• TABLE OF CONTENTS
HIDE
 Title Page
 Letter of transmittal
 Members of the Florida state board...
 Official staff Florida state board...
 County health officers
 Florida state board of health
 Foreword
 Table of Contents
 Bureau of preventable diseases
 Bureau of tuberculosis control
 Nutrition investigations and...
 Sanitary engineering
 Maternal and child health
 Local health services
 Laboratories
 Field technical staff
 Health information
 Vital statistics
 Narcotics
 Finance and accounts






Title: Annual report - State Board of Health, State of Florida
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Permanent Link: http://ufdc.ufl.edu/AM00000243/00019
 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: VID00019
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Title Page
        Page i
    Letter of transmittal
        Page ii
        Page iii
    Members of the Florida state board of health
        Page iv
    Official staff Florida state board of health
        Page v
    County health officers
        Page vi
    Florida state board of health
        Page vii
    Foreword
        Page viii
        Page ix
        Page x
        Page xi
    Table of Contents
        Page xii
    Bureau of preventable diseases
        Page 1
        Epidemiology
            Page 2
            Page 3
            Page 4
            Page 5
            Page 6
            Page 7
        Venereal disease control
            Page 8
            Page 9
            Page 10
            Page 11
            Page 12
        Cancer control
            Page 13
            Page 14
            Page 15
            Page 16
            Page 17
            Page 18
            Page 19
            Page 20
            Page 21
        Typhus fever studies
            Page 22
            Page 23
            Page 24
        Veterinary public health
            Page 25
            Page 26
            Page 27
            Page 28
        Industrial hygiene
            Page 29
            Page 30
            Page 31
            Page 32
    Bureau of tuberculosis control
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
    Nutrition investigations and services
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
    Sanitary engineering
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Entomology
            Page 70
            Page 71
            Page 72
            Page 73
            Page 74
            Page 75
            Page 76
            Page 77
            Page 78
    Maternal and child health
        Page 79
        Page 80
        Page 81
        Mental health
            Page 82
            Page 83
            Page 84
            Page 85
            Page 86
    Local health services
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Public health nursing
            Page 94
            Page 95
        Dental health
            Page 96
            Page 97
    Laboratories
        Page 98
        Page 99
        Page 100
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
    Field technical staff
        Page 108
        Page 109
        Page 110
    Health information
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
    Vital statistics
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
    Narcotics
        Page 125
        Page 126
    Finance and accounts
        Page 127
        Page 128
        Page 129
        Page 130
        Personnel
            Page 131
            Page 132
            Page 133
            Page 134
            Page 135
        Purchasing and property
            Page 136
            Page 137
        Hospital licensing
            Page 138
Full Text


49th ANumal Report




STATE BOARD OF HEALTH

state of / orida


1948







The following statistical reports will be published separately:
SUPPLEMENTAL I FLORIDA VITAL STATISTICS, 1948
SUPPLEMENTAL II FLORIDA MORBIDITY STATISTICS, 1948



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
























His Excellency, FULLER WARREN
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, 1948, to Decem-
ber 31, 1948, inclusive.


Respectfully submitted,


HERBERT L. BRYANS, M.D.
President

August 30, 1949
Pensacola, Florida






U J. .
; .
^ .7 /,'.,*
t ,Y.





















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

Dear Dr. Bryans:


I herewith submit the forty-ninth annual report of the
Florida State Board of Health for the year ending Decem-
ber 31, 1948.
Sincerely yours,


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

August 30, 1949
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, D.D.S.
Miami



MARK F. BOYD, M.D.
Tallahassee








OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH

State Health Officer................................................W ilson 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.
Division of Venereal Disease Control-.......Roger F. Sondag, M.D.
Division of Industrial Hygiene...................---------John M. McDonald, M.D.
Division of Cancer Control...--........-----Roger F. Sondag, M.D.
Florida Rapid Treatment Center...............---immy F. Henry, M.D.

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

Bureau of Laboratories -----------............................Albert V. Hardy, M.D., Dr.P.H.
Miami Regional Laboratory...........-------Vincent R. Saurino
Tampa Regional Laboratory........................H. D. Venters
Tallahassee Regional Laboratory.................Elizabeth Freeman
Pensacola Regional Laboratory....................Joe Gray
Orlando Regional Laboratory.............---------....Max T. Trainer

Bureau of Maternal and Child Health..........Frances E. M. Read, M.D.

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

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

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

Division of Health Information ------......................Elizabeth Reed (Acting)
Jess Wheeler (In temporary charge)

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









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.... -.....-..-- ........................-- M. Lewis Gray, M.D.
Calhoun Gadsden Liberty. ---.....................Edward C. Love, M.D.
Charlotte DeSoto Hardee.....................- .James W. Ferris, M.D.
Citrus Pasco Sumter....----.......................... R. N. Nelson, 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.................................... Maurice M. Hall, M.D.
Franklin Gulf Wakulla............................Terry Bird, M.D., M.P.H.
Glades Highlands Hendry...........................G. L. Beaumont, M.D.
Hillsborough................. ...................Frank V. Chappell, M.D., M.P.H.
Holmes Okaloosa Walton......................... (Vacant)
Indian River Okeechobee St. Lucie...........J. Ross Hague, M.D.
Jackson Washington.................................Robert G. Head, M.D.
Jefferson................. ........................ (Vacant)
Lake......................................... Charles O. Parker, M.D.
Leon................................... ....................H. A. Sauberli, M.D., M.P.H.
Levy................... ..... ........................Paul W. Hughes, M.D.
Madison Taylor..............-.....................Holland M. Carter, M.D.
Manatee Sarasota......................................William L. Wright, M.D.
M arion....................... .........................C. H. Blandford, M .D.
Monroe....-.................................James B. Parramore, M.D.
Orange.................................Leland H. Dame, M.D.
Palm Beach.............................. ..... Burton F. Austin, M.D.
Pinellas......................... ........................ T. Paul Haney, M.D., M.P.H., Dr.P.H.
Polk................... .....................Edwin G. Riley, M.D., Ph.D.
Seminole........................ ......................Frank L. Quillman, M.D.
Volusia......................................................R. D. Higgins, M.D., M.P.H.







FLORIDA STATE BOARD OF HIEALTTH-
GOVERNOR OF FLORIDA
FIVE BOARD MEMBERS

STATE 4EALTI OFFICER










FOREWORD

The following pages reveal, in detail, the record of the past year.
But for those who would like to quickly peruse our major accomplish-
ments and problems in the field of public health-
Nutrition work goes on apace, especially among the school children.
This is due largely to the cooperation of lunchroom workers and teachers
all over the state.
Tuberculosis control's main activity was the mass x-ray survey-20%
of Florida's people were examined. The tuberculosis death rate of 29.1
per 100,000 population was the lowest on record in this state. This was
lower than any other southeastern state. Much credit for this excellent
record is due to the excellent efforts of the state and county Tuberculosis
and Health Associations.
Preventable diseases: a public health veterinarian was added to the
staff. Typhus fever shows a marked decrease. 1,503 cases of cancer were
approved for state aid.
Sanitary engineering: for those who read national picture maga-
zines, it will come as no surprise that our major project has been the
abatement of pollution of underground and surface waters.
Entomology: malaria continued to decline on the basis of reported
cases, although there was a slight increase in reported deaths. Progress
was made in the control of all insect-borne diseases.
Maternal and child health: emphasis was again placed on services
in migrant labor areas. 16 recent medical graduates worked in 25 coun-
ty health units, doing school health examinations and immunizations.
A study of midwives showed that approximately half were 60 years
of age or over. A program was established to train younger women in
this profession. Infant and maternal death rates continued to decline
and the 1948 rates were the lowest on record in this state. However,
they are still considerably higher than the national average.
Mental health: four mental health clinics were established through-
out the state and one study program was undertaken in Volusia County.
Local health service: Palm Beach and Citrus Counties were added
to the list of accredited county health departments, leaving only Collier,
Lee, Martin, St. Johns and Hernando. Martin county has levied a
millage for matching funds for a health unit and will probably be organ-
ized in 1949.







Public health nursing: has had the great problem of coping with an
increasing turnover of personnel but this was stabilized somewhat this
year.
Dental health: a full-time director was employed at the beginning
of the year by the Division of Dental Health. His resignation, however,
prevented any appreciable extension of the dental program on the state
level.
Laboratory: the amount of work performed substantially exceeded
that of any preceding year.
Vital Statistics: a proposed amendment to the Florida Vital Statis-
tics Law was prepared and distributed to members of the state legisla-
ture. This amendment would make birth records confidential and pro-
tect individuals from unnecessary disclosure of illegitimacy, adoption, or
other information on this record which might be embarrassing.
Field Technical staff: acts as a liaison officer in coordinating the
work in the state with that of the counties. The staff has limited per-
sonnel but continue to do very effective work.
Health information: 45 food handler's programs were conducted in
27 Florida communities. Health Notes, the official monthly publication,
is now being mailed to a revised list of 10,000 persons. A Negro health
educator was employed and has been loaned to the Jackson County
Health Department.
Narcotics: still engaged in the enforcement of all laws in connection
with narcotics, medical, and pharmacy laws.
Finance and .accounts: the purchasing and property section was
added to this Bureau.
We no longer wish to dwell on the events of the past. Rather we
look forward to the future.
S During the coming year we have hopes of expanding our program as
follows:

LEGISLATION: 1. The amendment to the Vital Statistics Law
previously mentioned.
2. An enabling act to permit the formation of sani-
tary districts for the purpose of providing water
supply, sewerage disposal and garbage collection.
3. A law for the compulsory vaccination of dogs
against rabies.
4. A law to permit a program for the control of
diabetes aid to provide funds therefore.
5. A law to provide for the compulsory isolation of
recalcitrant persons with tuberculosis.







In addition to the above we have hopes of securing sufficient funds
from the State Legislature for expanding the following programs: School
health, dental health, mental health, stream pollution, cancer control,
the training of food handlers, and the organization of the remaining
counties of the state into county health units. We anticipate the receipt
of funds from federal sources for a heart disease control program and
for a more active program for the prevention of deaths among prema-
turely born children.
In this brief summary, the trained eye can detect the thousands of
manhours spent by all the personnel in carrying forward new programs
and coping with unexpected problems. No mention has been made of
routine work, without which we could not function or adequately serve
our citizens. Our appreciation is extended, as always, to the hundreds
of loyal and outstanding employees of the State Board of Health and
the County Health Departments.

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 ........--..----..........------...------------- 8
Cancer Control ....-.................----- -------.-------- 13
Typhus Fever Studies ...................--------- ------------ 22
Veterinary Public Health .................---------------.......------25
Industrial Hygiene ...................---------------------------------- 29


Tuberculosis Control --................-------------- -----------. 33

Nutrition Investigations and Services ............------------------------ 48

Sanitary Engineering ....----........---------------- ------------ 54
Entomology --.................---.------- ---------------- 70


Maternal and Child Health ........-............-.....-----..--.----- 79
Mental Health ..........................---------------- 82

Local Health Services ....-.......................--------- ...-- 87
Public Health Nursing ..........-- ........-......--- ----------- 94
Dental Health ............-- ...-...-- ----- -----------. 96


Laboratories ................ -----------... ...............98

Field Technical Staff .---- ----------.........---.....---- --------- 108

Health Information ........................ --------------------- 111

Vital Statistics ..............---......--------- ------------ 119

Narcotics .-........-...-..-...------------------------- 125

Finance and Accounts ..-.......--......-..---.--- ---------------- 127
Personnel ........... ..--------------------------- 131
Purchasing and Property .....--..--................--- ....------------ 136
Hospital Licensing .......-.... .-----------..----------- 138









BUREAU OF

PREVENTABLE DISEASES

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

During the year 1948 morbidity from all important reportable di-
seases remained at a normal seasonal expectancy or was below median
levels.
On January 1, 1948, Dr. J. E. Scatterday, Public Health Veterinarian,
was added to the staff of the bureau to expand the control of diseases
having their origin in animals. This expanded veterinary public health
program was a major activity of the bureau and the first summary of
activities is included in this report.
Dr. J. B. Hall, director of the Cancer Control Division, was granted a
leave of absence for one year to complete training for his Master's De-
gree in Public Health. He left during the month of August.
With the exception of Industrial Hygiene and the Veterinary Public
Health program, most of the activities of the other divisions within the
bureau were carried on by the director.
The reports of the various divisions and field activities under the di-
rection of the Bureau of Preventable Diseases follow.


[1]







2 ANNUAL REPORT, 1948


EPIDEMIOLOGY
R. F. SONDAG, M.D., Director

There were no notable outbreaks of communicable diseases during
1948. The incidence of all important reportable diseases remained about
equal to the median figures for the preceding years.
The reporting of cancer showed a marked increase over the preced-
ing year. This merely represents an improvement in the reporting of
this disease, as reporting in previous years lagged far behind the mortality
from cancer for the state as a whole.
Diphtheria showed a slight increase in cases reported over last year,
most of the increase being concentrated in Duval and Hillsborough Coun-
ties. This should serve to emphasize the need for increased immuniza.
tion, as this is a disease against which specific means of protection are
available and should be utilized to maximum benefits until the disease
has become as rare as smallpox.
There was a considerable increase in the number of enteric infec-
tions reported as compared to the previous year. This increase was due
to several outbreaks which occurred in various parts of the state. One
outbreak, in the Jacksonville Beach area was investigated and the enteric
infection was found to be due to Salmonella Montevideo. A number of
employees and guests at one of the beach hotels were acutely ill for sev-
eral days from this infection. The same organism was isolated from every
individual examined, but the vehicle responsible was not positively identi-
fied; however, it was presumed to be due to contaminated unpasteurized
cream. Appropriate measures were instituted to avoid a repetition of such
an outbreak.
Another outbreak investigated involved 120 students at the Florida
State University. This outbreak of Bacillary Dysentery was due to Shi-
gella Sonnei, and was investigated by the health officer of Leon County,
who determined the vehicle to be contaminated uncooked food in salads
prepared in the school cafeteria. The carriers were excluded from the
kitchen and placed under observation, after which the epidemic promptly
.subsided.
There was almost a three-fold increase in the number of infantile
diarrhea cases reported in 1948 as compared to the previous year. Ap-
proximately half of this increase was due to an epidemic of infantile
diarrhea in Miami. This epidemic was thoroughly investigated by the
Dade County Health Department, 75 infants being involved, with 11
deaths. It was determined that the outbreak in the hospital was intro-
duced from the outside by the admission of infants with diarrhea need-
ing hospital care. The disease soon spread to the new-born nursery, ap-
parently through faulty technique, injudicious interne and nursing re-
lief, and overcrowding within the nursery itself. At the time of this out-
break, the City of Miami was also having an outbreak of gastro-enteritis
in older children.







PREVENTABLE DISEASES 3


There was a considerable decrease in the number of influenza cases
reported during the year.
Eleven new cases of leprosy were reported, all of whom voluntarily
submitted to treatment in the National Leprosarium at Carville, Louisi-
ana.
Of the childhood diseases, measles and mumps particularly, there was
a considerable increase in reporting during 1948. This, no doubt, repre-
sented better reporting rather than increased incidence as compared to
previous years.
The incidence of poliomyelitis was of normal seasonal expectancy,
but the hysteria and apprehensions resulting from the epidemic in North
Carolina created more headaches for the bureau than the cases occurring
in Florida.
Morbidity from typhus fever again showed a marked decrease over
the previous year. No cases of rocky mountain spotted fever were re-
ported during 1948. Most of the employees working for the U. S. Fores-
try Service were immunized against this disease with vaccine supplied
by the U. S. Public Health Service.
There was a three-fold increase in the incidence of tetanus, the ma-
jority of cases being reported from Duval and Dade Counties. It again
must be emphasized that elimination of this disease is dependent upon
increased active immunization with tetanus toxoid for those likely to be
exposed to infection, reinforced by another injection of toxoid at the
time of injury. A person lacking adequate previous immunization should
receive 1500 units tetanus anti-toxin given on the day of injury.
New cases of typhoid fever were reported sporadically throughout the
year from most sections of the state. There was an increase in the num-
ber of typhoid carriers needing surveillance under health department
rules and regulations. Many of these carriers migrated here from other
states and a carrier file is maintained on them. All carriers are investi-
gated every six months by local health officers. Many carriers moving
here from other states voluntarily report to local health departments to
subscribe to health department rules and regulations. No known new
cases of typhoid fever were the result of typhoid carriers. Most of the
new cases of typhoid fever resulted from eating infected shellfish originat-
ing from condemned areas.
The diseases reported by counties in Florida during 1948 are shown
in Table I.








TABLE I
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1948 -
AND STATE TOTALS FOR 1946 AND 1947



E .c





TOTAL FOR 1947 1,025 745] 1,969 84 67 2 59 11 8 31 64 20,160 2711 4,605t 1,083 24 216 121 14 1,315
COUNTIES f I




TOTAL FOR1948 1,880 3881 1,402 93 1913 153 179 40 5 24 52 56 18,820& 773g 5,008 366 66 197 1075 4,802
ALACHUA 38,245 12 4 4 5 548 14 306 1 3 12 59




BAKER 6,3260 10 1 21 22 1 44 12
BAY 57,70 3 1 2 53 4 4 1 22
09 o 0 a5 l
-8U U U U 0 0 0 CE U U U 0 0 0 X -b .* E 5

TOTAL FOR 1946 1,041 818 9 88 1 361 79 27 8 14 4 59 13 18,543 57 3,805 227 32 176 459 44 3,491 W
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 1,31
TOTAL FOR 1948 1,880 388 1,402 9 191 327 153 179 40 5 2 18,820 773 ,008 66 66 197 107 4 4,802
ALACHUA 38,245 126 4 8 1 4 5 1 14 306 1 3 12 59
BAKER 6,326 10 1 2 1 22 1 44 12
BAY 57,700 3 1 1 1 2 563 1 4 1 22
RADFORD 12,000 5 1 2 1 1 87 2 55 1 14
BREVARD 21,400 6 8 1 5 3 50 5 23 1 5 2 31
BROWARD 57,200 63 1 21 1 1 6 1 1 177 7 7 4 1 1 1 258
CALHOUN 8,230 1 8 3 241
CHARLOTTE 4,580 1 1 1 4
CITRUS 5,427 2 3
CLAY 12,300 6 15 2 1 26 111 62
COLLIER 4,957 2 1 2 11 4 23 7 2 4 2
COLUMBIA 17,300 3 1 25 542 1 1 2
DADDE 345,800 588 8 308 17 167 8 1 15 2 4 22 3,32 8 1 33 5 4 1 2,167
DESOTO 6,854 5 2 1 1 53 5 1 16
DIXIE 4,926 1 1 11 1 6 1 1
DUVAL 314,900 157 62 186 5 1 85 92 13 3 18 3,301 140 124 3 1 26 1 1 257
ESCAMBIA 125,000 55 18 2 1 42 1 1,828 29 156 5 1 2
FLAGLER 2,652 1 1 1 1 69 3 1 14 2
FRANKLIN 9,300 13 53 1 27 1 1 4
GADSDEN 31,300 5 1 1 2 2 1 2 311 8 68 1 17
GILCHRIST 3,466 4 1 1 1 1 1 1 1
GLADES 2,281 4 10 3
GULF 7,050 3 3 28 6 43 1 11
HAMILTON 8,731 3 3 1 1 10 3 64 3 2 4
HARDEE 8,585 4 2 6 1 1 4
HENDRY 5,066 7 1 4 10 5 2
HERNANDO 5,700 1 14 1
HIGHLANDS 20,700 3 2 11 2 1 92 9 44 2 2 2
HILLSBOROUGH 225,600 321 38 297 31 8 62 3 1 1 11 9 2,117 79 254 82 4 32 2 1 426
HOLMES 14.627 4 84
INDIAN RIVER 9,160 7 4 10 1 1 1 2 3 1 78 3 31 34 34
JACKSON 34.570 1 2 1 1 17 8 8




TABLE I (Continued)
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1948 -
AND STATE TOTALS FOR 1946 AND 1947



zo ; ,* i -
,-x < 6 0
COUNTIES <. E > I

LV 9 23 2 7 5 a 1 a 2 0 4& *, 98 1 1 9



LAFAYETTE 3,995 2
4, S Cg 4 o o C 6 E 4


JEFFERSON 11066 6 3 1
LAKE 28,400 7 1 13 1 1 2 3 58 6 106 7
LEE 27,500 7 1 8 37 10 2 1
LEON 37,900 5 5 53 1 2 11 120 1 937 1 4 2 2 112
LEVY 9,902 23 2 7 5 1 26 4 38 98 1 11 9
LIBERTY 3,193 1 1 6 8 2 1 9 2 10 4
MADISON 15,537 8 1 3 2 1 1 56 2 32 28
MANATEE 27,300 44 2 3 1 127 12 335 2
MARION 37,700 10 11 3 1 380 7 81 2 4
MARTIN 6,094 1 3 2
MONROE 22,200 6 1 7 9 6 1 1 497 1 19
NASSAU 10,900 15 1 2 1 1 1 21 1 80 2 1
OKJALOOSA 18,300 2 8 1
OKEECHOBEE 2,919 3 1 4 1 1 1 31 8 25 40 1 12t7 l
ORANGE 97,500 9 3 158 6 1 1 2 3 444 18 1 1 71] -
OSCEOLA 10,900 14 1 2 1 19 5 1 1 50 1 1 3
PALM BEACH 183,100 17 28 28 3 1 1 1 3 310 111 6 1 27 1 400 Z
PASCO 13,729 11 1 6 3 1 35 7 219 13 N-
PINELLAS 154,900 44 7 13 2 2 1 1 551 26 2 1 2 145
POLK 128,900 54 7 58 13 5 18 2 27 5 390 18 265 5 9 1 311
PUTNAM 17,837 15 5 1 1 1 252 15 14 2
ST. JOHNS 22,600 2 19 1 603 2 3 13 tl
ST.LUCIE 13,600 7 3 1 5 8 1 1 161 32 4 1 7 1 27
SANTA SARO 17,600 1 2 3 7 82 1
SARASOTA 21,200 32 4 1 1 92 3 1 1
SEMINOLE 26,000 1 2 8 8 3 1 200 14 36 10 6
SUMTER 10,417 12 24 2 2 1 86 8 140 1 2
SUWANNEE 17,900 3 1 3 2 1 38 5 5 1 1 2 2 W
TAYLOR 10,738 4 1 18 1 7 1 42 1 3
UNION 6,051 8 15 1 170 1 c.
VOLUSIA 62,600 112 5 88 2 8 2 2 2 42 14 128 1 16 2 15
WAKULLA 5,059 1 18 24 1 42 85
WALTON 138,871 2 1 10 2 265
WASHINGTON 11,889 5 1 44 1 216
____ ____ ____ ____ ____ U

















COUNTIES





TOTAL FOR 1946
TOTAL FOR 1947
TOTAL FOR 1948
ALACHUA
BAKER
BAY
BRADFORD
BREVARD
BROWARD
CALHOUN
CHARLOTTE
CITRUS
CLAY
COLLIER
COLUMBIA
DADE
DESOTO
DIXIE
DUVAL
ESCAMBIA
FLAGLER
FRANKLIN
GADSDEN
GILCHRIST
GLADES
GULF
HAMILTON
HARDER
IIENDRY
HERNANDO
HIGHLANDS
HILLSBOROUGH
HOLMES
INDIAN RIVER
JACICSON


81 3 8


TABLE I (Continued)
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1948 -
AND STATE TOTALS FOR 1946 AND 1947


59 1
438
332
332 1


2


16,067
16,653
15,395
244
31
195
32
117
515
39
29
23
36
44
86
2,063
80
15
1,958
808
83
49
258
6
38
63
74
38
71
32
156
1,510
21
69
120


81 123
67 151
74 167
3





TABLE I (Continued)
CASES OF REPORTABLE DISEASES, BY COUNTIES, FLORIDA, 1948 -
AND STATE TOTALS FOR 1946 AND 1947


COUNTIES





JEFFERSON
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
SUWANNEE
TAYLOR
UNION
VOLUSIA
WAKULLA
WALTON
WASHINGTON


00 0
0
0 0


Z :E 0 a
-. ^ s 5On a


1
1
I 1
II


ii
1 1
1
1




1




1 a
I
1 1








il
Si


1 ~1 2 2

2 1
64
2 1
3 1 1 4

26 2 1 79
1


tI1
Cd




w
U



ni

M
>
:p,





En
nil
W
M







8 ANNUAL REPORT, 1948


VENEREAL DISEASE CONTROL

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

Year after year between 18,000 and 20,000 new cases of gonorrhea
and 15,000 to 18,000 new cases of syphilis are reported to the Venereal
Disease Control Division.
One might ask "Are we making progress in venereal disease control?"
Those who are unimpressed by the progress that has been made or who
are gloomy concerning the future, need to analyze the situation. Ac-
tually, there was a decrease of 1,000 cases or more for both syphilis and
gonorrhea during 1948. The number being reported and under treat-
ment is still significant but should be no cause for pessimism, because
paradoxically, the more syphilis and gonorrhea being treated by prac-
ticing physicians and venereal disease clinics, the less we have to fear
the spread of these diseases.
Modern treatment has become so effective that the treatment of gon-
orrhea may be accomplished in better than 95% of the cases with a single
injection of penicillin, and four times out of five, a case of syphilis may
be cured in a week or ten days with penicillin treatment. The number
of cases of syphilis and gonorrhea under treatment, therefore, is not a
true index of increasing prevalence. We must continue treating large
numbers of cases of syphilis and gonorrhea annually until the hidden
reservoir is exhausted. As long as this is accomplished, we should have
just cause for optimism, as eventually these diseases should be treated
out of existence.
The treatment control of gonorrhea and syphilis alone, however, has
its limitations, and its control cannot be left solely in the hands of the
so-called experts. All resources must be properly and simultaneously
employed to bring about a reduction in venereal diseases. The com-
munity as a whole has a tremendous responsibility in this problem. That
responsibility can be discharged in many ways by seeing that laws against
vice are rigidly enforced; that the community cooperates to the fullest
extent possible with the public health agencies seeking to keep venereal
disease incidence at the lowest possible level; by providing proper recrea-
tional facilities; by promoting youth movements and teen age clubs; and
by the promotion of home, school, and religious teaching in the field of
ant an attitude toward the moral offender. Those who are unresponsive
human relations in the broadest sense of the term. Society has too toler-
to appeals on moral grounds must be made to listen and heed warnings
regarding their health. Venereal diseases are spread by promiscuous
sex behavior. Promiscuity costs society heavily in money, in a feeling






PREVENTABLE DISEASES 9


of general well being, in the respect of neighbors, in the chances of hav-
ing happy and successful marriages, and in many other ways.
The strongest fort, therefore, against such behavior is stable home
and family life. Greater and greater strides in the social and moral ap-
proach must be made to improve the preventive phases of this problem.
Home, school, and religious training can tremendously improve upon the
behavior problems of the past. The control of venereal diseases cannot
be left alone to the health officers and restricted to a case finding and
treatment program. When the program reaches the point where good
moral home, school, and religious training combine forces simultaneously
with the case finding and treatment programs, then we will be able to
point to a true downward trend in the incidence and prevalence of
venereal diseases.
The Rapid Treatment Center at Melbourne is a significant factor
in the control of venereal diseases. During 1948, 7,379 cases of syphilis
and 381 cases of other venereal diseases were treated there. Since strep-
tomycin was made available, the Rapid Treatment Center facilities have
been used almost exclusively in the treatment of granuloma inguinale.
Patients suffering from this disease have no refuge and the Rapid Treat-
ment Center has been a haven for the treatment of this loathsome condi-
tion. Streptomycin has proved so effective in the treatment of granuloma
inguinale that it is conceivable to eliminate this condition in the not too
distant future.
The statistical tables covering various activities of the venereal disease
program follow.







TABLE II

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 ADMITTED TO THE RAPID TREATMENT CENTER, BY COUNTIES, FLORIDA, 1948


STAGE OF INFECTION


COUNTY
E


RACE AND SEX SOURCE OF REF

WHITE COLORED


-2 1 J.. I0 -


LATE






69 60- 5 18 3
8 7 -1 -
92 27 3 11 1



4 11-- 2-
6 7- 2
8 8- 2 -
16 14- 3 1-
27 31- 2 9-
795 617 4 33 54
15 24- 2 10 1
5 3- 2 2-
592 428 14 53 41 3
318 178 1 23 22-
25 20- 2 3-
19 21- 1 1-
50 21 1 4 5 1
2 2 1-
14 3- 3-
24 17 1-
27 23- 3 4-
9 14- 1 3-
23 25 1 2 -
10 13- 2 -
45 48 4 8 2
453 472 16 52 35-
3 2- 1-
17 24- 1 5-
39 18- 13 -
10 4 1 1-
6 5- 1 7-
63 481 1 16 -
46 38 1 11 -


59 4
8-
90 3
2-
57 2
314 5
1-
16-
14 1
13-
32 1
34 2
1,064 9
35-
4
934 7
153 2
50 1
19
9-
1-
2 1
27-
7-.--
14-
20 -
27 2
84-
782 7

26 2
27 3
10 -
2
114 -
89 1


AGE GROUPS


*6 6 -
-6 (' -
-6~ .


244 18 22 25 81 116- 185
31 2 3 2 9 17- 23
195 15 34 44 39 78- 105
32 6 5 14 13 30
117 7 13 9 41 54 60
515 26 43 47 166 259 201
39 2 1 6 9 23 38
29 5 5 14- 13
23 2 2 3 7 11 9
36 3 2 9 12 13- 23
44 3 1 3 16 24- 12
86 4 5 5 33 43- 52
2,063 66 351267 612 833- 999
80 3 4 6 32 38- 45
15 2 1 2 10- 11
1,958 95 167238 570 983-1,024
808 27 65 74 269 400 655
83 3 4 7 37 35-- 33
49 1 5 10 13 21 30
137 19 3 4 48 82- 128
6 1 1 2 2- 5
38 5 2 1 22 13 36
63 3 7 8 17 31 36
74 2 1 2 32 39 67
38 1 8 4 10 16- 24
71 6 2 2 25 42 51
32 2 2 8 6 16- 5
156 2 5 10 53 88 72
1,510 37 254268 473 515- 728
21 7 4 4 6- 21
69 3 4 3 32 30 43
120 7 12 8 39 61- 93
29 5 1 1 12 15 19
24 1 5 1 5 13 24
173 8 15 21 64 73 59
161 141 22 58 70 75


Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee


ADMISSIONS TO
RAPID TREAT
MENT CENTER


40
3
28
1
11
47
5

1
7

8
332
8

489
48
11
2
25

4
6
4
2
5
4
14
224
7
8
15
5

12
23


-6
7 30
2 7
- 1

2 17
7
1 1
6
-1
12-
1 2
1 4
1 2
2

3 7
2 21
1
1 3
2 17
1-
2 2
3 8
1 12


-c



13
1
6


25
1


0
CO


0
S 0




12 7 3
1 1
13 1 1
1 2
13 9 2
34 16 3
5 2
3 5
1 3





11
2 2
5 3 2
9 4 5

8 1 3

166 54 26
76 18 5
9 3 1
5 4 2
6 1 2
1--
1 --
5 1 2
5 5 1
9 1 2
3 -
1 1 -
12 7 2
168 77 39
2 2 -
4 4 1
4 3 1
3 -
15 10 6
15 10 --


E
E K
z

127 52.0
17 54.8
89 45.6
40 125.0
84 71.8
159 30.9
35 89.7
21 72.4
14 60.9
26 72.2
19 43.2
49 57.0
538 26.1
73 91.3
13 86.7
1,010 51.6
663 82.1
59 71.1
21 42.9
103 39.9
3 50.0
36 94.7
33 52.4
56 75.7
29 76.3
44 62.0
11 34.4
120 76.9
588 38.9
9 42.9
60 87.0
85 70.8
21 72.4
21 87.5
59 34.1
44 26.8





TABLE II (Continued)
TOTAL NUMBER OF SYPHILIS CASES BY STAGE OF INFECTION, PREGNANCY STATUS,
RACE AND SEX, SOURCE OF REFERENCE, AGE GROUPS AND THE NUMBER AND PERCENTAGE OF
CASES ADMITTED TO THE RAPID TREATMENT CENTER, BY COUNTIES, FLORIDA, 1948


STAGE OF INFECTION RACE AND SEX

LATE WHITE I COLORED


5----00 0 -
6 U z o: 7
0. dO CV2O oz 5 5 3^,


COUNTY




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
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington
State Hospital
State Prison
Out of State

TOTAL


91 60
28 19
7 3
16 13
41 40
59 56
11 14
30 25
10 7
20 9
12 17
254 206
27 35
358 206
28 45
186 215
369 367
92 80
22 20
41 44
9 6
31 45
96 127
23 15
20 16
11 5
8 3
74 100
3 5
10 11
20 8
9 106
29 23
29 44

5,17814,427


195 -
38-
13-
29-
67-
86-
20-
28-
22-
24-
21-
81-
326 -
31
404 -
44-
235
404-
120 -
O
26
105-
9-
45-
171-
37-
37
15-
11
107-
6-
22 -
24-
28-
2 -
17-

,866 -


SOURCE OF REF AGE GROUPS





o. V. ? N I 0
= .. t-


i,790 6,6948 8i88 428 5,159 4,1482,630 1,416


ADMISSIONS TO
RAPID TREAT-
- MENT CENTER



E
t z


43.0
55.7
111.1
75.8
63.5
67.8
71.4
68.1
91.5
96.0
63.5
41.9
69.9
59.5
60.4
52.0
45.0
49.8
46.3
73.5
81.8
34.8
42.4
58.8
54.5
74.2
28.4
74.5
91.7
75.0
76.5



50.0


1,99012,857


--





342 161 5120 15,484 65011,65211,69215,27416


, I I


-
















TABLE III
ADMISSIONS AND READMISSIONS TO FLORIDA RAPID TREATMENT CENTER
BY DISEASE, STAGE OF INFECTION, RACE, AND SEX, BY MONTH, 1948


DISEASE AND STAGE OF


INFECTION N


ADMISSIONS READMISSIONS


SYPHILIS




0


00
-0
" o Z


z
0


00
i1
0


Z

CRACE AND SEX

RACE AND SEX


WHITE


- C1


COLORED l

O




c
_'0


I I
9


January 386 140 57 29 33 645 5 18 -1 20 688 4 3 7 695 57 84 245 309
February 395 152 65 33 23 668 5 16 3 23 715 11 3 14 729 49 46 292 342
March 373 192 81 31 83 710 7 29 6 53 805 20 1 6 27 832 55 65 349 363
April 311 233 85 47 28 704 10 38 6 57 815 23 2 25 840 58 55 328 399
May 253 218 106 41 43 661 3 37 7 47 755 15 1 3 19 774 52 61 326 335
June 193 197 153 32 58 633 8 32 5 93 771 30 7 37 808 54 47 294 413
July 203 147 158 42 49 599 9 31 4 75 718 32 7 39 757 6 44 292 365
August 188 191 167 62 42 650 8 22 7 62 749 40 2 4 46 795 58 57 320 360
September 148 202 146 52 36 584 7 11 11 62 675 23 1 4 28 703 37 48 281 337
October 141 174 162 37 26 540 8 22 6 55 631 30 6 36 667 46 58 257 306
November 132 157 143 56 35 523 6 17 3 34 583 35 5 40 623 49 44 256 274
December 109 146 131 45 31 462 6 26 4 23 521 45 1 46 567 60 51 218 238
TOTAL 2,832 2,149 1,454 507 437 7,379 82 299 51 6168,426 308 5 51 364 8,790 631 660 3,458 4,041

Per Cent 32.2 24.4 16.5 5.8 5.0 83.9 .9 3.4 .6 7.0 95.9 3.5 .1 .6 4.1100.0 7.2 7.5 39.3 46.0


MONTH
OF

ADMISSION







PREVENTABLE DISEASES 13


CANCER CONTROL
R. F. SONDAG, M.D., Director

With the passage of the Cancer Control Law by the 1947 Legislature,
and the establishment of a Division of Cancer Control in the Bureau of
Preventable Diseases on September 27, 1947, all the interest and concern
about cancer as a major public health problem were crystalized into
definite and organized action. The cancer control law provided a four
point program of (1) Education; (2) Establishment of tumor clinics;
(3) Tissue diagnostic service to all needy patients; and (4) Financial
aid in diagnosis and treatment of medically indigent patients, within the
limits of available funds. To provide these services, a state appropria-
tion of $200,000 per year was made available by the Florida Legislature
beginning with the fiscal year July 1, 1947.
The cancer program has now operated a little over one year, so
activities during the calendar year 1948 offer the first opportunity to
analyze the accomplishments to date, and to consider the possibility of
further progress possible under the provisions of the Florida Cancer Con-
trol Act.
This report covers those cases approved for state assistance, which
represents only a part of the total cancer morbidity in Florida. It is not
appropriate nor possible to evaluate a one year program and this fact
should be remembered when interpreting the data and making compari-
son.
During 1948, 1,503 cases were approved for state aid under the can-
cer control program as having a malignancy or a suspected malignancy.
Of these, 776 (51.6 per cent) were cases of cancer or other malignant
tumors, 298 (19.8 per cent) were non-malignant, and 429 (28.5 per cent)
diagnosis not determined at time of this report (Table IV). The num-
ber of cases approved in the white race, 1,166 (77.6 per cent), was more
than four times the number of cases approved among Negroes. There
were 253 (32.6 per cent) malignancies discovered in the white males,
and 341 (44.0 per cent) in the white females. More white females were
approved for state aid than any other group and more malignancies
were diagnosed in this group. In the colored race, 56 (7.2 per cent)
males and 126 (16.2 per cent) females were diagnosed with cancer or
other malignant tumors.















NUMBER AN


TABLE IV
D PERCENTAGE DISTRIBUTION OF CASES APPROVED FOR STATE-AID
ACCORDING TO STATUS, BY RACE AND SEX Z
FLORIDA, 1948


WHITE COLORED
TOTAL MALE FEMALE MALE FEMALE
STATUS NO. % NO. % NO. % NO. % NO. %
Cancer and other malignant tumors 776 51.6 253 32.6 341 44.0 56 7.2 126 16.2
No malignancy 298 19.8 62 20.8 162 54.4 24 8.0 50 16.8
Incomplete information 429 28.5 139 32.4 209 48.7 21 4.9 60 14.0
TOTAL 1,503 100.0 454 30.2 712 47.4 101 6.7 236 15.7


TABLE V
NUMBER AND PERCENTAGE DISTRIBUTION OF CASES OF CANCER AND OTHER MALIGNANT TUMORS
ACCORDING TO SITE, BY RACE AND SEX FLORIDA STATE-AID, 1948
WHITE COLORED
TOTAL MALE FEMALE MALE FEMALE
SITE NO. % NO. % NO. % NO. % NO. %
Buccal cavity 64 8.2 37 57.8 14 21.9 9 14.1 4 6.2
Total digestive organs* 64 8.2 20 31.2 22 34.4 17 26.6 5 7.8
Stomach 15 1.9 5 33.3 3 20.0 7 46.7 -
Respiratory system 40 5.2 26 65.0 7 17.5 5 12.5 2 5.0
Total genital** 214 27.6 6 2.8 128 59.8 10 4.7 70 32.7
Uterus & Cervix 184 23.7 121 65.8 63 34.2
Urinary system 14 1.8 8 57.1 3 21.4 2 14.3 1 7.1
Breast 94 12.1 59 62.8 -- 35 37.2
Skin 237 30.5 140 59.1 89 37.5 3 1.3 5 2.1
Other 49 6.3 16 32.6 19 38.8 10 20.4 4 8.2
TOTAL 776 100.0 253. 32.6 341 44.0 56 7.2 126 16.2
*Includes Stomach
**Includes Uterus and Cervix


ty

0







PREVENTABLE DISEASES 15


The number and percentage distribution of cases of cancer and other
malignant tumors according to site, by race and sex are shown in Table
V. Of the 776 malignant neoplasms, 237 (30.5 per cent) involved the
skin, which is comparable to incidence statistics of other southern states.
and suggests that cancer of the skin may be associated with exposure to
the sun. It is noteworthy that 229 of the 237 skin malignancies were
discovered in white persons. Neoplastic conditions of the skin was the
most common site in white males, with neoplasms of the buccal cavity
and respiratory system next in order, whereas, cancer of the genital organs
was the most predominant lesion in white females, with skin second and
breast third in order.

The Tennessee Department of Public Health, in their annual report
for 1947, published data showing the percentage distribution by site of
malignant neoplasms for their tumor clinics, Memorial Hospital of New
York, and the State of Connecticut. These data and corresponding data
for Florida during 1948 are given in Table VI. It will be noted that
the percentage distribution of malignancies in Florida is comparable to
the experience in Tennessee.



TABLE VI
PERCENTAGE DISTRIBUTION OF MALIGNANT NEOPLASMS BY SITE, IN TENNESSEE 1947,
MEMORIAL HOSPITAL OF NEW YORH 1946, STATE OF CONNECTICUT 1935-1946,
AND FLORIDA 1948
Memorial I State of
Hospital of Connecticut
Florida Tennessee New York 1935-1946
SITE 1948 1947 1946
Buccal cavity 8.0 6.0 16.0 5.0
Digestive organs 8.0 6.0 16.0 29.0
Respiratory system 5.0 2.0 7.0 5.0
Female genital organs 24.0 27.0 7.0 14.0
Male genital organs 4.0 4.0 3.0 5.0
Breast 12.0 15.0 22.0 14.0
Urinary system 2.0 3.0 3.0 4.0
Skin 31.0 27.0 12.0 10.0
Others 6.0 10.0 14.0 14.0
TOTAL 100.0 100.0 100.0 100.0


The number and percentage distribution of malignant cases by age
group, sex and race is given in Table VII. The data by site, age groups,
sex, and color is presented in Table VIII. Of the 594 white cases, 17
(2.9 per cent) were of persons under 25 years of age and 2.7 per cent
of the colored cases were in that age group. The greatest number of
cases were discovered in the 45-64 age group for both white and colored.
Approximately one third of the neoplasms of the female genital organs
m both white and colored were diagnosed in the 25-44 age group. As
for the other sites, the diagnosis of neoplastic disease in most instances
was made after 45 years of age.












TABLE VII
NUMBER AND PERCENTAGE DISTRIBUTION OF CASES OF CANCER
AND OTHER MALIGNANT TUMORS BY AGE GROUP, SEX AND RACE
FLORIDA, STATE-AID, 1948


MALE FEMALE
AGE TOTAL WHITE COLORED WHITE COLORED
No. % No. % No. % No. % No. %
Under 25 22 2.8 4 18.2 13 59.1 5 22.7
25-44 177 22.8 36 20.3 12 6.8 83 46.9 46 26.0
45-64 304 29.2 90 29.6 24 7.9 147 48.4 43 14.1
65 & Over 273 35.2 123 45.1 20 7.3 98 35.9 32 11.7
TOTAL 776 100.0 253 32.6 56 7.2 341 44.0 126 16.2



TABLE VIII
NUMBER OF CASES OF CANCER AND OTHER
MALIGNANT TUMORS ACCORDING TO SITE BY AGE, COLOR, AND SEX,
FLORIDA, STATE-AID, 1948
I ALL AGES | UNDER 25 | 25-44 i 45-64 65 AND OVER
SITE | White [ Colored I White | Colored [ White | Colored | White | Colored [ White I Colored
I M ] F I M I F MF F i M i F | M | F M F M F I M I F ] M F M I F
Buccal Cavity 37 14 9 4 7 3 2 1 12 6 3 3 18 5 4 -
Total Digestive Organs* 20 22 17 5 1 -7 2 3 2 8 11 9 2 5 8 5 1
Stomach 5 3 7 1 4 1 4 2 2 -
Respiratory System 26 7 5 2 3 2 1 15 3 2 1 8 2 3 -
Total Genital** 6 128 10 70 3 2 3 43 3 26 1 57 3 28 2 25 4 14
Uterus & Cervix 121 63 2 43 24 54 26 22 13
Urinary System 8 3 2 1 1 2 3 1 1 3 2 1 -
Breast 59 35 1 1 17 14 23 7 18 13
Skin 140 89 3 5 1 1 12 13 1 43 40 1 1 84 35 1 4
Others 16 19 10 4 3 7 1 2 3 3 2 8 6 5 1 3 3 2 -
TOTAL 253 341 56 126 4 13 5 36 83 12 46 90 147 24 43 123 98 20 32

*Includes Stomach
**Includes Uterus & Cervix


C



M
10
O


:P












TABLE IX
NUMBER OF CASES OF CANCER AND OTHER MALIGNANT TUMORS
ACCORDING TO SERVICE AND COST BY SITE
FLORIDA, STATE-AID, 1948
DIAGNOSIS HOSPITALIZATION TREATMENT
BIOPSY -SURGERY X-RAY RADIUM OTHER
Site No. of No.No. oNo ofo. of No. of No. of No. of No. of TOTAL
Cases Cost Cases Days Cost Cases Cost Cases Cost Cases Cost Cases Cost COST

Buccal Cavity 19 485.00 17 202 2,489.88 10 770.00 47 2,664.00 2 75.00 20 347.45 6,831.33
TotalDigestiveOrgans 7 204.00 48 857 12,174.27 36 4,925.00 26 732.50 1 83.30 30 1,160.80 19,279.87
Stomach 12 227 3,000.52 12 1,450.00 6 217.50 6 223.80 4,891.82 -
Respiratory System 5 190.00 25 276 3,892.52 15 1,700.00 33 2,057.50 19 731.20 8,571.22 W
TotalGenitalOrgans 20 530.00 117 1,642 18,286.27 50 4,491.50 156 13,219.50 69 6,936.59 62 1,192.00 44,655.86 M
Uterus & Cervix 18 405.00 98 1,205 13,422.22 35 3,172.50 137 12,017.00 68 6,911.59 54 1,030.00 36,958.31 <
Urinary System 1 50.00 12 278 3,836.14 8 890.00 7 481.00 6 547.00 5,804.14 t
Breast 11 345.00 50 703 7,805.73 41 3,785.00 71 5,683.75 2 227.85 24 476.00 18,323.33 Z
Skin 41 1,076.00 47 541 6,585.13 28 2,150.00 176 5,621.00 15 637.00 33 381.50 16,450.63 D-3
All Other Sites 7 320.00 21 271 2,871.33 14 1,250.00 38 2,566.50 1 25.00 15 436.94 7,469.77 :P
TOTAL 111 $3,200.00 337 4,770 $57,941.27 202 $19,961.50 554 $33,025.75 90 $7,984.74 209 $5,272.89 $127,386.15 6'
til
-r,

rn
w:







18 ANNUAL REPORT, 1948


The data on the number of malignancies according to treatment re-
ceived and cost by site are presented in Table IX. Of the 776 malignant
cases, 337 were hospitalized for treatment, 202 received surgery, 554
X-ray therapy, and 90 radium therapy. Some of the cases received a
combination of all three types of treatment. The funds expended for
other costs in Table IX represents charges other than hospitalization.
surgery, x-ray, and radium, such as blood bank charges, estrogens, etc.
The average cost per day for hospitalized cases and the average cost per
case including all services paid by the state aid program are shown in
'Table X.
Included in Table IX on services and cost by site is a column showing
111 cases that were approved for diagnostic biopsies. These patients
were either hospitalized for the biopsy or received this service in the office
of their private physician. In addition to these biopsies, the number of
indigent patients examined through the facilities of the biopsy mailing
service increased from 304 in 1947 to 973 in 1948. Private physicians
perform the biopsy and mail the suspected tissue to the pathologist of
their choice. The pathologist examines the tissue, submits his finding;
to the physician and mails a copy of his report to the State Board of
Health. The cost for this service during 1948 amounted to $4,865.00.
The number of biopsy specimens examined by color, sex, age group, and
site, are shown in Table XI and Table XII.
The number and percentage distribution of deaths from cancer b!
site and sex is represented in Table XIII. As elsewhere in the United
States, the crude death rate from cancer in Florida has shown an union
terrupted increase during the past years and ranks as the second leading
cause of death. In all probability there will be further increases in the
crude death rate from cancer for the next several years because other
states conducting organized cancer control activities find that cancel
deaths increase for several years after launching a control program. PB
reviewing Table XIII, one can easily determine where major emphasis:
should be directed to reduce the number of deaths from cancer; namely
the digestive organs, the genital organs, the respiratory system, and thi
breast. Improvement in diagnostic methods, early diagnosis and adequate
immediate treatment should reflect a reduction in deaths from cancer:
in these predominant sites.
During 1948 the State Board of Health gave financial support ti
newly established tumor clinics in Tampa, West Palm Beach, Pensacol
and Miami. These tumor clinics were established by the medical so
cities in those counties according to the standards of the State Board o:
Health and the American College of Surgeons. Additional tumor clinic
are planned in Tallahassee, Orlando, Lakeland, Ft. Lauderdale and St
Petersburg. Some financial support was given to detection clinics if
Ocala, Gainesville, DeLand, and Daytona Beach.








PREVENTABLE DISEASES


TABLE X


COST ANALYSIS OF CASES OF CANCER AND OTHER MALIGNANT TUMORS

ACCORDING TO HOSPITALIZATION AND TOTAL SERVICES BY SITE
FLORIDA, STATE-AID, 1948


SITE

Buccal Cavity

Total Digestive Organs

Stomach

Respiratory System

Total Genital Organs

Uterus

Urinary System

Breast

Skin

All Other Sites

TOTALS


HOSPITALIZATION
ONLY


Average
Number
Days Per
Case

12

18

19

11

14

12

23

14

12

13

14


Average Average
Cost Cost
Per Day Per Case

12.33 146.46

14.20 253.63

13.22 250.04

14.10 155.70

11.14 156.29

11.14 136.96

13.80 319.68

11.10 156.11

12.17 140.01

10.60 136.73

12.15 171.93


TOTAL SERVICES
INCLUDING
HOSPITALIZATION


Number Average
of Cost
Cases Per Case

64 106.74

64 301.25
15 326.12

40 214.28

214 208.67

184 200.86

14 414.58

94 194.93

237 69.41

49 152.44

776 164.16


TABLE XI

BIOPSY EXAMINATIONS

BY COLOR, SEX, AGE GROUP, AND FINDINGS
FLORIDA 1948


MALIGNANT
White Colored Total
Age Group M F M F
Under25 0 5 1 3 9
25-44 12 35 6 19 72
45-64 '4 45 9 29 117
65 and over -6 35 12 11 104
Age Unspecified 5 6 1 6 18
No Data 16
TOTAL 97 126 29 68 336


NON-MALIGNANT
White Colored Total
Mh F M F
14 27 10 19 70
21 145 7 79 252
21 90 12 38 161
20 40 9 12 81
10 11 3 6 30
43
86 313 41 154 617






















TABLE XII

BIOPSY EXAMINATIONS
BY COLOR, SEX, SITE, AND FINDINGS
FLORIDA, 1948


Wh
SITES M

Skin and Subcutaneous 68
Uterus and Vagina 0
Other Genital 0
Breast 0
Buccal Cav. Incl. Lip 18
Other Digestive 2
Urinary 1
Papanicolaou Smears 0
Other 8
Incomplete Data

TOTAL -97


ite
F

39
45
2
6
9
9
0
7
9

126


MIVALI lNAIN


Colored
M F

4 3
0 41
2 1
0 12
9 2
5 2
0 1
1 1
8 5

29 68


Unspecified

9
2
0
0
1
0
0
0
4


16


Total

123
88
5
18
39
18
2
9
34
0

336


White
M F

39 62
0 166
2 4
4 14
19 14
8 6
3 1
1 31
10 15


86 313


INUNIJL,~LJN SIN


NiN-MVJAIiNAiN1
Colored
M F Unspecified

15 9 3
0 87 12
4 9 0
1 9 0
8 7 0
5 8 0
0 2 0
0 10 2
8 13 4


41 154 21


Total

128
265
19
28
48
27
6
44
50
22


I







PREVENTABLE DISEASES 21

Financial support was given to the annual cancer seminar which was
held in Tampa. The program was outstanding and the faculty of prom-
inent cancer specialists gave lectures on the early diagnosis and treatment
of cancer of those sites responsible for the greatest number of deaths and
those sites presenting the greatest difficulties in early diagnosis. More
than 400 physicians attended this three day seminar. Most of the lay
educational program was conducted by the Florida Division of the Ameri-
can Cancer Society; however, the Cancer Control Division purchased
most of the educational pamphlets which were distributed. This society
is doing intensive work in stimulating and carrying on a program of edu-
cation and the state division, as well as the county units, have cooperated
to the fullest extent with the efforts of the Division of Cancer Control.

Due to the large number of requests for state aid, the Division of
Cancer Control found it necessary to limit approvals to those indigent
patients presenting a good prognosis. Cancer treatment is expensive and
the funds are limited, therefore cities, counties, and welfare agencies must
assume the costs of necessary palliative treatments or other medical care
which is necessary to relieve suffering and provide reasonable comfort to
the far advanced cancer patient.

It is apparent from this report that much has been accomplished
since the inauguration of a cancer control program in Florida; however,
much credit is due to the medical profession who individually have ren-
dered the diagnostic and treatment services, and collectively through of-
ficial medical societies and specialty groups, have supported and cooperat-
ed in all phases of this program. With continued effort in this direction,
further progress can be anticipated in the future.





TABLE XIII
NUMBER AND PERCENTAGE DISTRIBUTION OF DEATHS FROM CANCER,
BY SITE, BY SEX, FLORIDA, 1948

MALE FEMALE TOTAL
SITE Number % Number % Number %
Buccal Cavity and Pharynx 84 6 15 1 99 3
Digestive Organs and Peritoneum a/ 592 42 520 34 1,112 37
Stomach 215 15 117 8 332 11
Respiratory System 257 18 63 4 320 11
Male and Female Genital Organs b/ 205 14 452 29 657 22
Uterus & Cervix 373 24 373 13
Urinary Organs 86 6 52 3 138 5
i r 4 260 17 264 9
A'h 41 3 33 2 74 3
All Others 159 11 146 10 305 10
TOTAL 1,428 100 1,541 100 2.969 100
a/ Includes stomach
b/ Includes uterus & cervix
* Less than 0.5%







22 ANNUAL REPORT, 1948


TYPHUS FEVER STUDIES

E. R. RICHARD, M.D., Director


At the beginning of the year the use of a building at the Florida State
Tuberculosis Sanatorium in Tampa was secured. As this building had
previously been used as a medical laboratory, it was adapted for our
purposes with but little expense. Adequate animal quarters were also
provided on the grounds of the same institution.
In order to be better informed in planning studies in the field and
to secure an abundant supply of rodents and ectoparasites for laboratory
studies a county wide rodent survey was begun at the beginning of March.
A large representative area of the City of Tampa was selected in which
no wide spread organized control measures had been carried out. Blocks
were designated for trapping in a checker board arrangement. From 6
to 9 traps were set in each block for three nights in places most likely
to harbor rats. The survey in the city was ended in September. A similar
survey in all the rural sections of the county was also started in March.
In the rural survey, farms instead of blocks were considered as units.
Trapping was generally limited to three nights on each farm and the
number of traps set out varied according to the judgment of the trapper.
Rural trapping has been continued to the end of the year in order to
supply material for laboratory studies. In addition to the routine survey,
trapping was carried out at possible places of infection of persons living
in the county who had typhus during the years 1947 and 1948. Rats
were brought into the laboratory alive, combed for ectoparasites, which
were later identified, and rats bled for the complement fixation tests for
murine typhus. The numbers of rats caught and the results of the comn
plement fixation tests have been summarized in Table XIV. These re-
sults indicated no great abundance of rats, and with the exception of
the probable places of infection of the typhus cases, relatively low comr
plement fixation indices.
Ectoparasites observations show that low flea indices have persisted
throughout the year with X. cheopis as the predominant species. R.
rattus appears to be almost five times as abundant as R. norvegicus.
In addition to the county wide rodent survey, systematic retrapping
in five representative residential areas in the City of Tampa has been
carried out throughout the year as part of a study in cooperation with
the Department of Parasitology of the Johns Hopkins School of Hygiene
and Public Health. Results of complement fixation tests on rats taken in
these areas have been summarized and again low complement fixation in-
dices have been observed.
A rather large number of wild species have been examined by con-
plement fixation for murine typhus. A considerable number of these








PREVENTABLE DISEASES 23

TABLE XIV
RODENT SURVEY IN THE CITY OF TAMPA AND HILLSBOROUGH COUNTY
Urban Rural Investi- Investi- Total
Routine Routine gation gation
Trapping Trapping of 1947 of 1948
Typhus Typhus
Cases Cases
Number of urban blocks or rural farms
investigated 190 283 37 16 526
Number of blocks or farms in which rats
were taken 126 230 24 11 391
Percent of blocks or farms in which rats
were taken 67 82 65 69 75
Total number of rats caught 456 1,272 113 121 1,962
Average number of rats taken per block
or farm with rats 3.6 5.5 4.7 11.1 5.0
Number of rats examined by complement
fixation for murine ty. 313 782 86 67 1,248
0 at 1:4 265 633 53 38 989
Titers observed 1:4 27 62 2 4 95
1:8 5 29 2 3 39
in complement 1:16 1 14 2 4 21
1:32 4 11 4 1 20
fixation tests 1:64 1 10 5 2 18
1:128 1 8 6 0 15
1:256
or more 9 15 12 15 51
Number of blocks or farms with one or
more rats with titers of 1:8 or more 16 49 10 5 80
Percent of blocks or farms with one or
more rats with titers of 1:8 or more 8.4 17.8 27.0 31.2 15.2
Percent of rats examined with titers of
1:8 or more 8.6 11.1 35.3 37.3 13.1


species, particularly cotton and wood rats, have been found to be posi-
tive; however, there is still doubt as to the specificity of the test with the
sera of these animals. Observed titers have been low and there have
been a few instances in which such results were obtained with the sera
of cotton rats bred in captivity under conditions precluding infection.
This subject, therefore, requires more study before concluding that the
cotton rat is a natural reservoir of infection.

Cotton, rice, and wood rats, as well as laboratory white mice, all have
been successfully bred in the laboratory in order to assure an abundant
supply of known animals for experimental work. A simple method of
breeding fleas has been devised and is producing in abundance.

Some work has been carried out on the flea feces complement fixa-
tion test described by Pollard, Davis and Olson (1). Tests on normal
flea feces have indicated that these are often anti-complementary in the
dilutions employed. Further work must be done before reaching any
conclusion as to the utility of this test.

An abandoned building quite remote from human habitation was
prepared to make it as attractive as possible to rats by providing abund-
ant harborage and food. One hundred known negative and ectopara-
site free rats, R. rattus, were released simultaneously in the building.
Trapping and re-trapping has been taking place in the building and sur-
rounding territory. Contrary to expectation, over 90% of the rats ap-
peared to have left the building soon after release and only nine have
been retrapped in surrounding territory. The remaining population has
begun to multiply and has become infested with ectoparasites. The ob-







24 ANNUAL REPORT, 1948


ject of this experiment is to observe the multiplication of rats and their
ectoparasites under known conditions over a period of at least one year.
All human typhus cases which occurred in the county during the
years 1947 and 1948 were investigated and reports of investigations sub-
mitted to state and county health departments. There were 37 cases in
1947 and 11 cases to the end of November in 1948. Of the total of 48
cases in the two year period, 25 were believed to have been infected at
home, 10 at business establishments, and in 13 cases the probable source
of infection could not be determined. Thirty-seven cases were of urban
origin and 11 rural.
There would seem to be no reason to doubt that organized control
measures carried out by the health department have contributed to the
decrease in typhus in recent years. A decrease has been noted, however,
in areas where very little, if any, control measures have been applied.
In order to determine what factors other than organized control might
be operating against the spread of typhus, a house to house canvas was
conducted in four areas in the City of Tampa which were representative
of the various economic strata in the population. In 589 interviews,
occupants were questioned as to prevalence of rats now as compared to
former years, the keeping of poultry now as compared to formerly, the
use of insecticidal sprays or powders containing DDT and measures
applied by the householder to combat rat infestation. It was found that
in the first and middle class residential districts, there had been some de-
crease in poultry rearing since the war years. The use of insecticidal
sprays containing DDT was found to be very common. From 80 to 90%c
of persons interviewed reported using such sprays. It was believed that
this factor of all those investigated was the most important as a contribu-
tory one toward the reduction of typhus.
In order to gain information as to the past incidence of typhus in the
human population of Florida the pre-marital serum specimens submitted
to the various laboratories of the Florida State Board of Health for ex,
amination for syphilis were examined for complement fixing antibodie
for murine typhus. To the end of November, 2844 of these specimen
had been examined, of which 187 or 6.6% showed positive fixation in di
lution of 1:4 or more. Approximately 1000 of the specimens were fron
persons with addresses in Hillsborough County. The remainder wen
from persons residing in 58 of the state's 66 other counties. This stud'
is being continued with the ultimate objective of examining 10,000 speci
mens representative of the entire adult population of the state.
The study of complement fixing antibodies in the sera of humal
beings at varying intervals after infection from one week to four year
was completed and results reported in the scientific literature (2). Thes
results were summarized in the Annual Report for 1947.







PREVENTABLE DISEASES 25


VETERINARY PUBLIC HEALTH

J. E. SCATTERDAY, D.V.M., Director

A Veterinary Public Health Program was started January 1948 and
has completed its first full year. This program is concerned with those
diseases of animals communicable to man. These diseases may be broken
down into two divisions-those communicable by contact and those
spread by animals and animal products as food.
Rabies has been and persists in being a major problem as demon-
strated in Table XV.
The estimated dog population in Florida is roughly 312,000 or one
dog to 6.2 people. Sixty-eight thousand eight hundred and seventy-seven
(68,877) dogs were reported vaccinated this year (1948), but not all
veterinarians reported in response to a questionnaire. Approximately
22% of the dog population is protected by vaccination. Authorities on
the control of rabies state that at least 60% of the dog population should
be vaccinated to effectively control the disease.
Five-hundred and twelve (512) animal heads were examined in 1948;
332 were found positive, and one human case reported. Thirteen hun-
dred and twenty-two (1322) anti-rabies treatments were issued by the
State Board of Health.
The majority of cities in Florida have had some type of dog ordinance
enforced in varying degrees. Many towns and cities have good vaccina-
tion and dog control programs and rabies has either been eliminated or
brought under control. Other cities, even though rabies is prevalent have
not seen fit to attempt wholehearted effort to combat it.
Local ordinances have been adopted this year in most communities
where outbreaks have occurred. These have been patterned after the
proposed state wide regulations and fair enforcement has been obtained.
The weakness of all programs has been the control of the strays and a
better system of collection and impounding of those unowned or owned
dogs which run at large unvaccinated should be devised.
In Leon County where fox rabies was prevalent a very efficient trap-
ping program was conducted. This was in cooperation with the Florida
Fresh Water Fish and Game Commission, the U. S. Fish and Wild Life
Service, represented by Mr. Canup, the Leon County Health Department,
and farmers of Leon County. Between 600 and 700 foxes were trapped
in 90 days. This has so far controlled the disease in these animals and
no case of fox rabies has been reported for some time. Madison County
paid a bounty on all foxes destroyed. This did not prove too effective.
Floods throughout North Florida, where fox rabies existed, occurred at










26 ANNUAL REPORT, 1948
TABLE XV
TOTAL NUMBER OF ANIMAL RABIES REPORTED BY COUNTY 1948, FLORIDA


COUNTY





Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
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
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington

TOTAL


U, ui
O < < 0 0 p -
-u 0 (n u


332 261


3 2



22 6 1


1 1


1
2
1

16

2


















1

4




- 26 I6


NOTE: ONLY ONE CASE OF HUMAN RABIES WAS REPORTED FOR 1948-
(Hillsborough County)







PREVENTABLE DISEASES 27


whelping time and much of the cover and county where foxes ranged
was under water. This, I believe, had much to do with controlling the
disease. Where fox rabies was prevalent, considerable loss in livestock
was reported, both in work stock, horses, mules, and cattle-a much larger
figure than appears on the chart has been reported and diagnosed clinic-
ally, but not confirmed by the laboratory so were not reported.
A Veterinary Public Health Laboratory has been set up in the Bureau
of Laboratories, sponsored by the Veterinary Division of the U. S. Public
Health Service and the Florida State Board of Health. This laboratory
will aid in better diagnosing and identifying those diseases of animals com-
municable to man.
To combat Brucellosis, cities and towns have been encouraged to
adopt a clause in their existing milk ordinances requiring one of the
various brucellosis control programs or plans approved by the Florida
State Live Stock Sanitary Board and the U. S. Bureau of Animal In-
dustry. Several cities have seen fit to do this and through the cooperation
of the above mentioned organizations and their personnel much has been
accomplished.
Many county sanitarians are working in cooperation with the local
practitioners, federal and state veterinarians, arranging for and assisting
with the blood testing of the family milk cows for Brucellosis. This is a
service which the rural family appreciates and for which no charge is
made when done by the state and federal veterinarians.
Seventy-four cases of brucellosis or undulant fever were reported in
1948. This, we feel, is a very low figure and many more cases were not
diagnosed as such, as the percentage of infection in cattle and hogs in
Florida would indicate a much higher percentage of human infection.
Bovine tuberculosis has largely been eliminated from the United
States, but the harder job of finding and eliminating the small foci of
infection still exists. This, in Florida, is a bigger task than in many of
the other states, Florida being a dairy cattle importing state, not raising
its replacement cattle but importing them from various southern states
and as far north as Ohio and Wisconsin. The Florida State Milk Laws
require an annual test of all cattle from which milk is sold, regardless if
it is to be consumed raw or pasteurized. The larger milk areas enforce
this fairly well, but other areas are lax, and bovine tuberculosis is on the
increase in those areas. This must be corrected and the proper stress
placed on healthy cattle in Florida dairies. The U. S. Public Health
Service Code and the Florida Milk Regulations rate the health of the
cow so high that no dairy should be rated as Grade A unless the required
annual test for tuberculosis is complied with.
Surveys of abattoirs and slaughtering plants have been made in many
of the Florida counties regarding the inspection and sanitation of meat
and meat products. With the exception of the federally inspected plants,
of which Florida has three, the fourteen state inspected plants, supervised
by the Florida Live Stock Sanitary Board, and a very few of the munici-







28 ANNUAL REPORT, 1948

pal abattoirs, much needs to be corrected in this field of Veterinary Pub-
lic Health as a large portion of the meat slaughtered and processed has
no inspection whatever and no regard given to sanitation nor the ingre-
dients put into processed meats, such as sausage, etc.
As Public Health Veterinarian we have assisted in the Florida State
Board of Health Training Center in Alachua County with regards to
training in milk inspection, meat inspection, and rabies control. Two
classes of sanitary officers, fifteen in one group, five in another, were
given training. Also, five health officers have received some training.







PREVENTABLE DISEASES 29




INDUSTRIAL HYGIENE

J. M. McDONALD, M.D., Director


The program of the Industrial Hygiene Division was described in
detail in the Annual Report for 1947. Briefly, it includes a continuation
of surveys in plants not hitherto visited; organization of the analytical
laboratory; attention to requests; planned studies of lead exposures, phos-
phate mining, and citrus dermatitis; investigation of occupational disease
claims; cooperation with the Florida Industrial Commission; cooperation
with other state and local agencies; and training of personnel.

In all, 321 visits were made to 216 plants employing 34,522 people.
This includes 62 visits to 51 plants for the purpose of making technical
studies of potential hazards. The number of improvements recommended
was 40. Contacts were made with many industries not hitherto visited.
Among the more interesting industries contacted during the year were the
Naval Air Training Base at Pensacola, and the Jacksonville Naval Air
Station.

TABLE XVI
OCCUPATIONAL DISEASE CLAIMS
January 1, 1948-December 31, 1948
TOTAL ............ ........... ..................... ..............------------ 1317
Conjunctivitis ......................... ...........--- .........------ ----------... 235
W elders ........................................ ... .......... ..... ..... .... ----- 208
Chem ical .......................................... .......... .......... ........................ 5
O their ..........................................-.......... ....... ................ 22
Infection ....................... .............. ... --------- .-- 47
M eat ............ ..-------...........-........................ 19
Other ................------- .... ..........-.........- .......-. .......... ..... 28
Repeated Motion, Pressure and Shock .................. ----- --------................ 15
Temperature Changes .....................---. .------ -------------- 23
Respiratory Irritations ........................... -------------------- ............ 32
G ases ......................................................... 6
Metals ---...---....---........ ------------------------------.-------------------- 4
Lead -.... ......................................-------------------- 3
Zinc .....-......... .......................... .. ..-- --- .--- ------------ 1
Carbon Tetrachloride .--.......................... ------- ---------- 1
Diagnosis Indefinite ....... ........................--------------------- 8
Dermatitis .....--------...... ........-------------- ------- 946
Fruit ...... ............----------... .................. 117
Alkali ..........-- ..----- ...............-....... ... ................. ... 255
Solvents & Oils .... .................. ..... .. -----.....-- --------- 121
Other Chemicals .................-- ........... ..... ------- ------------- 125
Plant ... ........................................... -- ..------------ 40
Fungus ---------........................ ......-------- -.. .----------------- 77
Larva Migrans ............................. ------------------ 116
Actinic ..............................................-------------- 2
Parasite .......... ....... ........-...................------ ----- 10
O their .......................... .. .... .. ............... ... 83







30 ANNUAL REPORT, 1948


The analytical laboratory made 816 analyses on the 221 samples sub-
mitted. The blood and urine lead determinations inaugurated last year
appear to have been much appreciated because the number of samples
received in 1948 was 97 as compared with 22 in 1947. In addition, two
determinations of mercury in urine were done. The work of the labora-
tory was required to cover a very wide range because of the number of
nuisance complaints investigated throughout the year.
Requests for services totaled 66, including one from the Greyhound
Bus Lines on methods for determining carbon monoxide concentrations,
one from the Seaboard Railway for the prevention of dermatitis, one for
prevention of injury in the engraving industry, one for analysis of dust
in a local electric plant, and several for information on the laws and
regulations for the protection of health of industrial employees in Florida.
Among the 14 complaints investigated was one relating to gases discharged
from a phosphorus plant; another from a pulp and paper plant; and two
others from lead smelters. The study of the discharge from the phos-
phorus plant required much time and effort, both in the taking of sam-
ples and their analysis. It has been rather surprising to note the amount
of atmospheric pollution in the State of Florida where the geographical
and meteorological factors would be expected to favor the speedy dis-
persion of smoke and fumes.
The study of lead hazards was continued on a broader scale to in-
clude several plants not hitherto covered. Technical studies were done
in 3 smelters and 7 storage battery plants. The citrus dermatitis study
was continued by visits to all plants engaged in peeling and sectionizing
citrus fruit. All occupational diseases reported in the industry were in-
vestigated. Employment figures were obtained and dermatitis incidence
rates were calculated. The results of the calculations were embodied
in a report, a copy of which has been sent to all the plants visited. This
report will serve as a benchmark for future investigations. A preliminary
investigation was made into the occurrence of dermatitis from larvae
migrans.
During the year 204 occupational disease claims were investigated.
In this connection it is interesting to note that the investigation of a group
of occupational diseases in 1947 paved the way for a full-scale investiga-
tion in 1948 of the hazards encountered in cleaning out the sludge from
the condenser tank at a phosphorus plant.
Cooperation with the Workmen's Compensation Division of the Flori-
da Industrial Commission continued, the most striking incident being
the study of the cause of three deaths which occurred in cleaning out a
shallow well used by a packing plant in the Everglades. Late in the
year, two other requests for studies were received. One of these con-
cerned a potential hazard from exposure to silica dust in a small monu-
ment job. The other request was in connection with a nuisance com-
plaint already under investigation.
With the assistance of the Bureau of Health Information, division
personnel assembled the material for the March issue, 1948, of Florida







PREVENTABLE DISEASES 31

Health Notes, which was devoted entirely to industrial hygiene. In addi-
tion to sending 80 copies to various state and local industrial hygiene
agencies, more than 200 copies have been distributed among the indus-
tries of the state. The reception of this issue has been very favorable.
Seventeen abstracts were written for Excerpta Medica.

The annual meeting of the American Conference of Governmental
Hygienists in Boston was attended.

The director joined the Nassau County Medical Society and attended
five of their meetings.




TABLE XVII

SUPPLY SECTION
DRUGS AND BIOLOGICS DISPERSED, 1948
Average Annual
Per Month Total
Bismuth, 30cc ................................- ............ ...... 41 497
Bismuth, 60cc ...................--- ............... ....... ..... 15 185
Bismuth, 500cc ................ .............-- ....-...- ..------. 1 18
Clorarsen, .067 ...-..----....-- -.............- .................... 298 3,579
Clorarsen, 0.67 ....................................... .... ............ 46 555
Crystoids, bottles of 5 caps. ...-.................................. 776 9,312
Diphtheria Anti-Toxin, 10,000 Units .........--- ......-....-.. 71 856
Diphtheria Anti-Toxin, 20,000 Units ..............-.............. 61 732
Diphtheria Tetanus Combined, lcc ... ------------------ 4 45
Diphtheria Tetanus Combined, 2cc .-.-......................... 22 265
Diphtheria Tetanus Combined, 10cc ............................. 26 311
Diphtheria Tetanus Combined, 30cc ..........-......-----...- 105 1,258
Diphtheria Toxoid, 5.0cc ...........................-.......... 2 33
Diphtheria Toxoid, 10cc .----------....................--...---- 295 3,547
Diphtheria Pertussis Vaccine, Sauer, 6cc ...................... 30 368
Diphtheria Pertussis Vaccine, Sauer, 24cc .-................ 39 473
Diphtheria Pertussis Tetanus Combined, cc ................ 0 2
Diphtheria Pertussis Tetanus Combined, 3cc ................... 0 10
Diphtheria Pertussis Tetanus Combined, 10cc ............... 829 9,955
Immune Serum Globulin, 2cc ......-- -..........-- ..--....----- 607 7,291
Insulin, Globin, 10-U-40 .....------........----- .----..------ 160 1,921
Insulin, Globin, 10-U-80 ........................................ --- 128 1,532
Insulin, Plain, 10-U-20 ...-..........................-.......... 17 206
Insulin, Plain, 10-U-40 .................. ............--. .... .... 299 3,590
Insulin, Plain, 10-U-80 ......-..... .....-----...........---.... --95 1,149
Insulin, Protomine Zinc, 10-U-40 -.............................. 49 592
Insulin, Protomine Zinc, 10-U-80 ............................-----. 462 5,546
Mapharsen, .06 .---------------------- 440 5,284
Mapharsen, 0.6 ... -----------............... 129 1,551
Penicillin, 100,000 Units .....-..........-....-- .-....----- ....-- 447 5,364
Penicillin, 200,000 Units -..............-------------.....------ 138 1,664
Penicillin, 500,000 Units .---------.........--....- --....--. ---. 1 17
Penicillin, 10cc vials, 300,000 Units, (POB) ................ 567 6,811
Penicillin, Ice vials, (GC KITS) ..-.......-..... ---- .------- 339 4,070
Pertussis, Upjohn, 5cc ....--...................--- .....-..------ 47 570
Pertussis, Upjohn, 10cc ..........--..---....... .---------- 16 196
Pertussis, Upjohn, 20cc ..........................--- .... ------ 57 685
Pertussis, Sauer, 24cc ... ...........-..-.....-------. ------ 50 610







32 ANNUAL REPORT, 1948





P. P. D. Tuberculin, 1st Strength (per pkgs. of 10) ...... 50 597
P. P. D. Tuberculin, 2nd Strength (per pkgs. of 10) ...... 40 488
Rabies Vaccine (per 14 dose series) ................................ 110 1,322
Schick Test, vials 5cc (50 test) ....................................... 66 790
Silver Nitrate (per pkgs. of 2 each) ................................ 964 11,575
Sulfathiazole Tablets (per bottle of 1,000 each) ............ 25 305
Tuberculosis Patch Tests (10 to a package) ............. 171 2,059
Tarter Emetic .................................................... 18 219
Tetanus Anti-Toxin, 1,500 Units ................................... 149 1,792
Tetanus Anti-Toxin, 10,000 Units .................................... 67 811
Tetanus Toxoid, lcc .............................. ................... 51 615
Tetanus Toxoid, 30cc ........................ .......................... 274 3,285
Tetachlorethylene, 8 min., 5cc ....................... ...... 1236 14,835
Tetrachlorethylene, 16 min., 5cc .............................. 714 8,567
Tryparsamide, 1.0 .......--....................... ....... 5 60
Tryparsamide, 2.0 ..................... ...... ............. 6 70
Tryparsamide 3.0 ...............-..-........... -. --. 6 70
Typhoid Paratyphoid Combined Vaccine, 20cc .......... 641 7,688
Typhoid Paratyphoid Combined Vaccine, 50cc ............ 77 926
Vaccine Points, (per pkgs. of 10 each) ............................ 802 9,620
Water, Distilled, 50cc'ottles ............................... 29T 3,487
Water, Distilled, 100cc bottles .................................. 552 6,629










BUREAU OF

TUBERCULOSIS CONTROL

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

The general activities of the Bureau of Tuberculosis Control have
continued to increase, and as a result of the intensified efforts a larger
volume of information is available this year than was reported in the
1947 annual report. This report will be more or less written in line with
the 1947 report so that a comparison can be made concerning the volume
of work performed, and the epidemiological findings with regard to the
tuberculosis problem in the State of Florida further clarified.

DEATH RATE
No analysis of the tuberculosis situation in a community would be
complete without studying the death rate. As a contrast to 1947, the
figures show that there has been as much decrease in tuberculosis
deaths during the year of 1948 as there was an increase over the
year of 1946. The total death rate for 1948, in spite of the fact that
population estimates in the State as a whole have increased, shows that
there were 720 deaths from tuberculosis in Florida as against 760 deaths
during the year 1947. The mortality rate during the year 1948 has
declined to 29.1 per 100,000 population as contrasted to a rate of 31.6
per 100,000 during 1947. This rate represents the lowest tuberculosis
mortality rate in the history of Florida, and is lower than in any other
southeastern state. In fact, it is considerably lower than the national
average for tuberculosis.
It should be noted that the mortality rate for the white population in
the State has reached the rate of 17.5 per 100,000 population, which in
this group compares very favorably with the best states in the country.
The Negro mortality rate, however, still remains high, although there
has been a decrease from 68.0 per 100,000 population during 1947 to
66.9 per 100,000 during 1948.
It is believed that the addition of the 500-bed sanatorium in Tampa,
and the 200-bed sanatorium in Marianna, where advanced cases of the
disease can receive the necessary isolation, is finally beginning to show
results, since it has definitely been proven from a public health stand-
point that tuberculosis rates can be decreased if adequate provisions are
available to isolate the infectious cases of the disease.
Table XVIII shows the recorded deaths from tuberculosis and the
death rate per 100,000 population, by race, from the year 1917 through
1948. Fig. 1 shows the mortality rate in graph form with the definite
decreases as demonstrated in the table.









3-1 ANNUAL REPORT, 1948


TABLE XVIII

RECORDED DEATHS FROM TUBERCULOSIS (ALL FORMS) AND DEATH RATES

PER 100,000 POPULATION, BY COLOR, FLORIDA 1917-1948


TOTAL
DEATHS RATE


720
760
687
701
791
834
859
916
961
921
987
966
905
903
953
1,039
1,093
1,067
1,015
1,014
1,102
1,097
1,187
999
1,054
1,079
1,019
951
1,016
993
1,084
1,085


29.1
31.6
29.4
30.9
36.0
39.2
41.8
46.1
50.3
49.7
55.0
55.6
53.9
55.7
60.1
66.9
71.5
70.8
68.6
70.8
79.7
82.2
92.3
80.8
88.7
94.7
93.5
91.3
102.3
103.7
115.9
118.9


WHITE
DEATHS] RATE


332
371
333
340
369
363
360
362
379
376
407
400
387
397
381
398
395
427
432
416
481
483
519
426
457
490
440
401
423
461
494
472


17.5
20.2
18.8
19.9
23.1
22.9
23.6
24.8
27.2
27.9
31.4
32.0
32.3
34.5
33.9
36.1
36.5
40.1
41.3
41.3
49.7
49.8
58.3
50.0
56.2
63.3
59.9
57.6
64.3
73.4
81.2
80.3


YEAR


FIGURE 1
TUBERCULOSIS DEATH RATES, BY COLOR
FLORI DA 1917-1948


YEARS


COLORED
DEATHS RATE

388 66.9
389 68.0
354 62.7
361 64.9
422 70.8
471 87.1
499 93.6
554 105.5
582 112.4
545 107.3
580 116.4
566 115.8
518 108.2
506 107.9
572 123.9
641 142.1
698 156.2
640 144.8
583 134.0
598 140.6
621 149.5
634 156.4
668 169.0
573 148.7
597 159.1
589 161.2
579 163.0
550 159.3
593 176.8
532 161.6
590 180.4
613 188.7







TUBERCULOSIS CONTROL 35


REPORTED CASES
A rather intensive effort has been made during 1948 in a study of
the morbidity from tuberculosis in the State. This has been made from
several sources; one, by the reporting of the disease in clinics operated
by the State Board of Health and by the local health departments; an-
other, by reporting from private physicians and general hospitals as well
as by sanatoria. Out-of-state notifications, death certificates and Vet-
erans Hospitals, as well as the newly organized Selective Service, have also
been sources of reports which have been analyzed.
During the year 1948 the tuberculosis cases reported by age, sex and
stage of the disease have been analyzed on punch cards by the number of
cases per county and the number of deaths per county. This is well
demonstrated in Table XIX. In some instances, there have been rather
marked increases in the number of cases reported for each death, but
this is a relative figure since the population differences in many of the
counties far outweigh the reported cases. For instance, in Hillsborough
County there were 6.54 cases reported per each death from tuberculosis,
while in Duval County there were only 2 cases reported per each death.
In Dade County-which is our largest county-there were 4 cases re-
ported per each death.
During 1948 there were 3,313 cases of tuberculosis reported in the
State of Florida which shows a rather marked decrease over the 4,335
cases reported in 1947. The primary reason for this decrease in the num-
ber of cases reported is believed to be due to the fact that there were not
nearly so many old cases newly reported for 1948. For instance, the an-
nual report for 1947 showed that over 25 percent of all cases reported to
the State Board of Health were old cases which were previously known
to some other source, but which were first reported to the health depart-
ment. During 1948, however, practically all of the cases reported repre-
sent new cases of tuberculosis found. For example, the new cases re-
ported in 1947 were 3,251 whereas in 1948 there were 3,112, there being
only 201 old cases newly reported, which accounts for the decrease in the
number of cases reported.
An analysis of the source of reporting is shown in Figure 2 which shows
a comparison in the percentage of tuberculosis cases reported by source of
report in Florida for 1947 and 1948. It continues to show that there is a
marked increase in the amount of reporting from county and city health
departments with a consequent decrease in the reporting of the disease
by private physicians as well as by general hospitals.
There has been no appreciable reduction in the number of cases first
reported by death certificate. Four percent were reported by death cer-
tificate in 1947 and the same figure holds true for 1948. There have
been fewer cases reported from the Veterans Administration, and also
fewer cases reported from other sources.










TABLE XIX

TUBERCULOSIS CASES REPORTED BY RACE, SEX AND STAGE OF DISEASE WITH RESIDENT DEATHS
AND NUMBER OF CASES PER DEATH BY COUNTY, FLORIDA, 1948


CAS ES RE PO RTED


RACE AND SEX


COUNTY


STAGE OF DISEASE


E
L-


o-
5 2<


WHI







S3,313 1,523
42 19
4 2
34 17
6 3
16 6
131 53
4 3
8 5
3 2
8 4
2 1
13 7
499 259
19 10
3 2
239 92
145 68

6 8
15 4
27 9
2 1
4 1
11 4
4 1
11 7
7 1
3 -
11 6
484 252
10 4
17 7


T


TE COLORED






S943 442 287 118
9 6 7 1
1 1 -
9 3 5
1 1 1
6 1 2 1
61 17 9 1
1 -
2 1
1
3' 1
2 3 1 -
146 43 29 22
6 2 1 -
1
43 49 46 9
40 21 15 1
1 1 -
1 2 -
2 7 2
4 10 1 3

1 1 1 -
1 3 3 -
2 1
1 1 1 1
4 2 -
1 1 1
2 3 -
154 49 18 11
5 1 -


0 0
> E ,

- a -


TOTAL
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden (Ex.)
State Hospital
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Ind.ian River


5
1
3
3

3
200
7
5


0-




".00

4.52
3.00
4.00
6.80 10
3.00 "
4.00
6.55
2.00

1.00
4.00

2.17
3.99
9.50

2.08
4.68
2.00
3.00
1.50

0.67
2.00
5.50
1.33

3.50
1.50
2.20
6.37
10.00
2.83
I. 7


4
1
4
1
4
21

1
2
1

1
44
1
1
41
21


2
3
2
2

1

3
1

35
4


14
1
5
2
4
20
2

3
2

6
125
2

115
31
1
2
10

3
2
2
3

2
2
5
76
76
1
tG
0


ID I' A -


8

14
1
6
38

1

1

4
129
8

55
53

2
2
9

2
4
1
5

1
5
154
3
4
T


"


n~


I 1'


1,134 | 912 797


4 4 | 409 733




TABLE XIX CONTINUED
TUBERCULOSIS CASES REPORTED BY RACE, Si .X AND STAGE OF DISEASE WITH RESIDENT DEATHS
AND NUMBER OF CASES PER DEATH BY COUNTY, FLORIDA, 1948


CASES REPORTED

RACE AND SEX


STAGE OF DISEASE


WHITE COLORED


--- .-
E o ,
E E E E S C
:: 0I
3< t <


Jefferson
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
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington


101


S


2
1
6
6
10
2

1
18
8
4
6
2
4
1
89
4
86
1
65
26
8
3
2
8
3
18
4
1
6
6
2
88
2
4
1


'


COUNTY


E








S 1 3

1 1 11
1 1 6
8 7 8
2 3
-- -
4 6
5 4
13 24
1
6 8
1 7
4 3

1 28 38
2 1
1 28 30
4 6
3 18 28
1 17 20
4 6
3 7
1 7
2
11 8
2 7
3 4
1 3 4
2 2 6
9 1
16 16
1 41
1
8 4


'


1

6
10
9


6
-


18
6
2
5
3
2
1
97
6
61
1
48
31
5
4
7
6
5
17
4
2
1
3
7
25
8

1


2

4
5
9


6
11
14
1
4
2


80

34

14
17
3
1
9

6
-

7
4
3
8
4
9

1
1


-


I


2

8
1
9
4

6

5
1

1


21

26
1
8
7
4
1
3

3
-



8

1
2
2
13


1


4



1
2
1



7

14

15
8
2

2


3


2


1


5

8
7
6
4

8
9
17
2
6
2
3
2
61

38
2
47
18
6
2
9
6
10
12
6
2
8
8
29
1

4


I


-


,


2.33

2.09
5.00
5.25
2.33

2.83
13.00
1.75
9.00
2.63 (
1.00 m
4.33 m

6.97 0
9.00 C
9.87 -
1.33 0
6.79 C
4.85 '
3.33
1.29
3.43
-o
7.88 Z
3.14 '-
2.50
8.75 0
4.20 -'
81.00
6.38
6.00

2.75 4







38 ANNUAL REPORT, 1948


Another factor which concerns the reporting of cases is that in 1948
there was an appreciable increase in the number of cases first reported
from state tuberculosis sanatoria. This represents 7/2 percent of all the
cases reported as against only 4 percent during 1947. This data is shown
in Figure 2.



FIGURE 2
COMPARISON IN PERCENTAGES OF TUBERCULOSIS
CASES REPORTED BY SOURCE OF REPORT, FLORIDA,1947&1948
0 0 20 30 40 9 50 O 70 80


PRIVATE PHYSICIANS

COUNTY CITY
HEALTH DEPT.
GQM. HOSPITAL

SANATORIA

OUT OF STATE 1
REPORTS 1947
ODATM CERTIFICATES

VETERANS ADMIN.
HOSPITALS
OTHIE SOURCES __



A detailed total breakdown of the number and percentage of tubercu-
losis cases by race and sex is shown in Table XX. There is not a tre-
mendous variation in the percentage reported in 1947 and 1948. We
still find that the white male occupies the highest position. Forty-six
percent of all cases reported were among white males, and white
females averaged 28.5 percent of all cases reported. A striking feature of
this table, however, shows that in spite of the fact that the tuberculosis
mortality rate among Negroes is almost four times that of the white popu-
lation of the State, which would lead one to assume that the morbidity
among the Negroes would be higher-this is certainly not borne out by
the figures shown in Table XX. The morbidity among Negroes shows
that 13.3 percent of the cases reported were colored males and 8.7 per-
cent were colored females, making a total of 22.0 percent of all reported
cases among Negroes. The exact significance of this is rather difficult
to state. Whether it represents a certain racial susceptibility to the di-
sease, or whether it represents strictly an economical factor is one of those
intangible things which certainly cannot be determined without a con-
siderable amount of controversy. It could be entirely due to the fact
that the diagnosis is established in fewer Negroes than it is in the white
population group.







TUBERCULOSIS CONTROL


TABLE XX
COMPARISON OF NUMBER AND PERCENTAGE OF REPORTED TUBERCULOSIS CASES
BY RACE AND SEX, FLORIDA, 1947 AND 1948
1948 1947
CASES PERCENT CASES PERCENT
TOTAL 4,335 100.0 3,313 100.0
White Male 1,987 45.8 1,523 46.0
White Female 1,289 29.7 943 28.5
Colored Male 614 14.2 442 13.3
Colored Female 445 10.3 287 8.7
Unknown 118 3.6

It will again be noted-as would be expected-that the largest num-
ber of cases continue to be reported from the larger county health de-
partments where more people live, but it should also be pointed out that
the mortality rates among these larger health departments is higher.
The largest number of cases reported was from Dade County where 499
new cases were reported; in Hillsborough County 484 new cases were
reported; in Orange County 356 cases were reported; in Palm Beach
County 381 new cases were reported, and in Duval County 339 new cases
were reported.

It is interesting to observe in studying the morbidity of tuberculosis
that in Palm Beach County, which is a new health department, there
were 9 cases reported for each recorded death, and in Orange County
there were 7 cases reported for each recorded death; Hillsborough County
reported 6 cases for each recorded death while Dade County reported only
4 cases for each recorded death, and Duval County reported 2 cases for
each recorded death.

Table XXI shows the number and percentage of tuberculosis cases
reported by age groups during the year 1948 which is well represented in
Figure 3. An analysis of this graph shows that the highest incidence of
tuberculosis cases reported is between the age group from 45 to 54, and
the second highest between the age group from 35 to 44. This cor-
responds fairly well with the mortality figures for the same age groups.

TABLE XXI
NUMBER AND PERCENTAGE OF TUBERCULOSIS CASES REPORTED BY AGE GROUPS,
FLORIDA, 1948
AGE GROUPS CASES PERCENT
TOTAL 3,313 100.0
-5 18 0.5
5-14 18 0.5
15-24 274 8.3
25-34 536 16.2
35-44 633 19.1
45-54 669 20.2
55-64 524 15.8
65+ 438 13.2
Unknown 203 6.1







40 ANNUAL REPORT, 1948


FIGURE 3
PERCENTAGE OF TUBERCULOSIS CASES
REPORTED, BY AGE GROUPS, FLORIDA 1948


S20








0

I-




-5 5-14 15-24 25-34 35-44 45-54 55-64 66+ UNKNOWI
AGE IN YEARS


Figure 4 illustrates a comparison between the cases reported for 1947
and those reported in 1948. As stated before, there is no striking differ-
ence between the percentage of the total cases reported for 1947 and
1948 in either the white or colored population. It does bear out the
fact, however, that there were a slightly larger number of white males
reported and a slightly smaller number of colored males and females
reported during 1948.







TUBERCULOSIS CONTROL


FIGURE 4
COMPARISON OF PERCENTAGE OF TUBERCULOSIS
CASES REPORTED BY RACE f SEX6 FLORIDA 19471948

PERCENTAGE OF TOTAL CASES REPORTED
0 10 20 30 40 so

WkITS MALE


W141ITE FEMALE


COLORED MALE
mH 1948
COLORW FEMALE B -- I 1947


UNKOW ______________


An analysis of the Central Case Register shows that 34 of the more
populous counties have operating case registers at the present time which
are duplicated in the State Office. This is shown in Table XXII which
gives the number of active cases in the register, the number of ques-
tionably active, the number of inactive, and those in sanatoria. It will
be noted that the cases represented in the Central Case Register have
increased from 7,417 as of December 31, 1947 to 8,850 as of December
31, 1948. This shows that better controls have been established over the
cases in the State.
Table XXII also is revealing in that it shows the number of patients
with positive sputum who are residing in their homes. There were 871
cases with positive sputum at home and 2,033 with undetermined sputum
which were considered active cases. There were 503 cases residing at
home with negative sputum who were also considered as active cases.
There were also 831 cases in the home who were considered as question-
ably active. These known cases show that there are potentially 4,238
persons who possibly need hospitalization who are not receiving treatment.
In addition, there were 1109 cases in sanatoria during 1948 as compared
with 1360 in 1947. Table XXII also shows the cases in the register with
current status residing at home.









TABLE XXII
ANALYSIS OF CASES IN THE CENTRAL TUBERCULOSIS CASE REGISTER
J~TiT wER 31 1948


COUNTIES Pos. Sputum


Alachua 8
Baker 1
Bay 4
Bradford 0
Broward 16
Dade 195
Dixie 0
Duval 22
Escambia 18
Franklin 0
Gadsden 12
Gulf 1
Hernando 7
Hillsborough 194
Jackson 14
Lafayette 1
Lake 13
Leon 6
Levy 1
Manatee 4
Monroe 5
Nassau 3
Orange 54
Pasco 5
Pinellas 24
Polk 24
Santa Rosa 2
Sarasota 5
Seminole 8
Sumter 3
Suwannee 2
Volusia 14
Wakulla 1
Washington 2

City of Jacksonville 157
State Hospital-
Chattahoochee 45
TOTAL \ R71


Active Cases
Neg. Sputum I Undetermined 0. Act. Cases
Sputum


18
1
8
2
7
131
1
12
13
1
1
1
2
26
12
0
7
5
1
2
3
2
51
4
11
16
5
2
9
1
0
22
1
2

60

63
5032


15
0
22
3
14
776
1
14
69
3
26
3
7
472
23
3
21
31
3
7
5
9
91
7
18
41
9
4
5
1
1
10
1
8

251

59
2 ,033


Inact. Cases


104
8
56
5
72
734
5
48
177
3
47
5
8
716
30
2
41
78
16
27
41
18
218
10
259
139
17
36
41
6
9
87
4
6

230

134
3,437


DJCMlB- I X


In Sanatoriums Other TBC Total Cases Current in % of Patients Z
Examination Current Out- E:
side of Sans

28 0 210 90 42.9
3 0 15 6 40
30 2 146 37 25.3
3 0 19 7 37
23 2 172 119 69.2 O
258 34 2,295 372 16.2
0 0 12 10 83.3
34 0 138 57 41.3
69 2 378 87 23.1
6 0 17 7 41.1
14 0 116 30 25.8 ,
8 0 24 11 45.8 D
1 0 27 3 11.1
109 5 1,600 313 19.6
17 0 113 34 30.1
1 0 9 4 42.2
9 2 100 25 25
21 0 172 67 39
3 0 34 17 50
13 1 74 43 58.1
8 1 77 45 58.4
11 0 47 19 40.4
73 1 565 193 34.1
2 0 35 5 14.3
67 4 400 250 62.5
55 1 326 152 46.6
9 1 49 7 14.3
9 0 69 29 42
21 0 94 14 14.9
2 0 15 6 40
4 0 26 19 73
34 0 189 80 42.3
2 0 13 9 69.2
6 0 35 12 34.3

156 10 880 175 19.9
0 359 125 34.8
1,109 66 8,850 2,479 28.01







TUBERCULOSIS CONTROL 45


DIAGNOSTIC CLINICS

All of the permanent diagnostic clinics in local health departments
as well as the itinerant clinic operated by the Bureau of Tuberculosis
Control have shown a marked increase in activities over 1947. During
1947 there were 9,434 large 14x17" X-rays read by the Bureau of Tuber-
culosis Control received from local health departments, consultation
films from private physicians, the itinerant clinic, and from tuberculosis
and health associations. During 1948 this service has increased rather
markedly to 13,538 X-rays interpreted. This is shown in Table
XXIII. Sixty percent of all large films read during 1948 were initial
X-ray films and 39.5 were subsequent or follow-up X-ray films. Table
XXIII also shows the number of negative films, the number of minimal,
moderately advanced and far advanced cases found, also the patients
with thoracoplasty and pneumothorax, broken down by age and color.
Of the films interpreted, approximately 18 percent showed evidence
of tuberculous pathology and an additional 8.5 percent showed evidence
of suspicious tuberculous pathology. In 1947 twenty-three percent of all
X-rays examined showed evidence of tuberculous pathology. In addition
to the tuberculous pathology found on the films read in 1948, 4.6 percent
showed evidence of pathology other than tuberculosis. It is rather sig-
nificant that of all the patients examined, 322 cases, or 2.4 percent
showed evidence of far advanced tuberculosis, while 1460, or 10.8 per-
cent showed evidence of minimal pulmonary tuberculosis by large film
X-ray. This is in marked contrast to previous figures and to the type
of patient previously admitted to tuberculosis hospitals where approxi-
mately 70 to 80 percent of all admissions were in the advanced stages of
the disease. There were, however, fewer minimal cases of tuberculosis
found in clinic and consultation X-rays during 1948 than in 1947.


MASS CASE FINDING
The principal activity of the Bureau of Tuberculosis Control during
the year 1948 was in the field of mass X-ray survey, using portable and
mobile 70 mm X-ray equipment which we have continued to concentrate
on community-wide X-ray services.
During the second full year of operation of the four mobile and
portable survey units carried into communities by the State Board of
Health, and the two stationary X-ray units operated by the Dade County
Health Department and the Hillsborough County Health Department as
well as mobile units operated by the Dade County Tuberculosis Associa-
tion, the Polk County Health Department, and the Orange County Tu-
berculosis and Health Association, there were 415,599 adults of the State
of Florida examined. This represents approximately 20 percent of the
population of the State and is an increase over the 315,696 films taken
during the year 1947. During 1948 a total of 1,306 cases of definite
tuberculosis were found and 3,167 cases of suspicious tuberculosis path-
ology were demonstrated. In addition to the tuberculous pathology

















Age


0-10



11-20



21-30


Color and
Sex
W-M
W-F
C-M
C-F
W-M
W-F
C-M
C-F
W-M
W-F
C-M
C-F


W-M
W-F
31-40 C-M
C-F
W-M
W-F
41-50 C-M
C-F
W-M
W-F
51-60 C-M
C-F
W-M
61 AND W-F
OVER C-M
C-F
TOTALS
PERCENTAGE


TABLE XXIII

TOTAL NUMBER OF CLINIC AND CONSULTATION X-RAYS INTERPRETED DURING THE YEAR 1948
DIVIDED INTO STAGE OF DISEASE, AGE, SEX AND COLOR, WITH PERCENTAGE
OF PATHOLOGY IN THE VARIOUS CATEGORIES Z

Second Unsatis- Minimal Moderate Far Thoracoplasty Pneumothorax Pri- Other C
Film Negative factory Active Inactive Active Inactive Advanced Active Inactive Active Inactive Susp. mary Path. Totals a
84 199 9 0 0 0 0 0 0 0 0 25 10 10 253
108 234 13 0 1 0 1 0 0 0 0 0 33 13 8 303w
49 89 4 0 0 0 0 0 0 0 0 0 11 12 3 119 t]
38 72 4 0 0 0 0 0 0 0 0 8 8 2 94 1
196 491 7 6 9 2 1 0 0 0 0 1 31 8 10 566 W
215 582 11 6 6 2 1 0 0 0 0 3 18 0 20 649 3
112 271 5 0 4 2 1 1 0 0 0 0 18 7 2 311
80 204 1 0 1 2 1 9 0 2 0 0 12 2 3 237.
272 647 6 18 37 12 10 9 1 5 0 7 59 30 841
405 933 18 20 52 16 7 6 0 4 2 18 54 1 1,164
99 294 6 1 14 2 3 11 0 0 0 1 17 6 11 360
107 294 8 11 10 5 2 7 0 1 0 4 17 5 364
363 602 8 27 84 24 25 11 2 26 1 9 59 0C 34 912
454 775 17 23 113 17 30 18 0 17 1 14 71 22 1,118
117 225 4 10 27 12 3 21 0 2 1 2 30 0 11 348
159 272 10 9 17 9 4 12 0 6 0 2 29 0 9 379
380 395 18 23 123 34 45 44 0 10 2 14 76 0C 49 833
337 505 14 4 84 14 30 0 12 0 6 64 0 29 774
113 164 2 4 22 10 10 18 0 0 0 5 37 0 11 283
116 186 6 5 20 3 7 7 0 3 0 2 22 0 9 270
361 239 18 44 145 31 44 42 0 6 0 2 99 0 56 726
276 305 13 6 108 7 31 7 0 10 0 2 67 C' 31 587
67 68 7 6 17 7 6 5 0 0 0 2 21 0 16 155
75 86 2 1 18 2 4 6 0 0 0 0 10 C' 11 140
402 262 13 28 157 49 59 48 0 2 0 4 142 1 101 866
217 250 10 14 88 18 29 14 1 2 0 0 79 Cl 74 579
90 75 7 3 25 8 10 12 0 0 0 0 22 C 19 181
50 84 4 3 6 2 2 2 0 0 0 15 C 8 126
5,342 8,803 245 272 1,188 290 366 322 4 108 7 98 1,146 62 627 13,538
39.5 65.0 1.8 2.0 8.8 2.1 2.7 2.4 0.03 0.8 0.05 0.7 8.5 0. 4.6


. _








TUBERCULOSIS CONTROL 45

demonstrated, 2,332 persons with pathology other than tuberculosis were
demonstrated. Table XXIV shows a summary of the mass X-ray sur-
veys along with the 14" x 17" X-ray follow-up and the percentage of
follow-up. This table also shows the number of patients for whom hos-
pitalization was recommended after follow-up, and those for whom clini-
cal study was recommended. This is demonstrated in Figure 5.




FIGURE 5
MASS I-RAT SURvr SIMMARI OF IINIATUE N I AIND Il4 x 17 I-RAT FOLLOW-UP 1948

FirMDrS FROII 15,599 MINIATURE I-RAT FILMS


Other Pathology


I ,!473


S2,332


FINrrnS OF U4 x 17 FTLM FOLLO-UP ON 67% o9 rS EFINITE AND SUSPICIOUS TUR CULOSIS CASES


Neber of 14 x 17 X-rays Taken


Total Cases of Tuberculosis Found 2,000


rEC mDED DISPOSITION

347l Hospitallatio Advised


C1101ea1 Otudy Alv 1,000


500 1,000 1,500 2,000 2,500


3,000 3,500 l,000 1,500


As was the case in 1947, a great deal of the credit for the large num-
ber of X-ray films taken is to be given to the Florida Tuberculosis and
Health Association and the county tuberculosis and health associations
who participated wholeheartedly in a cooperative effort for community
organization.

The Florida Tuberculosis and Health Association continues to pay
a part of the salary of one of its field secretaries who spent the greater
part of her time in organizing communities for the X-ray survey services.
We feel certain that any increase in activities that have been brought
about were due to a great extent to the activities of this organization.


S2,983


-~---


Definite and Suspicious Tuberculosis





i I I I I




TABLE XXIV
MASS X-RAY SURVEY SUMMARY OF MINIATURE FILM AND 14 x 17 X-RAY FOLLOW-UP, 1948


Miniature Film )


Location Persons Definite Suspicious
Examined Tuberculosis of Tuberculosis


Alachua 7,954 8 30
Univ. of Fla. 1,172 2 4
Univ. of Fla. 10,833 6 43
Broward 13,669 45 148
Charlotte 1,333 2 11
*Dade (Assn.) 22,399 81 163
Dade (H. D.) 13,206 12 266
DeSoto 3,314 4 32
Dixie 1,372 1 11
Escambia 18,560 32 114
Naval Air Base 4,444 9 41
Escambia 327 1 4
Franklin 825 1 14
Gilchrist 541 3 3
Gulf 2,203 2 17
Hamilton 1,000 3 15
Hardee 1,502 1 9
Hillsborough 59,731 92 389
*Hillsborough (H.D.) 41,034 571 80
Holmes 1,780 4 15
Jackson 5,415 13 44
Jefferson 1,798 1 11
Lafayette 504 0 4
Lake 9,598 17 85
Lee 5,580 10 60
Leon 13,796 7 65
A. & M. College 1,634 0 5
Fla. St. Univ. 4,710 3 12
Madison 3,052 2 17
Manatee 7,545 9 66
Martin 1,824 4 14
Okaloosa 2,584 6 30
Orsn e 29,100 49 223
.... (H. D.) 10,716 19 154
Palm Beach 46,082 168 555
**Polk (H. D.) 21,920 14 112
St. Lucie 4,437 15 29
Santa Rosa 1,981 4 17
Sarasota 8,440 15 78
Suwannee 1,969 6 21
Taylor 3,218 12 34
Fla. St. Prison 1,648 10 17
Volusia 15,905 32 80
Wakulla 1,068 2 12
Walton 1,726 3 10
Washington 2,150 5 13
TOTALS 415.5i9 1,306 3.167


Other
Pathology


Persons Followed-Up Cases of NJ
with 14 x 17 X-Ray Tuberculosis
Found


30
3
14
112
5
178
59
22
13
75
15
2
3
6
14
13
8
197
426
11
41
18
3
74
24
61
0
13
14
85
12
13
131
22
396
45
13
7
58
13
23
13
67
14
13
15
2,332


22
2
36
164
9
77
236
33
8
104
46
0
12
6
13
13
7
829
265
17
46
6
3
60
61
61
8
13
18
74
10
10
244
118
503
76
19
16
83
21
36
15
83
7
9
15
2.983


I M iniature Films ......... .. ... f I


10
1
13
87
7
27
77
25
4
76
23
0
2
3
4
5
4
253
529
6
17
1
0
36
27
26
0
2
7
45
5
5
147
27
296
21
9
15
60
11
18
8
50
3
3
6
2,000


14 x 17 Follow-Up on Tuberculosis an ious cases


ew Cases
Found

10
1
5
63
7
27
77
21
3
21
19
0
2
1
3
1
2
208
0
3
12
1
0
25
19
15
0
0
6
34
2
3
124
23
201
14
3
12
41
6
0
5
18
2
2
4
1,04Ce


Hospitalization Clinical Study
Advised Advised

0 6
1 0
1 9
14 68
0 6
7 34
60 17
12 4
2 3
0 68
1 0
0 0
1 1
0 1
3 5
1 1
2 3
47 0
34 960
2 4
5 10
0 1
0 0
10 26
3 28
5 15
0 0
0 2
3 3
4 40
0 8
0 4
5 25
27 48
66 167
5 0
4 9
2 3
2 49
2 9
0 0
6 0
6 36
0 3
2 0
2 4
347 1,r30


Percent
Follow-Up


58.0
33.3 >
74.5 Z
85.0 Z
69.2 C
31.6
84.9
91.7
66.7
71.2 t
90.0 *0
.0 O
.o O
80.0
100. -
68.4
72.2 ,.
70.0 10
68.4
89.2
89.5
80.7
50.0
42.9
58.9
85.0
84.7
60.0
86.7
68.4
98.7
55.6
27.8
89.7
68.2
69.6
60.3
43.2
76.2
89.2
25.9
78.2
55.6
74.1
50.0
69.2
83.3
66.7







TUBERCULOSIS CONTROL


TUBERCULOSIS ACTIVITIES IN COUNTIES
The Monthly Activity Report of the Bureau of Local Health Services
shows that there were 19,704 clinic visits made during 1948. This is a
slight increase over the visits made in 1947. This report also reveals
that there were 25,789 field nursing visits made which is approximately
the same number of visits made in the preceding year. In addition there
were 9,038 office nursing visits made which is a marked increase over
the 5,940 office visits made in 1947. Also in 1948 there were 1141 pa-
tients hospitalized through the local health departments, while in 1947
there were 1065 patients hospitalized through this source.

SUMMARY
The above report illustrates with a fair degree of accuracy the
progress that has been made in the public health aspects of tuberculosis
case finding and a study of the extent of the tuberculosis problem in
Florida.
There still remains, however, the old problem of isolation and ade-
quate hospitalization. The tuberculosis mortality has shown a decided
decrease over the preceding year which we believe can be explained to a
large extent by the addition of some 700 beds for the isolation of the in-
fectious cases of the disease. This, however, is not adequate since there
are known to be potentially 4,282 patients who need hospitalization.
The ultimate control of tuberculosis in the State of Florida, therefore,
would seem to resolve itself into a relatively simple formula, and that is
to provide a bed for the isolation and treatment of every known case of
tuberculosis in the State.










NUTRITION INVESTIGATIONS

AND SERVICES

WALTER WILHINS, M. D., Ph. D., Director

The demand for nutrition work in Florida has increased greatly dur-
ing the past two years. This has occurred in spite of the fact that the
average family income has been at an all-time high. It is not an indi-
cation that malnutrition is on the increase but rather that more people
are appreciating the role that nutrition, good and bad, plays in determin-
ing the health level, efficiency, and longevity of both young and old,
both rich and poor. The health workers and the private citizens of Flori-
da are showing increasing interest not only in the prevention of malnu-
trition but in the advantages of what good nutrition has to offer. The
emphasis is shifting from "avoiding something" to "gaining something".
This does not mean that the problem of malnutrition has been solved
-far from it. But it indicates a growing realization that nutrition is
something that affects all of the people all of the time for better or for
worse.
During times of economic prosperity the incidence of the severer
nutritional diseases usually decreases because more people have more
money to spend for food. In spite of painfully high food costs, there are
indications that the average Florida family is as well fed as it was before
or during the late war.
Someone has said that poor nutrition is due to the three I's: Income
(low), Inertia, and Ignorance. There is good evidence that each of
these is yielding to the efforts of the various agricultural, educational,
and public health workers as well as to the work of many other interested
groups and individuals.
The name, Nutrition Investigations and Services, indicates the dual
nature of the public health nutrition program in Florida. The investi-
gative work during 1948 has continued along the lines begun two years
ago. The service phases are largely educational in character. Emphasis
is being placed upon demonstration techniques and other dynamic means
of presenting information, stimulating motivation, and generating a de-
sire to "use what we know" about nutrition.
In a broad sense, the entire program is educational in nature since,
in the course of investigative work, every opportunity is grasped to create
interest in the work that is in progress. It is felt that sometimes more ac-
tual "learning" occurs under such conditions than takes place with some
of the more conventional methods of teaching. For example, those who
have seen it have been impressed by the interest shown by school children
of all ages in the tests that are done on their blood. The hemoglobin
test is rapidly becoming known as the "red test". How red is my blood?







NUTRITION 49


Why is my blood "low"? What can I do to get it red like it should be?
Is Johnnie's blood better than mine? These types of questions are fre-
quently heard by staff members doing hemoglobin and other tests in the
schools. If we had the answers to all of the questions the children ask,
there would be no need for further nutrition investigations in Florida.
What better teaching opportunity could one ask for?


NUTRITION INVESTIGATIONS
EYE CONDITIONS:
Several abnormal eye conditions have been found to be prevalent in
some areas. Among these are "poor eyesight" or decreased visual acuity
which is all too common in all areas and among all groups. How much
of this stems from or is related to nutritional conditions is not known.
Extensive studies of this problem are in order and are being planned.
Follicular conjunctivitis (granulated eyelids) is found to occur in as
high as 70% of the children in some schools. On the other hand, almost
none is found in other schools. Why? We do not have the answers.
Several years ago studies conducted by the School of Home Economics
at Florida State University suggested that this condition is related to
vitamin A intake. A few preliminary tests by our staff have given var-
iable results.
In order to get more definite information on this problem a coopera-
tive study is being conducted by the Florida State Board of Health and
Florida State University. In the fall of 1948 a survey was made among
the white school children of Leon County to determine the incidence
and degree of severity of the condition. Over 2400 children were ex-
amined and the following findings on follicular conjunctivitis recorded:
Number Percent
Children Examined ................................................ 2,456 100.0
Children free of Follicular Conjunctivitis .................... 1,343 54.6
Children with Follicular Conjunctivitis .........--............. 1,113 45.4
M ild ................... ...................... ............. 912 37.1
M moderate .........-------- -................. ......-- ....... 166 7.0
Severe ....................-- -.................-............ 35 1.4
Thus, over 45 percent showed some degree of follicular conjunctivitis.
Between 350 and 400 children were selected for the study. These in-
cluded most of the severe and moderate cases and over 100 children whose
eyelids appeared to be normal. Letters were sent to the parents of these
children offering them the opportunity of participating in the study.
Visits were also made to some of the homes. The response by both par-
ents and children was almost 100%.
Blood studies were done on both groups to determine the amount of
vitamin A present. Therapeutic tests with vitamin A, carotene, and
other substances are still under way and will continue until May, 1949.







50 ANNUAL REPORT, 1948


Every school day the participating children of each school are met in
the lunchroom by a worker who "administers" the vitamins, watches each
child gulp down his test dose, and records the event on the permanent
record.
Whether it will be necessary to continue the work for another year
cannot be determined until the initial study is completed.

ACNE:

The studies on acne which were begun in 1947 were continued in
1948. Most of this work has been done in Leon High School and the
Elks Club of Tallahassee has assisted in purchasing some of the test ma-
terials. The 1947 study gave such promising results that the same gen-
eral plan was followed in 1948. Again over 200 students participated.
All students were carefully examined on two separate occasions before
the therapeutic testing was begun. They were divided into three groups
of about 75 students each. Cases of different degrees of severity were
equally divided among the three groups. The three groups were placed
on different combinations of supplements. Each student reported to the
nutritionist at the school clinic every school day (five times per week)
to take his test dose.
The testing continued for a period of twelve weeks. During this time
records were kept of all procedures, absences, etc. As in the previous
year, the examiner in doing the final check-up did not know to which
group any student belonged. The results were even more encouraging
than they were in 1947. They are given in the following table:

Areas of Face Graded 2* or More on Examination at Beginning
Type of No. of Average Grade Average Grade Average
Supplement Areas Beginning End Improvement
Group I Control 170 2.2 1.9 .3
Group II Vitamins A & C 174 2.2 1.6 .6
Group III Multivitamins 145 2.2 1.3 .9
Areas of Face Graded 3* on Examination at Beginning
Type of No. of Average Grade Average Grade Average
Supplement Areas Beginning End Improvement
Group I Control 40 3.0 2.7 .3
Group II Vitamins A & C 35 3.0 2.3 .7
Group III Multivitamins 24 3.0 1.8 1.2
* The following code was used to express absence and degree of severity of acne:
0 None
1 Mild
2 Moderate
3 Severe

The results indicate that such vitamin supplementation would be a
reasonable supportive measure in the treatment of acne. However, there
is no thought that it should be considered primary treatment itself. The
results of these tests do not indicate that acne is a "sign of" or due pri-
marily to malnutrition. They do indicate that supplementation with
certain nutrients is helpful.







NUTRITION 51


A nutrition questionnaire was filled in by the group under study and
by over 800 other students in the school. A summary of the results fol-
lows:

Which of the following do you eat at home?


Acne Groups Other Students
Percent of Students Percent of Students
1. Butter 24.3 25.9
Margarine 15.7 17.3
Both 58.9 56.4
Don't know 1.0 0.4

2. Whole wheat bread 3.0 2.4
White bread 47.7 50.1
Both 49.2 47.5

3. Iodized salt 66.0 65.7
Plain salt 10.2 15.8
Don't know 18.8 17.2
Both 5.1 1.2

4. I eat breakfast on school days
Always 73.6 76.6
Usually 14.7 14.4
Occasionally 7.6 5.1
Almost never 2.0 2.3
Never 2.0 1.7

5. I eat sweets
Frequently 40.6 35.2
Occasionally 55.3 60.6
Almost never 3.6 3.9
Never 0.5 0.2

6. The average amount of milk I drink daily is
None 4.1 6.9
1 glass 17.8 16.2
2 glasses 29.9 29.8
3 glasses 22.3 21.9
4 glasses 16.2 16.2
5 glasses 4.6 3.9
6 glasses 3.6 2.9
7 or more 1.5 2.0


ANEMIA:

The blood studies on anemia and sub-optimal hemoglobin levels have
been continued. Therapeutic testing previously done with iron alone
has shown little evidence of increasing such hemoglobin levels. A group
of children in Hillsborough County participated in a study to determine
whether iron and copper supplementation would elevate sub-optimal or








52 ANNUAL REPORT, 1948


anemic hemoglobin levels. Children from the first through the fifth
grades were included as shown in the table below:

Average
Upper, Middle Difference -
or lower 1/3 Total between Hb.-
according to number Average Hb. Average levels at -
beginning Hb. Average Number tests level at Hb. level beginning -
level Supplement Age Children done beginning at end and end-

Upper Iron 9.2 10 176 12.9 12.5 0.4 -
Middle 8.8 10 163 12.1 11.8 0.3 -
Lower 9.1 10 169 11.4 11.1 0.3
Iron and
Upper Copper 9.2 18 238 12.7 12.3 0.4 -
Middle 9.1 19 264 12.1 11.9 0.2 -
Lower 8.6 19 250 11.2 11.2 0.0
Upper None 8.9 23 290 12.6 11.9 0.7
Middle 8.7 23 286 11.9 11.6 0.3
Lower 7.6 22 260 10.3 10.1 0.2 -
TOTAL 153 2,096



Several separate hemoglobin tests were done on each child at the be-
ginning and at the end of the testing period of 9 weeks. Although this
study was purely preliminary, the results show that, under the condition
of the experiment and in the amounts given, there was no elevation of
hemoglobin level as a result of the supplementation with iron plus copper.

Plans have been completed for a comprehensive study of anemia and
sub-optimal hemoglobin levels in pregnant women. This will necessarily
be with smaller groups than similar blood studies on school children.
Preliminary indications are that anemia is extremely common in such
individuals with somewhat lower average levels in Negro than in white
women. This study has been started in cooperation with the Bureau of
Maternal and Child Health and the Alachua County Health Unit, and
it is anticipated that it will be expanded to include several other areas
when time and personnel permit such expansion.

At present iron is being furnished all health departments requesting
it for use in prenatal clinics, but we have as yet little information of a
local character as to its efficacy, if any, in preventing or alleviating such
low hemoglobin levels in pregnancy.

GRANTS OF SUPPLIES:

During the year we received a gift from Mead Johnson & Company of
a large supply of testing materials, including:

221,000 Thiamine hydrochloride tablets, 1 mg.
70,000 Thiamine hydrochloride tablets, 5 mg.
68,000 Riboflavin tablets, 1 mg.
40,000 Riboflavin tablets, 5 mg.
34,000 Ascorbic acid tablets, 100 mg.






NUTRITION 53


PUBLICATIONS DURING THE YEAR:
1. Walker, Vera W., Fowler, Nettie Mae, Geiger, Winnifred. What
Shall We Teach Our Children About Food? (Report of a Dietary
Study in Union County, Florida.) Published in mimeographed form
by Nutrition Investigations and Services, Florida State Board of
Health, August, 1948. This study was reviewed in a number of
scientific journals and as a result large numbers of copies have
been requested by nutrition workers from all over the United States.
2. Wilkins, Walter. Better Nutrition For All. Alaska's Health, Octo-
ber, 1948.
3. Englar, Thomas S., Blakely, Ruth, and Wilkins, Walter. Hemo-
globin Studies on Albemarle County School Children. Virginia
Medical Monthly, Vol. 75, Pages 236-240, May, 1948.
4. Walker, Vera W. and Wagner, Florence. Workshops in Florida
on Food For Children. School Life, April, 1948.
5. Wilkins, Walter, and Boyd, French. NUTRITION FOR YOU,
Second Edition. Second printing.

NUTRITION SERVICES
The requests for educational and demonstration services have con-
tinually increased. Staff members have taken part in numerous meetings,
conferences, teacher workshops, lunchroom workshops, agricultural meet-
ings, and dietetic and home economic meetings within the state. Num-
erous conferences on nutrition and related problems have been held with
public health workers from all sections of the state.
The director, in his capacity of chairman of the Nutrition Committee
of the American School Health Association, has kept in touch with nu-
trition activities in school health programs in different sections of the
United States. In spite of the smallness of the staff in proportion to the
problems we face, it is felt that definite progress in being made among
the school children of Florida. A large part of this is being accomplished
by the lunchroom workers and teachers all over the state.
A nutrition manual for use by Nurses is being prepared in coopera-
tion with the Division of Nursing. The plan is being worked out to give
every public health nurse in the state an opportunity to indicate what
type of manual she would find most useful.
The booklet, NUTRITION FOR YOU, has been widely used
throughout Florida and other states. All State, Territorial, and Provin-
cial health departments were extended the invitation to reprint the book-
let.
Enrichment of flour, bread, grits and cornmeal has been encouraged.
At present Florida is the only state in the deep South not requiring such
enrichment. It is hoped that Florida will soon have this progressive legis-
lation and thus benefit along with 25 other states by such advantages
modern science has placed at our disposal.
During the year the unit has had numerous visitors from all over the
world including Egypt, India, Canada, various South and Central Ameri-
can countries, as well as from many sections of the United States.











BUREAU OF

SANITARY ENGINEERING

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

The tabulations of which this brief report is principally comprised
afford a statistical picture of physical features of activity in public health
engineering in Florida during the year. Equally important, however,
are certain phases of this effort which cannot be included in a mere
numerical listing. Included in these would be the results of the cam-
paign or program directed toward the abatement of pollution of under-
ground and surface waters of the state. It is felt the citizenry is showing
more interest in seeing needed corrections made.

Application of effort of the bureau has continued to be more effec-
tive through its regional engineers. This has served to point up the need
for further bolstering these local offices, which is planned for the ensuing
year under favorable circumstances relating to resources and availability
of personnel.

In the latter months of the period, construction costs involved in im-
proving and providing public health utilities appeared to be reaching
some degree of stability. Waterworks and sewerage construction will
likely be accelerated under more stable economics or a downward trend
in costs. The results which have been obtained in the course of river and
tidal water studies and subterranean water investigations made by the
bureau during the year strongly emphasize the need for going forward
with such construction at several points in the state without further delay.


PUBLIC WATER SUPPLY AND TREATMENT

NEW AND PROPOSED CONSTRUCTION
In Table XXV are listed those public water projects for which plans
and specifications were received and approved by the Bureau of Sanitalr
Engineering during 1948. The total number of projects (39) and the esti-
mated cost ($4,699,776) were both considerably less than those receiving
approval in 1946 and 1947. However, it is still evident that improve-
ments and extensions to established plants and construction of complete
new water systems is being maintained on a high level. The highlight
of the year's progress was the placing in service in November and Decemi
ber of new complete water treatment plans for the cities of High Spring
and Gainesville, respectively.







SANITARY ENGINEERING 55


TABLE XXV
PUBLIC WATER SUPPLY PROJECTS APPROVED IN 1948


MUNICIPALITY

West Palm Beach
Orlando
Fort Walton
Florida Industrial School
University Park S/D (Miami)
Florida A & M College
Lantana T. B. Sanitorium
Burkett S/D (Jacksonville)
McIntosh
Atlantic Beach
Homesdale S/D (Jacksonville)
Mauham-Butler Inc. (Miami)
Ellinor Village S/D (Pensacola)
Leon Terrace S/D (Jacksonville)
Bond Elementary School
Groveland
Cocoa
Ellinor Village S/D (Ormond)
Fla. Farm Colony (Gainesville)
Biscayne Water Co. (Miami)
N. B. Rood Apt. Gr. (Miami)
Odessa Water Co. (Jacksonville)
U. S. Phosphoric Prod. Co.-
(E. Tampa)
Female Corr. Inst. (Ocala)
City of Miami
Pinellas Co. Water Company
Naples
Baldwin Public School
Murray Hill Gardens (Jax)
State Hospital (Chattahoochee)
Daytona Beach
Homosassa Springs
Apalachee Institute
Tampa
City of Miami
Trenton
New Port Richey
Miami Pineapple Plantation
Gainesville


PROJECT


Additions to chemical equipment
Water Plant Piping & equipment
Additions to water dist. system
Water supply system
Water system
Water system extensions
Water system
Water system
New well and plant improve.
Municipal water plant
Water system
Water system
Water system
Water system
Leon Co.-water system
Water main extensions
Water plant
Water system
Additions to distribution system
Pump house & distribution system
Water system
Distribution system

Additions to existing system
Water system
Upper well field extensions
Clearwater new 16" trans. line
Water works additions
Water system
Water system
Piping revisions
Water system additions
New water system
Jackson Co.-water system
Water works improvement
S. W. emergency well field
Water supply well
Water supply well
Water treatment plant
New well


* Under construction; ** Completed; Estimated Cost $4,418,976.


EST. COST

$ 100,000*
1,835,000*
98,300*
44,000
9,000**
8,800
99,461*
10,374*
3,100**
150,000
10,000
7,000*
10,000**
10,000**
3,500
1,500**
100,000*
67,963**
12,814*
40,000*
9,500*
7,500

5,000**
20,000*
60,714*
287,500*
5,000*
6,000*
15,000
6,500*
38,950*
1,200*
75,000*
1,330,000*
165,000*
4,100*
4,000
35,000
35,000
$4,731,776






56 ANNUAL REPORT, 1948


OPERATION
Bureau activity on operation of public water systems while not as ex-
tensive as desired continued to be an important feature of our over-all
plan. Routine visits to water plants was more of an activity of regional
engineers than of central office personnel. This, however, was in keeping
with the purpose for establishing regional offices. This year saw the estab-
lishment of the fifth regional office providing decentralized coverage to
all sections of the state.
During the year, regional short courses for water, sewage and indus-
trial waste treatment plant operators were held at Clewiston and Clear-
water with enthusiastic response from operators and interested persons.
The annual five-day Conference and Short Course for Water and Sewage
Plant operators held in June at the University of Florida in Gainesville
was, as usual, well attended. Bureau personnel engaged in active instruc-
tion in both the water and sewage fields as well as providing instruction
in swimming pool design and operation.
Pursuant to the statutory obligation of supervising the operation of
public water systems, numerous instances of bacterial pollution of sys-
tems were investigated and guidance furnished for correction. Situations
requiring drastic action to protect public health necessitated, in some
cases, recommending that all consumers boil water for drinking and culi-
nary purposes until corrective action was effective. Two extreme cases
of pollution of deep well sources of municipal supplies were investigated
in detail. In each case, the source of pollution was located and remedial
measures prescribed.
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 61 permits for public water supply wells during 1948.
It is suspected that many more public water supply wells were actually
drilled without applications being forwarded to this Bureau, but 1948
showed a 30% increase in applications over those received during 1947.
This leads this office to hope that through further publication of informa-
tion informing well drillers of Statute requirements that submission of
applications for water well permits will be more nearly universal during
the forthcoming year.
Several months of an engineer's time were devoted to the detailed
study of pollution of deep-seated ground waters. Cooperation was re-
ceived from the Federal and State Geological Surveys and the State
Division of Water Survey and Research. Surveys and reports were made
on the situations in Orange and Suwannee Counties. This work showed
clearly that corrective action is urgently needed to prevent ruination of
the state's deep well waters.
BOTTLED WATER PLANTS
Operational permits for 30 bottled water plants were issued in 1948.
This was an increase of six (6) since 1947. Issuance of these yearly
permits is based upon at least annual inspections and approval of bottling








SANITARY ENGINEERING 57


facilities by County and/or State Health Department representatives, and
on submission of monthly water samples for bacteriological analysis which
must meet the Minimum Standards as recommended by the U. S. Public
Health Service and which have been adopted by this department.


SWIMMING POOLS

Swimming pools for public use are permitted on a permanent basis
as long as sanitary regulations are observed. In 1948 this office issued
permanent permits for operation of 10 pools, making a grand total of
105 pools permitted throughout the State. Plans and specifications were
approved for the construction or alteration of 34 pools, estimated cost of
which is over one million dollars. Bathing Place permits were issued to
16 public bathing places during the year 1948.



TABLE XXVI
PLANS AND SPECIFICATIONS APPROVED FOR SWIMMING POOLS 1948


LOCATION


Miami Beach
Miami Beach
Rainbow Springs
Coconut Grove
Miami Beach
Duval County
Miami Beach
Miami Beach
Miami Beach
Miami Beach
Vero Beach
Miami Beach
Miami Beach
Palm Beach Shores
Miami Beach
West Palm Beach
Miami Beach
Miami Beach
Jacksonville
Palm Beach
Sarasota
Miami Beach
Miami
Hollywood Beach
Hollywood Beach
Miami Beach
Miami Beach
St. Petersburg
Miami
Miami Beach
Delray Beach
Miami Beach
Miami Beach
Miami Beach


PROJECT


Delano Hotel Swimming Pool
Continental Hotel Swimming Pool
Rainbow Springs Bath House
Adirondacks Fla. School Swimming Pool
S. P. Kingston Hotel
San Jose Swimming Pool
Beach Comber Hotel
White House Hotel
J. I. Wohl Apartments
Norman Shoreham Hotel
Municipal Pool
Sherry-Frontenac Hotel
Sirkin Cabana
Palm Beach Shores, Inc.
Monte Carlo Hotel
Brown-Dal Corporation (Tourist Court)
Shoremede Hotel
El Morocco Hotel
Timuquana Country Club
Monte Cristo Apartments
Florasota Gardens Swimming Pool
Belmar Hotel
South Seas Hotel
Additions to existing pool
Hollywood Beach Hotel
Soyamore Hotel
Saxony Hotel
Vinoy Park Hotel
Mr. L. Codomo
Tatem Waterway
H. G. Flagler
Sorrento Hotel
San Juan Hotel
Delmonico Hotel


ESTIMATED COST

$ 25,000
25,000
5,000
4,000
25,000
45,000
25,000
35,000
25,000
42,000
15,000
55,000
50,000
50,000
40,000
5,000
45,000
50,000
25,000
6,000
10,000
50,000
30,000
2,000
25,000
70,250
45,000
35,000
30,000
60,000
18,000
25,000
25,000
35,000
$1,057,250







58 ANNUAL REPORT, 1948


TABLE XXVII
PERMITTED BATHING PLACES AS OF 1948

COUNTY NAME BaP. PERMIT NO.

Clay Spring Cove Bathing Place,
Green Cove Springs 10-1-48
Camp Immokalee 10-2-48
Kingsley Beach 10-3-48
Keystone Beach 10-4-48
Gold Head Branch State Park 10-5-48
Seminole Boys Camp 10-6-48
Camp Chowenwaw 10-7-48

Franklin Gorrie Bridge Bathing Place 19-1-48

Hamilton White Springs Bathing Place 24-1-48

Hillsborough Forest Hills Country Club 29-1-48
Palm Beach Tourist Court 29-2-48

Leon Camp Flastacowo 37-1-48
Levy's Bathing Place 37-2-48

Liberty Lake Mystic 39-1-48
White Springs 39-2-48

Martin Hospital Pond Bathing Place 43-1-48

Orange Lake Estelle 48-2-48
Lake Lorna Doone 48-1-48

Pinellas Boy Scout Camp Soule 52-1-48

Wakulla Wakulla Springs 65-1-48




COMMON CARRIER WATER SUPPLY AND
WATERING POINT SANITATION

Each year the U. S. Public Health Service circularizes common carrier
companies on or about December 1 for the listing 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 coopera-
tive 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.







SANITARY ENGINEERING 59


TABLE XXVIII
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-Prov. Appr'd-Prov.-Proh.

Water Supply
Examination 57 35 7 1 13 1

Watering Point
Sanitation 68 43 10 1 9 4 1



WASTES TREATMENT AND DISPOSAL

MUNICIPAL SEWERAGE PROJECTS
The high level of planning and design studies for sewers and treatment
plants continued throughout 1948. This activity included the approval
of plans for (32) projects, having a total estimated cost figure of $8,376,-
935. Seventeen of the above approved projects, with an estimated cost
of $2,961,157 were under bid or construction during the past year. Of
the seventeen, ten have been completed to date. A list of the cities for
which plans were approved is shown in Table XXIX.
From the standpoint of the treatment of municipal sewage great
strides forward have been made. The past year has seen plans put into
concrete form for sewerage or sewage treatment plants at the University
of Miami, Surfside, Silver Springs, Milton, and Lakewood Subdivision.
Construction equipment has been hard at work on sewage treatment
plants for: Winter Garden, Winter Park and Daytona Beach. The year
ended with the go-ahead signal being given on actual construction of the
Orlando sewers and sewage treatment plant and with advance planning
on plants for Tallahassee and Lake City. Preliminary surveys were in-
stigated for Bartow, Inverness and Tampa; and advertisement of bids
for Ocala. Active plans were underway for sewerage projects at Fort
Lauderdale, and Vero Beach as well as Panama City and Quincy.








60 ANNUAL REPORT, 1948


TABLE XXIX
SEWERAGE PROJECTS APPROVED IN 1948


MUNICIPALITY

Apalachee Institute
Bradenton
Baldwin School
Belle Glade
Brewster
Clewiston
Coral Gables High School
Daytona Beach
Frostproof
Florida Farm Colony
Female Correctional Institute
Flagler Beach
Gainesville
Jacksonville
Jacksonville School System
Lakeland
Lake Alfred
Lake Worth
Lantana
Miami Beach
Miami, 36th Street Airport
Miami, International Airport
Manatee County School
Marianna, Florida Indust. Sch.
Marietta School
Palm Beach
Plant City
Pensacola
Sarasota, Manatee Airport
St. Augustine
Volusia County Kennel Club
Wesconnet School


PROJECT


Sewage Treatment
Interceptor Sewer
Septic Tank & Sand Filter
Sanitary Sewerage Project
Sewers & Treatment Plant
Sewerage Improvements
Septic Tanks
Sewers and Sewage Treatment
Improvement to Plant
Sewer Additions
Sewers, Septic Tanks, Sand Filters
Septic Tank
Sewer Extensions
Sewer Extensions
Septic Tanks, Filters
Sewer Extensions
Sewage Treatment Plant
Sewer System
Sewerage System
Sewers
Storm Sewers
Sewage Plant
Septic Tank, Filters
Sewerage Project
Septic Tank & Sand Filters
Sewer Project
Sewerage Project
Sewer Extensions
Sand Filters
Sanitary Sewerage Project
Septic Tank, Filters
Septic Tank, Filters


* Under Construction or Bid On
** Completed


S ESTIMATED COS1


65,000
265,367*
12,000*
725,000
362,000
66,000
20,000
2,290,000*
5,000**
13,390**
40,000*
12,000
7,000*
964,000
18,000
59,000
25,000**
860,000
98,778
66,000
140,000**
45,500**
5,500**
55,000*
6,000*
885,000
115,000
32,000**
7,400**
1,100,000
6,000**
6,000*

$8,376,935







SANITARY ENGINEERING 61


INDUSTRIAL WASTE
Industrial waste problems came in for increased attention during the
past year. Disposal of citrus wastes continued to be of primary concern.
Probably next in importance was the waste from the pulp and paper
mill industry. The phosphate industry continued its financial support
of a research program on phosphate wastes. This work is being done un-
der the auspices of the Engineering Experiment Station of the University
of Florida in collaboration with the department.
All of the aforementioned industries have expressed a willingness to
cooperate with the Florida State Board of Health. Efforts to solve in-
dustrial waste problems will be further emphasized particularly if coopera-
tion with industry materializes into the financial assistance so necessary
to the making of a comprehensive survey and recommendations.
Plans for the disposal systems for nine laundries have been approved
during the year. These plans are the result of the wide use of launder-
ettes. Table XXX lists the laundry plants.

TABLE XXX
PLANS FOR INDUSTRIAL WASTE TREATMENT APPROVED IN 1948
LOCATION TYPE OF INDUSTRY $ ESTIMATED COST
Miami Laundry 2,500
Miami Laundry 2,500
Miami Laundry 2,500
Miami Laundry 2,500
North Miami Laundry 2,500
University of Miami Laundry 3,000
St. Petersburg Laundry 2,700
Pinellas Park Laundry 2,000

$20,200
DRAINAGE WELLS
Permits were approved for a total of (153) drainage wells in 1948.
The applications for approval were carefully reviewed. Most of the per-
mits granted were for the disposal of water from closed air conditioning
systems. These were considered as recharge wells since a closed system
is used and clean waters are involved. Other well permits approved were
for the disposal of surface water, control of lakes and disposal of swim-
ming pool and laundry wastes. The last two categories were approved
only if the well was drilled to salt water. Table XXXI shows the distribu-
tion, by counties, of these approved wells.

TABLE XXXI
DISTRIBUTION OF APPROVED DRAINAGE WELLS
COUNTY NO. OF WELLS
Alachua 1
Broward 27
Dade 110
Jackson 1
Levy 2
Madison 2
Orange 5
Palm Beach 2
Putnam 2







62 ANNUAL REPORT, 1948


STREAM POLLUTION

Stream pollution survey work was actively undertaken with the aid
of the mobile laboratory truck. Table XXXII lists the surveys conducted
during 1948.

TABLE XXXII

POLLUTION SURVEYS


Location


Principal Pollutant


Status


Apalachicola River & Bay
Manatee River at Bradenton
Rice Creek
Crescent Lake at Crescent City
Lake Tsala Apopka at Inverness
St. Johns River at Palatka
Orlando & Vicinity (Preliminary
Groundwater investigation)
Live Oak (Preliminary Groundwater
investigation)
Homosassa (Tidewater area)
St. Augustine (Bay waters)
St. Petersburg (Bay waters)

Indian River (Sebastian Inlet &
Vicinity)


Domestic waste
Domestic waste
Industrial waste
Domestic waste
Domestic waste
Domestic waste

Domestic & Industrial waste

Domestic & Industrial waste
Domestic waste
Domestic waste
Domestic waste


Domestic waste


completed
completed
completed
completed
completed
completed

completed

completed
completed
report preparation
active survey, pre-
liminary report

active survey


A State-wide "sight" pollution survey was conducted by the regional
and county sanitary engineers, giving an insight into the sites which
should be investigated.


FEDERAL HOUSING ADMINISTRATION
(Sewage Disposal and Water Supply)

The tremendous amount of residential construction work in 1948 was
reflected by the number of FHA forms approved. This represented the
third year of operation of the cooperative agreement between the Florida
State Board of Health and the County Health Units on the one hand and
the Federal Housing Administration on the other, a modification of the
original FHA-State Board of Health working agreement. The Florida
State Board of Health and the County Health Department certify indi-
vidual sewage disposal and water supply systems serving premises for
which the property mortgage is insured by the Federal Housing Admin-
istration. The following list summarizes this activity:

Form No. Description No. Approved
FHA-2218............Inspection Report & Certification (Sewage Disposal) .................. 8,582
FHA-2217............Inspection Report & Certification (W ater Supply)............................ 136
FHA-2084C .........Subdivision Percolation Report.......................... .......... ......... 17






SANITARY ENGINEERING


TOURIST COURT AND TRAILER CAMPS
There continues to be a high level of activity in the approving and
issuing of permits to operate tourist courts and trailer parks. The follow-
ing list tabulates the activities in this respect.

REISSUED NEW TOTAL
Tourist Camp Permits 37 293 330
Trailer Camp Permits 48 177 225
TOTALS 85 470 555

Together with those trailer park and cabin court permits which con-
tinued valid, the reissued permits and permits issued for newly constructed
courts and parks brought the total number of permits in effect for the
year to 1803.

SCHOOLS
Active cooperation has been given the Florida State Department of
Education under an extensive school construction and remodeling pro-
gram. The Florida State Board of Health has endeavored to check the
sanitary facilities for all new schools or additions thereto. Inquiries were
handled during the last three months of 1948 for the State Department
of Education on 15 schools. Investigations were made and plans ap-
proved on an additional 18 schools.

SANITARY MILK CONTROL
During 1948, the number of accredited and organized county health
units increased to cover sixty-two of the sixty-seven counties. Milk sani-
tation programs are now in effect and are an active part of the public
health programs in over fifty of these city and county health units. Their
sanitation activities practically cover the entire Florida dairy industry.
In 1948, the third post war year, improvements in sanitation, equip-
ment and processing were made, and at an accelerated rate by the pro-
ducers, distributors and health department personnel. During the year,
forty-four local and county milk programs were appraised, reviewed and
planned.
Seven complete milk sanitation compliance rating surveys were made,
covering communities' milk supplies, with the cooperation of the local
milk sanitarian. Panama City rated above 90% in milk sanitation com-
pliance; the Honor Roll Class. High ratings were attained by St. Peters-
burg, Sarasota, Avon Park and Sebring, although they were not quite
up to the grade A standard on compliance, 90%. Cooperative efforts
with local sanitarians brought the eleven milk distributors serving in-
terstate carriers up to the grade A standard compliance, to be "fully
approved"; rating over 90%.
The problem of handling shipped-in cream was emphasized when
cream was implicated in an outbreak of food poisoning, gastroenteritis,







64 ANNUAL REPORT, 1948


involving over twenty persons. Assistance was given to the medical epi-
demiologist in investigating this outbreak. The shipped-in cream con-
cerned had an excessively high standard plate count and coliform count
and had been bottled by the distributor from the bulk shipped-in can
without further processing. This was a violation of good dairy practices,
as well as public health regulations. The matter was promptly corrected
when the dangers of this practice were brought to the attention of the
distributor. The need of proper handling of shipped-in products was
circularized to the larger health departments after this outbreak occurred.
This illustrates the need for constant vigilance over the milk supply.
In cooperation with local sanitarians, nearly three hundred inspections
and visits were made to plant producers' farms, producer-distributors, and
pasteurization plants, in carrying out the state level program of consult-
ing and advisory service to city and county health units, in matters con-
cerned with the adoption, enforcement and interpretation of the local
milk ordinances.
The second printing of the booklet on "Dairy Building Plans" was
made and was well received throughout the state by the health depart-
ments, the dairy industry and the builders.
The Milk Sanitation Consultant assisted in the writing of a leaflet
on "Brucellosis-Undulant Fever".
The Florida Milk Commission activities were carried on for only six
months of 1948. This assignment was transferred to another bureau in
June, 1948.
Some of the technical services made by the Milk Sanitation Consult-
ant to the dairy industry included:
Thermometers checked and adjusted-............................. 13
Alkaline soaker solution analyzed ...................................- 4
Milk Samples collected for analyses ..........................----...... 151
Strip cup examinations made ........................................ 120
Direct microscopic examinations .................................... 14
Abnormal milk found ---................-.........-............ 5
Dairy plans reviewed ...................... ............................ 2
Arrangements were made with the U. S. Bureau of Animal Industry
to receive their monthly reports on tuberculosis and Bang's testing, which
the department now receives and promptly forward to the health depart-
ments concerned for their information and follow-up.
A technical memorandum on "Mastitis Control" was written and was
well received throughout the state. This stimulated interest in proper
milking methods and herd management.
The increased milk sanitation activities are confirmed by the increased
number of samples of milk and milk products collected by the local and
county sanitarians for laboratory examinations. Copies of examination
reports were received during the year from seven state laboratories and
the results recorded in the office ledgers. Over seven thousand milk and
milk product samples were collected for laboratory examinations. These






SANITARY ENGINEERING 65


reports were examined for compliance and any other information that
they might reveal. The reports revealed that one distributor had been
selling reconstructed milk in violation of the Florida Milk and Milk
Products Law.
The quality of milk distributed in the state showed a slight improve-
ment over 1947; much room still exists for improvement. Of the seven
thousand milk samples analyzed, over 3,000 were pasteurized milk; 3,000
plant-producer samples and over 600 producer-distributor samples. Over
70% of the pasteurized milk samples were within their bacteriological
grade; i. e. not over 30,000 standard plate count. This is a slight im-
provement over 1947 when 67% of the samples were satisfactory bac-
teriologically. 69% of the plant-producer samples were within their
grade bacteriologically; i. e. not over 200,000 standard plate count. In
1947 this figure was 64%. Of the raw producer-distributor samples
60% were within their grade bacteriologically; i. e. not over 50,000 stand-
ard plate count. Only 600 retail raw samples were collected in 1948,
compared to over 1,000 in 1947. This represents the definite trend to-
ward consumer preference for grade A pasteurized milk samples showed
unsatisfactory pasteurization. This is 2.16% of the samples examined.
This Bureau had a part in instigating in the laboratories coliform plate
counts on the pasteurized milk. The work was started late in 1948. The
results from over seven hundred samples collected indicated that only
about one-half of the pasteurized milk is meeting the more stringent 1948
standards for grade A pasteurized milk; less than 30,000 standard plate
count and less than 10 coliform count and satisfactory phosphatase tests.
The other half of the pasteurized milk samples violate these standards
mainly in high coliform count and standard plate count. This indicates
there is frequent contamination after pasteurization and that increased
attention should be devoted to the handling of pasteurized products and
particularly from the pasteurizer to the bottle filler. A few samples
showed unsatisfactory pasteurization by the phosphatase test.
Only one Milk Sanitation Consultant carried on the state level pro-
gram. Many activities were not adequately covered. A minimum state
level program to provide the advisory and consulting service necessary
to the sixty city and county health units would require a state level staff
of five consultants. The developments in dairy science and technology,
the growth of the dairy industry in Florida, and the status of milk sani-
tation point to the need for an effective state level program to serve the
industry, the State Board of Health, and the community.
In addition to carrying on the above program in 1949, several pro-
jects are planned. These include:
A memorandum on the construction, operation and maintenance
of High-Temperature-Short-Time Pasteurizers.
A report on the further study of coliform count in grade A pas-
teurized milk and its significance.
A technical memorandum on suggested platform tests and labora-
tory tests for the small and medium sized milk plants.
A milk plant operator's hand-book.







66 ANNUAL REPORT, 1948

TABLE XXXIII
SANITARY MILK CONTROL SUMMARY OF ACTIVITIES

Local and county milk programs reviewed, appraised and planned------------................................. 44
Communities' milk sanitation compliance rating surveys....--..........--- .-------- 7
Communities attaining satisfactory sanitation compliance rating of 90%-
Panama City, Florida..................---------------------- -.
Sources fully approved for use on interstate carriers (above 90%)...............----------- 1
Inspections and visits:
Pasteurization plants ...................----------------- -----.... ----- 86
Producer-distributors ...................... ....................-------------- -- 19
Plant producers ......... .....--. ..-----------.....---------........... 188
Total inspections and visits made...............................---------------------------- 29
Food handling establishments -------................................ ............. ..................... 2
Technical services:
Thermometers checked and adjusted ........ .............................------------------------- 15
Alkalie soaker solution analyzed ............................... ----------------------- 4
M ilk cooling efficiencies checked ........................................ ---------21
Sediment testing made ..................---------------...................... 1
M ilk samples collected for analyses ..................- .................................. 151
Strip cup examinations made ............-- ...........-.............................. 120
Direct microscopic examinations made -------------........................---------. 14
Abnormal milk found ......................... .. .. ...... ................ 5
Dairy plans reviewed ........................................------------------------------------ 2
Assistance in rating local meet and abattoirs ............... .---------------------- 1.
Assistance in investigating food poisoning outbreak .------------------....................... .... .. 2
Talks given: Training Course-Sanitary Officers-Gainesville-Atten: 57-------........................ 2
Florida Milk Commission meetings-(6 months only).................................................. 11
Conferences on Laboratory procedures ................... .....----------------------.--...
Conferences on milk program with sanitary officers ................................------- ----- 8
Conferences with U. S. Bureau of Animal Industry Officials ..............................-- ......
Conferences with U. S. Public Health Service Officials ............-----------..... -----
Dairy Industry (group meetings) ............ ------------------------------.
Florida Dairy Industry Association Meetings .................... ................
Florida Public Health Association Meetings ........... ........................--
Florida Milk Sanitarians' Meeting ......... --------........ ---- -----------.
U. S. Federal Court-attendance on dairy case ..............---------------
Technical memorandum on "Mastitis Control" .-............. .---------------------
Staff Meetings ...................... ........ ................---- .... .. ... 3






TABLE XXXIV
SANITARY MILK CONTROL LABORATORY EXAMINATIONS REPORTED


Description Number Percentage

Total milk samples analyzed...................... .... 7.162
Pasteurized milk samples--------............................ 337
Samples satisfactory standard plate count........... 2.380 71.32
Unsatisfactory phosphatase tests..........------.-----...... 72 2.16
Plant producer milk samples..............---------.. ..... ... ,214
Samples satisfactory standard plate count...--------- 2,2412 69.76
Producer-distributor milk samples ............ -------- 611
Samples satisfactory standard plate count ........... 69 60.39







SANITARY ENGINEERING 67


TABLE XXXV
SANITARY MILK CONTROL
COLIFORM COUNT STUDY LAST QUARTER OF 1948


Description Number Percentage

Grade A pasteurized milk samples analyzed....-. 733
Number complying with grade A standard
of not over 30,000 standard plate count,
and not over 10 coliform count and satis-
factory phosphatase tests......-.......................... 591 55.5
Number having unsatisfactory standard plate
count, over 30,000 .................................. 151 17.8
Number having unsatisfactory coliform count
over 10 ....................................... ............. 104 14.2
Number having both unsatisfactory standard
plate count and unsatisfactory coliform
count .......................................... ...-.--- 83 11.3
Number having unsatisfactory pasteurization
phosphatase tests .................................... 24 5.2


SEAFOOD SANITATION
(Shellfish and Crustacea)
OYSTERS
The oyster industry finds itself in a critical economic
the entire state during this third post-war year of 1948.
factors have contributed to the now scant supply and lack
namely nature and man.


condition over
Two evident
of production;


Record flood rains and freshets of the past two years have taken a
heavy toll throughout the state of our native Ostrea virginica. The Sep-
tember hurricane of 1947 damaged the beds at Apalachicola. Lack of
thorough scientific oyster conservation by man himself cannot be ignored.
These factors have slowed the state production to an estimated one half.

The above conditions have had a decided retarding effect on improve-
ments in construction, equipment and sanitary operation. Producers not
making money and plagued by hardships are not amicable to spending
for sanitary improvements. Considering the shortage of funds and per-
sonnel needed to effect more adequate sanitary supervision of the indus-
try, this one-man division is managing to hold the gains made, but with-
out help cannot vouch for the future.

CRUSTACEA

Fresh packed crabmeat, a luxury item at $2.50 per pound during the
war, has, during 1948, flooded the New York and Baltimore markets at
a price as low as 50c per pound. The 1947 situation of too many pro-
ducing plants continued through this year. Sanitary standards in con-
struction, equipment, and operation have been maintained and com-
pare favorably with other producing states.







68 ANNUAL REPORT, 1948


SCALLOPS
The succulent prized bay scallops moved into the shallow areas around
St. Petersburg and Bradenton this year. The local population of Pal-
metto had a month's scallop spree. A hundred or more local citizens, in
varied attire, and with tubs, buckets and burlap sacks, waded the waters
off Sneed's Island most every evening of the short season, feverishly
gathering the scarce and high priced shellfish; thereby saving themselves
$1.80 per quart.
Since scallops were found only in this area, commercial production
was negligible due to the local citizens' competition. As with Florida
oysters, here again, one is forced to realize that a once large production
of a prized seafood is practically extinct due to the lack of conservation
and research.
CLAMS
This year the Thousand Island section of the lower west coast saw
the end of production by the Doxie Clam Company. For several years
this company produced around 70,000 bushels of clams annually. These
clams were processed into canned clam chowder and juices for the mar-
ket. Depletion of the beds is attributed to the clam's traditional enemy,
the conch, together with no conservation, and lack of research.
Only two small raw clam shucking plants are now operating. One
at Englewood, and the other at St. Augustine. Both are well equipped
and maintain sanitary standards.
TABLE XXXVI
SUMMARY OF ACTIVITIES SEAFOOD PLANTS

Operating State New
Description Certificates Inspections Plants
Issued Made Constructed

Oyster shucking and packing 61 424 1
Oyster shellstock only 5 15 1
Scallop shucking and packing 3 9 0
Clam shucking and packing 2 10 0
Crabmeat picking and packing 40 194 1
Lobster picking and packing 1 2 0

TABLE XXXVII
SEAFOOD SANITATION ADDITIONAL ACTIVITIES 1948

Oyster growing area pollution surveys ............ .. ........... ............................ 4
Oyster growing area water samples analyzed ......................................1,42
Oyster meats specimens cultured and analyzed ...----- -...................------------. 5
Oyster bootleg activities investigated ................ .......... .. .. ................
Half-shell bar inspection and consultation ......-- .....------- -----------------.. 47
Lectures-Seafood Sanitation (Sanitary Officers' Short-Courses U. of Fla.-
Gainesville) ........ .......-......................-- ..............- -
Lecture South-Eastern Food & Drug Assoc.-Oyster Sanitation ....................------
Out-of-State meeting of South-Eastern Branch A.P.H.A ................................-- 1
M meeting Florida P.H .A ............................................ ...............................................
Meetings Apalachicola Shellfish Dealers ................. ............. .............. 5






SANITARY ENGINEERING


PROJECTS DEVELOPED AND ACTIVITIES
PERFORMED BY THE BUREAU DRAFTING ROOM-1948

1. Preparation of maps, charts, graphs, etc. to illustrate the following
pollution surveys and reports:

(a) Apalachicola, Flint and Chattahoochee Rivers, and Apala-
chicola Bay.
(b) Manatee River
(c) St. Johns River (vicinity of Palatka)
(d) Crescent Lake
(e) Homosassa area (waters in vicinity of)
(f) Lake Tsala Apopka
(g) Rice Creek (follow-up)
(h) St. Augustine (preliminary)
(i) Waters vicinity of St. Petersburg (preliminary report)
(j) Live Oak area and Orange County (subsurface pollution sur-
veys and reports.)

2. Sight Pollution Map of Florida, showing streams and waters polluted
by industrial and domestic wastes.
3. Detail drawings for engineers' field kits.
(a) Alkalinity, chloride and soap hardness kit.
(b) Dissolved oxygen kit.
4. Detail drawings for water sample shipping cases-18 bottle and 6
bottle type.
5. Plans and specifications for State Board of Health Central Florida
Branch Laboratory and Headquarters Buildings, Orlando, Florida.
6. Preparation of numerous maps, schematic drawings and illustrations
for reports on features at schools, swimming pools, water impound-
ments, water and sewage treatment plants, towns, and subdivisions.
7. Routine recording and filing of plans reviewed and/or approved by
the bureau, preparation of stencils and reproduction or original draw-
ings of maps, graphs, charts, etc. on the ozalid printing machine.
8. Illustrations for several issues of "Health Notes" and complete illus-
trations for U. S. P. H. S. Maternal and Child Health Florida booklet.
9. Display standards for Mobile T. B. X-Ray units.







70 ANNUAL REPORT, 1948


DIVISION OF ENTOMOLOGY

JOHN A. MULRENNAN, Director

Considerable progress was made during the year in the control of
insect-borne diseases in the State.
The disease, malaria, continued to decline as was evident on the basis
of reported cases, although there was a slight increase in reported deaths
over 1947. Seven deaths were reported in 1947 and 11 deaths were re-
ported in 1948 from malaria. Eight deaths were reported from typhus in
1948, whereas only 7 were reported in 1947.
The number of reported cases of typhus fever showed a marked de-
cline in 1948 as only 166 cases were reported as compared to 344 reported
cases in 1947.
The U. S. Public Health Service contributed $187,253.00 during the
year for malaria control and $62,438.00 for typhus control activities in
the State. In addition to the federal contribution, the State, counties
and municipalities made available $176,822.00 for malaria control and
$75,098.78 for typhus control.

STRUCTURAL PEST CONTROL
Since the passing of the Florida Structural Pest Control Act of 1947,
the State Board of Health has realized an increasingly cooperative re-
lationship with the structural pest control industry in Florida. There is
every reason to expect that this relationship will continue.

RULES AND REGULATIONS
Work was begun and progress has been made on the rules and regu-
lations which are to be a part of the Florida Structural Pest Control
Law. These minimum standards of work, covering all phases of struc-
tural pest control, have been reviewed and criticized by authorities in all
sections of the country, and a rough draft is now in the hands of com-
petent members of the structural pest control industry of this State for
review. Their adoption is expected during the early part of 1949.

INVESTIGATIONS
Seventy-nine investigations were made of complaints of home owners
and of reports of illegal operations by various pest control firms, all of
which were satisfactorily concluded after the facts in each case were
made known. All violations were corrected without legal action.
One certified pest control operator was cited before the Florida Struc-
tural Pest Control Board for failure to register his firm with the State
Board of Health, and for other incriminating activities. The Board re-
voked this individual's certificate, making it impossible for him to legally
operate a pest control business in Florida.






SANITARY ENGINEERING


REGISTRATIONS
Registration of structural pest control firms continued throughout
the calendar year.
144 licenses issued in 1947-48 @ $25.00 each...................... $3,600.00
456 identification cards issued in 1947-48 @ $1.00 each........ 456.00
Total revenue for the 1947-48 fiscal period ............................ $4,056.00
142 licenses issued in 1948-49 @ $25.00 each ........................ $3,550.00
517 identification cards issued in 1948-49 @ $1.00 each ...... 517.00
Total revenue for 1948-49 (through 12-31-48) .................... $4,067.00

Personal visits were made to all localities in the State so that a ma-
jority of the firms were contacted at least once.
Bulletins pertaining to matters of common interest were drafted and
issued to all licensed pest control firms from time to time. One such
bulletin, in particular, established tentative regulations governing the
use of sodium fluoroacetate (Compound 1080) as a rodenticide.

RESIDUAL DDT HOUSE SPRAYING
SUMMARY OF 1948 SPRAY OPERATIONS
Residual spray programs were carried on in thirty counties as an ac-
tivity of the local health departments during the 1948 season. As out-
lined in Table XXXVIII, 69,881 houses were treated, using 83,857 lbs.
of DDT. Approximately 1.3 man-hours and 1.18 lbs. of DDT were re-
quired for each treated house. The cost to the participating counties
amounted to $0.78 per house.
An outbreak of malaria in Naples, Collier County, required the treat-
ment of 130 houses in that community after scheduled spraying opera-
tions were discontinued.
A program of spraying out-buildings with a 5% DDT emulsion was
begun by the Jefferson County Health Department. The purpose of this
work was to control the insect vectors of equine encephalomyelitis. A
summary of the work as of December 31, 1948 is shown in Table
XXXIX.
EVALUATION OF DDT HOUSE SPRAYING
Entomological inspections were made in unscreened and poorly
screened houses to determine the effectiveness of the spray applications
in keeping houses free of malaria vectors. These inspections revealed
that a high degree of protection was being obtained. Of 678 inspections
i sprayed houses, Anopheles quadrimaculatus were present in only 3.83%
as compared with 27.4% in unsprayed houses. However, the control of
house flies was not as satisfactory. Inspections revealed an unusually large
population of flies in certain counties west of Tallahassee, and complaints,
from this area, indicated an unsatisfactory control by DDT residues. Also,
recent evidence indicates that house flies may develop some degree of
resistance to DDT. Tests were conducted whereby adult flies were con-









72 ANNUAL REPORT, 1948


fined, by means of cages, to sprayed surfaces for one to four hours. Re-
sults of these tests showed a 65.9%/ mortality of the test flies. Observa-
tions indicate the need of a sound program of environmental sanitation
supplemented by the proper use of insecticides to obtain a satisfactory
control of flies.


TYPHUS AND RODENT CONTROL

SUMMARY OF TYPHUS CONTROL ACTIVITIES

Typhus and Rodent Control programs were carried on in five coun-
ties during the calendar year 1948. Projects were in operation in Dade,
Escambia, Hillsborough, Pinellas, and in the City of Jacksonville in Duval
County. All projects functioned as an activity of the health department
concerned.

TABLE XXXVIII
HOUSES RECEIVING RESIDUAL SPRAY, 1948 WITH COST OF LABOR AND DDT PER
HOUSE, BY COUNTIES
Total Total Cost Average Average Average Cost County
Houses To CountyMan-Hours Number Lbs. to County Man-Hours
County Sprayed (Labor) per House*DDT per House Per House per House

Baker 300 94.00 .893 .93 .313 .893
Calhoun 1,761 1,437.00 1.373 1.275 .816 1.272
Citrus 1,655 1,189.20 1.235 .728 .718 .993
Clay 2,283 2,019.50 1.258 1.200 .884 1.047
Collier 130 .738 .776 -
Dixie 1,317 1,806.00 2.119 .722 1.371 1.828
Escambia 2,501 1,615.00 1.143 1.356 .645 .874
Franklin 338 285.00 1.810 1.665 .843 1.110
Gadsden 5,159 4,371.00 1.313 1.038 .847 1.179
Gilchrist 835 875.20 1.935 1.227 1.048 1.609
Gulf 1,948 856.00 .879 1.419 .439 .673
Hamilton 1,997 2,130.00 1.802 1.26 1.066 1.530
Hernando 1,742 1,174.80 1.259 .966 .674 1.031
Holmes 3,620 3,009.43 1.000 .886 .831 .912
Jackson 6,735 4,631.20 1.289 1.221 .687 1.203
Jefferson 2,769 2,047.40 1.245 1.081 .739 1.042
Lafayette 908 814.50 2.017 1.963 .897 1.638
Lake 3,197 1,432.20 .795 1.129 .447 .685
Leon 3,158 2,800.00 '.476 1.004 .886 1.260
Levy 2,875 2,337.10 1.278 .873 .812 1.139
Liberty 735 604.00 1.216 1.251 .821 1.142
Madison 3,078 3,395.60 1.751 1.311 1.103 1.510
Okaldosa 4,811 2,339.00 1.175 1.790 .486 .972
Pasco 45 .355 1.622 -
Santa Rosa 483 164.00 1.159 1.480 .339 .679
Sumter 2,593 1,837.00 1.172 .974 .708 .987
Suwannee 3,555 4,398.00 1.559 .943 1.237 1.428
Taylor 2,761 1,911.80 1.167 1.307 .692 .967
Wakulla 1,632 1,298.50 1.320 1.155 .795 1.085
Walton 3,023 1,650.00 1.103 1.235 .545 .878
Washington 1,937 1,937.00 1.526 1.614 1.000 1.329
Totals 69,881 54,459.43 1.303 1.186 .779 1.118
*This includes the man-hours contributed by the local Governments and those contributed by CDC.

TABLE XXXIX
Encephalomyelitis Control Activities
October 25 December 31, 1948
No. Premises Out-buildings treated Lbs. DDT Man-Hours
County Visited Barns Sheds ChickenHouses Used CDC Local


508 0 486


Jefferson


306 493 737 635






SANITARY ENGINEERING 73


Applications of DDT dust were reduced to two complete coverages
of the designated areas and control of the rat ectoparasites was obtained.
The reduction in the number of applications of DDT dust enabled the
projects to expand the dusted areas so that a greater number of premises
were dusted than in the previous year of 1947.

DDT DUSTING: There were 41,173 premise dustings completed
in the five operating projects. The amount of 10% DDT dust used in
this work was 145,083 pounds, making an over-all average of 3.52 pounds
per premise dusted.

LABOR EXPENDED: The total man-hours paid for in all phases of
the programs amounted to 88,064. Local contributions amounted to
61,965 man-hours; State and Federal, 26,099 man-hours. A further
breakdown of these totals shows that 15,822 man-hours were expended
on dusting activities for an average of 23 minutes per premise dusted.
Ratproofing used 28,001 man-hours, poisoning 13,449, and evaluation
trapping 12,871. Man-hours contributed by local sources amounted to
70.3% of the total.

RAT POISONING ACTIVITIES: Rat poisoning was done on
all projects. Extensive poisoning work was carried on by Dade, Duval
and Hillsborough Counties. Principal poisons used were Red Squill,
Barium Carbonate and Zinc Phosphide in the form of poisoned baits.
A total of 15,081 pounds of bait were placed in 20,156 establishments. In
addition, 4,191 pints of "1080" water were set out in 2,914 establish-
ments, and 100 pounds of "1080" poison bait were used in 80 others.

RAT PROOFING: Ratproofing activities were carried on in five
cities with a total of 397 places ratproofed. In addition, 99 establish-
ments, formerly rat-proof, were inspected and repaired.

EVALUATION: Evaluation trapping to determine the degree of
ectoparasite control was done on all projects. In connection with this
work, 4,082 rats were trapped, 3,614 alive and 468 dead. Blood samples
were taken from 3,205 rats and examined by means of complement fixa-
tion tests.

There were 1929 blood specimens taken from dusted areas and 5%
were positive; from undusted areas, 17.1% were positive out of 1,276
specimens submitted.

EDUCATION AND PROMOTION: Educational work was con-
ducted through newspaper articles, lectures, motion pictures, radios and
by dissemination of pamphlets and literature. A representative of the
typhus control unit conducted classes and field demonstrations on typhus
and rodent control during the Short Course for Sanitarians which is con-
ducted every three month period at Gainesville, Florida, by the Alachua
County Health Department, the Commonwealth Fund, the University of
Florida and the State Board of Health.









FIGURE 6


Murine typhus fever cases reported- year period-State of Florida.


450-



400-


1944
1944


LEGEND

Reported Cases
Untreated Counties.
Reported Cases
Treated Counties.


1945


1946 1947


1948


74 ANNUAL REPORT, 1948


500-


350-


300-



250-



200-



150-



100-


50-


0-







SANITARY ENGINEERING 75


ANOPHELES ALBIMANUS IN FLORIDA
Anopheles albimanus has been recognized as the most important ma-
laria vector of the Caribbean region for a good many years. This species
was found at Key West in 1904. Entomological surveillance, begun in
1946, was continued during this period to determine the density, distri-
bution and biology of this species in the Florida Keys and on the extreme
southern tip of the mainland. Apparently the only well established breed-
ing area is confined to Big Pine Key, which is, by highway, eighty miles
south of the Florida mainland. No indication was found that an increase
in malaria could be attributed to this species. However, nearly 1,000
larvae and 20 adults were furnished the Malaria Investigation Labora-
tory, to establish a colony of A. albimanus for malaria transmission stu-
dies.


LABORATORY ACTIVITIES

During the year, 1,619,314 adult mosquitoes collected in light traps,
and 7,050 collected either while biting or in natural resting places, were
identified and reported. Also, 10,313 larvae were identified. In addi-
tion, 25,235 rat ectoparasites and several hundred ticks, household pests,
and other arthropods of medical importance were identified.


WATER IMPOUNDMENTS AND MOSQUITO CONTROL
A decrease in the construction of water impoundments for the year
was noted, in that 12 permits for this purpose were issued during 1948
against 19 for the previous year. Most of these projects were constructed
in Northwest Florida for irrigation or for recreational purposes.


TABLE XL
PRINCIPAL ACTIVITIES-TYPHUS AND RODENT CONTROL BY PROJECT
1948
No.
Estab- Total Average "1080" Poisoned Baits
lish- No. Total Lbs. Poisoned All Kinds
COUNTY ments Premise Lbs. DDT Water
rat- Dust- DDT per No. Pints No. Pounds
proofed ings Used PremisePrem. Used Prem. Used

Dade (Miami) 73 9,772 27,546 2.82 1,161 1,536 7,978 10,477
Duval (Jacksonville) 185 5,141 12,742 2.48 1,401 2,048 12,073 3,981
Escambia (Pensacola) 48 13,257 48,700 3.67 19 24 14 18
Hillsborough Tampa) 79 8,979 39,172 4.36 326 576 171 705
Pinellas (Dunedin, Largo,
Pass-a-Grille) 4,024 16,923 4.20 -
Polk (Bartow) 12 7 7 -
TOTALS 397 41,173 145,083 3.52 2,914 4,191 20,236 15,181


Forty-nine inspections were made of water impoundments which had
been constructed in past years to determine if they were being maintained
in accordance with the Florida State Sanitary Code.








76 ANNUAL REPORT, 1948


TABLE XLI
RATS TRAPPED ON CDC TYPHUS CONTROL PROGRAM-
January 1, 1948 to December 31, 1948


RATS TRAPPED


BLOOD DETERMINATIONS


COUNTY


No.Sera No. No.
No. Live Dead Sent In Pos. Neg.


Per- Per-
Cent Cent
Pos. Neg.


DADE
Dusted Area 451 353 98 153 22 117 15.83 84.17
Control Area 120 110 10 68 4 55 6.78 93.22
DUVAL
Dusted Area 423 356 67 330 7 319 2.15 97.85
Control Area 193 179 14 170 53 116 31.36 68.64
ESCAMBIA
Dusted Area 575 524 51 486 25 452 5.25 94.75
Control Area 285 266 19 251 26 224 10.40 89.60
HILLSBOROUGH
Dusted Area 309 280 29 275 6 255 2.30 97.70
Control Area 197 191 6 189 26 142 15.48 84.52
PINELLAS
Dusted Area 656 574 82 570 11 494 2.18 97.82
Control Area 410 376 34 371 31 309 9.12 90.88
GADSDEN
Dusted Area -
Control Area 60 41 19 39 13 23 36.12 63.88
JACKSON
Dusted Area -
Control Area 52 42 10 34 16 13 55.17 44.83


ST. JOHNS
Dusted Area
Control Area
TOTALS
Dusted Area
Control Area


146 133 13 115 30 82 26.79 73.21
205 189 16 154 36 115 23.85 76.15


2,560 2,220 340
1,522 1,394 128


1,929 101 1,719 5.00 95.00
1,276 205 997 17.06 82.94


MOSQUITO CONTROL INVESTIGATIONS

The newly-established station for mosquito control research and
evaluation at Orlando completed its first year of operation still in the
exploratory field expected from its first few months. The objectives out-
lined in last year's report were pursued as closely as possible. Methods of
mosquito control evaluation were particularly investigated. Areas not
within control districts were surveyed in anticipation of future control
programs. The biology of the most important pest mosquito of Florida
was studied intensively. Within time and personnel limits, contact was
maintained with most agencies involved in control work in Florida. Co-
operation was the key-note of the first year of operation.

Listed below are the activities undertaken and accomplished:

1. A cooperative project was set up with the Florida Engineering
-and Industrial Experiment Station at the University of Florida for the
development of a mosquito-sampler better adapted to the needs and con-
ditions of Florida than the presently used New Jersey light-trap.






SANITARY ENGINEERING 77


2. In Leesburg, under a cooperative arrangement with the city of-
ficials, a program of city-wide mosquito control was carried on. This
project was essentially an attempt to evaluate: (1) a space-spraying
program where the prevailing mosquitoes are Mansonias, and (2) the
efficiency of a modern and widely used ground fog-machine.
3. A cooperative investigation of sandfly biology and control was
entered into with the Bureau of Entomology and Plant Quarantine (U. S.
Department of Agriculture) and the mosquito control districts of Dade,
Broward, and Palm Beach counties.
4. A biological investigation of Aedes taeniorhynchus, the common
salt-marsh mosquito, was begun on Sanibel Island in Lee County. This
is to be a continuing study of the little known but important factors in
the production and dispersal of this mosquito.
5. With the cooperation of the Brevard County Mosquito Control
District, an investigation of mosquito production and control was made
in the Cocoa area. The object in this work was to compare various
methods of gauging population changes following aerial control opera-
tions and to determine the limitation imposed on each method by weather,
time consumption, and other factors.
6. A study similar to the above was made in Broward County with
the cooperation of the Broward County Anti-Mosquito District.
7. In Punta Gorda, the local mosquito situation was surveyed and
experimental power spraying was done with the cooperation of the city
officials.
8. Special year-long light-trap surveys were made in Manatee Coun-
ty and in the cities of Ft. Myers and Lake Wales, all of which areas were
contemplating the establishment of control programs. In all these, the
cooperation of local officials was welcomed and utilized.
9. Help was given the City of Naples in organizing a mosquito con-
trol program. An incipient malaria outbreak was met immediately with
a residual spraying program.
10. A very large number of light-traps were operated in a general
survey of the uncontrolled coastal counties from Hillsborough to Monroe.
This survey has produced not only an extended acquaintance with that
coast-line and a good picture of mosquito distribution and densities, but
also has revealed foci of extraordinary abundance of certain mosquito
species which could serve as excellent study and experimental areas for
the species concerned, should such ever be indicated.
11. Liaison was maintained with personnel and projects of various
governmental and civic organizations, to mention a few, the Bureau of
Entomology and Plant Quarantine (U. S. Department of Agriculture),
the U. S. Fish and Wildlife Service, and the University of Florida.
12. Assistance was given to Manatee County officials in helping to
promote a mosquito control district which was voted in during the Novem-
ber general election. Only one small precinct in the entire county voted
against the formation of a district.






78 ANNUAL REPORT, 1948


Wherever the word "cooperation" has been used, it meant not just
mutual understanding and best-wishing, but actual getting together of
the cooperators in financing and actually doing the work.


COMPLETED STUDIES AND PAPERS
PUBLISHED
1. A Far South Record of Anopheles quadrimaculatus Say in Florida.
Mosquito News, March, 1948. D. C. Thurman, Jr.
2. Records of Anopheles quadrimaculatus Say For the Florida Keys.
Mosquito News, June, 1948. Ernestine H. Basham and James S.
Haeger.
3. Species of Ticks Associated with Rocky Mountain Spotted Fever
Cases in Florida. Journal of Economic Entomology, October, 1948.
Doyle J. Taylor, J. A. Mulrennan and D. C. Thurman, Jr.
4. Culex (Melanconion) mulrennai, A New Species From Florida.
Annals of the Entomological Society of America, March, 1948. Er-
nestine H. Basham.
5. Key To Florida Triatoma With Additional Distribution Records For
the Species. The Florida Entomologist, Sept., 1948. D. C. Thur-
man, Jr., J. A. Mulrennan, Ernestine Basham and Doyle J. Taylor.
6. Description of the Male of Androlaelaps setosus Fox. The Journal
of Parasitology, April, 1948. D. C. Thurman, Jr., Nina Branch &
John A. Mulrennan.
7. United States Records of Typhlodromus mariposus (Fox) from Rats
in Florida. Journal of Economic Entomology. D. C. Thurman, Jr.,
and Nina Branch.









BUREAU OF MATERNAL

AND CHILD HEALTH

FRANCES E. M. READ, M.D., Director

The present director of this bureau assumed her duties here as of
October 1st and has placed special emphasis on the establishment of a
program for the care of the premature infant.
During 1948 MCH funds were available for hospital and public
health services to both the mothers and children in the area to be served
by the Western Palm Beach County Public Hospital, known as the Belle
Glade Hospital. This hospital was governed by a Board of Directors
who were supposed to be fairly representative of the community. This
program was established to provide services for the migrant labor group
of the population. The objective of this service was to provide insofar
as possible complete services to any mother and child in the State of
Florida, but more especially to this group of migrant workers in the
Western Palm Beach County area. We were very fortunate in obtaining
such highly qualified personnel for this program. This personnel included
a full-time obstetrician, a part-time pediatrician, an obstetrical nurse
supervisor and two general duty nurses. During the year 354 maternity
cases and 138 pediatric cases received complete care in this hospital.
The director outlined the pediatric care of the premature at six con-
ferences of local health officers and nurses, located at strategic positions
throughout the state. During these conferences, she stressed the great
need for trained personnel to supervise the work in the care of the prema-
ture. She suggested the attempt to offer consultation services to the local
hospitals through a public health nurse who had received at least one
year of special training in general pediatric nursing and in the care of
the premature. The State Board of Health has distributed incubators
throughout the various counties and has ordered heated carriers to trans-
port prematures from the home to the central general hospital.
The special school health services program was carried out with the
State Department of Education and began in February when 16 recent
medical graduates came into the state and worked in 25 county health
units to do physical examinations and immunizations. Children with
defects were referred to the family physicians and in cases where such
service was not available, local resources were used. Thousands of school
children were examined who might otherwise not have had this service
due to the lack of personnel in the local health departments.
The director worked with the consultant on education of "exceptional
children" on the standards for the exceptional child. She outlined the
pediatric standards for this monograph and placed a great deal of stress
on the argument against the traditional compartmentalizing of remedial






80 ANNUAL REPORT, 1948


work. She felt that it was only by considering the fundamentals of the
disability and adjusting those to the psychosocial environment that the
optimum conditions could be worked out. The State Board of Health,
through its existing facilities in the six mental health clinics which have
already been established, has been able to afford a diagnosis of those
children who would fall into the exceptional child class. Under the
existing facilities, if 10 exceptional children are available in one locality,
a special class may be established in that school by the State Department
of Education.
Audiometers for testing the hearing of children were purchased by
this bureau and distributed to various local county health departments.
A demonstration of the technique to be used in testing the hearing of
school children was outlined at six local health conferences. At this time
it was stressed that these examinations should be made by a trained tech-
nician. In the three counties where a generalized hearing program has
been carried out, arrangements have been made with the local nose and
throat specialists who have contributed their specialized services in the
correction of these defects. Local organizations, namely the Pilot Clubs,
have purchased radon and the hearing aid apparatus. In the remaining
counties, there is need for developing a similar program.
Massachusetts vision testing materials were provided by this bureau
for each of the county health departments. A demonstration of the pro-
per method for testing school children was made in six different locali-
ties. During this demonstration, it was pointed out that this was a very
time consuming method and the relative value of this form of testing as
compared with the routine Snellen testing was questioned. The director
has worked closely with the Florida Council for the Blind and is pleased
to report that 14 sight saving classes have been developed throughout
the state- during the past year. The Florida Council for the Blind pro-
vides special books and large type posters and the Lions Club provides
the special lighting, special blackboards and special desks. In two of
our local health departments where there are large rural areas, the pub-
lic health nurses have worked with the Florida Council for the Blind and
arrangements for the eye examinations were made through the coopera-
tion of these two organizations. In only one county health department
have attempts been made to cope with the problem of the preschool
blind child and the preschool hard of hearing child.
Scholarships to the postgraduate Pediatric Seminar in Saluda, N. C.,
were provided for one local health officer and one local MCH director.
Scholarships to attend the postgraduate Obstetric Seminar in Augusta,
Georgia, were provided for six local health officers and clinicians who
work in the local health departments. 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.
Hospitalization and consultation were provided at the Florida A. &
M. College Hospital for abnormal maternity cases in the Leon County
area.







MATERNAL AND CHILD HEALTH 81


The director worked closely with the Florida Children's Commission
as pediatric consultant to the planning committee. She outlined the
health problems of Florida children to be presented to the Nemours
Foundation in order that they might make a study of the all over need
in this state prior to making any commitments from the point of view of
financial assistance to any one group of children. Dr. Shands, medical
director of the Alfred I. duPont Institute, of Wilmington, Delaware,
stated that he wanted the money to be spent where it was most needed;
so he consulted the Florida Children's Commission because it was the
fact finding and planning agency in the field of child welfare for Florida.
Nutrition services were available in this bureau during the first three
months of 1948. During that period of time, services were rendered in
cooperation with the child welfare division of the State Welfare Board.
The director worked with the Florida Crippled Children's Commis-
sion, the Cerebral Palsy Association, the Florida State Conference of So-
cial Work, the Child Planning Committee of the State Welfare Board
and the Florida Council for the Blind. The director has met with the
chairman and secretary of the Maternal Welfare Committee of the Flori-
da Medical Association in order to work out plans for a coordinated study
sponsored by the Florida Medical Association and the State Board of
Health on the causes of our high maternal mortality rate.
A study was made of the ages of our licensed practicing midwives and
it was found that of the 472 midwives, 216 were 60 years of age and
over. Our state midwife teacher assisted and helped plan in the training
of a group of young midwives to replace the older ones, who had started
practicing many years ago. This training program was a community
wide project worked out with the local health officer in one of our coun-
ties. Additional midwife teachers will be employed during the ensuing
year in order that we may retire the older midwives and replace them
with young trained ones.







82 ANNUAL REPORT, 1948


MENTAL HEALTH PROGRAM

FRANCES E. M. READ, M.D., Director

The Mental Health Program which was authorized by the United
States Public Health Service made it possible for us to develop several
clinics in the State of Florida during 1948. The director resigned during
March to enter private practice and we have not been able to replace
him with the services of a full-time psychiatrist.
Only two mental health clinics were in operation in the State by the
end of 1947. During 1948 four mental health clinics were established
throughout the state and one study program was undertaken in Volusia
County. That study represented an almost complete county-wide survey
conducted during a period of three months.
Pinellas County-Since September 1944 a Child Guidance Clinic
headed by Dr. Paul W. Penningroth has been in operation but during
1948, Dr. T. Paul Haney, director of the Pinellas County Health Depart-
ment, integrated this clinic with the mental health services the Pinellas
County Health Department had to offer. The additional funds received
from the State Board of Health made it possible for the Pinellas County
Child Guidance Clinic to (1) reorganize on a county-wide basis, (2) com-
plete a full "team" staff and (3) place increased emphasis on the quali-
tative standard of performance. The staff of this clinic has been organ-
ized in such a way that we have available a complete team consisting of
Dr. Bailey, psychiatrist, two psychologists, one psychiatric social worker
and one medical social worker. Funds have been provided from the fol-
lowing sources: Mental Health Fund, Juvenile Welfare Board, Com-
munity Chests of St. Petersburg and Clearwater, and the George Davis
Biven Fund. During the year there have been 294 new and reopened
cases. This clinic limits its service to children only.

AGE RANGE NUMBER
Under 6 23
6, 7 and 8 51
9, 10 and 11 72
12, 13 and 14 57
15 and over 46

The children were referred by a wide variety of individuals and agencies.
The largest single number of referrals came on the initiative of the parents
themselves. In the experience of this clinic, the parents have more and
more come on their own initiative indicating that both the services ren-
dered and the educational program undertaken have steadily helped
parents to focus necessary attention on the mental health needs of fami-
lies and children.







MATERNAL AND CHILD HEALTH 83


REFERRALS
Parents ...................... ...........................39%
Juvenile Court .........................--- .........---- ...... --16%
Schools ................------------------......................15%
County Health Dept. ........................................ 9%
Other Agencies .................... .....................15%
Other Individuals ............................................. 6%

In breaking down the problems into the variety of reasons for referral,
we may summarize them in four general categories with the recognition
that some of the children seen showed symptoms described in one or more
of these descriptive groups.
1. Unacceptable social behavior such as temper outbursts, lying, steal-
ing, destructiveness, sex misbehavior, disobedience.
2. Personality problems, such as shyness, worries, fears, over-activity
and daydreaming.
3. School adjustment problems, such as dislike of school, special dis-
abilities and poor school work.
4. Vocational guidance problems especially for youth who are confused
about the type of work for which they should prepare.
Throughout the year there were a total of 973 interviews with children
and 993 interviews with parents. The number of interviews for any par-
ticular child or parent varied with the length and intensity of service ren-
dered from a week or two to over a year. This clinic has been actively
represented on the State Committee of Mental Hygiene which is inter-
ested in establishing clinics, improving commitment procedures to our
mental hospitals and improving treatment and care given to the mentally
ill.
Dade County-This was the second clinic in the state in operation by
the end of 1947. Dr. T. E. Cato, director of the Dade County Health
Department, and the Mental Hygiene Society of Southeastern Florida
had succeeded in setting up this clinic and had provided supplementary
funds to establish it. The School Commissioners of Dade County sup-
plied the funds to pay the social worker and provided space for the unit.
This clinic is staffed by a psychiatrist, a psychologist supplied by the Uni-
versity of Miami and a full-time social worker. The clinic manager acts
as secretary and playroom worker. The sources of funds were: Mental
Health Funds, Dade County Board of Public Instruction and the Dade
County Health Department. During 1948, 140 patients were seen in
this clinic with only two adults in the entire group.

SOURCE OF REFERRALS
Dade County Board of Education ............96%
Dade County Health Department ............ 3%
Social Agencies ................... .-----................. .8%
Private Doctors ...................................... ... .2%







84 ANNUAL REPORT, 1948

The types of problems presented were:
1. Behavior disorders of children ........................................---53
2. M ental deficiency ............................. ..................----- 15
3. Psychoneuroses ..................... ----------....------- 6
4. Psychoses ....................--.. ------ --- -- -- ... 2
5. Character disorders ................----------........................----45
6. Disturbances associated with organic and
infectious diseases ....................--.... ---. .. ...-------17

This clinic had the services of Dr. Goodman, psychiatrist, for three half-
day sessions per week up until December when he resigned. Since that
period Doctor Fishbein and Doctor Kells devote their services to this
clinic. During 1949 it is hoped that this clinic will be able to expand
to the extent that we will be able to service patients referred to us from
the Juvenile Court. With that expansion we hope for additional finan-
cial assistance from the Juvenile Welfare Board in Dade County.
Leon County-This clinic is under the auspices of Dr. H. A. Sauberli,
director of the Leon County Health Department, and Florida State Uni-
versity. This clinic is staffed by a team consisting of a psychiatrist, Dr.
Herman Selinsky of Miami, a clinical psychologist and a social worker
as well as an executive secretary. Funds were received from the Florida
State University and the Mental Health Fund. About 9 students from
Florida State University who were seniors in either the Department of
Clinical Psychology or in the Department of Social Work were utilized
to do a limited amount of psychometry and social case history field work
under the supervision of the psychologist, Dr. Sweetland, and Mr. Hicks,
the social worker. A total of 207 cases were seen with 105 children and
102 adults.
SOURCE OF REFERRALS
Leon County Health Unit ............................30%
Public Schools .............................-.........15%
Self-referral .-........................... ....... 5%
Family ............................-........... 5%
Physicians, V. A., Judges
and Social Agencies ............................. 45%
The types of problems presented were:
1. Behavior disorders of children ......................80
2. M ental deficiency ...................................... 31
3. Psychoneuroses .......................-.............- 67
4. Psychoses -...........-- -........... .............. 6
5. Character disorders .................................... 18
6. Disturbances associated with
organic and infectious diseases ................ 5
During a two months period the psychologist spent from three to five
days each week in various counties throughout the state doing psychome-







MATERNAL AND CHILD HEALTH 85


tric work to assist in setting up classes for the exceptional child. Through
this clinic it was hoped that the problems of mental health in the com-
munity would be taken care of and the students would be trained in
clinical psychology and social work to such a level that they will be of
use in expanding the mental health program throughout the state. The
psychologist has been very active on the mental health committee of the
Florida State Conference of Social Work.
Orange County-The clinic was opened in April, 1948, under the
direction of Dr. Leland H. Dame, health officer of Orange County. The
psychiatrist, Dr. Lowell S. Selling, had resigned as director of the Mental
Health Program with the State Board of Health and had taken a very
active part in the formation of this clinic. Dr. Selling had addressed
the Health Committee of the Council of Social Agencies and the Com-
munity Planning Organization as well as the judges of the various courts.
Arrangements had already been made for Dr. James H. Russell, professor
of psychology at Rollins College, to serve part-time as clinical psychologist
for the clinic in Orlando. The Orange County School Board obtained
the full-time services of a psychiatric social worker. The sources of
funds were: Mental Health Funds, Orange County School Board and
Orange County Health Department.
During 1948, 187 patients were seen in this clinic with 167 children
and 20 adults.
SOURCE OF REFERRALS
Juvenile Court .......-.........--......................40%
County Welfare .....................-..-........-... 10%
Schools ...........--- ....... ................. 30%
Red Cross -................-.........-....-.....- 1%
Children's Home Society ..............................-------- 5%
County Health Dept. ..... ..................-.......- 9%
Parents or other interested individuals .......... 5%
The types of problems presented were:
1. Behavior disorders of children ..................----92
2. Mental deficiency .........-................-.......36
3. Psychoneuroses ..................... -----................... 10
4. Psychoses .................------ .....................--------- 9
5. Character disorders .........................------ ....----- 9
6. Disturbances associated with organic
& infectious diseases .......................----..-----.............--31
Polk County-During October, 1948, the Polk County Guidance Cen-
ter was established under the direction of Dr. Edwin G. Riley, health of-
ficer of Polk County. The Polk County Guidance Center had been or-
ganized through the initiative of Judge G. Bowdon Hunt of the Polk
County Juvenile Court and the clinic occupied space in the Juvenile
Court offices. The staff of the Center included Dr. Lowell S. Selling,
psychiatrist, a psychologist and a social worker.
This clinic received financial support from the Polk County School
Board and the Women's Federated Clubs as well as the Mental Health
Funds from the State Board of Health and the contribution made by







86 ANNUAL REPORT, 1948


the Polk County Juvenile Court. During 1948, 45 patients, all children,
were seen in this clinic.
SOURCE OF REFERRALS
Schools ...........- ....................-..........40%
Juvenile Court ............. .....------------...........34%
Health Department ..........-----------... ....................14%
Parents -----....................----...... ..-------- 7%
Physicians .------.............-.........--------- 2%
State Welfare .................. ........-------------- 2%
The types of problems presented were:
1. Behavior disorders of children ..............-------.......16
2. M ental deficiency ......---............--........--.. .. .. 7
3. Psychoneuroses .................................--------------.... 9
6. Disturbances associated with organic
& infectious diseases ....--.......... ......------------... 13

Hillsborough County-The Marriage and Family Council of Hills-
borough County was incorporated in June, 1948, after recognition had
been given to the need to provide a center for specialized marriage coun-
seling. A director and an executive secretary were employed. Appoint-
ments with the psychologist, Dr. Paul W. Penningroth, director of the
Pinellas County Child Guidance Clinic, were made in order that he would
be able to interview the patients during one day of each week. In the
work of this Council, the staff encountered many problems of family
situations that involved children. Dr. Frank V. Chappell, director of
the Hillsborough County Health Department, had felt that it would be
possible to include child guidance services and that it would be the most
desirable step to be taken. This type of work in child guidance has been
worked out in the Tampa Clinic through the relationships that exist
between the parents and the children. In view of that, Dr. Chappell
felt that they should maintain the present marriage counseling service
and add a second department of child guidance, both under the same
kind of professional help. In November, 1948, through the cooperation
of the school authorities, space was made available for a child guidance
clinic in the Henderson School in Tampa. The financial support for
this clinic has been obtained from several local organizations as well as
the mental health funds through the State Board of Health. The staff
consists of a psychiatrist, Dr. Bailey, a psychologist and an executive secre-
tary. The services of a psychiatrically trained social worker will be avail-
able in 1949. During 1948, a total of 27 patients were seen with 22
adults and 5 children.
Duval County-Dr. Selling addressed the Council of Social Agencies,
the P.T.A. and the Florida State Conference of Social Work in this area.
The Fall meeting of the Florida State Conference of Social Work had
as its theme, "Living in a Troubled World." This was conducted by
Dr. Herman Selinsky, neuropsychiatrist of Miami, who attempted to
integrate the work in the mental health field from the point of view of
the psychiatrist and the social worker.










BUREAU OF
LOCAL HEALTH SERVICES

GEORGE A. DAME, M.D., Director

The year 1948 showed further advancement in the organization of
accredited county health departments. Two counties, Palm Beach and
Citrus, were added leaving only Collier, Lee, Martin, St. Johns and Her-
nando without accredited health units. Martin has levied a millage for
matching funds for a health unit and probably will be organized in 1949.
A great deal of interest in organized public health has developed in Lee
and St. Johns. Appreciating fully the value to the citizens of the State
of full time county health units, the Bureau of Local Health Service
and other agencies of the Florida State Board of Health will continue
to give all possible service toward full coverage for the entire State.
Another major objective of this Bureau is to secure more adequate
financing for the county health units. In 1946-1947 the counties with
accredited units contributed 58 cents per capital of their population. In
1947-48 this contribution increased to 64 cents, and in the latter half of
1948 the local contribution increased to 70 cents. Nineteen of the coun-
ties contribute 80 cents or more. Of these counties in the upper bracket,
eight contribute $1.00 or more. The banner county is Liberty with $1.50
per capital:

Liberty .....................-- ..... $1.50 Leon .........---------......... ..... $0.88
Nassau .-...................-...... 1.16 Volusia ...............-- ........----- .88
Alachua ... -------.................. 1.06 Wakulla .. --------................. .88
Glades ........................--.. 1.05 Lafayette --...........----......... .84
Gilchrist .......................... 1.04 St. Lucie ........................------- .84
D ade ................................ 1.00 D uval ...........................--------- .83
Flagler ..-......................... 1.00 M onroe ---- ---...................83
Okeechobee .------.................. 1.00 Baker .....---------........... ...... 80
Dixie ......................---.........--- .97 Pinellas ......--------............. .80
Charlotte .....-------.............. .80

On the average the 776 persons now employed in the local health
units of the state are better trained, better experienced and better paid
than at any time since the organization of the first accredited local health
unit in 1930. All of this is reflected in more programs, better programs
and better preventive health service to the State of Florida. There is
still a shortage in some categories of personnel, particularly nurses. Next
most urgent and difficult to secure are physicians. The whole picture,
however, looks better.





TABLE XLII
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1948




ACTIVITIES .
B M0 d W 0 M
M L) U U r)


COMMUNICABLE DISEASE CONTROL
Admissions to service (A 1)
Field visits (A 3-9)
Smallpox immunizations (A 15)
Dipthheria 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 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 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 SERVICE
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
S,~e.-im-ns ,xmined


29
48
994
960
5,174

1,453
304

33
377
22,108
642

535
955
618
2,520

619
1,402
822
3,166

583
1,045
640
1,788

432
962
3,696
1,565
302
262

12,228


1 57 32
3 84 115
196 610 534
383 637 472
1,123 1,590 127

45 652 145
29 1,685 115

10 14 197
97 203 72
81 1,165 210
108 407 327

62 178 101
147 288 123
85 275 236
329 633 307

219 115 465
534 323 444
352 389 954
1,506 590 1,311

2,1273,915 371
8063,956 441
207 368 695
760 530 194

8 41 22
89 554 50
982 2,468 284
536 1,541 393
2 291 42
0 265 28

1,077 5.159 2.034


32 98
105 372
53 14,235
154 722


1.1581 6.018 2,029


17 0
18 0
36 543
36 229
304 806

4 6
4a 0


10 0
22 7
39 1,279
7 0


2,767
3,604
6,377
5,200
4,918

7,331
14,368

3,429
796
16,129
2,844

2,632
3,631
6,850
9,020

3,431
2,618
8,023
10,784

111,779
13,930
3,143
16,506

1,265
1,263
54,786
33,675
1,393
2,038


0 78
0 232
148 1,360
74 1,918
1,494 3,996

56 4,482
81 2,398

0 0
60 406
1,109 79
88 1,134

32 64
82 395
41 157
182 1,129

62 1,408
140 2,467
64 3,419
93 6,538

589 4,843
312 1,151
143 737
0 7,693

11 1,749
193 4,040
991 7,986
551 2,037
23 4
12 0


46711,03111.503i5,0431177,7881 1,16311,546


00
0O


255
973
1,700
3,287
12,567 t'

O
1,365 W
5,575 -

1,789
924
25,389
1,417

555
510
1,648
1,035

718
631
854
1,494

6,041
942
650
0

193
521
4,332
2,051
613
304


21,443|22,476




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