• TABLE OF CONTENTS
HIDE
 Cover
 Title Page
 Letter of transmittal
 Members of the Florida state board...
 Official staff Florida state board...
 County health officers
 Foreword
 Table of Contents
 Bureau of preventable diseases
 Bureau of tuberculosis control
 Nutrition investigations and...
 Bureau of sanitary engineering
 Bureau of local health service
 Health information
 Laboratories
 Narcotics
 Field technical staff
 Vital statistics
 Bureau of finance and accounts
 Purchasing and property
 Hospital licensing






Title: Annual report - State Board of Health, State of Florida
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 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: VID00018
Source Institution: Florida A&M University (FAMU)
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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 )
    Official staff Florida state board of health
        Unnumbered ( 6 )
    County health officers
        Unnumbered ( 7 )
    Foreword
        Foreword 1
        Foreword 2
        Foreword 3
        Foreword 4
        Foreword 5
    Table of Contents
        Table of Contents
    Bureau of preventable diseases
        Page 1
        Epidemiology
            Page 2
            Page 3
            Page 4
            Page 5
            Page 6
            Page 7
            Page 8
            Page 9
        Venereal disease control
            Page 10
            Page 11
            Page 12
            Page 13
            Page 14
            Page 15
            Page 16
        Typhus fever studies
            Page 17
            Page 18
        Industrial hygiene
            Page 19
            Page 20
            Page 21
        Cancer control
            Page 22
            Page 23
            Page 24
            Page 25
            Page 26
            Page 27
            Page 28
    Bureau of tuberculosis control
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
    Nutrition investigations and services
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
    Bureau of sanitary engineering
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Division of entomology
            Page 64
            Page 65
            Page 66
            Page 67
            Page 68
            Page 69
            Page 70
            Page 71
            Page 72
    Bureau of local health service
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Division of public health nursing
            Page 80
            Page 81
            Page 82
        Mental health program
            Page 83
            Page 84
            Page 85
            Page 86
            Page 87
            Page 88
            Page 89
            Page 90
    Health information
        Page 91
        Page 92
        Page 93
        Page 94
    Laboratories
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
        Page 103
        Page 104
    Narcotics
        Page 105
        Page 106
    Field technical staff
        Page 107
        Page 108
    Vital statistics
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
    Bureau of finance and accounts
        Page 115
        Page 116
        Page 117
        Personnel
            Page 118
            Page 119
            Page 120
            Page 121
            Page 122
            Page 123
            Page 124
    Purchasing and property
        Page 125
        Page 126
    Hospital licensing
        Page 127
Full Text
LEGILAll'E R[EFERF! NC LI~ 7 iT

48Eth Annual i port



STATE BOARD OF HEALTH
S&de 4t 4lZfida



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



1947


- :- : -' ^ -"_
FLORIDA STA!, Fo, OF HEALTH
Jacksonville 1, Florida


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48-kh 4mumial Repauo

STATE BOARD OF HEALTH








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


FLORIDA


STATE BOARD OF
Jacksonville I, Florida


HEALTH












6/q





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, 1947,
to December 31, 1947, inclusive.

Respectfully submitted,

HERBERT L. BRYANS, M.D.
President

August 30, 1948
Pensacola, Florida


















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


DEAR DR. BRYANS:


I herewith submit the forty-eighth annual report
of the Florida State Board of Health for the year
ending December 31, 1947.

Sincerely yours,

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

August 30, 1948
Jacksonville, 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


J. E. EDWARDS, M.D.
Miami


MARK F. BOYD, M.D.
Tallahassee









OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
State Health Officer ......._ .. ---Wilson T. Sowder, M.D., M.P.H.

DIRECTORS

Bureau of Local Health Service_- .....-.George A. Dame, M.D.
Division of Public Health Nursing.....Ruth E. Mettinger, R.N.
Division of Dental Health-.....----.... George A. Dame, M.D.

Bureau of Preventable Diseases ._..-..Roger F. Sondag, M.D.
.Divisiorn of Venereal Disease Control.Roger F. Sondag, M.D.
Division of Industrial Hygiene ......John M. McDonald, M.D.
Division of Cancer Control ..-....James B. Hall, M.D.
Florida Rapid Treatment Center....- Robert V. DiPasca, M.D.

Bureau of Tuberculosis Control ..--..Clarence M. Sharp, M.D.

Bureau of Laboratories .. ..Albert V. Hardy, M.D., Dr.P.H.
Miami Branch Laboratory___- .._Vincent R. Saurino
Tampa Branch Laboratory _......H. D. Venters
Tallahassee Branch Laboratory_ ..Loretta C. Ellias
Pensacola Branch Laboratory ---.. Joe Gray

Bureau of Maternal and Child Health -T. Paul Haney, M.D., M.P.H., Dr.P.H.

Bureau of Sanitary Engineering.-..-..David B. Lee, M.S., Eng.
Division of Entomology _. -John A. Mulrennan

Bureau of Vital Statistics ..... ... ....Everett H. Williams, Jr.

Bureau of Finance and Accounts-..-- Fred B. Ragland
Personnel Supervisor.-.. .. ...--Paul T. Baker

Bureau of Narcotics --- .... M--Marshall H. Doss

Division of Nutrition Investigations
and Services ......-- ...-... -Walter Wilkins, M.D., Ph.D.

Field Technical Staff.. ._... -. L. L. Parks, M.D., M.P.H.

Division of Health Information. .----.Ruth S. Allen


Purchasing Agent ......--------.... ........ -.....G. Wilson Baltzell









COUNTY HEALTH OFFICERS

Alachua --Frank M. Hall, M.D., M.P.H.
Baker Nassau --- ---.John W. McClane, M.D.
Bay __..._.--......-.....-- _- .-Franklin H. Reeder, M.D., M.P.H.
Bradford Clay Union .____A. Y. Covington, M.D., M.P.H.
Brevard Osceola ...James H. Wells, M.D.
Broward .__ -- -- George A. Dame, M.D.*
Calhoun Gadsden Liberty -.. ---- George A. Dame, M.D.*
Charlotte DeSoto Hardee ...-- ..Daniel H. Rowe, M.D.
Columbia Hamilton Gilchrist .--.. Joseph C. Weeks, M.D.
Dade --.-______-_- -__ ....T. E. Cato, M.D., M.P.H.
Dixie Suwannee Lafayette ....E. H. John, M.D.
Duval ................------- ..-Thomas E. Morgan, M.D., M.P.H.
Escambia Santa Rosa .......- .T. W. Reed, M.D.
Flagler Putnam _....._ --Wm. G. C. Hill, M.D.
Franklin Gulf Wakulla -----. -Terry Bird, M.D., M.P.H.
Glades Highlands Hendry _....- Harry W. Hollingsworth, M.D.
Hillsborough _Frank V. Chappell, M.D., M.P.H.
Holmes Okaloosa Walton -...-.- -Charles J. Roehm, M.D.
Jackson Washington ...-... M. Lewis Gray, M.D.
Jefferson .-... ......... -- ----B. L. Arms, M. D.
Lake ---______- ..-R. J. Dalton, M.D.
Leon ---.....--------.. H. A. Sauberli, M.D., M.P.H.
Levy --Carroll T. Bowen, M.D.
Madison Taylor --.-------- --Robert F. Sayre, M.D.
Manatee Sarasota --- --- ---William L. Wright, M.D.
Marion ------.. ------Paul H. Jenkins, M.D.
Monroe __-----James B. Parramore, M.D.
Orange -. -_-Leland H. Dame, M.D.
Pasco Sumter ---- R. N. Nelson, M.D.
Pinellas -. ---George A. Dame, M.D.*
Polk -----.. -._Edwin G. Riley, M.D., Ph.D.
Seminole ----__-Frank L. Quillman, M.D.
Volusia ---...--------.. ----....... -....- -R. D. Higgins, M.D., M.P.H.
Indian River-Okeechobee-St. Lucie-George A. Dame, M.D.*
(*) Acting Director until a Health Officer is appointed.










FOREWORD
The year 1947 was a significant one in the annals of the State
Board of Health. The legislature saw fit to double our appropri-
ation, the increased funds being allocated to the support of county
health units, a new cancer control program, a general mosquito
control program, expansion of laboratory services, including the
establishment of a branch laboratory in Orlando, and expansion
of engineering activities. New duties were also placed upon us.
A law was passed requiring the inspection, regulation and li-
censing of hospitals which receive federal aid through the Federal
Hospital Construction Act. We were also given the responsibility
for regulating and inspecting the work of pest control operators
in the State. Federal funds were also made available for the first
time for a mental health program and the Governor designated
the State Board of Health as the state agency to carry on this
program. The legislature also increased the membership of the
State Board of Health from three members to five which was
the first change made in the membership of the Board since its
establishment in 1889.
We were fortunate during the year in that there were no ex-
ceptional outbreaks of communicable diseases but additional
measures were taken to deal with problems of long standing in
this field. In February, due to a lack of funds, our Rapid Treat-
ment Center for venereal diseases which had been operated
aboard the former Army Transport, Ernest Hinds, in Jackson-
ville, was closed. In July the center was reopened and in better
quarters at the former Naval Air Station Hospital at Melbourne.
In order to more effectively deal with the cancer problem a
Division of Cancer Control was set up in the Bureau of Preventa-
ble Diseases and Dr. J. B. Hall was selected as its first director.
Animal rabies became an increasing problem during the year,
more cases being reported than ever before in Florida's history.
Because of this problem and other related problems plans were
made to employ a public health veterinarian in the Bureau of
Preventable Diseases. The duties of a public health veterinarian
will be concerned not only with the control of rabies but to assist
in the control of all diseases of animals which are transmissible
to man. Because of expanded activities in the field of preventable
diseases the work of our laboratories increased substantially, the
number of tests performed being 18.7% higher than during the
preceding year. A laboratory was opened at the Rapid Treat-
ment Center in Melbourne in order to serve that facility and
plans are being made for the establishment of a branch labora-
tory in Orlando. A Division of Industrial Hygiene was organ-
ized in the Bureau of Preventable Diseases and Dr. J. M. Mc-
Donald was appointed as its director. Investigations were made
in various industrial plants of conditions that might be dangerous







to the health of workers and appropriate recommendations made
to the Industrial Commission and to the industrial plant con-
cerned. We have continued a project for the investigation of the
incidence and epidemiology of typhus fever in cooperation with
the Rockefeller Foundation. This project is under the direction
of Dr. E. R. Rickard with headquarters in Tampa and we believe
that much useful data has been gathered which will enable us to
better cope with this very serious problem within the State.
Our tuberculosis control program was greatly expanded and
x-ray surveys throughout the state were made in greater num-
bers and with better results than ever before. In a six week's
period 100,000 persons were x-rayed in Dade County and this
without calling for additional federal assistance. By using to the
greatest advantage state and local resources and by cooperating
closely with the local Tuberculosis Association, this survey was
made at a remarkably low cost per x-ray. Steps were taken
during the year to coordinate the efforts of the State Board of
Health, The Florida Tuberculosis Board and the Tuberculosis and
Health Association by the appointment of a coordinator whose
salary and travel was shared by all three agencies.
During the year fifteen additional counties, making a total
of sixty in all, established a county health department. Florida
now leads the nation in the percentage of its people which are
served by local health departments which are staffed by a compe-
tent corps of physicians, nurses, sanitary officers and other tech-
nical personnel. In spite of a nationwide shortage of such per-
sonnel we have been able-to maintain an almost unique record of
keeping most of our positions filled.
With the assistance of the Commonwealth Fund, a Field Tech-
nical Staff was organized January 1, 1947. It consists of a physi-
cian, two sanitation consultants, two nurse consultants, and two
record consultants. The primary purpose of the staff is the con-
tinual training of health workers in the counties, by demonstra-
tion, observation, and teaching new techniques.
There are still some vacancies in public health nursing posi-
tions but these are few in number and we can be proud of our
record here as compared to experiences in other states and in
comparison to other agencies within the state which employ
nurses. The Division of Public Health Nursing has devoted much
of its time to solving this problem.
In order to supply the demand for trained personnel the opera-
tion of the training center in Alachua County in cooperation with
the Commonwealth Fund and the Alachua County Health De-
partment was continued. Arrangements were continued with the
University of Florida and the Florida State University for post-
graduate training of bacteriologists. Most of the trainees will be
employed permanently in the laboratories of the State Board of
Health.







The death rates for infants and the maternal mortality rates
were the lowest on record in the state. Continued emphasis was
placed on services to mothers and infants in migrant labor areas,
to premature infants, and to school children. During the late
winter and spring thirty-six young graduate physicians were em-
ployed temporarily to assist in the school program carried on by
our county health departments. The mental health program was
started by the employment of a psychiatrist and a plan was de-
veloped by which regional mental health clinics would be estab-
lished in the principle cities of the state. Special emphasis to
be given to the problems of children and youth. Our staff of
nutritionists under the direction of a physician trained in that
field continued its investigations in the field of malnutriton and
anemia, and its work also included education, demonstration, and
consultation services.
It is also hoped that during the next fiscal year to be able to
employ a competent director for the Division of Dental Health
and expand this program considerably. There is an urgent need
for a better public health dental program in the State.
In the field of environmental sanitation the Bureau of Sani-
tary Engineering reviewed and approved plans for the construc-
tion of water and sewage plant facilities, the cost of which
amounted to about $18,000,000. In addition considerable work was
done in connection with stream pollution investigations and ap-
propriate recommendations made to municipalities, sanitation
districts and to private industries.
The Bureau of Malaria Control was consolidated with the
Bureau of Sanitary Engineering and set up as a Division of
Entomology. Its work was expanded to include the control of
pest mosquitoes as well as those which are known to transmit
diseases. In addition this division was given the responsibility
for the regulation of pest control operators and for the rodent
control program.
In cooperation with the State Hotel Commission and the
Florida Restaurant Association a mobile food handlers' school
was organized. In the beginning most of the expense of this
school was borne by the State Board of Health and courses were
offered to local restaurant operators and food handlers in DeLand,
Sanford and Perry and a workshop for operators was conducted at
the Florida State University in Tallahassee.
During the year a new system for the collection of vital sta-
tistics data was inaugurated in the interest of greater economy
and efficiency. Registration districts were consolidated in forty-
nine of the sixty-seven counties and the county health officer
was given the responsibility for the collection of this data within
his county.
Improvements in the business administration of the affairs of
the State Board of Health were continued and various significant







changes were made in bookkeeping methods, purchasing pro-
cedures, property accounting, and in other phases in this field.
Better procedures were initiated to control the expenditure of
funds for personal services, equipment and supplies, and to co-
ordinate such expenditures with existing budgets and with avail-
able funds. The complexity of this problem is indicated by the
fact that we had the responsibility for the supervision of ex-
penditure of eighty-eight different funds appropriated by dif-
ferent bodies or appropriated for different purposes.
The Bureau of Narcotics continued its excellent work under
the direction of Mr. Marshall H. Doss in the enforcement of the
laws dealing with narcotics, the medical practice act, the phar-
macy laws and the registration and licensing of drug stores.
Through the Division of Health Information the people of
the state were kept in constant touch with current public health
problems. Through the medium of our official publication
"Health Notes," which has been published since 1892, we have
made available to the people of the state the latest ideas on
health. Our excellent library has also been the means of keep-
ing not only our own employees but physicians and others in-
terested in public health and the healing arts abreast of current
scientific knowledge. We have also used the press, radio, posters
and moving pictures as a means of informing the public of the
best means of meeting our health problems from day to day.
In February we were able to persuade the U. S. Public Health
Service to locate one of two Diabetes Demonstration projects pro-
vided for the entire country, in the City of Jacksonville. This
Project has been carried on under the direction of Dr. Malcolm
J. Ford in cooperation with the City and County Health Depart-
ments and the State Board of Health. It has consisted in the find-
ing of diabetes cases by urine and blood tests; and classes have
been offered to all sufferers from the diesase by a nutritionist,
nurse and physician in the dietetic management of their condi-
tion. Private physicians have welcomed this service and those
who are acquainted with the program would like to see it acti-
vated on a statewide basis.


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































Edited by
EVERETT H. WILLIAMS, JR.











TABLE OF CONTENTS

Preventable Diseases .--...............----------- -......--.... 1
Epidemiology ...- --.............. ... .........------------------- 2
Venereal Disease Control ---.. --- --. 10
Typhus Fever Studies __-......-... ._--.__ ....... 17
Industrial Hygiene ...------_ -------....... --._... _--_-_-. 19
Cancer Control .......-----.- ....._. .......... 22
Tuberculosis Control -__------.-...... .....-._._........___ -_ ...----. 29
Nutrition Investigations and Services -___----_ 41
Sanitary Engineering ..-..........--.-_ --------.........-__........-- 51
Entomology --.................. .... ..... ... ---- 64
Local Health Services -------- ---------- 773
Public Health Nursing __ ----__ --___ -__ ---- 80
Dental Health .-----------............ --..--- ---.. 83
Health Information _-__ .......... ...... -. --....... 91
Maternal and Child Health --.....--......_---_---_.. .-- --. 85
Mental Health ............... _-......--------........-. 88
Laboratories .........---...... ......----.....--------._.---- 95
Narcotics .___............. --..... .-_...._ .......... 105
Field Technical Staff .....--_............._..........--------.. 107
Vital Statistics ....__. .. .... .........-------- ____ _..-- --. .. 109
Finance and Accounts _.- __- --------------------- 115
Personnel _-_____-__................--___...._ .. ....-----.-. 118
Purchasing and Property -- -- -___- --.------ -- 125
Hospital Licensing _~_-__ __ --------.-- 127










BUREAU OF

PREVENTABLE DISEASES

R. F. SONDAG. M.D.. Director

During the year 1947 there were no notable outbreaks of com-
municable diseases. The incidence of most reportable diseases
remained at a normal seasonal expectancy.
This Bureau was chiefly concerned with the development of
a well rounded cancer control program and a report of activities
on cancer control is included in this report.
There was a slight set-back in venereal disease activities due
to the lack of funds to maintain the Rapid Treatment Center for
the remainder of the fiscal year 1947. It was necessary to close
the Ernest Hinds Rapid Treatment Center in February. Due to
the administrative impossibilities on the Ernest Hinds it was
deemed necessary to find a land base facility. The Naval Air
Station Hospital at Melbourne was finally secured for the Rapid
Treatment Center and the program began operating again in
July. The lack of funds not only affected the in-care treatment
of venereal disease patients but also drastically curtailed the
purchase of drugs for out-patient treatment. The Venereal Dis-
ease Control activities also follow in this report.
On November 1, our epidemiologist resigned to accept a posi-
tion as County Health Officer of Polk County. The epidemi-
ological activities since his resignation have been carried on by
the Director of this Bureau.
The Cancer Control Division was created by the Board on
September 20, and Doctor James B. Hall, formerly Health Officer
of Highlands-Glades County Health Department was selected as
Director of the Cancer Control Division.
During December, plans were made to add a Public Health
Veterinarian to the staff of the Bureau of Preventable Diseases
and Dr. James E. Scatterday, formerly with the Alachua County
Health Department, was selected for this position. During the
ensuing year efforts will be made to expand the control of dis-
eases that have their origin in animals and are transmitted to
man.
The reports of the various divisions and field activities under
the direction of the Bureau of Preventable Diseases follow:
[11







2 ANNUAL REPORT, 1947


EPIDEMIOLOGY
E. G. RILEY, M.D.
Following the 577 cases of poliomyelitis that occurred during
1946, as expected, 1947 showed marked decrease, with only 111
cases reported. Several isolated situations called for attention
and the National Foundation for Infantile Paralysis was asked to
investigate a problem arising from this disease in West Palm
Beach. There was still some apprehension prevalent, especially
by out of state visitors, and many letters were received asking
about the status of poliomyelitis in Florida.
Plans were conducted in cooperation with the state repre-
sentatives of the National Foundation for Infantile Paralysis to
place upon a more permanent basis arrangements for treatment
of cases of this disease. It is hoped this planning will be con-
tinued in the future.
Cancer has again shown an increase in the number of cases
reported over the last year. This is no doubt due to two reasons,
an increased interest in this disease created by the newly set up
cancer control program and the general improvement of reporting
cases of notifiable diseases.
An arrangement has been worked out whereby the Labora-
tory includes a completely filled out report card which is sent to
physicians with every positive laboratory report. This method
relieves the physician of filling out these cards and it is felt that
reporting has been improved by this method.
Diphtheria has shown a decrease this year over last and is
again approaching the average number of cases which has been
constantly declining since this disease was first made reportable
in 1918.
Malaria has also shown fewer cases to be reported and most
of these were found to be in young men of military age.
Tuberculosis has a two-fold increase in the number of cases
reported due to the very excellent case finding program of the
Bureau of Tuberculosis.
On the whole, those diseases against which we have specific
means of protection have shown a uniform decrease. Just how
much of this has been brought about by increased immunization,
which has been rather great during the past several years, or to a
general recession, is difficult to state.
Typhus fever has continued to show a downward trend which
was followed by the peak year of 1944 and it is felt that this
represents a natural recession in the disease. The Typhus Fever
Studies conducted by Dr. E. R. Rickard are incorporated in this







PREVENTABLE DISEASES 3


report. The typhus fever survey in which the Epidemiologist
participated last year has now developed into a localized pro-
gram and the investigation of current cases has been done by
lay investigators who have reported many unreported cases but
not in the proportion of two and a half times as occurred in the
general survey. The investigators have spent much time in the
local health units, hospitals and with private physicians inform-
ing them of typhus fever and asking their cooperation in the re-
porting of the disease. It is felt that if the reporting of diseases,
in general, is ever to reach any degree of completeness such edu-
cational methods must be employed.
Particular interest this year was had in Rocky Mountain
Spotted Fever. This disease presents many of the features of
typhus fever and it is hoped to demonstrate all the conditions in
order to stimulate physicians to endeavor to differentiate between
the two.
Two proved cases of Spotted Fever were found, one of which
was interesting in view of the fact that it was first thought to
be post vaccinal encephalitis and was diagnosed as Rocky Moun-
tain Spotted Fever only after a complement fixation test was
performed.
A public health program for leprosy was planned during the
year following a visit by the Epidemiologist to Carville. It was
learned at that time that there have been 85 cases of this dis-
ease in persons from Florida since 1922. Most of these cases
have come from Key West, Miami, and Tampa, with Key West
contributing the largest number. A two fold program is contem-
plated; first, to institute an intensive educational program, and,
second, it was hoped to institute a case finding program in order
that those persons affected with leprosy could be placed under
proper treatment and public health control. Great public inter-
est has been manifest in this program.
An attempt was made during the year to follow more closely
various out-breaks of enteric infections and detailed information
was had on six, four of which were investigated by the Epidemi-
ologist and one by Dr. Sondag. One of these involved about 300
people who were infected with gastroenteritis due to Salmonella
typhimurium. Another occurred in a day nursery and involved
twelve children. The only organism which may have been the
source of the difficulty isolated was a paracolon organism. This
instance was interesting in that the mother of one of the children
in the home was found to be a dysentery carrier and her child
later developed this disease even though the woman had been
thoroughly instructed in how to guard against transmitting the
disease.







4 ANNUAL REPORT, 1947


The third out-break investigated was that in an educational
institution in which about 200 cases of acute gastroenteritis oc-
curred and three species of Salmonella were isolated from the
stools of the individuals involved although the out-break was
characterized by a very uniform onset and course.
One out-break was due to Salmonella from eating infected
raw oysters and although the organism was isolated from the
oysters it could never be identified in the patients. Several
hundred persons were affected in this out-break.
The other out-break was probably due to a Staphylococcus
type of poisoning and occurred at a high school banquet, thirty
persons being involved.
Three of four out-breaks of enteric diseases were rumored
but it was impossible to obtain specific information concerning
them.
There was also a small out-break of typhoid due to infected
oysters. The out-break was quickly brought under control by
stopping the sale of oysters which originated from condemned
areas.
The most important disease problem during the year was
rabies. There were more cases reported during 1947 than ever
before in Florida's history. (See Tables I and II.)
This is due to two factors, first, more rabies, second, better
reporting. Fortunately, no human disease occurred, although
1434 people had the Pasteur treatment following animal bites.
The State Board of Health issued 1434 anti-rabies treatments,
consisting of the 14 dose series, at a cost of $4.25 per treatment.
The total cost to the Florida State Board of Health was $6,094.50.
This figure, of course, does not include the vaccine bought by
practicing physicians. Thus it can readily be seen that the Pas-
teur treatment is not only painful, but costly.
Quarantine was placed into effect in Hillsborough, St. Johns
and Dade Counties. These quarantines were not too effective
because enforcement agencies are handicapped by public senti-
ment, ignorance and lack of control legislation to impose and
thoroughly carry out uniform regulations. The Florida State
Veterinarian's Association was instrumental in introducing a
rabies control bill into the State Legislature but the bill failed
to pass. Rabies is a disease which can be effectively controlled
and completely eradicated. Effective legislation, however, is
necessary in order that steps can be taken to eradicate this most
dangerous disease. The Public Health Veterinarian now with the
Bureau of Preventable Diseases will devote the major portion
of his time to the control of this dangerous condition.
Other diseases showed minor variations from previous years









PREVENTABLE DISEASES 5


in the number of cases reported and the diseases reported con-
formed to normal seasonal expectancy.









TABLE I

TOTAL NUMBER OF ANIMAL RABIES REPORTED BY COUNTY-1947-
FLORIDA




z
COUNTY


E g 8 E

TOTAL 438 341 15 5 2 0 2 0 20 53
Alachua 1 1
Baker 2 1 1
Bay 1 1
Broward 1 1
Calhoun 1 1
Clay 1 1
Dade 123 76 4 1 2 1 39
Duval 26 26
Franklin 4 4
Gadsden 5 4 1
Hillsborough 136 133 2 1
Holmes 8 5 2 1
Jackson 3 3
Jefferson 17 17
Lake 2 2
Leon 4 4
Madison 3 3
Orange 11 9 1 1
Palm Beach 1 1
Pasco 1 1
PinelUas 4 3 1
Polk 6 4 1 1
St. Johns 12 12
Santa Rosa 5 5
Volusia 60 41 7 2 10











TABLE II
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1947-AND STATE TOTALS FOR 1945 AND 1946



i a
z 0
COUNTIES
N P 0 0 z N



TOTAL FOR 1945 I 450 722 1,791 19 44 235 89 31 9 1 2 42 172 18,088 244 4,583 120 23 197 152 518 671 153
TOTAL FOR 1946 1,041 818 959 88 51 381 79 27 18 14 4 59 153 18,548 257 3,805 227 32 176 459 44 3,49 77
TOTAL FOR 1947 1,025 745 1,969 84 67 283 59 5 11 4 8 31 64 20,160 271 4,605 1,083 24 216 121 14 1,315 49
ALACHUA 38,245 10 69 1 1 276 12 9 52 4 22 9 2
BAKER 6,326 9 8 2 47 3 23 13 3
BAY 53,200 5 17 18 3 1 2 1 639 5 1 3 7 7
BRADFORD 11,600 1 1 2 107 85 3
BREVARD 20,750 3 11 1 1 1 12 1 1 76 4 3 1
BROWARD 55,100 21 15 39 5 4 1 6 267 7 1 4 3 1 12
CALHOUN 8,230 10 440
CHARLOTTE 4,470 1 1
CITRUS 5,427 5
CLAY 11,600 3 6 1 5 53 2 53 3
COLLIER 4,957 1 15 1
COLUMBIA 17,250 4 1 1 54 3 68 55 24 1
DADE 336,300 530 189 553 3 54 9 6 3 24 3,757 41 19 56 7 38 4 5 278 5
DESOTO 6,854 4 1 1 51 3 43 1 1
DIXIE 4,926 1 3 2 1 14 1
DUVAL 302,200 1 171 355 11 3 40 17 1 1 2 12 3,737 49 129 2 2 40 6 28 6
ESCAMBIA 118,900 4 59 12 11 1 1 1,773 3 471 2 1 2 85 1
FLAGLER 2,652 3 5 54 34 1
FRANKLIN 8,900 2 10 2 49 1 3 2
GADSDEN 31,041 2 8 12 4 314 5 243 8 2 5 1 1
GILCHRIST 3,466 1 1 1 11 1 1
GLADES 2,281 5 1
GULF 7,040 2 2 98
HAMILTON 8,731 1 6 1 174 5
HARDEE 8,885 1 1 1 2 26 1
HENDRY 5,066 6 26 2
HERNANDO 5,700 1
HIGHLANDS 19,300 2 5 5 1 1 95 9 24 112 1
HILLSBOROUGH 220,100 272 38 195 11 1 49 1 1 3 8 7 2,774 41 71 214 13 56 5 7 88 15
HOLMES 14,627 1 2 1 10 159 2
INDIAN RIVER 9,130 2 2 10 4 1 3 34 18 1 1
JACKSON 34,5500 3 1 24 2 1I


-



to



a
2
.,a








TABLE II
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1947-AND STATE TOTALS FOR 1945 AND 1946 (Continued)




II ~ ~ ~ ~ 0: N E. i ogi
S~t PS~ @ N N r -^Sl; S S 3 p a '
COUNTIES 0 w z E.

EFEO1 0 N N o S N 0
5NoeN % N a E N z N u o j N M N i a s 3 3 zo N N W O N z o o
P4 rn No m 0 m 0 z z NN
0p C,; 0u0 0 0 0 0 u ~
TV'm.'PDQAtJ ----i-----------------------------,---------- -- --- -- ----


LAFAYETTE
LAKE
LEE
LEON
LEVY
LIBERTY
MADISON
MANATEE
MARION
MARTIN
MONROE
NASSAU
OKALOOSA
OKEECHOBEE
ORANGE
OSCEOLA
PALM BEACH
PASCO
PINELLAS
POLK
PUTNAM
ST. JOHNS
ST. LUCIE
SANTA ROSA
SARASOTA
SEMINOLE
SUMTER
SUWANEE
TAYLOR
UNION
VOLUSIA
WAKULLA
WALTON
WASHINGTON


,
3,995
28,300
26,300
37,100
9,902
3,193
15,537
27,100
36,900
6,094
21,200
10,900
17,65c
2,910
94,200
10,800
126,700
13,729
147,300
123,800
17,837
22,300
13,400
17,400
20,600
25,600
10,417
17,800
10,738
6,051
61,600
5,059
13,871
11.889


5
6 1
40
3
1
272 1
7 1
9 2
51
12 37
1
25
1
20
32 1
7
2
20 2
40
21


M

2 4
OC
2 9

t'



2I
1 l


rA
m

Fn











TABLE II
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1947--AND STATE TOTALS FOR 1945 AND 1946 (Continued)





COUNTIES Z 0 UP-

B RADsFOR 11945 5 1
m : o F. |Il .4 a Z Z | g n



TOTAL FOR 1945 3 5 329 43 16, 1,351 9 103 1 1
TOTAL FOR 194 1
ALACHUA 1 24 3 3 3 10 1 1 9 1 3 1 3
BAKER 22 1 2 34 143 3 1
BAY 22 1 1 3 284 73 3 1 12
BAY DORD54 18 4 7
BR ADRD 1 1 5 178 23 1 1 14
BREV1 1 2 1ARD61 2 3 2 44
BROWARD 30 1 2 6 1 2 10 1 518 61 2 39 2 46
CALHOUN 1 4 1 1
LAYC2 2U3 5 2 3 24 7 313 2 12


CHARLOTTE 3 1 1
CITRUS 1 33 30 1
CLAY 1 5 1 2 73 9 4 2 10
COLLIER 2 22 5
COLUMBIA 1 2 2 1 4 5 114 35 3 1
DADE 2 231 11 31 1 123 3 87 32 1,6 1 82 2 5 22 6 15 79
DESOTO 2 3 1 8 11
DIXIE 7 9
DUVAL 6 97 4 87 20 8 26 737 302,591 2 322 1 4 25 6 20 181
ESCAMBIA 4 1 7 2 1 68 2 5 2 22
FLAGLER 38 12
FRANKLIN 2 6 4 1 36 12 2
GADSDEN 14 3 5 309 2432 25 1
GILCHRIST 1 12 i 3 1
GLADES 23 5 1 1
GULF 3 73 11
HAMILTON 37 4 1
HARDER 1 6 1 1
HENDRY 47 1 1
HERNANDO 36 11
HIGHLANDS 4 11 2 141 21 3 1 33
HILLSBOROUGH 3 282 4 3 9 231 43 136 3 7 25 ,743 3 404 8 42 9 74 43 2
HOLMES 3 8 1 30 7 5 1
INDIAN RIVER 10 2 3 1 91 14 2 9 6
JACKSON 2 3 7______ 78 41 14








TABLE II
CASES OF REPORTABLE DISEASES. BY COUNTIES. FLORIDA. 1947- AND STATE TOTALS FOR 1945 AND 1946 (Continued)



0 w E .4 r z z "
COUNTIES S4 5 U



JEFFERSON 1 57 17 33 15 2 2 31
z pq PQ



LAFAYETTE 6 13 5 1
LAKE 8 29 1 2 12 1 1 332 40 3 5 3 37
LEE 180 20 3
LEON 19 5 4 4 5 1 748 1 90 1 1 2 5 2 5
LEVY 12 1 2 2 91 23 1 2 1 5
LIBERTY 15 7 1
MADISON 1 1 3 83 25 4 2 1
MANATEE 1 41 129 16 3 1
MARION 1 2 2 1 1 1 253 1 10
MARTIN 48 23 2
MONROE 1 1 1 50 41 1 17
NASSAU 2 59 1 2 1 1 57 33 11 1 2 4
OKALOOSA 1 2 1 7 60 21 3 10
OKEECHOBEE 24 1 1 11
ORANGE 2 71 2 4 11 16 12 81 269 2 8 1 2 237
OSCEOLA 11 1 1 4 58 37 5 3 1
PALM BEACH 13 1 2 37 1 1 15 1,067 1 81 1 3 2 1 10
PASCO 2 1 2 1 1 1 1 77 25 3 3
PINELLAS 19 1 2 1 4 1 4 9 31 447 221 5 18 11
POLK 2 4 3 34 9 6 4 9 1 667 1 185 6 13 3 6 61 2
PUTNAM 1 1 1 1 195 29 4
ST. JOHNS 11 2 12 108 36 1 5
ST. LUCIE 5 1 1 2 246 30 19
SANTA ROSA 3 2 5 3 16 31 10 1 1
SARASOTA 14 55 2 1 109 33 2 1 4 7
SEMINOLE 1 9 1 3 11 1 284 49 5 3
SUMTER 92 1 72 14 3
SUWANEE 193 21 7 5
TAYLOR 12 1 1 17 4 20
UNION 4 1 213 13
VOLUSIA 1 2 18 1 1 2 60 11 8 1 382 91 1 2 6 22
WAKULLA 2 1 22 4 1 21
WALTON 2 34 1 14
WASHINGTON 54 22 12 15







10 ANNUAL REPORT. 1947


VENEREAL DISEASE CONTROL

R. F. SONDAG, M.D.

With the development of penicillin for rapid venereal disease
treatment, we now have the means at our disposal to render
non-infectious virtually every case of syphilis and gonorrhea that
can be brought to treatment. With the discovery of streptomycin
as an effective antibiotic agent in the treatment of granuloma
inguinale, we likewise have at our disposal a therapeutic agent
which now renders this disease non-infectious and effects a cure
in a very short time. Modern science, therefore, has made it
possible to arrest syphilis in as few as ten days. This is import-
ant for the victim, but it means also that he or she can't spread
the disease to anyone else. THAT'S IMPORTANT TO SOCIETY.
A victim of gonorrhea can be cured in as few as four hours and
is also rendered non-infectious at the same time. Patients with
granuloma inguinale frequently have progressive lesions for many
years, but with streptomycin it is now possible to render them
non-infectious in five days' time and effect a permanent cure.
The Rapid Treatment Center at Melbourne is the chief bul-
wark in the venereal disease control program in Florida. Equally
important, though, are the case finding activities carried on by
private physicians and county health departments. There is
only one way people can catch venereal diseases-that is by inti-
mate contact with someone who has a venereal disease in an
infectious stage. Unless those who have a venereal disease are
rendered non-infectious immediately, venereal diseases will con-
tinue to spread.
The statistical tables covering the venereal disease control
program for 1947 follow:








PREVENTABLE DISEASES


FIGURE 1
TOTAL SYPHILIS S REPORTED


LI


53%








35%





1914


BY YEAfS


ALL OTHERS


EARLY LATENT



PRIMARY and SECONDARY


43%













195
1945


TABLE III-NUMBER OF SYPHILIS CASES REPORTED


S38%









2 h



1946 1947
BY STAGE OF INFEC-


TION SHOWING NUMBER AND PERCENT AS TO TREATMENT SOURCE
1947
TREATMENT SOURCE
Total
Stage of Syphilis Cases
StageReported R. T. C. CLINIC OTHER

Number Percent Number Percent Number Percent
Primary and Secondary 4,364 1,629 37. 863 20. 1,872 43.
Early Latent 6,041 2,113 35. 1,580 26. 2,348 39.
Lateand Late Latent 4,879 1,053 22. 872 18. 2,954 60.
Congenital 408 215 53. 104 25. 89 22.
TOTAL SYPHILIS* 16,653 5,010 30. 3,568 21. 8.075 49.
(Out of State Cases Excluded)
*-Includes Unknown Stage of Syphilis.


30-


25-




20-


15-


10-


///


28i







1943
















TABLE IV-ADMISSIONS AND READMISSIONS TO FLORIDA RAPID TREATMENT CENTER BY DISEASE. STAGE OF INFECTION, s
RACE AND SEX, BY MONTH* FOR 1947


DISEASE AND STAGE OF INFECTION
RACE AND SEX
ADMISSIONS READMISSIONS

SYPHILIS
White Colored
2 __________

MONTH OF 2 0
ADMISSION :|




January 239 396 01 49 37 3 905 10 25 19 66 1025 43 43 1068 102 99 431 436


July 207 331 102 41 33 21 735 4 16 6 34 795 795 54 65 289 387
August 176 420 77 ** 48 38 759 2 18 2 46 827 827 56 76 303 392
September 141 252 80 ** 29 38 540 14 4 44 602 1 1 603 50 55 213 285
October 207 196 79 18 3 533 5 14 40 592 1 593 50 48 194 301
November 184 115 57 16 3 415 3 13 1 23 455 2 1 458 34 35 164 225
DecembeJanuary 239 39 101 49 37 83 905 10 25 19 66 1025 4 43 106 102 4 1 166 195
February 233 309 78 8 23 60 711 4 14 8 52 789 19 1 20 809 59 63 364 323


TOTALJuly 207 331 102 41 33 21 35 4 16 6 34 795 52995 54 65 5597 447 4 2 2124 2544
August 176 420 77 1 48 38 759 2 18 2 46 827 827 56 76 303 392
September 141 252 80 29 38 540 14 4 44 602 1 1 603 50 55 213 285
October 207 196 79 18 33 533 5 14 40 592 1 1 593 50 48 194 301
November 184 115 57 16 43 415 3 13 1 23 455 2 1 3 458 34 35 164 225
December 242 94 47 11 18 412 2 11 19 444 444 42 41 166 195
TOTAL 1629 2113 621 98 215 334 5010 30 125 40 324 5529 65 3 68 5597 447 482 2124 2544
Percent 29.1 37.8 11.1 1.8 3.8 6.0 89.6 .5 2.2 .7 5.8 98.8 1.1 .1 1.2 100.0 8.0 8.6 37.9 45.5
*Ernest Hinds Center, Jacksonville, closed Feb. 28, 1947. Melbourne Center opened July 7, 1947
**Pregnancies counted in proper stage of syphilis starting August 1, 1947.


c:
r



0

tl









PREVENTABLE DISEASES 13


TABLE V-NUMBER OF PREVIOUSLY UNTREATED V. D. CASES
DIAGNOSED OR ADMITTED TO CLINICS, 1947

Primary Other Total
Period and Early Congenital Other Total Gonorrhea Venereal Venereal
Secondary Latent Syphilis Syphilis Diseases Diseases
TOTAL 2,330 3,754 283 1,455 7,642 18,600 879 27,121
Jan.-Mar. 684 1,068 82 437 2,271 4,451 242 6,964
Apr.-June 556 929 62 348 1,895 4,835 223 6,953
July-Sept. 612 846 99 389 1,946 5,035 260 7,241
Oct.-Dec. 478 731 40 281 1,530 4,279 154 5,963






TABLE VI-NUMBER OF CONTACTS OBTAINED BY
CLINICAL PERSONNEL INTERVIEWING KNOWN CASES OF V. D., 1947

Primary Other Total
Period and Early Congenital Other Total Gonorrhea Venereal Venereal
Secondary Latent Syphilis Syphilis Diseases Diseases
TOTAL 2,128 2,236 151 840 5,355 12,335 303 17,993
Jan.-Mar. 592 701 71 329 1,693 3,147 96 4,936
Apr.-June 598 529 46 183 1,356 3,549 96 5,001
July-Sept. 480 516 26 174 1,196 3,189 54 4,439
Oct.-Dee. 458 490 8 154 1,110 2,450 57 3,017






TABLE VII-NUMBER OF PERSONS BROUGHT TO TREATMENT
AS A RESULT OF EPIDEMIOLOGIC INVESTIGATIONS, 1947

Primary Other Total
Period and Early Congenital Other Total Gonorrhea Venereal Venereal
Secondary Latent Syphilis Syphilis Diseases Diseases
TOTAL 986 2,133 153 945 4,217 4,798 125 9,140
Jan.-Mar. 323 718 62 309 1,412 1,331 40 2,783
Apr.-June 251 622 41 272 1,086 1,300 41 2,427
July-Sept. 229 445 24 200 898 1,205 27 2,130
Oct.-Dec. 183 448 26 164 821 962 17 1.800




















TABLE VIII-DISTRIBUTION OF V. D. DRUGS AS TO RECIPIENT AND KIND FOR 1945 1947

PRIVATE PHYSICIANS CLINICS, HOSPITALS, R. T. C. TOTAL DISTRIBUTED
DRUGS AND OTHERS
1945 1946 1947 1945 1946 1947 1945 1946 1947
Mapharsen (In doses) 13,080 14,688 3,265 234,680 68,205 72,798 247,760 82,893 76,063
Neoarsphenamine (In doses) 1,340 1,012 10 2,165 2,104 547 3,505 3,116 557
Sulpharsphenamine (In doses) 5 55 1,045 541 24 1,050 596 24
Tryparsamide (In doses) 380 204 70 4,780 2,094 340 5,160 2,298 410
Bismuth(In c's) 14,040 17,240 3,960 264,790 139,480 75,670 278,830 156,720 79,630
Sulphathiazole (In grams) 1,000 7,500 6,500 199,190 201,452 223,000 200,190 208,952 229,500
Distilled Water (In ec's) 144,300 103,000 27,900 2,783,200 1,432,600 599,700 2,927,500 1,535,600 627,600
Tartar Emetic (In c's) 125 125 145 3.580 4,595 3,540 3,705 4,720 3,685
*Penicillin(100,000 unit vial) 747 1,184 20 107,862 82,954 11,819 108,609 84,138 11,839
Penicillin (200,000 unit vials) 269 103 9,693 9,344 9,962 9,447
Penicillin (500,000 unit vials) 3,110 3,110
Penicillin in Oil (3,000,000 unit vials) ___41 110 __ 1,235 8,501 1,276 8,611


1945 Totaled
*Penicillin Distributed-1946 Totaled
1947 Totaled


10,860,900,000 Oxford Units
15,789,200,000 Oxford Units
28,906,300,000 Oxford Units








TABLE IX
TOTAL NUMBER OF SYPHILIS CASES REPORTED BY STAGE OF INFECTION, PREGNANCY STATUS, RACE AND SEX, SOURCE OF
REFERENCE, AGE GROUPS, AND THE NUMBER AND PERCENTAGE OF CASES REFERRED TO THE RAPID TREATMENT CENTER,
BY COUNTIES, FLORIDA, 1947


STAGE OF INFECTION RACE AND SEX Source of Ref. AGE GROUP Cases Re-
_ferred to
Late White Colored Rapid
COUNTY -- Treatment
S 3 | Center
S' ^ t


Aac u 54 O3 10 088 2
Baer 8 2 13 7 1
Bay 30 37 139 51 10
Bradford 9 14 14 8 1 1
Brevard 12 44 53 49 2 6
Broward 48 45 250 144 7
Calhoun 4 4 13 14 3
Charlotte 3 3 4 1 1
Citrus 1 1 6 17 2
Clay 5 14 35 12 1 1
Collier 1 6 2 10 1
Columbia 9 10 40 42 2
Dade 327 203 565 477 9 18
DeSoto 8 19 17 29
Dixie 2 4
Duval 253 568 900 619 3 33
Escambia 45 119 323 132 2 11
Flagler 5 4 33 11 1
Franklin 1 2 16 14
Gadsden 47 36 111 25
Gilchrist 2 7 1
Glades 1 3 10 9
Gulf 8 3 34 25
Hamilton 1 6 18 11
Hardee 1 7 5
Hendry 1 2 21 22 1
Hernando 1 5 12 16
Highlands 20 12 50 48 1 1
Hillsborough 219 322 389 570 17 45
Holmes 9 5 11 2 1
Indian River 5 7 41 27
Jackson 6 6 25 35 2
Jefferson 4 3 9 7 2
Lafayette 1 1 5 4
Lake 19 30 170 80 7
Lee 17 32 44 69 2


2 4
4 1
1 1
7 4
17 82
5 2
1
38 174
13 1
3
5
2
2

2 1
1

16
3 6
39 142
2
11
4
2 6
2
14 12
7 9


350 33 18
34 5 5
284 11 25
54 4 7
178 11 17
518 44 39
41 5 3
12 3
33 3 5
73 5
22 1 3
114 13 7
1,698 57 283
80 5 2
7
2,588 127 253
646 27 56
57 2
38 3
221 33 2
12 1 1
23 1
73 7 3
37 2 3
15 1 3
47 3 2
3G 1 6
141 11 14
1,743 61 287
30 1 8
91 3 10
78 4 9
33 2
13 3 2
332 17 19
180 21 19


19 3
123 14
27 2
93 3
260 17
23
4 2
12 6
33
8 2
52 1
627 26
37
4 1
1,177 111
302 5
20 1
15 4
132 4
86
12
39 1
20 3
6
23 4
18
55 8
691 8
2
31 6
28 20
15 2
6
166 5
79 9


249 101
aly lul
15 19

47 7
55 123
235 283
39 2
5 7
4 29
55 18
4 18
53 61
848 850
21 59
3 4
1,106 1,572
493 153
38 21
22 16
126 95
5 7
16 7
26 47
27 10
10 5
9 38
5 31
41 100
711 1,032
22 8
26 65
61 17
26 7
4 9
132 200
71 109


23
38'
52'
91'
47'
25'
117'
50'
45'
60'
36'
32'
29' .'
46' -
57' M
22- <
42- M'
82' "
21' -1
43' M
58' t
30' t
22' M
73'
40' 0
36'
22' t
34' V
231 r
30
58' n
41'
58'
62'
26'
268
26


, l


,












TABLE IX
TOTAL NUMBER OF SYPHILIS CASES REPORTED BY STAGE OF INFECTION, PREGNANCY STATUS, RACE AND SEX, SOURCE OF
REFERENCE, AGE GROUPS, AND THE NUMBER AND PERCENTAGE OF CASES REFERRED TO THE RAPID TREATMENT CENTER,
BY COUNTIES, FLORIDA, 1947 (Continued)


STAGE OF INFECTION RACE AND SEX Source of Ref. AGE GROUP Cases Re-
ferred to
Late White Colored T Rapid
a__ ______ .- Treatment
COUNTY ? Center
U Q 3 E z 0 2
-.4 Center

S l ^ B B g d 0 1* 0

Leon 61 235 227 110 2 15 98 748 13 55 24 215 186 268 247 501 7 81 184 104 66 34 272 81 11.
Levy 7 15 40 24 3 2 91 9 3 6 30 49 3 51 40 3 22 28 20 7 5 6 4752.
Liberty 1 5 4 3 1 1 15 3 2 6 4 1 2 6 4 1 2 19127
Madison 10 16 27 25 3 2 83 15 6 4 20 52 1 53 30 17 37 22 1 6 4352
Manatee 18 16 59 31 1 4 129 5 1 5 42 78 3 112 17 2 28 56 1 10 13 2 84 65.
Marion 6 57 104 59 2 5 15 5 253 16 15 13 84 134 7 148 105 5 53 87 41 25 29 13 115 45.
Martin 3 10 22 9 2 2 48 1 4 2 11 28 3 2 23 9 11 13 8 5 2 2654.
Monroe 3 6 14 23 1 3 50 1 5 14 12 12 7 31 19 4 20 8 9 5 4 17 34
Nassau 4 15 22 12 1 1 2 57 8 8 6 14 28 1 27 30 11 19 13 4 4 6 24 42.
Okaloosa 15 14 18 9 2 2 60 7 10 18 15 14 3 35 25 8 26 11 3 6 6 25 42.
Okeechobee 3 2 14 4 1 24 2 2 2 7 13 1 23 4 11 2 3 3 1 9 38.
Orange 64 70 323 247 6 13 87 810 24 84 81 215 331 99 174 636 6 74 277 221 116 78 38 177 22.
Osceola 2 7 21 23 3 1 1 58 4 5 9 17 25 2 25 33 1 12 17 15 3 8 2 37 64.
Palm Beach 103 111 433 313 6 25 35 41 1,067 46 74 77 360 536 20 533 534 4 167 393 228 152 86 37 446 42.
Pasco 10 13 22 25 1 3 3 77 7 9 15 16 33 4 18 59 1 14 24 16 11 7 4 2431.
Pinellas 65 79 176 98 3 8 16 2 447 37 51 50 123 197 26 230 217 4 94 165 77 42 36 29 150 34.
Polk 71 97 218 155 1 18 17 90 667 38 89 68 197 278 35 208 459 7 114 228 125 71 69 53 208 31.
Putnam 12 17 70 85 1 6 4 195 22 15 21 46 111 2 55 140 1 34 81 31 25 18 5 46 24.
St.Johns 6 17 52 24 1 8 108 13 5 7 40 49 7 54 54 19 49 18 10 3 39 36.
St.Lucie 33 24 69 54 1 12 53 246 15 9 8 91 127 11 130 116 3 46 115 3 22 8 9 7932.
Santa Rosa 1 1 6 5 2 1 16 2 4 6 3 3 14 2 3 3 6 3 1 7 44.
Sarasota 16 15 30 28 3 4 13 109 5 17 7 46 36 3 54 55 15 43 23 13 12 3 41 38.
Seminole 9 25 103 132 3 9 3 284 15 12 13 104 150 5 105 179 3 46 85 50 28 20 52 6824.
Sumter 9 3 30 28 2 72 6 11 3 21 25 12 17 55 3 32 15 12 2 16 22.
Suwanee 38 15 127 6 1 3 3 193 5 9 9 82 89 4 24 169 1 38 66 15 25 6 42 33 17.
Taylor 2 8 3 3 1 1 18 2 1 3 11 3 9 9 6 3 6 2 1 422.
Union 3 6 11 4 24 1 3 6 15 22 2 4 12 5 2 1 1667.
Volusia 35 34 136 136 2 7 23 9 382 26 36 34 121 1 8 18 173 209 13 54 125 91 34 34 31 111 29.
Wakulla 4 10 5 1 2 22 2 1 4 4 10 3 9 13 6 5 7 1 3 11 50.
Walton 2 4 17 5 1 5 34 4 5 7 6 13 3 25 9 1 20 9 1 2 1 10 29.
Washington 9 7 28 7 1 2 54 8 10 8 9 25 2 40 14 2 12 20 13 2 2 3 25 46.
State Hospital 2 7 27 52 88 13 14 28 20 13 88 1 7 21 24 35
State Prison 1 1 68 119 189 1 48 2 125 14 189 18 63 61 29 17 1
Naval Air Station 3 3 2 1 3 3
Out of State 8 12 29 24 2 25 100 2 40 18 21 15 6 35 65 11 33 18 8 22 8
TOTALS 1,8172,5676,0704,543 56 304 410 98616,753 8781,787 1,790 5.079 7,245 852 7,688 9.065 177 2.383 5,998 3,392 2,077 1,474 1,252 5010 30.


0
:4













PREVENTABLE DISEASES 17


TYPHUS FEVER STUDIES

E. R. RICKARD, M.D.

During the year the State-wide survey of typhus fever in
Florida begun in 1946 was completed. A detailed report of the
results of this survey was furnished to State and local health
officers and sanitarians who were directly concerned with the
control of typhus fever and a condensed edition of the report was
presented at the annual meeting of the American Public Health
Association. The survey which covered cases occurring in 1944,
1945 and 1946 demonstrated that typhus had been approximately
two and one half times as prevalent throughout the State during
this period as indicated by the numbers of previously reported
cases. Homes rather than places of business were found to have
been the most common sources of infection. The disease was
found to occur with about equal frequency in urban and rural
regions. An epidemic recession was noted in the greater part
of the State irrespective of whether control measures had been
applied, although in two counties where these measures had been
extensively carried out, the recession appeared to have been
more marked than in the rest of the State.
The study of dosages of murine typhus vaccine in human
beings done in cooperation with the International Health Divi-
sion Laboratory was completed. A report upon the results of
these experiments is being prepared by one of the staff of the
Laboratory.
In July a new staff member, Doctor C. Brooke Worth, was
assigned to the project and the scope of the investigations was
widened to more detailed studies of all phases of the disease in
a limited area. Hillsborough County was chosen as the area for
study. From July through September a survey of the common
native mammals was carried out. A collection of museum skins
was prepared, and habitats occupied by the various species were
determined. In October, investigation of the disease in the ani-
mal and arthropod hosts was begun in representative areas in
the county. Commensal and wild rats, other small mammals and
birds have been trapped alive. The animals have been routinely
bled for complement fixation tests to determine the incidence of
past infection. Samples of their ectoparasites have been taken
for identification which has been done by the Bureau of Ento-
mology of the Florida State Board of Health. The animals have
been marked for subsequent identification and released with the







18 ANNUAL REPORT, 1947


objectives of not disturbing the natural equilibrium and of sub-
sequently being able to estimate the time at which any individual
became infected. The results of these investigations for the
period October 15th to December 31st, 1947, are summarized in
the following table.

COMPLEMENT FIXATION RESULTS OF THE EXAMINATIONS OF ANIMALS
TRAPPED AND BLED, OCTOBER 15th TO DECEMBER 31st, 1947.

Number Number Number Percent Positive
Species Trapped Bled Positive Sera
Norway rat 45 44 4 9.1
Roof rat 123 83 15 18.1
Cotton rat 94 70 15 21.4"
Rice rat 14 12 0 0
Opossum 1 1 0 0
Burrowing owl 5 3 0 0
* The apparently higher incidence of positive sera in cotton rats is offset by
the fact that most of these were positive only in very low dilutions and may
represent non-specific reactions.

Although the percentage of positive serum examinations has
been low, it should be noted that the survey of human typhus
has indicated that the disease is now in an epidemic recession.
Likewise, these examinations were begun in the season of the
year when typhus is known to begin to decline.
Serum specimens were obtained from 459 persons who had
had typhus or had been suspected of having had the disease and
whose cases had been investigated during the course of the recent
survey. These specimens were obtained with the objectives of
determining the accuracy of the complement fixation test as an
indicator of past infection and as an additional check upon the
true prevalence of the disease as indicated by the survey. The
examination of these sera was completed by the end of the year.
Although results have not been completely tabulated, preliminary
analysis has suggested that the complement fixation test indi-
cates past infection in approximately 85 to 90 percent of the
cases up to a period of three years after illness. The performance
of these tests also served the purpose of training personnel in
serological procedures useful in the study of typhus in human,
mammalian and arthropod hosts.







PREVENTABLE DISEASES 19


DIVISION OF INDUSTRIAL HYGIENE

JOHN M. McDONALD, M.D.

The Division of Industrial Hygiene, which was created in 1946
has now completed its first full year of operation. Its program
was as follows:
1. A survey of industrial plants which had not been visited in
the U. S. Public Health Service survey of 1946, in order to discover
potential hazards to employees' health; and to inform industrial
management of the services available through the Division.
2. The organization of the analytical laboratory.
3. Response to all requests for services from industry and to
requests for talks to organized groups.
4. Planned studies of:
a. The naval stores industry.
b. Lead exposures.
c. The phosphate mining industry.
d. The commencement of a citrus dermatitis investigation.
5. Investigation of occupational disease claims.
6. Integration of the industrial hygiene program with the
Workmen's Compensation Division of the Florida Industrial Com-
mission.
7. Close cooperation with other health services in the State
Board of Health, other state agencies, and with the medical pro-
fession.
8. Instruction of division personnel by attendance at meetings
and lecture courses.
9. Technical study to enable director and engineer to pass
their State Board examinations.
Progress under the above program is summarized as follows:
1. In all, 303 visits were made to 239 plants employing 24,731
people. This includes 30 visits to 25 plants to make technical
studies of potential health hazards. Improvements recommended
were 128 in number.
2. The analytical laboratory made 560 examinations on the
127 samples submitted. Among these were the first blood and
urine lead level determinations to be made available in the State
of Florida.







20 ANNUAL REPORT. 1947


3. Requests for services totalled 33. Examples concerned
lead exposures in storage battery plants, carbon monoxide ex-
posures in trucks carrying passengers, and working conditions in
a textile plant. Among the 13 complaints investigated was one to
determine the severity of atmospheric pollution arising from the
operation of a non-ferrous metal plant alleged to be producing
toxic fumes. Another concerned the source of sulfur bearing
gases said to arise from a phosphate plant.
4. The investigation of the naval stores industry covered 8
plants. One new potential hazard disclosed was the presence of
acid fumes caused by the use of sulfuric acid sprays to increase
the flow of gum. Technical lead studies were done in 3 smelters
and 4 storage battery plants. In one of the latter, regular pre-
employment and periodical physical examinations were instituted
and satisfactory progress is being made in the improvement of
working environment. Industrial hygiene surveys were made of
3 phosphate mines. Numerous samples of rock and dust were
collected and analyzed in the chemical laboratory. Following the
investigation of citrus dermatitis begun by Dr. D. J. Birmingham
of the U. S. Public Health Service in January, followup investi-
gation was initiated to be continued next year.
5. During the year, 51 occupational disease claims were in-
vestigated, and several interesting leads for future study were
uncovered.
6. Consultation to the Workmen's Compensation Division of
the Florida Industrial Commission included:
a. Field instruction of Commission Inspectors.
b. Attendance at hearings on proposed regulations for the
control and prevention of occupational diseases.
c. Revision and amplification of the above mentioned reg-
ulations. This included a complete re-writing of the
Code as proposed, together with the addition of lists of
respiratory protective equipment, lighting requirements,
and regulations for work under compressed air.
d. Conference with inspectors of the Commission.
e. Address at the Florida Industrial Commission Confer-
ence at Miami Beach.
7. Whenever necessary, industrial management was advised
of the health services available in County Health Units, such as
chest x-rays. In all questions of sanitation and in-plant feeding
establishments, management was referred to the local health
unit.








PREVENTABLE DISEASES 21

8. The engineer attended a ten weeks' course on industrial
hygiene at the Georgia School of Technology, as well as other
technical meetings. The director attended several technical and
association meetings, and gave 8 talks on various aspects of in-
dustrial hygiene.
9. Both the director and the engineer tried and passed their
State Board examinations.
Some idea of the magnitude and diversity of the problems
confronting the division may be obtained from a study of the
following table of occupational disease claims for the current
year. (See Table X.)

TABLE X
OCCUPATIONAL DISEASE CLAIMS. 1947
TOTAL .... ..- -.....--- -- -------------.... 1241
Conjunctivitis --.......------- 225
Welders .. ----- -------------------------------. 209
Chemical ------- 16
Infections ...........--- ---------------------- -------- 46
Repeated Motion, Pressure & Shock --.....--- ....-.---. 28
Heat _-- --------------- ---- 35
Respiratory Irritations .-- ...-.....-.... .----- .......--- ....--- 31
Gas ----- -- 8
Carbon Tetrachloride ...... .------------------.....-------------------- 1
Metals --------------------------------------- 7
Lead ..-.. ..------------------....-------- 3
Zinc ...------- -.......-.... ------- -------.-.- --- 3
Other --. -------------- ---- 1
Silicosis -..... -- -- ----......-------------------- ------------ --------------.... 1
Dermatitis .----- -----------------_ -__------- 859
Alkali --... ------------------------------------- 197
Solvent and Oil .------------.... -----....--___----_ 100
Other Chemicals -..- .. ............. 118
Fruit .----..--.. .....--.......... .----- ---- 120
Plant __ ....------- --31
Larva Migrans ...---- --------------- 116
Fungus -............-..--.-..... ----------------. 90
Other ---------- -- 1







22 ANNUAL REPORT. 1947


CANCER CONTROL
R. F. SONDAG, M.D.
I. B. HALL, M.D.
Prior to 1947 initial steps were taken to develop a cancer
control program with the aid of federal funds. The first phases
consisted chiefly of liaison activities with the American Cancer
Society, Florida Division, the Cancer Control Committee of the
Florida Medical Association, the Florida Radiological Society,
the Florida Pathological Society and various other medical
groups.
The first step in the development of a well rounded cancer
control program was the development of a state-wide tissue
diagnostic mailing service. This service was developed by the
Bureaus of Preventable Diseases and Laboratories in cooperation
with the Florida clinical pathologists. All of the Florida patho-
logists agreed to cooperate and have done so since the inaugura-
tion of the plan in March 1947. The plan provided that the biopsy
would be sent directly to the pathologist of the physician's choice.
After examination of the tissue the pathologist's report is re-
turned directly to the physician. The State Board of Health pays
a flat fee of $5.00 for all appropriate specimens from individuals
certified as medically indigent.
During the ten months in which the service has been offered,
302 specimens have been examined under the plan. The sites
from which the biopsies were taken were chiefly the cervix, skin,
and exposed mucous membranes. A limited number were re-
moved at operation from internal tumor masses.
The pathological diagnosis indicated malignancy in 118 (39
per cent). An additional 32 (11 per cent) were non-malignant
neoplasms. The remaining 152 (50 per cent) were chiefly due to
various inflammatory lesions. The predominating malignant
tumors diagnosed were basal cell carcinoma and carcinoma of
cervix.
The patients from whom the specimens were removed were
as follows:
White Male .---------- -_----. __ 54
White Female ---------- ------- 164
Colored Male ---- _- 22
Colored Female _.._______ .. 55
No data as to sex or color -- ------ 7


Total







PREVENTABLE DISEASES 23
The males of both colors were chiefly in the older age brack-
ets. The age peak for white females was 30 to 39 years and for
colored females 40 to 49 years.
The individuals served resided in 50 of Florida's counties.
Polk and Monroe use the service more freely than other areas.
Considering population there was limited demand from the urban
centers with hospital facilities available for the indigent.
Since there was no state law on cancer control nor a state
appropriation, the Bureau of Preventable Diseases, in cooperation
with the American Cancer Society, Florida Division, drew up a
cancer control bill for presentation to the State Legislature in
April. The Legislature passed this bill and it became a law
without the Governors signature on June 16, 1947. The title of
the bill was as follows:

"AN ACT TO PROMOTE THE PREVENTION AND CURE
OF CANCER: TO AUTHORIZE THE FLORIDA STATE
BOARD OF HEALTH TO ESTABLISH A STANDARD
FOR THE ORGANIZATION, EQUIPMENT, AND CONDUCT
OF CANCER UNITS OR DEPARTMENTS IN HOSPITALS
OR IN CLINICS IN THIS STATE: TO CONDUCT AN
EDUCATIONAL CAMPAIGN FOR THE CONTROL OF
CANCER: TO PROVIDE A PLAN FOR THE CARE AND
TREATMENT OF INDIGENT PERSONS SUFFERING
FROM CANCER."

The State Legislature provided an appropriation of $200,000
per year for cancer control activities. These funds were incor-
porated in the State Board of Health general appropriation and
are especially earmarked for the cancer control program. The
funds under the state appropriation were made available with
the beginning of the fiscal year July 1, 1947. In addition, the
sum of $40,000 was received from the U. S. Public Health Service
for the cancer control program.
With federal and state funds available, the plans which here-
tofore remained in a discussion stage were now placed into
effect. The cancer control program was then able to render
service to medically indigent cancer patients, and the procedure
for handling such patients was developed. Tentative rules and
regulations, fee schedules, and forms were developed and adopted
by the Board on September 20, 1947. At this meeting the Board
also created a Division of Cancer Control and Dr. J. B. Hall was
appointed as director. The tentative rules and regulations, pro-
cedure for handling cancer patients, and fee schedules were
incorporated in a cancer manual and became effective November
1, 1947. The regulations state:







24 ANNUAL REPORT, 1947


Cancer clinics were visualized and are in the process of being
established in the following counties: Duval, Dade, Escambia,
Orange, Hillsborough, and Palm Beach. These counties make
up most of the urban population in the state and it was deemed
advisable to have general diagnostic and treatment facilities in
these areas. These cancer clinics must make their services avail-
able to the surrounding counties if they expect to receive finan-
cial assistance under the state aid program.
Much needed equipment was purchased for those clinics which
were established and in most counties where cancer clinics are
to be established equipment will be supplied and funds provided
for full time personnel to carry on the activities of the clinic.
The greatest handicap met thus far in establishing cancer clinics
has been lack of space. Once the cancer clinics are established
and the minimum standards met, Florida will have one of the
best cancer programs in the nation. In addition to the diagnostic
and treatment centers, information and detection centers are
operating in Alachua and Volusia Counties.
The cancer program has had a slow start because of the
multitudinous problems connected with a medical care program.
This included working out arrangements with local health de-
partments, city and county hospitals and their medical staffs,
the medical specialists, and the medical profession in general.
The cooperation on the part of all has been excellent. Since
inaugurating the program a total of 196 cases of cancer have been
approved for state aid. Of this number treated for cancer, only
three have died. The location of cancer in the patients approved
for state aid was as follows:

MALES FEMALES
Gastrointestinal __--.. 7 8
Genitourinary --_. 21 8
Breast .------ 31
Uterus Cervix __ 56
Lung ----__ ----- 2 1
Bone -. -... 4
Skin ----.... -----..----... 34 23
Brain Tumor __....-. __ 1

70 126

Total ------- ------------------ 196







PREVENTABLE DISEASES 25


Of the total number approved for state aid the following types
of services were rendered:

Major and minor operations .. 52
Hospitalization ._ 39
X-ray and radium therapy .----- ---- 144

The average amount spent per case was $84.22; however
additional expenditures for radium, x-ray therapy, and hospitali-
zation can be anticipated on many of these cases.
Cancer reporting improved during 1947, but the number of
deaths occurring from cancer more than doubled the number
of cases reported. During the year there were 1,025 cases report-
ed as a disease, and 2,643 deaths. It is evident that much remains
to be done to reduce this appalling death rate and focus more
attention on the early diagnosis and treatment of those lesions
which later develop into cancer.
During 1947 the cancer program had a good beginning, but
most of the cases approved for state aid were patients with well
developed cases. Our efforts in the future will be toward early
diagnosis of cancer, and with effective lay and professional edu-
cation, the death rate from cancer should be considerably reduced.
"Most of the federal and state funds available for the control
of cancer and other malignant tumors will be expended in the
various counties of the state under the direction of the county
health departments, but under the rules and regulations pre-
scribed by the State Board of Health. Counties not having health
departments will have a lump sum reserved at the State Board
of Health for use in these counties; such funds to be expended
directly under the supervision of the Bureau of Preventable
Diseases."
The working principles of the cancer control program are as
follows:

1. The patient must be a resident of Florida one (1) year
immediately subsequent to the date of application.
2. Patient must be medically indigent and certified either by
the local welfare board and/or the county health officer.
3. No funds are available for out of state treatment.
4. No money is to be expended on terminal cases.
5. Fees will be paid as outlined in the manual for hospitaliza-
tion, radium therapy, surgery, etc.
6. These funds cannot be used to replace or substitute for
local funds appropriated for indigent medical care.







26 ANNUAL REPORT. 1947


Since it was evident that the proper treatment of cancer re-
quired certain basic equipment and that cancer patients should
preferably be treated where they would be given the advantage
of the best possible diagnostic and treatment facilities, the next
step in the program was the development of adequate cancer
diagnostic and treatment facilities. The Board passed a regu-
lation specifying a certain deadline after which all state and
federal cancer control funds would be expended only on indi-
gent patients who had been routed through an approved clinic
meeting the minimum standards of the State Board of Health.



FIGURE 2


,CA ,C ER
MDIMET CASE APPOVED FMT STATIAtID DU=O 19 67
70 -
TOML 196 I

I0-I



S50I






60-


20I
I0I



.oN- I WAI
b0- I I-m m







PREVENTABLE DISEASES 27
SUPPLY SECTION
During March a Supply Section was created jointly by the
Bureaus of Preventable Diseases, Laboratories, and Local Health
Service. All the forms, drugs, biologicals, laboratory containers,
and other supplies were placed under the supervision of this
section.
With the creation of a Supply Section, and the services of a
-'full time employee, it was possible to render better service to the
county health units and hospitals requesting drugs and supplies,
and it was possible to keep better records of the drugs and
biologicals distributed.
The amount of drugs and biologicals distributed by month
and for the year is shown on the following table.
TABLE XI-DRUGS AND BIOLOGICALS DISTRIBUTED, 1947
Average per Month Annual Total
Bismuth, 30cc .__......._- 58 699
Bismuth, 60cc __ _____- 38 463
Bismuth, 500cc ---------- ----- -- .. 13 152
Crystoids --------------- --------------------- 494 5,931
Diphtheria Anti-toxin, 10,000 Units .._-- 152 1,828
Diphtheria Anti-toxin, 20,000 Units 35 420
Diphtheria Tetanus Combined, 2cc -...--------. 40 482
Diphtheria Tetanus Combined, 30cc_ ...... 115 1,386
Diphtheria Toxoid, 10cc ....---------.._ ------ 166 1,994
Diphtheria Pertussis Vaccine, Sauer, 6cc .. 14 173
Diphtheria Pertussis Vaccine, Sauer, 24cc 44 539
Diphtheria Pertussis Tetanus Combined, 10cc 670 8,036
Immune Serum Globulin ---..........-.--. -..--....-- 146 1,759
Insulin, Globin, 10-U-40 --..--.......... ..------------. 44 530
Insulin, Globin, 10-U-80 -- 61 743
Insulin, Plain, 10-U-20 -....--...... ............. 48 580
Insulin, Plain, 10-U-40 --- --.........-...- ..- .... 298 3,579
Insulin, Plain, 10-U-80 ------.-... ---------... 69 835
Insulin, Protamine Zinc, 10-U-40 ----...-----..... 547 6,567
Insulin, Protamine Zinc, 10-U-80 ..---------...- 292 3,504
Mapharsen, .04 ----.... ----.--- .-----------------.... 42 509
Mapharsen, .06, Cloarsine .067 --__-- 1,201 14,419
Mapharsen, 0.6, Cloarsine 0.67 316 3,795
Penicillin, 100,000 Units ----------.- 120 1,451
Penicillin, 200,000 Units --_..------- 366 4,400
Penicillin, 300,000 Units (P.O.B.) 579 6,955
Pertussis, Upjohn, 5cc --------------- ... 41 494
Pertussis, Upjohn, 20cc -- --..----..--- ...._.... 109 1,316
Pertussis, Sauer, 24cc ---.........--- ....-- 53 636
P.P.D. Tuberculin, 1st Strength (Pkgs. of 10) 48 584
P.P.D. Tuberculin, 2nd Strength (Pkgs. of 10) 46 552
Rabies Vaccine (per 14 dose series) .---------..... 1 8 1,422
Schick Test ----..................--.......--..- ......----- 88 1,058
Silver Nitrate (Pkgs. of 2 each) ....... 1,427 17,127
Sulfathiazole Tablets (Bottles of 1,000 each) 36 434
Tuberculosis Patch Tests -----......-...--......... .... 1,616 19,397
Tarter Emetic ..............--------... 52 628
Tetanus Anti-toxin, 1500 Units __ 99 1,190
Tetanus, Anti-toxin, 10,000 Units _--------- 39 475
Tetanus Toxoid, 1ce .....----..--.-----.---.----- ..... 33 400
Tetanus Toxoid, 30cc --...---.----- ..------- ---......... 169 2,034
Tetrachlorethylene, 8mm, 5cc ---...__~.._......... 1,216 14,598
Tetrachlorethylene, 16mm, Ic .----------.. ------... 876 10,515
Typhoid Paratyphoid Combined Vaccine, 20cc 1,715 20,584
Vaccine Points (Pkgs. of 10 each) ........--..---.. 1,191 14,299
Water, distilled, 10cc Bottles ..- ... 454 5,455









BUREAU OF
TUBERCULOSIS CONTROL

C. M. SHARP, M.D., Director

During the year 1947, the general activities of the Bureau of
Tuberculosis Control have shown a marked increase over those
of 1946. Statistical summaries have been prepared showing vari-
ations between 1946 and 1947 in various graphs and tables which
follow.
DEATH RATES
The death rate from tuberculosis showed an increase over
1946. During the year 1946 there were 685 deaths from tuber-
culosis with a death rate of 29.3 per 100,000 population which
was the lowest rate that has ever been recorded for the State of
Florida. During the year 1947 the number of deaths increased
to 760 with a death rate of 31.6 per 100,000. As usual the death
rate among the Negroes was much higher than among the white
population, in spite of the fact that the morbidity among the
Negroes apparently shows very little variation when compared to
the white population. Table XII and Fig. 3 show the tuberculosis
mortality rate by race from the year 1917 through 1947, and it
might be noted that this is the first year since 1940 that there has
been an increase in the death rate.
An explanation for the increase in the death rate could
possibly be that due to an intensified case finding program,
many advanced cases were found during the preceding year,
which probably would not have been diagnosed as having tuber-
culosis. As many as 481 cases were first reported during 1946
who were in the far advanced stage of the disease and an addi-
tional 347 cases in the moderately advanced stage of the disease.
It is safe to assume that during 1948 the rate will continue to
decline since there are proportionately fewer cases reported in
the advanced stage and more cases reported in the early stage
with a better chance for recovery.
REPORTED CASES
During 1947 there were 4,335 cases of tuberculosis reported in
the State of Florida against 2,437 cases reported in 1946. In Fig.
4 we have attempted to analyze the sources of reporting cases for
the calendar year 1947 as compared with the sources of reporting
cases for 1946., It reveals, many ,striking features, .Whereas in
1946, of all cases reported 29.4% were first reported by health
[ 29 ]









30 ANNUAL REPORT. 1947


TABLE XII
RECORDED DEATHS FROM TUBERCULOSIS (All Forms) AND DEATH RATES
PER 100,000 POPULATION. BY COLOR. FLORIDA, 1917- 1947


TOTAL WHITE COLORED
YEAR
Deaths Rate Deaths Rate Deaths Rate
1947 760 31.6 371 20.2 389 68.0
1946 687 29.4 333 18.8 354 62.7
1945 701 30.9 340 19.9 361 64.9
1944 791 36.0 369 23.1 422 70.8
1943 834 39.2 363 22.9 471 87.1
1942 859 41.8 360 23.6 499 93.6
1941 916 40.1 362 24.8 554 105.5
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 53.9 387 32.3 518 108.2
1935 903 55.7 397 34.5 506 107.9
1934 953 60.1 381 33.9 572 123.9
1933 1,039 66.9 398 36.1 641 142.1
1932 1,093 71.5 395 36.5 698 156.2
1931 1,067 70.8 427 40.1 640 $44.8
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 92.3 519 58.3 668 169.0
1925 999 80.8 426 50.0 573 148.7
1924 1,054 88.7 437 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 1,084 115.9 494 81.2 590 180.4
1917 1,085 118.8 472 80.3 613 188.7



FIGURE 3
TUBERCULOSIS DEATH RATES, BY COLOR. FLORIDA. 1917-1947.

200-


ISO


123


100


1917 to


S So S5 40 45 '47
YEARS


\ \ COLORED


-













i i t i ii .....I I I. I i
-Li


v. . . .


75







TUBERCULOSIS 31


departments, during the year 1947, of all cases reported 53.4%
were first reported by health departments. Another outstanding
fact made evident by this graph is that during the year 1947 there
is a marked reduction in the number of cases first reported by
death certificates. Of all cases first reported, 12.1% were first
reported by death certificate in 1946, whereas in 1947 only 3.7%
were first reported by death certificate. Another point that
should be brought out in connection with reporting is that 9.2%
of the cases reported in 1946 were first reported after admission
to tuberculosis sanatoria, whereas in 1947 there was a drop to
4% of cases first reported by tuberculosis sanatoria. This in
conjunction with the increased reporting from local health de-
partments shows that cases are being found and reported before
admission to sanatoria and before death.
A detailed analysis of the new cases reported during the year
for the 31 counties in the Central Case Register which comprise
71% of the total population of the state is shown in Table XIII.
This represents an analysis of 3,514 of the 4,335 cases reported in
1947. This table shows a break down of cases reported by stage
of disease, race and sex, source of report, and age group.


FIGURE 4
COMPARISON IN PERCENTAGES OF TUBERCULOSIS CASES
REPORTED BY SOURCE OF REPORT, FLORIDA. 1946 and 1947

0 10 20 30 40 50 60
Private Physicians

County & City
Health Departments____
General Hospitals

Sanatoria

Out of State I 1946
Reports 19
Old Cases Newly
Reported
Death Certificates

Veteran's Adm.
Hospitals

Other Sources












TABLE XIII
ANALYSIS OF 3514 CASES REPORTED DURING 1947 OF COUNTIES IN THE CASE REGISTER BY STAGE OF DISEASE, RACE AND
SEX. SOURCE OF REPORT AND AGE GROUP, FLORIDA, 1947


STAGE OF DISEASE BY RACE AND SEX SOURCE OF REPORT BY AGE GR OUP
White Colored


COUNTY *



z E- r0 0 z 5 E 0 0 0 0 0

Alachua 5 64 33 31 12 145 53 43 24 25 145 17 44 2 74 4 4 145 3 7 23 24 40 20 21 7 145
Baker 4 1 1 6 5 1 6 4 1 1 6 2 1 3 6
Bay 3 24 20 15 8 70 21 37 10 2 70 5 49 4 1 10 1 70 3 6 12 9 15 11 13 1 70
Bradford 8 3 3 5 2 21 14 2 4 1 21 2 9 9 1 21 7 1 4 2 5 1 1 21
Broward 8 15 15 18 9 65 24 14 17 10 65 6 37 1 2 11 4 4 65 8 7 15 8 9 9 4 5 65
Dade 5 283 251 261 72 872 458 282 72 60 872 10 586 34 7 18 185 10 22 872 2 25 120 190 203 167 138 27 872
Dixie 6 1 2 9 5 3 1 9 5 3 1 9 1 2 2 1 2 1 9
Dural 3 3 73 87111 77 354 142 79 90 43 354 10 146 6 11 8 117 26 30 354 7 17 72 92 64 44 21 37 354
Escambia 58 49 413 3 181 88 51 16 26 181 2 96 16 7 50 6 4 181 8 45 44 33 21 20 10 181
Franklin 6 1 3 1 11 4 4 1 2 1 11 1 1 1 3 3 3 1 11
Gadsden 2 36 7 14 11 70 30 17 13 10 70 3 27 11 2 26 1 70 2 7 9 19 9 10 9 5 70
Gulf 6 2 3 2 13 6 3 4 13 1 1 13 2 1 3 6 1 13
Hernando 6 2 1 1 10 6 3 1 10 1 8 1 10 1 1 2 2 1 3 10
Hillsborough 2 102 121 126 43 394 181 131 48 34 394 7 312 14 6 35 9 11 34 4 9 54 69 78 82 72 26 394
Jackson 13 12 15 7 47 23 10 7 7 47 2 15 14 16 47 11 14 8 8 4 2 47
Lafayette 1 2 2 5 3 2 5 3 1 1 5 1 2 2 5
Lake 2 2 11 8 14 43 20 11 10 2 43 2 12 27 1 1 43 2 1 3 12 4 9 6 6 43
Leon 6 26 13 10 12 67 18 13 21 15 67 11 32 3 1 16 1 3 67 6 7 14 10 11 6 10 3 67
Levy 1 9 1 8 19 6 5 5 3 19 2 11 5 1 19 1 4 3 3 2 5 1 19
Monroe 2 12 12 8 11 45 1 20 3 3 45 4 18 3 17 2 1 45 1 2 9 12 7 6 2 45
Nassau 1 17 6 10 6 40 17 10 6 7 40 2 19 17 2 40 2 5 9 9 10 5 40
Orange 3 4 73 60 56 70 266 111 84 39 32 266 1 118 6 4 113 7 3 266 6 9 41 49 49 40 38 34 266
Pasco 14 4 4 4 26 11 8 1 26 1 17 3 3 2 26 2 4 6 2 11 1 28
Polk 3 58 35 38 22 156 73 5 15 12 156 11 68 6 62 6 3 156 3 3 23 28 30 30 31 8 156
Santa Rosa 1 10 9 4 4 28 1 10 4 28 4 6 1 1 14 2 28 7 5 5 5 4 2 28
Seminole 23 7 10 6 46 20 12 9 5 46 2 28 1 1 11 2 1 46 1 5 7 9 7 14 3 46
Sumter 3 6 2 1 12 9 2 1 12 10 2 12 2 1 2 7 12
Suwanee 5 6 5 2 18 7 6 3 2 18 11 2 1 1 18 1 4 5 5 3 18
Volusia 1 4 17 25 20 12 79 28 2 14 8 79 3 45 1 5 21 1 3 79 5 3 17 17 3 11 19 4 79
Wakulla 3 1 3 7 4 2 1 7 5 2 7 1 3 1 2 7
Washington 7 9 3 1 20 13 2 4 1 20 11 1 4 3 1 20 1 4 7 4 4 20
Gadsden (Fla. State Hospital) 1 187 76 39 66 369 162 107 55 45 369 *199 157 13 369 2 33 50 96 66 77 45 369
TOTALS 18 2 1,175 885 873 5113,514 1,595 1,059 498 362 3,514 1241,963 53 103 721,001 98 100 3,514 61120 536 701 724 588 554 230 3.514
-Reported by Fla. State Hospital.


C4









w
12'
'U





~cs

0
z





(CD
-4
t*4
to
V3








TUBERCULOSIS 33


It will be noted that the largest number of cases reported,
as would be expected, continue to be from the largest county
health departments. The largest number reported was 872 cases
from Dade County. This was undoubtedly due to the mass X-ray
survey which was conducted during the latter part of the year in
this county. The second largest number was 394 cases of tuber-
culosis reported by Hillsborough County. This is a considerable
increase over 1946 and is probably due to the fact that continuous
X-ray surveys were being done with the stationary 70 mm survey
unit located in the health department in Tampa. The number of
cases reported from Duval County was approximately the same
as in 1946.
A striking feature of this table is that approximately 24%
of these tuberculosis cases reported during the year 1947 were
among the Negroes which comprise 24% of the population of
the state. It shows that the reporting incidence among the Ne-
groes is approximately the same as among the whites.
During 1946 and 1947 an analysis was made of the current
examination status of patients in the register, as shown by Table
XIV, and it was found that there has been an appreciable increase
in the over-all average of patients who are current in their ex-
amination status. In 1946 the over-all average of patients with
current examination status in the case register was 25%, where-
as in 1947 the over-all average has increased to 38.8% in current
examination status.
An analysis of the tuberculosis cases in the Central Case
Register as of December thirty-first, 1947, is very enlightening.
It shows that of a total of 7,417 cases in the register, 6,157 are

TABLE XIV
PERCENTAGE OF TUBERCULOSIS CASES WITH CURRENT EXAMINATION
STATUS IN 31 COUNTIES OF FLORIDA AS OF JANUARY 1, 1947. INCLUDES
ONLY CASES AT HOME, EXCLUDES CASES IN SANATORIUM.

RANK COUNTIES PERCENT RANK COUNTIES PERCENT
1 Dixie 77.8 17 Dade 39.6
2 Pasco 72.3 18 Nassau 39.6
3 Gulf 70.2 .. State Average 38.8
4 Bradford 70.0 19 Broward 36.8
5 Seminole 62.7 20 Sumter 35.0
6 Wakulla 62.5 21 Bay 34.8
7 Volusia 58.6 22 Suwannee 32.1
8 Washington 57.9 23 Leon 30.0
9 Baker 56.3 24 Levy 27.3
10 Monroe 51.4 25 Escambia 23.5
11 Alachua 50.0 26 Hernando 22.7
12 Gadsden 50.0 27 Duval 22.4
13 Santa Rosa 48.5 28 Lake 22.2
14 Polk 48.3 29 Jackson 21.7
15 Orange 43.9 30 Lafayette 20.0
16 Franklin 42.9 31 Hillsboro 15.7








34 ANNUAL REPORT, 1947


cases who are at home, while 1,260 cases are located in sanatoria.
Table XV shows a breakdown of the home cases by activity and
sputum status. Compared with the previous year there are fewer
patients at home with positive and undertermined sputum, and
approximately twice as many patients with negative sputum.
The number of inactive cases has increased and sanatorium admis-
sions increased from around 900 in 1946 to 1,260 in 1947.

TABLE XV
HOME CASES OF TUBERCULOSIS IN STATE REGISTER BY ACTIVITY AND
SPUTUM STATUS, FLORIDA, 1947

Activity and Home Percent
Sputum Status Cases
Positive Sputum 769 12.5
ACTIVE Undetermined Sputum 2,354 38.2
Negative Sputum 343 5.6
Questionable activity 430 7.0
Inactive 2,281 36.7
TOTAL 6,157 100.0

An analysis of the number of cases reported during 1947 shows
that almost all of the increase in reporting cases was in the white
race, and while the number of cases among the Negroes increased,
there was a proportionate decrease in the percentage of cases
reported as exemplified by Table XVI and Fig. 5.
Comparison of the number and percentage of the cases re-
ported by age groups is also very revealing. It shows that there
has been a rather definite increase in the percentage of cases
reported in the age groups over forty years, while there has been
a very definite decrease in the percentage of individuals reported
with tuberculosis under the age of forty years. This is shown in
Table XVI and Fig. 6.
TABLE XVI
COMPARISON OF NUMBER AND PERCENTAGE OF REPORTED TUBERCU-
LOSIS CASES, BY RACE AND SEX, AND BY AGE GROUPS, FLORIDA, 1946
AND 1947
1946 1947

Cases Percent Cases Percent
TOTAL 2,437 100.0 4,335 100.0
White Male 950 39.0 1,987 45.8
White Female 581 23.8 1,289 29.7
Colored Male 453 18.6 614 14.2
Colored Female 316 13.0 445 10.3
Unknown 137 5.6 ... ...
AGES
0-10 Years 55 2.3 76 1.8
11-20 Years 123 5.0 152 3.5
21-30 Years 446 18.3 661 15.3
31-40 Years 514 21.1 847 19.5
41-50 Years 414 17.0 882 20.3
51-60 Years 311 12.8 707 16.3
61 Years and Over 291 11.9 711 16.4
Age Unknown 283 11.6 299 6.9







TUBERCULOSIS 35


FIGURE 5
COMPARISON OF PERCENTAGE OF TUBERCULOSIS CASES REPORTED
BY RACE AND SEX, FLORIDA, 1946 & 1947


White Male


White Female



Colored Male


Colored Female


Unknown


PERCENTAGE OF TOTAL CASES REPORTED
10 20 30


40 50


FIGURE 6
COMPARISON OF PERCENTAGE OF TUBERCULOSIS CASES
REPORTED. BY AGE GROUPS. FLORIDA, 1946 AND 1947

S1946
3] 1947
!o -





00 1-





5: r,


21-30 31-40 41-50
AGE IN YEARS


-77-






EMl 1946

EJ 1947
//////7 7 ____-"-'l_ 19_-7


51-60


61 + UMKOWN


0-10 11-20






36 ANNUAL REPORT, 1947


DIAGNOSTIC CLINICS
During the past year almost all of the permanent diagnostic
clinics which have been located in the health departments of the
larger counties have been placed in operation and the Bureau of
Tuberculosis Control is constantly receiving X-ray films for in-
terpretation from units placed in these health departments. Six-
teen of these units are now in operation. In addition to the per-
manent diagnostic clinics in the health departments, treatment
facilities for indigent patients have been made available to re-
gional health department units which include Escambia and the
surrounding counties, Jackson and the surrounding counties,
Pinellas County, Volusia County, Orange County, Hillsborough
County, and Dade County.
The diagnostic X-ray clinics show a marked increase in the
number of films taken. During 1947 there were 9,434 X-ray
films read by the Bureau of Tuberculosis Control received from
local health departments, private physicians, itinerant clinics,
and tuberculosis and health associations as compared to 6,324
films read in 1946. A critical analysis of these films is shown
under Table XVII where the film interpretations have been
broken down according to diagnosis, color, sex, and decade of life.
A few comments on the clinic and consultation X-rays are in
order. These consultation films are taken on contacts, suspects,
known cases for follow-up, patients displaying symptoms, and
follow-up of mass X-ray surveys. It, is very noteworthy that
the number and percentage of earlier cases of tuberculosis is
much higher in 1947 than in 1946. It may be pointed out that
during 1946 only 3.2% were minimal while in 1947, 12.7% were
minimal, 3.8% were moderately advanced in 1946 while 6% were
moderately advanced in 1947, and 3% were far advanced in 1946
while 2.4% were far advanced in 1947. As usual the groups
showing the highest percentage of reinfection tuberculosis were
the white males over 60 years of age and the colored males be-
tween 50 and 60 years of age. Of all the films examined during
1947, a total of 23% showed evidence of reinfection tuberculosis
as compared with 13.7% during 1946.
MASS CASE FINDING
One of the principal activities of the Bureau of Tuberculosis
Control has been mass case-finding, using portable and mobile
70 mm X-ray equipment which has been concentrating on com-
munity-wide X-ray services.








TABLE XVII
TOTAL NUMBER OF CLINIC AND CONSULTATION X-RAYS INTERPRETED DURING THE YEAR 1947 DIVIDED INTO STAGE OF
DISEASE, AGE, SEX AND COLOR, WITH PERCENTAGE OF PATHOLOGY IN THE VARIOUS CATEGORIES
MINIMAL MOD. ADVANCED
AGE COLOR AND Far Other
SEX Negative Active Inactive Active Inactive Advanced Arrested Primary Suspicious Pathology Total
W-M 137 0 2 0 0 1 0 35 11 6 192
0-10 W-F 172 0 0 0 0 0 0 50 22 13 257
C-M 56 0 0 0 0 0 1 26 2 4 89
C-F 89 0 0 0 0 1 0 30 6 4 130
W-M 330 5 1 3 0 1 3 11 38 17 409
11-20 W-F 370 5 7 2 0 1 4 5 16 12 422
C-M 134 3 0 2 0 0 0 7 19 11 176
C-F 167 1 0 5 0 3 0 8 14 4 202
W-M 277 27 16 23 5 12 15 0 42 31 448
21-30 W-F 484 29 22 14 2 10 18 0 43 22 644
C-M 104 7 6 2 1 7 5 0 23 11 166
C-F 264 7 2 9 1 11 3 0 15 10 322
W-M 311 58 34 45 15 13 17 0 48 40 581
31-40 W-F 479 52 41 32 11 11 19 0 35 40 720
C-M 110 15 6 11 1 9 5 0 24 13 194
C-F 200 14 8 5 4 9 3 0 25 6 274
W-M 233 67 51 49 13 20 15 0 62 48 558
41-50 W-F 323 42 60 25 9 6 18 0 50 27 560
C-M 75 16 6 13 2 14 4 0 34 28 192
C-F 134 14 4 6 0 5 6 0 15 11 195
W-M 178 61 65 57 19 21 12 0 56 67 536
51-60 W-F 161 16 48 12 14 5 10 0 25 28 319
C-M 140 8 5 12 1 14 0 0 17 14 211
C-F 98 1 6 5 0 4 0 0 6 7 127
W-M 204 68 72 52 11 24 8 0 52 92 583
61 and Over W-F 173 30 43 21 12 8 8 0 31 62 388
C-M 58 9 12 6 8 8 0 0 11 17 129
C-F 16 4 4 4 4 3 1 0 3 6 75
W-M 66 22 19 9 0 3 2 0 12 6 139
Unknown W-F 13 25 13 5 0 1 5 0 9 4 75
C-M 40 16 2 8 2 3 0 0 13 8 92
C-F 1 10 8 1 0 1 0 0 6 2 29
TOTALS 5,627 632 563 438 135 229 182 172 785 671 9,434
Percentage 59.7 6.7 6.0 4.7 1.3 2.4 1.9 1.8 8.3 7.1 99.9







38 ANNUAL REPORT, 1947


This is the first full year of operation of the 6 units and the
number of X-rays taken has increased from 104,606 films made
during 1946 to 315,696 during the year 1947, resulting in the un-
covering of many more unknown cases of tuberculosis. In 1946
only 886 cases of definite tuberculosis and suspicious tuberculosis
were found on the miniature films, while 4,076 cases of tuber-
culosis and suspicious tuberculosis were found in 1947.
During 1947 fifty-one different communities in the State re-
ceived mass X-ray survey services by this Bureau. A summary
of the findings of the 70 mm project films and the 14 x 17 inch
follow-up films is shown in Table XVIII. It is gratifying to note
that of the 4,076 cases of definite and suspicious tuberculosis
found by mass surveys in 1947, we were able to do 3,408 or 83.1%
follow-up with 14 x 17 inch X-rays. Of this group, 1,873 cases
of reinfection tuberculosis were demonstrated. In 1946 we were
able to find only 252 cases of reinfection tuberculosis with 14 x 17
inch X-rays.
An innovation in 14 x 17 inch follow-up was started with a
survey held in Dade County where, with the approval of the
medical society, routine 14 x 17 inch X-rays were made of the
cases of suspicious and definite tuberculosis found in the 100,124
persons examined. The interpretations of the X-ray films were
made at the Bureau of Tuberculosis Control. Eight hundred
eight-seven or 86.5% of the definite and suspicious tuberculosis
cases found by 70 mm film were followed-up with 14 x 17 inch
X-rays, and 606 patients showed definite or suspicious tubercu-
lous pathology and were referred to their private physicians or
to the chest clinic in Miami.
Since the Dade County Survey was our largest survey to date
we have attempted to summarize the film findings from this sur-
vey. There were 1,025 individuals out of 100,124 examined found
to have definite or suspicious tuberculosis on the 70 mm film of
which 887 received 14 x 17 inch X-ray follow-up and 138 have
received no follow-up to date. Of the group who received large
film follow-up, 119 were negative, 162 showed evidence of other
pathology, and 606 showed evidence of definite or suspicious
tuberculosis.
We have also attempted to show the final recommended dis-
position of patients seen at the follow-up clinic after this survey
and it will be noted that of the 606 cases, 423 were recommended
for further follow-up. One hundred sixteen cases were recom-
mended for hospitalization while 307 were felt to need clinical
study. One hundred eighty-three cases were believed to be in-
active cases requiring no additional follow-up.










TUBERCULOSIS 39




TABLE XVIII
MASS X-RAY SURVEY
SUMMARY OF MINIATURE FILM AND 14" x 17" X-RAY FOLLOW-UP

M E 14" x 17"X-RAY FOLLOW-UP
MINIATURE FILM ON DEF. & SUSP. TBC.

Persons
LOCATION Persons Negative Definite Suspected Other Followed- Percent Cases of
Examined TBC. TBC. Pathology up With Follow-up TBC.
14" x 17" Found
Alachua 10,239 10,143 12 41 43 40 75.5 23
Alachua (U. of Fla.) 16,915 16,859 5 35 16 38 95.0 13
Baker 1,208 1,200 1 4 3 4 80.0 3
Bay 10,714 10,543 29 85 57 94 90.4 37
Bradford & Clay 2,253 2,221 11 19 2 25 73.3 13
Brevard 2,602 2,541 5 35 21 3 07.5 1
Calhoun 1,346 1,329 1 10 6 11 100 10
Collier 1,302 1,281 2 18 1 7 35.0 1
Columbia 3,036 2,989 6 31 10 6 21.6 2
Dade* 100,124 98,678 225 800 421 887 86.5 606
Dade 9,153 8,276 81 518 278 599 100 181
Dade (U. of Miami) 2,597 2,577 5 11 4 18 100 9
Dixie 1,304 1,021 1 6 6 7 100 5
Franklin 1,460 1,436 4 10 20 14 100 8
Gadsden 6,606 6,532 10 44 20 32 59.3 12
Gadsden (State Hosp.) 5,629 5,256 91 222 60 313 100 234
Glades 442 436 0 4 2 4 100 3
Gulf 1,794 1,760 5 16 13 16 76.2 6
Hernando 869 858 3 7 1 10 100 9
Highlands 1,624 1,601 7 14 2 13 61.9 8
Billsborough 27,960 27,437 132 256 135 371 95.0 244
Holmes 1,534 1,524 0 5 5 5 100 4
Indian River 2,541 2,512 8 11 10 1 05.2 1
Jefferson 1,911 1,891 3 12 5 8 60.0 5
Lafayette 541 536 1 3 1 4 100 2
Lake 2,126 2,116 1 6 3 7 100 3
Leon (Fla. A&M) 1,461 1,449 1 9 2 10 100 3
Leon (F. S.U.) 697 692 1 4 0 5 100 2
Levy 743 720 5 14 4 12 66.7 8
Liberty 818 808 3 5 3 8 100 8
Madison 3,039 2,999 3 16 21 15 83.3 7
Marion 6,159 6,066 12 60 21 64 88.9 26
Martin 2,314 2,254 6 42 12 38 79.2 15
Monroe 4,223 4,187 3 29 4 18 56.2 3
Nassau 2,443 2,407 5 22 9 17 62.9 8
Okaloosa 1,020 1,008 3 8 1 8 72.7 3
Okeechobee 641 628 0 7 6 4 57.1 0
Orange" 13,277 13,052 5 201 19 175 85.0 100
Osceola 1,632 1,586 2 36 8 7 18.4 4
Pasco 2,107 2,058 12 23 14 26 74.3 19
Pinellas 14,944 14,597 62 182 103 125 41.4 40
Polk** 16,886 16,703 38 99 56 66 84.2 33
Putnam 2,446 2,421 5 16 4 13 61.9 3
Seminole 2,862 2,785 14 53 20 54 80.6 26
Sumter 1,055 1,035 6 10 4 12 75.0 9
Suwanee 1,882 1,867 3 9 3 12 100 10
Taylor 2,837 2,810 5 16 6 21 100 14
Union (State Prison) 1,578 1,544 15 11 8 26 100 18
Wakulla 1,105 1,083 1 9 12 8 80.0 4
Walton 1,066 1,059 2 1 4 3 100 1
Usnas (Banana River) 1,994 1,979 2 10 3 12 100 4
NAS (Jacksonville) 4,520 4,469 7 34 10 41 100 2?
NAS (Pensacola) 4,553 4,494 5 44 10 49 100 29
Whiting Field 1,582 1,568 4 7 3 10 90.9 6
Pensacola (City) 1,341 1,329 2 10 0 11 91.7 3
TOTAL 315,696 310,113 866 3,210 1.507 3,4)8 83.1 1,873

'-State and Tuberculosis and Health Association Units combined.
"*-Tuberculosis and Health Association Units only.







40 ANNUAL REPORT, 1947


A great deal of the credit for the success of this large survey
is to be given to the Florida Tuberculosis and Health Association
and the local Tuberculosis and Health Associations who partici-
pated in a cooperative endeavor to coordinate all agencies having
to do with tuberculosis control.
One of the field secretaries of the State Tuberculosis and
Health Association was appointed Tuberculosis Program Co-
ordinator for the State as an official representative of the Florida
State Board of Health, The State Tuberculosis Board and the
Florida Tuberculosis and Health Association. Greater community
response was the result of the efforts of this coordinator who
brought the various groups together for discussion of the prob-
blems relating to tuberculosis. Thus greater community organi-
zation and publicity were achieved in community X-ray surveys.

TUBERCULOSIS ACTIVITIES IN COUNTIES
There has been further expansion of the tuberculosis activities
in county health departments. Whereas during the year 1946
patient visits numbering 16,530 were made to the various clinics
operated by local health departments, during 1947 a total of
25,712 patient visits were made. In 1947 there were 26,554 field
nursing visits as well as 5,940 office nursing visits made, whereas
in 1946 there were 20,069 field nursing visits and 3,212 office
nursing visits made. Also during 1946 there were 596 patients
admitted to State Tuberculosis Sanatoria through the local health
departments, but 1,065 patients with tuberculosis were hospital-
ized during 1947 through the local health departments.
It will be recognized that in any tuberculosis control program,
as well as any other public health program, the backbone must
of necessity be the local health units.










NUTRITION INVESTIGATIONS
AND SERVICES

WALTER WILKINS, M.D., Ph.D., Director

In Florida, nutrition is taking its place in the health depart-
ment along with sanitation and communicable disease control
as one of the important factors in maintaining health. The
problem of food nutrition is one of our greatest and most com-
plex problems in modern preventive medicine. Public health
officials in Florida recognize that nutrition problems present a
whole new sphere of health department responsibility.
Appraisal of nutritional status is essential in prevention and
control of malnutrition. Investigations as to the extent and
location of existing malnutrition and thorough studies of the
relationships of signs, symptoms, and disabilities to specific
deficiencies will provide some of the fundamental information
needed to develop more nearly adequate health programs in the
communities of Florida.
The nutrition staff devotes a great 'deal of time to investiga-
tions and fact-finding, but its work also includes education,
demonstration, and consultation services. The investigations are
directed toward determination of causes of various conditions
found which suggest nutritional relationships. Obviously it would
be impossible to carry out preventive measures without a knowl-
edge as to causes of disabilities found.
Among the various problems which have already presented
themselves are: anemia and borderline anemia, hookworm in-
festation in relation to nutrition and anemia, anemia of preg-
nancy, toxemias of pregnancy, relationships to various infectious
diseases, various skin conditions, granulated eye lids, poor vision,
retarded or abnormal bone development, relationships to learning
ability, effects of nutrition on working capacity, relationship of
diet to dental caries, effect of nutrition on aging processes, effects
of sub-minimal vitamin C intake on health, and possible relation-
ships of the intake of certain nutrients to mental hygiene and
emotional stability.


[ 41 1







42 ANNUAL REPORT, 1947


The following types of procedures are being used:
1. Limited physical examinations
2. Laboratory tests
3. Histories
4. Diet records
5. Therapeutic tests
The so-called "therapeutic test" is one of our most useful
tools and is being widely used. In every-day language it means
"try-and see." When a given sign, symptom, or disability sug-
gesting a nutritional deficiency is found, it is studied carefully
in an attempt to determine what shortages, if any, are responsible.
Then those nutrients thought to be lacking are given singly or
in various combinations. They are usually furnished in concen-
trated form to different groups. Periodic observations are made
to determine whether improvement occurs. Much checking and
re-checking must, of course, be done in order to get results which
are accurate and reliable. Otherwise false conclusions might be
drawn.
As yet our facilities for nutrition appraisal are far from com-
plete but they are serving as a starting point for the development
of more satisfactory procedures for nutrition appraisal by public
health workers. Facts gained by such procedures are basic to
any rational nutrition program.

NUTRITION INVESTIGATIONS
ANEMIA:
More than 3,500 Florida children have been given over 15,000
hemoglobin tests this past year. Although only a small per cent
had severe anemia, many had borderline or sub-clinical anemia,
as judged by the usual standards. We have found the anemia
to be more prevalent in rural than in urban children and more
pronounced in Negro than in white children even though fewer
Negro children are found to be infested with hookworms. Paral-
lel "semi-quantitative" hookworm examinations have confirmed
widespread hookworm infestation. Undoubtedly this contributes
to the anemia when the infestation is heavy but apparently has
little effect on the hemoglobin level when the infestation is light.
Also, many children with negative hookworm reports have low
hemoglobin levels.
In four counties, Polk, Hamilton, Lake, and Hillsborough,
groups of children were given iron and other supplements daily
in an effort to determine whether the lack of such substances is
the cause of the "pale thin blood." To date, over 2,000 children
have been tested therapeutically with iron. Thus far, however,







NUTRITION 43


iron when given alone has shown very little promise in raising
subnormal hemoglobin levels to normal, regardless of the pres-
ence or absence of hookworm infestation. This testing is still
in progress. The cooperation of the faculty and students in the
schools that participated in the testing has been very gratifying.
These blood tests have brought to light, among other
things, the fact that the hemoglobin level of an individual varies
during the course of the day and is usually higher in the morn-
ing than in the afternoon, a fact not heretofore recognized. Since
this finding has been confirmed, at least two hemoglobin tests
have been made on every child both before and after therepeutic
testing-one in the morning and one in the afternoon-and the
average computed.
Below is a summary of average hemoglobin levels of 231
pupils, from grades one through seven, who were divided into
four groups. Three of these groups were supplemented with iron,
or folic acid, or both of these substances, for a period of three
months. Each child had four hemoglobin determinations before
starting the therapeutic testing and four after-making a total
of 1,848 tests done on this group.
TABLE XIX
EFFECT OF IRON AND FOLIC ACID, SEPARATELY AND IN COMBINATION.
ON HEMOGLOBIN LEVELS OF SCHOOL CHILDREN
Average Hemoglobin in Grams per 100 cc Blood
Group Supplement No. Before After Improvement
1 Folic Acid 46 11.1 11.6 0.5
2 FeSO4 51 11.1 11.7 0.6
3 Folic Acid & FeSO4 63 11.1 12.0 0.9
4 Control 71 11.5 12.1 0.6

It can be seen from the above table that there was no sig-
nificant rise in the average hemoglobin level of any group as
compared with the controls. There were no unusual weight gains
in any of the groups. At the end of the testing program hook-
worm treatment was given by the county health department to
those who had positive stool specimens.
In the same school five children (not included above) of one
family were found to have severe anemia, i.e., averaging 5.7
grams. All five had heavy hookworm infestations. During the
last five weeks of school four of these children were given three
small supplementary high-potency feedings daily, consisting of
peanut butter, Brewer's yeast, milk, eggs, liver, etc. The aver-
age hemoglobin increase was 3.7 grams during the five week
period as may be seen in the following table:








44 ANNUAL REPORT, 1947


TABLE XX
THE EFFECT OF SUPPLEMENTARY FEEDING ON THE HEMOGLOBIN LEVELS
OF ANEMIC CHILDREN WITH HEAVY HOOKWORM INFESTATION
Grams of Hemoglobin per 100 cc. Blood
Children Age Before After Increase Percentage Increase
J.S. 7 5.3 9.0 3.7 70
C.S. 8 4.3 8.9 4.6 107
B.S. 10 5.0 8.5 3.5 70
G.S. 11 9.5 12.2 2.7 28
Average 6.0 9.7 3.7 62
* E.S. 13 4.2 8.2 4.0 95
* This 13 year old boy (E.S.) was in a hospital at the time when this feeding was
in process. There he was treated for hookworm disease and given three trans-
fusions of whole blood. The first four children (J.S., C.S., B.S., and G.S.) were
not given the hookworm treatment until the "after" hemoglobin tests were done.
It is interesting to note that this increase took place in spite of
the heavy hookworm infestations. Note that the oldest child
(E.S.) did not participate in the feeding program but was treated
for hookworms and given three transfusions of whole blood. His
hemoglobin level increased from 4.2 to 8.2 grams with a net
increase of 4.0 grams. This increase was in the same range as
that shown by the four children whose only "treatment" con-
sisted of supplementary feeding at school.
An unusual type of supplementary feeding program was car-
ried out in two schools (Polk City and Loughman) in Polk Coun-
ty and two schools (Green and Jasper Colored) in Hamilton
County. The supplement consisted entirely of turnip green "pot
likker." Two glasses per child each school-day, one in the
morning and one in the afternoon, were provided for periods of
from four to five months. School lunch workers cooperated in
the study. In each instance this procedure failed to bring about
very significant rises in average hemoglobin levels for the group.
However, less tangible improvements were noted in the children
by their teachers such as: fewer absences from school, fewer
colds and infections, brighter eyes, increased appetites, more
energy on the playground, clearer complexions, etc. Weight
gains were above the average.
ACNE
The first of a series of large-scale controlled experiments de-
signed to help determine the relation, if any, of nutritional factors
to adolescent acne was conducted in Leon High School, Tallahas-
see. Nearly 300 students, all volunteers, participated in the tests.
It was carefully explained beforehand that the procedure being
used was not treatment. No promises of cure, or even of
improvement, were made. Before starting the supplement, the
degree of severity was graded on two consecutive days, on the








NUTRITION 45


forehead, right cheek, left cheek, and chin. The following system
of grading was used:
0 = None
1 = Questionable to mild
2 = Moderate
3 = Severe
The students were divided into three comparable groups
which were given different combinations of vitamin concentrates.
A staff nutritionist was present throughout the school day in the
school clinic room. Each student reported to her once a day to
take his test dose. Careful individual records were kept. The
entire group was similarly graded twice at the end of three
months. The examiner was present only at the beginning and
end of the testing period and did not know the names of the
students or to which group any of them belonged.
One of the practical applications of such findings lies in trans-
lating the successful vitamin or vitamins into terms of foods con-
taining them. Persons having acne are usually advised, among
other things, to reduce their intake of fats and sweets; however,
these students were not given dietary advice until after the test-
ing period was over. Later each student was given the oppor-
tunity of having a private conference with the nutritionist.
A similar test on acne was made on a group of girls attend-
ing Florida State University. Another smaller group of high
school students in Tavares also participated in similar tests.
Following is a brief summary of the findings in Leon High
School:
TABLE XXI
TOTAL GROUP OF 282 STUDENTS
Average Degree Average Degree
of Severity of
Group Number Daily Supplement Before After Improvement
I 86 Controls 1.3 0.9 0.4
II 108 100,000 I.U. Vitamin A 1.1 0.5 0.6
50 mgs. pyridoxine
1 multivitamin
III 88 50,000 I.U. Vitamin A 1.2 0.5 0.7
50 mgs. pyridoxine
2 multivitamins
THE 50 SEVEREST CASES
All Students With All Areas Graded "2" Or More at Beginning
Average Degree Average Degree
of Severity of
Group Number Daily Supplement Before After Improvement
I 19 Controls 2.3 1.7 0.6
II 17 100,000 I.U. Vitamin A 2.5 1.4 1.1
50 mgs. pyridoxine
1 multivitamin
III 14 50,000 I.U. Vitamin A 2.5 1.2 1.3
50 mgs. pyridoxine
2 multivitamins







46 ANNUAL REPORT. 1947


It can be seen from examination of the above table that the more
severe cases, when tabulated separately from the entire group,
showed more improvement than did the group as a whole. In
the 50 severest cases, the degree of improvement expressed in
percent was 27% in Group I, 44% in Group II, and 53% in
Group III.

ONE-DAY DIET RECORDS:
About 2,500 one-day diet records on school children were made
and analyzed to determine the trends in eating patterns of groups
of school children. These one-day records are often quite reveal-
ing. For instance, in one large high school, over 43% of the 740
students who participated did not have any fruit for the day.
This was a typical school day in February-when citrus fruits
are plentiful in Florida. Other findings were as follows:
12% had no vegetables
34% had no eggs
16% had no milk
21% had only 1 glass of milk
In another high school 35% of the children who did not eat
in the school lunchroom had no milk during the day and almost
70% of them did not eat an egg. Those eating in the school lunch-
room had better diets than those who ate elsewhere. Children
of the Negro school in the same town showed even poorer eating
habits. Over 65% of those not eating in the school lunchroom
did not have milk or meat during the day; almost 20% came to
school without breakfast; and 100% did not have an egg during
the day.
These typical findings suggest the great amount of nutrition
education work which lies ahead.

GRANTS OF SUPPLIES:
Grants of supplies for therapeutic testing have included pyri-
doxine from E. R. Squibb and Sons, folic acid from Lederle Lab-
oratories, and a large supply (3,700,000) iron tablets from Mead
Johnson and Company. The Kiwanis Club of Tavares furnished
some of the testing materials used in the local schools. The Elks
Club of Tallahassee supplied part of the supplementary nutrients
used in the acne study in Leon High School. An interested citi-
zen in Polk County provided food materials worth approximately
$1,000.00 for testing purposes in that county.







NUTRITION 47


PUBLICATIONS DURING THE YEAR:
1. Wilkins, Walter. New Types of Activity for Nutrition Services
in Public Health. Milbank Memorial Fund Quarterly, 25:3,
July, 1947.
2. Wilkins, Walter. A New Public Health Approach to the Nutrition
Problem. The Interne, June, 1947.
3. Nutrition Staff. Florida Health Notes. Nutrition Survey Issue.
39:7, July, 1947.
4. Walker, Vera W. and Wagner, Florence. Food For Children As
Presented Through Summer Workshops in Florida. School
Life. (In press).
5. Wilkins, Walter, Blakely, Ruth, and Brunson, Julia. Hemoglobin
Levels of Parker High School Students. Journal of the South
Carolina Medical Association 63:2, February, 1947.
6. Englar, T. S., Wilkins, Walter, and Blakely, Ruth. Hemoglobin
Studies on Albemarle County School Children. Virginia Medi-
cal Monthly. (In press).
7. Wilkins, Walter, and Boyd, French. NUTRITION FOR YOU,
Second Edition, 1947. The first edition of this nutrition booklet
was prepared and used throughout the country during World
War II. It has been completely revised and reprinted for use
in Florida. Reprinting privileges have been offered gratis to
all other state health departments.

The Director, with the assistance of staff members, prepared
a section, THE ROLE OF THE HEALTH DEPARTMENT IN
NUTRITION APPRAISAL, for a manual on nutrition surveys
being published by the Food and Nutrition Board of the National
Research Council. The consensus of public health officials through-
out the United States and Canada regarding public health nutri-
tion programs was obtained through a comprehensive twelve-page
questionnaire. Approximately 500 copies were filled-in and re-
turned. These furnished valuable material for use in the prepara-
tion of the above section.



NUTRITION SERVICES


EDUCATION, DEMONSTRATION, AND
CONSULTATION SERVICES:
Nutrition education services have been at both professional
and lay levels. Such professional services have been provided for
the staffs of County Health Departments, Agricultural Extension
Workers, teachers, and school lunch workers. The Director and
staff members have participated in many meetings of profes-
sional groups in the fields of health, nutrition, dietetics, and home
economics.







48 ANNUAL REPORT. 1947


During the past year, educators in the public school system
of Florida have shown great interest in the health and nutrition
of their children, so that Health has become one of the areas of
major emphasis in the school program and in teacher workshops.
The number of requests for nutrition services has been far great-
er than the present staff could handle; however, discussions of
problems of child nutrition, methods and materials for presenting
food for children, and/or hemoglobin determinations for the
teachers themselves (as a means of emphasizing personal nutri-
tion) were provided for ten teacher workshops during 1947. In
addition, one staff member gave full time to three workshops
for school-lunch workers. Each of these was held in connection
with a teacher workshop and each lasted three weeks. As a
result of a project planned by staff members a grant was made by
General Mills which provided funds for the payment of salaries
of additional personnel to teach nutrition and school lunch man-
agement at three of these summer workshops. In the case of the
Bay County workshop the program was unique in that every
teacher attending the workshop was given training and experi-
ences in "foods for children." A report of these workshops was
prepared jointly with a school lunch specialist of the State De-
partment of Education and has been accepted for publication in
SCHOOL LIFE, a journal issued monthly by the United States
Office of Education. Cooperation and assistance have also been
given to school personnel wishing to carry on dietary studies.
One such study has been reported in the form of a mimeographed
bulletin for general distribution.
Nutrition education for communities and the public in general
has been provided through many talks which were illustrated
with slides, food, and other materials. Groups such as the Parent-
Teacher Associations, health councils, women's clubs, and college
and high school students were among those requesting such serv-
ices. Radio scripts have been prepared, radio broadcasts made,
and newspaper stories released. Consultation services on special
dietary problems have been given on request, and leaflets have
been prepared on nutrition in special situations, for example, for
donors to the Mothers' Milk Bank of Jacksonville.
Florida is the only State in the "deep South" not requiring
the enrichment of white flour, bread, and degerminated corn meal
and grits. Findings have indicated that enrichment of these
products would give the citizens of Florida an extra measure of
health insurance. A bill requiring such enrichment was intro-
duced in the 1947 Florida legislature, was approved by the Agri-
culture and Public Health Committees of the Senate, and was






NUTRITION 49


passed by the Senate by a vote of 31-5. Unfortunately, however,
this bill was not approved by the Public Health Committee of the
House. Several members of the nutrition staff were asked to
testify before Senate and House Committees as to the desirability
of this bill.
During the 1946-47 term the Director served as President of
the American School Health Association. At the annual meeting
of this association in Atlantic City staff members gave two reports
on th'e Florida Public Health Nutrition Program. Many indi-
viduals expressed the hope of starting similar programs in vari-
ous other state health departments. A similar paper was given
by the Director at the meeting of the American Public Health
Association during the same week. One staff member, Miss Ruth
Blakely, was elected to the Governing Council of the American
School Health Association. Also during the year the Director
discussed the plan and progress of the Florida public health
nutrition work at the annual meeting of the Georgia Public Health
Association in Atlanta and at a meeting of the Food and Nutrition
Board of the National Research Council in Washington, D. C.
During the year one of the nutrition consultants, Mrs. Vera
Walker, served as President of the Florida Home Economics
Association.
Numerous individuals who are doing nutrition work in other
states and other countries observed the field work of the staff
and participated in some of the activities for short periods of
time. The resulting exchanges of experiences and ideas were
mutually helpful.













BUREAU OF
SANITARY ENGINEERING

DAVID B. LEE, M.S. (Eng.), Director

This abbreviated report covers a digest of the major activities
of the Bureau of Sanitary Engineering. During the year 1946
many of the wartime stringencies were alleviated and 1947 saw
much sanitation-consciousness throughout the State. Considera-
ble improvement during the past year was effected by the Bureau,
not only in the major fields of public water supply, sewerage and
sewage disposal, but also in numerous other important public
health engineering activities.
A serious recognition of responsibility to the public pervaded
our personnel. Two engineers pursued advanced studies for
degrees in public health and sanitary engineering. Field surveys,
primarily in regard to stream pollution problems, were started.
Numerous talks were given, in order to inform citizens more
fully of the basic facts underlying better sanitation. Many in-
vestigations of sanitation conditions were made.
Just as better education brings to light more data about sig-
nificant facts of living, so has this Bureau in 1947 developed more
nearly to fruition the growth of a realization by many communi-
ties of important public health engineering needs. The Bureau
itself, limited in endeavor only by the physical strength of its
personnel, continues in daily concern for more adequate means
to accomplish its statewide responsibilities in the public health
engineering field.

PUBLIC WATER SUPPLY AND TREATMENT

NEW AND PROPOSED CONSTRUCTION
In Table XXII below are listed those public water projects,
plans and specifications which were received for review and
approval by the Bureau of Sanitary Engineering in 1947. It will
be observed that 48 different projects are listed with an estimated
cost of $7,900,035.29. Similar approval was given in 1946 to 51
projects having an estimated construction value of over $6,000,000.
The marked increase in population experienced in Florida since
1940 has necessitated a noticeable increase in water plant ex-
pansions and/or additions.
[ 51]










52 ANNUAL REPORT. 1947









TABLE XXII
PUBLIC WATER SUPPLY PROJECTS APPROVED IN 1947


MUNICIPALITY PROJECT EST. COST


Pahokee
Holly Hill
Florida City
Inglis
Hialeah
Jacksonville
So. Jacksonville
Niceville
Miami Beach
High Springs
Miami (Dade Co.)
Jacksonville (Greenfield Manor)
Jacksonville (Roosevelt Gardens)
New Smyrna
Bay Island-Sarasota
Miami Beach
Miami
Miami
Fort Lauderdale
Fort Lauderdale
Miami
Daytona Beach
Holly Hill
Holly Hill
Coral Gables
Jacksonville
Tarpon Springs
Ormond
Cocoa
Flagler Beach
St. Johns County-(St. Augustine and
vicinity)
Miami
Quincy
Cocoa Beach
Cocoa
Jacksonville (Lake Forest)
Pensacola
Jacksonville
Miami
Boynton
Port St. Joe
Hollywood
Dania
Pinellas County (Indian Rocks)
Chiefland
Marineland
Sarasota (Lido Beach)
Dania
Brewster
Palm Beach Shores


Enlarged Water Treatment Plant
Water Supply-Additional Storage
Water Plant & Distribution System
Florida Power Corp.-Water System
Construction of Water Supply System
Water Supply-Country Club Estate
Water Dept. Project No. Fla.-8-P-135
Water Supply Distribution System
11th Street Pumping Station
Water Treatment Plant
Water Distribution System
Water Distribution System
Distribution System and Well
Water Supply Project
Water Distribution System
Sunny Isles Water Co.
50th St. Heights Subdivision, Water Dist. Sys.
Hyde Park-Water Distribution System
Water Main Extensions & Miscl. Additions
Water Main Extension & Miscl. Additions
Flamingo Village Water Distribution
Water Supply Project
Water Storage
Water Plant Extension
University Manor Subdivision Water System
Southside Estates Water Distribution
Water System Improvements
Water Distribution System
Temporary Raw Water Supply Line
Water Treatment & Distribution
Water Supply Project
50th St.-Pump House and Well
Waterworks Improvements
Pumping Station; Water Supply & Dist. Sys.
Improvements to Water Facilities
Water System Elevated Tank
Waterworks Pumping Station-Water Well
Water System Improvements
Additions to Water Treatment Plant
Improvements to Water Facilities
Iron Removal Plant
Extensions to Water Plant
Water Facilities
Indian Rocks Water Plant Extension
Waterworks Project
Softening Unit Addition
St. Armond Lido Beach Water Facilities
Water Treatment Facilities
Water Dist. System (American Cyanamid Co.)
Water Distribution System


*-13 projects under construction $1,690,820 estimated cost.


$ 192,692.00
Unreported
75,000.00
15,000.00
6000,000.00
Still proposed
2,205,790.29
139,550.00
125,000.00
73,147.00
Unreported
10,000.00
*25,000.00
258,410.00
56,440.00
Unrerorted
*12,500.00
9,000.00
15,600.00
60,000.00
*23,000.00
*424,320.00
Unreported
Unreported
6,000.00
*50,000.00
174,315.00
285,590.00
245,330.00
65,000.00
334,430.00
*Included prev.
200,000.00
*49,000.00
98,250.00
*20,000.00
225,000.00
Unreported
*555,000.00
Unreported
*18,000.00
*350,000.00
*168,000.00
*86,000.00
85,000.00
*12,500.00
101,671.00
140,000.00
81,500.00
229,000.00
$7,900,035.29


I







ENGINEERING 53
OPERATION
In addition to review and approval of proposed new construc-
tion of public water supply improvements with respect to func-
tional design, the activity of the Bureau in the public water supply
field continued on sanitary control of the operational phase.
Sanitary supervision of operation, however, was confined princi-
pally to emergency investigation and corrective action, only a
few routine visits to water supply systems being possible during
the year under the existing personnel limitations.
Quality of operation of public water supplies was again en-
hanced by two actions: (1) The excellent five-day program of
instruction included in the water and sewage treatment con-
ference and short course held in June at the University of
Florida by its General Extension Division. The Bureau personnel
detailed on this work actively functioned in treatment, mainten-
ance and laboratory instruction to the nearly one hundred opera-
tors attending.
With the establishment of four regions, each headed by a
regional sanitary engineer, and the planning for a fifth such
region, more satisfactory coverage regarding public water systems
has been effected. Much closer sanitary supervision is still
necessary.
Supplementing the Annual Short Course and Conference held
in Gainesville during June of each year, the Bureau instituted
regional short courses for water and sewage plant operators
during the year. The first such regional short course and confer-
ence was held in Panama City in September and far exceeded
our expectations in enrollment and subjects covered.
WATER SUPPLY WELLS
Following up certain State statutes which place control of all
waters of the State of Florida under the jurisdiction of the State
Board of Health, this office approved 45 permits for water supply
wells during 1947. We suspect that many more public water sup-
ply wells were actually drilled without applications being for-
warded to this Bureau, but we feel that over-all coverage by per-
mits is improving as well drillers become acquainted with the
law.
BOTTLED WATER PLANTS
Operational permits for 24 bottled water plants were issued
in 1947. Issuance of these yearly permits is based upon at least
annual inspections and approval of bottling facilities by County
and/or State Health Department representatives, and a submis-
sion of monthly water samples for bacteriological analysis which
must meet the Minimum Standards of the U. S. Treasury Depart-
ment for Drinking Water.








54 ANNUAL REPORT. 1947


SWIMMING POOLS
Swimming pools are permitted on a permanent basis as long
as sanitary regulations are observed. In 1947 this office issued
permanent permits to 39 pools, making a grand total of 95 pools
permitted throughout the State. Plans and Specifications were
approved for the construction of 16 pools and/or bathing areas
in 1947.
TABLE XXIII
PLANS AND SPECIFICATIONS APPROVED FOR SWIMMING POOLS-1947

Location Project $ Estimated Cost

Delray Beach City Pool Improvements $ 5,000.00
Orange Park Bathing Area-Camp Seminole 5,000.00
Miami Beach Marseille Hotel Swimming Pool 40,000.00
Pahokee Lions Club, Pahokee Swimming Pool 20,000.00
Miami Beach Dorchester Hotel Swimming Pool 25,000.00
Palm Beach Seiden Holding Corporation Pool 60,000.00
Miami Beach Richmond Hotel Swimming Pool 32,500.00
Melbourne For: E. B. Narber 10,000.00
Miami Robert Clay Hotel Swimming Pool 25,000.00
St. Petersburg Bahama Shore Hotel Swimming Pool 40,000.00
Gainesville Florida Farm Colony Pool 6,500.00
Surfside (Miami) Blue Horizon Hotel Pool 25,000.00
Miami Beach Hotel Maurice Pool 30,000.00
Miami Beach Cromwell Hotel Pool 30,000.00
Daytona Beach Y. M. C. A. Pool 40,000.00
Miami Waverly Apts. (Biscayne Island) Pool 35,000.00
$429,000.00

COMMON CARRIER WATER SUPPLY AND
WATERING POINT SANITATION
Each year the U. S. Public Health Service circularizes com-
mon 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 Engineering for investigation and recommendation of
certification. Continuing the cooperative effort with the U. S.
Public Health Service, District Office No. 4, New Orleans, La.,
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 tabulation.







ENGINEERING 55
TABLE XXIV
COMMON CARRIER WATER SUPPLY AND WATERING POINT INSPECTIONS AND
RECOMMENDATIONS FOR CERTIFICATION TO U. S. PUBLIC HEALTH SERVICE
Number of Railroad Air Vessel
Inspections Companies Lines Companies
Made Appr'd Prov. Appr'd I Prov. Appr'd Prov.
Water Supply
Examination 68 40 3 8 0 15 2
Watering Point
Sanitation 55 30 4 5 0 13 3

WASTES TREATMENT AND DISPOSAL
SEWAGE
The Bureau closely cooperated with municipal officials and
designing engineers on a considerable volume of sewerage plan-
ning. This activity resulted in approval of some 32 separate
projects having a total estimated cost of $10,117,600.00. List of
cities for which plans were approved is shown in Table XXV.
The Bureau was also engaged in many planning and design
studies which are still in progress at the end of the year and
give promise of a continued high level of plan completion in 1948.
It may be appropriate to note that several of the largest projects
in the state are in a very active state of development at this time.
Several important projects have been under construction dur-
ing the year. Probably of greatest statewide interest is the com-
pletion of the sewage treatment facilities at the University of
Florida. These facilities are very important in the protection of
the public water supplies in Alachua County. In addition, the
completion of these facilities makes available to the students and
faculty of the University plant-scale works of most modern de-
sign and uniquely suitable for advanced instruction and research.
Much emphasis has been placed on improving the quality of
operation of sewage treatment plants and obtaining compliance
with state regulations. Standard operation report forms have
been prepared and adopted for general use throughout the state.
Members of the Bureau staff visited every treatment plant in the
state to advise the operators on treatment problems, and to install
and explain the operation reporting policy. Success in this activi-
ty is difficult to evaluate at this time due to the small number of
adequate treatment facilities and generally poor quality of oper-
ating personnel.
STREAM POLLUTION
The report on the St. Johns River Pollution Survey was pub-
lished in October. The study covered three years of field ob-
servations and presented for the first time a picture of the condi-
tion of Florida's most important river system. Studies of less
extensive scope were made and, reported on Rice Creek and Lake







56 ANNUAL REPORT, 1947


Worth. The Bureau is now making pollution and sanitary sur-
veys of the waters at St. Augustine, Sarasota, and Bradenton;
in East Bay in Santa Rosa County; Apalachicola, and the Jack-
sonville Beaches area. Plans have been made to survey prac-
tically all important water areas when funds and personnel are
available.
Publication of the Pollution (October) issue of Florida Health
Notes stimulated considerable public interest in this problem.
SANITARY DISTRICTS
The Bureau has been active in efforts to obtain a statewide
enabling act for the creation of sanitary districts. It is felt that
legislation of this type will be of tremendous aid to the State
Board of Health and local political subdivisions in setting up
sanitary districts. Much study has been given this subject with
the view to having a draft of desired legislation prepared for the
consideration of the next legislature.
DRAINAGE WELLS
The Bureau has found it necessary to approve a total of 55
applications for drainage wells during 1947. These approved
wells were distributed as follows:
Broward County 1 Marion County --__-. 1
Dade County __.____ 39 Orange County __. 11
Jackson County 1 Putnam County .-_- 2
It will be noted that practically all of the drainage well prob-
lems are located in Dade and Orange County. The approvals of
wells in these areas were for the most part conditioned on the
use of other means of waste disposal when these latter become
available. The progress now being made in development of
sanitary sewerage systems for Orlando and Miami makes it appear
probable that many drainage wells in these critical areas may be
closed in time.
INDUSTRIAL WASTE
The problem of industrial waste treatment and disposal be-
comes more acute each year. During 1947 the Bureau collaborated
on the design, construction and operation of 9 industrial waste
treatment plants. For the most part these were small plants for
treating the waste from laundries and were quite successful al-
though often expensive.
The larger problems being created by mining operations,
slaughter houses, and citrus processing received much attention
and some progress toward solution may be claimed. However,
much remains to be done by the Bureau in collaborative studies
with the industries and other state agencies.








ENGINEERING 57


TABLE XXV
SEWERAGE PROJECTS APPROVED IN 1947


MUNICIPALITY OR OWNER PROJECT Estimated Cost
Holly Hill Collection System $220,000.00
Stuart Sanitary Sewerage 366,800.00
Jacksonville Beach Sanitary Sewerage 850,000.00
Coral Gables (Univ. of Miami) Sewerage; Sewage Treatment *20,000.00
St. Augustine (School for Deaf and Blind) Sanitary Sewers *50,000.00
Milton Sanitary Sewerage Facilities *224,800.00
Gainesville (Univ. of Florida) Sanitary Sewerage *555,000.00
Sarasota Sewerage 1,783,300.00
Winter Park Sanitary Sewerage Improvements 608,000.03
Lake Wales Sanitary Sewerage Improvements 507,000.00
Holly Hill Sewage Disposal Plant 80,000.00
Winter Haven (Hospital) Sewerage *5,000.00
Jacksonville (Lakewood Garden Apts.) Sanitary/Storm Sewers '78,000.00
Atlantic Beach Sewage Treatment Project 187,800.00
Delray Beach Sewerage Improvements 850,000.00
Fernandina Sanitary Sewerage Improvements 600,000.00
Jacksonville (Lakewood) Sewage Treatment Plant *45,000.00
Jacksonville Beach Emergency Sewer Repairs *140,000.00
New Smyrna Beach Sanitary Sewerage Project 474,000.00
Clermont Sanitary Sewerage Improvements 188,000.00
Niceville Sanitay Sewerage System 213,000.00
Live Oak Sanitary Sewerage Improvements 183,000.00
Lakeland Sewage Treatment Plant *250,000.00
Winter Garden Sewage Treatment Plant *70,000.00
Dade City Sewerage Improvements 280,000.00
Miami (Port Authority) Sewerage Improvements 82,200.00
Dunedin Sewerage Improvements 306,000.00
Silver Springs Sewage Treatment Plant 15,000.00
Winter Garden Sewerage System *93,000.00
Surfside Sewerage System 700,000.00
Fort Lauderdale Sanitary Sewerage Extensions 75,000.00
Sarasota Sewerage System 17,700.00
$10,117.600.00
*-Eleven projects under construction; $1,530,800.00 estimated cost.


TABLE XXVI
PLANS FOR INDUSTRIAL WASTE TREATMENT APPROVED IN 1947


LOCATION TYPE OF INDUSTRY Estimated Cost
North Miami Laundry $ 5,000.00
Jacksonville Laundry 2,500.00
Miami Laundry 3,000.00
Opa Locka Laundry 2,000.00
Orlando Dairy 11,000.00
Leesburg Laundry 2,000.00
Rio Vista Laundry 1,000.00
Mount Dora Laundry 2,000.00
Duval County (Near Jacksonville) Chemical Plant 2,000.00
$30,500.00
All Completed







58 ANNUAL REPORT, 1947


SANITARY MILK CONTROL
During 1947 milk control activities became a part of the public
health program in the fiftieth organized county health unit in
Florida. The milk programs in these fifty counties and city
health units practically covered the entire State in sanitary milk
control. In 1947, the second post-war year, improvements were
made in milk sanitation by producers and distributors, and in
control by health department personnel.
City and county unit milk control programs were reviewed
and appraised. Complete milk sanitation compliance rating sur-
veys were made in Madison and Pensacola. These two communi-
ties made the "Honor Roll" group, having a sanitation compli-
ance rating over 90 per cent. The State level program of serving
in advisory and consulting capacity to county and local health
departments in matters concerned with adoption, enforcement
and interpretation of the recommended milk ordinance and code
resulted in over 300 inspections of plant-producers, producer-
distributors, and pasteurization plant facilities.
During the year the State Legislature passed Senate Bill No.
656 which had the effect of transferring the authority for making
regulations relating to the production and processing of milk
from the State Board of Health to the Florida State Department
of Agriculture. This law had the effect also of leaving without
local regulations about thirty small communities that had been
using the State Sanitary Code as their local milk code. The
Bureau's program has been, and will continue to be, to urge these
communities, with approximately 100,000 in population, to adopt
up-to-date local milk ordinances. The Bureau's cooperation with
the Department of Agriculture continues on a highly satisfactory
level. Joint inspections were made on surveys and on checking
of high-temperature short-time pasteurizers.
The state milk sanitarian's technical services were made avail-
able to producers in the making of direct microscopic examina-
tions of milk from suspected cows for evidence of mastitis.
Seventy-six samples were taken for direct microscopic examina-
tion and three abnormal samples found.
Sources of milk and milk products were approved for use on
interstate common carriers. Although the volume of products is
small, these distributors are eager to maintain their "approved"
ratings.
An important new activity of the State Milk Sanitarian was
that of being a member and taking part in the activities of the
Florida Milk Commission by attending its meetings and open






ENGINEERING 59


hearings. This official state commission determines and estab-
lishes minimum prices for milk and milk products. In this activi-
ty the Bureau has taken an active part.
Increased milk control activities during the year are confirmed
by the laboratory reports of samples submitted to the five State
laboratories. The results showed an improvement in quality over
the 1946 samples. However, there still exists much room for
improvement. Over six thousand milk samples were analyzed;
of these nearly half were pasteurized milk samples; over twenty-
five hundred were wholesale raw milk samples; one thousand
were retail raw milk samples. Two-thirds of the pasteurized milk
samples submitted were within their bacteriological grade, that is,
less than thirty thousand standard plate count. Only forty-
seven per cent of the retail raw milk samples were within their
bacteriological grade, that is, less than fifty thousand standard
plate count. Sixty-four per cent of the samples submitted from
plant producers were within their bacteriological grade, that is,
less than two hundred thousand standard plate count. Of the
pasteurized milk samples submitted only forty-nine showed un-
satisfactory pasteurization by the phosphatase tests. This is
approximately 11/ per cent of the samples submitted, a note-
worthy improvement over 1946, during which year 31/ per cent
of the pasteurized milk samples submitted showed unsatisfactory
pasteurization.
Milk control activities from the State level were limited be-
cause of the shortage of trained and qualified personnel. Only
one milk sanitation consultant worked from the State level during
the year.
A statistical summary of the activities is given in Table XXVII.

SEAFOOD SANITATION
(Shellfish and Crustacea)
OYSTERS
New regulations of the U. S. Pure Food & Drug Administra-
tion became effective on January 15, 1947; these regulations con-
trol the size, identity, classification and count per gallon of oyster
meats as well as the liquid content of the gallon container. Dur-
ing March this Bureau assisted the Administration's inspectors
in bringing about compliance. In order to meet the drainage and
liquid requirements every interstate plant installed an additional
large stainless steel oyster drainage skimmer. By autumn the
Administration's inspectors were finding adequate compliance.
At the opening of the oyster season on September 1, the 39
Apalachicola plants were in better physical condition than ever









60 ANNUAL REPORT, 1947




TABLE XXVII
SANITARY MILK CONTROL SUMMARY OF ACTIVITIES

Local Milk Control Programs reviewed and appraised................................................... 49
Milk Sanitation Compliance Rating Surveys............................................................ 4
Communities attaining satisfactory sanitation compliance................................................ 2
Sources approved for use on common interstate carriers.................................................. 10
Inspections-Plant-Producer Dairies.................................................................. 230
Producer-Distributor Dairies............................................................. ......... 10
Pasteurization Plants................................................................................ 67
Thermometers checked.................... ................ ........ ........... ......... ....... 14
High-Temperature Short-Time Pasteurizers checked.................................................... 3
Alkali Bottle Washing Solutions analysed ............................................................. 2
Milk Samples collected for analyses.................................................................. 89
Direct Microscopic Examinations made. .............................................................. 76
Abnormal milks found by direct microscopic examinations ................................................. 3
Nuisances investigated....................................... ......... .... ................ 4
Dairy plans reviewed ................................... .. .................................. 1
Inspected Proposed Food (Crab Meat) Plant........................................................... 1
Talks given: Training Course for Sanitary Officers (34 attending-Gainesville)............................ 3
Articles written: "Brucellosis-Undulant Fever" (Health Notes) ........................................... 1
Out-of-State Meetings-Rabies Control................................................................ 1
Meetings, Florida Milk Commission...................................... ...................... 15
Meetings, Florida Milk Sanitation Association .......................................................... 3
Meetings, Florida Public Health Association ....... ................. ....... ................ .. ............. 1
M meetings, M ilk Distributors ............. ....................... ..... .............................. 3


TABLE XXVIII
SANITARY MILK CONTROL


DESCRIPTION Number Percentage
Total milk samples analyzed........................................... 6,687
Pasteurized milk samples ............................................ 2,991
Samples satisfactory standard plate count 2,006 67%
Unsatisfactory Phosphatase Tests.................................. 49 2%
Plant-Producer milk samples 2,677
Samples satisfactory standard plate count 1,710 64%
Producer-Distributor milk samples 1,019
Samples satisfactory standard plate count 486 47%





TABLE XXIX
SEAFOOD PLANTS


Number Number New
DESCRIPTION Certificates Inspections Plants
Issued Made Constructed

Oyster Shucking and Packing 79 450 3
Oyster Shelstock Only 6 24 3
Scallop Shucking and Packing 4 46
Clam Shucking and Packing 2 6 1
Crabmeat Picking and Packing 42 206 3
Lobster Picking and Packing 2
Shrimp Cooking and Packing 1 5







ENGINEERING 61


before. Skimmer rooms had been painted in white enamel; plant
and equipment were in good condition. However, because of the
economic status of the too many small plants, ideal operating
conditions in this locality remain yet to be attained.
Hurricanes of September 15 and 23 inflicted severe water
damage upon all the Apalachicola plants located on the open
beaches. One plant was eliminated. Although discouraged by
this heavy loss the operators repaired, remodeled, and gradually
resumed business. The bureau gave necessary and constant
supervision of this rehabilitation.

CRUSTACEA
The 42 certified crabmeat packing plants endured an adverse
business year brought about by a flooded New York market with
consequent low market prices. The market condition was caused
by the opening of so many new plants during the two post-war
years of 1946 and 1947. Through inspections and consultation
sanitary standards have been kept up. Two well equipped mod-
ern new plants were established, one in St. Augustine and one in
Panama City.

SCALLOPS
The mobile scallops showed up only around Panama City this
year. The "Red Tide" of the lower west coast might have been
a factor in the geographical shift. Ten thousand gallons were
packed and frozen.
TABLE XXX
SEAFOOD SANITATION- SUMMARY OF ACTIVITIES

Oyster growing area pollution surveys started............... ..................... ... .......... 4
Oyster growing area water samples taken and analyzed............................................... 151
Oyster meats specimens analyzed and cultured.......................................................... 87
Oyster bootleggng activities investigated ... ................ .... .......................... 4
Typhoid epidemics investigated ............................. ......................... 1
Fish market reconstruction and sanitation............................. ................... ... ........ 6
Lecture on shellfish, crustacea and seafood sanitation made to Sanitary Officers Training Courses, Gainesville ... 4
Shelfish Technical Memorandum compiled for County Health Department Sanitary Officers; Out-of-State
agencies requesting copies .................. ........... ........ ...... ..... 1
Conventions attended: Florida Public health Associaton meeting and National Shellfisheries Association
m meeting ...................................... 2...................... 2

WATER IMPOUNDMENTS AND MOSQUITO CONTROL
An increase in the construction of water impoundments for
the year was noted, in that nineteen permits for this purpose
were issued during 1947 against ten for the previous year. Most
of these projects were constructed in Northwest Florida for irri-
gation or for recreational purposes.
The Bureau policy on the granting of permits of this type
remained the same as before with a separate field inspection








62 ANNUAL REPORT. 1947


required both for the preliminary permit and the subsequent
permit for maintenance.
To attain maximum efficiency in the granting of these permits
as well as to coordinate the mosquito control program most effec-
tively, issuance of all water impoundment permits is now accomp-
lished directly by the Division of Entomology under Bureau
supervision.
TABLE XXXI
MISCELLANEOUS PERMITS ISSUED BY BUREAU OF SANITARY ENGINEERING
Total Total
Under Under
Permit Permit
Description 1946 1947 Remarks
Tourist Courts and Increase is attributable to greater avail-
railer Prs 9 ability of building materials and more
Trailer Parks 937 1490 acute needs for tourist housing. Permits
are permanent rather than seasonal or
annual, and are revokable only for
cause.
Food Canning and These are also permitted on a perma-
Preserving Plants 138 158 nent basis with revokation only for
Temporary Labor **Permits seasonal only, July 1 to June
Camps 99** 16** 30.
TABLE XXXII
PROJECTS DEVELOPED IN THE BUREAU DRAFTING ROOM-1947

1. Location maps, charts, and graphs to illustrate the St. Johns River
Pollution Survey.
2. Sanitary survey map of the Tallahassee area.
3. Sanitary survey map of the Port St. Joe area.
4. A large scale outline map of the State to be used as a key base map
for all departments to show location and progress of work.
5. Two completed, colored prints of the above outline map to show all
waste treatment works by location, type, and status of operation.
These prints mounted on board for wall displays.
6. Two completed, colored prints of State outline map to show all
crustacea and seafood activities. These prints mounted on board
for wall displays.
7. State transportation map for Rapid Treatment Center.
8. Pollution survey map of the State to show subsurface, stream, and
industrially polluted areas for publication in Health Notes.
9. Base map for field use in Lake Worth Pollution Survey.
10. Base map for field use in St. Johns County Pollution Survey.
11. Base map for field use in Jacksonville Beaches Pollution Survey.
12. Twenty-two typical plans of milk houses and dairies showing sani-
tary features.
13. Twelve typical plans and details of restaurant construction and -ir-
rangement showing sanitary features.
14. State map showing all permitted swimming pools.
15. Revisions and new drawings of metal forms for septic tank con-
struction.
16. Working plans for septic tanks to be built of concrete blocks.
17. Reproduction of numerous tracings on the Ozalid Printing Machine
for this and other Bureaus.
18. Routine filing of plans and maps of all projects reviewed by the
Bureau.








ENGINEERING 63


FEDERAL HOUSING ADMINISTRATION (SEWAGE DISPOSAL
AND WATER SUPPLY)
During 1947 the working agreement with the Federal Housing
Administration continued in effect; the Bureau continued to cer-
tify individual sewage disposal and water supply systems serving
premises for which the property mortgage is insured by Federal
Housing Administration. Briefly, this agreement involves inspec-
tion, by local health department personnel primarily, of the
systems; also involved is the processing of pertinent documents
to see that the sewage disposal and water supply systems meet
State Sanitary Code requirements.
An integral part of this feature of the program is investigation
into water table elevation, soil texture, and drainage characteris-
tics of areas proposed for housing developments. These items
bear upon the suitability of septic tanks with subsurface tile fields
as means of sewage disposal.
The following Table XXXIII summarizes this activity in co-
operation with local health departments and the Federal Housing
Administration.

TABLE XXXIII
FEDERAL HOUSING ADMINISTRATION DEVELOPMENTS
Form No. of
No. Description Items
FHA-2218_Inspection Report & Certification (Sewage Disposal)_ ._4,836
FHA-2084c-Percolation Report (Soil Characteristics & Water Table 24
FHA-2217-Inspection Report & Certification (Water Supply)-......---- 37

There were 30 less percolation tests (FHA-2084c) than in 1946;
subdivision investigations dwindled. There were 20 more FHA-
2217's than in 1946; more water facilities for existing or planned
subdivisions were actually provided. But there were 4099 more
FHA-2218's than in 1946; the nearly six-fold increase was due
to greater availability of building supplies and the accompanying
enlarged activity in building private homes.







64 ANNUAL REPORT. 1947


DIVISION OF ENTOMOLOGY

JOHN A. MULRENNAN, Director

This constitutes the initial report from the Division of Ento-
mology, officially organized as of July, this year.
While satisfactory progress was made during 1947 in the many
activities carried on by the division, two accomplishments in par-
ticular were outstanding. These comprised the passage of legisla-
tion to regulate pest control operators, and the establishment at
Orlando of a field station for mosquito studies whereby more
effective and economical means of control may be developed
without undue disturbance to the balance of nature.
The programs of both malaria and typhus control moved for-
ward favorably. The division received from the federal govern-
ment a sum of $211,000.00 for malaria control and $63,000.00 for
typhus control. It should also be noted that counties appropriated
$62,102.00 for malaria control, while approximately $80,000.00
were furnished by Florida cities in sponsoring typhus control.
Malaria death rates continued on a downward trend with
seven deaths reported this year as compared to 17 in 1946. The
same trend was evident in typhus fever with eight deaths reported
as compared to 17 for the previous year. Of recorded cases of
typhus fever, 344 occurred in 1947 as compared to 393 cases in 1946.
It is of interest to observe that two cases of spotted fever, one
of which was fatal, were recorded in the morbidity reports of the
State Board of Health this year. This disease is transmitted by
ticks, and, considering the emphasis that is being placed on fire
control in woodlands where many species of this arthropod are
encountered, it is possible that tick populations may increase and
spotted fever cases recur. This division is now, by the use of
tick surveys, studying the biology of Florida species in order to
become fortified with information whereby control procedures
may be worked out to check the spread of this virulent disease.

STRUCTURAL PEST CONTROL

Another milepost along the highway to higher standards of
public health in Florida was reached when the Structural Pest
Control Act became a law on July 1, 1947. Under this Act, the
State Board of Health has been charged with certain duties and
legal enforcement, and these are being carried out by the Divi-
sion of Entomology.







ENGINEERING


The duties and legal enforcement which the State Board of
Health is empowered to perform are as follows:
(1) To promulgate rules and regulations for each phase of
structural pest control. The various phases of structural
pest control are classified as (a) general pests, (b) ter-
mites, (c) rodents, and (d) commercial fumigation. The
rules and regulations are being designed primarily as mini-
mum standards of work.
(2) To enforce the various sections of the Act, and all rules
and regulations thereof.
(3) To issue an annual State Board of Health business license
to each qualified establishment and, in addition, to issue
individual identification cards to each person employed by
a licensed establishment to do structural pest control work,
commercial fumigation and/or to solicit business.
Since each recorded business location of a firm or individual
engaged in structural pest control work is required by the Act
to procure an annual business license from the State Board of
Health, no one may legally perform such work as a business un-
less properly licensed. Therefore, a state-wide survey was made
to determine what firms or individuals were engaged in structural
pest control work in order that their qualifications for continued
work in this industry could be properly judged before a business
license was issued.
Public health has been advanced in Florida as a result of the
passage of this Act because of the higher standards of work re-
quired. In addition, unsatisfactory work and unreasonable
charges by unscrupulous, unqualified pest control operators are
being eliminated.
RESIDUAL DDT HOUSE SPRAYING
SUMMARY OF 1947 SPRAY OPERATIONS
The residual spray program for the 1947 season was completed
October 21. A total of 68,737 houses received treatment with 5%
DDT emulsion during the past season in thirty counties. Approxi-
mately 1,500 houses were treated as emergency flood relief work
in south Florida along the east coast storm area, where spraying
included houses in Vero Beach, Hobe Sound, Stuart, Ft. Lauder-
dale, Davie and Dania. This flood relief work brought the State
total for 1947 to 70,237 homes given protection from the malaria
vector.
An average of .9 lbs. of DDT per house was used, with a total
of 65,011 lbs. of DDT being applied. The State man-hours per
house, including county-paid personnel and CDC county super-
vision, averaged 1.4 man-hours per house.









66 ANNUAL REPORT, 1947


Of the 84,485 houses examined, 70,237 were treated. In addi-
tion 36,964 privies were sprayed. Assuming an average of 4.5
persons per household, the 1947 residual spray program afforded
malaria protection to 328,113 of Florida's citizens.

EVALUATION OF DDT HOUSE SPRAYING
Entomological inspections were made in unscreened houses
both before and after spraying with DDT residual house spray.
These inspections were made to determine the effectiveness of
the spray application on the populations of insects in the sprayed
houses. Records were made primarily on Anopheles quadri-
maculatus, the vector of malaria. Additional records were made
of populations of flies, roaches and pest mosquitoes.



TABLE XXXIV
HOUSES RECEIVING RESIDUAL SPRAY, 1947, WITH COST OF LABOR AND
DDT PER HOUSE, BY COUNTIES
Total Total Cost Average Average Average Cost County
COUNTY Houses to County Man-Hours Number lbs. to County Man-hours
Sprayed (Labor) per House* DDT per House per House per House
Alachua 329 $ 526.00 2.1 .9 $1.60 2.1
Baker 1,291 1,500.00 1.3 .7 1.16 1.1
Bay 4,128 4,000.00 1.0 1.0 .97 .8
Calhoun 1,456 950.00 1.3 .8 .65 1.1
Charlotte 987 1,300.00 1.4 1.0 1.30 1.1
Citrus 1,658 1,250.00 1.5 .7 .76 1.3
Dixie 1,200 1,229.00 1.8 .9 1.00 1.5
Franklin 1,162 1,200.00 1.8 .8 1.03 1.5
Gilchrist 762 812.00 1.9 .7 1.02 1.5
Glades 743 600.00 1.8 .9 .80 1.3
Gulf 1,387 1,300.00 1.1 .7 .94 .9
Hamilton 2,020 2,022.00 1.7 1.1 1.00 1.4
Hendry 1,572 1,300.00 1.1 .8 .83 .8
Hernando 1,344 1,372.00 1.6 .4 1.04 1.3
Holmes 3,393 3,270.00 1.3 .9 .96 1.1
Jackson 7,120 7,000.00 1.3 1.0 .98 1.1
Jefferson 2,502 2,192.00 1.4 .9 .88 1.0
Lafayette 911 1,042.00 2.0 .9 1.14 1.7
Lake 4,730 3,090.00 1.0 .9 .63 .8
Leon 3,828 3,137.00 1.4 .7 .82 1.3
Liberty 720 800.00 1.7 1.0 1.11 1.4
Madison 3,277 3,333.00 1.6 .9 1.01 1.3
Okaloosa 4,522 3,000.00 1.1 .9 .66 .9
Okeechobee 865 750.00 1.2 .7 .86 .9
Sumter 2,668 1,715.00 1.2 .9 .65 .9
Suwanee 3,191 3,455.00 1.4 .9 1.08 1.2
Taylor 2,571 1,613.00 1.2 .9 .63 1.0
Wakulla 1,727 1,627.00 1.4 .8 .99 1.3
Walton 4,029 4,051.00 1.1 1.0 1.00 .9
Washington 2,646 2,666.00 1.5 1.3 1.00 1.2
Total 68,737 $62,102.00 1.4 .9 $.93 1.1
*-This includes the man-hours contributed by the local governments and those contributed by C. D. C.







ENGINEERING 67
Anopheles quadrimaculatus: The dosage of 200 mg. of DDT
per square foot gave protection to more than 90 per cent of
houses sprayed, although a control survey of unsprayed, un-
screened houses showed only 62.7 per cent to be infested with the
malaria vector at the time of the inspections. All inspection
records accumulated during the 1947 season were from houses
within one-half mile of natural resting stations showing quadri-
maculatus densities above 10. This quadrimaculatus density was
determined by observing outbuildings and other types of resting
stations at the same time the houses were inspected.
In records from houses sprayed for the first time in the 1947
season, only 23 per cent as many quadrimaculatus were observed
alive during afternoon inspections as were recorded from un-
sprayed, unscreened houses for the same season. In houses where
previous applications had been made during the 1946 season and
the 1945 season or in the 1946 season alone, only 10 per cent as
many quadrimaculatus were counted as in unsprayed houses. In
houses receiving treatment during 1947, 1946 and 1945, or 1947
and 1946, the highest degree of control was obtained; only four
per cent as many quadrimaculatus were found alive as in un-
sprayed houses. This data suggests that a residual effect endures
more than twelve months where thorough applications are made.
The influence of natural resting place quad density on the per
cent of houses infested with quadrimaculatus is shown in data
obtained from 817 inspections in sprayed houses and 338 inspec-
tions in unsprayed houses. Of houses found to contain living
quadrimaculatus in afternoon inspections, unsprayed houses were
62.7 per cent quad-positive, sprayed houses only 8.5 per cent
quad-positive.
Flies: Densities of flies in sprayed and unsprayed houses were
measured by counting the number of flies resting on an area
three feet square. The area with the largest number of flies was
the area chosen for making the count in each house. The average
of these counts was taken to be the index for the sprayed and
unsprayed houses. It was found that in unsprayed houses, a
fly index of 3.32 was obtained from 368 inspections while in houses
which had received residual spray during 1947 the index was
only 1.06.
Control of other household pests: Roaches, bedbugs and Tri-
atoma were observed to have been killed by the DDT household
spray applications. Residual effects of the applications inhibited
development of infestations for a considerable period of time and
prevented the rapid increase of the pest populations when acci-
dental reinfestations were acquired.







68 ANNUAL REPORT, 1947


TYPHUS AND RODENT CONTROL
The Typhus and Rodent control program was conducted on
the same basis in 1947 as during the previous year. Projects were
operated as an activity of the local Health Department in six
counties; namely, Dade, Escambia, Hillsborough, Pinellas, Polk
and in the city of Jacksonville, Duval County.
DDT Dusting: Rat runs, rat burrows and other places fre-
quented by rats were dusted with 10% dust in nine cities in five
counties. During the year, 51,180 premise dustings were carried
out, requiring the use of 152,012 lbs. of dust. The average pounds
of dust used per premise was 2.6 for the first six months, and
3.24 during the latter half of the year, making the over-all average,
2.96.
Evaluation: Of 1,250 rats trapped in the undusted areas, 1,020
were captured alive. Of live rats captured, 1,018 were combed.
Identification of the ecto-parasites recovered showed the X. che-
opis index to be 6.16.
Each month blood sera from rats in both the dusted and un-
dusted areas were sent to the Virus Laboratory in Montgomery,
Ala., for complement fixation tests. Of the 928 sera submitted
from the undusted areas, 311 or 35.18% were found positive for
typhus; while only 202 or 12.40% of the 1,719 sent in from the
dusted areas were positive.
Rat Proofing: Organized rat proofing programs were operated
in the cities of Jacksonville, Pensacola, Tampa, Bartow, and some
work was done in Miami the latter part of the year. These
activities resulted in the rat proofing of 621 establishments. Breaks
in rat proofing were repaired in 196 establishments. Where re-
infestation had occurred in these structures, eradication measures
were again instituted.
Poisoning Activities: Poisoning activities included the dis-
tribution of 15,096 lbs. of bait mixed with various rodenticides in
14,441 establishments. In addition, 2,598 pints of 1080 poisoned
water were distributed in 2,214 places, and bait poisoned with
1080 was put out in 725 premises, making a total of 17,350
poisonings with various types of rodenticides..
Trapping and Gassing: Where the occupants of infested es-
tablishments objected to the distribution of poisoned bait, resort
was made to trapping. This type of control was instituted in
approximately 500 establishments. In 107 other instances, the
distribution of Cyanogas "A" Dust with a specially designed foot
pump was the method employed.









ENGINEERING


General Inspections: There was 90,261 premise visits made,
including contacts relative to rat proofing and poisoning activi-
ties, replacement of worn out garbage cans, removal of harbor-
ages, answering complaints about rat infestation, and attending
to other miscellaneous calls.
Reduction in Typhus Fever: In 1944, 64.25% of the cases
reported in the State were from six counties which, in 1945, re-
ported 69.23% of the cases. This influenced the selection of these
counties for intensified control measures, as it was believed
effort should be concentrated where the problem appeared most
serious.
For the State as a whole, there were 344 cases of endemic
typhus fever reported in 1947, 393 in 1946; a reduction of 12.47%.


AVERAGE NUMBER OF FLEAS
(XENOPSYLLA CHEOPIS) PER
RAT


5-

-\

3- \
2-


It I<
It II

I I I t
l Ia





'I It
II






1 1
I \







I
,
*
*


LEGEND

UNOUSTED
O- USED















0 /
\


333-
0-
I C I I C I I I I I I
JAN FEB MAR APRIL MAY JUNE JULY AUG. SEPT OCT NOV. DEC

Figure No 7 Seosonol comparison of Xenopsyllo cheopis indices on dom-
estic rots before ond ofter application of D D T dust for experimental typhus
control (Nine Cities in five counties in Florido )








70 ANNUAL REPORT. 1947


0 so o00 450 o '250 o00





194 1
|aax.


LEGEND
SReorted Cases
61 Counties,lUntre.o ft

Reported Coses
6 County$ Treated,


947 I


F.qgre No Mourne typhus fever cases reported 4 yer Period -State of Florldo



Educational Work: Educational work has been conducted
through newspaper articles, lectures, motion pictures, radios, and
the distribution of the booklet, "Roddy the Rat."
A representative of the typhus control section has been as-
signed with the classes in the Short Course for Sanitarians held
in Gainesville. By means of lectures, films, and through field
demonstrations, the trainees have been taught the principles of
typhus and rodent control.
Financing: Operations were financed through an allotment
of $63,000 from the U. S. Public Health Service, and through con-
tributions from communities in funds and services which amount-
ed to approximately $80,000.



TABLE XXXV
PRINCIPAL ACTIVITIES TYPHUS AND RODENT CONTROL -BY PROJECT.
1947

Total No. Average 1080 Poisoned Baits
No. Estab. Total Total lba. Poisoned AU Kinds
COUNTY Visits lish- No. lbs. DDT Water
All ments Premise DDT per
Reasons rat- Dustings Used Premise No. Pints No. Pounds
Proofed Premise Used Premise Used
Dade (Miami) 27,722 249 8,505 16,500 1.92 808 1,083 4,688 5,543
Dural (Jacksonville) 20,023 200 10,582 27,880 2.63 1,088 1,088 10,266 9,750
Escambia (Pensacola) 10,537 51 9,153 26,970 2.95 6 8
Hillsborough (Tampa) 19,375 51 14,118 52,820 3.74 286 391 182 408
Pinellas (Dunedin Largo,
Tarpon Springs, Pass-a-
Grille, Pinellas Park) 10,478 8,787 27,772 3.16 1 3
Polk (Barto.w Winter Haen) 2,120 70 35 70 2.00 25 25
TOTALS 90,261 621 51,180 152,012 2.97 2.214 2,598 15,136 15.701







ENGINEERING 71


Rat Ectoparasites Identified: Ectoparasites combed from 3,009
rats during 1947 totaled 50,512. Of these ectoparasites, 14,631
were combed from 1,991 rats in dusted areas, while 35,881 were
combed from 1,018 rats in undusted areas. In comparison with
12,446 fleas combed from 1,018 live rats in the undusted area, only
2,205 fleas were combed from 1,991 rats in the dusted area. A
total of 14,651 fleas were determined. From the same 3,009 rats,
16,354 mites, 19,476 lice and 31 ticks were combed and identified
as to species.
ANOPHELES ALBIMANUS IN FLORIDA
The Anopheline Survey of the Florida Keys, begun in 1946,
was continued January through April, 1947. Collections of
Anopheles albimanus larvae and adults were made in all four
months on Stock Island. No A. albimanus were found on Key
West.
During the period of May through August, although dipping
for mosquito larvae was discontinued, adult A. albimanus con-
tinued to appear in light traps operating on Stock Island and
Cudjoe Key. The U.S.P.H.S. quarantine service personnel col-
lected 34 females from Vaca Key. Two females were taken by
Navy Personnel on Boca Chica in July. One female was collected
at Fisher's Island, Dade County, by quarantine service personnel
during September but no larval specimens of A. albimanus were
taken. Dipping for anopheline larvae was resumed with nega-
tive results. Additional light traps were located from Key West
to Homestead.
Females of A. albimanus were collected in light traps on Big
Pine Key and Matecumbe during October. Larvae were dis-
covered on Big Pine Key in November and December while adults
continued to occur in light trap catches on both Big Pine and
Matecumbe.
Two specimens of A. albimanus were determined by quarantine
service personnel from light trap material at Miami Beach in
November.
The records of A. albimanus collections this year suggest that
the species breeds from Key West to Miami in environments to
which it is adapted although population densities of this species
are low.
SPOTTED FEVER VECTOR SURVEYS
Entomological investigations of two cases of Rocky Mountain
spotted fever, one of which was fatal, were made during the
year. Two suspected spotted fever cases were also investigated.
Special collections of ticks were made in the immediate locality








72 ANNUAL REPORT. 1947


of each case. Selected specimens of ticks from the locality of
two of the four cases were sent to the laboratory of the U. S.
Public Health Service at Montgomery, Alabama, to be tested
for the presence of spotted fever rickettsia. All tests were nega-
tive.
COMPLETED STUDIES AND PAPERS
PUBLISHED
1. Ault, John G. The Operation of the Extended Malarial Control
Program in Florida. Report of the Eighteenth Annual Meeting,
Florida Anti-Mosquito Association, April 27, 28, 29, 30, St. Peters-
burg, Florida.
2. Pritchard, A. E., E. L. Seabrook and J. A. Mulrennan. The Mos-
quitoes of the Florida Keys. The Florida Entomologist, Vol. XXX,
Nos. 1 and 2, August 1947.
3. Pritchard, A. E., E. L. Seabrook and M. W. Provost. The Possible
Endemicity of Anopheles albimanus in Florida. Mosquito News,
Vol. 6, Number 4, December, 1946. (Not listed last year).
4. Basham, Ernestine H., J. A. Mulrennan and A. J. Obermuller.
The Biology and Distribution of Megarhinus Robineau-Desvoidy
in Florida. Mosquito News, Vol. 7, No. 2, June, 1947.
5. Thurman, D. C., Jr., and J. A. Mulrennan. Occurrence of the
Brown Dog Tick on Florida Rats. Journal of Economic Ento-
mology, Vol. 40, No. 4, Scientific Notes, August, 1947.
6. Thurman, D. C., Jr., and J. A. Mulrennan. The Occurrence of
Sarcoptoid Mites on Rats in Florida. Journal of Economic Ento-
mology, Vol. 40, No. 4, Scientific Notes, August, 1947.

IN PRESS
1. Branch, Nina, and Thurman, D. C., Jr.
United States Records of Typhlodromus mariposus (Fox) (Acari-
na, Laelaptidae) from rats in Florida.
2. Thurman, D. C., Jr.
A Far South Record of Anopheles quadrimaculatus in Florida.
3. Basham, Ernestine
Culex (Melanocomion) mulrennani, a new species from Florida.
4. Thurman, D. C., Jr., Nina Branch and J. A. Mulrennan.
Description of the male of Androlaelaps setosus Fox and the
occurrence of this acarid in Florida (Acarina, Laelaptidae)










BUREAU OF
LOCAL HEALTH SERVICE

GEORGE A. DAME, M.D., Director

During the year, 1947, the chief activities of the Bureau of
Local Health Service, outside of routine administrative duties,
were the establishment of county health departments, securing
of more adequate local contributions from counties, the employ-
ment of a more adequate number of trained public health workers,
and the extension of more and better local programs.
During the latter part of the year, 1946, there were in active
operation forty-five organized accredited county health depart-
ments, showing an increase of nine over the previous year. At
the close of 1947 there were sixty accredited county health de-
partments, an increase of 15 over the previous year. The State
will begin the year, 1948, with only seven counties without or-
ganized public health facilities. Two of these will be organized
not later than March, leaving only five. These five are St. Johns,
Lee, Collier, Martin, and Hernando. It is believed that at least
three of the five will be organized in October, 1948.
At the close of the year, 1947, organized county health depart-
ments were serving a population of 1,863,411. This constituted
nearly 83 per cent of the total state population. Areas excluded
from these figures were the unorganized counties and the City
of Jacksonville. County public health budgets averaged $1.10
per capital, built up as follows: Contributions from county agen-
cies 64 cents; from the State 37 cents; from federal agencies 9
cents. It should be noted that county contributions increased
from 58 cents per capital in 1946 to 64 cents per capital in 1947. It
is quite certain that there will again be quite an increase in
1948. The counties that ended the year with contributions of
as much as 80 cents per capital were:

Glades .. --------------- $1.05 Dixie -..---- --__. -----.. ..85
Okeechobee ....-------. 1.00 Nassau ---------------- .85
Flagler .---------------.. 1.00 Hillsborough --------.... .84
Baker ---- ------- .95 Volusia ------------- .83
Liberty -- ---- .94 St. Lucie ---------- ....-. .82
Dade ...----------- .92 Monroe ...------- -------.. -- .82
Gilchrist ---....-----..... .87 Leon ..---.-___--------..--.-. .81


[ 73 ]










74 ANNUAL REPORT, 1947














FIGURE NO. 10

We present here a chart showing the 60 Florida counties with

currently active health departments. Leading the list in the

lower left hand corner is Taylor County, the first to establish

a health department after the Enabling Act was passed by the

Legislature to allow counties to participate with the State

Board of Health in public health control. Leon followed suit

the next year. However, Taylor's department was closed from

1933 through 1935, while Leon's has been continuous in its

activities. Six other counties. Hendry, Calhoun, Liberty, Osceola,

Gilchrist and Flagler also decided to discontinue their public

health programs after they had functioned a number of years.

However, all six were re-admitted to active service this year.


Llberty


ialhnula
0ak011.a
lusboron





M2f



Jackson Jackson


I Eece.. IbEa. ba I eamabia IEem.bia


I Leon eon I lien Leon l eon iLeon I


I..yo I T! ior I yt|o,- I--- I ---. ...


. .. ... 0 9 i -


ohkland





F raln i


Mon-ro


--)J V31 19 i3. 193 M 1 193b 19W 19P8


Eaibia E.acambia
Leon Leon
Tyl-r 1Ta1-r


Vw'CL'


PI*mYm































Sarasota




Union


DSle

Suvannee


Alachua Alachua Alachua

Sumter Sumter Sumter


1 4 F I


LOCAL HEALTH



Mn'vn 59


St Lucie 5'


Manatee 55

fardee 54

Putnami
Brevard 2

Sarasota 1




wolem 48
Carl.otte 4



Dlixe 46

Suwannee 45
Colmbia 44

Alacha 43
Sumter 42


tWehington Washington Washin n Wshgton W shington Washangton 39

MMadison Madison Madison Madison Madison Madison 38

Voluala Volusaa Teluala Volusia Volusia Volusia

Jefreffr efferon Jefferon Jefferson Jefafersn Jeffeann J-6
Santa Rosa Santa Rosa Santa Rosa anta Rosa Santa Roea Santa Santa Rose 35

Okaloosa Okalooea Okaloosa Okloosa Oi lolosa Oatloosa Okaloo.e 3

Walton Walton W Iton Walton Walton Walton Walton 33
Seminole Seminole Seminole Seminole Smnole Seminole Selnole 3

Flaler Flagler Flagler 3

Clay Clay Clay Cla Cla5 Clay Clay. 3
Bradford Bradford B~rdford Bradford Brad2ord Bradford tBeford 29
Gladea lalas Glades Clades Glades Glades Olades Glades 28

Gilchrist Gilchrist Gilchreit Gilchrist Glcbriat 27

Levy Levy Lev, Levy Levy L.evy Le- La

Baker Baker Baker Baker Bake) B r Ba.er Bael -

Bmilton Ramlton Hamilton amilton lamnlton
Oltes me olm OcealA 1_________n 2

Naseau Nasaau Nassau Namsau Nassau Nassau Nassau Nasa.u 22
Dade Dade Dads Dade Dade Dade Dade Dade

Handr --- -- -~ ---- -- -2dr 2
r Bay Bay Bay Bay Bay Bay Bay Bay 1

1 Duval Dural Duval Dural Duval Dural Dueal Dural 18
: Lake Lake Lakie LIe Lake Lake Lake Lake 17

__ orange orage Orange Orange orange Orange oran orange L6

as Highlands iahlada Hiland ihland hlands Blland Hllaa Eihlaa 15
- --- -- -- - --- -- Lirty 14

SLiberty 11

1la Wakulla Wakulla Wakella wakulla Wakulla WVakulla Waklla Vakuilla 12

moroi Rillsborom illaboroui iillaboro ii Bllobero illaborou Rillaboro 'IllBe1sboro 111borote Xl
tif Culf Culf Gulf Culf Gulf Gulf OGir ulf 10

1ai Fank1 Frankklln FaBan4 Franklin Franlin FranklIUn PrMklln Zankl3n -

JAL_ Pinellam Pinellas Pinellas Pinalla. Pinellan. Pnll.. Pinlm M Pinlea-

mo Noni Monroe Monroe Monroe Aonre Monroe 4i0= Honro onrM -

,den CGadden Cadden Gadeden Godaden Oadeden Gadaden Gadsden Gadeden 6

aord Breard Brosrd Breoard Brovarad roerd Bromvard Broard Brord
wen Jackeon Jackson Jackeon Jackso JJackmn Jacekso JJackan Jacskon 4
Ibisa Eaambla Esacabla Bacamba Ecambia Secsbia Egcambia Ecambia Esacmbia _

a Leon Lcon Leon Lean Leon Leon a Ion s aLe 2
or Taylor Taylor TaUylo Ta.lor Taylor Taylor Tylor Taylor
1 44 4 1 6 1


-nll


Polk


'Y'.


9- ) I f







76 ANNUAL REPORT. 1947


It is to be noted in the above list, size of population did not
affect the picture to any extent: The counties ranged in popu-
lation from 2,281 to 315,138. Several other counties almost made
the honor roll.
It should be borne in mind that $1.10 per capital for county
budgets does not include $140,609 of Cancer Funds allocated to
counties, nor various other services rendered to the counties by
state level agencies. Formula contributions have only been
considered.


STATE OF FLORIDA


i Acceed.ite& Cou.ntq
Health Departments


r Without Accred.tecL
H health Departnents


I---


'COLLAIt
C01lt
I --


0 --


FIGURE No. 9-DISTRIBUTION OF COUNTY HEALTH UNITS IN FLORIDA







TABLE XXX'"-SOME MAJOR G 1947


ACTIVITIES


COMMUNICABLE DISEASE CONTROL
Admission to service (A 1)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Diphtheria immunizations (A 16-18)
Typhoid immunizations (A 19)
VENEREAL DISEASE CONTROL
Admission to medical service (B 1)
Field visits (B 4)
TUBERCULOSIS CONTROL
Admission to med icalservice (C 1)
Admissions to nursing service (C 2)
Number of persons X-rayed (C 4)
Field nursing visinists (C 7)
MATERNITY SERVICE
Cases admitted to medical service (D 1, 8)
Cases admitted to nursing service (D 2, 7, 10)
Visits by antepartum cases to med. conf. (D 3)
Nursing visits (D 5, 6, 11, 12)
INFANT AND PRESCHOOL HYGIENE
Individuals admitted to medical service (E 1, 8)
Individuals admitted to nursing service (E 2, 9)
Visits to medical conference (E 3, 10)
Nursing visits (E 5, 6, 12, 13)
SCHOOL HYGIENE
Inspections by physicians or nurses (F 1)
Physical examinations (F 2)
Field nursing visi iits (F 5)
Dental inspections (F 7)
SANITATION SERVICES
Approved water supplies installed (J 1)
Approved excretia disposal systems installed (J 2, 3)
General sanitation field visits (J 4-11)
Field visits to food handling establishments (K 2)
Field visits to dairy farms (K 4)
Field visits to milk plants (K 6)
LABORATORY
Specimens examined


--~


J 4, a a -" k.zi
o I il I C I I C


A p

3 2 124 34 61 112
34 102 645 54 74 215
810 239 1,226 428 1,888 375
1,023 345 915 273 779 897
4,774 967 3,011 118 7 12,947

1,126 85 810 195 69 487
374 24 1,692 185 240 1,528

55 72 67 106 31 56
421 42 114 71 108 259
24,458 1,2889,275 1,0222,650 331
881 55 554 375 142 1,410

582 58 112 60 168 552
875 166 97 72 115 743
721 63 224 124 396 933
2,033 337 240 191 352 1,543

511 239 453 241 334 568
921 410 170 258 151 1,158
787 449 541 558 712 1,068
2,330 1,112 232 698 378 2,179

135 1,842 4,468 1,206 1,218 2,46
1,863 152 4,723 1,023 2,626 1,759
1,020 124 588 313 174 825
0 49 3 0 0 0

257 5 15 80 7 543
1,098 103 395 80 243 2,732
4,137 8752,173 286 878 2,751
1,257 561 1,112 495 5351 2,079
243 19 226 26 108 128
170 0 131 16 2 38

14,601 9657,3523,630 927 6,052


1,332
1,981
8,875
5,018
22,683

5,035
11,758

2,918
955
16,840
2,795

2,035
3,155
5,486
7,505

2,574
3,744
7,666
12,696

127,385
6,579
3,158
7,067

41
1,228
45,250
29,751
1,577
2,077

168,694


4 54 185
4 207 338
1162,740 2,072
51 875 1,929
3522,345 8,360

323,545 2,398
74 1,237 3,790

20 141 1,296
21 332 1,294
59 933 1,697

12 60 641
19 307 610
13 97 2,357
58 892 1,063

0 1,060 491
34 1,794 653
02,654 505
694,125 1,453

315 3,142 11,649
1,237 2,414 2331
143 417 585
1,1681,054 0

4 1,305 382
116 3,397 574
7737,257 3,189
2772,150 1,643
35 10 867
12 7 560

1,408 6,884 25,086


0 10 20
0 25 25
204 3061,411
82 86 1,080
203 754 1,66

37 93 361
19 160 544

0 70 198
0 332 389
0 1,751 ,746
0 34 710

0 36 436
11 40 797
0 63 926
21 811,862

0 67 472
22 53 1,554
34 902,873

74 354 5,017
350 1,076 1,600
136 35 460
0 7431 290

9 43 253
2 60 554
263 766 1,300
91 4571 393
14 13 122
10 4 27

2703,0514,992


0 17
0 41
20 117
3 54
422 991


17 59

3 5
17 103
452 61
1 226

6 8
12 85
6 8
16 240

13 26
13 217
13 35
20 890 0
0
134 1,439
31 429
101,741
0

0 37 E;
2 221 B
23 875
33 705
91 76
6 1

2061,549


.








TABLE XXXVI-SOME MAIOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1947 (Continued)


ACTIVITIES 2 |
i0-


COMMUNICABLE DISEASE CONTROL 7 4 0 20 1,958 23 1 44 38 22 52 19 1 6 11 240 53 103 0
Admission to service (A 1) 9 0 6,097 95 1 6 11 28 151 3 74 12 55 11 443 7 0
Field visits (A 2-9) 46 0 1 338 4,235 485 15 39 506 262 856 1,51 170 37 52 246 3 369 521 121 0
Smallpox immunizations (A 15) 64 0 0 67 4,030 612 97 1,803 1,053 141 752 1,125 37 71 110 426 401,522 623 88 0
Diphteria immunizations (A 16-18) 274 0 1,086 748 200 1,015 72,462 1,430 791 26 7,319 2,087 18 1,527 57 150 1,023 1,4431,0941,184
Typhoid immunizations (A 19)
VENEREAL DISEASE CONTROL 19 6 5 163 2,656 60 10 652 124 23 289 3,258 35 3 155 272 68 258 67 35 13
Admission tomedicalservice(B1) 72 90 1 96 7,996 47 20 51 164 27 2951,765 164 17 111 316 336 164 145 54 9
Field visits (B 4)
TUBERCULOSIS CONTROL 0 0 0 31 2,913 4 0 11 156 13 1 191 8 6 69 3 11 127 99 0 0
Admission to medical service (C 1) 37 6 0 1152,4 99 02 113 13 55 236 318 94 20 47 110 48 335 179 68 7
admissions o nursing serve (C2) 33 0 0 1,72828666 1,5972,21 272,102 5802,241 617 779 848 3,159 70 04,6792,641,111 3
Fieldnursingvisitsy(C7) 50 8 0 172 3,932 247 33 200 13 50 426 378 143 38 130 155 61 574 376 78 3
MATERNITY SERVICE 25 0 0 25 1,306 21 0 89 2 7 162 230 53 0 193 1 2 140 t4 1 0
Cues admitted to medical service (D) 7 10) 43 0 3 36 2,160 83 10 342 252 30 301 370 72 15 144 55 4 195 251 41 13
Cases emitted to nursing service (D 2,7, 1) 36 0 0 2 69 2,573 7 0 81 2 7 204 341 175 0 332 1 2 173 158 2 0
Visits antepartum cases tomed. con. (D3) 81 0 6 64 5,65 2 16 910 477 87 660 1,199 132 39 2431 126 6 770 441 79 21
nursing visits ( 54,004 647 25 6, 11, 12)
INFANT AND PREtSCOOL HYGIENE 72 0 1 1, 9,6 18 1 15 1 29 175 94 3 1 127 320 0 181 203 0 0
105, 4 3,2 9 2 24 17l 325 1 i7 2
Individuals admitted to medical service ( J 2, ) 1 0 3 62 5,23 258 32 75 813 373 46 14 195 65 19 327 3 27
Individuals admitted to nursing service (K 2 9) 16972 0 1 167 ,107 22 1 137 1 42 12 101 1 1 152 561 0 337 5 0
Nursgvisits ten e CE13,10) 271 0 6 103 12,088 482 27 389 782 147 1,376 635 53 42 264 100 202,406 927 117 35

Inspections by physicians or nurses (F 1) 326 158 01,70926,9622,823 80 7851,490 4164,093 2,139 224 614 58 979 7442,036 5,191 627 19
Pied visits dairy farmon s (K 4) 1,1318 1 0,574323 25 983 594 80 2 2,129 1,906 633 1 132 124 1 0
Field nursing visits (F 2) 21 25 0 531 4,004 647 25 301 73 130 326 329 110 29 132 188 15 255 414 1562 20
Deltal nusingpsits (F7) 1,323 0 0 0 9,673 178 215 0 0 0 311 363 146 0 96 48 86 415 80 log 19
SANITATION SERVICES
Approved water supplies installed (J 1) 8 6 0 2 4,071 20 0 14 47 1 609 103 32 3 48 56 6 37 3 14 0
Approved exeretia disposal systems installed (J 2, 3) 35 25 0 75 3,235 99 0 30 105 42 727 214 177 5 50 325 48 61 171 232 0
General sanitationfieldvisits(J4-1) 512 153 38 20139,6 844 52 382 685 188 2,493 12,107 1,602 79 860 ,38 2901,2291,72 509 0
Field visits tofoodhandling establishments (K 2) 16 179 29 194 14,915 28 21 631 187 61 81 1,540 139 50 1329 717 25 1245 8 0
Field visits to dairy farms (K 4) 18 2 141332,39285 450436 33 42 210 6 0298106132 024 62 0
Field visits to milk plants (K 6) 0 2 0 68 1,300 0 0 29 10 6 25 108 0 0 63 18 11 68 27 3 0
LABOeRATORY1
Specimens examined 1,700 117 64 1,442 80,350 3,038 743,6702,066 1,3414,372 12,968 1,629 1,342 ,3112,174 1,058 4,679 3,122 2,344 0


:0
0


0
t-
m
Mo






TABLE XXXVI-SOME MAT )


ACTIVITIES S
M0 0o o i


COMMUNI CABLE DISEASE CON IRnUl
Admissions to service (A 1)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Diphtheria immunizations (A 16-18)
Typhoid immunizations (A 19)
VENEREAL DISEASE CONTROL
Admissions to medical service (B 1)
Field visits (B 4)
TUBERCULOSIS CONTROL
Admissions to medical service (C 1)
Admissions to nursing service (C 2)
Number of persons X-rayed (C 4)
Field nursing visits (C 7)
MATERNITY SERVICE
Cases admitted to medical service (D 1, 8)
Cases admitted to nursing service (D 2, 7, 10)
Visits by antepartum eases to med. conf. (D 3)
Nursing visits (D 5, 6, 11, 12)
INFANT AND PRESCHOOL HYGIENE
Individuals admitted to medical service (E 1, 8)
Individuals admitted to nursing service (E2, 9)
Visits to medical conferences (E 3, 10)
Nursing visits (E 5, 6, 12, 13)
SCHOOL HYGIENE
Inspections by physicians or nurses (F 1)
Physical examinations (F 2)
Field nursing visits (F 5)
Dental inspections (F 7)
SANITATION SERVICES
Approved water supplies installed (J 1)
Approved excretia disposal systems installed (J 2, 3)
General sanitation field visits (J 4-11)
Field visits to food handling establishments (K 2)
Field visits to dairy farms (K 4)
lield visits to milk plants (K 6)
LABORATORY
Specimens examined


907 7 2 128
1,182 15 2 181
1,751 419 01,560
2,650 328 011,442
6,853 27 0 360

617 40 8 866
1,222 84 461,018

169 39 0 803
793 68 481,388
14,069 71 27 1,635
1,835 178 461,100

494 5 4 462
590 12 14 606
972 20 4 1,386
981 33 221,606

1,889 98 01,288
2,064 92 81,900
2,800 207 02,885
2,718 192 22 4,887

4,379 902 135 9,786
8,002 1,362 913,778
1,841 115 842,236
7,833 0 01,237

325 11 0 6
1,072 342 0 175
4,271 877 583,107
1,900 1,097 11 404
18 130 0 4
7 71 0 1

7,182 542 332 8,700


0 23 46 473 8 2 35 4 80 45 9 118 13 6,734
0 31 56 188 9 9 210 5 164 65 11 189 10 14,694
0 317 397 230 181 759 174 107 414 320 234 728 6 43,838
0 390 764 351 464 829 72 170 282 92 224 636 13 38,333
2,163 1,672 1,234 31 01,203 944 456 21 867 6061,689 170 106,649

4 54 166 288 101 204 24 34 782 43 39 112 0 26,813
24 78 302 736 68 682 107 59 739 24 8 87 26 41,033

0 44 37 30 7 12 12 0414 20 0 15 010,492
5 66 137 18 172 48 82 21 414 32 12 18 1 13,465
2 1,934 2043,150 902 1,93812,909 43 847 1,161 1,037 116 54 175,516
7 93 488 621 174 50 208 3911,461 91 49 80 75 26,554

0 0 53 210 12 7 18 27 154 55 0 45 0 8,753
17 31 90 526 33 12 59 19 412 118 20 84 67 14,714
0 0 65 334 12 7 24 53 328 98 0 58 0 19,118
40 46 254 1,761 38 19 127 7711,259 206 44 246 124 35,869

0 0 243 424 123 21 7 68 746 115 6 229 0 18,754
19 43 92 704 44 15 49 191,046 434 4 168 72 27,671
0 0 255 770 150 94 17 8111,762 312 21 324 0 37,305 t"
28 79 2703,802 78 49 109 363,125 811 18 626 124 68,575 O

01,3581,847 6,359 435 0 4712,6726,179 1,078 4211,438 51 204,959
0 113 1,528 1,997 5931,552 804 6814,670 6241,061 1,000 0 97,011
11 301 5943,178 102 53 43 10511,077 120 276 240 9 30,174
0 0 463 1,998 0 300 23 1404,88 0 0 80 0 43,967 m

0 20 325 164 14 74 39 7 766 58 113 7 10,926
0 99 623 345 55 86 257 14 859 11 432 210 128 22,306
0 428 2,430 1,997 821 565 2,482 633,943 1,741,827 972 1,162 168,070
0 661 595 724 174 936 253 10115,868 121 228 408 299 84,006
0 55 133 11 33 252 56 23 465 2 50 203 6 9,306
0 2 61 14 0 10 4 0 326 0 6 16 1 5,462

02,0831,647 2,8192,763 1,192 1,418 2,2079,9011,3702,1092,296 230 445,446







80 ANNUAL REPORT, 1947


DIVISION OF PUBLIC HEALTH NURSING

RUTH E. METTINGER. R.N., Director

Much has been said about the shortage of nurses, but it has
been revealed there is a larger number of nurses than ever be-
fore. However, there is a greater demand for nursing service
making it impossible to serve all who need it. The expansion of
Public Health in Florida, naturally, has made vacancies which
have been and are being filled more rapidly than anticipated.
At the end of the year 1947 there were no counties that did not
have some type of nursing service in public health activities.
As of January 1, 1948, there was a total of 329 public health nurses
which included all agencies.
The need for co-ordination has been stressed to prevent over-
lapping of visits, for economical reasons and a continuity of
service.
The Nursing Division serves every bureau and division of the
State Board of Health. Therefore, it has endeavored to arrange
for distribution in accordance with need of nursing assistance
to formulate plans and policies, and to insure an effective
program.
Progress in the educational field has continued by sending
12 county health unit staff nurses to Gainesville for the two
months' in-service orientation program. These nurses had no
training or experience in the field of public health. In addition
to the generalized program in which they were given theory and
experience, the Red Cross nursing service gave the accelerated
home nursing course by sending an instructor from the south-
eastern division to Gainesville who remained a month to observe
the classes which these nurses taught following this week of
intensive training. These classes were taught to groups of women
in the rural areas organized by the local Red Cross Chapter. The
course consisted of improvising in the home and teaching simple
emergencies and treatments when nursing services cannot be
secured, and also to give a better understanding of the Public
Health Nursing program to the communities.
Through scholarships granted by the State Board of Health
five nurses were given the basic Public Health Nursing course
at universities offering the approved course in public health
nursing.







LOCAL HEALTH 81


Scholarships in pediatric nursing were given to four nurses
employed in institutions with the understanding that they would
return to their present positions which would enable them to
give more valuable service to the hospitals in which they are
employed. During this course field experience was given to the
nurses which gave them a better understanding of the close re-
lationship in the field of Public Health Nursing and the hospitals.
Further education has been stressed and nurses encouraged
to take advantage of the G.I. bill of rights. As a result approxi-
mately eleven nurses will complete their public health course
in June 1948.
Arrangement and direction of in-service training for nurses
was carried on through an institute sponsored jointly by the State
League of Nursing Education, the State Nurses' Association, and
the Division of Public Health Nursing which included the hos-
pital group as well as the public health nurses. This was con-
ducted by a representative of the U. S. Public Health Service who
gave a series of four institutes, two days each, in strategic points
in the state. The subject was "The Social and Health Concept of
Nursing in the Basic Curriculum." These institutes pointed out
the value in the preparation of the nurses who will have an
understanding of the patient as a person, and who will be as
versatile in health nursing as in sick nursing. This stimulated
interest in several hospitals to affiliate in the field of public
health nursing.
Two State Supervisors' meetings were held, one in Gaines-
ville and one in Daytona Beach. Discussions brought out the
need for district meetings and having demonstrations in the vari-
ous phases of public health.
Five of the county health units have accepted 25 graduate stu-
dents from the Peabody College, Vanderbilt University, and the
University of North Carolina for field experience. These units
were visited by the representatives from the universities to
determine if they will secure the needed experience in relation
to the felt needs of the students.
It was the privilege of the Director of Public Health Nursing
to attend the Eighth Annual Conference of the Field and Resident
Faculty of Public Health Nursing Division held at the George
Peabody College for Teachers. The theme for the conference
was "Making the Curriculum in Public Health Nursing Effective
Through Group Planning." The discussion made paramount the
joint responsibility of the agencies for providing field experience
if public health nursing is to go forward.
Upon invitation by the Maternity Center Association of New








82 ANNUAL REPORT, 1947


York, one of the consultants attended and participated in a three
weeks' work conference. Following this, premature institutes
were conducted in the majority of the county health units, as
well as the hospitals in giving the newer methods in maternal
and child health.
The special school project established for the examination of
school children in the counties was a means of helping the nurses
in many counties to work more closely with the teachers. A
state nursing consultant prepared in Health Education was em-
ployed on a temporary basis to assist the nurses with the screen-
ing of children, as well as following through these cases needing
correction of defects.
The Nursing Division with approval of the county health
officer and the director of Maternal and Child Health has con-
tinued to license midwives. There are 561 midwives in the state.
Upon recommendations of the county health officers 22 honorable
discharges were given to midwives due to their physical disa-
bility to carry on the work as well as becoming aged.
We were indeed sorry to lose the white midwife consultant
who retired July 1. She worked diligently in bringing up the
standards of the midwives and investigating those who were




TABLE XXXVIII
NUMBER OF NURSES EMPLOYED FOR PUBLIC HEALTH WORK IN THE
STATE OF FLORIDA, JANUARY 1, 1947

Nurses Employed
Agencies
Supervisors Staff
State Health Department 1 5
Other State Agencies 1 1 6
RURAL 42 9 110
Departments of Health
URBAN 17 13 103
RURAL 7 9
Boards of Education
URBAN 3 7
RURAL 2 2
Other Official Agencies
URBAN 7 1 26
RURAL 3 3
Non-Official Agencies
URBAN 12 3 30
Schools of Nursing 1 1
TOTAL 96 33 296







LOCAL HEALTH 83


practicing illegitimately. Her retirement has necessitated plac-
ing most of the responsibility upon the county health units. The
other nurse certified midwife has concentrated more on insti-
tutes, supervising more closely deliveries and home visits.
Consultation service has been given to every county to guide
local health units in planning their nursing program, executing
the program, observing the field and clinic procedures, and an
evaluation of performance through a review of periodic reports.
The following table depicts the number of nurses employed
for public health work in different agencies in 1947.



DIVISION OF DENTAL HEALTH

GEORGE A. DAME, M.D., Acting Director

As the services of a competent dentist could not be secured
to fill the position of director of the Division of Dental Health
during the year 1947, the director of Local Health Services acted
in that capacity. Lack of other personnel prevented anticipated
expansion of the program as planned; however, as will be seen
by studying the statistics given, much worth while dental service
was rendered by the Division's only dentist. In addition, the
county health departments conducting dental programs accomp-
lished a commendable amount of work. Of necessity, only a very
small number of part-time clinics were operated.
It is now believed that satisfactory expansion of the dental
program can be made during the year of 1948. Beginning early
in 1948, the Division will be directed by an able doctor of dental
surgery. It is believed that one or two other dentists may be
secured for service in the field. There should, therefore, be a
considerable expansion in service during the coming year. In
1947, the mobile unit, under the operation of Dr. John E. Urich,
served fourteen counties. It is believed that probably double this
number can be served in 1948. A reference to Table XL under
the heading, "State Dentomobile Demonstration Clinics," will
show that a very considerable amount of work was accomplished
by one dentist.










84 ANNUAL REPORT. 1947


TABLE XXvm
PART-TIME DENTAL SERVICES IN COUNTIES

Fillings
Counties & No. Filling
Mos. Dentists Par- Mater- Pre- Treat- Extrac- Prophy-
ticipating nal school School Total ments tions Ama. Sil. Cem. laxis
1 Bay 1 6 6 .. 6 .. .. 6 3
4 Duval 1 22 22 13 22 3 10 14
3 Franklin 1 1 8 9 5 7 17 .. 12 1
5 Hillsborough 1 10 .. 56 66 6 90 2 2 .. 1
1 Lake 1 .. 4 4 3 .. .. 1 3
4 Monroe 1 20 20 9 18 31 .. 11 3



TABLE XXXIX
FULL-TIME COUNTY HEALTH DEPARTMENT CLINICS


Hills- Pin
Dade Duval borough ellas Totals
5 mos. 11 mos. 8 mos. 6 mos. 30 mos.
Patients, new 155 892 772 683 2,502
repeat 208 1,699 506 801 3,214
Inspections 3,342 917 9,939 1,112 15,310
Prophylaxis 14 247 85 163 509
Corrections:
Fillings -(Deciduous & Permanent)
Amalgam 277 805 274 774 2,130
Cement 111 580 41 663 1,395
Silicate 37 30 85 37 189
Extractions-(Deciduous & Permanent) 134 610 883 326 1,953
Treatments 94 424 184 417 1,119
X-rays ... 72 ... 72
Miscellaneous 12 550 ... ... 562
Total Corrections 665 2,999 1,539 2,217 7,420
Health Education:
Chair instruction 10 47 421 ... 478
No. Pieces Literature given out 585 195 781 ... 1,561
No. talks and attendance ... 1/25 ... ... 1/25
No. movies shown and attendance ... 9/1700 ... ... 9/1700



TABLE XL
STATE DENTOMOBILE DEMONSTRATION CLINICS


School Total

Patients, new 2,695 2,695
repeat 1,058 1,058
Inspections 2,703 2,703
Prophylaxis 2,741 2,741
Corrections:
Fillings-(Deciduous & Permanent)
Amalgam 2,110 2,110
Cement 425 425
Silicate 18 18
Extractions (Deciduous & Permanent) 921 921
Treatments 1,429 1,429
X-rays ..........
Miscellaneous 6,801 6,801
Total Corrections 11,704 11,704
Health Education:
Chair instruction 3,663 3,663
No. Pieces Literature given out 6,865 6,865
Classroom talks and attendance 107/4200 107/4200
Talks--other 1/50 1/50










BUREAU OF
MATERNAL AND CHILD HEALTH

T. PAUL HANEY. M.D., Dr.P.H., Director

In addition to those services which have been established and
expanded throughout the years since the Bureau of Maternal
and Child Health was set up, special emphases during the past
year have been on services to mothers and infants in the migrant
labor areas, to premature infants and to school children.
Because of the liquidation in July 1947, of the Labor Branch
Program of the Department of Agriculture, which included the
operation of the Migratory Labor Health Association, a plan was
worked out whereby MCH funds were made available for hos-
pital and public health services to mothers and children in the
area to be served by the Western Palm Beach County Public
Hospital, known as the Belle Glade Hospital. This area was in
especially great need of such a program because of the high per-
centage of indigency brought about from the influx of migratory
labor beyond the ability of local facilities to take care of them.
A combination of hospital services, medical and dental care serv-
ices and complete public health services was made available to
mothers and children, more especially in the western area of
Palm Beach County, but hospital and medical care services were
also available to similar patients residing anywhere in Florida
if the request for such services was made by a county health
officer within the State of Florida. The personnel to be em-
ployed included a full-time obstetrician, an obstetrical nurse
supervisor and a part-time pediatrician, but by the end of the
year not all of the positions had been filled although the indi-
cations were that they soon would be.
A number of premature infant incubators have been pur-
chased and placed at strategic points throughout the State to
better insure the specialized care needed by immature infants.
Plans were initiated to provide heated carriers for transporting
infants to hospitals when birth occurs at home or in a hospital
where incubator facilities are not available.
The Special School Health Services Program was carried
out with the cooperation of the State Department of Educa-


[ 85 1







86 ANNUAL REPORT. 1947


tion and began in January when 31 recent medical graduates came
into the State and worked in 42 county health units to do physical
examinations and immunizations. The staff also included a nurse
consultant and a supervising pediatrician. Children with reme-
diable defects were referred to their family physicians and in
cases where such service was not available, local resources were
used. Thousands of school children were examined who otherwise
would not have had this service due to the lack of personnel and
the large areas to be covered by some health officers.
The director also worked with the State Department of Edu-
cation in establishing the use of health educators in Florida, pri-
marily in an effort to improve school health services. The ob-
jectives were (1) to increase the number of corrections of physical
defects found in school children, (2) to improve the health habits
of school children, (3) to give greater assurance of immunization
against diseases for which immunizations are available before
the child enters school by better educational procedures with
parents and teachers, (4) to insure more complete cooperation
between health department officials and workers and the Depart-
ment of Education authorities and personnel, (5) to expand facil-
ities for improving the educational program particularly among
all types of food handlers and other adult members of the busi-
ness in general, and (6) to improve public relations between the
health department and the public in an effort to have the general
public more appreciative of public health activities and thus more
willing to lend active and financial support to them. Audio-
meters for use in testing the hearing of school children were
purchased.
Scholarships at the Southern Pediatric Seminar in Saluda,
North Carolina, were provided for four local health officers in
July.
Lecturers for the Postgraduate Medical Assembly, which is
an annual course held in Jacksonville by the Florida Medical
Association, were furnished with funds from this bureau.
Participation in the Mothers' Milk Bank in Duval County
which has now become an established service was through the
provision of funds for travel and salary of the nurse director.
Hospitalization and consultation were provided at the Florida
A & M College Hospital for abnormal maternity cases in the
Leon County area.
Liquidation of the Emergency Maternity and Infant Care
Program began on July 1st when Congress, through the U. S.
Children's Bureau, issued the regulation that only women who
were eligible as of June 30, 1947, would be entitled to the benefits







MATERNAL AND CHILD HEALTH


of the program if the husband was in one of the four lowest pay
grades of the Armed Services at sometime during the pregnancy.
This means that maternity cases which deliver early in April of
1948 will be paid for and infants of the women who were author-
ized for care will be eligible for medical, hospital and nursing care
and well-baby supervision until they are one year old. This will
carry the program on through April 1949, or until such a time as
all authorizations made have been paid for or canceled.
Nutrition services have been provided in the form of staff
education for many of the county health departments, and com-
munity education for the communities they serve. Talks, illus-
trated with slides, food, and other illustrative materials have been
made for community groups, such as P.-T.A., church groups and
local public health committees. Conferences for community
leaders have been held to help plan community nutrition activi-
ties and to help set up exhibits for county fairs and the like.
Nutrition services have been provided to maternity patients, both
directly, when the nutritionist has participated in prenatal clinics,
and indirectly, when the public health nurses have continued the
type of nutritional advice. Food classes have been held for
midwives to demonstrate proper food for antepartum and post-
partum patients. Nutrition materials for maternity patients, pub-
lic health nurses and midwives have been distributed through this
bureau. Advice on special problems of infant feeding and other
special dietary problems has been given on request. Consulta-
tion services in nutrition have been given to a number of child
caring institutions and convalescent homes. This has been done
at the request of and in cooperation with the Child Welfare Divi-
sion of the State Welfare Board. Services have included studies
of food purchasing, assistance in menu planning and staff educa-
tion for the institution staff. Materials on quantity food service
have been distributed from time to time.
During the year the department was enlarged to include the
newly established Mental Health Program and a separate report
is being submitted by the director of that activity.
Talks were made by the director before the State Department
of Education on school health services and before other interested
groups on subjects relating to maternal and child health.




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