. At present there is the best team work and a
laudable esprit de corps throughout the entire department.

Pages 18 to 22 inclusive show a summary of financial conditions
for the period 1923 to 1931 inclusive. Pages 23 to 26 inclusive contain a more
detailed statement of expenditures for 1932 and show commendable stewardship of
state funds.

Among the forward steps of the last few years we express appre-
ciation to the last Legislature for passing the County Health Unit law. We hope
the counties will take advantage of this law and establish a health service under
the general supervision of the State Board of Health.

The report of the Tuberculosis Clinician again brings out the
advantages of the Florida climate. In his case finding he finds a much lower
infection rate among the Florida born children than what prevails in other states.
This work should be continued.

The work in the public health laboratories has shown a phenomenal
growth and the report speaks for itself. The same can be said for Engineering,
Communicable Diseases and Vital Statistics. I commend them to you.

Respectfully,

<^W7c^> S~ir


H. Mason Smith, M.D., President.






VII


JYnuary 1, 1933




Dr. H. Mason Smith, President
State Board of Heelth

My dear Dr. Smith:

I have the honor to submit a report of the activities of the
pest calendar year together with sumamries covering the years intervening since
the last published annual report. The last annual report is the biennial report
for 1921-1922. It is very difficult to cull out the important features and to
leave wbht apparently is less important in a report which is virtually a review
of the public health activities covering a decade. About all I Pnd the balance
of the staff have been able to do is to outline leading features of the activities
covered during the ten years in question. There are many things which hbve been
omitted whichh are worthy of discussion. With the limitation of personnel end
finances we are putting out the most economical report possible.

When I first took over the office of State Health Officer certain
changes and additions appeared necessary. One of these was the appointment of a
physician as director of the Public H-a lth Iaboretories. There are many problems
in connection with the laboratory work which require medical education and some
years of experience in order to arrive as nearly as possible at the correct
solution of the laboratory problems.

There was a greet deal of agitation in the country during the
years of 1928-1929 over Child Hygiene and Public Health Nursing. A Bureau of
Child Hygiene should be heeded up by a physician with pediPtric training. The
set-up in this state pieced the Public Health Nursing under the director of the
Bureau of Child Hygiene. A woman physician with pediatric training was secured
to fill the place of director of this bureau. WPny of the ideas of the new
director were excellent and were put into practice. An unfortunate incompati-
bility between the director end some of the older nurses developed which made it
desirable to temporarily suspend the bureau for re-organization. The financial
conditions which we encountered in 1901 brought this about. A great deal of
confusion seems to crop up in this bureau in connection with child welfare end
child hygiene. In the minds of a great many these terms are thought of as
synonyms, which of course is not at all the case.

Very soon after taking over the office I began to survey mortPlity
statistics. Among the communicable diseases I found tuberculosis, typhoid,
diphtheria and malprie to be in a sense leaders in the mortality tables. Although
numerically tuberculosis deaths rank fairly high the case incidence in this state
is not more then about ten to one. During the past ten years tuberculosis deaths
have fluctuated between about 1000 and 1067 which would indicate an approximPte
total of about 10,000 cases of active tuberculosis. As compared with previous
years there heve been most creditable results in typhoid and diphtheria control.
Our maternal mortality, however, has been very high but until the last Legislature
there has been no legal control of the midwife problem in the state and there had










been no general effort "6 point out the reasons for this mortality until 1930
when Dr. J3 R, McCord, Professor of Obstetrics at Emory University, put on a
series of post-graduate courses in obstetrics over the state. This course was
highly beneficial to the Ooctors and raised the standard of obstetrical practice.
Now we are putting into execution the midwife law by which we hope to eliminate
the unfit among the midwives and gradually reduce their number to those who are
most nearly qualified for such work.

In surveying the malaria and hookworm situation in thq state it
soon became apparent that these were the outstanding factors interfering with
economic d development in the rural cooaunities, especially In-m portion of the
state whjdi will be found to the north and west of a line drawn from 'Yaksonville
or the m6ith of the St. 3Thns River to Tampa Bay. This is the principal farming
onim~unity of the state. tn this area we have found a malaria incidence among
school children which has varieA from 5% up to 84- of the children in school.
In' 1929 a Proup of 531 persons examined in West Florida showed 588%positive for
malaria by'microscopic examination. In the:same areas we found 'hookworm
incidence running from 280 to 80% of the children examined. In one school in the
western portion of the state I found all thes pupils and the teeaher infected with
hookworms. We put on a demonstration in 1930 in twenty ef the counties most
seriously infected with the idea of teaching the people in these counties how they
could best protect themselves against malaria eMd hookworm disease. All depart-
ments of the State Board Of Health have recognized malaria and hookworms as out-
standing factors and have concentrated on the problem. The Engineering Department
has devote& e grePt deal of time to privy construction and screening. The members
of the Bureau of Communicable Diseases have also preached to the rural people that
they should have their houses screened and sanitary privies constructed. A grent
deal has been done which is worthy of a more detailed analysis. It would form a
very interesting study and report to tabulate the work done in the Bureau of Com-
municable Diseases in the Schick tests and the immunization with toxin antitoxin
and later toxoids. The space, however, does not permit going into details.'

The Potivities of our nurses have given good results and have teen
popular as~ng those with whom they have worked. These are given In detail in
their respective secttlons of 'the report.

As executive officer of the Boprd I want to acknowledge the
owediel ,Qioperetion of alJl the members of the State Board of Health and of the
s'aff frod the lowest in rank to the highest. *There has been a mos-t creditable
spirit of loyalty and interest in the work notwithstanding the feat that there
have been several discouraging periods in pay reductions and various other
Aimfltatiozjs coming as a result of the present economic conditions.
Respectfully yours,


Henry Hanson, M.D.,
State Health Qfficer.







-.10.


A DECADE IN PUBLIC HEALTH

1923-1932 Inc.



The law requiring an Annual Report from the State Board of Health
has not been ormplied with since 1922. from the first of 1923 to the close of
1932 is a 0deoae of great importance in History. The world, and the United States
in pertiealar, has passed through peculiar periods of fluctuation in economic
stability alternating between peaks of affluence and the troughs of depression.

During this period people have built in imagination wonderful plans
for future development, principally to gat rich quick.

The boom of 1985-1926 in Florida Is the most outstanding example of
a mental (aberration) intoxication, spreading (fom one to another) lske a highly
contagious comnunicable disease. During this period everyone confidently expected
to grw rich to become millionaires. No one took heed of the inevitable tomorrow,
the' rainy day which came simultaneously with the collapse of the boom. The
balloon is now-almost completely- deflated. The boom introduced an org of spending
whibh permeated both the homes and official circles, and caused 4evelopent of
projects the cost of whioh all but wrecked the state. Many communities were forced
into bankruptcy.

It is only fair to admit that some of this affected Health Departments,
and gave rise to proposals whieh could hare been carried out on. a more economic
basis. And yet it is a fact that the plans and operations of the State Board of
Health have always been' on an honest consotentious basis and usually on an economical
plei Sfalaries for health workers have never been on a par with those in the
oamrial fields. While there have been individual discrepancies no one has
actually been overpaid.

The responsibilities of the State Health Officer are as grave as
those fv any State Official and yet he is paid a smaller salary than is paid to a
distrt- Judge,

During the decade the oamposition of the State Board of Health has
been as follows:

President and Mombers of State Board of Hoalth. State Hoalth Officer
and Socrotary.

Jhne 1921 to August 1985 C. T. Young,M.D.,President, Plant City
Qhas. H. Iuan Jacksonville
F. C, Moor,M.D., Tallahassoo
R. C. Turck,M.D.,Secrotary, Jacksonvillo

August 1925 to So-tember 1919 -
Chas. H. Mann, Prosident, Jacksonvillo
W. D. Nobles. M.D., Pensacola
H. Mason Smith, M.D.,Tampa
B. L. Arms, M.D.,Secrotary, Jacksonville







-.10.


A DECADE IN PUBLIC HEALTH

1923-1932 Inc.



The law requiring an Annual Report from the State Board of Health
has not been ormplied with since 1922. from the first of 1923 to the close of
1932 is a 0deoae of great importance in History. The world, and the United States
in pertiealar, has passed through peculiar periods of fluctuation in economic
stability alternating between peaks of affluence and the troughs of depression.

During this period people have built in imagination wonderful plans
for future development, principally to gat rich quick.

The boom of 1985-1926 in Florida Is the most outstanding example of
a mental (aberration) intoxication, spreading (fom one to another) lske a highly
contagious comnunicable disease. During this period everyone confidently expected
to grw rich to become millionaires. No one took heed of the inevitable tomorrow,
the' rainy day which came simultaneously with the collapse of the boom. The
balloon is now-almost completely- deflated. The boom introduced an org of spending
whibh permeated both the homes and official circles, and caused 4evelopent of
projects the cost of whioh all but wrecked the state. Many communities were forced
into bankruptcy.

It is only fair to admit that some of this affected Health Departments,
and gave rise to proposals whieh could hare been carried out on. a more economic
basis. And yet it is a fact that the plans and operations of the State Board of
Health have always been' on an honest consotentious basis and usually on an economical
plei Sfalaries for health workers have never been on a par with those in the
oamrial fields. While there have been individual discrepancies no one has
actually been overpaid.

The responsibilities of the State Health Officer are as grave as
those fv any State Official and yet he is paid a smaller salary than is paid to a
distrt- Judge,

During the decade the oamposition of the State Board of Health has
been as follows:

President and Mombers of State Board of Hoalth. State Hoalth Officer
and Socrotary.

Jhne 1921 to August 1985 C. T. Young,M.D.,President, Plant City
Qhas. H. Iuan Jacksonville
F. C, Moor,M.D., Tallahassoo
R. C. Turck,M.D.,Secrotary, Jacksonvillo

August 1925 to So-tember 1919 -
Chas. H. Mann, Prosident, Jacksonvillo
W. D. Nobles. M.D., Pensacola
H. Mason Smith, M.D.,Tampa
B. L. Arms, M.D.,Secrotary, Jacksonville







- 3


September 1929 to October 1930 -
Chas. H. Mann, President, Jacksonville
W. D. Nobles, M.D., Pensacola
H. Mason Smith, M.D., Tampa
Henry Hanson, M.D, Secretary, Jacksonville

October 1930 to date H. Mason Smith,M.D., Preside#t, Tampa
Henry E. Palmer, M.D., Tallahassoe
lUdward M. L'Engle,M.D., Jacksonville
Henry Hanson, M.D., Secretary, Jacksonville

As the Annual Reports for previous years are examined it is found that
there was no report for the year 1919. Dr. W. H. Oox of Brooksvillo was then State
Health Officer in the Administration of Governor kidney J. Catta.

..The following are extracts from a report, to the President of the State
Board of Health in 1929 which was never completed or published.

"The present Stato Health Officer assumed office on the 16th
of September, 1929 succeeding Dr. B. L. Arms, resigned. In
December 1927 he resumed a relation with the State Board of Health
which was interrupted in May 1916. His pro-war connection with
the State Board of Health was in the capacity of Senior Bacteri-
ologist in the State Board of Health Laboratories, which service
.was terminated in Mlay 1916.

"Although not a stranger to the state or the public health
work the assumption of the duties of State Health Officer pre-
sented rather large and difficult problems. Only three and a
half months have passed since assuming office and this is scarcely
enough timo for one to become oriented in the duties of an office
of the magnitude of the Executive of the State Board of Health of
Florida. Thoro is much that is new in the routine of the (executive)
office which differs from the routine followed thirteen years ago.
Tho State-Board of Health is now organized in five separate bureaus
which appear to be operating independently. There has not boon
enough timn to arrive at definite conclusions regarding the pro-
cedure or any changes which might be inaugurated in the inter-
departmental organization.

"On entering the State Board of Hoalth building after an
absence of about ten cars, one is impressed with the crowding
and crying nopd for more space. Having noted the installation
of the Bureau of Vital Statistics shortly before leaving in 1917,
it was a surprise to find this Bureau had overflowed its quarters
and was occupiin the hall-way and all otherwise available un-
occupied nooks in the headquarters building.

"A similar condition prevails in the Laboratory, due to the
phenomenal growth in the volume of work as compared with conditions
while the'writer was Laboratory Director. A glance at the old








reports from 1910 to 1916 shows that the work multiplied itself
six times during that period as compared with the year 1909.

"The Bureau of Sanitary Engineering also has shown rapid
growth and is having some difficulty in accommodating itself to its
present cramped quarters. The Bureau of Child Hygiene and Public
Health Nursing Las had a great impetus during the past few years,
largely due to additional funds made available by the Children's
Bureau, Department of Labor, through the instrumentality of the
provisions of the Shepard-Towner Act.

"The library was established by Dr. J. Y. Porter, the first
State Health Officer and is essential both to the public health
group and the physicians in practice. A few years ago this
service was disrupted. Anyone endeavoring to keep abreast of the
trends of the time must have ready available reference material
(end it is hoped that an effective library service may soon be
reestablished.)

"On the ';bole the staff of the State Board of Health is out-
standing for ability and training. Several members have long
....- Ad creditable service, among which the following are deserving
of mention. Henry P. Brown completed twenty years of unbroken
service on the 15th of December, 1929, and Dr. F. A. Brink will
complete twenty years service on April 1, 1930*.

Thanks to the Rockefeller Foundation we were able to reestablish
the Library in Januory 1932. It was not established as a purely public health
library but as a general medical library for the use of the entire medical
profession of the Stato of Florida and others who may have occasion to use it. A
library of this nature is as important to public health and medical men as the
lawyers books are to the legal fraternity. There is a continuous progress in
scientific discoveries which one mast keep abreast of in order to render effective
service to the State. It is felt that the present library service has increased
the efficiency of the staff by 50%. It has made possible a research which will
benefit all who have occasion to call on the State Board of Health for help.

At the time of writing or attempting a resume of ten years of the
State Boerd of Health's activities, three and one half years after assuming the
office of State Health Officer, one has a fairly comprehensive grasp of the .belth
problems in the State. It seems an irony of fete, however, to be faced with a
general economic condition which may necessitate the most drastic cut in the budget
which tne 15WBa8w ever boon called upon to meet. The Governor has accepted the
challenge of balancing the budget, a staggering task, in which his Cabinet is
valiantly cooperating. As usual erch of the State Governmental Departments wish
the economies applied to the other department and not his ouw. It is natural that
"the State Board of Health feels that it should not be cut as heavily as some others
and yet in an effort to comply with instructions from the Chief Executive and to
manifest a spirit of cooperation the Health Department has cut its budget more
8rasticalUy then any other State Department with the exception of the State
Department of Pubifc Welfare. How much can sick people accomplish? Can a Health
Deportment be sick?









Tho State Board of Health as now organized consists of the follow-
ing:
Administration
Bureau of Communitable Diseases
Bureau of Diagnostic Laboratories
Bureau of Sanitary Engineering
Bureau of Vital Statistics
Division of Public Health Nursing
Division of Malaria Research
Division of Malaria Control Studies
Division of Library Service
Division of Drug Inspection

There is at present a Division of Public Health Nursing which is the
survivor of the Burcau of Child Hygiene and Public Health Nursing. When first
organized this was known as the Bureau of Education and Child Wolfare but at a
mooting of the State Board of Health on April 19, 1926 the name of this Bureau was
changed (from the Bureau of Child Welfare) to the Bureau of Child Hygiene and Public
oHalth Nursing.

For a number of years tho State Board of Health operated a Division
known as the Orthopedic Department, or a service to crippled children. The Chief
Surgeon hold clinics in various sections of the state and there examined all who
presented themselves at the clinics. From those he would select some who were in'
most urgent need of operation and whore the results wore most promising. As many
of them were taken as the funds set aside for this purpose would permit. In 1929
a law was passed creating a Crippled Children's Commission. During the first year
after the passage of this law, while the Commission was getting organized, the
State Board of Health continued its work and treated (91 during 1929-1930 and 40
during the first 6 months of 1931) 131 children at its own expense. During the last
few months of the Board's participation in this work certain funds were poolod. with
the funds of the Crippled Children's Commission and the service of the Board con-
tinued as before with this one exception. There is attached in a later section.of
this report the work done for crippled children and its per capital cost,

We have also a Division of Drug Store Inspection which was provided
for by acts of the Legislature in 1927. This division has rendered a service of
considorablp value to the drug trade in the state. It has raised the standards of
pharmacy and offers a groator guarantee to the sick that they will have prescription;
accurately compounded by graduate licensed pharmacists. It often happens that
health is vitally affected by the employment of drugs (chemicals) of a known
potency. In critical illness this is a matter of lifo or death.

RESEARCH

We at present have three separate divisions on malaria investigation.
The first Of these, the Division of Malaria Research, was established in 1930 by
the Rockofdllor Foundation with Dr. Mark F. Boyd as director and Dr. W. K. Stratman-
Thomas as associate. In 1931 the U. S. Public Health Service established ( in co-
operation with the State Board of Health) a Division of Malaria Control Studies
under tho direction of Dr. T. H. D. Griffitt.s. For some yo rs the Bureau of Ento-
mology has had a station in the state studying different problems, devoting some-
time to insects which affect man. This station has boon under the immodi.te









Tho State Board of Health as now organized consists of the follow-
ing:
Administration
Bureau of Communitable Diseases
Bureau of Diagnostic Laboratories
Bureau of Sanitary Engineering
Bureau of Vital Statistics
Division of Public Health Nursing
Division of Malaria Research
Division of Malaria Control Studies
Division of Library Service
Division of Drug Inspection

There is at present a Division of Public Health Nursing which is the
survivor of the Burcau of Child Hygiene and Public Health Nursing. When first
organized this was known as the Bureau of Education and Child Wolfare but at a
mooting of the State Board of Health on April 19, 1926 the name of this Bureau was
changed (from the Bureau of Child Welfare) to the Bureau of Child Hygiene and Public
oHalth Nursing.

For a number of years tho State Board of Health operated a Division
known as the Orthopedic Department, or a service to crippled children. The Chief
Surgeon hold clinics in various sections of the state and there examined all who
presented themselves at the clinics. From those he would select some who were in'
most urgent need of operation and whore the results wore most promising. As many
of them were taken as the funds set aside for this purpose would permit. In 1929
a law was passed creating a Crippled Children's Commission. During the first year
after the passage of this law, while the Commission was getting organized, the
State Board of Health continued its work and treated (91 during 1929-1930 and 40
during the first 6 months of 1931) 131 children at its own expense. During the last
few months of the Board's participation in this work certain funds were poolod. with
the funds of the Crippled Children's Commission and the service of the Board con-
tinued as before with this one exception. There is attached in a later section.of
this report the work done for crippled children and its per capital cost,

We have also a Division of Drug Store Inspection which was provided
for by acts of the Legislature in 1927. This division has rendered a service of
considorablp value to the drug trade in the state. It has raised the standards of
pharmacy and offers a groator guarantee to the sick that they will have prescription;
accurately compounded by graduate licensed pharmacists. It often happens that
health is vitally affected by the employment of drugs (chemicals) of a known
potency. In critical illness this is a matter of lifo or death.

RESEARCH

We at present have three separate divisions on malaria investigation.
The first Of these, the Division of Malaria Research, was established in 1930 by
the Rockofdllor Foundation with Dr. Mark F. Boyd as director and Dr. W. K. Stratman-
Thomas as associate. In 1931 the U. S. Public Health Service established ( in co-
operation with the State Board of Health) a Division of Malaria Control Studies
under tho direction of Dr. T. H. D. Griffitt.s. For some yo rs the Bureau of Ento-
mology has had a station in the state studying different problems, devoting some-
time to insects which affect man. This station has boon under the immodi.te







-5-


supervision of Mr. G. H. Bradley until a few months ago when Dr. W. V. King returned
ftcm his ~reign detdi and is now in personal charge of the ssttioni When Dr. King
returned to the state he very graciously ageMd to be Gonsultant in tgmtoology to
the State Board of Health. This gives Florida the benefit fa the expert knowledge
ad training of three leading malariologists in this country. The work thet has
ben done and is being dne in these three divisions is of the greatest value to the
state.

Dr. Boyd's work is largely a stydy of the clinical phases of malaria,
together with the role of the Anopheles mosquito as a transmitter, the native at
the disease, and its application as a ocereoting agency in certain nervous system
di seaee. INumrous publications hare come out from this station replete with
knowledge which has not heretofore been available to the scientific world. A
brief statement of his work will be found in another section of this repeat.

Dr. Griffttts started his work first in a series of mosquito (Ano-
pheles) surveys both for adults and larvae thereby locating the areas which are
moat likely to show a high incidence of malaria in the population in that vicinity.
LTter on a aeriea of blood smear surveys were made in schools in seven counties
where the average incidence in the counties ran from 2 to 1 positive by tmiro-
scopic examine ion. In some schools of some counties the positive blood rate ran
as high as 84% of the children in school. Nany of the schools showed a rate
running from 30% to 70M. Dr. Griffitts' findings are included in this report,
where the percentages can be studied in more detail.

Dr. King's work has not yet been organized insofar as his partici-
patioa in the State Board of .Jealth program is concerned. It is expected, however,
that before the close of 1933 we will have valuable contributions from Dr. King
and his associates.
MALARIA R~SLRCH

Most people think of malaria as a malefactor and it is for that
reason we beve the elaborate researchh and study and the aid of the nationally and
internationally known experts mentioned above, engaged in the effort to eluoldate
the unknown of this tropically world wide disease. In the course of these studies
we haie run into a phese of "Llarie the benefactor". Wagner Tauregg of Vieana in
working with malaria found that certain individuals suffering with neurosypiilia
showed improvement after an attack of mPlria. This naturally opened fields for
invewstgatlon and confirmatory experimentation. The results of the experiment
Justified further study, and led to further artificial inoculation of certain types
at patients, sufferers with such neurosyphilia as general paresis and tabes dorsalia.
About 130 persons with general paresis of the insane have been given this treat-
ment in our Malerie Research Division with the result that many have iaproed
sufficiently to be paroled to their homes*

During the past year we have applied the experiment to selected
individuela who have developed the condition known. s *Wassermann fastness" where
cerebral symptoms were becoming manifest. We hIve one outstanding case, a meohanto,
who wea practically incapacitated ad was doing pd work of any consequence, in fact,
he was about to be dismissed from the shop. After a course of this treatment he
has gone beok to full duty and hes gained 80 pounds in weight. Later the treatment
wes tried on tabetics and one case of amyotrophic lateral sclerosis. The results
of these experiments ;ill be reported next year.







-6-
DECADE IN PUBLIC HEALTH

The typhoid death rate in. 1923 was 15.5 per 100,000 and copntinied at
about this level until the middle of .198 whon it foll below 15 and from then on
thdro has beep aoezftueaus decline untilX the middle of 1950 which shows a slight
rise. :Th rbte not is about 5.f.

MALARIA
Malaria seems to run to a peak every ten years with some intermediate
fluctuations. The highest rate inthe decade under discussion occurred in 1929,
with 470 decths, a rate of 35.8 per lO0b0 the previous peak being the one in
1919 Which showed a death rate of 45 pe 100,0000 The case rate in tnlaria is
usually 200 clinical cases for each dorth. The number of reported'deaths has run
from 205 to 4V0 during this samo doeado dor from 41,000 to 94,000 olihcal. cases.
cr.ch yer-'. :

TUBERCULOSIS
'Tuberculosis has had a consistently falling curve except for the year
1926 '(boom yobr) which may be accounted for by a discrepancy between the estimated
populations and the actual. The rate in 1923 wea 95 as compared with the 1931 rait
of 70.

DIP1HT~RIA
Diphtheric at the beginning of 1923 had a rate of about 8 plus, As a
result of an active immunizing program started in 1986 the rate has fallen con-
sistently to loss than 5 in 1929, to rise to just over 5 in 1930 and then dropped
to 4.9 in 1931. If parents were more consistent and prompt in calling a qualified
physician when the children complain of sore throat the death rate from diphtheria
would beo much lower A death due to diphtheric is evidence of delayed diagnosis
and either insufficient or too lato administration of diphtheria antitoxin.

PINFUMONIA
The pneumonia rate in Florida has been low except during years when
"Flu" was epidemic but even then was lower than the rate for the U. S. Registration
Aror~ in 1923 thd rate in Florida wae about 65 while for the Registration Area it
was 110. In 1931 our rate was about.55 while in the Registration Area it was near
85. It is unfortunate that many of our tourists do not realize the advantage of
remaining in Florida in the spring which is the most dangerous pneumonia period in
the north.

AUTOMOBILE DEATHS
We crossed the curve for the U. S. Registration Area in 1983 and have
remained from 10 to b0 points above everspince. It is n fact, however, that many
of our automdbile fatalities occut among tourists. The rate in 1923 was 15 in
1931 it was dbout 33 per 100,000.

INFANT MORTALITY
Infant Mortality in 1923 was about 78, rose to 82 in 1924, both years
above the rate for the U. S4 Registration Area but from that time on it began
foiling and has fallen consistently ever since. It foll below the curve for the
U. S. Registration Area in 1928 when the rete was 77 and has slowly and steadily.
declined sinoo to the 1931 rate of 64. We are inclined to credit the drop in
infant mortality in pert to a consistent improvement in milk sanitation throughout
the state. There are elso mpny other factors, such as Public Health Nursing and
the work of the Buroau of Communicable Diseases which is discuss, in another
section of this report.







PUPERAL RATES
(Deaths of mothers dub to child bearing)

Puerperal Rates in Florida have been high. These reached thsir peek
in 1923 with a rate of 12.4 per 100 live births. These dropped quite steadily until
th middle of 1998 to the kate of 9.5 then rose tb 9.9 in 1930 which is the rate
fop 1931. Curiously there was exactly the asue amaber dying,fom thqs eause in 1930
and 1931, or 267 each year. The reports for 1932 ble incomlpete and 6annot'be in-
eluded in this discussion* There were however 12 fewer deaths during,the first
eleven months than for the corresponding period of 1931. Up to the tle of the
enactment of the midwife law by the Legislature of 1931 we had no legal control of
midwives and any one .puld enaige in that practice. It ti said that there were at
one time 17 male midwives in the state both block and white. lWhle the deaths
charged to midwives appear fewer or in other words the puerperal rate is op the face
of it mas favorable to midwives then to physio laa it should be reembere that the
midwife refers all of her difficult cases to the doctor who' then is barrged with'
the deaths.
PELLAGRA

Pellagra is one disease whieh seems to have defied the depression.
The fatalities have dropped from 313 in 1929 to 220 in 193l the same binber as for
1927. There is still some difference of opinion as to etilogy but it seems that
the majority of medical men have accepted the dietary theory.
SMALLPOX

Smallpox which used to be one of the most serious among the ommuni-
eable diseases is well under control. There has not been a death from amllpox in
-this state since the one (a colored man in Seminole County), in June 19286 People
who possess normal intelligence are accepting the protection which vaccination offers
and one can truthfully say that only people who are mentally unbalanced make
serious objection to vaccination.
POLIOMYELITIS

Poliomyelitis (infantile paralysis) which frequently causes greet
alarm in the north by its extensive outbreaks has never been a serious problem in
Florida. Sporadic cases occur but these seem to be isolated and there has been
no extension of the disease into anything like an epidemic.

HOOKWOI S

Unless one turns to the records of laboratory examinations made 20
or 25 years ago it may seem that the hookworm problem in the state is serious and
that little or no progress has been made. In 1910 the first 7500 tests made for
this disease showed 57% to be infected, most of them seriously so. Last year an
analysis of 250,000 tests showed about 25% positive manifesting a distinct improve-
ment. We still have sections (in the sandy portions) in the state where from 20 to
80% of the children are infected. This condition together with the prevalence ot
melaria constitute the most serious handicaps to our rural population. It is what
holds the state back.
VENEREAL DISEASES

The Venereal Disease rate (incidence) presents the most appalling
problem for the Health Officers, The new case rate over the nation is 3.46 for
syphilis and 5.71 for gonorrhea per 1000 population (eat. 1930). There are 643,000
oases of syphilis constantly under treatment and 474,000 eases of gonorrhea (est.:
1930).










The *eriousness from the Communicable Disease standpoint is that among the ignorant
end poor treatment is neglected because of failure at first to recognize the true
nature of the disease and seo6ndiy for want of teans to pay for treetment-when
it will do the greatest good. We ought to have a special appropriation of- *0,000.
to $30,o00., tor strictly treetmeti. linics. The financial lose due to incepeai-
tation s 1 brmous. Saeliim tion for evidence of Venereal Diseases constitutes the
biggest ping e item in'the list% of lebsraetry tests. See section dealing With
report of Di'eet' o of the piagnostf';iLaboretorie"s

In the earlier part of this report, quotation from unpublished reB
port, referehee'was made to! the rapid increase in the 1iboratory work. It is
striking to potpare the volume of work in 1900 and 1932, wht .h is as follows:
5,I6~ for 19t and 820,000 for 1938. Of this volu\ e the Kahn teats far outnumber
all ethers individually.

The decade covered in this report has shown a rather remarkable
change 'in dipeese incidence. It has swung most of the leading.causes of deaths
into the ol4 age group. end .those.represented by the worn out moahinery. The
average expectancy of life has been increased about ten years. The maximumalength
of life however does not appear to be greatly affected.

TWEfTY LEADING CAUSES OF DEATH, FLORIDA, 1931


CAUSES

Heart DiseaseA(a.ll 'foms) .
S Nephritis ( all forms)
Cerebral HemorrhFgo
Cancer (all fq~rms)
Tuberculosis (all forms')
'* Pneumonia (all~ forms)
S ..Influenza (ell forms) .
A' automobile Accidents
Syphilis
Homicide by Firearms :
DiPrrhee and Enteritis
Other Diseases of Stomach
.Pellagra
S Appendicitis
Diabetes Mellitus
*" e 1lP-ria
Hemiplegis
S-ccidental Treumatiam 'by Fa.*1
icoidentel Drowning
O 'rrhoais of Liver


DEATHS

2,810
1t737'
*1,304
1,078
1,067
863
607
514
458
300
292
223
220
220
216
205
190
172
140
131


* .


.* ..




* ." "' i .


'






- 9 -


TWENTY LEADING CAMSB OF IZ-'T, FLORIDA, 1923

oAuS-


Heart Disease (all forms)
Tuberculosis (ell forms)
Nephritis (all forms)
Cerebral Hemorrlh ge
Pneumonia (all forms)
Cancer (all forms)
Diarrhea and Enteritis
Paralysis
Mle ris
Other Diseases of Stomach
Influenza (all forms)
Homicide by Firearms
Syphilis
Automobile Adoidents
Typhoid
Appendicitis
Accidental Drowning
Diabetes Mellitus
Puerperal Albuminuria & Convulsions
Intestinal Obstructions


1,761
1,079
1,002
832
815
642
556
313
293
244
225
179
178
177
129
110
97
94
92


It is interesting to note in the table on the leading Causes of
deaths that tuberculosis, which in 1923 was second on the list, dropped to fifth
plase in 1931, and typhoid which wps fifteenth in 1923 had dropped out of the
first twenty in 1931. As the table is examined it is startling to note that
automobile deaths which were fourteenth on the list had come up to the eighth
place when these statistics were completed. While it is a feet that there are
many more who travel by automobile than there were ten or twelve years ego, it else
seems that there is an increasing recklessness on the part of a number of drivers,
who not only menace their own lives but the lives of the careful driver end those
who are riding with him. It seems that many experience e Dr. Jekyll and Mr. Hyde
change as they get in and out of their ears. In their automobiles they not only
leak ordinary courtesy but are manifestly intolerant of the most patent rights of
the other driver. Why it should be so important to reach the stop light before
the other person is difficult to guess, In this effort many burn their brake bands
which soen leads to difficulties and possible accident on account of improper
functioning when it is important to be able to stop in an emergency. Among auto-
mobile drivers there is NO, "YOT FIRST i DEAR ALPBCNSO", but rather a "MB FIRST,
- DA~ YOO, STAY BACK, GET OUT OF THE WAY OD LET ME BT I I Unfortunately there
is little the health department can do about it, there seems to be no immmization
against the reckless driving aPfia.
RPABINS

From the time of the earliest medical literature rabies has been
known and dreaded. There is no cure for rabies (hydrophobia) once the clinical
symptoms are definitely manifested. The suffering is one more of mental anguish
than acute physical pain, but the mental anguish seems to surpass anything kno-w
as a torture to human beings. Since Pasteur's discovery of the principle of drying






- 9 -


TWENTY LEADING CAMSB OF IZ-'T, FLORIDA, 1923

oAuS-


Heart Disease (all forms)
Tuberculosis (ell forms)
Nephritis (all forms)
Cerebral Hemorrlh ge
Pneumonia (all forms)
Cancer (all forms)
Diarrhea and Enteritis
Paralysis
Mle ris
Other Diseases of Stomach
Influenza (all forms)
Homicide by Firearms
Syphilis
Automobile Adoidents
Typhoid
Appendicitis
Accidental Drowning
Diabetes Mellitus
Puerperal Albuminuria & Convulsions
Intestinal Obstructions


1,761
1,079
1,002
832
815
642
556
313
293
244
225
179
178
177
129
110
97
94
92


It is interesting to note in the table on the leading Causes of
deaths that tuberculosis, which in 1923 was second on the list, dropped to fifth
plase in 1931, and typhoid which wps fifteenth in 1923 had dropped out of the
first twenty in 1931. As the table is examined it is startling to note that
automobile deaths which were fourteenth on the list had come up to the eighth
place when these statistics were completed. While it is a feet that there are
many more who travel by automobile than there were ten or twelve years ego, it else
seems that there is an increasing recklessness on the part of a number of drivers,
who not only menace their own lives but the lives of the careful driver end those
who are riding with him. It seems that many experience e Dr. Jekyll and Mr. Hyde
change as they get in and out of their ears. In their automobiles they not only
leak ordinary courtesy but are manifestly intolerant of the most patent rights of
the other driver. Why it should be so important to reach the stop light before
the other person is difficult to guess, In this effort many burn their brake bands
which soen leads to difficulties and possible accident on account of improper
functioning when it is important to be able to stop in an emergency. Among auto-
mobile drivers there is NO, "YOT FIRST i DEAR ALPBCNSO", but rather a "MB FIRST,
- DA~ YOO, STAY BACK, GET OUT OF THE WAY OD LET ME BT I I Unfortunately there
is little the health department can do about it, there seems to be no immmization
against the reckless driving aPfia.
RPABINS

From the time of the earliest medical literature rabies has been
known and dreaded. There is no cure for rabies (hydrophobia) once the clinical
symptoms are definitely manifested. The suffering is one more of mental anguish
than acute physical pain, but the mental anguish seems to surpass anything kno-w
as a torture to human beings. Since Pasteur's discovery of the principle of drying






* 10 -


a portion of the cord of a rabbit, and emulsifying it in glycerine and giving daily
inoculations of this attenuated virus we have had a preventive for rabies of hydro-
phobia. During the last few years a vaccine has been prepared for dogs, and the
experience indicates that of dogs so inoculated 85f to 90% will not develop rabies
even though bitten by other rabid animals. Last summer we drew up a model ordinance
for municipalities to require all dogs to be licensed and given the annual inocula-
tion against rabies. Since that time we have had less rabies in the state than
during the months previous to this requirement. Some municipalities (Sarasota for
example) have had no rabies since enforcing such an ordinance. Previous to the
adoption of the ordinance we had five humpn deaths within a year's time. We hope
all municipalities will adopt and enforce such ordinance.

THE WORK IN GENERAL

While the preceding discussion has brought out to some extent what
the work of the State Board of Health is, there still remains a great deal which
the average citizen can visualize only by a personal visit to the headquarters
offices or by going with the employees in the regular daily round of duties. The
offices at headquarters are never closed except for a while on Saturday and Sunday
afternoons. The laboratory is open all days of the year whether a legal holiday
or not. In the report from the laboratory division the extent of the work is
portrayed.

On the fourth page of this general discussion the organization set
up is found. At present there are four Bureaus and five Divisions, in fact there
actually is another, the Division of Accounting. The work in Florida is different
from other states, in that there are only three cities which have full time health
departments,; and only three counties with a full time health unit for the county.
The health work in the balance of the state is at present a duty of the State
Health Depertment, and when you consider the extent of territory, the staff avail-
able for the work is too slall. From epcksonville to Key West is about 520 miles
and from Jacksonville to Pensacola is 384 miles. The field medical officers each
,heve 20 counties to cover, and it is evident that these men can only do a super-
ficial type of work. They can only respond to emergencies or be what is known as
"trouble shooters". Rather than reduce the staff it should be increased. When
we succeed in developing enough county health units we will be able to reduce
certain portions of the central staff and at the same time have more effective work
in the organized counties.

The Public Health Nursing at present is inadequate. We have five
nurses, two devoting full time to midwife licensing and registration. For this
work there ought to be at least five nurses devoting full time to the teaching of
the midwives. Classes should be held regularly. We must have them for the rural
communities where the doctors will not go.

One nurse is devoting all of her tine to "Perent Education", a phase
which deals with psychology and factors which control character development, health
habits, etc. This is a very important phase of child hygiene in which the parents
are made to realize that parents should inculcate the vital principles of health
in a growing child's habits.

Another nurse has worked with the Sureau of Communicable Diseases in
the tuberculosis case finding and testing clinics. One nurse for this program is
not enough. -There should be enough nurses to make possible adequate follow-up and
a cooperation with the practicing physician interested in tuberculosis.







At present we have only one nurse on general public health nursing
duty. Here too there ought to be enough nurses to contact the county nurses and
other health workers so as to work out a coordinated program for the entire state.
There is a great need for home visits, to teach hygiene in the home, how to care
for communicable disease and other factors influencing the health of the people.
We need at least five additional public health nurses.

Florida ought to start rebuilding its Child Hygiene program, which
can be done without setting up an elaborate division as if it were something
independent of a general public health program* Everything which the health depart-
ment does has a direct bearing on the health of the child. It is unfortunate that
some in their enthusiasm for proving their own importance have beclouded the issue
with the idea that child hygiene is a thing apart from public health. Those phases
of health development of the child which do not belong in the field of public
health belong to the private practitioner or the pediatrician. There is no call
for the Health Officer to trespass on the field of the private practitioner.

The State Health Department has outgrown its present quarters. The
building was designed on the basis of expectations 25 years ago, when one could not
Tizuelize a hundred percent increase in population in 20 years and what it would
take to meet the new demands. When the present building was designed the State had
no Division of Public Health Nursing, Senitary Engineering or Vital Statistics, as
we have now, each doing extensive and important work.

The Division of Public Health Nursing we are housing in the Adminis-
tration building in a room which was originally designed for an office for the
Director of Laboratories. The Engineers have been moved. nto a building which wee
put up for an animal house for the experimental animals used in connection with the
laboratory work*

When the Division of Vital Statistics was first established it began
its operation in a room on the first floor which was intended (and for about four
years used) for an assembly room.* The magnificent progress made in collecting
vital statistics rapidly filled all available space. The vault which ws put in
was soon over-filled and the records began overflowing into the corridors and all
available nooks. Since the law requires such records (which by-the-way cannot be
replaced if once destroyed) to be kept in a fire proof building in a fire proof
vault, the Board had to look about for more suitable offices, and rented space in
the Florida Theatre Building for this Bureau until such time as the State should
find itself in condition to provide new and adequate quarters for the State Board
of Health. For 2,657 square feet of flobr space in a class A fire proof building
for the Bureau of Vital Statistics we are now paying $300.00 per month in rent.
Last year we paid .580.00 per month rent for the Bureau of Vital Statistics. Even
at $300.00 per month it amounts to $3600.00 a year which would pay interest on
S60,000.00 at af per annum. At the present time an excellent building could be put
up for $120,000.00. Building c-n be done on a more economical basis now than at
any other time and at the samo time furnish employment to a greet many who need an
income to buy food for themselves and family.

.The new building would add greatly to the efficiency of the State
Board of Health staff in having all department heads in the same building also it
wouldd make operation more economic. Florida could well do this as an advertise-
ment to tourists and prospective settlers who wish health guarantees before coming
to the State.


*The Duval County Medical Society held its meetings in this room and duringg
this period the present Stpte Health Officer enjoyed the honor of being
President of the Duval County Medical Society.


- 11 -






-18-


We need added space to house such important activities as:

Malaria Research
Malaria Control
Entomological Studies
County Heafth Unit Developmejt
Venereal Disease Control
Dental Hygiene

We have (up to date) been negligent in provision for Dental Hygiene
which is very important in the development of the child.

Since most people enter and leave the Stat. viae acksonville a
strong advertising point would be to cite the State Board of Heal-; building and
offices as one of the attraPttons for visitors. It would at the same time give
them an assurance of health proetiten which Wauld bh self evident to those seeing
the work in progress,
Insofar as a budget is concerned the State Board of Health should
have its services evaluated and appropriation or mllage voted accordingly. It is
proper to ask what the State Board of Health is costing t6e tax yr.i On The
beasi of a half mill it means that every person who pays axes on $J.000, 00 of
asseaed. velastin pays 509 r, the support of the Health Pqpartment. re. enp
analysis shoks in a disttiboqt on of the tax dollar that oily 14 gVes 0o health. The
most tbe,:St~e Health Deparltien has cost the State was it t~e ,isoal yer.l192-.l 27..
the hurricane year at the end of the boom, a total of $354,256.10, .The cost for
the fiscal year 1931-1932 was $227,987.11. The annual loss due to malaria alone
vries between$40,000Q00 eland $1000,000.00 each year. The loss from hookwom
disease Is greater -than that. Approximately 250,000 per ona in thia State beve
hook eeao ioh has been estimated to cause an annual loss to the State of bj'tweei
800,a0,000 aad $10,o00,000.00Q. A great deal of both of these loeseq oan be savdg
Oqr MW proposed budget of $178,370.00 is inadequate and iot in proportion to what
oihae ~tate departments are spending. The least sum on w1ich the StPte Bo d of
Health can Berate efficiently is (even in these times of reduced pay and4 powered
costs) $S40,O00 O.Oo This is a 164 per capital per annum fir health. How little can
a State like 1ir ids afford to spend?

In closing I want to say that the leading features in the State
program are:
1. Development of County Health Unitse

2. MNleria Research and Control Studios

3. An Efficient General Program

Acknowledgment is mnde-of valuable aid froi the Rockefeller Feunde-
tion to the Laboratory, for aid in reestablishing the Library and for the excellent
research program at Tallahassee. To the U. S. Public Heapth Service for aid in
developing .he County Health Units and for the establishment of the Station for
Wslaria Control Studies, a;d far assistance in segregation of lepers,

The staff has been faithful and cooperative in spite of many dis-
couragements and cuts both in salaries end operation.








- 13 -


At the close ef the year 1932 the Florida State Board of Health
bhd the moet ndvancei program in its history and wes widely recognized.

Acknowledgment is made of the eardial cooperation of the Governor
and of the StPte Boprd of Henith.





ORTHOPEDIC DEPARTMENT


NO. PATIENTS
XAMINED.


28
52
52
57
60
39
35
32
356


NO, NB PATIENTS
TREATED


26
46
52
57
55
36
27
24
323


PATIENTS FR1
PREVIOUS YRS.


4
7
14
14
9
11
8
67


APPOX. COST
PER PATIENT

$ 165.57
122.06
215.78
180.89
177.25
273.06
219.59
201.25
$1.555.45


CAUSES OF CRIPPLING


Spastic Paralysis
Infantile Paralysi a
Ischemic Paralysis
Spine Bifida with Paralysis
Birth PprAlysis
Synostosis of radio ulna joint
Chroea-Hypopituriteri am
Club Foot
Tuberculosis of Elbow
Tuberculosis of Spine
Tuberoulopis of Hip
Tuberculosis of Knee
Tuberculosis of Secro-iliac joint
Bone Tumor benigh
Disloeation of Hip
Dislocetion of Elbow
Muscular Atrophy Progressive
Osteomyeliti a
Torticollis
Syringomyelia
Har lip
Harelip & Cleft Palate
Arthritis (all forms except Tb.)


Ununited Fracture
Pea Planu4 3rd degree
Ankylosis of Joints
Ricketts
Congenital deformed foot & leg
Contracted seer from burn
Pigeon Brepst
Abscess Knee
Abscess Hip
Fractured Spine
Stenosis Trachea
Scoliosis
Periootetis
Legg-Perthes Disease
Fractured Kmee
Fractured Tibia
Fractured Feaur
Knock-Knee & Flat Feet
Web Fingers
Ha.mmr Toes
Encephalitis
Polydectylitis


YEAR

1924
1925
1926
1927
1928
1929
1930
1931












Dr. Henry Hanson, State Health Offiber
State Board of Health
.Jacksonville, Florida


Dear Dr. Hanson:-
I herewith submit the-annual report of the Library of the
State Board of Health for the year January 1, 1932 to January 1, 1933.



Om January first, 1938, re-organization of the State Board of Health
Library was begun. The selection consisted of something over two thouaand bound
volumes and magazines,- together with a large number of pamphlets, bulletins, state
health report, etc. The larger portion of this collection* was on shelves in the
third floor ettic. The two rooms on the second floor which had been planned for
the Library were put in shape to house the collection. Suitable shelving, consisting
of wall and center book-cases was obtained.
Classification

The-Library is olasified by the Library of Congress system. This is.
by far the m6st scientific Classification yot evolved and is the ono 'in use in many
special libraries.

CTAILOGUE ARD ACCESSIONS

At tho end of 1932 the catalogue contained 3090 typed cards and a total
of 1667 volumes had boon catalogued. Thoro is also a pamphlot file containing
approximately 2000 pamphlets arranged alphabetically acord ing to subjoct. This
file is of the utmost importance as it contains for the most part reprints of
valuable current papers on medical anO public health subjects.

AR ANGEMEHT

The main room of tho Library is used as the gqnoral reading room for
%ho staff and patrons, and contains tho eataloguo, medical diroetorios, Florida
ronorts and material, the pamphlet ooliebtion and the moro gonoral reforonco books.
There is also a magazine rook whi h holds the current copy of all magazines rocoivod.

BINDING

The magazines bound sinoo January 1932 are as follows:
Amoerican Medical Ass'n. Journal
Journal of Infoctious Diseases
American journal of Public Health

The binding of todhnidal-magazinos is of importanco, because only in
this way aro they mado available for quick and accurate r foronoos, and only in
this way are they preservo4 for the collection. Tho State Board of Health Library
is very fortunate in having nearly 600 bound volumes of various medical periodicals
which in many oases begin in the 1890's and continue through 1916. Thoro are also
approximately 3000 unbound magazines.


- 14-







-15 -


GIFTS

The doctors of the State have shown their interest in the Library
by donating large files of magazines, which have been of auch use to us in oamplet-
nlg our files. We have also received a good may books through various sources.
The Florida Tuberculosis and Health Association have turned their ontiro collection
over to us, and have given us some 200 book. In this collection is the current
file of the American Review of Tuberculosis, American Heart Journal, Journal of
the Outdoor Lifo, and the Survey.

SUMVICE AND USE or THE IEBRAR

The response of the public health workers and the medical profession
of the state during this first year indicates the vital need for such a library.
Tho Library is able to be of much help in preparing papers, souring information
and bibliographies from various sources not generally open to the individual
worker. We have answered letters and questions relating to medicine and public
health from all over the state.

Very truly yours,
(Signed) Elizabeth Bohnenbergor,
Librarian


RIUG STORE INSPECTION


January 1, 1933


Dear Dr. Hanson:


The following is a statement for the Division of Drug Store Inspeo-
tion for the calendar years July 2, 1928 to December 31, 1932.


1928 (1 Inspector)
Stores Rogistered
383 (1-4 pharmacists)
8 (no pharmacist)
Inspections made

1930 (2 Inspectors)
Stores Registered
310 (1-4 Pharmacists)
14 (no pharmacist)
Inspections made

1932 (2 Inspectors)
Stores Registered
608 (1-4 Pharmacists)
1 (no pharmacist)
Inspections made


391


674


324


1,149


609


1929 (2 Inspectors)
Stores Registered
646 (1-4 pharmacists)
9 (no pharmacist)
Inspections made

1931 (2 Inspectors)
Stores Register
792 (1-4 pharmacists)
3 (no pharmacist)
Inspections made


Signs removed


655


1,900


796


2,180


283


2,119


Respoctfully submitted,
(Signed) M. H. Dons, Chief Inspector.












1TLTIGR PPH ID2 F PrfPT'MRFrpT
State Board of Health
Jacksonville, Florida


Report of the multigraph department for the number of sheets handled
mimeograph machines, and the other hFndling of peper to complete the job.


through the multigreph rnd


Year Sheets
Through
Yultigrroh


Sheets
Through'
'inmeogr'ph


Ppds Perforrtions
of
Sheets


Books Sheets Sheets
Stitched Punched Assembled


Sheets Pheets
Folded Numbered


1920
1921
1922
S 1923

1925
1926
1927
1928
1929

1931
1932
Total


670,571
810,345
1,186,465
1,220,695
1,266,756
1,254,755
2,072,755
1,667,516
1,535,527
876,520
2,256,378
1,569,594
787,173
17,155,030


The above total figures are for the yeprs 1920 to June 30, 1932. The total number of ,obs
in work book is 6,170, but does not record the Pctual number of forms set for the various jobs.


as recorded


10,740
18,265
17,165
24,970
12,940
25,714
46,685
59,950
44,325
54,785
447,670
65,080
62,990
871,279


831
2,926
3,922
5,558
5,620
5,700
5,700
8,083
7,235
5,494
9,203
7,619
1,486
69,377


200


40,000
40,000
49,000
30,500

34,750
74,100
20,000
45,000
49,625
137,500
32,500
552,975


17,000
7,657
43,100
7,976
7,600
14,900
9,310
'3,627
4,000
2,769
3,457
4,998
2,698
129,092


50,000

45,000
34,000
59,175
100,000
46,0010
334,175


1,000
2,000
26,200
29,400


2,558
2,558


1,000
5,750
6,750








-IT7


Jc.nuary 1, 1933




Jr. Henry Hanson
State Health Officer
Jacksonville, Florida

DeAr Doctor Hansons

The following are concise Financial Stetements of Receipts and Dis-
bursements of the Stpte Board of Health for calendar years beginning
with 1923 and ending with 1931. Full and complete financial reports
are made every year and copies sent to the Governor, State Comptroller,
State Auditor and members of the State Board of Health.

The balance brought fcrw-rd from 1922 ($27,500.01) is the figure shown
in printed report of the State Board of Health for 1921-22*

Also included in this report are the small accounts from Special Fees
beginning with the years in which the activities began:

Centralisation of Merriage rnd Divorce Records,
Registration of Doctors, Midwives, Etc.,
Drug Store Inspection,
Division of Valaria Research.

The 1952 statement is made up in more detail and embrrces-General
Statement of Receipts and Disbursements, Analysis of Receipts rnd
Statement qf Disbursements by Departmentas rlso the 1932 statements
for the following small .rccountse

Centrealiation of Mirriage rnd Divorce Records,
Registration of Doctors, Midwives, Etc.,
Drug Store inspection ,
Division of Uirlaria Research,
Leon County Health Unit,
Registration of Midwives.

Yours very truly
(Signet) G.Wilson B ltBell
Auditor


PV1





-16-


ANNUAL STITS TS
STRE MAIOP 1VAM

1993
Balance from 1922 . . .
Receipts from all sources 1923 . . .

Disbursements, 19235 . * * *
Bnlrnce December 31, 1923 .

1924
Balance from 1923 . . . . .
Receipts from all sources 1924 . . .

Disbursements, 1924 . ... . .
Balance December 31, 1924 .
*** *************** ***
1925
Balance from 1924 . .. *
Receipts from all sources, 1925 .*

Disbursements, 1925 . *
Balance December 31, 1925 .
+*** ****** ***** *******
1926
Balance from 1925 .* . . *
Receipts from all sources, 1926 . .

Disbursements, 192 * 6 * * .
Balrnce December 31,1926 .
i * * *
1927.
Balance from 1926 & *
Receipts from all sources, 1927 *. *.

Disbursements, 1927 .. .* * * *
Bclrnce December 31, 1927 *

1928
Balance from 1927 6 6 * 6
Receipts from all sources, 1928 ... * *

Borrowed from Agricultural Department ...


Loans from banks


S 0 0 6 0 6 6 e 6 * a


Disbursements, 1928 .. . . .
Bolrnce December 31, 1928 *
* * * * * *
1929
Balance from 1928 ..... .. *
Receipts from all sources, 1929 * *

.Loan from Centralization of Merriage & Divorce Records

Disbursements., 1929 ... *


Paid off Loans * ** *
Balance December 31, 1929


6
*


a 27,500.01
133,716.20
$ 161,216.21
132,313.42
3 28,962.79

S28,902*79
217,504.22
) 246,480T.01
205,485.93
) 40,921.68


40,921.08
259,281.61

227,152.63



, 73,050.06
297,093,63
: 370.143.69
362,102.75
8,040,94


,0 8,040.94
306,620.50
> 514,661.44
286,414.34
. 28,247.1z


; 28,247.10
212,877.03
M 241,124.15
25,000,00
266,124.15
24,999.62
S291123.75
258, 767.48



~ 2,356.27
297 310.39
53299666.66
10,000.00
'539,666.66
256 670.07
9 82.996.59
49,999.62
,,: ,g7


*


|
II









A;., 117-


1980
Balance from 1929 . -* *
Receipts from all sources 1930. *


Loans from
Inspection Pund Agricultural Department .
Centralisation of Marriege & Divorce Records


* S


3 5,000.00
15,000.00
-*6-


Disbursements, 1930 . . . . .

Peid loan to Centralisation of rMrriage & Divorce Records .
Balance Deoamber 31, 1930 . .
************* * * *


32 8,996.97
280 089.11



20 .000.00

291,431.06

10 000.00
39#5 8.o5


1931
3annoe from 1930 . . . 3965.02
Receipts from all sources 1931 . 209,132 23

Lora from Centralization of MWrrirge & Divorce Records 15000.00

Diabrsements, 1931 . . . 260685.2

Return of loan from Centralization of Mlrriage
and Divorce Records . 15 000.00
Deficit balnnoe December 31, 1931 . 898
This .a a deficit operating balance.
The State Comptroller shows
balanme as of Dec.31,1931 7,610.58
which does not trke into
account Dee. disbursements not
paid until Jrna.ry, 1932 19 509.15
giving balance as above . .
* * * * * 9 a *










CENTRALIZATN OF RMT E & V oTSECOQDS


1927
receipts .. 4,910.00
,)iebursements . . 4,849,50
Balance Detember 31, 1927 6.,50

1928
Balance from 1927 . . .. 60.50
eceipts ........ .. 12,293.75
~Receipts


disbursements, 1928 .
Balance December 31, 1928 .
* *** * ** *


9.860.81
.l-,i- ,--


1929
Balance from 1928 . .. .
receipts . .. .. *. *

disbursements, 1929 . . .

Loan to State Board of Health .* . .
Balance December 31, 1929

1930
Balance from 1929 ............ * .
Receipts . .* * *

Loan repaid by State Board of Health .. . .

Disbursements, 1930 ... . . .

Loan to State Board of Health . . .
Balance December 31, 1930 .
** *e aa* ** *


.2,493.44
15,643.95

6,295.43

10,000.00


1,841.96
12,703.50
*14,5465.44
10,000.00
$24,545.46
8 979.868
$15,565158
15,000.00
0 565.58


1931
Balance from 1930 . 565w58
Receipts . .. . 12,999.39
$131,564.97
Loan returned by StPte Board of Health A 6 15,000.00
P28,564.97
Disbursements, 1931 . .. .. 12,033.13
-16 531.84
Loan to State Board of Health ...... 15,000.00
Belanoe December 31, 1931 1,531.84
********** *****,,t**


1212,5fi4026








-e21



RTISTYRIT W DCOYC"wS.MIWIVES.'TC.


1927
Receipts . . .


Disbursements, 1



Balance from 192
Receipts

Disebearmsot, 1



Balance from 192
Recetpts

Disbursemnta, 1



Belamoe from 192
Reoeipe





Balance from 195
Receipts

)i bursements, 1


.927


* *0


S 0 0 0 0 0


Braltnce December 81, 1927 .
********C ************C
1928



S.928 .
'Balance December 31, 1928 .C.
* C C C C C 0 C *
1929

. . . . .

929 . . . . .
Belane December 31, 1929 .

1950
19 .... 0 0 0 S 0 0 0
9 . . . . 3

.950 . . . . .
BPlance December 31, 1930


01 . .



Balance December 31, 1931 .
*** *c** C*C cc**c***C


.1


781.00
779.98



1.02
2 048.00





1,118.56
2 ,s6.00

1 787.91



1,878,45


3 072.77



1,062.68
2 335.00

1 777.50
1,618.1







-22-


ANIPTa STTIgMETS

tDRUG STORE SP-C'?TION


iedelpts ... .
Disbursements, 1928

*

Balance from 1928
Reoelpt s

Dis~arsements,.1929

$


1928
. o. . o

Balance December 31, 1928 .. .

1929




* * * *


1930
Bplance from 1929 . . .
Receipts * *

Disbursements, 1930 . . . .
Balance December 31, 19O0
>*i * * *


Belance from 1930
Receipt s


Disbursements


1931
* 5 0 5 5 S S
* S S 5 0 0 4 S 0 5 S 0 5


i, 1931 . ... . . .
Balance December 51, 1931
DIVISION* * * *
DIVISION OP MIALAIrIA RESEPA1CH


S2,669.86
7 20.00
9,989.86
9,207.69
3 '--y8Z1T r


All funds contributed by Rockefeller Foundation

1931


Receipts . . . . .
Disbursements, 1931 . .. .


$10,300.00
10,275.46
. 24.54


Balance of $24.54 returned to Rockefeller Foundetion under
agreement to refund any unexpended funds for each budget yerr.


3,710.00
2,344,27
S,,365 173


1,365.73
5,520,00
6,885o73
5.490.06



1,395.67
6 950.00
8,35=67
5 675.81
2,669.86


'0'
5,








*23-


STATE BOARD OF HEALTH


January 1,1932 To December 31,1952


RNROIPS


Balance from 1951 (Deficit) . .. .
Receipts from all sources 1932 . . * *
Total. . .
DISBRSEVENTS
Disbursements 7208,179.46
Contribution of Florida Power Corp.,taken
from State Board of Health account and placed
to credit of Leon County Health Unit (Feb) 500,00
Deficit operating balance Dec.51,1932

State Comptroller shows balance Dec. 31,1932 of
which does not embrace December bills not paid
until January, 1933 $ 16,185.64
and one November bill 443520
Deficit operating balance as above


First Six Months
January
February
March
April
MayJ
June


$ 11,898.57
214,234.75
,-202 ,336.18




208 679.46


$ 10,285.56


16,628.84
S ,343.Z8


AENUAL STATEEPnT CP RECEIPTS FOR 1992
Second Six Months
$ 17,266.58 July 12,178~.8
15,200.56 August 22,383.87
18,979.02 September 16,597.27
31,286.55 October 15,443.59
6,789.44 November 19,185.99
1,3651.91 December 27.478.48
t103174.6o $11 ,o060.68


First Six Months *. .
Second Six Months .
Total .

Taxes
Tax Redemptions
Transfers from General Re1

Rockefeller Foundation
Rosenwald Fund
Florida Power Corporation


*000SeO O . .. .
* 0 00O


AMALYSISf


venue Pund


OF 1932 ECEIPTS
S95,282.94
16.526.28


$ 1.500.00
393.75
94.80


Refund from Drug Store Inspection $ 60.00
Auto Ins. Premium 13.22
Orthopedic Case (1929-30) 188.85
Miscellaneous Refunds 87,07
Sale of least & Imbulsing Drugs
City of Tampa Rent of Space in Laboratory
Warrant #111214 (5/16/27) Cancelled and Restored to balance


$103,174.07
111,060.68



$111,809.22
99 500.00



1,988.55




349.14
277.04
300.00
10.00
r~oo
*gma~nryy







STPTEP BOARD OF H ABIM


~agerry 1,1932 To December 31,1932

Disbarsements by departments and Konths for First and Second Periods, 1932


First Six Eonths


Administration
Labov tort -MI .
Cornmnicalb.p Diseases
Engineering'
Vital Statiktics
Child ygiene & P.H.N.
Blologics
Apistance to countyy
; Healith*ibits
llarUi Cittreil Studies




Administrartnon
Laboratories
Coaaunicaipee Tiseases
Engineering
Vital Stp tistics
Child Hygiene & P.H.N.
Biologics
Assistance to Cotnty
Health Units
Malaria Control Studies


Jenuar y
2,1.6o538

2 635 ,? 2
2,612.59
5E:745e16
5,135.16
l,.19.86


February
1,913.15
5.826,90
3.).36,45.
5,266,17
2,91184
752,65
1,923.25


191.67 241.17


L7-rch
2,180,21
3 415.57
3,067.72
2075.10
2,595,19
794.97
3,119.82

429.16


April
1,970.29
5,390.71
2,655.20
2,791.65
5,101,57
1, 0 6.30
1,890.55

467.71


1,#.71
2,976.75
2,751.54
2,665.74
2,054473
8b3^40
1,845650

472,48


June
2,6.070.88
5,275.63
2,91.4a1
2,998,85
2,307.25
838.21
2,691.59

472,55


$19,7896 f$17,977.58 $ 1855.74 $1-7,281.98 15'45 $17,346.17


July
1,875.77
3,540 995
5,204S-3
2,641.52
2,635052
760.14
415.86

656.26


A)gest
1,680.54
3,05~.58,
2,3227.VL
3,557.05
2,550&68
460.56
2,229.25

656.28


Second Six fthaths
Sept, Oetber
2,341.85 1,953.87
5 803594 3,557.33
2~,99.24 2,838.51
2g526.89 2,558.64
2,4P4.56 3,186.60
1.12 .75 705.07
2,.92.39 2,004.80


656.28


656.26


Nove
2,050988
3 ,464 55
3,099.10
2,898*9
2,125.80
798.97
2,833.55

656.26


Dec.
1,988.94
3 ,55.12
2,881.98
2,67f.r&
2,256.15
789.06
1,295.14

656.26
175.11
6,185.64


Total
12 047 $2
20,744 64,

17,086.10
18,715474
5,591.65
12,690.57

2 274.74

9106,066.28


Total
11,854.55
20,968.47
17,009.83
S16,5.9.17
15,154.11
4,656.57
11,740.97

3,937.60
175.11
)102.11348M


$15,725.75 $1523!. L F.70B v4 T- 17 9 -


First Six Months . . .
Second Six Monthe . .. .. .
Total ,


.4 .. .*. $ 106, 6.28
*. .. . 12 13
* .' .. * PSpj~y 4


I'
"
t~








ANNUAL STLT'gENTS

Jnaary 11932 To IDeceAber 31,1932


CENTRALIZATION OF IAERIAGE & DIVORCE RECORDS
Available balance brought forward from December 51,1931
Receipts, 1932

isbarsements, 1932
Operating balance December 31,1932 .
Strte Comptroller's balmnce December 31,1932 1959.51
does not include December bills not paid intil
January, 1933 957.17
Operating balance as above . 21


5 1,531.84
11 629.90

13 159.60
ZeI4I~


* * 0 * ** * * * *


REGISTR.TICOK O DOCTORS pDWIVES, C..
Available balance brought forward from Dedember 31,1931
SReceipts, 1932

Disbursements, 19352
Operating balance December 31,1932 .
Strte Comptroller's balance December 31,1932 1,465.56
does not include December bills not prid
until January, 1933 95.00
Operating balance as above . 1,370o.


2 165.00

2 412.62
13 70.5


* e * * * * e .7* .
DBER STCR INSPECTION
Available balance brought forward from December 31,1931 'A 782.17
Receipts, 1952

Disbursements, 1932 7 516.78
Operating balance December 31,1952 2435a39
State Comptroller's balance December 31,1932 $3,365,21'
does not take into r.coount December bills "894.21
not paid until Janu.ry, 1933
also one November bill not paid until
January, 1933 55.61 929
Operating balance as above . ... .


* * * e * *
DIVISION OF MARIA RESEARCH
All fntds contributed by Rockefeller Foundrtirm. Donations designated
"Station for Field Studies in re1laria."
Receipts, 1932 .13,050.00
disbursements, 1932 413031.65


The unexpended balnre of w18.35 wrs returned to the
Rockefeller Poundtion in accordance with their budget provisions.


Ce *ge* egg.. gee. gesece geese...gg


16.35








-S6-
AMNNAL ST M'ENTS
STATV DCIMH
Janar. ,lt9 32 #To December 31,193

LON COU!MY RALTK~ UNIT
(Assistince to County Health Units)

Funds are provided by State Board of Health, Leon County, City of Tallobassee,
U. S. Public Health Service, RQsenwald Fund, Board of Education end Florida
Power Corporation.

This report only indlldes moneys deposited with the $ttte Treasurer by Leon
County, Board of E tidetion and Florida Powei Corporetlon and dlabtrsed through
State Comptroller's office.

She Leon County Health'UlMft began Cper'tions the firot part of 1932,

eeipts, 192 . . . . 494.41
Disbursements, 1932 . . . ,491.41
Operating balance December 31,1932, S 3
State Comptroller:,.ho*s balance as of Decembor 31,1952 3527.19
which does not include December bills not paid until
January, 1933 324,19
Opexrting balance as above . 5 S
S S * l? * * * * * * *
Tr-GISTRATION OF MIDIWIVES

C, 192 * * 777,91
'"It raements, 1932 . . . . 44.06
3 733.86e

4J' : il sof Receipts:
Fee's from Midwives . 769.50
Interest on Snvings Account 8e41 3 777.91
Analysis of Disbursements:
refunds to Midwives $ 43,00
Tax on Cashier'i checks for refunds *56
ReturA to Midwifo account over payment .50 44.06
Belnnce as above 733.85

Midwives' Fees deposited in Prnett Netiont 4 Bank Snvings Account pending
passage of Enabling Legislation to sAtthorize expenditures of these fees0
which was not provided in last act.




- 7 -


F Brink, N. D., Director
Bureau of Commsnioable Diseases


During the ten year period to be covered by this summary, there has been little
change in the general policy of the bureau. The ala has always been to prevent the
spread of communicable disease, utilizing every available agency and all practical
methods of control. An earnest effort has been made to learn of new development s
and follow the procedures that have been tried and approved by recognized authori-
ties.



At the beginning of the decade the personnel of the bureau consisted of two Dis-
trict Health Officers, one of whom was Acting Director, and an office secretary.
On J\ine 15, 1924, one of the District Health Officers was made Director which
position he still holds. Due to resignations and sickness the bureau continued to
operate with two and three District Health Officers during the remainder of the
year although five were authorized. It was during this year that the immnizing
work was made a major activity as a means of positive disease prevention. This
work has been continued through the balance of the decade.

Due to the difficulty of procuring and retaining qualified men at the authorized
salaries, there were but two to four District Health Officers on duty during 1925
until December when a salary increase was authorized and a full force was again on
duty.

In 1986 an increase of personnel was provided and the force of District Health
Officers was gradually increased until in November and December there were ten.
From November 1926 to July 1927, with ten doctors doing field work, the bureau
rendered more efficient service than at any other time in its history. The dis-
tricts were smaller, less travel was required and more time could be given to the
essential work. Since September 1927, there have been five District Health Offi-
oers on duty nearly all the time and this has been the authorized number.

The selection and training District Health Officers has required careful con-
sideration. At times it has seemed best to engage men with public health expeil-
once obtained in other states and acquaint them with the procedures and health
needs of Florida before placing them in the districts. A number of excellent field
men have, however, been developed by taking health-minded, dependable physicians
practicing in the state and giving them their training and field experience under
personal supervision. In any case, before a man is sent into the field he is re-
quired to spend a few days at headquarters, get acquainted with the personnel and
functions of the other bureaus, learn the policies and procedures of this bureau,
the method of making daily, monthly and expense reports and then make a tour of a
port of his district in company with the director during ihich furbhe instructions
are given.

The Director, with the advice and approval of the State Health Officer, plans the
work and outlines the policies of the bureau, directs the District Health Officers,
handles a large volume of technical correspondence and goes into the field for con-
ferences, observation of the field work, special investigations and educational and
communicable disease control work.

It is our policy to have the personnel of the bureau identity itself with organized
medicine, attend the meetings of local societies and maintain cordial relations
with individual doctors all for the promotion of mutual understanding, exchange of
ideas and Improvement of public health.




- 7 -


F Brink, N. D., Director
Bureau of Commsnioable Diseases


During the ten year period to be covered by this summary, there has been little
change in the general policy of the bureau. The ala has always been to prevent the
spread of communicable disease, utilizing every available agency and all practical
methods of control. An earnest effort has been made to learn of new development s
and follow the procedures that have been tried and approved by recognized authori-
ties.



At the beginning of the decade the personnel of the bureau consisted of two Dis-
trict Health Officers, one of whom was Acting Director, and an office secretary.
On J\ine 15, 1924, one of the District Health Officers was made Director which
position he still holds. Due to resignations and sickness the bureau continued to
operate with two and three District Health Officers during the remainder of the
year although five were authorized. It was during this year that the immnizing
work was made a major activity as a means of positive disease prevention. This
work has been continued through the balance of the decade.

Due to the difficulty of procuring and retaining qualified men at the authorized
salaries, there were but two to four District Health Officers on duty during 1925
until December when a salary increase was authorized and a full force was again on
duty.

In 1986 an increase of personnel was provided and the force of District Health
Officers was gradually increased until in November and December there were ten.
From November 1926 to July 1927, with ten doctors doing field work, the bureau
rendered more efficient service than at any other time in its history. The dis-
tricts were smaller, less travel was required and more time could be given to the
essential work. Since September 1927, there have been five District Health Offi-
oers on duty nearly all the time and this has been the authorized number.

The selection and training District Health Officers has required careful con-
sideration. At times it has seemed best to engage men with public health expeil-
once obtained in other states and acquaint them with the procedures and health
needs of Florida before placing them in the districts. A number of excellent field
men have, however, been developed by taking health-minded, dependable physicians
practicing in the state and giving them their training and field experience under
personal supervision. In any case, before a man is sent into the field he is re-
quired to spend a few days at headquarters, get acquainted with the personnel and
functions of the other bureaus, learn the policies and procedures of this bureau,
the method of making daily, monthly and expense reports and then make a tour of a
port of his district in company with the director during ihich furbhe instructions
are given.

The Director, with the advice and approval of the State Health Officer, plans the
work and outlines the policies of the bureau, directs the District Health Officers,
handles a large volume of technical correspondence and goes into the field for con-
ferences, observation of the field work, special investigations and educational and
communicable disease control work.

It is our policy to have the personnel of the bureau identity itself with organized
medicine, attend the meetings of local societies and maintain cordial relations
with individual doctors all for the promotion of mutual understanding, exchange of
ideas and Improvement of public health.






28 -



The chief methods used to accomplish the purpose of the Bureau the control of
communicable diseases ha o been education, immunizatiQo, investigation, isolation
(-quarantine) and treatment

4uition: Information has been earoied to-the public t rqugh Health Notes, nevs-
papers, leturo4, c onf roners, inteorvi s and bulletins. I The newspapers have been
most generous and cooperative. Their columns have always been open to all reason-
able material and information furnished them for the good of their respective
communities. Lectures have been doliverd., in schools, before civic clubs, women's
clubs, parent-toacher associations, college classes and conventions of various
sorts.

In 1924 a bulletin on Tuborculosis was prepared and pri tiod. With slight change
and reprinting it has been in use and iMde3ly distributedP since that time. An
illustrated'1-page Hookworm pamphlet was prepared in .190. This has been reprinted
several timos and is in general use. The Malaria Crterohian (20 pogos) yrs revised
and reprinted'in 1950. A four-page folder telling "What to do When Diphtheria and
Other Diseases occur in School" is another publication of the bureau, also leaflets
in Influenza, Sore Eyes and Whooping Cough.

For four years the mobile motion picture service, offering visual education in pub-
lic health, has boon directed from the office of this bureau. A Dolca generator,
mounted in a Ford truck furnishes the current, a portable projector and suitable
films complete the outfit. The pictures relate to the principal health problems
of the south and, accompanied by the operator's lectures they carry the stc.y of
health to the remote 'prt'j of the state, supplementing effootively the other ser-
vices of the Stnte Board of Ho.lth.

.nmunizati-cA Vaccination far the prevention of smallpoX is a procedure so well
khoWn thtt 'it need be mentioned here only to say that it has boon applied by the.
State Bo'-d of Health with the greatest caro, by the moso modern method and uaing
a virus of unquestioned purity so that the resulting 'trnke' would be small and
harmful complications nvertod.

The present method of producing individual immunity to typhoid was first adopted by
the U. S. Army in 1909, made compulsory in 1911 and still uaed, is the method us9d
by this Bureau. It has been used extensively by us with most gratifying results*
Protection of children from diphtheria by injections of a toxin-antitoxin mixture
cnmo into general use about 1920 rnd by 19B3 its value become. widely recognized.. It
was at thit time that the practice was, started in Floridp and in 1924 it was adopted
as a routine procedure by this burecU. A moaps of sopartting immune from non-imiune
'children by means of the Schick tosthad been provided c.d many children have been
protectedd by first testing, then giving the treatments tP the .non-immune. Toxoid
has recently been substituted largely for toxin-antitoxin. This immunizng has
been done mainly in the schools because hero the children were easily reached under
suitable conditions. Spopial clinics for this work havq been organized when needed,
that is, when certain diseases appear. in a community and the people are moved to
accept thd service.

Our objective in starting the program of immunization wers to demonstrate the safety
and usefulness of the procedure, particularly that for diphtherzc control. This
his been accoMplished as shown by the absence of bad results, the absence of diph-
theria in treated children and a colnsstent decline in the diphtheria death rate.
Dit fielty has been experienced in getting people.to go to their own doctors for
this service so that we might relinquish the work.entirely to them.


- 96





- 29 -


Investigation: It is often possible, by making a careful epidemiological study of
each case of infectious disease in a community, to determine with a fair degree of
certainty, the source from which the infection has been acquired. This knowledge
is then used in applying effective control measures. For the control of diphtheria
it is customary to take cultures from large numbers of children who have been
associated with a child having the disease. Carriers are thus found and isolated.
By learning the source from which a number of typhoid patients have obtained their
water, milk, vegetables, shellfish and other foods, it is often possible to trace
the infection to its source and prevent further spread.

Isolation: This term has taken the place of the word "quarantine". It means the
separation of a communicable disease patient and his infected surroundings from
susceptible persons in such a manner that others may not contract the disease.
Application of proper isolation methods requires a knowledge of the means by which
diseases are transmitted. It is the duty of each District Health Officer to give
suitable instructions to the attendants of each communicable disease patient re-
garding disposal of discharges, use of disinfectants, visiting, exclusion of in-
sects and the time of terminating the period of isolation.

Epidemics of a serious nature have for the most part been prevented. Making due
allowance for the natural climatic advantages of the state, credit must be claimed
for the intelligent and energetic work of the State Board of Health personnel in
the discharge of their duties.

The only major epidemic of the period was one of smallpox in 1926 (2,890 cases
reported) and 1927 (1,356 cases reported). At this time a large portion of the
population was susceptible, there having been few cases of the disease and con-
sequently few vaccinations during the preceding years. There was also a most un-
usual amount of travel into and throughout the state during these two years. During
the two years more than 60,000 persons were vaccinated by the personnel of the
bureau and an unknown but probably much greater number were vaccinated by private
physicians, using vaccine furnished by the State Board of Health.

Note: A periodical outbreak of smallpox is inevitable when vaccination of a
population is neglected for a period of years. All children should be vaccinated
before entering school.

Treatment is rarely applied by the State Board of Health. This is felt to be a
function of the practicing physician whose field is invaded only on rare occasions
and under special conditions. When the treatment of the patient is an important
control measure (as in venereal diseases and malaria) it is provided, if possible,
through local doctors.

Venereal Disease Control: Ten clinics for the free treatment of venereal patients,
opened during the war and operated by as many local doctors were continued until
June 30, 1926. Those were financed jointly by the State Board of Health and the
U. S. Government and they did splendid work at small cost.

During the operation of the clinics, neoarsphenamine for intravenous treatment of
syphilis was furnished to the clinicians. Subsequently it has been furnished to
private physicians for the treatment of indigent syphilitics. Due to lack of funds
it has not been possible to give adoquato support to this type of work.







- 30 -


COUNTY HEALTH UNITS

With the aid of the personnel of the U. S. Public Health Service and a substantial
cash contribution, three county units have been organized as follows:

The Taylor County Unit began to function on September 1, 1030 The Leon County
Unit began on January 1, 1931.. The Escambia CoLr;. y J~Let u .n-i Ma..i.h 1., 193. .. Lifter
June 1, 1931; the S'tat' Board of Health contributr.,d .. sL's''sania.l amount to t, e
budget of each ITn.:, ar. ',-.e Public Health Service continued it. support vith
slightly diminished allJtuenbs

These Units render locally the services that would otherwise come from the state
and they render it more completely because the personnel is more nearly adequate
for the area and population served.

The promotion, direction and supervision of those units is now a duty of the Dir-
ector of this Buroeu.


REPORTS

A considerable amount of labor is involved in handling the reports that come in to
-.nd others that ,-re prepared in the office.

Daily and monthly reports and iionthly expense statements are received from the
District Health Officers, the Tuberculosis Clinician and Nurse and the Motion
Picture Operator. Each County Unit renders a ;-eekly narrative report, a monthly
report of disbursonents and a quarterly progress report.

All morbidity reports are received and tabulated in the office, weekly summaries
published and distributed to proper authorities.

Table No. 2 shows the number of cases of certain communicable diseases reported to
the State Board of Health during the decade. Reporting is admittedly incomplete
but it does afford a fair index of the prevalence of the more important diseases.

A monthly narrative and an annual report are prepared for the State Health Officer
and the board members.

Table No. 1 is intended to show in a greatly condensed form the volume and variety
of work done by the District He-.lth Officers. Although this table may not accom-
plish what is intended, it represents a great deal of labor and assurance can be
given that faithful service has been expected of and rendered by the field force.





S Activities durn 1923-1932, .boe h inclusive --. ---- --..- .

1923 1924 1925 1926 1927 1928 1929 1930 1931 1932

Interviews and 3267 3623 2294 8604 6722 4225 3264 4.474 .6397 7746
Conferences
Public Addresses 222 466 185 692 607 415 310 467 691 821

Newspaper Articles 48 56 46 83 118 52 92 121 198 169

Schools Visited 257 658 386 1898 1997 1549 1522 2040 2140 2809

Clinics Attended 44 131 66 90 626 1223 1420 1391 1809 2698

Persons Exemined 8962 28682 8581 9084 12986 12807 22282 13897 6703 10769

C. D. Investigated 566 669 161 1890 1612 775 518 740 1017 1135

Crsee Isoleted or 162 434 141 861 977 672 303 477 659 572
Excluded
Houses PltcFrded 34 39 6 245 234 105 74 134 293 73

SSmallpox Vr.ccinrtions 2289 2603 1014 41410 22665 8588 5482 6520 11276 17325

Typhoid Inoculrtions 792 824 6097 21431 43301 46927 38862 37268 55409 94160

Schick Tests 3329 4395 4022 23406 25. 5 17210 14880 19025 19989 21000

Toxin-rntitoxin Given 685 1206 2064 22275 23462 23902 18781 18357 23865 21439

Thro.t Swrbs 653 182 683 847 1470 822 857 1560 4598 2605

Other Specimens 58 171 25 17 180 232 1659 2654 2789 2948

Hookworm Trertments 2087 1144 2100

Tuberculin Tosts 334 2798 10769

irlrrie Smerrs 52 713 57 3146

Quinine Trertments 721 146






-'5.

TALE 10O. 2


Number of oases of certain communicable diseases reported to the State Board of
Health, 1923-1932, both inclusive:


Typhoid

Typhus

Malaria

Smallpox

Measles

Scarlet Fever

Diphtheria

Influenza

Poliomyelit is

Encephalitis

Tuberculosis

Syphilis

Gonorrhea

Pellagra

Undulant Fever

Tularemia


1923 1924 1925 1986 1927 1928 1929 1930 1931 1931

605 638 746 639 587 327 172 140 183 266

0 4 3 16 45 49 48 39 31 42

1070 1030 665 400 560 844 1535 576 339 318

228 117 206 2890 1356 156 36 28 27 33

2896 3544 128 1126 2582 1709 1117 5287 3779 217

94 155 175 459 501 376 351 541 266 235

619 681 768 1224 1095 588 580 491 501 735

994 345 761 1213 481 1631 3769 104 1543 335

15 8 59 16 39 23 33 11 17 8

5 8 11 6 10 4 7 3 1 1

1210 1575 1463 1335 1107 943 782 487 511 591

2090 5066 5736 3509 4955 4307 4273 4199 3965 4063

1425 2816 2670 1495 1426 882 828 802 714 713

96 126 136 42 74 84 66 51 64 60

0 0 0 0 0 0 8 4 3 2

0 0 0 0 0 2 4 1 2 2


** ******







-33-

LTAL NO. 3

Iumbar of pamphlets distributed by the Buroan of CO manidnblo Diseosos
1924-1938, both inclusive.

j94 925 196 1927 1988 1929 10 1931

2984 928 215 89 938 664 251 758

tho Ostrich 1750 966 289 255 332 624 6

action in the 1815 838 519 789 679 1030 355 210
Homo
Pit 3467 1437 338 1176 2349 3738 3739 390

's Port 2808 1088 320 2226 922 963 2100 388

Happy Woman- 1818 1014 266 491 2946 3876 3249 283
hood
action in Schools 208 555 210 771 635 995 1485 234

Against Pros- 141 177 220


titution
Hon to Fiht Venereal 492
Diseasos
Syphilis Information 476

Gonorrhea Infomit ion 3888

Sanitary Codo 5425

Tuberculosis 6379

T'phoid 85

Malaria 2715

Hookwarm 2735

Scarlet ever-Moaslo s 1349

Rabies 4947

Cc.noer 4029

Pollagra 2959

Diphtheria 628

Smallpox 663

Whooping Cough 745

Soaro yos

What To Do When


247

800 742 295

395 931 298

212 42 33

2258 577 1022

1428 887 2027

2126 456 1136

5934 20077 17355

1060 663 421

310 225 83

58 34

269 125 283

214 2156 2547

219 1989 2811

77 13 531

238 3944 465

38 9515 4862


147 110 150 0 165

97 110 150 0 165

25 19 10 7

1015 4841 4219 3850 1895

395 886 1660 1879 341

511 1832 7130 4921 2440

4515 7557 14767 11263 8675

226 781 120

63 6 50



670 339 54 389 455

1410 6660 6470 3739 2589

618 3889 770 2874 1730

168 599 285 120

764 272 1890 1149 250

1656 3268 2190 4384 4235


Manpo'wez

Outdoing

Sexa duc

Keeping

The Girl

Honlthy

Sea Efuc

Citizens











Influon

Inf luonza

Fly

Mosquito

Skpitary Privy

;iosrquito Campaigp


TABLE

1984 1925


1280

725

275

68593


1429

859

2105

265


N10. oat' d

196 108 1928

158 70091

217 52 163

196 61 105

422 22 55

12


CTGURTIVE MATERIALS DISTRIBUTED

Nooarsphonamine Yeast
Ampulos 1bs

4,069

5,556

6,000


300

890


1200

930


600

1550


Quinine
3gz. 5 grp


10,000 75,000

73,000


440


1929

3693

68

53

70


1930

3430

15

55

25


1932

155

500

50


Year


1924

19895

1926

1987

1988

1929

1930

1913

1932







- SB -


1932 ANNUAL REPORT
BUREAU OF COM3NICABLE DISEASES

Personnel

F. A. Brink, M. D, Director
Myrtle McLendon, Secretary
W. A. Claxton, M. D., Tuberculosis Clinician
M1ry Dodd, R. N., Nurse for Tuberculosis work.


District Medical Officers

Those. E. Morgan, M. D. District No. 1
Columbia, Bakor, Nassau, Duval, Union, Bradford, Clay, St. Johns, Alachua,
Gilchrist, Putnm, Levy, Marion, Flagler.

C. W. Peaso, M. D. District No. 2
Volusia, Lake, Sominole, Orange, Osceola, Brevard, Okeechdbee, St. Lucie,
Indian River, Martin, Palm Beach, Broward, Dade.

A. C. Hanblin, D. District No. 3
Citrus, Hernando, Sumter, Pasco, Pinellas, Hillsboro, Polk, Anatee, Hrdee,
Sarasota, DeSoto, Highlands, Charlotte, Glades, Lee, Hendry, Collier.

H. A. MeCluro, M. D District No. 4
Franklin, Liberty, Gadsden, Leon*, Wakulla, Jefferson, Madison, Taylor*,
Hamilton, Lafayette, Dixie, Suwannee.

C. W. McDonald, M. D. District No. 5
Escambia*, Santa Rosa, Okeechobee, Walton, Holmes, Washington, Jackson,
Bay Calhoun, Gulf.

*Served by County Health Unit.



There was no change in the personnel of the Bureau during the year and no loss of
time except that one District Medical Officer had a month's leave without pay.
********

Epidemiological Investigations

Wherever any considerable number of communicable disease oases were reported in a
community, an investigation into the possible source of infection was undertaken.
Pertinent facts regarding each case were gathered and correlated and from these
studies it has been possible in nnmorous instances to determine with some accuracy
the source of infection and to formulate plans for preventing further spread.

The direct spread of infection to contacts in the home has been prevented in many
instances by the application of measures known to be effective. Besides sanitation
and screening these consist of isolation in the home (or hospital), concurrent
disinfection, disposal of discharges and instruction of attendants in the paper
teohnique. Immunization of contacts has been insisted upon and has been quite
readily accomplished.






- 36 -


A number of typhoid patients were found to have eaten oysters rc-w from condemned
beds and this is believed to have been the source of their infection. Thes, find-
ings have strengthened and supported the position of the State Board of Health in
its efforts to prevent the sale of oysters from polluted wabers-

In one instance the blame for six typhoid cases was placed on a small dairy and
the trouble soemeodundoubtedly to be due to contaminated bottles returned to the
dairy from the original case.

Most of the typhoid cases reported during tho year were scattered over the state
more or loss remote from other cases and the exact source of infection was un-
determined though presumed to be from unknown carries through flios, food and
personal contact.

The immunization program of previous years, carried out mainly in the public
schools, was continued through those parts of the year when schools were in ses-
sion. A few special clinics wore arranged for immunizing pro-school children and
these met with varying success. A few were very well patronized but the results,
on the whole, have not been encouraging. It is difficult to get parents inter-
ested enough to bring the children and it is more and more evident that this ser-
vice should be rendered by a local health agency or, better still; sponsored and
carried out by practicing physicians. With that end in view cards were printed,
(revised from a previous form), bearing in conspicuous letters the following:


IS YOUR CHILD PROTECTED AGAINST

DIPHTHERIA

SMALLPOX

TYPHOID

SEE YOUR DOCTOR

HENRY HANSON, M. D. STATE BOARD OF HEALTH
STATE HEALTH OFFICER BUREAU OF COMMUNICABLE DISEASES


Those were for posting in doctors' offices and many of them have been placed. The
results of this are not easily determined but it should help to keep diphtheria
in the public mind and bring about a discussion between the doctor and his patients.

Although active iiaunization to diphtheria takes longer than that for typhoid and
smallpox, the injections havo been extensively given to children exposed and those
presumed to have been exposed so that their future might be more secure. Large
numbers of cultures have been taken from school contacts and others. By this
means numerous carriers were detected and isolated. This procedure, coupled with
the continued program of immunizing, has prevented anything resembling an epidemic.
Although there was in increase in the number of cases and deaths from diphtheria
over 1931, 81% of the children who died were under six years of age and, therefore,
not within reach of the school clinics. This is noted particularly to emphasize
the need of getting the younger children immunized. This increase in diphtheria
clearly indicates the need of increasing our efforts so that the good record of
recent years nay be continued,






37 -


With the present facilities for reaching and immunizing the pre-school children,
no marked progress is to be expected unless it be through inducing local agencies
to assume the responsibility or through a marked increase in the educational pro-
gram actively supported and aided by local doctors so that the children may be
treated by the local doctors,

Dried brewers yeast in two-pound packages has been distributed to pellagra pati-
ents on the request of their physicians. Of this product 765 packages have been
handled, 373 were sent free to indigents and 392 were sold at 50 per package
which amount covers the cost and postage.

Venereal disease control activities have consisted of distributing educational
material, answering inquiries and furnishing neoarsphenamine to practicing phy-
sicians for the free treatment of their indigent patients. A total of 930 doses
were thus furnished and 190 doses were sold at cost to contract doctors who were
thus enabled to treat syphilitics not otherwise provided for.

The program for the study and control of tuberculosis is under the able guidance
of the clinician, who was assisted by one nurse detailed to help with the conduct
of clinics and, so far as possible, fellow the recognized cases into the homes to
give advice and teach the application of protective measures. The detailed re-
pert of this activity, prepared by Dr. Claxton, is attached. It is quite
obvious that little more than a demonstration could be expected from two workers
endeavoring to distribute their services over the State of Florida. Yet much has
been accomplished through the cooperation of physicians and others. In the
educational phase of this service lies its greatest value. Without the aid of the
Florida Tuberculosis and Health Association and its local, county representatives
the program could not have been carried out with anything like the degree of suc-
cess that was attained.

While the health education work of the bureau has been general, it has had for its
chief aim the control of communicable diseases. Every available means of reaching
the public has been used including health talks in schools, public addresses be-
fore civic clubs, parent-teacher associations, wamen's clubs, etc., newspaper
articles and the monthly contribution to Health Notes.

MOTION PICTURES

Our motion picture educational service.has been well received, particularly in
rural areas. Showings are given largely in the public schools afternoons and even-
ings. Silent pictures are shown which teach the cause, manner of spread and means
of preventing communicable diseases, particularly tuberculosis, diphtheria, malaria
and hookwonm. The operator maintains interest and improves the value of the pic-
tures by explaining while they are shown. There are many children and illiterate
adults who cannot follow the titles and explanations as they are thrown on the
screen. The films, projector, Delco generator and light motor truck are given the
best of care by the operator. It is possible to show the pictures in any building
though not provided with commercial electric current, they are even shown in the
open air on many occasions. This service dovetails very nicely into the work of
the District Health Officers who find a much more intelligent acceptance of the
services they offer if preceded by the pictures. The total number of showings
during the year was 291 and the total attendance was 72,686.

A large volume of correspondence is handled in the office. This covers many phases
of public and personal health and involves answering many inquiries some of which
are but remotely related to the subject,









PHYSICAL EKMINATION OF SCHOOL CHILDREN

he number of physical examinations of school children has been limited by press'
of other work. Unless provision is made for correcting the defects that are found
these examinations are looked upon with disfavor because they only interfere with
school routine and consume the time of the examiners. It has, moreover, been our
policy to encourage school authorities t6 get the examinations made by local doc-
tors so that the District Health Officers may devote more of their time to pre-
ventive work.

The ever present hookworm problem has received its share of attention. The ser-
vice of the laboratories has been augmented by the number of specimens for diag-
nosis submitted by the field men and the number of infestntions found in certain
schoolsfounh to be 100% including the teacher. Contrary to our wishes and the
general policy of the bureau, a considerable number of treatments have been given
by the District Health Officers. This has been authorized only when the children
could not be gptton to the local doctor and the procedure had been approved by him.
Our experience confirms the belief of the State Health Officer that this is one of
our major problems deserving much greater attention. Always in this connection the
preventive value of sanitation is stressed with results that are not too satis-
factory.

Tho cooperation of practicing physicians in carrying out the communicable disease
control program of the bureau is gratefully acknowledged. The members of the
staff have frequently referred to their cordiality and ready response to all re-
quests for assistance, advice, information and moral support.

By calling on local physicians as frequently as possible the Bureau members have
endeavored to merit their confidence and good will and to-benefit by their know-
ledge of local conditions.

There is no material difference in the kind or proportionate amount of service
rendered to whites and negroes. There is a great deal of intermingling between
the races which gives abundant opportunity in the home for contagion and the prb-
toction of either race will benefit both. Smallpox spreads rapidly among non-
immune negroes and it is interesting to note that colored children can be Schick
tested as readily as white and, though negro children seem somewhat less sus-
ceptible to diphtheria, cases and carriers are found among them.

Much poverty has been occasioned by the depression and unusual calls have been
made on the District Health Officers for medical and financial aid. It is diffi-
cult at times to convince applicants that the state health doctor cannot take care
of them but the policy to restrict activities to public health has been adherred
to most creditably. Our aim is to avoid encroachment into the field of medical
practice and, though there hay have been deviations, they have usually been made
in order to render first aid or temporary medical relief and have been commendable.





- 39-


The cooperative program of rural health service, conducted on the county unit plan
has been one of the Communicable Disease Bureau's responsibilities and, though
there were but three units in operation during the year, it is rather remarkable
that one of those vas organized during a time of retrenchment. The Pensacola-
BsaemBia County Unit began to function on March 1, 1932. At the closo of the year
the Taylor County Unit had been in operation for two years and three months; the
Leon County Unit for two years.

The reports of these units which aro attached indicate quite clearly their functions

The Health Units are financed jointly by the State Board of Health, the U. S. Pub-
lic Health Service and the counties in which they operate. The City of Pensacola
particip.tos in the support and benefits of the Escambia County Unit; Tallahasseeo,
likewise, contributes to the cost and enjoys the services of the Leon County Health
Unit which also received financial aid from the county school board, the West
Florida Power. Company nd the Rosenwald Foundation.

County Health Units

Date Budget Phy- Nurses Inspec- Clerk
Organized per sicians tors
Annum

Taylor Sept. 1 $9,000.00 1 1 1 1
1930
Leon Jan. 1 18,467.00 1 2 2 1
1931
Escambin March 1, 16,892.00 1 2 5 1
1932

Throughout the yoar there has been nothing more gratifying than the active pro-
motion and support that vas given to the Escambia Unit by the County Medical
Society. Without the backing of this society and the active participation of its
health comittoe in promoting, crg-nizing and sustaining the unit, it could not
have survived or even comeinto being. There has boon strong opposition to the
program and the personnel from a few individuals who, apparently for personal
reasons, mAde a.decided effort to disorganize the unit. Led by the physicians
mary of the substantial citizens voiced their approval of the hwolth work, the
newspapers gave it dignified recognition and its enemies failed in their effort.

This report would not be complete without a word of commendation for each member
of the staff. Everyone of them has shown a remarkable degree of unselfish into-
rest in the cause of public health in Florida and each has had a largo part in
maintaining the standards of service .and in holding communicable disease incidonco
at a remarkably low level.



Table No. 3 (2nd prgo) shows the distribution of certain curative products by
this bureau; namoly, noecrsphonnine for treating syphilis, quinine, three and
five grain capsules for malaria control and yeast for pellagra patients. Those
products have been furnished principally to the indigent and usur.lly through or on
reconmendrtion of a local doctor.

Following are tho reports of the Tuberculosis Clinician and the three County
Hoalth Officers.





'40 -


TUBERCULOSIS DIVISION
W. A. Claxton, M. D., Clinician

Active measures for the clinical diagnosis and control of tuberculosis by the
State Board of Health began in 1930. Before this time the Floridi Tuberculosis
and Public Health Associrtion held diagnostic clinics in a few centers and en-
couraged "Early Diagnosis Clinics" through local branches of that organization.
Regular clinics had boon established'dt Miami, Jacksonville, ard Tampa. In May
1930, the State Board of Health began a series of clinics which were held at
Pensacola, Quincy, Ocala, Dade City, New Port Richey, Kissimmee, Bradenton,
Sarasota, Fort Myers.

Summary of work done

Number of persons attending clinic 1008
Number of tuborculin tests done 606
Number of tuborculin tests read 473
Number of positive reactions 54 (11.4%)
Number of physical examinations 706
Number of cases tuberculosis found 42 (5.9%)

During 1931 a more extensive program was planned. Clinics were held at fourteen
towns on the Enst Coast from Key West to Daytona. At these clinics 2,563 tuber-
culin tests were done and 324 persons given a physical examination. Twenty-four
adult cases of tuberculosis was discovered. Besides this, in the fall of 1931,
tuberculin tests were made on the school children of LaBelle.

At the beginning of 1932 a tuberculosis clinician and nurse were assigned to full
time duty, Our program has consisted of two main divisions of activity; namely,
tuberculin testing of school children and clinics for chest examination of adults.

In tuberculin testing we made a complete survey of school children in five counties,
Marion, Lake, Seminole, Nassau and Leon. We tested 5,181 white and 4,290 colored
children of ages ranging from five to 20 years. Among the white children we found
11.8% infected while among the negroes 18.4% were infected. This shows that there
is one and one-half times as much tuberculous infection among colored as among
white children. This infection rate of 11.8% among white school childrenis low as
compared to North Carolina's 19%, New York's small town rate of 25% and Massa-
chusetts rate of 30%.

The amount of infection in a community or state depends on the closeness of con-
tact among the people of that community and larger cities always show a larger per-
centage of infected children. In our Florida climate this close contact is not so
marked hence less infection. Casual or chance infection from one exposure on the
street or in public gatherings is not so apt to produce tuberculosis as a disease
as continued contact with an active case of.tuberculosis in a family so our efforts
should continue along the line of discovering these active cases and preventing
contact between them and growing children,

Our program of tuberculosis control is handicapped by the difficulty of obtaining
X-ray examinations of the chests of tuberculin positive children. This is the only
way in which a diagnosis can be made. Georgia, Tennessee, North Carolina, Alabama
and other southern states have either mobile X-ray machines which can be carried
to clinic centers or have arrangements to carry children to the state sanatorium
foi X-ray examination.










Tho handicap of doing control work on children without X-rny facilities is so
great that there is not much use of doing wholesale tuberculin tests in a county
unless the tests can be followed by X-ray examinations on the tuberculin positive
children. Any tuberculosis control program is handicapped without tuberculin
testing in the community and such authorities as Opie and Aronson have shown that
this is one of the most important phases of all tuberculosis work both from the
standpoint of discovering hidden adult tuberculosis and in early diagnosis of the
disease in children. Besides the tuberculin testing in the five counties men-
tioned above which was used as a basis for obtaining statistics on the rate of
infection in the state, groups of children were tested in Polk, Minatee, Volusia,
Lee and Hendry counties.

The adult clinics were held in the following fifty-two towns and cities in forty-
two counties of the State: Apalachicola, Arcadia, Belle Glade, Bonifay, Bradentomn
Bushnell, Century, Cleorwater, Cocoa, Crestview, Dade City, DeFuniak Springs,
DeLand, Daytona Beach, Eustis, Fort Myers, Fort Pierce, Fernandina, Gainesville,
Green Cove Springs, Kissimmee, LaBelle, Lake City, Lakeland, Lake Wales, Leesburg,
Live Oak, Madison, Mirianna, Monticelle, Mt. Dora, New Smyrna, Ocala, Orlando,
Pahokee, Palatka, Pensacola, Perry, Quinoy, St. Augustine, St. Cloud, St. Peters-
burg, Sanford, Sarasota, Stnrke, Stuart, Tallahassee, Thmpa, Tarpon Springs,
Wauchula, West Palm Beach and Williston.

At these clinics, 884 white and 399 colored persons were examined. Seventy-five
white and twenty-six colored persons were found to have tuberculosis. Analyzing
the findings on white persons it was noted that of those examined 513 were born
in Florida, while 371 were born in other states or counties. Among the 513 born
in Florida, 34 or 6.e6 were found to have tuberculosis while among the 371 not
born in Florida 41 or 1% were found to have the disease.

It is rather difficult to draw definite conclusions fran this variance in findings
one might hazard the opinion that the larger percentage of tuberculosis among
patients fran other states was due to people coming to Florida with tuberculosis
of which they may or may not have been cognizant or we might say that persons
from other states being more accustomed to such Board of Health clinics were more
prone to avail themselves of these facilities for diagnosis of their illness.

Among the 399 negroes examined 26 were found to have tuberculosis. The 179 born
in Florida yielded 12 cases of tuberculosis (6.6%) while 220 born in other states
revealed 14 positive cases (6.3%). Here as can be seen the difference is so small
as to be negligible as most of these negroes lived in other southern states under
the same conditions as the Florida born and as their training and education are
about the same we would expect this similarity of findings.

Besides the diagnosis of tuberculosis enumerated above the following diseases con-
ditions were found in the patients presenting themselves at our clinics:

Disease White Colored Total Disease White Colored Total
Bronchitis 149 36 185 Heart Disease 52 14 66
Bronchiectasis 9 9 Enlarged Thyroid 14 2 16
Lung Ulcers 1 1 Enlarged Tonsils 104 42 146
Pleurisy 1 1 2 Adenoids 5 1 6
Bmpyema 3 3 Pyorrhea 127 64 191
Asthma 12 7 19 Decayed 70 27 97
Sinms Infection 15 1 16 Pellagra 13 13






- 4re-'


The State Tuberculosis and Health Association under the directorship of Mr. Sherwood
Smith with its numerous county branches has been most generous in assiting our work
by helping to arrange our itinerary. Employing field workers to do preliminary
and follow.up work and by furnishing X-ray plates for use on indigent patients.

Public Health Nurses in the towns and counties visited have cooperated enthusiasti-
cally as have school principals and county school superintendents. Members of the
State Federation of Women's Clubs have given valuable assistance when called upon.
There is much more to be done in tuberculosis control work. One of the things to
be done is to correct the impression that tuberculosis cannot be cured in Florida.
The statistics from the tuberculosis work of the Jackson Memorial Hospital at Miami
under the direction of Dr. M. Jay Flipse, the County Sanatorium at Tampa under Dr.
A. F. Higgins, the County Snnatorium at St. Augustine under Dr. J. M. Irwin and
other places are continually demonstrating that tuberculosis can be cured by proper
rest in bed.

Among patients treated in home: A young woman in Starke contracted tuberculosis,
went to bed for a year, gained 50 pounds, hc.d her disease arrested and is doing
light housework. A young man in DeLand with a definite diagnosis of tuberculosis
was put to bed. He also gained 50 pounds, his temperature become normal and he is
on the road to recovery. A woman in DeLand treated by the same physician, Dr. W. A.
Pay, is also showing satisfactory improvement and can be back at her housework in a
short time. A woman in Bradenton came from Georgia 10 years ago with hemorrhages
and positive sputum; a far advanced case of tuberculosis weighing 90 pounds, she
now toighs 157 pounds, does most of her housework and will probably die from smme
other cause. It is purely a matter of making contact with people who have tubercul"
osis examining them, outliving a proper regimen of "cure" and assisting in direct-
ing their treatment. This aid is welcomed by the practicing physicians most of
whom frankly state that they appreciate the advice given at the tuberculosis
clinics.





-43-


U. S. Public Health Service
State Board of Health Cooperating-

1982 AmmA, RIPOw si CO rIW 5 EW IT

A summary of the work dono by tho Taylor County Henlth Unit fr -the twelve
months period tfroa january 1, 198 to December 31, 1938.

CHILD HWGIE:

Adviceand 'one Visits
There have been 18 expectant bothe ire .v ao.doo, 18 midwives instructed at 18
classes, 9704 children instructed conoerting their physical health (all. children
being leoturod noro than once) and 2078 home visits have been made by the nurse.

Examinations
Two hundred forty one infant and prelsohool children and 8410 school phil4den have
been mnmaned. One hundred fifty nine of the infants and prie sbool and 1849 of
the school children were.found defective with.a total of 5094 deftts, Ope
hundred -thirty two children were oxeluded frao school for saie conrtgiou* disease
until froe from such disoeao. Two hundred sixty one drills in hyglon. were held
Pro-school clinics were held at the following places: Foleyr Perry, Shady Ogov,.
Pino Grov re. ovington, Oakland, Pine Levol, Stophenrillo, Carbur, Athema, Boyd
Fbnholloany and Pisa.pho.


rlve oaI esawe-e held at eaeh of the-following schools: Pory (with -a ..aig ageof
*64 girls attending), Shady Grove (31 atteading), Cabbage Grove (23 attendinLS
Foley (30 attending) and Carbut (26 attending). heee classes were 1i
(1) Personal Health. (2) Home Health. (3) Itfant CGar. (4) Comiuniable Ditease
(stressing hookworns and malaria), and, (5) Comaunity Health and First Lid.

CCaOSICABL DISE~ES:

Twenty seven cases of contagious diseases have boon quarantined, entailing 198 visits
by the physician and nurse.

DRhtberla
Seven hundred sixty three people were tested for 'iphtherina sua ptibility W0 were
found susceptible and 144 were protected against this disease. This includes tho
non-tested proschool children. Ninety seven nose and throat ulttures for dihtheria
germs have been taken.


Two thommbed three hundred sixty three spetlumks were rmaind for hookamas, with
1168 ha3ag hookwln rm and 996 -wee treated iidler tho suparvision of the 4~ eotor,
the posftlro cases of Adoorkwo were 49.179$ 1a-13B as compared with 8W.83" in 1931.
19.3 o o all children that have been tested treated and then tested a in hove
been shown to be negptivo for hookwaors.

Fifty eihthousand five hundred eigahy oae (88,581) five grain oapules of qMinine
were distrAbted to 188 people at 83 cllaise in the county. Approximately lU.1 of
all homes in the ruzl section have been screened. L1,ost 10% of these w-er during
the year 219O During the year of 192 the malaria index as shown by splea exmni-
nation of school children under twelve yoars of age was 80.860 as ola red ,vwth







Eight -unWfifty one people were protected against smallpox.

Tuberculosis : ,. *- .. .
There were people examined for tuberculosis with 5 having been found to have this
diseasis.'I chest eaaiirAgXo clinics were held byrAhe tubqrOutoets clinician of
the State Board of Health. There have been three deaths from'thl"s' disease. Each
active ease is being. is1tteidraegualy by the physician and narse ,in order to assist
the family physician in the cure df the vioSttaand to prevent infection of. father mem-
bers of the family. Two hundred forty one home visits have been made.

Clinic
An orthopedic clinic was held during the year when 42 ceippled-chJldoxl:ew ee examined
by the OitAepeaio Surgeon t.fo -thae Ctypp9es Qai8Udzn a COoiission' Some of theee will
res4ce6iv uiroal :eorectio during the' net year.

00RRBCTIOMS

er e f 86 sanlatA toiletse built (these include three types: new sanidaty pit
toilets- pr,'vie, restored to at ttary type and septiCo tanks) and two new sewer cow-
nectioast in'atleU. Three new water connections were found installed. There were 66
sWiieed of'w*atei tolleeted4 and sena to the Stats Board of Health for alysds.3r This
tbiade" watet for drinkl ta and that frcm aw1*lting pools .Four dairies sowedm marked
iaPreiment and two swsfti bi pools -twereA improveo d The, drug stores under a new ani-
tary' dritkig cup ordinaaeb hao ehw,' Bnon marked 1-*roemb~at. ,Ten sanitary nuisances
were corrected, the most important of these being the cleaningof Spring Creek below
the city sewage outlet. This creek had become badly obstructed and was in a deplor-
able state. Part of Rock Creek was also cleaned of obstructions* This oereek was a
Shealt maBartal breeder. Ono hundtra e6thty six dwellings and 18 sleeping quarterS
haveebookti eootA against flies and mosquitoes. ,Eight hundred twenty one detfeo*p in
school chilArton a 40 in pr. ~hool children have teea corrected,. with 16 asohooL
blhilitea. beh iOq% i health ad- 83 of Othem ,being blue ribbon children.


Fourteen demonstrations in toilet building and one in screening have been held.

EDUCATION4Al
There have been 5804 circular distributed throughout the county. Those have varied
from the care of the hair to tho care of the feet. There have been. 90 ppstors put up
amnotinoa* ithe 4artous clinioseft bo be 1,4


A gold star, blue ribbon program was held at three schools and a gold star program
only was hold at four schools. A child who had no physical dafocts and who had taken
the pmteCtive tr*atmenta ;aaga% t typhoid fever, diphtheria and aiallpox and tho.had
subditted a specgoar to be: oamiineda -for. h aorqr ai. who, had. tanln the hookwo3m
amditoiae, -if I: or she -had hooheanms8 *aW Aivea a g8Xl4 _,*r. If '.he dafty health
hoWtt chat. was kept for six wae ek4t)ia chart .reqpies the child tp carry cut tho
essential health habits and must be signed- hisWor her pe5ent) and his or her
academic work was good, a 100% health button with a blue ribbon and a health certifi-
cate showing physical excellence were given. If the child did not cnrry out the
health chart, thon'a 100 he4Xt ,Wtea.wa'rgve.a. A health banger swas presented to
the'ne aid two teacher schoolss and one to the three or more rte~cer schools, who had
the largest per cent 6f gold star-children to their average attendance* The pennants
were won'a y tWo rural schools. The roosin-sach school that had tho:,lagest number
of 'ed star was givo -4 priee: of eith er a .bock org.a picture. A health playpre-
ceded the awarding of the blue ribbon certificates and blue ribbons in Perry school.









This depicted tho essential health habits. A graduation program which included a
onypolo dance, followed the giving out of blue ribbon oartificatos at Foloy School*
A speech was made at coach school when the b~00 buttons or the certificates and 100%
buttons were givon out.

TIWIHBRCB DRILL
A tooth brush drill was hold at Parry schools with 400 children of the first four
grades participating* This drill depicted in song and pantomime the correct method
of brushing tooth. A motion picture on correct method of brushing teeth preceded
all practices. A still picture of this drill was taken. aeh child unable to buy
a tooth brush was given a free one donated by one of the local civic clubs and each
child was given a free sample of tooth powder,


Thoro wero 1065 inspoetions of private premises, 410 of public promises, including
all food handling places, and 57 inspections of dairies (a monthly inspection being
made at least, and oftenor if necessary). All food handling places including drug
stores, were inspected regularly. The sanitary officer has dipped for mosquito
larva numoros timos throughout the county and, with the exception of places whore
dusting was being done anophelene larv wero found. One pool has boon stocked
with top flooding minnows. Duating has been done at the following places: Boyd,
Wilson LtI~bor Company, Burtoa~nwartsz Prry and Foley.

One hundred forty two milch aots in the four dairios wore tested for undulant fever
and 50 out of the 142 were found to be reactors.

Sanitary comont drinking fountains wore built at three of the consolidated rural
schools during 1932.

Approximatoly 14.10% of all rural homes have had a sanitary toilet built. 10.50%
of thoso were sanitated during tho year 1938.

29.12 of physical defects in school children woro found corrected during 1938 as
compared with 9,99. in 1931.






'46 *
TREASURY DEPARTMENT
U. S. PUBLIC HEALTH SERVICE
STATE BOARD OF HEALTH CQOPERATING

Tailahbssee, Florida January 1, 1933

1932 ANNUAL REPORT LEON COUNTY HEALTH UNIT

TO THB OFFICIALS OF TE STATE BOARD OF HEALTH LEON COUNTY, CITY OF:.TLLAN&SEE !_ND
OTHER COMTRIBdING, AGENCIES:

We herwith submit the following report of the,activities of the Leon County
Health Unit. for the year 1938:

EDUCATIONAL:
During the year 102 health talks were made to approximately 5,600 people; ,5,560
piece of literature were distributed; 51 newspaper articles were wriftt.; themot-
..on pictures of the. State Board of Health were shown for ten days; one health ex-
hibit at County Fair; and numerous comfererpes were held by all members of the: nit
on the various phases of public health.

ISP3ETION, SAnITATION, MOSQUITO C NTROLW WRK, ETC.
In adaitioD to the inspections made by the regular City and County Inspectors, a sys-
tematic house-to-house inspection has been maintained throughout the year, re-
quiring from one to three men. A total of 78,701 inspections of private premises
were made in the interest of sanitation and mosquito control work. 1,389 inspec-
tions of public places were made; 721 inspections of dairies; and 244 inspections
of oyster dealers and other food handling establishments.

CWMUNICABLE DISEASE CONTROL:
During the year 118 visits were made to cases or suspects and 34 cases quarantind.
Excepting the outbreak of influenza near the end of the year, no other epidemic
of importance occurred in the County. Only one know case of typhoid occurred in
the County outside of Tallahassee and only a few in the City.

VENhEAL DISEASE CONTROL:
All during the year the physicians treated gratis a number of venereal cases who
would furnish their own medicine; the Health Unit would order the neoarsphenamine
for these semi-indigent cases at cost. In September a cooperative clinic to treat
the colored syphilitic cases was started at the A. & M. College Hospital, since
that time 175 treatments have been given. 539 specimens of blood for Kahn test
have been taken by the Health Unit during tho year.

TUBERCULOSIS CONTROL:
Tuberculosis is not regarded as a serious problem in this County. 2,793 tuberculin
tests were made, practically all on school children and approximately equally
divided among the white and negro children. 10% of the white children and 19% of
the negro children gave positive reactions. Numerous home visits were made to
determine the source of infection, but the results were not encouraging as in a
majority of the cases no contact could be traced. Fourteen children who were sus-
pects were examined by the State Chest Clinician but no evidence of active tuber-
culosis was found.

The nutritional work among the underweight school children can be properly included
under preventive tuberculosis work. The nurse conducted these classes in the
various schools enrolling 277. The children were weighed each week and were gi7en
such instructions in health habits as the nurse seemed advisable. Practically all






- 47 -


of the children made satisfactory gain in weight and the teachers expressed them-
selves as being tell pleased with the results. These classes were continued on
through the summer, the children at the health office once each week. During the
latter part of last school year the Woman's Club furnished S3 pints of milk each day
to the indigent underweight school children. By the beginning of tho present school
yoar all of tho civic clubs, Churches and othor organizations of tho City had unidod
their efforts and 155 pints of milk are being given daily to thoso children.

The colored nurse has organized health clubs in every colored school in the County.
The object of theso clubs is to teach the children tho importance of personal
hygiene and the obsorvanco of othor laws of health.

HOOKWORM ERADIC&TICW:
1,470 tests for hookworm wcro made and 894 treatments given. A comploto hookworm
survey of tho negro children in all the rural schools was bogun in Docombor and
rill continue into the new yoar.

IBUtJIZATION AND TESTS:
Near the beginning of the school year 1,093 children were givon the Schick tost and
tho positive oases wore givon toxin-antitoxin or tozoid. During the year 384
children, mostly infants and pro-school woro inmunieod against diphtheria, 2,407
comploto typhoid inoculations woro given and 1,508 persons vaccinated against
smallpox.

PRENATAL:
A prenatal clinic nas hold at the A. & UM College Hospital at which 51 cases eoro
cxaninod. Each WVdncsday at the colored Health Center pregnant womon o~co for Kahn
tosts, urinalysos and consultation. During the year the nurses havo contacted 12
casos, and made 465 home visits, hold 16 group meetings, and had 298 office con-
sultationa with expectant mothers.

Classes for tho midaivos have boon hold each month during the year.

INFANT, PRESCHL A SOOL AD SCH WORK:
127 infants and pro-school children noro examined; 780 homo visits woro made and 480
office consultations uith parents of infants and pro-school children.

3,924 oxaminations of school children woro mado; 564 hao visits and 760 office
consultations nith parents.

The colored nurse sigheded, measurod and tested vision and hearing of 1,977 children
in the colored schools*

The Blue Ribbon contest is being put on by somo of the schools. The High School vill
give a hoalth letter (or omblem) to each student who has boon successfully vaocinato
against smallpox, imuunizod against typhoid and diphtheria and has all physical o-
focts corrected that can be remodiod. Much interest in health Tork has boon arotas-.
in this school and a very largo percent of tho students will receive tho health .-tt.

Under auspices of the KiEanis Club 38 indigent children had tonsils romovod. The
Lions Club sponsored tho examination and fitting of glasses to indigent children-
About 30 voro examined and 12 -oro furnished with glasses. Tho Exchange Club
furnished 1,000 five-grain capsules of quinine to nobody children at one school.
Most of this eas administered at the school by the teacher to tho ones with






-4 l


clinical symptoms of malaria. This onablod sov6ral children to attend school regu-
larly who previously worro unablo to do so on account of fever.

EEHIBIT:
Our booth at the County Fiir omephasized nutrition, sanitation and scrooning.

DAIRIES:
All of the dairios in the county havo mado improvOmonts and comply fairly vcll vith
the roquiromo~ts of the Standard Milk Ordinance., All dairy cattle have boon tostod
for tuberculosis and infectious abortion.

LABORATORY TESTS:
2,688 specimens of various kinds have boon sent to the State Laboratory during the
year.

SANITATION:
Duo to the depression the sanitation work has fallen short of our expectations for
the year. 561 sanitary pit toilets have boon installed; 57 septic tanks and 136
no.. sower connections made during the yoar.

WORK OF ORAL HYGIEKIS,:
2345 children were examined and the teeth of 745 were cleaned.

MALARIA COntROL WORK:
One whito and one colored man nith truck have oiled and dusted all standing rater
within the (City of Tallahassee; also a number of ponds adjacent to the City at reg-
ular intervals all yec.r. The Florida Poner Corporation dusted a series of ponds at
weekly intervals all fall. The total acreage of these ponds was approximately 275.

Tro marshy breeding places in and near the City have been cleared during the year.
Through the R. F. C. considerable drainage work has been done and is still in pro-
gross.

A total of 19,195 cubic yrds of dirt has been moved. The length of ditch rork done
totals approximately 2 3/4 miles. When the work is completed, it will be a groat
aid to us in our malaria control work.

About the first of Decomber an engineer was added to the personnel of the Unit. His
duty Is to promote screening and minor drainage projects. (His salary and expenses
are paid by the Rockefeller Foundation and State Board of Health) His work so far
has boon making a survey of the lakes and ponds of the county, supervising the
ditching and looking over now drainage projects.




1, 7Y Cravos, M. D., Director,
Loon County Health Unit.






- 49-


U. 3. PUBLIC HRaLTH SRVICZ
STATE BOARD OF EALTH COOPERATING

1932 ANNUAL REPORT 3SCAIA COUWP HEAL'1 UNIT

The first ten months that organized health work has been conducted throughout
Pensacola and Ibcambia County brings the unit to the beginning of a new year with
two major results, viewed with great pride by the Bsoambia County Medical Society,
social and civic leaders, and others interested in public health work here.

First, public sentiment is overwhelmingly in favor of curbing the spread of dis-
ease by preventive measures. In other words, the majority of the people in the
city and county fully realize the value of public health work.

Second, typhoid fever has been practioally- wiped out, though previously a year
neved passed without a large and unnecessary -nmber of deaths resulting from this
disease.

In fact the stamping out of typhoid has been so intertw$ed with the growth and
development of the unit that more attention is given to this subject in that con-
nection.

BRIW HISTOWr OF UNIT

With the City of Pensacola, the County of scarmbia, the State Board of Health and
the U. S. Public Health Service cooperating, the Iscambia County Health Unit was
organized d1Wing the -onth of March 1932. Offices were established in the State
Board of Health laboratory building, 803 North Palafox Street.

The present director began the organization on March let, adding to the personnel
during the month, completing the organization after April. lt. The persone.. at
that time consisted of director of unit, secretary, one public health nurse foa
city, one public health nurse for county, one sanitary inspector for county, three
sanitary inspectors for city and one dairy supervisor who acted as food inspector.

During the month of March a survey of the city and county was made,: There was an
outbreak. t typhoid fever which threatened to become epidemic, thirty-nina oases
being reputed during the.month of Maroh, Ie activities of the health department
during March was directed towards finding out the source of the disease and pre-
venting a further spread.

It was learned thet untreated sewerage from the city emptied into Pensacola Bay
and that oysters rere being taken from these polluted waters and sold on the streets
or from house to house by peddlers.

Also, it was learned, thore were over 2,000. insanitary fly-breoding, open back sur-
face toilets in the city.

An ordinance to prohibit the sale of oysters from the polluted areas was prepared
and presented to city council which adopted it without delay.

A second ordinance, to make surface toilets illegal,. was likewise prepared and
adopted by council. This forced the owners of promises, on which sach toilets were
located, to either connect with sever liesMs install toilets with septic tanks or
pit privies of an approved sanitary type.










_ZT-AMIOAL


Equally Important with the cooperation of public officials has been the campaign
of education carried out.

Public addorssoe have -bo.inmadg by~ the diaetor. or nurses to civic organizations,
Paront-Toachors associations,:.hundrods of talks directly to. olhi1ron in thair
"aehoolroom~, reaching an :etinated total of -approximatoly 20,000. Public health
bulletins #oro postod in ~~patpio ufwIeasC. ~ ts-he nowspapors of the city oontri-
butod liberally of their space to the cause of public health, both editorially and
through thbir ase~s columns. a

SANITARY ThiPECTXONS

Sdnitary I~npoetioni -urfng that iton-moonth portd totalled 14 654. Thosq, inspoctione
4includod private promiios,, putkl 1pltacoasch as school a cs,ch uroos, touris- camps,
hotels and other food handling and producing places. "-TDuring that time ,2010
nuisances woro found and corrected. The campaign of sanitary inspections was es-
nocially diroetod againit-fly-brooding :paao-b ati t.io city, back lots, oro lcJ.anod
up, wdedsne~uro0.eut, oil was used ow n andingvTator, 'ald Sarfawo toilets -oro dostroyc

SPECIAL INSPECTIONS

ppocial inspections rwro dirootod to all food handling places such as markets,
t' obtaurants, bakeries, cafes and dairies. Inspections of dairies alonor totalled
f,611. FYfty-throo aitiosn aro now sollintg.Gradoe-A milk in Pensacola, a 8a result
6f thoso inspections and adoption by city council of the Standard Milk Ordinance.

Passage of this ordinance was especially gratifying to the dairymen booause there
a 'bfs oeen mdrkod inere6e ih th to orn~ibitihn&of milk. IT fate. saeoe of~t he largest
producers are unable-to satisfy full 'the demand.

SCHDIUM HYGIE -

There is a rigid lan coeoorning the practice of midwifory in this state. It is
'' o6pulsmoey for midwivors ei atbnd meetings to rodoive instructions bof6rcothey.are
pormi-tted to practice. The ignorant an&athoibs physlally unfit are not-permittod
S6o"practite. Hoho sitet, pr6onatci6 vi'it aare ma1f by tho publiob-hmath nurses
and 'i-ststetions given. -During the pa'st ton months 1,l87' visits of-this kind vero
made

it 001JMUICABLE DISEASE CONTROL

The director of the unit or one of the publio'abelth nursose Visits evory caseof
communicablo disease whon information is furnished of such diseases. The house-
hoidor' ii givon*both verbal and tritton'instruotions about, provonting the spread
of the disease. Quarcntinablo diseases are isolated and. qhavrantinod and the
quarantine sign is not allowed to be removed except by the health officer or the
public health nurses

Hookworm disease is very prevalent in this county. Examirmtions are being oonstantl:
mado andifreoo treatment furnished. It Is %ho purpose of this organization to carry
h i an' intonsiv:W e paign throughout btho county against this disoasew.
-. ...






- 51 -


During the past ton months, sixty-four cases of typhoid fever voro reported, five
resulting in deaths. Thirty-nino of those noro reported during March, eleven in
April and fourteen the remainder of tho year. ONLY aE DEAIT WAS REPOfTED WHERE
THE DISEASE WAS C0FTPACTED AFTER THE HEALTH MIT WAS ORGANIZED. I'ooplo receiving
eomplote antityphoid inoculations at the hoelt) unit totallo3 5,623. It is safo
to say that at lost 3,000 received imnunisation from private physicians. This,
.ith the elimination of thq surface toilets, tho prohibition of selling oysters
from polluted waters, the rigid inspection of our milk supply, contributed to the
groat reduction of typhoid fever in this city.

This loads to our outstanding objective for 1953.

TUBERCULOSIS CONTROL

Tuberculosis is ono of the greatest problems in this community, rith the possible
exooption of venereal diseases. Wo are handicapped in the control of tuberculosis
in this county as there is no institution to earo for those cascs in the county or
state. Only educational work can be done but to are confident that EDUC&TION AND
THE COOPERATIc OF THE PUBLIC CAN CURE THIS EVIL IN THE SAIE WAY THAT TTPHOID WAS
WIPED OOT HERE. Frequent visits are mado to each tuberculosis case by the director
and public health nurses and instructions givon as to hor to prevent the spread of
tho disease in that particular household. Thore woro probably forty deaths from
this disoaso in 1932.

VITAL STATISTICS

Wookly reports from tho registrar of vital statistics are mado to this office, as
tho registration of vital statistics is done olsovhoro.

LABORATORY

All laboratory work of a public health nature is done at the local branch of the
stato laboratory. Examinations mod during the past ton months totalled 1,405

OUTSTAUDING POINTS OF I]TERHST COWTCERING
THE ESCAMBIA COUNTY HEALTH UNIT SINCE IT WAS ORcNIED:

First: The education of tho gonoral public in this county as to the neod of a
health organization of this kind in their midst.

Socoand The adoption by the city council of a sanitary erd(niAoo outlawing the
insanitary surfr.co privy.

Third: The adoption by the city council of the Strnd-rd Milk Ordinaco of the Unitor
States Public Health Servico which insures a safe milk supply.

Fourth: The adoption by city council of an ordinance regulating the sale of oyster:
in the city of Ponsacola.

Fifth: The practical elimination of typhoid, largely as a result of the first four
points.







AWPORT OF TUH BUU01 OP CH=D WELFARE


Personnel:


Laurie Jean Aeid, R. N;, Director
Staff Nurses:
Harriet J. Sherman, R. N. January 1
Auth Mettinger, R. N. January 1
Noreita Alvis, R. N, January 1
Estelle Bonner, R.N. (oolored) January 1
Secretary: LMrgaret Loest Jamnary 1
Stenographert Half-time, Maternity and Infancy,


- December
- December
- December
- December
- December
Wiillie Mae


31
31
3.1
31"
.31-
LicCarmiek.


The work of the Bureau of Child Welfare was limited practically to maternal
and infant hygiene since no funds had been appropriated for other activities.

The program was a continuation of that introduced in the summer of 1922 when
the Sheppard-Towner funds first became available, whereby each of the three white
nurses wasedetailed to a district of approximately one-third the state, 22 counties,
and the colored nurse to the state at ler~q. By Febfuary 1923, the state-wide
suwvey begun in September 1922 had been practically completed, the white nurses
having spent approximately one week in each county contacting as many midwives as
could be reached in that time. (The nurses were on railroad transportation until
early in 1923.) During this survey each midwife contacted had bee .given a manual
and a small supply of silver nitrate with instructions to obtain further supplies
from her local registrar.

During 1923 the state was again covered by the same staff chiefly in the
interest of better midwifery although the program was broadened to include mothers'
meetings, infants and preschool well-baby conferences (examinations made by local
physicians), birth registration, and.general educational work, including talks,
conferences and newspaper publicity.


Midwivea: 2800 were visited in their homes and in
through 118 meetings. 631 were given "Certificates of
introduced by a State Board of Health ruling in lieu of
impossible by the failure of the Legislature to enact a


addition 649 reached
Fitness", an innovation
desired registration made
law legalizing midwifery.


Other Activities; 280 mothers' meetings were held attended by 5516 mothers;
a total of 14,588 "instructive" home visits were made; 34 well-baby conferences
were held with an attendance of 1720, 729 of which were "normal", A total of 993
defects were noted., Formulae were given to 220. A total of 223 talks and
lectures were made by the -Director. (Some difficulty was encountered in securing
a continuation of tho appropriation from the Legislature, the Senate finally being
won over, the bill passing by a vote of 17 to 12.)

364 previously unreported births were found and reported. About 150 women
found practicing midwifery the preceding year stopped voluntarily when advised by
the nurse to do so. A manual for mothers -- How Shall We Feed Our Children --
was prepared by the Director.








AiPORT QV TH9 BU3AJ U OF CHILD WELFARE

1924


Laurio Joan Acid, d. N., Director
Staff Nurses 15
Secretary: Margarot Loast January 1 -
Stonographjr, part-timN: Willio Mao McCormick mJuary 1 -
Hovio Truck Operator: Tom handle October 1 -


December 31
December 31
Dcoabe r 31


On May 1, five school and eomnunicablo disease nurses were employed by the
State Board of Hoalth and added to the staff of the Bureau of Child welfare. In
addition thereto, two maternity and infancy nurses weor added, making a total of
six employed in tho latter activities.


Harriot Sherman, A. N.
Ruth Mottingir, A. N.
Noruite Alvis, d. N.
iSstlle Bonnor, R. N. (col.)
IMude Holmen, d. N.
Thulma kosolay, d. N.
Teen Ocnpbell, A. N.
Coru Boortsch, A. KN.
Inoz IM. Rooho, it. U.
Isabulla WacConn, A. N.
Estollo Sumner, R. N.
Lulc Dcvis, A. N.
Byrtono Andrsaon,- R. N.
Wkry Corrothnrs, d. N.
.Lrtho Lonsdon, A. N.


Jamnury 1 Decomber 31
January 1 Decumber 31
January 1 December 31
January 1 Decembur 31
April 1 October 1
Soptembor l-DuI-cbor 31
Wy 1 October 1
May 1 Docomber 31
hby 1 Decomnbr 31
Septembor 1- Ducjmber 31
NLy 1 Duoombe r 31
crch 1 December 61
MWy 1 Documbor 31
September 1-Documbor 31
Dooumbir 1- Dccumoer 31


The state vts re-districted, the number of counties to eech nurse being
reduced from 22 to from 11 to 14.

The health movie truck vas djtuiled to the Bureru the first of October for a
period of two months. The following pictures vrre shown: "Our Children" and
"ill Born", borrowed from the Federal Children's Bur~uu, a film on hookworm, one
on birth registration, one on diphtheria, and onc on mosquito control,

Other than school nursing, no new activities were introduced except the
intensive investigation of stillbirths reported on the monthly forms sent in by
midwives and a shift in the manner of reaching the mothers, public meetings being
dropped and private groups -- "Neighborhood Institutes" -- being substituted
therefore.

Midwives: A total of 1834 were investigated in their own homes besides
reaching a similar number in classes. Improvement in the cleanliness and camplete-
ness of the begs was noticed. It was estimated that about 500 midwives had ceased
this activity since a careful check-up of their methods had been introduced. 723
were examined during the year; 114 were licensed, certificates refused to 51, and
the remainder were givon renewals.

Birth Aegistration: Intensive birth registration was continued, a total of
999 unreported births being found and added to the list. Florida was admitted to
thu Federal Birth registration Area October 10, 1924.


Parsonnal:







S54.


Other Activities: 370 Neighborhood Institutes were held; also a total of
108 infant and preschool well-baby conferences (with some school children included)
with an attendance of 3143.

Home Visits: A total of 5872 were made in the interest of maternal, infant
and preschool child hygiono.

Little Mothers Leagues were introduced in two communities. A large number
of persons were raaohod in numerous meetings, in routine talks, lectures, etc.

DIVISION OF CMIUNICABLE DISEASES AND SCHOOL HYGLINE

A total of 939 schools were visited, 10,564 children given class-room
inspections, and 26,262 individual inspections.. A total of 724 children were
excluded because of pediculosis, skin diseases or symptoms of communicable disease.
2704 parent consultations were held at school, 780 class talks, and 211 tooth
brush and handkerchief drills given.

Office work: Approximately 30,.000 pieces of lIterature, besides 46,291
school health records, 8489 boxes of silver nitrate and 4564 midwives monthly
reports were sent out. 2808 midwives monthly report blanks were received*

PUBLIC HEALTH NUrSES

A considerable increase in the number of locally employed public health nurses
occurred. 16 white and 2 colored were employed in the early part of the year and
5 county and 3 school nurses, the latter through the direct influence of the
Bureau, were employed. One of the staff nurses was detailed as field supervisor
to assist the Director in handling this increased work.


1924





AgOORT OF' TB9 BUAWiAJ OF CHIlD IJAni
1935


Personnel:


Laurie Jean Aoid, A.N., Director
Staff Nursos 19
Hbrriot J. Shbrman, R.N.
Ruth MKttingnr, A. N.
destolloa onn~r-, R.N. (col.)
Nor.ita Alvix, A;N.
Cora Ba3rtsch, d.N.
Isabulle MacCann, d.N.
Sstoll3 Sumnor, d.N.
Lula Davis, A. N.
Byrtene Anderson, A. N.
Mery Corzothors, d. No
Mbrtha Lansdon, R. N.
ivea Bordon, a. N.
Fairy Sotti, A. N.
zlizab-th ioodson, a. N.
Beulah Hiubur, A. N.
Iary G. Dodd, R. N.
Laura Niblock, A. N.
Htlo a Dbvis, i. N.
)Iry L. Crosby, A. N.
Secretary: Margarot Locat
Stenographor, part-time: Williea ee
Movia Truck Operator: Tom Randle


The Ebovo 19 nurses were dmployod a total of 130 months.

The routine work with midwives, mothers, infants, preschool children, and
school children was interfered with to a considerable degree by the influx of
tourists brought in by the boom. Three nurses wero detailed to do maternity and
infancy work in the tourists camps alone. A general re-organization within the
Bureau was initiated with the expectation of changing from a specialized to a
generalized nursing program by September 1, 1925.

Two sttet-wide campaigns wore conducted, one to interest tho public for the
first time in the celebration of Lty Day, the object being the preparation of the
prosohool child for school, and the other a hookuorm survey. 16,000 apocimons were
collected. Attention was also given to Notional Negro Health WokJ wherever sufficient
number of negroes was found to warrant this procedure.

Midwives: 2872 wore investigated in their own homes; 1440 were examined;
certificates were issued to 575; the equipment of 1721 was inspected; 461 classes
wore held.
Other Activities: The Neighborhood Institutes were dropped for lack of time*
Talks, lectures, home visits, the usual office work, and infant and preschool well-
baby conferences were carried on as well as could be under the unsettled annditionse
Intensive birth registration continued, 581 hitherto unreported birbha were found
and registered.
Division of Conuanicable Diseases and School Nursing.

45 school clinics were held with an attendance of 1842; also one tonsil clinic
with 28 corrections, and ton tuberculosis clinics, nine white and one colored, with
on attendance of 109, and one eye clinic with an attendance of 65, all defective.
This was the first time attention hod been given by the ba du to strictly clinical
worked
Arrcngomonts were made for new nursing services in eight counties and one city;
namely: Volusia County, Putnam County, Brevard County, Marion County, Alaohua County,
Escambia County, St.Luoie County, Pcln Beach County, and in Key West.


January 1 Suptmbur 30
January 1 Septomb.r 30
Jamary 1 Docjmbur 31
January 1 ?Aobruary 28
January 1 July 31
January 1 Lc~ratber 31
January 1 8iarch 31
January 1 cmocmbur 31
January 1 ibc-mbur 31
January 1 Docimber 31
January 1 August 31
Fobrunry 1 Dacombor 31
April 1 August 31
October 1 Decomber 31
September 1-Decombur 31
October 1 ocoimbur 31
November 1 -Dec October 1 Decembur 31
November 1- December 31
January 1 Docjbnr 31
McCormick January 1 December 31
January 1 Deconibr 31





56.

ARPOiT OF THl BUriAU OF CHILD HYGIaNL AND PUBLIC HaLTH NURSING

1986-1927-1928-1929

juimay for the first half of 1926

(Taken from the nurses' monthly reports to the Bureau of Child
Hygiene and Public Health Nursing)

During these six months 462 midwife classes were held with a total attendance
of 964.

Home Visits: A total of 7642 home visits were made. These were divided as
follows: Prenatal and Lying-in, 682; infant, 2591; preschool, 4369. A total
of 118 previously unrecorded births were found and registered.

Summary from July 1, 1926 to June 30 1929

(Taken from Reports to Children's Bureau)

During this time a total of 3018 midwife classes were held with a total
attendance of 9966. The number enrolled total 4695.

Homa Visits: A total of 20,974 home visits were made. These were divided
as follows: prenatal, 2063; postnatal, 552; infants, 8050; preschool, 10,309

Other Activities: A total of 773 talks were given of which 59 were before
physicians, 30 before nurses, 673 before lay groups, and 11 by radio. A total of
77,856 pieces of literature was distributed.

47,205 infants and preschool children and 4445 expectant mothers were reached.

During this time the following counties have taken over maternity and infancy
work: ascambia, Dade, Palm Beach, Orange, Pinullas, Volusia, Hillsboro, Sarasota,
Manatoe, Dade, Pinollas, Taylor, Duval, St. Johns, Marion.

Summary for the Last Half of 1929

(Taken from the nurses' monthly reports of the Bureau of Child
Hygiene and Public Haalth Nursing.)

During this half-year 570 midwife classes wore held with a total attendance
of 2037.
Homd Visitst A total of 4652 home visits wore made. These were divided as
follows: Prenatal and Lying-in, 420; tinfat, 1805; preschool, 2427. A total of
125 previously unrecorded births wore found and registered.


Together thaso reports show a grand total of 4040 midwife classes with a total
attendance of 12,967 during the four yuers.

Likewise a total of 33,268 homo visits divided as follows: 3717 prenatal
and lying-in visits; 12,446 infant; and 17,105 preschool.






4EPOAe or 7" RMU OF c&u anz Z


AND MiW *aby* Wj


1990


Personal: Laurie Jeat dtid, A.N., Director
Lucile Spire Blachly, M.D., Dizeotor
Harriet Shaman, R. N.
Mary Dodd, a N.
Clio MoLaU~lin, B. N.
Jule Graves, A. N.
Joyce Ly, R. N.
Sarah diohardS, R. N.
Nanna Colby, A. N.
rances Hall, t. N.
Thora doberts, RH. N.
Lalla abry Oosgans, A. N.
Annie Gabriel, R. N.
Irene Ode 11 MaoGreen, R. N.
Office Staff: Lillian S. Tarlyn
Helen Van O0dell
Blanche Mathis
Nort Huntly


January 1 January 31
January 3U* 31
January & + 4.* Iy
January 1 DoMd*ar 31
January 1 Deooeber 31

JXanary 1 Doeaeber 31
January 1 December 31
January 1 Deceaeor 3
Jamary 1 December 31
Jamas 1 Noweber 1
September 1-December 31
December 15-Daoember 31
September 1-Deember 31
January 1 March 51
January 1 Deoember 31
May 15 July 1
July 1 December 31


Midwivea: routine midwife work was carried on in 41 counties of the state. This
consisted of arranging for and conducting four classes for each midwife group*
At this tiam the midwife equipment was examined. On completion of the class owek,
which was based on the Midwife IMnual, an examination oral and practical was given*
The old 31enases were collected and the now ones given out. to thbse who had passed
a satisfactory examination, uhose bags were complete, ar reasonably complete, and
whose record as a midwife for the past year was good. A total of 804 midwives
were contacted. 5% wer found to be practicing without license. 757 midwives
were examined for the purpose of obtaining lieaene to practice with the following
results:


Certificates wens issued to
Certifioiates refused to
Certificates renewed
Certificate revolad


15%
5%
75%
5%


652 demonstrations and classes were bald for midwives.
was 1697. 977 bag inspections were moad, with the following
oompleo; 15% vroe incomplete; 3% had no equipment.


The total attendance
results 82a were


Infant and Preschool ConferenoOsl Under the auspices of the Woan'a Clubs,
Parent-Toacher Associations, Home Deaonstation Clubs and otber groups, 171
Infant and Preschool conferences were held in approximately 41 oounties. 115
of these were for'whilt children and 56 for colored. The total attendance was
1642, ihite 964 and colored 678.





58.
1930 58.


Health Circus: The health demonstrations were held in connection with the
screening and pit toilet demonstrations in 20 counties for both white and colored.
The exhibit consisted of 'the following,

1. Infant Layette 7. The Baby's Bed
.' Prechool Clothing 8. The Baby's Bath
3. VMternity Clothing 9. Food for the Baby
4. Obstetrical Package 10. Food for the Preschool Child
5. Modol Confinemeat Room 11. Food for the Nursing Mo her
6. -Mother's Tray 12. Food for the Expectant Mother.

Litoraturu-vas given on each subject demonstrated and pra- and post-natal
names obtained for-the Maternity Letter mailing list. Demonstrations were given
from time to time as the crowds gathered and were interested.

Birth Registration: 383 visits wore made to local registrars. 89 birth
certificates wero secured from doctors and 81 unreported births reported.

School f6rk: Routine school work was carried on in 24 counties. 321 schools
wQar visited -- 253 for white children and 68 for colored children. 4201 children
were inspected, 2901 white, and 1300 colored,

Where possible local doctors made the inspections. If this could notV be
arranged the nurse made the inspections. 20% of the inspections wen. made by
doctors, 80% by nurses. The nurse notified the parents of the findings in each
instance by a special slip when a child was found to have physical defects, 2339
children -ero found to have 6155 physical defects.

Parents meetings were held to. discuss the need of corrective measures, immuni-
zation and the value of keeping fit. 50 parents meetings were held in schools, with
a total attendance of 369. 49 meetings were with white parents, with an attendance
of 329. 1 meeting was held for colored parents with an attendance of 40. Home
calls were made on the parents of children with physical defects when the parent
did not attend the parents meeting. A total of 2002 home calls were made in
behalf of school children, 1638 white and 364 colored.

Community Health Meetings: :Community health meetings were held in Bay, Leon,
Lioerty, Suwannee and Walton Counties. These county-wide Community Health Meetings
were a means of promoting closer cooperation of the school authorities, local
,doctors and dentists, farm agents, club leaders, parents and the State Board of
Health. A program was arranged which included several talks on health, Malaria
and hookworm were always discussed. Other topics usually discussed were tonsils,
adenoidsb care of the teeth, nutrition, conserving vision, etc. These rather
scientific talks were alternated by presentations of the various county schools,
such as, selections by the high school orchestra, a one act health play, drills
by the primary grades, special vocal numbers, etc. Attendance was usually good,
from 200 to 400.

Hookworm: Distribution of hookworm bottles and collection of specimens to
send to the laboratory was a major part of the school work. A talk on the life
cycle of the hookworm together with explicit directions for obtaining specimen
were given each group. After the laboratory reports were obtained slips were
made out with the name of the child and the result of the laboratory analysis.
These were given to the teacher for distribution to the children or their parents
and her cooperation asked in urging parents to have positive cases treated. 1907
hookworm specimen bottles were collected,







1930


CHILD HBGIAS W7iKS

Child Hygiene rteeks wro conducted in Duval, Calhoun, Okoloose and Volusia
Counties. The chief features of Child Hygiene Week are:

1. A soical cases survey of the county made by the state nurse previous to
the Child Hygiene ~eak.

2. An ell-dcy health institute for community loaders attended by one delegate
from each of the organizations, clubs, associations, etc., in the county,
including among others, representatives of schools end churches and the
local official health authorities,

3. A one or two days' demonstration child health conference to introduce the
periodic physiotl excrinntions, especially of infants and preschool
children, the axamLnotions to be made by the f-mily physician in his own
office.

4. AEhibits: Axhibits of those supplies and meteritls essential to the
rounding out of the- child's whole health are aseiqbled by lolc groups and
featured cs a part of the, eek; nmely, toys, books, tools, music, art,
play-ground supplies, atc., in addition to the specific exhbits of
special vcluo in introducing m:tern-l and infant hygijn.,

5. Follow-up: I-ch child ex-minod during Child Hygiane Week was followed up
:by the stU.te nurse for thl purpose of determining hovw "ull the instructions
given by the doctor irae cirriod out.


Social Assots Survoys wero meda in the following counties: Alachup, Baklr,
Broward, Cclhoun, ColumbiL, DdcA, Du3oto, Duvrl Frrnklin, Gilchrist, Hamilton,
Leo, Leon, Lovy, Ok1loosL, Palm B~A ch, Putnom, au'.mnoo, S.ntc aosa, Wekulla.

MATA.TITY LrTTJR SifdVICE

Pronctcl letters were prepared by the Director, one sot for mothers expecting
to use physician in their cncmineamnts and another set for mothers expecting to
use midwives. These sets consisted of nine lotters with enclosures. A set of
postnatal letters consisting of five letters with enclosures was also prepared by
the Director. 741 mothers were enrolled for the maternity letters during 1930.







LAST drPOaT OF BUREAU
,of
CHILD HYMIENR AND PUBLIC HiiLTH NURSING
19351


Personnel:


Lucile Spire Blachly, M.D., Director, January 1 December 31
Olio McLaughlip, R.N., Chief, Nursing Division, Janucry 1 December 31
Mary Dodd, R. N. January 1 December 31
Annie Gabriel, A. N. January 1 December 31
Jule Graves, i. N. January 1 December 31
Joyce Ely, R. N. J ;.nury 1- Decomber 31
Frances Hall, iR. N. January 1 December 31
Sarah Richards, R;N. January 1 December 31
Lalla Mary Goggans, R. N. January 1 December 31
Nannae olby, i3. N. January 1 December 31
Helen Van Osdull January 1 December 31
Nore Huntly Janucry 1 June 1
Dorothy Huntly June 1 December 31


At ths beginning of the year it. was hoped the program worked out and tenta-
tively 'introruo0d in 1930, to replace that which had maintained from about
-September 1, 1922 to 1931, could be carried .n intensely in its entirety but one
phase of it~ naumly, the "Child HygienA Weeks" had to be postponed to some degree
in the interest of work with the midwives. With this exception the other three
phases, namely, the maternity letter service, classes and instruction in parent
and pre-paoental education and. work with the county units went on as planned.

The physical inspections of children, infants, preschool and school, by the
nursing staff were discontinued September 1, 1930. In lieu 'thereof it was planned
to have the field nurses concentrate on follow up, including assistance in a
larger meaure in the program of tbh Bureau of Communicable Diseases. This was
accomplished to-some extant even though the demands made by the state-wide m~ndwife
survey were enormous, One nurse was detailed to the Bureau of Communicable
Diseases to assist with chest clinics from July to October. Further assistance in
one way or another was rendered the District Health Officers from time to time
throughout the year.

The attempt to obtain ip movement in the current reports and records started
in 1930 continued throughout the first half of the year with a creditable measure
of success following the attendance of the Chief of the Nursing Division at the
Conference d-f Supervisors of Nursing Staffs in Chicago May 21, 1931.

An effort early in the year to comply with a request from the State Health
Officer for a resume of work of the Bureau from the time of the last published
report (1921-22) until the present re-emphasized this lack and likewise disclosed
roam for improvement in the methods of filing.

Assistance was given in three national campaigns devoted to the improvement
of child health, nlmely, May Day, sponsored by the American Child Health Associa-
tion, the White House Conference on Child Health and Protection, called by
President Hoover, and Mothers' Day, sponsored by the Maternity Center Assaciation
of New York,







1931 61.

The State Midwife Survey

The compilation of the Laws, Rules and R6bulations Pertaining to the Practice
of Midwifery, the working out of plans for putting the midwife law, passed early
in the year, into effect, together with the assembling of data, writing of articles
and frequent conforonocs made necessary by the above, took hoevy toll of the tima
of tha nursing staff and the Dirootor.

Activities

The activities ccrried on during the year included:

A. The matorxity letter service.
B. Parent Educ action
a. Paront education per so
b. University classes
c. Demonstrations in the Hygiene of iMternity, Infancy and
the Preschool Child.
d. Exhibits.
C. Work with midwives.


A. Maternity LItter Service

During the year 2224 mothers registered for prenatal letters,
including postnatal, and 241 for postnatal clone. Tea prenatal names
came from 61 counties ranging from one fran Monroe County to 181 from
Palm Beech.

B. Parent duucction

a. Parent Tbccher and Other Groups*
In an effort to supply the demand of local public health nurses
for assistance uith mothers' study groups, a nurse especially trained in
parent education, Miss Annie Gabriel, vas added to the staff. On January
6, 1931, work started with a group of mothers of the tlinland High School
in Daytona Beach. A total of 43 study courses were conducted during the
year in ten counties,

b. University classes.
One class in Child Care and Training and one in Iternel and
Infant Care were introduced for the first time at the State University
during the summr. The nawnoss of the courses together with their
classification and length discouraged large enrollments, the former being
but 12 and the letter 9. However the interest shown wcs remarkable, so
much so that Miss Gabriel has ben asked to repjct the courses during the
sumar of 1932 with assurance that certain changes as to hours and place-
munt will be made so as to permit larger ottondanco.

c. Demonstrations in the Hygiene of WMternity, Infancy and the
Preschool Child.
These demonstrations wore carried on at intervals by various
members of the nursing staff during the year. Tho demonstrations most
popular were: Additional Foods for the Infant under One Year, The Baby's
Bed, the Baby's Both, the Model Confinement toom, the Baby.g Tray and
the Mother's Tray.






1931


d. Exhibits
The equipment used in the above demonstrations, totaling 300
or ore itemia, ,ias used as exhibits throughout the year principally in connection
with annual istate-wide meetings, such as Federation of Woman's Club, State Parent
Teacher Association, State Medical Association, the State Nurses Association, etc.

0. Work with Midwives.

The practice of certifying midwives measuring up to certain stan-
dards set by the State Board of Health in 1924 was continues through 1930. During
that year it became increasingly evident to the Director that unless more
stringent regulations were introduced and enforced little further reduction could
be expected in the still shamefully high maternal mortality rate.

Following a series of conferences with the State Health Officer,
with Dr. McCord and with various memBrs of the nursing staff, a decision was
reached to institute a state-wide midwife survey to obtain data on which to base,
(a) the initiating of joint supervision with local boards of health and public
health nursing services, (b) a renewed and insistent demand for a law legalizing
midwifery, and (c) scope of such law.

Early in January the plans for such a survey were evolved and the
forms necessary for its promotion worked out. Briefly this meant a personal con-
tact by some member of the nursing. st'af'with each midwife, licensed and
unlicensed, either alone or in groups, who Vas known to have delivered a patient
in 1930. All local registrcrs wore visited and data obtained as to number of
babies registered. The information obtained through th3 personal data card
included the name, address, sex, color, marital state, age, academic education,
professional education, experience, other occupation, disease history, date of
last license, date of lost instruction and names and addresses of local doctors
relied on when needed. The work was put in charge of Miss Joyce Ely, who
together With Miss Mary Dodd, worked ip tbh first survey in Duval County.
Following this test, minor revisions were made and the work carried to all parts
of the stete.


ACTIVITIES OF THE DIRECTOR

The activities of the Director during'the year included the working out of
plans for the state-wide midwife survey, together with plans for putting the new
law into effect; the fashioning of forms for routine and special reports;
assistance to county units; talks, special lectures and demonstrations to
organized classes; examination of infants and preschool children; attendance at
committeee meetings; instruction of the nursing staff; attendance at annual
state meetings and service on special committees.

The Director served as State May Day Chairman and as Secretary of the Florida
Cpuncil' on Health, Welfare and Education.

In carrying out the above 35 talks, made mostly at state and county wide
meetings, were given to audiences totaling 2989 persons. 22 talks on the Hygiene
of Maternity, Infancy and the Preschool Child were given at Demonstration Child








1931



Health Conferences with an attendance of 603; 9 lectures were given at the summer
session of the State University, attendance 282; 14 lectures to the 4-H Club
Girls, attendance 480.

Examination of 463 infants and preschool children were made at Demonstration
Child Health Conferences in four counties.

Six committee meetings of special importance were attended in the interest of
the State Council on Hsa]th, welfare and Education, State Conference on Child
lialth and Protection, May Day, Social Hygiene, the Marriage Bill and the
registration of midwives.

Numerous conferences tece had with the Chief of the Nursing Division and with
the field nurses, singly rnd in groups, with reference to tabulating data obtained
at Demonstration Child Health Conferences, the daily-monthly reports, statistical
and narrative, the midwife survey and the registration of midwives.

Both full-time county health units, Leon and Taylor Counties, were visited
several times in tha interest of initiating Child iygiene programs. A total of
343 children was examined in the former and 40 in the latter. In both instances
the initial conferences wvre a part of the Child Hygiena Weeks.

The plan for making the state-wide midwife survey was drawn up, foms for
its conduct mad., the findings rram 57 counties us tabulated by Miss Ely, worked
up in narrative and chart form for the State Health Officer, the Laws, rules and
Regulations Pertaining to the Practice of Midwifery compiled and included with
the revised Khid&ife Manual under one cover, and plans for putting the law inte
effect evolved aed cddjd to the nurses manual.

Seven annual state meetings and one national, the meeting of the American
Public Health association at Lontreal, were attended.

Considerable time was spent in assembling the published and unpublished
reports of the Bureau and such other data as could be had, since its beginning
in 1918. Reports rrom 1922 to 1929 inclusive, uere summarized for the State
Health Officer.








Report of the
DIVISION OF PUBLIC HfALTH NURSING

1932


Personnel

Joyce Aly, R.N., State Supervisor of Midwives, January 1 September 15
Lalle Mary Goggans, R.N., Assistant Supervisor oC Midwives, Aug. 18- December 31
Jule 0. Graves, a. N., Field tonteat Nurse, September 15 December 31
Mary G. Dodd, A. N., January 1 December 31
Annie Gabriel, R. N., January 1 December 31.

Miss 1ly, State Supervisor of Midwives, was awarded the dockefeller Fellowship
in midwifery and left September 15th for a ten months study leave in New York.

Miss Dodd was assigned to the tuberculosis clinics assisting Dr. Claxton with
the tuberculin tests. She has assisted in arranging the clinics and in as much
follow up as was possible considering the time consumed in the clinics themselves.
Up to the end of the year Miss Dodd was assigned to the Bureau of Communicable
Diseases.

Office Staff

Helen Van Osdell, January 1 December 31
(Miss Van Osdell has been temporarily loaned to this division from the
executive Office.)
Anne King, March 17 December 31.


Activities


A. Work with midwives
1. Midwife Registration


(a) 1932
(b) 1933


2. Field Work
3. Midwife exhibitt
B. Other than midwife work
1. Work with county units
2. Public Health Nurses
3. Child Hygiene Exhibits
4. Parent Education.
C. Maternity Letter Service
1. Letters distributed in quantity lots
2. Individual.
D. Literature and Supplies
Z. Miscellaneous: Meetings attended.







1932


A. iork with Mildives.
1. (a) tMiWife Registration 1932.

The midwife work for the year 1952 was chiefly assisting midwives
to comply with the 1931 midwife registration law. Applications for license tW
practice midwifery were sent out to al4 midwives who uere listed in the 1931
midwife survey. On December 31, when the midwife registration was closed for the
year 1932, there were 947, 107 white and 840 colored, who had made application for
license to practice midwifery according to the law, 816 applications for license,
714 colored and 102 white were approved by the State Health Officer and license
granted. Of these licenses, 8 were Class A, 23 Class B, and 785 Class C. All
licenses were martd "temporary" because no examination was held during the year
for midwives. There were 650 miadives, 75 white and 575 colored, who made appli-
cation for certificate of registration and paid the registration fee of one dollar.
166 midwives, 21 white and 145 colored, failed to have their licenses recorded in
the Court House and make application for certificate of registration in accordance
with the law, Mbst if not all of these midwives wrote into the office, begging for
mercy and telling of the "hard times" in the district where they lived. The people
they had "waited on" were not able to pes them anything for their services and in
some instances the three cents were borrowed in order to get a stamp to write "in".

During the year there were 143 midwives, 9 uhite and 134 colored,
who were refused license to practice midwifery by the State Health Cfficer, the
reason for refusal being old age, small amount of practice, syphilis, and inability
to secure recommendations of two licensed practicing physicians. 528 midwives,
83 white and 245 colored, were notified not to practice midwifery because they had
not made application for license according to the midlife registration law# Tio
midwives had their license to practice midwifery revoked by the State Health
Officer and one case was filed with the county prosecuting attorney for practicing
midwifery without t license and registration.

(b) Midwife Registration 1933.

770 applications for license to practice midwifery for the year
1955 were sent out in November and early in December as the temporary licenses
to practice midwifery issued in 1932 expired on December 31 5534 midwives, 25
white and 309 colored, made application for license and 264 licenses to practice
midwifery, 25 white and 239 colored, were issued for January 1, 1933. Of these
licenses 6 were Class B and 258 Class C.

2. Field Work

42 counties were visited one er more times in the interest of
midife registration, i.e., Alechua, Bradford, Broyard, Calhoun, Charlotte,
Columbia, Dade, DeSoto, Duval, sbeembia, Flegler, Gedsden, Gilchhist, Gulf,
Hardee, Hernando, Hillsboro, Holmes, Indian diver, Jackson, Jefferson, Lake, Lee,
Levy, Leon, Marion, Okaloose, Osceola, Orange, Palm Beach, Pinellas, Polk, Putnam,
St.Johns, St.Lucie, Santa Aosa, Seminole, Suwannee, Taylor, Volusia, lalton,
Washington.

The supervision and instruction of midwives was delegated wherever
possible to local health authorities. During the year 22 city and county health
departments accepted all or part of the responsibility of supervising and.
instructing the midwives.





66.
M4dwife Mbetings
(In counties with local supervision)

At the request of the local suprvtiors of midwives, visits were made to
the following counties to assist with the midwife registration work an Li ai.ife
classes: Dade, Duval, Hillsboro, Lee, Lake, Marion, Osceola, Orange, Pojk,
Putnam, Seminole, St. Johns.

In 8 counties the following.exhibits were set up and demonstrated:
1. The Model Confinement Aoom
2. The Mother's Tray
3. The 0Ostptrical Package.

Number of midwives attending classes: Total 417; white 16; colored 401

Bag Inspections:
Total 100 white 9 colored 91
Complete equipment 43 4 39
Reasonably complete 41 3 38
Incomplete equipment 10 0 10
No equipment 6 2 4

Mi .Ct e Meetings
(In counties without local supervision)

County-wide all day midwife classes were held in the following 17
counties: Bradford, Charlotte, Columbia, DeSato, Flegler, Gadsden, Gilchrist, Gulf,
Hardee, Holmes) Jackson, Jefferson, Okaloosa, Santa Rosa, Suwannee, Washington,
alton.

Program for Classes

1, 1931 Florida Midwife Law
(a) iAxplained in detail
(b) Sections 1, 2 and 7 from Chapter 12005 read from "Laws,
rules and regulations Pertaining to the Practice of
LMidw ifery."
2. Birth Certificates
(a) The importance stressed of reporting all births to the Local
Registrar, in the community where the baoy is born, within
ten days of the date of birth,
(b) Sections 13 and. 22 from Chapter 6392 read. from "Lavs, Rules
and regulations."
3. Midwives not having 1932 License and Certificate of Registration
(a) A check up on the number of midwives present not having
1932 license and registration.
(b) Names obtained of midwives in county that are practicing
without license and registration.
4. Midwife Manual
(a) The new Midwife Manual explained and discussed.
(b) Demonstration of midwife bag given.
(c) Use of ne-w articles in bag explained safety razor, mask,
new cord dressing.
(d) <,uestiohs.
5. Bag Inspection
(a) All equipment used by midwives on a case inspected.
(b) Bags marked with tag according to completenrss of equipment.
(o) Equipment assembled.









Number of midwives attending classes: Total 229; white 30; colored 199.

Bag Inspections: Total 181 white 58 colored 143
Complete equipment 103 16 87
Reasonably complete 42 7 35
Incomplete equipment 28 5 23
No equipment 17 10 7

An effort was made while in the field to enlist the support of the local
doctors, public health nurses, nurses, registrars and interested individuals
in bettering the cork of tha midwives.

Personal Intervie~a

Health Officers .. 33 Nursea-not public health 15
Doctors-not public health 59 Interested Individuals 281
Public Health Nurses .. 180 Rigistrars . 23

Whenever time allowed, homa visits were made to miwiives who had not attended
the miidife meetings, investigations of midivos ..ho were practicing withouL
license and registration and discovering unreported births.

Homa Visits to Midbives: total 62; white 8; colored 54

Number of midwives practicing without license and registration investigated:
total 60; white 18; colored 42.

A colored man living in a poverty stricken rural community in the Western part
of the state had apparently never heard of the law requiring midwives to register,
or that births end deaths asould be recorded with the local registrar of that
voting precinct. He had delivered his "last wife of most" of their 14 children
and had also "attended" tVo of his daughters when they "ient in". On October 6,
1932, his wife died, ono month after her baby was born and the baby only lived
about six woeks. -qecontly he had been called in to deliver a white rman of 24
,hose husband was 82. T.o internal oxa mnations were mado and the baby died on
the 8th day... This feoble old man of 72 seemingly attached little importance to
the miduife law as ho did not care to become a "regular midlife". The duty was
always forced on him.

Unreported births discovered: total 29; white 14; colored 15.

All of the unreported births discovered wore obtained from midwives who were
practicing without liconse and registration.

3. idwife Exhibit
An exhibit was proparod for the fourth annual moating of tiD
Florida Public Health Association whioh was held in Ocals Docomber 5th to 7th.
Two maps 29 x 29 inchs showing tho number of colored and whita midwives at the
present time in Florida by counties, that wore licensed and registered, lionsed
only and unlicunsea. The model midwife bag, mi&dife manual, pictures ct Florida
midwives, prenatal and postnatal literature wore also displayed.






68.
B. Other than Midwife Work

1. Visits to County Hbalth. Units
Visits to observe the work in the county health units in .scambia,
Taylor and Loon Counties aoro made: Taylor County, 5 days; Leon
County, 8 days; Ascambia County, 1 day.

2. Public Health Nurses
The newly appointed public health nurses were visited and the
outline of their programs discussed. Invitations to visit the State
Board of Health in Jacksonville for observation was extended to all
public health nurses.

3. Child Hygione Exhibits.
The Child Hygiene Axhibits wore listed and made available as loans
to public health nurses to be used in connection with their maternal and
infant programs. The following exhibits eore loaned to Loon County
Health Unit, Marion County Public Health Nurse, Jacksonville Health
Department, iscrmbia County Health Unit:

Layette, Preschool Clothing; The Baby's Bath, The Baby's Bod,
Preparing Additional Foods for the First Year, Preparing the Baby's Tray,
The Mother's Tray, The Obstatrical Package, The Model Confinement Room.

4. Parent Education

As is indicated in the statistical report, the work for the year
just closed has extended from Jacekonville to Kay dest and St.Potersburg. The
greater interest has been in the more thickly populated counties. The classes
in the city P.T.A.'s are larger and better attended. The uneducated are less
interested in self-improVement than thosOe who have had some training. Some of
the most eagyr learners are college grad-uates in Home Economics.

The two largest classes tero the mothers of high school students
in St. Petersburg and the Gorrie Elomantary school mothers in Tampa. Each class
had an 6nrollmant of sevonty-five.

Tho comploto totals are as follows:
Enrollment in parent groups 2565
High School Classes 478
Attendance at individual talks 1132
Total 4175

Some of those jho attended individual talks were enrolled in
classes, but I feel confident that around thirty-five hundred-persons have been
reoachd in audiences.

While the work %oas in progress in Pinellas County, the St.Petersbuog
newspapers put out a Uby Day special supplement devoted entirely to Child Health.

A nev service was inaugurated in the fall -- that of giving
individual interviews in homes. This gives the mother time to talk over in
detail her child training problems. This work is time consuming as each inter-
view requires two or more hours, so the number that can be given per week is
small.- These interviews seem to be filling a real need as I have had more calls
than I could meet.








When parents are asked abut subjects for their discussion groups,
they usually wish something about behavior, obedience, disaoplias, i ts r or -
stdbbornness. But physical health is ono of the principal interests. A record
has been kept of all questions brought up for discussion and the.topic having the
largest number of questions is that of sex education, the next largest number is
in regard to physical health.

Much of the bed behavior.in children starts over food and mealtimes,
or is due to malnutrition or other physical defects. Health and acceptable
behavior or the lack of either cannot be separated in the ehild. The child is an
individual, a unit, and must be so dealt with. So, I find it easy to show the
mother the need for medical attention when the child has poor appetite and
stubborn spells, or frequent colds and is unruly.

Eventually, when we get parents sufficiently educated to demand and
provide for pre-parental education for our boys and girls, most of the work now
being done in our parent education classes will be taken care of by the family
physician, or the pediatrician. In the meantime there is need for some one to
help parents see the relationship between health, health habits, development and
behavior.

Statistical iRport

Parent Groups

Date County or Mo.Groupa No. No. Total No. Certif-
Town Lesson- Enrolled Attendanoe icates.
1/8-1/22 Nunree 2 U '174 3? 18
1/24-2/26 Dade 14 68 450 892 125
5/1-4/4 Volusia 8 .39 219 630 85
4/11-5/20 Pinellas 14 72 411 131.9 203
5/23-6/2 Cocoa 3 16 80 204 29
9/19-10/20 Duval 18 91 464 1089 199
10/24-11/23 Eillsborc', 15 71 670 1812 37
11/28-12/2 Pasco 2 10 70 210 24
1/8-12/16 Marionh 2 7 47 92 28
Totals 9 -78 397? 2565 6625 1022


0. Maternity Latter Service
Since the suspension of the Bureau of Child Hygiene and Public BEalth
Nursing made it impossible to continue the maternity luttur service on the same
scale, public health nurses through the state were notified that the State Board
of Health would be glad to supply these letters to them in quantity lots, the
nurse assuming the responsibility of distributing them each month in her district.

(1) Lettors distributed in quantity lots: Complete sets of maternity
letters were sent to 20 public health nurses in 14 counties, i.u., Baker, Dade,
Duval, decembia, Hernando, hillsboro, Leon, Orange, Oscola, Palm Beach, Polk,
St. Johns, Taylor.
Number Prenatal Letttrs 23,523
Number Postnatal Letters 12.233
Total 35,756







(2) Letters to Individualst ,,Woe individual maternity letter service
reached 439.mothera, 134 w es aA, 305 colored, in 62 counties. All counties
but ,Gitrw~isDixe, .Martin, Okaeohbbee and St. Lucie. 349 of these requests were
referred tor thl State Board of Health by midwives, 54 by physicians and 35 by,
interested individuals. 9 seta of the maternity letters were sent to the
following states:- Oklahoma, Illinois, Georgea, Massachusetts, New York.

Number Prenatal Letters 7,673
Number Postnatal Letters 6.683
Total 14,356


D. Literature and Supplies Distributed;

federal Children's Bureau Booklets
Infant Care ... . *. ... 895
Prenatal Care ....... 451
The Child from 1 to 6 ....... 405
Are You Training Your Child to be Happy? 184

Federal Children's Bureau Folders
What Builds Babies? .. ... 25
Breast Feeding .... 8 62
Keeping the Well Baby Well ... 108
Out of Babyhood into Childhood . 178
Why Drink Milk? ... ... .. 182
Why Sleep? . 136
Sunlight fo Babies ...... .. 109
Minimum Standards of Prenatal Care ..... 36

SMidwife Supplies
Silver Nitrate . . boxes 3482
Midwife EMonthly deports ... . 5482
Midwife Manuals .. . . 937
Joint Pledge Cards . .. 034
Midwife Bag Inspection Tags . 585
Mask Patterns .. . .. . 241
Cord Dressing Patterns . 26

Miscellaneous
Abdominal Binder Pattorns 10
Prenatal Report Blanks for Maternity Letters 2574
Teachers Physical Examinat ion Blanks .. 2550
Hookwcrm Spocimen Report Blanks Negative 2200
Positive 1480
E. Miscellaneous Meetings Attended
Antituberculosis Institute, Jacksonville, February 9-10.
Conducted by Miss Violet H. Hodgson, R.N., Assistant Director of
the Nutional Organization for Public Health Nursing.

American Legion Area C Child Welfaro Committoe, Jacksonvilla,
February 12-13.

Florida State Nurses Association, St.Augustine, Nov. 2nd,3rd, 4th.

Fourth Annual MNeting of the Florida Public Health Association,
Ocala, Depamber 5th, 6th and 7th.








71 -

:T'llahassee, Florida
February 23, 1s32



Dr. Heiry Hapson, State Health Officer
Florida State Board of Health
Jackponvi lle, Florida

Dear Dr. Banson:

In response to the verebl request given during your
recent visit to the station, I enclose herewith an adaptation of cer-
tain parts of the annual report which I trust May serve your purpose.

Sincerely yours,
(Signed) Mark r. Boyd.

Division of Malpria Research, Floride State Boerd of Health,
Tellahassee. :

The field studies prosecuted by the station during 1931 may be
summarized as follows:

Malaria Reconnaissenee in Northern Flqrida.
It was considered desirable that before the contemplated station was
established in Florida, m6re detailed information then that available from mortality
statistics be gathered for the Vrientatiod of the station. Accqrdingly, Dr. W. K.
Stratman-Thamas was, .on the invitation of the State HIelt Officer,i detailed to that
state to make a reconnaissance, largely in the counties *. West central Florida
lying between the Suwanne4 and Apai Phieoeo rivers. The investigation was to be
based on the results of spleea exemi1ntioqs of o4?1 children, both white and
colored. Accordingly, Dr, Thomas tool the field in January and continued this in-
vestigation te the end ef Mroh, i sititU-ail schools in seesioe at the time. It is
a pleasure to acknowledge the hearty cooperation he received froa the county
superintendents of schools, and from the te*Wherxs It is impiadtioable, in the
limited space,evailable, to give ana ccqunt of the results secured et each school.
Suffice it to say that these have been plotted on a large scale map of the region.
The results, simnarized by counties, incorporating als date gthired by myself
during the previous December, are given in the following table. These data indicate
the existence of a severe mlar.e ,problem in several of these counties, and an
appreciable problem in all. The lightest ilciddnee'i6 found in t e red hill section,
in which are found the larger towns, as well as the major portion of the negro
population. The heaviest incidence it observed in the #iiey flt Woods section,
which is sparsely inhabited by a rural white population. The incidence is higher
in the western then in the eastern pert of this territory.







TABLE 1


County Schools visited E~wpined Schools Results Total Index
White Coloed o )Sex White Col. Neg., P.D..I. #1 "'2 t 't#4 All pelp. Palp. All ExclA
excl P.D.I.
______________P.D.I.

203 0 27 16 9 0 0 52 2' 12.3
Jefferson 7 33 both 1587 9 41 12 11 5 0 67 26 11.4
S19 o0 3 7 12W 7 0 0 5 "17 7.7
Madison 7 -12 both, 215 6 25 T 0 0 5 35 10 16.5
-- ---V 15 5 2 -0 -- 2- -w -8.3
Franklin S 5 )ale. 88 1,. T 8 4 0 .." 8 0 2"5 12 28.4
41 0 45 .56 18 5 105 60 24.8
Wakulla 15 0 bot -
100 0 19 9 T _" 6_ 17 _; ,.. 14.
Lafayette 1 0 both ** '
110 0 I21 19 0 -4 25- 20.8
Liberty 5 5 both 41 2 I 7 1 0 0 8" 19.5
2- ,1. 731 2 24- 7 .- 14 9 45 21 2 16,1
Dixie 7 2 Male "54 1 2 2. 29"
-"-- -245 2 29 128 5T T 0 72 .- 41 1. 7.5
Leon 8 26 both; .96 5 37 10 0 0 0- 47 10 8.1 .
512 1___ I 74 1W 2 0 48 9.
Gadsden 13 14 both ____ 62 2 3% '12 5 0 0 48 0 1 T .7
649 0___ 109 54 6. 6 .0 192 .84 1.6
Jackson 19 29 both -2 501 1: 76 15 O 7 41 5 28 ,2
479 1 183 41 25 '9 5 0: 258 .- 7 15.6
Taylor 12 5 both 78 0 6 C o







- 73 -


Ml3aria Field Studies,


Systematic field studies of malaria were planned as one of the pro-
jects of the station. It wns desired to organize intensive studies, where the
flowing incidence of malaria can be followed tor a considerable period in a highly
endemic cifrumscribed area served by a single physician. After earmining the
possibilities, the territory in and adjacent to Sneads in Jackson County was
selected. Since mid-summa, routine observations on Anopheline incidence in this
area have been been made, and a survey of school children was made in November.

A considerable -incidence of. malaria occurred in this area despite the
dry season, as is shown by the results o: the school survey.


School Race Ixam Number with Number with
splenomegaly positive-
ind. P.D.I. Percentt Blood Percent
Sn1ea White 3355 90 8 3.4
Sneadl Colorad 58 11 9 4 10.5
Sinai Colored 42, 25 54.7,. 14 33.3
Little
Zion Colored 77 21 27.2 4 5,2

The three common lnophelines of the southeastern United States were
found in this area. Their relative monthly incidence has been as follows:


.. Per cent of specimen identified
Species Jly August Sept mber Octobor November Daecmber
A. quad 22.8 30. 40.6 34.7 11. 4.3
Larvae A. punet 16.6 338 .2 1.7 .. 4. 81. 83.R
A. Crucs. 60.5 36.5 38. 17.1 7.9 12.2

Adults A. uad. -- 62.5 79.4. 67,9 66. 16.4
A.. ptet. 5. 3 8.6 18.4 77.
A. au es. -- L52.1 16.9m 'b;S3 21.4 6.5


These data suggest that in this latitude, each species has different
periods of maximum abundance. It appears that crucians is a summer species,
quadrimaculatus being most abundant in spring and fall, while punctipennis is
a winter species. The idea of a spring and fall peak of quadrimaculntus is con-
firmed by the catches at the station on the Wacissa river.







- 74 -


Those observations suggest that crucians may be an important factor
in malaria propagation in this state.

The different spocios havo had the following typos of production areas
in the 3 periods oharactQriZod by the dominance of each species in succession.


Typo :No. No. No. larvae idontifiod
of w-tor observations positive 7. quad. punt A. rucians
S Permanent stream 8 2 19 -
SInt.str.flowing 8 _____ 1 .. 1 1
I Int.stir.ooled 4 3 -.45 2
S caY,2 i.ons 4 3 46 .... -, ...
SWlls, springs 61 37
Lime sinks _____
i os &ponds 140 7 19 83___
Tompwtr 1 5 "10 1_ ll

S Permanent stream .9 7 40 5
SInt.str.flowing 8 3 ____ 17 2
SInt.str.pooled 15 14 9 201 38
Excavantion 16 8 2 9 18
Wolls,spring 13 8 103 4
r r TLimo sinks 11i 0
O 4 Lakos & ponds 170 92 409 107 237
Tome, .wator 23 12 42 9 22

Permannt strom ,821 19 8 299 3
W Int.str.flowing -
Int.str.poolod 7 4 3 71 1
Excavations 0 -
Wolls; springs 4 4' 1 -
8 Time inks- o0 ,
PO5 g Limo Rinks 1-
S akes & ponds 94 26 35 80 47
S Temp. wator 9 1 9 17 1


It may be noted that in the vicinity of Tallahassoo, we have encount-
ored the tree-hole breeding Anopholine, babor, in the climax type of beech-
magnolia forest.

Division of Malaria ResoarCh, Florida State Board of Health,
Tnllahassee. 1932
MALARIA
Induced Malaria


Since its establishment in Tallahassee, Florida a little more than
eighteen months ago, the Station for Malaria Research, acting in co-operation with
the Florida State Board of Health and the Florida State Hospital has been largely
occupied in the study of naturally induced malaria as employed in the therapy of
paresis and neurosyphilis.







- 75 -


Although the work was initiated by utilizing wil4 Anopheline .laaginos
it was placed upon a much secure technical plane by the perfection of an insootary
which permits the roaring of an abundance of Aaopheles quadimaculatus in captivity.
In fact, in the insectory there have been reared in captivity in the space of a
year eleven consecutive lineal generations of this Anopheline. These have the
further advantage of being as large, vigorous aAd blood thirsty as the best wild
specimens, as well as being free from any possibility of malWria infection. One
of the factors in this success has been the discovery that properly ripened pans
oS hay infusion constitute the best pabulum yet encountered for the nourishment of
the larvae.

Several improvements in laboratory procedure have resulted in a per-
fection of the technique of propagating the malaria parasites through their
sporogonous or mosquito cycle. A high proportion of the mosquitoes are success-
fully infected, effective methods of manipulation and conservation during incubation
and storage have been developed, so that mosquito mortality is low, and largo
numbers of the infectious insects are available. The controlled application of
these mosquitoes to patients for whom malaria therapy has been prescribed produces
very dependable results.

Most of the patients have been inoculated with Plasmodium vivax. Of
this species of malaria parasite, five strains have been employed. During this
period one of these has been propagated through ten consecutive and lineal
Anopheline-human transfers. Most of these inoculations have been effected with
Anopheles uadrimaculatus, although propagation of this parasite by A. punctipeanis,
A. ucians (inland), A. atropos and A. walker has been successful. The oonserva-
tive employment of this species of mai ria parasite demonstrates that it can be
successfully used in malaria therapy wilt very little risk to the patient.

A few negro patients have been successfully inoculated with Plasmo-
diu falciarum by the employment of Anopheles auadrimaculatus. A limited
experience with this species of parasites suggests that milder strains may bo
effectively employed in therapy, providing the medical attendants are watchful to
interrupt the clinical evolution of the infection, if necessary to the welfare of
the patient.

An accomplishment of especial interest has been the successful
propagation of the parasite of quartan malaria, Plasmodium Malarine, by means of
oxpekarentally infected Anopheles qQd ignaMlatus. The station has had available
three strains of this parasite, the first of which was received from the United
States Public Health Service. Most of the quartan inoculactiones have been made by
the transfer of blood. However, mosquitoes have been successfully infected with
two of these strains, including that received from the Public Health Service. The
successful human inoculation with mosquitoes noted above was affected with the
latter strain, whilo the results of mosquito inoculations with another strain are
pending.

The experience already gained with Plasmodium ivax throws some
interesting light on benign tertian malaria. The infectiousness of a patient
harboring this parasite, considered from the standpoint of the number of cysts
which develop on the stomach of an Anopholine, is proportional to the number of
mature microgametocytoe in the patient's blood. A patient experiencing an attack
of benign tertian malaria due to any of the strains of the parasite investigated,
acquires a tolerance to the presence of the parasites of this strain which makes
reinfection or suporinfection impossible. They still remain susceptible to other
strains of the parasite. While the primary inoculation of same white patients has







boon successful, there has not as yet been encountered a white patient who was
refractory to inoculation when a sufficient number of mosquitoes was employed.
Primary inoculations performed by lightly infected single mosquitoes fail in about
one-third of'the cases, although all white patients on whom four infected mosquitoes
wore applied, including those resistant to the light doses, have become infectobi
Considering the probable "dose" of sporozoitos a patient has received, particularly
from the standpoint of the intensity of the stomach infection which charactericss
a given lot of mosquitoes, indicates that tho length of the incubation period, a:vi
the character and severity of the clinical manifestations are directly proport'itcal
to the probable dosage of sporozoiteo. No incubation period has. been less than 10
days in duration, while very few exceed 20 days, and, in white patients have not
been observed to exceed 35 days. Negroes are strikingly refractory to inoculations
with P. vivax. Only throo inoculations of this race have been successful, though
producing -oly light and transitory infections of no therapeutic value. Adult
negro males have been found with a tolerance that successfully resists the appli-
cation of 16 Anophelines of proven infectivity. Some evidence has been secured
that indicates the refractoriness:of nogroes is a racial rather than an acquired
characteristic.

To the end of the year, results of malaria therapy can only be fully
considered in the 56 cases inoculated in the first six series. Of those 8, or 14.2
per cent have improved sufficiently to warrant their parole from the institution.
All in all, 41.1 per cent show varying degrees of mental improvement, although it
is interesting to note that even where no.mental improvement is observable, a very
evident improvement in their general physical condition nearly always follows.
Of these 56 patients, only three have died, ir none of which instances could the
mortality be attributed to the malaria infection. The experience indicates that
where care is employed in selecting patients for this mode of therapy, and that
where the cases are conservatively managed, there is little risk to the patient.
Attention must be directed to the discovery of a species or strain of the malaria
parasites suitable for the inoculation of negro paretics.


Boyd, Mark F.


Boyd, Mark F.



Boyd, Mark F.



Boyd, Mark F.



Boyd, Mark F.


Boyd, Mark F.


"A note on the preparation of Anophelino dissections for examination'
American Journal of Hygiene, XVI (1932)

"On methods for the manipulation and conservation of Anopheline
imagines"
Amorican Journal of Hygiene, XVI (1932)

and Cain, T.L.Jr., "On large scale rearing of Anophelos qaigi-
maclatus in captivityy,
American Journal of Hygiene, XVI (1932)

and Stratman-Thomas, Warren K.,"Studies on Plasmodium vivax:l.The
microgametocytes as a factor in the infectiousness of the infected
human". American Journal of Hygiene, XVI (1932)

"Studios on Plasmodium vivax; 2.The influence of temperature on
the duration of the extrinsic incubation period".
American Journal of Hygiene, XVI (1932)

"Successful cage rearing of Anophelos quadrimaculatgs".
Science 76,370, October 21, 1932.


The following papers have been submitted for publication:

Boyd, Mark F. and Stratman-Thomas, Warren K., "Studies on benigh tertian malaria:
1, On the occurrence of acquired tolerance to Plasmodium vivax"


- 76 -





_- 77 -


Boyd, Mrk F. and Stratman-Thomans Warren 1L, "A controlled toochnique for the
omploymont of naturally induced malaria in the therapy of porosies.

JItheson, Robert; Boyd, Mark F., and Stratman-Thomas, Warron L., *Aniophlos
walkerls Theobald, as a vector of Plasmodium viv tssi and
Folottiw.

Boyd, Mark F., and Stratman-Themas, Warron K., "Studics on benign tortian malaria:
The clinical characteristics of the disease in relation to the
dosage of sporozoitos".

Boyd, Mark F., and Stratman-Thomas, Warron K., "Studies on benign tortian malaria:
3. On the absence of a hotorologous tolerance to Plamodium vivaxe.

Boyd, Mark F., and Stratman-Thomas, Warren K., "A note on the transmission of
quartan malaria by Anopholos quadriaaoulatus'.

Boyd, Mark F., and Stratman-Thomas, Warren K,, 'Studies on benign tertien malaria:
4. On the refractoriness of negpoea.

MALARIA

Malaria and Physiography

The geographical distribution of malaria mortality in the southeastern
United States presents several peculiar features. It had already been noted that
it is largely confined to the coastal plain, quite closely dolimitbd by the loWe
margin of the Piodmont platoau. More recent studios have elucidated further
oharaotoristics. Thus in Georgia it largely occupies a wedge shaped zone extending
transversely across the state, with its broadest section lying in the southwest,
At oithor end there is an extension into adjoining states. It extends into South
Carolina on the northeast, and on the southwest t projects into tho extreme south
eastern portion of Alaboma, and boldly extends into the coastal counties of central
Florida which border the Gulf. The peculiarities of this position cannot be attrl-
' bted either to olovation or to the fluvial hydrography, as excepting the Florida
section the area is not coastal, while in Georgia the malnria belt bisects all of
the river basins of the state considerably above their points of discharge.

A study carried out at the Station for Malaria Rosearch in dollabora-
tion with the Florida State Geological survey* indicates that this region has a
peculiar phystography, attributable to the character of the underlying geological
formations, .whih make it peculiarly susceptible to the annual fluctuations in
precipitation.

It is found that this area of intense malaria lying in these four
states very olosoly co-incides with the area of outcropping of certain limestone
of the tertiary period, particularly those known as the Tampa, Vicksburg and Ocala
formations. In the areas where those limestone closely underlie the surface, the
usu 1 horizontal type of stream erosion leading to the development of an abundance
of surface wator courses is but slightly developed. In its stead there exists
what physiographors designate as "solution topography'. This develops since the
highly soluble limestone are gradually dissolved by the downward percolation of
water, leading to the formation of cavernous passages occupied by underground
streams. As a result of this diversion of water, the effect of the erosionary
processes which mold the topography of other regions is minimized, and consequently
such a region is not an areo of high relief. In time, many places in the roof of
those passages booeam weakoned and give way, forming steep walled funnel shaped










depressions of relatively small diameter, known as "sink h60os". Further erosion,
either subbtrranoan or surface, may either enlarge .such doposasions, or effect a
partial filling. Consequently in such solution areas, the topography is character-
izod by the presence of basin shaped depressions, varying in dimensions from a
few hundred foot to miles-in diameter. Some are permanently filled with water,
forming lakps or ponds, others remain dry except during periods of heavy rainfall,
when they hold temporary ponds. Usually in the last instance the water is derived
directly from precipitation, though most of the former are fed by springs which
represent the outlets of solution passages.

It was further ascertained that the annual fluctuations of malaria
incidence in the areas of solution topography closely co-incide with the fluctua-
tions in the summer precipitation, particularly in the six months from May to
October inclusive. The tire. area of solution topography lies in a zone which
normally receives the major part of its precipitation during the summer months.

Thus the solution topography produces many shallow basin shaped
depressions devoid of an outlet, in which surface water is retained in wet summers.
It thus appears to promote the opportunities for the breeding of Anopheles quadri-
manulatus in temporary water.

The following paper is in press:

Boyd, Mark F., and Ponton, Gorald, "The recent distribution of malaria .in the
southeastern United Status"b


DIVISION OF MNAARIA CONTROL STUDIES

The Division of Malaria Control Studios, under the direction of
Surgeon T. H. D. Griffitts, U. S. Public Health Service, began in September, 1932,
a countrywwido malaria parasite index. It is planned to extend this survey to
include all counties in Floridd -whero maldria is considered of major importance.
Aside from obtaining the most nearly exact hnad reliableoindex rate of malaria
among school children, it is hoped'that through this thick smear blood index to
establish a direct relationship of evaluation between the parasite rates and the
reported death rates by counties. To begin with, a group of counties showing a
mortality rate of 100 or more per 100,000 population has been selected in which
all of the school children have been or will be, examined for malaria parasites.
As was expected, the high mortality.ratos correspond to the Countios with a
relatively high P. falclparum rate in the counties thus far surveyed,

The result's of blood oxaminations in seven counties are given in the
following tables:




-49 -
MALARIA ]L0O) IJDUI

192. 1936

(Thick Films)

Pos.
lEalaria E.A.* B.T. Eixed Sp.?
BBAPB COITY NoExam. No. % %
( s cl o o s--

White

New River 45 3 6.6 100,0 0.0 0.0 0.0
Theressa 20 1 5,0 100.0 0.0 0.0 0.0
Rising 64 2 33. 0.0 50.0 0.0 50.0
Brooker 159 5 3.1 80.0 0.0 0.0 20.0
LawteJ 233 6 2.6 0.0 0.0 0.0 100.0
Hampton 107 2 1.7 100.0 0.0 0.0 0.0
Heilbron 66 1.51,5 0.0 0.0 0.0 100.0
State 388 5 0.8 0.0 33.3 0.0 66.7
Yanderbilt 49 0 0.0 0.0 0.0 0.0 0.0
Graham 29 0 0.0 0.0 0.0 0,0 0.0
Woodlawn 32 0 (0.0 0.0 0.0 0.0 0.0
Boat~train 15 0 0.0 0.0 0.0 0.0 0.0

Colored

Hampton 54 4 7,4 50.0 0.0 25.0 25.0
Claa 37 4 10.8 50.0 50.0 0.0 0.0
Lawtrb 111 I1 0.9 0.0 0.0 0.0 100.0
Stalar 113 0 0.0 0.0 0.0 0.0 0.0
New Nver 43 0 0.0 0.0 0.0 0.0 0,0
Pleasant Grove 30 0 0.0 0.0 0.0 0.0 0.0
Bro*dkljn 20 0 0.0 0.0 0.0 0.0 0.0
Sampsal City 32 0 0.0 0.0 0.0 0.0 0.0
Thurateo 36 0 0.0 0.0 0.0 0.0 0.0
Schoolr-21 1643 32 1.9 37.5 18.8 3.1 40.6

CITRUS COU~R -
(I scas) -

Whier 15 0 00 0 00 0.0 0.0 0.0

Chassahowtiska 15 0 0.0 0.0 0.0 0.0 0.0
Hernanton 46 1 2,2 100.0 0.0 0.0 0.0
Oak Grove 25 0 0.0 0.0 0.0 0.0 0.0
Oselle 12 1 8,3 000 100.0 0.0 0.0
Homosassa Springs 9 2 22.2 0.0 100.0 0.0 0.0
Homosassa 65 10 15,4 10.0 50.0 0.0 40.0
Holder 22 0 0.0 0.0 0.0 0.0 0.0
New Hope 21 0 0,0 0.0 0.0 0.0 0.0
Red Level 16 0 0.0 0.0 0.0 0.0 0.0
Inverness 196 6 3.1 33,6 66.4 0.0 0.0
Crystal River 112 10 8.9 20.0 80.6, 0,0 0.0
Citronella 15 1 6.7 0.0 100.0 0.0 0.0.
Fl6ral Citf 61 0 0.0 0.0 0.0 0.0 0.0
Pleasant Green 50 0 0.0 0.0 0,0 0.0 0.0
CitLra 19 0 00q 0.0 0.0 0.0 0.0
Learte 62 2 3,2 100,0 0,0 0.0 0.0






1i. aria


cITMUs O.Dffi Cont.e,


B.A.* B.T.


Mixed


C 01 or ___No.Ex*r O.% % %
Colored
Red Level 8 3 37.5 0.0 100.0 0.0 0.0
CrVstal River 74 12 16.2 41.7 58.3 0.0 0.0
Inverness 63 2 3.2 50.0 50.0 0.0 0.0
Leesmount 14 3 21.4 0.0 66,7 0.0 33.3
Russell Hill 18 1 5.6 .0.0 .0 0.0 100.0
Holder 18 0 0.0 0.0 0.0 0.0 .0.0
Floral City 42 1 2.4 100.0 0.0 0.0 0.0
HernanAe 52 4 7.7 75.0 25.0 0.0 0.0
Schools 24 1015 59 5.8 30.5 59s.3 6.6 16.2
DIXIE CONU- -
!Schools)
White
Cross City 406 6 142. 4040 20.0 20.0 20.0
Patch 20 1 5.0 0.0 0.0 0.0 100.0
Horse Shoe 21 0 0.0 0.0 0.0 0.0 0.0
Rock Sink 9 0 0.0 0.0 0.0 0.0 0.0
Butler 16 0 0.0 0.0 0.0 0.0 0.0
Jena 34 2 5.9 50,0 50.0 0.0 0,0
Hill 11 0 0.0 0.0 0.0 0.0 0.0
Oltown 84 8 9.5 62.5 37.5 0.0 0.0
Hines 27 0 0.0 00. 0.0 0.0 0.0
Pine Hill 17 2 11.8 0.0 100.0 0.0 0.0
Colored
Summerville 30 2 6.7 100.0 0.0 0.0 0.0
Hines 17 .3 17.6 33.5 0.0 0.0 0.0
Bow Legs 19 .9 47.4 10Q.0 0.0 0.0 0.0
Eugene 15 2 15.4 100.0 0.0 0.0 0.0
Oldtown 23 1 4.5 100,0 0.0 0.0 0.0
Shamrock 152 6 3.9 100,0 0.0 0.0 0.0
School 16 899 941 4.5 70.6 17.1 2.5 4.
FLAcLER coUT *
(Schools)
White
Gilbert 29 .0 0.0 0.0 0.0 0.0 0.0
Plagler Beach 41 2 4.9 50.0 50,0 0.0 0.0
Bunnell 272 6 2.2 100.0 0.0 0.0 0.0
Colored
Espanola 27 0 0.0 0.0 0.0 0.0 0.0
St. Joseph 18 '0 0.0, 0.0 0.0 0.0 0.0
St. Johns Park 4 0 0.0 0.0 0.0 0.0 0.0
Welden Johnson 53 2 308 100.0 0.0 0.0 .0.0
Favorite 13 0 0.0 0.0 0.0 0.0 0.0
Orange Hammock 16 1 6,2 0,0 0,0 0.0 100.0
Schools 9 473 1 2,3 81.8 9.1 0.0 9.1
Gilchrist Co ,ty -
( SCHOOLS)
White
Bratram 23 0 0.0 0.0 0.0 0.0 0.0
Cleveland 15 0 0.0 0.0 0.0 0.0 0.0
Frankland 38 2 5.3 0.0 0.0 0.0 100.0
Bell 267 7 2.6 57.1 28,6 0.0 14.3
Trenton 348 6 1.7 10.0 90.0 0.0 0.0
Hickory Hill 27 1 3.7 .0 0.0 0.0 100.0
Colored
Trenton 60 3 5.Q 0.0 100.0 0.0 Q00
Schools 7 -781 18 24 26.4 52.6 0.0 7_ 1*


Sp.?





LIOi COrT -


ISCHCOLS)
White
Woodville
Strickland
Vlccosukee
Cproline Breverd
Chaires
Fort Breden
Senley


Colored
Ftwkins Pond
Ch.ires
Schools 9
LT'VY ConVS -
(SCHOOLS)
White
Sumner
C son
Otter Creek
Ellzey
Gulf Hammock
Union
Cedar Keys
Ebenezer
Chieflend
--nkeetown
Inglis
Tide WIter
Rocky ILamock
Port Inglis
Bronson
H1rriston
Copper Sink
Tovble Sink
Creech
Williston
Colored
Otter Creek
Montbrook
Sumner
Bprne Hramock
Cednr Keys
Si;a
filley
Oven Prairie
Gulf Hpjmock
Bronson
Williston
Union
Chiefland
Morriston
Lebanon
Gulf Hnmiock
Billerd Still
Raleigh
Adrsmville

Gr~a trl- 2539
OGnl-d 2--6.-V-5~5


wo .gxa.


135
12
71
92
61
67
80


47
90
6558


19
29
55
16
85
21
205
17
413
36
58
12
16
20
97
147
33
34
14
273

33
50
14
29
29
10
is
14
35
49
93
28
39
29
18
54
37
50
39
2249
7715


Por.
wMlaria


E A.* B.T. Mixed Sp.t
% % % 1 <


o.


9
5
5
9
4
6
7

6
11
62


5
1
16
5
7
0
2
0
6
5
5
2
0
2
4
3
0
1
0
12

26
3
5
9
0
0
16
3
7
9
4
3
3
0
8
13
19
8
1
213
4537


6.7
41.7
7.0
9.8
6.6
8.9
8.8

12.8
12.2
9.5


26.3
3.4
29.0
31.2
8.2
0.0
0.9
0.0
1.4
13.8
8.6
16.6
0.0
10.0
4.1
2.7
0.0
2.9
0.0
4.3

78.7
6.0
35.7
51.0
0.0
0.0
84.2
21.4
20.0
18.3
4.3
10.7
7.6
0.0
44.4
38.2
51.3
16.0
e.8
9w4
5,9


55.6
100.0
80.0
100.0
100.0
66.6
85.7

100.0
100.0
87.1


80.0
0.0
56.3
60.0
42.8
0.0
0.0
0.0
0.0
0.0
20.0
50.0
0.0
0.0
50.0
66.7
0.0
100.0
0.0
81.8

65.3
33.3
80.0
44.5
0.0
0.0
81.2
33.3
71.4
88.8
50.0
50.0
0.0
0.0
50.0
84.6
89.4
37.5
0.0
60.0
58.1


22.2
0.0
0.0
0.0
0.0
16.7
0.0

0.0
0.0
4.90"


20.0
100.0
25.0
20.0
28.6
0.0
0.0
0.0
66.7
180.0
80.0



25.0
33.3
0.0
0.0
0.0
9.1

3.9

0.0
33.3
0.0
0.0
12.5
538,8
14.3
11.2
25.0
0o0
33,3
0.0
12.5
15.4
5.3
62.5
100.0
23.9
25.9


0.0
0.0
0.0
0.0
0.0
16.7
0.0


S0.0 0.0
0.0 0.0
1.6 6.4


0.0
0.0
0.0
0.0
14.5
0.0
50,0
0.0
0.0
0.0
0.0
50.0
0,0
0.0
25.0
0.0
0.0
0.0



1106
0.0
11.6
0.0
20.0
11.1
0.0
0.0
0.0
3808

0,0
14.3
0.0
0.0
0.0
0.0
0.0
57.5

0.0
0.0

6.6
Val


22.2
0.0
20.0
0.0
0.0
0.0
14.3


0.0
0.0
18.7
20.0
14.53
0.0
50.0
0.0
3SS.
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0,0
0.0

19.2
33.5
0.0
11.1
0.0
0.0
6.3
335.3
0.0
0.0
25.0
50.0
66.7
0.0
0.0
0.0
5.3
0.0
0.0
9.5
11 .


rPi~rs'ett~o*ps~r p;lIF iptec ist one wrtos not ee aes**e.


_ -, -


I


---- ----


IIBI .. .. w N. .


I I I


I


I


I


I












January 1st, 1933.




Dr. Henry Hanson,
State Health Officer,
Jacksonville, Florida.

Sir:-

I have the honor to submit herewith a condensed report of the
work of the Bureau of Laboratories for the period which has elapsed since
the publication of a formal report by the State Board of Health (1922).

For a long time Florida has experienced an annual influx of
tourists during the Winter season. This phenomenon in itself'has added to
the health problems of the State by the annual re-introduction of new strains
of disease organisms with their attendant problems But it fades into
insignificance beside that greater phenomenon known as the 'boom'.

In 1925 and 1926 there were in Florida according to the
estimates of competent authorities upwards of two millions of people as
against One million in 1922. And this swelling of population was not for
the tourist season alone, nor made up of the ordinary tourist class. It
could not fail to influence'evory human relation, particularly those
considered under the general heading of Public Health.

H3)OkWORM DISEASE AND MALARIA

Hookworm disease and Malaria, two scourges of the South, seem
to have been very little influenced by the population changes referred to.-
In the case of Hookworm the number of specimens submitted was more than
doubled from'1923 to 1926. 1Thereafter the rate of increase was match less,
the total increase from 1926 to 1932 amounting to not more than 50%. The
percentage of positive findings remains fairly constant. In view of the
contention that Hookworm has been conquered in the South, our findings are
difficult to interpret.

Malaria is believed to have a cycle of about ton years.
Whether this be true or not,'the disease reached a high point in ineidencr
and virulence in 1929, a phenomenon which cast its shadow a full year ahead.
The' actual number of specimens subsequently grows with the population but the
percentage of positive findings fluctuates in a very interesting way.

DIPHTHERIA AND TYPHOID FEVER

Those diseases resemble each other in the fact that adequate
immunologiao defenses have boon devised. Their conquest has howovor, boon
more dramatic than icompleto. In palliation of public apathy may be urged
the fact that the present generation has never soon those diseases at thpir
.yworSt. .


'. V







- 83 -


VENEUREAL DISEASES

The Vencreal Diseases are still of great importance as causes
of disability and death. The number of specimens submitted for the
detection of the Gonococcus increases slowly, while the porcontago of
positive findings falls as slowly.

In the ease of Syphilis, we are reasonably sure that tho
increase in the number of specimens submitted does not point to an increased
prevalanco of the disease but rather to a more frequent resort to the
Laboratory for a routine 'blood test'. Some six or seven thousand of the
tests for Syphilis credited to the Laboratory represent duplicate tests
perfonmod for the double purpose of familiarizing the Staff nith new methods
and testing the now methods against our old ones. The more fact that a
method is now is not sufficient warrant for adopting it, but on the other
hand a one-cylinder automobile in perfect running condition would be of
more interest as an antique than as a means of transportation.

RABIES

Rabies reached its highest porcontago of positives in 1926,
its largest number of positive animals in 1929 and its largest toll of
human life in 1931 and 1932. The reluctance of the public to take measures
against this disease, is very hard to understand.

PESO~NEL

In spite of the increase in work the technical staff remains
the same, numerically, as it was at the beginning of the period covered by
this report.

Respectfully,
(Signed) Paul Eaton,
Director of Laboratories.







rTTPBRS CF SyCI'"r!vS FX7PIPT'D IT CFTW1FAI. /LD BRAP.CH LPBOiPltTrT'R
BY YRIS \7ITH P rTl'PAGES 0r P TITIVT rIfDIYGS

1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 TOTPL

HOOyWOrY 11967 19359 27110 31384 29374 30007 30067 38342 40040 43293 300943
Positive 3146 5794 8013 9842 7085 8557 9456 10702 10177 11984
% Pos. 26.4 30.0 29.4 31.2 24.1 28.5 31.4 28.0 25.2 27.6

DIPTFfTHIRA 9448 9743 11830 15567 21583 12939 15557 14916 26200 39305 177088
Positive 1014 832 859 1387 1910 1025 1073 724 1206 1972
% Pos. 10.7 8.5 7.2 8.9 8.9 7.9 6.9 4.9 4.6 5.0

VALLAIA 7518 7478 6714 5908 7233 6875 9852 11614 9859 9864 82915
Positive 556 491 299 193 141 401 1067 739 490 409
% Pos. 7.4 6.5 4.5 3.3 2.0 5.8 10.7 6.3 5.0 4.1

TYPHO!D WFEVER 5462 5454 5488 5202 6941 6876 9274 7226 10926 11637 74486
Positive 404 385 311 257 353 245 203 159 268 257
4' % Pos. 7.3 7.1 5.7 4.9 5.1 3.6 2.2 2.1 2.5 2.2
i
TUBERLCTC'LIS 4024 4036 3745 5874 3629 3943 4301 4239 4175 4371 40337
Positive 693 643 633 625 577 619 595 632 594 651
PoS?.. 17.2 16.0 16.8 16.1 15.9 15.7 13.8 14.9 14.4 14.9

GCIOReHOE 4610 5536 5419 7089 7913 7765 9139 9361 11071 12771 80674
Positive 1379 1613 1911 1890 1779 1694 1998 2001 2285 2562
% Pos. 29,8 29.2 55.1 26.8 22.6 21.8 21.8 21.4 20.7 20.0

SYPHTLIS 20010 23655 29994 37130 43643 47141 56173 64377 68740 81658 472521
Positive 2711 3711 4807 7748 9786 9483 11560 10735 9369 10782
P Pos. 13.5 15.9 16.1 20.8 22.4 20.0 20.5 16.8 13.7 13.2

STIES 271 311 344 221 576 577 428 23S 281 298 3140
Positive 122 172 162 153 146 153 182 69 10? 75
SPos. 45.0 55.0 27.0 60.0 38.8 40.7 42.5 10.6 36.3 25.1

TISrLL TrOCTS 9031 9159 11240 16235 19169 20841 21628 26271 35240 '1251 200148


72341 84711 101884 1'2610 153861 136664 156419 176579 206535 234648


14325?7








-85-


LOUVL G. LlPET, CHIN ENGINE~
BUREiU OF ENGINEERING
STATE BOARD OF HEg.LT.
INTROIDCTION -


The Bureau of Engineering of the State Board of Health was created in
1916 for the purpose of rendering helpful assistance to cities and tows in
solving the Sanitary Engineering problems confronting them. To this end its
efforts have been directed entirely with slight deviation necessitated by
modern practice. Thus, the Bureau has a four-fold division of work, namely;

I Field Surveys, Studies and Investigations;
II Bacteriological Water Examinations and Special Studies;
III Office management and consultation;
IV Educational Activities.

in outline of the work undertaken is listed under the following:

1. Water Supplies.
2. Sewerage and Sewage Disposal.
3. Mosquitoes and Malaria Control.
4. Waste other than Sewage Disposal.
5. Sanitation of;
a. Schools
b. Swimming Pools
c. Canneries
d. Oyster Packing Establismhents
e. 'Fairs
f. Tourist Canps
g. Institutions, Orphanages, etc.
6. Milk.
7. Rabies Control.
8. Special Reports, Investigations, etc.

This report of Bureau of Engineering activities and accomplishments covers
the period from January first, 1923, through December 1932, and comprises only
a generalized report of that period.

PERSONNEL -

The Bureau organization during this decennial period is shown on the
accompanying personnel chart.




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