• TABLE OF CONTENTS
HIDE
 Cover
 Title Page
 Letter of transmittal
 Members of the Florida state board...
 Foreword
 Table of Contents
 Bureau of preventable diseases
 Bureau of tuberculosis control
 Bureau of malaria control
 Malaria research
 Nutrition investigation and...
 Bureau of sanitary engineering
 Bureau of maternal and child...
 Bureau of local health service...
 Health information
 Bureau of laboratories
 Bureau of narcotics
 Bureau of vital statistics
 Bureau of finance and accounts
 Finance and accounts






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/AM00000243/00017
 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: VID00017
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Cover
        Cover
    Title Page
        Title Page
    Letter of transmittal
        Unnumbered ( 3 )
        Unnumbered ( 4 )
    Members of the Florida state board of health
        Unnumbered ( 5 )
    Foreword
        Foreword 1
        Foreword 2
        Foreword 3
        Foreword 4
    Table of Contents
        Table of Contents
    Bureau of preventable diseases
        Page 1
        Epidemiology
            Page 1
            Page 2
            Page 3
            Page 4
            Page 5
            Page 6
            Page 7
            Page 8
        Epidemiology of human typhus
            Page 9
            Page 10
        Venereal disease control
            Page 11
            Page 12
            Page 13
            Page 14
            Page 15
            Page 16
            Page 17
            Page 18
            Page 19
            Page 20
            Page 21
        Industrial hygiene
            Page 22
            Page 23
            Page 24
    Bureau of tuberculosis control
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
    Bureau of malaria control
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
    Malaria research
        Page 51
        Page 52
        Page 53
        Page 54
    Nutrition investigation and services
        Page 55
        Page 56
        Page 57
        Page 58
    Bureau of sanitary engineering
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
    Bureau of maternal and child health
        Page 77
        Page 78
        Page 79
        Page 80
    Bureau of local health services
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Public health nursing
            Page 94
            Page 95
            Page 96
        Dental health
            Page 97
            Page 98
            Page 99
            Page 100
    Health information
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        The library
            Page 106
            Page 107
            Page 108
    Bureau of laboratories
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
    Bureau of narcotics
        Page 115
        Page 116
    Bureau of vital statistics
        Page 117
        Page 118
    Bureau of finance and accounts
        Page 119
        Page 120
    Finance and accounts
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Personnel office
            Page 126
        Purchasing and property
            Page 126
            Page 127
            Page 128
            Page 129
            Page 130
            Page 131
            Page 132
            Page 133
Full Text

47th anual report



STATE BOARD OF HEALTH


Stt&e


o


pt
*~ *


WILSON T. SOWDER, M.D.
FLORIDA STATE HEALTH OFFICER


1946


FLORIDA STATE BOARD OF HEALTH
JACKSONVILLE 1, FLORIDA


64-3

194+6
C.2








47th Annual Report


STATE BOARD OF HEALTH
State of Florida



WILSON T. SOWDER
FLORIDA STATE HEALTH OFFICER




1946




FLORIDA STATE BOARD OF HEALTH
JACKSONVILLE 1, FLORIDA










6/4



0q46




The Honorable HERBERT L. BRYANS, M. D., President
Florida State Board of Health
Pensacola, Florida

DEAR DR. BRYANS:

I herewith submit the forty-seventh annual report of the Florida
State Board of Health for the year ending December 31, 1946.

Sincerely yours,

WILSON T. SOWDER, M. D.
State Health Officer

Jacksonville, Florida
September 2, 1947






















His Excellency, MILLARD F. CALDWELL
Governor of Florida
Tallahassee, Florida

SIR:

I beg to hand you herewith a report of the Florida State Board
of Health for the period January 1, 1946, to December 31, 1946,
inclusive.

Respectfully submitted,

HERBERT L. BRYANS, M. D.
President

September 2, 1947
Pensacola, Florida





























Members of the

FLORIDA STATE BOARD OF HEALTH

HERBERT L. BRYANS, M.D., President
Pensacola

WILLIAM PARR, Ph.G.
Tampa

ROBERT B. McIVER, M.D.
Jacksonville








FOREWORD

The State Board of Health is proud of many of its achievements,
during the year 1946, but it is proudest of the type of personnel whom
we have attracted to our cause. No organization attracts good people,
however, unless it deserves it. The ultimate reason that we are get-
ting and keeping personnel is that the people of the State of Florida
have shown over a period of many years that they earnestly desire
a good public health program. This feeling has been impressed upon
our legislators and other public officials, including our Governor.
These officials, however, have shared this feeling and have in very
many instances, especially in the case of our Governor, been leaders
in pointing out the need for better public health in the state. It is
very doubtful if any health department in any state has received
quite so much support as we have been fortunate enough to have from
our Chief Executive.
Florida has also been fortunate enough to receive hearty support
for its public health program from its local officials both county and
municipal. Not only has there been a steady increase in the number
of county health departments established but there has been an ex-
tremely praiseworthy tendency towards streamlining and consolidat-
ing local organizations in this field. With few exceptions we no longer
have in Florida multiple overlapping and competing health depart-
ments representing municipalities, counties, school boards and volun-
tary agencies doing the same work in the same area. Nearly everywhere
in Florida officials of school boards, municipalities and counties have
joined their efforts and are carrying on a public health program
through a single agency, a county health department.
Some outstanding accomplishments are briefly summarized as
follows: The number of counties with accredited health departments
increased during 1946 from 36 to 52. The Training Center for public
health workers operated in cooperation with the Alachua County
Health Department at Gainesville has done excellent work under the
direction of the county health officer, Dr. Frank Hall. During the
year a total of 28 sanitary officers, eight public health nurses and
one clerk have been given formal training. In addition to' this a sub-
stantial number of additional personnel have profited from briefer
periods of observation and orientation there. This center is jointly
financed by the State Board of Health and the Commonwealth Fund.
A new undertaking will begin in January with the assistance of
the Commonwealth Fund, a Field Technical Staff. This staff will
consist of a physician, two sanitarians, two nurses and two clerks who
will visit various county health departments at their invitation and
lend advice and assistance in carrying on a well-rounded public health
program.
In cooperation with the Rockefeller Foundation a survey of the
occurrence of typhus fever in the state was carried on by Dr. E. R.






Rickard of the Rockefeller Foundation. A large number of cases of
this disease were discovered which had previously been unreported.
The survey also enables us.to better plan and carry out the typhus
fever control program which we have had for several years. Our
efforts in the control of typhus fever have been directed by Mr. George
Bote, of the U. S. Public Health Service who has been assigned to the
Bureau of Sanitary, Engineering, and have been confined largely to
rodent control. Rat proofing has been considered to be the key to
the whole problem although experimental work has been carried on
to determine the effects of dusting rat infested premises with DDT
in order to kill the typhus bearing flea.
During the summer the state was visited by an unusual outbreak
of poliomyelitis. No state health department and no county health
department can go through a more trying experience than such na
outbreak brings. This is due largely to our lack of knowledge of any
effective means of controlling the spread of the disease. During the
year 1946, 551 cases were reported with 41 deaths. Although many
other diseases outranked poliomyelitis during the year in the death
toll exacted this disease always creates an unusual amount of hysteria
and apprehension because it is mysterious in many ways and because
it affects children. Since this outbreak Dr. Edwin G. Riley, our
epidemiologist, with assistance from the National Foundation for
Infantile Paralysis has initiated a survey of the cases that occurred
in order to determine the final outcome as to deaths, crippling affects,
recoverences, etc.
A continued campaign has been carried on against general diseases
which is one of Florida's foremost health problems.
A new Division of Industrial Hygiene was established and this
program will consist mainly in investigating the industrial health
hazards actual and potential in the various industries of the state.
The personnel of that division will work closely with the State Indus-
trial Commission and will keep that agency advised of its findings.
A cancer control program was started in a very small way with
funds available from the Federal Government.
In the field of tuberculosis control several mobile units have been
in operation, some of them for the first and over 100,000 persons were
x-rayed. All persons whose x-ray showed tuberculosis or any symp-
toms of tuberculosis were followed up. Every effort was made to get
infected persons into the State Sanatoria. A case register covering
6,500 infected persons, with accurate information as to their where-
abouts and the stage of their disease, was established in the central
office of the Bureau of Tuberculosis Control.

Continued investigations in the field of malnutrition and anemia
were made by Dr. Walter Wilkins and his staff of the Nutritional
Investigations and Services Unit.
During the year the Bureau of Sanitary Engineering reviewed
and approved plans for the constructions of water and sewage plant
facilities the cost of which amounted to about $20,000,000.








The program aimed at the control of the malaria bearing mosquito
was continued and great emphasis was placed on residual DDT
spraying in homes.
The Bureau of Laboratories has continued to expand its activities.
Its staff has been strengthened and studies have been carried on con-
cerning not only the prevalence of hookworm in the state but of the
various degrees of infestation. An optimistic view is made possible
in this field for the first time by the discovery that in spite of the high
prevalence of hookworm infestation amongst our children the ma-
jority have only a very light degree of infestation and little harm
is done in these cases by the parasite. In spite of this, the number
of cases of heavy infestation is substantial and our efforts to eradicate
hookworm will continue. These efforts will consist largely in improving
sanitary facilities.
In the field of vital statistics the Board decided to streamline its
organization for the collection of data on births and deaths. This
activity in the various counties will be centralized in the county health
department with as many sub-registrars as are necessary in various
parts of the county. This reorganization is under way but will proceed
slowly in order not to interrupt the efficiency of the present set up.
A purchasing unit was established in which all purchases are
centralized and it is believed that under this setup greater efficiency
and economy will be attained. Thousands of dollars have all ready
been saved through systematic purchasing procedures.
Although it is gratifying to report these signs of progress, it
should be emphasized that much remains to be done. Ceaseless vigil-
ance and effort is necessary if the health of the people of this state is
to be brought up to an acceptable level, and further effort necessary
to keep it there.
WILSON T. SOWDER, M. D.-State Health Officer.



































Edited by
EDWIN G. RILEY, M.D.








TABLE OF CONTENTS

Preventable Diseases ....-----.------.. ---------.--.- ----------------- 1

Epidemiology ...........-- -- -- --- ---------- ----- 1

Epidemiology of Human Typhus .-------.......-------------- 9

Venereal Disease Control -------------------------11

Industrial Hygiene ---------------------------------- 22

Tuberculosis Control --------------...---------------------- 25

Malaria Control .......---------------- ------------------------ 41

Malaria Research ----..-...--. ........------------ --- .. -------51

Nutrition Investigation ...... .....------------------------- 55

Sanitary Engineering ...----------...------ ----------- ---- 59

Maternal and Child Health .--...................----------- ------------- 77

Local Health Services --.......---- -------------.------ 81

Public Health Nursing __--- ....... .-------.-------.-----------. 94

Dental Health .......... -------------------------- 97

Health Information .......--------------------- ------------- 101

The Library ------.........-------- ----------------------------- 106

Laboratories .---...-- ----------------- ------------ 109

Narcotics ----- --.----..-- --.---------------- 115

Vital Statistics .--...-- -----------.---.----------------------- 117

Finance and Accounts .- -------------------------------------119

Personnel .--.. --.. -------------...-- -------------- ---------- .126

Purchasing and Property ----............--- ------------- ....126









BUREAU OF

PREVENTABLE DISEASES
R. F. SONDAG, M.D., Director
Following the creation of a Bureau of Preventable Diseases late in
1945, the new bureau, with the employees of the Bureau of Venereal
Disease Control, continued on, and no additions were made to the
personnel staff until March, 1946, when an epidemiologist was added.
Later in the year, a Division of Industrial Hygiene was created and
personnel added to this division to carry on the functions of an in-
dustrial hygiene program. The various activities of cancer control
were carried on by the Director of the Bureau of Preventable Diseases.
The present annual report incorporates the epidemiological activi-
ties for 1946 prepared by the Epidemiologist, Dr. E. G. Riley; the In-
dustrial Hygiene Division activities, prepared by Mr. H. N. Doyle,
Chief Engineer, on loan to the State Board of Health by the U. S.
Public Health Service; and the activities of the Venereal Disease Con-
trol Division by the Director of the Bureau of Preventable Diseases.
A Division of Cancer Control has not as yet been created; with a
small amount of federal funds some forward steps have been taken
to develop a cancer control program. In the absence of a specific law
designating the State Board of Health as the agency to do cancer
control, the responsibilities for the control of cancer logically fall
upon this organization. During the year, the only definite phase of
the cancer control program developed was the tissue diagnostic mailing
service. The Bureau of Preventable Diseases cooperated closely with
the Florida Division of the American Cancer Society and the Florida
Medical Association in the development of a proposed cancer control
program. As more state and federal funds become available, it is
anticipated that this program will expand considerably during the
coming year.
The report of epidemiological, venereal disease control, and indus-
trial hygiene activities follows:

EPIDEMIOLOGY
E. G. RILEY, M. D.
The picture of communicable diseases in Florida for 1946 was
marked by the largest outbreak of acute anterior poliomyelitis the
State has known. A total of 551 cases were reported. The previous
high was 263 cases in 1941. The increased incidence began in 1945
when a total of 143 cases were reported. An abnormal number of cases
continued to occur during the cooler months of 1945-46 and March
and April showed a rapid increase in cases with the largest number
occurring in June (Fig. 1). At the end of the year new cases were
still being reported.









BUREAU OF

PREVENTABLE DISEASES
R. F. SONDAG, M.D., Director
Following the creation of a Bureau of Preventable Diseases late in
1945, the new bureau, with the employees of the Bureau of Venereal
Disease Control, continued on, and no additions were made to the
personnel staff until March, 1946, when an epidemiologist was added.
Later in the year, a Division of Industrial Hygiene was created and
personnel added to this division to carry on the functions of an in-
dustrial hygiene program. The various activities of cancer control
were carried on by the Director of the Bureau of Preventable Diseases.
The present annual report incorporates the epidemiological activi-
ties for 1946 prepared by the Epidemiologist, Dr. E. G. Riley; the In-
dustrial Hygiene Division activities, prepared by Mr. H. N. Doyle,
Chief Engineer, on loan to the State Board of Health by the U. S.
Public Health Service; and the activities of the Venereal Disease Con-
trol Division by the Director of the Bureau of Preventable Diseases.
A Division of Cancer Control has not as yet been created; with a
small amount of federal funds some forward steps have been taken
to develop a cancer control program. In the absence of a specific law
designating the State Board of Health as the agency to do cancer
control, the responsibilities for the control of cancer logically fall
upon this organization. During the year, the only definite phase of
the cancer control program developed was the tissue diagnostic mailing
service. The Bureau of Preventable Diseases cooperated closely with
the Florida Division of the American Cancer Society and the Florida
Medical Association in the development of a proposed cancer control
program. As more state and federal funds become available, it is
anticipated that this program will expand considerably during the
coming year.
The report of epidemiological, venereal disease control, and indus-
trial hygiene activities follows:

EPIDEMIOLOGY
E. G. RILEY, M. D.
The picture of communicable diseases in Florida for 1946 was
marked by the largest outbreak of acute anterior poliomyelitis the
State has known. A total of 551 cases were reported. The previous
high was 263 cases in 1941. The increased incidence began in 1945
when a total of 143 cases were reported. An abnormal number of cases
continued to occur during the cooler months of 1945-46 and March
and April showed a rapid increase in cases with the largest number
occurring in June (Fig. 1). At the end of the year new cases were
still being reported.






2 ANNUAL REPORT, 1946


The largest number of cases occurred in Dade County followed
by Palm Beach and Hillsborough (Table 1). Monroe County had a
rate of 2.1/1000 which was the only place where an epidemic state
existed if the accepted definition of an epidemic of poliomyelitis of
one case/1000 population is applied.
As is usually the case with the disease, counties with large numbers
of cases were frequently next to counties from which no cases were
reported.
Figure 2 shows the age distribution of 1946 cases. The age group
0-4 contained the largest number of cases. This is at variance with
the situation in other parts of the country in which the age group
5-9 is more frequently attacked. The youngest case was that of a 13
day old child while the oldest was 48 years.
There were 501 cases among white persons and 50 among colored,
288 females, 263 males.
The rates for various sized towns were as follows:
Above 100,000 30.5/100,000
10,000- 100,000 30.9
2,500- 10,000 32.5
Below 2,500 16.0
At the present time, with the assistance of a grant from the National
Foundation for Infantile Paralysis, a study is being made to determine
more fully the nature of the outbreak. Among other things the number
of cases with paralysis and the extent and degree of paralysis will be
determined.
An epidemiological study of the disease was made in Key West
from which no conclusions could be drawn as to how the disease there
was spread.
During the height of the outbreak telegraphic reporting was in-
stituted and a daily report was issued on the numbers of new cases
reported.
In cooperation with hospitals and the state offices and local Chapters
of the National Foundation for Infantile Paralysis an arrangement
was arrived at whereby all acute cases could be hospitalized in an
institution which served a number of counties. This eliminated the
difficulty which was occasionally encountered of having some acute
cases refused hospitalization because they were not a local resident.
Too much cannot be said for the assistance given the medical and
public health authorities by the National Foundation during this
difficult period.
Further details of the 1946 outbreak will be published in forth-
coming reports.
Other diseases showed minor variations from previous years in
the number of cases reported.






PREVENTABLE DISEASES


The number of cancer cases reported doubled over the number
included in last year's report. This was due to the institution of a
system whereby death records from cancer were included in the
morbidy report.
The number of cases of diptheria this year doubled that for last
year and was the largest number of cases since 1938. The general
trend in reduction of the number of cases of diptheria that started in
1928 is still continuing in spite of the increased incidence for this
past year.
The number of cases of malaria reported this year is still large
although less than last year. An attempt was made to determine
whether the infections reported were acquired in the United States
or outside of the United States but the results were unsatisfactory.
It was observed, however, that the major number of cases reported
were in young men of military age.
There was also a large increase in the number of cases of measles.
Rabies in animals showed a marked increase in the number of
cases recorded and although officially only 55 rabid animals were
reported, conversations with veterinarians and others interested in


150.





t10.



.8
| 50






Jan Feb Mar Apr Maq Jun Julq Aug Set Oct Nov Dec
Figure No. 1-Distribution of cases of poliomyelitis by month of occurrence.
Florida, 1946










TABLE I-PROVISIONAL TABLES OF MORBIDITY FOR 1946





NI 0

TOTAL LASTYEAR 488 72 1,9801 24 93 2 4 0 43 76 18,088 244 4, 13 197 641 703 67








BREVARD 20.100 7 1 2211 284 4 8 11 6 .3
CITRUS 54271 2 4 1 Z 1
-CLAY 10. 900 3 11 2 104 1 12 2 16 a
Su W w N % w 0 H E

EA00 5 H 2 Z Z3 11 15 14 -
DDE 32 1 3 1 51 2,8 47 1 5 5 44 Z






DIXIE 4 6 1..0 1 1 0
TOTALLAST YEAR 48 722 1,980 21 245 93 28 4 0 43 176 18,088 244 4,576 130 197 29 641 703 167 0
TOTAL THIS YEAR 992 818 930 84 49 428 79 27 18 14 4 56 150 18,548 257 3,680 215 176 467 40 3,262 76 27
ALACHUA 38,245 8 13 6 1 2 266 7 8 3 3 22 14
BAKER 6,326 2 1 1 33 1 58 1 2
BAY 48,700 3 21 1 1 1 1 169 21 3 3
BRADFORD 11,200 2 1 4 6 13
BREVARDGULF 720,100 7 1 2 1 28 4 8 3 1 6 3
BROWARD 53,0 19 12 11 2 34 1 9 139 3
CALHOUN 1 6 9
CHARLOTTE 4,30 4 1 5
CITHENDRY 5,427 1 2 47 1 1
E RA 0 0 3 1 7 2 104 1 12 2
COLLIER 4,957 3 1 38 1 12
COLUMBIA 17,200 5 2 3 1 1 1 161 2 263 11 15 14 1
DADE 326,800 436 181 192 30 32 1 1 1 3 110 1 2,808 47 12 71 23 256 484 9 2
DESOTO 6,854 1 4 61 4 40 1 5
DIXIE 4,926 1 50 1 1
DUVAL 289,500 25102 1183 6 62232 12 14 22,937 23 206 7 19 83 1 450 1 4
ESCAMBIA 112,800 8 32 6 1 16 1 1 3 1,993 5 38 6 7 36 4 1
FLAGLER 2,652 6 1 1 85 1 28 1
FRANKIN 8,500 1 1 9 73 24 1 6 1
GADSDEN 31,041 11 13 8 88 1 1 375 5 43 12 98 58 2
GILCHRIST 3,466 3 1 13 16 1 6
GLADES 2,281 6 36 2 13
GULF 7,030 4 1 14 57
HAMILTON 8,731 4 3 1 1 2 17 1 204 36
HARDEE 8, 21
HENDRY 5,66 6 20 1 1
HERNANDO 5,700 1 1 5
HIGHLANDS 17,900 8 13 2 3 7 105 7 7 9 3 6 33
HILLSBORO 214.600 189 40 93 20 96 2 3 19 48 2,330 30 176 9 265 26 26 722 21 2








TABLE I-PROVISIONAL TABLES OF MORBIDITY FOR 1946--(Continued)

Ai
a z






HOLMES 14,627 3 2 5 15 1 14 321
INDIAN RIVER 9,100 2 2 45 2 1 1 31 1 25 1 1 2 16 2
JACKSON 34,530 1 5 1 2 197 2 22
JEFFERSON 11,066 1 7 1





LAKE 28,100 7 23 191 10 42 264 6 271 6 4 1 193 1
LEE 25,100 5 8 5 178 4 -1 1


LEON 36,400 3 9 1 10 14 2 761 1 22 10 24 21
LEVY 9,902 3 4 11 32 1 25 3 5
LIBERTY 3,193 1 1 1 M
MADISON 15,537 4 1 1 64 97 2 4 2
MANATEE 27,000 5 16 8 5 322 9 58 2 5 7 1
MARION 36,100 2 12 9 4 1 662 7 67 1 5 7 28 2
MARTIN 6,094 1 5 9 11
MONROE 20,200 5 5 15 10 1 209 2 2 7



PALM BEACH 120,300 13103 722 5 12 7 780 24 5 7 9190 5 6
PASCO 18,729 6 2 5 13 10 2 1



PINELLAS 189,700 40 12 613 1 1 2 504 9 3 3 2 5 6 42 6
POLK 118,700 69 8 3 217 45223 1 14 2 474 1 40 17 2 15 22 7 1
PUTNAM 17,837 1 5 1 25 3 69 1 6 25 1 1
ST. JOHNS 22,000 5 8 46 4 3 1
ST.LUCIE 13,200 2 15 1 1179 3 2 7 3
SANTA ROSA 17,200 2 1 31 0 5 1 16 21
SARASOA 20,000 6 2 99 1 77 3 1 2 92 1




SEMINOLE 25,100 7 3 9 18 192 6 25 9 2 3 10
SUMTER 10,417 1 1 221 1 2 66 1 277 1 1 9 1
SUWANNEE 17,700 5 1 1 48 12 1 2 1





TAYLOR 10,738 2 3 1 5 6 1 366 1 4
UNION 6,051 21 1 2 18 1 1 3
VOLUSIA 60,700 14 5 8 3 110 3 12 1 94 1





WAKULLA 5,059 2 1 25 74 3 63
MARION 36,100 2 12 9 4 1 1 4 7 67 1 5 228 2
MARTIN 6,0948 1 6 3 1 2 3 69 1 91 1 M




TMONROE 200 15 1 1 9 2 7
NASSAU 10,900 4 4 1 3 1 1 63 3 1168 1 0











WALTONA 18,871 1 2 1 1 9 63
SHINGTO E 211,889 1 1 1 1 12 1 2 1
ORANGE 90,895 1 59 136 1 201 1 2 528 91 274 5 7 216 4 M
OSCEOLA 1,700 65 1 1 3 4 1 1 1
PALM BEACH 120,3008 1 103 72 2 5 6 1 36 7680 24 5 7 46 t
PINELLAS 139,0 12 61 3 1 21 2 3 3 2 42 6 2
POLK 118,700 69 8 3 21 7 45 2 2 31 1 8 47 1 40 3 2 1022 7 1
ST. JOHNS 226,000 5 1 4 4 3
ST.LUCIE 13,200 2 15 1 9 6 2 7i







WASHINGTON 11.889 812 1.1 1 21 1










TABLE I-PROVISIONAL TOTALS OF MORBIDITY FOR 1946



0. 0

o y II
6 u g |


ALACHUA 7 5 2 x 49 55 1 1

BAEm 21 30 u,



BAY 3 8 10 187 30 1
BRADFORD 85| 1: 1 78 10 3 S
BREVARD 1 5 9 168 1 2 1N
0* P. G 02 E- E E- E- E- 9 0 > N ;w i

TOTAL LAST YEAR 1,0 23 1,103 143 383 1 1,073 13 124 442 0 2 115 477 810 1 8
TOTALTHIS YEAR 1,74 20 24 467 757 142 0 16,067 40 2,1 10 6693 0 81123 1,050 27 8 4 10 7
ALACHUA 5 2 1 7 5 8A 1 1 12
BAKER 21 30 9 1
BAY 8 3 10 187 3 1
BRADFORD 85 1 1 1 78 10 3
BREVARD 6 1 1 5 9 14 1682 19 2 2 1
BROWARD 10 7 4 383 28 3 25 1
CALHOUN 1 1 7 2 1
CHARLOTTE 1 15 0 2
CITRUS 2 I 24 3
CLAY 1 3 2 91 2 2
COLLIER 5 1 1 30 5
COLUMBIA 1 11 7 3 2 10 1 137 5 1 8 1 1 1 2
LADE 317 9 6 30112510 1442 29 1,627 9 334 4 652 311 2 87 1 2
DESOTO 1 1 44 3 1 1 1
DIXIE 1 1 23 1 7
DUVAL 63 1 2 136 57 31 8 7 42 18 2,689 6 257 2 18 37 3 28 158 8 1
ESCAMBIA 10 4 2 5 16 1 2 6 2 684 2 95 1 65 1 2 1
FLAGLER 7 9 5 98 1 1
FRANKLIN 10 37 7 1
GADSDEN 12 1 17 3 1 2 588 42 4 12 2 48 2 1 1
GILCHRIST 1 3 2 1 21 11 2 2
GLADES 1 1 1 26 0 2
GULF 1 1 1 78 6
HAMILTON 29 1 25 4 1
HARDEE 1 7 20 1 1
HENDRY 183 0 1 1
HERNANDO 2 34 11
HIGHLANDS 12 14 3 1 2 178 1 4 1 1 20
HILLSBORO 49 1 1 5 127 5817 57 58 947 7 464 1 8 57 6 29 90 921 2
HOLMES 83 8 38 1 10 4








TABLE I-PROVISIONAL TOTALS OF MORBIDITY FOR 1946-(Continued)






JACKSON 2 1 5 99Z 9 1 1
SLAFAYE0 TTE 2






LAKE 7 44 1 I 2 1 5 I I 914 I 1 |
LEE 2 126 10


LEON 24 1 1 2 5 12 1 368 46 3 7 4 1 1 LEVY 8 1 1 2 1 93 1 11 7 M
w 0
z 0 Ei Em E,




LIBERTY 1 1 "0 1




MADISON 3 4 105 24 3 2 2
MANATEE 6 157 15 1 8 7


MARION 8 S 4 4 6 2 2 293 197 1 1 10 4 2
MARTIN 40 1 4 4
MONROE 1 643 2 78 1 2 1 69 1 9
NASSAU 225 1 2 2 1 368 45 13 2 2
OKALOOSA 1 1 2 1 28 1 11 7
OKEERTCHOBEE 1 14 0 1
ORANGE 63 29 3 17 15 1 1 51 18
OSCEOLA 3 1 1 1 3 3 4 2 3
ALM BEACH 569 16 72 1 9 1 1,98 59 1 3

PASCO 1 1 2 78 1 2 6 1 1 1
PINELSSLAS 8 2 16 25 36 1 115 2 18 3 1 60 1 1
OKAM 2 7 2 8 1 6 3 2 8 45 8 6
. JOHNSEE 1 2 1432 I



ST. LUCIE 2 218 4 4 1 "
OANGEA ROSA 27 9 4 2 20 1 1 5 1 3118
SAASEOLA 7 1 1 0 16 1 23 1 2
SEMIOLE 9 1 2 1 2 1 01 19 1 9



SUANNTEE 8 8 1 11 5 5 2[
TAYLOR 1 48 14 1S 1
UNION 1 1 83 6 1 1
PO2NAM 8 14 6 553 2 80 345 8 8 63



VOALUA 1H 2 10 2 5 6 2 5 14 1 5
J GONS2 1 132 4 1 1_
ST. LUCIE2
SWALTON 21 1 2



ASHINGTON 9 2
MINO3LL 9 14 6 3
SUWALTONE a 8 32 11 5 3 21
UHNION I 17 11

WTN 25 3 3 2





8 ANNUAL REPORT, 1946


this disease would indicate that the situation in many areas was
reaching a critical state. Most of the rabid animals were not from the
cities but rather from the areas immediately adjoining the cities and
presented a rather difficult problem of control.
The number of cases of typhoid reported were less than last year.
During the coming year reports will be issued covering detailed
information on various communicable diseases in Florida.









150-



100-






O- m -
A so-



i Iii
04 59 1014 1519 2024 2529 3034 3539 40444549
Ag6 Groups in Years.
Figure No. 2-Age distribution of cases of poliomyelitis in Florida,
1946








PREVENTABLE DISEASES


EPIDEMIOLOGY OF HUMAN TYPHUS

Over a period of years there has been a gradual increase in the
number of cases of typhus reported in Florida. In order to determine
the epidemiology of the disease in this State, Dr. E. R. Rickard, staff
member of the International Health Division of the Rockefeller Found-
ation, with the cooperation of the Bureau of Preventable Diseases has
been studying the problem. In July, 1946, a statewide survey of the
condition was begun. Typhus or suspected typhus cases were investi-
gated by specially trained lay field investigators who worked under
close medical supervision and filled out standard case history forms
with the object of verifying the diagnosis and determining the probable
place of infection for each case. The sources of information leading
to cases were: Official reports to health departments, positive reports
from state and private laboratories, hospital records, interviews with
clinicians, information from patients or friends and neighbors of
patients, and death certificates. Cases having their onset within the
years 1944, 45, and 46 were included in the survey.




TABLE II-RESUME OF PROGRESS OF THE TYPHUS SURVEY
JULY 1 TO DECEMBER 31, 1946




0 E- 08
"a^ 5s I3
County Population u w


_____ _______. Z8 z P U_ _
Calhoun 8,225 9 0 0 9 0
Charlotte 4,220 0 0 0 0 0
Collier 4,957 0 1 0 1 1
*Dade 315,138 124 52 200 376 164
DeSoto 6,854 11 14 0 25 2
Escambia 105,262 137 36 31 204 191
Flagler 2,652 1 0 0 1 1
Gadsden 30,992 35 4 3 42 14
Hardee 8,585 16 11 1 28 0
Hendry 5,066 0 0 0 0 0
Hernando 5,672 2 2 0 4 0
Highlands-Glades 18,5:1 8 2 2 12 7
Hillsboro 207,844 369 175 28 572 203
Jackson 34,509 18 4 10 32 2
Lake 27,946 32 3 3 38 20
Lee 23,593 21 3 0 24 2
Leon 35,451 23 9 10 42 19
Manatee 26,803 15 0 0 15 5
Marion 35,132 43 15 9 67 19
Orange 86,782 56 44 1 101 33
Pasco 13,729 17 1 0 18 4
Pinellas 130,268 64 24 12 100 62
Polk 112,429 78 18 21 117 54
St. Johns 21,596 29 18 19 66 3
Sarasota 19,202 43 11 0 44 10
Seminole 24,560 6 10 3 19 7
Sumter 10,417 8 1 2 11 1
Volusia 58,492 58 11 4 73 49
Total 1,349,745 1,223 469 349 2,041 873
*Survey only about half completed in this county.








10 ANNUAL REPORT, 1946


In Table II the progress of the survey from July 1 to the end of the
year has been statistically summarized. Here it may be observed that
by the methods used, approximately two and one half times as many
cases or suspected cases of typhus were demonstrated to have occurred
as had been officially reported. Further analysis of data concerning
probable place of infection, seasonal and geographical distribution, etc.,
will await the termination of the survey. Of the State's total popula-
tion of 2,250,061 inhabitants, 1,349,745 or 60% live in the area so far
covered by the survey. This area has been illustrated on Fig. 3.


K.I.


ftRMMK JU


COUNTIES IN WHICH
SURVEY IS COMPLETED


COUNTY IN WHICH
SURVEY IS PARTIALLY
COMPLETE


Figure No. 3-Counties in which typhus survey has been
completed


0


completed or partially







PREVENTABLE DISEASES


It is planned to complete the survey about April of 1947, at which
time the epidemiological follow-up will be continued by the State
Epidemiologist with the assistance of a lay investigator. It is hoped
that on the basis of methods developed in the present survey future
reporting and epidemiological information of typhus in Florida will
be much more complete than in the past.

VENEREAL DISEASE CONTROL
R. F. SONDAG, M.D., Director
A year ago, in this publication, the following statement was
made: "Now that the War is over, everyone should hold firmly to
the great public health and law enforcement gains made during the
War and pledge greater confidence and determination in an all-out
effort to stamp out venereal diseases." One of the great public health
mile posts to stamp out syphilis was the enactment in the 1945 Legis-
lature of the Premarital and Prenatal laws, which became effective on
October 1, 1945. Prior to 1945, those unfortunate individuals who
married with venereal diseases and the diseased children of these
marriages, suffered the grave effects of neglect. The 1945 Legislature,
therefore, enacted laws which offer some ray of hope among those
individuals who approach the altar unknowingly infected with syphilis,
and made it possible for the first time by legislation to detect syphilis in
expectant mothers and thereby prevent the birth of diseased children.
All over the civilized world, the cry has always been WOMEN AND
CHILDREN FIRST. Prior to the enactment of the Premarital and
Prenatal laws, mothers and children were left to their doom-to become
maimed, blind, paralyzed, insane, bedridden, or otherwise rendered
helpless. These progressive laws are two in the armamentarium of
health organizations hard at work fighting venereal diseases.
Blood tests of candidates for marriage licenses and of pregnant
women are shown in Tables 3, 4, and 5. Since the laws have only been
effective for the past fifteen months, 1946 is the first complete year
on which results can be shown. Table 3 shows that 42,407 blood tests
were made in compliance with the Premarital Blood Test Law, and of
these 2,825 were positive. This means that in the absence of such a
law, 2,825 individuals would have approached marriage blissfully
ignorant that they were infected with syphilis. Over 2,800 cases of
syphilis were discovered in 1946 by means of this law, and these
individuals, after having been apprised of their infection, were
allowed to marry, provided adequate treatment had been given or the
disease rendered non-infectious.
During the 1943 Legislature, effective laws were enacted to lend
support to fearless law enforcing agencies. Law enforcement repre-
sentatives, therefore, have the tools by which they can correct and
prevent conditions leading to a high venereal disease rate. Prevention
must be as definite a police function as detection and apprehension.
WE HAD TEAMWORK DURING THE WAR AND IT BROUGHT
RESULTS LET'S NOT DISCARD IT NOW.






12 ANNUAL REPORT, 1946


In Table 4, the results of the Prenatal Law reveal a total of
37,878 tests taken on expectant mothers, of which 1,938 were posi-
tive. In the absence of a Prenatal Law, over 1,900 expectant
mothers could have gone to maturity unknowingly infected with
syphilis and could have given birth to dead babies or babies infected
with syphilis. The Prenatal Law is the most effective tool devised
to aid in the elimination of congenital syphilis. That some progress has
been made is reflected in the number of cases of congenital syphilis re-
ported during the past few years. In 1943, cases of congenital syphilis
reported to the State Board of Health totaled 753, and in 1946, the




30- r-- OAll Others
0 Early Latent
I Primary and.

61% 5econdaru






35% 42% 37
20-
















Figure 4-Total Cases of Syphilis Reported by Years.
Figure 4--Total Cases of Syphilis Reported by Years.














TABLE III-NUMBER AND RESULTS OF SEROLOGICAL TESTS FOR SYPHILIS PERFORMED BY STATE LABORATORIES
IN COMPLIANCE WITH PREMARITAL BLOOD TEST LAW, 1946

NEGATIVE DOUBTFUL POSITIVE TOTAL Total

Male Female Male Female Male Female Male Female

White Colored White Colored White Colored White Colored White Colored White Colored White Colored White Colored

Number 14,465 4,444 15,392 4,873 59 129 73 147 311 930 302 1,282 14,835 5,503 15,767 6,302 42,407
Percent 97.50 80.75 97.62 77.32 .4 2.34 .46 2.33 2.1 16.90 1.91 20.34 35 13 37 15 100



TABLE IV-NUMBER AND RESULTS OF SEROLOGIC TESTS FOR SYPHILIS PERFORMED BY STATE LABORATORIES IN
COMPLIANCE WITH PRENATAL BLOOD TEST LAW, 1946







14 ANNUAL REPORT, 1946


first year of the Prenatal Law, 447 cases were brought to our attention.
Every known method of follow-up is being utilized to make the Pre-
natal Law the most effective weapon in the elimination of congenital
syphilis. As we progress with this effective weapon, congenital syphilis
in the State of Florida should become a rare condition.
THE PREMARITAL AND PRENATAL LAWS HAVE AL-
READY PROVEN A HUGE SUCCESS OVER THE FIRST
FIFTEEN MONTHS OF OPERATION AND ADDITIONAL
BENEFICIAL RESULTS WILL BE REFLECTED IN YEARS
TO COME BY HAPPIER MARRIAGES AND STRONG,
HEALTHY CHILDREN.

In this issue a year ago, it was also stated that "failure to hold
the gains made in the control of venereal diseases would almost surely
place Florida back on the unenviable list of states with high venereal
disease rates." This should never happen-BUT IT IS HAPPENING.
During war-time, a fine cooperative job achieved impressive gains
in the fight against venereal diseases. The motivating factor of patri-
otism lent impetus to the cooperative effort, but as so many have pre-
dicted, we are not only beginning to' slip back-we have slipped!
The vital factor in the retreat from progress is the slackening of public
interest and support. Since the war ended law enforcement against
prostitution has relaxed. There is every reason to believe that those
who control the prostitution racket have already developed plans to
renew their activities. This movement must be resisted by every de-
cent citizen in Florida because it carries with it disease and corrup-
tion. Law enforcement responsibility to a community is greater than
that of any other agency and deserves the backing of every citizen
in the correction and prevention of conditions leading to delinquency
and disease. Proper discharge of police obligations and responsibilities
requires dealing with the individual law violator, whose conduct
menaces public health and safety, and close observation of places and
conditions which may be regarded as breeding places for crime and
delinquency.


TABLE V-NUMBER AND RESULTS OF SEROLOGIC TESTS FOR
SYPHILIS BY STATE LABORATORIES IN COMPLIANCE
WITH PREMARITAL AND PRENATAL LAWS BY
RACE AND SEX, 1946

NEGATIVE DOUBTFUL POSITIVE TOTAL

Number % Number % Number % Number %

Male 18,909 93.0 188 .9 1,241 6.1 20,338 100
Female 55,983 93.3 442 .8 3,522 5.9 59,947 100
White 56,656 97.7 190 .4 1,125 1.9 57,971 100
Colored 18,236 81.7 440 2.0 3,638 16.3 22,314 100

Total 194,784 93.3 1,260 .7 9,526 5.9 160,570 100







PREVENTABLEE DISEASES


Prevention is still in the horse and buggy stage as compared to
the streamlined advancements made in diagnosis and treatment of
venereal diseases, yet prevention remains the key to successful control
of venereal diseases. Venereal diseases are definitely preventable, but
prevention is a broad task. Among other things, prevention means
an understanding that conduct, and not medication, lies at the core
of the venereal disease problem. Prevention means steady, vigorous
citizen support of the work of law enforcement officials in repressing
prostitution. Prevention means knowledge on the part of each and
every person, young and old, of the dangers of venereal diseases, the
need to avoid exposure, and to seek treatment promptly if infection
occurs.
A splendid beginning has been made, but syphilis and gonorrhea
remain formidable public health problems. Relaxation in control
efforts reflects itself immediately in rising infections. That this is true
is evidenced by a 43% increase in primary and secondary syphilis in
1946 as compared to 1945. As great as this increase might seem, it is
estimated that many more cases of primary and secondary syphilis
fail to come to the attention of private physicians and public health
officials. These cases are the individuals who promote the spread of
syphilis and gonorrhea and hinder the effective control of these diseases.
Greater attention and more trained personnel must be devoted to
case finding activities. Every infectious case must be found and
brought under medical care. Rapid treatment must be made available
within reach of all who need it everywhere. Rapid treatment, which
renders syphilis non-infectious, will go far toward wiping out syphilis
if new cases can be found and brought under treatment fast enough.
During 1946, 79% of the primary and secondary cases of syphilis
discovered in Florida were referred to' the rapid treatment center for
intensive therapy. Tables 6 and 7 show the number of cases admitted
to the rapid treatment centers by stage of disease, race and sex. During
the year more cases could have been treated in the rapid treatment
centers, had not this phase of the venereal disease control program
met with some uncontrollable circumstances.
In April, 1946, a major fire destroyed half of the hospital at Ocala,
necessitating a curtailment in admissions to that center. After this
catastrophe, negotiations were started to acquire a new rapid treat-
ment center, which finally culminated in the acquisition of the Ernest
Hinds Hospital Ship, which was opened as a rapid treatment center
on the St. Johns River in Jacksonville on July 1, 1946. This facility,
too, had its limitations and it was necessary to restrict admissions on
many occasions because of inadequate space.
As this goes to press, the State Board of Health is still searching for
a suitable, modern facility to provide adequate treatment for all those
in need of intensive therapy.















TABLE VI-ADMISSIONS AND READMISSIONS TO FLORIDA RAPID TREATMENT CENTERS, ACCORDING TO RISEASE,
STAGE OF INFECTION, RACE AND SEX, 1946


DISEASE AND STAGE OF INFECTION RACE SEX




a a
o a o
CENTER 0 | i "I a | I |

Jacksonville Rapid Treatment Center 26 172 100 25 14 56 693 8 5 51 14 66 0 0 837 395 442 473 364

Sub-Total 199 1865 340 80 151 253 4088 124 63 160 174 165 9 194 4803 931 3872 2549 2254
Percent 29.4 38.8 7 1.6 3.2 5.3 85.1 2.6 1.3 3.3 3.6 3.4 .2 4.0 100 19.0 81.0 53.0 37.0
Is 0 *53 |
a as a a o o s a s

Ocala Rapid Treatment Center 1073 1693 240 55 137 197 3395 116 58 109 160 99 9 128 3966 536 3430 2076 1890
Jacksonville Rapid Treatment Center 326 172 100 25 14 56 693 8 5 51 14 66 0 66 837 395 442 473 364
Sub-Total 1399 1865 340 80 151 253 4088 124 63 160 174 165 9 194 4803 931 3872 2549 2254
Percent 29.4 38.8 7 1.6 3.2 5.3 85.1 2.6 1.3 3.3 3.6 3.4 .2 4.0 100 19.0 81.0 53.0 37.0
Ernest Hinds Treatment Center 1470 1799 327 155 172 364 4287 58 97 168 219 152 3 155 4984 923 4061 2413 2571
Percent 29.5 36.1 6.6 3.1 3.4 7.3 86.0 1.1 1.9 3.3 4.4 3.1 .1 3.1 100 19.0 81.0 48.0 52.
TOTAL 2869 3664 667 235 323 617 8375 182 160 328 393 317 12 349 9787 1854 7933 4962 4825
Percent 29.3 37.4 6.8 2.4 3.3 6.4 85.6 1.9 1.6 3.3 4.0 3.2 .1 3.6 100 19.0 81.0 51.0 49.

Ocala and Jacksonville RTCs closed June 30, 1946
Ernest Hinds Treatment Center opened at Jacksonville July 1, 1946
* Includes V. D. other than Syphilis and Gonorrhea.


0
s;

c.
i4
r

W
M


i->
CO
n-
01








PREVENTABLE DISEASES


TABLE VII-NUMBER OF CASES OF SYPHILIS REPORTED, BY STAGE
OF INFECTION, WITH NUMBER AND PERCENT TREATED IN
THE RAPID CENTERS, 1946


Percent
Stage of Syphilis Total Cases Treated in Treated
Reported RTC in RTC

Primary and Secondary 3,651 2,869 79%
Early Latent 6,009 3,664 61%
Late and Late Latent 3,463 667 19%
Pregnancies 347 235 68%
Congential 447 323 72%
Central Nervous System 704 617 88%
Total Syphilis* 16,135 8,375 52%

*Includes Unknown Stage


TABLE VIII-NUMBER OF VENEREAL DISEASE CASES REPORTED IN
FLORIDA, BY DISEASE AND YEAR, 1942-1946


Year Syphilis Gonorrhea Chancroid Granuloma Lymphopathia
Inguinale Venereum

1942 30,104 10,165 453 135 124
1943 33,540 16,925 844 251 254
1944 19,087 14,351 535 217 248
1945 16,546 18,088 722 244 197
1946 16,067 18,548 818 257 176

(Out of State Cases Excluded)









18 ANNUAL REPORT, 1946

TABLE IX-NUMBER OF CASES OF SYPHILIS AND GONORRHEA RE-
PORTED BY COUNTY-FLORIDA-1942-1946


COUNTY 1942 1943 1944 1945 1946

Syp. Gon. Syp. Gon Gon. S. on yp. Gon. Syp. Gon.
Alachua 965 105 784 118 348 65 307 187 439 266
Baker 76 20 45 10 31 25 30 13 30 33
Bay 412 255 553 422 437 454 323 868 187 169
Bradford 182 97 199 86 193 97 134 114 78 99
Brevard 168 2 419 91 73 33 120 40 168 28
Broward 773 110 742 231 479 258 349 210 383 841
Calhoun 26 2 48 5 9 1 6 1 7 6
Charlotte 170 8 65 33 15 17 5 15 15 5
Citrus 17 0 170 11 13 7 16 30 24 47
Clay Ex. 62 61 108 48 155 66 40 59 65 101
Camp Blanding 329 1478 316 1875 69 91 143 42 26 3
Collier 190 1 35 14 23 3 18 41 30 38
Columbia Ex. 59 8 714 24 88 31 64 48 137 161
Govt. Hospital 69 2 17 0
Dade 4229 522 4459 1349 2588 2016 1724 2444 1627 2808
DeSoto 264 14 166 47 53 50 43 41 44 61
Dixie 74 1 215 0 14 5 27 39 23 50
Duval 3516 2115 6214 3032 3909 1826 2470 2387 2688 2814
Naval Air Base 31 428 36 503 43 529 62 706 1 123
Escambia 661 514 792 1127 812 1487 641 1934 684 1993
Flagler 79 11 94 8 108 55 173 70 98 85
Franklin 96 30 117 158 142 675 85 184 37 73
Gadsden Ex. 199 56 299 40 120 53 348 296 409 375
State Hospital 172 0 183 1 159 0 155 2 179 0
Gilchrist 42 0 4 1 1 0 4 5 21 13
Glades 110 7 18 8 32 6 29 3 26 6
Gulf 148 16 143 13 84 13 46 21 78 14
Hamilton 77 50 3 0 8 6 14 11 25 17
Hardee 95 17 36 5 34 10 16 9 20 0
Hendry 205 6 181 57 135 24 240 25 183 20
Hernando 53 0 142 2 9 5 3 11 34 5
Highlands 344 35 299 260 183 280 107 153 178 105
Hillsborough 2437 803 2920 1430 1417 1815 1205 2176 947 2330
Holmes 18 1 51 0 51 14 30 5 38 15
Indian River 210 11 279 16 68 22 153 40 114 31
Jackson 237 109 211 133 113 164 50 169 99 197
Jefferson 432 42 201 64 78 47 79 101 87 70
Lafayette 7 1 14 0 4 1 2 0 4 3
Lake 611 97 380 95 201 96 199 121 355 264
Lee 650 108 286 39 149 41 101 127 126 178
Leon 659 1111 450 687 359 1128 309 1123 368 761
Levy 301 15 152 62 10 3 65 26 93 32
Liberty 4 0 7 1 0 1 1 3 0 1
Madison 235 13 467 38 16 4 118 40 105 64
Manatee 503 35 218 187 178 84 184 241 157 322
Marion 359 27 1026 77 263 111 242 899 293 662
Martin 66 2 95 8 7 0 83 19 40 5
Monroe 147 80 808 171 142 220 117 228 78 209
Nassau 309 59 201 126 114 102 90 36 72 50
Okaloosa 140 24 171 248 61 224 42 164 28 19
Okeechobee 2 2 72 0 36 12 18 16 14 2
Orange Ex. 1023 629 850 846 580 313 781 514 721 528
Fla. T. B. Sanat. 2 1 2 0
Osceola 132 3 113 9 6 4 16 6 36 6
Palm Beach 1245 258 1274 835 2324 353 2069 814 1398 780
Pasco 114 2 175 4 55 3 31 5 83 13
Pinellas 1111 277 927 596 370 319 268 279 386 504
Polk 690 34 1135 245 526 161 552 336 553 474
Putnam 401 6 320 39 82 37 193 67 232 25
Saint Johns 264 10 213 36 137 44 222 71 132 46
Saint Lucie 127 14 339 105 165 42 160 115 213 179
Santa Rosa 58 27 55 18 33 88 13 38 20 31
Sarasota 570 83 181 46 139 53 91 78 60 77
Seminole 1169 104 589 210 335 197 546 175 301 192
Sumter 227 14 190 165 85 6 93 24 105 66
Suwannee 259 9 377 10 9 4 34 17 13 48
Taylor 301 75 127 58 62 110 26 17 48 6
Union 24 1 20 1 11 7 15 12 31 18
State Prison 238 5 89 2 144 0 143 0
Volusia 944 83 660 260 310 186 350 460 459 435
Wakulla 85 15 111 290 16 21 15 11 14 25
Walton 164 12 46 45 58 69 55 48 32 9
Washington 45 0 141 22 47 56 42 57 25 12
Quarantine Hosps. 271 616
Grand Total 30104 10165 33540 16925 1908 14351 16546 18088 16067 18548
(Out of State Excluded)




















TABLE X--DISTRIBUTION OF DRUGS AS TO SOURCE AND KIND FURNISHED FOR 1944-1946


Distributed to Distributed to Total
Private Physicians Clinics, Hospitals and Others Distributed
DRUGS
1944 1945 1946 1944 1945 1946 1944 1945 1946

Mapharsen (In doses) 36,270 13,080 14,688 398,820 234,680 68,205 435,090 247,760 82,893
Neoarsphenamine (In doses) 3,260 1,340 1,012 9,095 2,165 2,104 12,355 3,505 3,116
Sulpharsphenaminee (In doses) 155 5 55 2,760 1,045 541 2,915 1,050 596
Tryparsamide (In doses) 940 380 204 10,550 4,780 2,094 11,490 5,160 2,298
Bismuth (In ee's) 37,470 14,040 17,240 517,720 264,790 139,480 555,190 278,830 156,720
Sulfathiazole (In grams) 4,000 1,000 7,500 1,055,000 199,190 201,452 1,059,000 200,190 208,952
Distilled water (In cc's) 318,600 144,300 103,000 3,048,900 2,783,200 1,432,600 3,367,500 2,927,500 1,535,600
*Penicillin (100,000 unit vials) 0 747 1,184 10,920 107,862 82,954 10,920 108,609 84,138
Penicillin (200,00 unit vials) 0 0 269 0 0 9,693 0 0 9,962
Penicillin (500,000 unit vials) 0 0 0 0 0 3,110 0 0 3,110
Penicillin in Oil (In cc's) 0 0 410 0 0 12,350 0 0 12,760


*Penicillin distributed-19 ts.


M

M





M

tri
u


tri
M


m
M
oa








TABLE XI-REPORT OF SYPHILIS ACCORDING TO STAGE OF INFECTION, PREGNANCY STATUS, RACE AND SEX,
SOURCE OF REFERENCE AND AGE GROUPS BY COUNTIES AND FOR STATE OF FLORIDA


BY STAGE OF INFECTION BY RACE AND SEX Source of Ref. BY AGE GROUP


Late White Colored
COUNTY .


02 V
I I a 'e I o P |
_________ l-i-J__ ___o Zi-_ I0Z0p
Alachua 49 39 182 102 0 10 22 35 439 7 21 28 155 209 26 439 351 88 27 14 100 160 83 36 19 439
Baker 3 5 7 4 1 4 1 5 30 4 3 2 14 0 30 22 8 0 1 3 11 7 6 2 30
Bay 16 52 70 21 0 6 2 20 187 10 18 28 57 77 7 187 130 57 7 2 50 77 28 15 8 187
Bradford 10 23 26 7 0 5 0 7 78 0 6 15 29 26 2 78 53 25 3 0 18 38 12 4 3 78
Brevard 7 22 59 29 1 10 5 35 168 4 8 18 53 83 6 168 57 111 6 4 16 58 50 18 16 168
Broward 28 32 208 72 1 12 10 20 383 23 27 24 144 169 19 383 262 121 27 3 68 157 74 36 18 383
Calhoun 1 1 4 0 0 0 1 0 7 0 4 3 0 0 0 7 5 2 1 1 2 3 0 0 0 7
Charlotte 2 6 4 1 0 0 0 2 15 0 2 4 3 6 0 15 11 4 1 0 3 7 0 3 1 15
Citrus 5 0 10 7 0 0 0 2 24 2 3 3 5 12 1 24 5 19 0 0 9 7 3 4 1 24
Clay 8 19 22 11 0 0 3 2 65 1 7 16 11 31 0 65 44 21 0 1 16 28 9 8 3 65
Collier 1 5 12 7 0 2 2 1 30 0 0 2 9 19 0 30 21 9 1 0 4 11 5 7 2 30
Columbia 13 11 51 39 0 7 6 10 137 3 14 14 41 67 1 137 61 76 7 5 22 53 22 21 7 137
Dade 151 211 645 352 12 60 34 162 1627 49 213 203 554 622 35 1627 1198 429 43 15 194 718 381 170 106 1627
DeSoto 4 8 10 13 0 0 2 7 44 2 4 11 10 15 4 44 18 26 3 2 4 15 9 8 3 44
Dixie 1 3 9 4 2 2 1 1 23 1 3 4 4 12 0 23 16 7 0 0 4 5 8 4 2 23
Duval 216 378 863 505 8 89 49 580 2688 68 300 335 812 1068 173 2688 1540 1148 282 30 338 974 562 298 204 2688
Escambia 104 110 310 123 6 16 13 2 684 10 69 76 239 295 5 684 563 121 6 7 145 320 132 47 27 684
Flagler 12 3 45 12 1 3 22 0 98 1 9 3 49 37 0 98 97 1 0 12 21 21 16 19 9 98
Franklin 5 3 11 13 0 1 0 4 37 2 5 2 11 10 9 37 18 19 1 0 6 17 4 4 5 37
Gadsden 73 44 219 39 1 5 13 15 409 9 12 14 136 241 6 409 293 116 20 6 101 137 81 42 22 409
Gilchrist 1 6 7 2 0 1 0 4 21 0 2 3 8 8 0 21 4 17 2 0 4 4 5 4 2 21
Glades 2 10 8 0 0 4 26 0 1 1 17 6 1 26 19 7 0 0 3 10 9 1 3 26
Gulf 3 9 33 24 2 2 3 2 78 0 7 8 28 33 2 78 55 23 7 2 16 30 10 9 4 78
Hamilton 4 5 8 5 0 1 1 1 25 1 3 2 7 10 3 25 20 5 0 0 7 9 6 2 1 25
Hardee 0 0 6 4 0 1 1 8 20 0 3 6 5 5 1 20 4 16 0 0 5 7 4 1 3 20
Hendry 8 23 131 6 0 9 1 5 183 0 2 3 153 21 4 183 167 16 3 0 5 113 41 18 3 183
Hernando 2 13 9 6 0 1 1 2 34 0 3 1 11 19 0 34 19 15 1 1 10 13 5 2 2 34
Highlands 32 22 70 27 0 7 2 18 178 3 7 14 67 82 8 178 107 71 7 1 28 67 44 22 9 178
Hillsborough 137 143 224 209 8 56 29 141 947 31 175 151 266 341 14 947 632 315 29 11 155 388 189 119 56 947
Holmes 4 3 13 9 0 2 6 1 38 2 11 16 6 4 1 38 33 5 3 3 7 9 8 3 5 38
Indian River 11 14 50 20 0 8 1 10 114 0 11 10 32 60 1 114 82 32 6 1 20 36 27 15 9 114
Jackson 15 12 53 12 0 2 4 1 99 2 10 18 27 38 6 99 89 10 12 2 21 44 9 8 3 99
Jefferson 6 15 48 7 0 3 3 5 87 1 3 8 30 45 1 87 68 19 4 1 36 29 7 5 5 87
Lafayette 0 2 0 1 0 0 1 0 4 0 0 2 2 0 0 4 3 1 0 1 1 0 1 4
Lake 48 47 124 72 6 21 5 32 355 6 34 34 152 119 16 355 221 134 18 3 43 148 94 27 22 355
Lee 28 16 55 14 0 2 1 10 126 0 10 7 52 40 17 126 93 33 39 1 11 45 15 10 5 126







TABLE XI (Continued)-REPORT OF SYPHILIS ACCORDING TO STAGE OF INFECTION, PREGNANCY STATUS, RACE
AND SEX, SOURCE OF REFERENCE AND AGE GROUPS, BY COUNTIES AND FOR STATE OF FLORIDA


BY STAGE OF INFECTION BY RACE AND SEX Source of Ref. BY AGE GROUP


Late White Colored
COUNTY
a 105
,i- a .g _
a a a ,a




LbMartin 0 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 6 40
Manatee 18 20 65 26 0 11 11 6 157 4 17 20 47 72 1 157 127 30 6 4 36 55 27 23 6 157
Marion 27 42 121 71 0 8 12 17 293 2 17 16 102 142 16 293 215 78 27 3 43 120 50 28 22 293
Martin 2 11 10 9 .0 1 1 6 40 1 5 3 14 15 3 40 20 20 8 0 3 10 6 7 6 40
Monroe 3 6 33 22 1 1 0 12 78 2 11 12 22 28 5 78 66 12 3 0 4 35 22 3 11 78
Nassau 2 11 19 28 0 1 1 10 72 9 4 2 26 37 3 72 29 43 3 1 14 25 15 7 7 72
Okaloosa 3 6 9 4 1 3 28 0 5 8 6 9 0 28 21 7 0 1 7 9 5 5 1 28
Okeechobee 2 1 6 1 0 3 0 1 14 0 0 0 9 5 0 14 10 4 0 0 1 6 4' 1 2 14
Orange 104 115 253 91 1 28 22 107 721 12 77 104 198 259 83 721 423 298 54 14 104 293 149 72 35 721
Osceola 5 6 10 6 0 1 0 8 36 0 6 7 9 8 6 36 15 21 4 0 6 9 9 3 5 36
Palm Beach 87 13 663 295 10 83 41 81 1398 14 10 7 63 543 45 1398 995 403 30 11 189 627 350 126 65 1398
Paseo 4 14 24 28 0 1 0 12 83 2 9 1 11 46 3 3 14 69 3 0 12 27 0 14 7 83
Pineas 61 88 131 57 2 7 1 2 65 6 109 132 11 386 273 113 16 7 78 158 59 43 25 386


St. Johns 7 11 45 36 0 5 1 27 132 2 18 11 29 53 21 132 48 84 27 1 17 51 15 11 10 132
St. Lucie 19 96 30 9 1 10 1 94 86 11 213 166 47 12 6 30 87 45 26 7 213
Santa osa 4 0 10 3 0 1 0 20 0 3 6 7 0 2 17 3 0 6 7 3 2 2 20
Sarasota 1 7 29 12 0 3 2 6 60 1 7 7 20 24 2 60 36 24 3 1 8 23 1 9 1 60
Seminole 9 29 98 114 0 11 3 37 301 3 10 4 12 11 149 8 301 157 144 35 0 35 99 59 49 24 301
Sumter 7 5 41 28 5 12 6 1 105 3 20 6 41 34 4 105 55 50 3 3 12 35 31 8 13 105
Suwannee 7 10 64 16 0 9 4 81138 8 12 44 46 3 113 91 22 19 3 16 29 21 1 11 1 13
Taylor 10 7 9 0 0 2 13 48 2 7 5 14 18 4 48 28 20 5 0 12 20 6 3 2 48
Union 5 8 11 5 0 01 1 1 31 1 3 4 10 14 0 3 24 7 1 1 4 16 3 5 1 31
Volusia 41 43 142 164 2 11 27 29 459 3 40 42 169 182 26 459 299 16 2 32 459
Wakulla 1 0 10 2 0 0 0 1 14 2 1 3 6 4 0 14 12 20 9 3 0 0 14
Walton 2 4 11 5 0 0 1 9 32 0 11 9 7 5 0 32 24 8 4 1 2 11 11 0 3 32
Washington 0 4 10 7 0 2 25 0 0 3 6 13 3 25 20 5 2 4 2 2 25
State Hospital 01 14 48 0 1 0 1 179 0 32 17 6 53 14 179 179 0 3 0 3 16 55 58 44 179
State Prison 3 0 0 140 0 0 0 0 33 4 91 13 2 143 143 0 63 0 8 25 26 13 8 143
Camp Blanding 1 2 0 1 0 26 7 0 19 0 0 26 26 0 0 0 0 23 3 0 0 26
Naval Air Station 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 0 1
Out of State 11 12 20 8 0 2 0 15 68 0 21 6 30 9 2 68 55 13 10 0 8 29 11 4 6 68
Florida-TOTAL 16002051 6003 3386 7 704 447 1867 16135 347 1720 1693 5557 6380 785 16135 10655 5480 1061 216 2474 6274 3351 1727 1032 16135






22 ANNUAL REPORT


INDUSTRIAL HYGIENE
H. N. DOYLE, U.S.P.H.S
The 1945 session of the Florida Legislature amended the Work-
men's Compensation Act to include occupational diseases. At the
same time it directed the Workmen's Compensation Division of the
Florida Industrial Commission to cooperate with the State Board of
Health in making a study of occupational diseases among the indus-
tries of the State. This survey was inaugurated in January, 1946
under the auspices of the Division of Industrial Hygiene, U. S. Public
Health Service. The survey which was completed in April, 1946, gave
a total of 905 establishments employing 64,528 persons. The survey of
these representative plants confirmed the conclusion that inadequate
medical, sanitation, and welfare services were offered to the worker
at his place of employment to protect him from occupational diseases.
The results of this report also shows that potential occupational
disease problems exist in certain groups of industry namely, citrus
canning, cigar, phosphate mining, and the manufacture of super-phos-
phates. The primary recommendation of this report was that a Divi-
sion of Industrial Hygiene be established in the State Board of Health,
and that its program be well integrated with the Workmen's Compen-
sation Division of the Florida Industrial Commission, and other
bureaus of the State Board of Health.
As a result of this report, the State Board of Health established in
the Bureau of Preventable Diseases in August, 1946, a Division of
Industrial Hygiene. The U. S. Public Health Service assigned to the
State, Senior Assistant Engineer, Henry N. Doyle, to assist in its
organization. During the ensuing calendar year most of the time was
spent in organizing the Division, securing the necessary personnel,
and purchasing the necessary laboratory and engineering equipment
for its operation. By the end of the calendar year, the staff consisted
of a State employed engineer and chemist, and arrangements had been
completed to secure a physician director; who is to report for duty
on February 1, 1947.
Financial assistance for the first year of operation was secured
from the U. S. Public Health Service by a grant-in-aid fund of $16,253.
However, the legislation has been prepared for introduction at the 1947
meeting of the Legislature to give the State authority to establish
an administrative unit of Industrial Hygiene, and to secure an annual
appropriation of $27,000.
Arrangements have been established with the Florida Industrial
Commission for the Division of Industrial Hygiene to act as a con-
sultant to this Agency for the control of occupational diseases and
in the adjudication of claims arising from such. This is another
responsibility designed to prevent and control occupational diseases.
These rules and regulations have been formulated and submitted to
the Florida Industrial Commission. The Commission has accepted
this Code and its adoption is expected following public hearings early
in 1947. The enforcement of these rules and regulations is to be en-
tirely in the hands of the Industrial Commission and the Industrial







PREVENTABLE DISEASES 23

Hygiene Division is to only act as consultant. Another cooperative
arrangement that has been established with the Industrial Commission
is the treatment of venereal diseases among those men injured in
industries that abide by Workmen's Compensation Act. The two
agencies have established a film library on safety and related indus-
trial subjects which is available to any industry within the State.
In addition, the Division of Industrial Hygiene has assumed the
responsibility to promote adult health service in industry.
Arrangements have been made to secure occupational disease re-
ports from the Workmen's Compensation Division. These are to be
studied and those that appear to be preventable will be investigated
by this division. During the calendar year 434 occupational disease
reports were received. This represented the period from April through
December. In order to give magnitude of the occupational disease prob-
lem, the statistical break-down of these reports is shown in the follow-
ing table:
Nature of Disability
Chemical dermatitis ------------------------------------. 29
Other dermatitis -- ---------- ---------_------ 163
Chemical conjunctivitis ----....-----_--- 6
Other conjunctivitis ----.------------ 70
Fungi, larvae and parasites __- ._..-- --- 43
Lead ................--------_-_..._....-----. 4
Other metallics __---_... ----~_ ._---- 5
Gas ------------------- -- ------------- ......... ...---............ 7
Tenosynovitis .... ...........-- ------------- ----- 1
Meat infections -----------------__--_ -- 15
Chemical burns ------...... --.--------------.. 21
Other infections ..--------. ----_ ---_--_-------. 24
Traumatic --__- ---- --------------_---__ 11
Heat --...- -- ---....-_.....-_.... ...._ -- _. --- 12
Respiratory ------.- --- .- --- ______ _- 6
Other --___.--------------------------------..-..... ... 17
TOTAL ---.---......------.......... ..---....... 434











r










BUREAU OF

TUBERCULOSIS CONTROL

C. M. SHARP, M. D., Director
During the year 1946 there were 685 deaths from all forms of
tuberculosis among the residents of the State of Florida. Of these
335 occurred in the white race comprising 76% of the total population
of the State, and 350 deaths occurred among Negroes, which comprises
only 24% of the total population. It thus becomes evident that 51%
of the tuberculosis deaths occurred among 24% of the population.
DEATH RATES
The tuberculosis death rate during 1946 for residents of the State
of Florida was 29.3 per 100,000 population, which is a decrease from
the rate of 30.9 in 1945. In 1946 there were 685 deaths from tubercu-
losis as compared with 701 deaths in 1945. For white residents, the
tuberculosis death rate was 18.9 per 100,000 population, which was the
lowest death rate which has been reported in the State of Florida for
its white population. As compared to the 1939, 1940 and 1941 rates
compiled during the last census, there has been an appreciable de-
crease in the tuberculosis mortality rates, The average of the mortality
rates for the three years 1939, 1940 and 1941 show a rate of 47.3 deaths
per 100,000. During the year 1946, however, there was a rate of 62.0
per 100,000 for the colored population of the State, which is almost
four times as high as for the white population. Table XII shows the
tuberculosis mortality rates by race from 1917 through 1946 which
has been plotted in Fig. 5.
REPORTED CASES
During 1946 there were 2,437 cases of tuberculosis reported in the
State of Florida, including 295 cases which were first reported by
death certificate. The corresponding number of cases reported for
1945 was 1,086. In Table XIII an attempt has been made to analyze
the cases reported for 1946 by stage of disease, race, sex and color,
by age groups and by source of report. It will be noted in this table
that only 25 of the 52 organized counties have been analyzed. An
analysis of the entire 2,437 cases is impossible at this time due to the
fact that only 25 counties have been worked up for the central case
register which was inaugurated during the last year. These 25 counties,
however, comprise 68% of the total population of the State, and it
is expected that during 1947 the case register will be complete for an
analysis at any given time.
In the case register there are 25 counties which represent 1,831
newly reported cases for 1946. It will be noted that the greatest num-
ber of new cases reported are from Duval County where there were
353 new cases of tuberculosis. The second largest number was from








26 ANNUAL REPORT, 1946

Hillsborough County where there were 340 cases, and the third largest
number was from Dade County where there were 303 cases reported.

One of the striking features of Table XIII is that of all of the
cases reported 471 were in the far advanced stages. Another feature
is that the vast majority of the cases reported were among white
residents, in spite of the fact that over 51% of all of the -deaths were
among the Negro race, which comprise only 24% of the population
of the State. There were 347 moderately advanced cases and only 253
minimal cases reported during the year with a total of 344 whose stage
is not known at the present time. This is in marked contrast to
findings in mass x-ray surveys where the vast majority of cases found
are in the early stages (see Case-Finding).
The source of reporting tuberculosis in the State is shown by
Fig. 6. This graph represents 100% of all of the 2,437 cases reported.
The largest number reported were by county and city health depart-
ments, which comprise a total of 716 cases. The second highest
number reported were in old cases which were newly reported com-
prise 511 cases. These cases were known to some sources but have
never been reported officially as a case of tuberculosis. The third
greatest number of cases reported were from death certificates. It
will be noted that 43% of all deaths from tuberculosis in the State
of Florida were first reported by death certificate. Three percent
of all of the deaths in the State of Florida during 1946 were caused
by tuberculosis.



TABLE XII-DEATHS FROM TUBERCULOSIS (All Forms) AND DEATH
RATES PER 100,000 POPULATION, DISTRIBUTED TO COLOR,
FOR EACH YEAR, FLORIDA, 1917-1946
YEAR TOTAL RATE WHITE RATE COLORED RATE
1946 685 29.3 835 18.9 350 62.0
1945 701 30.9 340 19.9 361 64.9
1944 791 36.0 369 23.1 422 70.8
1943 834 43.6 368 26.0 471 91.0
1942 859 44.9 360 25.8 499 96.4
1941 916 47.9 362 26.0 554 107.0
1940 961 50.3 379 27.2 582 112.4
1939 921 49.7 376 27.9 545 107.3
1938 987 55.0 407 31.4 580 116.4
1937 966 55.6 400 32.0 566 115.8
1936 905 53.9 887 32.3 518 108.2
1935 903 65.7 397 34.5 506 107.9
1934 953 60.1 381 33.9 572 123.9
1933 1,039 -66.9 398 86.1 641 142.1
1932 1,093 71.5 395 36.5 698 156.2
1931 1,067 70.8 427 40.1 640 144.8
1930 1,015 68.6 432 41.3 583 134.0
1929 1,014 70.8 416 41.3 598 140.6
1928 1,102 79.7 481 49.7 621 149.5
1927 1,097 82.2 463 49.8 634 156.4
1926 1,187 92.3 619 68.3 668 169.0
1925 999 80.8 426 50.0 573 148.7
1924 1,054 88.7 457 56.2 597 159.1
1923 1,079 94.7 490 63.3 589 161.2
1922 1,019 93.5 440 59.9 579 163.0
1921 951 91.3 401 57.6 550 159.3
1920 1,016 102.3 423 64.3 593 176.8
1919 993 103.7 461 73.4 532 161.6
1918 1,084 116.9 494 81.2 590 180.4
1917 1,085 118.9 472 80.3 613 188.7









TUBERCULOSIS


917 I8 19 20 21 22 23 24 25 26 2 2 29 20 t 31 2 33 14 36 3u 7 31 29 4 41 Q 41 4 4 4s 4
Figure No. -Tuerulosis death AR
Figure No. 5-Tuberculosis death rates for total population and races per 100,000











TABLE XIII-ANALYSIS OF 1931 TUBERCULOSIS CASES REPORTED DURING 1946
OF COUNTIES WORKED FOR CASE REGISTER BY STAGE OF DISEASE,
RACE AND SEX, SOURCE OF REPORT AND AGE GROUP

STAGE OF DISEASE BY RACE AND SEX SOURCE OF REPORT BY AGE GROUP

Unofficial Reports I IColor
UnofficialReports Official Reports White Colored Not
X-Ray Imp. Only Stated


oo
0 '3




Bay 8 1 14 37 151 2 3 1 4 3 1 11 16 3 2 210 5 6 5 3 6 37
B A
2 8



Broward 1 306 10 5 1 30 1 8 9 2 2 30


Dade 9 2 75 102 94 391 87 40 29 4 4 303 10 188 33 8 48 17 9 31 9 308 1 16 59 67 57 46 42 15 303
-0 ; r O C?'

Dixie 1 1 1 1 1 1 0
Duval 27 11 7 2 5 18 49 7 12 835 113 4 1 61 19 7 353 171 30 60 14 681 82527 353 11 14 65 8 61 32 218 54 88
Escambia 2 2 22 1 26 1 4 1 107 17 51 1 8 119 1 5 2 107 1 3 24 241 14 1 5 107
Bay 8 10 14 5 37 1512 2 31437111 163 5 1 37 2 1056 53637

Franklin 1 4 1 6 5 10 5 4 1 8 2 30
Gadsden 1 23 10 12 47 10 1 87 40 29 4 4 303 221 1 7 1 1 8 31 4 1 6 596714 1540 47
Dixie 1 1 111 1 11 4 4 1 1 1

Hillsborou 27 11 51 18 9 91154 340 113 4610 2 2 5 34 4 891 9 19 3 168 1 3 340 2 11 54 8 60 4 38 51 340
Jacaksonmb 4 37 10 36 19 26 21 41 17 51 1 8 21 815 2 10713 4 24 14 10 13 25
Franklin 1 4 1 1 1 2 3 4 4 4 2 6
Gadden 1 28 20 124 9 47 1011 17 8 4 2 74 12 28 4 2 41 2 13 74 17 2 312 19 14 10 9 7 47

Nassau 1 1 4 2 2 15 3 15 61 1 32 1 11 2 3 2 1 15
Orange ou 3 2 61 116 3 340 174 4042 24 9 19 3 4 108 5 3 340 152 61 26 6 10 1 20 26 144 8 11 34 107
Jaolk 39 2 4 6 1 1 3 34 154 416 47 2 8 154 5 39 16 17 3 1 2 113 154 11 27 3 26 23 11 1 154
Lafayette None

Santa Rosa 3 ke 1 1 4 21 11 42 1 14 21 2 31 14 2 8
Leon 11 1 28 2014 9743417 9 842741228 42421 21741 2 12191410 9 7 74
Nassau 1 1 2 4 2 3 2154353 15 611 2 32 15 4251 2 1 15
Orange 6 2 1 2 1 1 21 17 31 25 107 42 242020143 410753931561 26 66 1073 1 2023 181113107
Polk 39 46 1615 19303415441472527 6 8154 539 16 17 3 123 1139154511273526231116154
Santa Rosa 3 2 1 2 8141 1 1 8 1 2 11 3 8 221 12 8
Seminole 1 1 5 5 2 1327 949 27 5 4 1 6 36 1 1271 1 7 2 5 1 27
Suwannee 3 4 7 2 1 2 7 1 2 21 1 7 1 3 1 2 7
Volusia 1 5 1 1 4 15 12 10 49 18 18 4 62 1 49 225 4 2 12 1 7 1 49 2 12 8 11 5 4 49
Wakulla 1 21 4 21 1 4 2 1 1 4 1 3 4
Washington 1 2 2 3 8 5 2 1 8 1 6 1 8 1 2 1 1 2 8
98 9 38 21 7 1419 253 347 481 544 1831 709 452 333 248 55 34 1831 126 574 77 142 195 54 43 414 3 16 89 98 1831 39 90 331 410 20 237 206 198 1831








TUBERCULOSIS 29


The number and percentage of tuberculosis cases reported by
age groups for the calendar year 1946 are shown in Fig. 7. It will be
noted that the highest number of cases reported occurred between
the ages 21-50. Another very striking feature concerning the race and
sex of the cases reported is shown in Fig. 8. Of the total cases reported
1531 were among white residents while only 769 cases were reported
among the Negro race, who accounted for 51% of all tuberculosis
deaths during 1946.
Fig. 9 shows the percentage of tuberculosis cases reported by sex
and age groups during the calendar year 1946. It will be noted that
62% of all white cases reported occurred among males as against
39% among females. Of the cases reported among the Negroes 59%
were among the males as against 41% among females. It is, therefore,
extremely obvious that there has been a great deficiency in the work
done concerning the finding and reporting of cases among Negroes,
and increased emphasis should be placed upon case finding in this
population group. The death rate from tuberculosis among Negroes
in the State will continue to be high until the needs of the Negro
population are adequately met in case finding and in facilities for
hospitalization, which are extremely inadequate.
In further discussion of Fig. 9, the incidence of tuberculosis in
each age group, in decades, show that the male rate is consistently
higher in all age groups except in the age group between 11-20 where
the female incidence is higher. This, however, is consistent with
generally accepted statistics on this subject.
An analysis of the tuberculosis cases in the central register is
very revealing. It shows that of a total of 6,500 cases in the register,
5,490 are cases who are at home, while only 898 cases are located in
sanatoria. There are 3,900 cases whose sputum is undetermined and
900 cases in the home whose sputum is positive. An analysis of the



I-Private Phys;c;anl
2-County & City Health Departments
716 3-General Hosp;tals
4-San.tor. a
S-D.ahl Certificesn
6-Veterans' Hosp;tWis
7-Out of S.tte Reports
$-Old C.Ie Nrwly Reported
1 9-X-ry Impresions Only
20 : I-0-Laboratory Reports
II-Selecti;v Srvie,
PERCENTAGE 12-Mise.llmnou
OF
TOTAL
CASES 295
REPORTED
10 t 224




I 2 3 4 5 6 7 a 9 10 II 12


and percentage of tuberculosis cases reported by source


Figure No. 6-Number
of report for 1946








30 ANNUAL REPORT, 1946

30.


20.

PERCENTAGE
OF
TOTAL
CASES
REPORTED t10




a*


Figure No. 7-
by age groups


30 -


PERCENTAGE
OF
TOTAL
CASES
REPORTED


0 -
0-10 1120 21-30 31-40 41.S0 Sl-60 over 61 UnI ow
Age Groups in Yenrs
-Number and percentage of tuberculosis cases reported
-1946


40 950


92


.. U U UL U 6
Male Female Male Female Male Female
White Colored Unknown
Figure No. 8-Number and percentage of tuberculosis cases reported by race
and sex, 1946










TUBERCULOSIS


6 *


4-

3.2






0.0 10
0-10 llI.


Figure No. 9-Percentage of
and age groups, 1946


NUMBER OF
CASES IN
THOUSANDS -


12.4







0.7




/ ,














S I.*
31-40 41-50
Ag* G'o.p 1. Y.*


SM.I

F-






7.6





40











11.60 I6 .d V.I-


tuberculosis cases reported by sex


Tote
Total *t Home
Poitive Sputum
Und.etrmined Sputum
Negative Sputum
Qu.;tonabl. Activity
Inactive
SIntrium


2-







S 2 41 5

Figure No. 10-Number of tuberculosis cases in State register by
sputum status, activity and sanatorium care, Feb. 1, 1947


PERCENTAGE
OF
TOTAL
CASES
REPORTED












C-
I-.i-




r.am







nb p


P44
Z~w
CD~
r- s


< a

PC
*"o5




4)01


z e r.

P; ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I 4)44 IIIIII II II 11 I IIII II





<0 -0 z
0 0 I
0 0
o~, .. 0 U









to Z-0
"*~~ og


0 0~ -
hI n ri n tg
( Q a o ^aO OO


La 2 -.S'6 $' a







TUBERCULOSIS 33


cases in the central case register is shown in Fig. 10, which shows
the current status of the 6,500 cases.
Fig. 11 shows an analysis of the current examination status of the
25 counties analyzed in the central case register. It is rather distress-
ing to learn that the average patient whose examination status is
current, that is those who have received an examination within the
last six months, is only 23%.. This undoubtedly shows how much work
needs to be done in the State in bringing the tuberculosis case load to
a current examination status.
Table XIV shows the number of tuberculosis cases in the State of
Florida, by county, as of February 1, 1947.

DIAGNOSTIC SERVICE
During the last calendar year the Bureau of Tuberculosis Control
has attempted to establish diagnostic and treatment centers in 14 of
the larger centers of population. These centers did not begin adequate
operations except in minor instances until the last quarter of the
calendar year. In addition to the permanent diagnostic centers which
have been established in the various county health departments, a
portable x-ray clinic service has been available to the smaller county
health departments for examination of contacts and known cases of
tuberculosis about once every three months.
In the last six months of 1946 there were 62 portable diagnostic
x-ray clinics held totalling 2,419 14"x17" x-rays, averaging about 40
x-rays to a clinic. Following 57 of these x-ray clinics a personal visit
was made to the local county health departments by a clinician from
the Bureau of Tuberculosis Control, and a medical clinic was held with
patients found by the visit of the diagnostic x-ray unit. An average
of 15 patients per clinic were seen. This personal visit by the tubercu-
losis clinician was of considerable benefit to local health department
personnel, and to tuberculosis patients who had been at a loss as to
where to continue their post-sanatorium supervision. During the
coming year a marked expansion of this clinic service is anticipated.
During the year 1946 there were 6,324 14"x17" x-rays reviewed by
the Bureau of Tuberculosis Control. These films were sent in for
interpretation by local county health departments, by private physi-
cians, by tuberculosis and health associations, and 2,797 were taken
by the Bureau of Tuberculosis Control in its traveling x-ray clinics,
including the films taken at the Rapid Treatment Center in Jackson-
ville. A critical analysis of the 6,324 films broken down according to
diagnosis, and by color, sex and decade of life is shown in Table XV.
A few comments on the above mentioned statistics are in order.
Of all the films reviewed in these diagnostic centers 13.7%' showed some
evidence of reinfection tuberculosis. Of films on individuals over
twenty-one years of age, the percentage of reinfection type tuberculo-
sis was 18.0%. This is good evidence that from a public health stand-
point x-rays on children at least under the age of puberty and perhaps
even older are wasted. Frequently the x-ray itself is unsatisfactory







34 ANNUAL REPORT, 1946

and, if not, it may well fail to reveal anything significant, even in a
clinically ill child.
The groups showing the highest percentage of reinfection tuber-
culosis were the white males over 60 years of age, and the colored
males between 51 and 60 years of age. White females between the
ages of 21 and 30 showed the lowest percentage in the adult groups
in spite of the high number of films taken in this group. Generally,

TABLE XIV-NUMBER OF CASES OF TUBERCULOSIS IN FLORIDA
February 1, 1947, by County
(Preliminary figures)


County (Not in Register) No. Cases
Bradford __. ....... 46
Brevard ____.-......... 65
Broward ---------------165
Calhoun --......... 26
Charlotte -- --. -- 10
Citrus ______-- -- 21
Clay ..-----.. ------- ._108
Collier -..--... -.. ....... ---. 24
Columbia --___ ------__- 65
DeSoto ...... -- ...-..-. 31
Flagler ___ -------- 15
Gilchrist .-- _... 19
Glades -.. ...... 11
Hamilton _------- --30
Hardee _.... -.-- ___--__. 29
Hendry --- 20
Hernando -__-__ --17
Highlands --_-__ --- __ 62
Holmes ____----------- 19
Indian River ...-.----.....-... 56
Jefferson ..------. -- 31
Lee ------ --------63
Levy --......... 87
Liberty .......----..._.. 6
Madison ---------- 60
Manatee .... .. --- 90
Marion .---...................... --164
Martin -----. ------ 26
Okaloosa -----_--- 38
Okeechobee ----_.-------- 6
Osceola ----- ----41
Palm Beach ------ 489
Pasco -_ --------- 37
Pinellas ----------.... ... 694
Putnam -.------------ 40
St. Johns --------61
St. Lucie --- ---- 48
Sarasota -----.-----------. 131


Sumter .......-------......--...---- 37
Taylor _________--_ _-- 83
Union ..---.. .... ....-------...... 81
Walton -- ---- -------36
Chattahoochee (Mental Hos-
pital) .---.........-...------------... 400
Total ...------------ 2,414
County (In Register) No. Cases
Alachua ......- _-............-------- 169
Baker --------------------. 17
Bay _---_ ----- 126
Dade ... .. ....-----------. ----. 1,952
Dixie -__-__ --- 16
Duval* --------... --------. 193
Escambia --------338
Franklin --___- ---- ----_ 41
Gadsden .......---...........----.. 148
Gulf --------.. ---...-... .... ... ... 12
Hillsborough -- .------_1,174
Jackson _.......--. .-----. 75
Jacksonville (City) .----....1,250
Lafayette ......-----------------. 6
Lake ..........-- --... ........ ..... 186
Leon ......-------.....----.... .-------. 203
Monroe ......---------- ------... 164
Nassau .. ....... .....----------.. 79
Polk -----.---------- 458
Santa Rosa ----- ---- 36
Seminole --..------------. 122
Suwannee -- ----------- 27
Volusia -----.------------ 154
Wakulla .--------------. 18
Washington -------- 25
Orange --------------- 472
Total -- ----- 7,461
Total in register -___. 7,461
Total not in register .--..- 2,414
GRAND TOTAL __9,735
*Does not include Jacksonville












TABLE XV--ANALYSIS OF CLINIC AND CONSULTATION X-RAYS BY AGE, SEX
COLOR AND STAGE OF THE DISEASE, 1946

PER-
PER- CENT
NEG. UNS. MIN-A. MIN-IN. MOD-A. MOD-IN. FAR ARR. PRIM. SUSP. OTHER TOTALS CENT OF "T"
OF OF
TOTAL EACH
0-10
W-M 137 12 0 0 0 0 0 0 38 4 3 194 3.0 0
F 119 8 0 0 0 0 0 0 21 4 1 153 2.4 0
C-M 54 2 0 0 0 0 0 0 23 1 1 81 1.3 0
F 46 1 0 0 0 0 0 0 10 2 2 61 1.0 0
11-20
W-M 283 13 0 0 1 0 0 1 14 14 4 330 5.2 0.6
F 333 13 8 1 2 0 3 0 5 16 4 385 6.1 3.7
C-M 121 2 0 0 0 0 0 0 3 15 2 143 2.3 0
F 124 6 0 0 0 0 0 0 7 9 1 146 2.3 0
21 -80
wM 248 5 8 7 14 2 8 4 0 15 8 319 5.0 13.5
FW 439 15 10 6 9 3 2 7 0 17 6 514 8.2 7.2
C-M 119 2 8 2 6 1 7 5 0 4 1 155 2.4 18.0
F 186 1 8 1 7 1 8 2 0 18 3 235 3.7 11.5
31- 40
W-M 291 13 20 12 12 8 12 6 0 21 8 403 6.4 17.3
F 402 19 21 20 10 3 9 19 0 20 9 532 8.4 15.4 1
CM 183 5 8 7 5 5 16 3 0 11 9 202 3.2 21.7
F 175 8 6 3 7 3 14 3 0 13 9 241 3.8 15.1
41- 50
-M 215 12 13 13 6 6 22 7 0 14 7 315 5.0 21.2
F 263 9 28 7 12 4 11 4 0 19 7 359 5.7 16.7 M
C-M 90 5 7 8 6 1 9 0 0 14 11 151 2.4 19.9
F 130 5 0 6 5 0 7 0 0 6 8 167 2.6 10.8
51--60 Q
wM 124 9 15 6 14 7 13 1 0 24 12 225 3.6 24.9 d
F 154 8 7 8 14 3 5 5 0 19 4 227 3.6 18.5
CM 55 3 7 8 10 1 12 2 0 7 13 118 1.9 33.8 0
F 66 1 3 2 1 2 2 2 0 6 2 87 1.4 20.7 0
61 -
M 130 4 22 19 21 8 12 1 0 18 20 255 3.9 36.0
F 109 3 6 8 7 5 6 6 0 20 12 182 2.9 18.1 1
CM 52 2 2 8 5 3 3 2 0 5 4 86 1.4 26.7 0r
F 38 3 2 4 4 0 4 1 0 2 0 58 0.9 26.0
TOTALS 4,636 188 204 156 178 66 185 81 121 338 171 6,324
PERCENTAGE 73.3% 3.0% 3.2% 2.4% 2.8% 1.0% 3.0% 1.3% 2.0% 5.3% 2.7% 100%
AVERAGE 13.7% (Re-infection Tuberculosis)







36 ANNUAL REPORT, 1946


DIAGNOSTIC SERVICE continued
males ran a higher percentage than females in each group in both
races. (See Fig. 12).
It is most important to note that 5.7% of all films revealed late
tuberculosis, either active moderate or far advanced disease. These
were films on patients NOT in sanatoria, but exposing the population
to the tubercle bacilli until isolated.
With increased expansion of diagnostic facilities during the coming
year the incidence of diagnosed cases is expected to be higher. Em-
phasis has been placed upon examination of contacts to known cases
for the purpose of finding early cases of tuberculosis, since it is well
known that incidence of the disease among household contacts is ap-
proximately 14 times higher than among the general population.
COLLAPSE THERAPY FOR EX-SANATORIUM PATIENTS
Treatment centers have been established in Pensacola, Daytona
Beach and Orlando, where pneumothorax refills may be continued at
their county health departments by clinicians who operate on a fee
basis. In addition Hillsborough County and Pinellas County have
established full-time tuberculosis clinicians, and Dade County has
continued its program of chest clinics with a full-time tuberculosis
clinician.

MASS CASE FINDING
SIncreased emphasis has been placed on mass case finding during
the last calendar year. All new 70 mm. equipment has been obtained.
The year was begun with two units, the United States Public Health
Service unit, which was assigned to this State in 1944 continued
operation throughout the entire year as a portable unit, depending
upon local current to function. The State unit began the year with
35 mm. equipment mounted in a bus and having its own generator and
motor. This unit took chest x-rays from January through June. In
August a 70 mm. unit was mounted in the trailer with its own motor
and generator. In October another 70 mm. unit was added which
was used as a portable unit depending upon local current, but was
later transferred to a bus unit with its own generating equipment,
and began operation January 2, 1947. The units did mass surveys in
various counties and cities throughout the State.
A summary of the United States Public Health Service unit is
shown in Table XVI. This unit examined 37,532 persons demonstrat-
ing 443 definite or suspicious cases of tuberculosis or 11.8 cases per
1,000 examined. In addition there were 167 patients demonstrating
pathology other than tuberculosis.
During the year the units operated by the State Board of Health
examined 67,074 persons in ten months of operation. The result of
these surveys are shown in Table XVII. Of all the persons examined
729 showed definite or suspicious tuberculosis and 217 revealed path-
ology other than tuberculosis. In each thousand persons examined
by the State units 10.8 showed definite or suspicious tuberculosis.







TUBERCULOSIS 37


Prior to 1946 very little emphasis was placed on follow-up of cases
demonstrated by mass survey equipment. During the year 1946,
however, particularly during the latter half, great emphasis have been
placed on follow-up of cases demonstrated in mass surveys. In Table
XVIII the results of the follow-up of surveys with 14"x17" x-rays is
shown with the number of cases of definite tuberculosis found per
1,000. The average percentage of follow-up with 14"x17".
No attempt was made to do follow-up on the cases demonstrated
by the 35 mm. unit which was in operation during the first six months
of the last year. After receipt of the 70 mm. units an intensive attempt
has been made to follow-up with large films the cases of definite or
suspicious tuberculosis as shown in Table XVIII.
In addition to the four units now available for mass community-
wide x-ray surveys in the various counties, facilities were made
available during the latter part of the year for full-time 70 mm.
stationary equipment in the Hillsborough and Dade County Health
Departments. These units were made available during 1946 but did
not begin operation until the beginning of 1947, consequently no figures
are available for the operation of these stationary units.
HOSPITAL AND SANATORIUM FACILITIES
Hospital and sanatorium facilities in the State of Florida were
increased during the last year by the opening of a new sanatorium in
Marianna, Florida, with a capacity of 250 beds, and in Tampa, Florida,
with a capacity of 450 beds. It is now much easier to obtain hospitali-
zation for those far advanced cases which constitute such a severe



40.
WHITE MALE
S--- WHITE FEMALE
-- COLORED MALE
-- -COLORED FEMALE
30 /


PERCENTAGE
OF 20 ,
TOTAL
CASES -------
EXAMINED






Under 10 11-20 21-30 31-40 41.50 51-60 61 and over
Age Groups in Years
Figure No. 12-Percentage of total cases examined found to have tuberculosis,
by age, color, sex.









38 ANNUAL REPORT


TABLE XVI-SUMMARY OF MINIATURE FILM TAKEN BY USPHS UNIT
JANUARY 1, 1946-DECEMBER 20, 1946


Location

Jacksonville
Camp Blanding
Jacksonville Beach
F. S. C. Tallahassee
Florida A.&M. Tallahassee
Metal Containers Corp.
Pensacola Naval Air
Jacksonville Naval Air
Cecil Field, Jacksonville
Jacksonville Terminal Co.
Seaboard Rail Shop
Lake City Veterans Hosp.
Bethune Cookman College
Ft. Pierce (white)
Ft. Pierce (colored)
Ft. Pierce Ideal Holding
Deland High School
Euclid High, Deland
Stetson University
New Smyrna Beach
Mainland High, Daytona
Seabreeze High, Daytona
St Augustine
St. Augustine
St. Augustine


Tbc. and
Negative Susp. Thc.


Persons
Examined

7,720
291
573
1,975
1,226
556
4,487
5,266
170
1,043
991
270
935
2,597
2,006
200
504
119
1,801
303
584
302
2,495
525
593


121
3
4
19
17
5
46
65
3
20
15
0
4
46
39
0
0
0
9
2
0
0
18
2
5


Tbc. & Susp. Tbc.
Per Thousand
People Examined
15.6
10.3
7.0
9.6
13.8
9.0
10.2
12.3
17.6
19.2
16.2
0
4.3
7.8
9.2
0
0
0
4.9
6.7
0
0
7.2
3.8
8.4


TOTAL 1 37.532 I 36,922 443 I 11.8 1 167





TABLE XVII-SUMMARY OF MINIATURE FILM TAKEN BY STATE UNITS
JANUARY 1, 1946-DECEMBER 20, 1946

Tbc. & Susp.
Tbc. Per
Location Name Persons Negative The. and Thousand Other
Examined Susp. Tbe. People Pathology
Examined
Duval County S. B. H. 118 117 1 8.5 0
Okeechobee County 514 513 1 1.9 0
Palm Beach County 509 506 2 3.9 1
Migratory Camps 3,260 3,237 10 3.1 13
Hendry County 897 880 11 12.2 6
Glades 207 205 1 4.8 1
Hardee 485 477 3 6.2 5
Highlands County 1,078 1,064 12 11.1 2
Desoto County 770 758 7 8.1 5
Collier County 228 225 2 8.8 1
Lee County 1,290 1,280 6 4.7 4
Charlotte County 334 332 1 3.0 1
Sarasota County 1,550 1,529 11 7.1 10
Manatee County 3,296 3,250 30 9.1 16
Sumter County 520 513 5 9.6 2
Lake County 3,107 3.083 12 3.8 12
Pinellas County 11,103 10,926 162 14.6 15
Duval County Swisher & Son 766 752 9 11.7 5
Gadsden 7,430 7,323 84 11.3 23
Escambia 10,091 9,928 128 12.6 35
Leon 14,234 14,029 155 10.8 50
Jackson 3,650 3,587 55 15.0 8
Washington 1,345 1,324 19 14.1 2
Duval S. B. H. 292 290 2 7.0 0
TOTALS 67,074 66,128 729 10.8
USPHS TOTALS 37,532 36,922 443 11.8 167
104,606 103,050 1,172 11.2 384


Other
Pathol-
ogy
73
3
1
3
2
1
8
37
1
9
3
0
0
8
12
0
0
1
1
0
0
0
4
0
0


7,526
285
568
1,953
1,207
550
4,433
5,164
166
1,014
973
270
931
2,543
1,955
200
504
118
1,791
301
584
302
2,473
523
588







TUBERCULOSIS 39


public health problem, and for which facilities for hospitalization
have not been available.
State tuberculosis hospitals are not under the jurisdiction of the
State Board of Health, and the annual report of the State Tuberculo-
sis Sanatoria will show the statistical summary of the patients ad-
mitted to sanatoria. It might be stated, however, that 596 patients
were admitted to sanatoria as a result of the activities by local health
departments and the Bureau of Tuberculosis Control.

TUBERCULOSIS ACTIVITIES IN COUNTIES

There was also greatly expanded tuberculosis activity in the various
county health departments. A total of 16,530 patient visits were made
to the various clinics operated by the local health departments, and 20,-
069 field nursing visits as well as 3,212 office nursing visits. In general,
there has been great expansion of the tuberculosis control activities
during the last year, but there is still a great need for additional
training of public health nurses to implement our program of tu-
berculosis control by the generalized nursing service in local health
departments.


TABLE XVIII-SUMMARY OF 14"X17" X-RAY FOLLOW-UP ON
MASS X-RAY SURVEYS

MINIATURE FILMS 14"X17" X-RAY FOLLOW-UP
Cases of
14"X17" % 14"X17" Cases of Tbc.
Satisfactory Follow Follow-up Reinfection found per
Films up on on Tbc. 1000 70
Taken T& S T&S T&S found mm Films
Location with 14X17 Taken
Gadsden County 7,430 84 74 88.0 34 5.1
Escambia County 10,091 128 25 19.4 14 7.3
Leon County 14,234 155 107 69.0 42 4.5
Jackson County 8,650 55 38 69.0 11 4.4
Washington County 1,345 19 19 100.0 7 5.0
Duval (S. B. H.) County 292 2 2 100.0 1 4.1
Jacksonville 7,720 121 100 82.6 27 4.2
Camp Blanding 291 3 2 66.6 1 5.1
Jacksonville Beach 573 4 2 50.0 2 7.0
F.S.C.W., Tallahassee 1,975 19 19 100.0 5 2.5
Florida A&M, Tallahassee 1,226 17 17 100.0 4 3.3
National Container Corp. 556 5 5 100.0 2 2.6
Pensacola Naval Air 4,487 46 37 80.4 13 8.6
Jacksonville Naval Air 5,266 65 64 98.4 35 6.7
Cecil Field, Jacksonville 170 3 3 100.0 1 6.0
Jacksoliville Terminal Co. 1,043 20 7 35.0 1 2.7
Seaboard Rail Shop 991 15 3 20.0 1 4.8
Lake City Veterans
Hospital 270 0
Bethune-Cookman
College 975 4 3 75.0 0 0
Ft. Pierce (white) 2,597 46 45 98.0 25 9.8
Ft. Pierce (colored) 2,006 39 38 97.4 12 6.1
Ft. Pierce Ideal Holding 200 0
Deland High School 504 0
Euclid High 119 0
Stetson University 1,801 9 5 55.5 1 1.0
New Smyrna Beach 303 2 2 100.0 2 6.0
Mainland High, Daytona 584 0
Seabreeze High, Daytona 802 0
St Augustine (City) 2.495 18 18 100.0 10 4.1
St Augustine
(Col. Normal School) 525 2 0 0
St. Augustine (Hastings) 593 5 3 60.0 3 8.3
TOTALS 74,574 1886 636 71 8 1 25: 3.4









BUREAU OF

MALARIA CONTROL

JOHN A. MULRENNAN, Director
The Bureau of Malaria Control was established in 1941 and since
that time it has been supported partially by funds and personnel from
the Rockefeller Foundation. The Foundation withdrew its support
on June 30, 1946. The State has continued to contribute to the salary
of the director and Mrs. Nina Branch, medical technologist.
The U. S. Public Health Service, Communicable Disease Center has
allotted personnel, equipment, DDT and paid for travel to the amount
of approximately $325,000 for the calendar year 1946.

EPIDEMIOLOGICAL INFORMATION
The malaria death rate for the year was the lowest that has ever
been recorded for the State. A total of 17 was reported as compared to
22 deaths in 1945. No blood surveys were conducted during the year.
It was not considered worthwhile since the parasite rate had been prac-
tically nil in previous years. Practically all of the blood positive malaria
smears were confirmed from returned veterans. This information is
available in the report of the Bureau of Laboratories.

DDT RESIDUAL SPRAY PROGRAM
Interior House Spraying House spraying with DDT was carried
out in moderate to high quad producing areas in twenty-three approved
counties and a few homes were sprayed in a malarious area in Bay
County which was not on the list as an approved county. See Table
XIX.
A 5% DDT water emulsion was applied to the walls at the rate of
approximately 200 milligrams per square foot.
The spray program was initiated on April 1 and terminated on
September 25. During this period of time 47,206 houses were sprayed
one time and 13,582 houses were given a second application. It took
154,132 pints of 35% DDT, xylene, triton concentrate and 62,316 man-
hours of labor to accomplish the spraying.
After-spraying Inspections The effectiveness of, DDT residual
spray program was evaluated during this season by after-spraying
inspection of houses to determine the infestation with malaria vectors.
Of 3,641 inspections made, Anopheles quadrimaculatus was found
present in 25 houses. The total of adult "quads" in these 25 houses
was only 38. Higher protection against the malaria vector over a
longer period of time was obtained by increasing the amount of DDT
crystals applied to wall surfaces in an emulsion carrier. During the
1945 season the 100 mg. of DDT per square foot of wall surface gave







42 ANNUAL REPORT, 1946


protection for a three months period after which the population of
Anopheles quadrimaculatus in houses increased sharply. The 200 mg.
of DDT per square foot gave a high degree of protection throughout
the mosquito season for as long as six months after the time of spray-
ing. Results of the 1945 and 1946 seasons are presented in Fig. 13.
Anopheline Host Preference Studies Another method of evalu-
ating the success of the residual spray program as a malaria control
measure was by the collection of anophelines that had recently taken
a blood meal from a human or animal. These were captured in houses,
barns, privies and other buildings where they rest during the day.
Results are shown in the accompanying table. Human blood positive
Anopheles quadrimaculatus amounted to only 0.3758% of the specimens
collected before spray was applied. The application of DDT residual
spray reduced this by 63.03%.


COMPARISON


Species


OF THE EFFECT OF DDT RESIDUAL HOUSE SPRAYING
ON ANOPHELINE HOST PREFERENCES
FLORIDA 1946
Anophelines Tested From Capture Stations
Stations in Unsprayed Areas
No. Specimens Number with Percent with
Collected Human Blood Human Blood


A. quadrimaculatus 5587 21 0.37518
A. crucians 1887 1 0.00529
Stations in Areas with Sprayed Homes

A. quadrimaculatus 2878 4 0.1389
A. crucians 1448 3 0.0207


TABLE XIX-SUMMARY OF DDT HOUSE SPRAYING-1946

Total Houses Total Houses Man-Hours Pints 85%
County One Application Two Applications Spray Time DDT Concentrate
Alachua 2,929 341 3,670 6,412
Bay 12 12 24
Calhoun 1,267 356 1,441 3,641
Citrus 1,678 548 2,270 3,827
Dixie 1,066 496 1,510 4,686
Gadsden 2,921 821 4,129 11,226
Gilchrist 268 1 270 807
Gulf 496 295 496 1,440
Hamilton 1,969 516 2,733 5,889
Hernando 771 826 826*
Holmes 2,898 733 3,137 6,631
Jackson 5,700 2,170 7,484 21,691
Jefferson 2,721 1,012 3,868 11,199
Lafayette 315 77 363 1,182
Levy 1,425 533 2,170 4,610
Leon 3,262 1,070 4,890 12,996
Madison 4,416 1,041 3,975 16,371
Marion 8,415 756 5,137 9,846
Sumter 1,938 384 2,837 5,805
Suwannee 2,747 815 3,917 8,185
Taylor 874 352 1,432 3,798
Walton 1,751 493 2,324 4,118
Wakulla 572 320 909 2.676
Washington 2,295 452 3,016 .7,246
Total 47,206 13,582 62,316 154,132
*Low figure due to great number of only porches sprayed.











% OF SPRAYED HOUSES
WITH A QUADRIMACULA.
TUS IN THE AFTERNOON


N4 Ist. 2nd. 3rd. 4th'. 5th. 6th. DURING Ist. 2nd. 3rd. 4th. 5th; 6th.
MONTH AFTER DD T APPLICATION MONTH AFTER DD T APPLICATION
(100 mg.D D T per sq. ft.) (200mg.D D T per sq. ft.)

Figure No. 13-Comparison of residual effect of 1945 (100 mg. DDT) and 1946 (200
mg. DDT) house spray program







44 ANNUAL REPORT, 1946


DDT SPRAY DEMONSTRATIONS
At the request of the Farm Security Agency, Parent Teacher Or-
ganizations and several Civic Clubs, a series of demonstrations were
given to point out the proper use of household insecticides for the con-
trol of the vectors of insect-borne diseases.
From two to five demonstrations were given in the following coun-
ties: Escambia, Bay, Okaloosa, Columbia, Baker, Bradford, Union,
Lake, Manatee, Hendry and Lee. The most suitable types of spray
equipment, proper DDT spray mixtures and the rates of application
and the use of available commercial insecticides were discussed and
demonstrated very informally to rather large groups of individuals
whose interest was very evident, for many attended from distances
up to fifty miles.
This phase of Public Health has never been stressed before by this
Bureau, but from the enthusiastic response, both in attendance and
their letters of appreciation, it is evident that more emphasis should
be placed on the proper methods for effective control of insects in the
home.
It is the plans of this Bureau to make the services of these demon-
strations teams available to the health departments statewide, because
it is felt that insecticides have a very definite place in the public health
program and that greater emphasis should be placed on this subject
in the future.

DRAINAGE AND LARVICIDAL OPERATIONS
Minor Drainage and Larviciding This phase of activity was
carried on in Lake City, Tallahassee and Gainesville. There were
5,407 gallons of Diesel Oil and 970 pounds of Paris Green dust ap-
plied to 991 acres of breeding surface. A total of 5,541 linear feet of
ditches was dug and 33 miles of ditches were cleaned.

HERBICIDING AND CHOPPING OF WATER HYACINTHS
At Lake City herbiciding operations were carried on in Hamburg
and Alligator Lakes. A total of 204 acres of hyacinths was destroyed
by using sodium arsenite and "Weedone." Sodium arsenite used at
the rate of five pounds to fifty-five gallons of water was applied with
a power sprayer mounted in a boat. A small quantity of "Weedone"
was used in destroying 60 acres of water hyacinths. Approximately
150 acres of water hyacinths were destroyed in Alligator Lake and
60 acres in Hamburg Lake by using a cutting machine rented from
the U. S. Engineers. This method was very effective in deep water,
but could not be used effectively close to the shore.

AEDES AEGYPTI CONTROL
The domestic mosquito control program was expanded to several
new cities during the year and was set-up on a matching basis. The
























TABLE XX-SUMMARY OF WORK ACCOMPLISHED BY DOMESTIC MOSQUITO CONTROL

Panama City Pensacola Gainesville Tampa St. Petersburg Key West Miami
No. Premises Inspected 4,937 8,054 1,937 25,757 9,326 10,921 206,818
No. Premises Breeding
Aedesaegypti 1,329 707 568 5,276 1,726 1,090 8,870
No. Places Where Breeding
was corrected 1,327 701 563 5,241 2,320 1,080 -
No. Breeding Containers Eliminated 134,758
Sanitary Surveys Made 1,216 957 1,021 -
No. Catch Basins Sprayed 9,100 -
No. Gallons Oil Applied to
Catch Basins 2,276 1,265 278 -
Cisterns and Wells Inspected 27,181
Cisterns and Wells Fished 5,308 -
Cisterns and Wells Larvicide Applied -- 2,364







46 ANNUAL REPORT, 1946


cities were required to supplement the program on an equal basis
of man-power. The program was inaugurated in such a manner that
the individuals were assigned to work on domestic mosquito control
during the summer months and on general sanitation and typhus
control during the winter months. The program was quite successful
and a great deal of good was accomplished. In many towns the only
mosquito program is the domestic mosquito problem which is confined
to receptacle breeding, storm sewer catch basins and polluted ground
water areas. (Table XX).
The U. S. Public Health Service through the State Board of Health
assigned the following number of men: One man was assigned to Key
West, three men to Miami, three to Tampa, one to St. Petersburg, one
to Panama City and one to Pensacola.

ENTOMOLOGICAL ACTIVITIES
STATEWIDE MOSQUITO DENSITY SURVEY INSPECTION
In all of Florida's 67 counties anopheline density surveys were
conducted in order to learn the distribution and density of the malaria
vector. Approximately 24,700 inspections were made averaging more
than 350 separate station inspections per county for the season. From
these records it is possible to prepare spot maps of the stations indicat-
ing the highest Anopheles quadrimaculatus densities recorded, making
available to county health officers and other interested persons an
analysis of the malaria hazard existing anywhere in the State of
Florida. These maps will indicate the peak of "quad" population
during the 1946 season and include similar information from 27
counties surveyed in 1945. Areas where no A. quadrimaculatus were
found are also indicated. Intensive survey work was done in and
around cities, towns and villages as centers of human populations.
Rural areas were covered as thoroughly as possible, inspections being
made in catch stations usually near farm dwellings. Mosquito counts
were also made in areas where no human populations were present to
lay the ground work for malaria prevention in the event these areas
are settled. Throughout the State the areas of greatest malaria hazard
as represented in vector indices are now known. These records can be
used as a basis for future malaria control in the areas where a hazard
is known to exist.

SURVEY OF FLORIDA MOSQUITOES
In counties of southwest Florida and in the Florida Keys, light
trap and special adult and larval collections were made to obtain in-
formation on the species present and on species distribution of mosqui-
toes in that area. The following are records of mosquito species of
particular interest that were found to have a wider distribution in
the State than heretofore known: Anopheles quadrimaculatus -
Monroe County (Mainland); Aedes tortilis Palm Beach County;
Anopheles albimanus Monroe County (Keys); Aedes dupreei -
Citrus and Baker Counties; Aedes sticticus Calhoun County; Aedes







MALARIA 47


canadensis Charlotte, and Palm Beach Counties; Culex apisthopus
- Charlotte, Monroe and Palm Beach Counties; Culex elevator -
Collier, IMonroe, Lee and Manatee Counties; Mansonia titillans -
St. Lucie, Lake and'Indian River Counties; Megarhinus septentrionalis
- Leon County; Psorophora pygmaea Monroe County.

ANOPHELINE SURVEY OF THE FLORIDA KEYS
During the months of November and December 1946, an intensive
survey of the Florida Keys was inaugurated for the purpose of locating
suspected breeding areas of Anopheles albimanus and to determine
the distribution of this species in the Keys area. This anopheline sur-
vey has involved 150 larval collections of 565 anopheline larvae;
2,065 culicine larvae were also collected and determined. Light trap
collections amounting to 67,550 specimens in 305 separate collections
were made throughout the whole length of the Keys. One trap in
operation throughout the year on Stock Island collected 33 adult
A. albimanus during the months of August, September and October.
The 122 A. albimanus larvae dipped during November and Decem-
ber on the Keys were as follows:
Number Larvae Date Key
6 11/25/46 Stock Island
47 11/26/46 Stock Island
40 11/30/46 Stock Island
20 12/6/46 Stock Island
6 12/13/46 Stock Island
3 12/13/46 Key West

MOSQUITO IDENTIFICATIONS
The laboratory identified 2,365 mosquito collections of all types
from 51 counties during the year. This amounted to 280,286 specimens
representing 53 species of mosquitoes. Anopheles quadrimaculatus
formed only a small part of these mosquitoes 4,000. Of the total,
1,272 light trap collections were made, amounting to 274,526 of the
specimens received in the laboratory. Anopheline larvae identified
totaled 1,951, of which 541 were Anopheles quadrimaculatus.

EVALUATION OF TYPHUS CONTROL
In connection with the evaluation of the typus control program
43,123 ectoparasites were identified in the laboratory. These consisted
of 9,826 fleas, 18,320 mites and 14,927 lice. A number of unusual
species of mites have been identified from domestic rats in this State.
These included Borinquolaelaps mariposus, Cosmolaelaps gurabensis,
Dermatophagoides crassus, Cheyletus arcuatus and species belonging
to the genera Macrocheles, Androlaelaps, Atricholaelaps, Seiulus,
Uropoda, Caloglyphus. Only two species of lice have been taken from
domestic rats in connection with this program. The most common
louse is Polyplax spinulosa while the other is an undescribed species
of Hoplopleura.







48 ANNUAL REPORT


Table XXI presents a comparison of monthly variations in per-
centage reduction of infestations of rats with ectoparasites.

RECORDS OF TRIATOMA BUGS COLLECTED
Since Chagas first demonstrated that a peculiar SouthAmerican
disease (common in children in certain parts of Brazil) is caused
by a trypanosome, Tryponosoma cruzi, and that the intermediate
host is a reduviid bug, Triatoma megista, increasing interest has been
directed to the study of these insects. Additional records of members
of this group, the Triatominae, have been made by State Board of
Health employees in the past two years. These are:
Triatoma sanguisuga subspecies ambigua (Neiva)
Citrus Co., Lecanto, D. C. Thurman and A. J. Obermuller 8-16-46
Inverness, J. C. Burgess 8-24-46
Inverness, D. C. Thurman and John Lovett 6-6-45
Levy Co., Otter Creek, A. J. Obermuller 9-24-46
Chiefland, A. J. Obermuller 8-28-46
Suwannee Co., Branford, Marvin Braswell 10-7-45
Sumter Co., A. J. Obermuller 9-17-46
Duval Co., Jacksonville, Henry Hansen 5-22-46 & 7-2-46
Triatoma sanguisuga (Le Conte)
Citrus Co., Inverness, D. C. Thurman and John Lovett 5-22-46
Triatoma lectularius (Stal)
Citrus Co., Inverness, D. C. Thurman and John Lovett 6-6-46
Lecanto, D. C. Thurman and A. J. Obermuller 8-16-46
Suwannee Co., Bradford, D. C. Thurman and Marvin Braswell 10-7-45
Triatoma spp. (Nymphal skins)
1 skin, Fairfield, Marion Co., D. C. Thurman, August 1946
1 skin, Hastings, St. Johns Co., D. C. Thurman, October 1944

NEW RECORDS OF CULICOIDES
These small members of the Heleidae, commonly called sandfliess"
are known to be the intermediate hosts of filarial worms in tropical
Central and South America. In addition to the possibility that they
may transmit diseases the biting habits of these insects are extremely
annoying. On account of their small size these bloodsucking flies can
pass through ordinary mosquito screens.
During this season members of this genus have been identified from
the Florida Keys and from Lee, Charlotte, Dade and Collier Counties.
A species, apparently a new record for Florida, Culicoides insignis,
Lutz, was taken at Immokalee (Collier County). Culicoides furens
was recorded from Pineland (Lee County) and from Big Pine Key in
the Florida Keys.





















TABLE XXI-SUMMARY OF REDUCTION OF RAT ECTOPARASITE INFESTATION
BY THE USE OF DDT DUST-BY MONTHS-1946

Total Number
Of Rats Examined % Reduction in Number of Positive Animals in Dusted Areas ***
Month ND* D** X. cheopis E. gallinacea L. hawiiensis L. bacoti P. sninulosa
January 18 150 63.00 0 88.00 50.01 40.00
February 32 127 24.40 0 95.98 4.35 60.40
March 15 214 24.64 70.57 70.56 0 0
April 10 122 68.13 70.28 79.51 0 49.00
May 9 113 79.34 36.29 66.15 60.75 51.07
June 27 70 76.52 53.17 88.44 69.99 65.29
July 0 122 -
August 31 102 87.14 92.40 83.42 73.95 54.42
September 147 102 85.76 75.98 65.81 60.24 51.15
October 81 115 74.68 64.84 45.94 22.52 56.49
November 33 117 72.88 90.64 52.27 71.80 67.95
December 18 51 0 100.00 26.47 0 51.47
TOTAL. 421 1,405
% Education For The Year 66.92 33.97 90.00 24.41 37.22
ND Area Not Dusted
** D Area Dusted
*** When one parasite was found the rat was considered Positive for that species.










MALARIA RESEARCH
MARK F. BOYD, M.D., Director
This constitutes the final report from the Station For Malaria
Research, Tallahassee, as the International Health Division of the
Rockefeller Foundation discontinued this project with the retirement
of Dr. Mark F. Boyd from the staff of the division, December 31, 1946.

PERSONNEL
Dr. J. H. Paul was withdrawn on January 31 for reassignment by
the Home Office.
Dr. S. F. Kitchen was withdrawn on July 25 for reassignment by
the Home Office.,
Dr. Rafael Coello began duties on the malaria therapy service at
the Florida State Hospital, as resident physician, on April 15.
Miss Pauline Chason resigned as technician as of February 15.
Miss Eva Haynes entered training as her successor on January 21.
With the exception of Mrs. R. H. Witchard and Miss Lucile Logan,
all members of the staff were honorably dismissed on November 30
with a month of separation pay. Funds have been provided to retain
the services of Mrs. Witchard throughout 1947 and Miss Logan until
June 30, 1947, for the final analysis of various data.

MALARIA THERAPY SERVICE IN
THE FLORIDA STATE HOSPITAL
From the time of the departure of Dr. J. H. Paul until the first of
May, this service was in the care of Dr. Kitchen; and from that date
until the 1st of December, it was the responsibility of Dr. Rafael
Coello who was in residence at the hospital.
A summary of information obtained on parasite inoculations made
during this period by the Malaria Therapy Service for the Florida
State Hospital appears in the following table XXIa.
The McCoy strain of P. vivax was propagated through human-
anopheline passages 91-96 inclusive. The south Pacific strains known
as Steyers "A", "C", and "D", as well as the Burma strain were
discontinued during the year. The Costa strain of P. falciparum was
carried through human-anopheline passages 8 to 12 inclusive since
the last break in passage. The Jones and Trinidad strains of P.
malariae were maintained by blood inoculation.

INSECTARIES
The epizootic in the insectary colony of A. quadrimaculatus, which
occurred in 1945, continued with wide fluctuations. At periods when






52 ANNUAL REPORT, 1946


most severe, pupal production was embarrassingly restricted. Micro-
scopic studies made by Dr. Eusebio Garcia failed to reveal any de-
tectable parasite, and Dr. Kudo was of the opinion that Microsporidia
were not involved. Since the onset of this difficulty, it was necessary
to maintain rearing on a scale far greater than previously required
in order to compensate for the heavy mortality.
Although observations on the infected larvae were inadequate to
exclude the possibility that an infections agent may have been respon-
sible, there remained the impression that during the extended period
in which the colony was maintained it was progressively necessary,
even before the beginning of the epizootic mentioned, to increase the
rearing facilities in order to secure adults in adequate numbers. This
suggests that, perhaps due to the protracted inbreeding, the colony
was undergoing a progressive deterioration in vitality.
With the close of the station in December, rearing was terminated
and the colony allowed to die.


INSTRUCTION
Miss Logan gave six two-hour laboratory periods from April 1 to
12 inclusive for a class of 11 FSCW parasitology students; and a
lecture was given to the class by Dr. M. F. Boyd on April 11. A
further group of six students received five two-hour laboratory periods
from November 4 to 8 inclusive.
In addition the following persons were present as students for
varying periods:
Mr. Hernan Zuniga, El Salvador, Institute of Inter-American
Affairs
Dr. Francisco J. Cambournac, Portugal
Dr. Shao' Chow Kuo, Nat'1 Central University, Chengtu, China
Dr. Dudley Hargrave, IHD fellow
Dr. Fernando Bustamente, D. S. P., Brazil
Mr. Theodore Bachman, prospective medical student
Dr. W. S. Gilchrist, Medical Missionary, Angola
Pfc. Paul R. Tait, Oliver General Hospital
Dr. Eusebio Y. Garcia, Philippine Islands
Dr. John Hadjinicolou, Greece, IHD fellow
Mr. T. Ramachandra Rao, India, IHD fellow
Dr. John Sphangos, Greece, IHD fellow
Mr. Henry Merubia, Bolivia, IHD fellow
Dr. L. A. Rodriguez, Venezuela
Dr. E. Gonzales, Venezuela
Dr. J. J. Perez, Venezuela
Dr. L. Guerraro, Venezuela
Dr. Lassman, Mexico, IHD grant
Miss Madeline Pierce, Florida State Hospital

















TABLE XXIa

SUMMARY OF MALARIA PARASITE INOCULATIONS AT FLORIDA STATE HOSPITAL-1946


Status of
patient with Parasites Employed
Class corresponding P. vivax P. falciparum P. malaria
Inoculation species of
parasite Takes I Failures IPending Takes I Failures Pending Takes I Failure Pending
Natural
(Sporozoites) Primary 27 4 18 1
Reinoculation
after previous
failure
Reinoculation
after previous
take 2
Artificial
(Trophozoites) Primary 4 3 1 17 2
Reinoculation
after previous
failure 1 2 2
Reinoculation
after previous
take 12 9 ______ 2










NUTRITION INVESTIGATION

AND SERVICES

WALTER WILKINS, M.D., Ph.D., Director
On January 6, 1946, the State Board of Health in regular session
authorized the organization of Nutrition Investigations and Ser-
vices, and the director was appointed at that time. In connection with
this new unit, it is of interest to mention that Florida is the first
State in the United States to set up this service. The purpose of the
unit is primarily investigative in character but includes educational,
demonstration, and consultation services.
On February 1, a junior chemist was employed and a secretary was
assigned to the unit on February 25. During February a mobile trailer
laboratory was purchased and equipped with laboratory facilities.
With shortages of personnel trained in this particular type of work,
it was possible to make temporary appointments extending for only a
few months of a senior chemist, two laboratory technicians, a statis-
tician, and a typist. In June a nurse was assigned to the staff on a
permanent basis, and in September two nutritionists and a junior
parasitologist were employed on a permanent basis also. One nutri-
tionist, however, was assigned to Bureau of Maternal Child Health,'
and her activities are included in the report of that Bureau.
In the face of personnel shortages coupled with the fact that this
unit was still in the process of being organized, it was possible to do
only preliminary studies during the spring of 1946. At the end of the
year space was still a major problem which prevented the establish-
ment of a nutrition laboratory.
To assist financially in carrying on this work, grants were made
as follows:
Milbank Memorial Fund ---_.------ $15,000
Williams-Waterman Fund for the
Combat of Dietary Diseases ---------------........ 5,000
Nutrition Foundation, Inc-..-... ------- 2,500
Value of materials donated
(from other sources) ---------.---- ........ ...-.... 6,100

ANEMIA
The anemia problem in the Southeast has many angles and apparent
relationships with other problems such as hookworm disease, malaria,
eating habits, nutrient content of food consumed, soil conditions,
economic status, climate, etc. Preliminary studies are directed at
throwing more light on its etiology.







56 ANNUAL REPORT, 1946


HEMOGLOBIN DETERMINATIONS
The first step was to adopt a method for making hemoglobin de-
terminations rapidly on large groups. A method was worked out for
doing 200 or more tests per school day and was published in the Sep-
tember 1946 issue of the Journal of School Health under the title
"RAPID HEMOGLOBIN DETERMINATIONS ON SCHOOL
CHILDREN". A wide range in hemoglobin levels was found in
certain areas of the State, varying from 3.1 grams to 17.2 grams per
100 cc of whole blood. After the first check groups of children were
put on therapeutic tests. On comparing the hemoglobin levels of the
different groups before and after the period of therapeutic testing
some rather disconcerting trends were noted. Some of the controls
showed an appreciable increase in hemoglobin levels while some of
those receiving iron showed apparent decreases. The figures strongly
suggested that some unknown factors were involved. Every con-
ceivable factor was considered. The method itself was checked and
rechecked for range of accuracy and for possible sources of error. On
careful study of the conditions under which the "before" and "after"
tests were done, one trend was noted which upon further study was
sufficient to explain most of the discrepancies. This trend was for tests
done in the morning to show a higher average than those done in the
afternoon. On the basis of this observation, a group of children was
tested in the morning and afternoon of the same day and the majority
of these children showed appreciably higher hemoglobin levels in
the morning as compared with the afternoon. On applying these ob-
servations to the discrepancies noted in the tested and control groups
it was noted that most of the control children who showed an increase
in hemoglobin had received their "before" test in the afternoon and
their "after"' test in the morning. Many of the children in the tested
group who showed a decrease had had their tests in the reverse order.
These findings suggested very strongly that there was a diurnal vari-
ation in the blood hemoglobin level.
After many tests during the course of the year an article was
published in the Milbank Memorial Fund Quarterly, October 1946,
on "PRELIMINARY OBSERVATIONS ON DIURNAL AND
OTHER VARIATIONS IN HEMOGLOBIN LEVELS". After
doing the preliminary blood work in the spring, more and better
apparatus was obtained for doing such work. This work has been
almost entirely with school children.
During the year 15,554 hemoglobin tests were done on school
children, teachers, and college students in 7 counties. In connection
with these tests 2,512 physical inspections were done on school children
directed at detection of presumptive signs of malnutrition.

HOOKWORM TESTS IN CONNECTION WITH ANEMIA
STUDIES
There was some delay in getting hookworm tests completed since
the State laboratory could handle only a limited number each day.







ENGINEERING 57


Also it was felt that the hookworm tests should be quantitated to some
extent in order that the degree of infestation of each child be known.
This was done by the laboratory and the hookworm reports were
labeled negative, very light, light, moderate, and heavy. It was felt
that the old qualitative test would be almost worthless for the purpose
of this study.
One family of 5 children showing heavy infestation with hookworm
was chosen for special study. Three of these children were in school
and two were of preschool age. The three in school showed hemoglobin
levels of 4.3, 4.6, and 6.5 grams respectively. The local Parent-Teacher
Association made it possible to supplement the diets of these three
children for a period of two months. The three school children showed
marked increases in hemoglobin levels by the end of the first month
at which time they were treated for hookworm. The hemoglobin
values had increased to 8.9, 10.6, and 10.2 grams respectively at the
end of the one month period. This represented an average increase of
94 percent. The diet supplement was continued for another month
at which time the school was closed. The increase in hemoglobin level
during the second month was far less marked than during the first
month which was to be expected. The two children who were of pre-
school age, and who were not given supplementary feeding, showed
no change in hemoglobin level during the two month period. The find-
ings on these children suggest very strongly that inadequate diets may
play an important role in producing the signs and symptoms usually
associated with hookworm disease.
The director and the junior chemist gave reports on the Florida
studies at the joint meeting of the American Public Health Association
and the American School Health Association at Cleveland in November
1946. The director was elected president of the American School
Health Association for 1946-47 and the junior chemist was made chair-
man of the Florida Membership Committee.
At the Annual Conference of the Milbank Memorial Fund in New
York in October, the director presented a paper on "New Types of
Activity for Nutrition Services in Public Health".
At the December meeting 1946 of the Food and Nutrition Board
of the National Research Council, the director was made Chairman of
a Committee on Nutrition Programs for State Health Departments.
The junior chemist was appointed member of this committee. At
present the Committee is preparing a nutrition manual for use by
public health workers in the United States and Canada.
During the year members of the'staff participated in 57 meetings
of medical societies, health associations, teacher groups, pupil groups,
parent-teacher associations, and college classes.










BUREAU OF

SANITARY ENGINEERING

D. B. LEE, M.S.(Eng)., Director
This condensed report covers the more salient features of the
program of activity of the Bureau of Sanitary Engineering. Certain
phases of work were again restricted during the year. This is a re-
flection of the continued need of additional personnel for the purpose.
It should be mentioned here, however, that this first full year following
the recent war saw some alleviation of this situation inasmuch as
several workers of the bureau returned from military duty and re-
joined those few who were still with the organization. This fact,
coupled with prospects of additions which might be made during the
ensuing biennium, should place the State Board of Health in position
to more nearly fulfill its responsibility in the public health engineering
'field.

PUBLIC WATER SUPPLY AND TREATMENT
NEW AND PROPOSED CONSTRUCTION
The following list (Table XXII) of public water supply projects,
proposed for construction in Florida as post-war improvements, re-
ceived review and approval by the Bureau of Sanitary Engineering
in 1946 insofar as plans and specifications were involved. It will be
observed that the type of improvements varied from the construction
of complete water treatment plants and distribution systems for some
communities to plant and/or distribution system extensions or im-
provements to other municipalities already having water treatment
plants. The estimated cost value of these post-war projects exceeds
$6,000,000., which gives a direct indication of the desire of communi-
ties to deliver a potable, chemically adjusted water to consumers.









60 ANNUAL REPORT, 1946


TABLE XXII-PUBLIC WATER SUPPLY PROJECTS IN 1946

Est.
PManicipality Project Cost


Fort Lauderdale
High Springs
Jacksonville
DeLand
Fort Lauderdale
South Jacksonville (Spring-
dale)
Fort Lauderdale
Venice
Fort Lauderdale
Fort Myers
New Smyrna Beach
St. Augustine
Miami
Ft. Lauderdale
Ft. Lauderdale
Ft. Lauderdale
Sarasota
Jacksonville (Lakewood
Subd.)
Jacksonville (Southside
Estates)
Jacksonville Beach
Tallahassee
Miami
Pampano
Tampa
Ormond
South Bay
Dania
Indian Rocks
Jacksonville (Ridgeland
Gardens Subd.)
New Smyrna Beach
Starke
Wauchula
Bradenton
Jacksonville (Lake Forest
Subd.)
Pinellas County Water
System
North Miami
Bal Harbor
Milton
Gainesville
Hallandale
Jacksonville (Ortega
Forest Subd.)
Jacksonville (Lake Forest
Subd.)
Plant City
Fort Lauderdale
Jacksonville (Ortega Co.)
Jacksonville (Bishop
Homes Subd.)
Miami (Miami Park)
Jacksonville (Carvill Park)
Lake Placid (Highland Park)
Holly Hill
Pahokee


Extensions to Water System
Water Supply Well
Dist. System near Dame's
Point
Distribution System Ex-
tensions
Distribution System Ex-
tensions
Water Supply Well
Distribution System Ex-
tensions
Water Works Improvements
Water Main Extensions
Water Supply
Water Treatment Plant
Water Plant Extensions
Water Plant Improvements
Water Plant Improvements
%, MG Elevated Tank
1 MG Elevated Tank
Water Works Improvements

Water Supply (Unit No. 1)
Water Supply Facilities
Water Supply & Dist.
System Exts.
Water Plant & Dist.
System Exts.
36-inch and 42-inch
Main Extensions
Water Works Improvements
Water Plant Additions
Water Plant Additions
New Water Facilities
Water Works Improvement's
Water Main Extensions
Water Supply System
Water Supply Line
Elevated Tank
Water Works Improvements
Water Works Improvements
Water Distribution System
Improvements
Impounded Area Dam
Water Treatment Plant
Water Supply & Distri-
bution System
Water Works Improvements
Water Treatment Plant
Water System
Water System
Water System Improvements
Distribution System
Improvements
Water Works Extensions
Water Works Additions
Water Supply and Distri-
bution
Water Plant
Water System Mains
Water Mains
Extensions to Water Systems
Water Works Improvements


3,200
5,000
112,800

3,900


250,000
297,500
203,000
60,660
667,200





35,000
150,000
175.000
92.000
825,000
20,000
686,000
48,000
200,000
46,300
4.000
20,000
45,000
75,000
850,000
2,500
104,450
75,000

110,000
409,000
500,000
10,000
6,000
65,600
12,000
1,500
15,000
7,000
5,200
76,810
225,000


.






ENGINEERING 61


OPERATION
In addition to review and approval of proposed new construction
of public water supply improvements with respect to functional de-
sign, the activity of the bureau in the public water supply field con-
tinued on sanitary control of the operational phase. Sanitary super-
vision of operation, however, was confined principally to emergency
investigation and corrective action, only a few routine visits to water
supply systems being possible during the year under present per-
sonnel limitations.
Quality of operation of public water supplies was again enhanced
in 1946 through the program of instruction included in the water and
sewage treatment conference and short course held at the Univer-
sity by its General Extension Division. The bureau personnel de-
tailed on this work actively functioned in treatment, maintenance
and laboratory instruction to the sixty nine operators attending.
With the establishment of district health departments and the
assigning of an engineer in each of two of such districts, a more
satisfactory coverage has been effected during the year insofar as
concerns public water systems located in the two areas. Although
the coverage was not complete nor sufficient, the activity of the two
district engineers during the year has developed information which
bears out the urgent need for much closer sanitary supervision of
public water supplies.

WASTES TREATMENT AND DISPOSAL
SEWAGE
During the year a number of communities availed themselves of
federal planning money advanced through the Federal Works Agency.
Sewage collection and treatment have not kept pace in Florida with
water supply development and communities are becoming increasing-
ly aware of this situation. During the year thirty-four sewerage
projects whose estimated cost approximated $11,000,000 were reviewed
and approved from functional standpoint. Many of these projects
involved detailed cooperation with consulting engineers to eliminate
undesirable design features resulting from efforts to reduce con-
struction costs. Table XXIII presents data concerning the nature
of the projects. The bureau policy continued to be that of disapprov-
ing large sewer extensions in the absence of adequate treatment
facilities.
Design of high-capacity trickling filter plants was resorted to
increasingly to cope with widely fluctuating population loadings, a
major Florida problem in sewage treatment and disposal. At the
year's end a number of additional preliminary proposals had been
reviewed and approved.
High construction costs and the limited availability of materials
were dominant factors in delaying construction during the year.
Generally speaking, municipalities found it difficult to obtain reason-
able bids because of apprehension on the part of contractors as to






62 ANNUAL REPORT, 1946

future trends. However, toward the year's end a definite stabilizing
was noticed.
In spite of adverse economic conditions, construction was begun,
and in some instances completed, on nearly $450,000 of sewage collec-
tion and treatment facilities, involving nine projects.
Plant maintenance and operation continued to be a major weakness
in the bureau program because of lack of personnel. Encouraging
tendencies were observed on the part of municipalities to look to this
office for guidance on plant design and operation. Interest developed
in the Pensacola, Tallahassee and Lake Worth areas regarding sani-
tary district formation and administration. In order to implement crea-
tion of such agencies, it is the intention of the bureau to promote
presentation of state-wide enabling legislation to the State legislature.
At the instigation of the bureau modern sewage treatment facilities
to serve the University of Florida were planned and construction
started. These units will protect underground sources of nearby
public water supplies. In addition, it is anticipated that the plants will
be of material aid in connection with engineering instruction at the
University.








ENGINEERING 63


TABLE XXIII-SANITARY SEWERAGE PROJECTS APPROVED IN '946


Municipality Project Estimated Cost'


Fort Lauderdale
Plymouth
Jacksonville
Gainesville
Macclenny
Fort Lauderdale
New Smyrna Beach
Fort Pierce
Tallahassee
Pensacola
Bal Harbor
Miami Beach
Panama City
Pensacola
Gainesville
Jacksonville (Roosevelt
Gardens)
Ocala
Cocoa
Chipley
Gainesville
DeLand
Auburndale
Fort Pierce
Pensacola
Tarpon Springs
Sanford
Sanford
Pahokee
Auburndale
Jacksonville (Country Club
Estates)
Fort Pierce
Miami
Orlando
Jacksonville (Murray School
Subdivision)


Sewer Extensions -
new development
Sewer Extensions
Treatment Plant for
GM Service Shops
Treatment Plant for
Veterans Housing Group
Sewer Extensions and
Treatment Plant
Sewer Extensions -
new development
Sewer Extensions and
Treatment Plant
Sewer Extensions
Sewer Extensions and
Treatment Plant
Treatment Plant at
Naval Air Station
Sanitary Sewers and
Pump Station
Allison Island Sewerage
Sewer Extensions and
Treatment Plant
Sewer Extensions
Treatment Plant for
University of Florida
Sewers
Sewage Treatment Plant
Sewer Extensions and
Treatment Plant
Sewer Extensions and
Additions to Plant
Sewer Extensions
Sewage Treatment Plant
Treatment Plant for
Industrial Group
Sewer Extensions and
Treatment Plant
Sewer Extensions
Sewer Extensions and
Treatment Plant
Sewage Treatment Plant
Sewerage
Sewage Collection System
Treatment Plant for
Industrial Group
Sewers
Sanitary Sewers
Sewers in new development
Sewer Extensions and
Treatment Plant
Sewers
Total Estimated Cost


INDUSTRIAL WASTES AND STREAM POLLUTION


Stream pollution studies were limited during the year due to
personnel and laboratory restrictions. With the assistance of the
Office of District No. 4, U. S. Public Health Service, detailed bac-
teriological and sanitary surveys were completed of waters contiguous
to the City of Pensacola. Valuable data were obtained regarding
the sources and magnitude of pollution in the area studied.

Extensive field work was completed jointly with Jacksonville City


$ 37,000
2,900
5,000
41,000
90,450
4,900
345,000
200,000
682,000
320,000
75,000
8,500
2,000,000
49,000
282,000
10,300
290,000
55,000
40,000
5,700
435,000
15,000
600,000
26,000
175,000
196,000
380,000
250.000
18,000
65,000
750,000
S10,000
3,700,000
8,500
$11,182,250






64 ANNUAL REPORT, 1946


Engineer's Office on a study of St. Johns River conditions in the
Jacksonville area and the data derived are being analyzed.
After a study of Halifax River conditions in the vicinity of Day-
tona Beach, the area condemned for the taking of shellfish was ex-
tended.
Considerable hydrographic information was obtained through co-
operative agreement with the Surface Water Division of the U. S.
Geological Survey. These data were valuable in connection with the
review of sewage and trade waste treatment projects.
Continued expansion of the citrus industry resulted in aggrava-
tion of that phase of pollution of the State's surface and subsurface
waters. Further industrial activity and expansion emphasized pollu-
tion problems regarding operation of tanneries, milk plants, fruit
and vegetable processing installations, laundries, paper mills, meat
slaughtering and packing plants and phosphate mining.
Information obtained by study of conditions existing in the Alafia
River as a result of phosphate ore mining operations led to establish-
ment of a $19,000 fellowship at the University of Florida Engineering
and Industrial Experiment Station to develop practicable means for
eliminating or minimnzing stream pollution occurring from such
mining operations.
Following location of a kraft paper mill in Putnam County near
Palatka, and anticipating a waste disposal problem of real magnitude,
the bureau ascertained company proposals in this respect. Mill wastes
will be discharged to Rice Creek and ultimately to St. Johns River
after processing by modern save-alls. It is anticipated that operation
of this and other paper mills will be a major future problem.
Several laundry waste treatment plants utilizing fill-and-draw
coagulation units were approved during the year.
Late in the year, a mobile field laboratory was acquired for use
in connection with stream pollution investigations. This unit will
enable the bureau to obtain badly needed field data concerning specific
pollution problems.
DRAINAGE WELLS
Continued pressure was exerted on the bureau during the year to
permit utilization of drainage wells for disposal of storm water, trade
wastes and condenser cooling water from air-conditioning and ice
plant installations. This was particularly true of urban areas which
experienced rapid development without concurrent extension of
sewerage. Areas were encouraged to begin immediate planning for
adequate systems. Temporary permits were issued for 31 such wells
where public health implications were neglible. The bureau policy
continued to be that of regarding drainage wells as an expediency
and permitting them only after thorough field investigation and in no
case without adequate pretreatment of material discharged to the
well. An increasing appreciation by lay citizens of the public health
aspects of this method of wastes disposal was noted.







ENGINEERING 65


CIVILIAN PUBLIC SERVICE SANITATION PROJECTS
The Civilian Public Service Sanitation Program, under technical
supervision of the bureau of sanitary engineering, which originated
under the Selective Service Act as a program of constructive work for
religious objectors, came to an end in 1946 with the closing of all
camps originally established in Florida. The accomplishments of per-
sonnel of these camps were many and varied and added much to the
development of rural sanitation progress in this State.

COMMON CARRIER WATER SUPPLY AND WATERING POINT
SANITATION
Each year the U. S. Public Health Service circularizes common
carrier companies on or about December 1 for list of watering points
to be used by them during the next calendar year. About March 1
this list is completed and forwarded to the Bureau of Sanitary En-
gineering for investigation and recommendation of certification. Con
tinuing the cooperative effort with the U. S. Public Health Servee,
District No. 4, New Orleans, in common carrier water supply and
watering point sanitation, the bureau's activity in this feature of its
program is reflected concisely in the following tabulaton.

TABLE XXIV
Common Carrier Water Supply and Watering Point Inspections and
Recommendations For Certification to U. S. Public Health Service
No. of
Inspec- Railroad Vessel
,tions Companies Air Lines Companies
USPHS Form No. Made
Approved Provisional Approved Provisional Approved Provisional
8921-E Water Supply
Examination 58 35 5 6 4 12 4
8921-0 Watering Point
Sanitation 107 50 5 12 6 30 4
All field investigations of water supplies and watering points are
based on the following criteria:
Public Health Service Drinking Water Standards 1946
Sanitation Manual for Land and Air Conveyances
Applicable State laws and regulations.

SANITARY MILK CONTROL
Definite forward steps were made in 1946 in the promotion and
control of the production, processing and the distribution of grade
"A" quality milk. Milk control programs have been appraised and
are now an activity of forty organized city and county units. Com-
plete milk sanitation compliance rating surveys were completed in
eight counties and cities. Only Dade County and Miami rated in the
Honor Roll group having a compliance rating over 90%.
The unification and standardization of milk control was advanced







66 ANNUAL REPORT, 1946


by agreements with the Florida State Department of Agriculture and
revision of the Florida State Sanitary Code.
Nine of the thirteen high-temperature short-time pasteurizers in
the State were thoroughly checked during the year. Eight communi-
ties were added to the list having compulsory pasteurization ordi-
nances making a total of fifteen. An entire issue of the Florida Health
Notes for July, 1946, was written devoted entirely to pasteurized
milk. New milk producing areas are developing in Chipley, Marianna,
Moore Haven and Belle Glade regions.
A booklet on plans and layouts was written during the year. A
statistical table showed that 75 per cent of the urban population live
in communities in which over 90 per cent of the milk is pasteurized.
Fraudulent sales of recombined fluid milk have been practically
eliminated, and standards established for shipped-in fluid milk to be
labeled as "UNGRADED."
The investigation of an unusually large number of undulant fever
cases in one community was handicapped by the lack of a full time
organized health department in the county. Commercial milk was
apparently not implicated in the cases.
Over 1,200 milk samples were analyzed and the results reported to
the central office. Nearly 60 per cent of the pasteurized milk samples
was satisfactory, and only 40 per cent of the raw milk samples was
satisfactory.
A statistical summary of activities is given in TableXXV.

TABLE XXV
Sanitary Milk Control
Summary of Activities

Description Number Per Centage
Plant Producer Inspections --.. -----..-....-.....--------- 116
Producer Distributor Inspections .....---.---..-.- 71
Pasteurization Plant Inspections ----- 123
Institutions and Private School Supplies Inspected 17
Pasteurization Plants Approved for Interstate Carriers- 11
Pasteurization Plant Plans Reviewed ....- ...... 10
Pasteurization Plants or Supplies Closed .....--.--.... 2
Attendance at Talks and Lectures .------.------------. 350
Milk Sanitation Compliance Rating Surveys.----..-- 8
Total Milk Sample Analyses Reported --- 1,224
Number and Per Cent Satisfactory ..---- 675 55%
Pasteurized Milk Samples Analyzed --...--...-------. 400
Number and Per Cent Satisfactory .--- --- 236 59%
Retail Raw Milk Samples Analyzed --.......----------- 361
Number and Per Cent Satisfactory ___...--.- 145 40%








ENGINEERING 67


SEAFOOD SANITATION
\(Shellfish and Crustacea,)
TABLE XXVI
Ispections:
No. Plants No. Plants
Certified Certified
During During
1945-1946 1946-1947
Type of Plant Season Season REMARKS
Oyster Shucking & Forty-two interstate shippers in-
Packing 49 69 spected monthly. Twenty-seven
local plants inspected 6 times/
season.
Oyster Shellstock Inspected average 6 times/season.
Only 9 17
Scallop Shucking Inspected monthly during summer.
and Packing 14 23
Clam Shucking Inspected average 6 times an-
& Packing 5 3 nually.
Crabmeat Picking Inspected average 8 times an-
and Packing 30 31 annually.
Lobster Picking Inspected average of 3 times
and Packing 2 2 during season, which is relatively
short.
Shrimp Cooking Inspected monthly during pro-
and Packing 0 1 cessing season.

Construction and Additions:
Additions
No. New to
Plants Existing
Type of Plant Constructed Plants REMARKS
Oyster Shucking Included is a new 10-bench shuck-
and Packing 15 6 ing plant at Apalachicola, out-
standing in construction, equip-
Oyster Shellstock ment as well as from standpoint
only 8 of good housekeeping. Also at
Applachicola, a new crabmeat
Crabmeat Picking plant, 50 pickers, was constructed,
and Packing 3 1 and equipment includes stainless
steel tables, running-water flumes
and track-and-car conveyor sys-
tem. Other improvements such as
relaying concrete floors, metal
covering of picking and washing
tables, were made at existing
plants.

Evident improvement in construction, equipment and operation
of seafood plants has taken place during the year, considering short-
ages of funds and personnel needed to effect more adequate sanitary
supervision of the industry. Complicating sanitation of seafood in-
dustry has been the labor shortage and the low-price market. Some
possible lack of sanitation has been reflected in lawsuits involving four
crabmeat plants shipping their product in interstate traffic, which
action has been instigated by the Federal Pure Food and Drug Ad-
ministration. These circumstances in turn reflect the need for better
laboratory control of crabmeat processing, as well as shellfish handling,
from a sanitary standpoint; and serve to reiterate recommendations
pertaining to this need which have already been made.


WATER IMPOUNDMENTS AND MOSQUITO CONTROL

Construction of water impoundments during 1946 approximated
this activity for the previous year. During the year ten permits for
these projects were issued by the bureau. These were in northwest







68 ANNUAL REPORT, 1946


Florida counties and principally were for irrigation and recreation
purposes. Investigatory work incident to water impounding projects
was performed cooperatively with Bureau of Malaria Control. Further
investigations, from the standpoint of Florida State Sanitary Code
requirements, pertaining to a proposed impoundipent by the U. S.
Engineer Department on the Apalachicola River were made.

TYPHUS AND RODENT CONTROL
The typhus and Rodent Control measures were conducted on the
same basis in 1946 as during the previous year.
The State Board of Health has not as yet made an allotment of
funds to conduct this activity. However, the Public Health Service,
through the Communicable Disease Center in Atlanta, supplied an
officer experienced in this work and also made an allotment of funds
to assist the various localities in financing the program. Work was
carried on as activities of the local health departments in six counties,
namely: Dade, Escambia, Hillsborough, Pinellas, Polk, and in the
City of Jacksonville in Duval County.

EXPERIMENTAL DUSTING WITH DDT
Dusting of rat runs and places frequented by rats with 10% DDT
powder was carried out in seven cities in five counties for the purpose
of determining the effectiveness of this method in controlling the
ectoparasites on rats. Areas to be dusted were selected and previous to
starting the dusting operation, live rats were trapped, combed and
thoroughly searched for ectoparasites and blood sera collected to be
run in the Complement Fixation Test by the Virus Laboratory of the
U. S. Public Health Service in Montgomery, Alabama. The purpose of
these operations was to secure a flea index and gain an idea of the
percentage of rats positive for typhus before the work started so
that the effectiveness of the DDT could be fairly accurately meas-
ured. The extent of control was ascertained through the trapping
of rats at thirty day intervals after the dust was distributed. Good
results were achieved in the control of the rat-flea and particularly of
the Cheopis flea which is thought to be the principal vector in trans-
mitting typhus from the rat to human beings, and to a lesser degree
in the control of the other ectoparasites such as mites and lice.
At the start of the program in the latter part of 1945, and the early
part of 1946 the average flea index was about twelve per rat and the
percentage of rats positive for typhus as determined from blood sera
run in the Complement Fixation Test was approximately 75%. The
figures for the composite sampling of the six projects in eight cities
reveal that through one dusting the average flea index can be reduced
from twelve to below one flea per rat, or about a 95% reduction. Re-
duction in the other ectoparasites was considerably less averaging
around 40%. The aim of this experimental work is to determine
whether by holding all the ectoparasites and particularly the Cheopis
fleas on the rats to a very low number the typhus infection in the rats







ENGINEERING 60


would be reduced and eventually the oncoming generations of rats
would be practically free of typhus infection. Likewise, since the rat is
the reservoir of infection and the Cheopis flea is thought to be the prin-
cipal vector, whether this method would ultimately be effective in con-
trolling endemic typhus fever in humans must still be shown. The
projects have not been in operation for a sufficient length of time to
warrant drawing any conclusions as to the reliance which could be
placed on this method of control for preventing typhus fever among
humans. However, the data collected to date indicate the dusting pro-
cedure may have influenced the percentage of rats positive for typhus.
During the year the rats trapped in a dusted area four to six
months after it has been dusted show a lower percentage positive for
typhus than before the area was treated. If this cycle can be continued
for a long enough time, it would seem it would be instrumental in
markedly lowering the typhus infection among rats.
With the limited amount of funds available it was possible to con-
duct projects in only a few of the counties in the State during the
year. Consequently those areas in which human cases of typhus had
been reported or areas which seemed to be foci of infection were
selected. Dusting was repeated at three-month intervals in most in-
stances. The turnover in personnel was frequent and it was possible
to maintain this schedule on all of the projects and a few of the areas
received only two applications of dust during the calendar year 1946.
In later cases the reduction in the number of ectoparasites was not
nearly as marked as in those areas where dusting was done on the
three-month schedule.
Table XXVII gives a fairly clear idea of the extent and character
of the investigative work done in connection with the dusting opera-
tions. It will be noted this Table shows the findings before and after
the DDT dust was distributed.
In Fig. 14 is shown graphically the average number of Cheopis
fleas per rat in the dusted and undusted areas. The figures for Pre-
dusting and Control Areas were combined. No rats were trapped in
the undusted area during the month of July 1946.
Beginning August 1, 1946, Control Areas located at least five
blocks distant from the perimeter of the dusting areas were selected
to ascertain the difference in the number of ectoparasites and the
percentage of positive rats in the dusted and undusted areas. The in-
formation collected in this manner has been valuable in appraising
the effectiveness of the dusting operations.

RAT-PROOFING AND OTHER CONTROL ACTIVITIES
Organized rat-proofing programs were in operation in the City of
Jacksonville, Pensacola, Tampa, Bartow and some work was done in
Miami. These were all conducted as part of the program of the health
department concerned.
A complete resurvey was made of all buildings which had been
rat-proofed in Tampa since September, 1943, and all "leaks" which


















TABLE XXVII
RECORD OF ECTOPARASITES AND BLOOD SPECIMENS DDT DUSTING PROGRAM CALENDAR YEAR 1946

TOTALS FOR CALENDAR YEAR 1946 I PRE-DUSTING POST-DUSTING CONTROL AREAS
Total Rats Trapped 253 1,623 259
Total Rats Dead When Found 60 203 37
Total Rats Trapped Alive 193 1,420 222
Total Rats Combed 193 1,403 222
Total Rats on Which Ectoparasites were found 171 785 194
Total No. Ectoparasites recovered 8,832 22,257 11,499
Total Rats on Which No Ectoparasites were found 22 618 28
Total Rats Combed Ectoparasites not received
by Bureau of Entomology 1 10 0
Average No. Ectoparasites all kinds per rat 45.76 15.86 51.80
Total No. Fleas Recovered all kinds 3,789 4,597 1,383
Average No. Fleas per rat all kinds 19.63 3.28 6.23
Total No. X Cheopis Fleas Recovered 2,551 1,240
Average No. X Cheopis Per Rat Combed 6.15 .884
Total No. Ectoparasites other than fleas 5,043 17,660 10,116
Average No. Ectoparasites other than fleas 26.12 12.59 45.57
Number of rats from which blood specimens secured 169 1,067 204
Number Sera Positive 51 or 34.69% 322 or 34.40% 83 or 44.86%
Number Sera Negative 96 or 65.31% 614 or 65.60% 102 or 55.14%
Number Sera Anti-Complementary 6 59 15
Number Sera Quantity Ins. 6 33 4
Number Sera Broken 10 39 0
Total No. Live Rats Trapped 1,835
Total No. Live Rats Bled 1,440
Per Cent of Live Rats Bled 78.47%
No. Rats Combed 1,818
*Rats from Control Area included in Pre-Dusting Column








ENGINEERING


40 -


BEFORE DUSTING
....-- AFTER DUSTING
+***+NO RATS TRAPPED IN
UNDUSTED AREAS IN JULY


JAN. FEB. MAR. APRIL MAY JUNE JULY AUG. SEPT. OCT. NOV. DEC

1946
Figure No. 14-Seasonal comparison of xenopsylla cheopis indices
on domestic rats before and after application of D.D.T. dust for
experimental typhus control. (Seven cities in five counties in Florida)


AVERAGE
NUMBER
OF
X-CHEOPIS
PER
RAT


I 2
I. COMBINED'DATA (CONTROL AREA AND
DUSTED AREA BEFORE DUSTING)
2. DUSTED AREA AFTER DUSTING
Figure No. 15-Average number of fleas per rat before
and after dusting in test areas


AVERAGE NUMBER
OF FLEAS
(XENOPSYLLA
CHEOPIS)
PER RAT






72 ANNUAL REPORT


had developed were repaired and where reinfestation had occurred
eradication measures were instituted to again free the buildings of
rats. Rat-proofing construction like any other type construction re-
quires periodic maintenance.
Some experimental work was done with Sodium Fluroacetate
"1080" as a rodenticide. It was found to be very effective but since
there is no known antidote for it and because of its high toxicity
its use was limited to those places where careful supervision could be
given by a representative of the health unit. Another new product,
Antu (Alpha-Nephtyl-Thioureau) was used as a rodenticide in bait
and also as a dust. The available supply of Antu was meagre but the
department's limited experience with it led to the conclusion it was
fairly effective in the control of Norway rats and less so in the case
of the Alexandrinus or the climbing rats. Other rodenticides used
were Red Squill, Barium Carbonate, arsenic, thallium sulphate and
zinc phosphide. All of these except "Red Squill" are fatal to domes-
tic animals such as cats, dogs and chickens and this bureau has
strongly emphasized that caution be exercised and these poisons be
used under careful supervision to prevent the occurrence of an unto-
ward incident. Along with the dusting, rat-proofing, poisoning and
trapping activities, promotional and educational work was done during
the year to induce the proper storage, collection and disposal of
garbage to cut down the number of easily accessible feeding places.
The removal of trash, debris and other accumulation which provide
excellent harborages for rats has also been stressed.
Table XXVIII shows tabulation of principal activities carried
on during the year.
A certain amount of educational work was done through news-
paper articles, lectures, motion pictures and on the radio. The January
1946 issue of Florida Health Notes was devoted to a discussion of
murine typhus fever and recently a booklet "Roddy the Rat" has
been published. Both of these booklets give a brief outline of the cause
and manner in the spread of the disease and means of controlling it.
A good start has been made and it is hoped sufficient funds and
personnel can be secured to permit the development of an expanded
program more nearly adequate to meet the needs for control measures
as shown by the statistical data available on the prevalence and wide
distribution of typhus in the State.



















TABLE XXVIII-PRINCIPAL ACTIVITIES TYPHUS AND RODENT CONTROL
By Project 1946

Total No.
No. Estab- Average
Visits lish- Total Total lbs. No. Pints No. Prem. Total lbs.
COUNTY All ments No. lbs. DDT Places "1,080" Poisoned other
Reas- rat- Premise DDT Per Poisoned Water Other bait
_____ ons proofed Dustings used Prem. "1,080" Used Baits used
Dade County
(Miamui 11,528 61 7,777 9,173 1.18 528 264 5,984 2,992
Duval County
(Jacksonville) 19,058 271 15,966 33,104 2.07 1,600 1,496 10,944 5,342
Escambia County
(Pensacola) 7,176 67 5,931 10,041 1.69 34 17 1 1
Hillsborough
County
(Tampa) 16,171 209 9,044 27,243 3.01 131 262 211 162
Pinellas County
(Dunedin, Largo,
Tarpon Springs,
St. Petersburg) 9,752 0 8,682 28,283 3.26 71 35 0 0
Polk County
(Bartow) 1,003 39 4 28 7.00 31 16 0 0
TOTALS 64,688 647 47,394 107,872 2.28 2.395 2,090- 17,140 8,497







74 ANNUAL REPORT, 1946


LIST OF PROJECTS DEVELOPED IN
THE BUREAU DRAFTING ROOM
1. Sanitary Survey Map of Escambia County for color slide re-
production.
2. Sanitary Survey Maps of Polk, Pinellas, and Bay Counties.
3. Map of the State of Florida locating all permitted Drainage
Wells, indicating types.
4. Preliminary Sketches, final working plans and specifications
for the Warehouse and Office Annex Buildings constructed on
the State Board of Health grounds in Jacksonville.
5. Suggested Detail Drawings for Improvements in School Lunch
Room and Kitchen Sanitation.
6. Revised drawing of plan for a typical medium-size abbattoir.
7. Maps showing extent and kind of polluted waters in the Pensa-
cola Area to illustrate the Pensacola Pollution Survey Report.
8. Similar maps to illustrate the St. Johns River Pollution Sur-
vey Report.
9. Preliminary Plot and Floor Plans for a proposed three-story
addition to the existing Laboratories Building in Pensacola.
10. Preparation of Preliminary Survey Data and Sketch Plans for
a proposed Office Building for all bureaus and departments of
the State Board of Health.
11. Numerous City, County and State maps, locating projects pro-
posed.or in progress.
12. Preparation of numerous miscellaneous charts, graphs, tables,
and signs for this and other bureaus.
13. Preparation of numerous suggested septic tank, distribution
box, and drain field layouts for installations throughout the
State.
14. Reproductions of numerous tracings on the Ozalid-Black-Line
Printing Machine for this and other bureaus.







CHILD HEALTH 75


FHA HOUSING DEVELOPMENTS,
(SEWAGE DISPOSAL & WATER SUPPLY)
During the year the working agreement with the Federal Housing
Administration was continued whereby the bureau certifies individual
sewage disposal and water supply systems serving premises for which
the property mortgage is insured by the agency.
Briefly, the agreement mentioned involves inspections of the sys-
tems, which are performed principally by local health department
personnel, and processing of pertinent documents to see that the sewage
disposal and water supply systems meet State Sanitary Code require-
ments.
An integral part of this feature of the program is investigation
into water table elevation, soil texture through percolation tests and
drainage characteristics of areas proposed for housing developments,
to determine adaptability of areas proposed for housing developments,
to determine adaptability of septic tank and subsurface tile field
as means of sewage disposal.
The following (Table XXIX) summarizes numerically this activity
in cooperation with local health departments and the Federal Housing
Administration:

TABLE XXIX
Porim No. of
No. DESCRIPTION Item0
FHA-2218 .... Inspection Report & Certification (Sewage Disposal).. 737
FHA-2084C .. Percolation Report (Soil Characteristics & Water Table. 54
FlIA-2217 ...... Inspection Report & Certification (Water Supply)--- 17
The relatively large number of investigations (FHA-2084c) of
proposed housing development areas shows the activity in real estate
subdivisions for future and some current construction. However,
considerably fewer certifications (FHA-2218) of sewage disposal
facilities were made; which might be considered to reflect somewhat
chaotic conditions existing in housing construction during the year.










BUREAU OF

MATERNAL AND CHILD

HEALTH
LUCILLE J. MARSH, M.D., Director

The twelve objectives of the Maternal and Child Health program,
outlined in the annual plan, have as their ultimate purpose the elimina-
tion of all preventable disease and disability among all mothers and
children living in Florida.
By training personnel and providing clinicians for prenatal, post-
partum and well baby conferences in the organized county health
units, the existing facilities have been strengthened. A set of lesson
plans for use with mothers' classes was prepared in cooperation with
the Division of Public Health Nursing. Arrangements were made to
provide a technician in the Central Laboratory to do Rh typing.
Direct service in nutrition was begun in the maternal clinics of five
counties with the MCH nutritionist regularly holding conferences at
the clinics. Routine hemoglobin testing of all prenatal patients was
arranged for with the Bureau of Laboratories, and the determination
of serum protein made for patients in the clinics attended by the
nutritionist.
Nutrition service has been given to the Children's Homes licensed
by the State Welfare Board and to the hospitals convalescent homes
from which service is purchased by the Crippled Children's Commis-
sion. A monthly nutrition bulletin for food service directors of chil-
dren's institutions was begun late in 1946. The monthly newsletter
of nutrition activities, begun in 1945, was continued throughout the
year. Cooperation was given the University of Florida in the prep-
aration of nutrition materials for public schools, and to the State
Department of Education in its school lunch training program. The
nutritionist has supervised a special study of the acceptability of non-
fat dry milk solids in a school lunch program, which was a part of a
larger cooperative project of the U. S. Department of Agriculture
and the State Department of Education.
In order to assist in the extension of school health services through-
out the State, health educators, physicians and nurses have been pro-
vided in a few counties ready to begin this additional service.
Scholarships were made available to 3 local health officers and one
MCH clinician who attended the Southern Pediatric Seminar at Saluda,
North Carolina, in July. Scholarships were also provided from MCH
funds for the State Midwife Teacher at the Medical College of Rich-
mond (Va.), and for public health nurses and nurses employed in














C"
0,
'4






40


15~


0
1919-3 4 8 93 34 135 1940
Figure No. 16-Maternal mortality rate for Florida


U.S. Averaqe
- Florida Averaqe
" -----.. White
S -- r.ntlri


1944


'~~--.







LOCAL HEALTH


city or county hospitals in positions of responsibility where separate
maternity and pediatric units are contemplated or are now in use.
The latter were for short training courses in premature infant care
at Johns Hopkins and Michael Reese Hospitals.
Lecturers were provided for the Postgraduate Medical Assembly
held annually by the Florida Medical Association in Jacksonville.
Care for the immature infant continued to receive special attention.
In one of the rural county seats where a premature program is spon-
sored by a local organization, the bureau provided an incubator from
a nationally known manufacturer to be placed in the local hospital.
One of the larger urban counties has set up a premature program
which in time may serve as a pattern throughout the entire State.
This would need to include notification immediately after birth, public
health nursing instruction and supervision, transportation to the hos-
pital and hospitalization, if feasible. Demonstrations begun in previous
years by the consultant nurse, with special training in care of the
premature at Columbia University, have been continued.
Assistance was given in cooperation with other agencies toward
the establishment of a Mothers' Milk Bank in Duval County. Travel
and salary for the nurse were provided from MCH funds.
The Midwife Training Unit which had been set up in Leon County
in 1945 was discontinued. Hospitalization, however, was still provided
at Florida A & M College Hospital for the complicated cases among
the Negro women in that area. Consultation, when needed, was made
available by the white physicians of Leon County at no charge.
The bureau assisted in the Florida Study of Child Health Services
conducted by the American Academy of Pediatrics. Office space,
supplies, stenographic and clerical assistance were provided for the
executive secretary who came from Washington to supervise the study
in Florida. The MCH consultant nurse cooperated in the survey by
securing information of statistical value from hospitals, physicians
and county health units. Florida was among the first states to secure
100% reporting on hospital schedules. Primarily, the effort was a
fact finding study undertaken by physicians to learn their strong
and weak points. They believed that betterment of existing conditions
could be accomplished intelligently on the basis of factual data.
The Emergency Maternity and Infant Care program by a natural
sequence of events has consistently diminished throughout the year.
No date has been set as yet for its termination; however, it will require
months to close out cases already authorized when the program is
concluded.
A paper on maternal mortality in Florida was prepared by the
director in the hope that a study of the causes of maternal death
would point the ways in which further improvement could be made.
The accompanying chart shows the progress that has been made from
1919 to 1944. This paper was published during the last part of the
year in the Journal of the Florida Medical Association.







80 ANNUAL REPORT, 1946

The director served as a member of a number of committee, among
which were the following: Florida Citizens' Committee on Education,
School-Community Health Education Committee, and the Florida
Children's Committee. Talks were given on programs concerned with
maternal and child health and there was close cooperation with other
agencies in this mutual problem.
Before the end of the year, the MCH director resigned to become
Regional Medical Consultant for the Children's Bureau, Federal
Security Agency. Insofar as possible, the activities of the bureau
were carried on during the remainder of the year.










BUREAU OF

LOCAL HEALTH SERVICES

GEORGE A. DAME, M.D., Director
GENERAL REMARKS
The personnel of the Bureau at the close of the year consisted of
a director, two sanitation consultants, two records consultants, a chief
clerk and a junior stenographer. Mr. Robert G. Carter, sanitation
consultant, was transferred to the staff of the bureau on February 1.
Miss Prudence Ross was employed as a records consultant on October
12.
On a local level considerable progress was made during the year
in setting up new county health departments, in the number of new
programs, in the improvement of already established programs, in
securing more adequate and better trained personnel, and in the ap-
propriation of more adequate funds from the State and from the
counties.
There were trained for county health service at the training center
at Gainesville during the year, eight (8) nurses, twenty-eight (28)
sanitary officers and one (1) clerk. In addition to these, certain other
persons were given short orientation periods of training. Other per-
sonnel received training outside of the State. This training, in ad-
dition to instruction and supervision given by field consultants, will
gradually bring our county personnel to a much better standard of
efficiency.
The director of the bureau attended several conferences within
the year and gained information and training that will result in better
administration of local health services in Florida. These conferences
were: Institute on Public Health Administration, March 4, 5, 6, and
7 at Chapel Hill, North Carolina; Conference of Public Health Offi-
cials, U.S.P.H.S., District 4, at Edgewater Park, Mississippi on June
4, 5 and 6; School of Public Health, National Conference on Local
Health Units, September 9, 10, 11, 12 and 13, at Ann Arbor, Michigan;
Southern Rural Life Council at Nashville, Tennessee on December
6 and 7.
COUNTY HEALTH DEPARTMENTS
Public health services can only be fully administered on an efficient
basis when all of the counties of the State have been organized into
full time, completely staffed, fully financed county health departments
set up into local health units as contemplated in the State's enabling
act.
The effort to bring all of the sixty-seven (67) counties into the
orbit of complete public health coverage has been long and tedious.
At the end of 1944 there were thirty-six (36) county health depart-
ments. At the end of the year 1946 there were forty-five (45). All






82 ANNUAL REPORT, 1946


MAIN


:2"o


U Orqan'Ized


C


A Attached

] Unorganized








Figure No. 17-Distribution of county health units in Florida







LOCAL HEALTH 83


plans were completed in December, 1946 for the setting up of seven
(7) other county health department in January, 1947, making a total
of fifty-two (52). It is very probable that ten (10) others will be
organized in 1947. All of the State's sixty-seven (67) counties, it is
believed, will be organized not later than October, 1948.
LOCAL HEALTH UNITS
When all of the counties of the State have health departments
they will be administered through thirty-six (36) local health units.
Such groupings are provided for in the enabling act. These local
health units will be composed of one, two or three county health
departments, depending upon area, population, transportation and
community of interest.
Each county health department in a multiple local health unit
retains its identity, its own budget, programs, and its relationship
with its county officials and the State Board of Health and its own
individual personnel except that it shares the health officer, the super-
vising nurse and the supervising sanitarian of the local health unit.
As of December 31, 1946, there were 29 local health units composed
of the 45 organized county health departments, and seven (7) attached
counties.
These attached counties are not organized and do not have a budget
for local services. They receive certain supervision and services pro-
vided for by funds allocated to the unit to which they are attached.

STATE HEALTH DISTRICTS
These districts constitute a transitional phase of local health ad-
ministration and are for the purpose of giving services to unorganized
non-contributing counties. There were, as of December 31, 1946,
twenty-two (22) unorganized or non-cooperating counties, of which
seven (7) were attached to local health units. There were, then,
fifteen (15) counties constituting the State health districts.
State district funds were spent in these fifteen (15) counties for
salaries and expenses of district personnel for as adequate a program
of local health services as could be provided under the circumstances.
In addition to district funds spent in these fifteen counties, other
district funds were used for services of unit personnel in carrying
out public health activities in those unorganized counties attached
to local health units.
PERSONNEL STATISTICS
The local budgets are shown in the report of the Bureau of Finance
and Accounts. The number on the pay roll as of December 31, 1946 is
included in the report of the Personnel Office. Vacancies in each cate-
gory are shown below:
Health Officers 2; Assistant Health Officers 1; Part-time
Clinicians 1; Dentists 2; Nurses, including all classifications,
37; Sanitation personnel budgeted (all classifications) 15;
Clerical, including all classifications 5; All other classifica-
tions 17.









TABLE XXX-ACTIVITIES REPORT OF LOCAL HEALTH UNITS






STATE OF FLORIDA -
5 5
Annual Report, 1946 '2
3 o : 5-
*a a a S '
0 Id
-! B a W t a .3 o a
x) g >
CG -0 0


COMMUNICABLE DISEASE CONTROL
Admissions to service (A 1) 17 2 55 45 94 50 2 1,278 0 58 183 23
Consultations with physicians (A 2) 6 9 94 16 188 37 45 132 0 7 113 11
Field visits (A 3-9) 32 4 1,874 76 245 66 26 2,354 0 192 337 30
Smallpox immunizations (A 15) 492 329 549 45 129 193 5 6,514 7 1,711 1,430 96
Diphtheria immunizations (A 16-18) 603 440 561 89 591 54 212 4,191 57 1,195 2,165 69
Typhoid fever immunizations (A 19) 3,738 813 1,328 301 137 353 198 161 98 2,684 7,338 500
GENERAL DISEASE CONTROL
Admissions to medical service (B 1) 772 58 364 254 443 325 83 5,818 19 38 2,688 46
Clinic visits (B 3) 6,288 436 2,795 1,045 5,357 1,056 835 22,871 108 362 5,999 244
Field visits (B 4) 1,107 32 3,298 452 1,674 255 61 15,727 32 186 4,921 185
TUBERCULOSIS CONTROL
Individuals admitted to medical service (C 1) 2 14 12 108 237 35 42 2,106 3 140 7 12
Individuals admitted to nursing service (C 2) 321 53 208 123 236 37 56 862 7 328 780 75
Clinic visits (C 5) 2 81 212 124 375 33 52 2,724 0 5 0 47
Nursing visits (C 7-8) 869 105 863 218 1,213 93 107 1,996 7 1,063 1,775 142
MATERNITY SERVICE
Cases admitted to medical service (D 1-8) 442 55 47 43 369 76 42 1,475 13 112 480 41
Cases admitted to nursing service (D 2-7-10) 587 170 142 15 524 129 52 3,500 6 353 841 54
Visits by antepartum cases to medical
conferences (D 3) 573 80 132 82 718 144 55 3,417 12 134 1,693 89
Nursing visits (D 5-6-11-12) 1,774 352 551 60 1,288 335 110 7,145 41 925 2,027 135
INFANT HYGIENE
Individuals admitted to medical service (E 1) 168 36 10 57 222 55 16 1,246 1 199 0 9
Individuals admitted to nursing service (E 2) 444 139 84 20 354 57 14 2,289 10 444 585 14
Visits to medical conferences (E 3) 244 64 68 118 429 100 21 3,307 2 701 2 25
Nursing visits (E 5-6) 1,189 347 210 57 874 120 18 6,314 14 1,365 1,579 19
PRESCHOOL HYGIENE
Individuals admitted to medical service (E 8) 415 122 26 118 385 99 68 709 0 633 0 49
Individuals admitted to nursing service (E 9) 517 209 145 87 386 19 12 1,569 0 1,335 186 49
Visits to medical conferences (E 10) 512 199 42 206 600 168 94 1,442 0 1,611 0 86
Nursing visits (E 12-13) 1,299 503 396 105 702 50 24 4,297 22 3,137 553 80
Inspections by dentists or dental hygienists (E 14) 0 0 0 0 0 0 0 49 0 72 3 0


1,807
658
5,236 M
11,500 P
10,227 O
17,649

10,908
41,996
27,930 H

2,718 o
3,086
3,655
8,451

3,195
6,373
7,129
14,743

2,019
4,454
5,081
12,106

2,624
4,514
4,960
11,168
124


d

r














STATE OF FLORIDA '3
Annual Report, 1946 !c S o 5 ,
| g g o E 4 0 A

-_ l3 5& S


OVMMUNlVA ABiEl DISEASEJl CONTROL
Admissions to service (A 1)
Consultations with physicians (A 2)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Diphtheria immunizations (A 16-18)
Typhoid fever immunizations (A 19)
GENERAL DISEASE CONTROL
Admissions to medical service (B 1)
Clinic visits (B 3)
Field visits (B 4)
TUBERCULOSIS CONTROL
Individuals admitted to medical service (C 1)
Individuals admitted to nursing service (C 2)
Clinic visits (C 5)
Nursing visits (C 7-8)
MATERNITY SERVICE
Cases admitted to medical service (D 1-8)
Cases admitted to nursing service (D 2-7-10)
Visits by antepartum cases to medical
conferences (D 3)
Nursing visits (D 5-6-11-12)
INFANT HYGIENE
Individuals admitted to medical service (E 1)
Individuals admitted to nursing service (E 2)
Visits to medical conferences (E 3)
Nursing visits (E 5-6)
PRESCHOOL HYGIENE
Individuals admitted to medical service (E 8)
Individuals admitted to nursing service (E 9)
Visits to medical conferences (E 10)
Nursing visits (E 12-13)
Inspections by dentists or dental hygienists (E 14)


102
51
112
384
490
570

620
4,717
1,142

424
478
416
824

376
798
739
2,195

164
709
270
1,483

547
1,236
418
2,278
0


0 4 1
7 77 0
0 4 2
12 190 0


86
55
116
174
177
457

194
1,288
199

9
54
0
90

1
29
0
58

46
37
74
178

25
76
26
107
0


1,055
370
1,469
3,283
3,430
499

2,176
34,818
5,407

1,966
1,740
3,513
3,202

1,082
2,301
2,336
5,887

895
1,673
1,488
4,497

1,493
2,286
2,688
5,412
3


7
3
10
96
576
981

42
1,106
80

1
29
2
118

0
18
0
69

0
26
0
42

0
20
0
30


53
0
110
139
1,378
4,090

810
4,096
6

11
135
14
351

138
372
163
775

91
191
300
308

49
34
177
54
0


69
58
317
87
542
761

156
1,591
347

95
18
115
33

236
196
235
484

93
172
142
323

70
206
98
330
66


72
72
142
489
566
16

278
5,246
290

22
257
32
503

81
181
96
396

25
204
31
421

41
518
42
784
0


1,807
658
5,236
11,500
10,227
17,649

10,908
41,996
27,930

2,718
3,086
3,655
8,451

3,195
6,373
7,129
14,743

2,019
4,454
5,081
12,106

2,624
4,514
4,960
11,168
124


3,270
1,301
7,560
16,256
17,495
26,223

15,382
96,054
35,569

5,267
5,865
7,783 O
13,734

5,132
10,333
10,722 i
24,844

3,344
7,559 -
7,398
19,577

4,873
9,078
8,433
20,719
213 o0


,















STATE OF FLORIDA
Annual Report, 1946


COMMUNICABLE DISEASE CONTROL
Admissions to service (A 1)
Consultations with physicians (A 2)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Diphtheria immunizations (A 16-18)
Typhoid fever immunizations (A 19)
GENERAL DISEASE CONTROL
Admissions to medical service (B 1)
Clinic visits (B 3)
Field visits (B 4)
TUBERCULOSIS CONTROL
Individuals admitted to medical service (C 1)
Individuals admitted to nursing service (C 2)
Clinic visits (C 5)
Nursing visits (C 7-8)
MATERNITY SERVICE
Cases admitted to medical service (D 1-8)
Cases admitted to nursing service (D 2-7-10)
Visits by antepartum cases to medical
conferences (D 3)
Nursing visits (D 5-6-11-12)
INFANT HYGIENE
Individuals admitted to medical service (E 1)
Individuals admitted to nursing service (E 2)
Visits to medical conferences (E 3)
Nursing visits (E 5-6)
PRESCHOOL HYGIENE
Individuals admitted to medical service (E 8)
Individuals admitted to nursing service (E 9)
Visits to medical conferences (E 10)
Nursing visits (E 12-13)
Inspections by dentists or dental hygienists (E 14)


S >


47
20
119
2,170
1,210
5,101

1,458
11,004
1,023

85
48
268
121

237
259
331
798

42
103
76
215

25
111
46
175
0


7
18
20
440
80
3,219

26
411
409

24
71
30
185

43
70
90
189

5
22
5
33

0
3
1
7
0


0





6
4
6
170
58
1,097

201
2,270
115

119
122
204
169

180
167
663
323

39
120
45
165

41
118
59
189
0


0




73
28
307
445
1,717
2,821

321
2,061
157

199
303
260
546

127
150
282
454

92
128
165
371

27
166
93
678
2


a





71
137
101
326
550
1,535

88
1,187
144

27
127
43
357

56
180
168
410

33
120
98
251

105
243
462
512
0


C





15
2
24
141
134
1,796


0



788
166
1,202
2,126
2,374
8,870


15 924
71 6,515
53 1,447


0
16
0
84

0
24
0
80

0
23
1
51

0
7
0
41
0


146
693
7,367
1,898

517
529
745
871

237
473
381
708

833
1,153
1,363
1,353
441


57
7
108
942
899
156

622
7,178
562

469
727
374
1,431

372
504
1,167
1,456

433
582
1,035
2,024

881
1,153
1,604
2,497
18


43
25
113
355
437
57


0






262
13
134
803
736
1,623


'I'




223
145
224
135
307
22


3,270
1,301
7,560
16,256
17,495
26,223


152 92 223 15,382
613 476 1,826 96,054
817 96 694 35.569


0
370
75
1,393

0
21
0
51

0
9
0
27

0
6
0
7
0


1
70
1
113

0
46
0
104

0
40
5
98

0
86
0
184
0


236
550
260
1,717

198
328
265
1,459

182
524
259
3,515
1,780


5,267
5,865
7,783
13,734

5,132
10,333
10,722
24,844

3,344
7,559
7,398
19,577

4,873
9,078
8,433
20,719
213


o00





6'


S cS



4,862
1,866
9,918 M
24,309 Pd
25,997
52,520

19,504
129,666
41,086 i-

6,500 m
8,452
16,623
20,639

6,900
12,833
14,428
31,297

4,423
9,507
9,474
24,979

6,967
12,648
12,320
29,877
2,454


III














STATE OF FLORIDA
Annual Report, 1946 d a

o > 6 to s
3F fi ra & > 9a i :M M

COMMUNICABLE DISEASE CONTROL
Admissions to service (A 1)
Consultations with physicians (A 2)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Diphtheria immunizations (A 16-18)
Typhoid fever immunizations (A 19)
GENERAL DISEASE CONTROL
Admissions to medical service (B 1)
Clinic visits (B 3)
Field visits (B 4)
TUBERCULOSIS CONTROL
Individuals admitted to medical service (C 1)
Individuals admitted to nursing service (C 2)
Clinic visits (C 5)
Nursing visits (C 7-8)
MATERNITY SERVICE
Cases admitted to medical service (D 1-8)
Cases admitted to nursing service (D 2-7-10)
Visits by antepartum cases to medical
conferences (D 3)
Nursing visits (D 5-6-11-12)
INFANT HYGIENE
Individuals admitted to medical service (E 1)
Individuals admitted to nursing service (E 2)
Visits to medical conferences (E 3)
Nursing visits (E 5-6)
PRESCHOOL HYGIENE
Individuals admitted to medical service (E 8)
Individuals admitted to nursing service (E 9)
Visits to medical conferences (E 10)
Nursing visits (E 12-13)
Inspections by dentists or dental hygienists (E 14)


131
10
136
530
951
12

152
2,055
95

44
61
62
400

3
17
3
23

1
15
1
18

0
31
0
34
0


152
4
269
773
538
25

770
3,825
742

512
512
7
1,536

133
362
320
874

175
377
479
938

450
700
1,031
1,467
195


254 1


6
36
73
76
520
1,701

39
924
104

4
10
15
61

6
25
6
131

19
31
25
251

26
2
80
78
1


4,862
1,866
9,918
24,309
25,997
52,520

19,504
129,666
41,086

6,500
8,452
16,623
20,639

6,900.
12,833
14,428
31,297

4,423
9,507
9,474
24,979

6,967
12,648
12,320
29,877
2.454


5,253
2,001
10,579
27,757
28,612
57,102


20,625
137,826
42,348

7,151 t7
9,312 O
16,826
23,301 0

7,136 tq
13,486
14,928 W
32,885 M

4,666
10,212
10,071
26,657 X

7,545
14,009
13,627
32,621 m
2.650 -1


. v


,















STATE OF FLORIDA
Annual Report, 1946 E
f o o
2 Q CU O U 0 0


COMMUNICABLE DISEASE CONTROL
Admissions to service (A 1) 5 12 0 0 0 0 128 0 26 5,253 5,424
Consultations with physicians (A 2) 68 6 0 0 0 0 29 0 2 2,001 2,106
Field visits (A 3-9) 40 14 0 0 5 0 203 0 26 10,579 10,867
Smallpox immunizations (A 15) 0 0 0 0 0 0 29 30 7 27,757 27,823
Diphtheria immunizations (A 16-18) 375 836 0 16 0 0 161 67 5 28,612 30,062
Typhoid fever immunizations (A 19) 239 0 0 1 0 0 440 11 8 57,102 57,801
GENERAL DISEASE CONTROL
Admissions to medical service (B 1) 57 1 0 38 0 0 1 9 22 20,625 20,753
Clinic visits (B 3) 281 1 0 149 0 0 1 26 64 137,826 138,348
Field visits (B 4) 252 1 0 66 6 1 2 0 39 42,348 42,715
TUBERCULOSIS CONTROL
Individuals admitted to medical service (C 1) 31 0 0 3 1 0 3 0 9 7,151 7,198
Individuals admitted to nursing service (C 2) 83 0 0 1 3 9 4 0 61 9,312 9,423
Clinic visits (C 5) 44 0 0 0 1 0 2 0 8 16,826 16,881
Nursing visits (C 7-8) 61 0 0 4 7 9 5 0 89 23,301 23,466
MATERNITY SERVICE
Cases admitted to medical service (D 1-8) 13 0 0 0 0 0 2 0 7 7,136 7,158
Cases admitted to nursing service (D 2-7-10) 19 1 0 1 0 0 7 0 14 13,486 13,528
Visits by antepartum cases to medical
conferences (D 3) 14 0 0 0 0 0 3 0 8 14,928 14,953
Nursing visits (D 5-6-11-12) 25 1 0 1 0 0 14 0 29 32,885 32,955
INFANT HYGIENE
Individuals admitted to medical service (E 1) 19 0 0 0 0 0 0 0 6 4,666 4,691
Individuals admitted to nursing service (E 2) 1 0 0 0 0 0 6 0 12 10,212 10,231
Visits to medical conferences (E 3) 22 0 0 0 0 0 0 0 6 10,071 10,099
Nursing visits (E 5-6) 1 0 0 0 0 0 13 0 37 26,657 26,708
PRESCHOOL HYGIENE
Individuals admitted to medical service (E 8) 190 0 0 0 0 0 0 0 10 7,545 7,745
Individuals admitted to nursing service (E 9) 5 0 0 0 0 0 28 0 12 14,009 14,054
Visits to medical conferences (E 10) 221 0 0 0 0 0 0 0 10 13,627 13,858
Nursing visits (E 12-13) 13 0 0 0 0 0 35 0 23 32,621 32,692
Inspections by dentists or dental hygienists (E 14) 0 0 0 0 0 0 0 0 4 2,650 2,654


0

fr

o,

















STATE OF FLORIDA
Annual Report, 1946 d 2
0
? -r F u rI


SCHOOL HYGIENE
Inspections by physicians or nurses (F 1)
Examinations by physicians (F 2)
Individuals admitted to nursing service (F 4)
Nursing visits (F 5-6)
Inspections by dentists or dental hygienists (F 7)
ADULT HYGIENE
Medical examinations (G 1-5)
MORBIDITY SERVICE
Medical visits (H 3-4)
Nursing visits (H 5-6)
Admissions to hospitals (H 7)
GENERAL SANITATION
Approved individual water supplies
installed (J 1)
Approved excreta disposal systems
installed (J 2-3)
Field visits (J 4-11
PROTECTION OF FOOD AND MILK
Food handling establishments registered
for supervision (K 1)
Field visits to food handling establishments (K 2)
Dairy farms registered for supervision (K 3)
Field visits to dairy farms (K 4)
Milk plants registered for supervision (K 5)
Field visits to milk plants (K 6)
LABORATORY
Specimens examined (L 1-21)


6,203
1,335
556
1,241
0


1,656
123
74
103
0


3,742
719
229
967
96


3,534
1,413
3,817
6,695
0


2,145 195 488 425 542


133
83
0


374
770
8,411


229
1,722
21
234
14
111


2 26
84 167
0 0


15 107 2 251
58 369 18 1,067
665 2,423 -473 2,363


34
548
14
27
0
0


48
576
42
204
24
102


1,767
161
46
150
0

627


49 37
59 164
1 26


184
194
791


106
495
5
38
3
22


365
3,664
0
122
1
38


20,715 1 1,163 I 5,632 12,1341 5,437 I 1,974 11,6981


162,269
9,853
5,999
30,348
13,671


8,369
699
570
991
940


304 I 5 1 1,398


0 0
212 29
0 0


32
1,285
44,027


3,430
24,311
69
1,605
44
1,932

189,248


244
1,883
3,404


426
1,417
2
21
1
8

3.128


4,347
8
183
749
8

1,204


2 8
77 166
3 1


108
198
3,530


381
2,092
68
730
9
488

on ene


193,339
14,979
12,149
42,374
14,718

6,723

617
1,449
39 O
0

1,390 .
5,904
67,022 W


5,188
36,095 I
233 a
3,069
97
2,703

256.512


. ,




University of Florida Home Page
© 2004 - 2010 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Last updated October 10, 2010 - - mvs