• TABLE OF CONTENTS
HIDE
 Cover
 Title Page
 Letter of transmittal
 Table of Contents
 Epidemiology
 Tuberculosis control
 Venereal disease control
 Public health nursing
 Maternal and child health
 Dental health
 District and county health...
 Laboratories
 Drug inspection
 Vital statistics
 Multigraphing
 Engineering
 Malaria research
 Accounting
 Health education
 Appendix






Title: Annual report - State Board of Health, State of Florida
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Permanent Link: http://ufdc.ufl.edu/AM00000243/00009
 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: VID00009
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
    Cover
        Cover
    Title Page
        Page i
    Letter of transmittal
        Page ii
        Page iii
    Table of Contents
        Page iv
        Page v
        Page vi
    Epidemiology
        Page 1
        Page 2
    Tuberculosis control
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
    Venereal disease control
        Page 8
        Page 9
    Public health nursing
        Page 10
        Page 11
        Page 12
    Maternal and child health
        Page 13
        Page 14
        Page 15
    Dental health
        Page 16
        Page 17
        Page 18
    District and county health work
        Page 19
        Page 20
    Laboratories
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
    Drug inspection
        Page 30
    Vital statistics
        Page 31
        Page 32
    Multigraphing
        Page 33
    Engineering
        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
    Malaria research
        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
        Page 66
        Page 67
    Accounting
        Page 68
        Page 69
    Health education
        Page 70
        Page 71
        Page 72
    Appendix
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        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
Full Text
: ~iA4 4-


OF


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Of


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D CEMSEBR 3S 1935




JACKSONVI~Lt
FLORIDA STAe SBOAR 0 OF t4EATH
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STATE OF FLORID A ~O410
)it'


Thirty-Ninth An


nual


Report


of the


STATE BOARD OF HEALTH


Year Ending


for the
December


31, 1938


-.\joO


A. B. McCreary, M. D.,
Florida State Health Officer














FLORIDA STATE BOARD OF HEALTH
Jacksonville, Florida
1940


%H"b~j



















May 1, 1940







His Excellency, Fred P. Cone
Governor of Florida
Tallahassee, Florida

Sir:

I beg to hand you herewith a report of the Florida
State Board of Health for the period of January 1,
1938 to December 31, 1938, inclusive.


Respectfully submitted


(Signed)
N. A. Baltzell, M. D.,
Florida State Board of


President
Health


NAB:kbk

















May 1, 1940


Honorable N. A. Baltzell, M. D., President
Florida State Board of Health
Marianna, Florida

Dear Dr. Baltzell:

I herewith submit the 39th annual report of the
Florida State Board of Health for the year end-
ing December 31, 1938.

As the late Dr. W. A. McPhaul was State Health
Officer during the period covered by this report
and illness prevented him from preparing the
usual summary of the administrative activities, it
has been thought advisable to omit this feature.

Respectfully yours,



(signed)
A. B. McCreary, M. D.
State Health Officer


ABMcC;kbk















TABLE OF CONTENTS


Epidemiology. .

Tuberculosis Control

Venereal Disease Control

Public Health Nursing

Maternal and Child Health

Dental Health

District and County Health

Laboratories.

Drug Inspection

Vital Statistics

Multigraphing

Engineering .

Malaria Research

Accounting .

Health Education .


1


0 8

S10

13

S. 16

Work 19

21

... 30

S 31

S* 33

S 34

50
5. 50

S. 68

S. 70


(continued)













OF CONTENTS


Appendix
Table
Reported cases of notifiable diseases in the state of Florida
for the year 1938 IA

Reported cases of notifiable diseases, deaths, case rate and
death rate per 100,000 population, and percent of fatality
for Florida, 1934-1938, with 5 year average. IB

Midwifery in Florida ... II

Maternal and child health activities in Florida reported to
United States Children's Bureau for year 1938. III

Summary report of the central and branch laboratories IV

Annual report of the Jacksonville laboratory for the year
1938 V

Report of the Jacksonville laboratory by months for the year
1938 VI

Annual report of the Tampa laboratory for the year 1938 VII

Report of the Tampa laboratory by months for the year 1938 VIII

Annual report of the Miami laboratory for the year 1938 IX

Report of the Miami laboratory by months for the year 1938 X


(continued)


(continued)


TABLE














TABLE OF C N T E N TS (continued)





Table
Annual report of the Pensacola laboratory for the year 1938 XI

Report of the Pensacola laboratory by months for the year
1938 XII

Annual report of the Tallahassee laboratory for the year 1938 XIII

Report of the Tallahassee laboratory by months for the year
1938 .. .. XIV

Job activity of the Multigraph department for the year 1938 XV








EPIDEMIOLOGY


Dan N. Cone, M. D., Director







During the year no epidemic of any of the communicable diseases
occurred in any part of the state, but there was the usual number
of sporadic cases and the expected seasonal and cyclic occurrences
of the various children's diseases reported to the Bureau of Epi-
demiology.

Disease reporting efficiency has continued to improve, consider-
ing the reportable diseases as a whole, however, some of the most im-
portant of these diseases are still far below the average, such as
cancer and tuberculosis in all forms, malaria, and influenza. A list
of the reported cases of notifiable diseases for the state can be
found in the Appendix, Table I. This list includes the more important
diseases reported in the state for a five year period 1934-1938 with
the case and death rate per 100,000 population and also all the dis-
eases reported by each county for the year 1938.

Diphtheria*

Diphtheria deaths were the lowest recorded for the past several
years. The continuation of the program for early immunization of
each child should further reduce the number of cases of sickness and
deaths from this disease.

Infantile Paralysis-

Infantile paralysis (acute poliomyelitis) maintained the usual a-
mount of sporadic cases with no threat of an epidemic.

Scarlet Fever*

Scarlet fever shows a slight increase over the five year average.
Cases reported were scattered with no threat of an epidemic.

Undulant Fever*

Undulant fever has been reported from various sections of the
state, but no epidemic occurred during the year. Since Florida


*For number of cases reported, see Appendix, Table I. and IB








citizens do not use goats milk and since the disease is seldom con-
tracted by butchering an infected animal, such as cows, hogs, or
goats, raw cows milk remains as the principal source of infection.
At present the only known methods of prevention of undulant fever is
to use milk from herds and individual milk cows that are free from
Bangs disease, or drink only pasteurized cows milk.

Typhus Fever*

Typhus fever (endemic or flea-born) has been reported from dif-
ferent localities throughout the state. The infection of this dis-
ease is carried in the blood of a person or rodent sick with the dis-
ease and transmitted to a person or rodent by a flea that infests
only rodents (rats). However, pets, such as cats and dogs may act as
carriers for the infected fleas. The only known method to prevent
the disease is rat-eradication or rat proofing.

Pneumonia*

Pneumonia in all forms causes a great many deaths each year, how-
ever, it is one of the diseases that is not being reported consistent-
ly by the medical profession.

Typhoid*

Typhoid fever registered a slight increase above the five year
average for cases reported, but the deaths during the same period was
slightly lower. Eight typhoid carriers visited Florida from other
states during the year and were under observation of their respective
health departments while here. Two new carriers were also identifi-
fied during the year.


*For number of cases reported, see Appendix, Table LA and IB








TUBERCULOSIS


A. J. Logie, M. D., Director







In the two years that the Division of Tuberculosis has been func-
tioning, 22,674 individuals have been tuberculin tested, and 6,108
chest films have been made of the tuberculin reactors. In 1938,
13,692 individuals were tuberculin tested with PPD in two strengths
and 4,115 individuals had x-ray examinations of their chests.

At the request of the Florida Medical Association and with the
approval of the State Board of Health, a demonstration of tuberculin
testing and x-ray examinations was carried out at the Florida State
College for Women in Tallahassee. There were 669 freshmen students
who were tuberculin tested, of which 170 reacted. Of 57 reactors who
were x-rayed, none showed reinfection type pathology.

Numerous requests for the program have been received from a great
number of counties which do not possess county health organizations.
It has been necessary to give preference to counties with county health
units, since the program could be followed up properly and since co-
operation of the local personnel could be assured. Consequently, the
unorganized counties have not received equal consideration in this
work.

It is the intention of the division to alter this policy to some
extent. When all counties with county health departments have been "
investigated in the manner indicated by the antituberculosis program,
the work of this division will be brought into a county only at the re-
quest of the county health officer. The personnel of the Division of
Tuberculosis will act in an advisory capacity and the diagnostic fa-
cilities of this department will be made available to the county health
units. In this manner all tuberculosis work will be localized in the
respective counties.

It is probable that the school program will be discontinued and
that investigations in the future will be concentrated upon more sus-
ceptible groups, such as: indigent contacts, families on relief, and
custodial patients confined to state institutions. It seems advisable
to discontinue tuberculin testing temporarily until the value of tuber-
culin has been definitely settled in view of the conclusions in a study
made recently by Dr. Lumsden of the United States Public Health Service









to the effect that tuberculin requires a standardization and the tuber-
culin testing appears futile as a reliable indication of the incidence
of tuberculous infection.

In the future the duties of the state tuberculosis nurse will con-
sist of instruction and advice to public health and other nurses work-
ing in the field. Special attention will be given to the follow-up
of cases discovered through the antituberculosis program and cases ad-
mitted to and discharged from the State Tuberculosis Sanatorium at Or-
lando.

An urgent matter which requires immediate attention is the post-
sanatorium treatment of discharged cases which require pneumothorax
refills. There are many areas in the state where facilities for such
treatment are n6t available within a radius of 100 miles. It may be
possible that the local county health units organize tuberculosis
clinics not only for early diagnosis of cases but also for adequate
treatment of those who are unable to secure proper medical and nursing
attention.

An invitation was extended to the director of the division by the
Thomas County (Georgia) Medical Society to take part in their program
as guest speaker, December 21. He spoke on "The Changing Picture of
Tuberculosis". The director also presented a paper before the -Flor-
ida East Cost Medical Society October 29 entitled "The Value and Sig-
nificance of the Tuberculin Test", and later was elected secretary-
treasurer of the Society.

The director compiled the statistics of the incidence of tubercu-
lin reactors and x-ray findings which have been tabulated as a result
of the antituberculosis program in Florida for the past two years;
This study considers the tuberculin reactions in approximately 12,000
individuals tested and approximately 5,000 chest films. This article
has been accepted for publication by the AMERICAN REVIEW OF TUBERCU-
LOSIS and will be published in the March 1939 issue.

Antituberculosis Program in Counties

In 1938 the Division of Tuberculosis continued the state-wide
antituberculosis program which was inaugurated the previous year. The
program, consisting of tuberculin testing of senior high school stu-
dents and all indigent contacts and suspected cases of tuberculosis,
was inaugurated in eleven counties and the results are the following:

POLK COUNTY: In Polk County 2,045 individuals were tuberculin
tested. The senior high school group numbered 1,989 against 56 indi-
gent contact cases. Of the senior high school group 28.3% showed
positive tuberculin reactions -- the white children 24.2%
and the Negro children 42.8%. Of the positive reactors among the
children were found 7 cases (4 white and 3 colored) showing radiograph-








ic evidence of reinfection type tuberculosis. All these cases were at
a minimal stage.

Of the indigent contact group 76.3% had positive reactions to the
tuberculin test. Seven cases were found to have manifest x-ray path-
ology, characteristics of pulmonary tuberculosis. There were 5 white
cases and 2 colored cases in this group. Four cases are at an early
stage and 3 moderately advanced.

BROWARD COUNTY. There were 352 individuals tuberculin tested, of
which 306 were children and 46 were adults. Of the senior high school
group 19.8% were positive reactors, of which the white children were
14.8% and the Negro children 27.3%. Of the indigent contact group,
41.3% showed positive tuberculin reactions. None showed reinfection
type tuberculosis,

NASSAU COUNTY. Individuals tuberculin tested numbered 275; 68 of
them showed positive reactions and of 46 reactors radiographed, none
showed reinfection type tuberculosis.

ORANGE COUNTY. Individuals tuberculin tested numbered 1,341, con-
sisting of 1,196 senior high school students and 145 indigent contacts.
In the senior high school group, 31% had positive reactions -- among the
whites 28%, among the colored 34%. Of the indigent contacts 64,.1% show-
ed positive tuberculin reactions.

On x-ray examination, one senior high school student showed tuber-
culous pathology, 16 indigent contacts had reinfection type lesions,
and one indigent contact showed evidence of bronchiectasis.

LAKE COUNTY. Individuals tuberculin tested numbered 776. The
senior high school group numbered 701 against 74 indigent contact cas-
es. Of the senior high school group 27.3% showed positive tuberculin
reactions the white children 21.5%, and the Negro children 33%. Of
the positive reactors among the schooll children, 1 white case and 1
colored case showed radiographic evidence of reinfection type tubercu-
losis.

Of the indigent contact group, 54.4% showed positive reactions to
the tuberculin test. Three cases showed x-ray evidence of tuberculous
pathology and 1 case evidence of bronchiectasis.'

ALACHUA COUNTY. Individuals tuberculin tested numbered 843. The
senior high school group numbered 763 against 80 indigent contact cas-
es. Of the senior high school group, 35.8% of the white and 46.7% of
the colored showed positive tuberculin reactions, of the positive re-
actors among the school children showing x-ray pathology of the chest,
there was one girl with a possible tuberculous lesion and another with








evidence of upper lobe bronchiectasis. Both of these girls were white.

Of the indigent contact group, 54.7% of the white and 88.8% of the
colored showed positive tuberculin reactions. Of the white cases who
were ex-rayed, there were three female adults with tuberculous lesions
and two male adults, one having a tuberculous lesion and the other a
.possible lung mycosis. Of the Negro group showing x-ray pathology, there
were three female adults and one male adult with evidence suggestive of
pulmonary tuberculosis.

DADE COUNTY. Individuals tuberculin tested numbered 1,720. The
Senior-high school group numbered 1,685 against 62 indigent contact
cases. Of the senior high school group, 33.1% of the white and 38.4%
of the colored showed positive tuberculin reactions. Of the positive
reactors among the school children showing x-ray pathology of the chest,
there were two Negroes (males) with possible tuberculous lesions.

Of the indigent contact group consisting of adults, 78.9% showed
positive tuberculin reactions. Of the white cases which were x-rayed,
there were three females and one male with lesions suggestive of tuber-
culosis.

JACKSON COUNTY. There were 722 individuals tuberculin tested, of
which 570 were children and 152,adults. Of the children tested, 144
showed positive reactions (25.3%). Of the positive reactors among.
the children who were x-rayed, none showed tuberculous pathology of
the reinfection type.

Of the adults who were tested 56 showed positive tuberculin re-
actions (39%). Of the adults with positive reactions who were x-ray-
ed, 6 (12.8% of the positive reactors) showed tuberculous pathology.

GADSDEN COUNTY. Individuals tuberculin tested numbered 629, of
which 535 were children and 74, adults. There were 191 children (35.7%)
who had positive reactions to the test. Of the children with positive
reactions, 162 were x-rayed and 2 (1.2% of the positive reactors) show-
ed x-ray evidence suggestive of tuberculous pathology.

Of the adults who were tuberculin tested, 56 showed positive re-
actions-(59.5%). There were 43 adults with positive reactions who were
x-rayed, of which 5 (11.6% of the positive reactors) showed x-ray find-
ings suggestive of tuberculosis, and 3 with evidence of bronchiectasis.

WAKULLA COUNTY. There were 357 individuals tuberculin tested; of
which 191 were children and 166, adults. Of the children tested, 59.2%
showed positive tuberculin reactions. Of the positive reactors, 2 (1.7%
of the positive reactors) children showed tuberculous pathology on x-ray.








Of the adults tested, 54.9% showed positive tuberculin reactions
and 6 (6.6% of the positive reactors) of them showed tuberculous
pathology on x-ray.

MONROE COUNTY. There were 188 individuals tuberculin tested, of
which 156 were school children and 32, adults. Of the children test-
ed, 56.2% were positive reactors. Of the positive reactors among the
children, 4 (4.5% of the positive tuberculin reactors) showed tubercu-
lous pathology of the reinfection type on x-ray. Of the adults test-
ed, 83% had positive tuberculin reactions, and 11 (69% of the positive
reactors) showed definite tuberculous pathology on x-ray.


Summary of Activities


Interviews and conferences
Public addresses
Newspaper articles
Radio talks
Schools visited
Chest clinics developed
Clinics attended
County programs (antituber-
culosis) developed
Persons examined (x-ray)


93
43
42
4
35
8
24

11
4,115


Tuberculosis cases
investigated 361
Tuberculin tests 13,692
Pneumothorax clinics
developed 6
Medical society meetings 24
Counties inviting program 64
Lectures to nurses and
physicians 27
Papers to medical society 12








DISEASE CONTROL


L. C. Gonzalez, M. D., Director







The division of Venereal disease Control was created July 1, with
the financial assistance of the United States Public Health Service,
as provided in the Federal Venereal Disease Control Act of May 24,
1938. Besides the director of the division, the personnel is com-
posed of an assistant education director, a colored venereal disease
consultant and a secretary.

The purpose of the division is to coordinate and aid all venere-
al disease control work done by individual city and county health de-
partments and voluntary organizations; to seek improvements of present
clinic facilities; to promote the organization of those facilities in
localities where there are none; to work in harmony with and seek the
cooperation of private physicians in order to encourage better report-
ing; to furnish free drugs to practitioners for the treatment of in-
digent patients; and to promote an extensive and consistent state-wide
educational program as it affects venereal disease.

With these objectives in mind, a program was prepared and approv-
ed by the State Board of Health and is to be presented before the Ven-
ereal Disease Committee of the Florida Medical Association, so as to
secure their assistance and endorsement.

The first quarter of the division's existence was devoted to organ-
izational work. This consisted of the outlining of the duties of the
personnel; allocating funds to health departments, as provided in the
budget; conferring with public health officials, the chairman of the
Venereal Disease Committee of the Florida Medical Association and oth-
er numerous private physicians; visiting clinics and institutions tak-
ing part in this work and launching a state-wide educational campaign.

As requested by the United States Public Health Service, a roster
of venereal disease clinics operating in Florida was compiled. All
these clinics were requested to send in monthly reports of their activ-
ities, most of whom have responded wholeheartedly.

The distribution of arsenicals was relegated to this division. It
has also been entrusted with statistical analysis of the morbidity re-


VENEREAL









ports, which are increasing rapidly.

The director of the division has visited all health departments
and explained the program fully. He has conferred with city and
county officials and other interested citizens in order to secure fi-
nancial assistance to expand venereal disease work in their respective
communities. He has appeared before numerous lay organizations and
has explained the program to them.

During the month of October, the director, together with the state
health officer, the director of laboratories, and two serologists, at-
tended the United States Public Health Service sponsored conference,
"The Evaluation of Serodiagnostic Tests", in Hot Springs, Arkansas.

The assistant educational director toured the state, contacting
local authorities, civic organizations and newspapers, acquainting them
with the program and distributing metal placards on syphilis to combat
quack advertisements.

The colored venereal disease consultant also toured the state, and
conferred with colored physicians and other leading citizens of his
race and presented lectures before large groups in all sections of the
state.

During the Florida Public Health Association meeting held in Holly-
wood, November 28-30, 1938, the cooperation of all public health nurs-
es was requested in giving more serious consideration to follow-up
work.

This concludes the major activities for the year. The organiza-
tion has taken root and it is hoped that future narratives will show
evidence of a healthy growth.









PUBLIC HEALTH


Ruth E. Mettinger, R. N., Director







Continued emphasis on a generalized public health nursing program
characterized the activities of the Bureau of Public Health Nursing
for the year 1938. Administration was carried out through the five
districts into which the state is divided and each district had a
supervising nurse and a corps of assistant nurses, most of whom were
paid by WPA. Although nursing service carried on in such large dis-
tricts lacking any other health supervision is necessarily limited,
the nursing corps was able to be of considerable benefit to the popu-
lations served.

Working with the district medical officers from the State Board
of Health, the nurses assisted in immunization programs among school
children, both for smallpox and diphtheria. Thousands of children.and
adults were tested for hookworm and treatment given by private physi-
cians. Follow-up of this sanitation problem was done both by the nurs-
es and the district sanitary officers of the State Board of Health, and
through their efforts a fair number of sanitary privies were built
throughout the state.

In those counties having full-time local health service, the work
of the nurses was, of course, much more effective. It is possible to
see permanent, beneficial results from the nursing program in such
counties and the detailed reports made by the various county health
units will show this effect.

Since health education seemed to be the greUtes need for all nurs-
ing services, the Bureau of Public Health Nursing invited national
agencies to conduct and participate in several institutes during the
year. The first institute on health teaching was directed by Miss
Mary J. Dunn, R. N., Regional Consultant from the U. S. Public Health
Service, and was held from January 4 through 7 in the State Board of
Health Library. All units were represented by two or three nurses,
making a total of forty-five in attendance. The basis of Miss Dunn's
instructions was a well-rounded service, meeting all the nursing needs
of the family, and the method which each nurse should follow in teach-
irgthis need, regardless of environment.


NURSING









Immediately following this institute, Miss Dunn conducted a two-
day institute for supervisors only. This outline was based on (1)
qualifications for the supervisor, (2) introduction of the nurse into
the field, (3) staff education, and (4) records.

The part which Home Hygiene and Care of the Sick h.s played in the
nursing service demanded institutes on methods of teaching as applied
to Home Hygiene and Care of the Sick and these were conducted by Mrs.
Charlotte Heilman from the American National Red Cross. These in-
stutes were held in six series at strategic points throughout the state.

Due to the many demands made for classes in First Aid, a repre-
sentative from the American National Red Cross also conducted a series
of three institutes for nurses who qualified to teach this course.
Those later received certificates in First Aid.

Requests for exhibits demonstrating the "Homo Delivery Room",
"Proper Sanitation Around the Home", "Maternity Mortality", "Infant
Mortality", "Syphilis", "Tuberculosis", and also "Highway Safety" were
received from practically all health units, as well as from interest-
ed individuals in unorganized counties. Each county to which the ex-
hibits were loaned was requested to submit a report of the number of
people who viewed the exhibit and the total number amounted to 32,281.

Miss Jule 0. Graves, State Midwife Consultant, held fourteen one-
day midwife institutes, at which time nurses were requested to attend
and observe her method of teaching the midwives.* Through funds from
the Rockefeller Foundation an observation tour was given Miss Graves
and she visited five different states, remaining in each from three
to four days. During these visits she had the opportunity to go into
the field with the midwife supervisor and to review the records and
forms used by each department.

In connection with the health education program of the bureau 804
infant booklets, 767 prenatal booklets, 283 booklets entitled "The
Child from One to Six" were mailed to interested parents throughout
the state. The maternity letters to prenatal and postnatal cases
numbered 3,434. Numerous requests were made for pamphlets on tuber-
culosis, hookworm and malaria and these wire referred to the Bureau
of Health Education and Division of Tuberculosis.

At the request of the Works Progress Administration the nursery
schools were visited and the children inspected either by the local
nurse in the county or the district. nurse. A total of 4,067 white
children and 778 colored were inspected.

In addition to the nursery schools the WPA sewing rooms were visit-
ed and the women inspected. Cases referred to physicians because of
some physical defect or some communicable disease numbered 1,097.


*See Appendix, Table II








May Day celebrations were carried out in various forms in each
county and unit. The county public health councils which have been
quite active the past two years assumed full responsibility of this
program. These councils also sponsored Social Hygiene Day.

In connection with the Social Hygiene Day activities the pub-
licity kits furnished by the American Social Hygiene Association were
distributed to each district supervisor of nurses. Several venereal
disease clinics were organized in the counties and treatment given
through local physicians as a result of this intensified campaign and
it is believed the many programs on venereal disease prevention given
by the county nurses were directly responsible.

The public health nurses were urged to assist the teachers in plan-
ning programs in health education and to attend the parent and teach-
er meetings. They also assisted other civic organizations in planning
their programs, and in counties having full-time health units their
service became the connecting link between the public health officials
and the people. In counties not having local health service they play-
ed an important part in promoting better health protection for the
community they served.









MATERNAL AND CHILD HEALTH


F. V. Chappell, M. D., Director







The Bureau of Maternal and Child Health was organized early in
1936 through funds made available to the state under provisions of
the Federal Social Security Act. The financial assistance thus ob-
tained, matched with an equal amount of funds from the state appropri-
ation for public health has enabled the bureau to carry on an ever ex-
panding program each year since its organization.

During 1938 a maternal and child health consultant nurse was add-
ed which gave the bureau another opportunity to assist the local health
departments in the better organization of their Maternal and Child
Health activities. This nurse, on invitation of the health officers,
goes into the organized counties for from one to several weeks and has
been of much help in all the counties visited. Another maternal and
child health consultant nurse will be added next year to assist those
counties already organized with full-time health service and to help
organize the program in the several new counties which will be organ-
ized during the year.

The activities of the bureau rare carried on almost entirely in
those counties with local health departments, for it is believed very
strongly that without the proper supervision and follow-up which is
available in organized local health departments the money and effort
expended will not be used to best advantage.

During 1938 seventeen counties with local health services held
125 maternal and 46 well-baby clinics at regularly scheduled times and
places each month. These clinics were held at 45 well equipped perma-
nent Health Centers throughout the counties in the areas of greatest
need.

Most of these clinics are conducted by local practicing physicians
who are specialists either in pediatrics or obstetrics, or whose
practice is devoted largely to one or both of the specialties. During
the. year 60 of these physicians were paid for their services in these
clinics. A few of the clinics, particularly those held in areas where
local medical services are hot available, were held by the director of
the local health department,









A list of the maternal and child health activities carried on
throughout the state as reported to the United States Children's
Bureau will be found in the Appendix, Table III.

Early in the year the Maternal Welfare Committee of the Florida
Medical Association requested this bureau to assist them in a survey
of all maternal deaths during the year. This was done and due to the
very excellent cooperation of the Committee and all of those report-
ing maternal deaths, everyone of these cases will have been complet-
ed and reported on early in 1939. The material obtained will be most
valuable and should prove a great help to the Committee in their study
as to the cause of Florida's high maternal mortality.

The bureau also assisted the Committee on Postgraduate Education
of the Florida Medical Association financially in the postgraduate
courses held at Daytona Beach. All expenses incident to bringing an
obstetrician, a pediatrician, and a gynecologist to the state for
these courses were paid for by funds from the United States Children's
Bureau.

It is planned during the next year to continue to assist the Ma-
ternal Welfare Committee of the Association in the conduct of the sur-
vey of maternal deaths in the state; to strengthen the Home Delivery
Nursing Service which is carried on in Hillsborough County as a demon-
stration by adding an additional delivery nurse and make provisions
for the employment of an obstetric consultant to be called upon when
needed at deliveries in this area; and to add additional demonstra-
tions, not as a separate unit, but to be carried on as part of a gener-
alized public health program in two or three well organized counties
where this service will be most valuable.

It is hoped to expand and strengthen the local health services
by adding additional nursing personnel to be paid from the Children's
Bureau funds, to allow more money where it is needed for medical and
dental services and to improve those records and report forms having
to do with maternal and child health activities.

Rduamaer Courses are being planned throughout the state for the
year 1939 and it is honed to bring in as instructors outstanding men
in the field of pediatrics and obstetrics to conduct these courses.
The courses will be held under the direction and supervision of the
Committee of Maternal Welfare, Child Health and Postgraduate Instruc-
tion of the Florida Medical Association, and as in the past the Bureau
will assist financially the Committee on Postgraduate Instruction of
the Association.

Other objectives for 1939 are: to arrange for the public health
nursing training of a number of the nurses through funds from the Child-
ren's Bureau; to improve the midwife laws; to gather material and make





15


plans for placing the responsibility of maternity hospitals and homes
with the health department; and to add a full-time pediatrician to the
staff to consult with the private physicians and directors of the lo-
cal health departments on the better conduct of the clinics.









DENTAL HEALTH


Lloyd N. Harlow, D.D.S,, Director







The Bureau of Dental Health was without a director during most
of the first quarter in 1938. Doctor E. C. Geiger tendered his res-
ignation as director to enter private practice, and the present di-
rector assumed his duties on April 1,

It was necessary to become familiar with the work of the bureau
by studying the program used in the past and the programs used by
other states. A trip was made to North Carolina to observe the work
of the Division of Oral Hygiene in that state. The method of conduct-
ing the office, materials used and method of distribution were observ-
ed. Visits were made to county health units over the state and their
programs studied,

In Florida, county health units were visited and a study made of
existing conditions in each one. These counties all cooperated splen-
didly in the dental health-work and in each county where inspections were
made, the county made all arrangements for the inspections and the ed-
ucational program.

A program for demonstration purposes was carried on in Wakulla
County. This county was selected because of its high percentage of in-
digents and because of the county's not having a dentist. Approximate-
ly 200 children were given dental services which consisted of fillings,
extractions, and treatments. The plans are to re-examine and make cor-
rections for these children during their school days in the intermedi-
ate grades. Classroom attendance and improvement in studies are to be
noted year by year. The local physician and the health department are
cooperating in looking after the other health needs of the children.

Conferences were held with the dental organizations of the state,
and in each instance it was urged that clinics for the underprivileged
children be held. The director feels that unless some method is found
to care for such children the educational program of the bureau will
not be of the maximum benefit.

During the year, approxi3mtely 14,000 children were examined.
From these inspections, it was found there was an average of 75 per
cent of the Florida children defective in dental health. These run-








ning from a high of 89 per cent in some counties to 53 per cent in Pi-
nellas County. Elementary schools visited with the inspection pro-
grams numbered 250. Classroom talks on dental health education were
made in each school visited.

The director attended.the meetings of the-American Association of
Public Health Dentists at St. Louis, Missouri, the American Dental As-
sociation, and the American Association for Promotion of Dentistry for
Children. The meetings of the American Dental Association Committee
on Public Health were also attended. Eight meetings of district den-
tal societies were attended in the state as well as many local meet-
ings. The Florida State Dental Society which was devoted entirely to
the public health aspects of dentistry, and the Public Health Dentist-
ry meeting at Augusta, Georgia, were attended.

Papers on dental health were given by the director at five district
dental society meetings. Many other were given to local and county den-
tal societies. Talks were made to the district nurses and many parent-
teacher association and other civic organization meetings. Materials
were given to the teachers attending summer school at the University of
Florida, and the requests received from these teachers for dental liter-
ature were more than gratifying.

Prenatal and postnatal letters on dental health were rewritten and
distributed with the cooperation of the Division of Public Health Nurs-
ing. Inexpensive formulas for a tooth powder and a mouth wash, togeth-
er with instructions on the proper method of caring for the teeth, were
included in these letters.

More than 10,000 copies each of the booklets, "Five Little Pigs"
and "Jimmie Chew", were distributed to the children in the first two
grades. The dental health song, "Billy Boy", was distributed to each
classroom. The booklet, "Dentistry and Public Health," was distribut-
ed to each teacher and copies left in the library of every school
visited. Many copies of the materials used were supplied to schools
not visited when the materials were requested by the principals or
county superintendents.

Dental health exhibits were displayed at a number of county fairs
during the year, and some new exhibits are now being prepared for use
at the various fairs this coming year.

Too much credit cannot be given the Bureau of Health Education,
the Division of Public Health Nursing, the Bureau of Engineering and the
Central Organization of County and District Health Work for the co-
operation they gave this bureau in conducting the dental health program
during the year. The Bureau of Health Education cooperated in sending
advance publicity to the communities in which the dental health pro-
gram was to be conducted. This publicity caused a better response from




18



the school authorities which made the carrying out of the program much
easier. The cooperation of the Division of Public Health Nursing in
distributing letters and in assisting in the inspections was very much
appreciated.

It is planned to continue the program along educational lines with
more time to be spent on the preschool child. Arrangements have been
made for holding preschool clinics.

A great deal of time was spent in studying the possibilities of a
future dental health program which would be of the maximum benefit.
Much credit is given the Florida State Dental Society and all its com-
ponent societies for the splendid cooperation given and their work in
planning such a program.







/
DISTRICT AND COUNTY HEALTH WORK



A. B. McCreary, M. D., Director






At the end of the year 1938 the Central Organization of District
and County Health Work saw established in sixteen counties of the state
fifteen full-time county health units. The counties now having full-
time health service are Broward, Duval, Escambia, Franklin, Gadsden,
Gulf, Highlands, Jackson, Hillsborough, Lake, Leon, Monroe, Orange,
Pinellas, Taylor, and Wakulla. Lake and Duval Counties were the new-
comers to this group.

The Lake County Health Unit was organized in July as a result of
the activities of the Lake County Medical Society and many civic or-
ganizations. Without their interest and cooperation this full-time
health service for Lake County could not have becn realized. The
unit is located at Tavares and since its beginning has been active in
organizing a well-balanced health program.

The Duval County Health Unit, located in Jacksonville, was organ-
ized in November. The campaign for this unit was carried on intensive-
ly through the cooperation of various civic organizations and partic-
ularly through the assistance of the Jacksonville and Duval County
women's clubs. This unit has been established one month, so it is too
soon to report on the progress of this unit, however, the interest
evinced in establishing the unit is a guarantee that progress will be
rapid and of permanent benefit.

The expansion and supervision of adequate local health service is
the primary function of this bureau and during 1938 ground work was
laid for many other units. It is hoped that it will be only a matter
of time before every community in Florida will have adequate full-
time health service.

The director of the bureau addressed many organizations during
the course of the year, the outstanding ones being the Florida Medi-
cal Association's annual meeting held in Miami on May 10 and the Flor-
ida District Convention of Rotary on April 27 at Ocala. The paper read
at the 167th District of Rotary at which every Rotary Club in Florida
was represented, was entitled "What Price Ignorance"; the subject of
the paper read before the Florida Medical Association was entitled "The









Final Responsibility of Public Health Rests on the Medical Profession".

Most of the individual county health units issued their own re-
ports for the year 1938 and it is not the purpose of this report to
attempt to tabulate their activities except to say that public health
programs in those counties having full-time health service has been
rapid.

One of the greatest problems faced in the promotion and organ-
ization of health service in the counties was the raising of funds in
the local communities for the support of public health. Florida has
an Enabling Act, passed at the 1931 session of the Legislature, which
empowers county commissions to levy two mills on all taxable property
for the support of the cooperative health unit. This fund is added
to funds from the state and Federal government and is earmarked as the
county unit fund to be expended only in the county making such provis-
ion. In some of the counties where there was considerable difficulty
attending the collection of funds which were pledged by various groups
and municipalities within the county, every effort was made to place
the county on a more stable basis through convincing the commissioners
of the necessity of operating under the Enabling Act and levying two
mills for the support of the unit.

Florida is still relying somewhat upon the loosely woven district
scheme of dividing the state into five districts, each district having
a health officer, a sanitary officer, a public health nurse And a
clerk. As these districts comprise from twelve to fifteen counties
embracing a very large area and more than 300,000 population, it is
entirely obvious that such a set-up is inadequate to administer health
protection to such a large and populous area. Consequently, the ef-
forts of these district health organizations daring-the yea aceomplish-
.A-no more than could be expected with such limitations.

There has been a renaissance of public interest throughout the state
and the public is eagerly grasping for information regarding conserva-
tion of health and prolonging of life. Through this interest the bu-
reau is directing every effort toward an extensive program of expanding
full-time health service in Florida. The support of the medical pro-
fession has been state-wide and it is hoped that through this continued
cooperation that the very best in public health can be given the people.









LABORATORIES


J. N. Patterson, M. S., M. D., Director







The annual report of the activities of the Bureau of Laboratories
for the year 1938 is submitted in tabular form below and also in Tables
IV through XIV in the Appendix.

Table I summarizes the various ways in which work was distributed
among the five laboratories. There was a gross increase of 12.5% over
last year in the number of tests performed which increase was shared by
all laboratories with the exception of the branch laboratory at Talla-
hassee. The slight decrease in the amount of work performed by this
laboratory was due to two conditions, namely: first, illness of the
bacteriologist necessitating a transfer of work to the central labora-
tory for a period of three weeks and, second, discontinuance of the
Kahn test which will be mentioned later.


TABLE I
Examinations made in the laboratories
during the year 1938
LABORATORY DIAGNOSTIC UILK AND WATER TOTAL
CENTRAL
Jacksonville 229,245 9,832 239,077
BRANCHES
famp 75,324 4,560 79,884
YaIt 67,964 6,636 74,600
Pensaola 20,491 862 21,353
Tallahassee 15,185 386 15,571
TOTAL 408,209 22,276 430,485


Table II on the next page shows the distribution of the work in
the different laboratories by months. Examination of the chart re-
veals a striking seasonal variation in the work of the Miami labora-
tory. The marked variation noted in the Tallahassee laboratory re-
port can be accounted for by vacation and illness of the bacteriolo-
gist, both circumstances requiring sending of the work to the Jackson-
ville Laboratory. The decrease in the number of tests performed in
the two smaller laboratories during December was due in a large part









to the discontinuance of the Kahn test and a transfer of this work
to the central laboratory.

TABLE II
Total number of examinations made
by months during the year 1938
JACKSONVILLE TAMPA MIAMI PENSACOLA TALLAHASSEE' TOTAL
January 18096 6663 9080 1312 1423 36574
February 18755 6495 6237 1497 1453 34437
iMarh 20755 8282 6014 1805 1450 38306
April 19932 7026 5114 1950 1312 35334
May 19846 6505 4668 1926 1756 34701
June 19093 5804 4530 2365 1471 33263
July 19838 5616 4438 1837 1538 3J267
August 20766 5786 4750 2377 2016 35695
September 22583 6211 7234 2389 810 '39227
October 19643 7032 6487 2088 1433 36683
November 19728 7316 7508 1165 717 36434
December 20042 7148 8540 642 192 36564
TOTAL 239077 79884 74600 21353 15571 430485


Table III (on opposite page) lists the monthly distribution of
biological products. The seasonal incidence of the different dis-
eases can be determined by a study of this table. There has been a
moderate decrease in the quantity of diphtheria antitoxin used dur-
ing the year. A charge of $6.00 per complete course of 14 antirabic
treatments has been made to all patients, with the exception of in-
digents. The amount collected for these treatments during the year
was $1575.00.

Syphilis

A very substantial increase will be noted in the number of speci-
mens submitted which are tabulated in Table IV in the Appendix. This
increase of approximately 50,000 specimens over the preceding year is
no doubt due in a large part to the extensive campaign conducted a-
gainst syphilis by the United States Public Health Service, the State
Board of Health and other agencies. The increase actually amounts to
approximately 100,000 tests as both the Kahn standard three tube test
and the Kahn presumptive test is done on every specimen received.









TABLE III
Biologicals distributed during 1938


Diphthera Antitoxin
100t0 5000
units units


Sohiok Toxoid


Typhoid Vaooine
Vaooine Virus


Anti- Purified Protein Derivative Tuberoulin
rabio 100 test pkgs % 10 test pkgs
Virus 1st str. 2nd str. 1st str. 2nd str.


36 13 3510 2290 5184 3110, 145 3
54 13 3220 3590 1976 1452 82 12
48 39 7520 2410 2688 3205 112 21
46 23 7790 4290 3160 3603 139- 30
23 7 3960 1035 2632 3162 173k 1


45 37
15 30 42
21 20 20
31 12 19
31 21


14 1530 539 2992 1097 133 5 5 33 26


JULY 43
AUG 100


SEPT
OCT


1 1680 1180 4648 1056 125


5 4750 1015 3240 2072 73 5 5 28 22


7 7010 6431 4960 2506 71 5
12110 5350 1928 3184 106 21


7 42 37
20 54 41


10 4380 2760 1424 2330 106 2 7 23 23


16 5280 3910 424 2096


115 26


TOTAL 576 148 62740 34800 35256 28873 1381 131


24 56 43

135 296 354


However, as the specimen is only reported Kahn positive, doubtful or
negative, the two tests are recorded as one. Actually 484,702 Kahn
tests were performed.

In some laboratories the presumptive test is used as a screen
test and the standard test is only performed on those specimens giv-
ing a positive presumptive test. However, the laboratories of the
State Board of Health do both tests on each specimen, for although
in the majority of cases, the presumptive test is more sensitive
than the standard test, an occasional case is encountered in which the
presumptive test is negative and the standard is positive. If the pre-
sumptive test were used solely as a screen test those occasional cases
of syphilis would be missed. The laboratory relies mainly on the stan-
dard 3 tube test for the reading and uses the presumptive test chiefly
as a technical check and as an additional criterion in establishing the
absence of syphilis.

During the last month of 1938 the performance of the Kahn test was
transferred from the Pensacola and Tallahassee laboratories to the cen-


MAY
JUNE


22 23








tral laboratory. This change was made because this test can be per-
formed more accurately in a larger laboratory where many tests are
run each day and where the technicians are uninterrupted while per-
forming this test. Then too, the work at both of the smaller labora-
tories had been too heavy for one technician but not heavy enough for
two. This change should lighten the burden on the bacteriologist and
allow her more time to devote to the performance of other laboratory
procedures.

A new report form, which follows, has been adopted giving both the
old and new terminology and the laboratory's interpretation of the re-
sult,


INTERPRETATION

New Torminology Old Terminology
Positive //// or ///
A diagnosis of syphilis should not be made on a single positive

serological reaction alone. If the serological result is not supported

by the history, signs and symptoms, an additional specimen should be

submitted as a check examination. If the repeat test confirms the ori-

ginal, syphilis is indicated with a high degree of probability.


Doubtful //
Neither makes nor rules out alone the diagnosis of syphilis. If

in conjunction with a known history of syphilis and particularly if the

patient has been under treatment it may be considered as positive evi-

dence of syphilis. If there is no history or clinical evidence of syphi-

lis, one or more specimens of blood should be submitted for check ex-

amination. A provocative injection of neo-arsphenamine may be tried,

and samples of blood taken on the 2nd and 7th days should be sent to the

laboratory for examination.


Negative or-
A negative serological report does not exclude syphilis. Frequently








positive reactions are not found in the primary stage or after treat-

ment has been instituted. If there is any reason to suspect syphilis,

another sample of blood should be submitted for examination.


The central laboratory entered the Evaluation Test conducted by the
United States Public Health Service. The following quotation is taken
from a letter addressed to Dr. W. A. McPhaul, State Health Officer, by
Dr. J. F. Mahoney, Senior Surgeon, United States Public Health Service
and Director of the Venereal Disease Research Laboratory:

"The result of the performance of the Kahn standard test in the
Florida State Laboratories was well above the average of other
participants reporting this procedure. You have no doubt noted
the high degree of agreement between your reports and those
from Dr. Kahn's laboratory. This is probably indicative bf ad-
herence to the procedure prescribed by Dr. Kahn himself and
should encourage the laboratory force in their efforts to per-
forn a standard technique in a standard manner.'

Agglutination Test

The agglutination procedure has been completely revised and a tech-
nique has been adopted which employs the essential principles of the
test as used by the National Institute of Health in Washington and the
laboratories of the Board of Health of Maryland. Miss Pearl Griffith,
Bacteriologist in Charge, Mr. R. L. Robertson, one of the bacteriolo-
gists in the central laboratory, and the Director of the Laboratories
worked out the procedure now in use. The antigens for these tests are
made by the laboratory from cultures obtained from the National In-
stitute of Health. These antigens are checked for purity and also for
specificity of reaction and antigentic quality. Negative and positive
controls are always set up as a check,

Physicians are asked to submit 5 cc of blood in the agglutination
specimen container and to specify clearly the particular test or tests
desired. The physicians are urgently requested to send whole blood or
blood sera and to discontinue sending dried blood. Accurate dilutions
are not possible with dried blood, but are easily made with blood
serum and hence an accurate estimate of the agglutinin content can be
obtained. The macroscopic agglutination tests now performed by the
laboratory are much more time consuming than the older microscopic ag-
glutination tests, but the accuracy of the results more than justify
the added expenditure of time. It is hoped that in the near future the
laboratory will be able to do routine culturing of the blood clots on
specimens submitted for agglutination tests.








Macroscopic agglutination tests are now being used in the cen-
tral laboratory as an aid in the diagnosis of typhoid fever, para-
typhoid fever, A & B>, undulant fever, tularemia, typhus fever and
Rocky Mountain spotted fever. Both the 'H' (formalin killed)
antigen and '0! (alcoholized emulsion) antigen is used in the di-
agnosis of typhoid fever. These tests will be performed in the
branch laboratories shortly after the beginning of the new year.
Results of these tests are reported by titre on the new agglutina-
tion report blanks. An interpretation of the titre and a general
discussion on agglutination tests are given on the back of these
blanks. This interpretation is given below:

Titre of:

Typhoid (Widal) (1-40 or less no significance
Paratyphoid A & B (1-60 suggestive
Undulant Fever (1-80 or 1-160 and up usually
Tularemia diagnostic

(1-80 or less no significance
Brills (Weil-Felix) (1-160 suggestive
(1-320 and up usually diagnostic

The result of agglutination tests should be interpreted by

the physician only with a full knowledge of the clinical course

and the history of the patient, especially with reference to pre-

vious vaccination. Great care must be exercised in the interpre-

tation of vaccinated individuals. The test should be repeated, at

least in all doubtful cases, in order to secure an index of the

rise or fall of the agglutination titre. A rising agglutination

titre is strong evidence of that particular disease being present

but not absolutely diagnostic of it.

Agglutination tests in general do not lend themselves to early

diagnosis since agglutinins do not develop as a rule until the di-

sease has been present for one to three weeks. It is believed by

many authorities that the presence of '0' typhoid agglutinins is

indicative of infection whereas the 'H' typhoid agglutinins arise in

most instances from vaccination so that a rise in the titre of the serum a-








against the 'O' antigen (living or alcoholized emulsion of typhoid ba-

cilli) has more significance than does a rise in the 'H' antigen (for-

malin killed typhoid bacilli).

Bacterial Examination of Water

The bacterial examination of water and shell fish was transferred
from tne Bureau of Sanitation to the Bureau of Laboratories March 1,
1938. Miss Lena Starck, Bacteriologist, who has performed this work
for many years continued doing this part-time under the supervision
of director of the laboratories. On July 1, 1938, she was transferred
for full-time duty to this department. She now does the bacteriologi-
cal examination of water, milk and shell fish and keeps all records of
this work. Over 500 water samples were examined per month following in
strict detail the procedure outlined in "Standard Methods for the Ex-
amination of Water and Sewage" as published by the American Public
Health Association. In fact, the laboratory goes considerably further
than they prescribe, in differentiating between the colon and areo-
genes group.

Chemical Analysis of Water and Sewage

A chemist has been added to the laboratory staff and a room has
been set aside for chemical analysis. The chemist, S. W. Wells, is a
graduate in chemistry of the University of Florida and has taken post
graduate work in water chemistry from Dr. A. P. Black of the Universi-
ty of Florida.

Chemical investigation on the efficiency of operation of water and
sewage treatment plants over the state in conjunction with surveys con-
ducted by the Bureau of Engineering is a major function of the chemical
department. In addition, chemical examinations are necessary in check-
ing pollution of waters to determine their suitability for public uses
and determining required treatment for new water supplies, sewage and
industrial wastes. Naturally, only investigations of a public health
nature are performed by the chemist.

Special Work

One of the first duties of the new director of the laboratories
was to investigate the so-called "cancer serum" deaths in Orlando in
which eleven out of thirteen people stricken lost their lives. The
director performed autopsies on five of the victims, the other six
bodies having been embalmed before the seriousness of the situation
was fully realized and aid from the State Board of Health requested.








It was definitely proved by the autopsies and by extensive animal
experimentation, properly controlled, that these patients died from
tetanus (lockjaw) toxin present in two series of vials of the so-call-
ed cancer serum administered by a practicing physician in Orlando.
The findings were announced three days after beginning the animal ex-
perimentation and two days later the findings were confirmed by the
laboratory of the National Institute of Health, Washington, D. C. Dr.
W. G. Workman of the U. S. Public Health Service spent one day in Or-
lando and took a portion of the so-called "cancer serum" back to Wash-
ington with him.

This toxin was present in the vials of cancer serum sent out by a
biological company of Philadelphia, Pennsylvania. It was further prov-
ed by animal inoculation and artificial cultivation that no Clostridium
tetani were present in the serum. Further investigation revealed that
the so-called serum was made from beef digested by Clostridium histol-
yticum for seven days and then passed through a Berkefeld filter.
Clostridium tetani were introduced with the Clostridium histolyticum
or were present in the beef previously and the organisms (but not the
toxin) were removed by passage through the Berkefeld filter.

The director of the laboratories gratefully acknowledges the valu-
able assistance cheerfully rendered by Miss Homer Harris, Superintend-
ent of the Orange General Hospital, Dr. H. A. Day and other physicians
of Orlando. Especial thanks are given to Mr. Louis C. Herring, Techni-
cian of the Orange General Hospital for his very able and untiring as-
sistance,

Physical Equipment

Much of the laboratories' equipment is worn and in need of replac-
ment. This is the case in all the laboratories, but it is particularly
evident in the Miami laboratory. In this laboratory alone the follow-
ing new equipment is needed: large centrifuge, water bath, electric
refrigerator, binocular microscope, Kahn shaking machine and a typewriter.
The other laboratories need new equipment, but not as urgently nor in
as large a quantity as the Miami laboratory,

All of the laboratories performing the Kahn test should be equipped
with an automatic pipetting machine to facilitate obtaining maximum
speed with dependable accuracy. Quebec colony counters should be pur-
chased for each laboratory to speed up and make more accurate the milk
and water counts. A large lead vat is needed in the washroom for
cleaning Kahn tubes in acid solution. A large drying oven has been add-
ed to the washroom in the central laboratory. Two new binocular micro-
scopes have been added to this laboratory. All of the laboratories have
received pipettes, petri dishes, glass slides, etc., as needed.








Personnel

The staff, both technical and clerical is grossly overworked in
all of the laboratories except in the two smaller branch laboratori-
es in Tallahassee and Pensacola. Their burden has been lightened
by transferring the serologic specimens to the central laboratory.
The Miami and Tampa laboratories each need an additional technician
and typist. The central laboratory needs three additional techni-
cians and two typists. Because of insufficient personell the techni-
cians are required to work overtime practically every day. The wash-
room force in the central laboratory needs two additional workers.
If it were not for the help rendered both clerical and menial by the
N. Y. A. and the W. P. A. the work would of necessity be greatly cur-
tailed.

A satisfactory classification and salary scale for the labora-
tory personnel must be worked out in the near future. As a whole the
laboratory workers are greatly underpaid in comparison with those of
other departments. In most instances workers in other departments do
not compare in educational qualifications nor does their work require
the technical skill needed in laboratory procedures. The very nature
of the work requires constant alertness and vigilance by the labora-
tory workers for their personal protection. It is hoped that these
glaring inequalities will soon disappear and that the laboratory work-
ers receive a salary commensurate with their training, ability, quali-
ty of work and length of service.









DRUG INSPECTION


M. H. Dose, Chief Inspector







The Division of Drug Inspection, Narcotic Service, attempts to re-
strict the sale, prescribing and dispensing of narcotic drugs strict-
ly to those qualified from a health and educational standpoint to do
so. During the year 1938 the Division arrested 32 persons; 27 of these
were convicted in criminal courts and the cases of 5 are pending. Vio-
lations corrected without legal action numbered 26.

By order of the State Board of Pharmacy the licenses of 3 pharma-
cists were repossessed and two pharmacists were reported to the Board
for permitting violations in their stores.

Unregistered physicians investigated by the State Board of-Medical
Examiners under authority of the state narcotic law numbered 8.

During the year the matter of naturopathic physicians prescribing,
dispensing and possessing narcotic drugs was contested by appealing
to the Honorable George Couper Gibbs, Attorney General for the state
of Florida. An opinion was rendered to the effect that naturopathic
physicians were not qualified according to Section 1, subsection 2 of
the State Uniform Narcotic Drug Act. Therefore, such physicians were
disapproved with the United States Collector of Internal Revenue in
and for the state of Florida, as vell as the Federal Bureau of Nar-
cotics.

A hearing was requested by the naturopathic physicians before At-
torney General Gibbs and this was held on September 8, 1938, in Tal-
lahassee, at which time several naturopathic physicians and their at-
torneys, the state health officer, Dr. W. A. McPhaul, and the chief
inspector of the Division appeared. The Attorney General's former
opinion was affirmed and the case was appealed to the United States
Southern District of Florida Court, presided over by the Honorable
Louie W. Strum. This action was taken under a mandamus proceeding,
however, in effect, Judge Strum ruled with the Attorney General.
The case is now pending before the United States Circuit Court of Ap-
peals.








STATISTICS


Edward M. L'Engle, M. D., Director






It is a physical impossibility to prepare vital statistics tables
and an analysis of the figures for the year covered by the annual re-
port of the State Board of Health. It has, therefore, been thought
advisable to publish the full report of the Bureau of Vital Statistics
in a separate volume covering statistics for the year 1937. This re-
port has been completed and sent to health officers, government agenci-
es and libraries throughout the country. It will be sent on request
to interested persons as long as the supply lasts.

There is included herein only a narrative report of the activities
of the Bureau of Vital Statistics for the year 1938. During the year
the records of the Bureau of Vital Statistics were increased by the
filing of 33,930 birth certificates; 22,487 death certificates; 24,903
marriage licenses and 8,438 divorce reports. The total on file at the
present time of each of the above is 707,877 birth certificates;
449,962 death certificates; 231,125 marriage licenses and 59,228 di,
vorce reports -- a total of 1,448,192. These records are indexed,
bound and kept in fire proof vaults in the new building of the State
Board of Health at Jacksonville.

Certified Copies

During the calendar year 1938, there was a total of 9,714 certifi-
ed copies issued, of which 911 were issued without charge to govern-
ment agencies and for the purpose of supplying information needed in
connection with the Uniform Veterans' Guardianship Act of 1929 as is
provided by an act of the legislature.

Notices to New Mothers

A total of 29,729 notices of birth registration were issued to
new mothers. This is done in all cases where the original certificate
is filed within the statutory limit. Such notices are not issued in
case of the filing of delayed certificates. With each such notice is
included a small printed sheet advising each mother to have her child
protected against diphtheria.


VITAL








Annual Registration Healing Arts

For 1938, 3,071 persons holding licenses to practice in Florida
were registered. Of these, 2,215 were doctors of medicine, 389 doc-
tors of osteopathy; 193 doctors of chiropractic; 169 doctors of na-
turopathy and 105 chiropodists.

Some idea of the routine work required of a bureau of this kind
may be gained from the following figures. 105,765 original records
and 102,874 index cards were numbered; 114,593 index cards were typ-
ed; 34,561 letters, packages, etc., were prepared for mailing;
64,424 miscellaneous reports were prepared and mailed; 35,127 month-
ly reports-were received and checked; 6,555 divorce reports were
posted; 38,054 photostats were made, numbered and checked; 126,983
addressograph plates were run through the addressopraph; 115,025
mimeograph sheets were imprinted; 104,967 cards were punched; 82,773
punch cards were verified by the key verifier; 6,782,553 punch cards
were sorted by machines. This does not by any means include all the
acitivites of the bureau but will serve to illustrate the volume of
routine work performed during the year 1938.

There is an increasing realization of the value of birth certifi-
cates. More and more, different departments of the state and Federal
government are requiring such certificates for various purposes con-
cerned with the increased activities of both the state and Federal
government. This is shown by the greatly increased requests for the
filing of delayed birth certificates. This is an activity which re-
quires a great amount of correspondence, sometimes extending over as
much as two years before proof satisfactory to the State Board of
Health can be furnished for the filing of such certificates. Where
the application for permission to file such a certificate shows that
either parent is foreign-born, the rule of the bureau requires proof
from the Bureau of the Census that the facts relating to the date
and place of birth can be verified from that source. While it is felt
that the opportunity should be given those, who for one reason or an-
other have had no birth certificate filed at the proper time, to be
provided with such a certificate, it is equally important that the in-
tegrity of the records be maintained by requiring satisfactory proof
of statements made by the applicants.

The work of the bureau has vury greatly increased during the past
few years and is almost certain to continue to increase; not only be-
cause of the greater population of the state which the bureau must serve
but also because of the demands made by the Social Security Board, the
State Welfare Board and other official organizations. Some more satis-
factory plan should be worked out for serving these agencies than that
now in force. It would seem reasonable that Federal and state agencies
should make available directly to the Bureau of Vital Statistics funds
for the employment by it of additional personnel to serve their needs.








MULTIGRAPHING


E. F. H. Ganten, Operator






The increasing demand for the printed word as a medium of health
education is felt not only in the bureaus and divisions concerned
with this problem, but also in the multigraphing department of the
State Board of Health. Here the actual increase can be seen by study-
ing the volume of work done.

As in previous years the multigraphed sheets continued to out-
number the mimeographed sheets (3,255,081 sheets multigraphed and
400,333 sheets mimeographed), but in the matter of printing forms which
are used by the bureaus the mimeographed forms outnumbered the multi-
graphed forms (1,719 forms mimeographed and 742 forms multigraphed),
as this means of printing forms was found to be less expensive. Other
figures showing the amount of work done by the department can be found
in the Appendix Table XV.

Besides multigraphing and mimeographing forms and sheets the de-
partment supplies the bureaus and divisions with individual letterhead
stationery and envelopes. Other paper supplies are also ordered through
the department and the centralization of these orders has brought about
a great reduction in cost.

The various county health units and the district health departments
throughout the'state are also served by this department. Their annual
reports, forms, letterheads and stationery are printed in this office,
which saves these departments with limited personnel much time and ex-
pense.

It is believed that an increase in the full-time personnel of the
department would result in greater efficiency and quicker service, how-
ever, the part-time workers loaned by the WPA and the NYA have greatly
assisted in meeting the demand for more efficient service. The equip-
ment of the department could also be modernized and by the addition of
newer machines the printing of the various bulletins, pamphlets and re-
ports could be made more attractive.









ENGINEERING


George F. Catlett, Director







At the beginning of the year 1938 the usual duties of the.Bureau
of Public Health Engineering were divided between a Bureau of Engi-
neering and a Bureau of Sanitation. About the first of July, the
Rureau of Sanitation was abolished by the Board of Health and all
duties taken over by the Bureau of Engineering.

Personnel connected with the Bureau at the end of 1937 consisted
of the Director, an Assistant Engineer on Water and Sewage, J. Huston
McClane, and a Secretary. There was also provided by the U. S. Pub-
lic Health Service from a special appropriation for technical super-
vision of W. P. A. Community Sanitation and Malaria Control Projects,
an Assistant Director, A. C. Newman; a Draftsman, N. S. Thayer; and
four District Supervisors, C. R. Bill, W. W. McPhaul, C. R. Fox, and
J. B. Miller.
On the first of January, Russell Broughman was transferred from
the Bureau of Sanitation as Assistant on Malaria Control Drainage
Work, and J. W. Wakefield added as Assistant Engineer on Sewage and
Stream Pollution. In March, C. L. Richardson, Shellfish Inspector,
was transferred from the Bureau of Sanitation to act in the same ca-
pacity. In that same month, Miss LaVerne Tompkins was added to the
Bureau as Clerk-Stenographer.

July 1, with the abolition of the Bureau of Sanitation, the fol-
lowing were added to the Bureau of Engineering from that Bureau:

F. A. Safay (former Director, Bureau of Sanitation)
Dr. A. H. Williamson, Milk Sanitation Specialist
T. W. Miller, Special Sanitary Officer
Mrs. Florence Van Caeyzelle, Clerk-Stenographer
J. H. Ruge, Sanitary Officer
D. I. Sigman, Sanitary Officer
F. C. Moor, Jr. Sanitary Officer
C. A. Holloway, Sanitary Officer
S. D. Macready, Sanitary Officer

On that same date, due to a decreased appropriation to the U. S.








Public Health Service, A. C. Newman, Norman Thayer, and C. R. Fox
terminated their services on technical supervision of W. P. A.
Projects, and Messrs. Newman and Thayer were added to the Bureau's
organization, the former as Assistant Engineer on Malaria Control
Drainage, and latter as draftsman.

Following the July changes, the bureau was organized as fol-
lows:

G. F. Catlett, Director
J. H. McClane, Assistant Engineer, Water & Sewage
J. W. Wakefield, Assistant Engineer, Water & Sewage
Russell Broughman, Assistant Engineer, Malaria Control Drainage
A. C. Newman, Assistant Engineer, Malaria Control Drainage
A. H. Williamson, D. V. M., Milk Sanitation
C. L. Richardson, Shellfish Sanitation
F. A. Safay, Assistant on Sanitation


Sanitary Officers

J. H. Ruge C. A. Holloway
D. I. Sigman S. D. Macready
F. C. Moor T. W. Miller


Supervisors W. P. A. Community Sanitation and Malaria Control

C. R. Bill J. B. Miller W. W. McPhaul

On September 1, J. Huston McClane left the State Board of Health
and only one assistant was available on water, sewage, and stream
pollution for the remainder of the year.

The five resident district sanitary officers were continued
through the year as in past years.

With the decrease in appropriation for supervision of W. P. A.
projects, the state had to be divided into three districts instead of
four. A. C. Newman continued to give general supervision over malaria
control projects and supervision over community sanitation was trans-
ferred to F. A. Safay.

Public Water Supplies

Due to the fact that little has been done by the State Board of








Health for some years on the technical phases of water supplies and
water purification plants, this field demands a large amount of de-
tailed field work with municipal authorities and plant operators.
Samples from the supplies are examined regularly by the Bureau of
Laboratories, to whom the work was turned over in July, 1937. 'Un-
less there is a correlation of this work in the field, however, its
value is very questionable. From the first of the year until leav-
ing in September, J. H. McClane devoted practically his entire
time to visiting the water plants in the state, studying the problems
in detail and working with the operators of the purification works.

Plans for construction, alterations, and extensions to 17 pub-
lic water supplies were investigated and approved during the year:
Lakeland, Port St. Joe, Miami, Mount Dora, Mayo, Bradenton, Sarasota,
Macclenny, Umatilla, Haines City, Palatka, Melbourne, Pinellas Coun-
ty, Gainesville, Miami Springs, Jacksonville, and Fort Pierce.


Private Water Supplies

Proper check on private water supplies is almost impossible ex-
cept where there is a local health organization. To properly appraise the
safety of a water supply, it is absolutely necessary to make an in-
vestigation on the ground, and laboratory samples must be taken by a
person familiar with the work. Large numbers of requests are made.
for laboratory examinations of private waters, and if laboratory ex-
aminations are made without field surveys, many dangerous supplies
will not necessarily show pollution at the time of sampling. For
this reason, attempt has been made to get a field investigation by
the district sanitary officers. Fortunately, most requests of this
nature are not of an emergency character and the sanitary officer
makes his investigation upon his next visit in that vicinity. This
should be done, or the Bureau of Laboratories refuse to attempt such
service.


Bottled Water Supplies

Due to the high mineral content of most of Florida public water
supplies, there is quite a demand for bottled waters, and permits
were issued for 52 bottling plants in the state and for 5 located
out of the state. Before issuing permits to out-of-state plants, ap-
provals were obtained from the state authorities where they were lo-
cated.

There is a distinct and serious public health danger in these
bottled waters. If the source of the water is not a well protected
one, the cleaning and sterilizing of containers not properly done,









and the bottling carried on under sanitary conditions, a serious
epidemic may easily result.


Public Sewerage Systems and Sewage Disposal

Every effort has been made to promote extension of sewerage sys-
tems, and plans for 20 sewer extension projects were investigated and
approved. At least that many more extension projects were carried
out, but no plans submitted for approval. A defect in the statute
prevents the securing of complete submission of plans for all projects.
It is hoped that this defect may be corrected by the next legislature.

When Florida was made up only small towns and there were no large,
congested areas, disposal of sewage was a simple matter. Under present
conditions some serious problems now exist and they are increasing in
number. At Miami and Tampa there is quite a need for sewage treat-
ment. Orlando, Ocala, and one or two small communities are discharg-
ing sewage into the underground water supplies and something should be
done about this.

'The two sewage treatment plants at Pensacola were put into ser-
vice, and Assistant Engineers McClane and Wakefield spent several
weeks working with the operator. Plans were approved and work .start-
ed on a similar plant at Clearwater. At Umatilla plans were approv-
ed for additions to the septic tank. At Lakeland work was started on
a high rate trickling filter to follow the primary treatment already
in use. Frostproof also remodeled their disposal plant. Plans were
approved for: Escambia Farms, Edgewood Court, Virginia Park, High-
land Hammock Park, Lakeland, Ft. Clinch Park, Key West, Marianna,
Frostproof, Clearwater, Goldhead Park, Gainesville, Lake City, Pensa-
cola, Sulphur Springs, Umatilla. Industrial waste disposal was ap-
proved for the National Container Corporation, Jacksonville, and the
Fernandina Pulp & Paper Company, Fernandina, Florida.


Stream Pollution

The major part of the work of Assistant Engineer Wakefield dur-
ing the year was on stream pollution studies. Most of this work was
done in connection with areas condemned for taking shellfish and the
pollution maps for this purpose were revised. Extensive studies were
made at Fernandina, Pensacola, Daytona Beach, Vero Beach, and Fort
Pierce. Work was also done in the vicinity of Tampa in connection
with the watershed from which Tampa's water supply is taken,and on
the lower part of Hillsborough River and Hillsborough Bay in connection









with sewage disposal difficulty. Some studies were also made on Bis-
cayne Say. In addition to making the field surveys and collecting
samples, 2323 water samples were examined in the laboratory. Of these,
Assistant Engineers Wakefield and McClane did the laboratory work on
2080 samples, and the Bureau of Laboratories handled 243 samples. This
work is time-consuming and considerable of it should be done.

At Pensacola and Miami, work was done in connection with the pol-
lution of bathing beaches, but the entire Biscayne Bay area needs to
be surveyed and studied in relation to the disposal of Miami's sewage.

During the year, Miami Beach completed a sewer outfall 7,000
feet into the ocean. Although such would not be feasible elsewhere
in the state, the proximity to the Gulf Stream and the nature of the
ocean currents, make it permissible here. Approval was given pro-
visionally. If beaches are affected by pollution, treatment is to be
added.


Malaria Control Drainage

With the beginning of the year, an assistant was added to work
on malaria control drainage, and in July, A. C. Newman who had been
in general charge of W. P. A. Projects was transferred to the regu-
lar personnel of the bureau, and Mr. N. S. Thayer, draftsman, was
similarly transferred. Steps were taken to organize this work and
interest the county health units in developing a program of malaria
control.

The International Health Board of the Rockefeller Foundation of-
fered to cooperate with the State Board of Health in the malaria con-
trol work in the state. Following conferences with them, it was de-
cided to set up in a county a model program where efficient malaria
control work could be demonstrated. Escambia County and the City of
Pensacola agreed to endorse the plan and contribute to its support,
and this county was selected for the demonstration. A budget was
adopted, one-third each being contributed by the International Health
Board, the State Board of Health, and Escambia County with the City
of Pensacola. In addition, the I. H. B. contributed the services of
Dr. J. E. Elmendorf, Jr., as Director. Sanitary Engineer, David B.
Lee was transferred from the State Board of Health central organiza-
tion to this budget.

*With the addition of engineering personnel for malaria control
work, progress in this field was still handicapped by the lack of
epidemiological personnel to work with them. In any effective ma-
laria control program it is necessary that epidemiological studies








be first conducted and the malaria definitely located. This is fol-
lowed by entomological surveys locating the mosquito breeding places
responsible for the malaria transmission. Then, and only then, can
drainage and other control measures be designed to produce effective
results.

Practically all malaria control drainage accomplished during the
year was with the W. P. A. projects. These however, had to be confin-
ed to areas where there was a local health organization to make the
work effective. Even where there were such organizations, the health
officer was not able to do the preliminary epidemiological work to
gain the best results.

Many requests were made for the State Board of Health to sponsor
so-called malaria drainage projects, as no W. P. A. projects for this
purpose was eligible without sponsorship of the State Board of Health
and a much larger amount of W. P. A. labor could have been utilized.
However, it was explained in each case that no such work could be
worthwhile without the supervision of a health unit.

The following work was accomplished:

NEW WORK:

Main channel ditches: 418,537 lineal feet 177,098 cubic yards
Laterals: 133,631 lineal feet 32,618 cubic yards
Man hours: 1,087,126 Water surface drained: 275,871,039 square feet

RECLAIMED DITCHES:

Main channels: 606,031 lineal ft. Water surf. dr.:202,142,553 sq. ft.
Laterals: 117,886 i" 54,088,498 sq. ft.
Man hours: 319,318

FILLS: 36,616 cubic yards. 342,846 square feet

Man hours: 38,569 Team or truck hours: 1,833

AVERAGE NUMBER MEN WORKING EACH WORK PERIOD...................... 595


Post Mosquito Control

Post mosquito work is, of course, not public health work, and no
provision was made in the budget for work in this field. The bureau,
however, cooperated as far as possible with local authorities on this
work. An extensive W. P. A. project was sponsored for the City of









Tampa and some supervision given them. The bureau also cooperated
in trying to promote a mosquito district for this locality, but the
plan was discarded locally.


Aedes Aegypti Control

The State Board of Health contributed $15,000 towards an aegypti
control program in the City of Miami, the city and county putting up
a similar amount. This work was conducted under the supervision of
Mr. F. A. Stutz, Superintendent, Dade County Mosquito Commission. Ac-
complishments are contained in Mr. Stutz's annual report.


Milk Sanitation

The entire time of Dr. A. H. Williamson was devoted to milk sani-
tation. The work of the bureau was concentrated on the passage of the
Standard Milk Ordinance of the U. S. Public Health Service which is
recommended by the State Board of Health. Where such ordinances are
passed, efforts are mr.de to insure its enforcement and to advise with
the local authorities and generally supervise the work. Dr. William-
son reports on his activities as follows:

"Surveys conducted throughout 1937 showed conclusively that the
great majority of the 37 cities; which had adopted the U. S. P. H. S.
Milk Ordinance were not enforcing its provisions. A great many were
operating under old editions of the ordinance which in a good per-
centage of the cases dated back to 1932. It was ascertained that this
let-up in milk control was due to several factors. One of the princi-
pal reasons was that the State Board of Health had not been actively
engaged, on a scale of any magnitude, in milk control work in several
years and the program suffered because of lack of promotion. Another
factor greatly influencing the situation was that only a few full-
time county health departments had been established at this time and
the majority of the cities which had adopted the ordinance did not
have full-time city health departments and a good percentage had no
health department at all. Local sanitary officers were not trained
in milk control work and in a great many cases had abandoned their
ordinance and were depending upon other agencies to "carry on". It
was quite evident that very little improvement could be made until
more ground work was laid.

"The bureau strategy was to salvage as many of the programs as
could be salvaged and prevent the adoption of the ordinance by addi-
tional towns and cities which could not enforce it. The towns in
the last mentioned classification (about 18 in number) which had al-








ready adopted the ordinance were left to their own devices and the
remaining 19 were concentrated upon.

"During the first few weeks of the year the U. S. Public Health
Service collaborated with the Alabama Polytechnic Institute at
Auburn in putting on a short course in milk control work. The writ-
er attended this session and prevailed upon Dr. Franklin A. Clarke,
the service representative at the short course, to return to Florida
and help in injecting new life into the milk program. Dr. Clarke sur-
veyed the principal cities of the state and gave timely counsel re-
garding the handling of the individual problems as well as assisting
in setting policies which would help further the interest of the
Standard Ordinance.

"He particularly stressed "need of pasteurization" and pointed
out the vast majority of the so-called "pasteurized milk" was im-
properly processed and/or handled. The percentage of milk pasteur-
ized in the smaller cities was ridiculously low, averaging about 26%.
The percentage of pasteurized milk in the larger cities was consider-
ably higher, but still far below the disired level, the average be-
ing about 68%. Pasteurization plant machinery operators were unskill-
ed in the majority of instances, especially in the smaller plants,
and consequently pasteurization was improperly done and records im-
properly kept.

"At first attempts were made to go into each individual plant and
instruct the owners in its operation, and where full-time or sufficient-
ly trained inspection personnel was not available. Dr. Clarke point-
ed out that detail work on the part of the State Board was inadvisable
and suggested that the board concentrate its efforts on training lo-
cal personnel and leave detail work to them. This policy was adopted.
The press, the schools, the lecture platform, and motion pictures were
all used in reviving interest in local programs and in "pasteurization"
programs particularly.

"Seven Florida cities improved their programs to the extent that
they merited inclusion in the "satisfactory" list of standard ordinance
cities. These cities were: Miami, Coral Gables, Ft. Lauderdale, Holly-
wood, Pensacola, Perry, and Pompano. The other 12 cities on which
the bureau concentrated their efforts made phenomenal improvements in
their individual programs, but not sufficient to merit inclusion in
the list.

"Survey results were, in each case, sent to Washington and the
ratings were figured in that office. Follow-up work-was done by the
State Board of Health after each survey and this was, in the writer's
opinion, largely responsible for the continued interest of local in-









section personnel in their programs and the ultimate improvements
made in the local milk supplies. The state has endeavored at all
times to stay in the background and let all programs remain local.
It is believed that any other policy is inimical to the best in-
terest of the Standard Milk Ordinance.

"A 'Standardization Survey' of state work was made by the Gov-
ernment in March of this year. The purpose of this survey was to
determine the capabilities of state inspection personnel. Nearly
two hundred individual dairies were surveyed by the state and feder-
al inspectors. The inspections were made, using the U. S. Public
Health Service Milk Ordinance and Code as the yard stick, and using
Standard Inspection Forms for collecting data. The inspections of
each dairy were made simultaneously, with each inspector unaware of
the findings of the other. The data obtained by each inspector was
then sent to Washington where the ratings were completed. A maximum
variance of 5 percent in the state and federal rating was permitted
for the state work to be considered satisfactory. When the ratings
were computed in Washington and sent back to the State Health Of-
ficer, the average variance on 'Raw', 'Raw to Plant', and 'Pasteur-
ized' Milk was found to be 2 2/3%.

"A Milk Seminar was held in Memphis in May. This meeting was
sponsored by the U. S. Public Health Service and was attended by
the majority of state inspection personnel of the southern states.
A great many local inspectors also attended. The changes which had
been made by the advisory committee in bringing the old Ordinance up
to date were studied at length, as were the technical phases of
pasteurization. Newly developed pasteurization equipment was also
studied and the phosphatase test came in for its part of the discussion.
Sessions were long, but interesting. Plans were made to continue the
idea of sectional meetings of this kind and Atlanta was advanced as
the next logical meeting place in the south.

"In June, the Bureau of Animal Industry intensified its drive
to rid the state of tuberculosis and bangs disease. The State Board
of Health cooperated with this agency and the State Livestock Sani-
tary Board in furthering this work. Mastitis came in for its share
of attention. Only little headway has been made, however, in the con-
trol of mastitis. This test is not mandatory at this time in many
city ordinances. Broward County was the first and only county health
department to incorporate this provision in ordinances-which it recom-
mends for adoption. Fort Lauderdale, Hollywood, Dania, and Pompano
ordinances now require this test. The health of the herd has hereto-
fore been neglected throughout the state and a strenuous effort is
continuously being made by this bureau to direct attention to and em-









phasize the importance of this phase of milk control. Every new ordi-
nance drawn requires systematic tests for tuberculosis, bangs, and
mastitis.

"Educational work pertaining to practical farm sterilization has
continuously gone forward. Steam and chemical sterilization efficien-
cy has improved materially through this effort, but supplementary
treatment of fixed equipment is far from satisfactory. Much more edu-
cational work pertaining to this needs to be done, but effective edu-
cational work must be done by sanitarians trained in the basic prin-
ciples of milk sanitation. It is worthy to note that the only cities
making a satisfactory showing are located in counties having a full-
time county health department with the exception of Miami and Coral
Gables. These sheds are combined and are controlled by Miami which
maintains an adequate and well qualified staff of dairy supervisors.
This statement should not be construed to mean that all cities not op-
erating under the U. S. Public Health Service Milk Ordinance and which
are not located in counties having full-time county health departments
have unsatisfactory milk supplies. It simply means that their milk
sanitation status has never been determined by the state or federal
government."


Shellfish Sanitation

C. L. Richardson, Shellfish Inspector, was transferred from the
Bureau of Sanitation to the Bureau of Engineering in March. Mr.
Richardson, however, devoted his attention entirely to oysters, clams,
and scallops, the cooked seafood---crab, lobster, and shrimp meat--being
handled by the Sanitation Bureau. On July 1, however, all this work
was concentrated under Mr. Richardson. Oyster shucking houses in the
state were in quite a deplorable condition, so much so that the U. S.
Public Health Service threatened to discontinue approval of our per-
mits for interstate shipment of these products. At the request of
the bureau, Senior Sanitary Engineer, L. M. Fisher in charge of this
sanitary district, U. S. Public Health Service assigned Mr. Fletcher
of his staff to make inspections of Florida oyster packing houses.
Mr. Fletcher in company with Mr. Richardson listed the deficiencies
of each plant from the list of 67 permits that were issued by the
State Board of Health the previous season.

A letter'was them written to each holder of a permit by the Bu-
reau Director, enclosing the list of deficiencies found at his plant.
He was formally notified that unless these deficiencies were reme-
died and the regulations complied with, a permit would not be issued
for the coming season. The general reaction to this ultimatum was
the complaint that the State Board of Health had made such statements









before and where a number of dealers had spent considerable money on
their plants, permits continued to be issued to those complying and
those not complying. By personal interviews it was possible to con-
vince dealers that this time the State Board of Health meant what it
said.

In the majority of cases compliance meant rebuilding, or prac-
tically rebuilding of the plant. The shellfish inspector worked with
them, personally showing how defects were to be remedied and how
plants should be built and the proper equipment purchased. At the
end of 1938 only 52 permits had been issued and there was general com-
pliance with regulations. Fifteen or more plants went out of business
as the owners were convinced that they were not financially able to
continue in the business.

Crab, lobster and shrimp meat plants were similarly improved,
this work being started in 1936 with gradual improvements since then.

During 1938 the following permits werc issued:

Oyster houses.................. 52
Scallop houses................. 5
Crab & Lobster Meat Plants.....40

Frequent and systematic inspection of all those was necessary
to keep them up to regulations.


Swimming Pools

A state statute makus it a misdemeanor to operate a swimming
pool or bathing beach without a permit from the State Board of Health
and this board is empowered to make regulations for the control of'
such. The bureau issued permits during 1938 for 80 swimming pools,
after inspection and recommendation by the district sanitary officers.

Florida was one of the pioneer states on swimming pool sanita-
tion, but as progress has been made along this line in recent years
it has not been followed. Regulations need revising and requirements
such as accepted bacteria content standards included. Little has been
done in regard to bathing beaches due to lack of required personnel.


Tourist Camps

Florida being a tourist state has an abnormal number of tourist
and trailer camps. Occupants of these camps come from almost every









state, and there is a public health hazard in connection with them.
A state statute makes it a misdemeanor to operate a tourist camp with-
out a permit from the State Board of Health. The statute, however,
does not cover trailer camps, according to rulings of some local
courts and prosecuting officers, though the bureau has included these
in the work on tourist camps.

During 1938, permits were issued to 499 tourist and trailer
camps after inspections by district sanitary officers. The sanitary
officers have spent a very large proportion of their time on such
camps. In some sections, especially in south Florida, camps are in
most excellent condition. This is somewhat influenced by the patron-
age to be catered to. Where there is a large demand for tourist camp
facilities, owners are able to build very high class camps. In sec-
tions of the state where patronage is small, the poorly equipped camps
are found.


Food Canning Plants

During the time that Mr. E. L. Filby was state sanitary engineer,
attention was called and numerous complaints were made of insanitary
conditions found in food canning plants in the state. Arrangements
were made for regular inspections of these, and regulations passed by
the Board of Health with permit required for their operation. This
work has been continued since then and in 1938, 126 permits were issu-
ed for canning plants after inspection by sanitary officers.

Recently an investigation by the U. S. Public Health Service
showed severe cases of dermatitis on hands and arms of peelers and
sectionors in citrus canning plants. A survey by the Bureau of Engin-
eering showed quite a prevalence of this, and shows a need for more
inspection and regulation.


W.P.A. Community Sanitation Projects.

W. P. A. projects for use of their labor in the building of sani-
tary privies have been continued during the year 1938 as previously.
Since the '. P. A. only supplies labor to build these devices it is
necessary to have some other agency promote the construction of the
privies in the community. Where there is a local health organization
the work fits well into their program. In other cases, municipal of-
ficials have arranged for cooperation. District sanitary officers have
assisted to some extent, but their other duties and the wide area they
have to cover makes it difficult.









Congress has been making a yearly appropriation to the U. S. Pub-
lic Health Service for technical supervision of such projects. This
fund is used to furnish personnel to the various state health depart-
ments in proportion to the number of W. P. A. workers engaged in the
work. For the fiscal year 1937-38 the appropriation was $1,300,000;
for the fiscal year 1938-39. this was reduced to $500,000. Until
July 1, there was available in Florida a general supervisor, an of-
fice engineer, and 4 district supervisors. On July 1 this personnel
was cut to an amount not sufficient to pay 3 district supervisors
and State Board of Health funds were used to complete the salary and
travel for the three. Later the general supervision was assigned to
Mr. Safay.

Results may be tabulated as follows:

Average No. men working .....................424
Maximum counties operating................... 30
Minimum ...... .............. 24
(All counties except 1 operating from
Central Plant)
Privies constructed:
Wood slab.......... 862
Concrete slab.........4232
At homes..............4984
At schools............ 110
Privies repaired......1012
Septic tanks............. 3


Drainage Wells

A state statute forbids the discharge of any waste water into
the underground water sources of the state except by permit from the
State Board of Health. It has been the policy to refuse all such per-
mits for the disposal of sewage, and all other wastes where some oth-
er means of disposal can be found. The largest number of permits has
been issued for storm water in the Miami area, and in Orange and Polk
Counties. As there is considerable hazard to water supplies in this
practice, permits have only been issued after careful investigation.


Water Supplies and Sanitation of Interstate Carriers

For some years this, and other State Boards of Health, have co-
operated with the U. S. Public Health Service in checking the water
supplies, milk, seafood, and general sanitary conditions surrounding
railroad trains, steamships, busses, airplanes, and all passenger car-









riers. As the Public Health Service is responsible for this in inter-
state travel, inspections are made and reports made to the Service.
They, in turn, issue certificates to the carriers. This work is quite
extensive in Florida, and with additional personnel furnished through
Social Security funds, the Service appropriately asks for more complete
service in this connection. However, in 1938, only district sanitary
officers were available for the work and one inspection only was made.
It is planned to make this more complete next year, using engineer per-
sonnel.


Industrial Wastes

Florida not being an extensively industrial state, the problem
of disposal of industrial wastes is not so extensive. The chief prob-
lem is in connection with citrus canning plants. A large number of
these plants are located in the lake section of the state where no
streams are available for disposal. The liquid wastes from these plants
are very high in biochemical oxygen demand and when discharged into
lakes cause nuisances. Recently, the solid wastes--peel and rag--have
been utilized to manufacture a stock feed. This remedies the diffi-
culty in disposal of these solid wastes, but a liquid waste from the
stock feed is many times more concentrated than the ordinary canning
plant waste.

A solution of this problem requires research work, and a con-
tract was made by the State Board of Health, U. S. Department of Agri-
culture, and Florida Canners Association to conduct such research.
The Canners Association appropriated $1500; the State Board of Health
designed the experimental plant and furnished plans with engineering
consultation service; and the U. S. Department of Agriculture agreed
to operate the experimental plant and make necessary laboratory de-
terminations under Mr. H. W. von Loesecke in charge of Citrus Experi-
ment Station at Orlando. It is hoped that under this plan a treat-
ment method may be worked out for canning plants to utilize. Under
the statute the State Board of Health has responsibility for protec-
tion of lakes from pollution, but must have a practicable method of
treatment to specify to the canners in disposal of these wastes.

These studies do not include the stock feed wastes as the Can-
ners Association is not interested in this. Considerable mxperimen-
tation has been made by this bureau, in cooperation with the owners,
in order to work out some method of dewatering'the waste which is a
sludge approximating a sewage sludge. However, there is little space
available at most of the plants, and the plants are close to built-up
communities. Odors and insect breeding make such dewatering beds im-
practicable. As the waste does not contain matter with potential com-









municable disease organisms, a permit was given the Suni-Citrus com-
pany, at Haines City, to discharge this waste into a drainage well.
The permit is to be revoked if any effect is shown on water supplies,
and the company bear the cost of the experiment.

Florida has five paper mills in operation or being built. These
are: sulphate mills at Port St. Joe, Panama City, Jacksonville, and
Fernandina, and a sulphite mill at Fernandina. The sulphate is a
recovery process with only a small amount of cooking liquor going to
waste; in the case of the sulphite process, all digestive liquor is
discharged as waste. At Panama City and Port St. Joe waste is dis-
charged into the St. Johns River. At Fernandina, the sulphate mill
has constructed a holding basin from which waste is discharged on
outgoing tide only. The sulphate mill at Fernandina is to discharge
into an ocean outfall, with a provisional approval from the State
Board of Health.


District Sanitary Officers

For years the Bureau of Engineering has had field representatives
resident in districts, so as to economize in travel expense. None of
these have been technically trained men, however, The bureau now has
five of these with headquarters at (1) aLrianna, (2) Jacksonville,
(3) Ocala, (4) Bartow, and (5) Uest Palm Beach. In 1934 there were
five health districts set up with an office and a health officer and
clerk. The Bureau of Engineering districts were altered to conform
with these health districts and sanitary officers attached to these
offices. However, on instructions from the State Health Officer, the
sanitary officer continued to function as field representatives of
the Bureau of Engineering and operated directly under the bureau di-
rector.

They have been used mostly for inspecting and checking tourist
camps, swimming pools, bottled water plants, home water supplies and
excreta disposal, nuisances and reporting to the bureau activities
that require technical attention. In the early days of the bureau's
existence the field covered was not very broad and it was possible
for the director to draw necessary regulations and detailed specifi-
cations as to what was required, and the sanitary officer worked
quite successfully. With the broadened activities needed throughout
the state, this is no longer entirely practicable.









Legislation

The bureau has had considerable difficulty in prosecution of cas-
es for violation of sanitary regulations, and in numerous cases prose-
cuting officers advise that they cannot make out a case for us under
present statutes and regulations. Various boards and commissions have
been set up with power to make sanitary regulations which should be
the responsibility of the State Board of Health. Under the present
statutes, county health units have no clearly defined authority to en-
force sanitary regulations. The present regulations of the Board of
Health are in many cases, antiquated and do not cover important fields.
All of this causes confusion.

It is most necessary that efforts be made to get the next legis-
lature to amend'the statutes so that the State Board of Health may (1)
pass comprehensive regulations under a recognized sanitary code, (2)
that this sanitary code be superior to and supersede such regulations
passed by other state and local agencies; and (3) that power be given
local health officers to enforce the State Board of Health's Sanitary
Code.









MALARIA RESEARCH


Mark F. Boyd, M. D., Director*







A. Completed Studies and Reviews:

In the year under review, manuscripts with the following ti-

tles have been submitted to the home office. A discussion of their

contents is superfluous.

63) S. F. Kitchen. "Some Aspects of Immunity in Human Malaria".

This review was prepared for presentation at the meeting of the Flor-

ida Anti-Mosquito Association held at Jacksonville, Florida, on March

28 and 29, 1938, and appeared in the mimeographed proceedings of the

meeting.

64) Mark F. Boyd. "The Threshold of Parasite Density in Rela-

tion to Clinical Activity in Primary Infections with P. vivax."

65) Mark F. Boyd and S. F. Kitchen. "Vernal Vivax Activity in

Persons Simultaneously Inoculated with P. vivax and P. falciparum".

66) Mrk F. Boyd and S. F. Kitchen. "Demonstrable Maturity of

Gametocytes as a Factor in the Infection-of Anophelines with P. vivax

and P. falciparum".

67) ..Mark F. Boyd and S. F. Kitchen. "An Instance of Protracted

Latent Incubation Period in a Patient Infected with a North American

Strain of P. vivax".


*From the Division of Malaria Research, Rockefeller Foundation Inter-
national Health Division, Tallahassee, cooperating with the Florida
State Board of Health.
frfl








68) Mark F. Boyd and S. F. Kitchen. "The Clinical Reaction in

Vivax Malaria as Influenced by the Consecutive Employment of Infec-

tious Mosquitoes".

69) Mark F. Boyd and S. F. Kitchen. "The Demonstration of Sporo-

zoites in Human Tissues".

70) S. F. Kitchen, E. L. Webb and W. H. Kupper. "The Influence of

Malarial Infections on the Wassermann and Kahn Reactions".

71) Mark F. Boyd,.W. H. Kupper and Choice B. Matthews. "A Deficient

Homologous Immunity Following Simultaneous Inoculation with two Strains

of P. vivax".

72) Mark F. Boyd and L. T. Coggeshall. "A Resume of Studies on

the Host-Parasite Relation". Presented at the 3rd International Joint

Congress of Tropical Medicine and Malaria, Amsterdam, September,28, 1938.

73) Mark F. Boyd, S. F. Kitchen and Choice B. Matthews. "Consecu-

tive Inoculations with Plasmodium vivax-and Plasmodium falciparum".

74) Mark F, Boyd and Choice B. Matthews. "Further Observations on

the Duration of Immunity to the Holologous Strain of Plasmodium vivax".

75) S. F. Kitchen. "The Infection of Mature and Immature Erythro-

cytes by the Plasmodium falciparum and Plasmodium malariae.

76) S. F. Kitchen. "The Differential Inaection of Mature and Im-

mature Epythrocytes by the Plasmodia of Human Malaria". Presented at

Oklahoma City, November 17, 1938 at the joint session of the American

Society of Tropical Medicine and the National Malaria Committee.

77) S. F. Kitchen.. "Non-Specific Serologic Reactions in Malaria

Infections". Presented at the Hollywood meeting of the Florida Public








Health Association, November 29, 1938.

78) Mark F. Boyd. "Malaria: Retrospect and Prospect". Presi-

dential Address, delivered before the American Society of Tropical

Medicine, at the Oklahoma City meeting, November 17, 1938.

79) Mark F. Boyd and Choice B. Matthews. "An Observation on the

Incubation Period of Plasmodium falciparum".

B. Work in Progress:

1. Attempted hybridization of vivax strains.

Since from a theoretical standpoint it is conceivable that

some epidemics of malaria may be attributable to the origin of new

strains of parasites, and that such strains may most likely arise

through hybridization, it appeared desirable to experimentally attempt

hybridization. Since strain differentiation is at present effected im-

munologically, the demonstration of successful hybridization will de-

pend upon the production of a strain apparently immunologically differ-

ent from its progenitors.

We are proceeding along the following lines. As a prerequisite

there is required two strains which have been demonstrated to be im-

munologically distinct, in this case our McCoy and Cuban strains. The

following steps are planned:

a) Simultaneously inoculate susceptible subject (A) intravenously

with huge and approximately equal doses of trophozoites of both strains.

b) When the subject is infectious (assuming ganetocytes of both

strains are present) apply anopheline mosquitoes.

c) In mosquitoes hybridization may take place. Possibly present








on maturation sporozoites of each original strain plus hybrid sporo-

zoites.

d) Re-inoculate subject (A) with these mosquitoes. If a clinical

attack results it might possibly be attributable to a hybrid,' rather

than either of the original strains.

e) Again infect mosquitoes on subject (A) thus possible effect-

ing a purification of a hybrid from progenitors.

f) Inoculate several subjects with the mosquitoes infected in (e)

(B) (C) (D).

g) Before attacks in (B) (C) or (D) are terminated, sub-inoculate

one or two (E) (F) further susceptibles by intravenous introduction of

trophozoites from (B) (C) or (D).

h) On completion of attacks in (B) (C) and (D) re-inoculate them

intravenously with trophozoites from (E) or (F) with the following con-

trols:

1. Blood from (E) or (F) into Ist (B) and also 2nd into a new

susceptible, 3rd a McCoy convalescent and 4th a Cuban convalescent.

2. Blood from an active McCoy case into Ist a susceptible, 2nd

a NcCoy convalescent, and 3rd into (C).

3. Blood from an active Cuban case into let a susceptible, 2nd

a Cuban convalescent and 3rd into (D).

If hybridization with an immunologically distinct hybrid has

been infected, all except (B) in the first series, all except the Mc-

Coy convalescent in the second series, and all except the Cuban con-

valescent in the third series, should experience clinical attacks.








Although we have made several attempts to execute this pro-

cedure, only two have been sufficiently well performed to warrant dis-

cussion. The parenthesized letters refer to the steps in the preced-

ing outline.

Experiment 103: (a) The original subject B868 was intraven-

ously inoculated on July 23, 1937 by 18.5 million trophosoites each

of the McCoy and Cuban strains of P. vivax, from which a clinical at-

tack of 58 days duration was experienced. (b) Anophelines of lot 651

were infected from this patient. These mosquitoes were used to infect

(d) patient 296 (a variation), who experienced a 27 day attack, (e)

during which mosquitoes of lot 686 were infected. These were used (d)

to re-inoculate patient 296 on November 16, 1937. Thirty-one days lat-

er this subject experienced a sub-clinical rise in parasite density,

again on February 28, 1938 and again on May 14, 1938, but never attain-

ing proportions that suggested satisfactory infection of mosquitoes. On

the last occasion patient B890 was inoculated intravenously with the

blood of 296, and experienced a ten-day clinical attack. (hl) On

May 27, 1938, blood from B890 was 'inoculated into 296 (B895), a sus-

ceptible B893, a Cuban convalescent B870 (297) and a McCoy convalescent

B887 (292). Subsequently 296 presented a sub-clinical rise in para-

site density which lasted 10 days; B893 experienced a 16 day clinical

attack; B870 a sub-clinical parasite rise lasting 10 days and B887

was parasitologically and clinically negative. (h2) On June 10,

1938 blood from an active McCoy case 324, was inoculated into B890,

into a McCoy convalescent B887 (292) and into a susceptible B896.








Subsequently B890 remained parasitologically and clinically negative,

as did B887, while B898 experienced a 9 day clinical attack.- (h 3)

On June 28, 1938, blood from an active Cuban case was inculated into

B890, into a Cuban convalescent B899 (315) and into a susceptible B900

(1178). Subsequently B890 experienced a sub-clinical rise in parasite

density which lasted for 13 days, B899 remained parasitologically and

clinically negative, while B900 experienced an 8 day attack.

Interpretation: We are obviously limited to a judgment on the

nature of the parasites present in patient 296 (B895) in May, with

which patient B890 was inoculated. In (h 1) the McCoy convalescent

B887 was completely refractory, the susceptible B893 was completely

susceptible. The test case 296 (B895) and the Cuban convalescent case

B870 behaved in an identical manner, exhibiting an incomplete immunity.

In (h 2) the test case B890 and the McCoy convalescent B887 were com-

pletely refractory, while the control B898 was completely susceptible.

In (h 3) the susceptible control B900 was completely susceptible, the

Cuban convalescent B899 refractory and the test case partially immune.

The results show complete immunization against the McCoy strain

and partial against the Cuban. We are not justified however, in in-

ferring that the May recurrence in patient 296 suggests that hybrid-

ization was effected in either of mosquito lots 651 or 686.

Experiment 106: This was executed in strict accordance with

the essentials of the protocol.

a) On April 12, 1938, the original subject B886 was intravenously








inoculated by 30 million trophozoites of each of the Cuban and McCoy

strains, and experienced a 45 day attack. Mosquitoes (b) of lot 734

were infected on the patient, and on May 18 she was (d) re-inoculated

(B886-328) by them and subsequently experienced a 7 day attack with one

5 day recurrence. Lot 742 (e) was then infected on B886-328 and used

to infect patients 333 and 334 (f). These experienced 11 and 41 day

clinical attacks. Confirmatory sub-inoculations to test the nature of

the parasites in 333 and 334 were performed as follows:

hl) On August 15, 1938 blood from case 334 was inoculated into a

susceptible B910, and the day following into his co-partner and test

case 333 B911, into a Cuban convalescent 315 B899 and into a McCoy con-

valescent 335 B913. The susceptible experienced a 29 day attack, the

McCoy convalescent a 7 day attack, while the Cuban convalescent and

the test case both experienced a brief sub-clinical rise in parasite

density.

Interpretation: The patients 333 and 334 inoculated with

mosquitoes infected on case 238 B886 after her re-inocluation by lot

734 in which the possibility of hybridization is considered, are com-

pletely susceptible to the McCoy strain, and show a partial immunity

to the Cuban strain. No data suggesting hybridization were secured.

It would appear that this method of approach will not afford

a solution to the problem. Other methods are under consideration.

2) Specific Cross Immunity.

The results of this study were reported in paper 73.

3) Mexican Parasites and Anophelines.









We are collaborating with Doctor W. C. Earle in a study of the

comparative susceptibility of a Mexican race of A. pseudopunctipennis

and A. quadrimaculatus to Mexican and North American strains of P. vivax

and P. falciparum.

A strain of Mexican P. falciparum has been successfully intro-

duced but as yet our attempts to introduce P. vivax have failed. There

has been no difficulty in rearing A. pseudopunctipennis from ova ship-

ped from Mexico'by air express.

The available results may be briefly summarized as follows:

A. pseudopunctipennis A. quadrimaculatus
Parasite Strain Exam. Pc. pos. Esam. Pc. pos
P. falciparum Mexican 24 4.1 42 78..6
Long 28 7.1 44 43.2
P. vivax McCoy 30 10. 49 75.6

It is interesting to note that the Mexican pseudopunctipennis

appears to be but slightly susceptible to either the Mexican or Flor-

idian strain of P. falciparum, while the quadrimaculatus appears more

susceptible to the Mexican falciparum.

In this connection it is interesting to note that cross in-

oculations of persons who have recovered from an attack produced by one

strain, with the other strain, show unusual results, viz:

Results of re-inoculation
in convalescents from:
Re-inoculated by: Mexican Long
Mexican Take
Long Failure -

We had expected that both strains would be reciprocally

heterologous, and were surprised to find that the Mesican strain protect-









ed against re-inoculation with the Long strain. We have had two re-

sults in agreement and shall test them again.

4) Erythrocyte preferences on the part of P. malariae and P.

falciparum.

Dr. Kitchen's projected studies have been completed, the re-

sults being presented in papers 75 and 76.

5) The cholesterol content of the serum of malarial patients.

Dr. Choice Matthews reports as follows on this study:

Since the demonstration of a high percentage of blood samples

giving positive serological readings for syphilis in specimens taken

serially from a patient in an attack of malaria, a study was made of

the serum cholesterol of four malarial patients in an attempt to de-

termine if there was any relationship between these values and simul-

taneous serological tests. The data indicate no evident relationship

between the two values.

There was some'evidence to indicate that serum cholesterol

values might be directly related to hemoglobin values and this point

was investigated as a point of interest. While no direct relationship

could be established there was only one case in which a serum cholester-

ol reading within the normal range was found among samples with lowered

hemoglobin values.

6) Agents for the re-activation of latent malarial infections:

Dr. Choice Matthews reports as follows on this study:

The following is a list of drugs investigated as possible re-

activators of latent malaria, and which have been discarded as being









1. Ergot, fluid extract 7. Paraldehyde
2. Ephedrine, Sulphate 8. Glucose 50% (intravenous)
3. Pituritin, sulphate 9 Typhoid vaccine
4. Strychnine, sulphate 10. Epinephrine Hydrochloride
5. Aminophyllin 11. Amyl Nitrite
6. Neoarsphenamine 12. Nitroglycerine
The two substances that are being investigated further are

liver extract, administered intravenously, and old tuberculin, ad-

ministered subcutaneously.

Results with liver extract seem better if it is used with-

in two weeks immediately following the cessation of clinical malaria.

It is an interesting note that all cases in which it has been success-

fully used were cases with splenomegaly.

The use of old tuberculin is the most promising of all to

date. Two cases of two and one-half and three months quiescence re-

spectively after cessation of clinical activity have given positive

blood smears following the injection, and the former of these suffer-

ed a short clinical relapse. In no case has the injection provoked

appearance of parasites in the blood when a period of six months or

more has elapsed since the cessation of the clinical attack.

In patients whose clinical course has stopped but in whose

blood parasites are still demonstrable, an injection of tuberculin in-

variably causes a definite if temporary rise in parasite density.There

have been two instances in which the increase was great enough to cause

a brief clinical relapse.

7) Demonstration of humoral immunity in human subjects.

The importance of the demonstration by Dr. L. T. Coggeshal









of the existence of humoral immunity in rhesus monkeys recovering from

an attack produced by P. knowlesi indicates the desirability of con-

firming and extending these observations in human subjects. We are al-

so attempting the hyper-immunization of patients to the point" where

they are capable of immediately removing any reasonable quantity of para-

sites introduced.

One experiment performed to date appears to demonstrate the

existence of protective anti-bodies in a fully immune subject. Serum

from patient 34, who after the series of re-inoculations described in

paper 74, wis found to be fully immune, was utilized. Parasitized

blood was secured from an active McCoy case B819, and defibrinated.

Three 10 cc. portions were measured. The first was left alone. The

others were centrifuged and the serum removed. In the 2nd portion-the

volume was made up to 20 cc. with normal serum (i. e. from an individu-

al who had never had malaria), and the third portion was made up to 20

cc. with the serum of patient 34. All thrue were then placed in a 370C

incubator for 8 hours, when 1 cc. portion of each were separately cultur-

ed in nutrient broth. At the end of 24 hours further incubation, the

cultures being negative, e.ch sample was intravenously inoculated into

a separate patient. The patient receiving the incubated mixture of nor-

mal serum and parasitized blood developed an active clinical attack af-

ter 13 days incubation. The patient receiving the incubated whole blood

from the donor of the parasites remained parasitologically and clinic-

ally negative. The patient receiving the incubated mixture of parasit-

ized blood and immune serum became blood positive after an incubation








period of 11 days. Parasit's. were observed on only one day, and no

clinical reaction was experienced.

-S .Sufficient parasites survived the incubation of a mixture

of parasites and normal serum to infect a susceptible patients On the

other hand very few appear to have survived when mixed with the serum

of an immune convalescent, and none when incubated with their own homol-

ogous serum. This suggests that as early as six days after a clinical

onset, a patient's blood already possesses significant parasiticidal

properties.

C. Malaria Therapy.

Although in the previous report the early discontinuation of

the McCoy strain of P. vivax in routine therapy was forecast, it has

been possible to continue its employment during the year, in which peri-

od it has been carried through passages 38 to 43 inclusive. The Cuban

strain has been used to some extent.

The Jones strain of P. malariae has been carried on through

five blood passages.

The Long strain of P. falciparum has been carried on through

passages 13 to 18 inclusive.

A list of the inoculations performed at the Florida State -

Hospital during the year (tb December 1, 1938) will be found on the

next page. A total of eleven referred patients have been inoculated

during the year.

D. Insectaries:

The insectaries have been maintained in satisfactory condition,









Inoculations made in the Malaria Therapy Service,
Florida State Hospital. (1938, to December 1)

P. vivax Both P. vivax and P. fal-
alone P. falciparum ciparum P. malaria
Soorozoite Take Fail. Both One only Fail Take Fail. Take Fail.
inoculation. Primary 27 9 2 2 3 4-
Re-inoc. (a)
Prev.
unsucc. 6 1
Re-inoc. (b)
Prev.
take 10 1
Trophozoite
inoculation Primary 18 8 10 8 9
Re-inoc (a)
Prev.
unsucc. 1
Re-inoc (b)
Prev.
T____ ake 22 8 3

and the colonies of A. quadrimaculatus and A. punctipennis continue to

thrive. Extensive repairs to both insectaries were made involving re-

placement of the sills of both buildings which had rotted.

On request quadrimaculatus ova have been furnished to the Army

Medical School and the malaria laboratory of the U. S. Public Health Ser-

vice at Columbia, South Carolina, as well as to the I. H. D. laboratory

at the Rockefeller Institute, New York City.

Three shipments of ova of A. pseudopunctipennis have been re-

ceived by air express from Doctor Earle at Cuernavaca, Mexico, from each

of which a considerable number of adults were reared.


E. Field Work.

No field work directly under the auspices of the station has

been conducted during this period.








F. Instruction given:.

During the year the following persons have spent one or more

weeks at the station for the purpose of receiving instructions in

malariology:

Dr. Bulmer, Medical Department, Standard Oil Company
Mr. J. A. Mulrennan, Florida State Board of Health
Dr. J. A. Montoya, Colombia South Amerioa
Miss Ruth Smyth, Technician, Tennessee State Health Department
Dr. Silvestro Lopez Portillo, IHD fellow, Mexico
Mr. Thomas H. Weller, Medical Student, Harvard Medical School
Mr. George Palmer, Medical Student, JHU School of Medicine
Mr. Charles Renn, IHD fellow, Harvard University
Dr. Athanasios G. Mandekos, IHD fellow, Athens Greece
Miss Vilda Shuman, Medical Student, Vanderbilt Medical School
Dr. Bert Malone, Malariologist, Georgia State Department of
Health

The station cooperated with the department of biology of the

Florida State College for Women by giving the students taking the course

in parasitology in that department laboratory instruction in malaria for

eight, two-hour periods.

We have had the following visitors:

Dr. S. W. Bohls, Director of Laboratories, Texas Department of
Health
Mr. C. F. Catlett, Chief Engineer, Florida State Board of Health
Mr. Russell Broughman, Engineer, Florida State Board of Health
Professor Creighton, Department Entomology, University of Florida
Professor Hixson, Department of Entomology, University of Florida
Dr. Schoenleber, Medical Director, Standard Oil Company.
Mr. L. M. Clarkson, Georgia State Department of Health
Professor Creighton and class of 25 students in entomology from
the University of Florida
Dr. Harrison, Bradenton, Florida
Professor Juan B. Kouei, University of Habana
Mr. Norman Taylor, Cinchona Institute, New York City
Professor White of Florida State College for Women and class of 15
in hygiene
Dr. W. A. McPhaul, State Health Officer of Florida
Dr. Patterson, Director of Laboratories, Florida State Board of
Health









Dr. A. J. Logie, Director Division of Tuberculosis, Florida State
Board of Health
Mr. Bernard V. Travis, U. S. Bureau of Entomology
Dr. M. A. Barber, IHD
Dr. H. P. Carr, IHD
Dr. Justin Andrews, Director, Division of Malaria Investigations
Georgia State Department of Health
Dr. Bert Malone, Assistant Malariologist, Georgia State Depart-
ment of Health
Mr. John Henderson, Engineer, Georgia State Deaprtment of Health
Dr. Fruma Wolfson, Department of Protozoology, JHU School of
Hygiene

G. Travel, Consultation and Speaking:

On January 14 a trip was made to Jacksonville to confer with

Dr. McPhaul

From January 18 to 21, a trip was made to Birmingham, Alabama,

and Pensacola, Florida. At the former place a conference was held with

Dr. E. H. Hinman, Secretary of the American Society of Tropical Medicine

and Mr. C. P. Loranz of the Southern Medical Association. At the latter

place an inspection of the program of the malaria control project was

made.

On February 7 and 8 went to Savannah, Georgia, to be present

as IHD representative at the dedication of the Henry Rose Carter Memori-

al Laboratory of the U. S. Public Health Service.

From February 21 to April 19 was absent on a long tour through

Mexico and Central America. In Mexico conferred with Dr. Ferrell and

Dr. Earle re malaria program. In Panama conferred with Dr. Crawford and

spent three weeks in Costa Rica assisting Dr. Kumm in the advancement of

his program. On return via Havana gave four lectures on malaria in Span-

ish at the Finlay Institute.








A visit was paid to Pensacola from April 27 to 29, to in-

spect the progress made in the control program at that place.

In order to attend a meeting of the Board of Malaria Con-

sultants of the Tennessee Valley Authority, a trip was made to Mem-

phis, Tennessee, and Decatur, Alabama, lasting from June 25 to July

3. Qn the return on the 3rd, a brief visit was paid the Pensacola

project.

On invitation attended meeting of a committee of the coun-

cil of the American Association for the Advancement of Science, Wash-

ington, D. C., being absent from the 6th to the 10th of July.

A brief visit was paid to the Pensacola project on August

15, in company with Mr. Catlett and Mr. Peters.

August 30 to October 11, absent on European trip. The

period from September 11 to 25 was personal leave. From the 26th to

28th of September was in Amsterdam, Holland, in attendance at the 3rd

Joint International Congress of Tropical Medicine and Malaria. Pre-

sented a paper jointly with Dr. L. T. Coggeshall. Dr. Mark F. Boyd was

a member of the official U. S. delegation to the Congress, and also

represented the American Association for the Advancement of Science,

and American Society of Tropical Medicine (A. S. T. M.).

October 26-28, paid a brief visit to Pensacola.

Drs. Boyd and Kitchen absent from Nov. 12 to 20, in attend-

ance at the annual meetings of the National Malaria Committee and the

American Society of Tropical Medicine. Dr. Kitchen contributed to the

program of the joint meeting of these bodies (See paper 76). Dr. Boyd








as current president of the A. S. T. M., gave a presidential address

(See paper 78).

On December 1, lectured on malaria to the class in the Army

Medical School, Washington, D. C.

November 30 left on a long trip to South and Central America,

not expecting to return before end of February, 1939, at the earliest.

Conferences are to be held with health officials in British Guiana and

Venezuela before the end of the year.

The following further public addresses have been given:

January 17. Spoke on malaria before a meeting of the Leon

County Health Council.

Dr. S. F. Kitchen attended the meeting of the Florida Anti-

mosquito Association at Jacksonville, March 28 and 29, and contribut-

ed to the program.

April 21. Spoke on the Wassermann reaction in malaria be-

fore the Second District Medical Society.

May 13. Spoke on the general subject of Research before

the Tallahassee section of the Florida Academy of Science.

June 6. Spoke on syphilis before the Chattahoochee Rotary

Club.

August 18. Spoke before the Second District Medical So-

ciety.

Dr. S. F. Kitchen represented the station at the Hollywood

meeting of the Florida Public Health Association held from November

28 to 30. His contribution to the program (No. 77) is noted.








H. Staff:

Dr. W. H. Kupper resigned as physician on the staff of the

Florida State Hospital assigned to the malaria therapy service on

December 7, 1937. The position was filled by the appointment- of Dr.

Choice B. Matthews, on our nomin-tion, effective January 1, 1938.

Other th'n noted there hIve been no changes in the person-

nel of the station during the period. Miss Grace Moore, technician

on duty at the Florida State Hospital, has tendered her resignation

effective December 31, 1938. Miss Myrtle Hobbs, who has been in

training without pay since November 16, will succeed her.









ACCOUNTING



G. Wilson Baltzell, Auditor







The funds listed below passed through the State Board of Health
during the period beginning July 1, 1937 and ending June 30, 1938,
which is the fiscal year of the State of Florida and the Federal Gov-
ernment.

In addition to these funds, the Legislature appropriated $18,000.00
for a new addition to the building which added to 017,670.33, which had
accumulated from Centralization of Marriage and Divorce Funds, made. a
total of $35,670.33 which the State spent on the new building to match
W. P. A. Funds.

The figures below are merely the totals for the various activities.
A detailed financial report is compiled each year, giving the analysis
for every department and division.



Receipts including
balances f om last Balanoe
fiscal year Disbursements June 30, 1938
State Board of Health legislative appropriation 225,000.00 223,209.61 1,790.39
U. S. Public Health Service Title VI 151,340.29 143,597.01 7,743.28
Maternal and Child Health funds 112,277.94 81,883.61 30,394.33
SPECIAL FEES
Centralization of Marriage & Divorce Records 30,784.45 30,784.45
Registration of Doctors and Midwives 6,556.61 3,102.99 3,453.62
Certified Copies of Birth and Death Certificates 9,446.00 4,465.01 4,980.99
Drug Store Inspection 9,214.43 8,766.94 447.49
County Health Units, City and County Funds 101,097.33 101,694.58 597.25
Rockefeller Foundation
Division of Malaria Research 12,227.03 12,227.03
Rockefeller Foundation
Sp~ial Study of Hookworo .Disease 4,346.89 4,346.89
Rockefeller Foundation
Malaria Control Studies Esoaa':ia County 4,000.00 4,000.00

666,290.97 618,078.12 48,212.85





69


This being the second year of the Biennium, the unexpended balance
in the Legislative Appropriation is carried over and added to the an-
nual appropriation for next fiscal year. The Federal balances as of
June 30, 1938, may appear large, but this was caused by certain activ-
ities, fostered by the U. S. Public Health Service and Children's Bu-
reau, not getting into full swing until the last part of the fiscal year,
but whatever balances are left over are added to the annual allotments
for the next fiscal year, with resulting benefits for that year.









EDUCATION


Elizabeth Bohnenberger, Director





During 1938 the Division of Health Education attempted
to assist all bureaus of the State Board of Health with their
educational programs, and to coordinate them.

The division served as a clearing house for health infor-
mation to the public. Pamphlets, notion picture films, and
talks by the State Board of Health personnel were used as
media of health education. The division has a fairly large
collection of health films which have been shown in all parts
of the state. These have been scheduled in those counties
having full-time health units to assist the unit in carry-
ing forward its educational program. In counties -where there is
no health unit the films have been used by women' clubs,
parent-teacher associations and other civic clubs, and in
every case have been part of a program to promote the establish-
ment of full-time health service.

Physicians and nurses of the State Board of Health have
cooperated in filling requests for speakers at numerous meet-
ings. The division has assisted the speakers with health edu-
cation material and planned programs.

The publicity assistant prepared releases of health in-
formation to the newspapers of the state. In addition news
articles on the work of the State Board of Health personnel
were frequently published. The publicity assistant personally
contacted all newspaper offices in the rural sections of the
state and secured the active cooperation of many editors in
the publicity program.

In December, following the resignation of the publicity
assistant, a public relations consultant was added to the
Division of Health Education. News releases on a wider scale
than had ever before been attempted were sent to all newspapers
and widely published. A planned program of publicity is


HEALTH









already showing results in public interest in the work of the
State Board of Health and in requests for health information.

In January the Library of the State Board of Health was
made a part of the Division of Health Education. The Library
has been in existence since 1932 and has become a real force
for health education throughout the state. Library service
is given to all private physicians and nurses in the state.
The personnel of the State Board of Health and of the county
health units use the Library also.

Books, reprints and periodicals are sent by mail to
all persons in the medical, nursing and public health profes-
sions. Reference service, consisting of searches of medical
literature, preparation of bibliographies, editing of papers,
is also given. There is no charge for this service except
postage costs. It is planned to assist all full-time county
health units in the establishment and maintenance of basic
libraries for the use of the health unit staff.

It was also made a part of the health education program
to encourage the use of health material in the schools by
supplying school libraries with free pamphlet material. Re-
quests from teachers for suggestions on health teaching
material have been numerous and attempts to fill this gap
have been made in so far as possible. The division is look-
ing forward to the beginning of a coordinated health education
program in all Florida elementary schools and conferences with
school officials have been held to this end.

Radio addresses by State Board of Health personnel have
been made at various times throughout the year. The need
for a planned radio program is urgent and the use of the
dialogue or play form rather than the one-man talk is indi-
cated.

The Division of Health Education has attempted to cooperate
with all voluntary health organizations in the state. Inter-
change of speakers at annual programs and frequent conferences
with the leaders of these organizations have been held through
the year. It is felt that there is a mutual understanding of
aims and programs here.

FLORIDA HEALTH NOTES, the monthly bulletin of the State
Board of Health is edited in this division. A change of poli-
cy in the content of the bulletin was made in'1938 and instead
of publishing a number of short articles on various subjects,





72



each issue was devoted to one subject. In this way it was
felt that a better understanding of the health problems on
the part of the public would result. The mailing list for
HEALTH NOTES increased greatly in 1938 and it is intended
to give the bulletin a continued wider distribution.

As a separate division, health education is new in the
State Board of Health. The program is not in any case as wide-
spread as it should be. Particularly should the full-time
county health units be given more aid in developing an educa-
tional program for their communities. Staff education programs
planned in cooperation with each bureau and with the county
health units are needed and are planned for the future.















APPEnDIX




TA B 3 ZP .. IA:

REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA








P 01 0

TYPH 93 133 1 56 0 0i



..PARATYPHOID 4.15 10 .0 ........ 0 ....
T5 116 132 0 u 0 o 0 1








MEASLES 307 612 8593 0 1 2 0 282

SCARLET FEVER 299 386 356 2. 0 1 0 4 2 0

WHOOPING COUGH 383 520 860 o0 1 00 i 0
......................... ........................ ......... ....... ............. ..... ................... .................. .................. .................. ... ............ ........ ..... ................ o .....................

DI PH'TH ER I A 309 62.1 4931 2 0 1 2 2 3.1 0

INFLUENZA 8 90 12 0 0 0 0 0
.SH LLPO ............ ........... .......................










MUMPS 1F08E 662 632 0 0 0 0 0 0 0
DYSENTERY 31 46 67 O 0 1 2 1 0 0

LEPROSY 0 2 1 0 0 0 0 0 0 0

POLIOMYELITIS 42 28 32 0 0 0 0 0 6 0

LETH. ENCEPHALITIS 0 8 7 0 0 0 0 0 0 0

MENINGITIS 120 163 59 1 0 0 0 0 0 0

CHICKENPOX 750 728 1407 2 0 0 0 0 43 0
.. ................................................................. ....................... .................... ..... .......... ................................. ...................... ........................ ..
GERMAN MEASLES O 39 8 0 0 0 00 0 0 0

DENGUE 12 6 13 0 0 0 0 9 0 0

TETANUS 31 12 26 0 0 0 0 0 0 0
........... ......................I ................4................... .............. ........ .... ... ........g..... ... ... ........ .......I........... .........................
RABIES (HUMAN) 1 5 3 0 0 0 0 0 0 0
............ ..... ..................... ............... ............ ... .... I .......... ......... ............................. ... ..................... ................ ................................
TUBERCULOSIS 627 1156 1039 9 0 2 0 3 16
......................................... ...... ....................................... I........... ................. ................ ................... ........ I ........ ........ ................. ............................
SYPHILIS 3287 14433 17155 597 12 189 18 73 448 62
........................... ................... ...... ... ................ ....... ....... .... ......... ......... .............. .. .............. ......... ..... .. .............................
CHANCROID 96 95 33 0 0 0 0 i 0 0

GONOCOCCUS 1146 2350 1916 11 1 8 3 7 1 2

OPTH. NEONATORUM 3 6 14 0 0 0 1 0
...... .... ................ ..... ...... o ........... ........... ........ ..o... ... .. ............... .t .. ........... ... ..... ....... .. .. ...... ......... ..... ... ............... ...... l.......t .....
CANCER 240 215 1.82 0 0 1 0 a0 0

PELLAGRA 35 41 187 0 0 0 1 0 0 0

TULAREMIA 0 2 4 0 0 0 0 0 0 0
............................ .... ....... -......... ......... ... .... ...... .......... ......-...... ............. ............. ......... ......................
TRACHOMA i 7 16 0 0 0 0 0 0 0
....... ............. .. .. ...................... .......... *..... .... ..............
PNEUMONIA 6 454 836 3 3 0 2 0 0 0
.........-.....I ..- .....,. .. ........ .........6 ......... .*....... ... ... l.... ,...... .. ................

HOOKWORM 2211 8326 !3515 74 1 30 35 6 8 1.
........................................ ........ ...... .............. ....... ......................................................... ............... ..........................
TRICHINOSIS 1-2 7 1 0 0 0 0 0 0 0
...-- ....._.... .... ...... I ...... I... ....... ...f. .. ..... i >............. ..... .. ....,., .................... ....... ......... .......... .............. *. ........................
S016 20 3 o* 0 1 0 0 0 0.
X<.........^,,.. .........^.. ....- .. % ............ t..*. t.t. ,,*.mt t..,..





T A 3 L T 'IA (continued)



REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA





Ifl o a
3- .-
ta a 3 w 0 <
< 4 < -1 > u,
= ..1 0 o < w 1
u o U o o0 O


TYPHO 1 0 3 0 0 0 19 0 0 9 21

PARATYPHOID a 0 0 0 0 4 01 0 2 3


............................. ... ........I 6 ..0.......0......5... .3........


. M ......................................... ........... ...... ...... ........... .... ........ ..... ................ .. .............. .......... ..... ................... ......... .......... ....... .......... .......... ...... ...................... ..
TYPHUS o 0 o 0 6 L3 o 0 35 13

MALARIA a 7 0 0 4 16 4 O 48 9;

SMALLPOX 0 2 0 0 0 0 0 2 0 2

MEASLES 0 8 0 0 6 1689 2 0 3564 93
............................................................ ...... ........ ................ ................. ................... ................ .......... .... ... ............... ............... ....................... .................................
SCARLET FEVER I 0 0: 0 i 28 1 0 7 29
..........................................* .... .. .. .. .................... ... ...... ............... ................................................................................................................
WHOOPING COUGH 0 0 0 0 172 0 0 i 188 111
. . . ....................................................... ................................. .. . ............................................... ... . ................................. ....... ..................................
DIPHTHERIA 0 0 0 0 3 24 1 0 105 52
................................................................ ................. ................. ................ .................... ................ .................. ................. .................. ........................ ................. ........... ...
INFLUENZA 0 0 0 0 0 i 09 i 6
................................................................. ........ ........... ...... ........ ...................... ... ................... .................. ................... ....................... ...................................


DYSENTERY 1 0 0 0 14 1 0 30 2



L T. EL00........ ...... ............... ........... .
LEPROSY 0 0D 0 0 0 0 0 0 0 0

POLl OMYELITIS 0 0 0 0 0 1 0 0 3 2




CHICKENPOX 0 0 1 0 0 82 0 0 691 54

GERMAN MEASLES 0 0 0 o o 0 0 0 3 0
G E R M A N.. ................................... .... ................. ......... ........ ........ ......... ...... ... ...... ........................

DENGUE 0 0 0 0 0 0 0 0 3 0
D EK G O E 0000 ........-..... .... ...... ...... ...... ....... ........... .............

TETANUS 0 0 0 0 0 17 0 0 6 0

RABIES (HUMAN) 0 0 0 0 0 0 0 0 1 0

TUBERCULOSIS 0 0 0 0 34 165 0 0 213 150
SYPHILIS 9 30 6 4 252 1820 73 55 3930 676

CHANCROID 0 0 0 0 0 20 0 0 1 1
..... ......................................... .............. ............... ............. ................................. ............... ................. ... .... ..........
60NOCOCCUS 1 6 0 o 14 165 3 0 683 211
OPTH NEONATORUM 0 0 0 0 0 0 0 0 1 1
................... ... ........... ....................................................... ..... .......... .. ... ........... .. ..... .-.- ... ..-- .- ... ... .....................

..................... ... ................. .... -............. ......
CANCER C 0 0 0 i 4 16 05 0 1 1
........ .... ....... ....... .. ........... ........i.. ,*.4 .. .................... .. ... ..I..... .......... ........ .......... ..... ........
SPELLAGRA 0 0 0 0 11 4 0 075 3 6 94


TULAREMIA 0 0 0 0 0 1 0 0 0 0
S.j... ........... r-......... ..>- ...,......................................i..... .,.....- ...........4..,,................ .. 4........-,.. .,.-.
TRACH OMA 0 0 1 0 0 ) 0 0 0 0

PNEUMONIA 0 0 0 0 25 189 0 0 119 29
.................... .............................................. .... ............. .. ... ...... ....................... ...... ........... ............... .................... ............... ..............
HOOKWORM 9 32 21 1 81 35 39 .21 419 4*1

TRI CH NOSS 0 0 0 0 0 0 0 3 0

UNDULANT 0 0 0 0 0 10 0 0 3
.................................. ....... ...... ............................ ...... ...... ........ ................................. ...........





T. A


REPORTED CASES OF NOTIFIABLE DISEASES'IN THE STATE OF FLORIDA




I,-

S- z 0

4 44 4


..... ............................. .. ....
TYPHOID 11 39 0 0 0 0 1 0 0 0
....... ......... O ..... ...... .. D 0 ..... ... . ....... ..... .... ................... ...... ... .................. .......... .... ....................... ...............
PARATYPHOID 0 0 0 0 0 0 0 0 0 0
M L............. .... ........ ... .. . .. ...... ........................ .... ...............
..... ... ...P.X.0 ".0........ ...... ........................... .... .. ..... ...... ..... ......... .. ................ .. .......... ....... ............. ...................





MEASLES 0 0 1 0 0 2 0 0
................................................................................... ........... ... ............. ................... ...... ... .............................. .... ................................
SCARLET FEVER 0 0 2 0 0 0 2 0 0 0'




INFLUENZA 0 0 0 0 0 0 0 0 0 0
MUMPS 0 1 26 a 0 o a 0 2o
DYS ENTERY 0 0 0. 0 2 ........ ..................... .... ... ........ .... ... .........
LEPROSY 0 0 .0. 0 0 0 0 o O

POLIOMYELITIS 0 0 2 0 0 1 0 0 0 0
LETH. ENCEPHALITIS 0 0 0 0 0 0 0 0 0


CHICKEN OX 0 0 37 0 0 0 0 D 0 0
GERMAN MEASLES 0 0 0 0 0 0 0 0 0 0
DENGUE 0 0 0 0 0 10 0 0 0
TETANUS 0 0 1 0 0 0 D 0 0 0
RA.. S ................ .............................. ........... .. .... ........ ... .............................. ... .. ..




TUBERCULOSIS 7 0 18 1 1. 2 0 0 0
.Y.PILIs 3 223 36 1 39 1 26 16 1a



CHANCROID 0. 2 2 0 0 1 0 0 0 0
.GONOCOCCUS 0 .5 1,4 3 1. 37 1 7 7 = ""0 0
.o...J, NEO NATORtM 0 0 0 0 0 0 0 0
.CANCER 0 0 0 00 0 2 0
..........P. ... ....... .. .... ...... ..... ....... 2.... ...... . ...................... ................... ...., .... ....................................... .......... ....... .............

..LLAS.A 0 14 37 0 0 to0 1 O 0 .
TULAREMTA 0 0 1 0 0 2 0
.......... I .. ... . ........ ......... .. ...... ... ... ..... ..... 2 ...... ......... Z
..... ........ ................................ .


TR..IA.N. 0 0 0 0 0 0 0 0 0
CO 0 0 0 0 0" 0 0
.ONLUIOYLNTIS0 a 0 0 0 0
.......... .............................. -: ......... o .... ........ .. ........ ...... ......... .... ... o ....... .... .......... ....I .......... ........
S......... ....... .. .. ................
. ... .. .... .... . . . . ... . . . . . .. . . . .. .... . . . . .. . . . . . . . . . . . ...
T. ARIC IA 0 0 i 0 0 2 0 u : O : : : :

........ ...................... I....... ................ ............... ...... i ................... .................. ................ ................ .. ...................i........... ...- ............................
0 0 2 : 00 0 00 0 O0 -" 0 u :" 0
U..N......L..A. i i ". i .






TA B t t1 IA: (boiftlnneda


REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA



us
I 0 = W
at 0 -
zt o z I I-
.0 I. = 0 m
S .J IE O L. 4 5 5
o r c sa a c an
S --.3 "A I .I -J

TYPHOID 0 12 0 0 4 0 3 0

PARATYPHOID 0 0 i 0 00 0 0 1 0 1

TYPHUS 1 IO0 0 7 0 0 0 3 7

Malaria 4 1.2 4 0 7 0 0 8 1 5

SMALLPOX 0 1 0 0 1 0 0 0 0 0

MEASLES 31 580 0 1 29 0 0 6 1 6

SCARLET FEVER 0 80 0 0 1 0 0 16 2 10

WHOOPING COUGH 5 68 0 0 6 0 0 0 1 10
................. R... .......... . . . .. . ..... ......... .... .. .... .~ ... ....... ........... ...... ....... .... .. ... ..... ...... ... .....................
DIPHTHERIA 4 128 0 0 0 0 0 1 2 4
............ ......... .. ............................ I ......... ............. ................ 0.................. ................... 0............... ................. ....................... ................ ................. .....................
INFLUENZA 0 26 0 0 0 0 0 0 5 0

MUMPS 1 49 0 0 0 1 0 0 0 4

DYSENTERY 0 1 0 0 1 0 0 0 0 0
... .t . ....... .. .... ....... ..... ......... ................ ..............? ................. ................ ...... ..... ............... ..................... ................... .............................
LEPROSY 0 0 0 1 0 0 0 0 0 0

POLIOMYELITIS 0 4 2 0 4 0 0 0 0 0

LETH. ENCEPHALITIS 1 0 0 0 0 0 0 0 0

MENINGITIS 0 2 0 0 0 0 0 0 0 1

CHICKENPOX 6 89 2 0 0 0 0 4 4 17

GERMAN MEASLES 0 5 0 0 0 0 0 0 0 0

DENGUE 0 0 0 0 0 0 0 0 0 0

TETANUS 0 1 0 0 0 0 0 0 0 0
........ ..... ... ... ... .... .......... ......... ...... .................. ................. .. ..... .... ........................................ ................. ..............................
RABIES (Human) 0 0 0 0 0 0 0 0 0 0

TUBERCULOSIS 7 190 0 0 1 1 0 11 6 11

SYPHILIS 114 1728 32 65 48 27 0 508 116 379

CHANCROID 0 0 0 0 0 0 0 0 0 0

GONOCOCCUS 10 317 1 3 19 0 3 9 21 2

OPTH. NEONATORUM 0 1 0 0 0 0 0 0 0 0

CANCER 0 1 0 0 0 0 0 0 2 0

PELLAGRA 1 8 0 0 1 0 0 0 0 2

TULAREMIA 1 0 0 0 0 0 0 0 00 0 0
........ .. .... ... ....... ..................... ................................. ................... .. ..... ... .... ... ........ ..... ..... .. ......... ......................
TRACHOMA 0 2 0 0 0 0 0 0 0 0

PNEUMONIA 2 329 0 1 6 1 0 0 0 0

HOOKWORM 137 362 61 42 187 5 5 85 113 118

TRICHINOSIS 0 1 0 0 0 0 0 0 0

UNDULANT 0 2 0 0 0 0 0 0 0 2
.. ......................................... ............ ...............; .... .. .. ... .. .. .. .. .. .. .... .. ...... ..... .. .... .. ... .. .... .. .. .. .... .... .. .... .. ......... ..........





TABL )3 IA- (poatrnued)


REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA





S 2 -. 0
SZ O
x 0 z 0


TYPHO I D 0 0 0 1 0 1 0 2 0 2

PARATY P OI D 0 0 0 0 0 0 0 0 0 ..................
TYPHUS 0 0 0 0 0 0 0 0 0 0



SMALLPOX 0 0 0 0 0 0 0 0 0 0

MEASLES 8 0 1 9 0 0 357 3 3 0.

SCARLET FEVER 0 0 1 0 3 1 0 2 0 0 1

WHOO P I NG COU.H ..... .... 0 1.... .? .. .
WHOOPING COUGH 0 0 0 0 1 0 10 0 0 0

DIPHTHERIA 2 0 2 7 6 0 2 1 0

INFLUENZA 0 0 0 0 0 0 0 1 0 0

MUMPS 0 0 0 0 3 0 0 1 0 0



LEPROSY 0 0 0 0 0 0 0 0 0 0

POLIOMYELITIS 1 0 0 0 0 0 0 0 0 < 0

LETH. ENCEPHALITIS 0 0 0 0 0 0 0 0 0 .

MENINGITIS 0 0 0 0 0 0 0 0

CHICKENPOX 0 0 0 0 0 0 25 0 0 0
GERMAN MEASLES 0 0 0 0 0 0 0 0 0 0



TETANUS 0 0 0 0 0 0 0 0 0 0

RABIES human ) 0 0 0 0 0 0 0 0 0 0

TUBERCULOSIS (4 0 5 1 10 0 4 i 4 0 0
SYPHILIS 21 5 48 125 188 201 2, '4' .17, 1
.............. ... ... .. ..................... ...... ........ ..... .. ... .......... ......... ........ ...... ........ ...... ...... ...... ....... ........ .......... ..... ..... .... ..................
CHAN CRO ID 0 0 0 0 0 0 0 0 0 0

GONOCOCCUS 2 0 6 2 11 1 27 10 1 0
OPTH. NEONATORIU 0 0 0 0 0 0 0 O

CANCER 0 0 0 0 0 0 0 0 0
PELLAGRA 4 1 0 0 0 0 0 0 0 0
....... ..... ... ... ....... .......... ... ...... ........ .. ... ......... ............. ........ .. .... ................ ... .......... .... ........ .
TULAfREMIA 0 0 0 0 0 0 0 0 0 0

TRACtHOMA 0 0 0 1 0 0 3 0 0 0

PIEUMONIA 0 0 1 1 0 0 0 0 0 0
..........M..................................................... ...... f. ............. .......... ... ................ ........ ........ .........i. ..................
HOOKWORM '4 23 73 169 13 8 8 i.0 i 3. 8 '4u
TRICDEGNOSrSE 0 o 0 0 0 0 0 0 0 .
.... ............................ .. ... ... ..... ....... 0 .... .........
U U A0 00 ............. ....... .................. ................... .. .................Q......... ......... ............






kT A B L E IA (cortitntectd)-


REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA


z w
4 U
a U


TYPHOID 8 0

PARATYPHOID 0 0
................................................. ................... .............. ........
TYPHUS 6 0

MALARIA 3 0


w 4
O -J





0 2 6
...... ... ............. ............... .. ...... ..........
0 0 0

0 1 4

1 1 3 2


-c




0 00
o oo






6 0 9 0 0


SMALLPOX 0 0 0 0 0 0 0 0 0 0
................................. ... ..


MEASLES

SCARLET FEVER

WHOOPING COUGH

DIPHTHERIA

INFLUENZA


1178

27

48

11

1


MUMPS 43


DYSENTERY

LEPROSY

POLIOMYELITIS

LETH. ENCEPHALITIS

MENINGITIS

CHICKENPOX

GERMAN MEASLES

DENGUE

TETANUS

RABIES (Human)

TUBERCU LOS IS

SYPHILIS

CHANCROID

60NOCOCCUS

OPTH. NEONATORUM

CANCER

PELLAGRA

TULAREMI A

TRACHOMA

PNEUMONIA A

HOOKWORM

TRICHINOSIS

UNDULANT


0

0

0

0

1

131

o



0

1

30

9"7

a0







0

0
3








142
.... ..... ...



0




13


50 289 0 192

2 0 2 29

0 13 0 79
................ ................ ........... ....................


o o o 0

o o o 61
0 1 0 31




0 0 0 2
o a 0 61







0 1 0 1
... ........ .... ................. ... ....- .... ; ..... .. .. .........








0 0 0 1


0 5 0 110
O 0 0 1 0



0 0 0 0
....... ..... ................... ..... ............. ...................




0 0 0 0


0 0 0 0
00 O 0
.......... I...... ........... ..........a..........


52





0



0

0







o
.............
.. .. .

.. . .








.. .. ... .


1013

a



0

2

0

0

0

0

104

a
0


0
0










64
9




0





0


a


'5

564

0



0
.. ..............



1

1




139
........... .......
0

4


25

19

0

41

0


'i 0

1 0
.......................................
0 0

7 2

0 0


0 0

1 0

0 0
~......... .... .... ................... ....


1 0

0 0


o 1 o o o
1 0 0 0

0 0 0 0 0

0 0 0 0 0

2 0 0 1 0
............... ... ............... .... ......... ....... ... ............ .. .... .... ... ...................




13 1 0 0 0

0 0 0 0 0
o 1 : o o 0




0 0 0 0 0
............................. ... ....... ....................... ............. .........................







25 7 0 4 0


860 139 2n 82 0


47 21 2 3 0


0 0 0 0 0




3. o o 2 o
... ............. ................. I ................... ..............
















573 69 5,7 1?7 4
0 0 0 0 0








0o o o o
0 0 0 o 1
0


j


. .... .. ... .. .. .. .. ......... ..... .. .. ..... .. .. ... .. .. .. e(...... ... .. .. tew4 4stbet e te JO. 04w1.... ..


............... ... ... ..... ...... .. .. ........ ..... ..... .....: ....... ...; .......... I...........




TA B L R U (Qo otirnued)


REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA




4 ma u I-
<- 1J m < < <
bo W Z

TYPHOD 0 O o ao I 1 z' o C
TYPHOID 0 0 0 1 I 0 3 1 0 0

PARATYPHOID 0 0 0 0 0 00 0 0

TYPHUS 2 0 0 2 1 0 1 0 0 0
MALARIA 0 3 1 2 16 7 2 6 0 0
SMALLPOX 0 0 0 0 0 0 7 0 0 0

MEASLES 10 3 0 3 19 31 2 2 0 7


WHOOPING COUGH 0 0 0 0 17 0 8 2 0 2

DIPHTHERIA 6 0 0 0 2 2 9 0 0 0

INFLUENZA 0 0 0 3 2 7 3 0 0 0
MUMPS 2 0 1 0 0 1- 1 0 i 0
DYSENTERY 1 0 0 0 0 0 1 2 0

LEPROSY 0 0 0 0 0 0 0 0 0 0

POLIOMYELITIS 0 0 0 0 0 0 0 0 0 1

LETH. ENCEPHALITIS 0 0 0 0 0 0 0 0 0

MENINqITIS 0 0 0 0 0 0 1 1 0 0
CH ..KEN. . . . . 20. ........... ...... ...... ...... ........ .......................... ....
CHICKENPOX 8 0 3 1 20 1 0 2

GERMAN MEASLES 0 0 0 0 0 0 0 0 0 0
DENGUE 0 0 0 0. 0 1 C 0 0 0




TUBERCULOS I 5 6 4 3 1 10 0 0 2
.U..R.UL O..I.. S. ........... ...... ...... ....... ...............................

SYPHILIS 15.1 164 18 32 266 ,.4 368 36 15
CHANCROID 0 1 1 0 0 0 0 0 0 0

GONOCOCCUS 2 3 1 8 0 10 34 1 0

OPTH. NEONATORUM 0 0 2 0 0 0 0 0 0 0

CANCER 0 0 3 0 0 0 0 4 0 0


TULARERMA 0 0 0 0 0 0 0 0 0 0
......... ........ ............................ .............................. .............. ................ ................ ....... ................... ............ ............. ................... ...............................
TRACHOMA 0 C 0 0 0 0 C 0 0 0
PNEUMONIA 0 0 0 2 4 16 1 0 0 0

HOOKWORM 28 36 17 51 170 1 41. 295 32 29 7
...................... ........................ ................... ................ ........................... ... ........... ....... .. .. .
TRICHINOSIS 0 0 0 o 0 0 0 0 0 0 0

UNDULANT 0 0 0 1 1 0 0 0 0 0
TRACHOMA 0 0 OO l t O aI D










E P1D LG ABIE


Reported oases ef notifiable diseases, deaths, case rate and death rate
per 100,000 population, and percent of fatality for Florida,
1934-1938, with 5 year average


Case Rate Per
Cases 100,000 Pop.


Death Rate Per
Deaths 100,000 Pop.


Fatality
Per Cent


DIPHTHERIA


1934 491
1935 426
1936 30
1937 609
1938 492
5 year average 465


1934 16
1935 16
1936 42
1937 35
1938 32
5 year average 28


17.0
13.0
15.o
9.0
6.0


29.0
25.0
18.0
36.0
29.0

27.0


INFANTILE PARALYSIS


31.0
43.0
19.0
17.0
25.0

27.0


SCARLET FEVER


1934
1935
1936
1937
1938


5 year average 298


1934 8,115
1935 1,176
1936 307
1937 635
1938 9,149
5 year average2,274


1934 723
1935 532
1936 383
1937 540
1938 876

5 year average 610


11.0
16.0
18.0
21.0
21.0

17.0


485.0
70.0
17.0
38.0
548.0
232.0


MEASLES


WHOOPING COUGH


43.0
31.0
23.0
32.0
52.0
36.0


(continued on next page)


EPIDEMIOLOGY


TABLE IB


10.2










EPIDEMI 0 L 0 G Y


Case Rate Per
Cases 100Qj.O Pop.


Deaths


Death Rate Per
100.000 Pop.


EPIDEMIC MENINGITIS


1934 5
1935 19
1936 120
1937 168
1938 61

5 year average 64


1934 65
1935 662
1936 587
1937 544
1938 112
5 year average 394


1934
1935
1936
1937
1938

5 year average


1934
1935
1936
1937
193B
5 year average


1934 439
1935 451
1936 634
1937 551
1938 727
5 year average 560


1934 1,106
1935 813
1 36 869
1937 894
1938 471
5 year average 832


.3
1.07
7.0
10.0
3.6

4.39


3.0
39.0
35.0
32.0
6.0

23.0


.06
3.4
.9
2.2
2.5


68.0
48.0
39.0
27.0

36.0


INFLUENZA


23.0
57.0
55.0
53.0
23.0

38.0


UNDULANT FEVER


4.4
12.5
7.1
7.1


TYPHUS


12.2
18.5
16.5
11.2
8.2

14.3


PNEUMONIA (All Forms)

1,230
1,101
1,404
1,227
1,220

1,236
MALARIA


66.0
48.0
52.0
53.0
28.0
49.0


73.0
65.0
84.0
73.0
73.0

73.0


26.0
19.0
21.0
12.0
9.9
17.6


(continued on next page)


Fatality
PWr soat


40.0
40.0
4C.0
23.0
35.0
36.0


V 0 I r T A I ny- a-- -T A B LZ -13 ..o


Ir d B L E IR. (na~Wnuod~










,Z P Tn EMG '1 A L D H o d


Case Rate Per
Cases 100,000 Pop.


Death Rate Per
Deaths 100,000 Pop.


PELLUAG


1934 151
1935 74
1936 35
1937 37
1938 188

5 year average 103


TUBERCULOSIS (All Forms)


603
525
627
1,125
1,177


5 year average 810


1934 211
1935 200
1936 240
1937 233
1938 292
5 year average 235


1934 129
1935169
1936 93
1937 133
1938 160

5 year average 137


36.0
31.0
37.0
67.0
70.0

53.0


CANCER (All Forms)


7.7
10.1
5.5
7.8
9.5


1,325
1,4P2
1,458
1,622
1,551
1,681

TYPHOID FEVER

46
58
39
45
46


14.0
11.0
8.0
6.0
6.0

9.0


57.0
54.0
54.0
58.0
59.0
56.0


79.0
87.0
87.0
97.0
93.0
88.0


36.0
34.0
42.0
33.0
28.0

34.0


PUBLIC HEALTH NURSING TABLE II

Midwifery in Florida, 1938
White Colored Total
Midwives registered T 45 .
Midwives licensed, not registered 14 64 78
Class A 5 0 5
Class B 10 25 35
Class C 61 584 645
Midwives having physical examinations 50 571 621
Midwives with positive syphilis 2 21 2
Midwives with positive hookrorm 1 6
Midwives deceased .* 2 4
midwives refused license 1 14 15
Midwives license revoked 3 1 3 _
Stillbirths reported by midwives to the Bureau of Publio Health Nursing j ..71
Live births reported. 2,466


Fatality
Per event


1934
1935
1936
1937
1938


TAB LE IB continuedd)


E ? I D E M I 0 & 0 a y














Maternal and Child Health activities in Flories reported to
United States Children's Bureau for year 1938.

COMMUNICABLE DISEASE CONTROL
IMMUNIZATIONS (persons immunized)
Smallpox 26,716
Diphtheria, under 1 year 1#854
Diphtheria, 1 through 4 years 9,340
Diphtheria, 5 years and over 13,914

SCHOOL HYGIENE
Examinations by physicians 33,084
Examinations by physicians with parents present 3s067
Field nursing visits 41,85
Office nursing visits 13,066
Inspections by dentists or dental hygienists 32,091

ADULT HYGIENE
PHYSICAL EXAMINATIONS
Midwives 848
Teachers 102

MATERNITY SERVICE
Cases admitted to antepartum medical service 3,813
Cases admitted to antepartun nursing service 9,793
Visits by antepartum oases to medical conferences 9,976
Field and office nursing visits to and by antepartum eases 22,841
Cases given nursing service at delivery 471
Cases given postpartum medical examination 752
Cases admitted to postpartum nursing service 4,64
Nursing visits to postpartum cases 10,168
Midwives under planned instruction 2,262
Midwife meetings 787
Attendance at midwife meetings 3,361
Visits for midwife supervision 2,230
Enrollment in maternity classes 1,17
Attendance at maternity classes 3,301

INFANT AND PRESCHOOL HYGIENE
Infants Presohool.
Individuals admitted to medical service 3,219 4,629
Individuals admitted to nursing service 5,494 9,294
Visits to medical conferences 3,322 6,752
Field and office nursing visits 15,519 16,947
Inspections by dentists or dental hygienists 1,197


Enrollment in infant and preschool classes 2,530

Attendance at infant and preschool classes 1,897


YATERNAL AND CHILD HEALTH


TABLE III










L A B R ATnIE TALE I1V


INTERTINAL PARASITES
Hookworm
Asoaris lumbricoides
Oayuris vermioularis
Strongloides intest.
Tfpworm
eoMbfst- liu. diepr
THOAT Viruleoe test
DIphitheria
IPaea' ** angina
Stepteoooocus
MALARIA
Tertian
Estivo-Autumnal
Uhtyped
AGGLUTINATION TESTS
Typhoid
Para Alpha
Para Beta
Bruaella abortus
Spotted Fever
Well Felix
Tularense
CULTURES
Blood
Stool and Urine
TUSERCULOSIS
Mioroscoplo
Inoculation
OPHIHAMIMIA
Gon.




Dogs
Caui
Other animals
BNCHIAL SPIROCHA TOSIS
EP-HDS


Summary report of the
central and branch laboratories
for the year 1938

POSITIVE NEGATIVE PARTIAL UNSATISFACTORY


12,828
861
246
57
99
486
2
622
1,238
113
282
129
22


39,033


1
15,143
2,615
269

19,307


106 15,840
5 3,559
13 3,547
60 2,463
2
98 3,922
6 554

54
7 961


1,288 8,089


26
3,556

36,355
166
1
331
11
2
45
2


WATER Samples Reoo ved 8,744
MILK 6,538
ICE CREAM 622
MISCELLANEOUS ,
Smears and cultures for organisms


352
24,651

187,560
178

372
66
23
1,988
3


.7,460
7


10,976
2

28
9
2
10
6


TOTAL GRAND TOTAL


52,450
861
246
57
99
486
3
15,871
3,893
383
19,640
129
22

16,232
3,580
3,580
2,625
2
4,101
570

55
979

9,425
6

389
28,331

242,351
353
1
731
86
27
2,043
11


Tests Made 10,469
9,168
639

591 591
Total


54,199


20,150


19,791






30,690

1,034

9,431

389
28,331

242,351
353


845
2,043
11


10,469
9,168
639

591

430,485


_ I_ __ _


TABLE IV


LAB 0 RAT 0 RIES


1










L A U n 0 A T A 2 T W Q T L B L V


Annual report of the
Jacksonville laboratory
for the year 1938


INTERTINAL PARASITES
Hookworm
Asoaris lumbriooides
Oxyuris vermioularis
Strongloides intent.
Tapeworm
Trichooephalus dispar
THROAT Virulenoe Test
Diphtheria
Vincent' angina
Streptoooous
MALARIA
le-ian
Estivo-Autumnal
Untyped
,AGGLUTINATION TESTS
Typhoid
Pare Alpha
Para Beta
Bruoella abortus
Spotted Fever
Weil Felix
Tularense
CULTURES
Blood
Stool and Urine
TUBERCULOSIS
Microscopic
Inoculation
OPHTHALMIA
Gon.
GONORRHEA

Other:Evaluation test
RABIES Human
Dogs
Cats
Other animals
OCHAL SPIROCHAETOSIS
LE sROS____


POSITIVE

7,504
454
106
32
52
151
2
182
136
36
148
79

76
3
7
25

53
5

7


NEGATIVE

24,481


PARTIAL UNSATISFACTORY

450


1
6,304
571
127

13,853


11,921
1,918
1,912
1,769
2
2,269
523
44
467


461 4,577


6
1,791
24,113
166
1
190
5
1
45
1


134
13,096

98,152
178

232
46
18
1,988


TOTAL

32,435
454
106
32
52
151
3
6,492
707
163


14 14,015
79

27 12,107
1,930
1,930
61 1,855
2
2,376
3 536


5,056
6


140
31 14,918


2,29;


7,401
2


131,963
353
1
437
57
21
2,043
1


WATER Samples Received 5,936
MILK ", 921
ICE CREAM 26
MISCELLANEOUS i
'Cultures and smears for organisms


Tests Made 5,936
1,870
I" 26

300


Total 239,077


GRAND TOTAL





33,230


14,094






20,736

524

5,062

140
14,918

131,963
353


516
2,043
1


5,936
1,870
26

300


LABORATORIES


TABLE V










LARaRATORIE T A BLZ -VI


Report of the Jacksonville laboratory
by months for the year 1938


ANIMAL PARASITES
"ftbfch ---


Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Total Grand Total


Pos. 557 696 816 687 448 388 386 451 602 767 730 976 7504
Neg. 1601 1838 1948 2460 2595 1572 1553 1878 2333 2116 2061 2526 24481
Unsat. 26 32 19 88 35 17 16 8 39 44 19 107 450
ASCARIS 25 34 23 31 32 27 41 43 53 38 44 63 454
oCKYRIS 11 16 21 14 8 2 6 3 6 2 4 13 106
STRONGLOIDES 1 4 3 2 1 1 3 6 4 7 32
TAPEWIOn 8 4 8 9 3 5 2 3 3 7 52
TRICHIURIS 7 11 24 14 2 14 20 8 8 4 8 31 151
THROAT CULTURES
Pos. 47 39 18 9 6 4 7 5 7 15 12 13 182
Neg. 1003 830 591 380 280 344 315 265 457 600 790 449 6304
Unsat. 2 2 1 1 6
VIRULENCE TESTS 1 2 3
VINCENTS ANGINA
Pos. 11 6 10 13 10 10 16 17 5 16 16 6 136
Neg. 40 51 64 48 53 39 42 61 48 40 48 37 571
STREPTOCOCCUS
Pos. 6 1 2 1 1 10 2 3 3 3 4 36
Neg. 8 16 8 5 3 4 10 11 8 9 28 17 127
MALARIA
Pos. 9 11 13 14 24 24 27 30 25 27 12 11 1227
Neg. 783 886 1196 1132 1414 1449 1426 1649 1412 976 877 653 13853
Unsat. 2 2 2 1 2 3 2 14
AGGLUTINATION TESTS
TYPHOID
Pos. 3 1 1 2 7 7 6 20 20 6 3 76
Neg. 680 798 1067 1003 1274 1304 1300 1490 1062 748 627 568 11921
Partial 2 1 3 8 9 12 20 17 8 1 2 83
Unsat. 2 1 4 3 4 9 3 1 27
PARA TYPHOID A
Pos. 2 1 3
Neg. 120 140 125 151 245 260 265 292 130 86 58 46 .1)38
Partial 1 4 4 9
PARA TYPHOID B
Pos. 4 2 1 7
Neg. 120 140 125 151 245 260 265 290 130 82 58 46 1912
Partial 1 4 3 3 11
WEIL FELIX
Poe. 7 4 1 12 4 4 6 4 3 8 53
Neg. 118 132 120 149 225 250 256 300 280 164 145 130 2269
Partial 2 1 1 1 8 6 6 8 7 4 2 8 54
BRUCELLA ABORTUS
Pos. 3 2 2 1 3 5 5 2 1 1 25
Neg. 80 87 97 131 166 175 178 255 238 139 122 101 1769
Unsat. 2 1 4 1 4 6 14 17 5 5 1 1 61
TULAREMIA


Pos.
Nag.
Partial
Unsat.
POTTED FEVER
Neg.


3 1 1 5
32 39 47 46 44 49 27 78 65 41 18 37 523
1 1 2 1 5
1 2 3


33230




6495

797

163


14094




12107


1930


1930


2376


1855



536


2 2


(continued on next page)


L A S 9 R A T 0 R I E S


T A B L E V I










LTI -ABLE V I (oontituad)


TYPHOID CULTURES
Blood Pos.
Partial
Stool and Urine
Pos.
Neg.
Partial
TUBERCULOSIS :
MICROSCOPIC.


Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Total Grand Total

4 2 6 5 3 5 4 6 3 3 1 2 44
1 1 45

3 4 7
30 72 47 19 32 45 49 60 23 41 27 22 467
3 2 5 479


Pos. 45 33 42 38 41 36 35 30 39 47 46 29 461
Neg. 309 335 448 344 336 310 298 283 752 524 310 328 4577
Unsat. 3 2 2 1 1 2 2 2 3 18
ANIMAL INOCULATIONS 1 1 4 6
BRONCHIAL SPIRO-
CHAETOSIS
Pos. 7 7 19 4 7 1 45
Neg. 347 361 471 378 370 61 1988
Unsat. 3 2 2 1 1 1 10


5056
6



2043


OPHTHALMIA
Pos.
Neg.


1
13 10 14 15


1 1 1
7 11 6 17 16


1 1 6
8 10 7 134


GONORRHEA
Pos. 187 180 180 151 127 121 150 119 117 155 172 132 1791
Neg. 1013 990 1127 1074 1118 1074 1227 1286 1042 963 1040 1142 13096
Unsat. 1 1 2 2 1 7 1 1 6 6 3 31
SYPHILIS
KAN Poe. 1771 1719 2093 1980 1817 1910 1878 1899 2359 2242 2459 1986 24113
Neg. 7599 7563 8503 7884 7266 7621 8141 8099 9417 8377 8595 9087 98152
Doubtful 146 189 158 142 161 196 215 236 326 182 196 150 2297
Unsat. 518 475 558 559 662 595 776 936 790 455 539 538 7401
EVALUATION TEST
Pos. 69 74 4 19 166
Neg. 61 97 7 13 178
Doubtful 3 4 7
Unsat. 2 2


DO:7 Pos.
Neg.
Unsat.
CAT: Pos.
Neg.
Unsat.
HUMAN: Pos.
OTHER ANIMALS
Pos.
Neg.
Unsat.
LEPROSY Pos.
WATER
WILK
ICE CREAM
MISCELLANEOUS


33 26 26 25 24 9 8 7 7 5 10 10 190
39 31 24 24 15 14 17 13 11 14 13 17 232
1 3 2 2 2 3 1 1 15
1 1 1 1 1 5
3 7 4 3 5 2 3 4 1 7 4 3 46
1 1 1 1 1 1 6
1 1

1 1
2 3 2 1 1 1 2 2 1 3 18
2 2
1 1
348 531 468 485 515 653 604 353 476 484 461 558 5936
196 186 154 169 150 153 136 160 182 154 106 124 1870
10 1 3 12 .26
28 20 32 35 16 17 60 19 17 13 30 13 300



18096 18755 20755 19932 19846 19093 19838 20766 22583 19643 19728 20042 239077


140


14918



131963


57
1


21
1
.5936
1870
26
300


LABORATORIES


TABLE VI (aonff~iurd-)


TOTAL


239077










LABORATORIESAL


Annual report of the
Tampa laboratory
for the year 1938


INTERTINAL PARASITES
Hookworm
Asearis lumbricoides
Oxyuis vernioularis
Strongloides intent.
Tapewon
Triohocephalus dispar
THROAT
"f theria
Vincent's angina
Streptooocus
MALARIA
Tertian
Estivo-Autumnal
Untyped
AGGLUTINATION TESTS
Typhoid
Para Alpha
Para Beta
Bruoella abortus
Brueella melitensis
Weil Felix
Tularense
CULTURES
Blood
Stool and Urine
TUBERCULOSIS
Microscopic
Inoculation
OP THALKIA
0>n.
GONORRHEA
SYPWfILIS
Other
RABIES
Dogs
Cats
Other Animals
LEPROSY


POSITIVE

2,929
332
110
23
25
324

340
588
34

47
7
17
22


18

35
1


NEGATIVE

8,662


PARTIAL UNSATISFACTORY TOTAL

17 11,608
332
110
23
25
324


2,259
650
27

2,253


2,259
377
377
387
316
31

5
.113


519 2,059


8 159
937 4,447

4,732 35,561 2,190


1,527

10
3


WATER Samples Received 876
MILK 1,671
ICE CREAM 342
MISCELLANEOUS "
Cultures and smears for organisms


Tests Made 876
"I 3,342
I" 342

171 171


Total 79,884


GRAND TOTAL





12,422



3,907


2,325


-120

2,588


178
5,420

44,010


2,607
1,2 9


2,301
7
17

2,398
377
377
412

362
34

5
.115

2,588

178
5,420
44,010


876
3,342
342

171


T A.B LE VII


LAS 0 4 A T 0 R I E S










L ABRAT L R.


Report of the Tampa laboratory
by months for the year 1938
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dee
ANIMAL PARASITES

Pos. 141 187 562 344 237 171 143 196 158 310 187 293
Neg. 416 576 1226 1103 665 579 460 539 462 691 966 979
UIkia. 11 5 1
ASCARIS 16 20 80 23 41 26 24 19 8 10 46 19
OXYURIS 4 5 28 16 9 6 6 2 5 11 7 11
STRONGYLOIDES 1 2 1 1 6 1 7 3 1
TAPEWIBM 3 1 4 2 3 2 3 1 1 2 3
TRICHIURIS 9 24 51 20 44 42 21 26 36 14 14 23
THROAT CULTURES
DIPHTHERIA
Poe. 23 36 58 42 14 15 16 22 8 32 50 24
Neg. 136 198 254 314 153 115 122 151 99 290 255 172
Unsat. 1 3 4
VINCENTS ANGINA
Pos. 34 42 47 50 5 35 37 63 62 67 55 46
Neg. 52 64 57 49 62 49 35 53 40 63 70 56
Unsat. 1
STREPTOCOCCUS
Pos. 2 5 3 1 2 2 1 2 4 4 1 7
Neg. 2 8 2 3 6 3 3
MALARIA
Pos. 1 3 7 10 8 3 2 16 2 7 4 8
Neg. 155 184 180 210 233 213 205 220 210 147 177 119
Unsat. 1
AGGLUTINATION TESTS
TYPHOID
Poe. 4 1 2 2 1 2 4 2 4
Neg. 135 168 167 211 230 221 226 258 219 140 154 130
Partial 11 6 6 7 10 12 16 11 4 13 12 1
Unsat. 2 1 3 1 1
PARA TYPHOID A
Neg. 5 18 14 32 34 37 55 48 48 35 31 20
PARA TYPHOID B
Neg. 5 18 14 32 34 37 55 48 48 35 31 20
WEIL PELIX


Pos.
Neg.
Partial
Unsat.
BRUCELLA ABORTUS
Poe.
Neg.
Partial.
Unsat.
TULAREMIA
Pos.
Neg.
Partial
Unsat.
TYPHOID CULTURES
BLOOD Neg.


1 3' 2 1 2 7 6 4 5 3 1
8 12 10 27 26 25 51 44 36 27 30 20
1 1 1 2 2 1 1
1 1
1 2 1 1 6 4 2 1
88 18 11 33 27 41 61 57 44 33 31 23
1 1 2 1
1 1


2 1 2 5

1


1 1


Total Grand Tota


2929
8662
17
332
110
23
25
324


340
2259
8

588
650
1

34
27

71
2253
1


12422


2325


22
2259
109
8 2398

377 377

377 377

35
316
9
2 362


1
1 1 4 4 3 5 31
1 1
1


1 5 5


(continued on next page)


TABLE V.I I1


L A B 0 R A T 0 R I E S -









*ArP TW IT TT Inn(~d


L a LA AT V a a 4 &* M-1. ---M

Jan Feb Mar Apr May June July Aug Sept Oot Nov Deo Total Grand Total
TYPHOID CULTURES (continued)
STOL AND URINE
Pos. 6 4 5 5 6 3 10 3 5 34 .27 5 113
Partial 1 1
Unsat. 1 1 115

Pos. 22 54 64 24 53 54 23 44 49 45 45 42 519
Neg. 129 201 242 134 189 138 133 153 280 152 136 172 2059
Unsat. 2 3 1 3 1 10 2588


2
8 8 9
2


1 1
7 14 12
1 1


8 35 28
2 3


Poe. 75 85 104 85 70 86 78 71 77 80 51 75
Neg. 377 362 408 444 357 378 337 370 341 374 369 330
Uns&t. 1 1 4 3 2 17 1 1 1 5

Pos. 376 356 464 337 325 362 300 407 401 485 523 396
Neg. 3630 3055 3406 2587 2601 2376 252 2201 2876 3275 3425 3606
Doubtful 269 225 240 244 168 132 165 162 185 190 112 98
unsat. 217 166 149 123 118 111 101 104 96 106 128 108


Pos.


Pos.
lieg.
Unsat.


Pos.
Neg.
Unsat.
OTHER ANIMALS
Pos.
Neg.
N.E.


11 5 9 10 13 13 9
10 6 10 6 12 15 5
1 1 3

1
5 4 1 1 2 2 3
3


1
1 1 1
45 40 43 83 100 142 52 136 63 65 51 56
250 260 272 340 532 262 270 252 248 212 244 200
40 24 30 27 29 28 27 28 26 27 t6 30
16 31 22 13 19 8 12 14 11 7 7 11



6663 6495 8282 7026 6505 5804 5616 5786 6211 7032 7316 7148


Pox.
Neg.
Unsat.


1 2
9 14


1
7
2


8
159
11

937
4447
36

4732
35561
2190
1527
1


97
88
10


1

871
3342
342
171


6 6
4 7
3


5
4


178


5420




44010


222
876
3342
342
171


C l A l A T


79884 79884


TOTAL










L A B4 0 RA Tfl 0RXS A YBL EIX


Annual report of the
Miami laboratory
for the year 1938


INTERTINAL PARASITES
Hookworm
Asoaris lubriooides
Oxyuris vermioularis
Strongloides intest.
Tapeworm
Triohooephalus dispar
THROAT
Diphtheria
Vincent's angina
Streptoooocus
MALARIA
Tetian
Estivo-Autuminal
Untyped
AGGLUTINATION TESTS
yphoid
Para Alph&..
Brucela r
Bruoella melitensis
Weil Felix
Tularense
CULTURES
Blood
Stool and Urine
TUBERCULOSIS
Mioroscopic
Inoculation
OPHTIALMIA
Gon.
GONORRHEA

kahn
Other
RABIES
Dogs
Cats
Other animals
LEPROSY


POSITIVE

169
9
6

6
3
9
156
2

4
1


NEGATIVE

1,862


PARTIAL UNSATISFACTORY

34


5,769
592
69

357


605

17 a
604


292

126 570


2 11
313 4,573
4,871 41,256 2,405

22
1
2
3


WATER Samples Received 1,778
MILK 2,428
ICE CREAM 217
MISCELLANEOUS" "
Cultures and smears for organisms


Tests Made 3,496
"i 2,923
'," 217

34 34


Total 74,600


TOTAL

2,065
9

6
3

5,869
787
72

367
1

610

331
606


296

707

13
4,934
50,002


GRAND TOTAL





2,089


6,728


368





2,759

296


707

13
4,934

50,002


4

11


48

1,470




6


3,496
2,923
217

34


L A B 0 R A T 0 R I E S


TAB 5 E I I


''










L S U tA A n T rAqA.IeA


Report of the Miami laboratory
by months for the year 1938

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
ANIMAL PARASITES
HO0KWOR
Poe. 32 23 40 25 23 4 7 1 6 4. 4
Neg. 159 133 176 222 310 142 136 142 109 107 125 101
Unsat. 7 2 1 4 4 4 1 2 5 4
ASCARIS 1 3 1 2 1 1
OXYURIS 1 1 3 1
TAPEWIRM 1 2 2 1
TRICHIURIS 1 1 1
THROAT CULTURES
Poe. 2 1 1 1 2 1 1
Neg. 721 440 284 231 168 104 134 67 1926 558 815 321
Unsat. 8 3 4 1 57 12 6
VINCENTS ANGINA
Poe. 14 5 9 15 13 5 18 17 7 17 20 16
Neg. 57 42 82 87 53 47 46 35 53 25 32 33
Unsat. 20 13 4 2
STREPTOCOCCUS
Poe. 1 1
Neg. 2 7 27 5 2 5 3 7 4 6 1
Unsat. 1
MALARIA
Pos. 1 3 1
Neg. 26 38 45 29 20 27 27 38 41 25 19 22
Unsat. 1 1 1 3
AG6 INA TION TESTS
TYPHOID
Neg. 43 43 62 54 51 54 56 62 50 48 45 37
Partial. 1
Unsat. 1 2 1
PARA TYPHOID A
Neg. 43 44 62 54 51 54 56 62 50 47 45 37
Unsat. 1
PARA TYPHOID B
Neg. 43 44 62 54 51 54 56 62 50 47 45 37
Unsat* 1
WEIL FELIX
Neg. 43 44 62 53 51 54 56 62 50 47 45 37
Partial 1 1
BRUCEL1 ABORTUS
Pos. 1 2 1 1 2 3 5 2
Neg. 16 8 21 28 37 32 25 34 18 21 22 18
Unsat. 3 2 1 2 2 8 2 5 6 1 2
TYPHOID CULTURES
STOOL AND URINE
Neg. 59 23 28 20 27 18 20 24 25 17 12 19
Unsat. 1 2 1
TUBERCULOSIS
MICROSCOPIC
Pos. 17 7 19 7 4 23 8 11 12 10 8
Neg. 66 72 69 44 53 35 49 49 27 40 23 43
Unsat. 6 1 1 2 1

(continued on next page)


Total Grand Total

169
1862
34
9
6

3 2089

9
5769
91 5869

156
592
39 787
2
69
1 72

5
357
6 368


605
1
4 610

605
1 606

605
1 606

604
2 606

17
280
34 331

292
4 296

126
570
11 707


TABLE X


SA 1A f R1 Tf S




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