• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Board members, directors and field...
 President's letter of transmit...
 Table of Contents
 State health officer's letter of...
 Division of accounts, report
 Division of library service,...
 Division of drug inspection,...
 Division of malaria research,...
 Division of malaria control studies,...
 Division of entomology, report
 Multigraph department, report
 Division of public health nursing,...
 Bureau of communicable diseases,...
 Bureau of laboratories, report
 Bureau of engineering, report
 Central bureau of vital statistics,...
 Statistical tables 1932






Title: Annual report - State Board of Health, State of Florida
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Permanent Link: http://ufdc.ufl.edu/AM00000243/00004
 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: VID00004
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 ii
    President's letter of transmittal
        Page iii
    Table of Contents
        Page iv
        Page v
        Page vi
        Page vii
        Page viii
    State health officer's letter of transmittal
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
    Division of accounts, report
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
    Division of library service, report
        Page 23
    Division of drug inspection, report
        Page 24
    Division of malaria research, report
        Page 25
        Page 26
        Page 27
    Division of malaria control studies, report
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
    Division of entomology, report
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
    Multigraph department, report
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
    Division of public health nursing, report
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
    Bureau of communicable diseases, report
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
    Bureau of laboratories, report
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
    Bureau of engineering, report
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
    Central bureau of vital statistics, report
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
    Statistical tables 1932
        Page 136
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
Full Text




\~H""`


tHIRTY-POURTH

ANNUAL REPORT

FOR THE YEAR ENDING DECEMBER 31, 1933

















JAc.kboNVILLK
PLORIDA STATS BOARD OF HEALTH
1984


STATE BOARD OF HEALTH
OF

FLORIDA











STATE BOARD OF HEALTH

OF

FLORIDA















THIRTY-FOURTH

ANNUAL REPORT

FOR THE YEAR ENDING DECEMBER 31, 1933


ADMINISTRATION OFFICES

JACKSONVILLE

BRANCH LABORATORIES
TAMPA
PENSACOLA
MIAMI
TALLAHASSEE







JACKSONVILLE
FLORIDA STATE BOARD OF HEALTH
1934








- I -


BOARD MEMBERS, DIRECTORS AND FIELD PERSONNEL


Board Members


N. A. Baltzell, M.D., President
Marianna


Harry Dash Johnson,M.D.
Daytona Beach


R. L. Hughes, M.D.
Bartow


State Health Officer
Also Executive Officer and Secretary of Board
Henry Hanson,M.D.

Bureaus at Jacksonville


Laboratories ..................... .............. ....
*Vital Statistics .................. ........ .......... ...
Communicable Diseases ....... .....................*****
Engineering ..... ............. ................... ..******
Public Health Nursing ....................................
Accounting ................. ...................... ......
Librarian ............................................... o


*Registration Inspector .... .................. ...*****..
Drug Inspector ....... ........ ............................
Assistant Drug Inspector ................................


Paul Eaton,M.D.,D.P.H.
Stewart G.Thompson,D.P.H.
F. A. Brink, M.D.
Louva G. Lenert,B.S.,C.E.
Ruth E.Mettinger, R.N.
G. Wilson Baltzell
Elizabeth Bohnenberger


Anna C. Emmons
M. H. Doss
Frank S. Castor


Laboratories


Jacksonville ................................ ... .......
Miami ..................................................
Pensacola .............. ................ .. .****** **... .
Tallahassee ............ ... ....... ........... ... ....
Tampa ........ .................... .........********


Pearl Griffith, B.E.
E. R. Powell
Johnette McCormick
Estelle Bryan
H. D. Venters, B. S.


Medical Officers


West Palm Beach ..........................................
Inverness .......... ........... ...... ... ..........*******
Jacksonville .............................................
Jacksonville ......... .................................
Marianna ......... .... ... .... .4.4 .... ...... .......
Tallahassee .........................................
Tampa ..................................... ...****
*And Tuberculosis Clinician


C. W. McDonald, M.D.
Leland H. Dame, M.D.
W. A. Claxton, M.D.*
T..E. Morgan, M.D.
E. R. Marshburn, M.D.
H. A. McClure, M.D.
C. W. Pease, M.D.


District Sanitary Officers


Jacksonville ...... ............................ **. **
Marianna .............................. ....*.** ***.****.
Orlando ....................... ... ...s... **. ...*...
Tampa ...................................... *. ..... *...* .
West Palm Beach ................................*...*...*
On F.E.R.A. duty .....................................
On F.E.R.A. duty ................................*****.. .


George W. Hulvey
C. A. Holloway
Russell Broughman
Frank Pauley
S.D. Macready
T. S. Kennedy
Fred A. Safay







- II -


BOARD MEMBERS, DIRECTORS AND FIELD PERSOIMEL (cont.)


Public Health Nursing


Jacksonville ................................... ...
Ft.-Pierce ................ .......................
Jacksonville .......................................
Marianna ......................................
Tampa ................................ ... ......


Joyce Ely,R.N.(Acting Chief)
Annie Gabriel, R.N.
Johanna Sogaard, R.N.
Lalla Mary Goggans, R.N.
Julia 0 Graves, R.N.


Malaria Research


Tallahassee ......................................


Mark F. Boyd, M.D.,
(Rockefeller Foundation)


Malaria Control Studies


Jacksonville ....... ...................*.........


T.H.D.Griffitts, M.D.
(U.S.Public Health Service)


Consultant in Entomology


Directors Full Time County Health Units


Tallahassee, Leon County ...........................
Pensacola, Escambia County .........................
Perry, Taylor County ...... .............. .. ,...0...


W.V. King, Ph.D.
(U.S. Bureau Entomology)



L. J. Graves, M.D.
W. A. McPhaul, M.D.
W. H. Y. Smith, M.D.


Multigraph Department


Jacksonville ..................................


E.F.H. Ganten


Custodian


Jacksonville .............................. ..*****


Orlando ... ........................ .........


Frank M. Whiddon








- III -


January 1, 1934






His Excellency, David Sholtz
Governor of Florida
Tallahassee, Florida


Sir:

I beg to hand you herewith a report of the State Board

of Health for the year of 1933.

Respectfully submitted,
Florida State Board of Health
By N. A. Baltzell, M.D., President









- IV -


TABLE OF CONTENTS




Page
Personnel ........ ....... .................... ...... ................ I
President's letter of transmittal ........................................... IlI
Table of Contents.......................................................... IV
State Health Officer's letter of transmittal................................ 1
Summarized account of activities of State Board of Health............
Division of Accounts, report ................................................ 8
Division of Library Service, report ,....................................... 23
Division of Drug Inspection, report ......................... ............ 24
Division of Malaria Research, report ........*............................ 25
Division of Malaria Control Studies, report ............................... 28
"What is Malaria" bulletin ................................... 29
Division of Entomology, report .............................................. 33
Multigraph Department, report ....................... .......... ..... 38
Division of Public Health Nursing, report ................................ 47
Midwife Control ............. .. .............................. 51
Local Supervisors ....................................... .... 54
Parental Education ................ ...... ...................... 55
Registered midwives, white .................................... 62
Registered midwives, colored ....6...3................... 63
Unregistered midwives, white ..................................... 64
Unregistered midwives, colored ..................................... 65
Bureau of Communicable Diseases, report ................................. 66
Personnel ................ ................. e...g........... 66
Communicable disease investigations .................... ......... 67
Leprosy ..........................*............................. .... 68
Immunization ............................... ...... .......... 88
Health education .............* ................. ................. 69
Reports ........................................................... 69
County Health Units ............... ........ ...................... 70
Tuberculosis Division, report of Tuberculosis Clinician ........... 71
Summary of activities of Bureau of Communicables.....................
Tables ........... .............................. ...... ...... 73
Taylor County Health Unit,.report.................................... 76
Leon County Health Unit, report ................. ...... ..... 78
Escambia County Health Unit, report ................................ 80
Bureau of Laboratories, report ............................................. 83
Tables
1. Examinations made in Laboratories during 1933 .............. 87
II.Total examinations made by months ....... .................. 88
Central Laboratory ....................................... 89
Tampa Laboratory ............ ... ............................ 92
Pensacola Laboratory ............................ .. ........ 94
Tallahassee Laboratory .............. ....... .............. 96
Miami Laboratory ..............98....... ................. 9
III. Biologics distributed during 1933 .....................c..... 100











TABLE OF CONTENTS (cont.)
Page
Bureau of Engineering, report............ .. ............... ........ 101
Personnel .....I......... ....,,.....* ......... ..... 101
Water supplies ...................... .. .........* 103
Bacteriological examinations of water as conducted by laboratory
of the bureau during 1933 .......................* ............... 104
Certification to the Treasury Department ........... .......... 105
Bottled water .................. .......... .... ....... 10&
American Water Works Association, Florida Section ................ 106
Sewerage and sewage disposal ...................................... 107
School sanitation ........ ........... ............................. 109
Swimming pools and bathing places ......... ..g.. ...g.............g. 109
Tourist camp sanitation .....c.......i........c................ 110
Mosquito control ... ...... ...................., ..... 112
Anti-Mosquito Association ..................... ...... .......... 113
Waste artesian water ...................... ... .... .............. 113
Canneries .............e......................................... 114
Rabies .................. ........................................ 114
Drainage wells ............... ,,......... ..... ........ 115
Other camp sanitation .......c...... c......... ................. 115
Garbage disposal ................................ ................ 115
Milk sanitation ............l.g .......c.g..e S............ 115
Shell Fish sanitation ....... ........ ................... 116
Crab moat, scallops and shrimp .............................l8 118
Typhoid and hookworm ......... ................. .118
Labor Day tropical disturbance ..... ........ ..... ............... 119
Clean-up orders and complaints ................................... 119
Lectures ............................................ 119
F.E.R.A. operations ........ ........................... 120
P.W.A. activities ............................................... 120
Central Bureau of Vital Statistics, report ................... .......... 121
Preamble ................... ... ............. ........e....... 121
Contents ....................................................... 121
Original records .... ....... ................................. .. 121
Certified copies ............ ...... ....................... .. 122
Field work ........ ......... ......... ...... .......12.............. 122
Notices to now mothers ...1................. ........... ...... 122
Annual registration -Healing Arts *1....e.. ........ ...........c... 122
In the office .................................................... 123
Births .. ........ ............................................ .. 123
Births (exclusive of stillbirths) and birth rates per 1,000
population, by color, Florida, 1928-1932 (Tablo) ................ 124
Deaths .............. .............................. 124
Deaths and death rates per 1,000 population, by color, Florida,
198e-1932 (Table) ........................ ..................... 124
Infant Mortality .............................. ....... 124
Infant Mortality deaths of infants under one year of ago and
rates per 1,000 live births, by color, Florida, 1928-1932.
(Table) .......... ...... ........................... 124


-V-







-VI -


TABLE OF CONTENTS (cont.)

Page
Central Bureau of Vital Statistics (cont.)
Typhoid Fever .................. ....... .......... 125
Typhoid deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) .................................... 125
Smallpox ....................................... 125
Smallpox deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) ............,,... .,............. 125
Scarlet Fever ..*2..5...*................,.......... 125
Scarlet fever deaths and death rates per 100,000 population, by
color, Florida, 1928-1932. (Table) ............................ 125
Whooping Cough ............... ............ .....,.......... 126
Whooping Cough deaths and death rates per 100,000 population, by
color, Florida, 1928-1932. (Table) ............................. 126
Diphtheria .................. ,..,,..... .... ...... 126
Diphtheria deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) ........................,.......... 12
Influenza (all forms) *...........,,............ ,.. ,....,, 126
Influenza deaths (all forms) and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) .3............. 127
Rabies ..... ........ ...,... 127
Rabies deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) ..., ......... ....... ......... ... 127
Tuberculosis (all forms) .............. ...e.............. ...... 127
Tuberculosis (all forms) deaths and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) ................ 27
Syphilis ................... ... ..... ............................ 128
Syphilis deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) ............ ....... ... ..... 128
Malaria ................................................... ....... 128
Malaria deaths and death rates per 100,000 population, by color,
Florida, 1928-1932. (Table) ................................. 128
Cancer (all forms) .................. ........,........ ........ ... 128
Cancer (all forms) deaths and death rates per 100,000 population,
by color, Florida, 1928-1932. (Table) ......................... 128
Pellagra ............. .......................... 129
Pellagra deaths and death rates per 100,000 population, by color,
Florida 1928-1932. (Table) .................................... 129
Heart Disease (all forms) ....................... ..... 129
Heart Disease (all forms) deaths and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) ............. 129
Pneumonia (all forms) ...................... ............. ......... 129
Pneumonia (all forms) deaths and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) .............. 129
Diarrhea and Enteritis (all forms) ................... .......... 130
Diarrhea and Enteritis (all forms) deaths and death rates per
100,000 population, by color, Florida, 1928-1932. (Table) ....... 130
Nephritis (all forms) ..... ............... ......... ...... .......... 130
Nephritis (all forms) deaths and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) .............. 130







- VII -


TABLE OF CONTENTS (Contd.)

Page
Central Bureau of Vital Statistics (cont.)
Maternal Mortality ....................................... 130
Maternal Mortality Deaths of mothers from puerperal state and
death rates per 1,000 live births, by color, Florida, 1928-1932.
Table ............................................... ............. 130
Automobile Accidents ........1..................e... ............* 131
Deaths from automobile accidents and death rates per 100,000
population, by color, Florida, 1928-1932. (Table) ............... 131
Illegitimates and stillbirths 1.................................. 131
Illegitimate births and stillbirths, by color, FLorida, 1928-1932.
(Table) .............. ......... .......................... ........ 131
Deaths from diseases of pregnancy, childbirth and the puerporal
state, and rates per 1,000 livo births, by color, by counties,
Florida, 1932. (Tablo) .............. ..... ..................... 132
Deaths from diseases of pregnancy, childbirth and the puerporal
state, and rates per 1,000 live births, by color, by cities,
Florida, 1932, Citios 100,000 and over population. (Table)....... 133
Deaths from diseases of pregnancy, childbirth and the puerperal
state, and rats per 1,000 live births, by color, by cities, Florida,
1932. Cities 10,000 to 100,000 population. (Tablo) .............. 134
Cities 5,000 to 10,000 population ............................... 134
Cities 2,500 to 5,000 population .............................. 134

Appendix Statistical Tables 1932
#1. Estimated population by color, by counties, Florida, 1932 ........... V-1
#2. Estimated population by color, by cities, Florida, 1932 .............. V-2
#3. Births (exclusive of stillbirths) and birth rates per 1,000
population, by color, by counties, Florida, 1932 ;.................. V-4
#4. Births (exclusive of stillbirths) and birth rates per 1,000
population, by color, by cities, Florida, 1932 ............. ....... V-6
#5. Deaths (exclusive of stillbirths) recorded, resident and death
rates per 1,000 population, by color, by counties, Florida, 1932 ... V-8
#6. Deaths (exclusive of stillbirths) recorded, resident, and death
rates per 1,000 population, by color, by cities, Florida, 1932 ..... V-12
#7. Infant Mortality Deaths of infants under one year of ago and
rates per 1,000 live births, by color, by counties, Florida, 1932 .. V-15
#8. Infant Mortality Deaths of infants under one yoar of ago and
rates par 1,000 live births, by color, by cities, Florida, 192 .... V-17
#9. Stillbirths and illegitimate births, by color, by counties,
Florida, 1932 ...o................................................. V-19
#10. Stillbirths and illegitimate births, by color, by cities,
Florida, 1932 "... V-21
#11. Marriages performed, by counties, Florida, 1932 ...................... V-23
#12. Divorces and annulments granted, by coantios, Florida, 1932 .......... V-24
#13. Deaths from Typhoid Fovor, by color, by months, and by counties,
Florida, 1932 ................*................ ..... V-25
#14. Deaths from diphtheria, by color, by months, and by counties,
Florida, 1932 ................................................... V-26







-VIII -


TABLE OF CONTENTS (cont.)
Page

Appondix Statistical Tables 1932 (cont.)

#15. Deaths from tuberculosis (all forms), by color, by months, and by
counties, Florida, 1932 ............*.............** ** V-27
#16. Deaths from malaria, by color, by months, and by counties,
Florida, 1932 ......... -........... .........***************** V-28
#17. Deaths from Pollagra, by color, by months, and by counties,
Florida, 1932 ....."... ,. .......................... V-29
#18. Deaths from diseases of pregnancy, childbirth, and the puerporal
state, by color, by months, and by counties, Florida, 1932 *..... V-30
#19. Deaths from automobile accidents, by color, by months, and by
counties, Florida, 1932 ..... ..................e.* *** ** V-31
#20. Deaths from cancer (all forms), by color, by months, and by
counties, Florida, 1932 .......................************ V-32
#21. Deaths from typhoid fovor, by'color, by'ago, and by sox,
Florida, 1932 ................. *V-33
#22. Deaths from diphtheria, by color, by ago, and by sox,
Florida, 1932 ...........................V................... -.. V-34
#23. Deaths from tuberculosis (all fors), by color, by ago and by sex,
Florida, 1932 ...V-5........ .... *************************
#4. Deaths from malaria, by color, by ago and by sox, Florida, 1932 ... V-36
#25. Deaths from pellagra, by color, by ago and by sox, Florida, 1932 .. V-37
#26. Deaths from diseases of pregnancy, childbirth, and the puerporal
state, by color, by ago and by sex, Florida, 1932 ............. V7-38
#27. Deaths from automobile accidents, by color, by ago and by sox,
Florida, 1932 ............................*..*********** V-39
#28. Deaths from cancer (all forms) by color, by age, and by sex,
Florida, 1932 ........... ........***V-40
#29. Deaths by color and by diseases, Florida, 1932 ..................** V-41
#30. Gcmbinod totals for certain causes of docth, Florida, 1932 ........ V-49


V-50


Conclusion .,............**..**-- ........ ***********.....****** **..





ANNUAL REPORT
STATE BOARD OF HEALTH
1933


Dr. N. A. Baltzell, President
State Board of Health

My dear Dr. Baltzell:

I have the honor to present a report of the activities of the State
Board of Health for the year 1933. The report covers the.activities of the
following Bureaus and Divisions:

1. Division of Accounts
2. Division of Library Service
3. Division of Drug Inspection
4. Division of Malatta Research
5. Division of Malaria Control Studies
6. Division of Entomology
7. Multigraph Department
8. Division of Public Health Nursing
9. Bureau of Communicable Diseases
10. Bureau of Laboratories
11. Bureau of Sanitary Engineering
12. Bureau of Vital Statistics.

In the discussion of the report it is difficult to choose which
division or bureau to open with. To the Administrator, each in its
respective sphere is co-equal and necessary to an effective, well-rounded
program and a State Health Department is only as strong as its weakest link.
In this respect it is a satisfaction to state that all departments have
functioned as well as the available resources have pernited. One of the
Forum speakers in 1932 stated that it had been predicted that the year 1933
would experience a depression which would cause the years 1931 and 1932 to
appear years of prosperity and affluence. In general the prediction was
lamentably accurate. In the economic stress through which we have passed
and are still passing the majority of people have been in a state of
bewilderment, not knowing what to expect.

As will be noted in the Auditor's report, we have operated on two
different budgets the first half on the budget provided by the Legislature
of 1931 and the second half on provisions contained in the appropriations
bill of the Legislature of 1933. During the past year we have operated on
the lowest budget since 1923, a year when the budget was lower than the
present. It has been difficult to keep an efficiency in service and meet
many new demands brought out by the economic stress to which the people of
the state have been subjected. Notwithstanding the salary reductions and
increased work the entire staff from the lowest anployee to the highest
has worked faithfully and effectively throughout the year. In many
instances the salary cuts have reduced incomes to the point where the
individuals concerned have had only a bare living. In some instances
employees have been obliged to discontinue insurance policies, the only
savings possible for employees who have given many years of faithful service
to the state. The most unfortunate feature of which will appear when they
reach the age where or when the exigencies of the work require them to be
replaced by younger people. It is not a happy outlook for those who are
thus forced to look to welfare organizations for a living during life's
twilight hours.







- -


Among the special activities of the State Health Officer during the year
the following may deserve mention:

From the llth to the 14th of January was consumed in a trip to Carville,
Louisiana taking two lepers from Key West to the National Loprosarium maintained
by the U. S. Public Health Service at Carville. While I have had many oppor-
tunities to observe leprosy in various countries of Central and South America,
as well as in West Africa, I had not previously had an opportunity to note the
painstaking technique of the examinations made by Dr. 0. E. Dennoy and his staff
of experts. It was gratifying to note the hospital management and the abundant
wholesome food, one of the most important items in the cure of leprosy.

Few realize that Florida has had 60 cases admitted to the Leprosarium at
Carville. 25 Florida patients are there at the close of the year. The Florida
cases have been sent from Key West, Miami, Tampa, Tarpon Springs, St. Petersburg,
Lakoland, West Palm Beach, Daytona, Jacksonville and Pensacola. The principal
focus appears to have been Key West, probably first infected by contact with
West Indies and South America. There were 9 patients sent to Carville during
1933 6 from Key West and 3 from Miami. There were 2 that had previously
absconded readmitted during 1933, both from Key West.


LIBRARY

The library has continued to be a great aid to all manbors of the staff.
A library is an essential arm of a health department. There is a slowly but
steadily increasing use of the library by the medical profession. Due to the
reduced budget and the limited space available we have not been able to add more
than a few books and journals during the. past year. The purpose of the library
is to have available needed reference material for the employees of the Board and
also to serve as the one general medical and public health reference library in
the state. For further details the librarian's report should be consulted.


DRUG INSPECTION

The work of the Division of Drug Inspection has continued to the satis-
faction of all but a few of the pharmacists of the state and has been instrumental
in maintaining pharmaceutical practices on a high plane. The work has been great-
ly increased by new duties in the enforcement of the Uniform Narcotic Drug Act
(Laws of 1933). The work of the drug inspectors has revealed a serious smuggling
of marihuana cigarettes, which is one of the worst of the narcotic evils. The
marathon dance halls have been found to be favored hangouts for criminals en-
gaged in marihuana smuggling. A few unprincipled physicians have boon indicted
for trafficking in narcotics, such as opium, cocaine, etc. In order to check the
evils of narcotic addiction an increased inspection force rill be needed. The
inspectors could also assist in gathering information on violators of medical
practice and other healing arts, e.g. dentistry, embalming, etc.


MALARIA RESEARCH

It is with a feeling of gratitude that I report the continuation of the
Rockefeller Foundation station for field studies in malaria as the Malaria










Research Station of the State Board of Health. As in past years the work has
boon a research in unsolved phases of malaria, both from the human (clinical)
standpoint: its effect as a therapeutic agent in nourosyphilis and the intrinsic
as v;cll as extrinsic factors in transmission. There follows a brief report from
the Director, Dr. Mark F. Boyd. Those who are interested in the work done at the
station are referred to various publications reference to which will be provided
on request sent to the Library. The station maintains two insectoriums for the
rearing of mosquitoes (Anopholos). In each insoctorium there is an unmixed
species. All malaria inoculations are done by means of mosquitoes which have
fed on patients known to have an unmixed infection of a known species of malaria.
By using the mosquito method of inoculation, information is gathered regarding
incubation periods both of an intrinsic and extrinsic nature which could not be
obtained if the inoculation were blood inoculation by the hypodermic noodle
method, which is practiced in practically all northern institutions. It seams
that malaria therapy (inoculation by allowing mosquitoes infected with malaria
to insert the proboscis and draw blood) has an increasing value in the treatment
of the insane, especially those with nourosyphilis, paresis, tabos, etc,


MALARIA CONTROL STUDIES

This division has been hampered by the reduced budget of the State Board of
Health, also by the same conditions prevailing in funds available for the Scien-
tific Division of the U. S. Public Health Service and by difficulties in coordi-
nating the work of the ERA, CWA, and FERA, where drainage and general sanitation
has formed a part of the relief program. It is hoped that the economic situation
will adjust itself and that the people will realize the importance of malaria
control as a factor in economic adjustment in a large portion of Florida. There
is a great opportunity for the Director of the Division of Malaria Control
Studios and a big field for investigation as well as for practical application of
control methods. Dr. Griffitts, the Director of this Division, presents inter-
esting data on prevalence of malaria as manifested by blood smears taken from
thousands of school children, details of which are given in his report.


DIVISION OF ENTOMOLOGY

Owing to the disturbed conditions and the effort to put people to work we
have not utilized Dr. King and his staff as much as we had hoped or desired to do.
There is, however, a most excellent statement from Dr. King on mosquito invosti-
gations in Florida. This forms a very valuable contribution to our report.

We are indebted to the Bureau of Entomology of the U. S. Department of
Agriculture for the privilege of having Dr. King as our Consultant in Entcmology.
There is need for more extended studios of this nature in Florida; studies which
are vital to the work of the State Board of Health.

MULTIGRAPH DEPARTMENT

We have for a number of years taken care of the bulk of our printing in the
Multigraph Department. Those interested in details are referred to the report of
the Multigraph Department.







-4-


DIVISION OF PUBLIC HJELTH NURSING

During the first half of the year our staff of nurses was rather low. We
had only four nurses on duty at the beginning of the year 1933. Miss Ely, who had
boon away for a post-graduato course in obstetrics and midwifery, returned in
August and towards the close of the year tho services of Miss Sogaard wore added.
Other nurses shown in the setup wore on duty only a short time. For details of
the progress in the nursing division, the reader is referred to the report sub-
mitted by Miss Ely who was Acting Chief Nurse for the second half of the year.
It is worthwhile, however, to mention the inauguration of midwife institutes, the
largest and probably most outstanding of which was the institute hold in Talla-
hIssoo whon 234 midwives gathered to receive instructions in midwifery. Credit
for working up successful midwife institutes is duo Miss Lalla Mary Goggans and
Miss Jule 0. Graves. Throughout the year Iiss Annio Gabriel continued with her
parent education classes, a service which was very much appreciated by the Parent-
Teachers Association.

At the close of the year we had the promise of the development of an olebo-
rate nursing program as a part of the work of the FERA. During the ensuing year
it is to be under the exclusive supervision of the State Board of Health.

Unfortunately at the close of the year our maternal mortality still con-
tinues high.

BUREAU OF COMMUNICABLE DISEASES

The Bureau of Conmunicablc Diseases has had no unusual problems. The bureau
continues its commendable work and has again brought about a decided drop in the
diphtheria rate and divides the credit with the Bureau of Sanitary Engineering
for the continued decline in the typhoid incidence.

We regret to report that Taylor County felt unable to continue the full
time county unit. It is hoped that this county will some day resume this activity
and if not able to maintain its own unit, join with one or two adjacent counties
in a district with one health officer, a nurse and sanitary officer in each county
or at least a nurse for each county and a sanitary officer for the district.

Included in the report of the bureau thero is the report of the tuberculosis
clinician. Our tuberculosis work is not yet sufficiently elaborate to justify
setting it up as a separate division or bureau. Dr. Claxton has done good work
and by the tuberculin clinics has given a moro complete portrayal of the problem
than we have had heretofore. During the coming year wo expect to enlarge the
program considerably through the increased nursing force available as a result of
the FERA program.

The Loon and Escambia County Units are continuing on a satisfactory basis.


BUREAU OF LJAORIIBORIES

Your attention is invited to the report of the Bureau of Laboratories,
which shows large volume of work, varied in its nature. Inasmuch as I began my
work in the Laboratory Division in 1909 it is interesting to note the total number
of specimens examined and compare them with the work done the first year I was in






-5-


Florida. The total for 1909 was 5,762. Tho total laboratory examinations for
the year 1955 was 244,042. The detailed tabulations show the nature of this work,
both for the central and the branch laboratories.

It is sometimes asked whether we should continue to carry the heavy load
of the repeated Kahn or Wassormann test. Some argue that it is not a public
health problem after the case has once boon diagnosed and the repeated tests as
a guide to treatment should be done by private laboratories. However, certain
syphilologists as well as loading internists intimate that there is a degree of
infectiousness as long as there is a positive reaction. Those are problems which
we will have to look into during the coming year.


BURJEJ OF SANITARY ENGINEERING

This bureau started rather hopefully at the beginning of the year but owing
to the reduction in the budget and other changes there was some difficulty in
keeping the work up to its usual high standard. The field of activities of this
bureau is very wide and can only be appreciated by a careful reading of the full
report of the Chief Engineer.

As in the past, certain major problems are outstanding, one of which is the
sanitary control of the shellfish industry, especially the portion concerned with
the gathering and shipping of oysters. Every year we are faced with difficulties
in controlling the individuals who persist in bootlegging oysters. Bootleg oys-
ters invariably come from polluted areas and always show up by an epidemic of
typhoid fever or gastro-intestinal disturbances. It is hoped that our Senators
and Representatives in the next Legislature will realize the importance of this
business sufficiently to introduce and pass the law which enables the State Board
of Health to regulate the industry.

One of the annoying situations confronting this bureau is the milk law
introduced and passed at the instigation of a group of dairymen making dairy
inspection a function of the Department of Agriculture. This law introduces a
doubt in the minds of the sanitary officers as to their duty in the matter. The
Constitution adopted in 1885 definitely places the responsibility for all public
health matters with the State Board of Health. The inspectors of the State
Department of Agriculture, however, have assumed that they have jurisdiction over
the sanitation of milk and dairies. Dairy sanitation and problems related to the
industry in general will not be satisfactorily solved until the state as a wholo
operates under the Standard Ordinance (promulgated by the U. S. Public Health
Service and approved by the Bureau of Dairy Industry of the U. S. Department of
Agriculture). The State Department of Agriculture would then have its forces
available to assist dairymen needing help on problems of production and food.
Public Health regulation is a function of a health department. Milk and dairy
sanitation can best be provided for by making it the responsibility of local
health departments working in cooperation with or under the general supervision
of the State Board of Health. The cost to the state will be no greater. If an
independent inspection service is maintained by the Department of Agriculture it
will mean that additional milk inspectors must be hired and paid for by that
department. It will also imply the need for added laboratory equipment which is
illogical inasmuch as the State Health Department already has its laboratory
equipment and practically all the force required.







- 6 -


A great deal was attempted in malaria control by cooperation with and by
supervising the activities of the Emergency Relief Administration. The first
big drainage work of this nature was done in Duval County west of Jacksonville
and near the beaches, especially Jacksonville Beach. The difficulty with this
work was the haste with which it was put into operation and the lack of time for
making proper surveys. As the year advanced the demand for drainage increased
quite generally throughout the state. Many projects were started. The general
criticism of the drainage work was the lack of appreciation of what constitutes
a sanitation ditch. Drawings were gotten up by the Chief Engineer and also a
reprint was put out by the Director of the Malaria Control Studies Division but
in spite of all that, one constantly ran into ditches with wide, flat bottoms and
improperly sloped sides. The wide, flat bottomed ditches are wrong from two
standpoints: one is the waste of labor in digging ditches larger than are needed,
and the other is that a wide, flat bottomed ditch will itself become a breeding
place for Anopheles mosquitoes.

Rural sanitation is an outstanding problem for the Engineering Bureau. In
this the Bureau of Communicable Diseases divides interest equally. The hookworm
problem in the state will never be solved until there are adequate toilet facili-
ties and the rural population learns the importance of ceasing to pollute the
soil with material which contains hookworm eggs, etc. The deplorable condition
in the schools as reported by our district sanitary officers, especially Dr.
Kennedy and Mr. Safay, should have immediate corrective attention. So long as the
school children have examples of the insanitary privies about the rural schools,
just so long will they continue to be content with the lack of toilet facilities
at the homes. No school should be allowed to operate unless it has adequate
toilet facilities approved by the State Board of Health. Time and space will not
permit a general discussion of the activities of this bureau.


VITAL STATISTICS

The tabulation submitted by the Bureau of Vital Statistics, as well as the
narrative of the Director of the Bureau, are full of interesting facts. Unfortu-
nately there is some difficulty in giving final rates due to the fact that the
geographer in Washington has made changes in the population estimates. However,
for our own use, we can judge our mortality problems by using the estimated
county population and basing our rates on them.

It is interesting to note the falling birth rate.

We have had a creditable decline in the leading communicable diseases, e.g.
diphtheria and typhoid. Tuberculosis remains about stationary, with probably a
slight rise. Smallpox has continued Without a proven death. It is hoped that
the maternal mortality, which has been our greatest stigma, will be materially
lowered next year through the efforts of the enlarged nursing program made avail-
able by the FERA, as well as the midwife institutes inaugurated during the year.

.The Bureau of Vital Statistics has functioned with its characteristic
efficiency in a manner highly commendable.

Some bureau directors and the State Health Officer have had much additional
work supervising activities of the relief program principally during the last two
months of the year. No one on the regular State Board of Health pay roll has
received any rennneration from the relief organization.







-7-


Among the needs of the State Board of Health nothing is more acute than
the need for a now building. The space occupied is inadequate. The Nursing
Division needs two to three times the space it now occupies. The quarters of the
Engineering Bureau are small and not constructed in a manner which will allow its
adaptation to engineering purposes. There is inadequate room for the Library.
No room is available which could be assigned as office space for the Drug Inspec-
tor, District Health Officor, Tuberculosis Clinician or any additional activity.

The present building is in urgent need of repairs, and a real danger exists
of the roof caving in. During heavy rains leaks occur on all four sides along
the wall which owing to the continuous rotting has a tendency to cause the con-
crete to crystalize and weaken the supporting valls. If our petition to the P.W.
A. fails we should ask the next Legislaturo for $175,000.00 or $800,000,00 for a
new building and equipment for repairs to the present structure, and regrading
and landscaping of grounds.

In general the work of the health department from the Administrator's view-
point has boon as satisfactory as one could expect whon it is borne in mind that
we are working on a budget which was reduced 30 percent.

In closing I wish to extend my appreciation of the helpful advice and hearty
cooperation of the President and members of the State Board of Health.


Respectfully,

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


January 1, 1934








-8-
8 -
Jacksonville, Florida
January 1, 1954

Dr. Henry Hanson
State Health Officer
Jacksonville, Florida

Dear Doctor Hanson:

The following report for the calendar year 1933 embraces the last
six months of the fiscal year 1932-1933 and the first six months of the fiscal
year 1933-1934, the operations for the first six months January through June-
functioning under the 1931-1933 budget, and the succeeding six months July
through December being governed by the Appropriations bill of the 1933 Leg-
islature. However, the previous budget was revised downward several times,
which resulted in only a slight difference in the figures for the two periods.

Since July, 1931, the Board of Health received mill from taxes,
supplemented by General Revenue when receipts from taxes were insufficient;
and during the period from January 1st. to July 31st., 1933, General Revenue
provided $59,561.02. Under the Appropriations Bill of 1933, the millage was
increased to 1, with access to General Revenue if tax collections fell short
of our necessary and regular expenses. But the half mill did not begin to op-
erate until November of this year, when the 1933 taxes were collectable, and
we had to continue to operate on the quarter mill during July, August, Sept-
ember, October and November (tax collections not being turned in to the State
Treasurer until December), and General Revenue was called on for '27,359.97.
An examination of Receipts shows that in December we were credited with
$36,860.65 in taxes by the State Treasurer, which reflects the increased mill-
age; nevertheless, it must be borne in mind that December is the best month
for payments into the State Treasury by County tax collectors.

For convenience, the receipts and disbursements are devided into
two parts: first six months, and last six months, and the disbursements are
further aeggregated by departments.

This report also includes concise financial statements of re-
ceipts and disbursements for 1933, of the following Special Fee and other
small affiliated accounts:

Centralization of Marriage and Divorce Records
Registration of Doctors and Midwives
Drug Store Inspection Fund
Division of Malaria Research (Rockefeller Foundation Projects)

Full and complete reports are made for the above accounts, as
well as for the State Board of Health, proper, at the end of each fiscal year,
and copies sent to the Governor, State Comptroller, State Auditor and Members
of the State Board of Health.

Respectfully submitted,
(Sgd) G. Wilson Baltzell
Auditor







- 9 .


ANNUAL STATEMENT

STATE BOARD OF HEALTH


JANUARY 1, 1933 TO DECEMBER 31, 1933

-RECEIPTS


Deficit Operating Balance Brought Forward Frno 1932
Receipts frc'n all sources 1933, including General Revenue

Disbursements 1933
Operating balance December 31, 1933

State Comptroller shows balance as of December 31, 1933
CMiscellaneous Revenue)
which does not take into account the following unpaid bills
charged into our Disbursements:


$ 6,343.28
199,256.38
192,913.10
182 541.26
$ 19,571.84


$ 29,840.85


August
September
October
November
December


$ 3,209.26
4,284.76
3,195.24
36.92
8,521.07


19,247.25
10,593.00


21.16
$ 10,571.84


Warrant drawn on Special Account in error
(Adjusted in January, 1934)
Giving operating balance as above


NOTE: All unpaid bills were paid by State Comptroller
in January, 1934, leaving no outstanding accounts.









ANNUAL STATEMENT

STATE BOARD OF HEALTH


JANUARY 1. 1933


TO DECEMBER 31. 1933


ANNUAL STATEMENT OF RECEIPTS FOR 1933


First Six Months


Second Six Months


January Ta
February
March
April
May
June

Jan.-June Ge


ax6I & Mis. Rev. $ 10,782.17
S U 4,977.86
C V 3,431.43
11,178.91
3 3,670.49
O 0 6,314.86
$ 40,355.72
,neral Revenue 59,561.08
$ 99,916.74


First Six Months
Second Six Months


Taxes &
Misc. Revenue
9 40,355.78
71,979.67
$1t2.335.39


July
August
September
October
November
December


July-Dec. Gei


General
Revenue
$ 59,561.02
27,359.97
$ 86,920.99


axes & Mis. Rev. $8,550.55
S 5,765.31
S "* 3,763.82
S*" 7,683.89
9, 355.45
36,860,65
S?7i1,iB79.67
ieral Rever.ue 27,359.97
$ 99,339.64



Total
$ 99,916.74
99,339.64
$199,256.38


ANAL SIS OF 1933 RECEIPTS


Taxes
Tax Redemptions


$ 98,504.75
11,901.97


$110,406.72


City of Tampa--Rent of space la Laboratory $
Miscellaneous Refunds
Sale of Yeast &Immunizing Drugs

Rockefeller Foundation:
Stewards Librarian's Salary $
Malaria Control Studies
Warrant No. 20166 issued August 21, 1930, for
fire insurance claim Tallahassee Laboratory
XiLt sedn,-cancelled & restored to balance


300.00
68.00
463.67


675.00
375.00


831.67


1,050.00


47.00
$112,335.39


Warrants issued from General Revenue Fund
Fiscal year 1932-1933
Fiscal year 1933-1934


$ 59,561.02
27,359.97


86.920.99
$199,256.38


-* 0 a


T(









STATE BOARD OF HEALTH


JANUARY 1, 1933 TO DECEMBER 31, 1933


DISBLRSEJ MTS BY DE?ART MNTS ARD MONTHS FOR SIRST AND SECOND PERIODS, 1933


FIRST SIX MONTHS


DEPARTMENTS
Administration
Laboratories
Communicable Diseases
Engineering
Vital Statistics
Public Health Nursing
Biologicals
Assistance to County
Health Units
Malaria Control Studies


JANUARY
2,310.17
3,586.85
2,840.73
3,077.58
6,683,36
759.23
336.72

656.26
182.29
20,433.19


FEBRUARY
1,512.33
2,860.41
2,669.92
2,343.17
2,118.30
531.81
588.00

656.26
197.95
13,478.13


MARCH
1,549.84
3,421.39
2,276.15
2,782.66
1,855.02
1,157.63
575.48

531.23
153.88
14,303.28


APRIL
1,970.60
2,832.26
1,926.02
2,548.74
2,498.59
764.69
979.92

531.23
102.87
14,154.92


MAY
1,887.23
3,656,68
2,670.18
2,711.22
2,016.33
823.81
1,010.75

706.25
75.27
15,557.72


JUNE
1,792.49
2,960.68
2,207.10
2,839.24
1,869.93
718.78
816.98

656.27
47.85
13,909.32


SECOND SIX MONTHS


DEPARTMENTS
Administration
Laboratories
Communicable Diseases
Engineering
Vital Statistics
Public Health Nursing
Biologicals
Assistance to County
Health Units
Toxicalogical Examination


JULY
1,590.12
2,713.35
1,630.96
2,215.72
2,424.91
987.94
517.71


AUGUST
1,747.46
3,408,08
2,714.64
2,025.51
1,839.86
1,281.91
1,203.57


499.98 499.98

12 580.69 14,721.01


SEPTEMBER
1,969.56
3,439.92
2,106.49
2,199.04
1,969.39
1,171.55
2,850.35

374.99

16,081.29


OCTOBER
1,706.13
2,859.03
2,410.49
2,031.73
2,522.37
903.85
2,131.25

291.66
250.00
15,106.51


NOVEMBER
1,847.04
3,339.21
2,600.48
2,486.85
1,878.82
1,244.08
1,187.03

291.66


DECEMBER
2,092.12
3,319.92
2,910.95
2,051.86
3,956.99
1,208.33
1,016.54

583.32

17,140.03


TOTAL
11,022.66
19,318.27
14,590.10
16,302.61
17,041.53
4,755.95
4,307.85

3,737.50
760.09
91,836.56



TOTAL
10,952.43
19,079.51
14,374.01
13,010.71
14,592.34
6,797.66
8,906.45

2,541.59
250.00
90,504.70


First Six Months ..................................................... 91,836.56
Second Six Months .................................................. 9050470
Total ................................182,341.26








-12 -


ANNUAL STATEMENT
STATE BOARD OF HEALTH
JANUARY 1 1933 TO DECEMBER 31 1933

CENTRALIZATION OF MARRIAGE & DIVORCE RECORDS


Available balance brought forward from December 31, 1939
Receipts 1933

Disbursements 1933
Balance December 31, 1933
State Comptroller's balance December 31, 1933
does not include December bills not paid until
January, 1934
Operating balance as above


$ 2.14
12,953.75
12,955.89
11,148.87
$ 1l807.02


$ 2,535.82

728.80
$ 1,807.02


DISTRIBUTION OF DISBURSEMENTS


$ 4,946.65


Rent
Postage & Supplies
Miscellaneous


$ 3,300.00
2,673.62
228.60


62202.22
ll, 148.87


Rent for 12 months is $3,600.00 and was always paid
in advance until September when State Comptroller ruled
3Cate Department rents not payable in advance.


Salaries








- 13 -


ANNUAL STATEMENT

STATE BOARD OF HEALTH


JANUARY 1. 1933


TO DECEMiBER 31, 1933


REGISTRATION OF DOCTORS AND MIDWIVES


Available balance brought forward from December 31, 1932
Receipts -- 1933

Disbursements -- 1933
Balance December 31, 1933

State Comptroller shows balance for December 31, 1933 $ 2,585.96
which does not take into account December bills not paid
until January, 1934 100.00
Operating balance as above $ 2,485.96


$ 1,370.56
3,886.60
5,257.16
2,771.20
$ 2,485.96


ANALYSIS OF RECEIPTS


Doctors
Midwives
Doctors and Midwives


$ 2,412.00
1,474.60
$ 3,886.60


ANALYSIS OF DISBURSENMENTS


DOCTORS


Salaries
Operating:
Postage & Supplies
Refunds -- Not licensed
Total Doctors


$ 1,295.90
4.00


$ 1,038.31


1,299.90


$ 2,338.21


MIDWIVES


$ 432.99


Salaries
Total Midwives
Total Doctors and Midwives


432.99
2,771.20


""'











- 14 -


ANNLJAL STATEMENT

STA1TF BOARD OF HEALTH

JANMUiRY 1 1933 TO DECEMBER 31, 1933

DRUG STORE INSPECTION FTJTD


Available balance brought forward from December 31, 1932
Receipts -- 1933

Disbursements -- 1933
Balance December 31, 1933


State Comptroller shows balance December 31, 1933
which does not take into account December bills
not paid until January, 1934
Operating balance as above


; 2,435.39
8,310.00
10,745.39
7,353.84
$ 3,391.55


$ 3,496.17

104.62
$ 3,391.55
-


DISTRIBUTION OF DISBURSEMENTS


$ 4,500.00


Salaries


Operating:
Travel expenses of Inspectors & securing evidence $ 2,139.46
Postage supplies 249.67
Typewriter 50.00
Auto replacements 395.25
Miscellaneous 19.46
Total disbursements


2,853.84
$ 7,353.84










- 15 -


ANNUAL STATEMENT

STATE BOARD OF HEALTH


JANUARY 1, 1933 TO DECEMBER 31, 1933


DIVISION OF MALARIA RESEARCH


All funds contributed by Rockefeller Foundation. Project designated
as "Station for Field Studies in Malaria".

No balance to be brought forward as all unexpended balances are re-
turned to the Foundation at the end of their budget year which is
the calendar year.


Receipts -- 1933
Disbursements
Balance December 31, 1933, to be returned to
Rockefeller Foundation


DISTRIBUTION OF DISBURSEMENTS


Salaries
Rent, Fuel, Etc.
Travel
Less refund Auto Insurance
Contingent
Technician in training
Total


$ 351.85
1.86


State Comptroller shows balance December 31, 1933, of
which does not take into account December unpaid bills


Auto tag charged to 1934 budget
Transfer of title from State Board of Health
back to Division of Malaria Research(Arbitrary
valuation)

Refund on caLcelled auto premium
Balance due Rockefeller Foundation on 1933 budget


$10,611.00
10,555.30

$ 55.70



$ 8,600.00
336.09

349.99
869.22
200.00
$10,555.30



$ 171.55
119.96
50.59


$ 2.25


1.00


3.25
53.84
1.86
$ 55.70







- 16 -


Jacksonville, Florida
January 1, 1934



Dr. Henry Hanson
State Health Officer
Jacksonville, Florida

Dear Doctor Hanson:

The following three financial reports are for TAYLOR COUNTY
HEALTH UNIT, LEON COUNTY HEALTH UNIT and ESCAMBIA COUNTY HEALTH UNIT.

There have been no published consolidated financial reports
before of all agencies contributing to the support and welfare of these
units, so I have included statements for the calendar year 1932 as well
as for 1933.

Payments made to the Taylor County Health Unit were all made
direct to the personnel and contingent fund of the Unit until August,1933,
when an account was opened with the State Comptroller called "Taylor
County Health Unit" fund, into which were deposited moneys contributed by
the Rockefeller Foundation. But, as this Unit was discontinued shortly
thereafter, this account will be closed out.

Several sources of income to the Leon County Health Unit have
been handled through the Leon County Health Unit fund with the Comptroller,
as shown by the report for such receipts and disbursements, and a separate
statement is given listing all agencies contributing, either through the
Health Unit fund or direct to staff of the Unit and Miscellaneous expenses
set up in their budget under Contingent Fund.

The only moneys deposited into the Escambia County Health Unit
fund so far have been those from the Rockefeller Foundation, but the ulti-
mate plan is that all funds contributed to this Unit and all other units
are to be deposited with the State Treasurer and disbursed through the
office of the State Comptroller, the Board of Health acting as disbursing
agent, under provisions of Acts of 1931, Chapter 14906. As it is, the
figures given for contributions to the units are those which have been re-
ported in by directors of the units who have gathered them from the var-
ious agencies participating.

If all moneys donated to the units were disbursed through these
special accounts, which was the intent of the Health Unit bill which be-
came a law, it would enable the Board of Health to keep a more systematic
and expiditious accounting on the financial operations of the units, and it
is hoped that before loInr this will be accomplished.


Yours very truly,

(Sgd) G. Wilson Baltzell
Auditor







- 17 -


TAYLOR COUNTY HEALTH UNIT

JANUARY 1, 1932 TO DECEMBER 31, 1932


Funds were provided during the year by the Board of Health, United States
Public Health Service and Board of County Commissioners of Taylor County.

The following is a consolidated report of Contributions made to the Unit
by all Agencies and Budgets for the period.


Salaries, Travel
Expense & Contingent
Fund
State Board of Health
U. S. Pub. Health Service
Taylor County


Total Paid
To The
Units
$ 1,666.73
2,805.49
4,832.71
$ 9,304.93


Budget
1st. 6
Months
$ 500.00
1,833.30
2 250.00
$ 4,583.30


Budget Budget Average
Next 2 Next 4 Budget
Months Months For Year
$ 416.67 83.33 $1,750.00
333.33 666.67 2,833.30
750.00 1,500.00 4,500.00
$1,500.00 3,000.00 $9,083.30


JANUARY 1, 1933 TO DECEMBER 31, 1933


In August, 1933, an account was opened with the State Comptroller and state
Treasurer called "Taylor County Health Unit Fund" into which was deposited and
disbursements made from contributions from Rockefeller Foundation. The plan was
to handle all contributions through this fund, the Board of Health acting as
agent. However, the Unit was discontinued by action of the Taylor County Commis-
sioners in August, 1933.

Receipts from Rockefeller Foundation Deposited to Taylor County
Health Unit: $ 375.00
Disbursements: 312.50
Balance with State Comptroller, returnable to Rockefeller Foundation $ 62.50


The following is a consolidated report of all Agencies contributing:


Salaries, Travel
Expenses & Contin-
gent Fund
State Board of
Health
U. S. Public Health
Service
Taylor County
Rockefeller Foun-
dation
4|


Total Paid
To The
Unit


Budget
1st. 3
Months


Budget
2nd. 3
Months


Budget
July &
August


Budget
For
Sept.


B1,549.94 $ 625.00 $ 575.00 $ 416.67 $


866.66
2,860.09


500.00 425.03
1,125.00 1,125.31 666.67


Average
Budget For
Period


$ 1,616.67

925.03
2,916.98


312.50 250.00 125.00 375.00
5,589.19 $ 2,250.00 2125.34 1333.34 125.00 $ 5,833.68
U 2,250.00 -2, _E5,31 ~ v-









- 18 -


LEON COUNTY HEALTH UNIT

1932 -

(Funds were provided during the year by the State Board of Health, Leon County
Commissioners, City of Tallahassee, U. S. Public Health Service, Rockefeller
Foundation, Rosenwald Fund, Florida Power Corporation and others.)

This statement only includes moneys deposited with the State Treasurer by
Leon County Commissioners, Board of Education, Florida Power Corporation,
Rockefeller Foundation, and disbursed through the office of State Comptroller;
the State Board of Health acting as disbursing agent under provisions of Laws
of Florida, 1931, Chapter No. 14906.


Receipts & Disbursements through State Comptroller, Board of
Agent.


Health acting as


JANUARY 1, 1932 TO DECEMBER 31, 1932


Receipts:


Leon County -- Taxes
Leon County -- Board of Education
Leon County -- For colored nurse

Florida Power Corporation


$ 2,444.41
300.00
250.00
2,994.41
500.00


Disbursements through Leon County Health Unit Fund:


Part salaries and traveling expenses
Postage, Supplies and Miscellandous
Balance with State Comptroller


$ 3,134.91
356.50


3,491.41
$ 3.00


The above statement represents only moneys deposited with the
State Treasurer and disbursed through office of State Comptroller.
A consolidated report of all agencies contributing to the func-
tions of the Unit, whether through the Health Unit Fund or direct
to activities of the Unit follows on next page.


$ 3,494.41











LEON COUNTY HEALTH UNIT

JANUARY 1, 1932 TO DECEMBER 31, 1C


32


DISBURSEMEhTS AND CONTRIBUTIONS TO THE UNIT -- ALL AGENCIES:


RELATION TO BUDGET


Total
Payments
To Unit


Classification
Contributors:
State Board of Health, Salaries & Travel:
U. S. Public Health Service,Salaries & Travel:
City of Tallahassee: Salaries .................
Contingent ...............
Leon County (and other agencies as
named on foregoing page.)


$ 2,654.22*
4,0Z1.20
7,944.82
414.15
3,491.41
$18,535.80


Budget Budget
1st. 6 Revised
Months For 3rd.
Quarter


$ 1,066.68
2,833.32
4,300.00
200.00
1,500.00
$ 9,900.00


$ 812.50
573.00
2,018.50
25.00
900.00
$ 4,359.00


Budget
Revised
For 4th.
Quarter

$ 812.50
625.00
2,103.50
25.00
900.00
$ 4,466.00


Average
Budget
For
Year

$ 2,691.68
4,031.32
8,452.00
250.00
3,300.00
$18,725.00


*State Board of Health includes contribution of Rosenwald Funds
towards salary and expenses of colored nurse $187.50

The total amount of Disbursements for the year as shown above were
which includes a small part of salary of Sanitary Inspector for
Malaria Control Studies paid by the Rockefeller Foundation, but as
this was not a prescribed function of the Leon County Health Unit,
it should be deducted from Disbursements ..................................
Actual amount paid for activities of the Unit .............................


$ 18,535.80



150.00
$ 18,385.80







- 20 -


LEON COUNTY HEALTH UNIT


RECEIPTS AND DISBURSEMENTS THROUGH STATE COMPTROLLER, BOARD OF HEALTH ACTING AS
AGENT


JANUARY 1, 1933 TO DECEMBER 31, 1933
Balance brought forward from December 31, 1932
Receipts:


3.00


Leon County:
Taxes $ 3,296.23
Board of Education 300.00
Contribution towards
colored nurse 300.00
Florida Power Corporation
Rockefeller Foundation:
Salary, Inspector, Malaria
Control $ 1,125,001
Contribution towards
this unit 350.00
Rosenwald Fund:
Towards colored nurse


$ 3,896.23
500.00


I'


1,475.00

281.25


6.152.48
$ 6,155.48


DISBURSEMENTS through Leon County Health Unit Fund:

Part Salaries and Travel Expense $ 5,399.89
Postage, Supplies Equiptment &
Miscellaneous 302.35
Balance with State Comptroller December 31, 1933

State Comptroller shows balance for December 31, 1933 $
which does not take into account December bills not
paid until January, 1934 ..................$...19.27.
Less warrant drawn on Loon County Health
Unit, should have been State Board of
Health, proper, (Adjusted in January,
1934) 21.16
Operating balance as above ...................********.


5,702.22
$ 453.26


751.37





298.11
$ 453.26


The above statement represents only moneys deposited with the State Treasurer
and disbursed through office of the State Comptroller. A consolidated report
of all agencies contributing to the functions of the Unit, whether through the
Health Unit Fund or direct to activities of the Unit follows on next page.

*The Rockefeller Foundation contributed $1,500.00 during the 12 month period,
but $375.00 was disbursed through the State Board of Health funds, proper, be-
fore being deposited and disbursed through the Leon County Health Unit Fund.
Although the salary funds for this representative were handled through the
Leon County Health Unit Fund, his activities were not part of the regular
functions of the Unit, and were not contemplated by the budget for the Unit.








LEON COUhNTY HEALTH UNIT


JANUARY 1, 1933 TO DECEiBER 31, 1933


DISBURSEMENTS AND CONTRIBUTIONS TO THE UNIT ALL AGENCIES AND RELATION TO BUDGET


Contributors
State Board of Health
U. S. Public Health Ser-
vice
City of Tallahassee

Leon County Health Unit*


Total
Payments
To Unit
Salary & Travel 5 2,420.82


Salary & Travel
Salary & Travel
& Contingent
Salary, Travel
& Contingent


1,083.25


Budget
1st. 3
Months
$ 625.00

625.00


6,916.76 1,983.50

4,577.22** 948.75
$14.998.05 $ 4,182.25


Budget
2nd. 3
Months
$ 718.25

531.25

1,908.50

948.75
$ 4,106.75


Budget
Last 6
Months
$ 1,150.00


Average
Yearly
Budget
$ 2,493.25


1,156.25


3,580.50

2,630.00
$ 7,360.50


7,472.50

4,527.50
q15,649.50


*The budget for Leon County Health Unit comprises the following:
Leon County and Board of Education .............................$ 3,427.50
Rockefeller Foundation ........................................ 350.00
Florida Power Company ........................................... 500.00
Rosenwald Fund ........................................ ........ 250.00
$ 4,527.50

**Disbursements of $ 4,577.22 for Leon County Health Unit do not include salary paid Inspector for
Malaria Control Studies, contributed by the Rockefeller Foundation. $ 1,125.00 of which passed
through the Leon County Health Unit Fund, for disbursement, purposes, although his activities were
associated with the Unit.







- 22 -


ESCAMBIA COUNTY HEALTH UNIT

JANUARY 1. 1932 TO DECEMBER 31, 1933

Funds were provided during the year by the State Board of Health, United States
Public Health Service, Board of CountynCommissioners and City of Pensacola.

The following is a consolidated report of Contributions made to the Unit by all
Agencies and Budgets for the Period:

Total Budget Budget Budget Average
Salaries, Travel Expense Paid to March July Oct. Budget
and Contingent Fund: Unit June Sept. Dec. For Year
State Board of Health $ 1,988.00 $ 833.34 7 625.00 $ 625.00 $ 2,083.34
U.S.Public Health Service 2,031.15 833.33 625.00 625.00 2,083.33
Escambia County 3,366.77 2,316.67 1,147.51 1,012.50 4,476.68
City of Pensacola 6,453.06 4153.33 1977.49 2,118.72 8,249.54
13,838.98 8 136.67 4 375.00 4 381.22 16 892.89
*******-,**;<*: -* :.****-*****) t +++h'** **s>iF ;FFi th*''*** *

JANUARY 1, 1933 TO DECEMBER 31. 1933

In August, 1933, an account was opened with the State Comptroller and State
Treasurer called "Escambia County Health Unit Fund" into which was deposited
and disbursements made from contributions from Rockefeller Foundation. The
ultimate plan is to have all contributions handled through this fund, the Board
of Health acting as Disbursing Agent, under provisions of Acts of 1931, Chapter
14906:

Receipts from Rockefeller Foundation Deposited to Escambia County
Health Unit ......................................................... $ 900.00
Disbursements from Fund .................... ........ ........... 900.00
No Balance


The following is a consolidated report of Contributions made to the Unit by all
Agencies and Budgets for the Period:

Salaries, Travel Total Budget Budget Budget Average
Expense and Con- Paid to Jan. & March July Budget
tingent Fund Unit Feb. June December For Year
State Board of
Health $ 1,745.84 $ 416.66 $ 666.67 $ 600.00 $ 1,683.33
U.S.Public Health
Service 1,083.26 416.66 833.32 1,249.98
Escambia County 3,576.90 675.00 1,203.33 1,880.00 3,758.33
City of Pensacola 8,718.20 1,412.48 2,765.00 4,925.00 9,102.48
Rockefeller Foun-
dation 900.00 900.00 900.00
$16024.20 $ 2,920.80 $ 5,468.32 $ 8,305.00 $16,694.12







- 23 -


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

Dear Doctor Hanson:

I submit horoevith report of the State Board of Health Library for the year
1933: -

Books in the Library ...................................... 2551
Books catalogued during 1933 .............................. 884
Bound periodicals in the Library ........... 1003
Periodicals bound during 1933 ........2..................... 253
Pamphlets, reprints, etc. in the Library *................. 3752
Pamphlets, reprints, etc. added during 1933 .............. 1876
Books bound during 1933 .............................,..... 4
Gifts (periodicals unbound) ................................ 1800
Gifts (books) ............................................. 352
Letters of inquiry addressed to Library ................... 146
Letters referred to Library .............................. 166
Books loaned(other than to State Board of Health)........... 109
Pamphlets,reprints,etc. loanod(other than State Board of
Health) 475

In this second year since the re-establishment of the Library the book
collection has boon completely catalogued. The classification system used is the
Library of Congress system. This is the classification used by the U. S. Public
Health Service in the Surgeon General's Library and is one that lends itself well
to a special collection such as we have here. The pamphlets and reprints of
medical and public health articles are also classified and listed by subject and
author. The cataloguing and classifying of books and pamphlets means that every
book and every pamphlet in the Library is instantly available for reference. For
the State Board of Health personnel and for all in the State who are interested
in medicine and public health this is a very necessary procedure.

One of the most important accomplishments of this past year has been the
binding of our periodical collection. We had some three thousand unbound maga-
zines on our shelves at the beginning of the year. Those have been bound, with
their annual index, as we have been able to obtain missing numbers and complete
the volumes. Doctors throughout the State have shown their interest in the
Library by giving us files of medical periodicals. The Florida Medical Associa-
tion gave the Library approximately 1500 unbound periodicals which had been sent
to the Association in exchange for their own Journal. These consisted for the
most part, of Journals of other State medical societies. I believe it is the
intention of the Florida Medical Association to continue to give us these exchange
Journals as they are issued. Those which have been given this year have been
bound, and we will continue to bind each volume as we got them. This constitutes
a most valuable reference collection, and is of course available to any doctor
in Florida. The Library subscribes to the Quarterly Cumulative Index Modicus, and
ow have the second and third series of the Surgeon General's Index to medical
literature

The pamphlet and reprint file, which now numbers approximately 4000, con-
tains for the most part, current information on medical and public health subjects
This file takes care of the large amount of material which is issued currently,







- 24 -


the value of which is lost if not listed and filed in some order. This consti-
tutes one of the most useful parts of the Library collection and is referred to
constantly.

We have also a file of current reports from every State Health Department
which publishes them, and from many municipal health departments. These, to-
gether with the Public Health Reports and other material from the U. S. Public
Health Service are used widely by the State Board of Health staff.

We have received many books and periodicals as gifts during the yoar. These
have come in the main from doctors of the State, and from others interested in
public health work. The Rockefeller Foundation, the U. S. Public Health Service,
Bellevue Hospital Library, and others have also given the Library many valuable
publications. As the Library grows, we hope to obtain much more material this
way.

The Library has been in existence two years now, and wo feel that it has
proved its value. It is used extensively every day by the State Board of Health
personnel. It has been of use to lay groups throughout the State. Lists and
material on such subjects as child health, social hygiene, tuberculosis preven-
tion, malaria prevention, etc. have been spnt on request to members of Parent-
Teachers organizations, social welfare groups, nurses, public libraries, rural
schools, etc. The doctors of Florida have used the facilities of the Library
considerably. We have not advertised the fact that we have a Library extensively,
preferring to let its usefulness grow as its efficiency increased, but the
response to such a service has boon most encouraging. Each month the number of
requests for information and material grows larger, clearly proving the need for
such a center where public health information may be obtained,

Respectfully submitted,

(Signed) Elizabeth Bohnenborger,
Librarians



DIVISION OF DRUG INSPECTION


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

Dear Doctor Hanson:

The following is a yearly report of the Division of Drug Inspection for the
year 1933.

I am pleased to report that I have secured one hundred percent cooperation
from Mr. Harry J. Anslinger, Commissioner of Narcotics, Washington, D. C. and
his District Supervisor, Mr. T. E. Middlobrooks, Post Office Building, Jackson-
ville, Florida, as well as each and every narcotic agent working under Mr. Middle-
brooks.







25-

Open inspections ........................................ ........ ...1554
Stores registered with State Board of Health during 1933................ 673
Number of violations corrected where no legal action necessary ......... 90
Number of convictions practicing pharmacy without liconso............... 12
Number of court cases for practicing pharmacy which resulted in an
acquittal....*...................... ............ .......... .... .......... 2
Number of pharmacy cases pending in criminal court. .................... 6



State Uniform Narcotic Drug Act Violations and Action taken.
Criminal Investigation.


Number of violators of narcotic law which have been brought to trial.... 15
Number of convictions in court ......................... .......... 14
Number of narcotic cases which resulted in an acquittal................. 1
Number of narcotic cases pending in court..................*............. 4
Number of addicts committed to State Hospital for treatment ............ 3
Number of narcotic licenses issued to druggists............o.*.......... 737

The above report of the enforcement of the State Uniform Narcotic Drug
Act is for six months since this law was passed by the last Legislature. This
department was, I would say, two months preparing necessary forms and general
clerical work connected with this law, therefore, the above report would cover
about four months field work.


Respectfully submitted,

(Signed) M. H. Doss,
Chief Inspector.


DIVISION OF MALARIA RESEARCH


1. Anopholine mosquitoes:

The original quadrimaculatus colony continues to flourish. It is now
slightly over two years old. The current imagines are approximately the twenty-
fourth generation removed from the wild stock by which the colony was established,
No deterioration is apparent.

A second inscctary was build during the year. In the summer period an
effort was made to establish in it a colony of the inland variety of crucians.
Although several hundred reared imagines wero released in the interior, only
a very limited amount of oviposition was secured, insufficient to maintain the
requisite density of adults. The trial was discontinued with the approach of
cold weather, and punctiponnis substituted. Several hundred reared imagines
wero released in the interior. After a period of several weeks delay abundant
oviposition has been secured.. The present outlook indicates the successful
establishment of a colony of this species.






- 26 -


A comparison of the susceptibility of quadrimaculatus and the inland
variety of crucians to three species of human malaria parasites was made.
Quadrimaculatus was found to be definitely more susceptible than crucians to
infection by P.. vivax and P. falciparum, while crucians was definitely insuscep-
tible to P. malariae. Thus higher susceptibility on the part of quadrimaculatus
to the malaria parasites, is a circumstances of importance in understanding its
role in the propagation of malaria.

It was found that mosquitoes harboring P. vivax in their salivary glands
are most effective for inoculation purposes in the second ten day period after
the termination of the extrinsic incubation period, and that thereafter their
effectiveness progressively diminishes. Inoculation trials made with mosquitoes
in which gland infection was more than 50 days old have been negative, despite
demonstrable sporozoites in their glands. Depletion and degeneration of the
sporozoites appear to be responsible for the loss of infectiousness.

The routine therapeutic inoculations of neuro-syphilitic patients at the
Florida State Hospital have permitted the prosecution of several studies. These
may be noticed as follows:

2. Tertian Malaria:

Of 103 primary inoculations of white patients, 16 or 15.5 percent failed
to take. The re-inoculation of 12 of these failures were later attempted with
successful results in each case. These results indicate a high degree of suscep-
tibility among whites to tertian malaria. Failure of an inoculation to take is
probably most commonly attributable to deficiencies of the parasites in the
mosquito employed rather than to resistance on the part of the patient.

Attention has been called to the fact that a patient inoculated with one
strain acquires a tolerance to re-inoculation by the same strain, but is still
susceptible to re-inoculation by other strains. He develops a homologous but
not a heterologous tolerance. However evidence appears to be accumulating to
indicate that some heterologous tolerance is actually acquired. While the
patient can be successfully inoculated with another strain, the resulting attack
is usually of shorter duration and less severe than the first.

This appears to have an important bearing on the character of the malaria
attacks that are induced. Dr. Muench has analyzed the records of 26 patients
for whom fairly complete data regarding previous residence and prior experience
with malaria, were available. He found that the patients with a malaria history
tended to have milder attacks as judged by (a) a lower height of fever, (b) lower
proportionate hemoglobin reduction and (c) longer incubation period, than the
patients without such histories. Furthermore, the same differences are discern-
able between the attacks observed in patients originating in the south, as com-
pared with those coming from the northern states.

Studies have been made on the route of inoculation and the earliest
appearance of the parasites in the circulation following inoculation. A mosquito
that successfully feeds inoculates sporozoites directly into the blood vessel
she has pierced. On the other hand, it appears that sporozoites which have been
introduced into the subcutaneous tissues during an unsuccessful feeding can make
their way to a blood vessel. The blood of a patient who had a ten day incubation
period was not demonstrated to be infectious until two days before the parasites
were detected microscopically. This suggests the existence of an unrecognized
phase in the life history of the parasites.








- 27 -


3. Estivo-autumnal malaria:

The tolerance which most negroes exhibit to vivax practically excludes
negroes from enjoying the benefits of malaria therapy when this parasite is em-
ployed. In order to treat the patients of the negro race the employment of P.
falciparlm has been introduced. To date sufficient experience has been had to
indicate that by closely following the evolution of the infection so as to give
small interrupting doses of quinine when necessary, this parasite may be safely
employed It has been found that the employment of one or more ten grain doses
given whenever the patient's temperature attains 1040 F. will restrain the
tendency of the infection to overwhelm the patient and transform the temperature
from an ascending remittent, to an intermittent. The number of occasions when
quinine must be so employed, varies with different strains of the parasite.

Experience with estivo-autumnal malaria has revealed that a patient on
recovery possesses a owll defined tolerance to re-inoculation with the strain
which produced the original attack, but not to a different strain.



References.



1) Boyd, Mark F., and Stratman-Thomas, W. K., Studies on Bonigh Tertian Malaria
5. On the susceptibility of Caucasians.
Am. Jour. Hyg. (In press)

2) Boyd, Mark F., and Stratman-Thomas, W. K., On the duration of infectiousness
in anopholines harboring Plasmodium Vivax.
Am. Jour. Hyg. (In press)

3) Boyd, Mark F., and Stratman-Thomas, W. K., The Comparative susceptibility of
Anopheles quadrimaculatus, Say, and of Anopheles Crucians, Wiod.
(inland variety) to the parasites of human malaria.
Am. Jour. Hyg. ( In press)







-28-
iLLTL.L CONTROL STUDIES

activities in malaria control studies were continued during 1933 under
Surgeon T. H. D. Griffitts, U. S. Public Health Service in cooperation with the
State Board of HEalth. ..ftor completing blood indexes in the rural schools of
eight counties in the fall of 1932 and spring of 1933, it was decided to select
Citrus County, representing an average malaria infection rate, as the first
county in the state whore a county-wide program of control would be inaugurated.
It was planned to mcko further studios of L.nopholos production, areas involved,
housing conditions, feasibility of dreincgo, screening of hoursos, the appli-
cation of Paris grctn to important brooding areas, plans for securing treatment
of infected persons, etc., after which a program most suitcblo for malaria con-
trol was to be inaugurated. Prevailing economic conditions become so acute
that most of the contemplated work had to be abandoned. Horovor, with such
funds as were available, a limited survey cwas carriod on for about throe months
in the summer of 1933, and itabrine therapy hias applied to two groups of
population. Even this wns curtailed .;hon the C.W.A, program of employment was
inaugurated in November, necessitating the discontinuance of all regular
activities in malaria control. It is hoped that when the present emergency
is past, we can enter upon a permanent plan of malaria control in all of the
counties where malaria is a serious problem.

The blood index taken in the rural schools in 10 counties of Florida
up to the present is shown below, with the number of rural school children
whose blood was examined, and the relative rates.


ML ARIA INDEX
Rate in Rural Schools, Eight Counties, 1932 to 1934.

COUNTY No.Ex'md. iate

BRaDFORD 1643 1.9

CITRUS 1015 5.8

DIXIE 899 4 4.5

FLBGLER 473 2.5

GILCHRIST 781 2.4

LEON 655 9.5

LEVY 2249 9.4

~LDISON 648 9.3

SU4JNEE 1858 6.6

TYLOa 1520 13.7


T= 15.8


Total 11745 Jv.Rate







-29-


In connection with the Federal malaria control project in the state
(C.W.A.), the following Bulletin was prepared and made available for the use
of personnel engaged in malaria control drainage. This work was primarily
for employment of labor, had to be started on short notice with little or no
tima for careful surveys. Experienced personnel was not immediately avail-
able, and the issuance of this Bulletin was intended to readily familiarize
these workers with essentials of the main subject before them.

Bulletin

What is Malaria?

1. Malaria, also known as "chills and fever", bilious fever, swamp
fever, etc., is a disease of man occurring in hot and warm countries. The
symptoms of this disease are due to the development of small animal para-
sites which feed on the infected person's blood, turn loose toxin, or
"poison", in the blood, and rapidly destroy the red blood cells.

How You Get It

2. There are only two ways by which malaria may be introduced into a
person's blood: (a) by injecting blood from a malaria patient into a
person's system, and (b) by the bite of a certain kind of mosquito which
has previously (about 12 days before) bitten a person who had malaria para-
sites in his or her blood. In other words, the "malaria mosquito"
(Anopheles) gets her malaria from a "malaria man" and about 12 days later
gives malaria to persons whom she bites. In nature man gets malaria in no
other way.

How Prevented

3. To prevent malaria it is only necessary to keep Anopheles (malaria
mosquitoes) away from man. This may be done by preventing mosquitoes from
developing, or by thoroughly screening houses, and the people staying behind
screens from dusk to sunrise. (Malaria mosquitoes are active at night.)

Kinds of Mosquitoes

4. In the entire world there are more than 500 different kinds, or
species, of mosquitoes, and loss than a hundred different kinds of Anopheles,
or malaria mosquitoes. In the Vostern Hemisphere there are about 50 species
of Anopheles, but in the Southeastern United States there is only one anopheles
largely responsible for malEria. This is Anopheles quadrimaculatus, the
mosquito with four small dark spots on the wings. Anopheles that we have are:

Anopheles quadrimaculatus Anopheles atropos
Anopheles crucians Anophelos walker
Anopheles pynctipennis Anophelos barberi






-30-


Where anophelos tre Raised

5. Our principal malaria mosquito Anopheles quadrimaculatus like
all other mosquitoes, develops in water. The favorite places are fresh
water (not salty) ponds, lakes, ponded swamps, and the like. Of no
practical importance in malaria control are artificial containers like
water barrels, tin cans, house gutters and such. The anopheles lay their
eggs hundreds at a time on the surface of the water in ponds and pools,
which is covered with vegetation or collections of "flotago" (leaves, small
sticks, broken up weeds, grass stems and the like). The A.nopheles eggs
hatch into larvae (wigglo-tails) on the water surface, and the larvae wiggle
about and feed in the vegetation and flotage (trash) for about 7 to 10 days,
when they change to pupa, or "tumblers." They remain as pupae about 2 days,
just tumbling about (pupae do not eat), and then the back of the pupa splits
and the full grown mosquito crawls out. after about one day, when the wings
are dry, the mosquito's body is hardened and she becomes hundry, the female
mosquito flies away in.search of her best food blood of a warm-blooded
animal. She has no mclaria as she comes from the water. She gets malaria
only by biting and getting blood from a person who has malaria. (You will
note that the mosquito is referred to as "she". Only the female mosquito
bites; the males get their food from plant and fruit juices.)

Drainage to Eliminate Anopheles Production

1. Drainage to eliminate, or get rid of, water in which Anopheles
mosquitoes (malaria-carrying mosquitoes) produce may not necessarily be
good agricultural drainage, and good agricultural drainage may, under some
circumstances, create, or make worse, mosquito conditions. As an example
of the latter, wide drainage ditches, or canals, may be so constructed with
flat grade, wide bottoms and improper curves or angles, so that at low-water
stage there remains in the canals or ditches a series of quiet pools in which
vegetation grows and flotage (finely divided sticks, twigs, grass stems,
leaves and the like) occurs and forms ideal resting and feeding places for
Anopheles larvae .(wiggle-tails). Such places so created by bad drainage
(although, perhaps, good drainage agriculturally) may have drained a Wooded
swamp of shallow, foul water, which in its original condition produced few
or no Anopheles mosquitoes. By the improper construction of the canals and
ditches ideal pools of water of varying depth, width and length are created
for mosquito production. In anti-malaria (anti-.nopheles) drainage, two
purposes are kept in mind removal cf pools and ponds from the surface of
the ground and the avoidance of quiet or still water in the drains.

Cleaning Ponds and Re-Channeling Streams

2. As malaria-carrying mosquitoes produce mainly in quiet waters, such
as lakes, ponds, pools and sluggish streams, these are the important places
to be drained, cleaned, re-channeled or trained. If, on account of high
cost, or otherwise, lakes and ponds can't be drained, cleaning of vegetation
and flotage, or the application of larvicides will be necessary, provided
these places produce mosquitoes of malaria importance. Sluggish streams
should be straightened, banks made smoother, obstructions removed and bottom
grade corrected, in order to establish a current in the stream. A fair
current at low-water stage will prevent the production of Anopheles
quadrimaculatus.








Open Ditches


-3. Having determined upon the drainage of an area, a line of levels
should be run, right-of-way cleared, grade stakes set and a line should be
stretched along the course for the laborers to follow. In all instances
ditches should be as straight as possible from the outlet to the upper end
of the system. "i drainage system is no better than its outlet." Main
ditches, or canals, should be installed first and allow sufficient time to
elapse before constructing the lateral ditches. In this way, usually, fewer
lateral ditches will be indicated than before the main ditch has time to
drain such wator areas as it will. If the ditch is constructed in dry
season, it may be advisable to wait for a rainy season to indicate location
of additional lateral drains. Care should be always taken to have lateral,
or branch, ditches enter the main ditch headed down stream at an acute angle
or gentle curve, so that the flow will take place with that of the main
channel and not across it.


---r MkAI DITCH -






7/


When the flow line in the main ditch is a great deal lower than the
entering lateral ditch it may be advisable to step down the last 10 feet or
more of the lateral ditch so as to prevent spilling into the main ditch with
destructive effect. Do it thus:

IN DITCH


___--
9- --I-
BOTTOM OF
LATERAL DITCH


Slopes of ditch banks will be cut according to soil formation. In the
average soil a slope of 45 degrees, or 1 to 1 slope, will be correct. In
sandy or gravelly formation a 1W to 1, or even 2 to 1 slope may be required.
In clay a to 1 slope, or even a nearly vertical bank will stand. On hill-
sides the upper side of the ditch should be made flatter than the lower. In
all ditch construction the weight of the spoil banks should be away from the
edge of the ditch. In other words a "Berm"should be left between the edge of
the ditch bank and the spoil banks.. Openings should be made at intervals
through spoil banks to prevent impounding water behind them. In such
locations where it can be done, the dirt removed from the ditch should be
spread out evenly away from the ditch, or used to fill pools or low areas
nearby. When this is not practical, on account of expense or otherwise,
spoil banks will be made as described heroin. Ordinarily the berm should
be about two feet wide.




-32-
Do it thus:

Spoil Bank Spoil Ban

Berm / Serm / .


-N Narrow Bottom
CROSS SECTION

In placing culverts under roads, it is a rather common practice of
engineers to set culverts at greater elevation than the bottom of the ditch.
This is done so the culvert will better flush out at storm water stage.
This practice too often results in the impounding (ponding) of water in the
ditch at the upper end of the culbert and such pool may become an ideal
producing area for Anopheles mosquitoes. Generally, the grade should be
increased for the length of the cultert, but the mouth of the culvert should
be set low enough to empty the ditch at low-water stage.

Summary

1. Efficient "malaria drainage" may differ from "agricultural drainage".
The former requires that pools or ponds be removed from the ground surface
and that canals and ditches be either emptied at low water stage or that
current be maintained at all stages of the water; the latter (agricultural
drainage) may require, in addition, a decided lowering of the watur table
(ground-water level).

2. Open ditches should be carefully located, cut to proper grade,
sides sloped from 2 to 1 (in sand or gravel) to t to 1, or less (in stiff
clay), bottoms narrowed, laterals entering at an acute angle, or curve,
headed down stream; spoil banks located back from the edge of ditch and
a berm of about two feet provided between the edge of bank and the spoil
bank; culverts should have increased grade and be set low enough to empty
the ditch at low-water stage.


The foregoing covers, in brief, the requirements in hand-ditching;
machine and dynamite ditching require additional procedure.

3. Malaria is a disease resulting from the development and action of
malaria parasites in the blood of man.

4. Malaria parasites are injected into man by a mosquito which has
malaria that it got from a person who had malaria infection.

5. Malaria is prevented by keeping malaria mosquitoes from biting man.

6. There are over 500 different kinds of mosquitoes, but less than a
hundred kinds of Anopheles ("malaria mosquitoes"). ffe have six species of
Anopheles in the Southeastern part of the United States, but Anopheles
cuadricaculatus is the important carrier of malaria.

7. Anopheles quadrimaculatus is essentially a pond breeder. The
female bites (the male does not), gets malaria herself and carries the
disease to persons she bites after about 12 days from the time she (the
Anopholes) first got her "meal" of malaria blood.





- 35 -


DIVISION OF ENTOMOLOGY
by
W. V. King, Senior Entomologist
U.S. Bureau of Entomology


With headquarters in Orlando, the investigation of mosquitoes and other
insects affecting man and animals have been continued during 1933. The work of
the station in Florida during the year may be briefly summarized under the
following headings:

General Mosquito Survey of State: Records of the distribution, seasonal occur-
rence and economic importance of the various species of mosquitoes are being
compiled from collections made by members of the Bureau Staff, by the State Board
of Health and from other sources. During the year, several new distributional
records of some interest were obtained for the central part of the state. Anophe-
les punctipennis was obtained during the winter and spring near Rock Creek
Springs in the northwestern part of Orange County, and larvae were taken in asso-
ciation with our other two coanon anopheline species, A. quadrimaculatus and A.
crucians; Aedes mitchellae, previously reported only from the northern part of
the state, was identified for the first time from collections made in Orlando;
Culex nigripalpusg previously recorded only from the southern part of the state,
was found to be fairly caumon in Orange County and appears to be more abundant
in this area than C. salinarius, the species that it closely resembles; Anopheles
atropos was collected in a mangrove marsh near Ft. Pierce, St. Lucie County;
Mansonia titillans, a tropical species and previously known, in Florida, only
from the region south of Lake Okeechobee, was taken in some abundance on water
lettuce plants (Pistia) along the St. Johns River in Brevard County. This is
apparently the most northern record of its occurrence.

Anopheline Mosquitoes: In the cypress swamps of Orange and adjoining
counties, Anopheles crucians is by far the predominant species and in this habitat
is frequently taken in "pure culture." Along the edge of Lake Apopka and in
other overgrown lakes, larvae of Anopheles quadrimaculatus are usually taken with
those of crucians but nearly always in smaller numbers, and collections of adults
in the vicinity of Zellwood and Lake Apopka during the past two years have always
shown a great preponderance of crucians. Light trap collections made one night
per week near the large marsh area on Like Apopka during the period from Julj 8
to November 25, 1932 gave a total of 10,644 crucians and 126 quadrimaculatus. Of
the crucians taken, 6,755 were females. The largest single collection for both
species was recorded for the night of September 2 when 21 quadrimaculatus (all
females) and'2,482 crucians were obtained. On this occasion, 1,794 of the latter
were females. From weekly light trap collections obtained at Zellwood, Florida,
from March to December, 1933 (with the exception of the month of July), the
largest number of both species were taken on the night of August 27 with totals
of 32 quadrimaculatus and 179 crucians. The much smaller m~xamum in 1933 is
attributable to the difference in location of uhe trap since miscellaneous col-
lections at the edge of the Apopka marsh agajn gave very large numbers of
crucians, equalling the largest in 1932.

Collections in several shelters at Rock Creek Springs beginning in January,
1933, however, gave a majority of quadrimaculatus, in the proportion of about 2
to i. Since these collections are of some interest as showing the seasonal
occurrence of the three species of Anopheles in this particular area, they are
shown by dates in the following table:






- 34 -


Daytime collections of adult Anopheles from shelters at Rock Springs,
Orange County, Florida 1933


quadrimaculatus crucians punctipennis
Date 1933 Males Females Males Females Males Females

January 16 8 35 29 36 1 8
17 4 2 9 7 0 5
28 10 12 7 8 2 5
February 25 24 143 55 88 6 60
March 30 53 24 9 10 14 4
April 21 4 221 4 4 3 2
May 22 33 59 17 30 1 0
June 19 33 63 25 24 0 0
July 22 1 35 3 18 0 1
August 24 5 10 5 10 0 1
September 18 4 11 2 10 0 0
October 26 5 19 9 17 0 0
November 28 5 9 10 7 0 0
December 20 2 8 11 11 0 0

Total 191 651 195 280 27 86



In cooperation with the State Board of Health and for the most part in
connection with the use of unemployment relief labor for drainage work, anopholino
surveys were made at various points in central Florida, including the following
localities: Markham, Elder Springs and a rural area on the St. Johns River in
Seminole County: Wewahotee in Orange County; Fort Meade, Tavares, Umatilla,
Groveland and Mount Dora. At Fort Meade, larvae of A. qua&rimaculatus as well
as crucians were found in abundance in growths of water hyacinth in water-filled
phosphate pits and there appeared to be a definite relationship between this
source of Anopheles production and the occurrence of cases of malaria as locally
reported. Observations made at Wewahotee were also of some interest in view of
the fact that a new turpentine camp with some 85 families had been put up here
in the midst of a low swampy area and under conditions that would ordinarily be
expected to result in an outbreak of malaria. With MV. Broughman, Anopheles
collections about the camp were made on two occasions, and while crucians breed-
ing was quite'prolific, no specimens of quadrimaoulatus, either adults or larvae,
were obtained. Based on local, verbal reports, malaria has not as yet caused
any trouble among the imported population.

Mansonia Mosquitoes: Studies of M. perturbans, principally in the vicinity
of Lake Apopka, were begun by the Bureau in 1929, and two preliminary reports on
its habits have been published by Mr. T. E. McNoel. This and other species of
this genus have the unique habit, in the larval and pupal stages, of attaching
themselves to the roots of aquatic plants and this habit makes the problem of
their control with any of the ordinary larvicides unusually difficult. The larval
period of development is greatly prolonged and in northern states, where M.
perturbans occurs, it is thought to have but one annual generation, the adults
emerging over a period of several weeks in early summer. In Florida, however,
judging by the occurrence of two peaks in the seasonal abundance curve, there
appears to be two annual broods or at least a partial second brood. During 1933






- 35 -


the first and highest peak occurred during the week of May 9, with a second much
lower peak about the middle of August. Artificial rearing of this species has
proven very difficult to carry through successfully, but during the past season
the rearing experiments gave some results that were of interest in this con-
nection. At the beginning of the season a series of water tight boxes were pre-
pared with marsh soil and aquatic vegetation, to simulate natural conditions.
The last of April these were stocked with newly hatched larvae obtained from
eggs deposited by captured Mansonia females. By the first of August most of the
larvae present appeared to have reached the 4th, or last, larval stage, and be-
tween August 11 and September 30 a number of adults emerged. Nevertheless, full
grown larvae were still to be found in the tubs up to the end of the year, with
no further emergence during the fall, and since the larvae appeared to be healthy
they may be expected to emerge coincidently with the natural appearance of adults
in the spring. While these records prove that development may be completed with-
in three and one half months, the indications are that only a part of the brood
does so, the remainder lying over until the following year.

The principal host plant with which M. perturbans has been found associa-
ted in Florida is pickorel-weed (Pontederia cordata) but the larvae have also
been taken from arrow-head (Sagittaria), yellow water lilies (Nymphaea), cattail
(Typhia) and, very rarely, on water lettuce (Pistia) and water hyacinth (Piaropus).

Methods of control of these mosquitoes have been studied under laboratory
and field conditions and experiments were undertaken last season on the destruc-
tion of the host plants by cutting, using a Ziomson aquatic saw. This saw con-
sists of a narrow steel band less than a quarter inch wide and notched on both
edges. With one or two men on each end to operate the saw, a wide swath can be
cut by drawing the band back and forth with a 'awing motion. For the experimental
work, lengths of from 50 to 150 feet were tried and for certain types of plants,
such as water lilies, gave quite satisfactory results. The density of Pontederia
growths, however, and the conditions under which it usually occurs, plrved to be
very difficult to contend with and the results for the most part were not highly
successful from the practical standpoint (that is in the matter of cost and effi-
ciency) although breeding was entirely eliminated wherever the plants wore cut
beneath the water surfact.

Considerable experimental work has also been done with various chemical
weed killers and chemical larvicides, and studies of this nature will be con-
tinued during the coming year.

Salt Marsh Mosquitoes: Miscellaneous surveys of salt marsh areas on the
east coast were made during the summer in connection with the use of unemployment
relief funds on mosquito control. In November, a Federal Post Mosquito Control
Project, under the general supervision of the Bureau of Entomology, was authorized
by the Civil Works Administration, and an allotment of 1,000 men was provided for
salt marsh ditching work in Florida. The State Health Officer was appointed
State Director of the work and the organization of county projects was undertaken
by the Engineering Division. By the end of December plans were completed for
coordinated Federal and local projects in eleven east coast counties and six
rest coast counties. So far as possible, advisory supervision and assistance in
laying out the control work was provided by the Bureau of Entomology.

Little time could be devoted to research work on salt marsh mosquitoes
during the year, but the follow-ing collection records may be mentioned here.






- 36 -


In May, larvae of Psorophora ciliata, normally a fresh water breeder, were taken
with the salt water species Aedes sollicitans, A. taeniorhynchus and Deinocerites
cancer, in an area of marl marsh near Hollywood, Florida. In May also, larvae of
P. columbiae with those of A. sollicitans and A. taeniorhynchus, were identified
from pools along the St. Johns River in Seminole County at a point about 15
miles from the coast. The water in the latter breeding places contained about
0.5 percent salt. Adults of sollicitans and taeniorhynchus have occasionally
been taken as far inland as Orlando and Zellwood, although breeding has never
been found in Orange County. In and near Orlando, taeniorhynchus at times is
sufficiently numerous to be troublesome.

Light trap collections in Coral Gables during the nights of June 19 and
20, and near the bay shore south of Miami on the twenty-first gave the following
species:

Coral Gables Bay Shore

Aedes taeniorhynchus 54 139
Culex sp. (probably quinquefasciatus) 4
Anopheles crucians 1
Uranotaenia sp. 4
Deinocerites cancer 33

The collections were made toward the end of an infestation from the salt marshes,
and the absence of sollicitans in the area at this time may be noted. The col-
lection of Deinocerites cancer (the "crab hole mosquito") is the first record we
have of the taking of this species other than in the vicinity of crab holes in
the salt marshe s.

Outbreak of Psorophora columbiae in the Everglades: In Seboember, 1932,
reports were received at the Orlando office of an extrerrly severe outbreak of
mosquitoes in the Hialeah section of Dade County and extending along the eastern
side of the Everglades far many miles. A trip made by Mr. McNeel to the area
before the infestation had entirely subsided indicated that the principal species
involved was Psorophora columbiae, which had undoubtedly developed in portions of
the Everglades following a period of heavy rainfall. Of especial importance was
the severe loss of dairy cattle and other domestic animals that resulted from
the intense infestation. Reports were checked on the deaths of 80 head of cattle,
3 horses, 1 mule, 67 hogs, 20 chickens and 2 dogs. Most of the losses were in
the vicinity of Hialeah and nearly all of the deaths occurred on the first night
and the following day of the outbreak.

In August, 1933, another severe outbreak of mosquitoes was reported by
Dr. R. V. Allison of the Everglades Experiment Station of Belle Glade, and this
area was visited by the writer on August 11 14. An extremely heavy infestation
was found, attributable to recent heavy rains that had flooded large areas sur-
rounding Lake Okeechobee. While no direct loss of livestock occurred, remedial
measures in the form of smudges and oiling or spraying of animals had been
necessary, and much loss in milk production was reported by dairy owners. The
infestation centered in the area around the southern end of the lake, but was
noticeable over a large territory in all directions from these points. Psorophora
columbiae was the principal species encountered and constituted 85 percent of
the specimens collected. Other temporary pool breeders obtained w;ero P. cili.ta,
P. ferox, Aedes sollicitans ani A. infirmatus. Adults of Mansonia titillans,
Culex sp. and Anopheles crucians wore also taken






- 37 -


Mosquito Film: A three reel motion picture showing the breeding habits
and methods of control of important economic species of mosquitoes was released
by the Department of Agriculture during the year and has been shown in Florida
at public meetings in Coral Gables and Miami, and at meetings of the Rotary Club
in Vero Beach, of the State Board of Health at Jacksonville Beach, the Orange
County Medical Society at Orlando, the Community Club at Zollwood, and the State
Public Health Association at St. Petersburg. The picture requires about 45
minutes to show and is recommended especially for educational purposes in ac-
quainting the public with the life history and importance of mosquitoes, and in
encouraging counties to undertake antimosquito work.







-38 -


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

Dear Doctor Hanson:

I hereby submit to you the report of activities of the
Multigraph Department for the year 1933.

This report will bring to you the total number of the
numerous printed forms required by the departments for the
year, a report by months of the several operations to com-
plete the printed forms for delivery.

I have also included a report of the purchase of sup-
plies for the departments, bought on their own purchase
order, such as Bond papers, plain envelopes, index cards and
a figure for the repairs and replacement parts for the multi-
graph and mimeograph machines. I have not included the pur-
chase of stamped envelopes, mimeograph stencils and other
materials such as office supplies.

Thanking you for the courtesies that have boon shown mo
in the past year, I am

Yours truly,


(Signed) E. F. H. Ganten




- 39


REPORT OF

Paper, envelopes and other supplies purchased by the various departments for
the year 1933, as recorded in the purchase order books in the Auditor's office.


Bought by the Administration department and charged to the Multigraph depart-
ment:
Bond papers, onion paper, chip board Index bristol.............*.. $388.99
Gutting Charge for material................ ....*....... *** .*** 14.63

Multigraph machine ports:
Feed roller, Composition rollers, Platen, Platen shaft, etc....... 54.71
Ink, Supor-nurex cement, paper knife ground................ ..... 21.40
Electroplates..................................................... 7.50

Mimeograph machine parts:
Ink pads, Repairs to frozen cog, Mimeograph ink.................. 32.00

Bought and charged to the Administration Department:
Onion paper....... ..... .......................... ........***** *. 55.67
Cutting above paper............. .........................* 2.25
Envelopes.........*....... ... ......****.....***************** 16.50

Bought by the Administration deportment and charged to the Library:
Index card size 3 x 5......................** .....*.*** 5.65
Cutting cards to size..... .......... ......** .....*...********* 35
Punching one hole in cards ..............*..... **..************* 2.50

Bought by the Vital Statistics Department:
Bond paper, Envelopes, Index cards, Chip board, Clasp envolopeis.. 4t3&.62
No cutting charge shown on purchase order in this department.

Bought by the Engineering Department:
Bond paper, Envelopes..........................*** *** ***** 17.08

Bought by the Laboratory:
Paper, Clasp envolopes....... ........ ................. *********** 110.78
Cutting charge....................................*.* ..** ..** 2.85

Bought by the Communicable Disoeses:
Paper, envelopes............................................... 96.22
Cutting charge...*......*.........************* .......********** 3.80

Bought by the Child Hygiene:
Paper, etc.................. .............*.......************** 5.60
Envelopes................. .............. ... ****************** 52.71
Cutting charge on paper. .........................***.***. ....**** 200
$1,585.81

Repairs to multigraph
Including rollers..*.....** 54.71
Repairs to mimeograph....... 1.50
Cutting paper charge........ 25.08
81.29

Where bids have been asked for the cutting charge is included with the cost
of pDaer.













TABULATION SHOWING OPERATIONS FOR THE YEAR


1933 Multigrap


Perforations


Pads


Stapled


Assembled


Punched Numbered


188,564
111,315
108,771
35,215
151,061
78,985
125,759
134,648
111,295
223,955
101,830
190,892
1,562,290


3,872
4,500
1 ,090
76,615
1,120
3,625
1,560
6,180
4,100
40,655
2,090
5 985
151,392


46,000

66,500



14,300




12,500
159,300


512
144
90


1,991
150
12
207

1,285

4,391


2,750
70
6,18 0 2,876
1,000
2,288 38,000
1,000
250
4,154 45,626


13,000
1,500
1,750


2,750

1,000
5,000


1,750


2;750
1,000
1,350


1,000

31,800 7,850


Number of Multigraph compositions.................... 525
Number of mimeograph stencils..... ............... 318


Jan*
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
NOv.
Dec.






- 41 -


Printed forms and paper furnished Bureau of Engineering:



Letter heads...... ....................... 3,000
Bond paper ............... ............... 2,000
Onion paper................................ 1,500
Onion paper heading........................ 2,000
Mimeograph forms (86 Stencils).............14,355
Daily report of........................ 5,000
Envelopes.........................*....... 9,500
Business Cards............................. 580
Dairy Inspection....* *.................... 500
Water notice, post card......1............ 1,015
Rule No. 26........................*....... 200
Water analysis letter............0......... 500
Banquet tickets.......................... 250
Second sheets (yellow)..................... 7,500
Notice small water cases................ 50
Rule No. 79................................ 225
Water analysis data blank..................10,000
Shellfish application.......... ............ 250
Tourist Canp Information................... 250
Sanitary Inspection report.........*....... 5,000
Scratch pads, sheets...................... 2,500
Tourist Camp law........................... 300
Report of Inspection shellfish Pt.......... 300
Shellfish certificate...................... 500
Rule No. 96......................***.*..*.. 75
Model Ordinance No. 2...................... 150
Auto camp inspection...............*....... 250
Health cards..................** ....... 3525
Septic tank sketch...5.................... 175
Privy agreement, nano, addross............. 2,000
Sanitary survey of snhools................ 4,000







- 42 -


Printed forms, Bond paper, Onion paper, Envelopes, furnished to
Administration:


Administration

Letter Heads..................
Envelopes.....*.......*........
Letters......................
Bond paper...................
Onion paper.................
Mimeograph prints.............
Annual Report (Mimeograph) ...
Information blanks............
News clipping blank............
Telephone report blank..... ..






Auditing

Letter heads.................
Envelopes.....................
Letter heads-Seconds...*.....
Onion paper...................
Onion paper heading ..........
Purchase order blanks
4 sheets to set...............
Extra Purchase order Bk.......
Pay roll blanks....*.... ......
Warrants blanks................
Addition to expense
statement blanks.............
Voucher record card...........
Self-addressed slips..........
Voucher bill cards............
Invoice bill..................
Mailing labels ................
Insurance receipts............


* sots
B sheets


N






'7











N


Vital Statistics
.umber
5,650 Lotter heads ........*......
7,125 Envelopos..................
725 Envelopes, Gov.............
1,500 Envelopes, K.Klasp.........
5,500 Copy on second sheets......
120. Trade Mark sheets...........
'9,249 Scratch pads (sheets)......
125 Midwife birth stubs........
100 Midwife birth covers.......
2,000 Personal report cards......
Death Certificates........
Birth Index cards..........
Marriage.....**e............
Death..............*.......
Divorce...................
Acknowledgment............
Receipts (Emoons)..........
lumber Post card V. S. 21.........
775 Birth Supplemental Rep.....
850 Death.............. .......
300 Divorce chock sheets.......
4,000 Birth copy for record book.
130 Casket dealers No Sale
record..................
1,700* Photostatic certify copy
550 form.......... ..........
1,000 Registrar bill.............
209 Registrar report card
V. So 7s................
815 Record of photostatic copy
200 V. S. 120...............
200 Honlth Notes Envelopes.....
500 Marriage locating card.....
300 Birth search card..........
200 Word opy"................
300 Banquet tickets............
Report of No Births or
Deaths cards...........
Burial Permits .............
Requisition for supplies...
Report of divorce granted..


Number
14,350
49,535
5,000
2,500
3,000
5,000
11,000
43 ,500
1,500
2,000
55,000
29,300
33,000
19,000
2,500
1,000
500
1,000
5,000
5,000
1,000
2,000

1,000

100
1,000

10,491

20,000
10,000
5,000
5,000
20
350

5,000
25,000
5,000
5,000






- 43 -


Printed forms, Bond pupor, onion papor, etc. supplied to the
Bureau of Laboratories:


Letter heads............E...........................
Bond Paper.............,;0.......................
Onion paper.. ......... .......... ..*****... .., .......
Second yellow sheets.............................


Envelopes,


Envelopes,


Envelopes,

Envelopes,

Envelopes,


Jacksonville,


Tampa.......

0........
Miaai........
*S .o.....s
Pensacola...
".e...e..
Tallahassee..
.........


13....... ... n~o5 f, 500009
13's. 9r.. .... .. ~, ce g e e

13's.. S0*'* 50 e000 *500 ***O


13' 8..... ... ,,,... ... C**


j31 5,.*.*e** 0*gg** *05 .g.,

13(8 ee g a eee e. e o


Mimeograph copies......................................
Kahn Data.... .................................. ....
Diphtheria Data.......................................
Gonorrhoea Data.. ............... ......*.....
A, P. Data.....O.e......g..................... ........ ..
Miscellaneous Data.....................................
Agglutination Report.... .............................
Malaria Report....... ..c.............................
Miscellaneous Report....*..............e.........e....
Gonorrhoea Report ................. ....****** ..*******
Annual & Monthly Report of Labs......................
Examination of Rabies Datr. Information...............
Malaria Envelopes, Jacksonville.............**********
Tanpa...............................
Daily report of laboratories... ................*......
Kahn report record....................................
Container labels, Jacksonville. ...............e.. ...eo
Mailing labels, "................................
Buff cards.........*.,,...............................
Letter heads & envelopes, Dr. Griffitts..... .... ......


500
6,500
2,000
2,000
24,.790
10,192
750
6,000
2,000
250
3,000
4,500
2,000
750
500
1,250
150
96,000
53,464
32,000
96,000
8,000
32,000
32,000
4,500
16,000
1,000
1,000
10,326
2,000
5,000
5,000
6,800
3,000
1,000
650






- 44 -


Printed forms, Bond paper, onion paper, etc., supplied to the Bureau
of Commmuicable Diseases.


Letter Heads....................... 4,150
Envelopes... ....................... 4,250
Envelopes, Gov. ..... ........ ... 8,000
Bond paper......................... 1,000
Onion paper.. ................. 4,500
Scratch pads............... Sheets.. 2,000
Field service report................ 6,000
Morbidity letter heads ............. 6,000
Gov. Morbidity Envelopes........... 5,000
Morbidity weekly report............. 4,500
Mimeographs copies, (24 stencils)... 7,647
School Inspection cards, Buff........ 19,600
School Inspection Cards, White...... 25,000
T. B. Test, To Parent................ 9,000
Motion Picture Placards............. 3,000
Hookworm Treatment Envelopes...,.... 5,500
Free Hookworm Treatment.............. ,000
Carbon Tetrachloride Notice......... 4,500
Hookworm Cnpsules labels............ 2,000
Smallpox Vaccination Certificateo... 10,000
Typhoid request.................... 18,000
Typhoid Certificate Blank......... 15,000
Triple Request blank................ 24,000
Expense Account Book, Pocket form... 2,750
(275 Books)
Letter heads, Leon County........... 1,300






- 45 -


Printed forms, Bond paper, onion paper, etc., supplied to the Division
of Public Henlth Nursing.


Letter heads.*................ ....... 11,050
Bond papor............................ 4,200
Mimoograph paper...................... 27,000
Onion paper......................... 4,000
Envelopes. ................ ......*..* 6,500
Yellow second sheets....... ......... 1,500
Manila envelopes...................... 5,000
K. Klasp envelopos................... 2,875
Business cards..... .................. 1,500
Post cards............................ 9,585
Investigation cards................. 730
Midwife Practice without licenso...... 550
License to practice midwifery......... 225
Certification of rogistration......... 225
Midwife equipment................. 2,500
Midwife certificate of registration... 1,000
Monthly report for midwives........... 2,250
Hookworm negative blank............... 3,500
Letters..*.......,*................... 1,000
May Day Song............. .......... 250
Song rolease.................. 250
P. H. Workers................ 500
Post card................. 588
Diet chart No. 1.......2.............. 2,000
No. .... .................. 2,000
No. 5..................... 4,000
No. 4..................... 2,000
Postnatal letter No. 1................ 2,000
2 ............... 2,000
3................ 2,000
4................ 2,000
n 5................ 8,000
Mimeograph forms (27 S4ncils)........ 4,955
This Certifies That.................... 800
Midwife Institute Nurse Record........ 850
Midwife creed (Prnyet)................ 2,000
Midwife retired certificate........... 500
Midwife Instituto Program............ 750
Midwife Register Book.. (,9O9.99.OV1 99,000
Personal Data Midwives................ 1,000
Midwife acknowledgment not to Practice 600
Midwife Record........................ 1,600
Midwife Manual, 19 pgs.Mimoes.2000 bks. 38,000
Forms, A. and B. midwife .............. 6,000
Tampa midwife institute............... 1,800
Name Card................................. 200







- 46 -


Printed forms, etc. supplied to the Division of Drug Inspection:




Letter heds............................ ...... 750
Letters...... ......... ........ ............ 1,460
Record of Drug Stores...............*........ 1,000
Registration blanks.......*........**........ 1,500
Certificate of Narcotics...................., 100
Application for license Narcotics............ 100
Application for forfeit narcotics............ 100
Notice of Sale of Narcotics.................. 100
Request for forfeit narcotic drugs..*........ 100
Application for Retail Narcotic Liconse..... 800
Retail Narcotic License.................... 1,300
Application Narcotic License................. 500
Case Report.................................. 500


LIBRARY

Letter heads...................... .... 250
Yellow sheets............................... 1,000
Questionnairo, S. B. H...................... 225
Shelf Index Labels........................... 470


MULTIGRAIH

Labor & Cost sheets......................... 1,500


ENGINEERING, C.W.A.

Weekly report to District Supervisors........ 5,000
Fla. Post Mosquito Control.................. 5,000
Fla. Post Mosquito Control, Foreman.......... 1,600
Fla. Malaria Control.................* ...... 5,000
Malaria Control Ass't Director Weekly Report. 600
Mimeographs, (10 stencils).................. 5,750






-47-

DIVISION OF PUBLIC HEALTH NURSING





1933 has seen a marked growth in the development of the Division of
Public Health Nursing. At the beginning of the year there were but three nurses
in the division. One devoted her entire time to parent education study classes,
a second was in charge of midwife control, and the third, as field contact nurse,
visited in an advisory capacity all public health nurses in the state and kept
in touch with various lay groups who wrote in to the State Board of Health for
advice and assistance in health matters. A fourth nurse, connected with the
Bureau of Communicable Diseases, was engaged in tuberculosis clinic work.

Before the summer was over, the nurse from the tuberculosis team was
transferred from the Bureau of Communicable Diseases to the Division of Public
Health Nursing, a second nurse returned from a leave of absence for study pur-
poses, and another public health nurse -- a former staff member -- added, making
a total of six nurses in the Division of Public Health Nursing.


The state was then divided into
district, where she was responsible for
outlined by the State Board of Health.
of acting chief.


districts and one nurse assigned to each
all public health nursing activities as
The sixth nurse assumed the responsibilities


1933 left us with rumors and reports of many projects in the nursing
field, and with these added to the present set-up we believe that the coming year
will be a most fruitful one for public health nursing.


Personnel


Miss Joyce zly, Nurse-Midwife,



Miss Lalla Mary Goggans, R.N.


Miss Mary Dodd, R. N.



Miss Annie Gabriel, R.N.

Miss Jule 0. Graves, R. N.

Miss Frances Hall, R. N.

Miss Johanna L. Sogaard, R.N.

Iiss Helen Van Osdell


Supervisor of Midwives and Acting Chief Nurse
August 1 December 31.. Leave of absence for
study January 1 July 31.

Assistant Supervisor of Midwives,
January 1 December 31.

Staff Nurse, July 1 August 31.
Transferred from Bureau of Communicable Diseases,
July 1.

Staff Nurse, Jauary 1 December 31

Staff Nurse, January 1 December 31

Staff Nurse, July 10 October 7

Staff Nurse, November 24 December 31

Office Secretary, January 1 December 31


Clerk, January 1 December 31.-


Miss Anne King






-48-
Outline of the Program of the Division of Public Health Nursing

I. MATENITY SaVICE

1. Maternity Lotter Service

This service furnishes nine prenatal letters to the expectant
mothers whose names are sent in to us through doctors, nurses,
relatives, friends and midwives. The purpose of this service is:

a. To get in touch with all prospective mothers as early in
pregnancy as possible.

b. To see that they are provided with both medical and nursing
supervision throughout the maternity cycle,

c. To instruct mothers and fathers in maternal hygiene and
infant care

d. To instruct in the preparation for delivery.

e. To arrange or provide nursing assistance during delivery.

f. To provide or supervise adequate nursing care to mother and
the newborn baby.

g. To secure physical examination of the newborn baby.

h. To secure medical examination for the mother.

2. Midwife Control

This service is the major service of the division, and includes
licensing and registering midwives according to the law; securing
health examinations and blood tests for teo mid~ivos; assisting
in the correction of their defects; institutes for the midwives
and class work stressing the objectives -.lFed in the maternity
letter service, especially cleanliness.. cc.duct of the normal
delivery, the puorporium, and birth registration.

3. Home calls and conferences.

II. INFANCY SERVICE

1. Postnatal Letter Service

This service furnishes five postnatal letters to the new mother,
beginning with the birth of the baby, and covers the period of
the first year of life. The purpose of the postnatal letter
service is:

a. Assist in securing medical supervision including a physical
examination for every child.

b. To instruct the mother in the importance of proper feeding
Tith emphasis on breast feeding for infants.






-49;*

c. To instruct the mother in the bygene and daily regime of
the child.

d. To assist in communicable disease control by the early
recognition of symptoms.

e. To assist in communicable disease control by securing
immunization.

f. To assist in securing the correction of defects.

g. To supervise adequate nursing care for all sick infants.

III. PARENT EDUCATION

Course 1

Mothers Classes, Prenatal, Natal and Postnatal Care

The Confinement Room Demonstration.
The Sterile Obstetric Package and Postpartum Tray -
Demonstration and talk.
The Baby's Bath Demonstration and talk.
The Baby's Bed Demonstration and talk,
Additional Foods for the Infant Under One Year
Demonstration and talk.
Preparing Baby's Toilet Tray Demonstration and talk.
Literature of the Division.

Course 2

Mothers Classes The Infant and Preschool Child

Series 1. Habit Formation
2. Emotions
3. Adolescence
4. Pre-adolescence and Adolescence
5. Mental Hygiene.

Course 3

Classes at State University

NG 203 Child Psychology
NG 204 Maternal and Infant Care.

IV. COIIMNICABL DISEASE

Cooperating with the Bureau of Communicable Diseases the Division
bears in mind the following aims:

a. To assist in securing complete reporting of communicable
diseases.
b. To assist in securing medical supervision.

c. To secure or supervise nursing care.








d. To prevent the spread of disease through the teaching of
isolation, quarantine and immunization.

a. To emphasize the importance of convalescent care to
prevent sequelae.

f. To teach hygiene as a means of general disease prevention,

NOTE: We have not listed services under the headings of preschool, school
age, adult health service, morbidity, orthopedic, mental hygiene,
tuberculosis and venereal disease, as our service along these lines
is more of a general educational work in connection with Midwife
control and Parent Education Sections.



Service to or in behalf of individuals.

Statistical


One or more visits were made to white and colored
in 62 counties. Counties not visited:


Clay
Flagler
Nassau.


in 194 communities


Okeechobee
Union.


Home Calls

Antepartum
Postpartum
Newborn
Care and Feeding, Infant,
Preschool, and School
Communicable Diseases
1bleric
Hookworm
Tuberculosis
Other


Total
40
18
22

274
33
21
6
9
73
496


Whi te
17
10
12

142
18
14
5
4
30
252


Colored
23
8
10

132
15
7
1
5
43
244


Total number
Total number
Total number
Total number


Birth
Registration


visits to home
homes visited
conferences held
persons conferred about


496
206
61
174


115 visits were made to registrars.
60 unreported births were discovered,
28 white, 32 colored.





-51-


Personal Interviews

Total White Colored
Doctors-not public health 216 166 50
Health Officors 134 132 2
Nurses-not public health 148 107 41
Public Health Nurses 496 357 139
Teachers 37 33 4
Parents and guardians 5 4 1
Interested Individuals 2909 1977 932
Members of State Staffs 685 685
4630 3461 1169

Mi dife Control

Florida is now one of the fow states that has a nurse-
Nurse- midwife supervising the midwife program. Through a fellowship
Midwife granted by the Rockefeller Foundation to Florida, Miss Ely
completed a ten months' course at the Lobonstino Midwifery
Clinic in New York City and was issued a diploma of a graduate
nurse-mi dwife.

Outline of Midwife Program

One county at a time is to be visited and worked completely.
The nurse is to make her temporary headquarters in the county seat
of the county in which she is working. When work in a county is
completed the necessary forms and reports are to be filled out
and sent in to the Division of Public Health Nursing.

Where there aro local health authorities, work is to be
conducted as much as possible through them.

Class Work A minimum of four hours instruction with each
group of midwives.
The midwife manual is used as a text book.
Additional outlines of lessons and demonstrations are fur-
nished to the nurses by the Public Health Nursing Division*
The Child Itgiene equipment is to be used in teaching the
mi cives.
Each midwife is to be instructed to bring one or more mothers
to class with her, in order that the people she serves may know
what is expected of the registered midwife, and to learn the
minimum standard of prenatal, natal and postnatal care.
Class work is to be graded, good, fair, poor.

Bag Inspection Each bag is to be inspected, condition noted
on the tag, and then checked on the bag inspection sheet.

Reports -
1. Personal data card fo( all new midwives
2. Summary shoot of county midwives
3. Bag Inspection sheets
4. Investigation cards for those investigated
5. Deliveries by other than registered midwives
6 Doctors reports on health and Kahn tests
7. Reports on registrars visited
8. List of koy-poople visited in county, together with
their official title and position.







Midwife Law


Institutes
for
Midwives


-52-
The 1931 Act Controlling the Practice of Midwifery was
redrafted, with the idea of doing away with the procedure of
securing a new license to practice each year, by making a
license valid until revoked. In the re-draft a penalty for
violation of this act was provided for.

This bill (Number 212) was introduced in the Legis-
lature by Dr. C.W. Chowning but did not pass.

One great advantage of this bill (Number 212) is that
months of clerical work, now necessary under the 1931 law
in licensing each midwife every year, can be done away with.


1933 marks the introduction of the Institute for
Midwives in Florida. The first Institute was held August
20 to 27th at the Florida Agricultural and mechanical College
(colored), Tallahassee. It is most fitting that the first
Institute for Midwives was held in the capital city, at the
largest institution for negro education in the state, and
made possible by the interest and cooperation, of J.R.Ei. Lee,
President of the College, and one of the most outstanding
negro educators in the South.

The State IMdical Association, the State Federation of
Women's Clubs--who were largely responsible for providing
transportation for the midwives from their homos to
Tallahassee and back--and many other groups, lay and pro-
fessional, all cooperated to make this Institute, held for
the midwives of West Florida, a success. 234 midwives from
25 counties attended. The class work included lectures and
demonstrations by doctors and public health nurses on the
following subjects: annual hBalth examinations, prenatal
care, infant care, conduct of delivery and postpartum care,
midwife equipment.

Other interesting features of the Institute were health
examinations for the midwives, including urinalysis, hookworm
and blood test for syphilis; a prenatal clinic held at the
Florida A. and Mi. College Hospital as a demonstration, and
conducted by Dr. S.R. Norris, who represented the State
Medical Association; an adequate recreation program.

This Institute was most ably planned and conducted by
Miss Lalla iary Goggans, Assistant Supervisor of Micdives.

In November, from the 23rd to the 29th, a second
Institute was hold in Tampa for West Coast midwives at the
invitation of Dr. J.R. McEachern, City Health Officer, and
through the cooperation of the Tampa Urban League, represented
by Cyrus T. Greene, Executive Secretary. One outstanding
feature of this Institute was the participation of the
graduate midwives of Tampa, v&o assisted the public health
nurses in their program. 96 midwives from 18 counties were
present.









List of
Registered
Midwivos



Midwife
Manual






Mi dwife
Classes


A roster of registered midwives was printed in book form
this year instead of being published in Health Notes. A copy
was sent to each registered midwife, registrar of vital statistics,
public health nurse and doctor.

The midwife manual was revised and the technique of the prep-
aretion for labor made simpler. The midwife creed and prayer,
composed by the midwives of the St. Petersburg Club, and the
midwife song, "For We Are All Midwives, Indeed", composed by
Nurse Margaret Johnson, was included in this manual. The manual
serves not only as a book of instruction to midwives but is used
as a guide and text book for the class work.

Classes and demonstrations were held for the midwives of
the following 23 counties:


With local supervision
Dade Palm Beach
Duval Polk
Escambia Putnam
Loon St.Johns
Marion Taylor
Orange Volusia


Number classes held
Number midwives attending


Bag
Inspections


Without
Alachua
BrovCrd
Charlott
DeSoto
Gilchris
Hardee


Total
65
528


White
21
30


local supervision
Hendry
Levy
;e Martin
Monroe
it St.Lucie


Colored
44
498


The bag inspection is an important part of each midwife
meeting. Each nurse has a model bag with which to demonstrate
the standard equipment.


bags
bags
bags
bags
with


inspected
complete
reasonably complete
incomplete
no bags


Total
429
296
66
67
13


White
13
5
2
5
1


Colored
422
291
64
62
12


These model bags have been loaned on request to thb local
supervisors of midwives to use in their class work,


Number
Number
Number
Number
Number







-54-


Local The 19 public health nurses who accepted the responsibility
Supervisors of supervising the midwives this year in their communities are as
follows:


County


Local Supervisor


Dade
Duval
Escambia
Hillsborough
Indian River
Leon
Marion
Orange
Osceola
Polk Lake Wales
Winter Haven


Putnam
St. Johns
Seminole
Taylor
Volusia
West Palm


Beach city
county


Nurse Carrie Emanual, R.N.
Mrs. Lucy Knox McGee, R.N.
Mrs. Vandilla Blalock, R.N.
Mrs. Gladys Smith, R.N.
Miss Leila M. Bunkley, R.N.
Nurse I. Odell McGreen, R.N.
Mrs. Helen Sutton Harris, R.N.
lrs. Minnie B. Broughman, R.N.
Mrs. Ezma T. Schellenberg, R.N.
Miss Anne McCauley, R. N.
Miss Sylvia Erb, R. N.
Miss Frances Jones, R. N.
Miss Margaret W. Breese, R.N.
Mrs. Dorothy Lamb, R.N.
Mrs. fMary E. Herndon, R.N.
Mrs. Josephine Riley, R.N.
Nurse Zula Bonner, R. N.
Nurse Rosa Brown, R. N.


Most of the local supervisors have regular monthly
meetings for the midwives, checking bag equipment and holding
classes, based on the midwife manual.

We have records in our files of 1552 midwives, 50% of
this number have complied with the law and are licensed,
registered midwives. Of the 763 midwives who are licensed
and registered, 11% are white and 89% are colored. Of the
789 midwives who are not licensed and registered 20% are white
and 80% are colored.

These figures show the great need for adequate super-
vision in the field.


No. applications for license sent .
No. applications for license received
No. licenses issued . .
Class A .. ..
Class B . .
Class C . .. .
No. licenses refused . .
No. licenses returned voluntarily
and resigned . . .
No. licenses revoked . .
No. licenses reinstated . .


Total
1217
954
845
12
25
808
26


25
84
15


White
165
132
107



2

6
4
1


Colored
1052
822
738



24

19
80
14







-55-


No. applications for Certificate of
Registration sent out .. .
No. applications for Certificate of
Registration received ....
Total number Registration Certificates
issued . .
No. Registration Certificates issued
for 1933 . ..
No. Registration Certificates issued
for 1934 . .
No. midwives notified not to practice


Total White Colored

845 107 738

818 101 719


880

763

117
603


89 791

85 678

13 104
125 478


30 midwives were notified not to practice because their blood test
for syphilis proved positive. They wore asked to secure treatment from
their family physician and not to practice midwifery until their physician
gave them a certificate saying they were no longer a source of danger to
mothers and babies,


No. midwives practicing without
registration . .


Homo visits to midwives


Individual conferences with midwives .

Number of investigations of midwives .


789 162 627


43 209

44 824

27 109


Parental educationn

Miss Annie Gabriel, who is a specialist in parental education work
revised her study group topics for 1933-34, as follows:

Preschool groups The Mental Hygiene of Childhood


Why parents?
Personality Habits
Some undesirable habits
Parental attitudes
Individual differences in children
Achieving mental hygiene.


The Child at School


The school health program
What is education?
Abilities and capacities
The nursery school movement
Children's reading
Leisure and recreation.


. . .






-56-


The Adolescent

1. The mooning of maturity
2. Capacities and learning at adolescence
3. Who should go to college
4. Adolescent conflicts and escapes
5. Loosening family ties
6. Moral and religious development

Mental Hygiene for Adults

1. Fear and the personality
2. Conflicts
3. The effect of failure
4. History of the mental hygiene movenmnt and serious
mental disturbances
5. The objective attitude
6. The wholesome personality

Social Hygiene

1. Sex education in the young child
2. The emphasis at adolescence
3. Some difficulties
Masturbation Sex perversion
Petting The movies
Unmarried parenthood Bad literature
Day dreaming Sex talk
4. The venereal diseases
Syphilis and gonorrhea
5. Reproduction and Eugenics.


Classes were held in the
teacher association groups:

Number
Date County Grouns


following counties through the local parent


Number Number Total Number of
lessons enrolled Attendance Certificates


1/30-2/17
2/22-3/3
3/6-3/24
3/26-3/31
4/17-4/28
5/1-5/19
5/22-6/22
9/25-10/16
10/23-11/24
12/7-12/28


Seminole
Broward
Dade
Mcnroe
Vclusia
Pinollas
Brevard
Duval
Hillsboro
Scrasota


Total Counties 10 51 192 1724 3358 662


148
96
190
88
23
98
64
358
444
215


376
232
343
216
68
240
92
595
837
359


51 192 1724


3358 662


- -- --- --


. .,


Total Counties 10







-57-


School Classes and Talks


Town
Miami Senior High
Key West Junior High
Key West Senior High
Daytona High
Sarasota High
Total

Parent Classes
Talks
Total persons reached


No. classes
6
5
5
18
1
35


Enrollment
500
173
115
107
200
1095


1724
591
3410


Other Talks


Group
Seminole County teachers
Ft. Lauderdale 2nd Avenue P.T.A.
Miami, Shenandoah
Brandon
Tampa, Federation Women's Clubs
Sarasota: Baptist Young People
County teachers
Bay Haven P.T.A.
South Side P.T.A.
Central P.T.A.
Totals, talks 10


Number Attending
109
42
68
200
25
50
200
30
30
75
591


Two classes Child Psychology; Maternal and Infant Care were taught at
the University of Florida Summer School, Gainesville, June 8 to August 4.


Other Classes, Lectures and Talks


"Problems Relating to Midwifery" St. Lukes Hospital,
January 27, to 50 senior students from four
Training Schools for Nurses.

"Rural Public Health Nursing" St. Lukes Hospital,
February 10, to 50 senior students from four
Training Schools for Nurses.


Jacksonville,
Jacksonville


Jacksonville,
Jacksonville


"Resources Available to the Public Health Nurse from the State Board of
Health" Public Health Section, State Nurses Association, November Z.

"Problems in MIidifory" General session, Florida Public Health Association,
December 5.

"The First Florida Institute for Midwives" Public Health Nursing Section,
Florida Public Health Association, December 6.

"The School Nurse" at a meeting of the County School Board of Sarasota.









Public Health
Nursing for
Student Nurses


C.W.S.A.
Public Health
Nur sing for
Graduate Nurses.


A 15 hour lecture course on Public Health Nursing was
given to 35 senior students of the Orange Gonirak Hospital
and Florida Sanitarium at the Orange General Hospital in
Orlando.

With the advent of C.W.S.i. it was found necessary to
plan a series of lectures and demonstrations to fit the
county-wide nursing projects. Lectures were planned and
instruction and demonstrations in school nursing over a
period of one week each were given to nurses in Columbia
and Lalm Counties.


Maternity Letter Service


Letters distributed in quantity lots.

770 complete sets of maternity letters, consisting of 9 prenatal
letters and 5 postnatal letters wore sent to 20 public health nurses in
15 counties in quantity lots to be used in connection with their infant
and maternity program.

There are 11 pamphlets and leaflets --Children's Bureau publications --
enclosed with the prenatal letters, and 4 diet slips enclosed with the post-
natal letters.

10,780 letters
11,538 enclosures.

Letters sent to Individuals

This service reached 438 mothers, 80 white and 358 colorea, in
32 counties.

2286 prenatal letters were sent
2342 postnatal letters were sent
4836 enclosures were sent.


Total number letters distributed in quantity lots and to
individuals

Total number enclosures

Source of request: Midwives 358
Doctors 33
Nurses 30
Friends 17.


15,408

16,378







-59-


Other Literature and Supplies Distributed

.Children's Bureau Booklets and Folders

Prenatal Care . . ... 1117
Infant Care . . . 1389
The Child from 1 to 6 . 571
Are you Training Your Child to be Happy 489
What Builds Babies . .... 101
Breast Feeding .. .. 449
Keeping the Well Baby Well . 477
Out of Babyhood into Childhood . 477
Why Drink Milk ........... 529
Why Sleep . . . 495
Sunlight for Babies .. . .. 506
Minimum Standards of Prenatal Care 397


Midwife Supplies


Silver Nitrato . .
Monthly report forms ..
Manuals . . .
Joint Pledge blanks ..
Mask patterns . .
Cord dressing patterns ..
Midwife equipment instructions
Birth Certificate books .


* .
* *

* *


5634
5601
928
965
838
844
918
154


Miscellaneous


Roster of Registered Midwives . 817
Layette Instruction sheets 925
Teachers physical examination blanks 1763
Hookworm specimen report blanks-positive 2450
-negative 3400


Exhibits

The midwife and child hygiene exhibit were shown as follows:


Senior students of the four training schools
for nurses St. Lukes Hospital
Florida Federation of Women's Clubs, Avon Park
Florida Conference of Social Work, Sanford
Florida State Nurses Association,St.Petersburg
Florida Public Health Association,St.Petersburg


January 27 and
February 10
March 14-16
May 3-6
November 1-3
December 3-6.


Child Hygiene exhibits have been loaned to be used in connection
with mothers classes, to public heaLth nurses in the following counties:


Duval
Leon
Marion
Pinellas
Polk


Mrs. Lucy Knox McGee
Nurse I. Odell McGreen
Mrs. Helen Sutton Harris
Miss Bruce Hellams
Miss Anne McCauley






-60-
Picture Publicity

Moticn Pictures

The motion pictures, taken and arranged by Miss Jule Graves, have
proved to be a great source of interest wherever they are shown. These
pictures portray health problems met with every day by the public health
nurse--i.e., undernourished children, lack of sanitation, sickness, prenatal
care, and problems relating to midwifery.

1 reel "Florida Midwives" shown to senior students of four training schools
for nurses, Jacksonville, January 27.

1 reel "Health Activities" St. Lukes Hospital, February 10.

Both reels shown Orange General Hospital, Orlando, September.

These pictures were also shown to groups of midwives, who found them so
interesting they asked for a second showing.

Picture Folders

Small pocket-sized folders of kodak pictures showing interesting
details of the midwifery work have been prepared and used by the staff and
county public health nurses as a means of provoking the interest of the
public in the problems of midwifery.

Album
The large album of kodak pictures taken in the field, and showing
many activities of the State Board of Health, has proved to be a never
ending source of interest at every state meeting where it has been exhibited.

Meetings Attended

Annual meeting Florida Federation of Woman's Clubs, Avon Park, March 14-16
State Parent-Teacher Association meeting, Daytona Beach, April 1-7
Florida Conference of Social Work, Sanford, May 3-6
State Parent-Teacher Association Board Ieeting, October 18-20
Florida State Nurses Association, St. Petersburg, November 1-3
Florida Social Hygiene Association, St. Petersburg, December 1
Florida Public Health Association, St. Petersburg, December 3-6
Florida Educational Association meeting, Tampa, December 29-30.

Regional conferences for Public Health Nurses were held in Bartow
December 22 and in West Palm Beach December 8. Miss Alma Haupt of the
N.O.P.H.N. explained the moaning of public health nursing projects under
the C.W.S.A. At the Bartow meeting, Dr. Estello Ford Warner was a visitor
and talked on methods of starting child hygiene programs,





-61-
May Day Activities

Literature was sent during March to 85 public health nurses and
interested individuals in all counties of the state in an effort to
encourage the observance of May Day-Child Health Day.
Reports of May Day activities were received from eleven local May Day
Chairman. City-wide programs were hold in the following cities:

Sebring Deland
Rains City Lake Wales
Daytona Beach West Palm Beach.

County-wide programs were held in the following counties:

Lee Seminolo
Marion Pinellas.
Putnam

The reports from the chairmen give the total number participating in
the May Day programs as approximately 6550. Costume parades, health plays,
songs and games and May Polo dances were featured in many of the programs.

Newspaper publicity was widely used by the May Day Chairmen. Other
activities included were:
Summer round-ups: attendance 106
Diphtheria immunization clinics: attendance 400
Dental Clinics: attendance 488
Blue Ribbons presented: 450.

Clinics

Assistance was given the Pasco County Tuberculosis and Health
Association in conducting a tuberculin testing clinic for children. The
clinic was hold in Dado City, October 30.
Storm Area Survey

A survey of conditions caused by the September 4 storm was made.
Daily Record Sheets

The daily record sheet was revised to fit the need of our present
activities.


Total number miles traveled 61,655
Total number hours clerical work 2,581
Form letters sent 4,303
Post cards sent 4,415
Personal letters written 2,924.



Respectfully submitted,


(Signed) Joyce Ely, R. N.
Acting Chief Nurse.






REGISTERED MIDWIVES OF'RORIDA 1933 WHITE


STATE BOARD OF HiALTH
Division of Public Health Nursing
Jacksonville, Florida


Alachua 36,400
Baker 6,500
Bay 12,300
Bradford 10,100
Brevard 14,800
Broward 24,800
Calhoun 7,400
Charlotte 4,500
Citrus 5,600
Clay 7,300
Collier 3,500
Columbia 14,700
Dade 174,700
DeSoto 7,900
Dixie 7,800
Duval 168,800
Escambia 54,900
Flagler 2,500
Franklin 6,600
Gadsden 31,900
Gilchrist 4,300
Glades 2,900
Gulf 3,600
Hamilton** 9,454
Hardee 10,600
Hendry 4,300
Hernando 5,100
Highlands 10,900
Hillsboro 174,200
Holmes 12,900
Indian R. 7,800
Jackson 32,200
Jefferson**13,408


26,500
17,300
25,200
13,300
4,067
15,614
25,000
31,400
6,000
13,624
9,375
10,100


Orange 59,200
2 Osceola 11,800
3 Palm B. 62,800
4 Pasco 11,100
Pinellas 72,900
1 Polk 83,000
1 Putnam 19,200
2 St.Johns 20,500
St.Lucie 8,100
Santa Ros 14,200
ISarasota 15,100
1 Seminole 21,200
Sumter 11,500
Suwann o 15,731
Taylor 13,700
L2 Union 8,100
5 Volusia 48,900
vakulla 5,600
4 Walton 15,400
iJashingto 12,300


** 1930 Census No estimate


*** .
6d
SO






-63-
REGISTeRED MIDWIVES OF FL3RIDA 1933 COLORED


Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
DoSoto
Dixie
Duval
Escmbia
Fla gler
Franklin
Gadsden
Gil hris t
Glades
Gulf
Hamilton**
Hardeo
Hondry
HEIrnando
Highlands
Hill sboro
Holmes
Indian R.
Jackson
Jeffoirson**
LafoayAtto


STATE BOARD OF HEALTH
Division of Public Health Nurs ng
Jacksonville, Florida

cOUNTIES ESTIMATED NO.OF COUNTIES ESrIEIT.) NO.0F
POPULATION MIDWIVES POP. M.W.


36,400
6,500
12,300
10,100
14,800
24,800
7,400
4,500
5,600
7,300
3,500
14,700
174,700
7,900
7,800
168,800
54,900
2,500
6,600
31,900
4,360
2,900
3,600
9,454
10,600
4,300
5,100
10,900
174,200
12,900
7,800
32,200
13,408
4,400


6
26
23
1


** 1930 Census no estimate


Lake
Lee
Leon
Levy
Liberty**
I'adison**
Mane too
Marion
Martin
Monroo**
Nassau**
Okaloosa
Okeechobe
Orange
Osceola
,Palm B.
Pasco
Pinellas
Polk
Putnam
St.Johns
St.Lucie
Santa Ros
Scrasota
8ominole
,Sumter
Suwanne**
Taylor
Union
Volusia
Wakulla
a [lt on


26,500
17,300
25,200
13,300
4,067
15,;614
25,000
31,400
6,000
13,624
9,375
10,100
4,800
59,200
11,800
62,800
11,100
72,900
83,000
19,200
20,500
8,100
14,200
15,100
21,200
11,500
15,731
13,700
8,100
48,900
5,600
15,400


Washingtonl2,300 6
Total 678


***
610






S- -64-


UNREGISTERED MIDWIVES OF FLORIDA 1933 WHITE


STATE BOARD OF HEALTH
Division of Public Health Nursing
Jacksonville, Florida


COUNTIES ;STDBATEDi NO.OF
POPULATION iviDI


Alachua
Ba er
Bay
Bradford
Brevard
Broward
Cilhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
DeSoto
Dixie
Duva
-scamrbia
Flagler
Franklin
Gadsd4n
Gilchrist
Glades
Gulf
Hsrailton**
Hardee
Hendry
Hernando
Highlands
Hillsboro
Holmes
Indian R.
Jackson
Jefferson**
Lafayette


36,400
6,500
12,300
10,100
14,800
24,800
7,400
4,500
5,600
7,300
3,500
14,700
174,700
7,900
7,800
168,800
54,900
2,500
6,600
31,900
4,300
2,900
3,600
9,454
10,600
4,300
5,100
10,900
174,200
12,900
7,800
32,200


Lake 26,500
Lee 17,300
Leon 25j200
Levy 13,300
Liberty 4,067
Madison** 15,614
IvLnatee 25,000
Marion 31,400
Martin 6,000
Monroe** 13,624
Nassau** 9,375
Okaloosa 10,100
Okeochobee 4k800
Orange 59,200
Osceola 11,800
Palm B. 62,800
,Pasco 11,100
Pinellas 72,900
Polk 83,000
Putnam 19,200
St.Johns 20,500
St.Lucie 8,100
Santa Rosal4,200
Sarasota 15,100
Seminole 21,200
Sumter 11,500
Suwanee** 15,731


Taylor
Union
Volusia
Wakulla
Wa lton
Washing
Total


p
C,~i a


13,700
8,100
48,900
5,600
15,400
12,300


** 1930 Census-no estimate





-65-
UNR GIST-.AD MIDWIVES OF FLORIDA 1953 COLORED


STATE BOARD OF HaLTR
Division of Public Health Nursing
Jacksonville, Florida


alachua 36,400
Baker 6,500
?ay 12,300
jradfoid 10,100
Brevard 14,800
Broward 24,800
Calhoun 7,400
Charlotte 4,500
Citrus 5,600
Clay 7,300
Collier 3,500
Columbia 14,700
Dade 174,700
DeSoto 7,900
Dixie 7,800
Duval 168,800
Escanbia 54,900
Flagler 2,500
Franklin 6,600
Gadsden 31,900
Gilchrist 4,300
Glades 2,900
Gulf 3,600
HImilton** 9,454
Hardee 10,600
EHndry 4,300
Hirnando 5,100
Highlands 10,900
Hillsboro 174,200
Holms 12,900
Indian R. 7,800
Jackson 32,200
Jefferson** 13,408


Lake
Lee
Leon
Levy
Liberty**
Madison**
Mcnctee
Marion
Martin
Monroo**
Nnss:.u**
Okaloos a
Okooc hoboo
Orr, ngo
Oscoola
Palm B.
Pasco
Pin llas


Santa Rose
Scrasota
Sominolo
Sumtjr
Suwcanoo*
Taylor
Union
Volusia
Wokulla
ialton


a shling t on


**1930 Consus no ostimato


26,500
17,300
25,200
13,300
4,067
15,614
25,000
31,400
6,000
13,624
9,375
10,100
4,800
59,200
11,800
62,800
11,100
72,900
83,000
19,200
20,500
8,100
14,200
15,100
21,200
11,500
S15,731
13,700
8,100
48,900
5,600
15,'400


** u*


12,300





- 66 -


BUREAU OF COMMUNICABLE DISEASES

Personnel

F. A. Brink, M. D., Director
Myrtle McLendon, Secretary
W. A. Claxton, M. D., Tuberculosis Clinician
Mary Dodd, R. N., Nurse for tuberculosis work (to July 31, 1933)

District Medical Officers

Thos. E. Morgan, M. D. District No. 1
Columbia, Baker, Nassau, Duval, Union, Bradford, Clay, St. Johns, Alachua,
Gilchrist, Putnam, Levy, Marion, Flagler.

C. W. Pease, M. D. District No. 2
Volusia, Lake, Seminole, Orange, Osceola, Brevard, Okeechobee, St. Lucie,
Indian River, Martin, Palm Beach, Broward, Dade.

A. C. Hemblin, M. D. District No. 3
Citrus, Hernando, Sumter, Pasco, Pinellas, Hillsboro, Polk, Manatee, Hardee,
Sarasota, DeSoto, Highlands, Charlotte, Glades, Lee, Hendry, Collier.

H. A..McClure, 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
E. R. Marshburn, M. D.
Escambia*, Santa Rosa, Okeechobee, Walton, Holmes, Washington, Jackson, Bay,
Calhoun, Gulf.

*Served by County Health Unit.
***i***********

Dr. Claxton was granted a study leave from May 15th to October 1st.

Dr. Pease had twenty-two days leave in addition to his fifteen days vacation. On
July 25th he was transferred from the East Coast to the West Coast district.

On April 1st, Dr. Hamblin was relieved from duty.

Dr. McDonald was off duty from April 1st to May 1st and from July 31st to August
13th, when he proceeded to Jacksonville for conference and instructions and was
assigned to duty in the East Coast district.

Dr. E. R. Marshburn was appointed District Health Officer in July and on August
1st proceeded to Jacksoaville for ten days training and instructions after which
he returned for duty to District No. 5 with headquarters at Marianna, his place
of residence.

Dr. W. H. Y. Smith, formerly Taylor County Health Officer, was detailed to Hills-
boro and Citrus counties on September llth, 12th and 13th on account of a tropical
storm.

Dr. Leland H. Dame was placed on duty December 1st as Health Officer in a special
district consisting of Citrus, Sumter, Hernando and Pasco counties.






- 67 -


COMMUNICABLE DISEASE INVESTIGATIONS

The usual practice of the bureau with respect to investigating outbreaks and
isolated cases of communicable disease has been continued. Reports of cases com-
ing from physicians on the regular morbidity report form, by letter from physicians
or lay people and by telegram, receive the prompt attention which they seem to
merit. It is necessary to exercise discretion about these investigations. Many of
the reports relate to minor diseases in isolated sections or come from communities
where the local health officer or attending physician can be depended upon to
isolate and take adequate precautions. The appearance of the more serious com-
municable diseases particularly in a community without a local health service, is
our signal to investigate and institute control measures. District Health Officers,
when making these investigations, are expected to get all the information possible
bearing on the source of infection and see as many cases as can be found, so that
control measures may be made effective without delay. In making these studies the
cooperation of physicians is usually available and very helpful. Their instructions
to attendants about precautionary measures, disposal of infectious discharges, etc.,
are emphasized and supplemented by the District Health Officer making the investi-
gation.

Typhoid incidence was remarkably low during 1933. Investigations made by the
Director throw suspicion on oysters as the source of infection for six cases in
Tampa and six others at West Palm Beach. At Daytona, two typhoid patients wore
found to have eaten oysters from polluted waters, throo wore considered secondary
and eight others prosontod no tangible evidence as to the source of infection ex-
cept that they lived in or near the section where there were many open privies.

Diphtheria, likewise, has been reported with less than the usual frequency. There
can be no doubt whatever that the immunizing of many school children is a large
factor in preventing diphtheria. Even though the pro-school ago group are not
reached to any great extent by this program, the prevention of disease in school
children is certain to afford protection to the younger group.

A single case of smallpox was reported during the year and there is ample reason to
believe that this was, in reality, a case of chickenpox. The history of onset,
'haractor of eruption, presence of other cases of chickenpox in the community and
the absence of other cases of smallpox, are rather conclusive. The diagnosis was
allowed to stand, however, in doforoence to the attending physician. A considerable
number of other cases wore reported as smallpox but some of those were found to be
chickenpox, others wore syphilis with pustular eruption and some were nothing moro
than cases of impetigo and scabies reported as smallpox by non-medical persons in
order to get service from the State Board of Health. In spite of the absence of
smallpox from the State, more than 10,000 persons were vaccinated during the year,
enough, if continued from year to year, to prevent the occurrence of any. widespread
smallpox epidemic, such as occurred in 1926.

In February at Palatka there occurred an outbreak of sickness involving 400 or 500
persons who were attacked with vomiting, diarrhea and mild fever, the attacks last-'
ing twenty-four to forty-eight hours. No death occurred and there were no soquolac~
This outbreak was investigated by Dr. Claxtonwho suggests "intestinal influenza"
as the most probable diagnosis.




- 68 -


LEPROSY

Ton Florida lepers were transported to the National Loprosarium, Carville, Louis-
icna, during the year. Nine wore transported at federal expense and one taken
through in a car by the Bureau Director,who took opportunity to visit tho institu-
tion and see many of the patients. Seven of the ton wore now patients and throe
woro readmitted after having absconded. During the year throe Florida lepers
absconded from Carvillo and their whereabouts are unknown.

We believe the care given lepers at Carville is the best to be had. Many of the
patients do so well that they can safely be paroled. Their segregation while the
disease is active is the best known means of safeguarding others from infection.

IMJNIZATION

There is a growing apprehension among practicing physicians regarding the giving of
ft.e immunizing treatmeIt to children whose parents are able to pay a private phy-
sician for this service. In some communities this has caused us to modify our
usual program and give only Schick test in the schools, urging people to avail
themselves of the services of their own doctors for the inoculations. We par-
ticularly advocate this protection for pre-school children but as yet no marked
success has been noted and we are still in search of a method by which parents can
be persuaded to go to their own doctor for the protective inoculation of their
children.

The introduction of alum precipitated toxoid for diphtheria immunization, which can
be given in a single dose, has simplified greatly the work of the District Health
Officers and will, we believe, make it possible to get more children treated by the
feumily doctor. This preparation is less likely to give a reaction than is the tox-
oid solution in common use and the single dose is claimed to give better protection
ihan two doses of the ordinary toxoid. A small lump is left at the point of injec-
tion but this disappears in a few weeks.

Culturing of contacts and school children for diphtheria carriers has been continued
but on a much reduced scale, due in part to the decreased incidence of diphtheria.

Collection of specimens for hookworm diagnosis and the treatment of hookworm pati-
ents has been continued largely as an educational measure and always with the
approval of local physicians. This work affords a means of approach to the subject
of hookworm prevention and the importance of sanitation is stressed at every oppor'-
tunity. It is hoped that many sanitary privies of permanent construction will be
built with the aid of the CWA.

One of the duties of the Director is to inspect Child Caring Institutions for
approval of the State Board of Health which is a prerequisite to the issuing of the
annual license by the State Board of Publia Welfare. There are about 70 of these
places including orphanages, nurseries, boarding homes and lying-in hospitals. SOW-m
maintain such high standards that annual inspection is not necessary but approxi-
mately half of them are visited annually. Some are so bad that approval cannot be
given. Others are able to make certain improvements that are recommended, where-
upon they are approved after reinspection.

Physical examination of school children was continued but with no regularity. Only
on special request are these examinations given and not then unless there appears
to be a fair chance of getting corrections made when found necessary.




- 69 -


For the benefit'of colored doctors a five days institute was arranged and conducted
in Jacksonville. Lectures and practical demonstrations in diagnosis and treatment
of syphilis were given. Dr. Walter Clark of the American Social Hygiene Associa-
tion conducted the institute. Besides the State Health Officer and the Bureau
Director the following Jacksonville physicians gave lectures: Drs. N. A. Upchurch,
F. A. Copp, S. A. Richardson, T. E. Buckman, E. T. Sellars, J. L. Kirby-Smith,
Paul Eaton and C. E. Royce. Ten colored doctors were registered for the course.

Free distribution of neoarsphenamino to physicians for treating their private indi-
gent pyphilitics was continued. 1100 doses were thus sent out. Educational social
hygiene bulletins were furnished on request to educators, study groups, parents and
others requesting them.

The free distribution of dried brewers yeast to indigent pellagra patients was con-
tinued. Some 885 two-pound packages were thus furnished while 646 additional
packages wore sold at cost to those who could pay.

It is interesting to note that in spite of the depression the number of pellagra
cases and deaths has decreased. Just why this should occur it is difficult to say
but it might be attributed to an actual improvement in diet resulting from oduca-
tion as to proper diet, the necessity of producing more food stuffs at home and,
somewhat to the use of yeast.

Health Education

Free bulletins dealing with the control of preventable diseases wore distributed as
indicated in Table No. 2. Newspaper articles and public addresses before schools,
clubs, etc., are other methods of spreading public health information of which due
advantage has boon taken.

On March 1st the regular showing of the health education motion pictures was dis-
continued. This was made necessary by a lack of available funds. During the
balance of the year the pictures wore shosn only on special request. The total
number of showings for the year was 60 and the total attendance 10,358. Mr. W. Y*
Randle, the operator and lecturer has done excellent work and is to be commended
for his diligence and dependability. Tho motion picture service is undoubtedly of
great educational value and it is to bo hoped that it mty be resumed on a full time
basis with some now films which are needed and, perhaps, with sound or talking pic-
tures.

The amount of correspondence handled through the Bureau has continued to increase
and a diligent effort has boon made to answer each inquiry as promptly and fully as
possible though many of them have little to do with public health.

REPORTS

Daily reports and monthly narrative reports are received from the District Health
Officers and the Tuberculosis Clinician. The monthly reports are compiled into a
monthly bureau report for the information of the State Health Officer and Board
Members.

Each County Unit submits weekly and quarterly reports to this bureau. Annual re-
ports of the three units will be found on the following pages.

All morbidity reports are received and compiled in this office. Table No. 3 shows
the number of cases of certain diseases reported by months during the year.





- 70 -


Table No. 1 shows in condensed form a summary of some of the bureau activities as
compared with those of the three previous years.

Dr. Wd A. Claxton continued throughout the year as tuberculosis clinician but was
on leave from May 15th to October 1st. This time was spent in a study of tuber-
cuiosis under a scholarship grant from the Rockefeller Foundation. Dr. Claxton's
report will be found following this one,

Miss Mary Dodd, R. N., was detailed to assist with the tuberculosis clinics and to
do follow-up work (instructing patients and contacts in their homes) until the end
of July when she returned to regular duty in the Bureau of Public Health Nursing.

For tactful, earnest and diligent attention to duty it is a pleasure to express
gratitude and commendation for each member of the staff.

COUNTY HEALTH UNITS

The supervision of the county units has been a responsibility of the Communicable
Disease Bureau. Three units were in operation on the first of the year in the
following counties: Taylor, Leon and Escambia. On August 31st, the Taylor County
Unit was dissolved, due to the fact that the County Commissioners did not feel
warranted in making the necessary appropriation. Reports of the Units will be
found on the following pages.

Until June 15th, the U. S. Public Health Service contributed to the budget of the
county units. From July 1st, the Rockefeller Foundation allotted liberal amounts
to their support, enabling them to continue in spite of the withdrawal of federal
funds.

Under legislative authority, the State Board of Health has given substantial
financial aid to tho units which render excellent health service and rolieve tho
State Board of Health of much responsibility.

Sources and disbursoment of funds for county units are shown in the auditor's re-
port.





- 71 -


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

The activities of the tuberculosis clinician and nurse during 1933 followed tho
same general lines as in 1932 except that tuberculin testing was not encouraged
because it was realized that finding infected children was not of much value un-
less X-ray films could bo taken to pick out the diseased children from among
those who gave a positive reaction. Howover, tuberculin tests wore done in the
schools of Alachua and Pasco counties with the hope that X-rays could be procured
for the positive children. Later it was learned that the necessary funds wore not
available.

In Miami a special survey was mado in the white and colored high schools with
students ranging from 14 to 19 years of ago. Of 861 white students 16.3% gave
positive reactions and out of these 8 cases of tuberculosis wore found by X-ray
examination. In the colored high school'807 tests wore made and 35.81% wore posi-
tive reactors. This shows moro than twice the incidence of infection among the
colored students.

Tuberculin tests were made on tho inmates of the Florida Farm Colony for the
Epileptic and Feeble Minded. Heore pecularly only 19,7% of the males gave a posi-
tive reaction while among the females 42.1% reacted. This can be accounted for
either by the overcrowding among the females or by the fact that one or more open
cases of tuberculosis had infoctod a largo number of female inmates,

An interesting small clinic was hold in Tampa with Dr. C. D. Hopkins, City Physician.
Tests wore done on 30 contact children. Ton of those were positive reactors. X-rays
taken on those ton revealed two definite cases of paronchymatous tuberallosis.
These children had no symptoms or physical signs of tuberculosis. They were at a
stage when six months treatment wTould cure thmo. Think of the early cases that
could be discovered and cured if'we had funds for X-ray films in connection with a
large number of tuberculin tests.

Many chest examinations woro made at the request of physicians over the state. This
is a service which could be more generally requested by physicians. Most general
practitioners are glad to got this service and most of the patients are not able to
afford paid consultation for diagnosis and advice on treatment.

The tuberculosis cottage at the Prison Farm at Raiford was visited and a number of
patients examined with Dr. Whitakor. An adult clinic was hold in Alachua county
with very good attendance.

In May a course of study in the north was begun through the generosity of the
Rockefeller Foundation. This included the course at the school for tuberculosis at
Soranac Lake and a three months stay at the Henry Phipps Institute in Philadelphia.

These courses were productive of much valuable knowledge and experience in the field
of tuberculosis. The school for tuberculosis at Saramac Lake lasted six weeks. 24
doctors from the United States, Canada, Japan and China took the course which was a
complete study of the subject of tuberculosis from anatomy and pathology thorough
diagnosis with clinical cases furnished and demonstration of the latest methods of
medical and surgical treatment. Three months woro spent at the Henry Phipps Insti-
tute at Philadelphia whore clinical material, correlation of physical and X-ray
findings and association with loaders in the field of tuberculosis combined in fur-
nishing a valuable course of study.











The main features observed wore: that rest, good food and fresh air are still con-
siderod the basis for troatmont of tuberculosis; that early diagnosis is of para-
mount importance especially for shortening tho required period of treatment; that
X-ray is boing used more and more not only for diagnosis but to study the course of
the disease; and that surgical measures such as pnoumothroxo, phrenicoctomy and
thorccoplasty are being used more gonorally in selected cases. The aim of the
treatment is to got rid of cavities and this is most quickly accomplished by
collapse of the lung in one way or another.

As the end of the year is reached wo find all over the state a remarkable increase
in the interest of Tuberculosis Control Measures. Everywhere one goes there is the
same question "why isn't something done to provide a place to put our tuberculosis
patients?" This is the result of two factors; First, the fact that people have be-
come educated to the actual need of helping the tuberculosis sick and protecting the
contacts, Second, so many tuberculosis patients have appeared and applied for relief
from the County Officials, the Non-Official Relief Agencies and the Federal Relief
Councils. Wo find several counties and municipalities attempting to provide tuber-
culosis beds. Marion, Volusia, Escambia and Duval counties have boon attempting to
provide hospitalization for their tuberculosis residents. The City of West Palm
Beach is doing likewise. It is unlikely that all these plans will materialize but
that it shows the fooling of a definite need is evident

Our greatest need is a State Sanatorium not for tuberculosis patients to go to die
but for tuberculosis patio s to go to got well. It has boon hoped that a Sana-
torium might be built with federal funds. If this cannot be brought about then the
noxt legislature should surely provide for such an institution. A tuberculosis
sanatorium for the State of Florida will not only bo the fulfillment of a serious
need but will be a creditable monument to the State Administration that is respon-
sible for its construction.

Before closing this report I want to express appreciation to the Florida Tuber-
culosis and Health Association who have worked with us wholeheartedly and through
their county affiliations have deno much to foster the cause of tuberculosis con-
trol measures in the State.


- 78 -







- 73 -


TABLE NO. 1

Sunmary of Activities during 1930-1933, both inclusive

1930 1931 1932

Interviews & Conferences 4474 6397 7746

Public Addresses 467 691 821

Newspaper Articles 121 198 169

Schools Visited 2040 2140 2809

Clinics Attended 1391 1809 2698

Persons Examined 13,897 6703 10,769

C. D. Investigated 740 1017 1156

Cases Isolated or Excluded 477 659 572

Houses Placarded 134 293 73

Smallpox Vaccinations 6520 11,276 17,325

Typhoid Inoculations 37,268 55,409 94,160

Schick Tests 19,925 19,889 21,000

T. A. Given and/or Toxoid 18,357 23,865 21,439

Throat Swabs 1560 4598 2605

Other Specimens 2654 2789 2948

Tuberculin Tests 334 2798 10,769

Malaria Smears 713 57 3146

Hookworm Treatments 2087 1144 2100

Quinine Treatments 721 146


$** ** ** ***


1933

5279

698

117

1924

1611

6198

589

253

31

10,804

62,468

13,792

10,311

417

550

4697

683

4329







- 74 -


TABLE NO. 2



Number of pamphlets distributed by the Bureau of Communicable
Diseases, 1930-1931-1932-1933

1930 1931 1932 1933

Manpower 2513 758 248 737
Outdoing the Osttich 399
Sex Education in the Home 355 210 287 747
Keeping Fit 3759 390 393 523
The Girl' s Part 2100 388 389 100
Healthy Happy Womanhood 3249 283 381 720
Sex Education in the Schools 1485 234 305 416
Wonderful Story of Life for Boys 21
Wonderful Story of Life for Girls 21
Syphilis Information 150 165 440
Gonorrhea Information 150 165 90
Social Hygiene Outline 650
Tuberculosis 4219 5850 1895 1120
Typhoid 1660 1879 341 25
Malaria 7130 4921 2440 10,132
Hookworm 14,767 11,263 8675 13,977
Pellagra 54 389 455 800
Whooping Cough 285 120 51
Diphtheria 6770 5739 2585 2673
Sore Eyes 1890 1149 250 106
Smallpox 770 2874 1730 639
What To Do When 2190 4384 4335 1615
Influenza 3430 440 155 245
Flies 500 331
Rabies 50 10
Mosquito Control 100 677
Privy 186


COMMUNICABLE DISEASE PLACARDS: 245


$*~** ** ** *








- 75 -


TLBLE NO. 3


Number of cases of certain communicable diseases reported to the State Board of
Health during 1930-1933, both inclusive:

1930 1931 1932 1933

Typhoid 140 183 266 183

Typhus 39 31 42 54

Malaria 576 339 318 1011

Smallpox 28 27 33 1

Measles 5287 3779 217 1048

Scarlet Fevor 341 266 235 203

Diphtheria 491 501 735 452

Influenza 104 1543 335 1267

Poliomyelitis 11 17 8 7

Encephalitis 3 1 1 2

Tuberculosis 487 511 591 661

Synhilis 4199 3965 4063 4833

Gonorrhea 802 714 713 616

Pellagra 51 64 60 73

Undulant 4 3 2 6

Tularemia 1 2 2 1





- 76 -


COUNTY HEALTH UNITS.

U. S. Public Health Service
Rockefeller Foundation
State Board of Health
Cooperating
/

TAYLOR COUNTY HEALTH UNIT

A summary of the work done by the Taylor County Health Unit for the twelve months
period from September 1, 1932 to August 31, 1933.

CHILD HYGIENE

Advice and Home Visits: There have been 150 expectant mothers given advice. This
n:irely stressed the carrying out of the orders already given by the family physician;
Where no family physician was in attendance, each patient was advised to be exam-
ined by a physician just as soon as she could do so. Forty-five (45) more expectant
r'thers were reached this year than last year and 72 more than the first year the
1fealth Unit was in operation. An average of 11 midwives were instructed by the
nurse at 17 classes and 214 home visits were made. These classes were held in
order that the standards of midwifery might be raised, as maternal and infant deaths
are highest where midwives officiate in the deliveries. After attending the classes
each midwife was given a certificate by the State Board of Health provided she met
with the necessary requirements. All the midwives of Taylor County attended for
cn3 week an "Institute for Midwives" at Tallahassee. This institute acted as an
advanced course in midwifery. Three thousand and thirty-four (3034) children have
been instructed concerning their physical health (somo children in the school sys-
tom being lectured more than once), and 2420 homo visits have bdon made by the
nurse. Those wore to infants, pro-school and school children, pre-natals, post-
natals and medical and surgical cases. Whore a pro-school or school child had boon
examined, the nurse in her visit talked to the parents concerning the child's de-
focts. Whore the children had not boon examined, the nurse tried to persuade the
parents to have this done.

Examinations: Three hundred and six infant and pro-school children wore examined.
One hundred forty-six (146) of these were found to be defective with 183 defects.
Pro-school clinics were hold at the following places: Foley, Perry, Shady Grovo,
Pine Grove, Covington, Oakland, Mt. Gilead, Pine Level, Stephonsvillo, Carbur,
Athena, Boyd, Fonholloway and Pisgah. Two thousand two hundred eighty-five (2285)
school children wore examined, which included all of the white and colored children
in the school system at the time the examinations wore made. 1512 wore found do-
fcctivo with 2162 defects. There were 77.7% dofoctive school children last year as
compared with 66.17% this year, a decrease of 11.55%. 163 children wore excluded
from school for sane contagious disease until froo from such disease. 176 drills in
hygiono wore held.

Health Classes: Five health classes wore hold for teen ago girls at Perry, Carbur,
Shady Grovo, Foley and Cabbage Grove schools. Those classes were in: (1) Personal
Health, (2) Homo Health, (3) Infant Care,. (4) Communicable Diseases (stressing hook-
worms and malaria, and, (5) Community Health and First Aid.

ORTHOPEDIC CLINIC: An orthopedic clinic was held by Dr. Fort (Crippled Children's
Physician) at the Woman's Club building, when 42 children were examined,





- 77 -


Communicable Diseases: 42 cases of contagious diseases have been quarantiznd, on-
tailing 364 visits by the nurse and physician. Those wore 12 of diphtheria, 3 of
scarlot foyer, 1 of typhoid fever (this case died before the fever was clinically
recognized) and 29 of measles.

Diphtheria: 668 people wore tested for diphtheria susceptibility. 76 were found
susceptible and 285 wore protected against this disease (this includes the non-
tested pro-school children as well as the positive Schick reactors). This moans
that 22.4% of the people of Taylor County, during the past three years, have boon
protected against diphtheria. 108 nose and throat cultures for diphtheria germs
have boon taken. Those were to either diagnose the case at the beginning or the
necessary two cultures for release at the end of quarantine.

Hookworms: 1567 specimens were examined far hookworms. 729 of those were found to
be positive and 838 negative. 682 wore treated for those worms. Hookwomns have
boon reduced from 52.6% in 1931-1932 to 46.6% in 1932-1933, or 6%.

Malaria: 25,302 five-grain capsules of quinine have boon distributed to the people
of Taylor county. This quinine was supplied by the Reconstruction Finance Corpora-
tion for its members and their families. Malaria incidence in schoolchildren has
been reduced from 20.88% in 1931-1932 to 10.15% in 1932-1933, or a 10.753 reduction.

131,570 feet of drainage have been dug in 200 ditches throughout Taylor county. This
work was done by the Reconstruction Finance Corporation under the supervision of
the Health Unit.

Smallpox: 386 people were protected against smallpox. 10.8%f of the people of
Taylor county have boon protected since September 1, 1930.

Typhoid: 1053 people have been protected against typhoid fevor. 20.8% of the
people have boon protected during the past three years. Ono case of typhoid fever
(which died) occurred during the year. This was an imported case from South
Florida.

Tuberculosis: There were 14 people examined for tuberculosis with 3 having been
found to have this disease. There wore 12 active cases in the county during the
year, with 3 deaths.

Corrections: There wore 254 sanitary toilets installed (those include throo typos,
now sanitary pit toilets, privies restored to sanitary type and septic tanks).
Throe now water connections wore found installed. There were 90 samples of water
collected for analysis by the State Board of Health. This included water for
drinking and that from swimming pools. The four dairies showed marked improvement
during the year. 78 dwellings and 12 sleeping quarters have boon found to be offoc-
tively screened against flies and mosquitoes. 885 physical defects in school chil-
dren, or 40.93%, and 46 physical defects in pro-school children have boon found
corrected,

E~lucational: There have boon 2286 circulars distributed throughout the county.
Those have varied from the care of the hair to the care of the foot. Those cir-
culars wore distributed when home visits woro made, at the Unit office and at the
various clinics held.





- 78 -


%lue Ribbon Program: A blue ribbon, gold star programme was held in four schools,
and a gold star programme only was held in four other schools. Any child who had
no physical defects and who had taken the protective treatments against typhoid
fever, diphtheria and smallpox, and the treatment for hookworms (if he had them)
was a gold star child. If, in addition, he had kept the health habit chart for six
weeks, then he was a blue ribbon child. There were 372 gold star and 179 blue ribbon
children.

Sanitation: There were 796 inspections of private premises, 410 of public premises
(which includes all food handling places) and-56 of dairies (a monthly inspection
being made at the least and oftener if necessary). All milch cows in the four
dairies were tested for contagious abortion by Dr. Fish of the State Agricultural
Department. 50 out of the 142 were found to be positive.

*******i*****>*******


LEON COUNTY HEALTH UNIT

The following is a report of the activities of the Leon County Health Unit for the
year 1933:

Educational: Health education is the predominating aim in public health work and is'
stressed in every phase. This is carried out through news articles, talks at schools,
clubs and community meetings, through motion pictures, with literature and in pri-
vate conferences. During the year 59 news articles were printed; 128 health talks
were made to 12,335 people, 2,800 pieces of literature were distributed.

Early in the year community meetings were held at the various schools in the county;
malaria was the subject discussed. Health talks were made in all the schools
stressing especially malaria and hookworm. The purpose of the home visits by the
nurses is to impart information on prenatal care, infant care, tuberculosis,
pellagra or whatever is needed in the home visited.

The midwives in the county assemble once each month for instruction, and marked im-
provement has been noted in their personal appearance as well as their equipment.

A Health Exhibit was prepared and shown at the County Fair demonstrating various
health projects carried on through the grades of the public schools. This exhibit
consisted of health posters, books, essays, motion pictures, etc. The projects
sponsored by'tho County Civic Council were on display also.

General Activities of the Nurses: In addition to their many other duties the nurses
made homo visits as follows: Prenatal 275, infant and preschool 964, school follow-
up 561, tuberculosis 123, venereal disoaso 90, cripple children 91, miscellaneous
745.

Fifty complete layettes were provided by the women of the various churches in the
county for needy white mothers. This service has boon a blessing indeed, and the
women are to be commended most highly for joining with the Health Unit in this phasu
of its work.







- 79 -


Sanitation and Hookworm Eradication: During the year 287 pit toilets wore installed
in the rural sections of the county; 33 sower connections wore made in Tallahasseo.
1,091 hookworm treatments wore given.

Dairy Work: Rogular inspections, numbering 650, wore made to the dairies and sam-
plos of milk tested at the laboratory as usual. As a wholo the dairymen have co-
operated in maintaining a high quality of milk. Health certificates are required
annually of every one connected with the dairy work.

Moat and Oyster Markots: After the now moat market ordinance was passed by the City
Commissioners of Tallahassoe, regular inspections wore made to ascertain the sani-
tary conditions of the markets. Radical improvements wore made by a number of them.
Inspection of the oyster places is made to see that they handle oysters from approved
beds only and to see that the oysters are handled according to the proscribed regu-
lations of the State Board of Health. 1,116 inspections wore made to those markets.

Venereal Disease Control: Blood tests for syphilis wore made on 424 persons of whom
131 were positive Arrangements wore made to have the positive cases treated either
by private physicians or at the A. & M. College Hospital clinic. At the clinic 668
treatments were given; private physicians treated a largo number of the indigent
cases.

Iminunization Work: The number of persons immunized during the year is as follows:
typhoid 1,095; smallpox 610; diphtheria 405; 295 Schick tests wore made.

Only seven cases of typhoid occurred in the county in 1933 with no deaths. There has
not been a case of smallpox reported in the county during the past throe years.
Diphtheria immunization especially among the children under school ago needs more
attention. There wero eight cases of diphtheria during the year, no deaths, however,
occurred.

School Work: Realizing the rich opportunity for constructive health work through
the schools we have ondeavored to stress this more than ever. Early in Septombor
the principals of all schools in the county wore contacted and the health program
discussed. All children meeting certain requirements will be awarded a health cer-
tificate near the close of school.

During the year 2,697 school children wore examined. That there has been an ex-
cellent response by children and parents and that the teachers have rendered in-
valuable service in carrying out the health program is reflected in the comparatively
small number of uncorrected defects found among the children.

Throughout the last semester nutritional classes woro conducted in several of the
schools, enrolling 550 underweight children. This proved very beneficial as showv
by the marked gain in weight by most of the children. Through the County Civic
Council funds vero obtained from the various civic clubs and other organizations to
supply 135 pints of milk daily to the school children whoso parents wore unable to
buy it. This work was resumed in the fall and will continue during the entire
school term.

The Kiwanis Club sponsored a tonsil clinic at which 13 operations wore performed.
The club also paid for special examinations and glasses for five children with de-
fective vision.






-80 -


Sumner Round-Up of Pro-School Children: The summer round-up of the pro-school
children was sponsored by the P-T. A. s resulting in the examination and immuniza-
tion of 72 children. This phaso of the work needs to be emphasized more. Soventy-
three colored children wore examined on Hospital Day at the A. & M. College.

Laboratory Work: The number of specimens sent to the State Laboratory is as follows
Blood for Kahn tests (syphilis) 424; blood for malaria 984; smears for diphtheria 16;
sputum for tuberculosis 11; feces for intestinal parasites 1,805; water for B. coli.
45; milk for bacterial count: 347; typhoid cultures 220; miscellaneous 93; making a
total of 3,945.

It is noted with interest that during the past three years not a single sample of
city water tested showed B. coli nor a high bacterial count.

Mosquito and Malaria Control Work: In Tallahassoe the oil truck has boon in use
regularly throughout the year, and the house to house inspection has boon continued
as usual. A total of 99,029 inspections have been made by all inspectors during the
year. The efficiency of this work is reflected by the comparatively few complaints
from mosquitoes in Tallahassee during the summer. 72 rural and more than 100 urban
homes were screened during the year.

The ditching done with Reconstruction Finance Corporation labor under supervision of
the Health Unit will drain a number of ponds and several hundred acres of swampy
land or land that was easily flooded, making excellent mosquito brooding places.
32,180 linear foot or more than six miles of ditching have boon completed, and
16,214 cubic yards of dirt removed. Several road ditches wore opened. Only about
five acres remain within the City of Tallahassoe that can be regarded as a brooding
place for mosquitoes. This drainage will prove of lasting benefit and will aid
materially in our mosquito and malaria control work.

In conclusion the Health Department wants to acknowledge its appreciation for the
cooperation received by City, County and State Officials, Clubs, Churches, P-T.A.'s,
the Daily Democrat, Florida State News, and other organizations, to all contributing
agencies and to many individuals too numerous to mention.

*******************


ESCAMBIA COUNTY HEALTH UNIT

The following is a report of the activities of the Escambia County Health Unit for
the year ending December 31, 1933:

There have been no outstanding developments concerning the work of the Escambia
County Health Unit during the past year, there has boon no epidemic, routine work of
an educational public health nature being carried on under each division of public
health activity, namely, child hygiene including the pro-school child and midwife
control, communicable disease control with especial attention given to tuberculosis
control, food inspection and pure food control, sanitary inspections and special in-
spections. The above divisions may be divided and subdivided.

It has boon stated that any community, within certain limitations, can fix its own
death rate. Public health work in this county is in its infancy and the foundation
of a reduction in the death rate is now being laid.




81 -






If someone were to ask to name the greatest accomplishment of the Escambia County
Health Unit since it was organized, the answer would unhesitatingly be, the awaken-
ing of a health conscience in this community.

Before the Escambia County Health Unit was organized very little attention was paid
to public health matters. The city had pure water and everything else from a pub-
lic health standpoint was taken for granted. Since the Escambia County Health Unit
was organized, publicity has been given concerning every phase of public health
work especially has this been true in the public schools, until the majority of our
citizens have become "health minded" because they have learned that public health
is a community problem. It matters not if a person is wealthy and well informed,
he is not able to protect himself and family from certain conditions which are a
menace to health: disposal of sewage and garbage, his milk supply, the purity and
cleanliness of other food products, the protection of his children against quar-
antinable diseases except by the enforcement of the laws concerning these problems
acting through the Escambia County Health Unit.

The school should be a model of sanitation, it being a part of the child's life. It
is thore that the soods of health are sown. It has been thoro that our public
health nurses have tried to sell public health which would be carried into each
home by the child. The children of today.aro the "grown folks" of tomorrow.

Public health problems of this county are varied and many. With our limited por-
sonnel we have tried to handle each problem as best we could, especial attention
being given to child hygiene and hookworm disease; communicable diseases,especially
typhoid fever and tuberculosis.

Venereal disease is the greatest public health problem in this community. We have
not tried to undertake the control of this monster which today is the greatest
menace to our civilization. However, plans are being worked out to tackle this
great destroyer of health, lifo and human happiness. Perhaps first aid stations
will be established and other methods adopted to prevent the spread of this demon -

"Who lurks in the halls of the rich and great,
and hides in the pauper's homo."

Twenty cases of typhoid fever were reported during 1933 but actually there were only
fifteen cases. Subsequent investigations disclosed that five of the cases reported
wore not typhoid fever. There were sixty-seven cases reported after January and
February 1932, two deaths occurring during January and February of that year.

The Escambia County Health Unit was organized during March 1932. There have been
only two deaths since July 1932, and one of these was questionable as to being
typhoid. The average number of deaths for ten years prior to the organization of
the Escambia County Health Unit was eight and one-third. The source of typhoid
fever was found and practically eliminated, namely, infected oysters from sewage
polluted waters and the open back surface toilet, 2500 of those filthy, disease
breeding places have boon eliminated. An epidemic of typhoid fevor in this com-
munity is a relic of the past.

CONCLUSIONS

In conclusion permit me to say that our watch word is ONWARD. We must have more
stringent regulations concerning the housing problems more stringent regulations




- 88 -


concerning the handling of foods, especially is this true of our groceries, markets
and restaurants.

There'should be compulsory vaccination against smallpox, especially the school
child.

Some moans should be provided to take care of the city sewage so as not to contami-
nate our wonderful bathing beaches.

The recording of vital statistics should be transferred to the Health Department.

More nurses should be added to our nursing staff, a colored nurse should be employ-
ed to work in the schools.

A careful perusal of the statistical report will be interesting.

To the Escambia County Medical Socioty, the Press of Pensacola, Officials of the
City and County, the different Civic organizations, the Chamber of Commerce, and
others who have contributed to the success of the Escambia County Health Unit dur-
ing 1933, we desire to express our sincere thanks.


* *** **** **** ** ** $











January 1st, 1934.


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

Dear Poctor Hanson:

I have the honor to submit in tabular form a
report of the activities of the Bureau of Laboratories for the year
1933.

Table I shows the way in which the work was
distributed among the five Laboratories. There was a gross increase
of 4f in the amount of work done, which was shared by all the Labora-
tories except Miami, The decrease at Miami was probably due to the
disturbed economic condition,

Table IIshowing the distribution of work by
months indicated peaks in March and October, as in the previous year.

The gross figures show increases in the
number nf specimens examined for Animal Parasites, Malaria, Agglutina-
tion Tests, Stool and Urine Oultures, Tuberculosis, Gonorrhea, Syphilis
and Leprosy.. Notable decreases in volume of work occurred with Throat
Cultures, Ophthalmia, Rabies and samples of Milk and Water.

ANIMAL PARASITES

The total number of specimens submitted for
the detection -f Animal Parasites was 48254 as against 43294 in 1932.
The proportion positive for Hookworm (28.4%) checks so well with previ-
:us years that it may be accepted as an accurate index of the condition
of the children of the state, most of the specimens coming from school
children. Toward the end of the year a good many specimens were sent
in as a result of O.W.A. and allied activities. It is to be hoped
that the benefit derived from such activities will bear some direct
relation to the expenditure of money and effort involved.

DIPHTHERIA

A falling off of 15,000 in the number of
specimens submitted for examination was not unexpected since 1932 showed
a 50% increase ,ver 1931. The proportion positive for Diphtheria was
4.1%, a figure in line with previous experience.

VINCENT'S ANGINA

Of 2764 specimens submitted for the diagnosis
-f Vincent's Angina, 842 or 30.1% were positive. Ever since the World
War this disease has been on the increase and it deserve-s more attention






-84-


VINCENT'S ANGINA-cont.

than it has been getting. We are pleased tt note that many mf these
specimens were submitted by Dentists.

MALARIA

The experience with Malaria has been very striking.
A 40f increase in the number of specimens submitted was enough to excite
remark but when it was accompanied by an increase in the proportion of
positives from 4.14% in 1932 to 12j% in 1933, it demands explanation.
The highest yearly proportion of positives in the past was 10% in 1929.
Considering separately the experience of the individual Laboratories, the
percentage of positives ran as follows: Ta4lahassee 16.8, Tampa 15.7,
Jacksonville 11.0, Pensacola 8.7 and Miami 1.7.

The question arises, how much of this increase
is real and how much due to improved technique. Some at least can be
attributed to the latter factor. We are greatly indebted to Doctor
T. H. D. Griffitts rf the United States Public Health Service for im-
provements in the technique of staining and for instruction and assistance
in recognizing Malaria organisms in doubtful cases. An improvement for
which we are indebted to Miss Pearl Griffith consists in the making of
thick or thin films from the sediment found beneath the blood-clot in wet
specimens of blood. This method has revealed the presence of Malaria in
a large number of instances. The Chief improvement in the technique
consists in a wider application of the thick drop method. By applying
the Giemsa stain in very dilute solution to either fixed or unfixed blood
films (having exercised great care to adjust to 7.1 the pH of the water
Used in making up the stain), we obtain very beautiful preparations.

SPECIAL WCRK

In addition to the routine work we have had
the privilege of studying intensively several cases of
Malaria which were induced for therapeutic purposes. As a
result of these studies a new theory was evolved with respect
to the susceptibility of red cells to Malaria. A paper on
this subject was read at a joint meeting of the National
/ Malaria Committee and the American Society for Tropical
Medicine, at Richmond, Virginia, In this paper it was pointed
out that red cells in the reticulocyte stage, (that is, in
the first twelve hours after they enter the circulation) are
found to be infected with Malaria in a much higher ratio than
are adult red cells. The ratio found is consistent with the
belief that the reticulocyte is the only susceptible red cell.

This will account for relapses after hemor-
rhage and injury as well as after going from low to high
altitudes, the common factor being the presence in the circu-
lation of an increased number of reticulocytes or young red
cells called forth by the loss of cells on the one hand, or
the necessity for an increased number of red cells on the
other.






-85-


SPECIAL WORK-cont.

The paper referred to will be published
in the American Journal of Tropical Medicine.

TYPHOID FEVER

An increase in the number of blood specimens
submitted for the Widal test was accompanied by an actual as well as a
percentage decrease in positive findings. A marked increase in the
number of Stool Cultures for Typhoid was the result of a concerted effort
to make sure that Typhoid carriers are not permitted to handle food.

The distribution of Typhoid Fever in time and
space shows pretty conclusively that the "carrier" is the chief source of
the disease at present. This of course makes imperative an effort to
prevent the "carrier" from handling food of any kind. In the examination
and licensing of food handlers, a stool examination for B. Typhosus is
vastly more important than is a test for Syphilis.

We have corroborated the finding of Havens with
regard to the value of Lithium Chloride in selective media for Typhosus
and make constant use of it to advantage.

Of 1275 specimens of blo6d submitted for the
Well Felix test, 86 were positive. This test does not distinguish
between Brills disease and Rocky Mountain Fever (Eastern variety).

TUBERCULOSIS

A rather marked increase in the number of
sputum specimens (5389-4371) was accompanied by an increase in the
percentage of positive findings.
GONORRHEA

The number of examinations for Gonococcus
increased slightly while the number found positive diminished a trifle.
The number of cases of Ophthalmia found to be due to the Gonococcus was
exactly the same as in the preceding year.

SYPHILIS

A substantial increase will be noted in the
number of specimens submitted for the Kahn test 19%. The percentage
found positive shows a slight decrease.

RABIES

There has been a gratifying decrease in the
number of animals found to have Rabies, (20 as against 70 in 1932). This
is in all probability due to the increased amount of attention given the
subject owing to the unfortunate experiences of recent years and particu-
larly to the increased number of prophylactic inoculations of dogs.






-86-


LEPROSY

Of 78 specimens examined for Leprosy, 14 were
found positive as against 9 out of 29 last year.

MILK

Changes in personnel and assignment caused a
falling off in the amount of work done on milk and milk products.

BIOLOGICAL

Table III shows the distribution of Biological
materials.


The Staff, both Technical and Clerical is
grossly overworked.


Respectfully,

(Signed) Paul Eaton
Director of Laboratories.







-87-


CEI


TABLE I


EXAMINATIONS MADE IN THE LABORATORIES DURING THE YEAR 1933


LABORATORY EXAMINATIONS

DIAGNOSTIC MILK AND WATER TOTAL

NTRAL:
Jacksonville, Fla. 118,219 4413 122,632


BRANCHES:
Tampa, Florida.


Pensacola, Fla.


Miami, Florida.


Tallahassee, Fla.


TOTAL


53,034


9,652


29,500


10,868


221,273


5614


2383


9199


1160


22,769


58,648


12,035


38,699


12,028


244,042







-88-


TABLE II

TOTAL NUMBER OF EXAMINATIONS MADE BY MONTHS DURING THE YEAR 1933


JACKSONVILLE


January

February

March

April

May

June

July

August

September

October

November

December


9567

10753

11462

9403

9488

8763

9629

10547

9979

12260

10756

10025


TA.PA PENSACOLA

4894 836

4327 931

5950 1050

4525 953

3661 747

3200 1158

3876 916

4283 957

4044 1115

5429 1457

7773 1152

6686 763


MIAMI

3436

3371

3392

2767

3215

2616

2349

2586

2710

4465

3758

4034


TALLAHASSEE

1696

1179

1149

1086

950

851

904

716

925

1117

859

596


58648 12035 38699


TOTAL

20429

20561

23003

18734

18061

16588

17674

19089

18773

24728

24298

22104


12028 244042


TOTAL 122632









Jan Feb
i1~JIAL PRiLSITES
H0OIGJORMiT: Pos. 630 1468
Neg. 1606 2r739
Unsat. 37 104
ASCiAIS 23 76
OXYURIS 16 16
STRONGYLOIDES 1 11
TAPEWORIM 12 8
TRICHIURIS 6 15
THROAT CULTURES
DIPHTHERILA:Pos 59 31
Neg 1195 782
VINCENT ,~GINAi
Pos 27 27
Neg 60 58
STREPTOCOCCUS 9 3
KAL JR: Pos. 6 10
Neg. 310 290
Unsat.
IGGLUTIN.TION TESTS
TYPHOID: Pos. 2 1
Neg. 312 299
Partial 1
PALRA TYPHOID :A
Neg. 34 39
PARk TYPHOID:B
Neg, 34 39
TEIL FELIX: Pos 1
Neg 33 39
Partial
BRUCELL, ~L30DRT-S
Poe.
Neg. 26 22


Partial
TU-L4Ei.IA:Po .
Neg,
SPOTTED FLP E:


-LQ9-


49

49 44
1
49 40
3


6 1 8 11


61 62 113 137 104


1933
CENJTR L LABORATORY
Jacksonville, Florida.
liar Apr May June July Aug Sept Oct Nov Dec

634 394 327 259 413 267 423 674 632 585
3072 2103 1411 814 656 -835 749 1295 1258 1331
101 94 8 4 9 1 1 41 24 39
33 35 23 42 21 26 18 37 7 22
21 11 6 9 1 1 3 6 4 2
5 6 2 1 3 2 4 1 10
10 15 2 3 3 3 2 3 5 2
7 41 6 6 13 2 7 1 2

5C 23 11 12 19 30 17 22 43 41
830 621 477 401 379 681 849 1322 1564 1315

32 33 28 19 31 10 13 18 17 4
68 40 60 58 31 44 31 79 53 51
3 8 2 3 8 2 7 25 15 14
1 5 8 27 97 137 176 171 202 .70
356 347 465 757 917 1018 881 844 642 553
1

9 5 1 3 1 6 2 8
349 347 469 584 721 881 918 968 842 615
1 4 3 2 1 1 1 3


95 60 50 848 848


62 113 137 104
2 9 7 6
58 101 130 97
2 3 1


1
33 72
1

9 18


2
43 29 27


848
49
786
13

10
488
3
1


29 4 9 6 5 119


848


848



501

120


4 1 5 1 1


Grand
Total Total

6706
17869
463
363
96
46
68
106 25717

358
10416 10774

259
633 892
99 99
910
7380
1 8291

38
7305
17 7360


1 14


Neg. 1








1933
CENT .<_L LLBOR.TORY-cont.
Jacksonville, Florida.


Jan Feb EIar Apr ilay June July Lug Sept Oct Nov


TYPHOID CULTURES
Blood: Pos.
Neg.
Urine & Stool:
Pos.
Neg, 19


Grand
Dec Total Total


2 3 1


39 168 42


TUBERCULOSIS
Microscopic:Pos 31 25 27 28 41
Neg 184 173 199 171 182
Unsat 2 2 3
Lnimal Inoculations 7 5 6 3 6
OPHTHLL II.:: Po s.
Neg. 6 3 4, 3 4-
SGON ORIII-E: Pos. 87 69 86 90 125
o Neg. 422 439 498 490 5140
SUnsat. 5 4 2 9 2


SYPHILIS
nL- :T


RABIES
Dog:


Pos. 557 517 509 430 606
Neg. 3012 2802 3393 2977 3523
Partial 104 146 193 131 149
Unsat. 96 108 115 113 236


Cat: Neg.
Calf: Neg.
Cow: Pos.
Human: Neg.
Rabbit: Neg.
Squirrel: Neg.
LEPROSY: Pos.
Neg.


S 1
7 12


2 2 3


1


1 2


1 2 2


99 92


37
210
2
5


5
22 38


23 33 24
187 173 173
1 2
4 1 6


9
15 18 11 2 565 57.1


21 36
198 157
1
5 11


26
235


1 1 2
3 8 6 8 2 4 6
106 91 118 123 140 137 121
569 561 523 394 571 488 436
7 1 3 2 1 3 3

523 519 604 556 707 631 623
3189 3585 3766 3629 4099 3142 3132
163 139 152 65 166 173 154
223 369 294 205 169 125 1-48


1
5 3


4 3


1 2 1


1 2


352
2242
13
64 2671

57 61
1293
5931
42 7266

6782
40249
1735
2201 50967

16
87
3
17
1


132

16


Pos.
Neg.
Unsat.




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