S T A 07 FLORIDA
STATE BOARD OF
Year Ending December 31, 1939
A. B. McCreary, M. D.,
Florida State Health Officer
FLORIDA STATE BOARD OF HEALTH
December 1, 1940
His Excellency, Fred P. Cone
Governor of Florida
I beg to hand you herewith a report of the Florida
State Board of Health for the period of January 1,
1939 to December 31, 1939, inclusive.
N. A. Baltzell, M. D., President
Florida State Board of Health
December 1, 1940
Honorable N. A. Baltzell, M. D., President
Florida State Board of Health
Dear Dr. Baltzell:
I herewith submit the annual report of the Florida State Board
of Health for the year 1939.
Outstanding during the year was the Survey of Health Condi-
tions in Florida made by the American Public Health Associa-
tion at the request of the late Dr. W. A. McPhaul, then State
Health Officer of Florida. I feel that the survey marked an
important step in public health in this state. Florida's
health problems were made known to the people at large to an
extent never before attained. Ten thousand copies of the
Survey have been distributed to Florida citizens. Many of
the recommendations contained in the survey have already been
carried into effect.
Establishment of full-time health service in all Florida coun-
ties is the primary objective of the State Board of Health.
During 1939 additional county health units were established
and indications point toward the establishment of several more
within the next year.
A State-Wide Public Health Committee, composed of over two
thousand citizens from all Florida counties was formed during
1939, at the suggestion of the Survey Committee. The value of
this enthusiastic group of men and women, and the importance
of their contribution to public health in this state cannot be
ever-estimated. The officers and members have worked intel-
ligently and untiringly and have been responsible for the
spread of full-time local health service to a large degree.
The Directors and staff of the State Board of Health have
carried on their work faithfully and well during the year and
have cooperated in every way with the members of the Board and
the State Health Officer.
A. B. McCreary, M.Of
State Health Officer
Venereal Disease Control
Malaria Research .
Public Health Nursing.
Maternal and Child Health
Dental Health .
Health Education .
Local Health Service
Vital Statistics .
* 9 0 9 0
TABLE OF CONTENTS (continued)
Summary report of the central and branch laboratories for
the year 1939. .
Annual report of the Jacksonville laboratory for the year
Report of the Jacksonville laboratory by months for the year
Annual report of the Tampa laboratory for the year 1939
Report of the Tampa laboratory by months' for the year 1939.
Annual report of the Pensacola laboratory for the year 1939.
Report of the Pensacola laboratory by months for the year
1939. .. .
Annual report of the Miami laboratory for the year,1939.
Report of the Miami laboratory by months for the year 1939.-
Annual report of the Tallahassee laboratory for the year 1935
Report of the Tallahassee laboratory by months for the year
TABLE OF C CONTENTS (continued)
Maternal and Child Health activities in Florida report to
United States Children's Bureau for the year 1939. XII
Reported cases of notifiable diseases in the state of
Local Health Service XIV
Dan N. Cone, M. D., Director
During the year sporadic cases of various communicable diseases
occurred throughout the State but at no time was there a threat of
The grand total of all communicable diseases reported for 1939
was 15, 955 excluding venereal disease cases while the total for
1938 was 23, 127 excluding venereal disease cases.*
Diphtheria deaths remained practically stationary durinL the
year and this should serve as a reminder that each child should be
immunized early from six to nine months of age and unless the child
is known to be Schick negative a second dose of alium precipitated
toxoid should be given.
There were four typhoid carriers identified among the permanent
residents of the State and eleven out-of-State visitors who were car-
riers were kept under the observation of health officials while in
The number of undulant fever cases reported has increased since
1938 and the Bureau is continuing the program of recommending the
drinking of pasteurized milk or milk from dairy herds, or family cow,
which have been tested and found to be free of Bang's disease.
Typhus fever (endemic, flea-borntype) shows a decided increase
during the past year. Rat eradication and rat proofing was insti-
tuted in two of the small towns with favorable results.
* The number of communicable diseases reported by counties during
1939 will be found in the Appendix, Table Xlll. For the number of
syphilis and gonorrhea cases reported by age, sex, and color, see
Tetanus was the cause of thirty-seven deaths during 1939 there-
fore, it is felt that it is important to insist that every person re-
ceiving a deeply lacerated or punctured type of wound should have a
dose of the prophylactic anti-toxin at the time of injury.
From an economic stand-point, malaria and hookworm disease con-
tinue to constitute two of the major health problems of the State.
The planned programs being carried out for control of these two dis-
eases in counties with full-time health units are beginning to show
reduced incidence of these two diseases, and if continued should im-
prove the material as well as the health situations in these counties.
The tables on the following pages have been .designed to .show
the number of communicable disease cases reported by age, sex and
color and also to show the seasonal incidence of the communicable
- 3 -
REPORTED CASES OF COMMUNICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR
Age Group White
0 to 4 56 43
5 tc 9 46 37
10 to 19 15 23
20 te3 29 5 8
30 to 39 6 8
40 to 49 2 2
50 to 59 0 o o
6 to 69 0 2 0
70 and over 1 0 0
Age, Sex and Color not given
Age Group White Colored
i FM. F. .
0 to 4 38 33 2 1
5 to 9 55 90 o 4
10 to 19 32 62 1 1
20 to 29 6 22 0 0
30 to 39 11 7 0 1
40 to 49 1 3 0 0
50 to 59 1 o o o
60 to 69 o 1 0 o
70 and over 0 0 0 0
Age, Sex and Color not given
SEASONAL INCIDENCE OF REPORTED CASES OF COMMUNICABLE DISEASES
DIPHTHERIA Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
1939 37 30 20 22 10 20 17 14 42 24 34 29
1938 77 55 46 58 23 18 28 27 34 51 40 35
1937 47 37 29 19 29 39 16 22 47 99 125 100
1936 46 23 27 14 !11 0 13 11 38 43 34 49
1935 34 35 27 15 16 23 20 36 34 81 60 45
1939 41 58 55 34 30
1938 41 55 28 39 15
1937 36 28 39 97 24
1936 58 22 35 22 24
1935 47 35 20 12 14
28 16 14
11 13 8
14 12 8
13 11 13
12 12 11
18 22 42 39
16 32 48 46
5 23 38 53
16 24 20 41
23 23 33 31
"' ."' "' ` "
REPORTED CASES OF COMMUNICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND" OLOR (Cbnt.)
EASMgS WHOOPING COUGH
Age Group White Colored Totals Age Group White Colored
M. F. M. F. M. F. M. P.
0 to 4 129 151 8 8 296 0 to 4 177 212 24 35
5 to 9 342 358 17 18 735 5 to. 9 231 227 11 75
10 to 19 129 136 8 13 286 10to 19 36 5 o o
20 to 29 17 13 3 6 39 20 to 29 0 3 0 0
30 to 39 5 8 1 0 14 30 to 39 1 1 0 0
40 to 49 2 2 0 0 4 40 to 49 1 0 0 0
50 to 59 2 0 0 0 2 50 to 59 0 0 0 0
60 to 69 0 o 0 0 0 60 to 69 0 0 0 0
70 and-rver 1 0 0 0 1 70 and over O 0 0 0
Age, Sex and Color not given 1339 Age, Sex and Color not given
Grand Total 2716 Grand Total
SEASONAL INCIDENCE OF REPORTED CASES OF COMMUNICABLE DISEASES (Cont)
Jazi Feb Mar Apr May June July Aug Sept
227 446 436 739 549 198 60 9 11
479 1663 3466 2395 591 157 95 25 80
16 18 23 41 118 57 35 26 29
6 12 38 66 91 39 19 14 4
113 226 261 314 160 3 15 11 11
1939 49 123 203 206 200 114 90 41
1938 54 84 36 104 102 71. 86. 45
1937 37 20 42 119 63 65 65 23
1936 23 25 46 57 67 36 41 21
1935 72 30 56 91 74 51 47 30
Oct Nov Deo
24 11 6
45 92 61*
23 98 151
3 1 14
19 5 3
7 26 16
83 38 78
23 21 22
14 16 20
21 26 18
REPORTED CASES OF CCI UNICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR (Cont.)
Age Group White Colored
M. F. M. P.
0 to 4 7 5 1 0
5 to 9 2 1 6 5
10 to 19 10 7 9 7
20 to 29 11 10 2 1
30 to 39 3 10 6 o
40 to 49 3 3 1 2
50 to 59 4 1 o o
60 to 69 1 0 0 0
70 and over 0 0 0 0
Age, Sex and Color not given
Age Group White -Colored
U. F. U. P.
0 to 4 11 3 2 2
5 to 9 10 12 0 0
10 to 19 30 22 4 3
20 to 29 18 14 4 5
30 to 39 15 27 2 4
40 to 49 23 15 1 3
50 to 59 6 10 o o
60 to 69 8 8 0 0
70 and over 4 5 0 0
Ake, Sex and Color not given
SEASONAL e X4I1NCE V REPORTED CASES OF COM I CABLE DISEASES (Cont.)
TYPHOID Jan Feb Mar Apr Lay June July Aug Sept Oct Nov Dec. Totals
L39 3 6 11 18 27 10 12 10 12 6 5 8 128
1938 7 7 7 20 24 23 10 20 16 10 6 10: 160
1937 2 5 12 14 15 8 14 7 18 13 2 23 133
1936 5 10 8 11 17 9 4 7 12 5 2 3 93
1935 4 3 9 13 22 33 36 16 13 6 6 8 169
1939 24 11 19 41 33 16 76 47 62 50 30 26 435
1938 13 35 18 25 23 19 22 45 95 70 61 45 471
1937 13 9 20 30 39 81 162 155 179 98 61 47 894
1936 48 104 16 4 16 14 62 98 78 140 234 55 869
1935 16 7 14 21 20 56 130 42 56 173 64 214 813
REPORTED CASES OF COMQEICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR (Cont.)
Age Group White Colored
M. F. M. FP.
0 to 4 0 1 0 0
5 to 9 3 3 0 o
to to 19 7 13 0 0
20 to 29 18 5 1 0
30 to 39 19 to 3 2
40 to 49 13 6 2 0
50 to 59 6 7 o o
60 to 69 5 5 0 o
70 and over 5 2 0 2
Age, Sex and Color not given
Age Group 1hite Colored
U. F. U. F.
0 to 4 2 3 5 1
5 to 9 0 2 1 2
10 to 19 7 20 18 36
20 to 29 37 46 63 69
30 to 39 62 41 76 42
40 to 49 90 39 32 19
50 to 59 67 20 20 6
60 to 69 35 11 7 1
70 and over 9 9 0 1
Age, Sex and Color not given
SEASONAL INCIDENCE OF REPORTED CASES OF COaLiUNICABLE DISEASES (Cont.)
Jan Feb Mar Apr May June July Aug Sept Oot Nov Doe. Totals
1939 3 7 8 6 11 17 21 28 31 7 5 8 152
1938 2 6 4 5 4 8 11 7 6 7 3 12 75
1937 3 6 6 0 4 19 19 12 22 0 7 9 107
1936 2 3 2 0 1 2 16 11 11 3 1 3 55
1935 1 4 1 1 1 3 5 1 4 4 0 2 27
1939 67 82 98 988 77 88 87 63 48 56 75 916
1938 154 135 91 131 110 75 64 84 80 59 95 99 1177
1937 78 46 53 135 76 44 75 84 170 100oo 153 106 1120
1936 67 59 66 40 51 43 44 30 42 62 -58 59 621
1935 48 51 55 41 74 41 40 32 32 31 28 50 523
REPORTED CASES OF C(OM ICABLE DISE~SZS CLASSIFIED ACCORDING TO AGRi -SEX AND COLOR (Cont.)
Age Group White Colored
k. F. U. F.
0 to 4 9 9 3 2
5 to 9 8 14 1 1
o1 to 19 9 3 1 2
20 to 29 1 2 0 0
30 to 39 o o o o
40 to 49 0 0 0 0
50 to 59 o o 0 0
60 to 69 0 o 0 o
70 and over 0 0 0 0
Age, Sex and Color not given
Age Group White Colored
M. F. Il F.
0 to 4 0- 0 0 0
5 to 9 0 o o 0
10 to 19 0 0 0 0
20 to 29 0 0 1 0
30 to 39 0 0 o o
40 to 49 0 0 0 0
50 to 59 0 0 0 0
60 to 69 1 0 0 0
70 and over 0 0 0
Age, Sex and Color not given
SEASONAL INCIDENCE OF REPORTED CASES OF COML'UNICABLE DISEASES (Cont.)
Jan Feb Mar Apr May June July Aug Sept
1939 4 2 3 9 11 6 11 8 14
1938 2 3 0 1 6 5 5 3 2
1937 0 5 4 2 0 1 1 5 9
1936 0 o 1 1 4 1 7 12
1935 1 2 0 0 3 1 3 4 1
Oct Nov Dec
2 2 0
2 1 2
3 4 1
6 7 3
1 0 0
1 1 0 0 1
7 1 1 6 o
O 0 0 0 0
0 0 0 0 0
0 0 k2 2 0
0 0 0. 0
0 0 0 -0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 1
0 0 0
0 4 3
0 0 0
0 0 0
- I~ -- ~-
REPWCRMD CASS OF COMQ NICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR (Cont.)
Age Group White Colored "Totals
M. F. M. P.
0 to 4 4 9 1 3 17
5 to 9 2 4 2 1 9
10 to 19 33 6 5 1 45
20 to 29 64 13 4 12 93
30 to 39 31 8 8 12 59
40 to 49 28 19 2 8 57
50 to 59 21 15 4 3 43
60 to 69 7 9 6 1 23
70 and over 6 10 0 0 16
Age, Sex and Color not given 40-
Grand lotal 402
Age Group White Colored
M. F. M. F.
0 to 4 0 0 0 0
5 to 9 1 2 0 0
10 to 19 2 3 0 2
20 to 29 4 5 0 1
30 to 39 7 4 0 o
40 to 49 4 3 0 0
50 to 59 4 1 o o
60 to 69 o 1 0 0
70 and over 0 0 0 0
Age, Sex and Color not given
SEASONAL INCIDENCE OF REPORTED CASES OF COMMUNICABLE DISEASES (Cont.)
INFUENZA Jan Feb Mar Apr May June July Aug .Sept.
1939 9 6 27 57 134 31 23 10 18
1938 25 20 8 11 10 3 0 2 2
1937 109 120 132 72 21 5 1 3 3
1936 21 106 220 139 23 21 5 2 5
1935 251 264 93 7 11 1 1 2 4
1939 1 3 4 7 1 4 10 7 2
1938 0 2 3 5 3 1 7 6 3
1937 o 0 1 3 15 0 1 4 2
1936 0 0 2 5 2 1 1 0 2
1935 0 1 1 0 1 52 5 3 1
Oot Nov Dec totals
10 21 56 402
6 7 18 112
10 31 37 544
15 10 20 587
5 11 12 662
.- ~-1-~ -- --
- 9 -
REPORTED CASES OF COMMUNICASLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR (Cont.)
Age Group White Colored
M. F. M. F.
0 to 4 0 1 1 0
5 to 9 1 4 0 0
10 to 19 2 6 1 0
20 to 29 2 8 1 2
30 to 39 1 15 1 7
40 to 49 10 17 0 4
50 to 59 5 13 0 o
60 to 69 1 5 o 1
70 and over 3 7 0 0
Age, Sex and Color not given
Age Group White Colored
K. F. M. P.
0 to 4 0 1 0 1
5 to 9 0 1 2 0
10 to 19 0 0 3 1
20 to 29 1 0 1 0
30 to 39 0 0 1 1
40 to 49 0 0 1 0
50 to 59 1 o o o
60 to 69 0 0 0 0
70 and over 0 0 0
Age, Sex and Color not given
SEASONAL INCIDENCE OF REPORTED CASES OF CMAlUNICABLE DISEASES (Cont.)
PELLAGRA Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Totals
1939 7 7 13 15 50 22 23 9 12 7 3 4 172
1938 4 3 7 9 16 39 11 21 17 26 20 15 188
1937 2 0 5 0 0 o 11 1 6 0 10 2 37
1936 1 1 0 6 5 4 7 4 0 5 1 1 35
1935 3 12 3 11 24 7 1 3 2 3 4 1 74
1939 1 1 1 0 0 3 3 1 0 2 2 1 15
1938 4 1 2 3 0 0 3 3 1 3 3 2 25
1937 1 2 3 0 0 0 1 0 0 2 0 2 11
1936 3 1 2 2 1 6 2 4 1 5 3 1 31
1935 1 3 2 2 4 1 4 2 2 3 1 2 27
- 10 -
REPOeED CASES OF CGOMUNICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR (Cont.)
Age Group White Colored
m. P. x. P.
0 to 4 0 0 0 0
5 to 9 0 0 0 0
10 to 19 0 0 0 0
20 to 29 3 1 0 0
30 to 39 2 1 2 3
40 to 49 5 2 0 0
50 to 59 3 o o o
60 to 69 0 0 0 0
70 and over 0 0 0 0
Age, Sex and Color not given
Age Group White Colored
M. F. M. F.
0 to 4 1 0 0 0
5 to 9 o 0 0 0
10 to 19 0 1 0 0
20 to 29 2 1 0 0
30 to 39 4 1 0 0
40 to 49 1 0 0 0
50 to 59 o 1 0 o
60 to 69 1 0 0 0
70 and over 0 0 0 0
Age, Sox and Color not given
SSEASONAL INCIDENCE OF REPORTED CASES OF COMhUNICABLE DISEASES (Cont.)
LARMIA Jan Feb Mar
Apr May June July Aug Sept
Oct Nov Dec Totals
0 0 0 0
0 0 0 0
0 4. 1 0
0 0 0 0
0- 0. 0 0
II lrI -~
SYPHILIS CASES REPORTED BY AGE, SEX AND COLOR
MONTH 1 year
M. F. XL F.
January 1 5 1
February 0 5 2
March 0 2 .1
April 0 4 2
May 0 0 3
June 1 1 1
July 0 1 7
August 0 2 '2
SeptemberO 2 3
October 0 0 6
November 0 0 3
December 1 1 7
TOTALS 3 23. 32
1 to 9 years 10 to 19 years 20 to 29 years
White Colored White Colored White Colored
M. F. M. F. MI F.; m F. U. F. M. F.
1 o 6
2 5 6
2 0 8
2 1 2
0 0 1
0 6 1
1 4 5
0 3 3
0 3 8
1 1 0
3 2 6
3 3 4
15 28 50
15 28 50
5 2 2 9 31
5 5 6 24 33
o 3 5 13 29
5 9 8 21 26
7 1 6 16 21
3 3 3 5 27
4 6 13 24 32
15 6 14 18 37
14 11 13 30 48
6 10 14 16 51
6 8 8 13 50
3 4 33 48 91
73 68 125 237 476
.44 5. 33
90 44 59
89 36 48
57 34 47
62 33 40
19 19 28
105 82 116
103 62 75
128 74 93
140 47 81
125 55 100oo
187 56 -98
1149 577 818
30 to 39 years
M. F. M. F.
24 11 121 156
31 43 122 162
35 26 1oo 169
22 18 128 105
17 16 95 101
34 24 59 89
59 67 160 210
47 50 200 241
54 63 205 275
17 56 177 258
51 49 169 249
1, 56 228 310
32 479 1764 2325
SYPHILIS CASES REPORTED BY AG, SEX AND COLOR (Cont.)
Month 40 to 49 years
U. P. U. F.
January 20 11 73 37
February 19 19 62 49
March 17 11 59 47
April 23 18 48 37
May 14 8 46 44
June 22 5 26 25
Jly 53 25 73 83
August 40 21 101 89
September 50 45 96 97
October 37 34 88 74
November 30 27 58 87
December 28 29 113 104
TOTALS 353 253 843 773
50 to 59 years
I. F. U. F.
12 1 36 8
17 5 27 9
18 4 15 21
15 2 19 11
10 2 23 11
7 4 16 19
34 9 46 20
15 7 33 19
26 5 44 29
31 13 32 24
20 6 51 30
36 18 64 35
241 76 406 236
60 or Oror Age Not Given
White Colored White Colored
M. F. U. F. m. F M. F.
4 1 15 4 9 9 26 69
8 1 10 3 31 29 48 91
6 2 12 8 24 3 26 0
5 2 14 6 26 59 79 129
7 3 12 6 21 49 49 103
5 0 11 9 12 25 28 50
16 9 24 14 44 55 113 132
8 4 26 12 29 18 88 105
14 5 30 17 33 27 115 144
7 3 20 7 21 16 53 103
13 5 11 13 26 21 44 65
22 11 22 13 24 34 82 128
115 46 207 112 300 345 751 1119
Sex and 'Color not Given
GCNOCOCCUS CASES REPORTED BY AGE, SEX AND COLOR
1 year 1 to 9 years
White Colored White Colored
U. F. m. FP K. F. M. PF
0 0 2 0 0 2 2 5
0 0 0 0 2 0 0 0
0 0 1 0 0 0 1
0 0 0 0 0 4 1 3
0 0 3 o
0 0 1 0
o 1 6 o
0 0 2 0
0 0 14 1
0 1 5 3
0 0 0 0
2 '5 4 2
2 9 41 9
10 to 19 years 20 to 29 years 30 to 39 years
White Colored White Colored White Colored
M. F. PF. M. F. M. F. M. F. F.
6 13 6 11 7 3 2 1 4 1 2 0
3 4 6 3 30 5 13 2 7 0 3 0
9 3 2 1 23 8 10 1 3 0 2 0
11 1 15 1 27 6 11 1 5 1 1 0
4 4 10 0 17 8 16 0 7 3 8 o
8 0 3 2 15 6 6 1 3 1 4 0
10 4 15 1 68 15 23 2 21 i 3 0
19 13 10 4 49 17 15 4 1 3 5 2
17 5 11 2 47 14 12 2 11 6 7 0
6 12 5 3 20 15 21 10 4 0 7 3
13 2 21 0 18 12 26 1 10 5 7 0
12 7 10 4 14 3 4 6 0 0 7 0
118 68 114 32 335 112 159 31 85 26 56 5
GONOCOCCUS CASES REPORTED BY AGE, SEX AND COLOR (Cont.)
40 to 49 years
M* F. /. F.
1 0 1 0
1 2 1 0
3 1 0 0
6 1 1 0
1 1 1 0
2 0 1 0
4 1 1 0
12 0 4 0
6 2 1 0
3 0 1 1
3 0 2 0
0 0 0 0
42 8 14 1
50 to 59 years 60 or Over Age not Given Sex and oolor
White Colored White : Colored Ihite Colored not Given
i. F. P F. M. P. M. F. M. F.
1 0 0 0 0 0 0 0 3 2 o 9
0 0 0 0 0 0 0 0 3 4 3 2 15
0 1 0 0 -1 0 -o 7 4 2 3 15
1 0 0 0 0 0 0 0 6 3 4 2 17
0 0 1 0 1 0 0 0 5 3 4 2 14
o 1 1 o o 0 0 0 2 3 2 3 12
2 2 0 0 0 o 0 3 2 5 5 5
1 0 0 0 0 0 0o 4 3 6 4 10
2 2 0 0 1 0 0 0 2 2 3 2 12
2 0 1 0 1 0 0 0 5 3 3 2 12
o 0 0 0 O 0 0 0 6 2 4 2 14
0 0 o 0 o 0 o 0 4 3 7 5 13
9 6 3 0 4 0 0 1 54 35 45 32 148
VENEREAL DISEASE C NTROL
L. J. Hanchett, M. D., Acting Director
(P.A. Surgeon, U. S. Public Health Service)
The activities of the Division of Venereal Disease Control have
been considerably expanded during 1939. This was made possible by
an increased allotment of funds from the United States Public Health
Service and a special appropriation from the State Legislature to
carry on venereal disease control work. The personnel of the
Division now includes the following: director, nurse consultant,
colored educational consultant, a secretary and two clerks.
The plans for venereal disease control in the state have in-
cluded the following objectives:
(1) Expansion of and improvement in existing diagnostic and
(2) Improvement in the laboratory facilities for the diagnosis
of early syphilis.
(3) Advancement of educational work.
(4) Improvement in contact investigation and follow-up work
in the various clinics throughout the State.
(5) Improvement in the reporting of all the venereal diseases
by physicians, hospitals, and clinics.
(6) Distribution of free antisyphilitic drugs to physicians
for the treatment of indigent and semi-indigent patients with syphilis.
Diagnostic and Treatment Facilities. At the beginning of 1939,
there were forty public clinics in the State for the diagnosis and
treatment of syphilis patients. During the year, the number of
such clinics has increased steadily each month, until at present,
there are sixty-seven. These clinics are operated under the
jurisdiction of the various county and city health departments, and
financed largely from Federal and State funds. They provide free
diagnostic and emergency treatment to all patients who apply; free
diagnostic and treatment facilities to all patients referred by
private physicians, either for continued treatment or for consultative
advice and opinion; and all patients unable to afford private medical
- 15 -
- 16 -
During the past year the total number of syphilis patients
receiving treatment in all the various clinics has increased from
4,560 in January to 8,360 in December. This can not be interpreted
as indicating an increased number of syphilis cases in the state,
but rather as an indication that more people are coming under
treatment and fewer of thet are being ntglCcted because of indigcncy
or other reasons. A study of the accompanying graph (Fig. 1) will
show the continually increasing case load of syphilis patients being
treated in the clinics of tne State.
Laboratory Facilities. The laboratories of the State Board of
Health and its various branches, have for a number of years, been
doing serological tests on blood specimens sent in by physicians,
hospitals, and clinics from all over the state for the diagnosis
of syphilis. The number of such' specimen sent in has been increas-
ing each month during the year, and it has been necessary to take
on added personnel and to purchase more modern equipment to carry
During the past year darkfield equipment has been installed in
the central laboratory at Jacksonville. and in each of the branch
laboratories at Miami, Tampa, Tallahassee, and Pensacola, In all
of these laboratories, trained technicians are available to make
proper darkfield examinations on material sent in by physicians
or clinics to determine thb presence of treponema pallida. In
addition to this, the laboratories in Jacksonville, Miami, and
Tampa, are equipped to do direct darkfield examinations on male
patients with suspected early syphilitic lesions.
This is a vary definite forward step by the state laboratories
&ai provides a valuable service to physicians and to the public
throughout the state, by enabling the physicians to.make an earlier
and more accurate diagnosis of patients with primary and secondary
syphilitic lesions. Much educational work remains to be done in
order to familiarize physicians with the use ano value of this
Educational Activities. Because of the high incidence of
syphilis among the colored people, special emphasis has been placed
on educational work among this race. The colored physician' in the
Division has been in the field continually, presehting.lectures
and educ-tionnl films in the colored churches and schools over the
entire state. That his efforts have been worthwhile is evidenced
by the fact that the colored people are gradually becoming more
syphilis conscious and many more of them are now seeking treatment
in the early stages of the disease. Other educational activities
have included the distribution of informative literature on the
subject to both colored and white patients, through the offices of'
physicians and by the various clinics. In addition, advantage is
NUMBER OF SYPHILIS CASES IN UNITS OF ONE THOUSAND
0 -- o -0) CO t)
................. ................................ .......... ....... ... ",) "0 --
............................... ................................ ... ... ----- -
........... .... ..................... ... 0 -
............... ....................................... ...................................... ... ....
S-............... ................ ...................... .................
........................---...............----- ............................... ...................
.................... ....... ......... ........... .......
I I I
............. ....... ........................................................... ............. ... ..............
0 :" [
- 17 -
taken of every opportunity to present lectures and educational films
to various civic organizations and professional groups.
Epidemiological Work. As with other communicable diseases,
epidemiological investigation is one of the most important phases
of venereal disease control activities. To treat only those venereal
disease patients who voluntarily present themselves for diagnosis
and treatment is to miss many cases of early syphilis, who in all
probability are going untreated and spreading their infections to
untold numbers of our population. The follow-up work on delinquent
patients is also of the utmost importance in order to prevent
infectious relapses in inadequately treated patients.
Because of the extreme importance of this phase of the program,
every effort has been made to improve this work in local health
departments. An additional nurse was provided in all of the county
health units, so that the full time of at least one trained public
health nurse could be spent in tracing contacts of early cases and
bringing them in for examination and treatment, if found to be
infected and in making home visits to delinquent patients to persuade
them to return for fur-her treatment. Many of the city health de-
partments have also employed either nurses or social workers to
carry on these activities.
While in many of the county and city health departments the
quantity and quality of epidemiological work done ha..s been disappoint-
ing, in others, improvement has been noted snd desired results
are being accomplished. In the county health departments, there
were over three times as many home visits made to delinquent patients
during the past year as in the previous yeer.
Morbidity Reporting. Prompt reporting; of all cases of venereal
disease by all physicians and institutions is required by law in
this Stete. This is absolutely necessary to enable local and state
health officers to know the extent of the venereal disease problem
in various localities and in the state .'s a whole. Adequate and
complete reporting is also a necessity to enable the local health
departments and the State Board of Health to racke frequent periodic
studies of the effectiveness of various control activities.
With the beginning of the new ( iscal year, starting July 1, 1939,
renewed efforts have been made by the Division of Venereal Disease
Control, as well as by the various local county :nec city health
departments, to obtain better and more complete reporting of all
venereal disease cases b: physicians, clinics, and hospitals. The
response by all concerned to these efforts has been very gratifying
and it has been observed that most physicians really are anxious to
cooperate in every way with our program and they nor accept as a
matter of routine tncir responsibility in reporting promptly to the
- 18 -
Ii) -- ,,- -~
JAN FE8 M4R APR? MAY JUNE JULY AUG SEPT OCT NOV
proper health authorities every nw c.se of venererl disease coming
under their care.
The accompanying graph (Fig. 11) will show th- total number of
syphilis cases reported each month by all sources during 1939.
Properly interpreted, this does not mean that th-ro ar; more cases
of syphilis now than previously, but that more attention is paid
to reporting and that perhaps more patients who have the disease
are being diagnosed end treated.
Distribution of Drugs for the Treatment of Syphilis Patients,
The State Board of Health furnisncs free antisyphilitic drugs to
S.... .- ----- .
, .. ,.. -..-.. --. ..
- .-- ------- ---- I -------,-- ---- -- ---------------
----- -- --- -- -- -
--L . .
NIJlltBER OF SYPHILIS CASES
REPORTED PER MONTH
FLORIDA 4 195
-- -- --- --- --- ---- -- --------------- .. .. ............... ......
..................... ...... ..
- 19 -
physicians throughout the State for the treatment of indigent and
semi-indigent patients. Further interesting evidence of gains
made in the control of this disease is shown by a study of the
amount of such drugs dispersed each month- during the past year.
In January 1939 there were 671 doses of antisyphilitic drugs dis-
tributed free to private physicians in this State. During each
month of the past year this number has continually shown a marked
increase over the previous month, and during the month of December
1939, 4,379 doses of these drugs were distributed free to private
physicians. These figures would seem to indicate that the total
number of syphilis patients being treated by physicians over the
State has greatly increased during the past year and is further
evidence of results obtained by educational activities.
While the above is evidence of noteworthy gains made in the
program for the control of syphilis, there remains much yet to be
accomplished, if the disease is to be controlled in this State.
Outstanding needs may be listed es follows:
(1) Continued and more extensive educational activities
reaching all strata of society in every community.
(2) The establishment of additional diagnostic -nd treat-
ment facilities. Two-thirds of the counties in the State still
have no clinic facilities for the treatment of indigent and medically
indigent patients and are still without a full-time local health
(3) Improvement of existing facilities, expkcially in regard
to clinic equipment and provision for adequate personnel. The
decentralization of certain facilities, so that residents of rural,
as well as urban areas, may have rerdy access to treatment.
(4) More and better contact investigation and follow-up work,
especially on cases of early syphilis.
(5) More local and state funds to carry our share of the
expense, necessary to vigorously carry out all steps of the program.
A. J. Logie, M. D., Director
In 1939 the Division of Tuberculosis inaugurated the new anti-
tuberculosis program. The original program of tuberculin tests and
x-ray examinations among indigent contacts, indigent suspected cases
and senior high school students was altered. The present program is
concentrated upon indigent contacts, indigent suspected cases, tran-
sients, families of those on relief, unemployed, and unemployables.
Special emphasis is laid upon the negro population. Tuberculin tests
are used only in the case of children under the age of fifteen. The
Vollmer Patch Test is being encouraged because a recent comparative
study in Tampa convinced this Division that the patch test was more
efficient and more accurate than both strengths of PPD. The patch
test is also simpler to apply and there are fewer objections to its
application, since no needle is employed. The chief feature of the
antituberculosis program is the x-ray examination. This has been ;
done in the same manner as in the last two years. The Powers Rapid
X-ray Unit is employed with paper film in rolls.
During this annual period the original antituberculosis pro-
gram was continued in a number of counties:
GULF COUNTY. On January 16, tuberculin testing be-
gan in this county. The number of children tuberculin
tested was 113 of which 32 (28.3%) sho-.ed positive reactions. Of
these positive reactors none showed adult type tuberculosis
on x-ray. In Gulf County 52 adults 77ure tested, of which
34 (65.4%) showed positive reactions. Of these positive
reactors, two showed evidence suggestive of tuberculous
pathology on x-ray.
FRANKLIN COUNTY. Tuberculin testing btgan in this
county on January 16. The number of children tested was
276, of which 140 (53.6%) showed positive reactions. Of
these positive reactors none showed evidence of adult type
tuberculosis. Adults tested numbered 99, of which 80
(87.7%) showed positive reactions, and of these adult re-
actors, 6 showed pathology suggestive of adult type
- 20 -
- 21 -
HIGHLANDS COUNTY. Tuberculin testing began 9on
January 30 in this county. There were 266 individuals
tuberculin tested, of which 197 were school children
and 69 adults. Of the school children, 42.6% were
positive reactors. Of those children x-rayed, only 1
(1.1%) showed reinfection type tuberculosis on x-ray.
Of the adults tested, 73.9% were positive reactors.
Of the adults x-rayed, 6 (11.6%) showed x-ray evidence
suggestive of reinfection type pulmonary tuberculosis.
BAY COUNTY. Tuberculin testing began in this
county on February 6. There were 444 children tuberculin
tested, of which 31.5% showed positive reactions. Of
these positive reactors radiographed, only one showed
evidence of reinfection tye tuberculous pathology.
There were 145 adults tuberculin tested, of which
41% were positive reactors. Of these positive reactors
x-rayed, one showed tuberculous pathology.
Upon the request of the Florida Tuberculosis Association that
the x-ray field unit radiograph a special group of school children,
and upon an agreement that the local tuberculosis association would
contribute towards the cost of the x-raying at the rate of .40 per
film, the following counties were investigated:
MARTIN COUNTY. X-raying began in this county on
February 28. There were 185 children tuberculin tested,
of which 68 (36.9%) showed positive reactions. Of these
reactors x-rayed, none showed tuberculous pathology.
There were 24 adults tested, of which 15 (62.1%)
showed positive reactions. Of these reactors x-rayed,
one showed chronic pulmonary tuberculosis.
ST. LUCIE COUNTY. X-raying began in this county on
March 1. There were 236 children tuberculin tested, of
which 107 (45.3%) showed positive reactions. Of these
reactors who were x-rayed, none showed tuberculous pathology.
There were 23 adults tuberculin tested, of which 16
(69,5%) sho-red positive reactions. Of those x-rayed, only
one showed tuberculous pathology,
INDIAN RIVER COUNTY. X-raying. began.n t.i is county
on March 2. There were three individuals discovered who
showed definite reinfection type tuberculosis on the x-
ray plate, of which all;but one were minimal cases. The
results of the tuberculin tests and the x-ray findings
have been reported to the family physicians mentioned. by'
these individuals who were investigated. Reports in
these cases were distributed to these physicians by the
local health officer.
DUVAL COUNTY. In the latter part of March the
program was initiated in; this countyy under.thej direction of
Dr. K. K. Waering, the Director of the Duval County Health
Unit. In all, 3,462 individuals were tuberculin tested,
of which 3,236 were children and 226 adults. Of the
children tested, 997 (30.8%) had positive reactions and
of the adults tested, 122 (54%) reacted positively.
There were 1,197 children whose chests were given x-ray
examinations. Of this group, 12 (1%) showed x-ray evi-
dence of reinfection type tuberculosis. There were 329
adults who received x-ray examinations and, of these,
there were 28 (8.5%) who showed reinfection type
HILLS30ROUGH COUNTY. In this county the senior high
school students were tuberculin tested.and their chests
x-rayed avhen indicated. -This additional work of x-rary--
ing the students was done only because this county had not
been included in the previous program which concentrated
upon an investigation of high school students, for,.tubercu-
losis. Over 4000. students were tuberculin tested with
PPD tuberculin in two strengths. At the same time, for
the purpose of making a comparative study, each student
also received a patch test, using the Vollmer Patch Test.
The results of this comparative study are being worked
upon at the present time and will be published in the form
of an article at a future date. Those students who had
a positive tuberculin reaction, and the individuals from
the groups selected for the present. grogrrm ~..rc3eig e x-
ray examinations of their chests. Paper film in rolls of
100 exposures. were cimployed along. vith the Powers rapid-
. x-ray unit, Single flat films of the chest were taken in
the postero-anterior plane and then shipped to the Powers
X-Ray Company in Glen Cove, New York, for developing.
The Director of the Division. of Tuberculosis interpreted
the plates and forwarded.the results to the County Health
Officer so that a report on each case might be distributed
to the family and the family physician. 2,858 individuals
received x-ray examinations. Of this group, 13 cases
- 23 -
suggestive of active tuberculosis were discovered. These
cases were unknown and were found in apparently healthy
people. The percentage of cases of apparently healthy
persons showing chest lesions suggestive of pulmonary
tuberculosis in Hi-llsborough County was 0.48%. This low
percentage was expected, as the majority of the persons
investigated were high school students. The 13 cases dis-
covered were reported not only to the county health officer
but by direct communication to the family physician
interested in the case.
It was imperative that the antituberculosis program be revised
so that a more productive group of the population could be selected,
more cases discovered, and greater value received for the moneys
invested in the x-ray equipment. The Director of the Division de-
cided to obtain the opinions and suggestions of the local health
Several trips were made by the Director to the various Directors
of the county health units and conferences were held in order to
determine the tuberculosis needs of each independent organization so
that a revision in the original program could be made in consideration
of the particular problems to be met in any special area.
It is felt that the original antituberculosis program has
served its function extremely well. It was confined chiefly to
senior high school students in an endeavor to educate the children
in regard to tuberculosis and through them to reach the parents.
The results of the program have been excellent. The program has
proved to be an efficient case-finding medium. Although the cases
discovered were relatively few in number, in the great majority of
them the prognosis was favorable because of the early diagnosis of
the condition in the minimal stage. The program. hes. augmented and
materially assisted the work of the county health unit and has en-
couraged the inauguration of local antituberculosis programs. It
has been of great value and of mutual benefit to the patient and to
the physician in general practice. It has stressed the important
role of the family physician and the roentgenologist in the pre-
vention of tuberculosis. It has aroused great interest among the
laity and has served as an excellent means of health education.
It has combined the individual efforts of the Florida Medical
Association the Florida Tuberculosis and Health Association and
the State Board of Health, and has merged them into a concerted
attack upon the tuberculosis problem in Florida. The program will
be continued among contacts and probably extended to include inmates
of custodial institutions, certain industrial groups, persons who
are unemployed and a greater proportion of the negro population.
It is the.intention of this Division to revisit each county with
a health unit and to extend the program so that all indigent contact
and suspected cases of tuberculosis, es well as known cases, will be
x-rayed. It is also intended that as many of the negro population
be included in the.program as possible, since this race furnishes the
greatest tuberculosis mortality.
At a recent meeting of the Com.iittee on Tuberculosis and Public
Health of the Florida Medic.l Association, there was unanimous
approval of the features of the revised antituberculosis program, and
the suggestion was made that the program 'include as many negroes as
The need for a change in the program can re dily be seen in the
comparison between the number of cases discovered among contacts and
among those not reported as contacts. In the contacts, 4.6% were
found to have latent apical lesions, compared to 0.5% among those
with no contact. Among the contacts, 3.1% were found to have mani-
fest tuberculous lesions, as compared to 0.15% without contact.
The revised antituberculosis program was inaugurated in the
TAYLOR COUNTY. Beginning November 13, 1939, there
were 297 individuals who received x-ray examinations of
their chests. The great majority of them consisted of
indigent contacts and relief families. Of this group
there were 4 whose x-ray films shoved evidence sugges-
tive of tuberculosis. This gives the county a percentage
of 1.67, which if fairly low for susceptible groups.
GADSDEN COUNTY. X-raying in this county began
November 20, 1939. The statistics are as follows:
Number of individuals x-rayed- 1,688
Number of unsatisfactory .plates- 311
Number of positive x-ray findings- 24
As 311 plates were unsatisfactory we will have to
base our statistical results on the 1,377 satisfactory
plates. Of the satisfactory plates, 24 showed positive
findings as regards tuberculosis. This gives Gadsden
County a percentage of 1.74. In other. words, 1.74%
of the groups selected for this program showed x-ray
evidence of pulmonary tuberculosis which, to me, proves
that the program v: s very worthwhile and wve have finally
centered on that portion of the population '.here we can
really say that we are getting good vilue for our money.
There was one interesting case by name Lilla
Smith, a seven yeLr old white female, who showed en-
larged hilar lymph glands an active primary tubercu-
losis. There were also four individuals who showed
lung changes due to enormously large hearts or aortae.
- 25 -
LEONh- NAKULLA COUNTIES. X-raying in these counties
began November 27, 1939. In all, 1,848 persons were given
x-ray examinations. Of this group, 160 x-rays were un-
satisfactory. There were 28 cases which showed some
abnormality. Of these 28, 16 or 0.94% of the total x-
rayed showed evidence of active tuberculosis. There were
five cases which showed evidence of healed pulmonary
tuberculosis. There were six cases which showed enlarged
cardiac or aortic shadows, and one case of dextrocardia (a
true situs inversus).
The Director of the Division presented a number of papers to
several of the county medical societies. One of the papers, "The
Value and Significance of the Tuberculin Test", was published in the
Annals of Internal Medicine, Volume 13, Noe 2, August 1939.
In the March 1939 issue of the American Review of Tuberculosis,
Volume 39, No. 3, page 408 to 418, there ass published an account of
the results of the antituberculosis program by the director of the
Division under the title, "Tuberculosis Survey in Florida." Many
letters were received complimenting the nature of the program and
the results obtained; including one letter from Dr. J. A. Myers, past
president of the National Tuberculosis Association; another from Dr.
E. J. Murray, past president of the Southern Tuberculosis Association;
one from Dr. W. H. Hatfield, Provisional Medical Director, Vancouver,
The activities of the Director of the Division were quite
numerous and included conferences, talks to various organizations,
radio talks, lectures and among some of the more important activities
Round table conference concerning x-ray examinations of school
teachers and other school employees, at which the Director presided.
A representative of each of thu following groups w;as present at
this conference: Class-Room Teachers of the State, State Department
of Public Instruction, State Radiological Society, State Medical
Society, State Tuberculosis Association, and State Board of Health.
The result of this conference was that a recommendation was made to
the State Department of Public Instruction that an x-ray examination
of the chest be included in the annual medical examination of each
school employee before that employee can be awarded a contract.
A three-day institute was planned by the Director of the Division
of Tuberculosis to which each health officer come. The institute
concerned tuberculosis and was held at the State Tuberculosis Sana-
torium in Orlando. The result of this tuberculosis institute can be
gauged by the enthusiasm with which each health officer attended the
course and by the requests for repetition of like symposia.
A poignant factor is that the health officers had to.stand-the entire
expense of attending the institute and in spite of this handicap the
enthusiasm was overwhelming, and the attendance unanimous,
Mark F. Boyd, M. D., Director*
A. Completed Studies:
In the period under review, manuscripts with the following
titles have been submitted to the home office. A discussion of their
contents is superfluous.
80) Mark F. Boyd and Walter C. Earle. "On the susceptibility
of a Neotropical Anopheles punctipennis, Theobald, 1901, to Nearctic
and Neoptropical Strains of Plasmodium falciparum."
81) Mark F. Boyd. "On strains or races of the malaria
82) Mark F. Boyd. "On the susceptibility of Anopheles
quadrimaculatus to Plasmodium vivax after prolonged insectary
83) Choice B. Matthews. "Observations on Serum Cholesterol
84) S. F. Kitchen. "Multiple infection of the Erythrocytes
in Human Malaria."
85) Mark F. Boyd. "The influence of sporozoite dosage in
*From the Division of Malaria Research, Rockefeller Foundation Inter-
national Health Division, Tallahassee, cooperating with the Florida
State Board of Health.
- 28 -
86) Mark F. Boyd. "On the correlation between the incidence of
stomach and gland infection in Anopheles quadrimaculatus infected with
87) Mark F. Boyd. "Some characteristics of artificially in-
duced vivax malaria."
88) Mark F. Boyd and Daniel M. Jobbins. "Further observations
on the comparative susceptibility of Nearctic and Neotropical anophelines
to co-indigenous strains of Plasmodium falciparum."
89) Choice B. Matthews. "The reactivation of latent malaria
90) Mark F. Boyd, S. F. Kitchen and Choice B.'Matthews. "An
attempt at the hybridization of two...strains, of Plasmodium vivax."
B. Work in Progress:
1. The negative results of our attempts -to hybridize two
strains of Plasmodium vivax by feeding anophelines on an infectious
patient who had been simultaneously infected with two strains of
parasites, were submitted in paper 90.,previously listvd-. -'As yet we
have not had opportunity to ascertain the possibilities of the other
approach.to this problem.
2. The resignation of Doctor W. C. Earle from the staff hVs
terminated, temporarily at least, the study of the comprativo
susceptibility of A. pseudopunctipennis and A. quadrimaculatus to
Mexican and Floridian strains of P. vivax.
3. The results of the sudy of serum cholesterol in'malaria
indicate that it is unlikely that this subject can be further
- 29 -
pursued with advantage.
4. The Search for means to reactivate a latent malaria in-
fection has been terminated, at least for the present. Available
space in the infirmary is required for patients experiencing acute
attacks, which makes it impracticable to retain in, or return to
the infirmary, the latent cases required for this study. The results
secured were reported in paper 89.
5. Study of thio-bismal:
Thio-bismal, a drug used in the therapy of lues, has a
remarkable property first observed by Dr. Walter F. Schwartz of
Cleveland and called to our attention by Doctor Magath of Rochester,
Minn., of attaching the half-grovm trophozoites. Thus if administered
to a vivax patient with quotidian paroxysms, it will extinguish the
paroxysm due on the subsequent day, thus changing the attack to a
tertian. We have verified this property and arc making some ob-
servations to ascertain if it possesses any effect if given during
the incubation period.
6. Study of the Albumin-globulin rtio:
The occurrence of edema in certain patients suggested the
desirability of a study to ascertain if possible whether the development
of this symptom could be attributed to abnormalities in the ratio
of these serum components. Specimens of blood were secured at
regular intervals during the clinical attack and thereafter from
8 patients. The examination of these specinzns was affected by the
collaboration of Mr. H. 0. Proske, Chief of the Central Hygienic
- 30 -
Laboratory, of the Tennessee Valley Authority, Wilson Da9, Alabama,
who made determinations of total protein, albumin, globulin, fibrin and
euglobin on each specimen.
A preliminary report based on the results secured from
the systematically studied patients will be submitted at an early
date. None of these however, exhibited an edema, a circumstance
requiring the continuation of these observations as opportunities
The fluctuations in the euglobulin content appear of
In preparation-for a series of studies on humoral immunity,
a number of patients who have recovered from attacks induced by the
McCoy strain have been hyperimmunized. After some preliminary
infections spaced rather closely together, it was decided that it
is preferable to space these superinoculations three weeks apart,
in order to allow ample time for the development of superinfection.
The doses of trophozoites given were in general rather large, for the
most part in excess of 100 million parasites. Re-inoculations were
continued until they no longer produced a super-infection.
The foregoing hyperimmunizations were done with homologous
parasites derived from exogenous sources. We are also attempting
hyperimmunization endogenously. The idea developed from an opinion
often heard expressed by country people in Mississippi to the effect
- 31 -
that they .did not have as much malaria as they formerly had before
they received.typhoid vaccine.* While this was once interpreted as
signifying that much mild typhoid may have masqueraded as malaria,
the idea seemed possible that the injections of typhoid vaccine may
have stimulated sub-clinical relapses that accelerated hyperimmunization.
9. Minimal Infective Dose:
In connection with studies on humobal immunity to the McCoy
strain of P. vivax it. is: desirable to ascertain the minimal infective
dose. To date: three experiments have been performed, diminishing
the number by dilution. The first was performed with two inoculations
of 240 parasites, 2 with 120 and 4 with 60. All except one of the
60 resulted in takes., In the second experiment one was inoculated
with 45 and 3 with 15. All -resulted in takes. In the third ex-
periment one inoculation was with 30 parasites and three with 10.
All resulted in taka. s.
It is obvious that we have not as yet determined the
minimal infecting dose, and the result- sb far available suggest that
a single parasite may be the answer. This circumst.iice, however,
is not an obstacle to the Qxtension of observations on humoral
We shall continue the experiments to inoculation with
single parasites using both,the. dilution method and single cell
isolation, When working with single c-ells to be introduced in4
travenously there is always an uncertainty as to whether the single
cell was actually introduced. There is also the question of the
significance in relation to the age of the trophozoite employed, as
if one employed a presegmenter instead'of a half grown schizont, the
effect of the former might be nearly the same as an inoculation by
10. Humoral Immunity:
An experiment reported in the 1938 annual report appeared
to indicate the presence of antibodies in a patient who had not been
deliberately hyperimmunized. We are endeavoring to repeat and extend
these observations with the serum of hyperimmunized patients. Failures
from our first efforts indicated that certain previously unconsidered
factors required preliminary attention. Their examination has re-
quired the expenditure of considerable time and material. As a
consequence, however, we have ascertained that preliminary tests
must be made to determine the compatibility of the erythrocytes of
the donor of the trophozoites with the serum of the hyperimmune
individual and the contributor of the normal serum. It has further-
more been found that the parasite suspensions cannot be incubated
at 37 C for more than one hour in the relatively low concentrations
employed without an adverse effect on the parasites. Consequently
it is undesirable to incubate the immune-serum parasite mixtures at
37 C for more than 45 minutes.
We regard this project of such importance that it will
take precedence over all other undertakings.
11. Study of Comparative Susceptibility.
The results of this project were embodied in a report
submitted as number 88 in the foregoing list.
..12 .Morphological characteristics of strains of P. falciparum.
The study of possibly significant differences between
several. strains of faleiparuml gametocytes is being.. continued.
Statistical analysis (by Miss P. Putnaim) of quite.. a.number of linear
measurements indicated -that: 'Excepting in the case of Strain 1,
the.female gametocytes were longer on the average than the males
but .only in Strain 1V were the fem'ales "'ignificantly ..qonger than the
males. Femfles of strain lV were significantly longer .than those
for Strhin 11. Male gametocytes of Strain 1 were significantly
longer than those of Strain 1V. An effort is being made to determine
morphological criteri-a- that will permit closer estimation of age
of gametocytes than we .now. canmake. It is hoped that this will
per mit a fairer comparison between strains. ....
13. Study of Exflagellation-
On the Whole the technique we have employed to demonstrate
maturity of the gametocytes (exflagellation).has not given dependable
results. Some preliminary observations have been made with a view
of developing a technique whereby the factors influencing this
phenomenon can be more reliably controlled.
C. Malaria Therapy.
The inoculations made during the year on the malaria.
therapy service of the Florida State Hospital, are shown on the next
page. Re-inoculations for .yperimmunization are included.
P. vivax P. falciparum P. malaria
Takes Fail- Pend- Takes Failures Takes Failures
Natural Primary 26 11 4 16 11L
(sporozoites) a) Prev.
Total, 33 11 4 16 11
Aritficial Primary 20 23 29 2 5
Failure 16 15
take 18 9
Sotal 54 38 38 2 5
During this period, the use of the McCoy strain of P.
vivax has continued, being transmitted through passages 44 to 50
inclusive. In recent passages gametogeny has been poor, and the
incidence of infection in our mosquitoes has not beenhigh. The
Cuban strain has been artificially propagated at maintenance levels.
Our hyperimmunizations have necessitated the repeated artificial
inoculation of several convalescents from naturally induced in-
fection, which together with several experiments requiring this
method of inoculation, have increased the proportion of artificial
inoculations above our usual practice.
The long strain of P. falciparum has been carried on
through passages 19-22, although it was necessary to break the
continuity with an artificial passage subsequent to passage 22.
. I II I I
- 35 -
The Mexican and Panamanian strains of P. falciparum,
and the Jones strain of P. malariae, have been propagated at main-
A total of 11 referred patients have been inoculated with
the McCoy strain during the year.
The insectaries have been maintained in satisfactory
condition, and the colonies of A. quadrimaculatus and A. punctipennis
continue to thrive.
Several shipments of quadrimaculatus ova have been made to
the Texas State Board of Health and the Army Medical School has been
furnished with punctipennis ova and wild fueale A. crucians.
Infected quadrimaculatus have been furnished to'the U. S.
Public Health Service.
Ova of A. albimanus have been received from the Gorgas
The completion of an extensive annex to the building
in the basement of which our quarters are located, prompted a request
to the President, Dr. Edward Conradi, of the Florida State College
for Women, for the assignment to the station of the remaining space
in the basement of the old wing of the infirmary building. This
request was readily granted. The space, being largely interior,
has been utilized in the creation of a stock room and a store room,
adequate space for both of which purposes we previously lacked.
- 36 -
Transfer of supplies and idle material to these rooms has greatly
improved the appearance of the main laboratory.
F. Field Work:
No field work directly under the auspices of the station
has been conducted during the period.
During the year the following persons have spent one or
more weeks at the station for the purpose of receiving instruction
Dr. Alberto Ros, Havana, Cuba
Dr. Bustos, Mexico
Miss Mary Hood, Department of Biology, Fla. State College for
Dr. Marquez, Mexico
Dr. Idil Kamil. Turkey
Dr. Bernal, Panama
.Snr. Berti, Venezuela
Snr. Montisinos, Venesuela
Mr. T. S. Brooks, Dept. Preventive Medicine, University of
Mr. George Herrera, Cuba
Miss Florence Mason, Technician, Fla. State Hospital
Mr. Claudius Walker, Technician, Fla. State Board of Health
A special one-week course in the indentification of
anophelines was arranged at the request of the State Board of Health.
It was attended by the following engineers and inspectors of
county health departments, viz:
Mr. Russell Broughman, State Board of Health
Mr. A. C. Newman, State Board of Health
Mr. Burke Chester, Tavares
Mr. F. C. Moor, Jr., Marianna
Mr. Ford Thompson, Tallahassee
Mr. W. R. Hendrix, Tallahassee
Mr. J. B. Miller, Tampa
Mr. F. L. Coachman, Quincy
- 37 -
.I;e have had the folloTing visitors:
Dr. Justin Andrews, Georgia State Department of Health
Dr. Lund, University of Georgia
Mr. C. F. Catlett, Florida State Board of Health
Dr. A. B. McCreary, Florida State Board of Health
Dr. Smith .
Dr. J. A. Ferrell, International Health Division
Dr. G. K. Strode,International Health Division
Dr. J. E. Elmendorf, International Health Division
Dr. R. M. Taylor,International Health Division
Dr. Paul Russell, International Health Division
Dr. M. C. Balfour, International Health Division
Dr. L. J. Graves, Leon County Health Department
Mr. Norman Taylor, Cinchona Institute
Dr. Fred Bang, Asst. to Mr. J. A. Leprince,
Mrs. Eliz. Bohnenberger, State Board of Health
Dr. Adolph Kappus, University Gottingen
Dr. Fotheringill, Harvard University
Dr. J. de Castro, Cuba
Dr. Humbersky, Slovakia
Dr. Hathaway, Tulane University
Dr. Martin Young, U. S. Pub. Health Service
Dr. Robert Coatney, U. S. Pub. Health Service
Dr. G. W. McCoy,U. S. Pub. Health Service
Mr. L. M, Clarkson, Ga. St. Board of Health
Dr. T. H. Griffitts, U. S. Pub. Health Service
Dr. Gabaldon, Venezuela
On November 18 the station was open from 10 to 12 a.m.
for the reception of members of the Florida Academy of Science which
was meeting on the campus at this.time.
H. Travel, Consultation and Speaking:
From November 30, 1938 to March 10, 1939, M. F. Boyd was
absent on a tour in the Caribbean region, during which visits were
paid to.British Guiana, Venezuela, Panama, Costa Rica, Salvador
and British Honduras, in all of which conferences were held with
the Health authorities.
From March 22 to March 30, and again from October 19
to 31, M.F.Boyd was absent:on trips to Cuba to' confer with H. P. Carr.
On April 2 and 3 made a trip to Pensacola in company with
Drs. J. A. Ferrell and G. K. Strode, to inspect the control program
at that place. Further trips to that place were made on July 26th
and August 31st.
A trip was made to Jacksonville on August 28th to pay
respects to the new State Health Officer, Dr. A. B4 McCreary.
On December 22 a trip was made to Atlanta to confer vith
Dr. J. A. Ferrell and Drs. Abercrombie and Andrews of the Georgia
State Department of Health.
M. F. Boyd has attended the meetings of the following
a) The Florida Anti-Mosquito Ass'n., Daytona Beach, Apr. 16-18.
b) Georgia Pub. H4alth.Assn., Atlanta, June 8k.10..
A contribution was made to 'the'program of the latter.
c) Congress of Microbiology, Mew York City, and meeting of
Scientific Directors, I.H.D., Sept. 3-13.
d) Board of Malaria Consultants, Tennessee Valley Authority,
Chattanooga, Tenn., National Malaria Committee, Memphis,
Tenn., and Army Medical School, Washington, D. C.
e) Florida Pub. Health Ass'n., Jacksonville, Dec. 8.
I. Mr. Donald Lloyd, who served -two years as. insaect4ry..techinician,
resigned August 31 to enter Northwestern University Medical School.
He is succeeded by Mr. Ben Bridges, Jr.
Miss Myrtle Hobbs, who has beer our nurse-techinician at
the Florida State Hospital was honorably released at the end of the
year, as owing to a re-organization of the 'hospital laboratory
service, it appears undesirable for us to maintain a separate
laboratory at that place, although continuing to contribute to the
salary of a technician on the laboratory staff who will do our work,
HEALTH NUR NG
Ruth E. Mettinger, R. N., Director
Nineteen Hundred Thirty-nine saw the discontinuance of the Work
Projects Administration Nursing Service in unorganized counties. At
the request of the Work Projects Administration a project was written
to give nursing and clerical assistance in counties where health units
were established. Nurses were assigned only to clinics, and the
clerical assist-nats assigned to the health centers in the county.
This reduced the personnel front seventy-five nurses to approxLnately
thirty-five. Those w'ho could matriculate at the universities offering
a course in public health nursing, approved by the National Organiza-
tion for Public Health Nursing, were either absorbed in the unit, with
the purpose of sending them to college at a later date, or were sunt
to school for the course in public health nursing. Some new nurses,
who had deficiencies in their high school, as well as their nursing
education, are making g up those deficiencies in order to be el:ijiblo for
a course in Public Health Nursing.
The reorganizing of the State Board of Health nursing personnel
took place the first of August; this was a recommendation made by
the representatives from the American Public Health Association in a
survey of the State. Districts were abolished; six nurses were assign-
ed to units, two were sent to school and two ie-re brought into the
central office to assist in organizing the Public Health Committee, and
in making surveys in counties, and assisting in establishing health
The County Councils, which were organized six years ago by the
Bureau of Public Health Nursing, ~.rec merged -;ith the State-wide
Public Health Committee, however, the activities of these Committecs
are practically the same as heretofore.
It has been the object of the Bureau of Public Health Nursing
to assist with the organization of the nursing service of newly or-
ganized health units. Therefore, much of the State Consultants'
time was spent in the units. Nurses for these units were recommended
by the Bureau of Public Health Nursing to the Health Officers, cnd
six were employed during 1939. In order to give the proper service,
they remained in the county froa three to four weeks, or longer.
- 40 -
- 41 -
It was found that decentralization has secured more community support
and interest; also in building up the attendance at the clinics,
therefore, the nurses were requested to live in their district, as it
lessens the amount of time spent in travel and enables the nurse to
serve more people.
The consultants have found the appraisal fori of great help in
balancing the work of the nursing program, and since the Bureau of
Public Health Nursing acts in an advisory capacity to all of the
nurses in the state, even though they are not employed by the units,
a monthly report, provided by this Bureau, is requested from each
nurse. From these reports it was interesting to note that 4,366
maternity cases were carried by 57 nurses. It was also learned that
over 5,140 communicable disease cases were called to the nurses'
attention. Through the local physicians those cases were given some
For the most part these nurses have worked very diligently in
trying to stimulate interest in organizing health units. They have
established maternity end venereal disease clinics, and have solicit-
ed the interest of the local physicians to assist with the examina-
tions. There have been 829 requests for hookworm containers from
these nurses. First Aid classes have been conducted throughout the
state, with an enrollment of 137 adult and 113 hight school students.
In order to save time of the nurses and to lessen communicable
disease, to safeguard the health of the young and lay a foundation
for the adult life, the nurses.have taught 1,171 adults the course
in Home Hygiene and Care of the Sick, and over 443 high school girls
have received instructions in this course.
For those nurses who were unable to attend school, institutes
were conducted in January, February and April. A series of four
institutes was held by Miss Mary J. Dunn, Regional Public Health
Nursing Consultant .from the U. S. Public Health Service, on "Program
Planning." Each nurse attending the institute was requested to make
Sdcommunity survey of her county, which revealed many facts about the
community with which the nurse was unfamiliar. Supervisors continued
this study at monthly staff conferences, which has improved the work
Through the National Society for the Prevention of Blindness,
Miss Eleanor Mumford conducted a series of six institutes at strategic
points throughout the state. This institute also evolved program
planning as it applied to .ye health.. It pointed out that the pre-
school child was. being sadly neglected, and that too much time was
being spent by the nurse in vision testing, and that more responsibility
should be placed upon the teacher.
* American Public Health Association Appraisal form for local health
work N. Y., APHA 1938.
In April, Mrs. Charlotte Heilman, Assistant to the National
Director of Public Health Nursing of the American Red Cross, con-
ducted six institutes on "Methods of Teaching."
In connection with health education four of the hospitals in
the state requested that lectures be given to the student nurses.
These lectures were given by the public health nurses either in the
unit, or the field advisory nurses from the central office.
One of the health units has an affiliation with the local hospital
to provide field practice for student nurses. Each senior student is
assigned for a period of six weeks to observe all phases of the work,
as well as attend the weekly staff conferences. This is not a course
in Public Health Nursing, but merely an introduction in the field of
public health nursing.
The Bureau of Public Health Nursing planned the program for the
public health nursing section of the Florida State Nurses' Associa-
tion Convention, as well as the State League of Nursing Education,
which was held in Lakeland during November. Several outstanding
speakers from Washington and New York were present. Mrs. Eugenia
Spalding, from the Catholic University of America, appeared on the
State League program, end discussed "Vocational Occupation for Nurses."
Mtei Mary J. Dunn, and Miss Naomi Deutsch were the main speakers on
the public health section, discussing "Criteria of the Public Health
Nursing, and Home Delivery Service."
The Director of the Bureau of Public Health Nursing had the
privilege of attending the American Public Health Convention which
was held in Pittsburgh in October. Much benefit was derived, not only
from the lectures, but the contacts made. It is interesting to com-
pare the nursing service of Florida with that of other states.
Anticipating the establishment of the merit system, Miss Pearl
Melver was asked to discuss this topic at the Florida Public Health
Association meeting held in Jacksonville during the first of December.
She outlined very thoroughly the plan which had been worked out, and
which every state will no doubt adopt. Dr. Mayhew Derryberry, sta-
tistician from the U. S. Public Health Service gave a report on the
survey m.de of public health nursing, and Miss Ruth Heintzelman, from
the Children's Bureau talked on "Lay Participation in the Field of
The Director w.s pleased to participate in the two weeks' con-
ference which was held in Gainesville in August, to outline a manual
that would be helpful in working out plans for Florida's school
More and more it is found that morbidity service is an important
- 43 -
part of the family health service, and nursing care cannot be sep-
arated from the other health needs of the family. This service has
usually been administered on a specialized basis, but is now being
considered a part of a generalized public health nursing program,
to be used mostly as en approach to health e-ucation, and teaching
somemmber of the family how to care for the sick.
Due to an:indebtedness of the Crippled Children's Commission,
this Bureau was requested to assist with the work. A system was
established whereby reports were sent to the Director of the Crippl-
ed Children's Commission on the home visits that were made, cases
that needed hospitalizAtion and clinics were organized through the
efforts of the county and district nurses.
Since the finances of the Crippled Children's Commission again
enables them to employ nurses, they have requested the Bureau of
Public Health Nursing to assist them in selecting qualified nurses
for this work, as well as following up the crippled children in the
counties, and assisting with the clinics which are being held through-
out the state.
As one of the major problems of the Bureau of Public Health
Nursing is qualified personnel, three nurses were sent to George
Peabody College; one to Columbia University; ten to William and Mary;
one to University of Pennsylvania; four to Maternity Center; two to
Lobenstein Clinic, and five to Hedical College of Virginia.
Four of the above are on the state staff, employed as state
The nurses sent to Maternity Center h-d previously had a course
at Peabody, and were given a six weeks' course at Columbia University,
following the Maternity Center Course, after which they were given
one month in the Field Practice Center at Ccttaraugus County, New
The colored nurse who wres sent to Lobenstein has filled a great
need in the state since her return. She is assigned to the county
health units for two or three months for the purpose of giving more
intensive instructions and supervision to the ridwives, and follow-
ing up their cases. Doctors are becoming interested in this project,
offering their assistance--in many counties the midwives are allowed
to observe deliveries in the loc.l hospital. The colored midrrife
teacher is gradually eliminating midwives .hho arc too old to con-
tinue practicing. Through the social worker they are Liven old age
pensions. An effort is being m.de to replace them by younger mid-
wives who are high school graduates a:nd are far butter prepared to
carry on this work.
- 44 -
With the rural population of Florida it is impossible to olinm-
inate midwives, but with the establishment of county health unite there
is closer supervision and provision for prenatal care, therefore, they
are bringing their patients into the clinics and remaining with the
patient through the'examination..
Five hundred and seventy-five midwives were licensed and registered
during the year. In addition to this, eighty who applied for license
did not complete their registration. Due to the many unlicensed mid-
wives a survey was made and it was most interesting to note 61even men
who had never been licensed were practicing in one county. It is also
interesting to observe that three years ago approximately eleven hun-
dred midwives were registered in the state, and in 1939 only five hun-
dred and seventy-five. This shows that people are becoming educated to
the fact a physician should be in attendance during delivery.
The State colored midwife teacher assisted with the fourth Annual
Series of Farm and Home Institutes which were held during September and
October, and she also assisted with the Negro Health Week by giving talks
and demonstrations to several communities which requested her.
Several nurses to whom the bureau was unable to give stipends have
financed their own public health course and will be assigned to health
It is the purpose of the Director of this Bureau to proceed in
her efforts to raise the qualifications of the nurses in the state,
and to encourage those who have been given scholarships to continue
AND CHILD HEALTH
William H. Ball, M. D. Director
The Bureau of Maternal and Child Health was organized in 1936
through funds made available to the State by the Federal Social Security
Act administered by the Children's Bureau of the United States Department
The financial assistance obtained through the Children's Bureau is
matched .rith funds from the state appropriations for the maternal and
child health part of the general.public health program. These funds
have enabled the bureau to increase and extend its program and services
during 1939. The director of the bureau, a pediatrician and a Maternal
and Child Health Nurse Consultant, and a midlifee supervisor and teacher,
aid in furnishing medical and nursing consultation and -dvice to local-
health departments and communities for strengthening and organizing new,
or extending maternal and child health activities. The director and the
nurse, on invitation from the health officers, or the local community, will
go into an area or county for a period of several weeks for the purpose of
studying the maternaland child health problems and organize maternal and
child health programs. Also on the staff are: a full ti-me nurse midwife,
and assistant for organizing and directing supervision of midwives.
The activities of the Bureau of Meternal and Child Health are carried
on almost entirely in counties having full-time local health departments
because it is firmly believed that without a proper mechanism for super-
vision and follow-up of basic i.ork, which is available only in counties:
having a full-time health service, that the money and effort expanded can-
not be used to its fullest .advantage.
During 1939 there were 18 counties with full-time local health ser-
vice. In these county health departments 42 eternal and 41 well-baby
conferences were held at regularly schedules times, and places each month.
These conferences were held at 70 well-equipped health centers, throughout
the counties and especially in those rural counties heree the nebd is
The general.progrcm of the Bureau of Maternal and Child Health in-
cludes the following:
(For amount of work accomplished see Table -II)
- 45 -
M A E RN A
- 46 -
1. Health conferences for maternal, well-baby and pre-school
2. School Hygiene
3. Dental Hygiene
4. Supervison and the control of midwives
5. Post-graduate instruction of nurses, health officers, and
6. Immunization for the preventable diseases: diphtheria, small-
pox, typhoid fever, pertussis.
7. Maternal Mortality Survey
8. Maternal Delivery Service
9. Maternal-Child Hygiene Education:
a. Lectures and talks
b. Motion pictures and exhibits
c. News articles, pamphlets, leaflets
and radio transcriptions
d. Individual classes in matern-l hygiene
e. School hygiene
10. Nursing service
11. Consultation of physicians
12. Services of physicians and dentists in Health Conferences
It is the aim of the Bureau of Maternal and Child Health to extend
these services throughout the state, and especially in many of the new
counties which are now contemplating the opening and maintenance of full-
time health departments.
Maternal, Well-Baby and Pre-School Children Health Conferences
The health conference sponsored by the Bureau of Maternal and Child
Health is a meeting at a health department health center of a public health
nurse, a patient, and a physician or dentist. Here the patient receives
a physical examination appropriate to the type and is instructed regarding
defects found, and of the preventable measures thought necessary by the
physician. This instruction is supplemented by the public health nurse in
pamphlets, booklets, and information dispensed in mothers' classes and on
home visits. At these conferences infants are examined at regular inter-
vals and their parents instructed in the proper methods of feeding, and
they are given immunizations for small-pox and diptheria. The same general
principles apply for a preschool conference.
The maternal conferences are held at health centers at which time
maternal patients are given a complete physical examination, including
measurements of the pelvis, : test of the blood for syphilis, and a urin-
alysis, and other tests as indicated, such as: hemoglobin, hookworm test,
tuberculin test, etc. Here the mother is instructed directly by the phy-
sician in charge of the conference regarding all the pit-fells of child-
bearing. Her condition is checked at regular intervrls by the conference
physician. The public health nurse supplements these instructions in the
- 47 -
home or at the conference by visual and demonstrative teaching. Also,
at this conference the mothers are taught and shown how and what to pre-
pare for the final delivery in the home.
School Hygiene Program
These conferences are held at the schools and an attempt is made to
give a fairly complete physical examination of the school child in the pre-
sence of the parents so that any defects uncovered may be brought definitely
to their attention, and they are impressed with the importance of con-
sulting a physician for the correction of any defects noted. At these
school examinations the children are weighed, measured, and the hearing
and vision are tested, and if found abnormal they are referred for cor-
rection to the family physician.
Dental Hygiene Program
The Bureau of Maternal and Child Health contributes funds to the
Division of Dental Hygiene for the education of dental health of the school
child and of the prenatal patients. This Bureau contributed funds for the
establishment of several dental clinics for indigent children and mothers
conducted by local health departments. Twenty dentists.were paid in 1939
for $3350; for conduction dental clinics for treatment of indigent mothers
and children, or for the treatment of these groups in their offices. (For
dental work done see Tabulation Table 3).
These dentists are selected by the local county health officer from
a list of available men fdrnishvd by the local dental society.
During the past year this Bureau has formulated a code for the regulation
and the control of midwives practicing in this state. It is planned to
have this code adopted and enforced, thus, elevatingg standards of the mid-
wives. This department has a full-time nurse supervisor for midwives,-who
has a nurse-midwife license. This supervisor mc.kes routine trips -of in-
spection throughout the state, examining midwives,. making plans of local
health departments for their regular monthly classes for midwives practicing
in their county. Assisting in this is the full-tine state midwife teacher,
who visits counties having health departments and iiakcs observation studies
of individual midwives practicing. This is done by accompanying the midwife
on an actural delivery and observing her technique and understanding of
mid-ifery. At this time the midwife agairi receives instructions.
The Bureau of Maternal and Child Health contributes to the postgraduate
instruction of the physicians by contributing funds to the Postgraduate
Education Committee of the Florida Medical Association in furnishing the
service of lecturers in pediatrics and obstetrics for their annual short
course of post-graduate instruction.
21 nurses giving satisfactory service in health units who were not
qualified as a public health nurse, were given scholarships to various
nursing schools of public health in order to render them more valuable to
their health department and community.
Immunization For The Preventable Diseases
In all of the conferences, infant, pre-school and school, the value
and importance of a protection against the preventable diseases is taught
and stressed. In these conferences immunization for these diseases such
as: diphtheria, small-pox, typhoid fever, is encouraged and administered.
Maternal Mortality Survey
The survey of maternal deaths was continued. 209 maternal deaths
were investigated in 1939. This was done at the request, and in cooperation
with the Maternal Welfare Comitteo of the Florida Medical Association. The
homes of midwives, patients, and doctors were visited in the investigations.
Tabulation of the information relating to the deaths of these maternal
patients was made and was reported by the Chairman of the Maternity Welfare
Conmittee of the Florida Medical Association at their 1940 annual meeting.
It is expected that these surveys will be continued for several more years
in order to render the statistics and observations more accurate and valuable.
From time to time the Maternity Welfare Committee will publish the results
of these studies.
Maternal Delivery Service
This department contributed funds for the operation of tht home de-
livery nursing service, in one of the larger counties during the last year.
This service was for the indigent normal patient to be delivered in the
home. This service consisted merely of the furnishing of the nurse and
nursing supplies at the time of delivery in cooperation with, and aiding the
physician at the delivery. The patient delivered in this service received
adequate prenatal care, consisting of repeated physical examinations, blood
test examination, urinalysis, pelvic measurements, etc., and detailed in-
structions in maternal hygiene by a physician and nurse in the conferences
or in the home.
Maternal and Child Health Hygiene Education
a. During the year many lectures and talks were given throughout
the state by members of the county health department and the state staff to
PTA organizations, schools, and other groups on maternal and child hygiene.
These lectures were supplemented by the exhibition of motion pictures on
maternal and child health subjects.
- 49 -
b. From time to time articles in newspapers and magazines were pub-
lished on the hygiene of maternal and childhood health. Many pamphlets and
leaflets were distributed through public health nurse during the home visit.
Individual group classes in maternal hygiene were held at the conference
centers concurring with the maternal conferences. Many talks, lectures,
and demonstrations were given in the schools and county health departments
throughout the state.
This bureau contributed 26 full-time qualified public health nurses to
the health units for aiding in carrying out the home hygiene instructions
and nursing program in the maternal and child health field. The service
of a state nursing consultant, a state midv.ife supervisory, a state mid-
wife teacher were furnished for consultation to health departments and
Consultation By Physicians
Through activities of the health departments physicians were paid fees
for consultation furnished to physicians for indigent patients in maternal
and child health diseases.
Services of Physicians and Dentists In Health Conferences
Seventy-six physicians and dentists were paid nominal fees for contribut-
ing their services for the indigent patients in the maternal, infant, pre-
school and dental clinics conducted by the various health departments. These
physicians and dentists were chosen by the local health officers from a list
of available men furnished by county medical societies. (A tabulation of these
services is found in table 3).
It is the desire of the Bureau of Maternal and Child Health to extend
these services throughout the state and especially in many of the new coun-
ties which are now contemplating the opening and maintenance of a full-time
health department. The main objectives for the next year are as follows:
1. A state-wide education program in maternal and child hygiene
through lectures, radio, articles, and pamphlet distribution.
2. The sponsoring of a state-wide conference on the care of
mothers and babies.
3. Financial aid for post-graduate education of physicians who
are participating in maternity and child health programs.
4. To contLnue awarding scholarships to public health nurses
fcr cc',..ilc-ti.jg their public health training.
5. The appo;,r i of the enforcc;mnt of the new midwife laws.
6. The in.a;urat.ion of a state-wide premature infant program.
7. The dcimoistrction study of the anemias occurring in pregnancy.
8. Studies of the deaths of infants and children under five
years of age.
9. To offer refresher courses in pediatrics and obstetrics to
health officers and physicians who are participating in
activities in maternal and child health programs.
10. A cooperative intensive drive on maternal-congenital syphilis.
11. Analysis of maternal and child health problems and programs
in communities and local health departments.
D E N-T A L
Lloyd N. Harlow, D.D.S., Director
Several dental health.programs were being carried on in various
communities in Florida before the establishment of the Bureau of Dental
Health. Some have been highly successful, while others have not been
satisfactory because of the interference of local politics.' The absence
of, or inadequate education in the dental health field has not created
the cooperation or interest necessary to conduct a good program in many
communities. Some have failed because the communities have thrown the
burden of caring for the indigent children upon the shoulders of the
members of the dental profession rather than depending upon the coopera-
tion of everyone.
Florida's great area with its vast differences of living conditions
make it difficult to conduct an indentical dental health program in every
county. A survey was made to ascertain the most satisfactory program that
could be used to best advantage in all sections of the state. The pro-
gram sponsored by the Public Relations Committee of the American Dental
Association together with the programs of many states have been studied
and the ideas applicable to Florida incorporated in this bureau's program.
Too much credit cannot be given the members of the Florida State
Dental Society for their assistance and cooperation in planning and carry-
ing on the bureau's dental health program.
The studies made have convinced the director that the inspection
program which the bureau has been using should eventually be discontinued
and more time devoted to the educational features of a good dental health
It is believed that for a sound program it is necessary to first
educate the citizens of.each county of the need.for such a program.
Second, that dental clinics for the indigent should be established.
These clinics should be local and maintained by the community in which
they are located. Where Federal funds are available, the bureau believes
in assisting with the establishment of such clinics, but that they should
eventually be completely maintained by the local communities. The preschool
child should be given preference in all cases; After the establishment
of the clInics, the parents of the children and the children themselves
should be educated to the need of dental health.
- 51 -
- 52 -
In a survey of the school children during the year, it was found,
in counties in which clinics were established to care for the indigent
children, a great deal of progress was being made. In counties in which
the county health units paid the private dentists for corrective work
for the indigent, some progress could be made, but it was not in keeping
with the amount of money expended.
In counties where the dentists gave their time and material, it
was considered best to go slow with the program as it was unfair to
ask the dentists to carry the burden of so large an undertaking.
A survey was made of the children's clinics being conducted in
the state (at present there are seven). From this survey the conclusion
is that the best method of caring for these children is through the
school clinics. In the communities having such clinics, the results
are most gratifying. The dentists are well pleased vrith the arrangements,
and know the burden of caring for the underprivileged is upon the people
in the community as a whole, and not upon the shoulders of the dentists
From the experience this bureau has had with the dentists caring
for the children in their own offices, and being paid by the Children's
Bureau for their time, the method is considered most unsatisfactory.
It is believed that where full-time or part-time clinics are es-
tablished, sponsored by local dental societies, they can render more and
better service at less expense. The Bureau of Dontal Halth is .ndcL.tvoring
to havu such clinics sAt up in each county of the st-it. Thj dental societies
in all cases are sponsoring the program.
The bureau has assisted in the inspection of school children and
has carried on an inspection program of its own in which over 45,000
school children have been examined. From this survey it is found not
practical to conduct inspection programs unless means have b.en provided
to correct the defects discovered.
In making examinations, an effort was made to classify the children
into three groups--those able to pay, those not able to pay, and those
who were possibly able to pay something. Nurses, school teachers, and
welfare workers were all asked to make these classifications; and al-
though they are not absolutely correct, they give a very good cross
section of our population. The ratio of those able to pay was 20 per-
cent compared to 35 percent not able to pay, and 45 percent doubtful as
to means of paying anything, or even a small fee. This clearly demon-
strates the need of finding some means of caring for these children if
a sound program is to be established.
At the beginning of 1939, seven dental clinics were in operation.
Three clinics, Pinellas, Hillsborough, and Orange Counties, operate
in conjunction with the county health units. Dadj County operates -rith
the county. Palm Beach County operates fror funds obtained by
- 53 -
entertainments sponsored by the Kiwanis Club. The cities of Jacksonville
and Tampa have clinics operated by the respective municipalities. In every
clinic, the local dental society has a committee with direct supervision,
or acting in an advisory capacity.
During the year, Bay County established a clinic in conjunction
with its county health department. Hillsborough County has a dental
trailer which is making remarkable progress. All clinics are operated
either in the school building, in the county health unit offices, or
in a municipal building. In all the clinics operated in connection with
the county health units, the dentists carry on a dental health educational
program. Outstanding among these is the Hillsborough County Health
Mobile clinic in charge of Doctor John J. Torres, and Pinellas County
which is in charge of Doctor B. C. Forbes. Escambia and Duval Counties
have purchased dental equipment and both will start full-time dental
clinics the first of January 1940. Escambia Countyls clinic will be a
mobile unit, while Duval's will be operated at the county health unit
building. Gadsden and Jackson Counties are making preparation to pur-
chase equipment and expect to have clinics in operation early in 1940.
Conferences were held with the dental organizations over the state
urging that clinics for the under-privileged children be established.
The director feels that unless some method of caring for these children
is found our educational program will not be of the maximum benefit.
A great deal of interest was manifested in the areas visited and all
are urging the school boards and county commissioners to establish Lhese
clinics. Until such time as they are established, the dentists are car-
ing for the children in their own offices. In the majority of cases
the dentists are donating both their time and material.
The method of demonstrativL education was continued in Wakulla County.
This program started last year is to be carried on over a period of
years to determine the effect dental corrections will have on the physical,
mental, and general welfare of the children. As 1939 was only the se-
cond year, definite facts are not yet established; however, marked im-
provements were noted in the mouths of the children, showing that they
are becoming more dental health conscious.
Throughout the year, through the courtesy and cooperation of the
Bureau of Public Health Nursing, this bureau's prenatal and postnatal
letters and instructions were distributed to mothers and expectant mothers.
In localities having dental clinics, or where the dental organizations
are caring for the children, the Honor Roll system was encouraged. This
method, together with the half holiday for one hundred percent dental
health seems to give the children an incentive to care for their teeth.
But in those schools wheru it was im-ossible to obtain proper care for the
under-privileged children, the use of the system was discouraged.
Mimeographed copies of the dental health program were distributed to
members of the five district dental societies in the state. These pro-
grams served to awaken the interest of the members of the profession in
the need for dental health education. In every school visited by the
bureau, copies of the booklet, "Dentistry and Public Health," were left
with the teachers and in the libraries; and to the children, the book-
let, "The Five Little Pigs," and the dental health song, "Billy-Boy,",
Papers on Children's Dentistry were prepared and read at meetings
of the Northwest District Dental Society &nd the Central District Dental
Society. Talks on dental health were given at the following meetings:
St. Petersburg Dental Society, Pensacola Dental Society, Jacksonville
Dental Society, Miemi Dental Society, Volusia County Dental Society, and
Dental Hygienists Association.
In all counties visited, dental health talks were given to the schools,
and to a large number of parent-teacher associations and meetings of other
The director and assistant both attended the meetings of the Florida
State Dental Society, West Coast District Dental Society, Central Dis-
trict Dental Society, Northeast District Dental Society, the Public Health
Association meeting in Augusta, Georgia, and thu Florida Public Health
Association meeting in Jacksonville; also, the school health conference
held in Gainesville for the purpose of making plans for coordinating public
health teaching in the schools throughout the state.
The dental health exhibit wcs enlarged and improved to increase its
educational value. During the year it was shown at the following fairs:
DeSoto Exposition and Florida State Fair Tempa
Lake County Fair Eustis
Central Florida Exposition Orlando
Halifax Exposition Daytona Beach, Volusia County
Tobacco Festival Quincy, Gadsden County
Jackson County Fair Marianna
Taylor County Fair Perry
Florida Public Health Association meeting Jacksonville
In each instance the exhibits were favorably received. The bureau's dental
health literature was distributed in conjunction with the exhibits.
In order to impress school children in an interesting and entertain-
irg; ray with the necessity of observing dental health and general health
rules, the director has written a dental health movie, "Billy's Trip To
Health Land," that is produced in sound and color and acted by marionettes.
The story has a fairy tale background and the health lessons are taught
by the conversation of the school children, the school teacher, and the
visiting dentist who takes the children on an imaginary trip to Health
A great deal of time and hard work have gone into the making of this
motion picture. After the recordings were completed, the picture was
shown to the State Department of Education and its approval secured. The
film was then shown to approximately 2000 school children and their re-
actions noted. It was found that the voices used were not suited to the
characters in the picture and it was considered advisable to make new
sound. As new voices were going to be used, it was decided to arrange
the script so that the sound could be put directly upon the film. This
necessitated many changes and correct timing all of which will greatly
delay the completion of the picture. However, the film should be ready
by late spring and it will then be av ilable for the schools during the
Elizabeth Bohnenberger, Director
Jean Henderson, Public Relctions Consultant
During 1939 the Division of Health Education continued its endeavors
to coordinate the health education activities of the bureaus and divi-
sions of the State Board of Health and to assist the county health units
with their health education programs.
A program of general health education of the public was also attempted
and the media used are explained in the following pragraphs.
The State Board of Health Library is a part of the Division of Health
Education and contains 7,000 books and bound periodicals, as well as a
large collection of reprints and pamphlets on medical and public health
subjects. Full library service is given to all State Board of Health per-
sonnel, county health unit personnel, and to any doctor, nurse, or lay-
man interested in public health in the state. No charge is made for this
service except actual postage costs if material is mailed.
The Library issues lists of available books, pamphlets and articles
on various subjects of interest to the personnel of the State Board of
Health and to the physicians and public health workers in the state.
Package libraries and reading, lists arc furnished to various health in-
stitutes, classes, and seminars held in the state. Special attention also
has been given to work with the Negro physicians in cooperation with their
institutes on tuberculosis and venereal diseases.
Increasing interest has been shown in the library service and the
private physicians, particularly those from the rural sections of Florida
are using the Library more extensively each year.
Through the efforts of the Public Relations Consultant publicity
about the State Board of Health and the county health units was wide-
spread in 1939 and was carried in practically all Florida newspapers,
both weeklies and dailies. Attention was payed particularly to objectivity
in all news releases which included weekly associated press Sunday releases
- 56 -
- 57 -
over signature of the State Health officer, regular releases to county
weeklies and routine spot and feature articles.
Because the news was written in proper journalistic fashion and
submitted through correct sources it received excellent placing and tim-
ing. Both the Associated Press and the United Press cooperated in this,
and featured articles on public health in general were picked up in
many of the large papers, as well as the smaller weeklies.
The State-Wide Public Health Committee was responsible for 2,932
column inches of newspaper and magazine publicity in addition to the
314798 column inches of routine State Board of Health and county health
unit publicity. Combining these two figures, the total amount of public
health publicity for 1939 Was 34,730 column inches as compared with
17,002 column inches during 1938.
Extra curricula publicity was handled for the following annual meet-
ings: ,Florida East Cost Medical Association, Florida Public Health Asso-
ciation, Florida Anti-Mosquito Association.
Thehealth programs of such organizations as the parent-teacher
associations, women's clubs, Rotary, Kiwanis, American Legion, Junior
and Senior Chamber of Comderce, etc.., have been coordinated with the pro-.
grams of the State Board of Health and the county health units. Par-
ticularly the state organizations of such bodies have come to know-the,
health needs and objectives of the official health agencies.
In this connection, the survey of public health entitled "The
Health Situation in Florida" made by the American Public Health Asso-.:
ciation in 1939 has been used. Over 7,000 copies of this survey have
been distributed by the Division; the greatest number of these was dis-
tributed through the State-Wide Public Health Committee, and those re-
ceiving copies have been representative citizens of the state who have
in turn circulated their copies widely.
During 1939 all bureau directors vnd many other State-Board of-
Health personnel made talks before the public. An. attempt was made to
have a representation on all the large convention programs which would
reach influential members of Florida's citizenry." All talks before such
:organizations 'were carefully prepared and carried ono clear message:
the naming of Florida's health .problems and the first principle toward
.their solving, i. e., the establishment of full-time local health service
in all portions of. the state.
During the year talks were made frequently on the radio, but this
medium of health education has not been used to the extent it will be
- 58 -
in 1940. Plans for the coming year include a regular radio program, a
staff for which is already being assembled through the cooperation of
the Work Projects Administration. Scripts will be written from this
source but edited by the State Board of Health personnel and supervised
by the Public Relations Consultant.
FLORIDA HEALTH NOTES, the monthly bulletin of the State Board of
Health, continued to be edited in the Division of Health Education,
and when the Public Relations Consultant assumed the responsibility.of
publishing the bulletin, a change in make-up and editorial style was in-
stituted with the thought of making HEALTH NOTES more appealing to lay
persons. At that time the circulation was 6,500. By the end of the
year 4,000 carefully selected names had been added, bringing the total
circulation to 10,500. FLORIDA HEALTH NOTES is now received by people
heretofore not acquainted with Florida health problems and by public
health workers and school teachers who use the bulletin as study ma-
terial in health education.
The Division serves in an editorial capacity to the other bureaus
in the preparation of papers. Techinical publications of the bureaus
are submitted for suggestion as to format and lay-out. Cover designs
and illustrations for many of these publications are provided.
The annual reports of the State Board of Health are edited in
this Division and also surveys of health conditions in those counties
proposing to establish health units are edited and published from the
Pamphlets for distribution cover the usual communicable and pre-
ventable diseases, and largest distribution has been through the local
Especial attention was given this year to pamphlet material on
the venereal diseases. The newer publications of the United States
Public Health Service have been purchased and widely distributed, as
well as those of the American Social Hygiene Association. Venereal
Disease Information Supplement No. 6 entitled "The Management of Syphilis
in General Practice" was sent to every licensed doctor of medicine in
Florida in cooperation with the Division of Venereal Disease Control of
the State Board of Health and the Venereal Disease Committee of the
Florida Medical Association.
A new pamphlet on hookworm and a 71 page anti-hookworm kit was
prepared in 1939 through the efforts of the Public Relations Consultant.
The hookworm kit contained outlines for a hookworm eradication program
and included news releases, talks before lay groups, and plans for a
- 59 -
community organization program in connection with the local health
unit. News releases were so worded that they could be adapted by the
local health officer for use in local papers. This was also true of
the suggested talks and radio releases. Thu kit has been used in
several of the health units during 1939 and the consultant on hookworm
from the Bureau of Epidemiology found the kit particularly useful in
his work with the county health units.
The Division has also cooperated with the national cancer prevention
program and with the voluntary tuberculosis associations in the distri-
bution of their literature.
The Division has charge of the lendirig of all motion pictures on
health. The film library has grown considerably curing 1939 and pur-
chase of additional films will be made as produced. It is also in-
tended to mrko a picture on hooki~orm prevention during 1940,
The films are scheduled mainly to local health units. Projectors
for each unit are an important need cnd during 1939 it was possible for
several more of the units to make this purchase. With one exception,
all county health units now have a 16mm. sound projector or have access
The. Division has a moving picture operator who is also general
clerk and library page. 'This operator is loaned to all bureaus who
may wish to show moving pictures of a technical or popular nature
before professional or lay groups. The operator has charge of the in-.
spection, so-heduling and repair of the film collection -- a very
necessary function where films circulate as widely and as rapidly as
those of the Division.
Several of the counties have made moving pictures showing the work
of the health units. These have been powerful instruments in selling
the health units to the public and it is also planned next yar to use
these in the schools as part of health instruction.
This Division took over the responsibility for all exhibits which
were formerly supervised by the Bureau of Public Health Nursing and it
was possible with the help of WPA projects to'revamp the current exhibit
material during 1939. The county health units and the State Board of
Health have had exhibits at many county fairs, conventions, meetings,
With the employment of an artist to have charge of this, work,
much more is expected to be made of this medium of health. education.
Model posters and graphs and charts for use in school health instruction
- 60 -
have been made and it is planned to coordinate this portion of the pro-
gram with the health instruction units of the State Department of Ed-
School Health Services
As a result of frequent talks and plans made by the Director of
the Division and the Consultant in Health Education of the State De-
partment of Education, a coordinated school health program between the
State Department of Education and the Board of Health was worked out.
This plan was put into effect in the summer of 1939.
Previous to 1939 Florida has no coordinated, well-plaimed program
of school health. Some of the counties carried on spasmodic programs
of immunization. County nurses did considerable work in the schools
and some effort was made by county health units concerning a health-
ful school enviornment. However, a joint plan of procedure between
school and health authorities was not in evidence.
In the summer of 1939 at the instigation of the State Boa
Health and the State Department of Education, a group of peop]
the University of Florida and prepared plans for Florida's sct
program. This plan was published in bulletin form entitled "I
Florida's School Health Program."
Five thousand copies were distributed throughout the sta
State Board of Health to lay groups in every county. This wa-
order that the tax-payers might have knowledge of school heal
and the necessity for coordinating the school program with th<
health program. Five thousand additional copies of the school
plan were distributed by the State Department of Education to
officials, county school boards and school teachers. By the
year the school health program was widely known over the stat
e met at
-e by the
,nd of the
The school health plan as outlined is completely coordinated with
the co imunity health program. Full-time county health units will formu-
late their programs around this plan. Staff education concerning the
program is proposed for 1940 and to this end, study un-ts built on the
plan have been in preparation and will be used in county health unit
State-Wide Public Health Committee
The outstanding public relations achievement of 1939 was the for-
mation of the State-Wide Public Health Co.naittee, dedicated to the pur-
pose of furthering the Florida survey of the American Public Health
Association. As the year drew to a close, this organization of some
2,000 leading Florida lay and professional citizens represented one of
the strongest forces for public health education in the state and had
- 61 -
gained considerable national attention
Although plans for the State-wide Public Health Co:nmittee were
formulated in February, it was not until July that organization began
in earnest. The Public Relations Consultant was loaned to the Committee
by the State Board of Health to act as Executive Secretary and plans
were supervised in the beginning by field workers of the American Public
To facilitate operation of the Committee, the state was divided
into seven districts. Meetings were held in each district to intro-
duce the Committee and describe its function in promoting enactment of
the recommendations of the American Public Health Association survey,
"The Health Situation in Florida." Because attendance was good and
interest keen, a great many county meetings are planned for 1940.
The State-Wide Public Health Committee is an independent organiza-
tion whose policies are formulated and carried out by the State Executive
Board, composed of the following organization presidents: Florida
Medical Association, Florida State Chamber of Commerce, Florida Federa-
tion of Women's Clubs, Florida Congress of Parents and Teachers, Florida
State Dental Society, Florida State Bar Association, tht American Le-
gion, Florida Federation of Labor, and Florida Federation of Business
and Profession"1l W!omen. In addition there are eight members-at-large,
and the entire group is headed by John P. Ingle, Sr., Jacksonville, as
president and Mrs. Malcolm McClellan, State president of the Florida
Congress of Parents and Teachers, as vice president.
As a result of negotiations by the State-Wide Public Health Co-
mmittee, representatives of both the State Board of Health and the
State-Wide Public Hevtlth Committee, were guest speakers at meetings of
a large number of other organizations. Among the more important was
the series of five district conferences of the Parent-Teachers Asso-
ciation at which public health was the topic of talks and group dis-
cussions at each meeting, sometimes as many as two or three health talks
being scheduled for one program. The two topics featured were full-
time county health units and Florida's new school health plan.
The increased interest inspired in public health and the program
of the State Board of Health by the State-Wide Public Health Committee
was reflected in increased requests for speakers for both local and state
organization meetings, pamphlets, information, motion pictures, and other
media of health education.
Even more far-reaching than the record of publicity were the strides
made in promoting new county health units. By the end of 1939, two coun-
ties had requested health surveys from the State Board of Health pre-
paratory to inaugurating movements for health units and ground work has
been laid for about ten new health units.
Frank V. Chappell, M. D., Director
The director of Local Health Service was appointed in October
and at the same time the Bureau of District and County Health Work
was changed to Local Health Service. The director at the same time
continued to serve as acting director of Maternal and Child Health
until the new director was appointed.
This division of activities made it impossible to be out of the
office as much as desirable, but time was found to meet with the
county commissioners of a number of counties to talk in regard to the
advantages and possibilities of setting up a local health unit.
Twelve such visits were made to six counties and the commissioners of
four of these counties tentatively agreed to include a certain amount
of money in their budgets for 1940-1941 as their share necessary to
set up a health department. The director visited all of the local
health departments one or more times during the year and offered such
help and advice as he was able from time to time to give. All of the
units have made very definite progress during the year and nearly all
of the counties have issued well prepared and well written annual re-
ports of their activities for which they have every reason to be proud.
It is felt that there has been an awakening on the part of the
more intelligent group of the general public in regard to public
health, and this has made it much easier than formerly to interest
groups in the subject. Almost without exception all groups of citi-
zens and county officials have been most responsive to the plan of
using local funds for the setting up of a County Health Unit. It is
Believed that by strengthening those units already established these
units will sell their program to the adjacent counties, and that the
organization of additional units will be accomplished as a matter of
course. It is felt that from now on units can be established with
little or no effort, faster than it will be possible to supervise,
staff or assist them financially.
In the past one of the chief obstacles in the way of smooth func-
tioning of the units has been the rapid turnover in the personnel,
especially the health officer. It was resolved this year to put a
stop as far as possible, to this practice and try to assist the unit,
and the director personally, by insisting that he remain at least a
year or longer if possible, before making a change.
- 62 -
- 63 -
A paper titled "Balancing the Local Health Program" was read at
the meeting of the Florida Public Health Association in Jacksonville
and talks were made before a number of interested groups on the ad-
vantages to be derived by a county from a full time county health de-
partment. The director was made a member of the postgraduate com-
mittee of-Florida Medical Association, as a representative of the
Florida State Board of Health, to work with the committee on the an-
nual postgraduate course to be held in Jacksonville during July 1940.
The director attended the annual meeting of the Southern Medical
Association at Memphis, and attended as nearly as possible all of the
meetings of the Southern Branch of the American Public Health Associ-
ation, and also the Public Health Section of the Southern Medical Asso-
During the year four physicians attended the short course for
health officers at the University of North Carolina, one at his own
expense, and the expenses of the other three were met with Social Sec-
urity funds. One sanitarian was also sent to the University of North
Carolina for a full nine month's course and paid for by the State from
Social Security funds and four others went at their own expense for
the short course for sanitary officers.
A report of certain of the more interesting activities of the
seventeen county health units as reported to the United States Public
Health Service for the calendar year of 1939'will be found in the Ap-
pendix, table XIV.
Edward M. L'Engle, M. D., Director
Since it is not possible to give a statistical report for the
same year which is covered by the reports of the other Bureaus of
the Health Department, what follows is merely a resume of some of
the activities of the Bureau of Vital Statistics for the year 1939.
The detailed statistical report, which relates to the year 1938, is
being published in a separate volume.
There were added during the year 1939, a total of 92,798 items,
divided as follows: Births, 33,059; Deaths, 22,650; Marriages,
27,364; Divorces, 9,725. The total number of records on file as
of December 31, 1939, is 1,540,990.
During the calendar year 1939, 9,464 certified copies of
birth, death and marriage certificates were issued. Since this
Bureau receives only memoranda relating to divorces, naturally
no copies of divorce decrees were issued. Of the total certi-
fied copies issued, 1,255 were issued without the payment of the fee.
A total of 24,503 notices of birth registration were mailed to
new mothers. In the past, many of these notices were returned un-
delivered because of incomplete or incorrect address. It is hoped
that this difficulty will be largely overcome by the inclusion on
the new form of birth certificate of the requirement that the
mother's mailing address, in addition to her usual place of residence,
be shown on the certificate.
Annual Registration Healing Arts
Persons holding licenses to practice in Florida registered
with the Bureau of Vital Statistics, as required by law numbered
3,189. Of these, 2,267 were Doctors of Medicine; 408 Doctors of
Osteopathy; 212 Doctors of Chiropractic; 190 Doctors of Naturopathy;
and 112 Chiropodists.
- 64 -
- 65 -
The volume of routine work increased in 1939 by 9% over 1938 and
a new activity was inaugurated. This is a cooperative arrangement
with the Social Security Board by.which the Bureau of Vital
Statistics and the local registrars furnished the Social Security
Board with immediate proof of death of persons holding Social
Security account numbers. The Bureau believes it is an obligation
properly assumed to be helpful to the Board in its security program
and it is a pleasure to be able to record that the Board has shovm
a sympathetic understanding of the added burden of work placed on
the Bureau and is assuming its share of the added expense entailed
in this program.
Assistance is still being received from the Work Projects
Administration for work on the records. The work is adding to the
usefulness of the records and without this assistance, could not
otherwise have been carried out,
Organization of Bureau of Labstatories
Florida State Board of Health
State Board of Health
State Health Officer
Bureau of Laboratories
2. Investigative work
a. Kahn tests
5. Animal Inoculations
a. Kahn tests
Triple typhoid vaccine
for the following:
Throat cultures, etc.
J. N. Patterson, M. S., M. D., Director
The annual report of the activities of the Bureau of Laboratories for
the year 1939 is submitted in tabular form below and also in tables
in the appendix.
Table A shows the distribution of the work among the five laboratories.
There was a gross increase of 14 per cent over last year in the number of
tests performed. The greatest increase occurred in the work of the central
laboratory and increases of a lesser degree were noted in the work of the
larger branch laboratories located in Tampa and Miami. A rather marked
decrease occurred in the number of examinations performed by the smaller
branch laboratories located in Pensacola and Tallahassee. The decrease in
their work was due to the transfer of Kahn tests to the central laboratory.
This change became effective December 1, 1938.
Examinations made in the laboratories
during the year 1939
LABORATORY DIAGNOSTIC MILK A D WATER TOTAL
s7aoksonville 297,063 8,951 306,014
npa 88,289 2,411 90,700
Miami 74,436 6,586 81,022
Pensacola 13,785 881 14,666
Tallahassee 9,245 354 9,599
TOTAL 482,818 19,183 502,001
Table B on the next page shows the distribution of the work in the
different laboratories by months. It reveals again thu striking seasonal
variation in the work of the Miami laboratory and shows the necessity of
additional help in that laboratory during the winter season..
- 67 -
- 68 -
Total number of examinations made
by months during the year 1939
24057 7967 1084 9892
23031 6969 1346 6751
26125 7778 1277 6059
22895 6182 1000 4828
24684 8399 643 5219
23341 7012 1150 4771
23191 6628 1320 4840
26320 7525 1800 4929
28778 6778 1469 5873
30424 9276 1216 9022
28734 8813 1479 8481
24434 7373 882 10357
306014. 90700 14666 81022
Table C on the opposite page lists the distribution of biological
products by months. The seasonal incidence of the different diseases can
be estimated by a study of this table. There has been a substantial de-
crease this year over the preceding year in the amount qf diphtheria anti-
toxin and rabies vaccine used. However, the quantity of typhoid vaccine
distributed during 1939 was more than double that of 1938. Fifty thousand
capsules of tetrachlorethylene for treatment of hookworm were distributed
last year by the laboratories. A charge of $5.00 per complete course of
14 antirabic treatments has been made to all patients with the exception of
indigents. The amount collected for these treatments during the year was
A substantial increase will be noted in the number of specimens sub-
mitted for Kahn tests which are tabulated in Table (summary) in the appen-
dix. Due no doubt to the extensive campaign being waged against syphilis
by the U. S. Public Health Service, the State Board of Health and other
agencies there was an increase amounting to approximately 50,000specimens
over the preceding year. There was an increase of approximately the same
- 69 -
Biologicals distributed during 1939
Di eriaAntitoxin Anti-
001000 5 Typhoid Vaooine rabic
units units Schick Toxoid Vaccine Virus Virus
Purified Protein Derivative Tuber uin
100 test pkgs 10 test pkg
1st str. and str. 1st str. 2nd str.
Jan 31 8 6460 3920 2850 2740 112 8 8 35 42
Feb 49 4 3930 2110 7840 2500 76 41 39 68 55
Mar 75 2 9040 4360 15300 4870 92 74 72 175 89
Apr 28 6 4140 3520 13780 3350 123 69 27 13 16
May 51 1540 1420 12580 1260 97 105 104 8 8
June 49 11 2610 4350 9460. .2790 84 59 59 9 7
July 12 6?o 1000 5460 1610 68 41 34
Aug 43 5 1550 2660 4080 2570 64 185 168 2 2
Sept 59 5 6020 2920 4520 1900 66 54 34 41 26
Oct 41 5 5340 4200 2960 2300 63 33 37 33 23
Nov 41 6 8080 3280 3280 1990 28 101 95 13 14
Deo 39 7 2030 3740 1160 1990 40 32 31
TOTAL 518 59 51360 37380 83270 29870 913 802 708 397 282
number of specimens in 1938 over the number examined in 1937. Both the
Kahn presumptive test and the Kahn standard test were run on every specimen
received so that in reality there was'an increase of approximately 100,000
tests. However, as each specimen was reported only as Kahn positive,
doubtful or negative, the two tests were recorded as one. Actually 580,562
Kahn tests were performed.
The central laboratory and Tampa and Miami branch laboratories per-
forming the Kahn presumptive and standard tests follow in strict detail the
technic of each test as laid down by Dr. Kahn. Two serologists in each of
the three laboratories doing these serologic tests have had special train-
ing in the author's laboratory.
The central laboratory again entered the Evaluation Test conducted by
the U. S. Public Health Service and once more our laboratory was approved
for the performance of the Kahn test. During the last two months of the
year the central laboratory, with the assistance of Dr. Kahn's laboratory,
began a series of monthly evaluation studies of the branch laboratories.
The results of these studies showed a high degree of correlation in the
readings recorded by the different laboratories.
Within the past year a dark-field microscope has been added to the
equipment in each laboratory. Specimen container outfits for submitting
chancre fluid in capillary tubes and on glass slides, as well as blood for
serologic examination, are distributed upon request.
The diagnosis of gonococcal infections by cultural methods has been
added to the routine of the central laboratory. The technic advocated by
Carpenter and his associates has been adopted. It is planned to institute
culturing of gonococci as a routine procedure in the branch laboratories
during the next fiscal year.
The central laboratory has adopted a method of concentration of sputa
before examination. Staining by the steaming procedure has been replaced
by the cold method of staining. The central laboratory also performs
guinea pig inoculation upon request of the physician.
The agglutination procedure adopted last year has met with video favor
among the physicians. It has done much to re-establish the confidence of
many physicians in the work of the State Board of Hoelth Laboratories.
This f.ct was brought out strikingly in the Section on .Internal Medicine
at the annual meeting of the Florida Medicl. Association huld in Daytona
Beach, April, 1939. All Laboratories report steady rise in the number
of specimens submitted for agglutination tests.
Potassium tellurite media has been .dded to the arn :ment riuua of the
central laboratory and has been an invaluable aid in obtaining a pure cul-
ture of diphtheria bacilli, when indicated, before doing C virulence test.
Virulence tests are only performed-in the central laboratory as the branch
laboratories have no facilities for housing animals.
During the past year rapid strides have been made in replacing worn
out and obsolete equipment with new and modern equipment. The Hiami
laboratory, which was especially in need of new equipment, has been re-
equipped as follows: International centrifuge #2, large Kelvinator re-
frigerator, Precision water bath, Spencer binocular microscope, Zeiss
- 71 -
microscope light, Kahn reading light, Quebec colony counter, automatic
pipetting machine, Bausch and Lomb dark-field microscope and light, and a
Royal typewriter. A Kahn shaking machine in good condition was transferred
from the Pensacola to the Miami laboratory.
The central.laboratory obtained the following new equipment: A large
SPrecision water bath, 3 Spencer binocular microscopes, 2 Zeiss microscope
lamps, Spencer microscope lamp, Coleman eH. electrometer, International
centrifuge #2, 2 automatic pipetting machines, Bausch and Lomb dark-field
microscope, 4 Royal typewriters, Quebec colony counter, Kahn reading light,
and a large hot air sterilizer, A large lead acid bath with lead baskets
and block and tackle arrangement to lift the baskets was designed by us
and built by the Armour Plant froa scrap material without cost to the
The Tampa laboratory received the following new equipment: Dark-
field microscope, Spencer binocular microscope, Zeiss microscope light,
Precision water bath, Quebec colony counter, and a Royal typewriter.
The Pensacola and Tallahassee laboratories each received a Bausch
and Lomb dark-field microscope and light.
The physic. 1 equipment of the laboratories is now in good condition.
Expenditures in the future will be more evenly distributed as henceforth
it will be necessary only to replace equipment as it wears out. Any
-.large-expenditure oif ruiiy will be necessary only if new tests requiring
expensive e..uipment are adqpted in the future.
Within the past year the following personnel has been added to the
staffs of the different laboratories as follows: Central laboratory:
2 junior bacteriologists, 2 typists and 2 dieners; Tampa Laboratory:
a junior bacteriologist and a typist; and Miani laboratory: a serologist
and a typist. Of these skilled technical workers one has an M. S. degree,
two a B. S. degree and the other a B. A. degree. This increase in per-
sonnel has been a big step forward in relieving the overload carried by
the workers and h.s permitted the laboratories to give more prompt re-
porting without sacrificing accuracy.
Six serologists availed themselves of the opportunity for two wee.s
advanced training in Dr. Kahn's laboratory within the past year. In
addition a senior bacteriologist from the central laboratory studied
dark-field procedures Lor a saiilar period of time in the U. S. Public
Health Service laboratory in Hot Springs, Arkansas.
- 72 -
Considerable progress has been made within the last six months in
obtaining a fair salary scale for the skilled technical workers. However,
further progress must be made before the laboratory budget is large enough
to permit payment of salaries for skilled workers conmensurate with their
training, ability, quality of work, and length of service.
BACTER fI LO GI C AL EXAM INAT ONS OF WATER
As Conducted by the Central Laboratory, 1939
ULIC SUPPLIES PRIVATE SUPPLIES BOTTLED WATER MISCELLANEOUS TOTALS
'Good Doubtful Poor Oood Bubtful Poor Good Iubtful Poor GooWdO DoAtfl oor
Wells 1812 205 64 370 68 40 224 17 3 280
Wells 438 57 11 862 228 173 229 13 3 2014
Springs 6 1 2 2 156 18 20 205
Wells 1 21 26 62 110
Treated 423 105 9 537
Untreated 64 23 58 25 69 74 313
Oyster Beds 43 11 72 126
Pollution 10 8 14 32
'Effluent 2 2
Cistern 38 40 23 101
S 3951 145 14 1 2 1
TDTAL 27" 391 142 1294 430 393 632 48 26 53 19 886260
Good Results as indicated by Prosumptive Test no evidence contamination.
Doubtful Results as indicated by Presumptive Test but xhich failed to confirm as organisms
of the Coli-Aerogonos Group*
Poor Results as shown by presonoo of organisms of the Coli-Aerogones Group in completed test*
M. H. Doss, Chief Inspector
The Bureau of Drug Inspection, Narcotic Service, is under operation
with five officers, four state inspectors, and one police officer assigned
by the city of Jacksonville at no cost to this bureau. During the year
1939 the arrests and prosecutions numbered 33. Violations corrected with-
out legal action numbered 16, and narcotic addicts committed to the State
Hospital totaled 2.
The open inspection of drug stores totaled 3,752; drug stores reg-
istered for the fiscal year 1939-40 totaled 758; investigations conducted
totaled 149; and by order of the State Board of Pharmacy the license of
1 pharmacist was confiscated and confiscation orders from the board in
which no return was made numbered 1.
A definite set-back to narcotic control was an act passed by the
1939 legislature which prevents any patient from entering the state hospital
unless suffering from a psychosis; this prevents narcotic addicts from enter-
ing. Many simply criminal violations by those addicted to the use of nar-
cotic drugs were handled by forcing the guilty party to enter the hospital
for treatment until free of the drug habit. This bureau has always con-
sidered this constructive narcotic law enforcement since it is obvious
that the ultimate aim of narcotic control is a state free of narcotics,
except those narcotics used in the legitimate practice of medicine.
A more thorough understanding of the provisions of the Uniform Nar-
cotic Drug Act and a stricter enforcement of its provisions in view of
controlling the use of narcotics was started in 1938 under the assistance
of the office of the Attorney General, who has ruled that naturopathic
physicians and chiropractic physicians were not qualified according to
state law to prescribe, dispense and possess narcotic drugs. An appeal
was taken by the naturopathic physicians to the Federal Courts, Southern
District of Florida as iell as the United States Circuit Court of Appeals
at New Orleans, Louisiana.
At this time no court action has been taken by the chiropractic
physicians with reference to this ruling. These rulings of the Attorney
General leaves only the regular doctors of medicine and the osteopathic
- 73 -
physicians qualified according to state law to prescribe, dispense and
possess narcotic drugs.
It is hoped, with the co-operation of the pharmacist, medical doctors
and osteopathic physicians that this strict enforcement of the Uniform
Narcotic Drug Act will' continue.
ACC. UN T I N G
G. Wilson Baltzell, Auditor
The following funds passed through the State Board of Health
during fiscal year beginning July 1, 1938 and ending June 30, 1939:
From Last Disburse- June 30
Fiscal Year ments 19 39
State Board of Health Legislative Appropriation 253,386.61 253,363.89 22.72
U, S. Public Health Service Title V1 144,927.28 135,097.51 9,829.77
U. S. Public Health Service and Cities for
Venereal Disease Control 41,355.00 34,749.29 6,605.71
Children's Bureau for Maternal & Child Health 106,727.62 95,267.39 11,460.23
Centralization of Marriage and Divorce Records 19,620.18 18,005.32 1,614.86
Registration of Doctors and Midwives 7,545.98 6,163.26 1,382.72
Certified Copies of Birth and Death Certificates 11,694.93 9,491.91 2,203.02
Drug Store Inspection Fund 8,307.49 7,935.18 372.31
County Health Units County and City Funds 115,643.95 115,375.69 268.26
Rookefeller Foundation Division of Malaria
Research 13,390.00 13,285.91 104.09
Rockefeller Foundation Malaria Control Studies
Escambia County 3,435.11 3,435.11
726,034.15 692,170.46 33,863.69
Financial reports are in accordance with the fiscal years of the
State of Florida and Federal Government, and not the calendar year.
The above are grand totals for each Project and Activity. A
detailed report consisting of 87 pages covering every Department and
Division of the State Board of Health and affiliated activities,lin-
cluding County Health Units, has been published for the above period
and will be forwarded upon request.
- 75 -
- 76 -
As this financial resume for the fiscal year 1938-1939 is in-
corporated in the annual Report of the State Board of Health for the
calendar year 1939, there are no financial transactions shorn for the
last six months of 1939. Therefore, it might be in order to recite
that the legislature of 1939 appropriated the following amounts to
the State Board of Health for the next two years beginning July 1,
1939: Salaries $103,500.00, Necessary and Regular Expenses $121,500.00,
Maintainance of Health Units $50,000.00, For Prevention of Venereal
Diseases $38,00.00; and the U. S. Public Health Service allotted for
1939-1940, $155,297.00 under Title V1 of Social Security Act and
$68,675.00 for Venereal Disease Control; and the Children's Bureau
total of $86,913.01 for Maternal and Child Health Services and Train-
All Federal unexpended balances are carried over to next. fiscal
year and added to the annual allotments, thereby increasing the budget
provisions for ensuing year.
George F. Catlett, Director
At the beginning of the year 1939, the Bureau of Engineering had
the following personnel: a director and chief engineer, four assistant
engineers, a milk sanitation specialist, a shellfish sanitation spec-
ialist, six sanitary officers, three WPA sanitation and malaria con-
trol supervisors, a draftsman, a secretary and two clerk-stenographers.
Engineering personnel in a public health organization is concerned
with the onvironmontalfactors, the structures and machinery of utilities
that, if improperly constructed and operated, will cause the transmission
of disease. Medical science has demonstrated that so-called "excreta-
borne" diseases--typhoid fever, hookworm disease, dysentery, diarrheal
affections, etc.--are transmitted by the improper disposal of excreta.
Thus it becomes an engineering problem-to devise means of preventing
With this end in view, water supplies are constructed, and, where
necessary, water purification plants are properly constructed and oper-
ated. Sewerage systems are installed and where these are not provided,
other devices such as the privy may be used. Where necessary, sewage
treatment plants are required to be properly installed and operated.
All of this is to the end that excreta shall not reach the public water
supply, thq milk supply, or foods that are to be eaten by the public.
Since hookworm disease transmission is due to pollution of the soil with
human excreta, utilities and special devices must be so constructed and
operated that they will keep the excreta from the soil.
As food improperly handled, prepared, and processed is knov -to
cause sickness and transmit disease, plants for the preparation and
and structures for handling such foods must be correctly equipped and
Improper handling of milk has caused the transmission of many dis-
eases. Milk plants with their sterilizing, pasteurizing, and other in-
tricate equipment and machinery must be properly operated.
Medical science has demonstrated that malaria, yellow fever, and
dengue fever are transmitted by certain types of mosquitoes, and to con-
trol these diseases, breeding of those mosquitoes must be eliminated.
' 77 -
For such control, the measures utilized--drainage, filling, screening,
and the systematic application of larvicides--are distinctly of an en-
Typhus fever is transmitted by rats infected with fleas harboring
the disease organisms. To control the disease, there must be rat and
rat-breeding control and this involves necessary special features in
the construction of building as well as the systematic use of poisons.
Many epidemics have resulted from taking shellfish from polluted
waters, and measures must be taken for the control of this situation.
All such work involves knowledge and experience of common engineering
measures and knowledge, of the fields of biology and chemistry, as many of
the processes in connection with. sewage disposal, water purification, milk
handling and food processing are bio-chemical in nature and involve
structures and machinery for applying these processes.
Engineering Bureau in the State Health Department
Modern public health practice and the policy followed in Florida
as well as in other States, involves the formation of local health units,
upon whose personnel rests the responsibility for carrying out directly
the public health rvork in their jurisdiction. From an administration
point of view, only two officers may be considered-the State Health Of-
ficer and the County Health Officer (in some cases City Health Officer).
The Director of the Bureau of Engineering, like other Bureau or Division
directors, is a staff assistant to the State Health Officer, and his re-
lation to the County Health Officer is only as part of the office of the
State Health Officer. Under such considerations his activities may be
(1) Selection and development of personnel to be made available for
appointment by the County Health Officer as Sanitary Engineer or Sanitary
(2) Assistance to the County Health Officer in the development of
his Sanitary Officers.
(3) Advisory service and technical assistance to the County Health
Officer as he may require.
(4) Furnishing assistance to local health officers or municipalities
in co-operation with the health officer, including service on certain
highly technical activities where a local health organization or small
municipality cannot afford the services of a properly qualified man.
(5) Responsibility for certain activities that are of a Statewide
nature and overlapping the jurisdiction of more than one local health
The situation regarding these several responsibilities may be brief-
Selection of Sanitary Personnel: The qualifications of the sanitary
officer in a county organization or of a man to be trained or developed
for such a position have been very definitely prescribed by the Confer-
ence of State and Territorial Health Officers, the U. S. Public Health
Service, and other agencies. There are, of course, difficulties in the
way of getting in all cases ideally qualified men. Small and less
wealthy counties can not afford to pay salaries that would interest such
men, and possibly the duties are not.so exacting as in larger counties.
Also, when one well qualified man is secured in a large county, other
personnel, with less technical qualifications, may be added. It can not
be too strongly emphasized that care should be exercised in these selec-
tions and/ fi' fti qualifications adhered to. This is the basic need if
sanitation is to make satisfactory progress throughout the State.
Development of Personnel: Due to the fact that i ith the numerous
new health units beginning in the State, the sanitary officers are men
with little or no previous experience, it is particularly important that
systematic attention is given to their development.
Technical Assistance: The county health officers, to a certain ex-
tent, call upon the Bureau of Engineering for assistance in the more tech-
nical phases qf their work.
It is urgently recommended that through the Bureau of Local Health
Service, county health officers be induced to lay out c definite, well-
balanced program for their sanitary officers, in co-operation with the
State organization. This should be done with consideration for the
relative importance of the various sanitation activities in each county
in question, and help that may be available from the State organization.
In this way, priority will be established for the more important activi-
ties, the county sanitary officers will not undertake a multitude of
things beyond their power to carry out successfully, and the Bureau of
Engineering will be able to plan its o.n. program of assistance to var-
ious county organizations.
Activities with which a Bureau of Engineering may be concerned are
listed as follows:
(1) Public water supplies.
(2) Sewerage and sewage disposal.
(3) Milk sanitation.
(4) Strcaim pollution.
(5) Industrial wastes.
(6) Disease-carrying mosquito control
(7) Shellfish, including crab and lobster meat production
(8) Rodent control
(9). Home sanitation, including water supply, excreta disposal,
(10) School sanitation
(11), Swimming .pools
(12) Tourist camps
(13) Food canning plants
(14) State institutions
(15) Disaster relief
Public Water Supplies
The most serious ind the earliest-recognized disease epidemics
caused by poor sanitation vere associated rith public water supplies.
They heve great significance as media for the transmission of disease
because every man, voman, and child uses a public water supply. A
large factor in reducing epidemics from this cause is the fact that
most efficient methods and equipment have been developed for the pro-
tection and purification of water supplies. However, eternal vigi-
lance is still required. Should an epidemic occur in a Florida muni-
cipality, vhure great dependence is placed on the tourist business,
the catastrophe would be more serious than under ordinary conditions.
In Florida, as is the case in most States in the Union, a statute
which gives the State Bo:-rd of Health responsibility and supervision
over the waters of the Statj, requires that plans be submitted and ap-
proved by the Board before construction is started on installation,
extension, or alteration of a water or sewverage system, and empo ers
the Board to order necessary changes, alterations and improvements.
This statute, passed by the 1929 Legislature had a defect that serious-
ly questioned its validity. The error was corrected by the 1939 Legis-
In carrying out this provision, it is necessary to watch constantly
all systems for weak features that may exist in the Tmter supply or puri-
fication plant and in the operation of these. Continuous visits and in-
spections are necessary. Should such defects occur, it is necessary to
promote early correction. Larger cities are able and do have technical-
ly trained men for the operation of the vater works, but smaller cities
are not able to furnish that service. It:is customary practice, there-
fore, for the State Health Departments to render considerable assistance
in such cases.
Florida has 242 public water supplies. Of these, 37 have softening
and purification plants and 31 others have some treatment such as aera-
tion, chlorination, or lime stabilization. The remaining 174 have no
treatment. Some of these are from suitably constructed wells, securing
water from deep-seated sources. Others are derived from lakes or shallow
ground water which need some protective treatment if they are to be term-
ed safe. Many of the so-called deep-seated supplies are obtained from
wells that are drilled to an adequate depth but are cased only for a
Water treatment plants are quite complicated installations. The
processes employed are chemical and biochemical, and they can only be.
operated safely under a technically-trained operator, with a laboratory
where he can perform the required daily chemical and bacteriological.
tests needed to control the plant. Laboratories have been furnished
at Tampa, West Palm Beach, and Orlando' for a number of years. Quite
recently, to this list have been added six plants. Plants without
such facilities, are located in small municipalities which are hardly
able to afford the service. For example, Belle Glade has a very dif-
ficult water-to treat, fully as difficult as that used at Tampa.
Tampa employs a chemical engineer and the entire services of an ana-
lytical chemist are used in the plant laboratory. Belle Glade can not
afford this service.
Other plants depend entirely upon samples tested by the State
Board of Health Laboratory. Samples are submitted monthly from treated
supplies or those having defects in protective measures. On a majority
of the supplies, samples are only sent every three months. It is more
usual practiceto submit samples from all supplies monthly and even
oftener-from suspicious ones.
In order to guard these-water supplies properly, it is necessary
that the Bureau of Engineering keep in constant touch with the munici-
palities to insure that defects arf corrected. Alterations to water
supplies or water purification plants, in most cases, involve consider-
able financial outlay which the municipality can not always arrange. Thus,
considerable time has to be spent in visits, consultation, and correspondence
with authorities before improvements can be secured.
During.1939, plans were approved for improvements or installations
at Jacksonville, Lake Wales, Riviera, Tallahassee, Hobe Sound, Sanford,
Belle Glade :Camp, Ft.: Clinch Park, -Highlands Hammock Park, and Dixie
Court at Ft. Lauderdale. Minor improvements were secured on other sup-
An important consideration in the protection of water supplies is
the practice in Florida of disposing of wastes into the underground
waters through drainage wells. The statutes forbid this except with a
permit from the State Board of Health. It has been the policy to .re-
fuse .such permits for sewage, but to permit the discharge of storm
water, cooling water from condensers, and innocuous wastes. During 1939
24 permits were granted after investigation. Miami disposes of its
storm-water through 150 of these wells.
A most important piece of work in connection with water supplies
was the. Survey of Water Resources in Southeastern Florida begun in 1939.
For years, the Miami area has been greatly concerned with the problem of
an adequate source of water supply for that rapidly growing section.
However, definite basic.data regarding underground and surface sources
.has been lacking, and the collection of such data was obviously a very
expensive undertaking. Largely due to efforts of the present Mayor of
Miami.,,Alexander Orr, Chairman-Abel Wolman of the National Water Re-
sources.Committee became interested in the problem. However, the Fed-
eral agency would not co-operate in the project unless th' survey Was
broadened not only to cover the problem of public water supplies, but
all interests having to do ,with water resources. It was estimated that
the survey would cost about $300,000 and funds were available to meet
half this amount provided local and state agencies would raise the bal-
In June, 1939, seven of the fifteen wells supplying Miami with
water became salt, bringing the whole matter to a head. Governor Cone
appointed a committee of State and local representatives to work with
the Federal agencies. The Director of this Bureau was one of the ap-
pointees. This larger committee appointed a smaller executive or steer-
ing committee headed by Alexander Orr as Chairman, and Ben Friedman who
was elected as secretary. The Director of this Bureau was selected as
a member of the steering committee. The necessary funds were raised by
Miami and other municipalities in the area, and some State funds were
made available for matching purposes. Federal agencies co-operating
were the U. S. Geological Survey, the Bureau of Agricultural economics
and Soil Conservation of the Department of Agriculture, and the Army
Engineers. Besides the problem of water supplies there was also in-
cluded irrigation and other agricultural needs of the Everglades, fire
control, soil erosion, flood control and irrigation, wild life con-
servation, etc. Mr. Stanley Wright was employed as co-ordinator, funds
being supplied by the National Resources Committee and the State Plan-
ning Board. The.State Planning Board has sponsored the entire project.
The survey is of great importance to the public health and the
data to be derived will be of value to the State Board of Health in
connection with public water supplies, water pollution control, and
Public Sewerage Systems
The statute referred to above, relating to water supplies, gives
the same responsibility to the State Board of Health in regard to sewr-
erage systems. Florida is badly in need of sewage treatment plants in
certain congested areas, particularly in the cases of Miami, Tampa, and
Orlando. There is considerable need for them among the coastal towns in
Pinellas County. Clearwater began the installation of a modern treatment
plant, and this action will serve to encourage other municipalities.
The Bureau of Engineering spent a great deal of time in promotion of
this step and in making extensive surveys of polluted waters in the area.
Similar service was given Tampa in connection with their problem, and
some work was done on Biscayne Bay.
Sewerage plans were approved for Clearwater, Jacksonville, Sanford,
Jacksonville Beach, Lakeland, West Palm Beach, Tampa, and Ft. Lauderdale.
A considerable number of special plans for septic tank and drainage
field installations for schools, tourist camps, and institutions, were
furnished by the Bureau.
- 83 -
Stream pollutions is quite a problem in the State in connection
with shellfish sanitation and bathing beaches, as well as sanitary
nuisances. Surveys of these areas constitute an additional problem.
The surveys include investigation and study of all sources of pollu-
tion, following which samples must be secured for laboratory examination
under varying conditions of tide and wind. A part of the laboratory
work is accomplished by sending samples to the Bureau of Laboratories,
and a part, by engineers in the field.
Maps are distributed by the Bureau defining areas too greatly pol-
luted for the taking of shellfish. Considerable survey work was done
on this during 1938, and maps revised as of January 1, 1939. Some fol-
low-up work was performed in 1939.
There is still a great deal of work needed along this line if per-
sonnel is available.
Report is made of the milk sanitation work in 1939 by Dr. Williamson:
At the end of 1938, thirty-seven Florida cities had adopted.the
United States Public Health Service Milk Ordinande and Code, commonly
known as the Standard Milk Ordinance. Only seven of this number had
developed their program sufficiently to merit inclusion in the accred-
ited list published semi-annually by the U. S. Public Health Service.
In order to be listed, the individual municipalities must make a rating
of 90% or above on both their raw and pasteurized milk supplies. This
rating is made by a State Board ot a U. S. Public Health Service repre-
sentative who uses the U. S. Public Health Service Milk Ordinance and
Code as the yardstick in uvwlu-ting uach- supply. During the next twelve
months, five additional Florida cities came under the Standard Ordin-
ance banner, making a total of forty-two cities in the State operating
under the Public Health Service Milk Ordinance and Code at the end of
The principal aim of the State Board of Health in its milk program
is to promote adequate and uniform milk regulations throughout the State,
together with suitable health personnel to enforce them. It is believed
that the uniform adoption of a nationally-recognized ordinance such as
the Standard Milk Ordinance, together with the establishment of properly
constituted county health units is the quickest and best means to this
end. It is further believed that the Grade "A" label should actually
mean just what it implies.
Cities not properly enforcing the Standard Ordinance unwittingly
do a serious injustice, not only to themselves, but to the Ordinance as
an institution and to the State milk program at large. For this reason,
cities making little or no attempt to enforce the Standard Ordinance are
being removed from the official list of Standard Ordinance cities.
Twenty cities will be dropped from the list in 1940 for that reason.
The remaining cities were urged not to "rest on their laurels", but to
make consistent effort to attain the accredited list of 90% cities, if
they had not already done so. Those already on the list, were urged to
maintain the excellence of their inspection service so that they could
remain on 90% rating from year to year.
The surveys on which these ratings are based are made strictly in
accordance with the provisions of the U. S. Public Health Service Milk Ordin-
ance and Code. Records of the various cities previously established,
stand or fall according to the way ordinance enforcement is carried out.
Partisanship or politics do not enter the picture. If a municipality
makes the required percentage to be included in the accredited list,
one may be certain that they merit it. Due to apathy in some instances,
and in others to a change in personnel or increased duties of present
employees, every 90% city in the State, with one exception, failed to
maintain the required 90% rating and was removed from the accredited
list. Since then, these cities, with two exceptions, have regained
their status and additional cities have attained it.
This situation, on the surface, would seem to indicate that milk
sanitation is retrogressing in Florida under the State Board of Health
program. However, that is not the case. It is obvious that this holds
for those cities which have once attained the accredited list and have
been removed because of a let-up of enforcement, but by far the major-
ity of the Standard Ordinance cities of the State are those who have
never achieved this distinction yet have steadily improved the sanita-
tion status of their dairies to a point just below a 90% rating. Some
of these cities have attained 90% ratings. n their raw milk supply and
have been withheld from the list because the pasteurized milk supply
rating fell short of 90%. This rating must be made jn both the raw
milk and pasteurized milk before the city may be included in the accred-
Very gratifying results have been obtained in the pasteurized
milk promotion program. Pasteurized milk consumption has increased
materially and consequently the percentage ;f pasteurized milk has
grown somewhat in the majority of the cities. In one city that had
no available supply of pasteurized milk at the beginning of the year,
65% of the entire supply is now properly pasteurized.
Through the efforts of the county health departments and the
newly-organized State-wide Public Health Committee, public health
education has been disseminated widely over the State. The gospel of
safe milk (i.e., pasteurized milk) has been preached continuously by
these health-minded and public spirited citizens. Not only do they
stress pasteurized milk, but they urge consumers to determine whether
or not it has been pasteurized and protected under Standard Ordinance
Many surveys by the United Stated Public Health Service and by
the Engineering Bureau of the State Board of Health have proved that
a great percentage of the so-called "pasteurized" milk was inadequate-
ly processed and improperly protected from contamination after pasteur-
ization. In the great majority of instances, improper and/or inade-
quate equipment was being used to process the milk. The situation is
an indictment against the milk control agencies within the State and
causes the public to labor under a false sense of security. The con-
suming public has every reason to believe when they receive a bottle
of milk labeled "Grade 'A' Pasteurized" that it has been properly
pasteurized and protected against subsequent contamination.
Twenty-one Florida cities, operating under the Standard Milk
Ordinance have made definite improvement in the processing of their
pasteurized milk supply and are now complying in a fairly satisfact-
ory manner with the U. S. Public Health Service Milk Ordinance re-
quirements. Fourteen of them, however, fell short by two or three
percent of the coveted 90% rating. A rating this high is hard to make
and,once made, is hard to maintain because of the consistently strict
rating procedure followed by State and Federal authorities.
Parent-Teacher Associations and civic organizations throughout
the State are evincing interest in the milk sanitation program. Es-
pecially are they interested in the school milk supply.* Through them
it was possible to develop good -supplies for individual schools even
where the Standard Ordinance was not in force. They are beginning to
know the difference between just "pasteurized milk" as it is commonly
processed throughout the State, and properly pasteurized milk such as
is afforded by the nationally-accepted standards of the USPHS Milk
Ordinance under the direction of qualified health officers and trained
The health of the cattle producing the milk and of the employees
handling the milk is receiving more attention than this particular
phase of milk sanitation has ever received before. A close check on
these items is kept by the health officers in all the full-time county
health departments in the State and in those cities operating under
the Standard Ordinance. All milking herds on these sheds have been
tested for Bangs disease, and the tuberculosis test has been given
practically all of them during the last twelve months. Tests for
mastitis are not being made generally, but a concerted effort to em-
prove the situation is already under way. Every new ordinance drawn
requires a routine test .for mastitis as well as Bangs disease and T.B.
Great improvement has been made in farm sterilization procedure
during the year.. Individual tests on each sterilizing cabinet are be-
ing carried out in Standard Ordinance cities and if conditions warrant,
individual instruction of the dairymen by the supervisor is given show-
ing .ways to remedy any defect. Plans for cabinets of proper design as
well as plans for dairy.barns and milk houses have been worked out by
the Bureau of Engineering.which meet all Public Health Service Milk
Ordinance requirements and are now available to any interested dairy
The progress of the State Board of Health milk program, though
somewhat gratifying, falls far short of being satisfactory. Little
or no progress has been made in those counties having no adequate
health set-up.nor is it believed any can be made under such unfavor-
able conditions. In previous years, the only cities making satis-
factory showing were located in counties having full-time county
health departments, and the same holds true today. An ordinance is
ineffective unless adequate machinery is available to put it into
operation and keep it in force. Intermittent inspection service by
part time health officers and sometimes by policemen and foremen del-
egated to perform this technical service is a "parody" and a waste of
the tax payer's money. More than this, it serves to prevent the est-
ablishment of a properly constituted health department and subsequent-
ly the adoption of adequate rules and regulations to govern conditions
affecting the health of the people. A service of this sort is a balm
that lulls the community at large into a state of apathy and is in-
finitely worse than no service at all. The people under such circum-
stances think they have health protection and make no effort to get
real security. Not until the populace has been properly informed can
we expect a change. When the public realizes the need of adequate
health service and wants it, then it will come.
Another mistaken idea in the minds of the public is that low
bacteria count milk is good milk. Nothing could be more erroneous.
This idea dates back to a day when there were few State and local
health departments and practically no inspection personnel. The
only service that could be rendered under such conditions, and this
by only a few select communities, was "platform" inspection and milk
sampling. The modern conception of adequate inspection service is
entirely different. To be sure, we recognize theimportance of making
bacteriological examinations of milk, but we also recognize the limitations
of.its importance. But this is only a small part of the entire picture.
when we realize that is is not the amount of bacteria in the milk that
is significant, but the type, ve will have a clearer picture of the
situation. 11ilk having a bacterial count of 10,000 is generally con-
sidered throughout the State to be good milk. However, one can readily
see the danger if these were all typhoid fever organisms.
The way to keep typhoid fever and other harmful bacteria from a
milk supply is to check every angle of milk production consistently and
persistently with special attention to excreta disposal, water supplies,
fly control, and the health of personnel, including adequate tests for
"carriers" of pathogens such as those causing typhoid fever, diphtheria,
and dysentery. Such a service is very specialized and is ineffective
when attempted by part time and perhaps untrained health personnel.- A
full-time county health department, manned.by adequately trained and ex-
perienced personnel is the only way to get a well-rounded service and do
away with the idea that low count milk is good milk.
Industrial waste problems in the State are of interest in connec-
tion with paper mills, citrus canning and stock feed plants.
Unfortunately, citrus canning plants and stock feed plants utiliz-
ing citrus peel and rag are located largely in the lake area. The- .
wastes from these plants are high in biochemical oxygen demand and when
discharged into lakes cause serious nuisances. In 1938, the Canner's
Association, the United States Department of Agriculture, and the Flor-
ida State Board of Health entered into an agreement to study treatment
of canning wastes. This Bureau designed an experimental plant which
was constructed at Winter Haven with funds furnished by the Canner's
Association. The Citrus Experiment Station maintained there by the
Department of Agriculture under Harry vonLoesecke supervised experimen-
tal operations and did the necessary laboratory work. Experiments be-
gan in the 1938-39 season and were continued for the 1939440 season.
A report is -to be made early in 1940.
This study does not include the waste from citrus stock feed plants
which is a particularly obnoxious waste containing about 6% solid matter.
It -Cannot be handled by municipal sewerage systems, nor is it possible
to discharge this material into lakes without nuisance. As a last resort,
permits were given for experimental drainage wells to care for these
wastes. Such experimental wells were tried at Haines City, Lake Alfred,
and Lake Wales. The Haines City well has not been satisfactory; at Lake
Alfred, no trouble has been encountered; and the well at Lake Wales Lha
not been continued sufficiently long for adequate observation.
Malaria control work continued throughout 1939 with considerable
difficulty due to the lack of medical personnel to make necessary epi-
demiological surveys upon -which to base a mosquito control program.
The malaria control demonstration program in Escambia County under
Dr. J. E. Elmendorf was continued during the year, and results will be
found in a special report by Dr. Elmendorf. Arrangements were made
whereby, with expenses paid, county health officers and sanitary officers
were able to spend several days studying this work. A course was also
given by Dr. Mark Boyd for Assistant Engineers Nevwan and Broughman and
a few sanitary officers, on the differentiation of Anopheles species in
larval stage, etc.
Four counties were selected for promotion of malaria control pro-
-grams by county units. These were Gadsden, Jackson, Leon, and Taylor.
Only in Gadsden, however, was any definite program commenced. The City
of Quincy appropriated funds for the purchase of material for lined
ditches in the town and a WPA project was secured for the purpose. A
small amount of Dr. Elendorf's time was available in counties west of
Tallahassee and he co-operated with the Health Unit Director of Gadsden
County in an epidemiological survey. Cases were definitely located
showing the areas of malaria prevalence. Entomological surveys were
made and a drainage program designed.
Work has been carried on in co-operation with the County Health
Units in LIke and Hillsborough Counties. Also some work kas done on
the old drainage in Perry, Tayivr Cuunty, installed in 1921 1925
under State Board of H.alth supervision. In all of these counties,
entomological studies were made.
It is very difficult to make progress on malaria control. Any
undertaking of this kind involves the devotion of a large amount of
time by health officers and sanitary officers, as well as by State
Board of Health personnel. Muney is necessary for materials even if
WPA labor is utilized.
Drainage work accomplished during the year may be tabulated as
HAND WORK DRAINAGE
1, 318, 823 lin. ft.
484, 193 lin. ft.
79, 425 cu. yd.
19, 458 cu. yd.
Water Surface Drained:
Water Surface Drained:
Water Surface Drained:
176,336,858 sq. ft.
258, 530 lin. ft.
122, 870, 720 sq. ft.
66, 367 lin.ft.
131, 660, 160 sq. ft.
Fill: 32, 375 cu. yds.
Man Hours: 76, 231
Water Surface Filled:
Team or Truck Hours:
537, 975 sq.ft.
AVERAGE NUMBER MEN WORKING DURING EACH WORK PERIOD DURING YEAR: 259
Pest Mosquito Control
Co-operation was given mosquito control districts in the State, and
a salt marsh control project sponsored in Hillsborough County. Surveys
were made of Martin and Palm Beach Counties.
- 89 -
Shellfish and Other Seafood
Oyster shudking houses and shell stock shipments were kept in the
same highly satisfactory condition as was reported last year. Very
favorable comment was made concerning these plants by the U. S. Public
Health Service officials who base, on the State work, their recommenda-
tions as to oysters shipped in interstate commerce.
The most difficult problem in regard to shellfish sanitation is
preventing the taking of shellfish from sewage polluted waters. By far
the greatest number of epidemics traceable to shellfish are due to taking
the shellfish from such waters. The Bureau of Engineering publishes maps
showing these polluted areas, and the maps are kept up-to-date by repeated
surveys. However, personnel is lacking for the patrol of such areas.
The State Conservation Department has a force of 20 or more men doing
such patrol work for other purposes, and for years have agreed, in prin-
ciple, to include this work in their activities. Their co-operation,
however, has not been entirely satisfactory.
Permitted seafood establishments operating during the year were as
Total Shellfish Houses Operating: 61
Shellstock only: 17
Clams only: 2
Scallops only: 1
Orabmeat and Lobster Meat Houses: 27
The Shellfish Inspector makes continuous visits to all of these. An
inspection report is furnished the U. S. Public Health Service monthly on
oyster and clam establishments. In addition, considerable time is spent
with local authorities in preventing "bootleg" oysters from being market-
ed--i.e., oysters from unapproved dealers who, in a large number of cases
take oysters from sewage polluted areas and sell them to the public.
Many calls for assistance have been received from local health offi-
cers in connection with rodent control work where typhus fever outbreaks
occur. Some assistance has been given, but no personnel is available for
effective work in this field.
Service relating to sanitation in the individual home is not prac-
ticable except through local health units, and assistance has been given
them in this work. However, by the use of WPA labor, privy projects
have been promoted and secured in all counties having health units and
in some other counties where local interest supports them. The U. S.
Public Health Service has furnished three supervisors in connection
with these projects until July 1, when their funds available for the
purpose were reduced and for the remaining months of the year two men
were made available by supplementing the Public Health Service allot-
ment with Bureau funds.
6231 privies were constructed under these projects during 1939.
During the conference on public health education held at Gaines-
ville in the summer of 1939, general policies in regard to proper sani-
tation of schools were established and basis made available for a code
jointly with the State Board of Health and the State Department of Edu-
cation. Many school buildings in the State are in a very insanitary
condition. This work needs to be pushed actively by County Units. The
Bureau of Engineering has been furnishing plans for larger schools cov-
ering sewage disposal, and for small schools, standard plans are avail-
able. There is a definite need for advisory service by the Bureau on
larger school buildings.
Three bills were prepared by the Bureau and passed by the Legis-
lature during the year. Each was an amendment to old statutes. The
most important empowers the State Board of Health to set up a State
Sanitary Code covering sanitary and quarantine regulations on activi-
ties specifically stated so that no conflicts should occur with other
State departments making regulations. In addition, it is made possible
for local health units to use and enforce the Code.
A second bill amended and improved the statute in regard to tourist
camps so that it covers trailer camps as well.
The third bill remedied a defect in the old law giving the State
Board of Health authority on public water supplies and sewerage systems
and the pollution of waters in the State.
Fred A. Safay, Director
The Sanitation Section of the State Board of Health, as the name
implies, was created for the purpose of rendering assistance to citi-
zens on matters pertaining to every phase of sanitation as it effects
the public health. The Section thus formed began operation on October
first, 1939. This report showing activities and accomplishments of the
Section Cor 1939, therefore, covers the three month period only Oct-
ober, November and December.
The personnel of the Section is composed of a Director, an Assis-
tant Director,.four Field Representatives, two District Supervisors on
Community Sanitation Project, a Secretary and one Clerk-Stenographer.
The duties of the Section as defined are:
a. To encourage and assist in promoting, through educational
effort, the formation of County Health Units in the unor-
ganized counties in the State.
b. To create sentiment for privy sanitation projects both in
the organized and unorganized counties of the state.
c. To give assistance to the citizenry in the unorganized
counties of the state on matters pertaining to sanitation,
as provided by state law.
d. To supervise environmental sanitation as it pertains to
inspection and issuance of permits for the operation of
tourist camps, bottled water plants, swimming pools, and
canneries. In organized counties this work is done in
conjunction with the County Sanitarian. To conduct in-
spections of all child caring homes and institutions and
furnish reports to the State Welfare Board for use in is-
suance of licenses for the operation of these homes.
..e. Sanitary control is likewise maintained over public fairs,
schools, recreation and summer school camps, scout camps,
- 9 -
- 92 -
private home water supplies and service provided on storm
and disaster relief. The matter of rabid dog investigations
is referred to this department.
STATE-WIDE W.P.A. COMMUNITY SANITATION PROJECT
To this Section has been designated the responsibility for the State
Board of Health's part in the operation of the State-Wide W.P.A. Communi-
ty Sanitation Project, in cooperation with the United States Public
Health Service. Messrs. J.B.Miller and W.W.McPhaul of this office have
been appointed District Supervisors on this project, and Mr. Miller, work-
ing out of Section headquarters in Jacksonville, has been placed in di-
rect charge of the work to coordinate the operation throughout the State.
Mr. McPhaul covers work on this project in the southern part of the State,
working out of the Tampa office.
In connection with the operation of this Project, a monthly News-
Letter is prepared by the Section covering work of all projects in the
several counties. The information given in those News-Letters covers
the following items in detail for each county project:
Number of counties in which projects are operating.
Number of men on the projects.
Colt of material per unit.
Number of privies installed for the month.
Number of privies installed to date by the
WPA, CWA and FERA Projects.
The letter further gives information pertaining to staining, paint-
ing or varnishing done in'connection with construction of these privy
The close of December 1939 marked the end of the first quarter dur-
ing which the Sanitation Project had been operating under the supervi-
sion of the Sanitation Section. For this last quarter (October, Novem-
ber and December) of the year, the monthly average number of privy in-
stallations was 535. This number represented an increase of more than
four percent over the first nine months of the year.
The News-Letter .for December was of special interest for in ad-
dition to supplying information covering work of the privy projects, a
map of the State showing incidence of hookworm disease in each county
was shown on the cover page.
During the three month period 760 tourist and trailer camps were in-
spected by field personnel of the Section and permits were issued for op-
eration of 658 camps having met the State Board of Health requirements.
This tourist camp work in the organized counties was done in conjunction
- 93 -
with the sanitarians of the County Health Units and in the remaining
counties by the four field representatives of the Section.
An official list showing all tourist and trailer camps operating
in the State under permits issued by the State Board of Health, was
prepared during November and covered a total of 593 camps. Copies of
this list were sent to all Camp Operators, Chambers of Commerce in the
larger cities in the State, City and County Health Departments, as well
as interested organizations and officials outside the state.
Distribution of information concerning our permitted and properly
equipped camps tends to assure patronage of these satisfactorily main-
tained units by the travelling public. Tourist camp work is done under
provision of the State Law and State Board of Health ruling.
Sanitary operation of the food canning plants in the state is con-
trolled by sanitary supervision as provided by State Board of Health
regulation on this matter.. This regulation further provides that per-
mits for the operation of these plants must be secured before operation
starts. Annual canning plant permits expire on October 1, and no permit
is granted for new or.previously operated plants until a detailed sani-
tary inspection has been made. In organized counties, the county sani-
tarians are responsible for the initial inspection and later for the
sanitary control of the plant.
To the end of the year 1939, 96 had been inspected and permits for
their operation issued by the Section.
Control of the handling and sale of bottled water, which in this
State is quite extensive, because of the objectionable mineral content
of many of the deep well supplies is another duty of this Section. The
matter is covered by regulation of the Board and this department is
charged with its enforcement. Annual permits for these bottled water
establishments expire on December 31, and before renewal, inspection of
the plant is necessary. Provision is also made in the State Board of
Health ruling that samples of the bottled water as prepared for sale on
the market must be submitted to the laboratory for bacteriological ex-
amination at regular intervals. There were in the state at the close
of 1939, 56 bottled water plants offering their product for sale on the
market in accord with State regulation.
Annual permits for the operation of, (1) tourist camps, (2) food
canning plants, (3) bottled water plants and (4) swimming pools are all
prepared by the Section and issued in the name of the State Health Offi-
cer, countersigned by the field representative of the Section and by the
County Sanitarian for the County Health Unit. In counties not having or-
ganized health units all work of this nature is carried on by the Sec-