Annual report - State Board of Health, State of Florida

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STATE BOARD

OF

HEALTH

1953

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;~55

ANNUAL REPORT~~ '1~)

State Board of Health

State o 7d6a

1953

The following statistical reports will be published separately:
SUPPLEMENTAL I- FLORIDA VITAL STATISTICS, 1953
SUPPLEMENTAL II FLORIDA MORBIDITY STATISTICS, 1953

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

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

Dear Dr. Bryans:

I herewith submit the annual report of the Florida
State Board of Health for the year ending December
31, 1953.

Sincerely yours,

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

May 1, 1954
Jacksonville, Florida

His Excellency, CHARLmI E. JOHNS
Acting 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, 1953,
to December 31, 1953, inclusive.

Respectfully submitted,

HERBERT L. BRYANs, M.D.
President

May 1, 1954
Pensacola, Florida

Members of the

FLORIDA STATE BOARD OF HEALTH

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

T. M. CUMBIE, Ph.G.
Quincy

EDWARD L. FLYNN, D.D.S.
Tampa

ALBERT L. WARD, M.D.
Port St. Joe

CARL C. MENDOZA, M.D.
Jacksonville

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
December 31, 1953

DIRECTORS
State Health Officer Wilson T. Sowder, M.D., M.P.H.

Bureau of Local Health Service George A. Dame, M.D.
Division of Public Health Nursing Ruth E. Mettinger, R.N.
Field Training Center ____ --Frank M. Hall, M.D., M.P.H.
Field Advisory Staff __.James L. Wardlaw, Jr., M.D. M.P.H.

Bureau of Dental Health Floyd H. DeCamp, D.D.S.

Bureau of Preventable Diseases ....-- Lorenzo L. Parks, M.D., M.P.H.
Division of Venereal Disease ControlWilliam A. Walter, M.D., M.P.H.
Division of Industrial Hygiene John M. McDonald, M.D.
Division of Cancer Control .._Lorenzo L. Parks, M.D., M.P.H.,
Acting
Public Health Veterinarian James E. Scatterday, D.V.M., M.P.H.

Bureau of Tuberculosis Control Clarence M. Sharp, M.D.
Division of Heart Disease ControL____Simon D. Doff, M.D., M.P.H.

Bureau of Laboratories Albert V. Hardy, M.D., Dr. P.H.
Miami Regional Laboratory Dwight E. Frazier
Orlando Regional Laboratory Max T. Trainer
Pensacola Regional Laboratory ___. Emory D. Lord, Jr.
Tallahassee Regional Laboratory_ Robert A. Graves
Tampa Regional Laboratory H. D. Venters

Bureau of Maternal and Child Health__ Ralph W. McComas, M.D., M.P.H.
Division of Mental Health Paul W. Penningroth, Ph.D.

Bureau of Sanitary Engineering __ ._ David B. Lee, M.S., Engineering

Bureau of Entomology John A. Mulrennan, Sr., B.S.A.

Bureau of Vital Statistics _--- -..Everett H. Williams, Jr., M.S. ITyg.

Bureau of Finance and Accounts Fred B. Ragland, B.S.
Personnel Supervisor -Paul T. Baker
Purchasing Agent G. Wilson Baltzell

Division of Health Information--...-.. Elizabeth Reed, R.N., B.S.

Division of Nutrition and Diabetes Control- Lorenzo A. Parks, M.D., M.P.H.
Acting

Bureau of Narcotics ...--.... Frank S. Castor, Ph.G.

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
December 31, 1953

DIRECTORS
State Health Officer Wilson T. Sowder, M.D., M.P.H.

Bureau of Local Health Service George A. Dame, M.D.
Division of Public Health Nursing Ruth E. Mettinger, R.N.
Field Training Center ____ --Frank M. Hall, M.D., M.P.H.
Field Advisory Staff __.James L. Wardlaw, Jr., M.D. M.P.H.

Bureau of Dental Health Floyd H. DeCamp, D.D.S.

Bureau of Preventable Diseases ....-- Lorenzo L. Parks, M.D., M.P.H.
Division of Venereal Disease ControlWilliam A. Walter, M.D., M.P.H.
Division of Industrial Hygiene John M. McDonald, M.D.
Division of Cancer Control .._Lorenzo L. Parks, M.D., M.P.H.,
Acting
Public Health Veterinarian James E. Scatterday, D.V.M., M.P.H.

Bureau of Tuberculosis Control Clarence M. Sharp, M.D.
Division of Heart Disease ControL____Simon D. Doff, M.D., M.P.H.

Bureau of Laboratories Albert V. Hardy, M.D., Dr. P.H.
Miami Regional Laboratory Dwight E. Frazier
Orlando Regional Laboratory Max T. Trainer
Pensacola Regional Laboratory ___. Emory D. Lord, Jr.
Tallahassee Regional Laboratory_ Robert A. Graves
Tampa Regional Laboratory H. D. Venters

Bureau of Maternal and Child Health__ Ralph W. McComas, M.D., M.P.H.
Division of Mental Health Paul W. Penningroth, Ph.D.

Bureau of Sanitary Engineering __ ._ David B. Lee, M.S., Engineering

Bureau of Entomology John A. Mulrennan, Sr., B.S.A.

Bureau of Vital Statistics _--- -..Everett H. Williams, Jr., M.S. ITyg.

Bureau of Finance and Accounts Fred B. Ragland, B.S.
Personnel Supervisor -Paul T. Baker
Purchasing Agent G. Wilson Baltzell

Division of Health Information--...-.. Elizabeth Reed, R.N., B.S.

Division of Nutrition and Diabetes Control- Lorenzo A. Parks, M.D., M.P.H.
Acting

Bureau of Narcotics ...--.... Frank S. Castor, Ph.G.

COUNTY HEALTH OFFICERS

(As of December 31, 1953)

Alachua -- -------Frank M. Hall, M.D., M.P.H.
Baker-Nassau ------ John W. McClane, M.D.
Bay _------ _---- Albert F. Ullman, M.D.
Bradford-Clay-Union --....----- ...A. Y. Covington, M.D., M.P.H.
Brevard-Osceola-- --- Norman B. Edgerton, M.D.
Broward __ .. -Paul W. Hughes, M.D., M.P.H.
Calhoun-Jackson --___ ____A. K. Husband, M.D.
Charlotte-DeSoto-Hardee_._._.... ..James O. Bond, M.D.
Citrus-Hernando-Levy -- -Harold F. Bonifield, M.D.
Collier-Lee ..___......Vacant
Columbia-Gilchrist-Hamilton---- Joseph C. Weeks, M.D.
Dade ___.. -.---- --. T. E. Cato, M.D., M.P.H.
Dixie-Lafayette-Suwannee --...E. H. John, M.D.
Duval.________ __ -_Thomas E. Morgan, M.D., M.P.H.
Escambia -John C. McSween, M.D.
Flagler-Putnam_ --... -- ..W- Wade N. Stephens, M.D., M.P.H.
Franklin-Gulf-Wakulla ---- .Warren T. Weathington, M.D., M.P.H.
Gadsden-Liberty---.. .-----. .Vacant
Glades-Hendry-Highlands G. L. Beaumont, M.D., M.P.H.
Hillsborough-lt__ _Frank V. Chappell, M.D., M.P.H.
Holmes-Walton-Washington ....... R. N. Nelson, M.D.
Indian River-Martin-Okeechobee-
St. Lucie -_____Vacant
Jefferson-Madison-Taylor -----..-.. Harry A. Nevel, M.D., M.P.H.
Lake J. Basil Hall, M.D., M.P.H.
Leon--- -_-------- Joseph M. Bistowish, M.D., M.P.H.
Manatee- _____ John S. Neill, M.D.
Marion ____-_- _.--- -Luther A. Brendle, M.D., M.P.H.
Monroe -------------__-Raymond J. Dalton, M.D.
Okaloosa-Santa Rosa ..-.--.. __._. L. Turnage, M.D.
Orange ---- Terry Bird, MD., M.P.H., Acting
Palm Beach__ __.. ...____C. L. Brumback, M.D., M.P.H.
Pasco-Sumter ---Leo L. Burger, M.D.
Pinellas-----___ ..... ...-Robert E. Rothermel, M.D., M.P.H.
Polk_ ---.-- ---- Chester L. Nayfield, M.D., M.P.H.
Sarasota-. -- -- _- William L. Wright, MD., M.P.H.
Seminole -.Terry Bird, M.D., M.P.H.
Volusia -- -- ...-Robert D. Higgins, M.D., M.P.H.

FLORIDA STATE BOARD OF HEALTH
GOVERNOR OF FLORIDA
FIVE BOARD MEMBERS

I Statt H.bkh Officer

TABLE OF CONTENTS
Page

General Summary ...................... ..................... 1

Finance and Accounts (including Personnel and Purchasing)..... 7

Vital Statistics............................................... 21

Local Health Services (including Public Health Nursing, Field
Advisory Staff and Field Training Center) ................ 31

Preventable Diseases (including Venereal Disease Control,
Cancer Control, Industrial Hygiene and Veterinary Public
H health) ......................................... .. ... 73

Tuberculosis Control (including Heart Disease Control)........ 101

Laboratory Services............. .............................114

Maternal and Child Health (including Mental Health).......... 127

Nutrition and Diabetes Control..............................144

Dental Health.............................................. 151

Entomology .............................................. 156

Sanitary Engineering.................... .................161

Narcotics ................................................ 189

Health Information (including Library) ...................... 191

GENERAL SUMMARY
WILSON T. SOWDER, M.D., M.P.H.
State Health Officer

The year 1953 was marked by considerable progress in the field
of public health generally. The population continued to grow to
an estimated 3,111,100. While much of this was due to immigra-
tion from other states, there were 80,112 new resident births, with
a birth rate of 25.8 per thousand population. This was the highest
number of births and birth rate on record. Deaths totaled 30,603
among residents and the death rate was 9.8 per thousand population,
which was 0.1 higher than in 1952. This is not a cause for concern
since, if accurate, it is due to a higher percentage of older people
in the population. Heart disease caused 34 per cent of all deaths
and no effective method of prevention or control has been discovered.
The number of deaths and the death rate from cancer increased but
this is expected with the increase in the number of older people.
However, our excellent cancer program has undoubtedly saved many
lives but more funds are needed to make it even more effective.
There were 419 deaths from diabetes as compared with 422 in 1952.
Deaths from this prevalent disease can be prevented in most cases
but unfortunately our beginning efforts toward more effective control
measures were curtailed in midyear due to a reduction in federal
funds. Astonishing progress was made in reducing the death rate
from tuberculosis from 16.7 in 1952 to 9.8 per hundred thousand in
1953. This was accomplished in spite of a curtailed program due
to a loss in federal funds. However, the construction and operation
of new tuberculosis hospitals were of untold benefit. The number
of infected persons known to the health department remained about
the same. Cases of syphilis reported in 1953 were 6,722 as compared
to 10,824 in 1952. The death rate from this disease also declined
from 6.1 to 4.7 per hundred thousand population. Reductions in
federal funds also handicapped the efficient operation of the venereal
disease control program. The maternal death rate remained the
same (8 per 10,000 births) which is gratifying in view of the marked
drop in the rate in 1952. Special progress in infant mortality is
indicated by the decline in infant deaths from 34.1 in 1952 to 31.0
in 1953 per thousand live births.
The reporting of communicable diseases continues to be unsatis-
factory as an index of progress in this field. However, there were
no major epidemics of any diseases. A few more cases of polio-
myelitis were reported than in 1952 but hopes were raised for the

2 ANNUAL REPORT, 1953

control of this disease by the availability of gamma globulin which
is thought to be useful in its prevention.
Major developments occurred during the year in the field of legis-
lation. Federal funds were reduced by about $270,000 per year
effective July 1st which reduced the federal share in the financing
of the public health program in Florida to about 13 per cent. The
State Legislature however increased our general funds moderately
but not enough to absorb the federal cut. On the other hand the
Legislature made a liberal appropriation for permanent mosquito
control under a new law passed which amounted to $1,500,000. In
addition the appropriation of $350,000 for temporary mosquito
control work was continued. A new appropriation amounting to
$75,000 per annum was also made for community mental health
work which was badly needed to supplement federal and local
appropriations. An increase of $250,000 per annum was also voted
for county health departments, the total annual appropriation for
this activity now being $1,100,000. This is of course supplemented
by State and local funds. Other legislative accomplishments were
the passage of the law requiring the reporting of communicable
diseases by physicians and veterinarians; the passage of a law re-
quiring the inspection and licensure of nursing homes, with an
appropriation of $25,000; the passage of a law requiring the inspection
of mattresses and providing for the collection of fees for this work.
Another gratifying development was the letting of a contract for
a new Laboratory and Health Center building in Jacksonville, the
cost of which will be nearly $600,000. This building was made
possible by an appropriation of $80,000 by the 1951 Legislature;
by the permission of the Budget Commission to use fees collected
during 1952 and a part of 1953; and a 50 per cent matching by
federal hospital construction funds through the State Improvement
Commission. A part of the fee money collected was also used to
purchase a plot of land on Pearl and Second Streets next to the
headquarters of the State Board of Health for parking purposes.
Due to the loss of federal funds some important work of the State
Board of Health had to be curtailed. Reductions were necessary
in the operating budgets of nearly every Bureau and Division except
the Bureau of Finance and Accounts, the Bureau of Entomology,
the Division of Mental Health and the Bureau of Vital Statistics.
Among the major organizational changes that took place was the
elevation of the Division of Entomology to the status of a Bureau.
Due to loss of funds and the resignation of the director of the
Division of Nutrition and Diabetes Control, Edward R. Smith, M. D.,
this activity was placed temporarily under the Bureau of Preventable

GENERAL SUMMARY

Disease. Dr. Smith resigned his position in order to accept the
position as City Health Officer of Jacksonville. Simon D. Doff, M. D.,
director of the Division of Heart Disease Control, entered private
practice on November 1st but continued his position with the State
Board of Health on a part time basis. Following the appropriations
of State funds for mental health, a Division of Mental Health was
established in the Bureau of Maternal and Child Health. The entire
staff of the State Board of Health and its many friends were saddened
by the death of Mr. M. H. Doss, for many years director of the
Bureau of Narcotics, on July 80. Mr. Frank Castor, for many years
an inspector in that Bureau, was appointed by the Board to replace
Mr. Doss. During the year one change was made by the Governor
in the membership of the Board of Health. Carl C. Mendoza, M. D.
of Jacksonville, replaced Robert B. Mclver, M. D. of Jacksonville.
Dr. McIver had served as a member of the Board since 1942 and
made valuable contributions to the public health program of the
State during that time.
Specific comments will not be made on the work of the various
bureaus and divisions of the State Board of Health nor of the county
health departments. The work of these units is well covered in
other sections of this report and in general each of them did out-
standing work. The quality of personnel employed continued to
be excellent although the turnover rate was much too high, par-
ticularly in the health officer and clerical categories. Only better
salaries, which cannot be paid out of available funds, will correct
this situation.

ACTIVITIES OF THE BOARD
The Board of Health re-elected Dr. Herbert L. Bryans of Pensacola
as its President at the annual meeting in February. Six meetings
were held during the year during which meetings the following
important business was transacted:
February 10 Tallahassee, Florida
1. Granted certain salary increases and made changes in the com-
pensation plan.
2. Agreed not to ask for deferments from military service for
health officers.
3. Approved the seeking of certain amendments to the law pro-
viding for the hospitalization of persons with tuberculosis.
4. Agreed that direct grants of mental health funds should not
be made to the University of Florida but that assistance should
be given through the county health departments.

4 ANNUAL REPORT, 1953

5. Changed the name of the Field Technical Staff to the Field
Advisory Staff.
6. Decided as a policy not to subsidize speakers to county medical
societies.
7. Appointed Mr. Philip S. May of Jacksonville as attorney for
the State Board of Health to replace Mr. Rhydon C. Latham
of Jacksonville.
8. Met with State Improvement Commission officials to discuss
bids submitted for Laboratory and Health Center in Jacksonville.
No bid was accepted because sufficient funds were not avail-
able.
March 23, 24, and 25 Havana, Cuba
1. Discussed a proposed bill for the licensing of sanitarians.
2. Authorized the State Health Officer to accept the low bid for
the Laboratory and Health Center building in Jacksonville, more
federal funds being made available for the project by the State
Improvement Commission.
3. Discussed proposed legislation for a Crime Laboratory at the
State Board of Health.
April 26, 27, and 29 Hollywood Beach, Florida
1. Authorized certain salary increases and changes in the com-
pensation plan and Merit System specifications for personnel.
2. Discussed difficulties encountered with the Federal Housing
Administration concerning septic tanks and sewage disposal.
3. Directed that state owned cars assigned to counties be insured
under the general insurance contract policy.
July 18 Jacksonville, Florida
1. Approved proposed plans for expansion of Mosquito Control
Program and changed the Division of Entomology to the Bureau
of Entomology.
2. Agreed that the new Mosquito Research Laboratory should be
in St. Lucie or Indian River County.
3. Authorized the State Health Officer to purchase property on
Pearl and Second Streets if approved by the Attorney General.
4. Discussed the reduction of federal funds available on July 1st
and approved plans for curtailment of certain programs.
5. Discussed the new law for the inspection and licensure of
nursing homes and approved plans for procedure.
6. Created a Division of Mental Health in the Bureau of Maternal
and Child Health.

GENERAL SUMMARY

7. Designated the Bureau of Sanitary Engineering to enforce the
new mattress inspection law.
8. Approved the use of gamma globulin for distribution to health
officers and private physicians in the State.
9. Appointed William A. Walter, M. D., who is assigned to the
State Board of Health by the U. S. Public Health Service, as
Associate Director of the Bureau of Preventable Diseases.
10. Adopted a list of reportable diseases under a new law requiring
the reporting of communicable diseases.
August 22 Jacksonville, Florida
1. Approved rules and regulations for the inspection and licensure
of nursing homes.
2. Agreed that old records of the State Board of Health should
be offered first to the State Librarian rather than the University
of Florida as is legally required.
3. Approved certain salary increases and changes in salary ranges.
October 25 Jacksonville, Florida
1. Discussed per diem hospital rates for the cancer program.
2. Approved certain salary increases.
3. Discussed a plan for cooperation with the Foreign Operations
Administration in Washington for the assignment of State Board
of Health Personnel to foreign duty.
4. Appointed Mr. Frank S. Castor as director of the Bureau of
Narcotics.

ACTIVITIES OF THE STATE HEALTH OFFICER
The major activities of the State Health Officer during the year
consisted of directing and coordinating the work of the various
bureaus and divisions of the State Board of Health and the county
health departments. He acted as secretary to the Board at its vari-
ous meetings and furnished the members of the Board information
about current problems in the intervals between meetings. As in
other years a great deal of time was spent in liaison work with the
Governor's office, the Budget Commission and with other State officials
and departments. Also, it was necessary for him to participate in
the activities of numerous professional and lay organizations which
are connected with or interested in the work of the State Board of
Health. Maintaining proper relationships with the federal health
agencies, the U. S. Public Health Service and the U. S. Children's
Bureau, was a major duty of the State Health Officer and he also
participated actively in the affairs of regional and national medical

6 ANNUAL REPORT, 1953

and public health organizations. In addition to the executive duties
required of the position the State Health Officer necessarily acted
as the agency liaison officer with the numerous official and unofficial
state and federal agencies concerned with public health. The pro-
motion and maintenance of proper public relations required a sub-
stantial part of his time. Many talks were given and several formal
articles were prepared for publication.

FINANCE AND ACCOUNTS

BUREAU OF FINANCE AND ACCOUNTS
FRED B. RAGLAND, B.S., Director

The Bureau of Finance and Accounts has the responsibility of all
fiscal, personnel, and purchasing and property control matters.
The Bureau is a service organization, handling the business man-
agement of the Board. Every effort is made to handle efficiently
and expeditiously to the best interests of all Bureaus, Divisions, and
County Health Units the payment of salaries, travel expenses, and
other obligations; the personnel actions such as recruitment, employ-
ment, termination, reclassification, salary changes, leave records,
efficiency reports and training records; the purchasing by good busi-
ness methods; and the control of property.

FISCAL SECTION
The financial transactions of the State Board of Health for the
fiscal year ended June 30, 1953, as reflected by the records of the
Bureau, are presented in a condensed form in Tables 2-4 and in
Figure 1.
A detailed financial report for the fiscal year ended June 80, 1953,
has been prepared and distributed to the Governor, Members of
the Governor's Cabinet, members of the State Board of Health,
and all Bureaus, Divisions and County Health Units of the State
Board of Health.
The funds received (or appropriated) for the fiscal year ended
June 30, 1953, were from the following major sources:
State Appropriations .--...-..--- .....--------.... $2,539,278.11 42.3%
From Local Agencies for County Health
Units ..--..--.---- ..-._....----...-....--..- 2,246,934.06 37.4%
From Federal Grants-in-Aid ..---....-- -- 1,197,450.98 20.0%
From Private Contributions ....... ... 12,400.00 .3%

TOTAL .----....--..........----- --_...-----..-- $5,996,063.15 100.0%
Objectively, the operating and capital expenditures by the State
Board of Health in summary were for:
Personal Services (Salaries and Profes-
sional Fees) ...-..--.......---..----...--..--..--. ... $4,093,975.28 70%
Contractual Services (Repairs, Utilities,
Travel Expense, Cancer Program-
Fees and Hospitalization) ..---...--..- .__- 922,563.02 16%

8 ANNUAL REPORT, 1953

Commodities (Office, Medical, Labora-
tory, Mosquito Control, Educational).... 512,288.29 9%
Current Charges (Rents, Insurance, Merit
System Costs, Registrar Fees) ----------125,363.98 2%
Capital Outlays (Equipment and Fixed
Assets) -..--.......--....--.......--.... -..---.. 196,350.60 3%

TOTAL ..-......-...-............ ..__..... $5,850,541.17 100%
In addition to funds reported in the annual financial report and
summarized above, certain other funds and services were made
available by the Public Health Service of the U. S. Department of
Health, Education and Welfare to activities of the Board but were
not paid directly to the State Board of Health. They include:
Value of Public Health Service personnel on loan to
the Board in Preventable Disease Programs ______ $ 84,822.00
Value of personal services, supplies and equipment
furnished by Public Health Service Communicable
Disease Center for mosquito and typhus activities
under the Board's supervision .----.._............ __-- .... -17,942.83

TOTAL -....----..---...-..---..---..---....--..----..- $102,764.83
Fiscal operation followed a budget plan of 116 departmental
budgets. These budgets were occasionally revised to meet changing
situations. The majority of the revisions involved County Health
Unit budgets primarily because the fiscal year of the County differs
from the fiscal year of the State. At the time County Health Unit
budgets were initially prepared, it was not known exactly what
local funds would be available in each instance. It was, therefore,
necessary to revise a number of the County Health Unit budgets
during the year after the availability of funds from County sources
was determined.

FINANCE AND ACCOUNTS

PERSONNEL OFFICE
PAUL T. BAKER

The year 1953 was marked by steady progress in the field of
personnel administration. In conformity with established policy,
continued steps were taken to strengthen the Merit System structure
in the State Board of Health. Diligent attention was given to insure
that all appointments and terminations were made in accordance
with the rules adopted by the Board.
Leave records were developed and maintained, and efficiency re-
ports were obtained and recorded.
Records of in-service and post-graduate training of employees
were maintained and the application of regulations governing such
training was assured. All employees at the main office were en-
couraged by the Personnel Supervisor to discuss their employment
problems, if any, with him. At the times prescribed for consideration
by the State Board of Health of salary increases, full information
concerning each employee was made available to the Board in order
that employees might be treated fairly and equitably.
The payrolls for all employees were prepared in the Personnel
Office and forwarded to the State Comptroller for payment. All
matters pertaining to the Retirement Plan were handled promptly.
Prompt action was taken immediately after the Merit System
examinations to regularize the Merit System status of each provisional
employee. Employees were notified without delay upon attainment
of permanent status.
During the calendar year, the recruiting problems were resolved
in a very satisfactory manner. Little difficulty was encountered in
filling the requirements, although Sanitary Engineers, Dentists and
Stenographers continued to be in short supply. The generous State
Retirement Plan contributed considerably to the successful recruit-
ing program and to the retention of personnel after employment.
Salary increases were given to most of the personnel during the
year. These increases were predicated on the basis of merit. Work-
ing conditions were satisfactory and the morale of employees con-
tinued to be high.
A modest upward revision of the Compensation Plan was adopted
during the year to meet the continued high cost of living.
At the end of the year, sixty-six (66) of Florida's sixty-seven

10 ANNUAL REPORT, 1953

counties had organized health departments which were operating
under the State Merit System.
On December 31, 1953, there were 1,342 State employees (includ-
ing those in county health units) and 14 Federal employees on
loan to this agency. On December 31, 1952, there were 1,317 State
employees and 19 Federal employees.
During the year, there were 373 employment and 348 termina-
tions. The main reasons for terminations include marriage, pregnancy,
transfer of husbands from area, completion of work for which
employed, and acceptance of more profitable employment.
A tabulation of new employment, terminations, and turnover
rates according to classification is shown in the table below:

TABLE 1
NEW EMPLOYMENT, TERMINATIONS, AND TURNOVER
RATES, BY CLASSIFICATION
New Turnover
Classification Employments Terminations Rate*
Total .--_.._.... __ --.. --- 373 348 26%
Health Officers ___- -- 11 15 24%
Sanitary Eng. _..-....__ 6 4 16%
Sanitarians __ ___..... ....-- 37 22 12%
P. H. Nurses ....._.._..._ 80 65 21%
Clerical .._.....-.. .._... 100 94 29%
Others ........ 139 148 35%
*Turnover rate-terminations divided by average number of employees.
On December 31, 1953, the Merit System status of the State Board
of Health personnel was as follows:
Permanent and Probational .-.._.... 1,082
Provisional .-..._-.._.. ________..._ 26
Temporary -._..._______ ....-.....- 0
Emergency .._..--............ ...._....._ 4
Exempt and Part-time 2 .-.__ 230

TOTAL ..._..--...___ ___.... ..... 1,342
During the year, specifications were adopted for 6 new classifica-
tions; specifications were revised for 16 classifications; 3 classifications
were abolished and the salary ranges of 124 classifications were
revised.
Postgraduate training for one full academic year was completed
successfully during 1953 by 8 Health Officers; 4 Public Health Nurses;
1 Sanitary Engineer; 2 Sanitarians; 1 Bacteriologist and 1 Psychologist.

FINANCE AND ACCOUNTS

PURCHASING AND PROPERTY
G. WILSON BALTZELL
Purchasing Agent

During 1953 the Purchasing Agent received 2,134 requisitions for
supplies and equipment from the various departments and issued
3,635 purchase orders representing a total of $588,976.86. This was
slightly less than last year but when appropriations are cut, the
reductions are reflected in the procurement of supplies and equip-
ment, especially permanent equipment.
The last Legislature passed a law which provides that purchases
in excess of $1,000.00 must be made on competitive bids, and when
the purchase price is in excess of $2,000.00 competitive bids must
be received after advertising in a newspaper of general circulation.
The only feature of this law which in any way affects our purchasing
procedures is the newspaper advertising, as we have been getting
competitive bids on practically all purchases, large and small.
Property records are being kept at current levels, and the system
of memorandum receipts recently installed is responsible for 90 per
cent of the equipment in the central office being signed for. The
branch laboratories have been inventoried and memorandum receipts
obtained on the equipment under their supervision.
The State Board of Health carries automobile insurance in com-
mercial companies, and accidents are reported to Purchasing and
Property and claims for liability and property damage processed to
insurance company adjusters. During the year there were five claims
paid by our insurance company for damages amounting to $2,157.99.
Since the State Board of Health acts as self-insuror for collision
coverage, it might be stated that $1,558.80 was spent for collision
repairs to units of the fleet. However, $1,227.11 was reimbursed
to the State Board of Health by individuals and firms admitting
liability.
Fire insurance on building and contents is carried in the State
Fire Insurance Fund, under supervision of the State Fire Insurance
Commissioner.

BUILDINGS AND GROUNDS
All Central Office Bureaus and Divisions are located either at the
main office at 1217 Pearl Street or in leased space at the General
Administration Building in the St. Johns Shipyard, Jacksonville,

12 ANNUAL REPORT, 1953

Florida. The Superintendent has the responsibility for maintaining
and operating the buildings at both locations. Maintenance personnel
have carried out their duties efficiently during the year.
On April 9, 1953 a contract was entered into between the Florida
State Board of Health and O. P. Woodcock Company, General Con-
tractors, for the construction of a new building addition at the
corer of Julia and Second Streets. This addition will be principally
a laboratory building. The contract for $506,666.00 represented
the contractor's base bid and the agreement called for completion
of the building within 300 days. The entire building project is
estimated to cost $587,865.00, such amount to include the designing,
the construction, the supervision and inspection at the site and
equipment of the building. 50 per cent of the cost is to be from
Federal funds through the Hospital Division of the Florida State
Improvement Commission. It is expected that occupancy of the
building will take place during the spring of 1954.
DUPLICATING
This section is a valuable asset and aid to all departments of the
State Board of Health. A considerable saving is effected by this
section being able to supply the majority of the printing and duplicat-
ing needs at costs much less than commercial printing prices. When
the laboratory moves out of the Julia Street building, it is hoped
that there will be more room available for the Duplicating Depart-
ment and with additional equipment, it would be able to handle
printing which now has to be performed by commercial printers.

TABLE 2
SUMMARY OF RECEIPTS AND DISBURSEMENTS AND
BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 1953
RECEIPTS
FROM STATE FUNDS
From State Appropriations:
Salaries .. -- --- ...... .. $ 643,227.11
Expenses -----______ 555,503.16
County Health Units __ ... 859,334.34
County Mosquito Control ____.......----------.-----...... 350,000.00
Other:
Medical Laboratory Control ___ __ ...........__ 780.00
State Board of Health Trust Fund --......_--_-. ....----- 13-- 130,433.50
TOTAL STATE FUNDS ...._-___----------------. $ 2,539,278.11
FROM FEDERAL GRANT-IN-AID
Public Health Service:
Rapid Treatment Center -_.--._-___ __._ $ 94,905.64
General Health __. ...-.. --.....................__ 265,680.80
Venereal Disease ...... .._.... 292,938.85
Tuberculosis Control __ __ 113,666.00
Mental Health ..___._______ _.._.... 57,603.00
Cancer Control .. ..... .... ..... 58,946.00

FINANCE AND ACCOUNTS

TABLE 2-Continued
SUMMARY OF RECEIPTS AND DISBURSEMENTS AND
BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 1953
Heart Disease -.-. ---------- 34,436.00
Children's Bureau:
Maternal and Child Health ______ 279,274.69
TOTAL FEDERAL GRANT-IN-AID ____$1,197,450.98
FROM PRIVATE CONTRIBUTIONS
Water Pollution Research ______ $ 3,400.00
Franklin County Marine Laboratory 4,000.00
Citrus Canning Research _.. ..... .......... 5,000.00
TOTAL PRIVATE CONTRIBUTIONS $ 12,400.00
FROM LOCAL AGENCIES FOR COUNTY HEALTH UNITS...------ $2,246,934.06
Total Receipts $5,996,063.15
Balances July 1, 1952 -- 1,074,914.30
Total Receipts and Balances ------ $7,070,977.45

DISBURSEMENTS
OPERATING EXPENSE
Personal Services:
Salaries ---_-- --- --- -----.------ $4,046,338.79
Professional Services and Consulting Services_____ 47,636.49
Contractual Services:
Travel Expenses, including subsistence and lodging ...- 500,855.35
Telephone, Telegraph and Postage 87,978.86
Utilities 22,160.50
Printing, Binding, Photographing and Advertising __ 24,738.60
Freight and Express ______...... ....... 12,181.01
Cleaning, Laundry and Painting _.. .. 13,820.82
Repairs to Buildings and Equipment __.. ... 37,154.84
Subsistence, Care and Support of Persons ...... 201,853.15
Other Contractual Services 21,819.89
Commodities:
Stationery and Office Supplies ..-__ .... -..... ..... 70,578.70
Chemicals, Laboratory and Mosquito Control Supplies 219,475.38
Medical, Surgical and Dental Supplies 119,878.64
Gas, Oil and Fuel .. ... ..... ...... 58,652.36
Cleaning, Laundry, Parts, Fittings and Other Supplies--. 39,276.54
Educational Supplies _- 4,426.67
Current Charges:
Rental of Buildings and Equipment _._.-.-.............- 52,168.33
Insurance, Dues, Fees, Registration and Bonds ___ 57,817.61
Merit System .-__. _._....__. _.... -.... 15,378.04
TOTAL OPERATING EXPENSES__- -_ $5,654,190.57
CAPITAL EXPENSES
Office, Household and Mechanical Equipment ~__ $ 55,042.10
Engineering, Medical and Dental Equipment 30,413.06
Automotive Equipment .--__- __ -__ 72,662.49
Books, Educational and Other Equipment -- -_---- --_- 11,991.81
Buildings and Surroundings __ 26,241.14
TOTAL CAPITAL EXPENSES __ --_ ---- $ 196,350.60
TOTAL OPERATING AND CAPITAL EXPENSES ..-__ --_ $5,850,541.17

14 ANNUAL REPORT, 1953

TABLE 2-Continued
SUMMARY OF RECEIPTS AND DISBURSEMENTS AND
BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 1953
NON-OPERATING DISBURSEMENTS
Refunds of Registration Fees and Comptroller's Fee
Deductions _----....-... ------- -.---------- $ 88.40
Unexpended Project Balance Returned to U. S. Treasurer--- 87.42
Payments to Local Boards of County Commissioners for
Health Center Construction -_......... 21,000.00
Refund of Local Contribution _.__.......... -------.... 50.00
TOTAL NON-OPERATING DISBURSEMENTS $ 21,225.82
TOTAL DISBURSEMENTS __--- ------- ---- $5,871,766.99
BALANCES JUNE 30, 1953 .. 1,199,210.46
TOTAL DISBURSEMENTS AND BALANCES .-----------...... $7,070,977.45

TABLE 3

SCHEDULE OF OPERATING AND CAPITAL EXPENSES
BY PUBLIC HEALTH PROGRAM ACTIVITY
Health services to mothers, infants, preschool and school children_ $1,163,331.86
Statewide venereal disease control, diagnosis and referral of in-
fectious venereal disease patients to the prevention and control
centers and operation of centers --- 912,696.91
Mosquito and pest control programs, including pest control law
enforcement _--- ------- ---------- 704,754.70
Statewide sanitary engineering and environmental sanitation 684,173.92
Statewide tuberculosis control, x-ray surveys and follow-up work 561,985.83
Statewide cancer control program -----_____-- 214,148.72
Mental health program 116,150.59
Statewide narcotics, drug, medical practice law enforcement ---- 79,342.22
Heart disease program ---- ..----------------- 78,397.88
Industrial hygiene program --- ---- ----- 18,853.24
Other health programs and administration ------- 1,316,705.80
TOTAL OPERATING AND CAPITAL EXPENSES ...---- $5,850,541.17

SCHEDULE OF OPERATING AND CAPITAL EXPENSES
BY FUNCTIONAL ACTIVITY
General Administration and miscellaneous --.--. ... ..- $ 390,819.26
Vital Statistics -------164,528.00
Health Information -- ------- ---------- 57,060.78
Narcotic Enforcement --..- ---..-..---- ----------- 59,857.19
Sanitary Engineering ------186,063.10
Entomology and Mosquito Control ------------ 382,292.44
Laboratories -------------- ------ ----- ------------------- 389,700.65
Tuberculosis Control _--- --- --- ---- 117,864.87
Preventable Diseases (excluding Tuberculosis) --- 336,079.62
Chronic Diseases ...------ ---------- ------------ 295,728.28
Maternal and Child Health _------_ ----------- 109,521.72
Local Health Service _.___- --- 136,403.17
County Health Units -- -------- 3,224,622.59
TOTAL OPERATING AND CAPITAL EXPENSES .... $5,850,541.17

FINANCE AND ACCOUNTS

SUMMARY OF TOTAL OPERATING AND CAPITAL EXPENSES
BY MAJOR FUNCTIONAL LEVELS
State Level Organizational Units
State Funds -$1,028,699.85
Federal Funds _-... .... ......... 633,333.10 $1,662,032.95

State Level Special Services
State Funds .____. ............ $ 591,642.79
Federal Funds .. 336,501.99
Private Funds 8----_ ---- 35,740.85

*County Health Units
State Funds $ 829,446.08
Federal Funds 264,493.29

$ 968,885.63

Local Funds .------ 2,180,683.27 $3,224,622.59
GRAND TOTAL _. ..... ........._..___.. $5,850,541.17
* Total County Health Units expenditures $3,224,622.59 represents per capital
expenditures of $1.28 (833 State Funds, 104 Federal Funds and 850 Local
Funds), based on population served by County Health Units of 2,515,613. For
comparison with previous years, see 1952 Annual Report, Table 2, page 16;
1951 Annual Report, Table 2, page 24; and 1950 Annual Report, Chart 1,
page 16.

TABLE 4
FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM STATE BOARD OF HEALTH AND FROM LOCAL

SOURCES FOR THE FISCAL YEAR ENDED JUNE 30, 1953

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.............

Total
Funds

$ 66,979.01
13,201.78
59,191.70
21,910.00
27,135.49
100,709.36
13,021.00
7,619.00
10,241.11
20,617.49
11,996.58
20,003.07
611,012.51
12,695.47
10,385.24
111,367.72
108,313.46
9,132.75
15,937.29
39,013.17
8,732.02
9,055.10
18,222.58
12,450.07
16,377.70
10,328.64
9,528.21
25,642.32
391,833.26
17,495.68
19,315.78
36,782.92
18,434.28
8,443.08

STATE BOARD OF HEALTH

Total

Federal

LOCAL FUNDS

County Board of
Commissioners Public
Instruction

Cities

I 1- 1 1- 1I i I I I

$ 27,525.57
7,244.00
21,315.50
10,737.00
14,467.00
29,105.52
6,472.00
4,279.00
5,611.00
10,509.00
4,547.58
11,944.00
112,529.40
6,949.00
5,260.00
43,309.66
32,917.00
3,652.00
7,055.00
19,183.00
5,120.00
3,485.00
8,090.00
7,863.00
8,290.00
5,206.00
5,884.00
11,326.00
70,791.46
9,918.00
9,727.00
17,621.00
10,290.00
4,531.00

$22,053.00
7,244.00
15,601.00
10,737.00
14,467.00
19,271.00
6,472.00
4,279.00
5,611.00
10,509.00
1,125.00
11,944.00
43,448.00
6,949.00
5,260.00
20,892.00
28,167.00
3,652.00
7,055.00
16,303.00
5,120.00
3,485.00
8,090.00
7,863.00
8,290.00
5,206.00
5,884.00
11,326.00
30,861.00
9,918.00
9,727.00
17,621.00
10,290.00
4,531.00

$ 5,472.57

5,714.50

9,834.52

3,422.58

69,081.40

22,417.66
4,750.00

2,880.00

39,930.46
... .
... .
.......

... .
... .
... .
... .
... .

$ 39,453.44
5,957.78
37,876.20
11,173.00
12,668.49
71,603.84
6,549.00
3,340.00
4,630.11
10,108.49
7,449.00
8,059.07
498,483.11
5,746.47
5,125.24
68,058.06
75,396.46
5,480.75
8,882.29
19,830.17
3,612.02
5,570.10
10,132.58
4,587.07
8,087.70
5,122.64
3,644.21
14,316.32
321,041.80
7,577.68
9,588.78
19,161.92
8,144.28
3,912.08

$ 32,065.00
2,449.99
37,374.45
4,920.00
10,000.00
54,773.05
6,500.00
1,000.00
1,992.11
4,903.36
7,430.00
7,800.00
474,282.75
4,403.97
4,200.00
55,053.21
42,500.00
3,363.20
7,833.80
13,999.92
1,800.00
5,564.35
6,876.08
2,356.25
8,000.00
5,077,89
1,800.00
14,171.07
274,579.28
3,754.68
9,493.28
15,267.92
3,200.00
1,950.00

$.........
3,466.66
.....',...6.
4,000.00
2,250.00
10,680.00

1,860.00
2,600.00
2,700.00
............

1,250.00
900.00
............
6,000.00
2,098.80

3,930.00
1,400.00

3,000.00
2,175.00
............

1,800.00

3,750.00

3,000.00
4,800.00
1,943.83

$ 6,600.00

2,200.00
840.00

450.00

2,299.98

12,456.00
24,415.00
............
1,000.00
1,000.00
400.00

600.00

C

Fees and
Miscel-
laneous

S 788.44
41.13
501.75
53.00
418.49
5,310.79
49.00
30.00
38.00
205.15
19.00
259.07
24,200.36
92.50
25.24
548.85
2,481.46
18.75
48.49
900.20
12.02
5.75
256.50
55.82
87.70
44.75
44.21
145.25
46,462.52
73.00
95.50
294.00
144.28
18.25

O

II ..

II -

TABLE 4-Continued
FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM STATE BOARD OF HEALTH AND FROM LOCAL
SOURCES FOR THE FISCAL YEAR ENDED JUNE 30, 1953

STATE BOARD OF HEALTH LOCAL FUNDS
County Total
Funds County Board of Fees and
Total State Federal Total Commissioners Public Cities Miscel-
Instruction laneous

Lake ................. 75,824.33 25,841.00 22,061.00 3,780.00 49,983.33 40,607.97 ............ 8,895.00 480.36
Lee.................... 40,237.42 18,708.50 16,121.00 2,587.50 21,528.92 21,270.19 ............ ............ 258.73
Leon............... 81,699.37 36,996.60 26,805.00 10,191.60 44,702.77 42,258.89 625.00 1,100.00 718.88
Levy.................. 20,011.06 12,712.93 9,891.00 2,821.93 7,298.13 3,600.00 3,600.00 ............ 98.13
Liberty.............. 9,539.53 3,951.00 3,951.00 ............ 5,588.53 2,728.78 2,550.00 ............ 309.75
Madison ......... 17,896.43 10,761.00 10,761.00 ............ 7,135.43 3,500.00 3,500.00 ............ 135.43
Manatee ........... 35,664.25 15,715.00 15,715.00 ........... 19,949.25 19,285.00 ........................ 664.25
Marion ................ 52,076.17 21,921.00 21,921.00 ............ 30,155.17 29,961.75 ........................ 193.42
Martin................ 11,901.37 6,039.00 6,039.00 ............ 5,862.37 5,801.87 ........................ 60.50
Monroe .............. 41,223.08 17,992.00 17,992.00 ............ 23,231.08 12,604.68 3,500.00 4,800.00 2,326.40
Nassau................ 30,726.48 13,104.00 9,744.00 3,360.00 17,622.48 13,325.48 4,000.00 180.00 117.00
Okaloosa ............. 26,198.31 14,248.00 14,248.00 ............ 11,950.31 9,159.66 2,400.00 ............ 390.65
Okeechobee ............ 4,762.00 4,496.00 4,496.00 ............ 266.00 .............. ....................... 266.00
Orange ............... 107,089.56 36,583.97 21,577.00 15,006.97 70,505.59 46,619.00 10,000.00 2,200.00 11,686.59
Osceola .............. 18,666.25 9,652.00 9,652.00 ............ 9,014.25 6,000.00 2,400.00 ............ 614.25
Palm Beach........... 120,071.15 34,028.22 22,500.00 11,528.22 86,042.93 66,993.28 13,871.00 ............ 5,178.65
Pasco ................ 18,205.00 10,683.00 10,683.00 ............ 7,522.00 4,000.00 3,375.00 ............ 147.00
Pinellas .............. 274,999.23 58,830.00 29,240.00 29,590.00 216,169.23 194,252.42 ........................ 21,916.81
Polk.................. 104,616.96 36,499.38 24,066.00 12,433.38 68,117.58 62,169.34 ..................... 5,948.24
Putnam ............... 23,209.58 13,484.00 13,484.00 ............ 9,725.58 9,500.08 ....................... 225.50
St. Lucie.............. 24,911.30 13,740.00 13,740.00 ............ 11,171.30 10,675.05 ....................... 496.25
Santa Rosa........... 17,407.51 10,458.00 10,458.00 ............ 6,949.51 2,200.00 4,693.26 ............ 56.25
Sarasota ............... 41,021.98 17,140.00 14,305.00 2,835.00 23,881.98 23,055.00 ........................ 826.98
Seminole ............. 26,048.89 14,491.00 14,491.00 ............ 11,557.89 6,500.00 4,800.00 ............ 257.89
Sumter ............... 15,045.99 9,679.00 9,679.00 ............ 5,366.99 1,750.00 3,500.00 ............ 116.99
Suwannee ............. 24,610.18 13,167.00 10,307.00 2,860.00 11,443.18 11,277.68 ............ ............ 165.50
Taylor............... 15,475.72 9,394.00 9,394.00 ............ 6,081.72 5,750.00 250.00 ............ 81.72
Union ......... ....... 12,230.00 6,696.00 6,696.00 ............ 5,534.00 5,500.00 ........................ 34.00
Volusia .............. 137,801.00 38,844.00 34,849.00 3,995.00 98,957.00 84,000.00 9,800.00 200.00 4,957.00
Wakulla ............... 10,101.50 5,898.34 5,898.34 ............ 4,203.16 4,000.00 ........................ 203.16
Walton ................ 18,346.08 9,166.00 9,166.00 ............ 9,180.08 4,300.00 3,900.00 850.00 130.08
Washington............ 20,019.17 10,153.00 10,153.00 ........... 9,866.17 4,004.41 5,050.00 720.00 91.76
TOTALS......... $3,370,761.69 $1,123,827.63 $859,334.34 $264,493.29 $2,246,934.06 $1,887,386.14 $145,418.55 $ 71,205.98 $142,923.39

18 ANNUAL REPORT, 1953

FIGURE I
PROPOSED BUDGET FOR FLORIDA STATE
BOARD OF HEALTH DOLLAR FOR 1954

GENERAL ADMINISTRATION
VITAL STATISTICS
HEALTH INFORMATION
NArlCOTICS
SANITARY ENGINEERING
ENTOMOLOGY
LABORATORY
PREVENTABLE DISEASES(R-L,
TUBERCULOSIS CONTROL
CHRONIC DISEASES
MATERNAL N6 CHILD HEALL
TreAllhlNG
LOCAL HEALTH SERVICE
COUNTY HEALTH UNITS

N /530,1 3- 4.40/
165,020- 2.20
58,600- 0.8O
65,940- 0.90/
i 176,340- 2.30/
1,734,000- 23.00/
372,830- 5.00/
") 316,600- 4.20/
97,860- 1.30/
278,290- 3.60/
rT 92,660- 1.20/
67,210- 0.90
- 103,180- 1.40/
3,676,220-48.80/

7,535,955 DOLLAR

FINANCE AND ACCOUNTS 19

TABLE 5

DISTRIBUTION OF PERSONNEL-STATE BOARD OF HEALTH
(OTHER THAN COUNTY HEALTH DEPARTMENTS)
DECEMBER 31, 1953

Bureau or Division |8 .

Administration- SHO ........... ............. 1 ... .... .... ... .3 ..... 2 1 ... 7
Dental Health ............... .. ..... .... ...... ... 1 ...... ...
Fiscal... .............. ......................10 ...... .... .... ...10
Finance J Personnel..................... ..................... ..... 6 ...... .... .... .. 6
and I Purchasing and Property....................... .... ... .... 8 10 3... 21
Accounts k Total ..* .......................................... 24 10 3 .... 37
Health Information .............................. 2 .. 4 1 1 2 10
Jacksonville. ............. 1.............. 27 .......... 7 22 1 .... i 59
Miami .......................... ....... 11 ......... 2 4 1 ....... 18
Orlando .................... .. .. .. 3 ... .............. 2 .......... 5
Laboratories Pensacola.............. ........ ............ ........ ... 1 .........
Tallahassee................. ... 3 ........... ...... 2 .......... 5

Bureau............... 2 .. 2 ...... .... .... .... 4
Tampa..Nursing... .. ..... ..... ..... .......... 3 8 ....... 20

FieldTraining Center.. .... 1* .... .... 1 ..... .... .... ....
Total.................. 3 7 ... ...... ..........13 40 .... 112

Mat Bure au... ........ ..... .................... ........... ......... ....... 4
Local Health Service Field Advisory 2 1 2........2..................2.................7
andChild Field Training Center...... ... .... 1 ......... .... .... 1 ...... .......... 3

Health Total .. .. ...... ....... 3 ....... 3 ................. 7 ..... 2 .... 20
Narcotics.... ... u .... .... .. .. .... .. 1....... ... 2 .... 4
tritiond Child DiabetesControl.............. .. .... .... .... ...... .. .... 1 1 .... .... ....
eHealth Total..... ................. 1 .. .. .... . ..... 1 ... 7
Narcotics .............................................................. 2 5 6 ........ 13
Nutrition and Diabetes Control .................................... 1 2 4 .... 1 1 ............. 9
Bureau .................. 1............1 ...................1..................3
Cancer Control.... .......... .......................... .. 4 .................. 4
Preventable Industrial Hygiene ........... 1 ...1 1 ...... ... 1 ..........4
Diseases Venereal Disease Control...... 2 8 ........... 2 17 .... .... 10 3 4 .... 12 58
Veterinary Public Health......... .......... 1
Total...... .............. 4 8...... 2 3 17 ....... 16 3 5 ... 12 70
Sanitary Engineering ...................... .... ... 15* 71 1 10 1 2 .....36
Entomology ........................... ....... 3 1 15 ........... 5 8 19 2 1 54
SBureau. ................... 1 ........ ........... ......... 9 ... 7... ....17
TB Control Heart Disease Control ........ ............... ...... .... .... ....... .. 2
Total ...................... 2 ................ ... 9 ...... 7 1 .... 19
VitalStatistics...................... .... ... ....... ..... .... 1 2 38 3 3 ........ 47
GrandTotal....................... 12 16 1 18 13 75 23 4 2 135 72 51 8 14 444

*One on Academic Leave.

20 ANNUAL REPORT, 1953

TABLE 6
DISTRIBUTION OF PERSONNEL IN COUNTY HEALTH
DEPARTMENTS- DECEMBER 31, 1953

Alachu .............
Baker.... .
Bayker...............
Bay..di....:: ... .::
Bradford..........
Brevard ..........
Broward..........
Calhoun..............
Charlotte............
Citrus.............
Colier .............
Columbia...........
Dade............
DeSoto.........
Dixie............
Dual..............
Escambia...........
Flagler..........
Franklin.........
Gadsden...........
Gilchrist..........
Glades..........
Gulf...............
Hamilton.........
Hardee..............
Hendry.............
Hernando...........
Highlands...........
Hillsborough.........
Holmes......
Indian River....
Jackson.............
Jefferson............
Lafayette.........
Lake................
Lee.............
Leon.............
Levyo..............
Liberty ............
Madison...........
Manatee...........
Marion...........
Martin...........
Monroe.............
Nassau..............
Okaloosa ........
Okeechobee..........
Orange...........
Osceola.............
Palm Beach.........
Pasco..........
Pinellas..........
Polk...............
Putnam.............
Santa Rosa.......
Sarasota..............
Seminole...........
St. Lucie.........
Sumter.........
Suwannee...........
Taylor .............
Union...............
Volusia.............
Wakulla.............
Walton..............
Washington..........
Total.......

48 307 4 8 174 4 4 ..... 1 1S7

138 1 86 ...... 912

* Serves two or more counties-See Roster of County Health Officers.
t One on Academic Leave.
SOn Terminal Leave.

IJIIIIIIIII_

VITAL STATISTICS

BUREAU OF VITAL STATISTICS
EVERETT H. WILLIAMS, JR., M.S., Hyg.
Director

This report contains a brief summary of preliminary totals for
statistical data for the year 1958 and also covers the activities of
the Bureau of Vital Statistics. Final and more detailed statistical
data regarding births, stillbirths, deaths, marriages, and divorces
will be published separately as a supplement to this annual report
under the title, "Florida Vital Statistics, 1953." Another supplement
containing more detailed data concerning reported cases of disease
will be published under the title, "Florida Morbidity Statistics, 1953."

POPULATION
The mid-year population estimate for the State of Florida for 1953
is 3,111,100 and is divided by race as follows: 2,472,900 white and
638,200 non-white. These estimates were prepared by this Bureau
and birth and death rates in this report are based on these figures.
The 1953 civilian population estimate made by the U. S. Census
Bureau shows 56,900 more persons and is about 1.8 per cent higher
than the estimate of this Bureau. The Census Bureau estimates
have not been used in calculations because no information is avail-
able for a breakdown of population by race and by counties. A
study is being made to determine whether data is available for
use of Census Bureau methods in county estimates.

BIRTHS
There were 80,112 resident births for Florida during 1953 and the
rate was 25.8 per thousand population. This is the highest number
of births and also the highest birth rate on record for this State. The
white birth rate was 23.6 and the non-white rate was 33.9 per
thousand population. Table 6 shows the number of resident births
and birth rates for this State for the period 1931-1953. Preliminary
totals of births by color for all counties are shown in Table 8. More
detailed data for the year 1953 is not yet available. Final figures
for 1952 indicate that 98 per cent of the white and 61 per cent of
the non-white births were attended by a physician. A total of 5,989
illegitimate births were recorded during 1952. Of the white births,
2 per cent were registered as illegitimate as compared to 24 per cent
for non-white births.

22 ANNUAL REPORT, 1953

DEATHS
In 1953 there were 30,603 deaths among residents of this State
and the death rate was 9.8 per thousand population. The white
death rate was 9.4 and was 20 per cent lower than the colored
rate of 11.7 per thousand population. The trend of resident deaths
in Florida for the years 1931-1953 are shown in Table 6.
For each of the past three years, the death rate has shown a con-
sistent increase of 0.1 over the preceding year. There are two
possible explanations for this increase. One is that the State may
be growing more rapidly than we estimated. An under-estimation
of the population would cause an over-estimation of the death rate.
Another possibility is that the increasing death rate is a result of
the increasing age of our population.
Deaths by race and a comparison of 1952 and 1953 death rates
are shown in Table 7. Heart disease continued to be the leading
cause of death and accounted for 34 per cent of all deaths. Other
leading causes of death were cancer, cerebral hemorrhage, and
accidents.
The tuberculosis death rate continued its remarkable decrease
and dropped from 16.7 in 1952 to 9.8 per 100,000 population in
1953. After increasing for the past two years, the infant mortality
rate resumed its downward trend and decreased from 34.1 in 1952
to 31.0 deaths per thousand live births in 1953. There was no change
in the maternal mortality rate from the preceding year. One increase
which is worthy of mention was the influenza death rate which
went from 4.6 per 100,000 population in 1952 up to 7.2 in 1953.
MARRIAGES AND DIVORCES
There were 27,278 marriages in Florida during 1953; 354 more
than in 1952. The marriage rate was 17.5 persons married per
thousand population. The marriage rate for white persons was 17.4
and the non-white rate was 17.9. More detailed marriage data
according to age, race, place of residence, and previous marital
status will be published in the Vital Statistics supplement to this
report. Data for 1952 showed the median age at marriage for
brides was 23.8 and was 27.0 for grooms. It was the first marriage
for 62 per cent of the brides and 64 per cent of the grooms. Fifty-
two per cent of the marriages were the first marriage for both parties.
There were 20,173 divorces and annulments granted in Florida
during 1953, a decrease of 93 from the previous year. The divorce
and annulment rate was 13.0 persons per thousand population. Data
on divorces by race and age are not available in this State.

VITAL STATISTICS

ACTIVITIES
One of the major new projects started by the Bureau during the
year was the machine tabulation of data from the Mass X-Ray
Surveys and the Large Film Clinic and Consultation X-Rays made
by the Bureau of Tuberculosis Control. This data was previously
hand tabulated by personnel of that bureau. The tabulations made
by machine methods will contain data which was not practical to
obtain by hand methods. Much time was spent during the year
on consultation in revising tuberculosis tabulations.
The work load of the Bureau has continued to increase (see Table
12). The number of current certificates received increased 6 per
cent over the previous year and there was a 7 per cent increase in
paid requests for certifications. There was a 6 per cent increase
in fees collected and the total for the year was $102,649.00. The
bureau is in urgent need of additional employees to handle this
increase in work load. The number of employees has not been
increased since August 1951 while the work load has increased
approximately 14 per cent since that date. During the months of
August and September, the employees worked 1,003 person-hours
overtime to process incoming requests for certified copies. Since
money has not been available for the employment of additional
clerical personnel, it has been necessary to eliminate many procedures
which are thought to be of value. Many valuable checks for
accuracy have been stopped so that time would be available for
work which is absolutely mandatory.
The 1953 State Legislature enacted a law requiring the courts
to send a record of each Legal Change of Name to the Bureau. This
was a new responsibility and a total of 407 of these reports were
received during the last half of the year.
The Bureau is also desperately in need of additional vault space.
It is estimated that the present vault will be completely filled by
the middle of 1954 and records will have to be stored outside of
the fireproof vault after that time.
A consolidated "Vital Statistics Scoreboard" is shown as Table 11.
Counties are listed in order of rank showing their relative efficiency
in birth and death registration. A total of forty counties improved
their score over the previous year, however, this gain was offset
by a decrease in 26 counties and the State average was exactly the
same as for the year 1952. Those counties near the top of this score-
board are to be commended on their excellent results. Other county
health departments should analyze their deficiencies and make an
effort to persuade those persons responsible for late and inaccurate
certificates to mend their ways.

24 ANNUAL REPORT, 1953

TABLE 7

ACTIVITIES OF THE BUREAU OF VITAL STATISTICS
DURING THE YEARS 1952 AND 1953

Activitt 1952
Current certificates filed _......... .. 152,192
Delayed birth certificates filed 4,026
Adoption decrees received .. ..... ... ........ 1,629
Amended certificates filed for adoptions-... 1,543
Amended certificates filed for legitimations
and correction of parentage ...... 75
Legal change of name orders .....--------............. ..

1953
160,792
3,398
1,709
1,804

Requests for certifications
Fee Paid ..._.. 63,700 68,199
Free -.-...-.............. ......... .......... 19,262 18,871
Photostats made ....-.......- ... -.................... 77,259 77,718
Birth Registration Cards made ....21,158 24,428
Fees collected and transmitted to
State Treasurer ----- -..........$96,705.00 $102,649.00

Per cent
change
+ 5.7
-15.6
+ 4.9
+16.9

500 +33.3
407 (law effective
June 1953)

+ 7.1
- 2.0
+ 0.6
+15.5

+ 6.1

TABLE 8

RESIDENT BIRTHS AND DEATHS WITH RATES PER 1,000
POPULATION, FLORIDA, 1931-1953

Year Population Births Birth Rate Deaths Rate Death

1958*................... 3,111,100 80,112 25.8 30,603 9.8
1952..................... 3,006,400 74,219 29.7 29,136 9.7
1951.................... 2,901,800 70,431 24.3 27,857 9.6
1950..................... 2,797,100 64,370 23.0 26,525 9.5
1949.................... 2,692,500 61,642 22.9 25,317 9.4
1948.................... 2,587,800 59,685 23.1 24,505 9.5
1947..................... 2,483,200 60,201 24.2 24,150 9.7
1946.................... 2,378,500 54,347 22.8 22,750 9.6
1945.................... 2,273,900 48,839 21.5 22,594 9.9
1944..................... 2,196,195 49,186 22.4 23,251 10.6
1943..................... 2,125,935 46,783 22.0 23,213 10.9
1942 .................... 2,055,675 40,675 19.8 21,144 10.3
1941..................... 1,985,415 37,351 18.8 21,438 10.8
1940.................... 1,915,155 33,696 17.6 21,458 11.2
1939.................... 1,853,660 32,487 17.5 20,209 10.9
1938..................... 1,795,322 31,101 17.3 19,949 11.1
1937.................... 1,736,984 29,529 17.0 19,825 11.4
1936.................... 1,678,646 28,116 16.7 20,050 11.9
1935..................... 1,620,308 28,058 17.3 19,059 11.8
1934..................... 1,585,596 26,722 16.9 19,518 12.8
1933.................... 1,554,000 25,647 16.5 18,112 11.7
1932..................... 1,530,356 27,242 17.8 17,721 11.6
1931..................... 1,502,736 26,789 17.8 17,291 11.5

* 1958 data based upon preliminary totals.

TABLE 9

PRELIMINARY TOTALS FOR DEATHS BY IMPORTANT CAUSES, BY COLOR, FLORIDA, 1953, WITH
DEATH RATES FOR 1953 BY COLOR AND FINAL DEATH RATES FOR 1952

1953
1952
Rates
CAUSE OF DEATH Death Rates
(Numbers in parentheses refer to the International List of causes of death) Deaths (Per 100,000 Population)

Total White Colored Total White Colored Total

ALL CAUSES................................................ 30,603 23,143 7,460 9.8* 9.4* 11.7* 9.7*

Tuberculosis of respiratory system (001-00) .............................. 280 162 118 9.0 6.6 18.5 15.5
Tuberculosis, other forms (010-019)...................................... 26 11 15 0.8 0.4 2.4 1.2
Syphilis and its sequelae (020-029)................... ...... 147 60 87 4.7 2.4 13.6 5.0
Typhoid fever (040) .................................................... 2 1 1 0.1 0.2 0.1
Dysentery, all forms (045-048) .......................................... 19 7 12 0.6 0.3 1.9 0.7
Diphtheria (055)....................................................... 12 3 9 0.4 0.1 1.4 0.2
WhoopingCough(056).................................................. 4 1 3 0.1 0.5 0.2
Meningococcal infections (057).......................................... 33 24 9 1.1 1.0 1.4 1.0
Acutepoliomyelitis (080).... 48 44 4 1.5 1.8 0.6 1.3
Acute infectious encephalitis (082)............................. .......... 6 2 4 0.2 0.1 0.6 0.2
Measles (085) ....................................... 6 4 2 0.2 0.2 0.3 0.3
Typhus and other rickettial diseases (100-108)............... ........ 2 1 1 0.1 *** 0.2 0
All other diseases classified as infective and parasitic (030 to 138 with excep-
tion of above causes) ........................................... :... 152 79 73 4.9 3.2 11.4 4.7
Malignant neoplasms, including neoplasms of lymphatic and haematopoietic
tissues (140-205) ................................................. 4,508 3,840 668 144.9 155.3 104.7 139.5
Diabetes mellitus (260) ............................................... ............ 419 309 110 13.5 12.5 17.2 14.1
Anemias (290-293) ............................................ ... 82 51 31 2.6 2.1 4.9 2.9
Diseasesof thecardiovascular-renal system ............. ............... 15,382 12,180 3,202 494.4 492.5 501.7 476.8
Vascular lesions, central nervous system (330-334) ...................... 3,596 2,568 938 115.6 103.8 147.0 109.8
Diseases of the heart .......................................... 10,301 8,469 1,832 331.1 342.5 287.1 317.6
Chronic rheumatic heart disease (410-416)... .............. 369 302 67 11.9 12.2 10.5 11.2
Arteriosclerotic and degenerative heart disease (420-422).............. 7,619 6,594 1,025 244.9 266.7 160.6 231.9
Hypertension with heart disease (440-443).............. 1531 998 533 49.2 40.4 83.5 50.2
Other diseases of heart (430-434) .................................. 782 575 207 25.1 23.3 32.4 24.3
Hypertension without heart disease (444-447) ...................... 277 178 99 8.9 7.2 15.5 8.9
Other circulatory diseases (450-468) ........................... .. 793 648 145 25.5 26.2 22.7 22.9
Nephritis and nephrosis (590-594) ................................... 505 317 188 16.2 12.8 29.5 17.6

TABLE 9-Continued
PRELIMINARY TOTALS FOR DEATHS BY IMPORTANT CAUSES, BY COLOR, FLORIDA, 1953, WITH
DEATH RATES FOR 1953 BY COLOR AND FINAL DEATH RATES FOR 1952

1953
1952
Rates
CAUSE OF DEATH Death Rates
(Numbers in parentheses refer to the International List of causes of death) Deaths (Per 100,000 Population)

Total White Colored Total White Colored Total
Rheumatic fever (400-402)............................................ 23 11 12 0.7 0.4 1.9 0.9
Influenza (480-483) .................................................. 223 99 124 7.2 4.0 19.4 4.6
Pneumonia (490-493)........................ ............. ......... 796 428 368 25.6 17.3 57.7 25.4
Ulcer of stomach and duodenum (540-541) ................................ 205 159 46 6.6 6.4 7.2 5.5
Intestinal obstruction and hernia (560, 561, 570)........................... 222 151 71 7.1 6.1 11.1 7.4
Gastritis, duodenitis, enteritis, and colitis, except diarrhea of the newborn
(543, 571, 572)................................................... 201 100 101 6.5 4.0 15.8 7.6
Cirrhosis of liver (581).................................................. 335 29 39 10.8 12.0 6.1 11.2
Complications of pregnancy, childbirth, and the puerperium (640-652,
670-689) ...................................................... 65 23 42 0.8** 0.4** 1.9** 0.8**
Congenital malformations (750-759)...................................... 336 265 71 10.8 10.7 11.1 12.2
Birth injuries, postnatal asphyxia, and atelectasis (760-762) ................ 661 467 194 21.2 18.9 30.4 20.6
Infection of the newborn (763-768).......... ........................ 82 30 52 2.6 1.2 8.1 3.3
Other diseases peculiar to early infancy, and immaturity unqualified (769-776) 782 468 314 25.1 18.9 49.2 26.4
Senility without mention of psychosis, ill-defined and unknown causes
(780-795)................. .................................... 780 419 361 25.1 16.9 56.6 23.6
Motor vehicle accidents (810-835)....................................... 910 709 201 29.2 28.7 31.5 29.8
All other accidents (800-802, 840-962).................................. 1,226 878 348 39.4 35.5 54.5 37.2
Suicide and self-inflicted injury (963, 970-979)............................. 342 319 23 11.0 12.9 3.6 11.7
Homicide and operations of war (964, 965, 980-999)....................... 345 93 252 11.1 3.8 39.5 11.3
All other diseases (Residual).......................................... 1,941 1,449 492 62.4 58.6. 77.1 50.9
Infant mortality (deaths under one year of age)........................... 2,487 1,415 1,072 31.0** 24.2** 49.5** 34.1**

Rate per 1,000 population.
** Rate per 1,000 live births.
** Rate less than 0.05.

VITAL STATISTICS

TABLE 10

ESTIMATED POPULATION AND PRELIMINARY TOTALS OF
BIRTHS, DEATHS, AND INFANT DEATHS BY
COLOR, FLORIDA, 1953

BIRTHS DEATHS INFANT DEATHS
Estimated
Counties Population
1953 Total White Colored Total White Colored Total White Colored

80,112 5 8,469 21,643

STATE...
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..........
Levy..........
Liberty .......
Madison......
Manatee ......
Marion........
Martin........
Monroe.......
Nassau........
Okaloosa......
Okeechobee....
Orange........
Osceola .......
PalmBeach....
Pasco.........
Pinellas .......
Polk..........
Putnam .......
St.Johns ......
St. Lucie......
SantaRosa....
Sarasota.......
Seminole......
Sumter ........
Suwannee.....
Taylor .......
Union.........
Volusia........
Wakulla.......
Walton........
Washington....

61,950
6,320
42,720
11,910
26,430
105,660
7,920
4,320
6,510
17,130
7,510
18,880
612,900
10,800
3,900
324,600
117,900
3,850
5,800
40,010
3,630
2,200
7,830
9,150
11,070
6,630
7,300
14,900
277,730
14,010
13,690
34,750
10,410
3,440
41,800
23,410
56,300
11,060
3,180
14,210
39,820
40,170
8,970
37,110
14,150
34,920
3,750
133,600
11,950
121,550
25,000
178,070
132,000
27,390
27,200
24,900
19,550
35,090
28,430
11,900
17,010
10,400
7,440
84,450
5,380
15,290
11,890

1,387
202
1,515
267
1,311
2,940
227
71
134
560
212
469
13,442
175
106
9,740
4,614
125
149
1,025
78
44
261
257
224
165
182
386
7,041
300
362
914
305
56
919
659
1,448
255
94
445
868
1,002
195
1,274
408
1,471
98
3,639
252
3,034
481
3,155
3,506
746
606
625
618
713
852
271
429
265
94
1,665
114
403
262

30,603 23,143 7,460

893
143
1,192
185
1,065
1,811
192
61
87
475
148
286
10,478
119
86
7,214
3,600
59
102
300
65
21
171
107
195
105
105
253
5,802
285
233
561
86
49
634
481
817
122
78
177
569
529
104
1,137
262
1,402
74
2,824
196
1,920
382
2,481
2,592
445
368
314
551
552
436
175
290
176
59
1,180
78
333
197

494
59
323
82
246
1,129
35
10
47
85
64
183
2,964
56
20
2,526
1,014
66
47
725
13
23
90
150
29
60
77
133
1,239
15
129
353
219
7
285
178
631
133
16
268
299
473
91
137
146
69
24
815
56
1,114
99
674
914
301
238
311
67
161
416
96
139
89
35
485
36
70
65

479
58
304
108
332
1,034
67
79
65
121
68
186
5,330
101
31
3,042
966
42
68
319
33
20
58
99
103
60
66
164
2,634
124
137
320
129
16
410
283
437
106
33
162
512
452
96
243
130
192
47
1,414
220
1,363
252
2,812
1,219
272
293
239
160
453
317
115
158
109
42
1,020
41
134
104

2,487 1,415

241
36
236
77
252
756
52
67
48
93
46
112
4,583
78
21
2,001
626
25
39
109
31
16
37
45
95
32
44
121
2,147
114
105
186
48
14
320
214
217
63
21
72
415
242
62
185
75
169
33
1,158
193
1,001
208
2,572
922
148
180
156
133
398
159
79
102
64
32
801
22
113
81

3,111,100

238
22
68
31
80
278
15
12
17
28
22
74
747
23
10
1,041
340
17
29
210
2
4
21
54
8
28
22
43
487
10
32
134
81
2
90
69
220
43
12
90
97
210
34
58
55
23
14
256
27
362
44
240
297
124
113
83
27
55
158
36
56
45
10
219
19
21
23

1,072

20
2
11
3
12
60
4
2
1
4
5
14
105
5
3
117
75
2
3
34
0
0
5
8
2
9
3
4
61
0
2
11
11
0
18
7
35
5
1
19
18
21
3
4
7
3
1
35
3
67
5
37
45
17
8
23
4
10
27
3
3
6
1
28
2
3
5

" "

28 ANNUAL REPORT, 1953

TABLE 11
PRELIMINARY TOTALS FOR RESIDENT DEATHS FROM

SELECTED CAUSES BY COUNTIES, FLORIDA, 1953

CARDIO-VASCULAR-
RENAL DISEASES

9.- M 2.0.s ai
~I r 0 n5~' O~s
G: 2.I .l~ e

FLORIDA...

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

65 306 147 19

48 4508 419 82 1019 3506 10,301 1070 505 910 1226

* Includes all Vascular Lesions of Central Nervous System.

VITAL STATISTICS 29

TABLE 12
MARRIAGES BY COLOR, DIVORCES, AND ANNULMENTS
FOR FLORIDA AND EACH COUNTY, 1953

MARRIAGES

Counties Divorces Annulments
Total White Colored

FLORIDA............... 27,278 21,552 5,726 19,969 170
Alachua.................... 328 208 120 249 2
Baker ...................... 37 25 12 299 2
Bay. ..................... 402 318 84 131 ............
Bradford................... 80 63 17 587 8
Brevard ................... 303 233 70 537 4
Broward................... 1,629 1,214 415 612 4
Calhoun................... 22 19 3 42
Charlotte .................. 64 59 5 17
Citrus..................... 59 46 13 44
Clay..................... s80 66 14 81
Colier..................... 106 87 19 23
Columbia .................. 121 76 45 82
Dade...................... 6,084 5,276 808 4,923 45
De Soto................... 82 55 27 10
Dixie...................... 17 12 5 32
Duval ..................... 2,003 1,491 512 912 4
Escambia................... 727 597 130 821 20
Flagler .................... 84 56 28 138 ........
Franklin ................... 59 44 15 18 1
Gadsden .................. 142 54 88 77 ............
Gilchrist ................... 56 38 18 6 ...........
Glades..................... 27 13 14 5
Gulf ....................... 62 48 14 26
Hamilton................. 45 23 22 20 1
Hardee .................... 119 105 14 320 3
Hendry ................... 104 71 33 21 ..........
Hernando.................. 100 82 18 31 ............
Highlands .................. 168 124 44 144
Hillsborough................ 2,652 2,236 417 1,276 13
Holmes ................... 35 30 5 41 ...........
Indian River................ 162 114 48 57 1
Jackson .................... 168 97 71 85 1
Jefferson .................. 55 19 36 10 ............
Lafayette. ................. 17 13 4 6 ........
Lake ..................... 308 213 95 215 1
Lee........................ 257 193 64 130 1
Leon...................... 362 215 147 341 2
Levy...................... 87 56 31 29 .... .....
Liberty.................... 10 9 1 16
Madison ................... 61 42 19 37
Manatee .................. 344 272 72 72
Marion................... 290 182 108 208 1
Martin..................... 119 90 29 25
Monroe.................... 476 428 48 301
Nassau .................... 51 41 10 29
Okaloosa ................... 172 152 20 164
Okeechobee ................. 48 35 13 10
Orange..................... 1,217 939 278 421 1
Osceola.................... 181 136 45 15
Palm Beach ................ 1,408 1,019 389 673 4
Pasco..................... 275 230 45 103 1
Pinellas ................... 1,665 1,434 231 729 3
Polk ....................... 1,271 1,001 270 1,055 15
Putnam.................... 196 122 74 862 13
St. Johns ................... 189 151 38 641 6
St. Lucie .................. 232 143 89 121 2
Santa Rosa ................ 77 69 8 61 2
Sarasota................... 372 311 61 164 ...........
Seminole................... 276 161 115 157 .....
Sumter ................... 111 84 27 102 1
Suwannee.................. 103 74 29 57 1
Taylor ............... .... 56 43 13 32 .........
Union..................... 25 21 4 13
Volusia................... 638 515 123 1,384 7
W akulla. .................. 32 21 11 13 ...........
Walton.................... 78 69 9 68 ...........
Washington ................ 92 70 22 38 ...........

30 ANNUAL REPORT, 1953

TABLE 13
VITAL STATISTICS SCOREBOARD
Based on Promptness and Completeness of Certificates Filed in
1953

Percent of Percent of
Certificates Complete Percent of Total Change
Filed on Time Certificates Monthly Score from 1952
County Rank Reports (Maxi- Total
Submitted mum=500) Score
Births Deaths Births Deaths on Time

Wakulla............ 1 100 96 100 96 100 492 0
Dade............. 2 92 99 99 98 100 488 + 6
Seminole......... .... 3 99 98 99 98 92 486 +18
De Soto............ 4 98 100 97 99 92 486 + 1
Bradford........... 5 91 97 97 100 100 485 +16
Suwannee.......... 6 96 100 98 98 92 484 +3
Hernando........... 7 90 97 99 98 100 484 5
Martin........... .... 8 99 96 99 97 92 483 -14
Okeechobee.......... 9 96 93 96 98 100 483 +14
Charlotte .......... 10 100 99 100 91 92 482 +36
Franklin........... 11 97 91 98 96 100 482 + 3
Broward............ 12 85 98 99 99 100 481 +24
Madison............ 13 91 98 98 92 100 479 +39
Holmes............ 14 96 84 98 100 100 478 +7
Sarasota............. 15 91 99 98 98 92 478 -3
Volusia............. 16 90 92 98 98 100 478 + 9
Manatee............ 17 97 99 98 97 83 474 -17
Pasco.............. 18 86 94 97 97 100 474 +4
Palm Beach......... 19 83 94 99 98 100 474 +15
Leon............... 20 85 91 99 98 100 473 + 2
Marion............. 21 82 94 99 98 100 473 + 3
Escambia............ 22 79 97 99 98 100 473 +11
St. Lucie.......... 23 81 92 99 99 100 471 +13
St. Johns............ 24 97 94 99 97 83 470 3
Osceola............. 25 85 89 97 99 100 470 +33
Polk................ 26 80 94 99 97 100 470 7
Hillsborough ........ 27 90 98 99 99 83 469 +17
Baker.............. 28 94 97 90 87 100 468 + 4
Brevard............. 29 84 86 99 98 100 467 + 4
STATE......... 83 93 99 98 93 466 0
Lake ............... 30 87 84 97 97 100 465 5
Washington......... 31 79 88 98 99 100 464 + 5
Citrus.............. 32 74 98 93 98 100 463 +61
Lee .............. 33 75 98 98 97 92 460 6
Gilchrist........... .34 81 89 100 89 100 459 + 9
Santa Rosa......... 35 85 93 98 98 83 457 + 9
Clay................ 36 83 76 100 98 100 457 +11
Okaloosa......... 37 71 91 98 96 100 456 +24
Putnam............. 38 91 78 96 98 92 455 + 7
Orange.............. 39 81 89 96 96 92 454 -17
Levy................ 40 79 78 99 98 100 454 3
Bay.............. 41 69 89 99 96 100 453 +10
Dixie............... 42 67 97 99 97 92 452 3
Pinellas............ 43 73 88 99 99 92 451 -42
Monroe............. 44 84 84 99 98 83 448 +23
Sumter............ 45 78 81 96 92 100 447 9
Highlands............ 46 67 86 98 95 100 446 + 5
Columbia............ 47 82 90 99 98 75 444 3
Jefferson............ 48 61 94 98 99 92 444 +12
Nassau.......... ..... 49 74 90 98 98 83 443 + 9
Hardee............. 50 70 96 96 98 83 443 +17
Glades ............. 51 57 100 86 100 100 443 --43
Flagler............. 52 86 83 98 100 75 442 8
Union.............. 53 76 93 95 95 83 442 1
Duval............. 54 81 95 97 99 58 430 -16
Alachua............. 55 68 74 99 97 92 430 + 8
Gadsden............ 56 63 75 99 97 92 426 -9
Collier ............. 57 71 70 92 98 92 423 + 9
Jackson............. 58 71 67 96 95 92 421 8
Indian River......... 59 76 74 99 96 75 420 +31
Calhoun............ 60 70 78 95 84 92 419 -12
Walton.............. 61 55 89 99 99 75 417 -49
Hamilton........... 62 64 70 95 82 100 411 +16
Gulf............... 63 62 80 97 94 75 408 -37
Liberty ............. 64 63 76 84 86 92 401 -12
Hendry............. 65 47 71 95 92 92 397 +39
Lafayette............ 66 54 83 88 83 75 383 -24
Taylor ............. 67 33 74 96 96 83 382 -22

LOCAL HEALTH SERVICE

BUREAU OF LOCAL HEALTH SERVICE
GEORGE A. DAME, M.D., Director

Only major activities and accomplishments of this Bureau and
its component groups, will be discussed in this report. As usual,
separate reports are made by the Division of Public Health Nursing,
Field Training Center and Field Advisory Staff.
The 1953 session of the Florida Legislature increased its appro-
priation of funds for allocation to county health units from $850,000
to $1,100,000 per annum. This increase became available on July 1,
1953 and was a life saver to many of the smaller health departments,
and strengthened needy programs in all of them.
Federal grants-in-aid to the State Board of Health for the fiscal
year beginning July 1, 1953 were severely reduced. Considerable
sacrifices were made in state-level plans in order to minimize the
reduction of funds made available to the counties. However, the
amount of funds allocated to the counties from grants-in-aid dis-
tributed on the formula was reduced from $169,000 to $109,000
for the year, or approximately 35.5 per cent. A further reduction
in federal funds is anticipated for the next budget year.
In addition to federal funds allocated to the counties on the formula,
other funds were granted to some of the counties for special pro-
grams. The counties also had the benefit of certain programs which
were financed on the State level.
As of December, 1953 the counties were contributing to their
county health departments at the rate of 86 cents per capital (based
on the 1950 federal census). This is a fraction more than 10 per cent
over the 78 cents per capital contributed in the previous fiscal year.
The largest contribution is $2.12 per capital from Glades County,
and the lowest is 39 cents per capital from Pasco County. However,
it should be said that Pasco has almost doubled its contribution in
the past three years and we have every reason to believe that it
will double again within the next three years.
For some years Santa Rosa County Health Department has been
associated with the Escambia County Health Department under the
direction of one health officer. It was deemed wise to detach Santa
Rosa County and to associate it with Okaloosa County to form a
new health unit. At the same time Washington County was detached
from Jackson and attached to the Walton and Holmes Unit. Calhoun
was then detached from Gadsden and Liberty and was attached to
Jackson. All of these changes were agreed upon by the County

32 ANNUAL REPORT, 1953

Commissioners in each of the counties affected. The changes went
into effect on October 1, 1953.
Following long and careful investigation and consideration, and
after many conferences between members of the Palm Beach County
Board of County Commissioners, the West Palm Beach City Com-
missioners and personnel of the State Board of Health, the County
Commissioners and the City Commissioners voted to consolidate
the Palm Beach County Health Department and the West Palm
Beach City Health Department into one unit. The plans were
completed in December, 1953 for the establishment of the combined
health department as of January 1, 1954. Dr. Clarence L. Brumback,
County Health Officer and Dr. W. E. VanLandingham, City Health
Officer are congratulated for doing splendid work in effecting the
union of the two departments. Dr. Brumback will remain as health
officer. Dr. VanLandingham has for many years been the able and
efficient health officer of the City of West Palm Beach. He has for
some time desired to retire but had consented to remain on the
job in order to work for consolidation.
As usual in annual reports of the Bureau of Local Health Service
some of the most interesting reports from county health departments
are included. These are not the only interesting things that might
be written about but on account of space only a limited number of
items may be selected. Emphasis has been placed upon the con-
struction of health department centers and other interesting and
unusual programs. As a whole, public health in the county health
departments has shown a very satisfactory advancement.
In 1953 the Jackson County Commissioners took the necessary
steps to secure Federal funds under the Hill-Burton Act to be used
for the construction of a new health department building. Land
for the new building was secured from the Board of Trustees of
Jackson County Hospital. The site is on the north side of the hospital
grounds, with ample space for parking. An architectural firm is
presently preparing the preliminary sketches. The exterior of the
one-story building will conform to the styling of the Jackson County
Hospital. New furnishings will be used throughout. The sum of
approximately $70,000 has been allocated for this project. When
this new building is completed Jackson County Health Department
will have one of the best centers instead of the worst center in the
State. Dr. H. I. Langston is to be congratulated upon his very
successful efforts in securing this new building. Dr. A. K. Husband
has faithfully followed through.
In Clay County an auxiliary health center is nearing completion
in the rural community of Middleburg. This community and several

LOCAL HEALTH SERVICE 33

small nearby ones are some twenty to thirty miles distant from the
headquarters of the health department in Green Cove Springs. The
public health nurse in that district, Mrs. Grace Horn, discussed the
need for a small health center with several individuals and developed
quite a bit of interest in the Parent-Teacher Association, The Middle-
burg Civic Club, the Bird Club, the Dads Club, as well as many
local business men. The Middleburg Civic Club sponsored the
project and provided a building for renovation. It is interesting
to note that funds not only were donated by various groups but
money was raised through various projects such as dances and
suppers. The building will be quite adequate and will have all
necessary facilities. This project shows what can be accomplished
in small communities and reflects great credit on Dr. A. Y. Covington
and his staff.
Dr. Warren T. Weathington writes very interestingly of the
public health survey which has been conducted in Gulf County.
Comprehensive questionnaires were devised for the purpose of the
survey covering such questions as immunization status, infectious
diseases, amount of illness in family, environmental sanitation, hospital
insurance and services received by the family from private physician,
health department or other agency. The chairman of the committee
that drew up this questionnaire was headed by Doctor Wayne
Hendrix of Port St. Joe. Captains were appointed for each district
in the county. An attempt was made to have one hundred families
for each captain. Each captain then would have five enumerators
assisting him. There were twenty-three captains and one hundred
twenty-five enumerators. These were all carefully drilled before
starting out on their work. The survey was organized and conducted
by the Gulf County Health Council with Mrs. Alton Dendy of Port
St. Joe as chairman. Miss Enid Mathison, Assistant Director of the
Division of Public Health Nursing, was very helpful in organizing
and conducting the survey. At the last report 2,322 families or 95
per cent of all the families in the county had been interviewed. Some
of the interesting things developed by the survey are that 75 per cent
of all families are covered by prepaid hospital and medical insur-
ance; 30 per cent of the six year old children had not been immunized
against diphtheria and pertussis. Dr. Weathington will be asked
to make a final and complete report. This will be dittoed and
presented to the county health officers of the State. What has been
said about this report does not indicate the intense interest in public
health that was developed nor the far reaching results it will have.
Dr. J. C. McSween, Health Officer of Escambia County and the
director of sanitation, Mr. B. G. Tennant and other personnel have
done an outstanding job in sanitation. The activities of the sanitation

34 ANNUAL REPORT, 1953

division greatly increased in 1953. Garbage control laws were passed
by the legislature, which placed the responsibility for garbage control
in the hands of the County Health Department. The Board of
County Commissioners appropriated $129,800 for the operation of
sanitary landfills and an arthropod project. Two sanitary landfills
and one trash dump have been established. This is the first time
in the history of Escambia County that centralized dumping areas
have been made available to the public and to commercial operators.
A complete sanitary survey of all schools, public and parochial, was
made. This survey was printed in pamphlet form with deficiencies
and recommendations shown. One new plumbing inspector was
added to the staff. Two sewage treatment plants were constructed,
one privately owned and one government owned. The filing and
paper work of the sanitation division was completely overhauled;
new lighting was installed and the office air conditioned.
Dr. Raymond N. Nelson, director of the Walton-Holmes-Washing-
ton Unit has inaugurated steps for securing new health center build-
ings in Walton and Washington Counties. It is felt that Doctor
Nelson will be quite successful in the construction of these two
centers. It should be mentioned that he was successful in getting
very modern health center buildings constructed in Holmes and
Okaloosa Counties. As a result of a conference between the public
health nurse and Superintendent of Public Instruction of Washington
County, a meeting was called for the purpose of forming a School
Health Council, in order to better coordinate the services available
in the county. The following civic organizations were represented:
Kiwanis Club, Woman's Club, Lions Club and also present were
the public health nurse, county health officer, a welfare visitor, a
county commissioner, a private physician, Parent-Teacher Associ-
ation's Health Committee, and members of the Washington County
Educational Association. The Council was formed and much good
has resulted. A teacher for exceptional children was secured. A
local Chapter for Exceptional Children is under way. Training is
provided for the making of ear molds for children who need hearing
aids, both indigent and those who can pay. Eighteen hundred
children have had their hearing tested (colored and white). Teachers
interested in exceptional children are being recruited. Civic clubs
are more health conscious. Approximately twenty-five pairs of glasses
have been purchased for indigent children.
From Citrus County the following report has been received: In
February, 1953, a county-wide group of interested people met to con-
sider organizing a Child Health Council. From this the Citrus County
Consolidated was organized the object being to aid underprivileged
white children, preschool age through sixteen, as regards medical,

LOCAL HEALTH SERVICE 35

surgical, dental, optical corrections. In some cases, sanitary facilities
are to be considered. The membership consists of one director
from each organization listed as having pledged financial assistance.
This includes financial support from the County Commissioners with
the public health nurse being their representative. Nineteen lectures
were given by health department personnel prior to the organization
with twenty-six groups actively participating. Statements are sent
quarterly to the sponsoring clubs giving information concerning
completed and pending cases, the districts they are located in, and
a financial report. The money is used as a rotating fund and is paid
back into the organization by the assisted families on reasonable
monthly terms. It is hoped that Dr. H. F. Bonifield will be able
to interest the groups in including negro children.
The outstanding and significant activities of the Calhoun County
Health Department for 1953 are as follows: Working with the Board
of County Commissioners, the site for a new health department
building has been purchased and plans are underway to begin
construction as soon as possible. The County Health Department
has purchased a new Ampro 16 MM projector. A visual education
program has already begun with an excellent response from the
public. A wide-range program is looked forward to for next year
in this field. The planning and advertising from the local level has
been done for a mosquito control program that has been worked on
for many years. A sanitary survey of private premises has been
made in three sections of the county: North Blountstown, Altha,
and Kinard in an effort to improve toilet facilities, water supplies,
screening, etc. Some improvement has been made in these areas.
The work on this project will be continued next year by means of
the visual education program. Some pit privies will be built by the
agriculture classes of the various schools. A very active health
committee has been organized in Blountstown. This program is
doing good work through the public health nurse, the P.-T.A. and
the school.
From Dr. J. B. Hall comes the following report on a very coopera-
tive program in Lake County: "Excellent cooperation between health
department, schools, welfare, and the community has resulted in
active participation in the several Health and Welfare Councils in
the county. The public health nurses and the sanitarians are re-
sponsible for attending the meetings in their respective districts.
The memberships consist of representatives from the official agencies,
voluntary organizations, civic groups, P.-T.A.'s, and Dads' Clubs.
The main job is improving the health of the individual and the
community. It is also a means of coordinating the health work of
the schools and the agencies and a resource for utilizing community

36 ANNUAL REPORT, 1953

facilities. The public health nurses are finding their groups an
excellent medium of contact for obtaining needed correction of
defects for children and adults, and also a great time saver. Our
school health program has been improved by the public health
nurses working closely with the visiting teachers from the Depart-
ment of Public Instruction. Many more referrals for health services
has been noted."
From down in Hillsborough County Dr. Frank V. Chappell and
his personnel are still very much interested in building. A part of
a report from that county is here quoted: "The first center to be
started and completed was in Ruskin. This center provides very nice,
well constructed and convenient quarters for the Ruskin area. It
actually conforms with the county buildings which houses offices
of the Tomato Festival organization as well as the home demonstra-
tion agent and the farm agent; it is an addition to this building. This
center provides a large waiting room, adequate clinic rooms and offices
for the nurse and sanitarian in the area. The building was dedicated
last spring and named the Joyce Ely Health Center in honor of
Miss Ely who has been the public health nurse there for many years.
It was constructed through the efforts of the county commissioner
in that district with funds allocated by the county commissioners.
Floor coverings and heat are provided by the health department
through our regular operating funds. Shades, furnishings and certain
equipment were furnished by the citizens of the community. The
second building to be started and completed was also through the
efforts of one of the commissioners to provide better clinic space
for the large Negro population centered in this district (in Tampa).
It takes the place of two very inadequate clinics which had been
set up in the housing projects. This building is of concrete con-
struction and contains about 2,800 square feet of floor space. It
provides a very large waiting room, four examining rooms and a
dental office. It has also a large utility and work room and also
adequate rest rooms. This clinic was built also by funds appropri-
ated for this purpose by the county commissioners and through the
use of workmen already employed by the commissioner in his district.
The third building project, which should be completed not later than
the middle of February, is the addition to the health department
here in Tampa, and will make available a little over 4,000 square
feet of floor space. It will give us a large waiting room with adequate
Maternal and Child Health Clinic facilities as well as space for vital
statistics, including a twelve by sixteen foot fire-proof vault. The
administrative offices will be there also and a large ladies' lounge
for the employees. It will relieve the crowded conditions which
now exist in almost every division of the health department."

LOCAL HEALTH SERVICE

Mention should be made of the renovation of the health center
building in Pinellas County. Dr. Robert Rothermel states: "The
old Guisinger Building, a former school building over fifty years old,
was renovated and enlarged during 1952-53. The health department
moved back into this building on June 1, 1953. The one-story wing,
added to the Guisinger Building, has approximately 3200 square
feet of floor space. The renovations and addition cost around $117,-
000. Besides this, practically all furniture was replaced except for
a few filing cabinets and desks. The renovated Guisinger Building
is a two story structure and has the following rooms in it: Adminis-
trative suite consisting of a small waiting room, continuous with
secretarial area; three offices which house the health officer, assistant
health officer and health educator. Adjoining this is a clerk's office
and a storage room. Next comes the dental and hearing clinic suite
which includes a waiting room; sound proof hearing testing room
and office; two small dental cubicles with dental chairs and equip-
ment; two offices for dentist and dental assistant. Across the hall,
on the second floor, are two classrooms, one of which is combined
with the library area. Between the classrooms are a small office and
a large storage area. The first floor offices are used by the Division
of Sanitation, the Division of Nursing, the business manager and
assistant, vital statistics clerk, and switchboard. Storage area is also
connected to this office. The fourth room on the first floor is a
generalized clinic and waiting room. In the wing the space is
allocated to the: Main lobby and health card clerks; clinic utility
room; blood testing room; office for X-ray Technician; X-ray room
and dark room; tuberculosis clerk, tuberculosis control officer, pneumo
clinic (which includes fluoroscopy room and waiting room), venereal
disease investigator's office, and a small storage area."

From a letter received from Dr. Paul W. Hughes of Broward
County, December 9, 1953 the following is quoted: "I thought it
might be a good idea for the State Board of Health to give some
recognition to the City of Hollywood for its three and one-half
million dollar bond issue to provide a sanitary sewer system. The
folks in Hollywood made a very concerted effort and campaign and
yesterday, December 8, they voted twelve to one in favor of the
sanitary sewer system bond issue. More amazing to all concerned
is that 70 per cent of the freeholders came out to vote on this issue.
As far as I know, the City of Hollywood will be head and shoulders
above all other cities in Southeast Florida in taking care of their
human and commercial waste. As you know, a freeholder's bond
issue requires 50 per cent of the vote plus one which is usually a
very difficult task, no matter how good the project. The spirit of
the people in Hollywood has been truly remarkable to me in their

38 ANNUAL REPORT, 1953

over-all campaign and the fine results that they achieved. To me
this is a high point in the history of sanitation in Southeast Florida
and most likely will encourage other cities which need additional
or some facilities to make greater efforts to improve their disposition
of human waste."
A report from Dr. Chester Nayfield concerning the fine new health
center building constructed in Winter Haven, Polk County, in 1953
is here quoted: "The building is an ell-shaped affair of red brick
hollow wall construction. The floor plan includes a divided waiting
room, VD investigator's office, utility room, two examining rooms,
consultation room, dental room, x-ray and developing room. Re-
ceptionist office, vital statistics room, director's office, sanitary engi-
neer's office, personnel clerk's office, engineering clerk's office, sanita-
tion laboratory, chart room and two store rooms. There is also an
auditorium with 200 seating capacity and a large garage to house
the mobile x-ray unit and sanitation equipment. The total cost of
the project was $101,874.00, of which the Federal Government
contributed $40,749.00, the City of Winter Haven contributed
$8,500.00, local donations amounted to $9,625.00, the County Com-
missioners contributed $37,000.00, and $6000.00 came from a special
contribution and the health department budget. The building alone
cost $91,348.00 and equipment approximately $5,000.00. The re-
maining funds include architect fees and other miscellaneous items."
From Volusia County, under the direction of Dr. R. D. Higgins,
comes reports of several activities which should be mentioned, but
only one of which will be included in this report: "We consider
outstanding in Vital Statistics the colored tack maps in the director's
office. First, there is the map of births by the week in Volusia County.
This shows by different colored tacks the number of births attended
by the first five most active physicians, and a colored tack for others.
Second, there is another interesting weekly map of stillbirths and
infant deaths, broken down as to white and Negro, and causes of
death. These maps are proving helpful to local physicians."
In Manatee County Dr. John Neill has been very active in the
promotion of a new health center building at Bradenton to house
his county health department. The County Commissioners have
appropriated $39,000 to match funds appropriated under the Hill-
Burton Act. Complete details will be given in the next year's report.
One of the outstanding activities of Dr. Frank M. Hall of Alachua
County is the promotion of plans for the erection of a very fine
health center building in Gainesville. This, also, will be discussed
in the next annual report.
Sanitarians constitute the second largest group of persons engaged

LOCAL HEALTH SERVICE

in public health work in Florida. As of December 1, 1953, there
were 170 employed in the county health departments. An additional
thirteen were employed in the bureaus of the State Board of Health;
several others were employed in other State agencies. There are
needed about sixty more when funds are available for their em-
ployment. The standard set up for a satisfactory sanitation program
in this State is one sanitarian or engineer for each eight thousand
persons.
For some years the State Board of Health has worked toward an
improvement of the standards of sanitarians through better education,
better training, and better salaries. The specifications of the Merit
System now require a baccalaureate degree for all new employees.
In-service training at the Gainesville Training Center for a period of
three months is required. Sanitarians, as they become eligible, are
being given a nine months' course at an accredited school of public
health leading to a Masters degree in Public Health. The salary
ranges, though considerably increased, are still running quite short
of a realistic figure. The lowest salary is $225 per month. The
highest is $500. A sanitarian can not subsist decently on a salary
of $225 per month for most of them have wives and children. Almost
without exception our sanitarians are doing a vast amount of efficient,
effective work in the many categories assigned to them. They are
a very important group in the public health program in a State that
is greatly interested in health, tourists and economics.
For its interesting information and for its historic value there is
included in this report a paper entitled "The Growth of Local Health
Units in Florida" written by Wilson T. Sowder, M.D., M.P.H., State
Health Officer, and published in Volume 68, Number 11, Public
Health Reports, November, 1953.
"To a considerable degree, any separation of local health services
from services provided by other government echelons, is artificial
and somewhat illusory. Perhaps some persons interested in the
subject would define local health services as those that are com-
pletely financed and administered by local governments. If such
a definition is accepted and interpreted strictly, Florida would have
few local health services to report. In fact, there are few public
health services in the State which are not supported to some extent,
directly or indirectly, by State or Federal funds and which are free
entirely from some legal control, under State or Federal laws. In
this paper, therefore, will be described the development of those
public health services which are financed and administered, in whole
or in part, by local governmental agencies; and it will be left to the
reader to accept or reject this definition.

40 ANNUAL REPORT, 1953

"Facts about local health services during the several centuries of
the Spanish regime and during the brief British occupation are
fragmentary or lacking. However, in 1821, General Andrew Jackson,
in his capacity as Governor of the Territory, issued a proclamation
setting up a board of health in Pensacola and appointing a health
officer.
"The present State constitution, which was adopted in 1885, not
only provides for a State board of health, to have supervision over
all public health matters in the State, but also provides that county
boards of health 'may be established.' The State Board of Health
was established by legislative action in 1889, after a severe yellow
fever epidemic, and county boards of health were provided for by
statute and appointed within the next several years.

"However, even before the turn of the century, the State health
officer had recommended the abolition of the county boards of health
and the legislature had complied. This course was taken because
each county board of health had not only adopted its own regulations
for the control of communicable diseases, especially yellow fever,
but these regulations were enforced with varying degrees of zeal,
usually too much. Most funds and energy were spent on quarantine
procedures, with special emphasis on the exclusion of travelers and
goods from areas suspected of infection, and written permission was
necessary from each county involved before travel could be under-
taken. Such actions resulted in 'Iron Curtains' between the counties
of the State, since communicable diseases were frequently present
and oftener rumored. The abolition of county boards of health
was therefore probably quite justified and necessary in order to end
this state of chaos, and to bring about uniformity in health laws,

TABLE 1
GROWTH OF COUNTY HEALTH UNITS IN FLORIDA
FROM 1930 TO 1953, AT 5-YEAR INTERVALS

POPULATION SERVED2
Number of _______ Number of
YEAR organized Total ex- persons
counties1 Number Percent penditures3 employed1

1930.................. 1 13,136 1 $ 9,000 4
1935................... 3 76,129 5 41,903 29
1940.................. 25 618,541 33 329,654 147
1945................... 36 1,510,520 67 1,243,104 482
1950 .................. 64 2,511,898 91 2,733,325 755
1953.................. 66 2,879,880 93 43,674,320 796

1 Status as of December 31.
2 Population figures from Federal censuses of 1930, 1940, and 1950; State censuses of 1935 and
1945; and estimated data for 1953. Population of cities with independent health departments ex-
cluded, except where services limited and majority of services provided by county health department.
3 Expenditures are for the fiscal year beginning July 1.
4 Estimated.

LOCAL HEALTH SERVICE

regulations, and practices throughout Florida. Following this action,
for the next 80 years and more, except in the larger cities and towns,
public health services were provided by persons employed directly
by the State Board of Health.

County Health Departments
"The present era of local health administration began in 1930
with the passage of a State law authorizing joint financing between
counties and administration of county health units by boards of
county commissioners and the State Board of Health, and cooperation
with cities. Funds were to be deposited in the State treasury to
the credit of the county involved. Minimum personnel required
included a physician, a public health nurse, a sanitary officer, and
a clerk, who were required to devote their entire time to public
health work. Personnel were to be appointed by boards of county
commissioners with the approval of the State health officer and their
salaries were to be fixed by the State health officer with the approval
of the board of county commissioners. Multicounty units were
authorized with common budgets and personnel.
"This excellent law has been so entirely satisfactory that no attempt
has ever been made to change it. Soon after its passage the first

TABLE 2
TOTAL AND PER CAPITAL EXPENDITURES OF FLORIDA
COUNTY HEALTH UNITS, BY SOURCE OF FUNDS,
AT 5-YEAR INTERVALS, 1930-53

FIScAl YEAR
Source of Funds
u 1930-31 1935-36 1940-41 1945-46 1950-51 1953-541

Total Expenditures

TOTAL........ $ 9,000 $ 41,903 $329,654 $1,243,104 $2,733,325 $3,674,320
Federal.............. 9,000 5,503 148,911 297,879 272,832 208,680
State....... ........... 10,248 47,836 201,246 727,075 1,090,220
Local............... ........... 26,152 132,907 743,979 1,733,418 2,375,420

Per Capita Expenditures

TOTAL......... S 0.69 $ 0.55 $ 0.53 $ 0.82 S 1.09 $ 1.28
Federal............ .69 .07 .24 .20 .11 .07
State................. .. .13 .08 .13 .29 .38
Local .............. ...... .34 .21 .49 .69 .82

1 Estimated.

42 ANNUAL REPORT, 1953

health unit was established in Taylor County, a small rural county
in west Florida. Although this unit was discontinued after a short
existence, it was soon reinstated and there has been a steady growth
of the county health unit system since the passage of the county
health unit enabling act. Table 1 shows concisely the increase in
the number of organized counties among Florida's 67 counties, the
population and percentage of population served, the increase in
funds available, and the number of personnel employed. Table 2
shows expenditures and per capital expenditures by source, for each
of the 5-year periods since 1930. Figure 1 shows graphically the

Figure 1-Total expenditures and sources of funds of Florida
county health units.
(All 1930-31 funds were from Federal sources.)
$4.0

3 Federal)
3.0 1

of fundsSt Federal, State and local. Figure 2 shows the per capita
aocaca o
0
2.0

$5,503

1.0 10,248

Fiscal Year
expenditures for county health units for the period and the source
of funds, Federal, State and local. Figure 2 shows the per capital
expenditures by county health units and the sources, Federal, State
and local. In interpreting these charts it should be kept in mind
that Florida's population has increased rapidly. According to the
Federal census, in 1930, the population was 1,468,211; in 1940,
1,897,414; and in 1950, 2,771,305.

LOCAL HEALTH SERVICE

"It should not be assumed that per capital expenditures are uniform
among the counties of the State. On the contrary, there is a wide
variation. Local appropriations vary from a minimum of 34 cents
per capital to a maximum of $1.89 per capital; and the total of Federal
and State funds allocated to local health departments varies from
a minimum of 23 cents per capital to a maximum of $1.78 per capital.
State and Federal funds are distributed among the counties on a
formula basis, according to the population of the county, the per
capital amount decreasing with increase in population. In order to
encourage local appropriations, the formula includes a matching
factor so that larger per capital local appropriations are matched by
somewhat more State and Federal funds. The smallest grant of
State and Federal funds (1953-54) is $3,915 and the largest, $114,466.
"Additional funds not shown in the tables and charts are also
allocated on a project basis to 12 of the larger counties for special
programs which are conducted on a regional basis. These programs
include cancer, heart disease control, and mental health, and the

Figure 2-Per capital expenditures and sources of funds
of Florida county health units.

$1.40 -

II
MH
ME

1930 1935 1940 1945 1950 1953
-1931 -1936 -1941 -1946 -1951 -1954
Fiscal Year

1.00

, .80

.60 -

44 ANNUAL REPORT, 1953

total funds so allocated during the present fiscal year (1953-54)
amount to $99,900.
"Direct aid to local health departments in forms other than funds
is considerable. Laboratory services are furnished entirely by the
State Board of Health on a regional basis without local financial
participation. Biologicals, routine record forms, and accredited train-
ing are furnished on a State level, as well as the services of trained
consultants in nearly every field of public health. No detailed de-
scription of all such services given by the State Board of Health to
the county health departments will be given. However, they deserve
mention because a considerable increase in local funds would be
needed to carry on work at the present level if there were not such
a close State-local relationship as exists at present. On the other hand
the help given directly by the State Health Department is counter-
balanced by the wide range of responsibilities placed on county
health departments here. Many local health departments in the
country with the same or greater financial resources do not have re-
sponsibility for some programs, such as school health, milk inspection,
and vital statistics. This fact adds to the difficulty of making com-
parisons of the adequacy of local health department budgets in
different sections of the country. There is no doubt, however, that
most of our county health departments are inadequately financed.

The Multicounty Unit
"The development of the county health units in Florida has been
interesting in many respects other than in numbers, finances, and
personnel. One interesting development has been the evolution of
the multicounty unit. Figure 3 shows the situation on January 1,
1953, as to single- and multiple-county units. No major difficulty
was ever experienced in the grouping of small counties for local
health services, but after many years of experience it was discovered
that geographic propinquity of counties does not always guarantee
mutual admiration and trust. In fact, in some cases it was discovered
that local officials were loathe to appropriate money for a common
multicounty health fund because they feared that it would be spent
more for the benefit of their neighbors than for themselves. When
this attitude was clearly recognized, steps were taken promptly to
set up each county's budget separately, and to keep its funds separate,
including State and Federal matching funds. Each county health
department now has its own budget, personnel, and identity, and
where it is necessary to share personnel their salaries are prorated.
All multicounty units share the services of a health officer, and some
a supervising nurse and a sanitarian. Disagreements among counties
occasionally arise concerning the appointment, retention, or place of

LOCAL HEALTH SERVICE

Figure 3-Distribution of county health units in Florida,
as of January 1, 1953.

SINGLE COUNTY UNIT
MUL'.TrPLf COUNTY utJI
NO UNIT

residence of personnel,
satisfactorily.

but so far these problems have been solved

Municipal Health Services
"Many of Florida's counties, particularly the more populous ones,
have run the gamut of confusion and duplication incident to a
multiplicity of health departments and health programs separately
financed and directed. A typical example is Dade County, whose
largest city is Miami. Until 1943 there were in this county three
city health departments, a county health department, and a school

46 ANNUAL REPORT. 1953

health program under the county board of education. Only the
county health department was associated with the State Board of
Health, and even so, that State agency operated a venereal disease
control program more or less separately. Within a short time, under
the leadership of the chairman of the board of county commissioners,
complete consolidation of the four health departments and the school
health program was brought about with the cooperation and agree-
ment of all concerned. A law was passed which applied to Dade
County only and which effectively removed any legal barriers to
the consolidation. The law also set up an advisory board which
functions as a local board of health except that it has no adminis-
trative functions or authority to promulgate regulations.
"Under this plan the county undertook the entire responsibility for
financing the operations of the health department, except for avail-
able Federal and State funds. This arrangement has worked out so
satisfactorily that it has been used as an example of the benefit of
consolidating the city and county governments entirely, and this
development failed by a narrow margin in a recent election.
"A similar development started somewhat earlier in Hillsborough
County, whose chief city is Tampa. In spite of some opposition at
first from rural areas and from one small town, the consolidation
was promoted by the parent-teacher association because of a desire
to have better school health services. Past efforts to carry on a
separate school health program had not been satisfactory, and school
officials were loathe to provide for an expensive school health pro-
gram which would overlap the activities of the city and county health
departments.
"A few years later, and without much public fanfare, city and county
officials in Pinellas County (St. Petersburg-Clearwater) agreed upon
a consolidation, and effected it by legislative action. In this case,
a local board of health was provided, the only one in the State.
"Even before these consolidations took place, most of the smaller
cities and towns in the State had effected similar arrangements by
negotiation and agreement, and without special laws. In Pensacola
and Escambia County, for example, a city-county health department
was operated for years under a single health officer, with each agency
paying its own employees. In recent years city, county, and State
appropriations have been put into a common fund. While the trend
in recent years has been for the counties to assume the entire local
financial burden, in 1953, 27 municipalities contributed a total of
$65,890 to county health department budgets.
"Consolidation has not meant that the cities of Florida lack health
departments. Acting under specific agreements, and under the

LOCAL HEALTH SERVICE 47

general policy of the State Board of Health, each county health
department serves as the inunicipal health department for each
municipality within the county, unless the municipality has a health
department of its own. The county health departments are obligated
to enforce municipal health ordinances, and in fact the county health
departments would be greatly handicapped in their work but for
the existence of such ordinances. This is particularly true in the
field of milk and food sanitation where there is some dispersion of
responsibility among State agencies.
"At the present time only the city of Jacksonville has a complete
and fairly adequately financed city health department. It has a
budget of about $500,000 to serve a population of more than 200,000
people. The cities of West Palm Beach, Orlando, and Lakeland
have city health departments, but these furnish only limited public
health services, and their combined budget for this purpose is esti-
mated at less than $100,000. Public health services in these cities
are supplemented by the county health departments. It can be
seen, therefore, that of a total of about $4,339,820 spent by local
health agencies in Florida only about $665,000 is appropriated by
municipalities, and most of this is spent by the city of Jacksonville.

School Health Services
"Sentiment in Florida has always been against the development of
separate school health services financed and administered by educa-
tion agencies. In the past, many local school boards provided for
school health services, particularly public health nursing services.
There has been a continuous trend in recent years to discontinue
this activity, or to merge such efforts with the county health depart-
ments. In many counties, the board of county commissioners bears
the entire local cost of public health services, including school health
services, but at present in 39 counties the local school boards make
a contribution to the common fund of the health department. The
total amount so contributed in the 1952-53 budgets was $142,602.
This assistance is especially important since it is contributed pri-
marily in the smaller rural counties.
"It is especially interesting that the Florida laws governing
the expenditures of school funds provide that these can only be
spent for local services where the county health department is un-
able to provide needed services. At the present time, in only 7
counties are public health personnel employed by school boards
other than through county health departments. This personnel
consists of 19 public health nurses and 1 health educator. In 1 of
these counties, although 4 public health nurses are paid directly

48 ANNUAL REPORT, 1953

by the local school board they work under the supervision of the
county health officer. In the other counties, they work in close
cooperation with the personnel of the county health departments,
and the outlook for a complete merger of efforts in the future is
very bright.

Summary
"During the past 23 years steady progress has been made toward
statewide coverage by county health departments, and only one
county, with a population of 27,200, is now unorganized. Similar
progress has been made in the coordination and unification of local
health services provided by counties, municipalities, local school
boards, and the Florida State Board of Health."

TABLE 14
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

ACTIVITIES I I

A. COMMUNICABLE DISEASES
CONTROL
1. Admissions to Service.......... 20 28 49 44 52 47 3 11 5 27 3 8 652 5 0 82 112
2. Consultations and Conferences
with Physicians ............. 20 0 55 0 29 26 3 6 1 14 3 36 633 8 18 9 18
3. Field and Office Visits.......... 36 59 69 53 71 76 4 31 26 78 3 161 1,132 6 0 179 278
IMMUNIZATIONS COMPLETED
4. Smallpox .................... 570 90 2,677 213 371 1082 283 209 139 415 34 52411,745 89 162 1,283 5,032
5. Diphtheria (5-7).... ..... 1,580 366 2,261 631 1,348 4,121 191 223 111 510 694 2,28710,071 204 223 3,300 3,925
8. TyphoidFever............... 3,828 955 5,688 67 31 1,154 280 5 298 458 284 3,827 3,401 7 571 1,183 13,458 0
9. Whooping Cough (9-11)....... 1,475 366 2,116 584 1,219 3,511 190 170 111 507 340 2,287 9,940 199 223 2,631 728
12. Tetanus...................... 1,801 366 4,474 704 1,320 6,206 240 262 262 668 706 3,35610,203 205 416 4,020 1,035
INTESTINAL PARASITE CONTROL
14. Admissions to Service.......... 305 527 1,398 146 403 347 266 42 59 108 18 393 326 62 337 348 360
15. Field and Office Visits........ .. 319 5271,460 164 789 474 303 60 65 108 19 704 679 82 337 502 363
16. Treatments Given............. 311 527 1,402 142 382 347 265 40 61 104 13 661 189 121 399 367 354
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service..... 998 37 384 86 204 285 8 7 15 151 52 97 2,513 17 9 2,400 2,228
2. Visitsto Medical Conferences..... 1,780 71 496 115 219 529 18 11 28 213 72 14028,493 33 14 15,048 2,505 -
3. Field Visits and Epidemiological
Investigations................. 636 100 660 55 710 1,400 23 56 21 178 93 38513,857 14 21 2,686 1,280
4. Treatments Given............... 1,245 13 301 68 185 335 10 12 13 56 25 95 1,704 7 7 2,400 1,843 K
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service C/2
(A) Cases...................... 6 6 31 3 7 56 2 2 7 7 8 5 456 1 3 0 11 M
(B) Contacts and Suspects...... 0 34 12 38 21 40 4 2 3 5 30 7 4,274 17 3 0 0
(C) Arrested Cases............ 8 0 19 9 0 80 0 0 0 0 0 0 572 3 1 0 39
2. Admissions to Nursing Service
(A) Cases...................... 46 11 55 13 30 109 6 5 17 25 12 12 780 1 4 168 222
(B) Contacts and Suspects...... 185 72 69 44 107 326 44 59 22 86 55 52 205 5 21 640 604
(C) Arrested Cases............. 32 2 61 7 25 89 1 9 3 7 8 8 59 4 5 87 61 0
3. Number of Persons X-rayed
(A) MiniatureFilms........... 11,072 011,622 0 5,90724,466 1,075 986 0 0 1,697 413,126 3,028 1,07524,990 8,970
(B) Large 14" x 17" Films...... 747 50 663 162 173 806 117 67 47 86 66 41 4,831 84 32 860 1,364
6. Visits to Medical Conferences .... 116 45 70 61 37 147 20 4 10 17 42 3117,965 26 11 0 271
7. Tuberculin Test................. 197 87 105 23 385 2,327 85 97 27 45 68 9 1,110 17 21 573 88
8. Field Nursing Visits .............. 517 122 292 181 286 1,676 237 162 91 193 120 147 3, 272 25 24 1,580 1,504
9. Office Nursing Visits............. 21 71 35 0 176 865 49 89 26 49 59 8 74 8 49 54 303
10. Cases Hospitalized............... 66 2 41 5 8 35 4 2 2 11 8 5 499 1 2 9 19

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

ACTIVITIES
ACTIVITIES S | | I |l i s l l l

g fi ( u o tt t3 B M i B M 3 > ^ >

A. COMMUNICABLE DISEASES
CONTROL
1. Admissions to Service.......... 3 8 23 0 0 2 4 92 1 1 28 345 10 25 30 6 1
2. Consultations and Conferences
with Physicians ............. 0 7 0 6 7 0 104 22 0 48 182 5 11 8 0 3
3. Field and Office Visits........ 7 16 25 0 0 2 6 127 1 1 56 587 69 47 58 7 1
IMMUNIZATIONS COMPLETED
4. Smallpox ................... 31 160 2,179 12 29 121 16 187 117 245 54 4,876 158 145 337 215 28
5. Diphtheria (5-7)............... 186 313 1,329 245 72 239 253 541 225 113 239 5,248 568 541 1,834 735 128
8. Typhoid Fever............... 30 518 1,418 98 5 1,208 916 12 48 77 61 388 192 272 6,066 765 467
9. Whooping Cough (9-11)........ 136 307 1,329 250 66 225 258 310 165 69 217 3,228 448 352 906 258 129
12. Tetanus ................... 206 557 1,810 308 75 908 989 461 231 126 244 5,413 638 732 2,977 678 219
INTESTINAL PARASITE CONTROL
14. Admissions to Service.......... 49 148 173 89 68 87 754 293 103 587 232 1,399 424 49 819 176 69
15. Field and Office Visits.......... 72 148 173 89 79 87 754 305 104 741 232 1,444 443 55 821 184 69
16. Treatments Given............. 72 148 173 89 76 87 754 302 93 212 232 1,436 459 59 2,244 205 69
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service..... 9 81 155 7 5 15 90 15 20 18 124 1,025 12 12 285 12 4
2. Visits to Medical Conferences..... 17 117 155 7 13 19 95 19 30 26 216 3,555 14 11 320 14 5
3. Field Visits and Epidemiological
Investigations................. 40 123 368 38 2 41 68 34 5 63 81 5,898 70 137 667 35 6
4. Treatments Given............... 12 24 153 6 4 35 95 10 20 13 132 1,069 9 15 407 21 3
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service
(A) Cases........ ...... 2 4 1 0 1 0 5 8 3 9 127 5 0 2 2 2
(B) Contacts and Suspects...... 1 7 0 0 9 0 0 9 3 0 116 1,853 20 0 0 9 0
(C) Arrested Cases........... 1 4 0 0 7 2 3 0 0 1 14 421 3 0 0 0 0
2. Admissions to Nursing Service
(A) Cases ................... 3 4 21 2 2 7 6 11 3 10 8 388 8 8 46 8 0
(B) Contacts and Suspects...... 8 19 101 12 11 41 23 33 4 50 73 1,691 75 63 37 33 34
(C) Arrested Cases.............. 1 1 6 5 5 1 0 3 4 1 7 251 5 8 28 3 0
3. Number of Persons X-rayed
(A) Miniature Film........... 1,019 0 0 642 0 0 1,505 09 0 3,90188,489 1,144 0 0 768 806
(B) Large 14' x 17" Films...... 21 106 113 22 50 75 58 86 92 74 118 970 191 226 373 32 20
6. Visits to Medical Conferences..... 7 19 0 0 31 2 10 21 15 5 186 4,258 29 0 4 11 6
7. Tuberculin Test ................. 9 328 30 12 52 68 3 29 42 22 88 669 30 25 68 6 33
8. Field Nursing Visits.............. 40 19 349 50 31 80 65 30 20 306 114 3,220 233 180 158 85 114
9. Office Nursing Visits............. 9 17 11 0 20 43 12 44 6 161 107 101 102 125 86 13 31
10. Cases Hospitalized ............ 1 5 45 2 0 12 13 7 2 1 93 7 1 0 8 2

L-

M

O

Co

a

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

I I
ACTIVITIES

02 0 0 0 0 S fi
o3 .o 14 s o

A. COMMUNICABLE DISEASES
CONTROL
1. Admissions to Service........... 74 19 197 16 0 7 19 3 3 196 83 16 7 407 7 178 17
2. Consultations and Conferences
with Physicians ............. 96 12 135 1 9 24 6 3 297 154 8 5 303 7 36 10
3. Field and Office Visits.......... 206 33 277 17 0 9 26 5 3 351 201 57 9 1,007 7 441 25
IMMUNIZATIONS COMPLETED
4. Smallpox..................... 68 618 1,596 583 38 324 944 1,048 217 615 936 586 18 2,200 242 3,081 225
5. Diphtheria (5-7)............... 485 996 1,934 222 161 669 1,341 292 521 741 2,005 1,177 250 4,141 406 2,207 413 0
8. Typhoid Fever................ 65 1,754 4,066 296 188 2,182 1,804 4,597 160 976 2,913 235 124 6,502 101 951 186
9. Whooping Cough (9-11)........ 369 797 1,873 221 161 656 1,346 292 521 643 1,981 1,088 250 1,776 404 1,640 390
12. Tetanus ..................... 459 1,666 4,338 1,072 298 933 2,576 321 948 900 1,983 1,255 366 2,553 413 4,826 422
INTESTINAL PARASITE CONTROL r4
14. Admissions to Service.......... 296 71 275 258 196 119 140 391 168 40 420 167 144 136 154 82 750
15. Field and Office Visits.......... 514 85 336 281 196 119 178 632 168 41 603 167 157 212 161 93 832
16. Treatments Given............. 221 82 256 253 196 119 125 199 168 21 576 167 131 121 154 72 762
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service...... 27 330 1,765 11 1 68 238 615 69 503 30 118 6 407 58 1,134 78
2. Visits to Medical Conferences..... 97 826 1,871 15 1 103 547 880 69 589 664 118 6 1,086 58 2,395 131 I-
3. Field Visits and Epidemiological
Investigations ................. 74 361 2,421 38 0 19 513 1,278 203 1,802 165 742 78 3,300 98 1,415 137
4. Treatments Given ............... 12 282 1,270 9 1 69 168 389 65 490 122 118 16 388 57 1,614 63
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service W
(A) Cases..................... 0 25 18 1 0 10 19 0 0 5 3 2 1 31 4 36 22 M
(B) Contacts and Suspects.... 40 4 8 0 40 1 0 0 10 5 4 1 0 5 44
(C)Arrested Cases............ 9 6 0 0 4 12 0 1 3 1 1 0 15 1 23 17
2. Admissions to Nursing Service
(A) Cases...................... 40 54 55 11 3 10 68 88 9 9 7 7 1 171 11 144 22
(B) Contacts and Suspects...... 19 13 360 89 10 32 125 226 16 42 54 105 38 573 58 97 169
(C) Arrested Cases............. 46 22 29 11 0 1 32 46 5 12 19 4 1 158 2 58 22 C
3. Number of Persons X-rayed
(A) MiniatureFilms........... 8,817 0 10,453 0 0 0 9,078 9,510 0 0 0 159 016,307 1,676 6,976 0
(B) Large 14 x 17" Films...... 440 143 704 87 6 74 343 813 88 198 110 144 43 667 124 766 188
6. Visits to Medical Conferences..... 0 124 38 14 0 79 34 0 1 43 19 7 3 418 16 515 95
7. Tuberculin Test................. 49 76 213 94 0 38 283 91 3 46 43 639 158 124 193 319 106
8. Field Nursing Visits ............. 587 270 733 260 13 59 534 822 76 185 404 231 204 1,397 232 1,255 330 .
9. Office Nursing Visits............. 58 208 39 32 1 71 154 59 10 102 138 7 17 442 61 143 225
10. Cases Hospitalized............... 22 15 49 4 0 9 14 24 1 5 20 6 0 45 6 65 10

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

i M 0 A ia s I 4 0

A. COMMUNICABLE DISEASES
CONTROL
1. Admissions to Service.......... 117 94 13 6 25 54 29 19 8 7 13 52 0 8 0 3,421 ,
2. Consultations and Conferences
with Physicians.............. 19 45 8 4 22 68 29 1 2 9 1 16 0 14 0 2,632
3. Field and Office Visits.......... 138 192 18 20 49 69 92 19 1 9 5 9 13 122 0 15 0 6,717 3
IMMUnIZATIONS COMPLETED
4. Smallpox..................... 1,737 1,798 802 87 188 539 764 194 596 424 59 948 54 664 123 56,144 F0
5. Diphtheria (5-7)............... 2,915 2,261 1,549 659 977 931 625 589 670 591 204 494 210 878 469 76,838
8. Typhoid Fever ............... 509 186 674 1,141 2,767 78 33 463 1,148 1,316 344 97 985 192 499 85,568
9. Whooping Cough (9-11)........ 2,897 2,252 1,121 613 488 902 625 485 668 533 199 450 208 867 469 62,435
12. Tetanus...................... 2,806 2,233 1,891 812 1,641 1,781 618 638 913 955 207 507 391 1,012 478 95,028
INTESTINAL PARASITE CONTROL
14. Admissions to Service.......... 342 324 185 41 226 81 135 349 527 234 127 146 43 534 227 18,292
15. Field and Office Visits.......... 545 346 192 41 226 96 247 349 531 234 127 223 45 534 227 21,493
16. Treatments Given............. 305 324 193 40 226 83 171 349 528 234 124 136 45 534 226 19,536 CO
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service.... 495 448 55 82 34 175 96 86 148 25 46 142 58 54 4 18,786 C
2. Visits to Medical Conferences..... 2,280 767 79 138 48 371 133 112 153 35 80 406 87 76 7 68,646
3. Field Visits and Epidemiological
Investigations................. 3,032 776 320 245 19 352 492 30 108 37 40 740 68 83 18 48,855
4. Treatments Given .............. 699 328 74 65 23 145 96 52 141 18 21 194 58 67 30 17,491
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service
(A) Cases..................... 132 43 3 0 3 20 0 5 12 2 2 8 2 7 1 1,202
(B) Contacts and Suspects...... 330 22 11 0 6 14 0 5 4 1 7 28 0 16 0 7,167
(C) Arrested Cases........... 79 15 0 0 0 4 0 4 2 0 2 19 3 0 1,408
2. Admissions to Nursing Service
(A) Cases..................... 87 105 14 16 7 39 33 5 5 9 2 117 0 17 13 3,230
(B) Contacts and Suspects...... 191 354 72 163 47 183 91 45 94 73 11 349 30 51 19 8,967
(C) Arrested Cases.......... ..... 99 73 17 18 3 36 4 18 27 12 4 95 2 6 2 1,681
3. Number of Persons X-rayed
(A) Miniature Films......... 13,187 23,869 0 0 2,011 10,520 5,003 0 3,100 0 0 0 0 1,173 1,387 330,427
(B) Large 14" x 17" Films...... 6,770 1,020 1,046 122 42 507 160 79 110 65 39 968 31 40 37 28,797
6. Visits to Medical Conferences..... 986 186 19 0 6 64 20 22 33 3 16 419 11 47 1 26,716
7. Tuberculin Test................. 1,284 807 139 105 2 132 7 5 70 63 7 455 7 61 31 12,428
8. Field Nursing Visits.............. 1,483 1,348 312 488 107 374 174 68 118 102 26 1,238 22 149 82 29,206
9. Office Nursing Visits ............. 218 525 18 135 19 144 13 85 84 51 15 736 32 95 5 6,766
10. Cases Hospitalized............... 56 79 16 8 8 24 18 2 6 7 2 25 4 7 6 1,486

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

AcTiviTiEs g | .3

D. MATERNITY SERVICE
1. Admissions to Antepartum Medical
Service ....................... 432 51 220 97 148 417 15 8 19 72 49 194 2,566 0 51 55 338
Service ....................... 00 65 221 79 174 441 20 11 31 96 64 196 2,084 0 71 238 477
4. Visits by Antepartum Cases to
Medical Conferences ........... 932 95 587 225 359 873 26 14 36 162 80 514 9,796 0 160 132 492
5. Numberof ClinicSessions Conducted 136 43 40 23 9 28 38 23 117 421 0 28 23 100
6. Field Nursing Visits-Antepartum. 631 104 79 182 179 178 26 6 46 153 26 110 2,850 0 48 400 310
7. Office NursingVisits-Anteartum 1,877 16 611 21 358 1,616 48 23 20 203 261 443 420 0 170 164 1,568
10. Postpartum Cases Examined ...... 200 32 63 1 78 62 1 1 5 20 9 4 992 0 0 102 0
11. Admissions to Postpartum Nursing
Service ....................... 463 89 102 97 188 275 16 7 31 79 42 220 2,604 0 31 167 338
12. Field Nursing Visits-Postpartum. 1,02 9 94 260 289 304 17 17 50 124 48 57 6,416 0 9 273 527
13. Office Nursing Visits-Postpartum. 163 11 68 6 72 49 2 5 2 16 22 21 7 0 6 10 258
14. Admissions for Midwife Supervision 12 7 3 3 5 3 2 2 4 2 16 19 0 3 2 7
15. Attendance of Midwives at Meetings 32 20 0 0 10 21 0 0 5 0 0 67 260 0 17 0 24
16. Visits for Midwife Supervision..... 60 60 27 31 86 158 13 15 28 22 8 6 30 0 30 12 87
E. INFANT & PRESCHOOL HYGIENE
INFANT l
1. Admissions to Medical Service... 268 88 43 92 156 402 16 0 11 65 25 145 2,866 0 39 417 523 :
2. Admissions to Nursing Service... 673 136 114 189 340 792 26 30 50 131 6 355 3,574 0 64 916 853
3. Visits to Medical Conferences... 360 180 70 145 172 798 19 0 12 88 29 226 7,486 0 42 1,112 904
4. Field Nursing Visits............ 1,584 307 161 668 539 948 28 53 105 253 73 845 9,749 0 60 1,287 926
5. Office Nursing Visits........... 369 24 99 20 313 1,383 10 29 1 101 95 81 636 0 50 1,513 1,239 I
PREascooL
6. Admissions to Medical Service 274 250 25 102 72 144 145 5 7 245 1 221 3,494 126 100 1,095 155
7. Admissions to Nursing Service... 1,245 417 116 690 684 1,268 32 135 78 177 27 1,207 2,594 0 81 2,365 1,115
8. Visits to Medical Conferences... 325 501 36 108 105 150 146 7 75 255 22 318 6,305 126 103 2,459 159
9. Field Nursing Visits ............ 2,513 954 190 1,679 1,058 31 37 216 197 262 20 1,610 4,330 0 96 3,324 1,263 W
10. Office Nursing Visits ........... 214 80 55 10 488 2,370 9 185 0 63 38 12 333 0 20 2,494 880
12. Number of Infant-Preschool
Clinic Sessions Conducted..... 137 54 32 22 111 86 25 6 22 49 15 122 304 4 27 111 195
F. SCHOOL
1. PupilsInspected................. 1,906 3,047 2,661 962 1,731 7,195 63 554 568 851 303 3096,840 440 11 5,453 6,206 "
2. Pupils Examined ................. 1,217 1,026 1,881 228 84 1,590 188 358 952 225 237 1,562 20,327 885 121 136 1,167
4. Admissions to Nursing Service...... 651 299 169 169 631 3,306 63 188 42 351 40 419 1, 42 10 585 1854
5. Field Nursing Visits............... 1,067 365 371 36 287 635 194 40 63 132 71 17 4,323 91 102 905 699
6. Office Nursing Visits.............. 1,278 138 183 44 1,070 6,034 11 687 6 433 22 027,880 9 22 531 2,191 Cn
7. Number of Corrections Secured ..... 274 81 96 51 19 145 81 51 22 13 14 0 5,309 0 6 31 69 Q
8. Cases Hospitalized................ 2 0 0 0 2 1 0 2 0 1 2 0 0 0 1 10 1

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

Service ....................... 54 12 272 10 13 15 25 4 43 20 29 1,508 16 0 136 77 20
Admissions to Antepartum Nursing
Service ..................... 79 23 455 35 1 15 55 6 0 19 22 1,761 37 45 346 12 25
4. Visits by Antepartum Cases to
Medical Conferences ........... 125 20 440 30 34 18 39 5 132 33 51 5,621 29 0 238 137 55
5. NumberofClinicSessionsConducted 44 17 92 18 23 15 19 2 57 26 26 231 22 0 62 25 21
6. Field Nursing Visits-Antepartum. 13 18 197 81 3 7 85 3 0 24 22 1,605 37 102 294 107 27
7. Office Nursing Visits-Antepartum 204 59 931 23 0 41 98 7 0 33 8 6,971 46 87 801 311 73
10. Postpartum Cases Examined...... 10 2 63 1 0 0 6 2 0 6 1 750 9 4 59 1 0
11. Admissions to Postpartum Nursing
Service ....................... 7 7 532 44 2 4 49 11 0 21 13 1,327 37 59 317 138 15
12. Field Nursing Visits-Postpartum. 14 15 776 104 2 6 90 12 0 53 20 1,982 61 111 491 247 13
13. Office Nursing Visits-Postpartum. 27 2 104 0 0 0 1 2 0 5 4 819 5 12 127 8 7
14. Admissions for Midwife Supervision 3 3 13 1 1 4 4 2 0 1 8 14 0 5 18 13 1
15. Attendance of Midwives at Meetings 28 0 113 0 0 0 8 0 0 1 0 45 4 4 15 37 1
16. Visits for Midwife Supervision.... 17 6 118 1 6 17 10 7 0 2 53 34 22 14 186 15 21
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service... 45 19 106 26 11 8 48 5 26 17 69 1,802 81 0 79 9 19
2. Admissions to Nursing Service... 73 56 699 69 3 24 58 26 1 39 37 2,685 59 10 339 231 71
3. Visits to Medical Conferences... 84 22 13 9 80 7 34 22 151 4,713 101 0 94 9 22
4. Field Nursing Visits............ 42 64 1,236 228 5 77 112 26 0 78 108 2,475 101 213 488 578 108
5. Office Nursing Visits........... 146 59 301 2 0 8 6 5 1 21 14 5,121 24 91 133 148 81
PRESCHOOL
6. Admissions to Medical Service... 28 17 41 77 22 5 104 33 10 43 258 3,220 87 2 107 11 69
7. Admissions to Nursing Service... 102 9 1,105 172 0 68 146 78 1 105 32 4,078 146 145 139 273 237
8. Visits to Medical Conferences... 46 17 72 131 22 5 180 39 14 50 276 7,236 98 2 119 11 72
9. Field Nursing Visits............ 54 8 1,848 575 0 91 265 55 1 255 58 2,025 235 267 156 524 305
10. Office Nursing Visits........... 148 11 248 7 0 9 4 34 1 14 1 7,939 40 52 45 80 287
12. Number of Infant-Preschool
Clinic Sessions Conducted..... 44 16 54 40 12 4 80 16 36 34 24 410 32 0 43 10 20
F. SCHOOL
1. Pupils Inspected ................. 191 334 2,775 0 307 1,255 49 819 618 98 928 26,139 315 2,612 786 106 15
2. Pupils Examined.................. 11 162 359 729 162 87 592 1,082 343 725 655 13327 835 191 152 527 256
4. Admissions to Nursing Service ...... 32 1 1 1 10 335 2 261 16 13 149 4,532 18 588 151 4 187
5. Field Nursing Visits. .............. 27 12 438 39 11 221 0 51 24 221 119 3,017 202 496 142 22 122
6. Office Nursing Visits............. 880 136 413 1 2 757 2 393 6 40 85 5,179 137 268 124 12 311
7. Number of Corrections Secured.... 23 1 79 1 85 218 0 13 38 52 20 6,481 8 99 3 0 20
8. Cases Hospitalized ............... 0 0 0 2 1 0 0 0 4 0 1 16 0 3 0 0 0

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

o I
ACTIVITIES 4 0 A,

i. i-i z3 a o o 0 0 &

D. MATERNITY SERVICE
1. Admissions to Antepartum Medical
Service ....................... 67 93 351 48 13 55 71 0 0 96 30 33 1 408 50 525 30
3. Admissions to Antepartum Nursing
Service....................... 148 153 256 62 17 68 79 162 4 92 8 62 7 107 70 200 51
4. Visits by Antepartum Cases to
Medical Conferences ........... 167 194 1,037 109 16 219 209 0 0 239 51 50 1 1,181 68 1,043 52
5. Number of Clinic Sessions Conducted 42 61 98 51 16 71 47 0 0 59 20 29 1 184 32 139 35
6. Field Nursing Visits-Antepartum. 293 77 499 26 37 15 86 322 4 38 272 63 7 186 54 439 34
7. Office Nursing Visits-Antepartum 42 495 0 92 32 222 268 66 2 311 76 100 12 29 142 666 80
10. Postpartum Cases Examined...... 33 44 99 7 3 26 56 0 0 107 1 6 0 175 8 170 9 0
11. Admissions to Postpartum Nursing
Service...................... 206 212 468 98 19 162 87 162 6 79 73 39 3 306 63 434 31 0
12. Field Nursing Visits-Postpartum. 466 305 1,109 130 35 179 141 484 10 88 207 66 35 113 763 35
13. Office Nursing Visits-Postpartum. 7 77 3 9 1 38 54 4 0 113 17 3 0 3 31 20 16
14. Admissions for Midwife Supervision 7 3 11 9 3 9 5 16 1 15 9 1 0 4 0 9 2 t4
15. Attendanceof Midwives at Meetings 7 2 95 12 3 26 43 109 0 21 30 0 0 22 0 67 18
16. Visits for Midwife Supervision..... 48 7 5 18 0 39 54 70 4 71 112 8 0 13 1 35 8
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service... 36 62 262 17 5 37 73 0 24 98 66 50 3 435 25 323 24
2. Admissions to Nursing Service... 284 248 521 123 31 203 126 205 98 151 176 106 6 444 116 599 82
3. Visits to Medical Conferences... 56 75 315 18 5 57 81 0 24 129 131 52 5 489 25 576 32
4. Field Nursing Visits............ 729 474 1,476 183 95 262 174 612 222 103 453 271 21 523 175 1,624 65 -1
5. Office Nursing Visits........... 24 170 136 8 13 112 68 17 9 247 140 74 5 61 104 305 83
PRESCHOOL
6. Admissions to Medical Service... 13 14 344 2 2 79 108 0 196 159 360 137 1 1,518 17 52 26 D
7. Admissions to Nursing Service... 562 77 1,054 190 69 199 104 113 182 306 458 158 13 761 324 106 238
8. Visits to Medical Conferences... 13 16 395 2 2 130 108 0 196 326 894 141 2 2,362 18 71 43
9. Field Nursing Visits............ 748 115 2,178 251 130 41 163 358 436 249 1,167 285 25 975 488 170 231 W
10. Office Nursing Visits........... 39 31 192 20 2 518 186 2 9 671 700 120 2 129 256 143 247
12. Number of Infant-Preschool
Clinic Sessions Conducted..... 24 50 89 15 4 42 41 0 28 121 36 28 4 211 26 154 31 '-4
F. SCHOOL
1. Pupils Inspected ................ 4,600 1,167 3,930 1,177 59 83 1,792 5,809 767 5,453 6,520 3,572 162 9,506 1,606 7,975 2,813 M
2. Pupils Examined.................. 32 775 949 1,358 35 804 441 2,128 86 667 788 939 56 2,225 185 749 1,130
4. Admissions to Nursing Service...... 628 127 682 80 61 21 339 643 6 2,540 679 915 36 1,196 51 1,515 298
5. Field Nursing Visits....................... 559 175 1,129 82 48 46 519 1,017 6 295 787 314 98 1,818 117 1903 359
6. OfficeNursing Visits............... 464 119 98 2 57 109 45 1 15 5,532 1,999 483 13 1,283 169 3,671 180 01
7. Number of Corrections Secured..... 1 78 173 2 9 10 130 91 2 494 610 69 9 261 1 452 61 C/
8. Cases Hospitalized ............... 1 0 1 0 0 1 3 0 2 5 0 1 0 7 31 18 12

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

m a
AcTIVITIES i 0 0 0

.5 02 W u E- 0 0 ,
0 ii
9., 9,r~m 2 ) 2 4 1

D. MATERNITY SERVICE
1. Admissions to Antepartum Medical
Service...................... 469 343 110 17 21 47 79 30 117 65 46 79 44 49 25 10,398
3. Admissions to Antepartum Nursing
Service....................... 469 409 156 157 18 55 199 65 124 81 53 261 37 50 63 11,633
4. Visits by Antepartum Cases to
Medical Conferences .......... 1,458 948 221 17 36 93 254 51 384 172 112 386 83 82 26 30,449
5. NumberofClinicSessionsConducted 117 112 62 3 33 16 24 50 24 27 44 62 26 36 18 3,537
6. Field Nursing Visits-Antepartum. 714 290 60 110 1 112 338 66 66 26 184 539 49 26 26 13,012
7. Office Nursing Visits-Antepartum 2,150 722 299 390 46 99 212 77 405 234 100 397 21 148 136 25,583
10. Postpartum Cases Examined....... 177 56 29 0 3 25 31 5 1 8 16 37 5 30 7 3,696
11. Admissions to Postpartum Nursing
Service....................... 313 241 179 139 5 33 270 82 111 32 38 265 53 58 91 11,690
12. Field Nursing Visits--Postpartum. 706 427 170 230 4 89 487 139 208 29 45 592 108 65 134 22,108
13. Office Nursing Visits-Postpartum 194 41 55 31 3 25 23 25 14 12 12 34 1 50 41 2,798
14. Admissions for Midwife Supervision 3 2 11 5 1 1 3 5 4 6 0 9 7 6 4 361
15. AttendanceofMidwivesatMeetings 3 0 79 5 0 2 0 0 13 18 0 22 14 23 14 1,360
16. Visits for Midwife Supervision..... 14 18 75 13 1 3 90 47 10 35 0 50 12 61 19 2,143
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service... 641 229 118 15 14 84 25 24 74 20 95 119 52 53 22 10,651
2. Admissions to Nursing Service... 1,048 568 222 273 22 88 332 157 212 94 119 401 120 93 105 20,263
3. Visits to Medical Conferences... 1,250 450 154 18 14 98 30 33 82 24 135 327 77 67 22 22,024
4. Field Nursing Visits........... 2,573 1,046 144 489 18 207 722 253 446 113 210 1,134 230 99 114 38,785
5. Office Nursing Visits.......... 2,081 886 232 240 8 32 29 137 108 54 81 342 51 130 96 18,207
PRESCHOOL
6. Admissions to Medical Service... 1,021 216 77 2 31 83 0 32 330 7 90 461 117 92 137 16,403
7. Admissions to Nursing Service... 1,858 857 72 225 32 74 617 180 570 32 114 775 429 105 167 30,088
8. Visits to Medical Conferences... 1,655 236 117 6 35 90 0 42 329 7 136 963 191 108 137 28,361
9. Field Nursing Visits........... 1,910 850 85 374 28 138 1,432 283 850 52 286 1,811 641 36 239 41,527
10. Office Nursing Visits.......... 2,732 1,962 122 146 12 11 119 79 117 9 90 963 163 136 82 26,181
12. Number of Infant-Preschool
Clinic Sessions Conducted..... 164 64 70 7 48 10 14 73 24 11 44 173 44 33 27 3,907
F. SCHOOL
1. Pupils Inspected ................ 23,978 11 2,082 71 6920,50613,614 1,710 350 387 14610,354 796 589 132 297,954
2. Pupils Examined.................. 3486 575 878 99 1,199 532 610 638 938 720 110 994 305 991 189 79,257
4. Admissions to Nursing Service..... 8,516 29 130 18 690 495 841 253 210 21 33 1,676 56 533 131 50,832
5. Field Nursing Visits .............. 4,352 18 204 34 213 697 2,359 208 297 52 75 1,104 54 133 180 34,501
6. Office Nursing Visits.............. 7,323 50 223 5 570 128 468 252 82 191 21 2,008 180 1,108 52 76,739
7. Number of Corrections Secured.... 7,623 0 11 0 6 218 0 51 26 12 24 257 7 45 0 24,132
8. Cases Hospitalized................. 39 0 0 0 1 8 0 1 0 1 1 2 0 2 0 159

O')

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

a a a .S g
I T V T 0 A
ACT I IT .E 0 0 0 ...

G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4)......... 3,026 179 1,621 368 1,729 6,795 86 228 407 506 318 1,001 6,163 323 319 7,908 5,642
H. MORBIDITY
3. Field and Office Medical Visits..... 933 116 48 217 33 1,074 13 3 3 43 25 624 0 0 81 0 51
4. Field and Office Nursing Visits..... 202 62 51 120 124 2,280 38 26 109 52 52 820 276 0 162 136 385
J. CANCER CONTROL
1. Admissions to Service............. 159 13 52 31 22 98 7 19 7 31 16 23 7 21 15 184 287
2. Field Visits ...................... 11 3 105 75 53 289 114 61 20 61 23 5 179 73 27 34 436
3. Office Visits...................... 267 12 16 23 19 336 8 36 4 24 11 57 0 12 16 244 837 (
4. Ambulatory Cases Treated......... 13 0 30 2 8 267 56 10 2 18 1 5 0 3 0 1,717 72
K. DIABETES
1. Admissions to Service.............. 4 13 25 0 17 28 8 7 11 15 15 23 2 0 7 4 29
2. Field Visits....................... 13 2 1 0 80 107 12 27 43 19 18 0 8 0 15 15 40
3. Office Visits....................... 1 64 49 0 54 149 7 41 29 18 37 44 0 0 50 6 9 X
L. CRIPPLED CHILDREN
1. Admissions to Service.............. 74 13 78 36 58 67 24 27 21 45 10 6 10 0 13 14 264 >
2. Field Visits...................... 171 9 104 225 123 199 115 59 47 103 34 23 26 0 35 22 456
3. Office Visits ...................... 2 4 7 8 40 27 15 49 6 26 1 2 0 0 3 11 85
4. Clinic Visits...................... 267 47 143 104 40 2 53 46 17 54 3 0 0 0 20 0 94 -3
5. Cases Hospitalized................ 22 0 12 11 5 0 3 11 5 6 1 0 0 0 1 0 3
M. DENTAL HYGIENE
1. Admissions to Service.............. 0 0 0 0 0 0 0 286 87 115 0 0 293 0 0 371 144
2. Preschool Inspections ............. 0 0 0 0 0 0 0 0 0 115 0 0 0 0 0 0 0
3. School Inspections ............... 0 0 0 0 0 0 0 286 87 0 0 021,048 0 015,056 150
6. Fluoride Treatments Completed... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
P. SANITATION
1. Approved Water Supplies Installed 1--
(A) Private and Semi-Public..... 2 1 1 0 6 333 0 10 2 0 3 24 58 4 0 5 594
(B) New Public Water Connections 3 1 0 0 25 0 13 5 0 0 2 0 33 4 0 685 835
(C)Drinking Fountains......... 0 0 0 0 0 3 0 0 0 0 0 0 5 0 0 0 0
2. New Specification Privies Installed.. 342 2 13 0 7 60 5 0 0 0 5 13 0 4 1 2 6
3. Privies Reconditioned.............. 43 2 6 2 10 28 0 0 1 0 0 0 0 3 0 18 5
4. Percolation Tests ................. 59 0 59 16 41 297 0 13 0 244 13 40 1 2 8 1,913 277
5. New Septic Tanks Installed........ 286 31 268 21 376 4,083 40 26 18 86 165 651 449 9 3 1,837 1,681 (
6. Septic Tanks Reconditioned ........ 9 4 7 8 1 31 2 0 0 15 3 63 312 3 0 221 40 -
7. New Public Sewer Connections..... 0 21 34 0 4 0 3 6 0 6 0 7 1 0 0 132 132
8-17. Field Visits................... 5,101 1,340 4,649 469 2,399 13,312 903 363 524 922 981 2,14247,377 907 126 7,705 12,542

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

G. ADULT IIYGIENE-MEDICAL I I
EXAMINATIONS (1-4)......... 220 441 455 518 85 226 879 340 414 192 451 29,54 414 152 1,419 144 69

H. MORBIDITY
3. Field and Office Medical Visits..... 30 224 3 0 20 0 244 56 12 25 122 30 15 0 36 4 53
4. Field and Office Nursing Visits..... 50 576 544 559 22 454 136 52 78 35 77 2,894 45 187 90 63 77
J. CANCER CONTROL
1. Admissions to Service ............ 6 27 15 19 10 36 12 37 16 17 24 677 108 21 37 16 26
2. Field Visits ..................... 12 29 71 9 8 146 8 26 2 27 66 550 31 84 81 34 41
3. Office Visits ...................... 5 42 1 28 7 13 24 29 21 13 15 1,486 141 16 24 11 25 O
4. Ambulatory Cases Treated......... 0 10 0 0 3 7 1 3 1 2 193 17 15 0 1 0
K. DIABETES
1. Admissions to Service............. 2 16 23 2 1 12 4 16 8 5 28 297 30 20 1 4 10
2. Field Visits....................... 16 7 0 0 65 1 26 0 9 23 302 19 126 1 13 8
3. Office Visits..................... 10 13 36 6 18 50 3 79 45 5 69 1,034 194 48 4 6 74
L. CRIPPLED CHILDREN CO
1. Admissions to Service ............. 6 71 52 8 3 12 27 12 1 25 19 583 36 83 114 18 34 Cn
2. Field Visits...................... 64 47 237 27 4 78 9 10 0 48 15 814 100 451 77 70 142
3. Office Visits...... ............ 1 24 1 0 3 7 8 3 1 5 10 76 17 12 9 4 7
4. Clinic Visits................... .. 15 70 88 0 2 10 82 109 0 55 4 1,023 18 59 180 0 29
5. Cases Hospitalized............... 3 0 16 0 0 0 12 9 0 1 0 131 6 10 0 0 4
M. DENTAL HYGIENE
1. Admissions to Service.............. 0 4 121 0 147 0 0 65 0 120 0 3,225 0 5 682 0 0
2. Preschool Inspections............. 0 0 0 0 0 0 0 49 0 0 100 0 1 0 0 0
3. School Inspections.................... 4 121 0 0 0 0 65 0 120 0 1,946 0 3 860 0 0
6. Fluoride Treatments Completed.... 0 0 0 0 147 0 0 0 0 0 0 1,118 0 0 0 0 0
P. SANITATION
1. Approved Water Supplies Installed
(A) Private and Semi-Public..... 1 1 53 23 0 7 3 1 0 0 9 685 1 3 1 9 0
(B) NewPublicWaterConnections 50 1 251 0 0 41 0 3 0 6 11 1,356 11 0 0 1 0
(C) Drinking Fountains......... 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. New Specification Privies Installed.. 7 5 98 2 0 3 8 7 0 14 1 39 15 23 0 25 1
3. Privies Reconditioned....... ....... 1 0 172 6 1 3 6 2 0 1 3 115 6 0 0 48 0
4. Percolation Tests................. 29 18 7 1 0 29 14 0 0 0 5 718 4 29 294 6 0
5. New Septic TanksInstalled........ 15 14 37 41 7 39 24 20 45 11 105 2,026 17 175 55 9 4
6. Septic Tanks Reconditioned..... 2 2 38 24 0 2 2 5 0 0 10 48 2 24 1 2 0
7. New Public Sewer Connections..... 0 1 140 0 0 54 1 7 0 0 29 1,158 1 9 3 1 1
8-17. Field Visits................... 389 677 1,694 1,222 138 456 1,109 696 230 448 1,25735,535 300 951 1,221 862 30

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

ACTIVITIES g S

) s ] o o o&

G. ADULT HYGIENE-MIEDICAL
EXAMINATIONS (1-4).........
H. MORBIDITY
3. Field and Office Medical Visits.....
4. Field and Office Nursing Visits.....
J. CANCER CONTROL
1. Admissions to Service ............
2. Field Visits......................
3. Office Visits.....................
4. Ambulatory Cases Treated.........
K. DIABETES
1. Admissions to Service ............
2. Field Visits.......................
3. Office Visits.....................
L. CRIPPLED CHILDREN
1. Admissions to Service ............
2. Field Visits .................. ...
3. Office Visits.....................
4. Clinic Visits .....................
5. Cases Hospitalized................
M. DENTAL HYGIENE
1. Admissions to Service.............
2. Preschool Inspections.............
3. School Inspections ...............
6. Fluoride Treatments Completed....
P. SANITATION
1. Approved Water Supplies Installed
(A) Private and Semi-Public....
(B) New Public Water Connections
(C) Drinking Fountains.........
2. New Specification Privies Installed..
3. Privies Reconditioned ............
4. Percolation Tests..............
5. New Septic Tanks Installed........
6. Septic Tanks Reconditioned ........
7. New Public Sewer Connections.....
8-17. Field Visits ..................

876 1,7591 3,9581 481 77 6401 1,936 1,106 1521 1,845! 571 1,18K

351 1,011 32 45
171 61 131 431

21 15 18
65 12 16
81 8 17

0 141 0
0 213 18

1 1,781 231 11
4 2,007 394 1,1

2731 1,636 4841 2,645 2,046

5 81 5I 424
23 84 408 749

47 0 10 68 37 48 4 164 4 84 72
58 0 23 154 135 58 24 8 8 110 58
25 0 4 364 18 30 3 325 4 421 70
36 0 21 36 18 9 0 164 0 139 15

65 16
140 76
14 0

14 22 28 17 9
30 27 77 13 13
15 584 62 78 13

0 0 C
0 0 C
0 2,496 943
0 0 C

0 1,746
0 355
0 10,850
0 712

29 16 21
60 62 9
52 24 70

82
80
22
148
14

8
0
8
0

2 0C
996
1,037

0 92
0 C
0 327
0 C

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

d I
ACTIVITIES d 0 S 0
0) O.~ 0 0) ) CO 1-4 0

G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4).........
H. MORBIDITY
3. Field and Office Medical Visits.....
4. Field and Office Nursing Visits.....
J. CANCER CONTROL
1. Admissions to Service............
2. Field Visits.....................
3. Office Visits.....................
4. Ambulatory Cases Treated.........
K. DIABETES
1. Admissions to Service............
2. Field Visits.......................
3. Office Visits.....................
L. CRIPPLED CHILDREN
1. Admissions to Service ............
2. Field Visits.....................
3. Office Visits......................
4. Clinic Visits...................... .
5. Cases Hospitalized ...............
M. DENTAL HYGIENE
1. Admissions to Service.............
2. Preschool Inspections..............
3. School Inspections ...............
6. Fluoride Treatments Completed....
P. SANITATION
1. Approved Water Supplies Installed
(A) Private and Semi-Public.....
(B) New Public Water Connections
(C) Drinking Fountains.........
2. New Specification Privies Installed..
3. Privies Reconditioned ............
4. Percolation Tests..................
5. New Septic Tanks Installed........
6. Septic Tanks Reconditioned .......
7. New Public Sewer Connections.....
8-17. Field Visits...................

13,530 48 809 352

563 8 193 0
1,290 1,393 286 42

1021 1,012

3 64
181 126
13 291

0 1,811
0 6
0 1,762
0 0

6211 442 113,332

31 14
12 17

9,723
20,738

3,871
4,514
7,182
3,439

6 1,274
10 2,473
13 4,454

3,746
8,333
917
5,693
551

11,122
626
65,115
1,979

2,398
5,811
84
969
632
11,039
26,410
2,021
4,656
226,362

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

dCTI T E

R. PROTECTION OF FOOD AND
MILK
1. Food-Handling Establishments
Registered for Supervision......
2. Field Visits to Food-Handling
Establishments................
6. Dairy Farms Registered for
Supervision .................
7. Field Visits to Dairy Farms.......
8. Milk and Milk Products Plants
Registered for Supervision......
9. Field Visits to Milk and Milk
Products Plants ...............
10. Cows Tuberculin Tested..........
11. Cows Bangs Tested .............
S. MOSQUITO CONTROL
1. Surveys and Field Visits...........
3. Drainage-Linear Feet Completed..
5. Mosquito Breeding Places Eliminated
6. Breeding Places Controlled-Acres..
8. Structures Sprayed with D.D.T.....
T. RODENT CONTROL
1. Premises Rat-proofed .............
2. Premises dusted, trapped or poisoned
5. Field Visits................ .....
V. GENERAL ADMINISTRATION
1. Visits in the Interest of Vital
Statistics ......................
2. Lectures, Talks, and Motion
Picture Showings ..............
4. Radio Talks Delivered ............
5. News Articles Published ..........
X. LABORATORY
Specimens Examined (1-23)..........

75
554
4
47
2
24
550
550

5
2,765
14
0
0

0 0 0 0
8 175 0 12
0 548 1 42

15,891 1,362118,411 1,713 6,205122,734

1,195 1,791

5,115
38,874
84
1,819
84
3,377
11,818
90

0
0
0
0
0

117
10,732
14,153

251
278
11
115

106,416

48
496
6
107
1
14
44
9

2
0
0
0
0

0
5
0

66
81
0
0

2,196

601
1,140
O
42
610
4
68
3,243
2,784

143
0 t_-
5
18,879
0

3 En
258 i
277

<
117
290
2
29

25,568

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

.0

S-ACTI jITIE I I 4 I I d o I
Fio a a a a a 0 0 4
'-4~ -~, 00

R. PROTECTION OF FOOD AND
MILK
1. Food-Handling Establishments
Registered for Supervision......
2. Field Visits to Food-Handling
Establishments. ..............
6. Dairy Farms Registered for
Supervision ..................
7. Field Visits to Dairy Farms.......
8. Milk and Milk Products Plants
Registered for Supervision.....
9. Field Visits to Milk and Milk
Products Plants ..............
10. Cows Tuberculin Tested..........
11. Cows Bangs Tested .............
S. MOSQUITO CONTROL
1. Surveys and Field Visits..........
3. Drainage-Linear Feet Completed..
5. Mosquito Breeding Places Eliminated
6. Breeding Places Controlled-Acres..
8. Structures Sprayed with D.D.T.....
T. RODENT CONTROL
1. Premises Rat-proofed............
2. Premises dusted, trapped or poisoned
5. Field Visits. .....................
V. GENERAL ADMINISTRATION
1. Visits in the Interest of Vital
Statistics ......................
2. Lectures, Talks, and Motion
Picture Showings...............
4. Radio Talks Delivered ............
5. News Articles Published ..........
X. LABORATORY
Specimens Examined (1-23)...........

0 0 C
0 37 98
0 50 82

1,261 1,303 3,83

5 78
10 29
0 0
8 3

1,283 1,303

3,607 3,4051 2,985

0 0 C
0 0 6
0 0 21

2,34784,223 2,583 1,834 8,041 2,264 1,394

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

4, .

.W 0 0 0 ) ,
AcTivrrBEs 0 o 0 0

____ I 0 0 0 1I

R. PROTECTION OF FOOD AND
MILK
1. Food-Handling Establishments
Registered for Supervision......
2. Field Visits to Food-Handling
Establishments ...............
6. Dairy Farms Registered for
Supervision. ..................
7. Field Visits to Dairy Farms ......
8. Milk and Milk Products Plants
Registered for Supervision......
9. Field Visits to Milk and Milk
Products Plants...............
10. Cows Tuberculin Tested..........
11. Cows Bangs Tested ............
S. MOSQUITO CONTROL
1. Surveys and Field Visits..........
3. Drainage-Linear Feet Completed..
5. Mosquito Breeding Places Eliminated
6. Breeding Places Controlled-Acres..
8. Structures Sprayed with D.D.T.....
T. RODENT CONTROL
1. Premises Rat-proofed ...........
2. Premises dusted, trapped or poisoned
5. Field Visits.......................
V. GENERAL ADMINISTRATION
1. Visits in the Interest of Vital
Statistics ...............
2. Lectures, Talks, and Motion
Picture Showings...............
4. Radio Talks Delivered ............
5. News Articles Published...........
X. LABORATORY
Specimens Examined (1-23)..........

0 0 0
0 595 1,752
0 645 14

2,945 6.378128,142 4,932

0 0 0 1
0 234 0 243
0 343 0 165

9.067 4,614

1,351 8,11l

27
283
2
3
2
3
0
0

3
0
0
0
0

44
20
5

184
103
0
47

3,637

22
93
1
5
1
9
98
5

1
0
0
0
0

0
0
0

43
7
0
13

1,134

192
1,460
4
4
1
1
0
0

0
0
0
0
0

0
0
0

96
295
2
90

9,556

79
728
1
4
4
4
192
192

15
4,350
0
0
2

28
4

44
27
0
3

1,738

193
739
3
52 0
0
0
148
92
M
2 >
0 L-1
0
0
0
0 E-n
0
o a

0 CQ
0

16
24
0
24

3,793 0C
Lo

TABLE 14-Continued
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1953

ACTIVITIES | o 0

(ii P< r.i 02 01 01 lM oa a -3 i

R. PROTECTION OF FOOD AND
MILK
1. Food-Handling Establishments
Registered for Supervision......
2. Field Visits to Food-Handling
Establishments ...............
6. Dairy Farms Registered for
Supervision. .............. ..
7. Field Visits to Dairy Farms.......
8. Milk and Milk Products Plants
Registered for Supervision......
9. Field Visits to Milk and Milk
Products Plants...............
10. Cows Tuberculin Tested..........
11. Cows Bangs Tested .............
S. MOSQUITO CONTROL
1. Surveys and Field Visits...........
3. Drainage-Linear Feet Completed..
5. Mosquito Breeding Places Eliminated
6. Breeding Places Controlled-Acres..
8. Structures Sprayed with D.D.T.....
T. RODENT CONTROL
1. Premises Rat-proofed ............
2. Premises dusted, trapped or poisoned
5. Field Visits.....................
V. GENERAL ADMINISTRATION
1. Visits in the Interest of Vital
Statistics ......................
2. Lectures, Talks, and Motion
Picture Showings .............
4. Radio Talks Delivered ............
5. News Articles Published...........
X. LABORATORY
Specimens Examined (1-23)...........

750
2,248
38
409
12
148
4,774
366

15
1
1
0
0

68 1
2,743 17
1,197 22

0 0 0 0
0 53 20 17
1 53 6 30

0 0
1 0
1 0

33,6961 8,9031 2,9491 1,6581 1,806111,1251 1,7041 2,798 6,0751 1,765

18,38t
101,330
954
11,240
341
7,719
59,346
20,827

40,222
73,667
1,516
74,472
10,024

0 1 0 338
0 140 123 18,255
0 27 0 18,522

4,940
7,399
213
2,153

552,124

6,2411 1,0221 2,1901 2,597

LOCAL HEALTH SERVICE 65

DIVISION OF PUBLIC HEALTH NURSING
RUTH E. METTINGER, R.N., Director

One of the major objectives of the Division of Public Health
Nursing has been to help each public health nurse achieve the
knowledge and understanding of a well rounded public health
nursing program so that she may assist families to solve their own
problems. This has been done through the consultant nurses who
have interpreted to the public health nurses the significance and
the importance of having a working knowledge of community prob-
lems, community resources, and the programs of allied organizations.
The employment of new nurses without experience or training
in public health nursing has demanded more visits to the county
health units by the consultants. Many of these requests could not
be filled, since one of the consultants was assigned to nursing home
inspection. A total of 133 visits were made by the consultants to
the county health units.
Twenty-eight nurses were oriented in the field of public health
nursing. Many of the nurses had to be oriented in the local county
health units, since they were unable for personal reasons to go to
Gainesville for the two-months' orientation program. However, nine
nurses undertook this latter course.
A total of 823 nurses were employed by the State Board of Health
and by the county health units as of December 31, 1953. In addition .
there were 94 public health nurses employed by other agencies.
On December 31, 1953 there were only 13 vacancies in the county
health units.

IN-SERVICE EDUCATION, INSTITUTES, AND WORKSHOPS
The Division has continued emphasis during the past year on the
In-Service Study Program for public health nurses. Material ap-
proved by state and national organizations was sent to the Study
Groups for reference. The programs revolved around the activities
faced by the nurses from day to day, which covered all service
programs in the State Board of Health.
A series of eight 2-day heart institutes were held for public health
nurses in strategic points in the State. (See details in Division of
Heart Disease Control).
The Human Relations Workshops conducted by a Public Health

66 ANNUAL REPORT, 1953

Service psychiatrist in four different areas in the State have stimu-
lated role playing by staff members of the county health units and
have helped those who participated to recognize mental health
problems in individuals and to carry out subsequent action. The
attendance was limited to thirty for each workshop, which included
public health nurses and allied workers. Approximately 120 attended.
The Mental Health nurse consultant has worked very closely with
the Nursing Division in reaching the generalized nurses in the field
and correlating their work with this program.
The American Nurses Association, in cooperation with the State
Nurses Association (Public Health Nursing Section), conducted a
workshop in which the Division of Public Health Nursing partici-
pated. One of the purposes of the workshop was the development
of the Public Health Nursing Section as it affects the activities of
public health nurses and the relationship of this Section to the State
Nurses Association. Expenses for those who attended the workshop
were paid by the American Nurses Association and the State Nurses
Association.
The annual Supervisors' Conference was devoted to the evaluation
of the supervisor-nurse relationship. Resource persons in psychiatry
and psychology were secured from Florida State University.
The annual Seminar on Obstetrics, sponsored by the Bureau of
Maternal and Child Health, was attended by the staff of the Division
of Public Health Nursing and by nursing representatives from the
county health units.
Four nurses took the two-week course on the Care of the Premature
at Jackson Memorial Hospital in Miami.
The exchange visit program between public health and tuberculosis
hospital nurses was still in effect in 1953. Since the Program orig-
inated in 1950, approximately 300 public health nurses have spent
48 hours in one of the four tuberculosis hospitals, and about 50 nurses
from the hospitals have had a two-day orientation in a generalized
public health program in a county health department. Public health
nurses who made the 48-hour visit two or more years ago are re-
questing a return visit.

ADVANCED EDUCATION
Some public health nurses have indicated their interest in further
education by enrolling in the extension courses offered by the Florida
State University. The courses have been held in different sections
of the state. Each course carried three credits.

LOCAL HEALTH SERVICE 67

Four nurses took advantage of State scholarships for a year's pro-
gram of study in public health nursing. Two of the nurses who
accepted scholarships from the State have remained at the university
at their own expense to secure their Bachelor's Degree in public
health nursing.

SCHOOLS OF NURSING
The Division has participated in the planning of the public health
program in the basic curriculum of the schools of nursing by attend-
ing joint meetings with the instructors of the schools and the nursing
personnel of the local health departments. Applications received in
this office from qualified nurse instructors (especially in the field
of public health nursing) were referred to the various schools. Seven
county health units have accepted students from schools of nursing
for a three-day experience in the field of public health. The health
departments have also been asked to assist the schools in giving
lectures on the theory of public health nursing. Where a coordinator
is employed, this responsibility is left to her.

MIDWIVES
The State midwife teacher held 18 institutes with an attendance
of 187 midwives. Visits were made to twenty counties to assist the
nurses to further improve the midwife program, to recruit and train
persons replacing the old midwives, and to give individual assistance
to midwives in carrying out the policies and procedures of the State
Board of Health, such as filing birth certificates early. A total of 69
field visits were made to individual midwives and their cases. Ten
midwives were retired with honorable discharges. In 1953, 369
midwives were licensed.
The State midwife teacher spent three weeks at the Maternity
Center Association in New York City, attending a workshop on
Preparation for Parenthood.

VISITING NURSE ASSOCIATIONS
The organization and development of three Visiting Nurse Asso-
ciations (Clearwater, Ft. Lauderdale and Orlando) has been accom-
plished during the year, making a total of ten Visiting Nurse Asso-
ciations six of which are coordinated with the local health depart-
ments.

68 ANNUAL REPORT, 1953

CIVIL DEFENSE
The Division continued to participate in the State Civil Defense
Program by conducting classes for registered and practical nurses
on "Nursing Aspects of Atomic Warfare." A workshop was attended
in Gainesville on community participation in case of a disaster. This
was sponsored by the State Civil Defense organization.

SCHOOL HEALTH PROGRAM
A member of the staff participated in the joint meeting between
representatives from the State Department of Education and the
State Board of Health.

FIELD ADVISORY STAFF
J. L. WARDLAW, JR., M.D., M.P.H., Director

Personnel on the Field Advisory Staff consists of a director and
two each sanitation, record, and nurse consultants. The two nurse
consultants are loaned to the Division of Public Health Nursing and
function as district consultants through that office. Their activities
have been covered in the report of that division. As indicated by
the title of this division, personnel serve as general consultants to
the local health departments. They are concerned more with the
general over-all activities of the departments rather than with the
technical phases of the programs of the individual divisions and
bureaus, although all the consultants can and frequently do answer
technical questions which arise during their visits to the county
health departments.
While it is difficult to measure the accomplishments of a program
of this type, some indication of the activities of various members of
the staff is given in the accompanying table, except for the nurse
consultants. They work under direction of the Division of Public
Health Nursing. Routine visits are made to all new employees and
other visits are made to the counties only on request of the local
health department.
Although there were fifteen counties which were not visited by
the director, three which were not visited by a sanitation consultant
and five which were not visited by a record consultant, there was
no county in the state that was not visited twice during the year
by some member of the staff. The total number of visits made
represents an increase of slightly more than fifty per cent of those
made in the previous year.

LOCAL HEALTH SERVICE

TABLE 15
ACTIVITIES OF FIELD ADVISORY STAFF

TYPE VISITs PERSONS SERVED
Coun- Num-
Consultant ties ber Old New
Visited Visits Routine Request Em- Em- Health Group Other
ployee ployee Officer
Record...... 61 120 98 22 88 32 9 1 1
Sanitation.... 63 161 123 38 142 3 69 19 45
TOTAL... 124 281 221 60 230 35 78 20 46

This is indeed gratifying since beginning July 1 two things occurred
which drastically affected the program. First, because of budget
limitations it was impossible to replace one of the record consultants
who resigned, and second, the administration of the law requiring
the licensing of nursing homes was made the responsibility of the
Field Advisory Staff.

NURSING HOME LICENSURE
It became necessary to recall one of the nurses loaned to the
Division of Public Health Nursing and assign her and one of the
sanitation consultants to this program. Mrs. Feme Britt and Mr.
Claudius Walker were given this assignment. Their first duty was
to study the rules and regulations and the effect in other states having
similar regulations; and to develop a preliminary set of rules and
regulations for our program. This was quickly and efficiently done
and the tentative regulations were presented to the following com-
mittee:
Mrs. Ferne Britt, Nurse Consultant, State Board of Health
Mrs. Margaret H. Jacks, Social Worker, State Welfare Board, Jacksonville
Miss Marjorie Morrison, Chief Nutrition Consultant, State Board of Health
Mr. Liles W. Grizzard, Sec'y.-Treas., Dade County Convalescent Homes
of Dade County, Inc., Miami
Mr. Jack R. Rice, President, Convalescent Homes Association of Dade
County, Inc., Miami
Mr. Sidney Entman, Executive Director, River Garden Hebrew Home
for the Aged, Jacksonville
Miss Enid Mathison, Nurse Consultant, State Board of Health
Miss Mary Luvisi, Director, Visiting Nurse Association, Jacksonville
Mrs. J. Frank Rushton, representing Church Group, Jacksonville
Mr. J. B. Chancey, State Hotel Commission, Jacksonville
Mr. G. R. Wilson, Deputy State Fire Marshal, Jacksonville
Mr. Carl B. Davis, Chief State Fire Marshal, Tallahassee
Mr. Jack F. Monahan, Jr., Executive Secretary, Florida Hospital Asso-
ciation, Orlando
Mr. J. B. Miller, Sanitary Engineer, State Board of Health
Mr. Sherwood Smith, Director, State Welfare Board, Jacksonville
Mr. Philip S. May, Attorney, State Board of Health, Jacksonville
Wilson T. Sowder, M.D., State Health Officer, State Board of Health,
Jacksonville

70 ANNUAL REPORT, 1953

James L. Wardlaw, Jr., M.D., Director, Field Advisory Staff, State
Board of Health, Jacksonville
This Committee, which met on July 15, 1953, thoroughly studied
the proposed regulations and made many recommendations concern-
ing them. All of these recommendations were incorporated in a
second draft which was then presented to and adopted by the Board
of Health at their August meeting.
In order to acquaint the nursing home operators with the pro-
visions of the law and of the newly adopted rules and regulations,
meetings were held in fourteen key cities throughout the state where
Doctor Wardlaw, Mrs. Britt and Mr. Walker discussed the programs
and answered the questions raised by the nursing home operators.
The response to these meetings was excellent. They were attended
by four hundred and twenty-four people, including representatives
of the health departments in the cities where the meetings were held.
Following this series of meetings the actual inspection phase of
the program was begun. As of December 31 one hundred and fifty-
nine homes were automatically licensed (having until July 1954 to
meet standards) and forty-seven homes inspected. Although none
of the homes so far inspected have been able to meet the standards,
there were some who had very little to do in order to comply with
the regulations. There were many which were so far below standard
that they decided to go out of business immediately or before the
deadline of July 1, 1954.
It is our present plan to have all of the homes in the state inspected,
licensed and up to standard by July 1, 1954, at which time the pro-
grani will be turned over to the local health departments for the
continuance of inspections. In order to do this, however, it will
probably be necessary to provide another nurse-sanitarian team,
which will further handicap both our general consultation program
and that of the Division of Public Health Nursing.

HOSPITAL CONSTRUCTION AND LICENSURE
Although the hospital construction program in this State is the
function of the State Improvement Commission, the licensing of those
hospitals which were constructed in whole or in part through the
use of federal funds is the responsibility of the State Board of Health.
The following two new hospitals were licensed during the year, as
well as the eighteen previously reported in the 1952 Annual Report:
Hollywood Memorial Hospital, Hollywood ..---.... 75 Beds
Fish Memorial Hospital, DeLand --..-.........--------. 52 Beds

LOCAL HEALTH SERVICE

HEALTH CENTERS
New centers which were opened during the year were Winter
Haven and Hollywood and the Pinellas County Health Department
in St. Petersburg which was renovated.
Counties which are contemplating construction during the coming
year are Alachua, Jackson, Manatee, Broward and Hillsborough.

CIVIL DEFENSE
Due to the pressure of other duties, very little was accomplished
in the field of Civil Defense in the past year. At a Civil Defense
Leadership Conference held at the University of Florida on October
8-10, 1953, the State Medical Plan was discussed and in view of
recommendations made at that time the Committee was in agree-
ment that the plan should be revised. This project will be under-
taken as soon as possible after the nursing home licensing program
has become stabilized.

FIELD TRAINING CENTER, GAINESVILLE, FLORIDA
FRANK M. HALL, M.D., M.P.H.

The function of the Training Center (training personnel to meet
the demand for improved and expanded health services in Florida),
was limited severely during 1953 because of a budgetary cut. The
retrenchment in personnel coincident with the $16,000.00 budget
cut made it necessary to transfer the sanitary engineer from the
Training Center to other duties in the State Board of Health's central
office. This cut in financial support was effective July, 1953, with
the result that the counties sponsoring personnel for training at the
Center were required to meet all the costs of the training. It is felt
that this added responsibility placed on the counties, especially the
smaller ones, has not tended to encourage sending professional staff
members for field orientation.
While a training program has been created, with a staff capable
of organizing and manning field training activities, which it is be-
lieved serves public health needs in most areas, training has not been
as productive during the past year as formerly. The obvious factors
which cause this situation are: reduced financial support, transfer
of personnel, and academic leave. If the proper perspective can
be focused on public health personnel training to include assignment
of those who are qualified to do the training at the Center for specific
periods of time each year, the training program can be continued
successfully.

72 ANNUAL REPORT, 1953

On numerous occasions during the year, consultant service has
been rendered in one or more phases of the training program. This
service is heavily weighted in favor of sanitation problems. Requests
for assistance in various fields or activities are numerous and a sat-
isfactory solution is attempted either through correspondence or
personal visit and consultation. This consultant phase of the program
fits into the over-all cooperative training effort and the demand for
this type of service seems to be on the increase.
No specialized courses were offered during the year although the
training staff is interested in making this type of service available
on demand. These courses would be more specialized in content,
shorter in length and given on a decentralized basis, and tailored
to meet the needs of the group for which each is planned.
The personnel report of those participating in training activities
is as follows: 6 physicians (less than 1 month); 29 nurses (less than
1 month) and 6 (1-2 months); 8 sanitarians (2-3 months).
This training is offered to any person who can qualify under the
Merit System of the State. The principal purpose of the training is
to give the employed or prospective employee factual information,
orientation to field concepts and activities, and opportunity for prac-
tical experience in the field. The trainee is given an opportunity to
gain experience by actually participating in the regular activities of
an operating health department. Guidance and counsel are provided
by the training staff but each trainee has an opportunity to work on
his own in solving practical problems. Planned discussions, in which
trainees take part, precede and follow each field project.

PREVENTABLE DISEASES 73

BUREAU OF PREVENTABLE DISEASES
L. L. PARKS, M.D., M.P.H., Director

The Divisions of Communicable Diseases, Venereal Diseases,
Cancer Control, Industrial Hygiene, Veterinary Public Health and
Milk Sanitation constitute the Bureau of Preventable Diseases.
The activities of the various divisions are included in their re-
spective reports. Below are some of the problems and conditions
with which the Communicable Disease section has dealt during the
past year.
The reporting of most contagious diseases is far from complete
except in communicable diseases of major importance such as small-
pox, diphtheria or poliomyelitis. The number of reported cases of
many other illnesses indicate the trend of the disease in question.
Many communicable diseases have shown little change in incidence
in the past few years, such as amebiasis, typhoid fever, salmonellosis,
encephalitis, tetanus and typhus fever. There was one case of Han-
sen's Disease reported in South Florida this year.
The Medical Practice Act passed by the Legislature in 1951 nulli-
fied the regulations of the State Board of Health in the reporting
of communicable diseases. An Act was passed by the 1953 Legisla-
ture requiring the reporting of communicable diseases by certain
practitioners of the healing arts to the State Board of Health. This
Act required the reporting of communicable diseases by all attending
practitioners of medicine as well as veterinarians.
The State Board of Health continued to distribute biologicals to
the health departments without cost to the counties. The biologicals
are intended only for indigent patients and are not distributed to
private physicians for pay patients.
The distribution of gamma globulin for measles, infectious hepatitis
and poliomyelitis was made the responsibility of the State Board
of Health when this biological was taken off of the market. A few
people were disappointed in not being able to get gamma globulin
as freely as they desired, but it is believed that the distribution of
this product was handled reasonably well throughout the State by
the county health departments.
On July 22, 1953, Dr. Carl P. Bernet, Jr., was assigned to the Bureau
of Preventable Diseases from the Communicable Disease Center,
Atlanta, Georgia, for the purpose of evaluating the value of gamma
globulin in the prevention of poliomyelitis. Gamma globulin was

74 ANNUAL REPORT, 1953

made available from the Office of Defense Mobilization through the
National Polio Foundation and the American Red Cross. The quota
of gamma globulin made available to Florida was based on the num-
ber of cases of poliomyelitis which had occurred in Florida during
the years 1947-51. Certain rules and regulations, based upon the
recommendations of the Office of Defense Mobilization, were estab-
lished by the State Board of Health and presented to the local health
departments and medical societies for the handling of this biological.
At first, gamma globulin was made available only to household
contacts of poliomyelitis cases under thirty years of age and to pre-
natal cases of any age. Later, because of an increased supply, it
was extended to classroom school mates and other intimate or direct
contacts of cases. Although studies were carried out to evaluate
the effectiveness of gamma globulin throughout the state no definite
results could be drawn.
There were 733 cases of poliomyelitis reported in Florida or 70
more cases than were reported in 1952. Two hundred and nine (209)
of these cases were reported as being paralytic, 237 were non-
paralytic and 287 were not classified. Cases of poliomyelitis were
scattered over the State and occurred in 44 different counties. It
occurred every month of the year; however, the largest number of
cases were reported in October. The same was true in 1952. The
area affected most severely was Key West during September and
October; this area met the requirements of the Office of Defense
Mobilization for the mass gamma globulin immunization. An addi-
tional supply of this substance was made available to the Monroe
County area, and over 7,000 inoculations were given to children
under fifteen years of age, and to prenatal cases. After this immuni-
zation program a sharp decrease in the number of cases of the
inoculated group occurred, but how much credit could be given to
gamma globulin could not be determined.
There was an influenza epidemic in Dade, Collier, Brevard, Leon
and Okaloosa Counties during the first quarter of the year. No doubt,
there was also a marked increase of influenza in other parts of the
State which is not reflected by the case reports because of the in-
complete reporting of this disease in some counties. Influenza, as
a rule, is one of the poorly reported diseases, because many cases
are never seen by a physician, and the numbers can be multiplied
many times to represent the actual cases.
In contrast to influenza, measles hit a low record. Only 1,185 cases
were reported, the lowest number since 1948.
From only 66 cases in 1951 the number of diphtheria cases gradually
increased to 114 during 1953. Many of these cases reported were

PREVENTABLE DISEASES

in the South Central counties. In addition, a small epidemic occurred
in a colored housing project in Bay County. The importance of
immunization of the infant and pre-school child must be stressed
as the answer to the increase in diphtheria for the State.
Two diseases which were uncommon for many years are being
reported with increased frequency; namely, infectious hepatitis and
ringworm of the scalp. Both diseases are considered public health
problems. Infectious hepatitis increased from 4 cases reported
in 1949 to 301 in 1953. Children and young adults were the most
frequently involved, and the cases were scattered over Florida.
Ringworm of the scalp is less serious as it is not an acute illness
but it does affect the health of the child, and the interference in his
school life can be marked. This disease is due to two types of
organisms often referred to as the "human type" and the "animal
type." Formerly the more easily controlled "animal type" was the
causative agent in the majority of cases. The apparent increase of
the "human" infection has accounted for the rise in the total number
of cases.
The typhoid register showed 86 known typhoid carriers in the State.
There were 19 cases of malaria reported during the year. Most
of these cases were reported among returnees from Korea and no
known cases originated in Florida.
The incidence of communicable diseases for the year was not
particularly unusual for the State as a whole. No significant problem
occurred, but there was a slight rise in a few of the diseases which
emphasized the necessity of continued vigilance and control of the
scattered cases as they do appear.

TABLE 16
TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES, FLORIDA, 1953, AND STATE
TOTALS FOR 1952 AND 1951

*, i

151 B Z l l III a I l l i l l I I
Year 1953

1951............ ......... 5,057 317 2,603 90 60 66 88 47 17 8 10 214 12,709 417 6,561 584 46 40 23 2,431
1952 ............ ......... 5,333 462 1,261 72 143 82 161 235 12 13 82 304 11,809 233 ,611 218 236 120 50 4,072
1953 ............ .......... 5,717 328 1,900 145 96 114 177 53 9 22 42 305 11,459 109 4,206 1,406 301 96 19 1,316
Alachua 61,950 61 7............... 1 ... ... ......... ..... ... 127 76 8 224 ...... ...... 5 1 6 0
Baker ....... ........0... 3 00
Baker................. 6,320 8 ...... 6 ...... ...... .. ...... ...... ...... ...... ...... ... ... 3 142 ...... ...... ...... ....... 3
Bay ..... ... 42,720 62 1 26 3 ...... 11 15 4 ...... ...... 10 8 217 2 154 12 3 ...... ...... 8
Bradford ...... 11,910 15 .. 21 ...... ...... ...... 1 ...... ...... ...... ...... ... 3 ...... 69 ...... ...... ...... .... 2
Brevard............... 26430 4 13 100 ...... 1 ...... ...... 1 1 ............ 2 130 1 11 124 12 1 1 22
Broward.............. 105,660 147 13 33 ...... ...... 2 3 1 ...... 1 2 1 183 3 22 9 3 6 1 87
Calhoun.............. 7,920 12 ... ...... 2 ...... 2 ...... ............ .... ..... 6 ....... .........
Charlotte............. 4,320 19 ...... 33 1 ...... 1 .. ........ ......... 1 5 ...... 12 ...... .... ............ 1
Citrus ................. ,510 10 4 ...... ...... ...... ... ...... ...... .
rClay ........ 17130 17 2 36 ...... .... .1.. 1 ... .. ... .. ....... 1 18 1 5 ....... .
Collier. ............. 7,510 7 1 8 ...... 1 1 3 ...... ... ...... 1 2 26 ..... 1 165 1 1 ..... 36
Columbia ............. 18,880 32 ...... ...... ........ 2 ............ ................. 63 1 1 ...... .... 2 2 .....
Dade............ 612900 1,128 71 546 20 77 4 67 2 1 4 ... 30 2,025 11 9 261 42 7 ...... 228
DeSoto............... 10,800 24 ...... 1 ............ 1 ............ ...... ..... ...... 8 ..... 5 ........................ 2
Dixie ............... 1 3 0 00 4 36......... ...... ...... .............1... ...... .. .
Duval................. 324,600 444 93 187 2 2 4 18 3 ..... 1 .... 36 1,578 12 165 9 18 37 ...... 73
Escambia.............. 117,00 162 26 22 33 2 .... 3...... 3 ...... 19 891 2 24 44 28 3 7 10
Fagler .............. 3,850 11 ...... 23 .................... ... 4 ..... 7 ...... ......... 7
Franklin.............. 5,800 27 .. 4 .. 1 30 ...... 127 ..... .. 18
Gad den .............. 40,010 37 1 10 ...... ...... 4 1 ...... 1 ...... .... .. ..... 209 ...... 21 9 ...... ..... ....... 1
G ilchrist ....... ....... 3,630 11 ...... ...... ...... ...... ...... ...... ...... ...... ... 1 ...... 3 .. ... ...... ... ..
Glades ......... ..... 2,200 4 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2
Gulf. .e............... 7,830 12 ...... ...... ......... 1.......... ...... ................... 24 ......... 1......
Hamilton............ 9,150 17 .... . ..... .. ...... .... 55 ...... .... ... 1 ... .
Hardee............. ...... ............11,070 25 ........................ .............. 275 ..... 1...... ...... 1
endry.............. 6,630 7 ...... 1 ........................ 1 .................. ...... 9 ...... 4 ...... ..... ...... ...... 2
Hernando............... 7,300 11 ...... ...... .......... ... .. 1

Holmes............... 14,010 20 ...... 1 ...... ........ ...... ...... ..... ....... .... .. 2 ......... .......
Indian River........... 13,690 29 ...... 4 ...... ...... ...... ...... 3 ........... ............ 7 26 1 2 ...... ..... 9
Jackson............... 34,750 47 ...................... 1 ............... ...... ...... ...... 300 ...... ...... ..... 1 .... .......

TABLE 16-Continued
TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES, FLORIDA, 1953, AND STATE
TOTALS FOR 1952 AND 1951

3 s
C aS 0. t e
Year 1853 6 a

Jefferson .............. 10,410 12 ...... 9 .......... ...... ...... ...... .... .. ... 1 3 1 ...... 62 ...... 1 .... .. ..
Lafayette .............. 3440 6 : .......2 .... 8 i .. 2 ...... 52
Lake.................. 41,800 66 2..... .. i 3. ..... 7 138 8 1. .52
Lee ............... 23,410 49 12 8 ......... 2 29 ..... ...... 1 ..... 71 2 41 8 1 ............ 56
Leon................ 56,300 70 10 59 2 .. 2 1 8 .. 1 1 791 1 379 200 24 ............ 21
Levy................ 11,060 15 .... 3 ....................... ... ... ... ......... 2 ...... 186 2 .................. 2
Liberty .............. 3 180 3 ...... ..... ... ... .. ............ ... .. ............ ... .... ....... .. 154 ... .. 1 ................
M adison ............ 14,210 30 1 1 ...... ...... 1 ...... ....................... ..... 41 ...... 120 ............ ....... ..... 1
Manatee............. 39,820 84 5 11 5 ............ 1 1 ...... 3 1 ..... 98 2 111 14 3 ............ 5
Marion........ ........ 40,170 61 10 5 .. .. ............. .... ... ..... ........... 286 5 ... 41 ...... ... .. ...
M artin................ 8,970 20 ...... 25 .. ...... ........... 3 ............ 1 ..... 21 .... 5 16 .. 3 1 2
Monroe.............. 37,110 35 2 35 ...... 1 3 2 ...... ................. 4 281 .......... 20 ...... .. ... 65
Nassau.............. 14,150 18 1 6 ........ ........................................ 12 1 34 10 2 .... ..... 1
Okalo sa. ............. 34920 38 6 24 1 3 ...... 1 ...... ....................... 273 ...... 18 233 9 ............ 5
Okeechobee............ 3,750 2 ... 9 ............ 2 1 .. ...... 8 ...... 9 3 2 ............ 8
Orange............... 133,00 256 3 8 ...... 1 18 1 ...... ..... 207 7 37 7 29 ...... ...... 138
Osceola .............. 11,950 43 .. 5 2 .. 14 34 ...... 4 2 ...... ...... ..... 5
PalmBeach.......... 121,550 309 6 45 ............ 1 1 .. 2 ...... 1 524 31 5 5 1 22 2 51
Pasco .............. 25,000 54 1 67 68 ...... ...... ...... 1 ........................ 45 2 385 1 2 ............ 3
Pinellas ............... 178,070 516 4 45 ............ 4 7 2 2 ..... 12 1 280 2 125 7 2.......... 8
Polk.................. 132,000 187 2 9 ............ 16 ...... 3 2 ............ 1 207 1 41 37 26 ...... 1 146
Putnam ............... 27,390 39 2 4 ................. 1 1 .... ...... .... ..... 48 1 1 ...... 1 ...... ...... 1
St.Johns.............. 27,200 58 2 1 ..... 1 3 ................ ..... 1 .... 71 4 1 1 2 ............ 1
St.Lucie.............. 24,900 36 1 2 ...1 ...... ...... 1 44 3 10 3 ..... 1 .. ...
Santa Rosa............ 19,550 34 ..... 2 ........ 1 1 .. ........................ 3 2 ..... 184 ...... 1 ...... 1 2
Sarasota............... 35,090 84 .......... ..89 ...... 32 1 1 ............ 16
Seminole.............. 28,430 43 ...... 15 3 3 6 ....................... 1 7 83 ...... 5 19 11 1 ...... 12
Sumter ................ 11,900 16 7 .. .................... 3 ..... 1 ............ 52 ...... 182 23 .................. 28
Suwannee ........... 17,010 32 .. 2 1 .............................. 116 ...... 6 11 2 3 ...... 3
Taylor.............. 10,400 20 ...... 4 ............ 1 .................. ...... .... .. .119 ..... .. .. ..... ..... ......
Union ............... 7,440 8 ........... .......... ... ..............................10 .... 21 ...... .... .... ..
Volusia................ 84450 420 2 25 ............ 1 1 69 ........ 1........... 19
Wakulla ............... 5,380 12 1 5 ..... ............ ..... ........ ...... 1 45 ..... 55 21 .... ..... ..... 4
W alton.............. 15,290 33 2 ..... ..... ........ .... .. ........... ..... ..... ........ 94 ..... 1 ............ ...
Washington .......... 11,890 24 ...... 2 .. ..... .... ........... ...... .... ........... 2 ... 78 ................. ........

TABLE 16-Continued

TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES, FLORIDA, 1953, AND STATE
TOTALS FOR 1952 AND 1951
__ __ __ _- _- -_ - -

Year 1953

1951....... 92 2,101 14 8 727 362 11
1952........ 88 1,985 20 10 707 663 20
1953........ 102 1,112 7 15 959 733 58

Alachua................ 8 1
Baker............ ...... ..... .....
Bay .............. 5 16 ... .
Bradford.... ..... 25 .....
Brevard................. 17 .....
Broward................ 18 ......
Calhoun.......... ....... ....
Charlotte......... ...... 3 ......
Citrus .......... .. ................ .
Clay.................. 3 1
Collier........... ...... 4 ......
Colum bia.......... ...... ..........
Dade............ 10 458 1
DeSoto................ 2 .....
D ixie............. ..... .....I
Duval......... .... 18 64 .....
Escambia.......... 12 14 1
Flagler....... ....... 4 .....
Franklin. ........ .. ..... .. .....
Gadsden............... 2 ....
Gilehrist.......... ...... .....
Glades........... ...... ....
Gulf............. ....... ....
Hamilton.......... ...... ...........
Hardee........... .. .. .. ....
Hendry......... ...... I .... ....
Hernando......... ...... .... ....
Highlands......... ...... 2 1
Hillsborough....... 22 72 1
Holmes........... .. ..........
Indian River....... 1 4 .....
Jackson........... 2 ..... ....

7 1

19 1
37 ......

2 ....
2 ......
5 1
1 .
1 ....
132 ....

.45.......
19 2

1 ....

3 1.

65 9
2 3

...... 15

2

2

1

61 9,445
48 10,824
95 6,722

Other Diseases

5i

6 0 2 5
50 1 2 0
103 1 1 1

4 .....
2 .. ..
1 ..
3 2

55 70

56 7
32 ...
I
1 ......

9 ......

...... ......
5.. ..
112 6
2 ....
2 2

34 2,590 6
46 2,603 18
44 2,424 7

27 ......
5
S ... ..
42 ....
8

91 1
6.
3 .
2.
8
18 ...
13 ....
449 4
14 ..
2 .. .
268 .....
101 ...
5 1
3 .... .
57 ..
1 .
2 .
9 ......
9
6 .....
5

9 .....
22 .
278 .....
5 ......

14 ......
17 ......

...... ....

I ......
..... ..::::::
1 .
1.

1 .
11 i1

S .... ..

...... 1
....1 .....
.. ... 1
f

I i

E -i--I --I 1-

-1-1-1 I I I

I

' '

...... ..... 1
... i. 2 4.i

_ _^

I

' '

I I

I

TABLE 16-Continued
TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES, FLORIDA, 1953, AND STATE
TOTALS FOR 1952 AND 1951

Other Diseases

z .0
Year 1953 0

Jefferson .......... ...... 3 ...... ...... ...... ...... ...... ...... ...... ...... 9 ...... 5 ...... ...... 1 ...... ...... ...... .... ... .......
Lafayette.......... ... 7 ...... 1 .I ....
Lake.......... .. ... 28 ... .. 1 4 7 3 10 ...... 39 .... 1 2 3
Lee............... 1 3 ...... ... .. 1 4 ...... 3 3 ...... 103 .... 18 ...... ...... ...... ...... ...... 3 6 .
Leon .............. 1 7 ...... ...... 31 0 1 ...... 28 2 223 1 30 ... .. ... ... ......... 5 2 46 1 .....
Levy..erson............. 1 .................................... ......1 ........... ................. ...............
Libertyt......... ............. ............... ............... ............ ...... 2 ...... 1 ..
Madison.......... .... 28.... ........... ...... 2 ..... .... ...... ...... 30 ...... 8 ....... 2 3 .............
Manatee.......... 1 ....... 6 ..... 66 1 35 ........ ...... ............ 3 ...... .. ..... .. 1
arion.......... ... ... .. 1 1 ... 1.. 4 2 ..... 3 ... 1 45 .................... .. ....
Martin............. 1 1 ...... ...... ...... .......... ....7 ......... 2 ..0 .. ..... ..... .... .. ....
M onroer ........... 5 ...... 1 30 9 59 ...... ...... 8 ...... 93 1 8 ....... 1 ... .. ...... 3 24 .15 .... .... ....
Nassau............ 1 25 ................ 2 ................... ... ... 23 ...... 4 ....... ............ .......... ........ ....
Okaloosa.......... 1 23 ............ 22 ......... ... 4 ... 28 ...... 8 ...... ........... ...... .... .... ....... ..
Okeechobee...... ... 31 ...... ...... 1 ................. .... 15 ..... .... .... ... ...... .... .. ......... .. .. ...
Orange........... 3 63 .................. 64 3 .... 3 38 ...... 251 1 89 ...... 1 1 ......... .4 .. .... ....
Osceola....... .. 2 ...... ....... .... .. 3... ......... .. ..... 30 ...... 17 ...... .................. ..............
Pal Beach............ 20 ...... ...... 64 1 ....... 24 ....... 283 7 127 ........ ...... ...... ....... .. ........
Pasco .......... 35 ...... ...... .. 12 1 1 2 3 ... 33 ...... 12 ...... .. ...... ....... 6 1 .... .......
Pinellas........... 2 28 ...... 2 7 35 1 9 18 ...... 277 1 157 ...... 2 ...... ...... ... 3 4 .. ....
Polk.............. 7 11 ...... 4 65 36 1 ..... 23 1 164 ...... 101 ...... 2...... ... 1 12 1 ........
Putnam ........... 1 4 .... ............ 4 ...... ...... 4 ...... 47 ... 23 ... 23 ...... .... .. 2 ...........
St. Johns.......... .. .... 5 ..... ........ ....... 1....... 3 ...... 99 ...... 12 ................... ............
St. Lucie ......... 1 ...... ...... ...... 1 2 ... ............ ...... 36 ...... 11 ...... 2 .................. ...
Santa Rosa........ .. .............. ...... 2 16 ...... .. I.. 1 ...... 7 ...... 7 .. ...... ..... .......
Sarasota........... 1 .. .... .. .. .... ... 2 ........ ...... 7 ...... 1 ... .. ..
Seminter .......... 2 1 ...... ... ... 2 3 ............ 4 ........ 115 ..... 15 .... ... .. 1....... .. ... ....
Sumter............ ...... 9 ...... ...... 2 1 1 2 1 ...... 21 ...... 2 ..
Suwannee........ .... 2 .. .... ...... 4... 1 1 2 30 ... 11 ............ 1. ...........................
Taylor........... .... .. 3 ...... ...... 1 2 ...... ...... 3 ...... 19 ...... 7 ................... .... 7 ... .........
Union.................. 1 ................................................ ......... 24 ........ ... ................. ................
Volusia........... 1 18 ............ 1 6 2 .... 12 .... 127 ...... 43 ...... 2 1 ............ 8 ... .. ..
Wakulla..................... ........... 2 ............. ..... .... 9...... ........ .......... ............
Walton.................. 1 ......... 4 .......................... ...... 2 3..............................
Washington........ .. ..5..... .... ... .1 3...... ..6..5........ 1. ......I .........................

80 ANNUAL REPORT, 1953

VENEREAL DISEASE CONTROL
WILLIAM A. WALTER, M.D., M.P.H.,Director

During 1953 syphilis has shown a marked decline over the previous
year. Florida had a total of 6,722 reported cases of syphilis com-
pared with 10,824 in 1952. Thus there was a decrease of about 38
per cent. A total of 585 primary and secondary cases reported this
year compared with 785 primary and secondary cases in 1952 rep-
resents a decline in early infectious cases of 25 per cent.
The Central Registry Unit shows that approximately 50 per cent
of all cases of syphilis are reported by private physicians, which fact
is of tremendous value to the public health program. Yet we realize
that case interviewing, contact follow-up, and adequate treatment
must reach many of these cases reported by private physicians.
Often he is too busy to perform this important phase of venereal
disease epidemiology. Public health workers must strive untiringly
to enlist the cooperation of the private physician in this field, if
the situation is to improve. Only half of our known cases of syphilis
are being contacted through the county health departments.
The reported incidence of gonorrhea has shown a slight decrease
during the year. This relatively small drop in reported infections
has not resulted in any appreciable change in the gonorrhea case
load. A much higher percentage of cases of gonorrhea are reported
by the local health departments compared with reporting of syphilis
by private physicians. This is believed primarily due to one-visit
diagnosis and treatment of gonorrhea, whereas syphilis patients must
return for several visits before completing adequate therapy.
The lesser venereal diseases known as chancroid, granuloma in-
guinale, and lymphopathia venereum have all shown a decrease
during the past year. In previous years, it is believed that the rise
and fall in reporting of these diseases was often due to improper
diagnosis. This year, of the 533 cases of all the minor venereal
diseases reported only eleven cases were reported by private physi-
cians. The greater percentage of reported cases were diagnosed in
the Prevention and Control Centers.
The six Prevention and Control Centers located at Jacksonville,
Miami, Pensacola, Tallahassee, Tampa, and West Palm Beach have
functioned since the latter part of 1952. These centers have not
only cared for the venereal disease case load within their respective
counties but have given diagnosis, initial treatment, and/or valuable
aid to designated counties in their regions. A total of 96,622 persons

PREVENTABLE DISEASES 81

were examined during the year and 2,824 were given epidemiological
treatment. However, with the present drugs and proper epidemiology
to combat our venereal disease problems it is believed the Prevention
and Control Centers will soon give way to the local health units.
This will integrate this phase of public health into their regular
schedule of controlling public health hazards and problems within
the community.
Florida has seen a tremendous change in venereal disease control
in the past few years. The first federal assistance was received in
1936. The Division of Venereal Disease Control was established
in 1938, and consisted of a director and three lay workers. (For
an inclusive review of venereal disease activities in the years past,
please see the 1952 Annual Report.)
Briefly, in these fifteen years of venereal disease control, it can
be seen that the early methods of control were very unsatisfactory
due to long treatment schedules and poor epidemiology measures.
The inpatient care at the Rapid Treatment Centers was unquestion-
ably of utmost value in diagnosis, treatment, and follow-up of patients
and contacts. Now the trend is away from outpatient ambulatory
care in the Prevention and Control Centers and back to control by
county health units.
The venereal disease control program has achieved great success
during the past few years mainly due to improved medical treatment,
better epidemiology, and widespread public interest. Much of this
success has been possible because of federal assistance in technical
aid and funds.
TABLE 17
SYPHILIS CASES REPORTED BY STAGE OF INFECTION AND
RACE, AND RESULTS OF DIAGNOSTIC OBSERVATIONS
FOR VENEREAL DISEASES, FLORIDA, 1948-1953

SYPHILIS CASES REPORTED
V.D. DIAGNOSTIC
OBSERVATIONS
By Stage By RaceBSERVATIONS

> E0 S

1953 6,722 309 276 2,245 3,648 244 1,706 4,894 122 163,181 15,628 9.6
1952 10,824 392 393 3,870 5,730 439 2,347 8,284 193 132,360 13,967 10.2
1951 9,445 550 561 3,188 4,711 435 2,335 6,914 196 163,054 18,070 11.1
1950 10,784 769 741 3,997 4,833 444 2,750 8,034 159,666 28,992 18.2
1949 12,405 1,077 1,297 4,817 4,731 483 2,857 9,548 156,394 38,126 24.4
1948 15,395 1,990 2,857 5,178 4,844 615 3,344 12,140 137,998 35,556 25.8
Included in White.

82 ANNUAL REPORT, 1953

TABLE 18
TOTAL NUMBER OF SYPHILIS CASES REPORTED BY STAGE
OF INFECTION, PREGNANCY STATUS, RACE AND SEX,
SOURCE OF REPORT, BY COUNTIES, FLORIDA, 1953

STAGE OF INFECTION RACE AND SEX SOURCE OF
REPORT
White Colored

County

TOTAL............ 6722 309 276 2245 3648 244 213 875 831 2275 2619 122 3159 3465 98
Alachua............. 106 4 6 37 5 4 17 7 2 42 52 3 78 28 ....
Baker............. 15 1 1 2 11 .... 2 4 1 1 9 .... 7 8 ...
Bay............... 59 9 2 24 21 3 4 5 17 33 .... 45 12 2
Bradford........... ........ 2 7.... 1.... 1 5 1 2 8 1 ....
Brevard........... 161 6 9 66 76 4 2 11 13 63 72 2 111 50 ...
Broward............ 334 30 11 156 123 14 9 34 44 121 133 2 113 221 ..
Calhoun............ 3 2 2 .... 2 1.... 2 3 4 .... 3 6....
Charlotte........... 9 1 .. .... 8.... .... 3 2 3 1 6 ...
Citrus............... 8 ........ 4 4 .... .... 1 1 2 4.... 4 4 ...
Clay..... ...... 25 .... .. 5 20 .... .... 5 2 8 10 .... 19 6 ...
Collier........... 46 .... 1 15 28 2 2 4 3 9 30 .... 35 11 ....
Columbia............ 58 5 6 16 26 5 4 5 3 25 23 2 32 26 ....
Dade.............. 1376 55 45 395 836 45 42 268 286 333 453 36 418 958 ....
DeSoto............ 21 1 .... 1 16 3 ... 8 6 4 3 .... 5 16 ....
Dual........... 1100 26 47 395 612 20 20 109 87 358 512 34 398 702
Escambia ....... 166 12 7 60 77 10 4 10 13 67 76.... 150 16 ....
Flagler.. ........... 9 ..... 1 2 6 ..1 8 7 2 ....
Franklin ........... 15 .... ....9 2.... 2 5 1 7 11 4 ....
Gadsden........... 71 5 5 30 27 4 3 4 25 39.... 22 49 ....
Gilchrist.... ........ 2..... .... 2 ... 1 1 .... 2 ......
Glades............. 2 .... ... ..... 1 ... 1 ...... .... 1 1 .
Gulf .............. 14 .... 1 3 8 2 3 1 3 2 8 .. 11 3..
Hamilton........... 41 4 2 7 26 2 2 5 17 14 .... 29 12 ....
Hardee.............. ........ 3 3 .... .... 1 2 ..... 3 ... 3 3 ....
Hendry..... .. 17 3 .... 8 6 .... 1 1 1 6 9 .... 10 7 ....
Hernando......... 8 .... 1 2 5 ........ ........ 5 3 .... 7 1 ....
Highlands......... 31 2 1 8 16 4 3 1 2 14 13 1 15 16 ....
Hsborough.. 351 19 17 122 180 13 5 61 56 111 120 3 216 116 19
Holmes............. 9 ....... 1 8.... 1 3 3 3 ...... .... 5 4 .
Indian River......... 35 .... 10 19 3 2 5 4 8 18 4 31
Jackson.......... ... 42 1 1 9 21 10 .... 1 3 19 18 1 38 4
Jefferson............ 9 .... 2 2 3 2 .... .... .... 3 4 2 5 4 ....
Lafayette........... 2 4 1 .... 1 ........ 3 4 .... 2 5 ....
Lake.............. 69 5 1 24 38 1 3 7 2 28 32 .... 20 49....
Lee ............... 103 5 .... 54 44.... 4 8 8 29 57 1 82 21 ....
Leon............. 208 2 4 52 132 18 3 6 9 95 94 4 183 25 ....
Levy.............. 16 1.... 7 7 1 1 1 .... 9 6 .... 11 5 ....
Liberty.... ........ ... .. .... 1 1 ... 1 ...... ...... 2 ....
Madison............ 30 1 1 5 17 6 3 3 3 8 16 .... 18 12 ....
Manatee............ 66 2 1 27 32 4 .... 6 8 26 25 1 38 28 ....
Marion.............. 101 4 4 40 48 5 3 4 6 46 44 1 67 34 ....
Martin.............. 30 .... 2 12 16........ 3 2 14 11 .... 18 12 ....
Monroe............ 93 14 7 20 51 1 2 15 14 36 28.... 61 32 ....
Nassau.............. 23 1 3 3 15 1 1 1 5 8 .... 13 10 ....
Okaloosa........... 28 8 .... 8 12 .... 3 4 4 8 12 .... 19 4 5
Okeechobee.......... 15....... 10 5 .... .... 1 1 7 6 .... 12 3 ....
Orange ............ 251 5 25 86 130 5 5 36 40 73 97 5 94 156 1
Osceola........... 30 .... ... 5 25.... 1.... 5 10 14 1 22 8 ....
Palm Beach......... 283 14 4 149 106 10 7 34 31 144 74 .... 149 134 ..
Pasco............... 33 5 2 9 17.... 2 8 3 13 9 .... 14 19 ....
Pinellas............. 277 16 18 48 188 7 7 60 52 85 76 4 135 142 ..
Polk................ 164 9 7 53 93 2 3 26 17 53 59 9 41 123 ....
Putnam ............ 47 .... 1 13 32 1 4 4 5 21 17 .... 13 34 ..
St.Johns............ 99 5 4 44 42 4 12 6 5 47 41 .... 75 21 3
St.Lucie........... 36 .... 2 11 19 4 2 2 2 11 21 .... 20 16....
Santa Rosa.......... 7 ....... 2 5 ........ 2 2 1 2 .... 7 ...... ..
Sarasota............. 32 1 .... 6 25........ 4 4 10 12 2 4 28 ....
Seminole............ 115 4 4 50 54 3 10 2 7 53 2 1 20 95 .
Sumter.............. 21 2 1 8 9 1 2... 1 7 13 .... 11 10 .
Suwannee........... 30 .... 7 7 14 2 1 1 2 15 11 1 19 11 ....
Taylor........... 19.... ... 7 12.... 1 2 1 5 11 ... 11 8 .
Union............... 59.... .... 20 39 ........10 ... 44 5 .. 4 ..... 55
Volusia.............. 127 9 8 35 70 5 4 24 17 47 38 1 55 72 .
Wakulla ............. 9 ...... 8 1 ............ 4 4 1 8 1
Walton.............. 20 2 4 8 6 1 4 5 4 7 .. 15 5
Washington........... 6.. .... 3 1 2 1 2 .... 1 3 .......... 6
Federal Prison....... 15 4 4 7 ........ 8 7 2 13
State Hospital....... ... .. 23 59 ........ 21 10 24 26 1 82.. ...
State Prison......... 5 .... .... ...... 5 .... .... 2 .... 1 1 1 1 4 ....

PREVENTABLE DISEASES

CANCER CONTROL
L. L. PARKS, M.D., M.P.H.,
Acting Director

Cancer was again the second leading cause of death in the State.
There were 5,717 cases of cancer reported during 1953. However,
it is known that many cases are not reported since almost all reports
are obtained from death certificates, records of persons receiving
State aid, or from tumor clinics. Sixty-six per cent of the cases were
first reported by means of death certificates.
The services available under the Cancer Control Program at the
end of the year were limited to diagnostic procedures and the hos-
pitalization of cases through the seventeen tumor clinics in operation
in the State. The demand for assistance in the diagnosis and treat-
ment of cases has increased gradually since the program was started
in 1947.
Fees were paid to surgeons, radiologists and anesthetists in the
beginning of the program in 1947. Palliative x-ray therapy was
paid for as well as some drugs such as testosterone, but with the
growth of the program the fees to physicians, the supplying of drugs,
and x-ray treatment were curtailed little by little each year. In
September 1953 fees to radiologists for x-ray therapy and the fees
to anesthetists were discontinued because of lack of funds. The
hospital services exceeded the budget and it was necessary to call
upon the State Cabinet of Florida for additional funds in order to
pay hospital bills. Fifty-two thousand dollars was released by the
Cabinet and this grant, and the discontinuation of all physicians'
fees, ended the year on a cash basis for this program.
In order for a patient to be eligible for state aid under this program
it is necessary that he fill out an application stating his (or her)
financial condition and have it signed by the attending physician,
and approved by the county health officer or welfare worker as to
whether the case is indigent or not. Then the patient is processed
through one of the tumor clinics of the State. If the case offers
a reasonable hope of recovery the patient may be given assistance if
recommended by the tumor clinic director.
Since the State no longer pays for x-ray therapy it has created
a problem which has not been solved in some areas. Patients are
encouraged to go to tumor clinics early for diagnosis, but if x-ray
therapy is indicated it falls back upon the individual to pay for it,
or he has to ask for aid from the local welfare board or county
commissioners of the community in which he lives. Most of the

84 ANNUAL REPORT, 1953

radiologists that have been taking part in the cancer program have
been very liberal in giving their services. However, there are a few
cases for whom x-ray therapy has not been made available as it
should.
The standards under which the tumor clinics operate are those
of the American College of Surgeons and the Florida Cancer Council.
In order for a tumor clinic to obtain financial assistance from either
the State Board of Health or the American Cancer Society, Florida
Division, certain requirements must be met. These requirements are
reviewed annually by the Florida Cancer Council and must have
the approval of the County Medical Society. Provisional approval
of a new clinic is first given by the Cancer Council if the require-
ments are met. The American College of Surgeons representative
makes inspections about every fifteen months. In October 1953,
the American College of Surgeons listed the following diagnostic-
treatment clinics as having their approval: Halifax District Hospital,
Daytona Beach; Duval Medical Center, Jacksonville; Jackson
Memorial Hospital, Miami; St. Francis Hospital, Miami Beach; Orange
Memorial Hospital, Orlando; Escambia General Hospital, Pensacola;
Tallahassee Memorial Hospital, Tallahassee; Tampa Municipal Hos-
pital, Tampa; and the Tumor Clinic of the Palm Beach Medical
Society, West Palm Beach. Diagnostic clinics were approved at
the Alachua County Tumor Clinic, Gainesville, and Pinellas County
Tumor Clinic, St. Petersburg. The following tumor clinics have
the approval of the Florida Cancer Council: Munroe Memorial
Hospital, Ocala; St. Vincent's Hospital, Jacksonville; Morrell Memorial
Hospital, Lakeland; Manatee County Hospital, Bradenton; Sarasota
Tumor Clinic, Sarasota; and Fort Lauderdale Tumor Clinic, Fort
Lauderdale. The Bradenton and Sarasota Tumor Clinics were newly
established during the year.
Financial assistance in operating the tumor clinics is furnished
either by the State Board of Health or the American Cancer Society,
Florida Division, or by both agencies, depending upon the size of
the clinic. There is a full-time or part-time secretary in each of the
tumor clinics, and nurses are made available through the hospitals,
health departments or the local Cancer Society.
Biopsy service is made available by pathologists in private practice.
The pathologists agreed on January 1, 1951, to make tissue exami-
nations on indigent patients free of charge, providing the attending
physician made no charge for his services. If the attending physician
charges for the taking of the biopsy then the pathologist expects his
fee. This service has continued and seems to be working out very
satisfactorily.

PREVENTABLE DISEASES 85

Arrangements were made early in the cancer program to pay the
hospitals on a cost basis. The hospital is required to submit a detailed
cost basis statement. These costs (as submitted by the hospitals that
will accept state aid cases) vary from $8.34 to $28.94. The Florida
Hospital Association has presented the problem of the hospitals losing
money on the acceptance of state aid cases inasmuch as the maximum
allowance that can be paid hospitals for the acceptance of state aid
cases is $15.00 per day. This includes all services while the patient is
in the hospital: x-ray, diagnostic procedures, laboratory procedures,
drugs, operating room fees, anesthetic, dressings, room and meals.
All the hospitals that have been interested in this service have con-
tinued to accept state aid cancer patients with very few exceptions
even though they do lose money.
The Florida Cancer Council, which was organized in 1951, con-
tinued to function and held two meetings during the year. This Coun-
cil is made up of two physicians of the Cancer Committee of the
State Medical Society, two physicians of the American Cancer Society,
Florida Division, two physicians of the State Board of Health, and a
physician representing the American College of Surgeons, and has
been very helpful as a policy making body. It also has had the
responsibility of advising how cancer funds available from the State
Board of Health and the American Cancer Society, Florida Division,
may be used.
The state-wide three day seminar on cancer was not held for phy-
sicians this year. This was the first year this seminar was not held
since 1947. The Cross Roads Cancer Seminar was conducted in Live
Oak, Apalachicola, Marianna, Shalimar, Ocala, Arcadia, Fort Pierce
and Fort Lauderdale. Total attendance at these eight meetings were
127 physicians and 26 others including nurses and hospital tech-
nicians. This was the fourth year that the Cross Roads Seminars were
conducted. These meetings are only one-half day sessions held in the
small cities of the State and are intended to bring newer ideas on
cancer services to the physicians in these areas. The Seminars are
held in different cities each year. The speakers are usually from one
of the medical schools in the Southeast.
The Director of the Cancer Division of the State Board of Health
continued as a member of the Executive Committee of the American
Cancer Society, Florida Division, and has worked very closely with
the Cancer Society in the program of cancer education for the public.
He has taken part in the various cancer society meetings that have
been held throughout the State.
Certain types of cancer patients have been referred to the Oak
Ridge Institute of Nuclear Studies, Oak Ridge, Tennessee, through

86 ANNUAL REPORT, 1953

arrangements with that institution. The Institute accepted cases of:
osteogenic sarcoma, chronic granulocytic leukemia, acute leukemia,
polycythemia vera, multiple myeloma, certain thyroid cancers, patients
with ascites or pleural effusion due to neoplasms, and certain types
of cirrhosis of the liver. The cost at the hospital is borne by the
Atomic Energy Commission. The transportation to and from the hos-
pital was provided by the individual patient or in rare instances by
the Florida Division of the American Cancer Society. During the year
10 cases were referred to Oak Ridge through this Division.
The many problems that remain unsolved in the cancer program
are as follows: Early diagnosis of cancer is still the primary objective
of the program and state funds are limited for services to the cases
that offer a good prognosis. If the patient's condition is far advanced,
no assistance can be given because of limited funds for this program.
The care of the terminal cases reverts to the local community or to the
individual's family. As stated above, x-ray therapy is not always made
available because of lack of facilities in the community; prolonged
hospital stay is not permitted under this program because of limited
funds, and the financial responsibility often falls upon the hospital
or some other agency. The hospital per diem allowance by the State
has not been sufficient in some hospitals and where the patient is
hospitalized in an adjoining county hospital it creates an administra-
tive problem which has not yet been solved. It is difficult sometimes
to turn down the hospitalization of cancer patients, but, at the same
time, the administrator of such a program has to live within his
budget. However, it is believed that the patients that have been
refused state aid have been those cases in which the patient's con-
dition was too far advanced for services available: surgery, x-ray or
radium. Calls have been made on the program for some of the later
types of treatment, such as mustard gas, hormones, and other drugs,
but these services cannot be furnished with the limited funds avail-
able for this program.
After a full year of operation under the IBM tabulation system,
it was found that a detailed study of the cancer program could be
accomplished with greater ease than ever before. A summary of data
obtained from the cancer registry is shown in Tables 19-23.
During 1953 a total of 1639 persons were approved for state aid.
This is almost the same number as was approved in each of the three
preceding years. The number of white and colored persons accepted
for state aid remains in about the same proportion as the population
of Florida.
Fifty-one per cent of all persons approved for aid in 1952 were
diagnosed as having cancer (see Table 19). Preliminary totals for

PREVENTABLE DISEASES

1953 indicate about 47 per cent with cancer and 19 per cent with
diagnosis unknown. Many of the current cases with an unknown
diagnosis entered the program late in the year, and a diagnosis will
be obtained in the near future. It is noted that the proportion of
persons diagnosed as having cancer has decreased from 79 per cent
to approximately 50 per cent over a period of six years. We would
like to think this is partially due to the education of the public which
has motivated them to seek medical advice upon the development of
early symptoms.
An examination of the age distribution of those persons diagnosed
as having cancer indicates proportionately more colored than white
persons in the younger age groups. There are also proportionately
more females than males in this group. A summary of this data is
as follows:
PERSONS DIAGNOSED AS HAVING CANCER 1947-1953
Race & Sex Per cent under 55 yrs. of age
White males .... ................. ... 24.6
White females __....... ... 44.8
Colored males -_ ... 44.2
Colored females .- ........... .. .... .. ... ....... 62.9
Figures concerning cancer according to site (see Table 20) indicate
that a comparatively small number of colored persons had skin
cancer although the colored males had a higher rate of cancer of
the digestive system and genital organs than did the other groups.
In females of both races the major sites of cancer were breast and
genital organs. White males had a higher ratio of cancer of the
skin and buccal cavity than other sites.
A concentrated effort to follow-up all cases on whom money was
spent was made during the past year. The results of this are re-
flected in Table 21. A total of 73 patients who had previously been
lost to follow-up were located during the past year. Results to date
indicate that 3.5 per cent were lost to follow-up during the first year,
and a decreasing percentage lost in each successive year.
A study of those cases entering the state aid program during 1946
and 1947 reveals that 64 cases (42 per cent) of the 153 followed
were still living at the end of five years. Of those surviving, 47
are reported to have no indications of cancer; this is about 31 per
cent of those cases followed. Nine cases had been lost to follow-up,
and 80 cases died, 74 with cancer.
Due to more complete follow-up the survival rates (see Table 22)
are slightly lower than they were a year ago. Many of those cases
previously lost to follow-up were found to have died. Survival rates
of this type are based on the assumption that persons lost to follow-up
have the same proportion alive and dead as other persons in the study.
Thus, the knowledge that a sizeable number of persons are dead

88 ANNUAL REPORT, 1953

who were previously classified as lost, would decrease the computed
survival rates. Data for the fifth year of follow-up is based on a
relatively small number of persons and is therefore subject to greater
variation than data for other years.
Survival rates indicate that 52 per cent of the persons followed-up
were alive at the end of four years. Data according to site ranges
from 14 per cent survivors with digestive cancer to 79 per cent with
skin cancer.
TABLE 19
DISTRIBUTION BY DIAGNOSTIC STATUS, RACE AND SEX OF
PERSONS APPROVED FOR STATE AID UNDER THE FLORIDA
CANCER PROGRAM DURING THE YEARS 1947* 1953

DIAGNOSTIC STATUS

Number of Persons Percentage Distribution
Race, Sex, and
Year Num- Num-
ber Can- Pre- Non- Un- ber Can- Pre- Non- Un-
Ap- cer Can- Malig- known Ap- cer Can- Malig- known
proved cerous nant proved cerous nant

TOTAL PERSONS.. 9,246 5,060 37 3,058 1,091 100. 54.7 0.4 33.1 11.8

1947*.............. 205 163 0 37 5 100. 79.5 ...... 18.0 2.4
1948............... 1,350 818 3 405 124 100. 60.6 0.2 30.0 9.2
1949............... 1,059 639 2 324 94 100. 60.3 0.2 30.6 8.9
1950............... 1,682 919 4 597 162 100. 54.6 0.2 35.5 9.6
1951.............. 1,634 900 5 558 171 100. 55.1 0.3 34.1 10.5
1952............... 1,677 853 8 598 218 100. 50.9 0.5 35.7 13.0
1953............... 1,639 768 15 539 317 100. 46.9 0.9 32.9 19.3
White Male........ 2,925 1,826 15 737 347 100. 62.4 0.5 25.2 11.9
White Female...... 4,107 2,162 19 1,486 440 100. 52.6 0.5 36.2 10.7
Colored Male....... 667 319 1 241 106 100. 47.8 0.1 36.1 15.9
Colored Female..... 1,547 753 2 594 198 100. 48.7 0.1 38.4 12.8

1947 total includes 7 persons approved for State Aid in November and December, 1946.
TABLE 20
DISTRIBUTION ACCORDING TO SITE, RACE AND SEX OF
CANCER CASES ADMITTED TO THE FLORIDA STATE AID
CANCER PROGRAM DURING THE YEARS 1947* 1953

NUMBER OF PERSONS PERCENTAGE DISTRIBUTION
SITE
WM WF CM CF WM WF CM CF

TOTAL................... 1,826 2,162 319 753 100. 100. 100. 100.
Buccal Cavity .............. 216 64 36 25 11.8 3.0 11.3 3.3
Digestive System............. 157 125 95 45 8.6 5.8 29.8 6.0
Respiratory System.......... 158 42 31 12 8.7 1.9 9.7 1.6
Breast. ...................... 3 317 5 177 0.2 14.7 1.6 23.5
Female Genital............... O0 772 0 411 ....... 35.7 ....... 54.6
Male Genital ................. 59 0 62 0 3.2 ...... 19.4..
Urinary System .............. 70 32 20 15 3.8 1.5 6.3 2.0
Skin.... ......... ..... 1,055 709 26 25 57.8 32.8 8.2 3.3
Other Sites................... 82 76 30 29 4.5 3.5 9.4 3.9
Lymph. and Haem. Tissues.... 26 25 14 14 1.4 1.2 4.4 1.9

1947 total includes 6 persons approved for state aid in November and December, 1946.

PREVENTABLE DISEASES

TABLE 21

NUMBER AND PERCENTAGE OF CANCER CASES UNTRACED
AFTER EACH YEAR OF FOLLOW-UP ACCORDING TO
CALENDAR YEAR OF ENTRY TO PROGRAM

CUMULATIVE CASES UNTRACED AFTER EACH
YEAR OF FOLLOW-UP
Cases
Entering Number Percentage
Program
Calendar Year During
Calendar 1st 2nd 3rd 4th 5th let 2nd 3rd 4th 5th
Year year year year year year year year year year year

1947*.................... 153 7 9 9 9 9 4.6 5.9 5.9 5.9 5.9
1948................. ... 748 28 38 49 59 ...... 3.7 5.1 6.6 7.9 ...
1949..................... 599 18 31 48 ...... ...... 3.0 5.2 8.0 ..........
1950..................... 838 26 43 ...... ...... ...... 3.1 5.1 ..............
1951 .................... 815 28 ...... ........... .....1.. 3.4 ...

Based on follow-up experience of 3,153 cancer cases receiving monetary assistance under Florida State Aid Cancer
Program, 1947*-1951.
Includes 5 cases approved for State Aid in November and December, 1946.

TABLE 22

PERCENT OF CANCER PATIENTS SURVIVING
YEAR OF FOLLOW-UP BY SITE

AFTER EACH

PERCENT SURVIVING AT
Site
1 2 3 4 5
Year Years Years Years Years
TOTAL........................ 75 64 57 52 49

Buccal Cavity........................ 69 56 49 39 39
Digestive............................. 37 25 18 14 *
Respiratory ......................... 40 27 20 11 11
Breast .................. ........... 77 62 53 47 47
Female Genital....................... 74 58 51 46 46
Skin................................ 94 88 84 79 73
Other Sites .......................... 58 40 35 32 25

None followed for five years.
Based on follow-up experience through 1952 of 3,153 cancer cases who entered the Florida State
Aid Cancer Program during the period, November 1946 through 1951, and who received monetary
assistance.

90 ANNUAL REPORT, 1953

TABLE 23
NEW PERSONS APPROVED FOR STATE AID, NUMBER OF
PERSONS RECEIVING FINANCIAL AID, AND EXPENDITURES,
BY COUNTY, FLORIDA CANCER PROGRAM, 1952 AND 1953

Persons
New Persons Receiving Total Expenditures
County Approved Aid
1952 1953 1953 1952 1953
STATE TOTAL......... 1677 1639 1713 $ 157,003.37 S 162,825.22

Alachua.................... 24 34 30 3,415.30 2,278.65
Baker...................... 10 9 11 2,180.60 717.76
Bay........................ 38 28 38 2,203.85 3,391.50
Bradford................... 27 14 18 2,024.01 1,699.48
Brevard.................... 8 14 6 1,045.11 418.70
Broward................... 39 14 30 3,513.09 4,273.31
Calhoun.................... 22 22 22 1,140.74 1,703.75
Charlotte .................. 7 3 9 610.90 927.58
Citrus....................... 9 3 2 170.00 183.75
Clay ...................... 20 13 10 2,873.47 674.75
Collier.................... 5 8 5 944.50 513.52
Columbia................... 30 22 19 2,441.57 1,846.48
Dade........................ 77 36 50 5,023.75 4,208.75
DeSoto................... 15 25 20 1,346.28 2,245.72
Dixie..................... 9 8 6 186.06 263.99
Duval.......................... .... 18 8 17 2,063.13 2,901.31
Escambia................... 96 137 126 8,911.50 11,163.00
Flagler ................... 3 4 1 78.75 90.00
Franklin................. 21 23 20 1,708.08 1,686.74
Gadsden.................... 34 16 20 2,243.28 1,572.89
Gilchrist..................... 9 6 7 935.74 215.00
Glades.................... 0 2 3 0.00 22.50
Gulf...... ....... .... 10 21 14 1,167.67 2,478.20
Hamilton.................. 9 9 513.61 1,583.40
Hardee.................... 16 17 19 861.25 1,094.50
Hendry ................... 8 14 3 839.46 323.00
Hernando .................. 3 5 1 498.90 18.75
Highlands.... ........ 22 19 19 1,403.08 1,055.70
Hillsborough.... ......... 96 128 171 11,772.31 17,010.78
Holmes ................... 37 30 37 3,171.85 2,402.94
Indian River................ 8 12 9 391.90 1,860.12
Jackson................... 44 51 52 3,183.60 3,622.57
Jefferson................... 10 14 14 702.15 1,251.40
Lafayette................ 7 10 6 726.11 916.92
Lake......... ..... 13 20 8 1,925.58 1,784.00
Lee....................... 17 15 15 1,712.19 958.98
Leon...................... 70 62 56 2,697.10 3,390.84
Levy ...................... 7 10 7 1,747.77 1,137.44
Liberty.................. 10 5 6 884.63 239.69
Madison............. ....... 23 17 23 2,281.90 2,211.47
Manatee................... 15 18 19 2,451.78 2,115.51
Marion.................... 8 17 10 1,037.42 1,135.25
Martin .................... 21 15 9 1,806.50 648.63
Monroe................... 29 49 31 2,345.25 3,273.00
Nassau ..................... 19 13 11 2,084.68 653.68
Okaloosa.................... 34 29 38 2,860.25 2,856.25
Okeechobee................ 8 4 2 255.79 90.75
Orange........... .......... 30 21 26 5,920.91 5,468.30
Osceola........... .......... 9 1 5 109.65 1,249.95
Palm Beach................. 83 49 69 8,069.47 6,058.55
Pasco ...................... 36 36 38 4,288.55 4,611.75
Pinellas.................... 61 56 56 6,493.25 6,731.90
Polk ...................... 76 63 95 8,480.58 8,519.50
Putnam.................... 24 40 27 2,609.83 4,215.06
St. Johns................... 8 9 11 1,261.93 1,958.37
St. Lucie .................. 22 16 12 1,875.95 1,600.19
Santa Rosa ................ 22 37 46 2,536.25 3,931.25
Sarasota ................... 9 22 27 1,775.80 1,908.40
Seminole .................. 14 25 6 1,074.17 1,746.00
Sumter ................... 22 14 17 1,171.36 927.14
Suwannee ................ 33 44 28 2,216.90 2,013.05
Taylor ................... 23 16 21 1,779.61 1,041.87
Union ................. .. 10 10 10 779.23 1,161.60
Volusia .................... 44 50 60 6,287.11 5,644.76
Wakull .................... 12 14 15 737.25 787.27
Walton .................... 25 23 34 1,398.50 2,870.25
Washington ................. 49 40 49 3,283.54 3,267.16

	Front Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Official staff Florida state board...
	Directors
	County health officers
	Florida state board of health
	Table of Contents
	General summary
	Finance and accounts
	Vital statistics
	Local health services
	Bureau of preventable diseases
	Tuberculosis control
	Laboratory services
	Maternal and child health
	Nutrition and diabetes control
	Dental health
	Entomology
	Sanitary engineering
	Narcotics
	Health information

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