• TABLE OF CONTENTS
HIDE
 Title Page
 Letter of transmittal
 Table of Contents
 Epidemiology
 Venereal disease control
 Tuberculosis
 Malaria
 Malaria research
 Public health nursing
 Maternal and child health
 Dental health
 Health education
 Public relations
 Local health services
 Vital statistics
 Laboratories
 Narcotics
 Accounting
 Engineering
 Sanitation
 Appendix






Title: Annual report - State Board of Health, State of Florida
ALL VOLUMES CITATION PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/AM00000243/00011
 Material Information
Title: Annual report - State Board of Health, State of Florida
Series Title: Publication - Florida. State Board of Health
Physical Description: v. : ill., ports. ; 23-29 cm.
Language: English
Creator: Florida -- State Board of Health
Florida -- State Board of Health
Publisher: State Board of Health.
Place of Publication: Jacksonville Fla
Frequency: annual
regular
 Subjects
Subject: Public health -- Periodicals -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
 Notes
Dates or Sequential Designation: Ceased in 1968.
Numbering Peculiarities: Report year for 1893/94 ends Mar. 31; for 189<7>-1968, Dec. 31.
Numbering Peculiarities: Reports for 1923-32 combined in one issue.
General Note: Reports for 1910-<17> issued as its Publication.
 Record Information
Bibliographic ID: AM00000243
Volume ID: VID00011
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Title Page
        Page i
    Letter of transmittal
        Page ii
        Page iii
    Table of Contents
        Page iv
        Page v
        Page vi
    Epidemiology
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
    Venereal disease control
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
    Tuberculosis
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
    Malaria
        Page 37
        Page 38
    Malaria research
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
    Public health nursing
        Page 54
        Page 55
        Page 56
    Maternal and child health
        Page 57
        Page 58
        Page 59
    Dental health
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
    Health education
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
    Public relations
        Page 71
        Page 72
    Local health services
        Page 73
        Page 74
        Page 75
        Page 76
    Vital statistics
        Page 77
    Laboratories
        Page 78
        Page 79
        Page 80
        Page 81
    Narcotics
        Page 82
    Accounting
        Page 83
        Page 84
        Page 85
    Engineering
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
    Sanitation
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
    Appendix
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
Full Text






STATE OF FLORIDA


Forty-first Annual


Report


of the


STATE BOARD OF HEALTH


Year Biding


for the
December 31, 1940


W. H. Pickett, M. D.,
Florida State Health Officer





















FLORIDA STATE BOARD OF HEALTH
Jacksonville, Florida
1941





















November 1, 1941


His Excellency, Spessard L. Holland
Governor of Florida
Tallahassee, Florida

Sir:

I beg to hand you herewith a report of the Florida
State Board of Health for the period of January 1,
1940 to December 31, 1940 inclusive.

Respectfully submitted



Shaler A. Richardson, M. D., President


SAR:gs





















November 1, 1941


Honorable Shaler A. Richardson, M. D., President
Florida State Board of Health
Jacksonville, Florida

Dear Dr. Richardson:

I herewith submit the forty-first annual report of
the Florida State Board of Health for the year end-
ing December 31, 1940.

The work of the State Board of Health for the year
1940 was under the direction of the late Dr. A. B.
McCreary.

Respectfully submitted



William H. Pickett, M. D.
State Health Officer


WHP:gs











TABLE OF



Epidemiology .

Venereal Disease Control

Tuberculosis *

Malaria. .

Malaria Reasearch .

Public .Health Nursing.

Maternal and Child Health

Dental Health.

Health Education .

Public Relations .

Local Health Service

Vital Statistics .

Laboratories .

Narcotics .

Accounting .

Engineering .

Sanitation .


CONTENTS




1

S .14

S 25

37

.* *. 39

54

.* 0 57




S.
. 66

71

0 6 S 73

S 0 77

78

82

S 0 0 83

a S 0 0 86

0 96


(continued)











TABLE OF C 0 NTENTS (continued)


Appendix

Table
Summary report of the central and branch laboratories for
the year 1940. .. I

Examinations made in the laboratories during the year 1940. II

Total number of examinations made by months during the year
1940 III

Annual report of the Jacksonville laboratory for the year
1940 IV

Report of the Jacksonville laboratory by months for the year
1940 .. .. V

Annual report of the Tampa laboratory for the year 1940 VI

Report of the Tampa laboratory by months for the year 1940. VII

Annual report of the Pensacola laboratory for the year 1940. VIII

Report of the Pensacola laboratory by months for the year
1940 0 S 0 IX

Annual report of the Miami laboratory for the year 1940 X

Report of the Miami laboratory by months for the year 1940. XI

(continued)










TABLE OF C 0 NTENTS (continued)



Appendix

Table
Annual report of the Tallahassee laboratory for the year
1940 O XII

Report of the Tallahassee laboratory by months for the
year 1940 XIII

Bacteriological examinations of water IV

Maternal and Child Health XV

Multigraphing. .. XVI










EPIDEMIOLOGY


Dan N. Cone, M. D., Director





The State has been very fortunate during the year 1940. There
were no epidemics of the more serious communicable diseases.

However, there was quite an increase in the number of influenza
cases reported during the fall but the disease was a very mild type
and with few serious complications and a low mortality rate.

Diphtheria shows a new low of 222 cases reported in the entire
State. The educational program was continued emphasizing the im-
portance of early immunization against diphtheria during the first
year of life and the necessity of giving each child two doses of
alum-precipitated toxoid not closer than six weeks together unless
such child is known to be Shick negative.

Poliomyelitis cases show a slight reduction compared with 1939,
but above the five year average. The cases occurring have been
scattered sporadic cases. No case could be traced to a definite con-
tact with a preceding case. Unsuspected carriers must evidently play a
part in the spread of this disease.

Malaria and hookworm continue to constitute two of the major
economic health problems for the State to solve. However, counties
with full-time health service are beginning to show results in the
control of these two diseases.

This department has rendered consulting services to the directors
and health officers throughout the State when such service was re-
quested and has also rendered emergency services to all sections of
the State not having the services of a health officer.

The following tabulation will show the number of communicable
cases reported and tabulated according to age, sex, and color, and
also the seasonal incidence of each disease during the past five years.




REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA


-CCI

0 <


TYPHOID 109

PLRATYPHO ID 6

TYPHUS 11I

MALARIA 14X0

SWULLPCX 7

MEASLES 2305

SCARLET FEVER 270

?HOOPI G COUGH 38B

DIPHTHERIA 223

INFLUENZA 653

11UMPS 2.65

VtiCENTS 52

DYSENTERY 44

STREP.INFECTION 42

LEPROSY 4

POLIOLiELITIS 33

LETI. E! CEPHALITIS 9

DN GiGTTIS 7

CHICKENPOX 2014

GEr:'Ml MEASLES 151

DCTGUE 4

TETANUS 17

ITBE:CULOSIS 1C18

SYiHILIS 19,88)

CH-'iCM3 ID 97

GCCOCCCCUS 1824

OPT2.MJiEUATCRUU 15

A;'cME 339

PELLAG.L' 120

i*rRCHSIA II

PNMMEUIN L; 955

HOOKIORU!

TRICHINOSIS 0

TUNULANT 46

TULAREMIA 16


co g m m w U


o 1 0 0 0 6 o

0 0 C 0 C 0 0

0 C 1 0 0 0 C

0 3 0 1 8 :

0 3 o0 C 3 0

7 0 0 0 0 6 a

0 0 1 0 0 3 0

3 4 0 0 0 34

2 0 4 = 0 5 o


S 0 C 0 0 0
0 C 0 0 0 7 :


0 1 0 C 0 0

o 0 0 C


1

0

1



0





2
0

2
418

0

12



C

2



1

C
3

0

0


3

0

1 0

3 8

C 0



0 0

1 15

78 214



2 25

3

0 1

0 54



0 2

1 1132

0 03

' 33

0 C


0

0




0


1 0

" 0 c

0 22 0




0 0 0
0 0 0


1 1 22 0 0

12 115 634 1 20

S 6 1 3 0



0 0 0 0 3

o 0 C 0 0



0 0 0 ,3 0

0 3 C 0 C

o o 13 o o

0 3 1 3 03

3 0 0 3 0

0 3 1 0 0


o 1 43

0 1 4

0 1 29

0 2 13

0 0 C

0 2 28

0 2 30

3 0 20

o 1 10

0 4 140

0 0 35

0 o 27

0 2 14

o o 55

C 0 4

c 1 4

c 1 .5

0 0 1

c 0 2953

o o 3

0 0 1

C 0 11

0 96 315

24 103 3002

0 0 67

1 10 475

S 0 7

0 30 285

0 12 6

j 0 1

0 24 592

o 6 85

S0 0

0 0 22

0 9





REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA


TYPHOID 0 8 4

PARATY?HOID 0 0 1

TYPHUS 0 5 1

MALARIA 0 7 16

SZLLLLPOX 1 c 0

MEASLES 0 66 294

SCARLET FEVER 0 82 5

7 0CFPING COUGH 0 87 22

DIPHWERIA 0 53 8

INFLUEI ZA 3 15 19

lUMPS 137' a

v'mcmTs : 5 Ag

DYSENTErTY 7

ST RP.INFECTICN 5 1

LEPROSY 0 0 0

-CLIOLMYELITIS 0 1

LETH.ENCEPH;LITIS C 1

LI IGITIS 1 0

CHICKENPOX 0 779 11a

GER4AN LEASLES O 2 122

DNGUE 0

TET;.US 1 3

TUBERCULOSIS 104 45

SYPHILIS 77 2989 935

CHANCROID c 9 15

GCNOCOCCUS 1 458 241

CPTH.NE'NATORUM 03 3

CANCER 0 3 4

PELLAGRA 0 0 13

TR3CHOL' 0 1 0

FPiEUIAONi C 90 [r

HOCK.ORM 0 783 689

TRICHINOSIS 0 0 0

UNJLAU ?T 0 6 0

TULARiIA 0 2 0


C 02
G 2


0 3

3 0 C

0 3 1

0
0 0D

3 1 19

0 0

S 3 0

,J 0 3

1 0 45

24 224 510

*3 3 0

5 5 13

0 0 0

0 1

0 8 2

0 0

11 65

0 157 2747

3 0

0 1 0

0 0 1


a a
0

0 0



o 7

1 0

C g

O 0,
S 0P

1 1

o 31




3 0


0 0

3 3

0 4

0 0

0 0

1 4

0 0

0 0

0 0

2 1

26 79



1 0


0 0

3 2





0 C



0 0
C 0


6 sa

a W

7000

0 0 0 0

2 0 0 0

4 9 c

3 0 3 0

2

2 3 2 0

1 3 0

3 -4 0


0 0 1 0



3 3 3 0

0 3 3 C

3 0 c



6 3 0 0

0 0 c 0

C 1 C 6

O C C 0



0000
0 0 0 0

0 0 0 0

4 1 6 C

64 41 75 34

1 0 C 0

6 1 2 0

0 0 : 0

0 C. 0 '

6 0 0 0



0 1 o o0

69 9 13

o 0 0- 0

0 0 0 C0

r U* "


1 12
3 3
0 R

1 8





1 121
*3 3



1 1215

5 34

8 108

3 46

o 106

1 24



; 2

3 0



1 4

0 1

0 1

6 293

3 6

0 C

0 1

6 109

160 2225

C C

1 224

0 2

C 11

3 5

1 9

o 107

117 161

o i

0 1

o 0





REPORTED CASES OP NOTIFIABLE DISEASES IN TE STATE OF FLORID


a-4



1 -0

TEBOID -: 1 0 0

PARATYPHO ID 0 0 0

TYPHUS 0 0 0

MALARIA 0 '15 0

SMALLPOX 0 .0 0

MEASLES 3 0 0

SCAFiLET F-VFR 0 0 0

WIOOPiNG COUGH 2 2

DIPHTHERIA 1 0 2

INFLUENZA C 0 0

UMPS 0 0 0

VITCETB' 0 0 0

UDSSI TERY C O

STREP. ]:PECTION 0 0

LEPROSY 0 0 0

POLIOMYELITIS 2 2 3

LEM.ENCEPHALITIS 0 0

ME1D RG ITIS 0 0 0

CHICKENPOX C 0 0

GEIMAN MEASLES 0 0

D2XGUS 0 0

TETANUS 0 1 0

TUBEnCULOS IS 1 3

SYPHILIS 71 670 64

CHANCR01D 0 0 0

GONOCOCCUS 11 11 2

OPIH.NECN ATCRUM 0 0 0

CACER 0 0 0

PELLAhGR 0 0 0

TRACHOMA 0 0 0

PNEUMZOIA 0 0

HOOKWORn 14 382 0

TRICHINOSIS 0 0 3

UNW L.NT 0 0 0


-3


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0 0

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0 4

0 1

0 21

0 2



0 4

0 0

0 2

0 0

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0 1

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0 0

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O 2

3 2



o 3



3 147

0 0

0 9

0 0

0 0

o 0

0 0

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0 78

o 0

o 0


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3 0

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0 0

0 14

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1 7

12 C

4 10

0 1

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0 J

0 1

0 4

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0 3

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1 26

82 534

0 1

2 13

0 0

1 0

1 0

o 0

1 0

2 524

0 C

0 0


0 0

0 1

0 1

0 0
C c

0 o


U) E-.



0 0 0

0 0 0

0 0 1

0 0 7

0 0 0

0 o 0

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1 G 1

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0 C 2

0 0

0 0


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1 0 9

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C 0

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3 4

48 238
2 0











O 2
0 0















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0 1
3 4

48 298

2 0

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0 0

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,; o
C 0


S 0 0


TULAREMIA


0 0 0





REPORTED CASES OF NOTIFIABLE DISEASES IN THE STATE OF FLORIDA


TYPHC ID

PARATYPHOID

.TyPHOS

-.kLARIA

S. ALLPOX

ZEASLES

SCtALE .FEVER

W OOP'IG COUGH

D IPHTHERIA

J TLUB ZA

L=PS

VINCENTS

DYSE TERY

STREP. NFECT IC

LE ROSY

p IcIYELITIS

LETH.ENCEPHALITIS

UIIINGITIS

CHICKENPOX

GERMAN MEASLES

ENGUJE

TETANUS

TUBERCULOSIS

SYPHILIS

CHANCROID

GONOCOCCUS

OPTH .EONATORUM

CANCER

PELLAGRA

RACHOMA

PNEION IA

HCC KWR

TRICHINOSIS

TI4NLLANT


o 0 0
2 4 C 1

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f 12 1 9

0 4 3 11

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0 0 0

0 0 0

0 0 C c

0 0 0 0
0 0 0 u

0 0 0 0

3 0 0 0

0 174 C 143

3 0 0 1

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0 0 3 1

o 1 0 56

5 829 88 1l16
0 3 0 .

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0 1 0 0

3 1 0 0
0 0 0 3


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0 1014 0 2

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0 0 0 0 0 0

3 12 2 0 2 0

512030
5 1 2 0 0 0


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1 34123 C 0 0

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o 32o o o 2



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310

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001
0 C 0





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TJULA;EIA








REPORTEDJCASES OF COMMUICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR


DIPHTHERIA

Age Group ihite Colored
w. F. m. F.
0to4 39 46 7 5

5 to 9 22 25 4 7
10 to 19 16 14 1 4

20 to 29 3 8 0 2

30 to 39 2 3 1 0

40 to 49 4 3 1 0

50 to 59 1 2 0 0
60 to 69 o 0 0 0

70 and over 0 0 0 0

Age, Sex and Color not given

Grand Total


Totals


97
58

35

13
6

8

3
0

0

2

222


SCARLET FEVER

Age Croup Uhite Colored
IL F. IL F.
0 to 4 29 30 0 0

5 to 9 30 66 0 1
10 to 19 30 43 0 1

20 to 29 6 17 1 0

30 to 39 2 4 0 0
40 to 49 0 0 0 0

50 to 59 o o o o
60 to 69 1 0 0 0

70 and over 0 0 0 0

Age, Sex and Color not given

Grand Total


SEASONAL INCIDENCE OF REPORTED CASES OF COMIMNICABLE DISEASES


DIPHMERIA
1940

1939
1938

1937
1936


SCARLET FEVE
1940

1939
1938

1937

1936


Jan Feb Mar Apr May Jue

29 20 32 10 6 11

37 30 20 22 10 20

77 55 46 58 23 18
47 37 29 19 29 39

46 23 27 14 11 00


33 56 51 25 18 12
41 58 55 34 30 28

41 55 28 39 15 11

36 28 39 97 24 14

58 22 35 22 24 13


July Aug Sept Oct Nov Dec Totals

4 12 14 22 36 26 222

17 14 42 24 34 29 299
28 27 34 51 40 35 492
16 22 47 99 125 100 609

13 11 38 43 34 49 309


3 11 6 20 11 15

16 14 18 22 42 39

13 8 16 32 48 46
12 8 5 23 38 53

11 13 16 24 20 41


Totals


59

97

74
24

6

0

0

1

0

0

261









REPORTED CASES OP COUWNICABLE D EASES CLASSIIED ACCORDING TO AGE, SEX, AND COLOR


MEASLES

Age Group Ihite Colored
M. P. M. F.
0 to 4 172 140 8 2

5 to 9 575 425 20 8
10 to 19 290 235 10 4

20 to 29 54 45 0 0

30 to 39 11 9 2 2

40to 49 0 2 0 0

50 to 59 1 2 0 0

60 to69 1 0 0 0

70 and over 1 0 0 0

Age, Sex and Color not given

Grand Total


Totals


322

1028

539

99
24

2

3
1

1

307
2326


WHOOPING COUGH

Age Group White Colored
K. P. M. F.

0 to 4 84 100 14 ,13

5 to 9 62 60 12 9
10 to 19 9 10 0 0

20 to 29 0 1 0 0

30 to 39 0 0 1 0

40 to 49 0 1 0 0

50 to 59 0 0 o o

60 to 69 o o o o

70 and over 0 0 0 0

Age, Sex and Color not given

Grand Total


SEASONAL KCIDEMCE OF REPORTED CASES OP CO~U NECABLE DISEASES


MEASLES

1940

1939

1938

1937

1936


Jan Feb Mar Apr May June

62 191 668 457 621 253

227 446 436 739 549 198

479 1663 3466 2395 591 157

16 18 23 41 118 57

6 12 38 66 91 39


mOOPING COOGH

1940 28 42 64 54 45 23

1939 49 123 203 206 200 114
1938 54 84 36 104 102 71

1937 37 20 42 119 63 65

1936 23 25 46 57 67 36


July Aug Sept Oot Nov Deo Totals

36 14 6 3 8 7 2326

60 9 11 24 11 6 2716

95 25 80 45 92 61 9149

35 26 29 23 98 151 635
19 14 4 3 1 14 307


27 12 8 19 29

90 41 24 7 26

86 45 95 83 38

65 23 40 23 21

41 21 17 14 16


25 376

16 1099

78 876
22 540

20 383


Totals

211

143

19
1

1

1

0

0

0

0

376









REPORTED CASES OF COMIUNEABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR


TT~PID

Ago Group thite Colored
PF. PF.

O to 4 1 5 2 2

5 to 9 3 6 4 3
10 to 19 7 14 4 6

20 to 29 8 3 5 4

30 to 39 4 7 0 0

40 to 49 2 4 0 2

50 to 59 1 2 0 1

60to 69 1 0 0 1

70 and over 0 0 0 0

AgV, Sex and Color not given

Grand Total


Totals

10

16

31
20

11

8

4

2

0

13

115


MALARIA

Age Group hilte Colored
w. F. mL F.

o to 4 6 3 0 1

5 to 9 4 5 1 0
10 to 19 9 9 1 2

20 to 29 13 5 1 2

30 to 39 8 7 1 3

40 to 49 8 9 0 0

50 to 59 2 1 0 1

60 to 69 3 1 0 0

70 and over 2 0 0 0

Age, Sex and Color not given

Grand Total


SEASGOAL CIDENCE OF REPORTED CASES OF CMUJNICABLE DISEASES


Jan Feb Mar Apr May June

2 9 11 2 5 12

3 6 11 18 27 10

7 7 7 20 24 23
2 5 12 14 15 8

5 10 8 11 17 9


14 6

24 11

13 35

13 9
48 104


4 11 2 18

19 41 33 16

18 25 23 19

20 30 39 81

16 4 16 14


July Aug Sept Oct Nov Deo Totals

13 14 14 4 20 9 115

12 10 12 6 5 8 128

10 20 16 10 6 10 160

14 7 18 13 2 23 133

4 7 12 5 2 3 93


12 27 15 16 17 5

76 47 62 50 30 26

22 45 95 70 61 45

162 155 179 98 61 47

62 98 78 140 234 55


Totals

10

10

21

21

19

17
4

4

2

39

147


TYPHOID

1940

1939

1938

1937

1936


MALARIA

1940

1939

1938

1937

1936









REPORTED CASES OF CMUNICABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR


TYPHUS

Age Group White Colored
M. F M. F.
0 to4 0 1 0 0

5to 9 1 3 0 0
10 to 19 11 1 0 2

20 to 29 16 5 4 0

30 to 39 14 2 3 3
40 to 49 7 5 3 1

50 to 59 6 4 2 1
60 to 69 1 2 0 0

70 and over 1 0 0 0

Age, Sex and Color not given

Grand Total


Totals

1
4

14

25
22

16

13

3
1

15
114


MUMPS

Age Group 1hite Colored
e. F. m. F.

0 to 4 11 8 C 2

5 to 9 26 21 28 29
10 to 19 21 21 35 26

20 to 29 5 5 2 5

30 to 39 2 2 1 2
40 to 49 0 0 0 2

50 to 59 2 0 0 0
60 to 69 o o o o

70 and over 1 0 0 0

Age, Sex and Color not given

Grand Total


SEASONAL I~CIDENCE OF REPORTED CASES OF COMMNKABLE DISEASES


TYPHUS Jan Feb Mar Apr lay June
t demnic)
1940 5 5 2 5 1 9

1939 3 7 8 6 11 17
1938 2 6 4 5 4 8

1937 3 6 6 0 4 19
1936 2 3 2 0 1 2


20 44 50 87 1

54 103 148 67 74

68 83 222 89 48

47 83 172 120 70
185 293 156 143 58


July Aug Sept Oct Nov Dec Totals

23 27 15 11 8 3 114

21 28 31 7 5 8 152

11 7 6 7 3 12 75

19 12 22 0 7 9 107

16 11 11 3 1 3 55


6 5 4 14

61 12 10 9

15 13 14 11
18 29 25 15

24 19 30 36


17 8

6 13

11 29

16 8

25 39


278

598

659

744
1084


WIMPS
ngs

1940

1939

1930

1937
1936


9 .......









REPORTED CASES OP CCQYMNABLE DISEASES CLASSIFIED ACCORDIM TO AGE, SEX AND COLOR


POLIOMYELITIS


Age Group htite Cole
U. F. MU.

0to4 9 5 1

5to9 1 5 0

10 to 19 2 2 0

20 to 29 3 1 0

30 to 39 0 1 o

40 to 49 0 0 0

50 to 59 0 0 0

60 to 69 0 0 0

70 and over 0 0 0

Age, Sex and Color not given

Grand Total


ored
F.

2

1

1

0

0

0

0

0

0


SMALIPOX

Totals Age Group


Oto 4

5 to 9

10 to 19

20 to 29

30 to 39

40 to 49

50 to 59

60 to 69


lIite Colored
U. P. U.. F.

0 0 0 0

2 1 0 0

0 0 0 0

0 0 2 0

1 1 0 0

0 0 1 0

0 1 0 0

0 0 0 0


Age, Sex and Color not given

Grand Total


Totals


0

3
0

2

2

1

1

0



0

9


SEASONAL ICID ECE OF REPORTED CASES OF C IOUINEABLE DISEASES


POLIDYELITIS Jan Feb kar Apr Uay Juse

1940 0 0 1 1 1 2

1939 4 2 3 3 11 6

1938 2 3 0 1 6 5

1937 0 5 4 2 0 1
1936 0 0 1 1 0 4


SMALLPOX

1940

1939

1938

1937

1936


July Aug Sept Oct Nov Dec Totals

2 8 4 5 5 5 34

11 8 14 2 2 0 66

5 3 2 2 1 2 32

1 5 9 3 4 1 35

1 7 12 6 7 3 42


2 0

1 1

7 1

0 0

0 0








REPORTED CASES OF COMUIM ABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR


JHFUUENZA

Age Group lhite Colored
m. F. I, F.

o to 4 19 22 5 0

5 to 9 19 20 0 0
10too 19 71 23 4 0

20 to 29 35 47 8 17

30 to 39 41 34 2 5
40 to 49 22 32 8 14

50 to 59 29 21 7 6
60 to 69 17 23 1 2

70 and over 13 16 2 1

Age, Sex and color not given

Grand Tot-l


Totals


46

39
98

107
82

76

63

43

32
166

652


UDULANT FEVER

Age Group thite Colored
M. F. M. F.'
0 to 4 0 0 0 0

5 to 9 1 2 0 0
10 to 19 0 3 0 0

20 to 29 4 10 0 0

30 to 39 5 8 o o
40 to 49 2 6 0 0

50 to 59 1 2 0 0
60 to 63 1 0 0 0

70 and over 0 1 0 0
Age, Sex and Color not given

Grand Total


SEASONAL NCIIENCE OF REPORTED CASES OF COMM NIABLE DISEASES


Jan Feb iar Apr Wiay June

256 158 67 30 7 2

9 6 27 57 134 31
25 20 8 11 10 3

109 120 132 72 21 5

21 106 220 139 23 21


July Aug Sept Oct Nov Deo Totals

3 5 12 2 17 93 652
23 10 18 10 21 56 402

0 2 2 6 7 18 lit

1 3 3 10 31 37 544

5 2 5 15 10 20 587


IWLMUN T FEVME

1940

1939
1938

1937

1936


0 2 5 3 3 8

1 3 .4 7 1 4

0 2 3 5 3 1

o 0 1 3 15 0

.O o 2 5 2 1


2 8 11 1

10 7 2 7

7 6 3 6

1 4 2 4

1 0 2 1


2 1 46

6 1 53

5 1 42

3 4 37
2 0 16


Totals

0

3

3
14

13
8

3
1

1

0

46


I !'JT1 ZA



1939
1938

1937
1936









IEPCED CASES OF COMUIJ ABLE DISEASES CLASSIFIED ACCORDING TO AGE, SEX AND COLOR


PELLAGRA

Age Group 1hite Colored
M. PF. U P.
0 to 4 1 0 1 0

5to9 2 1 0 0
10 to 19 4 5 0 0

20 to 29 0 7 0 1

30 to 39 0 19 1 1

40 to 49 3 18 0 0

50 to 59 3 12 0 0

60 to 69 2 5 1 1

70 and over 2 2 0 1

Age, Sex and Color not given

Grand Total


Totals

2

3

9
8

21

21

15

9

5

17
110


TETANUS

Age Group Ifhte Colored
U. FO U. P.

0 to 4 0 0 2 0

5to9 1 0 3 1
10 to 19 0 0 2 0

20 to 29 0 0 2 1

30 to 39 0 0 2 1

40 to 49 1 0 0 0

50 to 59 0 0 1 0
60 to 69 0 0 0 0

70 and over 0 0 0 0

Ago, Sex and Color not given

Grand Total


SEASONAL IIIUCE OF REPORTED CASES OF COMIONABLE DISEASES


Mar Apr May Jue

27 2 12 7

13 15 50 22

7 9 16 39
5 0 0 0

0 6 5 4


2 0

1 0

2 3

3 0
2 2


.3 0
0 3
0 0

0 6

1 6


July Aug Sept Oot Nov Doo Totals

5 16 5 6 14 5 110

23 9 12 7 3 4 172

11 21 17 26 20 15 188

U 1 6 0 10 2 37

7 4 0 5 1 1 35


2 2

1 0

3 1
0 0

4 1


3 2
2 1

3 2

3 2

3 1


Totals

2

5
2

3

3
1

1

0

0
o
0

17


Jan Feb

5 6

7 7

4 3

1 1
1 1


PELLAgM

1940

1939

1938

1937
1936


T"sUS

1940

1939

1938

1937
1936









REPORTED CASES OF COMMUNICABLE DISEASES CLASSIFIED ACCORDMG TO AGE, SEX AND COLOR


CAREER

Ago Group Ihite Colored
U. F. M. F.

O to 4 0 1 0 0

5 to 9 1 o o o

10 to 19 1 1 0 0

20 to 29 1 3 0 4

30 to 39 4 18 2 4

40 to 49 13 29 10 6

50 to 59 30 29 4 3

60 to 69 44 39 4 o

70 and over 35 27 0 3

Age, Sex and Color not given

Grand Total


Totals


1

1

2

8

28

58

66

87

65

4

320


TOLARWIA

Age Group Ihite Colored
M. F. M. F.

0 to4 0 0 0 0

5 to9 1 0 0 o

10 to 19 C 0 0 0

20 to 29 2 0 1 0

30 to 39 1 ".1 1 0

40 to 49 1 2 0 0

50 to 59 0 1 0 0

S60 to 69 1 0 0 0

70 and over 0 0 0 0

Age, Sex and Color not given

Grand Total


SEASONAL INCIDENCE OF REPORTED CASES OF CM lUNICABLE DISEASES


Jan Feb Mar Apr May June

25 20 35 30 12 43

32 19 38 34 29 25

28 21 23 27 20 12

24 21 27 7 0 23

18 31 20 13 18 22


July Aug Sept Oct Nov Dec

25 28 24 31 18 29

39 31 28 27 26 28

22 32 23 40 19 25

17 16 11 33 28 26

26 12 18 17 18 27


0 2 3

0 17

0 1 0

0 0 1

0 0 0


Totals

320

356

292

233

240




16

25

2

6

2


Totals


0

1

0

3

3

3
1

1

0

4

16


CRICER

1940

1939

1938

1937

1936


T!ULABIA

1940

1939

1938

1937

1936












DISEASE CONTROL


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







The year 1940 saw a further extension of the activities of the
Division of Venereal Disease Control. This extension was due partly
to an increase in the number of health units and partly to a gradual,
but persistent demand on the part of the public for venereal disease
control measures. This demand is no doubt the result of the interest
created by the persevering educational campaign which had its inception
in 1935 and which is being continued on all fronts on a national scale.
During the latter part of the year, the nation began an earnest effort
to put into action its resources toward National Defense; and as a con-
sequence of the Selective Service Act, the activities of the Division
were greatly multiplied, in order to provide the necessary services de-
manded of it.

Gradually, one of the chief difficulties, that of providing satis-
factory service throughout the state, is being reduced. It is recog-
nized that in order to provide adequate venereal disease control service,
there must be as a corollary, full-time public health service. Conse-
quently, the addition of county health units reduces, by that much, areas
with no full-time health service and expands the sphere of action. Dur-
ing 1940 nine such county units were added to the roster of counties with
full-time public health service.


Personnel. The personnel consists of the following: a Director,
Assistant Director and Field Consultant, a Nurse Consultant, one Secre-
tary, two Senior Clerks and one Junior Clerk.


Administration. The plans for venereal disease control in the
state have included the following objectives:

(1) Expansion of and improvement in existing diagnostic and treat-
ment facilities.

(2) Improvement in the laboratory facilities for the diagnosis of
early syphilis.


VENEREAL









(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.


The program is still stressing the importance of improving present
clinic facilities and the expanding and coordinating of epidemiological
investigations. Due to the rapid organization of numerous military camps
in the state, and the emergencies thereby created, the Division's activ-
ities have been tremendously increased and taxed. Consequently, a great
deal of time has been spent in finding ways and means whereby the Divi-
sion of Venereal Disease Control can cooperate with the military author-
ities and effectively coordinate their activities. Because of the estab-
lishment of these military areas, it is proposed to concentrate venereal
disease control activities in civilian areas surrounding military camps.

On November 15, the Division acquired the services of a white field
consultant to replace the Negro consultant. A full-time venereal dis-
ease epidemiological worker has been assigned to Hillsborough County to
take care of.the expansion of epidemiologic activity in that area.

The Division cooperates with all the county healht units in the
state, numbering twenty-five at present. It also cooperates with the
two independent city health departments in Tampa and Miami. To all
these full-time health departments financial aid is extended and all
the services of the Division are offered to and used by them. No fin-
ancial aid is given to part-time health departments in keeping with the
Division's policies, but all the services of the Division are offered
to them. Besides the Division's services, all health agencies, whether
public or private, receive the services of the laboratories and health
education bureau. The laboratory services include serologic examina-
tions of blood and spinal fluids, darkfield examinations, gonorrhea
smears and cultures and blood level determination of sulfonamides. The
health education services include literature, films, posters, pamphlets,
and radio scripts.

A simplified form of key tabulating summary punch card has been put
into use. All venereal.disease morbidity report cards are tabulated, ex-
tracting all the information the report gives. With this procedure, a
better morbidity analysis can be made.









Diagnostic and Treatment Services. At the beginning of 1940 there were
sixty-seven public clinics for the treatment of syphilis and gonorrhea.
During the year 1940 the number of such clinics, including privately op-
erated ones, increased to eighty-seven. Seventy-four of these clinics
are operated under the jurisdiction of county and city health departments,
and are financed largely from Federal and state funds. Besides this in-
crease, the Division was also instrumental in securing the organization
of a venereal disease demonstration unit for Duval County and the City of
Jacksonville, which will begin functioning on January 1, 1941.

The Hillsborough County Health Department clinics have been materially
improved by the institution of a Central Tabulating Unit Service which
keeps accurate and complete records of all patients.

All the clinics 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 consultative advice; and all patients unable to afford private medi-
cal care.

During the year 1937, the United States Public Health Service re-
ceived reports on venereal disease activities from only seven clinics in
the state. During that year, the monthly average number of patients un-
der treatment reported was 423. In 1938, 42 clinics reported a monthly
average of 6,693 patients under treatment; in 1939, 67 clinics reported
a monthly average of 7,786 patients under treatment; and in 1940, 87
clinics reported a monthly average of 8,843 under treatment. Graph I
comparatively illustrates the increased venereal disease control activi-
ties throughout the state. This does not take into consideration the
fact that every syphilis report submitted by a physician was presumably
a case under treatment. Since approximately one-half to one-third of
the reports sent in were from private physicians, it can be conserva-
tively assumed that these figures represent one-half the monthly average
of old and new patients under treatment who were actually reported.

Cooperation with Armed Forces. Because of the numerous armed areas in
the state and the large number of military personnel thereby stationed,
the activities of the Division during the latter part of the year have
been concentrated to provide all possible assistance to local and mili-
tary authorities. The Division cooperated with the State Selective Ser-
vice Director by providing every examining physician with special sero-
logic blanks and blood specimen containers, as well as any information
he may wish. It also provides free drugs for the treatment of indigent
selectees, and through local health departments, epidemiologic, diagnostic
and treatment services to these same individuals. Nearly 100% of the
blood serologic examinations, gonorrhea smears, and cultures of selectees
are performed by the State Board of Health laboratories.












NUMBER OF CLINICS REPORTING (GRAPH NO.I)
10 20 30 40 50 60 70 80 90


1937
193842
1939



MONTHLY AVERAGE OF PATIENTS UNDER TREATMENT
1000 2000 3000 4000 5000 6000 7000 91O


1937
1938
1939 6
9404


The Division has also contacted the military authorities concerning
measures to be undertaken for venereal disease control in civilian areas
surrounding military camps. Since one of the important aspects of these
measures is the repression of prostitution, this phase of control is re-
ceiving major consideration. On the invitation of the Division, the Am-
erican Social Hygiene Association made a confidential prostitution sur-
vey in Jacksonville, Tampa, Miami, and Pensacola. These surveys were
used as factual data to stimulate local civilian authorities to action.
With the assistance of Mr. Bascom Johnson, legal advisor of the American
Social Hygiene Association, and the publicity given to the 8-point agreement
made by the United States Public Health Service, the Army and Navy, and
the State Board of Health definite progress was made along these lines.
The cities of Tampa, Jacksonville, and Pensacola have committed them-
selves to a program of repression. These are the areas where the largest
number of military personnel are stationed.

Epidemiological Service. The epidemiological feature of the venereal
disease control program is admittedly one of the worst problems. This is
due to the fact that the sudden increase of venereal disease control de-
mand has outdistanced available facilities. Despite this handicap every
effort has been put forth with the existing personnel to improve this ser-









vice and to stress selective, rather than quantitative, service. Practi-
cally every health department has been provided with an additional public
health nurse or social service worker to increase the epidemiological ac-
tivities. A nurse consultant was added to the staff of the Division and
was assigned to hold educational conferences with the nurses in order to
improve the quality of rork performed. During the year a total of 10,893
visits to delinquent patients and 3,342 visits to contacts were reported
by health departments. Besides these activities the Division sent thou-
sands of letters to patients located in areas not served by full-time
health service.

Educational and Informative Activities. The educational activities
of the venereal disease program are carried on by the Bureau of Health
Education in conjunction with the Division. From a statewide viewpoint
the educational program consists of stressing the activities in those
areas without any organized health service, stressing not only the value
of venereal disease control, but also the advantages of a generalized
public health program. Numerous county health units have been organized
through this method. In areas with full-time health service the educa-
tional activities are aimed to aid or augment the local health education
activities carried on by the health officer.

The Division cooperates closely with private agencies, notably the
American Social Hygiene Association, in promoting venereal disease edu-
cation and also the observance of Social Hygiene Day every year.

All materials of an educational nature sent to the Division by the
United States Public Health Service are carefully studied and those best
suited for statewide use are selected and promoted.

Radio transcripts, sent by the United States Public Health Service,
are being used by many radio stations in the state. Local health depart-
ments also use radio for the promotion of their venereal disease programs.

Press relations have been most cordial. The press in the state has
cooperated very thoroughly with the State Board of Health. Due to the
activities of the State-Wide Public Health Committee, enormous publicity
has been given to all health activities. A week never passes in which
some newspaper in the state has no information on venereal disease con-
trol activities.

The Bureau of Health Education has two films produced by the United
States Public Health Service for lay groups and one film for professional
groups also produced by the United States Public Health Service and the
American Medical Association. A new color film has been produced locally
by one of the venereal disease clinicians and it has marked potentialities.
This film has been sent to the United States Public Health Service for
further consideration.









Besides presenting papers and discussions before medical societies,
the Division answered numerous queries relative to venereal diseases
sent in by private physicians. It is noticed with gratification that
the physicians in the state are making more use of the services offered
by the Division, particularly consultative service.

The Division in cooperation with the Bureau of Maternal and Child
Health and the Bureau of Health Education has distributed to every phy-
sician in the state a copy of the United States Public Health Service
pamphlet, "Syphilis in Mother and Child," Supplement No. 7 to Venereal
Disease Information.

Three nurses were sent for post-graduate training as part of their
general public health education during the latter part of the year.
Three physicians were sent to Hot Springs for the special course in ven-
ereal diseases which is offered by the United States Public Health Ser-
vice.

The number of bulletins, pamphlets and other publications distri-
buted to the general public was 43,366; the number of bulletins, pam-
phlets, and other publications distributed to professional groups vas
2,350; and attendance at film showings total 13,924.

Laboratories. As a result of the increase in venereal disease con-
trol activities, the laboratories' facilities have been taxed beyond
their capacity; since close to 95% of the serologic examinations done
in the state are performed by the State Board of Health laboratories.
Despite this increase other venereal disease laboratory examinations
have been added and are offered to the clinics and private physicians.
These services are gonorrhea cultures, cell count and protein determin-
ation in spinal fluids, quantitative serologic examinations, and blood
level determinations of sulfonamides.

The State Board of Health Laboratory entered the 1940 National
Evaluation Study and was approved. Separate evaluation studies are
made from time to time between the Central and the other branch lab-
oratories.

Graph II presents the number of blood specimens and serologic ex-
aminations performed by the State Board of Health Laboratory with a
comparison of similar examinations performed in 1939. Besides the
blood serologic examination, other examination were performed as follows:

Spinal Fluid Examinations 3,114
Darkficlds 250
Gonorrhea Smears 32,491
Gonorrhea Cultures 97






































Distribution of Drugs. There has been a marked increase in the dis-
tribution of drugs to private physicians for anti-syphilis treatment.
This increase has not only been in the quantity of drugs, but also in the
number of physicians requesting such drugs. Three hundred and sixty-five
physicians in the state have requested drugs from the Division. The doses
distributed for 1939 and 1940 are shown in Graph II.

Morbidity Reports. Ever since the organization of the Division, the
morbidity reports for venereal diseases have been increasing both from
private physicians and clinics. The Division has been striving, with the
increase in reports, to receive as much information as possible from these
reports. Thus, a new venereal disease report form was put into use during
1939. With the installation of a tabulating system during this year, it
has been possible for the first time to analyze these reports, so that
they can be of value from a statistical standpoint. It has been gratify-
ing to note that private physicians have been reporting their cases more
diligently.




01VISIOn OF VErEREAL 01SERSE COnTROL-l AUAL REPORT-1940
GRAPH B
SHOWING TYPE OF NEW SYPHILIS REPORTED WITH
PERCENTAGE OF EACH FOR THE STATE 1940
P---PRIMARY 4-7 %
SECONDARY 5.19%





NOT STATED LATENT
54.5 o 31.3%




-LATE ACTIVE 2.3
S-- CONGENITAL 2-1%


GRAPH 1W


SHOWING SYPHILIS CASES REPORTED FOR THE FIRST
TIME ACCORDING TO AGE GROUPS FOR FLORIDA- 1940


o10-19 20-29 30-39


9I





40-49


/--4


I


so OVER


UNDER 10


--


I-





DIVISION OF VENEREAL DISEASE C1OTROL
ANNUAL REPORT 1940
(1)
Report of Syphilis according to Stage of mhfootion with Rate per 10,000 Population, Pregnancy Status, Race and Sex, Source of Reference
and Age Groups, by Counties and for State 1940



I 4


By Stage of mfeotion


I I


C I I I --


By Race and Sexl


White Colored
M P M F


Souree of Reference


Private
Physician


SClinio
or
3 htritute


By Age Groups


0- 10- 20- 30- 40- 50.
9 19 29 39 49 over
69


Alohua 67
Baker -
Bay 10
Bradford 3
Brevard 5
Promrd 16
Calhoun -
Charlotte -
Oltru
Clay
Collier -
Columbia. 1
Dd 289
DeSoto -
DixiA 2
Dlnal 80
Esoaaba* 47
Flagler 2
Franklin* 5
Gadaden 31
Oilohrist*-
Glades* 14
Oulf 3
Hamiltom 2
Hardee 9
Hendry 5
Hernande 1
Highlands 10
Hilllboro*60
Holmes 1
lhdian Rv. 1
Jaokson* 47
Jefferson 17
Lafayette -


42 62 16 146 2 5 9 75 424 109.8
- 74 5 79 121.3
14 25 9 27 3 9 122 219 105.9
3 -- 1 1 7 15 17.2
33 9 11 7 3 1 5 46 120 74.3
4 175 13 143 1 2 10 266 630 158.3
1 1.2
1 21 23 62.8
2 -- 7 9 15.4
2 2 1 8 6 7 26 40.2
7 1 3 1 12 24 47.2
1 1 24 3 1 72 103 61.1
138 376 448 244 69 28 44 1415 3051 114.0
3 2 7 11 3 27 53 58.0
1 1 14 19 5 35 77 109.7
129 185 133 212 15 31 33 2101 2919 138.9
24 197 39 56 8 10 581 962 126.6
1 6 2 2 5 3 4 25 83.1
32 7 1 19 2 2 98 166 277.1
47 1 29 4 2 3 9 282 408 129.7

4 5 1 10 6 3 43 156.7
6 3 2 10 1 1 53 79 113.7
6 76 4 126 2 11 41 268 274.1
1 1 2 36 49 48.2
12 15 3 25 2 13 75 143.2
3 1 30 35 62.0
3 33 11 61 2 6 32 158 170.9
92 348 34 624 14 20 132 901 2225 123.5
22 23 14.9
3 4 22 5 1 1 39 7 76.3
144 158 29 26 10 257 671 194.9
25 1 1 19 63 52.4
1 I 1 3 6.8


23 19 19 135 250 1 424
- 2 43 40 79
4 38 66 67 2 219
- 3 7 3 2 15
1 11 11 41 56 1 120
14 23 22 170 415 630
1 1
8 3 4 8 23
S11 2 5 9
1 3 10 12 26
2 1 3 10 10 24
22 4 63 14 103
56 462 347 1032 1171 39 3051
1 7 12 14 20 53
4 7 41 25 77
21 316 375 946 1253 29 2919
29 129 143 198 471 21 962
1 6 4 5 10 25
1 11 16 81 58 166
4 6 9 142 249 2 408

3 5 14 21 43
7 8 24 40 79
3 2 3 99 164 268
12 15 8 12 2 49
7 4 5 16 50 75
S 2 4 14 14 1 35
4 7 3 56 92 150
15 279 210 724 958 54 2225
11 1 1 2 23
2 4 39 31 -
4 37 51 177 403 3 671
2 6 1 19 36 1 63
2 1 3


10
77
166
3
2
578
1
16

16
30
1668
4
40
2136
656



27
29
236
2
67
29
95
1619
"6
646
3


414
2
53
12
118
52

7
6
10
24
73
1303
49
37
783
25

16
50
32
47
8
6
63
606
23
70
25
60
3


20 53 179
2 5 20
6 44 90
1 8
5 10 42
18 81 307

4 3 5
1 3
2 10
1 3 11
4 7 12
195 263 1246
3 6 15
4 12 24
316 291 1033
187 109 376
1 3 7
15 7 55
12 58 190

1 7 14
4 5 28
7 38 107
23 1 13
3 45
2 5 19
1 19 49
114 239 768
2 2 10
3 4 33
23 98 279
2 9 23
i


0 4I-k


Cotedy st


S3 a


111 48
32 11
47 24
2 3
37 19
157 50
1
5 3
4
5 4
7 2
8 54
806 324
17 9
20 13
710 331
177 74
52 26
91 40

8 12
30 5
66 23
9 3
14 7
8 1
48 24
585 339
4 2
19 6
135 74
16 8
1 1


424
79
219
15
120
630
1
23
9
26
24
103
3051
53

962
25
166
408

43
79
268
49
75
35
158
2225


63
3


_






(1)
Report of Syphilis aooording to Stage of nfeotion with Rate per 10,000 Population, Prognancy Status, Pao and Sex,
Souroo of Reference and Age Groups, by Counties *and for State 1940


R Sta e of 2nfection


By Race and Sex


1t


Source of Reft


YM__ Iaf o I c


cP 4. 0 L a

0. 3 3 < U ) & a!


Ake 2
a, 4
eon 9
.vy 2
,berty 1
ladison 1
natee -
lrion 4
krtIn .3
lonroe 4
lasau 25
)kaloosa 12
)kseohobee -
hange 2

)soeola -
'ala Boh. 25
'asoo -
'inella 19
'olk 17
utnaa 11
it. Johns 15
ft. Luole 7
iant& Rosa -
iarasota 26
ieminole 3
uaer -
umannee 2
iyolor 6
hrlon -
'olusia 3
rakull -
raltone
bahlngton -
;tate In. 1
ut State 6


36 11 60
1 4 6
10 102 97
2 2 1

4 6 13
- 1 2
48 8 14

5 13
4 13 128
2 1 -
2 3
6 173 8

9 36 11
- 4 -
34 60 61
90 210 234
3 16
- 2 10
1 4 7
1 -
10 67 7
18 1 18
3 4 5
1 3 2


3 7 6


5 51 27
8 1 17


- b
S 2
1 4

1 2

1 1
8 6 3




2 5 4

13 3 1
2 2
17 5 12
1 38

1 1 3
1 -
1 -



5 3 3


3 1 -
1 1
29 -

5 -
3-61

3 63 1
- 1 1


473 173-5
82 46.9
527 166.5
36 28.7
2 5.3
62 38.3
456 174.7
177 56.7
15 23.8
38 27.0
321 296.5
19 14.7
5 16.7
817 116.6
87 86.0
1024 128.0
71 50.8
441 48.0
917 105.8
106 56.7
69 34.5
49 41.3
5 3.1
263 163.3
207 92.8
26 23.5
24 14.1
132 114.1
9 12.7
108 20.1
35 64.1
14 9.8
3 2.4
155
89


Nhite Colored
I I
I I 04
x46


7 12
8 12 15
1 6 5
1 1
3
28 36
8 16 17
2 1
13 4
10 17
4 7

2 67 68
4 3
4 39 41
13 15
11 65 51
6 61 101
- 15 16
- 7 4
- 3 6
- 2 2
- 12 15
3 11 7
1 1 2
- 1 5
- 12 23
- 1 1
1 10 17

- 6 6
- 1 2
- 30 10
- 23 2


mB/ Ay o
21 41 1
142 309 49
9 16 -
1 -
25 29 -
149 242 1
52 92 -
4 7 1
8 12 1
94 195 5
4 4 -
2 3 -
369 ,'12 1
33 47 -
425 516 3
10 33 -
146 177 2
261 469 25
34 41 -
28 30 -
14 26 -
1 -
81 154 1
67 121 1
11 12 -
3 15 -
33 63 1
4 3 -
40 41 -
11 21 -
2

85 29 1
45 2 17


82
527
36
2
62
456
177
15
38
321
19
5
817
87
1024
71
441
917
106
69
49
5
263
207
26
24
132
9
108
35
14
3
155
89


Clinio Priv,
or I 1
Ihst.s


yju Aj -32
3 79 4
414 113 113
1 35 5
2 -
5 57 6
7 449 18
13 164 8
15 1
34 4 1
302 19 11
1 18 -
5 -
794 23 26
87 3
516 503 83
2 69 4
184 257 92
767 150 67
5 101 3
1 68 3
3 46 7
1 4 1
2 261 13
7 200 60
3 23 2
1 23 2
99 33 48
9 -
11 97 8
33 2 29
2 12 -
S 3 -3
155 52
83 6 18


By Age Groups


0- 0- 20- 30- 40- 50-
9 19 29 39 49 ovor
12


o/ -y2 -A'IV 3;I %U
7 29 24 13 5
75 222 82 26 9
3 15 5 6 2
1 1 -
3 18 23 11 1
56 173 121 49 39
19 64 57 22 7
3 5 3 3 -
3 15 8 8 3
25 118 96 38 33
8 7 3 1 -
- 3 2
62 342 218 109 60
6 25 21 13 19
89 380 261 139 72.
4 30 20 10 3
36 140 89 51 33
79 332 261 113 65
9 36 26 20 12
3 20 21 13 9
3 20 7 7 5
- 3 1--
19 116 64 34 17
15 60 40 21 11
2 6 10 3 3
4 10 3 5 -
7 45 20 10 2
- 7 1
7 40 22 20 11
- 1 3 1 1
5 2 .3 3 1
1 1 1 -
10 9 31 24 29
1 29 22 10 9


-/;
82
527
3
2
62
456
177
15
38
321
19
5
817
87
1024
71
441


69
49
5
26,
207
26
24
132
9
108
35
14
3
155
89


'lorida 938 1026 1998 1680 2561 ::243 223 413


10884 1 966 105.2 3 1943 1915 659 9266 276 19966 12435 7531 1715 2021 7500 4915 23I 1434 19966


Rates based on 1940 census population by races not available yet.
- Counties having full-time health services.


ountv I


--





r- L


L~ 1


.











TUBERCULOSIS


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







During the first half of the year the Division of Tuberculosis
supervised the activities of the original mobile x-ray unit in several
organized counties which had been scheduled for the x-ray program pre-
viously. The program included radiography of the chests of individuals
from the following susceptible groups:

1. Indigent contacts
2. Indigent suspected cases
3. Cases referred by local physicians
4. Relief families, low income groups,
families of those unemployed, and
unemployables
5. Negroes
6. Transients

The program produced the following results:

BROWARD COUNTY. X-ray interpretations reported April 29. There
were '1,727 individuals who were given chest x-ray examinations.
Of these, 343 plates were unsatisfactory due to fluctuation of
current. Of the 1,384 satisfactory plates, 30 showed evidence
suggestive of active tuberculosis. This gives a percentage of
2.16, which is most encouraging, as it proves that this program
is a very efficient case-finder and that we have selected the
proper groups for investigation. In other words, the result justi-
fies the effort and shovs how much more efficient this program
among contacts, suspects and relief families is, as compared to
the former program among school groups as well as indigent con-
tacts and suspects. Of the 30 active tuberculous cases, 25
(83.3%) were in the minimal state; 3 (10%) in the moderately ad-
vanced stage, and 2 (6.7%) in the far advanced stage. This high
percentage (83.3%) of cases discovered in the early stage is a
direct compliment to the Director for selecting the proper in-
dividuals for this study.

Of the remaining pathological cases, there were 3 showing
suspicion of tuberculous lesions, 2 with healed tuberculous









pathology, 2 with bronchiectasis, and one child with pneumonic con-
solidation. There were also 3 cases showing aortic or cardiac path-
ology alone, and 2 with pleurisy with effusion.

BAY COUNTY. April 29. In all, 1,290 individuals received x-ray
examinations of their chests. Of these, 166 were unsatisfactory
plates. Consequently, we shall have to figure our statistics from
the 1,124 plates which were satisfactory for interpretation. Of
this, there were six cases of active pulmonary tuberculosis. In
uthor nords, 0.52% of the persons x-rayed showed active tubercu-
losis. This is a rather low figure for relief groups, as in the
other counties we have found from 1.5% to 4% of relief peoples with
tuberculosis, although they were apparently healthy individuals.
Of the active tuberculous cases, 2 (33.3%) were in the minimal
stage and 4 (66.6%) in the moderately advanced stage. There were
none who could be classified in the far advanced stage. Of the
other individuals with x-ray pathology, there were 4 cases with
pronounced cardiovascular lesions that is, either an enlarged
aortic or cardiac shadow. There were also 3 cases which showed
x-ray evidence of healed pulmonary tuberculosis, 1 case of pneu-
monitis and 1 of a residual pneumonia.

ORANGE COUNTY. May 6. In all, there were 585 individuals who re-
ceived x-ray examinations of their chests. There were 47 unsatis-
factory plates among them, which leaves 538 plates which were sat-
isfactory for interpretation. Of the 538 plates there were 12
showing evidence of tuberculosis, of which five were in the minimal
stage, five in the moderately advanced stage and two in the healed
or healing stage. There was also one case suggestive of bronchiec-
tasis, one with a pleural effusion, one suspicious for a basal le-
sion, and three with cardiovascular pathology. Actually, in all,
there were 10 cases showing active tuberculosis, or 1.8% of the
total x-rayed. Of the active cases of tuberculosis, 50% were dis-
covered in the minimal state and 50% in the moderately advanced
stage.

LAKE COUNTY. May 10. In all, there were 212 individuals who re-
ceived x-ray examinations of their chests. Among these, there were
25 unsatisfactory plates, which leaves 187 plates satisfactory for
interpretation. Of these, there were two which showed evidence of
active pulmonary tuberculosis, both in the moderately advanced stage.
Among the films showing lung pathology there were the following:
One case suggestive of bronchiectasis, one case of pleural thicken-
ing with pneumothorax, one case suspicious for tuberculosis but re-
quiring further study before arriving at a definite diagnosis.
There was a large percentage of cases showing cardiovascular path-
ology 21 individuals had x-ray evidence of enlarged aortic and
cardiac shadows. The above concerns the Harry-Anna Home.











PINELLAS COUNTY. There were 1,988 individuals who received x-ray exam-
inations. There were 250 unsatisfactory plates, which leaves 1,738
plates for satisfactory interpretation. Of this number, there were 38
cases with x-ray evidence which was suggestive of pulmonary tuberculosis.
Of these, there were 3 cases which appeared healed. There were 35 (2.02%)
of total x-rayed which appeared to be active cases of tuberculosis. The
active cases were distributed as follows:

Minimal cases 19 (55.28% of total active cases)
Moderately advanced 13 (37.14%)
Far advanced 3 (8.58%)

Among the other films exhibiting pathology, there were 4 cases
which were suggestive of bronchiectasis, 3 cases with cardiovascular
pathology, 3 with some mediastinal mass, 2 cases suggestive of lung
abscess, 2 cases suggestive of benign tumor of the pleura 1 case
suggestive of bronchogenic carcinoma, 1 case suggestive of a resolving
central pneumonia, and 1 true dextracardiac. One of the cases with an
enlarged heart also exhibited pulmonary tuberculosis and another with
a pathological heart revealed an aortic aneurysm.

The percentage.of cases found among the total number x-rayed is
2.02%, which is extraordinarily good and which proves the effectiveness
of this program as a case-finding method.

LAKE COUNTY. There were 931 individuals who were given x-ray examina-
tion. Of this group, 106 had unsatisfactory phest films. Of the 825
persons with satisfactory plates, there were 23 showing lung pathology.
Of the 23 cases showing pathology, 18 (2.17% of total) showed evidence
of active tuberculosis. This is a rather high percentage and proves
the efficiency of this type of case-finding procedure. It also points
out the fact that the relief group is one of the best groups in which
to seek pulmonary tuberculosis.

The remaining pathological films include one apparently arrested
case of tuberculosis; one case showing pneunothorax, which may be spon-
taneous but probably tuberculous; one showing bronchiectasis and tro
with enlarged hearts.

Of the 18 films suggesting active tuberculosis, 12 (66.6%)
showed early lesions, and 6 (33.3%) showed advanced lesions. This
high percentage of early lesions proves that this case-finding medium
will discover the early, curable cases.

MONROE COUNTY. There were 689 individuals who received x-ray examina-
tions of the chest. Of these, 7 showed pulmonary lesions suggestive
of active tuberculosis, 2 with pulmonary lesions which may be considered
suspiciously tuberculous, and 1 case with an apparently arrested tuber-
culous lesion. The efficiency of this early case-finding program is









proved by the fact that 1.09% of the entire group investigated showed
active pulmonary tuberculosis. This also points out the fact that the
relief group is the proper group upon which to concentrate an early
case-finding campaign. Among the active cases of tuberculosis there
are two with minimal lesions and five with moderately advanced lesions.

HIGHLANDS COUNTY. In all, 170 persons received x-ray examinations of
their chests, of which 32 films were unsatisfactory. On the basis of
the 138 satisfactory films, there were a number which showed pathology
on x-ray examination. Of the films showing pathology, there were 6
with active pulmonary tuberculosis and 1 suspicious for tuberculosis,
or, 5.1% of the total x-rayed. This is a very high figure and proves
that we selected the proper group for this investigation. It also
points out that these relief peoples are certainly the ones who should
be investigated for tuberculosis. Of the 6 cases with definite tuber-
culosis on x-ray, 2 were in the minimal stage (33), 2 in the moderately
advanced stage, and 2 in the far advanced stage. Among the others show-
ing pathology, there wero 14 plates showing cardiovascular pathology, in-
cluding 1 with a definite aortic aneurysm. Among the unsatisfactory
plates, there were 2 which were suspicious for cardiovascular pathology.
There were also 2 cases showing evidence of bronchiectasis and 1 with
marked emphysema.

H3BDRY COUNTY. There were 130 people who received x-ray examinations
of their chests, of which 11 were unsatisfactory. Of the 119 satis-
factory films there were a number with pathology. Of these, 4 showed
active pulmonary tuberculosis, including one which had an associated
condition which appears very much like a bronchogenic carcinoma. This
gives us a total of 3.3% of the total number of individuals x-rayed.
This is also a comparatively high percentage of cases of tuberculosis
discovered among susceptible groups. All four cases of tuberculosis
were in the minimal stage. The other cases showing pathology include
three cases with possible cardiovascular disease.

FRANKLIN AND GULF COUNTIES. In all, 485 individuals received examina-
tions of their chests, of which 44 plates were unsatisfactory for in-
terpretations. Of the 441 plates which were satisfactory, there were
25 individuals who showed pathology on x-ray examination. Among these
25 were 6 cases of active pulmonary tuberculosis (1.1% of total x-rayed),
of which one was in the far advanced stage (10%), one in the moderately
advanced stage (10%) and 4 in the minimal stage (80%). Those with min-
imal tuberculous lesions prove that this program is not only an efficient
case-finder, but most valuable as it discovers the case in the early cur-
able stage this is proved by the 80% of cases in the minimal stage.
One of the minimal tuberculous cases is a rather interesting one, as it
is a progressive primary tuberculosis. The remaining pathology plates
include the following; one childhood type tuberculosis with enlarged
hilar glands, one possible bronchogenic carcinoma, one possible lung











abscess following an old empyema, two cases of arrested pulmonary tub-
erculosis, one case of chronic pneumonitis following an old empyema,
one case of calcified pleura and one case showing some mass in the medi-
astinum, which requires further study. There were also eleven cases
showing enlarged aortic and cardiac shadows suggestive of cardiovascular
disease. One of them was an unsatisfactory plate which should be re-
checked.

GADSDDE COUNTY. In all, 228 individuals received x-ray examinations of
their chests in this county. Of these, there remain 12 films yet to be
developed and reported upon and there were also 43 plates which were un-
satisfactory for interpretation. This leaves 173 films which were sat-
isfactory for reading. Of these, there were 11 cases (approximately
6.3% of the total number x-rayed) showing tuberculous pathology. Four
of these cases were in the minimal stage, three in the moderately ad-
vanced stage and four in the far advanced stage. The other patholog-
ical films were distributed as follows: two with bronchiectasis, four
with pleural adhesions, one with pleural effusion, and two with definite
evidence of cardiovascular disease. Two cases with evidence of non-
tuberculous pathology are included among the unsatisfactory films.

The Division cooperated with the State Welfare Board by inaugur-
ating a program of tuberculin testing and x-ray examinations where
necessary at each institution for children under the supervision of
the Welfare Board. This program was carried out with the hope that
this activity would stimulate each institution to make tuberculin
testing and x-ray examination of the inmates and the adult staffs a
routine procedure repeated annually. Some of the institutions were:

FLORIDA MTHODIST HOME Enterprise, Florida. May 1. In all
166 individuals received x-ray examinations of their chests. Of
this group there were 16 x-ray plates which were unsatisfactory.
None of the x-ray plates showed evidence of a tuberculous lesion.
There was one plate which showed a pathological lesion enlarged
cardiac shadow.

CHILDREN'S INSTITUTIONS Orange County, May 6. There were three
such institutions under the supervision of the State Welfare Board.
The results of the study are included in the report on Orange County
mentioned above.

CHILDRET'S INSTITUTIONS Lake County, May 10. There were three
such institutions under the supervision of the State Welfare Board.
The results of the study are included in the report on Lake County
mentioned above.

FLORIDA BAPTIST HOME Arcadia, Florida. In all, there were 153
individuals who received x-ray examinations of their chests, of









which 5 plates were unsatisfactory for reading. Of the 148
satisfactory plates, there were 6 cases which showed evidence
of some pathological lesion. Of those showing pathology, 2
showed definitely active pulmonary tuberculosis, both of which
were in the moderately advanced stage and 1 under pneumothorax
therapy. There were two cases which were very suspicious for
early tuberculosis and which require further study. There was
also one case of tuberculosis which appeared to be arrested and
which was under pneumothorax control; and one case showed evi-
dence of some cardiovascular pathology.

ODDFELLOWS' HOME FOR CHILDREN Gainesville, Florida. In all,
35 individuals received x-ray examinations of their chests, of
which 3 had unsatisfactory x-ray films. This leaves 32 films
which were satisfactory for interpretation. Among the films
that were satisfactory for interpretation there were 13 which
showed evidence of some pathologic condition. However, there
was not a single definite case of pulmonary tuberculosis, al-
though there was one which showed bronchiectatic changes, with
the possibility of an old productive tuberculous lesion assoc-
iated with it. There were two other individuals who showed def-
inite evidence of bronchiectasis and there were also five cases
with emphysematous changes. There were five cases which showed
enlarged aortic or cardiac shadows suggestive of cardiovascular
pathology which require further observation and study. The fact
that so many of these individuals were along in years explains
the bronchiectatic and emphysematous changes and to some extent
the generalized fibrosis and enlarged aortic and cardiac shadows.
It is interesting to note that none of the children showed any
abnormal lung condition.

CHILDREN'S INSTITUTIONS Pinellas County. In all, 51 individ-
uals received x-ray examinations of their chests, of which 2
had plates which were unsatisfactory for interpretation. Among
the 49 plates satisfactory for interpretation, there were 6 show-
ing some pathologic change. There were 3 cases which showed em-
physematous changes, 1 case with marked fibrosis and diaphrag-
matic adhesions, 1 case with enlarged aortic and cardiac shadows
suggestive of cardiovascular disease, and one case of true dex-
tracardia with the heart turned to the right and the liver on
the left, etc. The fact that there were so many individuals of
advanced age included in the study explains the relatively high
frequency of emphysematous and fibrotic changes in the lung
fields. It is interesting to note that there was not a single
case of tuberculosis among the children or the adults of these
institutions.

A tuberculosis case-finding program consisting of tuberculin test-
ing and x-ray examinations was inaugurated in several of the state in-
stitutions and Negro colleges. They are as follows:









BETHCUN 00-COO COLLEGE Daytona Beach, Florida. April 22. It
was rather surprising to find not a single case among the students
of this institution, although 310 of than received x-ray examina-
tions of their chests. Of the 310 individuals x-rayed, there were
26 with unsatisfactory plates. These should be re-x-rayed. The
remaining 284 individuals had negative plates, as there was no
lung pathology at all. It was unfortunate that only one or two of
the adult staff of the institution presented themselves for x-ray
examinations. It is customary to find more tuberculosis among
adults than in children. I was quite eager to have the teachers
and other employees of the institution included in this investiga-
tion. I also regret the fact that Negro contacts outside the in-
stitution were not included, although I suggested that this be
done. However, I hope that this x-ray survey will stimulate a
program of tuberculin testing and x-ray examinations annually at
the Bethuno-Cookman College. To encourage such a program tubercu-
lin will be supplied and x-ray examinations will be made available
in the future. However, it would be advisable to extend the in-
vestigation to indigent Negro contacts in the county and to every
adult connected with the institution.

FLORIDA NEGRO NORMAL AND INDUSTRIAL COLLEGE St. Augustine, Florida.
April 25. There were 38 Negroes who received x-ray examinations.
This is a very small percentage of the population of such an insti-
tution as the Florida Negro Normal and Industrial College. Of this
group, 24 individuals were negative, as their x-ray films showed no
pathology. Eight individuals had unsatisfactory x-ray films and
should be rechecked by the x-ray. Of the entire group x-rayed,
there were three who showed pathology on the x-ray film suggestive
of pulmonary tuberculosis; two of them in the minimal stage and one
far advanced.

The cooperation received from the Negro colleges was quite disap-
pointing, despite the fact that the Negro physicians who directed the
medical activities of these institutions were supplied with tuberculin
and were given every assistance possible. It was hoped that better re-
sults would be obtained if the Negro physicians carried out this program
on their own, without interference from an individual not of their race.

STATE SCHOOL FOR THE DEAF AND BLIND (White), St. Augustine, Florida.
Of the 70 individuals connected with the institutions, 57 were nega-
tive (showed no x-ray pathology at all). There were 12 unsatisfac-
tory plates (these should be re-x-rayed). Of the entire group,
there was only one individual with x-ray pathology suggestive of a
minimal tuberculosis a Negro laborer employed by the institution,
who also showed cardiovascular pathology. At such an institution
as the Florida School for the Deaf and Blind, it is usual to find
a few unknown cases of early tuberculosis. However, it is a pleasant









finding that there was not a single case either among the children
or among the teachers. I trust that this Division has been of some
benefit .to the institution and that the. x.ray survey will initiate
a program of routine tuberculin testing and x-ray examination on an
annual basis.

FLORIDA INDUSTRIAL SCHOOL FOR GIRLS (White), Ocala, Florida. In all,
116 individuals received x-ray examinations of their chests, of which,
7 had unsatisfactory films. This leaves 109 films which were satis-
factory for interpretation and among these there was only 1 case
which showed any abnormality of a pathological nature that is, a
57 year old white female who showed an enlarged aortic and cardiac
shadow suggestive of possible cardiovascular disease. These x-ray
findings cannot be taken as a definite diagnosis until further ob-
servation and study corroborate the findings. There was not a single
case of tuberculosis to be found among the girls or the adult em-
ployees who were included in the study. This study was carried out
in the hope that local authorities would inaugurate a program of
chest x-rays with or without preliminary testing annually.

FLORIDA STATE PRISON, Raiford, Florida. Of 1,141 convicts radio-
graphed, there were 31 with films which were unsatisfactory for in-
terpretation. Of 1,110 satisfactory chest films, there were 40
which showed lung pathology; among which are included 8 cases ac-
tive pulmonary tuberculosis, minimal stage, 4 moderately advanced
stage and 2 far advanced stage: 7 cases suspicious of active pul-
monary tuberculosis, 6 cases healed pulmonary tuberculosis, 1 case
artificial pneumothorax, 3 cases pleuritis, 2 cases calcified pleural
plaques, 1 case gunshot wound of chest with pleural effusion, 1 case
bronchiectasis, 2 cases cardiovascular pathology, 2 cases congenital
cystic disease of the lung or emphysematous bullae, and 1 case pul-
monary abscess, or basal tuberculosis with large cavity.

During the entire year over 10,000 individuals have been radiographed
by means of the x-ray unit of this Division. There were 2.44% who were
discovered as having active pulmonary tuberculosis; over 60% were found
with the disease in the minimal stage. The fact that the case-finding
program among susceptible groups revealed 2.44% of active cases, as com-
pared to 0.334 found among the school groups formerly, proves that the
change in the state-wide antituberculosis program of this Division is
justifiable. Preliminary tuberculin testing was requested by the Direc-
tor of the Division only in the case of children from susceptible groups
under sixteen years of age.

A comparative study made by the Director of the Division in Tampa
recently, proved that the Vollmer Patch Test was even more accurate and
just as sensitive as PPD tuberculin (both strengths). This result con-
forms with the favorable reports which have been circulated in the lit-









erature recently. For these reasons and for the cake of economy, it
was recommended that county health officers employ the patch test
rather than PPD in their testing programs. The reliability of tuber-
culin has been questioned and the standardization of the tuberculins
on the market today has been proved to be imperfect as shown in a re-
cent study by Lumsden and Dearing of the United States Public Health
Service. These findings coincide with the experience of this Division.

Mobile X-Ray Unit

During 1940 the activities of the Division of Tuberculosis were
concentrated upon building a new mobile x-ray unit by means of which
mass radiography could be done, using miniature films. Miniature radio-
graphy had become the most popular and the most economical method of
radiographing large groups of the population. It reduced the cost of
an x-ray film so appreciably that it permitted x-ray films to be made
available to larger groups of individuals than ever before.

For the past four years the Division of Tuberculosis had been em-
ploying the Powers Rapid X-ray Unit with paper film in rolls of 100.
By using this method the cost of an x-ray film equalled approximately
40 cents as compared to 60 cents for the standard size celluloid film.
By using the original mobile x-ray unit, approximately 50,000 individ-
uals had received x-ray films of their chests. However, this method
of radiography had several distinct disadvantages which were as follows:

1.Developed films had to be sent to Long Island, New York, for
developing, which necessitated a delay of two or three months
before the films could be interpreted and reported to local
health officers. In addition, the cost of transporting these
films became an expensive matter.

2. The paper film failed to reveal subminimal apical lesions of
the lung, so that it frequently became necessary to repeat the
x-ray study of certain individuals.

3. In inclement weather, individuals to be radiographed were ex-
posed to colds because it was necessary for them to walk from a
public building where they had stripped to the waist, to a room
in which the radiographic equipment had been set up.

4. With the original unit it was necessary to unload two tons of
x-ray equipment and then to load this apparatus on the truck again
when the work was completed.

5. It was necessary to obtain energy for the x-ray machine from
local supply companies. Frequently the local power supply company
would refuse to make the necessary alterations in the power lines









without charge or without receiving permission from higher author-
ities, which frequently caused unnecessary delay.

6. There was a loss of approximately 10% of the x-ray films due
to drop in line current and to fluctuation of the current.

7. When the various costs which accrued due to transportation of
films, alteration of power lines, etc., were added to the cost of
the films, the total amount equalled that of standard size cellu-
loid films.

For these reasons the Division of Tuberculosis decided to develop
an x-ray unit which would eliminate these problems and give more econ-
ony and even more satisfactory service. An order was placed with the
General Electric X-ray Company in Chicago for a photo-roentgenographic
unit which would permit 4" x 5" miniature x-ray films to be taken. How-
ever, the Company informed the Division that the Army had placed orders
for over 100 similar units so that this Division's order could not be
filled for at least one year.

Thereupon, the Director of the Division and the x-ray technician
studied the literature on miniature x-ray apparatus and after nany
months of trial and error, finally developed a photo-roontgenographic
unit for taking 35 nm.niniatures. The present mobile x-ray unit con-
sists of a trailer-truck 33 feet in length, which is hauled by the
original truck which had been cut into a cab for that purpose. The
trailer is divided into three compartments. The rear compartment con-
tains a generator which energizes the x-ray machine and supplies the
power needed for lights, cooling system, etc. The front compartment
contains seven dressing rooms and a developing room. The dressing
rooms are used only in inclement weather. The developing room is used
by the x-ray technician for testing x-ray films to be sure that they
are satisfactory. In the middle compartment there is a 200 n.a.
Keleket X-ray machine and the 35 am.photo-roentgen unit. This is the
compartment which the individual enters through a door in one wall and
leaves through a door on the opposite side. In addition there are fre-
quency meters, tachometers, a motor for running the generator, etc.

The photo-roentgen unit is of original design and wholly the re-
sult of our own ingenuity. It consists of pryanidal metal light-proof
box with a Patterson fluorazure screen at the large end and a Leica
camera at the smaller end with an F:1.5 lens. The film which has been
found most satisfactory is the Eastman Fluorographic film.

Miniature Radiography

Miniature radiography consists of photographing a fluorescent image
of the chest. In order to arrive at a proper technic, frequent experi-
nentation was required. The standard technic which we employ for 35 mm.









miniatures is 100 m.a., 3/20 sec., time, and a kilovoltage between 75
and 95, depending upon the thickness of the individual's chest. The
tube screen distance is thirty inches and the distance between the
screen and the film is thirty-four inches. A rotating anode tube is
employed which has a 1.2 focal spot. A method of identification has
been developed by means of which the name of the individual, the number
of the film, and all other pertinent information is photographed along
with the chest. The identifying mechanism is set in the lower panel of
the photo-roentgen unit below the angle of view so that when it is light-
ed by a separate relay, it does not interfere with the fluorescent image
of the chest.

The mobile -ray unit was completed in December 1940 after six
months work. It will go into action according to a schedule of county
visits which has been prepared for the first six months of 1941. By
this method the cost of an x-ray film of the chest has been reduced to
approximately 2 cents per exposure, which includes the cost of develop-
ing the film. A method of reporting positive cases to the local health
officer and the local physicians has been evolved which consists of a
report card containing the x-ray interpretation and the miniature x-ray
film itself mounted on the card. This will enable the local physician
to tell his patient about the x-ray findings and to study the film it-
self.

Selective Service

Although the chief activity of the Division of Tuberculosis was
concerned with the mobile x-ray unit, a program was formulated with the
cooperation of the State Selective Service which concerns the selectees
in Florida called for military service. After frequent conferences with
Selective Service authorities, it was agreed that all cases among selec-
tees diagnosed or suspected as tuberculous before the local draft boards
or at the induction centers would be reported to the Division of Tuber-
culosis. The Division would keep an active register of these cases and
would forward this information to the health unit in the county of which
the selectee was a resident. The county health unit will be requested
to initiate follow-up investigation and to report this information peri-
odically to the Division so that the Selective Service Board might be
informed of the disposition of each recruit rejected for tuberculosis.
Up to the present time, over twenty recruits have been reported and
followed-up. The x-ray facilities of the Division have been made avail-
able to the Selective Service Board.

School Employees

As a result of a number of conferences between health and education
authorities, it was recommended that school employees be required to have
an annual medical examination which must include an x-ray film of the
chest. For the next two years it was decided that each county work out









its own method. The physical-examination forms, laboratory reports and
chest film of each school employeeare to be sent to the Division of Tub-
erculosis for examination. Upon approval, the Director is to issue a
health certificate so that the school employee may be awarded a contract.
During the latter part of 1940, over 300 school employees have been a-
warded health certificates by the Division of Tuberculosis.

% ray Interpretation Service

Following the recommendation of the American Public Health Associa-
tion, the additional service of x-ray interpretation was offered to health
agencies and to physicians throughout the state by the Division of Tuber-
culosis. Special forms are distributed to physicians for this purpose.
When the films are interpreted by the Director of the Division, they are
returned with the x-ray interpretation.

During the latter part of 1940 over 200 films from health departments
and private physicians have been interpreted.

Study of Miniature X-rays

This Division assisted Dr. Dearing of the United States Public
Health Service in his study of 35mm. miniature mass radiography. The
results of the study were very favorable to miniature x-rays and were
published in PUBLIC HEALTH IRPORTS, Volume 55, Number 52, December 27,
1940, pp. 2369-2376. Credit was given to this Division and special
mention made of our work. This Division cooperated with United States
Public Health Service workers in an effort to determine the incidence
of calcified lesions of the chest in reactors and nonreactors to tuber-
culin, and the frequency of calcified lesions in the chests of children
living in the limestone districts of Florida.

The second annual symposium on tuberculosis was organized for
health officers at the State Tuberculosis Sanatorium. A series of
courses lasting three days was presented in December 1940. The maj-
ority of health officers throughout the state attended.











MALARIA


L. L. Parks, M. D., Director



The Malaria Division was organized January 1940, with a Malari-
ologist and two engineers. The Division was a cooperative one in that
the engineers worked jointly with malaria control and also with other
engineering problems.

Spleen Surveys

The Malariologist devoted about five months of his time to making
spleen and blood slide examinations in counties that had a local health
unit. His remaining time was spent in the Bureau of Local Health Ser-
vice. During this period the following counties were surveyed and a
summary of the examinations made are as follows:

Counties Number Percent Number Blood Number
Children Positive Parasite Tests Positive
Examined

Jackson 1619 20.1 608 6
Gadsden 109 7.3 28 0
Leon 1072 11.7 318 0
Lake 459 4.5 114 0
Marion 325 9.2 82 0
Taylor 519 12.0 15 0
Gulf 218 7.3 56 o
Franklin 243 8.6 63 0
Levy-Gilchrist 1838 4.1 360 0

Total Examinations 6402

The object of these surveys was to teach the local health officers
how to make spleen surveys. Through these eurveys the homes of the
children with enlarged spleens were located and the malaria mosquito
breeding places. Having found the malaria mosquito breeding places ef-
forts were then made to work up control measures such as drainage,
ditching, screening and other procedures.

Control measures of this nature were rather limited during the
year. Projects are under way in only six counties and more emphasis
needs to be placed on malaria control in many counties.

It is desired that the local health officer devote a small part





38



of his time especially in the months of October, November, and December
in surveys and from this a basis can be made as to the amount of malaria
and the extent of the malaria problems in each county.

This report does not refer to the malaria Demonstration Program
that is being carried on in Escambia County by the county, city of
Pensacola, the at'te Board of Health and the Rockefeller Foundation.











MALARIA RESEARCH


Mark F. Boyd, M. D., Director


A. Completed studies and papers:

In the period under review, manuscripts with the following

titles have been submitted to the home office.

91) Mark F. Boyd, S. F. Kitchen and C. B. Matthews. "On the

natural transmission of infection from patients concurrently infected

with two strains of Plasmodium vivax."

92) Mark F. Boyd and H. 0. Proske. "Observations on the Blood

Proteins during Malaria Infections."

93) Mark F. Boyd. "Observations on naturally and artificially

induced quartan malaria."

*94) Mark-F. Boyd. "Historical Introduction."

*95) Mark F. Boyd. "Malaria Symptomatology: General Considerat

96) Mark F. Boyd. "An Historical Sketch of the Prevalence of M

aria in North America."

*97) S. F. Kitchen. "The Morphology, Life Cycle and Physiology

Plasmodium falciparum."

*98) S. F. Kitchen. "Falciparum Malaria."

*99) S. F. Kitchen. "Quartan Malaria."

*100) S. F. Kitchen. "Blackwater Fcver."


ions".

al-


of









*101) Aimeo Wilcox and Lucile Logan. "Detection and Differential

Diagnoses of Malarial Parasites in the Schizogonous and Sporogenous

Cycles."


Paper 92 was prepared in collaboration with Mr. H. 0. Proske

of the Central Hygienic Laboratory, Health and Safety Division, Tennessee

Valley Authority, Wilson Dam, Alabama. Paper 101 was prepared in collab-

oration with Miss Aimee Wilcox, Assistant Technologist, Malaria Investi-

gations, National Institute of Health, Washington, D. C. The seven

papers marked with an asterisk (*) are reviews prepared for the Sympo-

sium on Malaria sponsored by Section N of the American Association for

the Advancement of Science, on from December 30 to January 1, 1941 at

Philadelphia, Pennsylvania.


B. Work in Progress:

1. Humoral Immunity:

In the report for the first semester it was mentioned that

experiments performed during that period in an attempt to demonstrate

parasiticidal antibodies in the serum of a hyperinmunized person had

given results which were either aberrant, or altogether negative.

In order to continue this work we are again hyperinauniz-

ing two convalescents from an infection with the McCoy strain of P.vivax.

2. Minimal infecting dose of trophozoites of P.vivax:

In 1939 we effected successful inocculation by as few as 10

trophozoites. An experiment designed to carry the dilution down to 3

trophozoites failed. We will return to the subject at the first oppor-









tunity.

3. Exflagellation:

Attempts to improve our technique for the demonstration of

exflagellation were resumed by Dr. Benbow. The method at present under

trial in these studies consists of exposure of the blood smears to an

atmosphere of carbon dioxide in desiccating chambers under conditions

of lowered temperature and increased humidity. Carbon dioxide ice was

used, thus providing an almost pure atmosphere of. carbon dioxide and

also affecting a decrease in the chamber temperature. The results of

these studies to date indicate an ability to demonstrate exflagellation

in a greater percentage of preparations than by former methods. The

studies are being continued at the present time.

4. Preservation of parasites by freezing:

The collection of strains of the different species of para-

sites is a matter of considerable interest, not only from the standpoint

of observing their pathogenicity, but in order to test their antigenic

similarity or dissimilarity, and ascertain whether characteristics can

be discovered which would permit of their morphological distinction. As

long as it is necessary to maintain these in patients there are decided

limitations, as to the number which can be preserved, as well as the in-

convenience caused to other projects as a consequence.

We have consequently become much interested in the possi-

bility of maintaining parasites by freezing at low temperatures as used

for viruses in the IHD laboratory at the Institute. We have spent much

time in an appraisal of facilities, and the dependability of arrangements.









As far as we have been able to determine without the use of a recording

thermometer, we apparently possess facilities which will dependably main-

tain a temperature of -700C in the intervals between weekly icings.

Our first trials using defibrinated blood containing various

species of parasites frozen for 2 weeks, did not result in any takes.

We expect to freeze heparinized blood as well as infected mosquitoes.

5. Aberrant inoculations:

We have attempted an inoculation by

a. rubbing mosquitoes from a heavily infected lot
into the skin of the antecubital space, and
b. administering mosquitoes from a heavily infected
lot eor os enclosed in a gelatine capsule.

The single trials to date have been negative.

6. Gametocyteless strains:

We are much interested in reports of reputedly gameto-

cyteless strains of parasites. Two years ago we secured a vivax strain

from the Mayo Clinic which was alleged to have this characteristic. We

infected mosquitoes and transmitted the infection to local patients by

their use and also sent infected mosquitoes back to Rochester. During

the past year we received from Cleveland, Ohio, another strain alleged

to be similarly deficient. We have infected mosquitoes with this strain

and transmitted the infection to local patients by their use.

7. Genetically pure line strains of A. quadrimaculatus.

The task of attempting to segregate and propagate pure line

strains of A. quadrimaculatus, obviously presents certain difficult tech-

nical problems, on the solution of which the attainment of the objective









appears to rest. It requires greater technical knowledge of entomology

than the regular station staff possesses. Since it appeared of a char-

acter suitable for a student who is a candidate for a doctorate, arrange-

ments were effected through Dr. John Creighton, Professor of Entomology

in the University of Florida, whereby a graduate student in that insti-

tution was appointed to a fellowship provided from the station funds,

and assigned to work on this problem. The incumbent is Mr. Jack C. Rus-

sell. According to the understanding reached with the university auth-

orities, Mr. Russell is required to spend the second semester at the

university, the balance of his tibo being spent at the station.

The first phase of this problem is the development of a tech-

nique whereby mating of individuals confined in small cages may be de-

pendably effected. While Mr. Russell has had some encouraging results

the dependable requisite has not as yet been satisfied.

We are at present utilizing not only our own strain of A. quad-

rimaculatus, but one which was locally isolated at Wilson Dam, Alabama

by the Tennessee Valley Authority staff.

8. Studies on Anopheles vestitipennis:

The station has been assisting Dr. H. P. Carr, Director of

the Malaria Commission of Cuba, in the prosecution of studies to oluci-

date the role of A. vestitipennis in the propagation of malaria in Cuba.

Miss Lucile Logan spent several weeks in Cuba dissecting anophelines

captured in the field, in a locality where this species was very abun-

dant. She dissected and examined the salivary glands of 1589 A. vestiti-

pennis, 126 A. crucians and 4 A. albimanus. The stomachs of 1000 vesti-





44


tipennis, 103 crucians and 3 albimanus were fixed and shipped to the

station for staining and examination. No glands were found infected,

and of the stomachs examined to date, all have been negative. A fur-

ther lot of 12 specimens, species unstated, which were fed on an in-

fected person, yielded 4 positive stomachs.

The final results have not as yet been reported to Dr. Carr.

9. The temperature of incubation of the sporogenous cycle of

P. falciprun.

As mentioned elsewhere the McCoy strain of P. vivax has

been carried through a series of 56 continuous and unbroken consecutive

anopheline human passages, without having experienced any serious risk

of a break in the continuity. We have not had comparable success with

our strains of P. falciparun. At times difficulties arise from a gam-

etocyte density insufficient to produce heavy infections in the mosqui-

toes, at others all inoculations are failures, even though the mosqui-

toes were demonstrably positive. These difficulties are the more glar-

ing when comparison is made with the McCoy strain. No explanation is

offered.

A possibility being investigated is the chance that our

customary practice of incubating the sporogenous cycle at 200C. may

perhaps be detrimental to the parasites.

10. Morphological differences of falciparum strains:

The study of possible strain differences in falciparum

gametocytes has been continued with the help of Miss Putnam. Statis-

tical analyses of data thus far available have been completed. Certain





45



significant results have been obtained and a method for taking smaller

but .adequate samples in an extension of the study has been devised.

11. Testing of synthetics:


pital,
ing of
casual
number


Dr. Rogers, the Medical Director of the Florida Stato Hos-
has granted permission for our facilities to be used in the test-
synthetic products, to ascertain whether they possess any merit as
prophylactics of malaria infection. We can carry on a limited
of such tests.


C. Malaria Therapy:

The inoculations made during the year on the malaria therapy

service of the Florida State Hospital, are shown below. Re-inoculation

for hypcr-innunization or cross immunity tests are included.


Status with P. vivax P.falciparum P.malariae
Class same species Takes Fail- Pend- Takes Fail- Pend- Takes Fail-PeR
parasite ure ing ure ing ure ing
Natural
inoc.
(sporozoites) Primary 27 9 5 10 16
Re-inoc.
after
previous
failure 1 1 1
Re-inoc.
after
previous
take
Artificial
inoc.
(trophozoites) Primary 30 15 42 2 1 12
Re-inoc.
after prev.
failure 6
Re-inoc.
after
prev. take 1 3 7
Total b5 27 5 bO 19 1 12 0 0









During this period, the use of the McCoy strain of P. vivax has

continued, being transmitted through passages 51 to 56 inclusive. The

Cuban strain of this species has been maintained at maintenance levels.

A new local strain, designated the "McDaniels" was secured from an

autochthonous local infection. We have also secured the strain thera-

peutically employed at the Cleveland City hospital, which we designate

as the "Ohio". The last two will be conserved temporarily.

We only succeeded in effecting two natural passages of the Long

strain of P. falciparum during the year, and its conservation necessi-

tated artificial inoculation. Gametocyte production has become unde-

pendable, while a large number of inoculations by infected mosquitoes

failed. The Mexican and Panamanian strains have been conserved by

artificial passage. We had opportunity to pick up three further strains

in territory adjacent to the hospital (Costa, Bynam and Harden strains),

whose antigenic identity has not yet been ascertained.

The Jones strain of P. malariae has been maintained at maintenance

level and in addition we acquired a local strain (Glisson strain).

It embarrasses us to attempt to carry such a number, and, unless

we can effect their preservation by freezing, we shall be obliged to

drop several.

During the year we have inoculated a total of 15 referred white

patients with the McCoy strain of P. vivax for practicing physicians.

One patient on arrival was found to be colored, and as a consequence

of unlikelihood of a take was refused inoculation'. A second colored

patient was admitted as a private patient to the hospital of the Florida









Agriculture and Mechanical College for inoculation .with quartan. The

results are pending.

Vivax infected quadrimaculatus have been furnished to the Psycho-

pathic Hospital of the University of Iowa. Quartan blood has also been

furnished to the Neurological service of the same institution, as well

as to the Rhode Island State Hospital.


D. Insectaries:

The colony of A. qundrimaculatus has been maintained in a

thriving condition. It was decided to discontinue the colony of A. puc-

tipennis as no use had been made of it for several years. The entire

colony, adults and larvae, were turned over to Dr. Raymond Laird of the

School of Hygiene, Johns Hopkins University, for further maintenance.

Several shipments of quadrimaculatus have been made to the United

States Public Health Service laboratories at Savannah, Georgia and Ccl-

unbia, South .Carolina.

With the addition of Mr. Jack Russell to the staff as graduate fel-

low, one of the insectaries was turned over to him for his exclusive use

in the prosecution of his problem. Mr. Russell's first concern is to

secure a line that will freely mate in small cages. In addition to our

own strain of A. quadrimaculatus, we have secured that established in

northern Alabama by the Tennessee Valley Authority.


E. Field Work:

No field work directly under the auspices of the station has

been conducted during the period.









F. Instruction:

During the year the following persons have spent one or more

weeks at the station for the purpose of receiving instruction in malar-

iology, viz:

Dr. L. L. Parks, Malariologist, Florida State Board of Health

Captain G. L. Orth, M. C., United States Army

Dr. C. T. Renn, Instructor Sanitary Engineering, Harvard.
University

Mrs. Evandro Chagas, Oswaldo Cruz Institute, Rio de Janeiro

Dr. J. H. Paul, IHD

Dr. and Mrs. R. B. Hill, IHD

Dr. Renn devoted the greater portion of his stay of two months

to an independent study of the surface film of water in relation to the

feeding habits of anophelines.

Mrs. Chagas, who expected to stay two months, returned abruptly

to Brazil on receiving news of the death of her husband.

The station collaborated with the department of zoology of

Florida State College for Women in the presentation of the course in

parasitology given in the second semester of 1939-1940 school year.

The assistance consisted in the giving of a series of 8 laboratory periods

of two hours each between February 6th and March 5th. The course was at-

tended by 9 students.

We have had the following visitors:

Dr. A. B. McCreary, State Health Officer, Florida
Dr. W. H. Pickott, Asst. State Health Officer, Florida
Dr. J. N. Patterson, Director of Laboratories, Florida State
Board of Health









Dr. L. L. Parks, Malariologist, Florida State Board of Health
Mr. Russell Broughman, Asst. Engineer, Florida State Board of
Health
Mr. A. C. Newman, Asst. Engineer, Florida State Board of Health
Dr. Barros Barreto, DNSP. Brazil
Mr. Martinez Marquez, Pan-m. San. Bureau
Dr. A. Fernandez, Havana, Cuba
Dr. Gordon Fair, Prof. Sanitary Engineering, Harvard University
Mr. J. L. Robertson, United States Public Health Service
Dr. Martin Young, United States Public Health Service
Mr. Knipling, United .States Bureau of Entomology
Dr. Dove, United States Bureau of Entomology
Dr. Summers, United States Bureau of Entomology
Dr. L. W. Hackett, I. D.
Dr. A. J. Warren, I.H.D.
Dr. W. A. McIntosh, I.H.D.
Dr. J. E. Elmendorf, I.H.D.
Dr. Bruce Wilson, I.H.D.
Miss Persis Putnam, I.H.D.
Dr. E. R. Rickafd, I.H.D
Dr. Justin Andrews, Georgia State Board of Health
Dr. Arthur Hill, Georgia State Board of Health
Dr. R. B. Watson, Tennessee Valley Authority
Mr. T. J. Brooks, Jr., University of North Carolina
Dr. Ralph Nauss, Cornell University Medical School
Dr. L. J. Graves, Health Officer, Leon County
Dr. F. M. Meader, Detroit, Michigan
Dr. M. E. Groover, Quitman,Georgia County Health Officer
Mr. J. A. Mulrennan, Pensacola
Mr. Jamieson, Eli Lilly Biological Laboratories
Mr. Hartshorne, Quincy Fullers Earth Company
Dr. James L. Massey, Quincy
Dr. M. M. Harrison, Bradenton, Florida
Miss Sybil Corbett, Jasper, Florida
Class of Dr. L. Lewis, Florida State College for Women
Mr. David Lee, Pensacola
G. Personnel:

1) Deaths.

Dr. Alban Stewart, Professor of Botany in the Florida State

College for Women, who since the station has been domiciled on the cam-

pus of the college has served as a liaisonfaculty committee to maintain


contact, died on June 1st.









Dr. Ralph Stevens, Medical Director of the Florida State

Hospital, died on June 7th.

2) Changes.

a) Dr H. ogers, physician on the staff of the Florida

State Hospital, succeeded to the position of Medical Director.

b) Dr. C. B. Matthews, physician on the staff of the Florida

State Hospital in charge of the malaria therapy service tendered his

resignation effective June 30th. We were given the privilege of making

a nomination for the place, and tendered the name of Dr. John T. Benbow,

a recent graduate of the University of Iowa, who entered upon his duties

July 1st.

c) Miss Florence Mason, technician in the laboratory of the

hospital, served us from January 1 to March 31, after which responei-

bility was transferred to Miss Henrietta Jacoby.

d) Mrs. Margaret Sauerbrun, technician at the station, ten-

dered her resignation effective December 31st. Mrs. Catherine Russell

began training December 1st, without pay for that month, in order to

qualify for this place.

e) The placo of Mr. Ben Bridges as insectary technician was

filled by the appointment of Mr. William Moody on July 1st.

f) The extra-mural fellowship in entomology established in

cooperation with the University of Florida, was on nomination of Dr.

John Creighton, Professor of Entomology, filled by the appointment of

Mr. Jack Russell, a candidate for a doctorate, who entered upon the

fellowship September 23rd.









H. Travel, Consultation and Speaking:

As may be seen, 1940 has been a year of heavy travel. MFB was

absent from January 3 to March 13, on a consultation tour in Mexico,

Guatomala, Salvador, Panana and Haiti. Inasmuch as the diary submitted

covers all events of the trip, it need not be mentioned further.

Visits were made to the malaria control demonstration project

under the direction of Dr. Elmendorf in Escambia County on April 15 and

16, August 5 and 6, and'December 12 and 13.

MFB attended two conferences of persons interested in malaria

problems hold in Atlanta, Georgia, on May 1st and again on May 28th, on

call of Surgeon General Parran, United.States Public Health Service.

From the first conference he proceeded to Washington to attend by in-

vitation the meeting of the Pan-4merican National Directors of Health

from May 2 to 8. He gave a brief talk on malaria control in the coun-

tries of the Caribbean region at one session. He was appointed an ad-

visor to the Malaria Committee of the Pan-American Sanitary Bureau.

A visit was paid to Gainesville on May 24, to confer with

Professor Creighton and Dr. Tigert, President of the University, re

the fellowship project previously mentioned.

.On June 17 MFB left for Washington to attend a meeting of

the Subcommittee on Tropical Diseases of the National Research Council,

to which he had been appointed, and from Washington proceeded to Chicago

to attend a conference with Drs. Taliaferro, Huff and Coggeshall at the

University of Chicago. Further meetings of this subcommittee on July

30 and October 24 were also attended. In addition considerable work









has been done on assignments for the meetings, while-MPB has also been

made secretary of the subcommittee.

A visit was paid to Cuba from August 8 to August 21 to visit

the cooperative malaria control work under the direction of HPC. The

itinerary included not only Marianao but also Bayano and Santiago.

The field operations of the malaria control personnel of the

Tennessee Valley Authority were visited from September 16 to September

19, rapidly covering the territory between Wilson Dan and Chattanooga.

MFB also attended a meeting of the malaria consultants of the Tennessee

Valley Authority at Louisville, Kentucky on November 11.

In company with Dr. Justin Andrews of the Georgia Health De-

partment a visit was paid to the area in which field studies are being

prosecuted in Baker County, and to observe the installation of precast

ditch lining at Quitman, Georgia, on July 16 and 17,

MSB has further attended the following meetings:

a) National Malaria Committee and American Society of Tropi-
cal Medicine, Louisville, Kentucky, November 12-15.

b) Florida Public Health Association, Tampa, December 5-7.

c) Malaria Symposium of Section N, American Association for
the Advancement of Science, Philadelphia, Pennsylvania,
December 35-January 1. MFB was chairman of the committee
which arranged the program for this meeting, which com-
prised an enclyclopaodic review of knowledge in this field.
There were 45 papers presented by 43 contributors. The
latter meeting was also attended by SFK.

Miss Lucile Logan was authorized to proceed to Washington to

spend the week of June 23 with Miss A inee Wilcox of the National In-

stitute of Health to further the preparation of their paper for the sym-

posiun,









In furtherance of the cooperative study of the susceptibility

of A. vestitipennis, Miss Logan spent the period from August 31 to Oct-

ober 11 in Havana, Cuba, engaged in the dissection of mosquitoes.

Mention may also be made of two appearances of MEB before the

Leon County Board of Comnissioners on June 7 and 11, re appropriations

for the local health unit. He also spoke on malaria before the fresh-

man class at the Florida State College for Women at the request of Dr.

White, professor of hygiene.


I. Acknowledgements:

Relations with the authorities of the State Board of Health,

of the Florida State College for Wonen and of the Florida State Hos-

pital, continue as in the past, uniformly cordial. All possible op-

portunities for mutual assistance and cooperation are utilized.









PUBLIC HEALTH


Ruth E. Mettinger, R. N., Director







During the year 1940, the Bureau of Public Health Nursing
continued to carry on an educational program with the unit nurses by
having the state consultants visit units and conduct classes in their
specialized field as well as evaluate the nurses program.

The state consultants visit the county health units upon in-
vitation of the health officer, and from a week to a month is spent in
each unit depending upon the need. On the initial visit to a unit a
study was made covering the period from the beginning of the unit's es-
tablishment and the appraisal of the nursing service was worked out
following the outline of the American Public Health Association. This
gave the nurse a picture of her program and has been a guiding post in
balancing it accordingly. Each consultant applied her specialized ser-
vice to. the generalized program.

In units where clinics have been conducted daily, the consul-
tant urged a close coordination between home visits and unit activities;
and in order that there is a continuous service, home visiting was stress-
ed as an essential part of the service which comprises a family health
program.

Because reports and records assist the nurse to render a better
service to the individual family and community, a complete study of the
nurses' records was made by the consultants when visiting the units.
Stress was laid upon keeping the Family Folder which contains the indi-
vidual records of each case in the family, and which considers the family
as a group.

As it is imperative that nurses keep up with the changing
scene and carry on effectively the public health nursing program, edu-
cation and professional growth have continued to be one of the main
objectives of the Bureau of Public Health Nursing.

Twelve students were sent to Peabody College on Social Secur-
ity scholarships; and four wore sent to the University of Pennsylvania,
two of whom were sent for specialized course in tuberculosis and venereal
diseases, and the other two for the generalized five months' course.


NURSING









Eighteen nurses returned in June from William and Mary Col-
lege having completed their course in public health nursing. In Sep-
tember seven nurses were sent to William and Mary, and five nurses to
Peabody College. One nurse returned from Lobenstein with her certifi-
cate in Midwifery. The selection of the nurses sent was made on the
work they have done and their educational background. Two nurses not
meeting the professional background to matriculate at the universities
took postgraduate work at Charity Hospital, New Orleans, to make up
their deficiencies. Three nurses not completing their high school edu-
cation made this work up and received a diploma.

From the census which was taken on all public health nurses
employed by county health units, volunteer agencies, boards of educa-
tion and county commissioners, it was learned out of 168 nurses in the
state 112 met the minimum requirements, of which, 69 were employed in
county health units.

Lecture courses have been conducted by nurses on the State
Board of Health nursing staff at Orange General Hospital, St. Vincent's
Hospital and the State Hospital at Ghattahoocheo. These have been Ori-
entation courses in order to give the senior students at the hospitals
an opportunity to learn something about public health nursing.

A series of classes wore conducted by the State Board of
Health nursing consultants with the City Health Department of Jackson-
ville and the Duval County Health Unit nurses. The subjects discussed
were maternity and infancy, tuberculosis, venereal diseases and mid-
wifery.

Individual job analysis on every nurse employed by the state
were reviewed and submitted to the Bureau of Maternal and Child-Health
for the Merit System.

As a member of the committee meeting to study the questions
of placement service and vocational counseling as an activity of the
American Nurses Association, a visit was made to New York to meet with
this committee. Recommendations were drawn up and referred to the Amer-
ican Nurses Association to be given consideration at the biennial meet-
ing which was held in Philadelphia in May. The director and throe state
consultants attended the biennial convention the theme of which was
"Nursing in Democracy."

At the American Public Health Association meeting hold in
Detroit in October, an all day session was held with the state directors
at which time the Merit System was discussed.

At a roll call of the states each representative gave a two
minute progress report on the "Merit System as it Affects Public Health
Nurses in my state.*









The Florida State Nurses' Association held their annual con-
vention in Pensacola, November 4 through 6. Miss Ruth A. Heintzelman
from the Children's Bureau, Miss Donna Pearce from the United States
Public Health Service, Miss Margaret Munkley from the American Nurses*
Association, Miss Erma Holtzhausen front Vanderbilt University, Miss
Alice Duggar from the American Red Cross and Miss Mary DeLasky front
the American Red Cross were national visitors. At the Red Cross Ses-
sion, Miss Mary DeLasky said it was necessary to enroll 10,000 nurses
to meet the National Defense quota.

At the Florida Public Health Convention held in Tampa, Dece...
ber 5 through 7, individual conferences consumed a great deal of the
directors time. This solved many problems and saved many trips to
county health units.

Seventy white and 543 colored midwives were licensed. This
is an increase of 38 midwives in the state over 1939. Midwife neet-
ings are held nonthl;' by the unit nurses; in unorganized counties the
nurses employed by other agencies are asked to hold these midwife neet-
ings. The state midwife consultant has conducted classes with the nur-
ses in the technique of delivery and observed the nurses holding classes
with the midwives. The state colored midwife teacher graduated from
Lobenstein and has been assigned to two counties. Much more has been
accomplished by concentrating on one or two counties rather than visit-
ing six or seven counties.











MATERNAL AND CHILD HEALTH


William H. Ball, M.D., Director







The Bureau of Maternal and Child Health continued its general
program of the last year, whose general objectives were the extension
and improvement of public health services, the development of new
public health services for mothers and children. The activities were
carried on largely in counties having full time health departments
because only in organized units is there an established mechanism for
the supervision and follow-up of basic work.

During 1940 there were 25 counties with full-time services. This
represents an increase of 8 counties with an increase of 82 maternal
and child health conferences which were held at regularly scheduled
times and at least monthly. These conferences were held at many cen-
ters throughout the counties in those areas where the need was greatest.

In the interest of better services funds from the Children's Bu-
reau were furnished to many health departments for completely equip-
ping health centers for maternal and child health conferences. This
included the furnishing of weighing scales, gloves, forceps, sheets
and towels, blood pressure apparatus, stethoscope, etc. The work in
many of these conferences was observed from an administrative and
nursing standpoint and resulted in improved services rendered at these
centers.

At these centers 3,858 mothers and 4,757 children were given ade-
quate preventive services. An experiment in the anemias of pregnant
women and of children was undertaken as a demonstration of the value
of prophylactic administration of iron in the prevention of the devel-
opment of iron deficiency anemias.

In these health centers immunization against some contagious dis-
eases: diphtheria, smallpox, typhoid fever was routinely taught and
administered.

School Hygiene Program

Much progress was made in the development and in the education
for the new school hygiene program as adopted and recommended by the









State Department of Education and the State Board of Health. Many
physical examinations and x-rays were done of many school employees
of the few counties adopting this program.

Dental Hygiene Program

The Bureau of Maternal and Child Health contributed funds to the
Bureau of Dental Hygiene for the education and demonstration of dental
health, especially on maternal and child health patients. Several new
dental clinics were organized by local authorities in conjunction with
the local health department and dental society.

During the year 38 dentists were paid $3,949.37 for holding office
and dental clinics for corrective work of indigent mothers and children
referred by the health department.

Midwife Supervision

During the year a revised code for the control of midwives in this
state was formulated and adopted. This code is boing carried out, thus
elevating the standards of midwives. This department has a full-time
nurse-midwife and a nurse-midwife teacher who carries out individual in-
struction work for the midwife throughout the state. This midwife super-
visor made routine trips throughout the state, examining, teaching and
inspecting the work and technique used by these midwives and organizing
many regular classes for teaching midwife work. There are 620 licensed
midwives.

Post-Graduate Professional Education

During the past year the maternal and child health funds were con-
tributed to the post-graduate education committee of the Florida Medical
Society for furnishing lecturers in pediatrics and obstetrics at their
annual short course of post-graduate education. Seven physicians were
sent for a short course in pediatrics and obstetrics to the Southern
Pediatric Seminar and the Chicago Lying-In Hospital. Funds were contrib-
uted to aid the State Dental Society for furnishing short.clinical courses
in childrenls dentistry in various sections of the state

Twenty-one nurses were given scholarships to various nursing schools
in public health for rendering Florida registered nurses qualified for
public health nursing service.

Immunization for Preventable Diseases

In all the health conferences for infants, preschool and school
children the value of protection against preventable diseases was taught
and practiced. Thirty thousand three hundred and twenty-four children
were immunized against diphtheria and smallpox.









Maternal Mortality Survey

In.onjianmt1on.with.the maternal welfare committee of the Florida
Medical Association, two hundred and nine maternal deaths were inves-
tigated during 1940.

'Maternal and Child Health Hygiene Education

a. During the year lectures and talks were given throughout the
state by members of the State Board of Health and County Health Depart-
ments to many lay organizations on maternal and child health subjects.
These lectures were supplemented with motion pictures and exhibits.

b. Articles in news papers and magazines were published on ma-
ternal and child health and loose-leaf type of pamphlets were used in
individual instructions to the patients by the nurse. About 2,000
copies were distributed without cost to the health departments.

c. Mothers'classes on maternal and child hygiene were taught by
many health centers. Many public health nurses held hygiene classes at
schools and other organizations.

d. Members of the staff of the state and local health departments
were available and contributed to many special programs on health in
schools, organizations, universities and institutions.

Public Health Nursing Services

The Bureau contributed the services of 25 full-time, qualified
public health nurses to local health departments for aiding in carry-
ing out the home hygiene instructions and nursing program in the ma-
ternal and child health field. The services of a state nursing con-
sultant, midwife supervisor and teacher were furnished for consulta-
tion to many health departments and communities.

Consultation by Physicians

Through activities of the health departments physicians were paid
fees for consultation furnished to family physicians for indigent mater-
nal and child health patients.

Part-Time Services of PhybecUns and Dentists
in Health Conferences

One hundred and six physicians and thirty-eight dentists were paid
$15,749.71 in fees for contributing their medical and dental services
in the indigent maternal, infant, preschool 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 fur-
nished by the medical and dental societies.











DENTAL HEALTH


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







The 1940 budget and personnel of the Bureau of Dental Health was
virtually the same as in previous years and the program was conducted
with the same ultimate objective--PREVETION OF DENAL DISEASE THROUGH
EDUCATION.

During the year considerable effort was exerted in trying to es-
tablish some form of corrective program in the counties before insti-
tuting an educational program. Meetings were hold with county health
committees, health units, and members of the dental profession. Con-
tacts were made with county commission boards, school boards, parent-
teacher and other civic organization groups, as well as interested
individuals, to convince them of the necessity for a corrective program.

The Bureau endeavored to educate the laity on the principal that
no public health program can hope to be of maximum benefit in any con-
nunity until and unless provision is made for the care of the dental
indigents as well as the near dental indigents; also, that the care
of the indigent should not be assumed by state and Federal govern-
ments, or by the local dentists, but by the community as a whole.

The advancement of the educational program was furthered by the
close cooperation between this Bureau and the local, district, and
state dental societies, as well as the individual members of the den-
tal profession throughout the state.

Early in the year the Bureau made a survey of the dental pro-
fession in Florida to ascertain the approximate number practicing
children's dentistry and how many would be interested in attending
a refresher course in children's dentistry. Ninety-four percent ex-
pressed a desire for the course.

As a result, plans were consummated and carried out for Dr. Frank
C. Cady, Senior Dental Consultant of the United States Public Health
Service, Dr. Lon W. Morrey of the American Dental Association, and
Dr. J. A. Sinclair of Ashevillo, North Carolina, to present lectures,
clinics, and radio addresses on children's and preventive dentistry









at the annual meeting of the Florida State Dental Society. These
three men are nationally known and their contributions to the pro-
grams were of actual benefit toward the promotion of preventive or
public health dentistry in this state. The three clinicians, to-
gether with the Director, appeared on the program of the State Den-
tal Hygienists' annual meeting.

The Bureau of Dental Health had copies of Dr. John C. Brauer's
brochure, "Pedodontics--An Outline of a Postgraduate Course in Child-
ren's Dentistry," printed and distributed to the members of the dental
profession-both white and colored. Plans are being made to bring
Dr. Brauer to Florida to conduct a postgraduate course in childrenls
dentistry.

Definite arrangements were made for Dr. Walter J. Pelton, passed
Assistant Dental Surgeon, United States Public Health Service, to pre-
sent a refresher course in children's dentistry to each of the five
district dental society meetings in January, 1941. Dr. Pelton has done
outstanding work along this educational line in a number of states.
Plans are also being mrido for Dr. George W. Matthews of Alabama, Dr.
R. E. Sturdovant of Atlanta-Southern Dental College, Atlanta, Georgia,
Dr. Ralph Jarrett of North Carolina, and Dr. M. S. Jenkins of Virginia,
to give clinics and lectures at these meetings.

Speaker's Bureau

The Central District Dental Society and the Bureau of Dental
Health cooperated in the organization of a Speaker's Bureau on Public
Health Dentistry. Members of the Society volunteered to speak in the
schools in their localities and this Bureau sent out letters to all
school superintendents and school principals in the Central (Dental)
District telling them of the service, and acted as a clearing house
in the placement of the speakers. A number of requests were received
and the dentists responded willingly and effectively.

In the interest of public health dentistry, the Bureau of Dental
Health secured and mailed to members of the dental profession a copy
of the JulykAugust, 1940, issue of Therapeutic Notes, an issue devoted
entirely to syphilis and excellent public health educational material.

Whenever possible the Director and Assistant Director attended all
meetings of the county, district, and state dental societies, as well
as meetings of dental hygienists, nurses, and the medical profession,--
keeping the dental health program before them. The mid-winter meeting
of the Public Health Dentists at Chicago was attended by the Director
and the Assistant Director. The American Dental Association and the
Public Health Dentists annual meetings in Cleveland, Ohio, were attended
by the Director. Many new and practical ideas, adaptable to the program









of this Bureau were obtained from the public health dentists attending
the national conventions.

The state meetings were of mutual benefit to this Bureau and to
the dental profession. The dental profession is kept informed of the
Bureau's activities and the connection between the two is drawn closer,
as the dentists more and more realize the part they play in public
health dentistry-that their cooperation with the Bureau means the pro-
notion of interest in dentistry by the general laity.

Dental Health Exhibits

During the year improvements and additions were made to the Bureau's
dental health exhibits and, in cooperation with the Bureau of Health Edu-
cation, the exhibits were displayed at various county fairs, conventions
and meetings open to the general public throughout the state. It is felt
that exhibits showing and explaining the functions of the Bureau of Den-
tal Health, together with the distribution of dental health literature,
is one of the most effective ways of educating the general public.

The most distinctive exhibit was the one shown in connection with
a public health exhibit at the annual convention of the State Dental
Society in St. Petersburg. The display as a whole gave a picture of
the problems confronting public health in Florida, and the important
part that dentistry serves public health in solving such problems.
This was done by means of panel drawings, photo-murals, and photographs
that covered the four walls of a large room. Every other panel pertained
to dentistry and the drawings depicted the rise and progress of dentistry
during the past 100 years and prior, and also showed its ever widening
influence in the field of public health.

Dental Health Film

The 1940-41 school year found the Bureau handicapped by lack of
sufficient dental health literature for distribution to primary and
elementary school children. However, it was with much pleasure and
pardonable pride that the Bureau made available to schools, civic or-
ganizations, and dental societies, the dental health film, "Billy's
Trip to Health Land." Nearly two years' work has gone into the making
of this picture. It is a story with a fairy-tale background which was
written by the Director especially for teaching dental and general
health lessons to small children. It is in sound and color with action
by marionettes. The voices are those of Work Projects Administration
dramatic project workers.

As stated in last year's annual report, the first version of the
script was shown to several schools, lay organizations, and local dental
societies and their reactions were noted. Also, it was shown to members









of the Executive Council of the Florida State Dental Society and members
of the Florida State Department of Education in order to secure their
approval of the script as an educational factor in the dental health
program. The approval was unanimous.

In February, 1940, at the annual meeting of the Chicago Dental
Society, the picture was presented for approval to members of the edu-
cational committee of the American Dental Association, members of the
Good Teeth Council, Canadian Dental Association, and state directors
of dental health departments who were attending this Chicago meeting.
In each instance, the film was rated as excellent dental and public
health educational material.

The picture was then re-written in order to shorten the running
time and to make it rore understandable and appealing to young children.
In its final version it was shown to the Public Health Committee of the
American Dental Association of Public Health Dentists at the 82nd Annual
Convention of the American Dental Association held in Cleveland, Ohio,
September, 1940.

By special request of the Ontario Dental Association, the Director
took the film to Toronto for presentation to the Ontario Dental Associ-
ation, the Minister of Health, the Minister of Education, and the Direc-
tor of Dental Services of the Province. Dental health talks were made
explaining this Bureauls program. En route to and from Cleveland, the
Director visited and inspected dental clinics in Kentucky and showed
the health film in several of the schools.

Since the completion of the picture in the fall, it has been pre-
sented as part of the Bureau's educational plan in eight different
counties. This represents seventy-five showings of the picture in
fifty-four schools, to approximately 12,000 school children. In ad-
dition, it has been shown to several lay organizations, dental socie-
ties, one Negro college group, one NYA Negro group, and several Negro
summer schools.

The intelligent interest manifested by the children leads the
Director to believe that worthwhile dental and general health lessens
are being made clear and workable to the young school child, and adds
weight to the theory that visual education is the strongest method of
putting over an idea.

Dental Corrective Programs

Experience in Florida and other states has proved that dental oer-
rective programs for the indigent are of the most benefit when conducted
and maintained by local communities through and under the supervision of
local health departments and local dental societies. One of the main
functions of this Bureau is to promote and assist in the establishment





64



of such programs. The Bureau at all times acts in an advisory capacity
to the corrective programs in regard to location, personnel, equipment,
and general set-up.

Two new dental corrective programs vent into operation the first
of 1940 and the results have been extremely good. The following pro-
grams are now established:

1. Corrective programs cooperating with county health departments

a. Full-time


Escambia County
1 dental trailer serving the entire county
Hillsborough County
1 dental trailer serving the entire county
except the city of Tampa
Orange County
Orlando
Pinellas County
St. Petersburg (1 white and 1 colored)
Clearwater


b. Part-time

Bay Oounty
Duval County
Jackson County


2. Counties using Maternal and Child Health funds for payment of
dental services rendered in private practitioner's office

Gadsden County
Highlands-Hendry County
Leon County
Nassau County
Taylor County

3. Corrective programs operating independently

a. Full-time

Dade County
Palm Beach County
City of Jacksonville
City of St. Augustine

b. Part-tine

City of Gainesvillo
City of Tampa









Dental health educational work was done among the Nogro dentists
by supplying them with copies of Dr. Brauor's brochure on "Childrents
Dentistry." Conferences with the leading Negro dentists in regard to
their work and on the subject of securing clinicians for their state
and local meetings were held. The Director appeared on the program of
their state meeting and assisted them with their clinics.

Negro schools were included in the educational presentations when-
ever facilities were available. Dental health literature was also dis-
tributed to them. There were 100 Negro preschool children included in
the summer preschool round-ups, and their mothers who accompanied them,
were given dental health information.

The preschool round-ups held during 1940 were not very successful
inasmuch as it is difficult to bring such a group together-especially
after schools have closed. The Bureau with the cooperation of the den-
tal society plans to make a survey of the conditions existing among
the prenatal and postnatal groups, and the preschool children during
the coming year. In conjunction with the county health unit programs
it is planned to use a dental trailer for this study. The program, al-
though a survey, will be of educational nature and should prove of value
to the health units in stimulating interest in the prenatal, postnatal,
and preschool groups. It is hoped that this program will be the means
of finding the best-suited program for the individual counties.

The Division of Public Health Nursing continued to send out dental
health information letters to prenatal and postnatal cases. Some of the
county and other health departments have held clinics for prenatal and
postnatal cases.

Additional educational material for the nurses, school teachers,
and children, has been planned for the coning year if funds are avail-
able for that purpose.











EDUCATION


Elizabeth Bohnenberger, Director







Because every service rendered by the State Board of Health in-
cludes educational activities, the Bureau of Health Education con-
tinued to serve all bureaus and division in an advisory capacity and
with active assistance in the formation of education plans. The per-
sonnel of the Bureau constantly directed efforts toward the first
objective of the State Board of Health the enlargement and improv-
ment of local health services.

The personnel of the Bureau of Health Education includes a di-
rector, who is responsible for the promotion of the general health
education plan; a secretary to the director, who is also in charge
of the Library; an artist, whose duties include assistance to every
bureau and division and to county health units in the preparation
of visual aids for education such as posters,graphs, exhibits, and
illustrations for pamphlets and teaching material; a typist who as-
sists in the preparation of mimeographed material; and a clerk who
has charge of filing all library material, care of the moving pic-
ture collection, the projection of moving pictures, and the running
of the addressograph machine.

School Health Services

In 1939 a plan for a coordinated school health program was pre-
pared by the State Department of Education and the State Board of
Health, with the assistance and approval of the Florida Medical As-
sociation, Florida Congress of Parents and Teachers, Florida Feder-
ation of Women's Clubs, University of Florida, Florida State College
for Women, and other civic and educational organizations. The plan
conformed to that recommended by the Educational Policies Committee
of the National Education Association and the American Medical Asso-
ciation, with adaption to Florida needs and conditions, called for
active cooperation between local boards of public instruction and
full-time county health units in the state.

As an outgrowth of this plan, a Health Education Workshop for
teacher training was held at the Florida State College for Women
during the sunner of 1940. Materials, including textbooks, reports


HEALTH H









and reprints for the students were furnished by the Bureau of Health
Education. Bureau directors and other persons from the State Board
of Health and county health unit staffs assisted with the course by
means of discussions of their particular phase of public health.

The students taking part in the Workshop, for which college
credit was given, prepared thirteen units of study on Florida health
problems. Each unit was carefully edited and then approved for dis-
tribution by the State Board of Health staff for technical accuracy
and be the staff of the State Department of EdAcation for teaching
worth and correct presentation. Copies of the study units were sent
to the committee chairmen of the Florida Medical Association and the
president of the Association took an active part in the editing and
revision of the study units before final approval.

Five thousand of these study units were mimeographed, a duty
which was shared by the State Board of Health and the State Depart-
ment of Education, and a large proportion of them were distributed
to the schools of Florida. Distribution and use of the units con-
tinues currently. Every county health unit staff has been given
copies of the study units and urged to become familiar with them in
order to push their use in individual counties. Speakers appeared
before the Florida Congress of Parents and Teachers, the Florida
Federation of Women's Clubs, and other organizations to tell about
the importance of the study units and to acquaint them with the aims
and purposes of the school health plan.

It is planned to hold a similar workshop and study course at
the Florida Agricultural and Mechanical College for Negroes in the
summer of 1941. Adaptation of the study units and revision for Negro
school use is contemplated at that time.

Coordinating Efforts in Connection with School Health Plan. The
plan for Florida's school health program was of necessity of long range.
It is realized that the practical application of the plan calls for a
promotion and aid program over a period of years. County health unit
personnel, as well as county school personnel, need to be more fully
informed of the ways and means of applying the program to their partic-
ular county situation. As one step toward forwarding this need, a
meeting of county school superintendents and county health officers
from all organized full-tine health unit counties was called in the
fall of 1940. Attendance was one hundred percent and the group net
at the Florida State College for Women in Tallahassee for one entire
day. The main objectives of the school health plan were presented in
the form of resolutions. Full discussion of each resolution occurred
after which the group voted for the adoption of the resolutions, with
such minor amendments as had been decided upon in discussion. Follow-
up of this meeting has occurred in a majority of counties since then.









Teacher Training Need. Oo outstanding need which nust be met
before 7lorida can reasonably expect to have a well-rounded program
of community health, including the school health instruction objec-
tives, is that of teacher training for health instruction. The
State Board of Health feels the importance of this point to the ex-
tent that plans are being formulated for the addition to the staff
of the Bureau of Health Education of a coordinator, who shall be a
person experienced and trained in teaching methods, with a major in
health education. The duties of such a coordinator will include
field service both among the county health units and in connection
with the teacher training institutions of the state. The prepara-
tion of materials for use of in-service teachers and for the use of
students in training will be an objective also.

Staff Education

Staff education with central organization personnel during the
year was centered around a detailed study of the local health service
of the state. Two hour staff meetings were held at bi-weekly inter-
vals at which time each county health unit was studied and reported
upon from the viewpoint of the various bureau and division directors.
Coordination of effort was the purpose behind these meetings. The
purpose also was to present a complete picture of the health unit
program as against the isolated viewpoint of each separate service
as it related to the central organization of the State Board of Health.

A *house organ" entitled YOUR N WS intended for the use of em-
ployees of the State Board of Health and all county health units was
begun during 1940. YOUR NEWS contained items of interest to all health
personnel and was published with the idea of acquainting all employees
with the work of public health on a state-wide basis. The personnel
is asked to submit items for publication.

Staff education among county health unit personnel was promoted
and planned by the consultant nurses of the Bureau of Public Health
Nursing and the Bureau of Health Education assisted in the planning
of programs and in furnishing materials for use in the study courses.
Staff education in several of the larger organized health units was
planned on a wide basis and to include all unit personnel by the dir-
ector and supervising nurse of the unit. The.Bureau of Health Educa-
tion indirectly assisted through furnishing of study material as re-
quested.

Public Health Education

Various accepted methods of general mass education for health
were employed during the year 1940. Motion pictures on health sub-
jects were widely shown to civic clubs, parent-teacher associations,









womenls clubs and other organized groups. Talks were given before
these groups by all members of the central staff and throughout each
organized county by county health unit personnel. Pamphlets on com-
municable diseases were distributed both from the central office and
through county health units. Special efforts were made to make such
literature available to the schools. Exhibits were prepared and shown
at many county fairs and at sweral state meetings of organized groups.
Posters were used to some extent and it is planned to use this medium
more widely during the coming year.

Public health education through the medium of the newspapers and
radio was employed to a considerable extent. A detailed account of
this is included in the report of the Public Relations Consultant to
whom these fields of public health education are delegated.

The monthly bulletin FLOPIDA HEALTH NOTES with a circulation of
12,000 was sent to representative citizens, to school teachers, and
to all licensed physicians and dentists in the state. HALTH NOTES
is available to any citizen of Florida on request.

Education with professional Groups

The State Board of Health assists with the financing of the Annual
Graduate Short Course for Doctors of Medicine in Florida. The Bureau
of Health Education aided in the Short Course through supplying films
for showing at the Course and through the Loan of an operator for the
motion picture projector and slide machine. The Bureau also had charge
of addressing and mailing out the program for the Short Course to Flor-
idats 2,000 doctors of medicine.

The booklet "Syphilis in Mother and Child" was sent to all doctors
of medicine through the cooperative efforts of the Bureau of Health Edu-
cation, the Division of Venereal Disease Control and the Venereal Dis-
ease Committee of the Florida Medical Association.

The State Board of Health co-sponsors with the Florida Tuberculosis
and Health Association the annual seminar for Negro physicians of the
state. The Bureau of Health Education assisted with the Seminar in var-
ious ways. A "package library" containing health education material
distributed by the State Board of Health was given each physician; a
reading list, supplementing the subjects covered in the Seminar, on tu-
berculosis, syphilis, gonorrhea pediatrics and obstetrics was prepared
from material available in the State Board of Health Library. Copies of
this list were mimeographed and given to each member of the Seminar. The
Director of the Bureau spoke to the physicians concerning the use of the
reading list and of the Library. Health and medical films from the Bu-
reau collection were also used during the Seminar. The Bureau of Health
Education lends its enthusiastic support to this most important endeavor.









Publications

The annual reports of the State Board of Health are edited,
mimeographed and distributed from the Bureau of Health Education.

Publications of other bureaus and division are frequently sub-
mitted for editing and this service is one which the Bureau of Health
Education is very desirous to enlarge. The need for careful editing,
for clarity of statement, for avoidance of repetition, for terminology
suited to the intended reader, for attractive, readable format, and
for proper printing methods is of vital importance from the educational
standpoint.

The Library

The State Board of Health Library now has a representative col-
lection of 7,100 books, bound periodicals on medical and public health
and a large reprint collection to supplement the textbooks and bound
magazines. The Library also subscribes to 168 current periodicals.

Services and materials of the Library are available to all public
health personnel, to all physicians, dentists, and other persons in-
terested in medicine and public health. The Library is used by physi-
cians all over the state and aid in the preparation of medical papers,
searches of medical literature, and bibliographies are a part of the
Library service. No charge is made except actual mailing costs for
material mailed to a borrower.

Use of the Library has continued to increase each year since its
establishment in 1932. As an educational force for public health, es-
pecially from the standpoint of professional education, the Library
is invaluable.











RELATION NS


Jean Henderson, Consultant







State-Wide Public Health Committee commitments from candidates
for Governor in regard to their attitude on public health advancement
in general and the American Public Health Association survey recom-
mendations in particular were secured by the State-Wide Public Health
Committee. Shortly after election Governor-Elect Spessard L. Holland
met with the Executive Board of the State-Wide Public Health Committee
and publicly reiterated his pledge to refrain from either giving or
withholding positions in the State Health Department for political
reasons. He said specifically:

"I want the State-Wide Public Health Committee to
know I have never had any intention of playing pol-
itics in public health, because public health and
the institutions of higher learning are not places
in which to play politics."

County affiliates of the State-Wide Public Health Committee sought
similar commitments from candidates for the Legislature from their par-
ticular areas in regard to the survey recommendations.

During 1940 the interest exhibited in public health by Florida Cit-
izens gained what has been described unprecedented momentum. Five
thousand summaries of "The Health Situation in Florida" were distrib-
uted during 1940, bringing the total number distributed for the State
Board of Health by the Committee to 12,000. At the end of 1940 the
State Board of Health had on hand about 6,000 copies, available for
further distribution.

FLORIDA HEALTH, bulletin of the Committee, was inaugurated and
mailed to members eight times during 1940. It has received praise
from one of the most prominent public health educators in the country,
Dr. Ira V. Hiscock, Professor of Public Health at Yale University and
Chairman of the Health Education Institute, American Public Health As-
sociation.

A Manual of 170 pages was written for the Committee and mimeo-
graphed for distribution.


PUBLIC









The Committee membership grew from 2,200 on January 1, 1940 to
5,800 December 31, 1910.

Health Notes

he circulation of FLORIDA HEALTH NOTES, official publication of
the State Board of Health increased from 10,500 to 12,000 as of Decem-
ber 31, 1940. There is a great need for an improvement in this pub-
lication that will be commensurate with its prominence as a health pub-
lication.

Publicity

The Press Increased activity on the part of the State Board of
Health and County Health Unit staffs has.resulted in a 67% increase
in the amount of space given public health by the Florida press during
1940. This upward climb began in 1939, when that year showed more than
100% increase over 1938.

Radio Programs

Radio A series of 15 minute weekly dramatic sketches was inaugu-
rated in the fall of 1940 with Work Projects Administration actors and
producers. These scripts are carefully edited and the subject matter
painstakingly supervised by the Assistant State Health Officer and in-
dividual bureau directors who may be affected by specific scripts.
There is no monetary cost to the State Board of Health for this pro-
gram, since Radio Station WJBP furnishes the time and the Work Projects
Administration the talent. The dramatic form is used because radio ex.
ports have found this to be the most popular educational method with
audiences.











HEALTH S RVICE


New County Health Units

During 1940 the following counties in Florida have organized
full-time local health units: Baker, Nassau, Levy, Gilchrist, Dade,
Hamilton, Hendry, Glades, and Osceola. Baker, Nassau,Dade and Ham-
ilton Counties organized their own health unit: the counties of Levy
and Gilchrist joined to form a single health unit. Osceola joined
the already existing unit of Orange. Hendry County was in operation
only ten months during the year; it was discontinued because of fin-
ancial difficulties.

Full-time Health Service in Florida

At the end of the calendar year 1940 there wore twenty-five
counties that were receiving the service of a full-time local health
service. This means only 37.3% of the counties in Florida have local
health units. One of the near-by states, Alabama with sixty-seven
counties like Florida has a separate health unit for all of its coun-
ties. It is desirable that each county have its own separate unit,
but because of the small population it is frequently more practical
for two or possibly three counties to form a single unit.

With the twenty-five counties now organized, approximately 52%
of the total population of the state is receiving full-time local
health service.

Definite progress was made in providing full-time local health
service. Four more counties could have been organized if state and
Federal funds had been available to match the local county funds
that were available. Much time was given to the existing health units
in the way of advising them about their programs and problems.

Health Surveys

Surveys were made in six other counties namely: Lee, Columbia,
Marion, Palm Beach, Volusia and St. Johns by various representatives
of the State Board of Health. These surveys were made because of re-
quests from local groups interested in obtaining a health unit for
their respective counties. Not all of the survey findings have been
made available to the counties concerned. The purpose of the survey
was to study the existing health service facilities and to make recom-


LO AL









mendations to the county concerning the best type of health service.

Considerable time has been spent in meeting with civic clubs,
medical societies and county commissions recommending the establish-
ment of county health units.

During the year four physicians attended the short course for
health officers at the University of North Carolin. Two went at their
own expense and the others were paid from Social Security funds. Four
sanitary officers completed the short course for sanitarians at the
University. Expenses were paid from Social Security funds for three
of these men.

Recommendations

There is a great need of two other workers in the Bureau of Local
Health Service: one, a statistical clerk to correlate the activities
of the various units and to visit all health units in order to assist
the secretaries in record keeping and making reports. In this way there
would be uniformity in recording the activities done by the individual
health workers throughout the state. The other assistant needed is a
physician, experienced and trained in public health administration, who
can visit and aid the individual county health units in balancing their
programs-making the program fit the needs of the county.

As time and funds permit there is need of aid to the existing
health workers. Various workers should be allowed an opportunity to
take advanced courses in public health.

On the following pages is a summary of major activities by
counties.






FULL TIME COtUTY HEALTH UNITS


TABULATION OF ACTIVITIES

January-December, 1940


:OMIMUNICABLE DISEASE CONTROL

draission to service
consultationss with physicians
Field visits
Smallpox immunizations
Diphtheria immunizations
Iyphoid fever immunizations

CEREALL DISEASE CONTROL
Admissions to medical service
"linic visits
fieldd visits

TUBERCULOSISS CONTROL
Individuals admitted to med-
ioal service
Individuals admitted to nurs-
ing service
;linio visits
lursing visits

(ATERNITY SERVICE
Cases admitted to medical
service
ases admitted to nursing
service
visits by antepartum cases to
medical conferences
nursing visits

INFANT HYGIENE

Individuals admitted to
medical service
Individuals admitted to nurs-
ing service
visits to medical conferences
lursing visits

Preschool Hygiene
individualss admitted to med-
ical service


U, 3
0 0
3- N W W -I
0 1. 1S O M z 0 0 u 1 I" a
0Q U, Q,.


19 1 91 38 33 48 6 13 21 12 653 6 39 26 4 0 7 395 2 77 10 10 151
4 2 56 19 22 0 17 68 31 10 0 11 35 58 2 443 18 49 14 22 2 0 i
108 23 93 141 443 797 373 367 41 168 508 16 154 123 18 699 18 1670 181 430 14 40 642
2241 313 368 2 1390 1020 a15) 404 29 2427 319 2721 225 712 1013 86 202 2290 5 1442 736 322 1952
143 152 473 1 456 1401 779 800 423 349 628 919 273 621 16 174 166 1685 18 1178 776 324 1175
153 76 88 18 139 751 1224 466 61 273 263 3423 44 1165 908 31 599 318 2 1349 1534 1452 1433


165 68 548 45 690 755 579 318 244 58 o 608 762 3004 1
11052 435 8811 1286 14979 13879 9031 8336 3246 1892 0 11396 12745 13131 3
1077 84 401 173 229 964 381 650 36 452 977 1023 719 776 0


8 1 76 66 285 92 2 459

16 8 54 171 85 55 4 36
0 0 1 342 1134 460 0 359
221 34 282 329 283 380 48 450


166 17 327 227 144 865 152 408

287 55 676 540 769 1166 175 400

360 33 837 608 174 2519 458 630
1259 155 1625 1070 1616 1677 496 1472



62 10 99 0 125 273 83 268

156 30 90 266 635 448 173 430
135 1 114 o 328 681 248 389
605 58 293 580 1757 1094 367 1542


126 13 56 6 380 35 113 172


12 316 0

6 306 305
6 326 5
20 180 707


32 34 501

34 159 1384

3 44 1259
71 460 3603



45 19 289

7 135 705
2 42 582
14 388 15C1


6 47 62 1

7 117 1 253 4
3 2 15 o
137 877 594 11


215 19 673 8

243 119 869 39

463 22 2004 2
375 225 1572 67



42 2 89 0

66 83 317 12
58 2 172 0
155 156 632 18


38 27 703 47 69 272 2


37 541 204 166 352 195 269 96C
1616 3033 6091 572 4968 2858 751 13016
133 79 555 69 263 210 98 844


13 WO7 '1) 3. 232 9 M
2 23 135 0 271 48 6 191
19 314 19 0 254 o 0 325
128 104 973 8 1285 79 20 715


131 29 190 1 394 77 58 466
123 45 225 11 588 234 142 828

382 36 717 2 1496 135 77 1226
520 135 e67 36 930 729 229 1918



42 14 214 5 287 44 16 .202

47 16 293 5 520 162 82 467
69 25 691 9 831 117 20 451
127 61 562 9 980 458 218 1058


46 33 335 14 301 69 2 28


STATE OF FLORIDA







FULL TI.E LOCAL COUNTY HEALTH UNITS


STATE OF FLORIDA


TABULATION OF ACTIVITIES
January-Deoember, 1940


0i 8-
U)

is__ -3 2.3W
8_ 0 I = = -a |- 5 I = = I 0 a..
________a g g ~ a g a asg 3 J sg l 8" ^ ^


Preschool Hygiene oont'd
Admissions to nursing service
Visits to medical conferences
Nursing visits
Insp. by dentist or hygienist
SCHOOL HYGIENE
Insp. by physicians or nurses
Examinations by physicians
Admissions to nursing service
Nursing visits
Insp. by dentist or hygienist
ADULT HYGIENE
Medical examinations
MORBIDITY SERVICE
Medical visits
Nursing visits
Admissions to hospitals
GENERAL SANITATION
Approved Individual water
supplies installed
Approved excreta disposal
systems installed
Field visits
PROTECTION OF FOOD & MILK
Food-handling establishments
registered for supervision
Field visits to food-handlin
establishments
Dairy farms reg. for super.
Field visits to dairy farms
Milk plants reg. for super.
Field visits to milk plants
LABORATORY
Specimens examined


120 61 30 17 1559 76 192 248 6 91 1429 42 153 300
216 12 176 o 555 71 464 329 o 67 1305 90 73 462
381 131 97 305 2914 734 543 1268 12 356 2473 74 326 660
0 o o o 31 0 0 0 0 0 9 0 0 0


0 46 9 349 7 460 223 15 54'
o 51 68 996 14 919 196 12 60o
7 65 42 901 36 1200 511 58 130'
o o 10 o o 261 0 0 31


3463 10 10559 4802 6039 6484 376 3365 519 793 2352 1158 2537 2526 203 2613 190 8831 1498 9185 8 1363 6881
2569 812 1463 1045 1169 9-'73 1854 626 256 2033 2852 977 2025 2206 1837 924 28 4075 519 1873 281 140 390:
51 1 41 30 87 13 56 57 3 65 827 16 81 658 3 o 6 5 o 5149 6 167 73:
584 6 468 478 3759 1355 290 666 36 708 2653 283 314 701 12 117 236 5334 32 3614 102 54 219(
0 510 1 7 4339 643 o 60 932 14 2143 228 0 280 0 0 20 6959 o 2037 573 o 187.


7 33 1993


0 425 172 67 297 64 267 118 193 26 423


13 120 2 1 91 1120 145 251 35 63 0 1025 0 19
115 41 73 57 277 1121 123 305 16 212 1300 742 22 82
0 1 23 0 3 0 0 5 7 3 0 0 1 21


3 1 46 1 2 47 0 55 0 o 40 14 7 76


6 463 147 352 28 18 180


6 521


o 1013 296 112 5 54 640 0 50(
6 200 240 871 15 1259 362 78 75:
0 42 1 30 2 264 0 0 4(


o 19 2 0 0 26 56


o 3!


375 30 548 39 289 321 301 322 66 84 894 192 642 43 3 212 126 245 277 2 144
1802 572 4995 1007 1282 7511 108 831 128 1291 2228 1737 3454 35 257 2121 693 1244 10 1048 3042 203 7


0 22 583


o o 91 87


34 41 2028 19 369 4133 322 91
O 0 1 0 0 59 o 4
329 3 162 5 o 709 59 58
0 0 1 0 0 20 0 0
73 o 191 0 0 118 9 3


o 47 1 0 3 377 1 89 26 1 0 5 o o 11

8 38 700 48 1 1184 82 269 180 1 1 346 221 45 10]
o 9 0 0 14 91 0 0 4 0 0 8 27 0
o 51 1 50 57 791 1 83 61 1 11 19 51 o 2,
0 5 0 o 1 15 o 0 0 0 0 2 27 0
0 0 1 0 7 94 1 35 o 1 16 6 50 0


3570 2708 4421 620 9664 12634 4584 12672 1129 2025 3629 8190 2572 7179 224 1268 2824 6248 1678 5323 4487 1349 98


Local HWalth Service 5/16/41











STATISTIC CS


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







For reasons given in previous reports, the Bureau of Vital Statis-
tics has continued to publish its detailed report separately from the
report of the State Board of Health. The 1939 report was published in
a separate volume; the 1940 report is now in process of compilation.
This is merely a short summary of the activities of this Bureau during
the year 1940.

There were added during the year 1940, a total of 35,262 certifi-
cates of birth, 24,347 certificates of death, 32,725 marriage licenses
and 11, 196 divorce reports. The total number of records on file as
of December 31, 1940, is 1,645,145.

The work of the Bureau was greatly increased by demands of the
Defense Program. The number of certified copies of records issued
showed an increase of 71%; the delayed certificates filed increased
61%; the number of searches increased 71%. It would have been im-
possible to handle this increase at all without the help of the Work
Projects Administration which furnished seven clerical assistants
whose work consisted of searching the records and preparing delayed
birth certificates.

Annual Registration Healing Arts

The number of persons holding licenses to practice the healing
arts who registered with the Bureau during 1940, totaled 3,466. Of
these, 2,418 were Doctors of Medicine; 492 were Doctors of Osteopathy;
221 were Doctors of Chiropractic; 230 were Doctors of Naturopathy;
and 105 were Chiropodists. This represents a total increase of 277
over the previous year.

The activities of the Bureau were carried on under difficulties
due to insufficient personnel and space. Without the loyal and active
cooperation of the office force, it would have been impossible to have
operated with the degree of efficiency which was shown during last
year.-


VITAL









LABOR RAT ORI S


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







During 1940 there were 693,779 examinations performed by the cen-
tral and four branch units of the Bureau of Laboratories. The numerical
increase over the tests run in 1939 was 191,778. This represents a per-
centage gain of 38.2. In comparison with 1931 there were 235 percent
more examinations.

It will be noted from Table 1 that all public health laboratory
services are offered to the people of Florida. The emphasis placed
upon certain of these procedures, as shown by the number of specimens
submitted, outlines the major health problems of the state. For instance,
100,625 feces specimens were received for parasitologic examination,
Nearly 31 percent of these gave evidence of infestation, with hookworm
ova being found in 28 percent of the samples. Naturally, a true cross-
section of the population is not represented, but the magnitude of the
problem is apparent. When careful search was mado for the cysts of
Endamoeba histolytica, they were found in sufficient numbers to warrant
the belief that amebiasis is more widely prevalent than generally
thought. It is hoped that further accumulation of data will etch more
clearly the relative position of the protozoan infestations. A slight
increase occurred in the total number of blood smears submitted for
diagnosis of malaria, but the incidence of positive cases (1.99 percent)
did not vary from that which was expected.

Cultural diagnoses continued to demand a large portion of the time
of the staff. There were 19,570 bacteriologic studies made of specimens
submitted from cases suspected of being diphtheria. The enteric infec-
tions also required considerable work. Up-to-date methods for the iso-
lation of the typhoid organism, Salmonella and the dysentery group were
instituted during the year. As a result, the number of bacteriologic-
ally confirmed infections has markedly increased. A total of 3,016
blood, feces and urine specimens was examined. Cultivation of the gon-
ococcus and tubercle bacillus was started on an experimental basis in
Jacksonville, and if the results are deemed satisfactory will be intro-
duced at the branch laboratories next year.

In the field of microscopic diagnosis 35,767 examinations were
made for suspected gonorrhea; 11,658 for tuberculosis; 3,436 for Vin-









cent's angina; 303 for rabies; 279 for syphilis; 14. for leprosy; 11 for
granuloma inguinale; and 960 for miscellaneous purposes.

Photoelectric colorimeters were placed in all the laboratories
near the end of the year. With them, determinations of the sulfone-
group drug levels, and concentrations of hemoglobin and protein in
spinal fluid will be made.

As in all public health laboratories, serologic tests constituted
a numerical majority of the examinations performed. The comparative
ease with which specimens can be handled and the high degree of relative
reliability of the results contribute to the popularity of the procedures.
Approximately one third of the staff devotes full time to serologic meth-
ods of diagnosis. There were 25,553 agglutination tests run with typhoid,
Para A and B, Brucella, Proteus OX-19 and P. tularensis antigens. These
antigens, prepared in the central laboratory from stock strains obtained
from the National Institute of Health, have given consistently satisfac-
tory suspensions.

The standard Kahn test was applied to 344,834 serum specimens re-
ceived for the diagnosis of syphilis. The Eagle macroflocculation tech-
nique was adopted as a second test for routine purposes during lats 1940.
With it 102,225 e-aminations were run. The Eagle-Kahn combination will
be the standard procedure of the Bureau of Laboratories for the present.
Spinal fluids are run by the Kahn method, 1804 being examined last year.

Sanitary analyses of water, sewage, milk and milk products re-
quired the services of two chemists and a bacteriologist in the central
laboratory and part of the time of a bacteriologist in each of the
branch units. These workers performed 12,218 bacteriological tests on
9,927 waters and 584 chemical determinations were made on 76 samples.
Eight thousand five hundred and seventy examinations were done on milk,
cream, ice cream and chocolate milk.

Because of the increasing load on the Bureau of Laboratories it
has been felt wise to make careful choices of new personnel. It is ex-
tremely fortunate that well qualified workers were available as they
were needed. A graduate of Tulane University, who earned the Doctor of
Philosophy degree under Craig and Faust, was placed in charge of the
parasitologic work. He is devoting his time to the improvement of diag-
nostic procedures and has already made numerous worthwhile additions to
and modifications of our technique. Neighboring states have recognized
that Florida now has the finest laboratory of parasitology in the South-
east by sending their workers to Jacksonville in order that our methods
might be studied. The caliber of examinations in our branch labora-
tories has been raised by permitting several of the persons who perform
parasitologic work in them to study at Jacksonville also.

A senior bacteriologist, a woman with a Master's degree in Bac-
teriology from Johns Hopkins, has been put in charge of all routine and









research culture work. The increase in number of specimens submitted
for microscopic examination for gonorrhea required the addition of a
junior bacteriologist to the staff. The person filling this position
has a B. S. degree in bacteriology and considerable practical experi-
ence. When time permits, this laboratorian aids in performing agglu-
tination tests and examines blood smears for malarial parasites.

A junior bacteriologist was added to the staff of the Tampa lab-
oratory in order that more careful attention might be paid to culture
methods and the specific identification of microorganisms. The man in
this position holds a Master's degree in bacteriology.

It is expected that the Selective Service program, the induction
of state militia into Federal service, the establishment of Army train-
ing camps and Naval Air Stations in Florida and the resultant swelling
of civilian population will combine to put a severe strain on the sero-
logic laboratory. To handle the work it may be necessary to hire sev-
eral more junior serologists. An additional clerk to help in prepara-
tion of the serologic reports will also be needed.

The fortnightly laboratory science seminars, which proved so
successful last year have been continued and expanded. The various
specialties of laboratory work have been explained in detail through
formal papers prepared by the bacteriologists, serologists, parasit-
ologists and chemists. These papers are published in mimeographed
form and are distributed to other state health departments, the Uni-
ted States Public Health Service, universities and colleges, and
physicians who request them. Informal discussions and demonstrations
of new equipment are also held. The meetings are attended by our own
staff and have excited the interest of local clinical and hospital
laboratory workers who, occasionally, also contribute to the program.

At the Tampa branch laboratory there are held weekly discussion
sessions during which the fundamentals of bacteriology and chemistry
and the current literature in those fields are reviewed.

A constant effort is made to keep our workers abreast of new
developments. During the past year one junior bacteriologist spent
three weeks studying procedures in the Albany, Georgia, Diarrhea and
Dysentery Laboratory of the United States Public Health Service.
Another bacteriologist visited well known milk, water and food lab-
oratories as far north as Baltimore and Washington, D. C., paying es-
pecial attention to work at the National Institute of Health. The
chief serologist traveled to the laboratories of Dr. Kahn, Dr. Kline,
and Dr. Eagle in order to check upon our performance of the techniques
originated by those men, and to the Venereal Disease Research Labora-
tory at Staten Island. The senior chemist was sent to the Research
Laboratory of the Children's Hospital in Cincinnati to standardize and
calibrate the photoelectric colorimeters which were purchased. The









gonococcus culture procedures employed at several hospitals and the
Brady Institute of Johns Hopkins University were also studied on this
trip by the chemist. The bacteriologists in charge of the Miami and
Tampa branch laboratories and a senior serologist from Jacksonville
received several weeks of instruction from Dr. Eagle in Baltimore.

In order to observe the methods of cleaning, washing, and steri-
lizing glassware and the preparation of specimen container outfits
the junior parasitologist was directed to spend two weeks visiting
neighboring state health departments. The procedures and equipment
seen will be modified and used as the basis for reorganization of our
own facilities.

The quarters of the Bureau of Laboratories are too small for the
scope of the work required. It is hoped that funds may be provided
for the construction of a laboratory building within the next two
years.

Tables I XIV in the Appendix show the statistical reports of
the central and branch laboratories for the year 1940.











NARC 0TIOS


M. H. Doss, Director







The Bureau of Narcotics operates with four State Inspectors and
one city policeman assigned special duty. The past year has shown a
decided decrease in the number of drug store violations, but an in.
crease in narcotic violations. Considerable time was spent in the in-
vestigation of medical law violations, although little legal action
was taken.

These investigations tended to show that violations of the medi-
cal practice act, that is to say, those practicing without license are
many; and this matter which most certainly is a public health measure,
should receive the attention of the State Board of Health. Plans are
now being made for the State Board of Health to assume this responsi-
bility with the permission of the State Medical Association and Board
of Medical Examiners. The Bureau of Narcotics is in a position with
its four field inspectors to enforce the provisions of this law.

The Bureau has been unable to commit addicts to the State Hospi-
tal, due to an Act of the 1939 Legislature which prohibits any one from
entering unless suffering from a psychosis.

There has been a decrease in the number of narcotic cases with
reference to the sale and possession of the drug marihuana. Some few
violations were found in the colored sections of the state, but this
in no way is serious. There were less than half dozen cases prose-
cuted during 1940.

Listed below are the activities of the Bureau of Narcotics for
the year 1940:

Number of open inspections 2562
Number of criminal prosecutions 61
Number of violations corrected where no legal action
was taken 144
Investigaticns conducted which resulted in either an
ar_-est, or where the violation was corrected with'
out action tei.ag necessary 205
Drug stores registered with the State Board of Health
for the fiscal year 1940-41 783













ACCOUNT ING


G. Wilson Baltzell, Auditor









The amounts listed below represent appropriations and funds made
available for health services for the fiscal year beginning July 1, 1939
and ending June 3), 19 0.


Legislature 1939:
Salaries
Necessary and Regular Expenses
Maintenance of County Health Units
Prevention of Venereal Disease


Continuing Appropriations:
Centralization Marriage and Divorce Records
Registration of Doctors, Midwivos, etc.
Birth and Death Certificates
Drug Store Inspection

Weleal'Vands:
U. S. Public Health Service Titlc VI of Social
," Venereal Disease
Children's Bureau Iaternal and Child Health


Security Act


Rockefeller Foundation Division of Ualcria Rescareh (Calendar Year
1939)

Rockefoller Foundation Malaria Control-Escambia County
Escambia County Malaria Control-Escambia County
City of Pensacola Malaria Control-Escambia County

Received from Counties and Cities for County Health Units


INSULIN: Separate Appropriation by the Legislature
outside of our Budget


103,500.00
121, 500.00
50,000,00
38,000.00


21,493.50
3,844.00
6,785.88
7,830.00


155,297.00
68,675.00
86,913.01


1,871.50
1,250.00
1,250.00


TOTAL ALLOTMENTS


313,000.00





39,953.38


310,885.01

13,650.00



4,371.50

135,059.19


10,000.00

826,919.08





84



All financial reports are in accordance with fiscal years of the
State of Florida and the Federal Government -- not the calendar year.

On the following page is a recapitulation of disbursements by
bureaus and departments. A detailed financial report consisting of
100 pages, covering every department and division of the State Board
of Health and affiliated activities including each county health unit
has been published for the above period and will be furnished on re-
quest.








RECAPITULATION OF DISBURSEMENTS

July 1, 1939 July 1, 1940


U. S. P. H. S. STATE
TITLE VENEREAL VENEREAL
STATE VI DISEASE DISEASE


Administration
Drug Inspection
Health Education
Laboratories
Sanitary Engineering
Epidemiology
Dental Health
Tuberculosis Field Unit
Public Health Nursing
Vital Statistics
Local Health Service
L~ternal and Child Health
Training
Venereal Disease
Aid to Cities V. D.
Dade County Anti-Mosquito
ialaria Control Studios
Esoambia County
Biological
SUB TOTAL


34,696.21
3,783.04
8,999.90
53,7;5.02
31,376.37
11,057.13
934.53
6,290.09
9,886.63
34,951.39
15,463.34


5,77 .65
1, 500.00
3,310.00
14,548.00
18,705.00
7,274.09
6,123.13
12,692.55
3,609.30
1,500.00
6,174.79


541.36 466.64
1,603.00 1,608.90
10,413.51 0,688.92


5,770.43 4,66a.14
8,992.90 2,642.7)
7,353.57


13,325.33
1,666.67
10.496.99


CHILDREN' S
BUREAU

1,320.00


4,786.50
8,080.47

12,490.91
11,505.35


OTHER AGENCIES
NAIE Ai tT
600. 0
6oo.o35
7,635.66


1,20.LC0
31,920.88


463.45


LOCAL TOTAL

43,601.87
12,910.72
15,521.80
67,395.45
50,081.37
18,331.22
11,844.16
20,982.64
22,776.40
68,372.27
21,643.13
12,490.91
21,943.92
11,635.69
7,817.02
13,325.33
1,666.67
10,496.99


2293 352. 31 2.48 34. 3,1.823*- 41,820.01 452,845.


Division of Malaria Research


48,338.71 32,361.14 18,960.25


5,545.24
132,907.02 329,654.38


49,251.08


bunulin

Counties


5,545.24
47 ,836.18


TOTAL


13,417.95


13,417.95


278,733,73 148,848.99 65,933.62 32,367.50 505- 33*./3 L)./.i --Z- )











ENGINEERING


George 1* Catlett, Director







At the opening of the year 1940, the Bureau of Sanitary Engineer-
ing consisted of the following persons: a director and chief engineer,
two assistant engineers on water and sewage, two assistant engineers on
mosquito and malaria control, 1 shellfish inspector, 1 dairy supervisor,
1 draftsman, a secretary and one clerk-stenographer.

On July 1, the beginning of the fiscal year, the Bureau was for-
tunate in securing the services of a principal assistant engineer highly
trained in the field of sanitary engineering. It was also during July
that the draftsman who had been with the department for the past five
years, passed away. The position was held open until October 1, at
which time a graduate in Civil Engineering of the class of 1940 from the
University of Florida was employed as draftsman and junior engineer. In
the interim between the time of the illness of the former draftsman, and
October 1, when the present engineer took over his work, the NYA fur-
nished a draftsman who gave valuable assistance to the engineering per-
sonnel.

Each one of the above-listed employees has been asked to fill out
job-description blanks for the Merit System Supervisor, and it is ex-
pected that during the coming year examinations will be held and those
making suitable showings will be assured of positions in the State Board
of Health.

Functions of the Bureau

In recent years, great emphasis has been placed upon preventt.
tive medicine," a phrase which brings to mind the fact that Sanitary
Engineering provides the very foundation for that type of disease con-
trol. Sanitary Engineering prevents disease by "eliminating or con-
trolling the environmental factors which form links in the chain of
transmission."

These environmental factors with which the Bureau of Sanitary
Engineering is concerned are listed below:

(1) Municipal water supplies; (2) municipal sewerage and sewage
disposal; (3) milk supply; (4) drainage and screening for mosquito con-









trol; (5) stream pollution control; (6) industrial waste disposal; (7)
protection of shellfish; (8) home and school sanitation (including wder
supply and sewage disposal); (9) institutional sanitation; (10) sanita-
tion of swimming pools and bathing places; (11) sanitation of railroad
trains, steamers, busses, airplanes; (12) sanitation of hotels, restau-
rants, etc.; (13) housing; (14) garbage disposal.

Some of the common diseases which can be prevented or controlled
by proper sanitary environment are:

(1) Hookworm disease, amoebic dysentery, bacillary dysentery, ty-
phoid fever, paratyphoid fever, infantile diarrhea, ascariasis, and epi-
demic gastrointestinal disturbances-all resulting from improper excreta
disposal.

(2) Through impure water supply these diseases are transmitted:
typhoid fever, paratyphoid fever; amoebic dysentery, bacillary dysentery,
epidemic gastrointestinal disturbances.

(3) Milk: typhoid fever, paratyphoid fever, diphtheria, scarlet
*fever, tuberculosis, undalant fever, and septic sore throat.

(4) Eating and drinking utensils: influenza, common colds, typhoid
and paratyphoid fever, tuberculosis, and possibly all diseases communi-
cated through naso-pharyngeal discharges.

(5) Malaria, dengue fever, yellow fever, filariasis--are transmit-
ted by mosquitoes.

(6) Through foods: antinonycosis, trichinosis, botulism, food
poisoning.

(7) Shellfish: typhoid fever, paratyphoid fever, food poisoning,
the dysenteries, gastrointestinal disturbances.

() Swimming pools and bathing places: typhoid and paratyphoid
fever, ringworm, scabies, tuberculosis and possibly many other communi-
cable diseases, especially those communicated by naso-pharyngeal dis-
charges.

(9) Garbage disposal; trichinosis, indirectly concerned in dis-
eases transmitted through flies, rats, etc.

(10) Animals: rabies (dogs); typhus fever and plague (rats),
psittacosis (parrots), tularaemia (rabbits).

(11) By improper housing: In addition to such items as unsatis-
factory water slr.ply, excreta disposal, plumbing etc., such items as
crowding, vntiltion, lighting, refrigeration and food storage, etc.,
are contributing factors in casee of tuberculosis and other common dis-
eases.









Water Supply and Sewage Disposal

In the Compilation of General Laws, 1927, Section 3181, 3184,
7737 and 7690 (Section 3181 as amended by the Legislature of 1939),
the State Board of Health is charged with the responsibility of in-
suring that public water supplies shall be derived from safe sources,
shall not be polluted, shall be protected by proper purification and
treatment works, and the works, and system operated in a safe manner
by reliable personnel. In a like manner, it is their duty to see
that sewage and waste are disposed of in a way to insure against pol-
lution of water supplies and waters sed for legitimate purposes.
Treatment works of proper types mus provided and operated to protect
the public health; and one municipality or group of persons must not
be allowed to endanger the health or rights of other municipalities
or groups or interests.

Therefore, when a new water or sewage works is contemplated, or
if alterations or extensions are to be made to existing systems, an
"Application for Approval" is made to the State Board of Health on
forms provided for the purpose. With this, is submitted an engineer's
report or in lieu of this, a data sheet giving details of the instal-
lation. Upon receipt of the application, together with plans and spec-
ifications, the State Board of Health approves or disapproves the plans.

During the year, the following cities in Florida were granted ap-
proval of water works or extension to existing systems:

Canal Point, Port Mayaca, Clewiston, Cocoa, Pensacola, Fort Lau-
derdale, Gainesville, Port Orange, Macclenny, Sanford, Chattahoochee,
Fernandina, Highland Hammock State Park, Princess Park Sub-Division,
(Tampa), High Springs, New Smyrna, Pahokee, (FSA Everglades), Lake
City and Madison.

These cities were given approval on sewage works:

Lakeland, Jacksonville Beach Camp Blanding, Gainesville, Winter
Haven, Arcadia, Fort Lauderdale, Apalachicola, Miami, Wewahitchka,
Chipley, Crescent City, Fernandina, Tampa, Pahokee (FSA Everglades),
Lake City and Madison.

In addition to municipal water and sewage works, the Bureau
passes upon water supplies and sewage disposal for institutions,
tourist and trailer camps, and other private-operated institutions.
Requests for approval or suggestion are received almost daily and
are taken care of either by correspondence or by visits in the field.

Samples of the public water supplies in the state are examined
in the State Board of Health laboratory at such intervals as are spec-









ified by the Bureau of Engineering. Some supplies are sampled monthly,
while it is only deemed necessary to examine certain other at quarterly
intervals. It is the duty of the Bureau to check with the laboratory
to see that the cities are sending in the samples as directed. When
it is found that a city has failed to submit samples at the allotted
time, a postal card is mailed by the Engineering Bureau, reminding the
officials, and asking them to avail themselves of the service offered
by the laboratory.

Stream Pollution

Pollution surveys of the various streams and waterways are made
by the Bureau at the request of local organizations. Since pollution
affects shell fish-growing waters and waters used for recreational and
other purposes, there is quite a demand for these surveys and the lim-
ited personnel in the Bureau prevents us from furnishing services to
as many localities as we receive requests from. However, the following
streams and waterways were checked during the year 1940:

(1) Bathing areas- Apalachicola
(2) Fernandina- Amelia River, Jolly River, Kingsley Creek,
Bell River, and Tiger Flats
(3) Lake County- Bathing areas
(4) Pinellas County- Pollution survey
(5) Panama City- Bathing areas
(6) Pinellas County- Oyster bearing areas

Drainage Wells

Statutory authority makes it a misdemeanor to discharge sewage
or surface drainage into the underground waters of the state without
a written permit from the State Board of Health. Accordingly, ap-
plication for a permit is made on forms provided by the Bureau of
Engineering, and if, upon investigation by a duly authorized repre-
sentative of the State Board of Health the application is approved,
a permit is issued to the person or firm operating the well.

There were 31 permits issued during the year for the operation
of drainage wells. Permission was granted only after investigation
was made and it was certain that there was no alternative.

Shellfish Sanitation

Oysters and clams, as well as crabmeat, shrimp, lobster meat,
and scallops, are included under the heading of shellfish. All of
these seafoods are supervised by the State Board of Health, but oys-
ters and clams are regulated also by the United States Public Health
Service. It is required that state regulations conform with those of
the Public Health Service so that the oysters and clams may be certi-









flie for inter-state shipment. A number is assigned each producer and
this number is affixed to every container of shucked oysters and clams,
and on the tags attached to each sack of shell oysters. These tags,
in order to be uniform, are furnished by the State Board of Health, and
are printed and stamped at the central office. In 1940 about 40,000
tags were issued to the shellfish dealers in Florida.

After an initial inspection has been made by the State Shellfish
Inspector and approval for a permit given, the Bureau issues a permit
to the shellfish producing house. If this plant is an oyster or clam-
establishment, a copy of the permit is promptly forwarded to the United
States Public Health Service so that the number will appear on the list
of plants certified for inter-state shipment.

In December, 1940, during which month the season was probably at
its height, there were 63 oyster-producing plants operating with State
Board of Health certification. Of this number 18 were "Shellstock
only" houses. In addition there was one certified for the production
of clams exclusively.

In the same month, 22 crab and lobster meat producers were oper-
ating under permits issued by the State Board of Health.

Milk Sanitation

The goals set by the Bureau of Engineering for its milk division
in 1940 were five-fold:

(1) To standardize milk control in Florida by promoting the
Model Ordinance recommended by the United States Public Health Service.

(2) To make the Grade A Pasteurized label mean just what it im-
plies by seeing that all pasteurized milk was properly processed.

(3) To increase pasteurized milk consumption.

(4) To make raw milk as safe as possible by improving enforce-
ment of local ordinances and looking to the health of milk producing
herds.

(5) To build prestige for the Standard Ordinance by seeing that
the cities given the distinction of being included in the list of
cities making 90% or above on their milk sanitation ratings merit the
honor.

At the beginning of the year it was realized that the Standard
Ordinance was in disrepute throughout the state because of the lack
of enforcement in a great many cities that had adopted it in years.
gone by. By the end of the year, five additional cities had come under









the Standard Ordinance banner, bringing the grand total to 42 cities
operating under the model.

The first step to enhance the prestige of the Model Ordinance
was to remove 20 cities from the accredited list of Standard Ordin-
ance cities after having determined that no enforcement personnel
was available to handle the situation in these localities and no pos-
sibility existed of getting any. Washington was immediately notified
of our action and their records were corrected accordingly.

The remaining 22 cities had adequate facilities to carry out B
good program and we felt that an earnest effort to this end would be
made by local authorities. By the end of the year, very gratifying
progress was evident. The six cities that had fallen out of the 90%
classification on the last Federal survey had regained their standing
and the rest had increased their enforcement rating materially so that
the average milk ratings of the 22 recognized Standard Ordinance cities
is now well up in the SOIs. Detailed attention was given the pasteur-
ization plants of the state and especially those in Standard Ordinance
areas. This effort has been rewarded by a material increase in the
percentage of properly pasteurized milk. Because of increased confi-
dence in the product and the establishment of Army and Navy posts
throughout the state the consumption of pasteurized milk has increased
by leaps and bounds. The educational value of this program cannot be
estimated. It has made the public "pasteurization conscious" and has
acquainted the dairymen with equipment and methods essential to the
proper processing of their product. It has also impressed upon them
the necessity of a system in the milk plant to insure proper day-to-
day operations. The State-Wide Public Health Committee has had an
important part in this educational program relative to milk. Not
only do the members of this committee stress the consumption of pas-
teurized milk but they urge the consumer to determine whether or not
it has been pasteurized and protected under Standard Ordinance re-
quirements.

Several cities not operating under the Standard Ordinance and
which supply Army and Navy camps, CCC camps, and other governmental
agencies have asked for and have received help in bringing their milk
supplies up to government standards. Because of the establishment of
these governmental agencies, milk consumption in certain areas has in-
creased 300% and the dairymen in these areas are enjoying profitable
business which we have reasons to believe will be permanent.

More and more attention is being given to the health of the pro-
ducing herds. Tests for Mastitis are being incorporated in all ordi--
ances being drawn for new Standard Ordinance cities and cities operat-
ing under old editions of the Standard Ordinance are being urged to
bring their ordinances up to date. Several Florida cities acted on
this suggestion during 1940 and now have "up to the minute" regulations.









State Board of Health efforts, however, in improving conditions
relative to the health of the milking herds received a serious set back
when the State Livestock Sanitary Authority abandoned its compulsory
Bang's testing program. Bang's testing is now done on a voluntary basis
except in areas which have local laws governing it. The better dairymen
are continuing the test on their herds, but in certain areas, the test
on herds supplying milk to be pasteurized has been abandoned. In these
areas it is absolutely essential that the processing of pasteurized milk
is properly carried out in order to prevent the occurrence of disease
and possibly deaths. In other instances even raw milk producers have
abandoned the tests for Bang's disease on their herds. These facts have
been comnunicatod to local health officials so that they can take appro-
priate action in the matter.

Malaria and Mosquito Control

Work Projects Administration malaria and mosquito control projects
in the state were continued under the supervision of the Bureau in the
past 12-month period. Although no funds for supervision were provided,
as in previous years, by the United States Public Health Service, two
of the assistant engineers of the Bureau kept vigilance over the projects
and gave considerable time to the writing and execution of those projects.

The actual number of projects was probably lower than it has been
due to the fact that the present Bureau policy is to promote mosquito
control programs only in localities where they are assured of proper
supervision (by county health units or other health officials) and where
maintenance of the work after construction is completed, is guaranteed.

A semi-monthly report of activities on malaria control drainage
is submitted to the Public Health Service. These consolidated reports
on the follvring page show the amount of work accomplished in 1940:









Malaria Projects

Counties operating during the year: Escambia, Gadsden, Lake,
Jackson and Hillsborough

HAID WORK DRAINAGE


Main Channel


38,734 ft.


45,892 cu. yds.


7,629 ft.

Man Hours


3,793 cu. yds.

40,369 1/4


RECONDITIONING (existing systems)


Main Channel
Water Surface Drained

Laterals
Water Surface Drained


5,475 ft.
3,000 sq. ft.

4,864 ft.
1,800 sq. ft.


Man Hours


2,810 3/4


FILLING


Fill-
Man Hours


21,084 1.2 cu. yds.
21,412 3/4
Team or Truck Hours 46


MISCELLANEOUS

26 acres cleared and grubbed
Cribbing: 4549 lin. ft. 548 sq. yd.
Cleared: 2775 lin. ft. right-of-way 456 man hours
Riprapping 900 lin. ft. 100 sq. yds.


Number of people protected:


54,033


DITCH LINING


Precast concrete Pan.C.Invert 24" pipe 18" pipe 6"farm 4"far
County Inverts on invert tile tile
24" 3rds 3b" equal to
with side 3rds with 14" pipe
walls side walls
Escambia 166b 1012 2771 1380 5411
Gadsden 1050
Lake 2770
TOTALS 2770 1050 1668 1012 2771 1380 5441


Laterals









Pest mosquito projects were operated in the following counties
(but due to the fact that the mosquitoes are merely pestiferous, this
work is not sponsored by the United States Public Health Service):

Hillsborough
Sarasota
Broward
Dade
Volusia

Reports of activities in the counties are made annually at the
meeting of the Florida Anti-Mosquito Association and may be read in
the proceedings of that organization.

Sanitary Surveys of Counties

The Bureau of Local Health Service, in the promotion of the estab-
lishment of fulitime county health units, has made surveys of health
conditions in several counties at the request of local civic and medical
associations. The Bureau of Engineering assisted in making these surveys
by reviewing the status of water supplies, sewage disposal, milk supplies,
garbage disposal, and mosquito control activities.

In 1940 Columbia, Lee, Palm Beach, Marion and Volusia Counties wore
surveyed and have been mimeographed for presentation to the organizations
requesting the check-up.

The State Sanitary Code

Chapter 19366, General Laws of Florida, Acts 1939, empowers the
State Board of Health to create and enforce the "State Sanitary Code."

With this authority, the Director of the Bureau drew up the fol-
lowing chapters of the Code for adoption by the State Board of Health
(these chapters were adopted and thereby made official regulations of
the Board on February 11, 1940):

I. Administrative Regulations
II. Public Water Supplies
III. Water Supply for Public Use
IV. Sewage Disposal in Unsewered Areas
VIII. Sanitary Equipment in Public Buildings and
Where Persons are Employed
X. Restaurants and Eating Places
XII. Commercial Food Canneries
XIII. Abattoirs
XV. Shellfish
XVI. Cooked Crab, Lobster, Crayfish and Shrimp Meat
Plants




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