Annual report - State Board of Health, State of Florida

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FLORIDA

STATE BOARD
OF
HEALTH

1954

___

ANNUALIII~II~ 1~ ~

State Board of Health

State ej 74azda

1954

The following statistical reports will be published separately:
SUPPLEMENTAL I -FLORIDA VITAL STATISTICS, 1954
SUPPLEMENTAL II -FLORIDA MORBIDITY STATISTICS, 1954

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

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The Honorable HERBERT 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, 1954.

Sincerely yours,

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

May 1, 1955
Jacksonville, Florida

His Excellency, LEROY COLLINS
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, 1954,
to December 31, 1954, inclusive.

Respectfully submitted,

HERBERT L. BRYANS, M.D.
President

May 1, 1955
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, 1954

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....................................George A. Dame, M.D., Acting

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 Control.......William 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. Hyg.

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 ControlLorenzo A. Parks, M.D., M.P.H.
Acting

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

COUNTY HEALTH OFFICERS

(As of December 31, 1954)

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.....................................James E. Speers, M.D., M.P.H.
Broward......................................... ... Paul W. Hughes, M.D., M.P.H.
Calhoun-Jackson............. ........... Henry I. Langston, M.D., M.P.H.
Charlotte-DeSoto-Hardee....................... Joseph W. Lawrence, M.D.
Citrus-Hernando-Levy...........................arold F. Bonifield, M.D.
Collier-Lee...........................................Merwin E. Buchwald, M.D., M.P.H.
Columbia-Gilchrist-Hamilton.. ............. Joseph C. Weeks, M.D.
Dade....................................T. E. Cato, M.D., M.P.H.
Dixie-Lafayette-Suwannee......................... J. Dillard Workman, M.D.
Duval............................. ......Thomas E. Morgan, M.D., M.P.H.
Escambia..................... ........ ....... John C. McSween, M.D.
Flagler-Putnam.....................................Norman B. Edgerton, M.D.
Franklin-Gulf-Wakulla............... .... Warren T. Weathington, M.D., M.P.H.
Gadsden-Liberty..........................................Frank J. Hill, M.D., M.P.H.
Glades-Hendry-Highlands...........................Theodore W. Weeks, Jr., M.D.
Hillsborough......................................Frank V. Chappell, M.D., M.P.H.
Holmes-Walton-Washington.......................R. N. Nelson, M.D.
Indian River-Martin-Okeechobee-
St. Lucie...............................................Neill D. Miller, M.D.
Jefferson-Madison-Taylor...........................Andrew P. Haynal, 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.............................................Vacant
Okaloosa-Santa Rosa..................................J. L. Turnage, M.D.
Orange....................................................Wade N. Stephens, M.D., M.P.H.
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, M.D., 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

Dioirin of Votorinoo~y

Disco,.
CoctroI nlheIi

TABLE OF CONTENTS

Page

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

Finance and Accounts (including Personnel and Purchasing).......... 8

Vital Statistics ..................................... ...... ................ 2 22

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) .................. ........................................ 62

Tuberculosis Control (including Heart Disease Control) ................. 90

Laboratory Services .................................................................. ...... 103

Maternal and Child Health (including Mental Health)...................... 117

Nutrition and Diabetes Control....................................................... 133

Dental Health ...........................................-.. 137

Entom ology ....................................... ........................ .............. 141

Sanitary Engineering ............................................................... 153

N arcotics ...................................... ....................-...... ...... 186

Health Information (including Library) ............................... 189

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

The year 1954 was a very difficult one for the State Board of Health
and its affiliated county health departments. Allocations of federal
funds to Florida for public health were further reduced by $180,000;
population of the state continued to increase at a rapid rate, and the
agency faced more responsibilities than ever before. However, it is
believed that because these difficulties were anticipated and planned
for, major disruptions in services rendered were avoided, and efficient
use was made of the funds that were available. On August 10, 1954
the Budget Commission with the Governor's approval provided an ad-
ditional $75,000 of state emergency funds which reduced the handicap
of federal fund reductions somewhat.
In spite of the difficulties cited above a good health program was
carried on in the state and substantial progress made in controlling
diseases and reducing health hazards. Some of the details of the work
of the State Board of Health are outlined in the reports of the various
bureaus and divisions of the State Board of Health which follow.
Due to fund shortages and many other factors the loss of trained
personnel to the agency continued at a very undesirable level. The
turnover of physicians, nurses and clerical personnel was especially
high and prevented maximum efficiency in the work with which these
groups were concerned. The recruitment of sanitary engineers became
increasingly difficult and the recruitment of dentists remained as dif-
ficult as it has been for many years. A decision by the State Budget
Commission that salaries would not be approved at levels beyond $10,000
aggravated the problem considerably. A further decision by the same
body that not more than a 5 per cent increase in salary would be
approved for salaries between $5,000 and $10,000 per year added
further difficulties to the retention of competent engineers and phy-
sicians.
An epidemic of disease resembling poliomyelitis occurred in Tal-
lahassee in October of 1954. Over 300 cases occurred and the facilities
of the Tallahassee Memorial Hospital were severely taxed. At one
time there were over 125 cases of this disease in the hospital from
Leon County and adjacent counties. Because of the financial strain
placed upon the hospital, the Governor took the leadership in making
a grant of funds through the Budget Commission and the State
Board of Health to the hospital in the amount of $25,000. An ad-
ditional loan of $25,000 was made.
One outstanding accomplishment during the year was the comple-
tion and dedication on December 3 of a new Laboratory and Health
Center building in Jacksonville at a total cost of about $600,000.

2 ANNUAL REPORT, 1954

This was financed by an appropriation of $80,000 by the 1951 legis-
lature, and fees collected by the State Board of Health which were
matched equally by federal hospital construction funds. Also, during
the year a contract was let for the construction of a building for re-
search in the control of mosquitoes and other arthropods at Vero
Beach. This building will cost about $200,000. In the field of com-
munity mental health, new clinics were established in Bay, Escambia
and Palm Beach counties. A thorough study of the needs of the state
in the field of mental health training and research was made by a com-
mittee appointed by the Governor. This committee was appointed at
the suggestion of the Commission on Mental Health Training and
Research, a body set up by the Southern Regional Educational Board
following a resolution made by the Southern Governors' Conference.
The State Health Officer served as a member of this commission.
During the year the U. S. Public Health Service made a grant of
$16,000 to the State Board of Health to study the problem of rabies
in bats. This followed the discovery of rabies in bats for the first time
in the United States by the regional laboratory in Tampa. The Na-
tional Foundation for Infantile Paralysis granted the State Board of
Health $18,000 to study diarrheal diseases in monkeys which are
important in research work in poliomyelitis. Since this work is being
done in the National Foundation's Monkey Farm in Bluffton, South
Carolina, this grant was a great compliment to the State Board of
Health and to the State of Florida.
The State Board of Health also received a grant of $18,165 from
the National Institute of Health to study the occurrences of malfor-
mations in newborn children.
During the year, with the Governor's consent and hearty approval,
the State Board of Health worked out a cooperative plan with the
Foreign Operations Administration in Washington to provide health
personnel to the countries in Latin America. The Federal Government
has difficulty in recruiting well trained public health personnel and
it was in the interest of the State of Florida to promote in every way
possible better understanding and relations with our Latin American
neighbors. Under this plan, one. State Board of Health physician has
already been assigned as Chief of a health field party in Uruguay.
This assignment will be for a two-year period after which time he
will return to Florida and continue his career with the State Board of
Health.
Some of the principal indications of accomplishments by the agency
during the year are the continued decline in the death rate from tuber-
culosis, syphilis and also in the maternal death rate. Other indications
were the performance of the same amount of work or more work with
no increase of funds and personnel. The work loads of the following
bureaus illustrate this point very clearly: the Bureau of Laboratories,
the Bureau of Vital Statistics, the Bureau of Tuberculosis Control and

GENERAL SUMMARY 3

the Bureau of Sanitary Engineering. However, the other bureaus and
divisions performed equally good work under the same difficulties even
though in some cases the results cannot be shown statistically. The
outstanding need of the State Board of Health and the county health
departments is for more funds and personnel with which to adequately
cope with the growing problems of the growing population.
The activities of the State Health Officer were about the same as
in previous years although made more difficult because of the facts
related above.

Articles Written by the State Health Officer:
1. Sowder, Wilson T., Mulrennan, John A., Florida's mosquito con-
trol system Pub. Health Rep. Vol. 69, No. 7 1954
2. Sowder, Wilson T., Why is the sex difference in mortality in-
creasing? Pub. Health Rep. Col. 69, No. 9 1954

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. Eleven meetings
were held during the year during which the following important
business was transacted:
January 17 Jacksonville, Florida
1. Discussed the Cancer Control Program with Dr. Ashbel Williams,
chairman of the Cancer Council. Special attention was paid to
whether or not fees should be paid to radiologists; whether the
counties should participate financially in the Cancer Control
Program and the amount that should be paid to hospitals for the
care of state patients. As a result of this conference the maxi-
mum per diem rate for hospitals was increased from $15.00 to
$16.00 per day.
2. Considered the use of a substitute for silver nitrate in the eyes
of the newborn. It was decided not to authorize the use of any
substitute at that time.
3. Authorized the employment of Dr. Simon Doff as part-time di-
rector of the Division of Heart Disease Control instead of full
time as he had been.
4. Authorized salary increases for certain county health officers.
5. Approved the building of a research center in Indian River County
and authorized the employment of an architect.
6. Reviewed the policy of purchases made by counties and mosquito
control districts with state funds allocated to them and decided
to leave such purchases in the hands of local agencies.

4 ANNUAL REPORT, 1954

7. Discussed with the engineering staff the sewage problem in San-
ford and decided that no change would be made in the policy
of requiring sewage treatment.
8. Discussed Merit System matters and made some changes in the
compensation plan and authorized certain increases in salaries.
February 8 Jacksonville, Florida
1. Discussed the purchase of additional property adjoining the head-
quarters in Jacksonville and authorized negotiations by the State
Health Officer.
2. Discussed Merit System matters and discontinued the granting of
family sick leave; modified the specifications for certain classes.
3. Authorized salary increases for sixty persons.
4. Discussed the transfer of the title of a dragline to Sarasota County
and approved it subject to the action of the Budget Commission.
5. Approved the terms of a contract with the architect employed
to draw plans for the Mosquito Research Laboratory.
6. Discussed financial matters with the State Health Officer and
director of the Bureau of Finance and Accounts.
February 9 Jacksonville, Florida
1. Discussed with a representative of the Foreign Operations Ad-
ministration the assignment of employees to foreign duty and
approved a suggested plan.
2. Approved the revision of certain chapters of the sanitary code.
3. Approved the use of a new vaccine (Salk) for poliomyelitis.
4. Elected officers.
March 27 Jacksonville, Florida
1. Revised certain chapters of the sanitary code.
2. Discussed the Sanford sewage situation further and heard Mr.
Lee, director of the Bureau of Sanitary Engineering, discuss a
plan for the solution of the problem which was satisfactory.
3. Discussed the problem of rabies and directed the public health
veterinarian to prepare a bill on the subject.
4. Discussed a proposed arrangement with the State Livestock Sani-
tary Board for cooperative laboratory work and directed the di-
rector of the Bureau of Laboratories and the public health
veterinarian to explore possibilities in this field.
5. Heard a report from the director of Laboratories on the operation
of that Bureau.

GENERAL SUMMARY

6. Authorized the State Health Officer to investigate the titles of
all property owned by the State Board of Health and to explore
the possibility of acquiring the vacant lot adjoining the labora-
tory building in Tampa.
7. Discussed retrenchment made necessary by anticipated reductions
in federal funds and approved the plan of the State Health Of-
ficer for such retrenchment.
8. Discussed Merit System matters and approved new salary ranges
and specifications.
9. Appointed Dr. Paul Penningroth as director of the Division of
Mental Health.
10. Approved the assignment of Dr. James Wardlaw to foreign duty.
11. Discussed purchasing procedures with the purchasing agent.
April 25 26 Hollywood, Florida
1. Authorized certain salary increases.
2. Reviewed the major policies of the State Board of Health which
had been established in recent years and confirmed them.
3. Discussed plans for the budget for 1955-57.
4. Directed that the director of the Bureau of Entomology, the
director of the Bureau of Finance and Accounts and the Purchasing
Agent be responsible for the preparation of specifications, letting
of bids and the making of recommendations to the State Health
Officer for acceptance of the lowest and/or best bid; the Board
to make the final decision on the letting of the contract for the
mosquito research laboratory.

May 23 Jacksonville, Florida
1. Discussed county health department problems with a group of
county health officers.
2. Authorized certain salary increases and promotions.
3. Discussed sanitation problems in Hillsborough County with the
county health officer and the director of the Bureau of Sani-
tary Engineering.
4. Adopted a minor change in the State Sanitary Code.
5. Endorsed a bill proposed by Congressman George Smathers in-
suring mortgages for community facilities.
6. Reviewed the plans for the proposed mosquito research laboratory.
7. Discussed the red tide problem with the director of the Division
of Industrial Hygiene.

6 ANNUAL REPORT, 1954

8. Discussed anticipated fund appropriations and a proposed request
of the Budget Commission for emergency funds.
9. Approved a contract with the Foreign Operations Administration
for the assignment of personnel to foreign duty.
10. Approved the attendance by the State Health Officer and Dr.
James Wardlaw at a meeting in Panama.
June 14 Tallahassee, Florida
1. Approved minor changes in the Merit System regulations and
certain amendments in class specifications.
2. Approved salary increases for certain county health officers.
3. Discussed rules and regulations pertaining to the mosquito control
law.
4. Discussed the financial situation and other problems with the
Governor.
August 22 Jacksonville, Florida
1. Established a Division of Veterinary Public Health.
2. Discussed city ordinances on milk sanitation and recommended to
all cities that a maximum 200,000 bacterial count be established
as a safe standard in milk ordinances.
3. Revised the rules and regulations governing the operation of the
Cancer Control Program.
4. Discussed the closing of schools during the polio outbreak with
the director of the Bureau of Preventable Diseases.
5. Adopted rules and regulations for the mosquito control program.
6. Reaffirmed its policy banning the supplementations of salary in
counties and mosquito control districts.
7. Adopted amendments to the structural pest control rules and
regulations.
8. Made certain changes in salary ranges and specifications and ap-
proved certain salary increases.
9. Nominated Dr. W. G. McLeod for re-appointment as a member
of the Merit System Council.
10. Discussed the city water supply of the town of Webster in
Sumter County.
11. Discussed the city water supply problem of the Lynnwood Sub-
division in Duval County.
12. Adopted rules and procedures for hearings in connection with
the nursing home licensure program.

GENERAL SUMMARY 7

13. Removed the rules and regulations for the practice of midwifery
from the sanitary code and made them separate, and adopted
new rules and regulations.
14. Discussed a matter involving a part-time employee in Tallahassee.
September 19, 1954 Jacksonville, Florida
1. Made an exception to the Board's policy on salary supplements
for an employee in Escambia County.
2. Raised the maximum per diem for hospitals for indigent cancer
cases from $16.00 to $17.00.
3. Accepted the bid of the Stephens Construction Company for the
Entomological Research Center in Vero Beach.
4. Discussed Merit System matters and approved certain changes in
the Merit System Regulations and changed certain specifications.
5. Discussed the problem of milk sanitation in Bradenton.
November 27-28 Miami, Florida
1. Reviewed the findings and approved the actions of a meeting
held in Jacksonville on October 31 at which only two members
were present and no quorum was present.
2. Adopted certain changes in the regulations to control psittacosis.
3. Discussed the proposed budget for 1955-57.
4. Recommended that the Budget Commission and Legislature ap-
prove higher salaries for the State Health Officer and other
personnel.
5. Discussed the milk situation in Bradenton.
6. Approved the appointment of a director of the Field Advisory
Staff.
7. Approved the appointment of a part-time psychiatric consultant.
8. Approved the appointment of an Administrative Analyst to work
under the State Health Officer.
9. Discussed Merit System problems.

8 ANNUAL REPORT, 1954

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

The business management of the State Board of Health is the re-
sponsibility of the Bureau of Finance and Accounts and includes all
fiscal and finance, personnel, purchasing and property control activities.
The bureau serves all of the bureaus and divisions and county health units
in the payment of salaries, travel expenses and other obligations of the
Board; the personnel actions such as recruitment, employment, termina-
tion, reclassification, salary changes, leave records, efficiency reports
and training records; the purchase of goods and supplies on a com-
petitive basis, the control of property; the maintenance and upkeep of
buildings and grounds; the operation of the duplicating department.

FISCAL SECTION
The financial transactions of the State Board of Health for the
fiscal year ended June 30, 1954, 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 30, 1954,
has been prepared and distributed to the Governor, 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, 1954, were from the following major sources:

State Appropriations and Funds ..................
From Local Agencies for County Health
U nits ..........................................................
From Federal Grants-in-Aid .....................
From Private Contributions ...........................

$4,682,004.27

2,470,397.58
919,011.26
33,887.08

TOTAL .................................. .... $8,105,300.19

Objectively, the operating and capital expenditures by the State Board
of Health were for:

Personal Services (Salaries and Profes-
sional Fees) ................... ......... .....
Contractual Services (Repairs, Utilities,
Travel Expense, Cancer Program-Fees
and Hospitalization) ............................
Commodities (Office, Medical, Laboratory,
Mosquito Control, Educational) ................
Current Charges (Rents, Insurance, Merit
System Costs, Registrar Fees) ...............

$4,383,187.35

57.6%

940,541.56 12.4%

543,516.70 7.1%

141,158.09 1.8%

57.8%

30.5%
11.3%
.4%

100 %

FINANCE AND ACCOUNTS 9

Capital Outlays (Equipment and Fixed
Assets) ............................................................ 592,646.96 7.8%
Grants to Counties and Mosquito Control
Districts, Chapter 389.21, Fla. Statutes.... 1,011,508.37 13.3%

TOTAL .................................................... $7,612,559.03 100 %
In addition to funds reported in the annual financial report and
summarized above, certain other funds and services were made avail-
able 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 .............. $78,993.34
Value of personal services, supplies and equipment
furnished by Public Health Service Communicable
Disease Center for mosquito control activities under
the Board's supervision .................................................. 9,320.00

TOTAL ........................................................................ $88,313.34
Fiscal operation followed a budget plan of 119 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 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.

10 ANNUAL REPORT, 1954

PERSONNEL OFFICE
PAUL T. BAKER

The year 1954 was marked by steady progress in the field of per-
sonnel administration. In conformity with established policy, con-
tinued 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 service ratings
were obtained and recorded.
Records of in-service and post-graduate training of employees were
maintained and the application of regulations governing such train-
ing was assured. All employees at the main office were encouraged
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 em-
ployees 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 with dispatch.
Prompt action was taken immediately after the Merit System ex-
aminations 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 stenogra-
phers continued to be in short supply. The generous State Retire-
ment Plan contributed considerably to the successful recruiting 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 continued
to be high.
At the end of the year sixty-six (66) of Florida's sixty-seven
counties had organized health departments which were operating un-
der the Merit System.
On December 31, 1954 there were 1382 State employees (includ-
ing those in the county health units) and 13 federal employees on

FINANCE AND ACCOUNTS 11

loan to this agency. On December 31, 1953 there were 1342 State
employees and 14 federal employees.

During the year there were 406 employment and 366 terminations.
The principal reasons for terminations include marriage, pregnancy,
transfer of husbands from area, completion of work for which employed
and acceptance of more profitable employment elsewhere.

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 ........................................ 406 366 26.87%
Health Officers .................... 13 15 25.42%
Sanitary Engineers ................ 4 5 19.23%
Sanitarians .............................. 21 21 11.23%
PH Nurses ............................ 89 65 19.40%o
Clerical .................................. 103 94 28.75%
Others ...................................... 176 166 38.69%
*Turnover rate-terminations divided by average number of employees.

On December 31, 1954, the Merit System status of the State Board
of Health personnel was as follows:

Permanent and Probational ................ 1118
Provisional ............................ ................. 22
Tem porary .............................................. 0
Em ergency ............................................ 4
Exempt and Part-time ........................ 238

TO TAL ............................................ 1382

During the year specifications were adopted for 7 new classifications;
specifications were revised for 20 classifications; 17 classifications were
abolished and the salary ranges of 3 were revised.

Postgraduate training on a stipend basis for one full academic year
was completed successfully during 1954 by 4 health officers; 4 public
health nurses; 1 sanitary engineer; 3 sanitarians and 1 bacteriologist.

12 ANNUAL REPORT, 1954

PURCHASING AND PROPERTY

G. WILSON BALTZELL, Purchasing Agent

During 1954 the Purchasing Agent received 2104 requisitions for
equipment and supplies from the various departments, and 3868 pur-
chase orders were issued, totalling $650,550.69.
This was an exceptionally busy year for the Purchasing and Property
Department due mainly to the expanded and intensified program for
mosquito control activities and equipping the new building addition.
The Purchasing Law passed by the last Legislature affected us only as
it applied to advertising in newspapers for purchases in excess of
$2,000.00. Otherwise, there were no changes or variations in our purchas-
ing procedures.
Property records are being kept at current levels. The system of
memorandum receipts has been installed and the inventory of the
central office was completed during 1954. The forwarding of annual
inventories requested by the State Fire Insurance Commissioner can
now be accomplished each year. The new building addition completed
during this year and the subsequent moving of various bureaus and
divisions called for numerous changes in the records. All of this is up
to date.
The State Board of Health carries automobile insurance on the fleet
of passenger cars, trucks, trailers, etc. This includes Public Liability,
Property Damage, Fire, Theft and Comprehensive. During the year
five claims were settled by our companies amounting to $406.65, and
claims for theft and comprehensive were settled for $267.33.
The State Board of Health acts as self insurer for collision coverage,
and in 1954 damages to our cars which we assumed amounted to
$374.48. Damages to our cars caused by others amounted to $582.26,
and these were settled by individuals causing the damages or their
insurance companies. Under our floater policy covering scientific equip-
ment in transit an electric generator used for auxiliary current for
tuberculosis X-ray surveys was damaged by overturning and settlement
of $1,841.11 was made for repairs and replacements.
Fire insurance on buildings and contents is carried in the State Fire
Insurance Fund, under supervision of the State Fire Insurance Com-
missioner.

BUILDINGS AND GROUNDS
Since the new building addition was completed and is now being
occupied by the several bureaus and divisions formerly housed in the
old Administration Building at St. Johns Shipyard, we have given up
tenancy there except a small area on the second floor which is still

FINANCE AND ACCOUNTS 13

retained by the Bureau of Entomology. It is hoped that the next Legis-
lature will make it possible for another building addition so that the
two inadequate temporary buildings can be removed and all bureaus
and divisions brought together again.
The Superintendent has the responsibility of maintaining and operat-
ing all buildings and the upkeep of the grounds. Maintenance personnel
have carried out their duties most efficiently considering the moving
and changes which have been taking place.
The maintenance shop has been moved from the temporary ware-
house to the basement vacated by the laboratory supply and washroom
giving more room for their operations.
During this year the upkeep of automobiles and trucks in the Jack-
sonville area has been put under the supervision of the Maintenance
Section, and has proved to be a most satisfactory and economical move.
Property was acquired at the southeast corer of Pearl and Second
Streets for future use as a building site.

DUPLICATING
The Duplicating Department, located in the basement of the Julia
Street building, is still serving the various departments satisfactorily
and economically, effecting savings by being able to supply printing
requirements at costs much less than could be obtained from commercial
printers. The laboratory operations which were previously housed in
the basement have now been moved to the new building, allowing more
room for Duplicating. Space is sufficient, but additional equipment
and personnel is needed to perform all work requested of this section.

TABLE 2
SUMMARY OF RECEIPTS AND DISBURSEMENTS AND
BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 1954
RECEIPTS
FROM STATE FUNDS
From State Appropriations:
Salaries .... ....... ...... ............. ........................................$ 715,034.00
Expenses ...................................................................... 610,567.67
Emergency Cancer Fund Release ................................ 52,000.00
State Mental Health ................................................... 75,000.00
Licensing of Nursing Homes ............................................. 25,000.00
County Mosquito Control ..................................................... 350,000.00
Mosquito Control Under Chapter 389.21,
Florida Statutes 1953 ...................... ....................... 250,000.00
State Matching Mosquito Control, Chapter 389.21,
Florida Statutes 1953 ................................ .......... 1,250,000.00
County Health Units ......................................................... 1,100.000.00
Franklin County Marine Laboratory ...... ................ 9,800.00

14 ANNUAL REPORT, 1954

Other:
Medical Laboratory Control .................................................... 740.00
State Board of Health Trust Fund ........................................ 198,751.60
Bedding Inspection Administration .......................................... 44,826.00
Advisory Hospital Council ........................................................ 285.00
TOTAL STATE FUNDS ..............................................$4,682,004.27

FROM FEDERAL GRANT-IN-AID
Public Health Service:
General Health ......................................................................... $ 219,172.00
Venereal Disease .................................... 165,979.75
Tuberculosis Control ............................................................ 85,594.00
Heart Disease ....................................................... ..... ... 26,677.00
Cancer Control .............................................................. ... 47,151.00
Mental Health .......................................................... .. 44,177.00
Prevention and Control Centers ......................................... 82,515.00
Children's Bureau:
Maternal and Child Health ....................................... ... 247,745.51
TOTAL FEDERAL GRANT-IN-AID .........................$ 919,011.26

FROM PRIVATE CONTRIBUTIONS
Grants and Donations ........................ ............... .... $ 33,887.06
TOTAL PRIVATE CONTRIBUTIONS ......................$ 33,887.08

TABLE 2-Continued
FROM LOCAL AGENCIES FOR COUNTY HEALTH UNITS $2,470,397.58
Total Receipts ...................................... ...................................$8,105,300.19
Balances July 1, 1953 .................................... 1,167,038.12
Total Receipts and Balances .................................................$9,272,338.31
DISBURSEMENTS
OPERATING EXPENSES
Personal Services:
Salaries ..................................................................... .. ........ .. $4,329,545.84
Professional Services and Consulting Services ..................... 53,641.51
Contractual Services:
Travel Expenses, including subsistence and lodging ............. 503,302.11
Communication and Transportation of Things ........................ 110,754.68
Utilities ................................................... 24,586.97
Repairs and Maintenance ......................................................... 34,376.13
General Printing and Reproduction Services ..... ............... 22,590.40
Support and Care of Persons .................................. .... 209,312.95
Other Contractual Services .................................... ... 35,618.32
Commodities:
Bedding, Clothing, Linens and other Textile Products ............ 961.37
Building and Construction Materials and Supplies ............ 4,651.26
Coal, Fuel Oil and Other Heating Supplies ........................ 6,718.62
Educational, Medical, Scientific and Agricultural
Materials and Supplies ................................. .. 382,431.37
Maintenance Materials and Supplies ................................ 25,510.05
Motor Fuels and Lubricants ......... ............................ 44,304.09
Office Materials and Supplies ..................................... .. 74,154.35
Other Materials and Supplies .................................................... 4,785.59

FINANCE AND ACCOUNTS

Current Charges:
Insurance and Surety Bonds ....................... ............. 28,145.49
Rental of Buildings and Equipment ................................... 57,360.19
Other Current Charges and Obligations .......................... 36,535.19
Merit System ........................................... 19,117.22

Total Operating Expenses .............................................. $6,008,403.70
CAPITAL EXPENSES
Books ....................................... ............. $ 3,116.54
Buildings and Fixed Equipment ...................................... 431,828.52
Educational, Medical, Scientific and
Agricultural Equipment ........................................................ 64,536.28
Motor Vehicles Passenger ............................................ 9,537.35
Motor Vehicles Other ............................................. 31,297.08
Office Furniture and Equipment .......................................... 24,162.87
Other Capital Outlay .............................................................. 3,168.32
Land .............................................................................................. 25,000.00
Total Capital Expenses ..........................................................$ 592,646.96
TOTAL OPERATING AND CAPITAL EXPENSES ....$6,601,050.66
Grants to Counties & Mosquito Control Districts,
Chapter 389.21 Florida Statutes 1953 ......................................$1,011,508.37
Total Program Expenses ................................................................ $7,612,559.03

NON-OPERATING DISBURSEMENTS
Refunds, Transfers and Revolving Fund
Establishments ..................................................................$ 2,339.30
TOTAL DISBURSEMENTS ........................................ .........$7,614,898.33
Balances June 30, 1954 .......................................................... 1,657,439.98
TOTAL DISBURSEMENTS AND BALANCES ..........................$9,272,338.31

TABLE 3
SCHEDULE OF EXPENSES
BY PUBLIC HEALTH PROGRAM ACTIVITY
Health Services to mothers, infants, preschool and school children....$1,303,732.34
Statewide Venereal Disease Control Diagnosis and referral of in-
fectious Venereal Disease Patients to the Prevention and Control
Centers and operation of Centers ............................................. 752,084.90
Mosquito and Pest Control Programs, including pest control law
enforcement ......................................................... ........... .. 1,851,541.75
Statewide Sanitary Engineering and Environmental Sanitation ........ 725,440.89
Statewide Tuberculosis Control, X-ray Surveys, and follow-up work .. 590,949.36
Statewide Cancer Control Program .................................................... 226,995.05
Mental Health Program ..................................................................... 207,265.27
Statewide Narcotics, Drugs, Medical practice law enforcement ........ 81,216.39
Heart Disease Program ............................... ................ 82,377.22
Industrial Hygiene Program ...... ...................................... 20,462.17
Building Construction, Jacksonville ................................................. 420,391.29
Other Health Programs and Administration .................................. 1,350,102.40
Total Expenses ....................................... ............................$7,612,559.03

16 ANNUAL REPORT, 1954

SCHEDULE OF EXPENSES BY FUNCTIONAL ACTIVITY
General Administration and Misc. Training ......................................$ 354,135.66
Vital Statistics ....................................... .. .. .......... 165,413.58
Health Information ........................................ ........................... 52,861.76
Narcotics Enforcement ...................................................................... 62,725.20
Sanitary Engineering ......... ................. .................... 187,089.51
Entomology and Mosquito Control ................................... .. 1,492,640.83
Laboratories ........................................................ 369,823.86
Tuberculosis Control ........................................ ........................ 104,469.73
Preventable Diseases (excluding Tuberculosis) ........................... 304,231.68
Chronic Diseases ...................... ....................................... 293,994.72
Maternal and Child Health .......................................................... 100,567.90
Local Health Service ........................................ ........................... 111,775.12
Building Construction, Jacksonville ................................... ..... 420,391.29
County Health Units ................................. ........... .... 3,592,438.19
Total Expenses ................................................... .. ................$7,612,559.03

SUMMARY OF TOTAL EXPENSES BY MAJOR FUNCTIONAL LEVELS
State Level- Organizational Units
State Funds ..........................................$1,551,336.66
Federal Funds ........................................ 430,317.34
Private Funds ........................... .. ....... 3,036.72
$1,984,690.72
State Level-Special Services
State Funds ............. .........................$1,735,234.67
Federal Funds .......................................... 296,844.67
Private Funds ................... .. ........... 6,779.80
$2,038,859.14
*County Health Units
State Funds .... ...........-............... $ 1,052,307.44
Federal Funds ................ .......................... 196,214.71
Local Funds ...................... ............... 2,340,487.02 $
$3,589,009.17

GRAND TOTAL .........................................................................$7,612,559.03

Total County Health Units expenditures $3,589,009.17 represents per capital
expenditures of $1.43 (50c State and Federal Funds and 93c Local Funds)
based on population served by County Health Units of 2,515,613 (1950 Census.)
For comparison with previous years, see 1953 Annual Report, Table 3, Page
15; 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, 1954

STATE BOARD OF HEALTH LOCAL FUNDS

State Board of Board of Fees &
COUNTY Total Mental CountyfCom- Public Mis-
Funds Total State Health Federal Total missioners Instruction Cities cellaneous

ALACHUA ..............
BAKER..................
BAY ......................
BRADFORD..............
BREVARD ................
BROWARD .............
CALHOUN ...............
CHARLOTTE ............
CITRUS. .................
CLAY ......... .......
COLLIER ...............
COLUMBIA.............
COUNTY HEALTH UNIT-
STATE AT LARGE........
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......................

5 34,916.00
7,482.00
25,259.00
12,682.00
16,961.00
35,630.00
8,280.00
5,044.00
7,544.00
13,180.00
8,009.00
12,685.00

10,908.10
137,085.76
8,595.00
4,849.00
48,101.31
39,324.00
4,157.00
7,177.00
21,837.00
4,570.00
3,476.00
9,209.00
7,343.00
10,430.00
6,573.00
5,839.00
13,174.00
74,516.83
11,290.00
10,586.00
21,506.00
9,437.00
4,247.00
28,998.00
22.733.00

$ 25,001.00
7,482.00
25,259.00
12,682.00
16,961.00
24,880.00
8,280.00
5,044.00
7,544.00
13,180.00
8,009.00
12,685.00

10,908.10
69,106.00
8,595.00
4,849.00
34,166.00
37,124.00
4,157.00
7,177.00
21,837.00
4,570.00
3,476.00
9,209.00
7,343.00
10,430.00
6,573.00
5,839.00
13,174.00
30,653.00
11,290.00
10,586.00
21,506.00
9,437.00
4,247.00
28,998.00
22.733.00

S4,455.00
.... .. .
.... .. .
I... .. .. .
. .. .
700.00

.... .

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

.. .. .
1,12.3
2..........
. .. ..
.... .. .

$ 5,460.00

10,050.00

67,979.76

11,375.31
2,200.00

42,741.45

S43,388.83
7,387.10
24,618.66
12,501.44
15,938.00
73,055.44
6,554.50
3,896.23
7,680.07
12,841.12
7,966.50
13,605.64

535,914.68
6,220.73
4,721.85
70,990.49
108,114.56
5,260.45
8,517.80
19,962.92
4,881.78
4,929.89
9,879.41
4,450.00
9,564.52
5,331.83
3,717.34
12,589.49
361,622.04
7,717.50
9,194.61
22,195.01
4,922.73
3,769.25
39,462.21
22,682.62

$ 33,161.15 $ 2,500.00
7,351.85 ............
24,041.34 ............
7,035.02 2,800.00
12,500.00 3,000.00
54,920.76 10,680.00
6,500.00 .......
2,000.00 1,860.00
5,049.32 2,600.00
10,282.37 ...........
7,914.00 ...........
10,060.47 3,300.00

506,825.97 ............
4,845.23 1,250.00
4,094.87 600.00
56,141.49 ..........
74,854.57 6,000.00
2,958.40 2,278.80
8,470.30 ..........
13,999.92 3,930.00
2,018.53 2,800.00
4,924.64 ..........
6,791.41 3,000.00
2,175.00 2,175.00
9,483.91 ..........
5,274.08 ...........
1,800.00 1,800.00
12,428.99 ............
298,305.85 ..........
3,810.00 3,840.00
7,874.86 1,200.00
18,302.26 3,000.00
1,600.00 3,200.00
1,800.00 1,960.00
35,686.69 .........
21,936.37 ..........

$ 6,600.00

2,600.00
1,080.00

2,400.00

12,960.00
24,357.49

1,000.00

25.00

1,200.00

600.00

S3,410.00

$ 1,127.68
35.25
577.32
66.42
438.00
6,374.68
54.50
36.23
30.75
158.75
52.50
245.17

29,088.71
125.50
26.98
1,889.00
2,902.50
23.25
47.50
1,033.00
13.25
5.25
88.00
75.00
80.61
57.75
117.34
160.50
62,116.19
67.50
119.75
292.76
122.78
9.25
365.52
746.25

0 78,304.88
14,869.10
49,877.66
25,183.44
32,899.00
108,685.44
14,834.50
8,940.23
15,224.07
26,021.12
15,975.50
26,290.64

10,908.10
673,000.44
14,815.73
9,570.85
119,091.80
147,438.56
9,417.45
15,694.80
41,799.92
9,401.78
8,405.89
19,088.41
11,793.00
19,994.52
11,904.83
9,556.34
25,763.49
436,138.87
19,007.50
19,780.61
43,701.01
14,359.73
8,016.25
68,460.21
45,415.62

p 273O

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

U

,

I

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, 1954 :

STATE BOARD OF HEALTH LOCAL FUNDS
State Board of Board of Fees &
COUNTY Total Mental County Com- Public Mis-
Funds Total State Health Federal Total missioners Instruction Cities cellaneous
LEON .................... $ 87,924.38 $ 41,794.90 $ 31,938.65$ 2,400.00 $ 7,456.2 $ 46,129.48 $ 43,805.48 $ 1,500.00 $ 300.00$ 524.00
LEVY.................... 18,526.61 10,207.00 10,207.00 ............ ............ 8,19.61 4,498.6 3,737.50 ............ 83.75
LIBERTY ................ 9,229.83 3,928.00 8,928.00 ....................... 5,301.83 2,738.3 2,550.00............ 13.50
MADISON................ 18,526.75 11,104.00 11,104.00 ....................... 7,422.75 800.00 3,500.00 .....122.75
MANATEE............... 42,988.75 21,327.25 21,327.25 ........................ 21,661.50 20,515.00 ............ ... 1,146.50
MARION ................ 53,283.12 26,689.00 26,689.00........................ 26,594.12 26,198.37........................ 395.75
MARTIN ................ 15,182.66 7,646.00 7,646.00 ........................ 7,536.66 7,328.11 ..... .... .208.55
MONROE................ 47,698.99 21,833.00 21,833.00 ............ ............ 25,865.99 14,199.03 4000.00 5,979.21 1,687.75
NASSAU............... .. 33,473.04 15,122.00 15,122.00 ....................... 18,351.04 14,041.79 4,000.00 180.00 129.25
OKALOOSA............... 29,030.64 16,766.00 16,766.00 ............ ............ 12,264.64 9,126.64 2,700.00 ........... 48.00
OKEECHOBEE........... 12,588.50 4,264.00 4,264.00 ........................ 8,324.50 8,09000........................ 234.50
ORANGE................. 120,770.98 43,698.00 32,418.00 7,145.00 4,135.00 77,072.98 51,865.98 10,000.00 2,600.00 12,607.00
OSCEOLA............... 18,963.50 11,53.00 11,35.00....................... 7,610.50 4,00.00 2,400.00 ........... 710.50
PALM BEACH........... 162,114.11 43,743.00 38,678.00 690.00 4,880.00 118,371.11 72,460.00 16,915.00 20,551.98 8,444.13
PASCO................... 22,065.25 13,096.00 13,096.00 ........................ 8,969.25 4,000.00 4000.00 ........... 969.25
PINELLAS ............... 317,721.68 68,852.20 37,833.00 1,305.00 29,714.20 248,869.48 208,060.35 ........................ 40,809.13
POLK.................... 115,623.37 41,347.74 34,665.00 ............ 6,682.74 74,275.63 68,304.14 ....................... 5,971.49 1
PUTNAM ................ 25,711.83 14,805.00 14,805.00 ........................ 10,906.83 10,666.58 ...................... 240.25
ST. LUCIE........ .. 27,934.89 15,789.00 15,789.00 ........... ......... 12,145.89 11,467.89 ........................ 678.00
SANTA ROSA............. 20,995.08 12,644.00 12,644.00............ 8,51.08 2,400.00 5,846.58 ..........104.50
SARASOTA............... 58,631.83 26,345.00 25,205.00 ............ 1,140.00 32,286.83 30,773.9 ........................ 1,513.44
SEMINOLE ............... 29,836.00 16,495.00 16,495.00 ........................ 13,341.00 7,700.00 5,400.00 ............ 241.00
SUMTER ................. 14,482.29 8,924.00 8,924.00 ............ ....... 5,55829 2,000.00 ,500.00 ...........8.29
SUWANNEE.............. 25,484.85 15,780.00 15,780.00 ...................... 9,704.85 9,382.68 166.67........... 155.50
TAYLOR................. 15,270.00 9,185.00 9185.00 ........................ 6,085.00 5,750.00 250.00 ........... 85.00
UNION ................... 13,634.75 8,063.00 8,063.00 ........................ 5,571.75 5,550.00 ............ ........... 21.75
VOLUSIA ................ 148,737.75 47,044.00 89,669.00 4,475.00 2,900.00 101,693.75 86,000.00 9,800.00........... 5,893.75
WAKULLA............... 10,826.50 5,821.00 5,821.00 ........................ 5,005.0 4,989.00 ......................16.50
WALTON................. 22,930.00 12,589.00 12,589.00 ........................ 10341.00 4,800.00 4,200.00 1,200.00 14100
WASHINGTON ........... 19,645.50 11,178.00 11,178.00 ....................... 8,467.60 4,198.75 3,400.00 780.00 88.75
TOTALS................... $3,789,464.67 $1,321,067.09 $1,100,000.00 $ 24,852.38 $ 196,214.71$2,468,897.58 $2,036,429.49 $ 151,639.55 $ 87,823.68 $ 192.04.86

FINANCE AND ACCOUNTS

PROPOSED BUDGET FOR FLORIDA STATE
BOARD OF HEALTH DOLLAR FOR 1955

GENERAL ADMINISTRATION
BUILDING CONSTRUCTION
VITAL STATISTICS
HEALTH INFORMATION
NMAR COTI CS
SANITARY ENGINEERING
ENTOMOLOGY
LABORATORY
PREVENTABLE DISEASES.H (f : )
TUBERCULOSIS CONTROL
CHRONIC DISEASES
MATERNALAND CHILD HEALTH
"T rI=i IJ I f11 G

329,272- 4.08/
135,000- 1.68
170,020 2.1 1 /
56,000- .70/
67,320 .83W
205,620 2.55V
1,934,000 -23.989
394,780 4.89v
133.480 1.65?
77,860 .97/
305,145 3.78V
107,940 1.34'
52,175 .659

LOCAL HEALTH SERVICE- 103,640- 1.281
COUNTY HEALTH UNITS -3,993,120 -49.51
-8,065,45T C "t
Oolt.lP

TABLE 5
DISTRIBUTION OF PERSONNEL-STATE BOARD OF HEALTH
(OTHER THAN COUNTY HEALTH DEPARTMENTS)
DECEMBER 31, 1954

Bureau or Division
0 *1 11 I
El | R S 5 5 a 0 -

Administration-SHO ............................... 1 3 3 1 8
Dental Health ...................................... 2 1 1 4
Fiscal................................. 11 11
Finance Personnel...................... ..... 6 6
and Purchasing and Property ................ 8 13 3 24
Accounts Total........................ .. 25 13 3 41
Health Information............................... 2 4 1 2 1 10
Jacksonville ......................... 1 1 33 7 21 2 65 O
Miami ............ .. 11 2 3 2 18
Orlando ..... ............ 2 1 3 6
Laboaratories Pensacola .............. .... 2 1 3 6
Tallahassee ............... ...... 3 2 2 7
Tampa .................. .. ...... 9 3 7 1 20
Total .............. ................ 1 1 60 14 39 5 2 122
Bureau.... ............ .. .. 1 2 3 =
PH Nursing. ................... 4 2 6
Local Health Service Field Advisory Staff............ 2 2 2 1 7
Field Training Center.......... 1 1 1 3 V1
Total ......................... 1 7 3 7 1 19
Maternal [ Bureau ................................ 1 1 1 2 5
and Child Mental Health......................... 1 1 1 2 1 6
Health Total.................................. 1 1 2 2 2 3 11
Narcotics............................ ......... 3 4 6 13
Nutrition and Diabetes Control ....................... 4 1 5
Bureau............................... 1 1 1 1 4
Cancer Control....................... 4 4
Preventable Industrial Hygiene..................... 1 1 1 3
Diseases Venereal Disease Control ............... 1 7 2 11 21
Veterinary Public Health............... 1 1
Total. ............................. 2 2 2 13 3 11 33
Sanitary Engineering ................................ 15* 5 3 13 3 39
Entomology. ........... ....... .................. 2 2 14 5 3 22 2 50
( Bureau............................... 1 8 7 16
TB Control Heart Disease Control ................ 1 1 1 2 2 7
Total.. ............................. 1 1 1 1 10 7 2 23
Vital Statistics ...................................... 2 2 41 1 3 49
Grand Total.................................. 7 10 2 17 10 80 9 4 3 142 61 60 11 11 427

*One on Academic Leave.

FINANCE AND ACCOUNTS 21

TABLE 6
DISTRIBUTION OF PERSONNEL IN COUNTY HEALTH
DEPARTMENTS-DECEMBER 31, 1954

Baker ............ I 1 3
Bay ... 1 t 2 1 1 14
COUNTIES 0

i Bradford 1 2 1 6.
cd a :5 0 o

Alachua.......... 1 8 2 4 3 18
Baker............ 14 1 1 3
Bay............ 6 3 2 1 1 14
Braord......... 1 2 1 6
Brevard.......... 1 4 2 1 3 11
Broward.......... 14 1 6 1 7 1 1 32
Calhoun.......... 1 1 1 3
Charlotte......... 1 1 2
Citrus............ I* 1 1 1 4
Clay..:::::::...........:: 2 1 1 1 6
Collier........... 1 1 2
Columbia......... 1* 2 1 1 1 6
Dade............ 6t 72 1 2 36 1 28 5 4 10 165
DeSoto.......... 1 1 1 3
Dixie ........... 1 1 2
Duval........... 1 10 4 6 3 5 1 1 31
Escambia ........ 2 10 8 7 3 3 33
Flagler.......... 1 1 2
Franklin.......... 1* 1 1 1 1 5
Gadsden......... 1* 5 2 2 1 11
Gilchrist.......... 1 1 2
Glades .......... 1 1
Gulf............. 2 1 i 1 1 5
Hamilton......... 1 1 1 1 4
Hardee........... 2* 2 1 1 6
Hendry.......... 1 1 1 3
Hernando........ 1 1 2
Highlands........ 1* 2 2 1 1 7
Hillsborough...... 6 33t 1 2 15 21 17 21 11 127
Holmes.......... 2 1 1 1 5
Indian River...... 2 1 1 4
Jackson.......... 1* 4 2 2 1 10
Jefferson......... 1* 1 1 1 1 5
Lafayette......... 1 1 2
Lake............. 1 6 3 3 13
Lee.............. 1* 4 3 2 1 11
Leon............. 1 6 3 1 6 2 2 1 1 23
Levy............. 2 1 1 1 5
Liberty........... 1 1 2
Madison.......... 1 1 2 1 5
Manatee ......... 1 4 2 2 9
Marion........... 1 6 2 2 1 1 1 14
Martin........... 1 1 1 3
Monroe.......... 3 2 3 1 1 1 11
Nassau........... 1* 3 1 1 1 7
Okaloosa......... 1* 8 2 2 1 9
Okeechobee ....... 1 1 2
Orange........... 1 12 1 5 1 1 7 3 8 39
Osceola........... 2 1 1 1 5
Palm Beach....... 1 17t 1 7 7 1 4 9 47
Pasco............ 1 2 1 1 5
Pinellas.......... 4 21 1 1 15 1 1 17 5 4 3 73
Polk............. 1 9t 1 8 7 2 7 35
Putnam.......... 1* 2 2 1 1 7
Santa Rosa....... 2 1 1 2 6
Sarasota.......... 1 6 3 3 13
Seminole......... 1 2 1 1 1 6
St. Lucie......... 1 2 2 2 2 9
Sumter........... 1 1 1 1 4
Suwannee ........ 1* 2 2 1 1 7
Taylor........... 1 1 1 1 4
Union............ 1 1 1 3
Volusia........... 1 12 6 1 4 4 7 1 86
Wakulla.......... 1 1 2
Walton.......... 1* 2 1 1 1 6
Washington....... 2 1 1 1 5
Total...... 51 337 4 8 177 4 4 189 44 64 84 2 968

*Serves two or more counties-See Roster of County Health Officers.
tOne on Academic Leave.

22 ANNUAL REPORT, 1954

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

A summary of the activities of the Bureau of Vital Statistics and
a brief analysis of statistical data based on preliminary tabulations are
given in this text. An analysis of vital statistics and morbidity data
for 1954 in greater detail is presented in Supplements 1 and 2 of
this report under the titles "Florida Vital Statistics, 1954," and "Flor-
ida Morbidity Statistics, 1954."

POPULATION
The population of the state continued to grow at a rapid pace.
The estimated figures as of July 1, 1954 are: total population, 3,481,528;
white, 2,797,718, and nonwhite, 683,810.
These estimates were prepared by the Bureau of Vital Statistics
and are based upon the increment of the school population of each
county between the census year 1950 fall enrollment and the fall
school term of 1954. The population of each county in 1950 was
increased or decreased according to the percentage change of the
school population between 1950 and 1954. This method yields a
figure closer to the Bureau of the Census estimate than previously
used methods. The sharp increase over the 1953 estimate is chiefly
the result of the adoption of this new technique of estimation. Much
of the apparent reduction in birth and death rates between 1953
and 1954 has resulted from the adoption of this method of population
projection. It is believed that the current estimate reflects the present
population of the state with reasonable accuracy. Birth and death
rates contained in this report are based on these estimates.

BIRTHS
Births to Florida residents increased by almost 5,000 to a total of
85,011. The birth rate in 1954 was 24.4 per 1,000 population. There
were 61,529 white births with a rate of 22.0 and 23,482 colored births
with a rate of 34.3 per 1,000 population. The 1954 total was the
highest number of births registered in the history of the Bureau and
reflects the continued growth of population. Births by race, by county
are shown in Table 10. The trend of births is indicated by Table 8, which
gives the resident births and birth rates for the period 1931 to 1954.

DEATHS
Despite the sharply upward trend of population growth of about
6 per cent a year, resident deaths increased by only 3 per cent over
1953 to a total 31,433. The death rate was 9.0 per 1,000 population.

VITAL STATISTICS

There were 24,063 white deaths with a rate of 8.6 per 1,000. It is
noteworthy that despite a continued growth of the colored population,
there were fewer colored deaths (7,370) in 1954 than in 1953 (7,429).
The colored death rate in 1954 was 10.8 per 1,000 population. Deaths
and death rates by cause and race are presented in Table 9.
Cardiovascular-renal diseases continued to be the major causes of
mortality with 15,923 deaths attributed to these causes. There were
4,802 cancer deaths.
Continued declines were noted for tuberculosis, syphilis and most
infectious diseases. An increase in poliomyelitis deaths from 46 in
1953 to 55 in 1954 reflects the increased incidence of this disease in
1954, while the reduction in influenza deaths from 223 in 1953 to 87
in 1954 reflects a post epidemic year low.
An increase in the number of suicides was noted. There were 342
deaths coded to this cause in 1953 compared with 417 in 1954. This
may be partially due to an increase in the number of older persons
in the population among whom suicide rates are higher.
The trend of resident deaths in Florida since 1931 is shown in Table
8.
MARRIAGE AND DIVORCE
There were 28,316 marriages in 1954, an increase of almost 4 per
cent over the 1953 total of 27,278. Both white and nonwhite mar-
riages increased. There were 22,460 white marriages compared with
21,557 in 1953, and 5,856 nonwhite marriages in 1954 compared with
5,721 in the previous year. Marriage rates (marriages per 1,000
population) were: total population 8.1, white 8.0, and nonwhite 8.6.
Divorces and annulments totaled 19,417 in 1954, a reduction from
the 20,139 recorded in 1953. The divorce and annulment rate was
5.6 per 1,000 population. Divorces and annulment reports do not
contain information concerning the race of the persons granted decrees.
ACTIVITIES
Because of the personnel shortage, only one new project was started
in the Bureau during the year. This was the tabulation and preparation
of data concerning patients in Mental Health Clinics. A summary
of these tables will be included in the report for the Division of
Mental Health.
The potential work load of the Bureau increased 8 per cent over
the previous year. The number of paid requests for certifications in-
creased 12 per cent, fees collected increased 10 per cent and current
certificates filed increased 2 per cent. Since 1951 the potential work
load of this Bureau has increased 22 per cent and during the same
period one new employee has been added for a 2 per cent gain. The
Bureau was unable to keep up with the increasing work load and

24 ANNUAL REPORT, 1954

therefore has been forced to eliminate a portion of the services and
procedures each year. During 1954, free searches of the records were
eliminated for many state and federal agencies. Statistical tabulations
were eliminated for all cities of less than ten thousand population.
The position of field representative has been left vacant for the past
15 months.
Additional vault space is urgently needed. As of the end of the
year the vault is completely filled. A small amount of non-fireproof
space is scheduled to be made available soon which will be sufficient
for approximately two more years.
A consolidated "Vital Statistics Scoreboard" is shown as Table 13.
Counties are listed in order of rank showing their relative efficiency
in birth and death registration. It is hoped that the local health de-
partments will take remedial action in those counties which are at
the bottom of the list and have shown little or no improvement. Proper
registration of births and deaths in each county is the responsibility
of the county health officer.

Technical Articles by staff members include:
Williams, E. H. Jr. Mortality Trends in Florida, Journal Fla. Med.
Assoc., Feb. 1954.

VITAL STATISTICS

TABLE 7

ACTIVITIES OF THE BUREAU OF VITAL STATISTICS

DURING THE YEARS 1953 AND 1954

Activity
Current certificates filed ..........................
Delayed birth certificates filed ..................
Adoption decrees received ............................
Amended certificates filed for adoptions ........
Amended certificates filed for legitimations
and correction of parentage ....................
Legal change of name orders ............................

Requests for certifications
Fee paid ........................ ................. .....
Free .............. ..... ... .....................
Photostats made ............................................
Birth Registration Cards made .................
Fees collected and transmitted to

1953
160,792
3,396
1,709
1,804

1954
164,001
3,123
2,221
2,090

Per cent
change
+ 2.0
-9.2
+30.0
+15.9

500 479 4.2
407 871 (Law effective
June 1953)

68,199
18,871
77,718
24,428

76,300
17,799
84,551
25,030

+11.9
-5.7
+ 8.8
+ 2.5

State Treasurer ..................................$102,649.00 $113,328.60 +10.4

TABLE 8
RESIDENT BIRTHS AND DEATHS WITH RATES PER 1,000
POPULATION, FLORIDA, 1931-1954

YEAR POPULATION BIRTHS BIRTH RATE DEATHS RATE DEATH
1954* 3,481,528 85,011 24.4 31,433 9.0
1953 3,111,100 80,087 25.7 30,529 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 32,437 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 12.3
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
*1954 data based upon preliminary totals.

TABLE 9

DEATHS AND DEATH RATES BY CAUSE, BY RACE, FLORIDA, 1954 (PRELIMINARY FIGURES)

CAUSE OF DEATH
(Numbers in parentheses refer to the International list of causes of death)

Deaths

Total

White Colored

Rate Per 100,000 Population
S0

Total

White IColored

ALL CAUSES ............................................................. 31,433 24,063 7,370 9.0* 8.6*

Tuberculosis of respiratory system (001-008) ................................ ...........
Tuberculosis, other forms (010-019) ...... .. ..................................
Syphilis and its sequelae (020-029) .......................................................
Typhoid Fever (040) ........................ ..........................................
Dysentery, all forms (045-048) ............. ....................................
D iphtheria (055) ..................................................
Whooping cough (056)................................. ............................
Meningococcal Infections (057)................ ................................... ..
Acute Poliomyelitis (080)............. .............................................
Acute Infectious Encephalitis (082)......................................................
Measles (085) ............. ...........................
Typhus and other rickettsial diseases (100-108)...............................................
All other diseases classified as infective and parasitic (030 to 138 with exception of above causes)..
Malignant Neoplasms, including neoplasms of the Lymphatic and haematopoietic tissues (140-205).
Diabetes Mellitus (260) ..................................................................
Anemias (290-293) .....................................................................
Diseases of the cardiovascular-renal system..................................................
Cerebral vascular disease (330-334) ......................................................
D diseases of the heart ................................................................. ..
Chronic rheumatic heart disease (410-416) ...............................................
Arteriosclerotic and degenerative heart disease (420-422) .................................
Hypertension with heart disease (440-443)...........................................
Other diseases of heart (430-434) ......................................................
Hypertension without heart disease (444-447) .............................................
Other circulatory diseases (456-468).....................................................
Nephritis and nephrosis (590-594) .....................................................
Rheumatic fever (400-402)............. .... ...............................................
Influenza (480-483) ......................................................................
Pneumonia (490-493) ....................................................................
Ulcer of stomach and duodenum (540-541)..................................................
Intestinal obstruction and hernia (560, 561, 570) ............................................
Gastritis, duodenitis, enteritis and colitis, except diarrhea of the newborn (543, 571, 572)..........
Cirrhosis of liver (581) ................... .....................
Complications of pregnancy, childbirth, and the puerperium (640-652, 670-689)...................
Congenital malformations (750-759) .......................................................
Birth injuries, postnatal asphyxia, and atelectasis (760-762) ..................................
Infection of the newborn (763-768) ............................... ..... .. ......... .....
Other diseases peculiar to early infancy, and immaturity unqualified (769-776) ...................
Senility without mention of psychosis, ill-defined and unknown causes (780-795)..................
M otor vehicle accidents (810-835)........ .. .... ........................................
All other accidents (800-802, 840-962)......................................................
Suicide and self-inflicted injury (963, 970-979) ...............................................
Homicide and operations of war (964, 965, 980-999)..........................................
All other diseases (residual)................................................................

263
14
121
0
22
10
1
22
55
14
14
0
128
4,802
424
99
15,923
3,728
10,595
355
8,162
1,278
800
251
851
498
16
87
755
180
225
234
343
54
416
658
99
808
772
887
1,219
417
341
2,010

147
10
61
0
5
4
1
14
49
9
10
0
72
4,071
320
69
12,784
2,767
8,853
293
7,145
798
617
157
704
303
12
27
457
152
168
105
300
17
328
451
53
462
420
639
850
391
112
1,493

7.6
0.4
3.5
0
0.6
0.3
***
0.6
1.6
0.4
0.4
0
3.7
137.9
12.2
2.8
457.4
107.1
304.3
10.2
234.4
36.7
23.0
7.2
24.4
14.3
0.5
2.5
21.7
5.2
6.5
6.7
9.9
0.6**
11.9
18.9
2.8
23.2
22.2
25.5
35.0
12.0
9.8
57.7

5.3
0.4
2.2
0
0.2
0.1
***
0.5
1.8
0.3
0.4
0
2.6
145.5
11.4
2.5
456.9
98.9
316.4
10.5
255.4
28.5
22.1
5.6
25.2
10.8
0.4
1.0
16.3
5.4
6.0
3.8
10.7
0.3**
11.7
16.1
1.9
16.5
15.0
22.8
30.4
14.0
4.0
53.4

10.8*
17.0
0.6
8.8
0 Z
2.5
0.9 C
0
1.2 >
0.9
0.7
0.6
0 T
8.2
106.9
15.2
4.4
459.0 0
140.5
254.7
9.1 1-.
148.7
70.2
26.8
13.7
21.5 10
28.5
0.6 U1
8.8 P.
43.6
4.1
8.3
18.9
6.3
1.6**
12.9
30.3
6.7
50.6
51.5
36.3
54.0
3.8
33.5
75.6

Infant mortality (deaths under one year of age)............................. ............. 2,650 1,533 1,117 31.2** 24.9** 47.6**

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

VITAL STATISTICS 27

TABLE 10
ESTIMATED POPULATION AND PRELIMINARY TOTALS OF BIRTHS,
DEATHS, AND INFANT DEATHS BY COLOR, FLORIDA, 1954

Estimated BIRTHS
COUNTIES Population
1954 Total White

STATE........ 3,481,528 85,011 61,529

Colored Total
23,482 81,433

DEATHS INFANT DEATHS

White Colored Total White Colored
24,063 7,370 2,650 1,533 1,117

Alachua......... 61,358 1,627 1,014 618 500 277 223 41 17 24
Baker.......... 6,272 170 112 58 60 39 21 10 6 4
Bay........... 52,307 1,823 1,518 305 338 261 77 34 25 9
Bradford...... 11,447 301 203 98 92 71 21 4 4 0
Brevard......... 38,650 1,282 1,012 270 310 238 72 35 21 14
Broward........ 133,842 3,392 2,091 1,301 1,172 872 300 110 41 69
Calhoun........ 7,664 195 148 47 75 59 16 5 3 2
Charlotte....... 5,135 85 66 19 70 59 11 2 2 0
Citrus.......... 6,124 156 107 49 86 62 24 2 0 2
Clay........... 18,633 608 524 84 117 89 28 17 13 4
Collier......... 9,538 201 167 44 82 47 35 18 13 5
Columbia....... 19,963 511 303 208 222 120 102 26 14 12
Dade........... 670,022 14,169 10,842 3,327 5,506 4,722 784 433 278 155
DeSoto......... 9,279 185 119 66 95 72 23 8 6 2
Dixie.......... 3,983 102 84 18 41 33 8 1 1 0
Duval........... 378,007 10,371 7,449 2,922 2,907 1,945 962 320 201 119
Escambia....... 148,449 4,939 3,875 1,064 954 641 313 160 92 68
Flagler......... 3,980 93 35 58 48 26 22 3 1 2
Franklin........ 5,472 153 106 47 71 54 17 8 5
Gadsden........ 38,962 1,037 297 740 813 106 207 51 6 45
Gilchrist........ 8,068 70 55 16 31 27 4 2 2 0
Glades......... 2,615 51 28 23 20 8 12 2 0 2
Gulf........... 9,047 263 184 79 60 40 20 5 3 2
Hamilton....... 9,117 244 98 146 73 42 31 9 5 4
Hardee ........ 11,399 240 209 81 99 91 8 6 4 2
Hendry........ 6,89 184 122 62 55 37 18 11 4 7
Hernando..... 7,720 195 127 68 79 55 24 7 8 4
Highlands...... 15,095 381 248 133 152 114 38 12 6 7
Hillsborough... 308,397 7,413 5,956 1,457 2,756 2,197 559 231 160 71
Holmes........ 12,998 254 239 15 95 91 4 7 6 1
Indian River.... 14,499 829 218 111 113 94 19 9 6 3
Jackson ........ 35,456 900 565 335 280 162 118 22 10 12
Jefferson....... 10,054 312 84 228 106 33 73 15 2 13
Lafayette....... 3,310 70 60 10 21 18 8 2 1 1
Lake........... 43,312 980 661 819 458 351 107 39 25 14
Lee............ 29,594 683 482 201 287 224 63 21 15 6
Leon........... 57,159 1,419 788 631 882 189 193 46 18 28
Levy........... 10,457 236 130 106 136 78 57 12 0 12
Liberty........ 2,646 75 65 10 5 24 11 3 1 2
Madison..... 14,376 391 159 232 138 59 79 17 1 16
Manatee....... 42,239 843 561 282 510 897 113 89 16 23
Marion......... 48,646 1,072 597 475 442 266 1ll 38 17 21
Martin......... 9,345 219 140 79 124 95 29 4 3 1
Monroe........ 45,495 1,423 1,278 145 277 220 5. 31 27 4
Nassau......... 14,667 435 287 148 119 60 5 8 2 6
Okaloosa....... 37,844 1,595 1,497 98 186 168 1 37 33 4
Okeechobee..... 4,041 117 80 37 42 22 2.) 5 3 2
Orange......... 164,112 4,144 3,156 988 1,505 1,262 243 96 70 26
Osceola......... 12,808 264 208 56 194 170 24 8 5 3
Palm Beach..... 154,279 3,455 2,241 1,214 1,429 1,046 883 121 65 56
Pasco.......... 23,987 441 364 77 819 274 45 17 14 3
Pinellas........ 205,502 8,163 2,491 672 2,989 2,752 237 104 62 42
Polk........... 149,733 3,776 2,792 984 1,311 1,025 286 97 67 30
Putnam........ 26,552 744 422 322 276 174 102 21 11 10
St. Johns....... 28,502 640 417 223 300 194 106 16 9 7
St. Lucie....... 25,221 759 382 377 257 150 107 34 10 24
Santa Rosa..... 21,351 640 584 56 150 112 38 17 11 6
Sarasota........ 35,687 723 550 173 445 398 47 23 14 9
Seminole....... 32,454 867 476 391 281 149 132 25 5 20
Sumter......... 11,188 268 157 111 93 61 32 10 4 6
Suwannee ...... 16,523 396 239 157 172 110 62 14 5 9
Taylor........ 12,97 325 237 88 117 78 39 12 9 3
Union.......... 8,379 88 57 31 44 33 11 3 1 2
Volusia......... 87,265 1,739 1,196 543 1,112 889 223 75 34 41
Wakulla........ 5,042 133 75 58 46 20 26 5 2 3
Walton......... 15,038 409 843 66 152 133 19 13 11 2
Washington..... 11,655 243 162 81 107 78 29 11 5 6

28 ANNUAL REPORT, 1954

TABLE 11

PRELIMINARY TOTALS OF RESIDENT DEATHS FROM

SELECTED CAUSES, BY COUNTIES, FLORIDA, 1954
.0 Cardio.Vassular-Renal Diseases

0 a
E .5 .7 1. .5 1 2

STATE.... 54 277 121 22 1 55 4,802 424 99 42 ,728 10,595 1,102 498 887 1219

Alachua..... 1 6 4 1 0 0
Baker....... 0 1 0 0 0 0
Bay......... 1 5 1 3 0 1
Bradford... 2 1 0 0 0 0
Brevard..... 0 2 1 0 0 1
Broward..... 5 8 5 4 0 3
Calhoun..... 0 1 0 0 0 0
Charlotte.... 0 0 0 0 0 0
Citrus....... 0 1 0 0 0 0
Clay....... 0 0 1 1 0 0
Collier...... 2 0 1 1 0 0
Columbia.... 0 0 1 0 0 1
Dade....... 5 58 17 0 0 10
DeSoto...... 0 1 0 0 0 0
Dixie....... 0 2 0 0 0 0
Duval....... 6 39 13 1 0 8
Escambia.... 2 16 6 0 0 8
Flagler...... 1 0 0 0 0 0
Franklin..... 0 2 0 0 0 1
Gadsden..... 1 5 0 0 0 1
Gilchrist..... 0 0 0 0 0 0
Glades...... 0 1 0 0 0 0
Gulf........ 0 0 1 1 0 0
Hamilton.... 0 1 1 0 0 0
Hardee...... 0 0 0 0 0 0
Hendry..... 0 0 0 0 0 0
Hernando... 0 1 1 0 0 0
Highlands... 0 2 1 0 0 0
Hillsborough. 0 22 10 2 0 6
Holmes...... 0 0 0 0 0 1
Indian River. 0 2 0 0 0 0
Jackson..... 0 1 0 0 0 1
Jefferson.... 2 0 0 0 0 1
Lafayette.... 1 0 0 0 0 0
Lake........ 0 4 3 0 0 0
Lee......... 0 2 1 0 0 2
Leon........ 0 4 1 0 0 0
Levy........ 0 1 3 2 0 0
Liberty..... 0 0 0 0 0 0
Madison..... 0 1 1 0 0 1
Manatee.... 0 4 2 2 0 0
Marion...... 3 3 2 0 0 0
Martin...... 1 2 2 0 0 1
Monroe..... 1 3 0 0 1 0
Nassau...... 0 0 2 1 0 0
Okaloosa.... 2 1 0 0 0 0
Okeechobee.. 0 2 1 0 0 0
Orange...... 2 9 7 0 0 5
Osceola...... 1 0 1 0 0 0
Palm Beach.. 1 16 3 0 0 3
Pasco....... 2 1 1 0 0 0
Pinellas..... 3 9 8 0 0 1
Polk........ 1 11 9 0 0 0
Putnam..... 1 2 1 0 0 0
St.Johns.... 0 5 0 0 0 0
St.Lucie.... 1 1 2 1 0 0
Santa Rosa.. 0 0 0 0 0 1
Sarasota..... 0 1 0 0 0 0
Seminole... 1 5 2 0 0 0
Sumter...... 0 0 0 0 0 0
Suwannee... 0 1 1 0 0 0
Taylor...... 1 0 0 0 0 0
Union....... 0 0 0 0 0 0
Volusia...... 2 8 4 2 0 1
Wakulla..... 1 1 0 0 0 1
Walton...... 1 1 0 0 0 1
Washington.. 0 1 0 0 0 0

60
3
36
11
43
193
7
6
13
17
8
16
1,012
14
6
409
110
4
5
35
1
1
9
6
11
4
13
22
443
11
12
35
8
3
68
43
53
14
3
15
64
53
18
42
13
18
1
239
22
238
48
543
189
27
54
41
21
82
36
13
22
20
5
174
5
19
12

7 7 19 68 159 17 11 14 23
1 0 3 9 11 0 5 2 8
5 0 11 84 95 9 5 6 29
2 0 0 14 32 3 1 9 2
4 0 6 50 103 10 4 6 10
16 5 42 117 407 38 25 48 45
0 0 3 15 26 2 2 5 6
1 1 1 16 23 2 2 0 4
0 0 2 9 32 4 1 1 7
1 1 5 13 29 0 6 7 8
0 0 3 8 17 5 1 4 2
3 1 17 47 55 6 0 7 8
77 20 113 600 1,842 200 71 160 161
1 0 3 19 27 1 4 6 2
0 0 2 4 19 2 2 0 0
38 4 87 355 910 90 38 78 132
9 1 21 92 245 12 18 36 44
1 0 2 5 18 4 0 0 4
0 0 3 9 19 3 2 1 7
4 1 20 39 91 8 6 12 14
0 0 1 4 15 0 1 2 0
0 0 1 1 9 0 1 0 0
0 1 1 4 13 2 2 4 7
1 1 1 9 15 4 3 3 4
2 0 2 13 33 4 0 2 8
1 0 3 9 21 1 1 1 1
1 0 2 6 27 2 2 1 7
3 0 6 25 54 0 2 7 3
50 5 57 255 923 77 54 84 95
3 1 1 18 25 4 0 6 8
3 1 1 10 46 6 1 5 3
4 0 12 61 73 18 5 8 9
2 1 4 20 31 0 8 2 1
1 0 1 1 9 0 1 0 1
10 4 13 51 158 12 8 11 24
2 1 8 35 80 10 4 13 14
8 0 15 44 108 10 10 15 13
2 0 5 20 43 1 1 2 3
1 0 1 5 15 2 1 1 1
2 0 3 26 40 4 4 4 2
5 2 20 55 202 29 9 9 16
4 1 16 41 161 9 9 10 25
1 0 1 16 42 3 2 3 5
5 1 14 32 69 10 0 15 14
1 2 3 14 34 8 3 5 11
0 0 9 19 50 4 7 6 9
0 0 0 4 18 0 1 2 2
17 5 39 167 565 52 13 49 55
3 2 6 30 75 5 2 3 7
19 2 37 141 506 38 20 45 63
3 1 7 35 127 18 4 5 8
43 16 44 405 1,196 156 15 35 74
13 3 39 172 463 54 21 38 45
6 2 11 30 88 7 28 7 16
5 2 9 33 107 14 6 1 8
3 0 9 33 73 7 5 11 16
0 0 2 21 50 7 3 9 9
6 0 8 45 160 17 3 11 21
4 1 10 26 107 6 4 11 19
0 0 1 16 22 1 0 5 4
1 1 6 21 64 11 1 10 7
0 0 6 19 27 4 3 4 12
0 0 1 7 18 0 0 2 4
14 1 32 153 389 58 23 15 34
0 0 3 6 8 3 0 0 1
3 1 6 28 43 5 2 2 7
2 0 2 19 34 3 1 1 7

VITAL STATISTICS 29

TABLE 12

MARRIAGES BY COLOR, DIVORCES, AND ANNULMENTS FOR FLORIDA

AND EACH COUNTY, 1954

MARRIAGES
COUNTIES Divorces Annulments
Total White Colored
FLORIDA. ............ 28,296 22,449 5,847 19,175 212
Alachua .................. 355 234 121 213 2
Baker.................... 29 22 7 518 4
Bay....................... 401 320 81 141 1
Bradford.............. .... 61 47 14 463 4
Brevard................... 319 256 63 560 2
Broward................... 1,674 1,313 361 686 7
Calhoun................... 26 24 2 51
Charlotte ................. 90 78 12 16
Citrus .................... 84 73 11 38
Clay...................... 103 88 15 74
Collier ................... 106 94 12 17
Columbia ................. 131 91 40 91
Dade.................... 6,193 5,349 844 4,623 43
DeSoto.................... 91 74 17 17 1
Dixie...................... 15 14 1 17
Duval.................... 2,066 1,591 475 928 10
Escambia ................. 724 592 132 860 18
Flagler ................... 62 41 21 192
Franklin................... 63 47 16 26
Gadsden................... 200 76 124 74
Gilchrist................... 35 29 6 5
Glades.................... 31 26 5 5
Gulf...................... 71 53 18 32 1
Hamilton.................. 29 17 12 48
Hardee.................... 130 109 21 337 5
Hendry.................... 105 69 36 18
Hernando................. 103 79 24 32
Highlands................. 161 123 38 150
Hillsborough ............... 2,738 2,282 456 1,430 10
Holmes.................... 58 51 7 45
Indian River............... 153 108 45 41 1
Jackson ................... 203 188 65 75
Jefferson ................... 66 25 41 5
Lafayette .................. 11 10 1 10
Lake...................... 386 269 117 279 7
Lee..................... .. 287 228 59 130
Leon...................... 366 209 157 309 4
Levy.................. 92 56 36 34
Liberty ................... 12 8 4 26 1
Madison................... 71 44 27 50
Manatee... ............... 328 279 49 54
Marion.................... 335 188 147 232 1
Martin ................... 93 69 24 17 1
Monroe.................... 455 388 67 250
Nassau .................... 45 40 5 26
Okaloosa.................. 237 214 23 188 1
Okeechobee................ 48 35 13 16
Orange.................... 1,250 983 267 430 1
Osceola.................... 184 135 49 25
Palm Beach ............... 1,387 985 402 732 9
Pasco ..................... 296 259 37 90 1
Pinellas................... 1,726 1,501 225 593 8
Polk. .................... 1,381 1,100 281 1,199 31
Putnam................. 201 118 83 894 16
St. Johns ................. 209 175 34 589 10
St. Lucie .................. 254 162 92 133
Santa Rosa ............... 81 70 11 43
Sarasota .................. 399 332 67 174 1
Seminole................... 276 155 121 152 1
Sumter ................... 103 64 39 101 2
Suwannee ................. 112 80 32 51
Taylor.................... 82 61 21 33
Union..................... 40 25 15 22
Volusia.................... 681 531 150 443 7
Wakulla ................... 27 14 13
Walton.................... 77 66 11 43 1
Washington ................ 88 63 25 29

30 ANNUAL REPORT, 1954

TABLE 13

VITAL STATISTICS SCOREBOARD

Based on Promptness and Completeness of Certificates Filed in 1954

Percent of Percent of
Certificates Complete Percent of Total Score Change
COUNTY Rank *Filed on Time Certificates Monthly (Maximum from 1953
SReports 500) Total Score
Births Deaths Births Deaths submitted
on Time

Manatee .............. 1 97 98 99 99 100 493 +19
Pinellas ............. 2 97 98 99 99 100 493 +42
Dade ............... 3 95 99 99 99 100 492 + 4
Franklin .............. 4 98 94 98 100 100 490 + 8
Suwannee ........... 6 96 98 98 98 100 490 + 6
Sarasota .............. 6 94 98 99 99 100 490 +12
Hernando............ 7 93 99 99 98 100 489 + 5
Baker................ 8 95 97 98 97 100 487 +19
DeSoto............... 9 99 99 99 97 92 486 0
Martin .............. 10 99 99 99 97 92 486 + 3
Okeechobee........... 11 99 95 100 100 92 486 + 3
Hillsborough.......... 12 96 98 99 99 92 484 +15
Escambia ... ...... 13 90 97 99 98 100 484 +11
Palm Beach........... 14 90 96 99 98 100 483 + 9
Santa Rosa............ 15 92 93 99 98 100 482 +25
Charlotte............. 16 93 96 95 96 100 480 2
Volusia.............. 17 89 94 99 98 100 480 + 2
Bradford ............ 18 97 100 96 94 92 479 6
Wakulla.............. 19 98 100 92 88 100 478 -14
Marion .............. 20 84 96 99 99 100 478 + 5
Brevard ............. 21 94 85 99 99 100 477 +10
Clay................. 22 90 91 98 98 100 477 +20
Holmes .............. 23 92 91 96 96 100 475 3
Polk ................ 24 87 93 98 96 100 474 + 4
Madison.............. 25 89 97 99 96 92 473 6
St. Lucie............. 26 87 92 99 93 100 471 0
Monroe ............. 27 97 91 99 97 83 467 +19
STATE............ 86 93 99 98 91 467 + 1
Walton .............. 28 78 90 99 99 100 466 +49
Bay ................ 29 84 86 99 96 100 465 +12
Leon................. 30 84 84 99 97 100 464 9
Okaloosa............. 31 82 85 99 96 100 462 + 6
Duval............ ... 32 80 95 97 98 92 462 +32
Levy................. 33 85 78 99 99 100 461 + 7
Lake ............... 34 83 84 98 96 100 461 4
Osceola .............. 35 79 93 99 98 92 461 9
Citrus ............... 36 72 95 97 97 100 461 2
Putnam ............. 37 88 84 97 97 92 458 + 3
St. Johns............. 38 94 97 99 99 67 456 -14
Pasco................ 39 74 94 93 95 100 456 -18
Washington........... 40 70 85 100 99 100 454 -10
Lee ................. 41 67 96 99 99 92 453 7
Highlands ........... 42 73 87 98 94 100 452 + 6
Hardee .............. 43 74 96 98 98 83 449 + 6
Calhoun ............. 44 84 76 96 91 100 447 +28
Flagler............... 45 90 86 98 95 75 444 + 2
Orange ............... 46 76 83 98 95 92 444 -10
Broward............. 47 64 91 99 98 92 444 -37
Union ............... 48 83 98 90 92 75 438 4
Gadsden.............. 49 67 82 99 97 92 437 +11
Dixie ............... 50 56 90 91 100 100 437 -15
Jackson.............. 51 74 71 97 94 100 436 +15
Gilchrist ............ 52 80 67 88 100 100 435 -24
Sumter.............. 53 72 70 98 95 100 435 +12
Lafayette ............ 54 58 83 100 92 100 433 +50
Seminole ........... 55 98 99 99 99 33 428 -58
Jefferson............. 56 74 93 98 97 58 420 -24
Nassau .............. 57 71 88 99 95 67 420 -23
Taylor............... 58 44 81 97 98 100 420 +38
Glades. ............ 59 40 100 80 100 100 420 +23
Alachua ............. 60 64 76 99 95 75 409 -21
Collier ............... 61 61 69 98 98 83 409 -14
Hamilton............ 62 46 69 94 97 100 406 5
Hendry ............. 63 40 74 98 100 92 404 + 7
Columbia............ 64 60 66 98 97 75 396 -48
Indian River......... 65 69 76 98 100 50 393 -27
Liberty ............. 66 92 67 77 85 67 388 -13
Gulf................. 67 54 45 95 96 42 332 -76

LOCAL HEALTH SERVICE 31

BUREAU OF LOCAL HEALTH SERVICE

GEORGE A. DAME, M.D., Director

At the beginning of 1954 there were sixty-six county health depart-
ments constituting thirty-seven units. According to the State Board
of Health estimate the county health departments were serving a
population of 3,141,000, exclusive of the City of Jacksonville and the
County of St. Johns. As of the last day of the year there was an
estimated population of 3,313,000 being served. Budgets set up for the
county health departments for the fiscal year beginning July 1, 1954,
on the adopted formula, were based on available funds totalling $3,715,-
634, derived as follows: County contributions, $2,553,869; State al-
location, $1,050,615; Federal grants-in-aid, $111,150. In addition to
the formula allocation six county health departments received a total
of $44,940 of federal mental health funds, and five counties received
$36,580 of state mental health funds. Twelve counties received can-
cer funds in the amount of $39,520, and one county received $6,480
of heart disease funds.
Based on the estimated population served as of December 1954,
and using the amounts set up in the budgets for July 1, 1954 and
still used, it will then be seen that the counties were contributing 77
cents per capital, the state was contributing (formula) approximately
32 cents per capital, and the federal government was contributing
(formula) approximately three cents per capital. Excluding the special
funds granted some of the counties it will be seen that the county
health departments were, at the close of the year, operating on $1.12
per capital, per annum. It has been estimated by conservative ex-
perts that a state should have at least $1.50 per capital.
In considering the needs of county health departments, it should
be taken into consideration that the nearly 1,000 persons employed
in county health departments constitute the battle line in our fight
for better health for our total state population. Thought should be
given to the vast importance of this work to the state's expanding
economy. The present inadequacy of funds available to the county
health departments has created a condition of poor salaries, insuf-
ficient personnel, inadequate travel, and less than needed for other
expenses. The availability of funds has not kept pace with the as-
tonishing increase in the state's population and wealth, nor has it
kept pace with the need for new and expanding programs of public
health and preventive medicine in the county health departments.
In June four health officers completed out-of-state training, re-
ceived their degrees of Master of Public Health, and reported back
to their respective assignments. Three sanitarians also completed train-
ing and received Masters degrees in Public Health.

32 ANNUAL REPORT, 1954

Of the thirty-seven directors of county health departments there are
now twenty-three holding the degree of Master of Public Health. The fol-
lowing Schools of Public Health are represented with the number of
graduates from each: Tulane University 5, University of North Caro-
lina 2, Johns-Hopkins University 7, University of California 1, Uni-
versity of Michigan 2, Harvard University 5 and Yale University 1.
One assistant director holds a degree from Harvard.
The following report covers some of the more interesting activities
in the promotion of public health in some of the county health de-
partments. Space does not permit the reporting of all worth-while
programs. Each year each health officer is invited to present one pro-
gram or activity.
Doctor Joseph M. Bistowish, Director of the Leon County Health
Department was presented a distinguished service award by the Tal-
lahassee Junior Chamber of Commerce. The award notes that he
was "selected as a recipient of the 'Distinguished Service Award' be-
cause of his untiring and courageous leadership during 1954 in the field
of public health in Leon County. When the epidemic of poliomye-
litis and encephalitis struck Leon County, Dr. Bistowish led the fight
against these dread diseases. Many physicians, nurses, and volunteer
workers helped in the valiant battle which was waged, and Dr.
Bistowish was constantly in touch with these workers, guiding and
helping them in their heroic efforts. His untiring efforts to reassure those
who had been exposed in the epidemic, played a major part in pre-
venting widespread hysteria which was a constant threat throughout
the emergency. He has been outstanding in helping to make Leon
County one of the cleanest and most sanitary counties in our nation,
but his achievements during the recent epidemic were nothing short
of heroic."
It is now reported that Washington County will build a health de-
partment center in 1955, and Walton County in 1956. Doctor Raymond
N. Nelson already has a fine new health department center in his other
county, Holmes.
Doctor L. L. Burger, Director of the Sumter County Health De-
partment has succeeded in getting the County Commissioners to double
their contribution in the past three years. This is a notable achieve-
ment.
A report from Doctor Terry Bird, Director of the Seminole County
Health Department is as follows: "There are two outstanding items
of interest that have occurred in this county this past year that per-
tain to public health. First, is the signing of a $3,000,000.00 contract
and actual beginning of laying an extension of sanitary sewers in
Sanford. Also, the signing of an agreement to construct a sewage
treatment plant. Second, is the signing of a contract of $1,500,000
for a new hospital in Sanford to be completed in June, 1955. This

LOCAL HEALTH SERVICE 33

hospital is 80-100 bed capacity and will serve the entire county. Hill-
Burton funds are being used in the construction of this hospital."
From Putnam County Doctor Norman B. Edgerton reports as fol-
lows: "The Business and Professional Womans Club of Crescent City,
with help and advice from the Putnam County Health Department, has
under construction a beautiful new Health Center located near the
Crescent City School. This new health clinic will provide office space
for the health unit, a room for the Red Cross and its supplies, and
an auditorium which will seat about seventy-five. Only one clinic
session per week is now provided by the Putnam County Health De-
partment in Crescent City but we hope to broaden this service with
the help of the local physicians, to include a well-baby clinic. The
possibility for broadening health education in this community will be
considerably helped by the new auditorium."
Doctor James Basil Hall reports some interesting items from the Lake
County Health Department: "Four articles printed and/or accepted in
national publications. 'Truth About Teeth'-a fifty page publication
for teachers was well received. We now have scheduled for Lake
County's Fair a 'wing-bite' x-ray survey available to all school children.
A dental manufacturing concern is furnishing two of their latest x-ray
units and two other manufacturers are donating 10,000 films. Twelve
Lake County dentists, with their dental assistants, are each contributing
one day at the fair. We expect to x-ray a minimum of 5,000 children."
From Doctor Andrew P. Haynal of the Madison County Health
Department: "An interesting activity in health education has been
initiated by the sanitarian, Bob Browning, and the nurse, Mrs. Dickey.
In cooperation with the teachers of our county schools one or the
other or both are making weekly home visits with the teacher to the
home of one of the teacher's problem children. The objective is to give the
teacher a deeper insight into the health and sanitation problems in
the home which may be responsible for the poor work the child is
doing in school, and result in better understanding of the child's pro-
blem. This enables our health department representative to get in a
few good on-the-spot licks for public health with both the teacher and
parent present. This service has already met with enthusiastic sup-
port from the parents and teachers."
The County Commissioners of Monroe County have appropriated and
earmarked $5,000.00 for renovation of the fine and commodious head-
quarters of the county health department. The county has been very
fortunate in recently securing the services of Doctor Francis X. Walsh
as the director.
Doctor Nell T. Pattengale, Acting Director of the Pinellas County
Health Department: "Major public health progress in Pinellas County
is obvious in three programs: the establishment of a St. Petersburg-
Gulfport Visiting Nurse Association, the tremendous strides in pro-
vision of adequate sewage facilities, and the results of a complete job

34 ANNUAL REPORT, 1954

of community organization and participation for the county x-ray sur-
vey. The organization of a V.N.A. for St. Petersburg and Gulfport
area in the fall of 1954 is another link in the plan to cover the county
with visiting nurse services. Extensive work has been done on plan-
ning for adequate sewage disposal facilities throughout the county in
large and small communities. Citizen interest voted for new plants,
extension of sewer mains, and other improvements, with the biggest
item being a new sewage treatment plant in St. Petersburg. Over
5,000 laymen planned and conducted a spring x-ray survey which
netted 192 cases of tuberculosis, 11 tumors and 353 other conditions
from a total of 68,000 persons x-rayed."
From Doctor John C. McSween, Director of the Escambia County
Health Department: "The Sanitation Department under the direction
of B. G. Tennant, has secured certified photostatic copies of all sub-
divisions recorded in Escambia County since the Plat Law went into
effect in 1926. These plats are photostats and are all the same size,
making it possible to bind them in alphabetical form. One set will
be on file with the health department and one set will be transmitted
to the Bureau of Sanitary Engineering, State Board of Health. Those
subdivisions which have had percolation tests, soil studies and water
table elevations determined will be shown on the reverse side of the
plat, giving the date of filing, type water supply and number of lots.
This will make it easy to check on the development of subdivisions
and their sanitary condition. As additional subdivisions are recorded,
copies will be transmitted to the state office with all the necessary in-
formation pertaining to the subdivision. I believe this will be of great
value to the state office and to our office in maintaining proper con-
tral over subdivision developments and will give complete information
on the number of subdivisions being developed in this county." Doctor
McSween also sends word about plans inaugurated in 1954 for the
construction of a county health department building for Escambia.
The undertaking has been approved by the State Improvement Com-
mission which makes it possible to apply for funds from the federal
government under the Hill-Burton Act.
Doctor Robert Higgins of the Volusia County Health Department
writes of his new Division of Health Education under the direction of
M. Elizabeth Bond. A public health nurse, and a recent graduate of
Peabody College, she served as a mental health nurse in Volusia County
before being assigned as a public health educator. During the in-
fancy of the division, various community groups have requested the
aid of the health educator. In addition, there have been requests from
individual faculty groups with health education programs, lunchroom
supervisors and work with food handlers, County Dental Association
and District Nurses Association, college students and teachers taking
post graduate work in health education. The individual staff mem-
bers feel that their efforts will be enriched by a co-worker who under-
stands the people with whom they work and who is interested in their
needs and problems which affect individual and community life.

LOCAL HEALTH SERVICE 35

This bureau received an interesting report from Doctor Paul W.
Hughes, Director of the Broward County Health Department. "The
county commissioners increased their appropriation to the health de-
partment by almost 50 per cent. The school board increased their ap-
propriation 20 per cent. A quarter of a million dollars of new health
centers have now been completed in this county. A large truck con-
taining a 70 mm x-ray unit is now operated by the health department.
Mr. Norman Tuckett and Mr. Willis Hillyer have done an excellent
job in supervision of construction and maintenance of the presently
existing one hundred and thirty-five public swimming pools. They
have also been active in expediting the installation of sanitary sewer
systems in more than twelve housing developments. Mr. Richard Al-
meida and Mr. O. J. Baker have done considerable work in attempting
to improve migratory labor camps. Mrs. Netta Kessler and her public
health nurses took care of two large programs in a fine manner. The
Salk vaccine program went along very smoothly. All of the public
health nurses worked with a committee of sixteen physicians during
diabetes week and carried out an educational and diabetic program
in all schools and clinics. Mr. Sidney Paetro's quick insight into a
matter of food poisoning probably saved a lot of people in Florida
considerable trouble. On discovering that two people had become ill
with a certain "T.V. frozen turkey dinner" he investigated and found
that twelve other packages had been returned to the same store because
persons did not like the appearance of same. Within one hour Mr.
Paetro contacted Dade County officials, Department of Agriculture
officials and the State Board of Health so that everyone would have
the facts concerning this widely distributed product. Mrs. Ethel Sayles
has accomplished much in the re-organization of the clerical section.
The Broward County Health Department would like to emphasize that
all the above mentioned members and those not mentioned have worked
well as a team."

Doctor Joseph W. Lawrence, Acting Director of the tri-county unit
composed of DeSoto, Hardee and Charlotte has written of a new pro-
ject set up in his unit in 1954. (Doctor Lawrence is locum tenens for
Doctor James O. Bond who is taking graduate training). "The most out-
standing thing that has occurred has been the establishment of a pilot
program for mental health and the assignment of a mental health
worker to our tri-county unit. It is true that the worker did not be-
gin her work until January 3, 1955, however, this program had been
initiated in the later months of 1954. The credit for this program
should be divided between three persons or groups: Doctor James O.
Bond, Doctor Paul Penningroth of the Division of Mental Health of the
State Board of Health; and the Child Guidance Committee of the
three counties. The intense interest and desire for this program has
been very gratifying. They all see the great need for mental health
work and strongly desire the eventual formation of a Child Guidance
Clinic in this area."

36 ANNUAL REPORT, 1954

Gulf County Health Department has some news of interest in re-
gard to its school health program, submitted by Doctor Warren T.
Weathington: "We are very proud of our school health program.
The only 'new' aspect is a system of monthly projects. Each subject
is announced well in advance and during that month lectures, movies,
pamphlets, debates and direct services, (example: intestinal parasite ex-
amination on each pupil), are all directed toward the one subject.
Teacher and pupil cooperation is much improved as they have a
sense of being part of the program. There is less lost motion in or-
ganizing the activities. The public health nurse likes the time table
because it allows her to plan well in advance. Flexibility is maintained,
however. When a case of diphtheria appeared in one school during
'colds' month, emphasis was easily shifted to immunization, which was
originally scheduled for a later month. Scheduled: Eyes and ears;
hookworm and nutrition; personal hygiene; colds; teeth and diet;
sanitation; immunization; safety; and preschool health."
Doctor Henry I. Langston, Director of the county health departments
of Jackson and Calhoun submits some interesting information in re-
gard to building plans: "The County Commissioners of each county
employed the architectural firm of Sherlock, Smith and Adams of Talla-
hassee and Montgomery to draw up the necessary plans and specifications
for the construction of a health department building in each of these
counties. In Jackson County the County Commissioners approved a
millage to secure the necessary funds for the construction of a proposed
Jackson County Health Department-the amount of approximately
$31,000. This fund was matched by federal funds from the Hill-Burton
Act; as administered through the Hospital Construction Division of the
State Improvement Commission which approved approximately $56,500
to assist in the project. The architectural plans were approved for a
building containing approximately 5,100 square feet of floor space. The
building will be located on the hospital grounds adjacent to the Jackson
County Hospital-a desirable location in the northwestern section of
Marianna. In Calhoun County the Board of County Commissioners
approved the allocation of funds for construction purposes. The plans
and specifications are awaiting the approval of federal funds from the
Hospital Construction Division. The proposed Health Department is
to be located on a spacious lot near the Court House in Blountstown.
The land has already been acquired by the county. This building and
equipment is expected to cost in the neighborhood of $69,000."
Doctor William L. Wright, Director of the Sarasota County Health
Department: "Probably the most outstanding item of local interest
during the past year has been the opening of a health department office
in Venice. Prior to the opening of this office all public health matters
having to do with the south end of the county had to be handled in
the Sarasota office. This meant that our nursing and sanitation person-
nel had to ride a considerable distance to take care of public health
matters and also that the residents of the south county area did not
have good contact with the health department. At the present time

LOCAL HEALTH SERVICE 37

we have two rooms set aside for our office in the city hall in Venice,
one of which is used by the sanitarian and the other serves as an office
for the nurse as well as a clinic room. This new office was opened
September, 1954 and the new arrangements have worked out very
satisfactorily."
A letter from Doctor John S. Neill, Director of the Manatee County
Health Department contains the following items of interest: "The County
Commissioners opened the bids for our new health center on December
6. The contract was signed on December 28. A ground-breaking cere-
mony was held on December 30. Clearing of land and construction
began immediately thereafter. One other item: A Master Card File
System was instigated last Summer. We feel that it has been a great help
in consolidating important information and increasing the efficiency of
our record system."
Doctor Clarence L. Brumback, Director of the Palm Beach County
Health Department, gives as his most outstanding activities the con-
solidation of the city and county health departments, the organization
of a mental health clinic and a poliomyelitis vaccine study. "A few
points about the consolidation with the West Palm Beach City Health
Department: This consolidation entered a trial phase of one year on
January 1, 1954. It had been effected by a 4 to 1 vote of the City
Commission after a great deal of resistance. The support of the County
Medical Society played a very important role in bringing the consolida-
tion about. After the favorable vote, cooperation from city officials was
excellent in taking care of necessary fiscal and personnel matters. We
have been surprised by the small number of complaints or adverse
criticism. On the contrary, all concerned have agreed that much has
been gained through this move. The second year's budget was approved
without question, and the consolidation may now be considered to be past
the probationary stage."
Doctor Frank J. Hill, Director of the unit composed of the health
departments of Gadsden and Liberty Counties sends in an editorial
published in the Havana (Fla.) Herald, which comments (in part):
"Sanitarians with the Gadsden County Health Department kept an eye
on health conditions in our towns, villages and on farms in the county
during 1954 Last year, over 700 investigations and samplings of
the safety or public and private water supplies were made. Nearly 500
visits (to restaurants) were made to inspect them and give advice where
needed. .. Nearly 200 visits to dairy farms and milk plants and milk
samples were collected and delivered to the laboratory for testing, 150
times. One hundred nine visits were made to schools in the county
concerning the sanitary aspects of the school health program. Thousands
of pamphlets on hundreds of various health subjects or disease conditions
were distributed throughout the county to all interested. Motion pictures
on health or talks reached an audience of 5,140 people. Thirty-one
articles were published in various county newspapers informing the
public about health conditions, services and statistics."
Another article published in the Gadsden County Times states (in

38 ANNUAL REPORT, 1954

part): "The staff of the Gadsden County Health Department issued
nearly 500 health cards, gave over 7,000 preventive 'shots', and made
over 1600 dental inspections during the year 1954. Much detailed verify-
ing of accuracy and making duplicate copies of about 1300 resident
birth and death records was necessary. The public health nurses made
nearly 1700 visits to assist expectant mothers to have normal deliveries
and have live, healthy babies."
From Orange County a progressive activity has been reported by
Doctor Wade N. Stephens, Director of the County Health Department:
"On December 31, 1954, there remained only one privy within the city
limits of Winter Park. In 1952 a survey showed there were 176 privies
in Winter Park. At that time a Sanitary Committee was formed by the
city. Mr. W. B. Whittaker, sanitarian of the Winter Park district of the
Orange County Health Department served as advisor and field man,
and worked in cooperation with the Committee. A revolving fund was
set up to make loans for the purpose of installing approved indoor
toilet facilities to those who could not otherwise afford to have the
work done. The City appropriated $3,000, Community Chest $2,000,
Winter Park Welfare Association (a voluntary agency) $1,000, and
Winter Park Methodist Church $100. Payments on the loans were set
at $8.00 per month. No interest was charged. At the present time no
one is delinquent in payments, a number have paid in full and there is
a balance of $1,900 in the revolving fund. The people of Winter Park
believe it is the first city in Florida to be free of privies. Mr. Medlock
has said that he would be glad to visit any city in the state to explain
the organization and help to set up a similar one."
Doctor James F. Speers, Director of the Brevard County Health De-
partment reports: "During 1954 a portable x-ray machine was purchased
by the Brevard County Tuberculosis and Health Association and has
been used by the health department in their tuberculosis program. The
machine has been used for the follow-up of known cases of tuberculosis
and their contacts, for investigation of suspects referred to us by private
physicians, and for x-rays of all food-handlers who apply for health cards.
A total of 15 new cases of tuberculosis were discovered by the use of
the machine. This is nearly twice as many as have been discovered in
the past, when there were no x-ray facilities easily available locally."
Doctor Neill D. Miller, Director of the Martin County Health De-
partment says: "Mr. James Doyle, sanitarian in Martin County, has
through his unrelenting work and perseverance, the establishment, (at
least on paper) of a sewage treatment plant in Stuart. This work thus
far has covered public relations as to the necessity of this plant, the
final drawing of preliminary plans by an engineering firm and the solu-
tion of financing by a fiscal agent. Next to occur is the bidding of con-
tractors within the next few weeks. The sewage treatment plant has
caused much controversy in the past several years but through Mr.
Doyle's working with city officials, contacting various engineering firms
and creating public interest he is to see the accomplishment of one of
his main objectives in public health work."

TABLE 14
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

3 51

5 U U U U U U

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service ..............
2. Consultations and Conferences with
Physicians......................
3. Field and Office Visits...............
IMMUNIZATIONS COMPLETED
4. Smallpox..........................
5. Diphtheria, (5-7) ...................
8. Typhoid Fever...................
9. Whooping Cough, (9-11).............
12. Tetanus ........................ ...
INTESTINAL PARASITE CONTROL
14. Admissions to Service..............
15. Field and Office Visits..............
16. Treatments Given .................
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service
2. Visits to Medical conferences
3. Field Visits and Epidemiological
Investigations......................
4. Treatments given...................
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service........
(A) Cases ....................
(B) Contacts and Suspects..........
(C) Arrested cases ................
2. Admissions to Nursing Service
(A) Cases ......................
(B) Contacts and Suspects..........
(C) Arrested Cases.................
8. Number of Persons X-rayed
(A) Miniature Films ...............
(B) Large 14" x 17" Films..........
6 Visits to Medical Conferences.........
7. Tuberculin Test ...................
8. Field Nursing Visits.................

615 482 603 170
632 485 851 177
618 482 603 164

572 60 216 156 19
573 10 227 162 19
672 77 226 160 18

128 318
18 318
197 318

144 _
12 0
428

4,461
4,203
6,724 t-
568
2,285

280
283
276

2,211
2,509
1,850
1,948

139
285
86 1-4
227
601 td
68
9,500
1,362 9
559 O
121
2,033

7
6 44
2 3

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service .............
2. Consultations and Conferences with
Physicians....................
3. Field and Office Visits...........
IMMUNIZATIONS COMPLETED
4. Smallpox .......................
5. Diphtheria, (5-7) ................
8. Typhoid Fever. ................
9. Whooping Cough, (9-11).............
12. Tetanus. .........................
INTESTINAL PARASITE CONTROL
14. Admissions to Service...............
15. Field and Office Visits...............
16. Treatments Given..................
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service
2. Visits to Medical conferences
3. Field Visits and Epidemiological
Investigations .....................
4. Treatments given...................
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service........
(A) Cases... .................
(B) Contacts and Suspects..........
(C) Arrested cases ................
2. Admissions to Nursing Service
(A) Cases .................. ...
(B) Contacts and Suspects..........
(C) Arrested Cases ................
3. Number of Persons X-rayed
(A) Miniature Films ...............
(B) Large 14" x 17" Films..........
6 Visits to Medical Conferences ........
7. Tuberculin Test. ...................
8. Field Nursing Visits................

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

Sa a a

O ~ ~ ~ ~ *? ( ~ :3: m 3
(I00- ,~~

263 312 56 1,246
263 360 75 1,681
263 331 39 323

z
z

538. 180
538 20C
538 232

64
64
56

2
1

28
105
190
105 0
152

65
65
65
10
2
1
b-t

i _

2
0
0
3
7
0
0
21
5
25
39

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service...............
2. Consultations and Conferences with
Physicians ....................
3. Field and Office Visits .............
IMMUNIZATIONS COMPLETED
4. Smallpox.........................
5. Diphtheria, (5-7) .................
8. Typhoid Fever................
9. Whooping Cough, (9-11)..........
12. Tetanus.......................
INTESTINAL PARASITE CONTROL
14. Admissions to Service ..............
15. Field and Office Visits ..............
16. Treatments Given .................
B. VENEREAL DISEASE CONTROL
1. Admissions to Medical Service
2. Visits to Medical conferences
3. Field Visits and Epidemiological
Investigations...................
4. Treatments given.................
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service.......
(A) Cases......................
(B) Contacts and Suspects..........
(C) Arrested cases ................
2. Admissions to Nursing Service
(A) Cases.........................
(B) Contacts and Suspects..........
(C) Arrested Cases ................
3. Number of Persons X-rayed
(A) Miniature Films................
(B) Large 14" x 17" Films..........
6 Visits to Medical Conferences ........
7. Tuberculin Test ...................
8. Field Nursing Visits ................

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

4)
<>
"
1)2Z O 0 O a o

103 85
63 46
240 113

0 16
0 35
0 2
0 14
3 62
2 7

481
95
530

679
596
936
505
950

10
12
12

155
315
694
130

10
22
2
17
74
6
1,926
159
66
180
152

305 111 205 109 120
305 180 391 109 155
305 78 184 109 106

120 -
93
120

401
723
375 t-
584
745

1,039
1,096
1,026

118
167
110
84

20
99
14 -
23
179
18
0
125 iP
139 i-
66
125

- _'.- --- I -- I

.
, ., ., ., ...,, .,-...

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

a < a a

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service.................... 579 151 25 17 118 48 66 47 28 14 23 763 164 1,939 6 28,850
2. Consultations and Conferences with 7 2
Physicians............................ 29 39 1 24 25 54 19 0 6 7 5 66 0 35 7 2,902
3. Field and Office Visits.................... 607 250 31 45 172 64 103 49 54 16 28 1,115 164 1,969 10 83,109
IMMUNIZATIONS COMPLETED .t"
4. Smallpox .............................. 2,060 1,428 844 79 568 534 252 499 200 321 127 419 109 626 413 61,099
5. Diphtheria, (5-7)........................ 2,618 2,259 1,512 383 1,167 663 342 868 617 283 307 624 272 960 556 76,469 0
8. Typhoid Fever..... 359 202 144 344 2,359 108 60 575 145 215 9 331 806 147 204 63,663
9. Whooping Cough, (9-11) ................. 2,618 2,189 973 382 720 663 342 694 575 243 158 335 272 969 626 61,511 O
12. Tetanus............................. 2,692 2,280 2,082 538 2,306 806 394 935 1,298 402 310 561 552 1,159 1,015 94,236
INTESTINAL PARASITE CONTROL
14. Admissions to Service.................... 534 550 326 47 239 83 193 456 180 74 123 79 175 635 172 22,945
15. Field and Office Visits.................... 781 586 326 47 239 125 319 466 180 74 123 110 178 635 172 27,206
16. Treatments Given ....................... 422 576 326 47 239 99 233 466 180 74 123 69 178 635 172 21,345
B. VENEREAL DISEASE CONTROL -0
1. Admissions to Medical Service 468 403 45 92 39 159 160 60 111 58 37 137 47 47 3 21,212 y
2. Visits to Medical conferences
3. Field Visits and Epidemiological 2,019 673 57 195 45 296 196 86 115 84 81 448 76 73 5 62,570 $N
Investigations........................... 2,515 391 266 60 39 322 318 28 31 33 7 790 31 55 14 43,552
4. Treatments given....................... 576 304 73 67 32 136 162 51 92 22 23 124 51 48 38 16,931
C. TUBERCULOSIS CONTROL
1. Admissions to Medical Service.............
(A) Cases............................. 231 37 4 0 6 22 1 3 11 2 2 15 5 20 0 1,449
(B) Contacts and Suspects............... 458 66 9 0 3 63 0 4 10 7 9 0 0 54 0 8,419
(C) Arrested cases...................... 76 13 0 0 0 8 0 4 0 1 0 23 0 0 0 1,460
2. Admissions to Nursing Service
(A) Cases ............................. 149 103 12 19 12 45 32 3 8 9 4 118 2 24 3 3,410
(B) Contacts and Suspects............... 275 375 38 97 51 285 118 69 59 15 27 416 43 72 22 9,093
(C) Arrested Cases...................... 64 107 6 32 5 20 5 12 0 3 3 120 6 11 6 1,572
3. Number of Persons X-rayed
(A) Miniature Films.... .. ..... 78,549 34,041 4,248 0 0 12,561 0 0 84 2,537 832 21,938 917 0 0 440,892
(B) Large 14" x 17" Films............... 7,885 1,344 876 134 32 691 117 80 27 42 23 961 41 123 51 32,512
6 Visits to Medical Conferences.............. 979 349 17 0 10 120 1 15 32 16 21 259 7 124 0 26,435
7. Tuberculin Test ......................... 329 305 97 29 2 234 11 17 34 12 6 496 11 108 25 17,378
8. Field Nursing Visits ............ ............ 1,743 1,527 265 373 144 548 220 56 81 54 35 1,086 69 190 61 29,637

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

Q 0 0 4 2 5
S B cU c m U A Q

C. TUBERCULOSIS CONTROL (Cont.)
9. Office Nursing Visits ............... 33 139 27 4 198 498 99 39 60 40 10 12 4 8 71 28 254
10. Cases Hospitalized. ............ ..... 26 13 28 7 13 44 5 0 4 4 5 6 505 2 5 23 137 -
D. MATERNITY SERVICE O
1. Admissions to Antepartum
Medical Service.................... 439 37 233 70 219 405 15 9 22 93 59 174 3,020 1 76 36 438
3. Admissions to Antepartum Nursing
Service........................... 481 82 234 72 181 443 17 14 42 116 78 312 2,438 0 74 235 537
4. Visits by Antepartum Cases to --1
Medical Conferences ............... 1,265 67 684 175 591 1,039 20 30 29 233 78 508 10,959 0 220 118 686
5. Number of Clinic Sessions Conducted. 207 51 46 20 113 121 15 19 19 30 19 133 448 0 29 19 135
6. Field Nursing Visits Antepartum..... 438 137 83 174 291 283 12 32 52 218 18 176 3,591 0 76 416 532
7. Office Nursing Visits Antepartum.... 1,990 9 727 39 477 1,671 33 40 22 283 196 777 229 0 222 185 1,771 r
10. Postpartum Medical Examinations.... 210 39 53 7 63 53 3 1 0 22 5 10 955 0 8 22 176
11. Admissions to Postpartum Nursing
Service....... .............. 468 88 94 108 205 297 10 12 28 95 25 328 2,885 0 41 234 419
12. Field Nursing Visits Postpartum..... 827 103 73 255 322 363 10 30 49 145 14 763 7,712 0 38 383 841
13. Office Nursing Visits Postpartum .... 159 9 73 6 61 55 2 11 1 5 18 2 26 0 29 9 199
14. Admissions for Midwife Supervision 13 7 3 4 6 5 1 2 2 3 2 9 18 0 3 1 7
15. Attendance of Midwives at Meetings.. 10 12 0 0 3 12 0 0 0 4 0 64 165 0 3 0 17 W
D. MATERNITY SERVICE
16. Visits for Midwife Supervision........ 55 42 12 30 44 116 1 29 12 28 2 56 23 0 34 8 86 C
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service....... 293 71 55 73 120 378 18 8 7 82 29 415 3,276 0 39 442 411
2. Admissions to Nursing Service....... 792 150 100 202 337 776 37 29 56 178 76 360 3,996 1 98 995 839
3. Visits to Medical Conferences....... 482 149 69 113 137 891 19 26 7 112 30 415 8,122 0 57 1,185 930 -
4. Field Nursing Visits................ 1,351 254 155 71 639 1,425 42 56 137 346 82 900 11,054 1 205 1,571 1,855
5. Office Nursing Visits..................... 425 15 93 17 246 1,340 45 45 0 137 77 39 161 0 67 1,177 1,584
PRESCHOOL
6. Admissions to Medical Service....... 357 335 50 76 109 31 71 12 98 283 10 174 3,467 113 117 913 25
7. Admissions to Nursing Service...... 1,197 510 127 734 737 147 119 110 94 273 27 1,159 3,311 120 243 2,127 703
8. Visits to Medical Conferences....... 376 706 78 94 136 66 82 16 101 29 1 174 6,200 113 127 2,152 31
9. FieldNursing Visits. .............. 1,744 999 232 1,802 1,176 44 48 185 238 464 33 1,565 6,803 28 427 3,067 1,315
10. Office Nursing Visits.............. 281 18 89 10 28 594 101 108 1 147 1 0 19 99 103 1622 702
12. Number of Infant-Preschool Clinic
Sessions Conducted................. 336 51 32 20 88 100 24 24 11 39 17 151 340 17 33 116 71

C. TUBERCULOSIS CONTROL (Cont.)
9. Office Nursing Visits ..............
10. Cases Hospitalized ................
D. MATERNITY SERVICE
1. Admissions to Antepartum
Medical Service ...................
3. Admissions to Antepartum Nursing
Service.........................
4. Visits by Antepartum Cases to
Medical Conferences ...............
5. Number of Clinic Sessions Conducted.
6. Field Nursing Visits Antepartum.....
7. Office Nursing Visits Antepartum....
10. Postpartum Medical Examinations....
11. Admissions to Postpartum Nursing
Service ............................
12. Field Nursing Visits Postpartum.....
13. Office Nursing Visits Postpartum ...
14. Admissions for Midwife Supervision
15. Attendance of Midwives at Meetings..
D. MATERNITY SERVICE
16. Visits for Midwife Supervision........
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service.......
2. Admissions to Nursing Service.......
3. Visits to Medical Conferences.......
4. Field Nursing Visits................
5. Office Nursing Visits ...............
PRESCHOOL
6. Admissions to Medical Service......
7. Admissions to Nursing Service......
8. Visits to Medical Conferences.......
9. Field Nursing Visits................
10. Office Nursing Visits................
12. Number of Infant-Preschool Clinic
Sessions Conducted ................

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

a8 *
I | 0 |
03 0I3

271 23 421

160 118 155
79 1 2

ZZ
Z

29
3

22
34 'd
45 0
20
50
55 -
0 -
17
28 '
9 O0
1
0

14

17
54
32
75
86

57
151
57
171
175
18

C. TUBERCULOSIS CONTROL (Cont.)
9. Office Nursing Visits................
10. Cases Hospitalized .................
D. MATERNITY SERVICE
1. Admissions to Antepartum
Medical Service...................
3. Admissions to Antepartum Nursing
Service......... .... ....
4. Visits by Antepartum Cases to
Medical Conferences.............
5. Number of Clinic Sessions Conducted.
6. Field Nursing Visits Antepartum ....
7. Office Nursing Visits Antepartum ....
10. Postpartum Medical Examinations....
11. Admissions to Postpartum Nursing
Service...........................
12. Field Nursing Visits Postpartum....
13. Office Nursing Visits Postpartum ....
14. Admissions for Midwife Supervision
15. Attendance of Midwives at Meetings..
D. MATERNITY SERVICE
16. Visits for Midwife Supervision........
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service......
2. Admissions to Nursing Service.......
3. Visits to Medical Conferences.......
4. Field Nursing Visits................
5. Office Nursing Visits................
PRESCHOOL
6. Admissions to Medical Service......
7. Admissions to Nursing Service.......
8. Visits to Medical Conferences........
9. Field Nursing Visits ...............
10. Office Nursing Visits...............
12. Number of Infant-Preschool Clinic
Sessions Conducted..............

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

Sg c % s '

0 0 I
5) Ir=i 3

3521 611 77
53 6 71

61 28

254
12 -4
0

30 0
46
33
31
32
52 d
2
40
46
11
1

84

33
85
73 t
tri

186
298
186
279
308
06

--II -I --I --I ul rvl I~ul *o
--

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954
4

O<

g oco
a S S K S i
I 0 Si S l *
Si & e. 2 s s 0 p 0 .6 'f ^

C. TUBERCULOSIS CONTROL (Cont.)
9. Office Nursing Visits..................... 1,164 501 27 84 20 281 15 109 53 22 14 611 100 145 16 8,310
10. Cases Hospitalized ..................... 98 51 12 4 6 15 6 1 11 2 1 40 8 10 2 1,626
D. MATERNITY SERVICE
1. Admissions to Antepartum
Medical Service....... ............ 424 539 147 6 13 49 77 21 112 37 51 86 62 53 36 11,580
3. Admissions to Antepartum Nursing
Service .............................. 424 58 186 211 16 59 187 84 168 46 62 234 41 53 69 12,976
4. Visits by Antepartum Cases to
Medical Conferences.................... 1,193 958 394 12 19 107 184 37 310 78 135 409 225 108 39 34,373
5. Number of Clinic Sessions Conducted...... 126 135 103 6 16 17 23 37 23 21 47 56 65 42 26 3,929
6. Field Nursing Visits Antepartum.......... 608 638 43 151 2 107 271 100 35 6 120 412 79 29 30 14,434
7. Office Nursing Visits Antepartum......... 1,446 1,485 474 311 22 95 128 96 422 105 135 410 17 153 111 27,765
10. Postpartum Medical Examinations......... 245 115 50 0 0 30 18 0 4 1 7 39 23 42 28 3,909
11. Admissions to Postpartum Nursing
Service ................... .............. 293 441 188 118 2 37 257 110 83 8 45 299 63 53 77 12,894
12. Field Nursing Visits Postpartum ....... 715 804 221 209 4 123 481 202 157 6 50 560 136 45 123 25,036
13. Office Nursing Visits Postpartum ......... 214 81 91 38 1 24 14 23 11 2 16 41 2 46 17 2,746
14. Admissions for Midwife Supervision .... 1 2 10 3 5 0 3 6 4 6 0 6 7 6 5 325
15. Attendance of Midwives at Meeting.s..... 0 25 87 2 2 0 0 7 4 3 0 4 25 10 12 1,137
D. MATERNITY SERVICE
16. Visits for Midwife Supervision ............ 1 38 50 11 9 0 116 32 3 20 0 31 15 17 13 1,836
E. INFANT & PRESCHOOL HYGIENE
INFANT
1. Admissions to Medical Service............ 707 466 109 20 18 46 17 17 50 44 67 97 56 77 69 11,875
2. Admissions to Nursing Service............ 1,028 764 250 377 22 83 298 169 161 64 80 410 115 94 92 21,729
3. Visits to Medical Conferences ............ 1,463 1,045 146 32 18 56 17 21 63 61 107 274 77 102 74 24,868
4. Field Nursing Visits .................... 2,328 1,819 280 631 16 205 619 306 304 27 150 880 259 85 107 42,673
5. Office Nursing Visits .................... 2,174 806 200 215 14 32 22 92 95 71 117 306 32 138 62 18,375
PRESCHOOL
6. Admissions to Medical Service. .......... 1,432 118 145 5 12 55 0 32 12 11 93 299 100 66 33 16,773
7. Admissions to Nursing Service............ 1,885 369 171 316 36 50 519 296 412 24 125 659 366 76 137 0,463
8. Visits to Medical Conferences..... .... 2,093 129 187 7 12 76 0 45 12 15 128 631 171 68 36 28,680
9. Field Nursing Visits..................... 1,867 1,039 164 579 29 170 1,215 395 628 21 218 1,122 628 14 187 42,908
10. Office Nursing Visits.................. 2,747 161 218 90 10 21 46 159 35 13 111 722 75 8 74 23,565
12. Number of Infant-Preschool Clinic
Sessions Conducted...................... 155 81 93 7 30 10 12 59 25 15 47 157 41 34 27 4,126

F. SCHOOL
1. Pupils Inspected ................... 1,453
2. Pupils Examined ................... 1,924
4. Admissions to Nursing Service....... 542
5. Field Nursing Visits................ 1,269
6. Office Nursing Visits ............... 984
7. Number of Corrections Secured...... 275
8. Cases Hospitalized ................. 0
G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4)............... 2,831

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 Public...........
(B) New Public Water Connections..
SDrinking Fountains............
2. New Snecification Privies Installed....

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

I 0 IU 1 U I
R s 2 c. J iS 3 O s a a 3
< 3 CQ C Q Q U U j O l

1581 1,507

8041 147 14 168
116 93 29 134

39 32 85
178 60 119
24 32 237
17 4 24

3 22 34
7 86 135
1 71 132

1381 223

774 6,712

5321 3641 8.398

0 0 12
2 0 405
0 0 0
7 3 9

10,509
1,147
1,977
740
1,940
290
8

7,171

28
344

194
404
1,074
10

63
166
2

287
543
23
2
5

1
0
97
0

-

F. SCHOOL
1. Pupils Inspected ...................
2. Pupils Examined................
4. Admissions to Nursing Service......
5. Field Nursing Visits .............
6. Office Nursing Visits ...............
7. Number of Corrections Secured......
8. Cases Hospitalized .................
G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4) ..............

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

o 3 a

'~do d ~.~

2491 5331 6111 4561 921 325

H. MORBIDITY
8. Field and Office Medical Visits....... 64 378 8
4. Field and Office Nursing Visits....... 136 585 1,230

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 Public............
(B) New Public Water Connections..
(C) Drinking Fountains.............
2. New Soecification Privies Installed....

O 1,628
0 0
0 1,633
0 208

o 76
0 803
1 10
13 7f

17 3 1E
123 3 2
70 5 118

574132,512

z
2x

26
i46
158
88
39
3
0

70

57 0
44

1-3
18
51
37
1
rO
10 U1
5 4
49

19
108
5
11
0

0
0
0
0

0
0
0
1

0 4,460 1,315
0 79 0
0 18,263 1,430
0 467

0

0
0
0
11

2

2

F. SCHOOL
1. Pupils Inspected.................... 4,303
2. Pupils Examined .................. 697
4. Admissions to Nursing Service....... 753
5. Field Nursing Visits................ 728
6. Office Nursing Visits................ 478
7. Number of Corrections Secured ..... 64
8. Cases Hospitalized ..................
G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4) ............... 700
H. MORBIDITY
3. Field and Office Medical Visits....... 1
4. Field and Office Nursing Visits....... 156
J. CANCER CONTROL
1. Admissions to Service .............. 25
2. Field Visits ....................... 82
3. Office Visits........................ 7
4. Ambulatory Cases Treated.......... 1
K. DIABETES
1. Admissions to Service.............. 21
2. Field Visits ....................... 58
3. Office Visits ....................... 5
L. CRIPPLED CHILDREN
1. Admissions to Service ............... 72
2. Field Visits ....................... 186
3. Office Visits ....................... 24
4. Clinic Visits........................ 73
5. Cases Hospitalized ................. 21
M. DENTAL HYGIENE
1. Admissions to Service............... 0
2. Preschool Inspections .............. 0
3. School Inspections.................. 0
6. Fluoride Treatments Completed...... 0
P. SANITATION
1. Approved Water Supplies Installed
(A) Private and Public............. 33
(B) New Public Water Connections.. 201
(C) Drinking Fountains ............ 0
2. New Snecification Privies Installed.... 0

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

r 0

0 0 a
C~

cl 0 5)
a f z o a

29 7
36 23
67 3

0 0 0 104
0 0 0 0
22 2,839 0 113
0 0 0 0

0 4
0 194
0 4
0 19

1831 1,944

434 5,1341 2,

40 19 81 8 6 12 2251
3531 6911 83! 70 275 8501

1 65
0 426
0 0
1 1

9,!
2,4
1,1
2,1

280
690
160
009
532
68 0
11

216
t-
76
204

78
109
77
14

26 X
32
86

137
115
58
302
34 1-

28 rj

~'''~~'~

0 0
3 4

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

5 3

r7
Q d I I I I Ii l I
a c iS .o a B 0
pd L] ). 5f 5 ) 3 5 3 .B

F. SCHOOL
1. Pupils Inspected....................... 25,020
2. Pupils Examined........................ 7,428
4. Admissions to Nursing Service............ 9,063
5. Field Nursing Visits..................... 3,786
6. Office Nursing Visits .................... 6,641
7. Number of Corrections Secured........... 16,758
8. Cases Hospitalized ...................... 46
G. ADULT HYGIENE-MEDICAL
EXAMINATIONS (1-4) ................... 16,837
H. MORBIDITY
3. Field and Office Medical Visits............ 614
4. Field and Office Nursing Visits............ 3,110

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 Public .................
(B) New Public Water Connections.......
(C) Drinking Fountains.................
2. New Snecification Privies Installed.........

148 291 30 24 52 35
51 199 71 123 56 110
549 746 44 2 131 52
106 14 31 28 32 35

1241 1,490

67 81 24 5
101 48 71 14
381 10 118 32

z

312,532
83,512
53,099
38,696
79,189 -4
29,518
165

125,290

8,225 0
21,978

3,663
5,036
7,543
1,633

1,815 U1
2,849 1.
4,994

4,429
8,890
1,045
6,892
614

20,359
336
87,714
1,066

3 2,315
0 5,829
0 110
23 748

23 748

5
5

3. Privies.. .....................
4. Percolation Tests...................
5. New Specification Septic Tank
Installed......................
6. Septic Tanks Reconditioned .........
7. New Public Sewer Connections......
FIELD VISITS (8-17)
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. Survey 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)..................

TABLE 14 (continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

a S W 0 0 0

M MS S 01 M U U O U U U 1 Q a

1
0

16
3
15
1,987

42
486

2
29
0
0
4
4

0
0
0
0
124

1 0
2 111
0 893

1
476

287
0
88
2,786

276

1,177
8
100

4
27
74
0

1
0
0
0
0

0 C
0 1
1 1i

15,6341 1,2401 8,4611 1,424! 5,522

0
5
42
2
4
407

16
36

4
32
1
9
353
71

0
0 C
0 C

1.695 15.031 1.9721 1.8871 1.731

0 59
0 10,497
0 14,102

3 489
5 719
0 14
0 159

5.481 67.707

0
2
14
12
0
194

23

0
0
0
0
0
0

0
0
0
0
8

0
0
0

70
149
0
6

9
408

1,737 L-
14
371 0
19,133

250 -

1,050
132 tM
931

14

101 -
3,318
3,145

7
15,326 M
1
1,561
0

0
o C

282
855 M

75
01
250
1
4

2.640 2.567 17.166121.476

. ,

,

3. Privies...........................
4. Percolation Tests .................
5. New Specification Septic Tank
Installed........................
6. Septic Tanks Reconditioned .........
7. New Public Sewer Connections.......
FIELD VISITS (8-17) ................
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. Survey 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) ...................

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

.26

0 0

7
28
14
4
8
718

31
305
2
21
0
0
27
27

120
9,030
3
534
38

0 0 0 0
0 86 124 0
0 89 82 0

1,316 1,5511 4.4481 6901 4771 2.8391 2.1388 3.5541 1.141

24
7
42
5
13
574

72
335
23
205
0
0
654
695

5
0
0
0
6

2
9
12
5
0
1,133

46
115
1
5
0
0
62
95

0
0
0
0
0

0
1
1

22
21
0
0

0
2
4
0
0
32

5
35
28
318
0
0
905
993

0
0
0
0
3

0
0
0

6
26
0
3

595

0 0
0 11
0 11

46,2 5 91,316

2,645191,316 .

3. Privies........................
4. Percolation Tests................
5. New Specification Septic Tank
Installed........................
6. Septic Tanks Reconditioned ........
7. New Public Sewer Connections......
FIELD VISITS (8-17) ................
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. Survey 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
i.d 1 ..

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

0)
i .i ,^ i e a
0 -S -S u z- o^ o^ 6^ '. '^ t S .

3117| 6646

7 0 21 305
9 0 34 168

0 0
0 3
0 0

oal8 16 A7

0 63 C0
0 770 16 1
0 248 0 1

1685[ 69661 277 8

0
6
49
13 8
4
1,269

98 1
599
6
67
0
2,981
2,746
o a

o
o W
0
o
O
o
0
o M

20
66 C
0
6

4,079

1976|20341

EXamn- ................ .. .. I I. ,= ws I -,o,, -'-- I
.1, GQ117181696 71301 617104

TABLE 14 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1954

3. Privies...............................
4. Percolation Tests .......................
5. New Specification Septic Tank
Installed ...... .....................
6. Septic Tanks Reconditioned ...........
7. New Public Sewer Connections ...........
FIELD VISITS (8-17) ....................
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. Survey 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) ........................

1,363| 2,107| 3,757| 2,210) 2691

0

9 0
0 2
0 0

0 2 0
0 28 13
0 16 0

5317 1565) 2138 25 3

U'

I-

z

772
18,971 C
30,165
1,571
6,143
262,704

17,438
95,448
944
12,893
358
10,232 1O
63,931
17,267 U'

30,751
134,523
921
109,871.5
5,235

144
16,327
17,004

4,027
7,970
298
2,662

491,708

1,363 2,07 3,57 2,210 2 69 5 317 155 2 ,31 0

LOCAL HEALTH SERVICE 55

DIVISION OF PUBLIC HEALTH NURSING

RUTH E. METTINGER, R.N., Director

This division has given consultative service to the county health units
on a limited basis during the past year due to the fact that the personnel
has been curtailed. Two consultants were assigned full-time to the
nursing homes project, therefore, reducing nursing consultant service
approximately 50 per cent.
The consultants have made an effort to evaluate the accomplishments
of public health nursing. This has been done through a closer work
relationship with other bureaus and divisions, and has resulted in a
greater overall efficiency.
One consultant retired in August and was replaced in September by
a public health coordinator, who previously served the four schools of
nursing in Duval County. Her first few months of employment were
confined to an orientation to personnel, policy and functions of the State
Board of Health, and the functions of bureaus and divisions. During this
orientation period, sixteen of the 25 counties to which she was assigned
were visited and one county revisited.

CONSULTANT FIELD SERVICE
Each generalized consultant has the responsibility of a geographical
area composed of 20 to 25 counties. Visits have been made on the
basis of the most urgent need. However, priority has been given to
counties lacking nursing supervision.
Securing well-prepared public health nurses for the county health
units has been one of the major problems. Many of the nurses employed
without formal public health training and experience have been unable
to take advantage of the two months' orientation program in the field
training center due to home responsibilities; also, due to the inability to
secure temporary relief during the orientation period. The consultants
have, therefore, concentrated on the one and two-nurse counties where
there is an urgent need for supervision and direct consultation, orient-
ing the nurse in the philosophy and trends of public health nursing.
Three of the consultants were assigned to the mass inoculation of
gamma globulin in Leon County's epidemic of polio, and the follow-up
of those cases hospitalized from the disease.

In January and February much time was given by one consultant in
the Alachua County Health Department, working with the three trainees
assigned for the two-month orientation program. This was necessary
because the director of nurses for Alachua County was away in school.

56 ANNUAL REPORT, 1954

WORKSHOPS AND IN-SERVICE EDUCATION
To better understand the program and work of the different bureaus
and divisions, workshops have been held with the Bureau of Dental
Health on fluoridation; the Division of Mental Health; and Nursing
Homes Licensure Program. Following these workshops, consultants
interpreted to the public health nurses in the county health units how
these programs could be integrated into their generalized program.
Thirty-five professional nurses attended the annual seminar on obstetrics
which was held in Daytona Beach.
The 48-hour tuberculosis hospital exchange visits were continued in
1954. Two evaluation meetings were held during the year. Assistance
was given in organizing the schedule of visits by the public health nurses
to the tuberculosis hospitals and the tuberculosis hospital faculty to visit
the health units. Sixty public health nurses had the 48-hour exchange
visit in the tuberculosis hospitals. Twenty-four tuberculosis hospital
faculty members have taken advantage of the two-day visit to the
health departments.
Due to the lack of leadership qualities of nurses in the smaller counties,
the division has assisted in planning the study program and assignment
of resource material to individual nurses. The in-service study programs
have stimulated interest in the chosen subjects presented.

SUPERVISORS' CONFERENCE
The supervisors' conference was held for two days in February, center-
ing around the evaluation of records and efficiency reports. The con-
ference was divided into five groups, each returning with recommenda-
tions. One of these was to establish a more meaningful efficiency report
for nurses. A committee was appointed to work out details and make an
interpretative guide to be used.

MIDWIFERY
(For additional information on midwifery, see report of Bureau of
Maternal and Child Health.) Twenty-three group meetings were held
by the state midwife consultant. Other conferences were held in the
larger health units which the consultant could not attend because of
previous commitments. Assistance was given with three orientation
groups at the field training center in Alachua County. An interpretation
of the midwife program was given to the student nurses in two schools
of nursing.
Replacement of the aged and physically unfit midwives in areas still
needing this service was carried out by the state midwife consultant.
Fifteen midwives were retired in 1954 and eleven new midwives were
trained.

LOCAL HEALTH SERVICE 57

ADVANCED EDUCATION
Five nurses returned from universities after completing the approved
program of study in public health nursing and supervision. Four scholar-
ships have been granted for the years 1954-55 in the field of public
health nursing. Many nurses have attended short courses in tuberculosis,
cancer, geriatrics, and heart disease, as well as extension courses from
the University of Florida.

FIELD EXPERIENCE IN PUBLIC HEALTH
At the request of Florida State University, five county health depart-
ments accepted ten student nurses for two months field experience in
public health nursing. This has required a certain amount of time from
the consultants in assisting the county with the preparation for the stu-
dents before arrival. Prior to all assignment of students, a conference
was held with the director of nursing service, advisory nurses and the
professor of public health nursing at Florida State University. On
completion of the four-year course in nursing preparation at the Uni-
versity, the nurses received a Bachelor's degree in nursing. This will
prepare them for first-level positions in public health nursing.
Three-year diploma schools continue to request orientation in the
field of public health. In two counties they have requested two weeks
to one month and in other counties requested three days.
VISITING NURSE ASSOCIATIONS
The organization and development of the Visiting Nurse Association
in St. Petersburg coordinated with the health department was accom-
plished in December with a staff of two nurses, making a total of twelve
Visiting Nurse Associations in the state, seven of which are coordinated
with county health units.

CIVIL DEFENSE
Three classes in nursing aspects of atomic warfare have been given
by one of the nursing consultants. Efforts have been made to coordinate
community activities relating to civil defense through the director of this
division, who is chairman of the Florida State Civil Defense Nursing
Service.
PERSONNEL
The accepted ratio of one public health nurse to each 5,000 popula-
tion has never been met and the average is now approximately one to
10,000 population.
As of December 31, 1954, 347 public health nurses were employed.
Thirty-six per cent of the public health nurses now employed in Florida
have completed the approved program of study (one year) required for
qualified public health nurses. This compares favorably with the national
average of 35 per cent.

58 ANNUAL REPORT, 1954

FIELD ADVISORY STAFF
GEORGE A. DAME, M.D., Acting Director

Due to the lack of operating funds, personnel actually engaged in
consultation service to the counties has been rather limited. At present
the director of the Bureau of Local Health Service is acting as director
of the Field Advisory Staff. Other personnel consists of one record con-
sultant and one sanitation consultant, and a secretary who also serves
the Nursing Home Program. The counties also receive nursing consulta-
tion from personnel of the Public Health Nursing Division. When funds
are available at least three record consultants and three sanitation con-
sultants should be employed. Also a full quota of nursing consultants
should be made available. Despite the paucity of personnel, the staff
has been able to accomplish a goodly amount of work. The consultants
are tactful, earnest and very efficient.
Sanitation consultant services were rendered to each of the counties
during the year, and the one county without a health unit was visited
in an investigation of a complaint. The greater portion of time was
spent in the smaller counties as the need for assistance is more urgent
in these areas.
Investigation of complaints received also consumed considerable time
and many of these complaints were unjustified. It was found that the
local health department had already taken necessary action if the com-
plaints were of a public health nature.
Initial plans have been made for the establishment of coordinated
in-service training programs for sanitarians.
Personnel turn-over in the county health units' clerical staff have
caused the record consultant to spend considerable time in some of the
counties training new personnel.
This year, due to the requirements of the nursing home licensure
program which got into full swing after the departure of the director
for duty in South America, the acting director made no visits to the coun-
ties expect in the interests of the nursing home program. Also, due to
the shortage of personnel, the record consultant was unable to visit
twenty-three counties. While the sanitation consultant was able to make
calls in every county, some of these visits were of such short duration that
little could be accomplished.
TABLE 15
ACTIVITIES OF THE ADVISORY STAFF

TYPE VISITS PERSONS SERVED
CONSULTANT Counties Number Old New Health
Visited Visits Routine Request Employee Employee Officer Group Other
Record......... 43 56 25 31 31 20 3
Sanitation...... 67 103 91 12 93 2 53 10 60
Total....... 110 159 116 43 124 22 56 10 60

LOCAL HEALTH SERVICE

NURSING HOME LICENSURE
A major change in the personnel administering this program was made
necessary by the departure of Doctor James L. Wardlaw, Jr., for duty
in South America, when Mr. Claudius J. Walker was assigned as super-
visor of the program. Mr. Walker was replaced by Mr. James C. Still
to act with Mrs. Ferne H. Britt, R. N., as the inspection-consultant team
in the field. A second team was employed in the field from January
until September. This team was discontinued with the retirement of the
nurse member in September.
During the year 23 county health officers accepted jurisdiction of
the nursing home licensure program in their respective counties. This
leaves as of December 31, only eight counties in which nursing homes
are still being inspected by central office personnel. These are Monroe,
Palm Beach, Hillsborough, Volusia, St. Johns, Duval, Alachua and Leon.
It is anticipated that all but three or four of these will assume control
early in 1955.
During 1954 a total of 327 licenses were issued. Two hundred and
eighty-three of these homes are still, to our knowledge, active. The
remainder, 44, have closed for a variety of reasons too numerous to
detail here. However, the main reason was inability to meet the require-
ments of the State Board of Health.
Personnel of the nursing home licensure program aided the State
Welfare Department in a time-cost study of the operation of homes of
all sizes and categories scattered throughout the state. This study will
continue into 1955. No results are as yet available.
Only two hearings were demanded as a result of notices of intent to
revoke or deny a license. One was held in Duval County, the other in
Pinellas County. The order resulting from the hearing in Duval County
has been appealed to the Circuit Court for that county. The case will
come to a hearing early in 1955.
Sufficient time having passed to show that there were certain de-
ficiencies in the original rules and regulations, a set of proposed changes
in the original rules have been formulated for the consideration by the
members of the State Board of Health.
Preliminary steps were taken, late in the year, to set up an educational
program for operators of all types of homes. This program is planned
as a joint enterprise of the State Board of Health and the General Ex-
tension Division of the state universities.

FIELD TRAINING CENTER
FRANK M. HALL, M.D., M.P.H.
The Field Training Center is prepared to serve in the planning,
preparation, and presentation of comprehensive programs for (1) em-
ployees of the state and local health departments and (2) students from

60 ANNUAL REPORT, 1954

colleges, schools and universities who are preparing for professional
careers in public health specialities. The purpose of the training is (1)
to provide pre-service and in-service training for all types of public health
workers associated with or employed by health agencies, (2) to provide
supervised field experience recommended as a component part of, or
supplement to, a rather limited academic instruction, and (3) to en-
courage agency relations and maintain liaison in the broad health de-
partment field for the purpose of creating enthusiasm among employers
and employees for staff training.

The training program in 1954 was affected by the lack of trained
supervisory personnel attached directly to the Center; restricted budgetary
appropriations; lack of enthusiasm for training on the local level, and
possibly a shortage in the number of applicants who meet the academic
requirements for training. In spite of these apparent discouraging cir-
cumstances the number trained during 1954 were: 6 physicians (less than
one month); 9 nurses (1-2 months), and 7 sanitarians (2-3 months).

The medical group included county health officers. Physician visitors
from foreign countries on educational grants of one sort and another
were also oriented. Three of the nurses receiving training were degree
applicants from Florida A. and M. University. In addition, sixteen
nurse affiliates of the local hospital, applicants for a diploma, participated
in a limited field experience. All of these persons were superior in that
their desire to learn and the willingness to apply themselves were above
the average.

The experiment in changed timing for the sanitarians' training was
instituted with the only group to report to the Center during 1954.
These men, of which there are seven, will report to the Center for four
weeks of field and academic orientation and then return to their res-
pective counties for the following four weeks. This division of time
will mean that instead of a three-months consecutive training period,
the course will extend over a period of six months. The second phase
of the training for the current group will be given in January of 1955.

Because of the smaller number of persons on the training staff at the
Center during 1954 it was necessary to requisition the services of State
Board of Health personnel and out-of-state people to conduct the sanita-
tion training program. However, we do feel the content and quality
of the material offered was not drastically curtailed as a result of this
handicap. It is still felt that the most inhibiting factor to greater parti-
cipation on the part of the trainees in the training program by the
counties is the fact the entire cost of the training must be carried by the
local unit while at the same time the respective county is denied the
services of the person being trained. Assistance to the counties in this
direction would be a tremendous stimulus to greater employee participa-
tion in training.

LOCAL HEALTH SERVICE 61

The training program of the Center has been under the continuous
direction of the Alachua County Health Department director. The
philosophy and content of the courses offered have remained substantially
the same, a base line having been established. Administrators from the
counties represented by the trainees are encouraged to make suggestions
for areas of emphasis (according to local needs) when the schedules
indicating course content are developed. It is felt that only through a
program of continuous training, retraining, and upgrading of personnel
who operate our local health departments will we attain a worth-while
standard of performance in the field of public health in Florida. In the
units where the workers are inefficient and undertrained, even the best
public health practices are likely to lose much of their effectiveness.

62 ANNUAL REPORT, 1954

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

The Bureau of Preventable Diseases includes the Division of Cancer
Control, Industrial Hygiene, Venereal Diseases, Veterinary Public Health,
(including Milk Sanitation), and Communicable Diseases.
During 1954, this bureau was staffed with a Director, a Director of
Industrial Hygiene, Director of Venereal Diseases (who was also Asso-
ciate Director of the Bureau), Director of Veterinary Public Health,
secretarial staff, four field representatives who devote most of their time
to venereal diseases, and one field representative who devotes his full time
to milk sanitation. Dr. William A. Walter, the Associate Director, was
recalled by the U. S. Public Health Service on December 31, 1954, for
another assignment.
Carl P. Bernet, Jr., M.D., was on loan from the Communicable Dis-
ease Center in Atlanta, Georgia. He remained with the bureau through
June of this year at which time he was recalled for another assignment.
Dr. Bernet gave invaluable service to the department and followed up on
the evaluation of gamma globulin given polio contacts during his assign-
ment in Florida; he assisted in the control of communicable diseases
through special assignments on disease investigations.
Florida's record in 1954, insofar as communicable diseases are con-
cerned, shows progress in reducing those diseases that are due to faulty
sanitation. There were 31 cases of typhoid fever reported during the
year. There are 88 known typhoid carriers on record in Florida. This
latter list has grown from year to year, but there has been a gradual
drop in typhoid cases for the last several years. Bacillary dysentery
showed a drop in comparison with previous years, and only 48 cases
were reported. There was a slight increase in the number of cases of
scarlet fever in comparison with the last two years. There was a marked
increase in the number of cases of measles; 10,766 cases were reported
and it is known that this disease is one that is greatly under-reported.
The availability of gamma globulin for the control of measles stimulated
reporting on this disease in 1954. There was a drop in the number of
cases of German Measles for the year as only 126 cases were reported.
There were very few cases of influenza reported. It was a good year
insofar as this disease is concerned, although we are aware of the fact
that a number of cases of so-called "virus" infections did appear rather
widely over the state during December. Malaria was reported to have
occurred in 11 individuals for the year, and these cases were among
individuals that had been in foreign countries.
The number of cases of venereal diseases occurring remains almost the
same as it was for the year 1953; 6894 cases of syphilis were reported.
It is encouraging to note, however, that the number of cases of primary
and secondary syphilis dropped to 396 in 1954 from 585 cases in 1953,

PREVENTABLE DISEASES 63

a reduction of 32 per cent. A number of cases of syphilis reported were
old cases and were located through the rather intensive blood surveys
that were made during the year in a special effort to locate hidden
cases of this disease. There were 11,841 cases of gonorrhea, a slight
increase over last year's record, or about the same number as were
reported for 1952.
The progress in the control of diphtheria, whooping cough and
tetanus was not what it should have been. There was an increase in
number of cases of whooping cough reported as compared with the
previous two years, and the same is true of tetanus. Diptheria showed a
slight increase over 1952 but a slight decrease from 1953. The above
diseases could be practically eliminated through immunization. During
1954, the county health departments completed 76,469 diphtheria
immunizations, 61,511 whooping cough, and 94,236 tetanus. This is about
the same number as was completed during 1953. There was an in-
crease of 5,000 smallpox vaccinations done, making a total of 61,099.
There were two cases of Hansen's Disease reported during the year
which is about the usual number. These cases were hospitalized at
Carville, La.
One case of psittacosis was reported in West Florida; though question-
able, it was officially accepted as a case.
It is noted that two cases of Rocky Mountain Spotted Fever occur-
red during the year.
The year 1954 will go on record as being Florida's worst year inso-
far as poliomyelitis is concerned. A total of 1,777 cases were reported.
Considerable effort and time was used in the control of poliomyelitis
through the use of gamma globulin. Gamma globulin was made
available through the National Office of Defense Mobilization and
was supplied to them by the National Foundation for Infantile Par-
alysis and the American Red Cross. It is estimated that the gamma
globulin used in Florida in 1954 would have cost approximately $2,100,-
000, according to current price. Gamma globulin was distributed
according to the recommendations of the NODM through the State
Board of Health and the county health departments. A mass immuni-
zation program was conducted in Monroe County where approximately
8,500 individuals in the age group selected for this biological received
it. Approximately 2,000 people in Fort Lauderdale received the gamma
globulin in the mass immunization program there, and approximately
20,000 received it in Leon County.
All known control measures were instituted in the various commu-
nities to control this disease; however, it is doubtful that the proce-
dures instituted were very effective. Faith and hope are being placed
upon the new poliomyelitis vaccine which was used with the second
grade students in Palm Beach and Broward Counties as well as in many
other counties throughout the United States. The effectiveness of this
vaccine has not yet been determined.

64 ANNUAL REPORT, 1954

An epidemic, which was described as poliomyelitis, occurred in Tal-
lahassee during September and October in which the patients had
muscle weakness, low grade temperature, nausea, stiffness of the neck,
and a general depressed feeling. It was somewhat atypical compared
with the usual symptoms of this disease: it occurred almost entirely
in the age group 20-45: more cases occurred in white women than
men, and very few cases among the nonwhite population there. A
number of well known consultants from out of state were called in
to assist in this epidemic. Gamma globulin was made readily available
but its effectiveness was not determined.
Gamma globulin was taken off the market because of its limited
supply in the spring of 1953; however, it was placed back on the
market on October 1, 1954.
There was an increase in rabies among non-domestic animals; how-
ever, no human cases were reported.
Table 16 shows the total number of cases of reportable diseases that
occurred during the year by counties. In general, it is believed that
through increased efforts towards more immunizations and the im-
provement of sanitation practices we can expect further reduction in
communicable diseases in Florida.
Technical articles by staff members include:
Parks, L. L., Problems in Poliomyelitis. J. Fla Med. Assn. 41:370-
372. Nov. 1954.

PREVENTABLE DISEASES 65

TABLE 16

TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES,

FLORIDA, 1954, AND STATE TOTALS FOR 1952 AND 1953

S" t a

County 0 0 I 0 I j 0

V a 00 a --
F U U U U 0 0

State 1962...
State 1958...
State 1954...
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....
Oseeola....
Palm Beach..
Pasco ......
PineUas....
Polk .......
Putnam. ...
St. Johns....
St. Lucie....
Santa Rosa..
Sarasota.....
Seminole....
Sumter .....
Suwannee ...
Taylor......
Union.......
Volusia .....
Wakulla.....
Walton....
Washington..

72 143 82 161 235
145 96 114 177 53
179 106 114 102 48
..... 1 1 2 .....

66 ANNUAL REPORT, 1954

TABLE 16 (continued)

TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES,
FLORIDA, 1954, AND STATE TOTALS FOR 1952 AND 1953

County : Id

I Im II a $ li I I
4 A

State 1952....
State 1953 ....
State 1954....
Alachua......
Baker.......
Bay.........
Bradford ....
Brevard .....
Broward.....
Calhoun.....
Charlotte.....
Citrus .......
Clay .........
Collier........
Columbia ....
Dade........
Desoto........
Diie.........
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. ..

4,072
1,316
10,766
26
30
77
16
317
479
3
14
32
2,998
86
837
818
33
7
55
35
6
6
53
246
724
4
4
61
8
125
189
205
22
1
52
32
44
109
37
58
55
367
102
145
25
1,150
471
37
4
15
3
104
170
53
11
... ... i
131
43
.... 3

663
733
1,777
11
54
1
13
95
3
1
9
4
2
283
4
133
36

2
2
2
4
1
1
117
11
3
17
14

16
408
4
5
17
2
4
39
6
14
1
69
3
63
8
78
70
5
3
14
5
22
7
4
5
35
7
12
5

PREVENTABLE DISEASES 67

TABLE 16 (continued)

TOTALS OF REPORTED CASES OF NOTIFIABLE DISEASES, BY COUNTIES,
FLORIDA, 1954, AND STATE TOTALS FOR 1952 AND 1953

-00
s ) L .

0 o
so C)' 1S 5 >d 50
a ,, .3 r? g c .a a 0
County 0 0 00 ^ --- .

C )& &&. 5,2

State 1952...
State 1953...
State 1954...
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 .....
Palm Beach.
Pasco .......
Pinellas ....
Polk.......
Putnam.....
St. Johns....
St. Lucie....
Santa Rosa..
Sarasota.....
Seminole....
Sumter.....
Suwannee..
Taylor......
Union.......
Volusia......
Wakulla.....
Walton......
Washington..

10,824
6,722
6,894
98
10
42
8
98
362
2
5
2
17
36
....47
1,259
38
6
2,006
160
10
9
141
2
7
19
20
11
12
44
355
6
21
31
17
2
93
107
100
11
4
35
68
119
21
43
23
31
4
186
16
279
23
181
132
54
31
32
2
55
90
17
17
22
31
152
1
9
2

68 ANNUAL REPORT, 1954

VENEREAL DISEASE CONTROL

WILLIAM A. WALTER, M.D., M.P.H., Director

One very real barrier standing in the way of a successful venereal
disease control program today is indifference. The feeling that this
is a problem for "the people across the tracks" is a definite stumbling
block to progress; that and the premature optimism which rises faster
than the disease incidence falls. This apathy is evident not only in
the lay public but to some degree in public health and professional
personnel. In-service and professional level stimulation is a vital need.
Any problem that costs the money and causes the misery of venereal
disease must be reckoned with by "all of the people all of the
time." Venereal diseases cannot be ignored into a state of non-existence.
The educational phase of general disease control was never more
important, both familiarizing the general public with the facts about
VD, and acquainting the private physicians with our desire to assist
them with any and all of the services, particularly those of interviewing
and investigation in an effort to locate infectious persons who otherwise
would remain undetected. Films continued to play a part in our educa-
tional program with 311 showings to 22,000 people.
Our funds have not been less in several years nor have personnel
activities been so thinly spread. Although the incidence of venereal
disease has also declined in the past few years, our control program is
reaching that point of "irreduceable minimum" much sooner than the
diseases.
In 1954 there were 6,894 cases of syphilis reported which is an in-
crease of 2.5 per cent over 1953. A small increase, but its significance
must not be overlooked. In 1954 there were 11,841 cases of gonorrhea
reported which is an increase of 3.3 per cent over 1953. These slight
increases can always be explained by pointing out that during 1954 blood
testing surveys were conducted in 14 counties which included two
major cities. This intensified effort resulted in the location and treat-
ment of several thousand infected people; and these same surveys
disclosed the fact that one out of every ten people tested was a positive
reactor. With percentages such as these holding true, we are in no
position to congratulate ourselves on winning the war against venereal
disease. The actual case rate was lower in 1954 than in 1953 due to
the population increase for the state. Tables 17 and 18 are self-
explanatory.

In the rural area, surveys by a team of two with the assistance of
local health department personnel accounted for 13,000 tests between
January and June. Rural surveying was discontinued at the end of
June due to lack of funds.

PREVENTABLE DISEASES 69

Special project funds were made available, late in the year, for rural-
urban bloodtesting surveys in Dade and Duval Counties. These sur-
veys ran for eighteen weeks and resulted in 45,000 tests.
One of the many needs that can be ascertained from these surveys is
that of establishing the serologic test for syphilis as a routine part of
examinations made by practicing physicians. The majority of positive
reactors disclosed by the surveys were from people who "more or less"
regularly visited a physician.
A beginning was made in an effort to strengthen relations between
health departments and private physicians by supplying trained inter-
viewer-investigators whenever requested to interview infectious patients
of private physicians for their contacts. This activity takes on added
importance when we note that in 1954 the reporting of early in-
fectious cases by private physicians dropped to 41 per cent from the
1953 level of 51 per cent. This decline may only be in the reporting
and not in the actual number of cases. The interviewer-investigators
working with the physicians should stimulate the reporting of all
venereal disease cases and improve our epidemiologic index of early
infectious syphilis. It is through this approach that the eventual con-
trol of these diseases may be accomplished.
On June 30, the Prevention and Control Centers ceased operation as
such, and control was returned to the county health departments.
However, the clinics formerly operating as centers continued to offer
diagnostic services to surrounding counties.
A venereal disease exhibit was shown at the "Health Fair" in Miami
and its "message" reached approximately 15,000 who viewed it.
TABLE 17
SYPHILIS CASES REPORTED BY STAGE OF INFECTION AND RACE, AND
RESULTS OF DIAGNOSTIC OBSERVATIONS FOR VENEREAL DISEASES
FLORIDA, 1948 1954

SYPHILIS CASES REPORTED V. D. DIAGNOSTIC
OBSERVATIONS
BY STAGE BY RACE

1954.... 6,894 268 180 1,786 4,866 294 1,469 ,300 125 171,206 17,112 10.0
1953.... 6,722 309 276 2,24 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 -14 2,750 8,034 159,666 28,992 18.2
1949... 12,405 1,077 1,297 4,817 4,731 -13 2,857 9,548 156,394 38,126 24.4
1948 ... 15,395 1,990 2,857 5,178 4,844 6 3,344 12,140 137,998 35,556 25.8
Included in White.

70 ANNUAL REPORT, 1954

TABLE 18

TOTAL NUMBER OF SYPHILIS CASES REPORTED BY STAGE OF INFECTION,
PREGNANCY STATUS, RACE AND SEX, SOURCE OF REPORT,
BY COUNTIES, FLORIDA, 1954

SOURCE OF
STAGE OF INFECTION RACE AND SEX SOUE O
REPORT

WHITE COLORED

COUNTY 0 S
E- U U l U

STATE ............
Alachua.............
Baker............
Bay................
Bradford..........
Brevard.............
Broward...........
Calhoun ..........
Charlotte ...........
Citrus ............
Clay.............
Collier .............
Columbia...........
Dade.............
DeSoto..............
Dixie..............
Duval ............
Escambia...........
Flagler............
Franklin............
Gadsden...........
State Hospital.....
Glades..............
Gulf..............
Hamilton............
Hardee............
Hendry ...........
Hernando..........
Highlands..........
Hillsborough........
Holmes.............
Indian River........
Jackson.............
Jefferson............
Lafayette...........
Lake. ..............
Lee...............
Leon..............
Federal Prison.....
Levy .............
Liberty...........
Madison............
Manatee............
M arion.............
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 .........
State Prison.......
Volusia.............
Wakulla..........
W alton ............
Washington .........

F. . .1 . i . i .
..... .... 3 8 2
..... ..... 1 1 .....

PREVENTABLE DISEASES

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

The cancer program continued to have two objectives: education
on the importance of early diagnosis of cancer, and service to the
patient. Cancer continues to be the second leading cause of death.
The number of cases reported for the year was less than it was for
1953: however, more cases were reported than in 1952. It is believed that
cancer is on the increase, and we know that it is poorly reported. There-
fore, the number of cases reported, according to our records, is far
from being a true picture. Undoubtedly, cancer is being diagnosed
more readily; more people are living to an older age. Because of these
two facts it is anticipated that cancer will continue to be a major cause
of death until some means of making an earlier diagnosis or treating
it more effectively is discovered.
The small budget available for the cancer program has necessitated
the limiting of the cancer services to early indigent cases. The budget
restriction has limited the program to those patients in which x-ray,
radium or surgery was indicated. Certain types of cancer patients have
been assisted through arrangements with the Oak Ridge Institute of
Nuclear Studies in Oak Ridge, Tennessee. Thirteen applications were
sent to this institution during the year and eight were admitted for
treatment. These patients were treated with isotopes.
Tumor clinics were in operation in the following cities during the
year: Pensacola, Tallahassee, Gainesville, Jacksonville (Duval Medi-
cal Center), Daytona Beach, Orlando, Tampa, St. Petersburg, West
Palm Beach, Miami Beach (St. Francis Hospital), Jacksonville (St.
Vincent's Hospital), Lakeland, Bradenton, Sarasota, Ft. Lauderdale,
Miami Beach (Mt. Sinai) and Ocala. The tumor clinics in the first
eleven cities just listed had the approval of the American College of
Surgeons for the year. A representative of the above organization did
not have the opportunity of inspecting the other tumor clinics listed;
however, the clinics did have the approval of the Florida Cancer
Council. One new tumor clinic was organized during the year: Mt.
Sinai Hospital, Miami Beach. Plans for the operation of a tumor
clinic at Panama City have been approved by the Florida Cancer
Council, but its organization was not completed during the year.
When the cancer program was begun in 1947, through funds made
available by the state legislature, it seemed desirable to establish certain
requirements for the operation of tumor clinics. Since the Ameri-
can College of Surgeons had already established standards for such
clinics the State Board of Health adopted these criteria.
Patients are eligible for services in the tumor clinic provided they
are first seen by a physician and an application for assistance is made.
Information as to finances is obtained from the patient, and approval

72 ANNUAL REPORT, 1954

of the local health department or local welfare agency is required. He
is then referred to the nearest tumor clinic where he is seen at an ap-
pointed time. In each of the tumor clinics there is a full-time or part-
time secretary. If the tumor clinic physician prescribes certain diagnostic
studies, such as laboratory tests or x-ray examinations, these facilities are
available at the tumor clinics. If the patient is in need of hospitalization,
this service is provided through State Board of Health funds.
The medical services at the tumor clinics are provided by the local
physicians. These physicians are not paid any fees for their services to
patients coming under this program. The tumor clinics are financed
from funds made available through the State Board of Health and
from the American Cancer Society, Florida Division. The hospital
where the clinic is located provides space and other incidental ex-
penses. The director of this program in the State Board of Health
serves on the Executive Committee of the State Cancer Society, and
budgets are prepared so that Cancer Society funds and State Board of
Health funds complement each other to the best advantage. Normally,
the Cancer Society finances expenditures for supplies, dressings, sta-
tionery, postage, phone services and records, and, in some clinics, the
salary of the secretary of the tumor clinic. On the other hand, the
State Board of Health pays the hospital or tumor clinic a minimum
fee for laboratory and diagnostic x-ray services, secretarial assistance
and for the patient's stay in the hospital.
Any hospital in the state that has the approval of the American Col-
lege of Surgeons may accept state aid cancer patients provided the hos-
pital submits a per diem cost statement on the prescribed form. The State
Board of Health raised its maximum to $17.00 per day to the hospitals
that accept these patients. This per diem covers all services while the
patient is in the hospital, such as room, meals, operating room fee,
drugs, dressings and nursing care. Twenty-seven hospitals accepted
patients under this program during the year. Patients that are sent to
Oak Ridge, Tennessee, for treatment with the isotopes must be provided
transportation by some individual or agency other than the state. In
a few cases it has been provided by the Cancer Society. There is no
charge for hospitalization of cases treated at Oak Ridge.
Those patients requiring x-ray treatment have created a problem in
some communities where there are no local facilities. The problem of
care for the terminal indigent patient is still unsolved in most com-
munities. Funds under this program are not sufficient to cover this
type of service.
When the cancer program was started in 1947 it was anticipated that
the appropriation was not sufficient to take over the existing cancer
diagnostic and treatment facilities already in operation in the state, and
this is still true. Therefore, Dade and Duval County, and the City of
Tampa, have continued to take care of their own cancer patients.
Some assistance has been rendered these three areas through the state
program when the budget would permit it. It is hoped that sufficient

PREVENTABLE DISEASES

funds will be made available in the future to provide the same services
to all areas of the state.
In the field of education the activities of the State Board of Health
have been coordinated with other educational activities of the State
Board of Health, primarily in providing films on cancer subjects through
its film library to lay groups as well as special films for physicians. The
educational activities have also been closely integrated with that of the
Cancer Society. Representatives of the State Board of Health have
appeared on numerous programs conducted by the Cancer Society
throughout the state. The purpose of each was to bring to the at-
tention of the public the necessity of early diagnosis and treatment of
cancer.
A three-day seminar for physicians was conducted in Miami imme-
diately following the American Medical Association Clinic Session in
December. Outstanding physicians were on this program, and the sub-
jects covered were most informative to those in attendance.
The Florida Cancer Council had only one official meeting during the
year; however, a number of matters were referred by mail to this
Council for their advice. The Council consists of two physicians from
the Cancer Committee of the State Medical Society, two from the
State Cancer Society, one from the American College of Surgeons, and
two from the State Board of Health. The purpose of this council is to
coordinate and advise in all phases of the cancer program that is in
operation by the State Board of Health as well as that of the Medical
Society and the Cancer Society. One of the aims of the Florida Can-
cer Council this year was to stress the importance of examining the
chest for early cancer, and to place more emphasis on the mass chest
x-ray program in operation by the State Board of Health and the
Florida Tuberculosis and Health Association.
Some attention has been given to the matter of unethical treatment of
cancer cases. Unfortunately, there are a few unscrupulous individuals
who take advantage of cancer patients, or others that do not have
cancer, if they can make money at it.
A total of 1588 persons were approved for state aid during 1954.
This is slightly less than the number of new cases approved during
each of the past few years, but it is felt this decrease was due to the
shortage of funds which occurred during the latter part of 1953. At that
time it was necessary to discontinue the payment of fees for x-ray ther-
apy, and, consequently, many of those cases for whom x-ray therapy was
the only means of treatment were not processed through the state aid
program. This is reflected in Table 23, both in the number of per-
sons receiving financial aid and in the amount of money spent for
treatment.
A total of 1864 follow-up requests were mailed to the tumor clinics
and health departments during the year in an attempt to encourage
early diagnosis and annual clinic visits. As a result, the number of

74 ANNUAL REPORT, 1954

patients with diagnosis unknown at the end of 1954 is 23 per cent
lower than for the previous year, and fewer patients were lost to fol-
low-up.

Table 21 shows that although the majority of patients lost to follow-up
are lost during the first year, this number has diminished, and cur-
rently the per cent of patients lost during the first year is less than
half what it was in 1947.

The proportion of cases diagnosed as malignant continues to de-
crease, dropping from 79.5 per cent in 1947 to 48.3 per cent in 1954.
Distribution of cases according to site remains much the same. Over
one-half of the white males had skin cancer, with the buccal cavity
being the second in line of incidence. For both white and colored fe-
males the major site of cancer was the genital organs. The digestive
system was the major site of cancer in colored males, with genital
organs second.

Of those cases entering the state aid program during 1946, 1947,
and 1948, 356 cases (40 per cent) of the 886 followed were still living
at the end of five years. Of those surviving, 248 were reported to have
no indications of cancer; this is about 28 per cent of those cases fol-
lowed. Sixty-six cases had been lost to follow-up, and 464 cases died,
388 with cancer.
Twenty-five per cent of the persons followed died during the first
year after they entered the state aid program. Another 26 per cent
died during the next four years, leaving 49 per cent of those followed-
up alive at the end of five years. (See Table 22.) Data according to
site, after five years experience, ranges from 11 per cent survivors with
cancer of the respiratory system to 45 per cent with cancer of the
female genital organs and 73 per cent with skin cancer.

PREVENTABLE DISEASES 75

TABLE 19

DISTRIBUTION BY DIAGNOSTIC STATUS, RACE AND SEX OF PERSONS
APPROVED FOR STATE AID UNDER THE FLORIDA CANCER PROGRAM
DURING THE YEAR 1947* 1954

DIAGNOSTIC STATUS

NUMBER OF PERSONS PERCENTAGE DISTRIBUTION

RACE, SEX,
AND YEAR c 5

g ~
a
.0 .0 a

Total Persons........ 10,851 5,961 39 3,796 1,055 100. 54.9 0.4 35.0 9.7
1947*.................. 205 163 ...... 37 5 100. 79.5 ...... 18.0 2.4
1948.................... 1,35 823 3 410 117 100. 60.8 0.2 30.3 8.6
1949................... 1,059 645 2 331 81 100. 60.9 0.2 31.3 7.6
1950................... 1,686 928 5 610 143 100. 55.0 0.3 36.1 8.5
1951.................... 1,638 929 5 577 127 100. 56.7 0.3 35.2 7.8
1952................. 1,679 867 8 618 186 100. 51.6 0.5 36.8 11.1
1953.......... ......... 1,643 839 14 629 161 100. 51.0 0.9 38.2 9.8
1954.................... 1,588 767 2 584 235 100. 48.3 0.1 36.8 14.8
White Male............. 3,412 2,165 17 913 317 100. 63.5 0.5 26.8 9.2
White Female .......... 4,749 2,489 19 1,838 403 100. 52.4 0.4 38.7 8.5
Colored Male............ 835 398 1 310 126 100. 47.7 0.1 37.1 15.0
Colored Female.......... 1,855 909 2 735 209 100. 49.0 0.1 89.6 11.3
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* 1954

PERCENTAGE
NUMBER OF PERSONS DISTRIBUTION
SITE
WM WF CM CF WM WF CM CF
Total..................... 2,165 2,489 398 909 100. 100. 100. 100.
Buccal Cavity ................ 250 79 44 29 11.5 3.1 11.0 3.2
Digestive System.............. 202 146 122 60 9.3 5.8 30.6 6.6
Respiratory System............ 193 48 46 13 8.9 1.9 11.6 1.4
Breast. ...................... 4 365 5 211 0.2 14.6 1.3 23.2
Femal Genital....................... 870 ....... 489 ...... 35.0 ....... 53.7
M ale Genital ................. 68 ....... 76....... 3.1 ....... 19.1...
Urinary System............. 78 35 25 20 3.6 1.4 6.3 2.2
Skin......................... 1,239 824 30 30 57.2 33.1 7.5 3.3
Other Sites .................. 95 92 33 38 4.4 3.7 8.3 4.2
Lymph. and Haem. Tissues..... 36 30 17 19 1.7 1.2 4.3 2.1
Includes 6 persons approved for State Aid in November and December, 1946.

76 ANNUAL REPORT, 1954

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
Cases YEAR OF FOLLOW-UP
Entering
Program
During Number Percentage
Calendar Year Calendar
Year 1st 2nd 3rd 4th 5th 1st 2nd 3rd 4th 5th
year year year year year year year year year year
1947*......... 149 7 8 8 8 8 4.7 5.4 5.4 4 5.4
1948.......... 737 27 37 47 56 58 8.7 5.0 6.4 7.6 7.9
1949.......... 591 15 28 43 53 ...... 2.5 4.7 7.3 9.0 .....
1950.......... 823 21 34 41...... ...... 2.6 4.1 5.0...........
1951 .......... 809 26 41............. .. ... 3.2 6.1...... .....
1962.......... 728 15 ...... ...... ......... ...... ....... .... .
1952.......... 728 15 ... 2.1
Based on follow-up experience of 8837 cancer cases receiving monetary assistance during the
year of admission under the Florida State Aid Cancer Program, 1947-1952. (Excludes those
who refused treatment.)
Includes 5 cases approved for State Aid in November and December, 1946.

TABLE 22

PER CENT OF CANCER PATIENTS SURVIVING AFTER EACH
YEAR OF FOLLOW-UP, BY SITE

PER CENT SURVIVING AT
SITE
1 Year 2 Years 3 Years 4 Years 5 Years
Total.......................... 74.9 63.1 56.8 52.5 48.6
Bucal Cavity ........................ 70.2 57.4 60.8 43.6 36.7
Digestive System .................... 87.1 24.6 18.3 14.4 13.1
Respiratory System ................... 39.7 26.9 21.6 16.1 10.7
Breast ................. ............. 76.1 69.7 49.9 45.6 42.4
Female Genital.................... 74.4 58.7 51.7 48.3 44.9
Skin ............... ........... 94.5 88.3 82.9 78.2 73.2
Other Sites (residual)................. 57.0 40.6 34.8 32.5 29.5
Based on follow-up experience of 3837 cancer cases receiving monetary assistance during the year of
admission under the Florida State Aid Cancer Program, November 1946 through December 1952.
(Excludes those refusing treatment.)

PREVENTABLE DISEASES 77

TABLE 23

NEW PERSONS APPROVED FOR STATE AID, NUMBER OF PERSONS
RECEIVING FINANCIAL AID, AND EXPENDITURES, BY COUNTY,
FLORIDA CANCER PROGRAM 1953 AND 1954

New Persons Persons Re- Total Expenditures
County Approved ceiving Aid

1953 1954 1953 1954 1953 1954
State Total................. 1,643 1,588 1,728 1,395 $162,825.22 185,673.30
Alachua................... 34 19 30 22 2,278.65 2,871.49
Baker..................... 9 10 11 8 717.76 682.00
Bay....................... 28 28 38 20 8,391.50 2,028.00
Bradford .................. 14 25 18 25 1,699.48 2,158.89
Brevard ................... 14 12 6 11 418.70 1,665.45
Broward................... 16 32 31 24 4,273.31 1,923.65
Calhoun .................. 22 81 21 23 1,703.75 1,108.42
Charlotte .................. 3 5 9 8 927.58 174.22
Citrus ..................... 4 3 2 4 183.75 1,853.21
Clay ...................... 13 19 10 14 674.75 2,853.70
Collier .................... 8 19 5 12 513.52 1,272.35
Columbia ................. 22 26 19 18 1,846.48 1,842.72
Dade ..................... 86 50 50 42 4,208.75 2,837.50
DeSoto ................... 25 26 20 12 2,245.72 1,217.13
Dixie..................... 8 8 5 5 263.99 410.50
Duval..................... 8 16 17 12 2,901.31 2,190.60
Escambia.................. 187 102 127 64 11,163.00 5,447.95
Flagler .................... 4 7 1 3 90.00 22.25
Franklin.................. 23 19 20 9 1,686.74 282.50
Gadsden ................... 16 33 20 29 1,572.89 2,861.59
Gilchrist .................. 6 3 7 3 215.00 249.20
Glades ................... 2 5 8 4 22.50 88.50
Gulf....................... 21 10 14 14 2,478.20 2,004.19
Hamilton .................. 9 15 9 12 1,583.40 1,758.50
Hardee................... 17 12 20 18 1,094.50 468.50
Hendry................... 14 11 3 3 323.00 159.00
Hernando ................. 5 3 1 3 18.75 355.83
Highlands.................. 19 18 19 16 1,055.70 1,072.35
Hillsborough................ 127 97 177 108 17,010.78 10,656.71
Holmes ................... 80 27 38 20 2,402.94 1,451.25
Indian River ............... 12 13 9 11 1,860.12 897.57
Jackson ................... 51 48 52 39 3,622.57 3,262.90
Jefferson .................. 13 11 18 13 1,251.40 1,470.72
Lafayette.................. 10 6 6 6 916.92 682.60
Lake...................... 20 22 8 10 1,784.00 1,212.50
Lee....................... 15 27 15 18 958.98 2,119.76
Leon ...................... 62 4l 56 51 3,890.84 8,208.02
Levy...................... 10 6 7 7 1,137.44 607.95
Liberty ................... 5 11 6 6 289.69 273.50
Madison.................. 18 21 24 18 2,211.47 1,416.03
Manatee................... 19 33 20 22 2,115.51 3,073.95
Marion .................... 16 12 10 19 1,135.25 1,940.86
Martin .................... 15 11 9 7 648.63 808.25
Monroe................... 49 39 32 32 3,273.00 3,871.00
Nassau.................... 13 23 11 15 653.68 367.47
Okaloosa.................. 29 34 38 15 2,856.25 677.40
Okeechobee ................ 4 5 2 4 90.75 163.25
Orange .................... 21 28 27 38 5,468.80 5,348.85
Osceola................... 1 9 5 8 1,249.95 251.50
Palm Beach ............... 50 46 70 65 6,058.55 6,180.00
Pasco ................... 36 29 38 82 4,611.75 8,058.15
Pinellas ................... 55 5 55 55 55 6,731.90 7,305.85
Polk ..................... 62 30 95 48 8,519.50 4,860.70
Putnam................... 40 48 27 46 4,215.06 4,686.22
St. Johns.................. 9 16 11 14 1,958.37 8,108.64
St. Lucie................... 16 24 12 16 1,600.19 1,703.16
Santa Rosa................. 37 26 46 20 3,931.25 1,896.50
Sarasota .................. 22 24 27 27 1,908.40 2,822.54
Seminole................... 25 24 6 21 1,746.00 8,519.86
Sumter .................... 14 12 17 8 927.14 771.57
Suwannee ................. 44 34 27 31 2,013.05 8,330.28
Taylor .................... 16 24 21 18 1,041.87 1,247.89
Union.................. .. 10 10 10 5 1,161.60 113.21
Volusia .................... 51 34 61 50 5,644.76 3,848.67
Wakulla................... 14 18 51 11 787.27 598.03
Walton.................... 24 19 35 13 2,870.25 668.00
Washington ................ 41 16 49 291 8,267.16 2,369.50

78 ANNUAL REPORT, 1954

DIVISION OF INDUSTRIAL HYGIENE
JOHN M. McDONALD, M.D., Director

LABORATORY
The Industrial Hygiene Laboratory made 729 tests on 584 samples
received. Of these, 416 were collected by division personnel. Industrial
physicians made greater use of the services available. Even with the
necessarily reduced activities, a total of 280 samples were examined in
response to requests from management, industrial physicians, and in-
surance carriers.
The long range program of periodic urine lead determinations was
one of the most severely cut activities. Instead of the regular three or
four visits to each of the lead processing plants as made in previous
years, these visits were limited to two or three times this year. Another
factor which interfered with the lead program was discontinuance of the
rapid screening method for urine lead. This was brought about by the
growing use of "versenate" as a preventive in lead poisoning. This
material interferes with complete precipitation of lead from urine and
thereby renders results of the rapid screening method unreliable. In
an effort to overcome these handicaps, the blood lead program was
stepped up. The local health officers cooperated by taking blood sam-
ples, and using special "lead-free" kits supplied by this office. The
samples were mailed to this laboratory.
The laboratory also provided special services to the Bureau of En-
tomology and the Purchasing Department by assaying samples of DDT
submitted in connection with supplying the expanded mosquito con-
trol program.

SPECIAL STUDIES
At the request of an industrial physician and with the consent of the
local postmaster, a technical study was made of working conditions in
a large post office garage. Urine lead as well as atmospheric lead
samples were collected and examined. Recommendations were made
for controlling contamination of the workroom air with lead fumes
and dust produced incidental to repair of truck bodies.
Special control samples were examined for an industrial physician
in connection with several suspected cases of lead poisoning. Samples
were tested in providing for information for diagnosis and the course
of treatment with "versenate" was then followed daily for extended
periods up to a month or more.

COOPERATION WITH OTHER DIVISIONS AND AGENCIES
The division made an epidemiological study in collaboration with the
Division of Veterinary Public Health. In the construction of a large

PREVENTABLE DISEASES

warehouse a number of plumbers contracted larva migrans. The origin
of infection was not clear because the building site had been newly
cleared of trees and brush and had not been exposed to the usual
source of infection. On investigation, it was found that some cats and
skunks had moved under the floor of the new building, thus establishing
a focus of infection. Suitable preventive measures were recommended.
Also, at the request of the above division a study was made to de-
termine the normal cholinesterase activity of certain varieties of mon-
keys. The results obtained were used as an aid to diagnosis of zoological
specimens suspected of having been poisoned with an organic phosphate
insecticide.
Assistance was given to the Jacksonville City Health Department on
several occasions. One was concerned with a dust problem in an in-
dustrial area. Help was given in collecting and analyzing samples.
Another problem was that of tracing an odor in a municipal building.

THE RED TIDE
Early in 1954 the "red tide" broke out again, this time centering
around Venice. The area involved was not as large as in the out-
break of 1947, but the condition persisted for a much longer time and
much larger amounts of the irritating aerosol were present.
Following the appearance of the "red tide," several people became
ill from eating mussels that had been collected in nearby tidal waters.
This combination of events is similar to what has frequently occurred
on the Pacific Coast. It has been established there that the organisms
causing the so-called "red water" produce a toxicity in mussels. The
organisms in the "red tide" of the Gulf of Mexico and the "red water"
of the Pacific Coast are similar. Because of these facts it was decided to
attempt to isolate the toxin accompanying the "red tide."
Air samples of over 100,000 cubic feet were taken. About twenty
gallons of sea water were passed through Sedgwick Rafter funnels and
a similar amount was filtered through qualitative paper. Each of the
residues was extracted, then separated into fractions on a chromato-
graphic column. The various fractions were tested in white mice. None
of the mice showed any toxic reactions. Further study had to be
abandoned because of the lack of personnel, but it is understood that
the research departments of two universities and a private laboratory
in the state are carrying on further work in this project.

AIR POLLUTION
The outstanding example of air pollution occurred around the phos-
phate treating plants in central Florida. Here, the general practice used
to be to mine rock and ship the raw phosphate to northern plants for
treatment. The present plan is to treat the rock in Florida and to
ship the concentrated product, thereby saving transportation charges

80 ANNUAL REPORT, 1954

on inert material. Treatment of the rock requires large volumes of
sulfuric acid, and it has been found profitable to make the acid locally.
At least six companies are now engaged in the manufacture of sulfuric
acid by the contact process. Five of the sulfuric acid plants are in an
area six miles in length. For a distance of about half a mile around
each plant there has been marked destruction of pine trees and some
lesser damage to other vegetation. In addition, there have been many
complaints of injury to health in the form of sore throats and mucuous
membrane irritation alleged to be due to the inhalation of fumes from
the manufacture of sulfuric acid, and its use in processing phosphate
rock.

At the request of the county health department, visits were made to
five of the phosphate companies. A meeting was held with the manage-
ment of these plants at which they were formally advised of the
complaints. They were informed that a study would be made of the
surroundings of each plant in order to determine the amount of sulfur
dioxide which was being given off from their stacks. A method was
selected for field determinations of sulfur dioxide and tested out in
the laboratory. Because of personnel shortages, and because the con-
dition occurred late in the year it was possible to make only a few
preliminary studies. The remainder of the study had to be deferred
until 1955.

In one instance it was possible to forestall the occurrence of a case
of air pollution. A group of promoters planned to erect an oil refinery
near Fort Lauderdale, an area which has long been an attractive re-
sort for tourists. This division worked with the Bureau of Sanitary
Engineering in meeting with officials of the refinery company and
advised them of the requirements which would have to be complied
with before their plant was set up. The officials of the company de-
cided not to go ahead with their plans.

X-RAY STUDIES
Rechecking of the shoe fitting machines was carried out to a limited
degree. A study was made of the operation of the X-ray Department
in a local hospital at the request of the hospital radiologist. The
equipment was found to be in safe operating condition.

INQUIRIES
As usual, inquiries covered a wide range. One concerned poisoning
from the eating of barracuda. Another was about the hazard of eating
chickens which had been fed on a commercial preparation containing
minute amounts of arsenic intended to stimulate growth of the chickens.
Still another inquirer wanted to know how to clean out a tank that
had contained ethyl gasoline as he intended to use the tank for watering
stock.

PREVENTABLE DISEASES

POLLEN COUNTING
Pollen counting was discontinued at the end of the year after having
been in operation for five years. Visits were made to two communities
that had asked for pollen counts. In one case no ragweed plants were
found and hence the advice was that pollen counts were unnecessary.
In another case so much ragweed was found that active control measures
were needed much more than pollen counts. A preliminary meeting
was held in connection with the proposed pollen count for Tampa
in 1955. At least two allergists are now conducting their own pollen
counts.

STUDIES INITIATED BUT NOT COMPLETED
Personnel shortages have seriously hampered the work of the Division.
In a preliminary study it had been found that the dry-cleaning in-
dustry is moving in the direction of establishing small dry-cleaning
plants in suburban shopping centers. These plants offer one-hour or
two-hour service instead of the former plan of sending all the work to
large plants downtown. The number of users of synthetic solvents is
thus increasing. As a result of our findings in some plants that have
been inspected, it was concluded that there should be closer super-
vision. The inspection program was suspended when the inspector was
transferred to another agency.
An interesting research program on ultra-violet light in Florida sun-
shine had to be abandoned because of personnel shortages. Investi-
gation of several printing plants disclosed the presence of some poten-
tial occupational dermatitis, carbon monoxide, and lead poisoning
hazards, but again the study had to be given up for the time being.

EDUCATION
A laboratory technician was instructed in the performance of cholin-
esterase tests for use in diagnosis of parathion poisoning. Several groups
were given orientation talks on industrial hygiene.
Much literature was distributed in industry and to the general public.
Among the literature sent out was the Florida Industrial Commission
Code, occupational health bulletins, pollen counts, humidity tables, and
material on industrial hygiene. There were 86 letters answered on
climatology.

CIVIL DEFENSE
In connection with Civil Defense activities, the director attended
the Fifth Annual Meeting of the County Medical Societies Civil De-
fense Conference held in Chicago. He was also present at a Radiological
Defense Conference which was mostly devoted to monitoring, and a
meeting of the Implementation Committee, both of which were held
in Atlanta. One meeting of the Jacksonville-Duval County Civil De-

82 ANNUAL REPORT, 1954

fense Council was attended at which time a report of the first Atlanta
meeting was given. A conference was held with the Regional Medical
Director of Civil Defense.
With the help of the State Civil Defense agency, the Division was pro-
vided with a new radioactive source consisting of 100 millicuries of
Cobalt-60. It is expected that this source will be helpful in teaching
radioactivity monitoring. Because of the illness and death of the for-
mer State Director of Civil Defense, Colonel R. G. Howie, there was
a temporary interruption of the Civil Defense program.

TRAFFIC AND OCCUPATIONAL SAFETY
Traffic safety continued to take a good deal of time. For example,
six meetings of the Traffic Safety Coordinating Committee in Tallahas-
see were attended as well as the Annual Conference on Traffic Safety
held in St. Petersburg. About 25,000 circulars were distributed through
county health departments and others to promote the observance of
Safe Driving Day. The director attended the President's Conference on
Occupational Safety in Washington, and also worked with the Jack-
sonville-Duval County Safety Council in planning their Second Annual
Conference on Occupational Safety. Several accident hazards noted
in trips through plants were reported to the proper office in the Flor-
ida Industrial Commission.
Technical Articles by Staff Members included:
MacDonald, W. E., Jr., Formaldehyde in Air A Specific Field Test.
Am. Ind. Hyg. Asso. Quart. 15, 217-219, 1954.
TABLE 24
STATISTICAL SUMMARY OF INDUSTRIAL
HYGIENE ACTIVITIES
Plant Activities
Total number of different plants serviced ........................................ 261
Number of workers covered by services ............................................. 4132
Number of plant visits made ................................................................ 336
Source of Service
Self-initiated ....................................................................................... 211
Requests from management, county health departments, state agencies,
etc ....................................................... ............................................. 89
Total ........ 300
General Type of Service Given No. of Services
Introductory, routine ......... ..................................... 39
Plant surveys ........................................ 119
Technical studies of hazards .......................................... 117
Investigation of occupational diseases .............................. 16
Investigation of nuisance complaints .................................. 28
Other ................................................... ......................... 5
Follow-up on recommendations .......................................... 16
Investigation of atmospheric pollution .............................. 9
Discuss report .......................................................... 31
Total ........ 380

PREVENTABLE DISEASES 83

Carried
Recommendations Made Out
Number of recommendations ................ 16 7
Plants involved ........- ....- .................... ------ 14 7
Workers affected .................................... 130 93

Specific Services
Samples collected for laboratory analysis or examination...... 416
Other samples received for laboratory analysis.................. 168
Biological .......... 432 Mineral .............. 31
Atmospheric ...... 45 Misc. .................. 76
Total ........ 584

Number of laboratory analyses and examinations .........................---............. 729
Field determinations of atmospheric contaminants ...........................----.............. 408
Field determinations of physical conditions ...............................-- .............. 215
Occupational diseases reported officially ..................................... .......... 1417
Occupational diseases investigated ................................ ................. .... 70
Research investigations ......................................................... 2

TABLE 25

OCCUPATIONAL DISEASE CLAIMS

January December, 1954
Conjunctivitis ...................................................--......-------------... 188
W elders' ........................................................................................ 171
Chem ical ...................................................................................... 5
O their ........................................................................................... 12
Infections ............................................................................................................... 65
M eat ........................................................................................... 28
T uberculosis ................................................................................ 3
U ndulant fever ............................................................................ 5
O their ............................................................................... ........... 29
Repeated motion, pressure and shock ................. 14
Temperature changes .. ........................................ 5
Variations in air pressure ...................................... 12
Respiratory irritations ..............................---------... 3
Radiation exposure ............................................. 1
Parathion poisoning ................................ .............. 12
Lead poisoning ...................................-........... 2
Diagnosis indefinite ...................................--........ 7
D erm atitis ............................ .. .. .................. 1108
C itrus ................................ .................... ............................ ........ 164
A lkali ................................ ......... ................................ ............... 134
Solvents and oils .... ...................................... ....................... 118
Cem ent ....................................................................................... 137
Glue ................. ..............--------------- -.... ----------......... 6
Other chemicals ............................-----................... .... 140
Plant ............................................................................................ 112
Creosote ............................ ................... ............... ......... ........... 10
Fungus .................................................... 53
Larva migrans .............................. --- 106
O their ......................................-.. 128
Total ........ 1417

84 ANNUAL REPORT, 1954

DIVISION OF VETERINARY PUBLIC HEALTH

JAMES E. SCATTERDAY, D.V.M., M.P.H., Director

The veterinary aspects of public health relate primarily to animal
diseases transmissible to man. For many of these, eradication or control
of the disease in animals appears, in the light of present knowledge, as
the only means of control in humans. A few of these "transmissible"
diseases, with which Veterinary Public Health was concerned this year,
are discussed in the following paragraphs.
One of the major incidents of the year was concerned with Veterinary
Public Health becoming a division in the Bureau of Preventable Diseases.
This was due to increased activity in the division during the past year,
as well as addition of personnel.
Another outstanding item was the establishment of an Animal Disease
Morbidity Reporting program. This is done in cooperation with the
Department of Health, Education and Welfare; Florida Livestock Board,
U. S. Department of Agriculture, and the State Board of Health. A
bimonthly report of the results is mailed to all practicing and state-
employed veterinarians within the state, as well as state veterinarians
and interested people in other states. Considering this as a year of
"introduction" to the veterinarians of the state, very good results have
been received. A cumulative report of these results for the year appears
in Tables 26 and 27.
Rabies Due to its human importance and interest, rabies is listed
first. There was a total of 89 cases of animal rabies this year, a break-
down of which is given in Table 28. This is a marked increase over
last year's total of 64. This is partly due to better reporting, and to the
fact that the disease exists to quite an extent in our wildlife.
A meeting of the Southeastern United States Rabies Conference was
held in Tampa, March 19-20th. This conference had a registration of
99, representing 19 states and five foreign countries. There were also
representatives from state, county and city health departments; State
and U.S. Fish & Game Commissions; humane societies; practicing vet-
erinarians and private agencies, both within and outside Florida.
Bat rabies, first reported by Florida in 1953, received additional study.
Funds obtained through a National Institute of Health grant permitted
the employment of a fulltime biologist to study the habits and migration
of these mammals. A possible method of census taking is being studied
with the population pattern of bats and its relationship to rabies in this
species. A total of 843 bats have been collected and examined during the
year. One (Lasiurus seminolus) of the 843 collected, proved positive for
rabies. (For additional information, see report of Bureau of Laboratories.)
Brucellosis During the year, 97,234 cattle were tested in 7,713
herds by practicing, and state and federal veterinarians. 1,725 brucel-
losis reactors were found and disposed of according to the state regula-

PREVENTABLE DISEASES 85

tions. 34,493 calves and 20,014 adult cattle were vaccinated against
brucellosis under the supervision of the U. S. Department of Agriculture.
Nine cases of human brucellosis were reported in 1954.
Bovine tuberculosis All cattle in dairy herds are required to be
tuberculin tested before milk is sold, and annually thereafter. Family
milk cows may be tested for tuberculosis either by a practicing veterin-
arian at the request of the owner, or when the State Livestock Board
reaccredits a county by testing at least 10 per cent of its cattle and herds.
3,291 herds, consisting of 142,553 cattle, were tuberculin tested in 1954.
72 reactors to the tuberculin test were found and removed.
Creeping Eruption Studies along this line were continued with
the cooperation of the Pacific Coast Borax Company. The several aspects
considered were:
1. Hatchability of the dog and cat hookworm eggs during varying
winter temperatures in Florida. (Approximately 38 750F.)
2. Length of time the eggs remain viable.
3. Survival time of the larva in soil between 38 75"F.
4. Herbacidal action of the various larvacides used in dog and cat
hookworm control, and the optimal strength desirable for use
on vegetation.
This work is not complete and will be reported on later.
Psittacosis Due to the geographic location of Florida, with its
ideal climate for the breeding of small psittacine birds, this disease has
been of considerable concern to some of the northern states. A few
human cases in some of these northern states have been tentatively traced
to Florida birds.
The bird industry in Florida has become alerted to the possibility of
an embargo against their exports. One questionable case of human
psittacosis has been diagnosed in Florida. From a total of 106 psittacine
birds examined from aviaries in Florida, five were found positive for
psittacosis.
Anthrax In spite of very good vaccination and quarantine control,
this disease appeared in two Florida counties. No new premises were
found infected, but two of the originally infected ranches in Polk and
Broward Counties did have recurrences.
MILK CONSULTANT ACTIVITIES
SAMUEL O. NOLES, B.S.A., M.P.H.
Greater demands by counties were made during the year for approval
of dairies for inter-county transfer of milk. The Central Milk Registry
was used extensively for this purpose, as well as a majority of the milk
consultant's time.
Two of the major milk sheds, Pensacola and Jacksonville, were sur-
veyed during 1954. Both sheds made a U. S. Public Health Service
rating of better than 90 per cent, thus attaining a position on the "Honor
Roll" of communities throughout the nation. Methods used by the milk

86 ANNUAL REPORT, 1954

consultant for making such ratings were checked and approved by
personnel of the U. S. Public Health Service.
Sources of milk and frozen desserts being used on interstate carriers
were checked and recommended for approval to the U. S. Public Health
Service.
The milk consultant continued work with sanitarians throughout the
state, making recommendations concerning the quality milk control
programs being conducted. Insufficient time was devoted to this activity.
Considerable work was done on further development of systems of
tank-truck pick-up of milk from cold-wall tanks at the farms, thus
eliminating ten gallon cans. This system has vastly improved the quality
of milk being delivered to plants. Several technical problems, however,
developed in connection with this system, all of which have not yet
been solved. The milk consultant worked with manufacturers on prob-
lems of construction of cold-wall farm tanks and other equipment. He
has been appointed to the "3-A Standards Committee" which has world-
wide responsibilities in development of standards for manufacturing dairy
equipment.
During 1954 the milk consultant worked in 43 counties. Seventy-two
milk plants were inspected, which were processing a total average of
approximately 100,000 gallons of milk and milk products daily. Over
800 producing dairies were inspected. All this work was done with
local sanitarians who were responsible for the quality milk control pro-
grams in the area concerned.
Much effort has been directed toward attaining a more complete
acceptance of reciprocal inspection between local health departments.
Good cooperation has been extended by most counties concerning such
efforts; however, there have been difficulties in some areas. Such a
program requires close cooperation of the local health departments with
the State Board of Health in submitting accurate and continuous infor-
mation on all dairies and milk plants under their supervision to the
Central Milk Registry.
In addition, it is necessary for the milk consultant to work with
sanitarians in such areas for the purpose of standardizing quality control
programs so that equal enforcement of sanitation requirements can be
maintained.
For all the activities mentioned above, more help is urgently needed.
A minimum of one more milk consultant is vital for supplying the con-
sultative service requested and needed throughout the state.
Counties visited 43
Plant producers inspected 810
Pasteurization plants inspected 72
Sanitation surveys completed 2
Dairy industry meetings attended 11
Articles by staff members: Noles, Samuel 0., Practical Sanitary Aspects
of Bulk Milk Dispensing. Journal of Milk and Food Technology.
July, 1954.

PREVENTABLE DISEASES 87

TABLE 26

CASES OF ANIMAL DISEASES REPORTED BY VETERINARIANS,
J FLORIDA, 1954

An- Lepto- Rabies Ring-
thrax spirosis worm

a'

a a) a o)

Alachua .......... 4 ... ... 18 ... 1 8 ....... 7 3 ... 8 ... ... ... ... ... ... 1 ....... ... 1
S a .g a

0.

I ... ... ... ... ... .. '
COUNTY 0 d a

Total............. 90 4 0177 4419307 14 9170402 96 34 6 1 18 7 24 14 82 0272 67 62
Alachua.......... ... ... 18 .. 1 8 ... ... 4 3 ... 8.. .. 5 .. .. ............ 1
Baker......... ..... ... .. .. .. ......... .. .. .... .. ... .. .. ... ... ... ... .
Bay.............. ........12 ......... 15............... ..... ........41 10 1
Bradford......... ........ .. 2...... ..... ..1..... ..... ... ... ......... ... .........
Brevard.......... 7... .............. .... 9. 2 ... ... .. .....1...... ... 2 2
Broward. ....... 15 3 4... 6 1 ........ 6 15 3 3 ....... ........ ... ...I ... 1
Calhoun.......... ... .. ... 8 4.. ... 4 .... 4 3 ... ... .. ... .. ... 2.... 3... ... 1 1...
Che ott ............. ... .. .. .. ... 1 .. 1 .. ........ ..... ... .. ..... ........

Dixitrus ................... .........................................................
Clay. .......... ... ... ......... ....... .... ......
Collier............ .1 ..... 1.. ... 7 ... ... ... .. 1.. .. .. .. ... 2 ... ..
Columbia........ ... ... ... 1 ... ... ......... .......... .. ... .. .
Dadde 7 71 .. .. ... 1 .. ..107 24 2 ... ........ .. ...... .. ... 51 14
DeSoto ....... .. ..... ...... .. 1 ... 1 1... 1 ........ .. ... ... .. ... ......
Glades........... ......................................................................
Duvalf............1...............1 8.....883913 ...... ........... ......3116 8
EsHambiat................. ......1 5 ..........22 56................... ... 2 ... 9 2...
Flagler........... ...... .1 ... 2 ............ ..... ............... ... ...........

Hendryanklin................ 7 .......... .......................... ............ ..............
Gadsden....................9 7 249... 2... 7' 7'... ............... 14... 19 1...
Gilchrist.......... ......... 6 1... ... ... ... ... ... .................. .... ... ... .....
G lads. ......... .... ..... ............... ..... ........... ...
Hil oro........... ... .. .. .9 20 .... ... 2 17 2 ... .. .. ... .. ... .: ..
Halme ........... ....... ... 1.. ......... ..........................
HJeff erso.......... .... ...... 18..... ... 2 ...... ... ... ... ... ... ...... ... ... ............
Hena ndoy......... .. .. .. .. ... ...... ... ... .. .... ....... .. ... ... ...... ...
Hihlands ............ .. .. .... ... .. .. ..... ... ... ...... ...... .... ........ ... .....
Hillsborough...... 1..... 3. 19 20...... 2 17 2 1............ 11... 2... 16 9...
Holmes............. ... ...... ... ... ..... ... .... ... .. ... .... ... ... .... ... ... ... ... ..
Indian River........ .. ...... .. ... ...... .. .. ... ............... ........ .. ...
Jackson.......... .. ... 10 18 5 25 5 ... ... ... 2 1 15 ... 14 ...... .....
Jefferson.......... 3 ...... 3.. ... ... .. ........ .. ... ... ... .. .. 1... ......
Lafayette ........ 3 .. .. .. ... .. ...... .. ... .....
Lake............. 6 ... 11 2 3 9.... ... 7... 1 6 .......................
Lee. .......... .. ........ ... 7 ... 1 ... 2 1 .. ... ... 4 .... ....21 2 ...
Leon....... .... 1 ...... 4 1 1 ...... 2. 1.....1 ... ... ....... .... 8....
Levy ............ ..... ... ... ... .... ... .... .. ... .. .. .. .. 7.... ..... ...
Liberty ........... ..... .. .. ... .. ... .. ... .... .. .. ... ... ... ... .. .. ...... ...
Madison............................. .. ......................... ............
M a oontee.......... ... ... ..... ... .. 5 ... ... .. ... .. ...... ....... 1 .. ...... .. .

MariOkeechobeen........... 1 ........5 11 39........4........1................ ......... 20
Manrtge........... 14 ...... 4 .. .1 8 20 ... ... 23 73 20 6 ... 4 ... 21... ... 3...... 31 5 ...
MOsconr .......... .. ... 1 ... ... .. .. ... .... 2 ... .. .. ..... 2... ... ..
al aca .. ... ... 1 ... ... 1 .... ... 1 ... .. 4 ............... ... ... ... 6 ... ...
a loos a .......... ... ...... ... .. .. ... ... .... .. .. .. .. .. ........ ... .. .. 1 ..
Okeechobee....... ........ ...... ... ... ....... .. ..... ............... ......... .
Orange............ 14 ... .... 418 2 ... 37 ... ... ..... .. 1 2 .. ... 1 ...
Osceola........... 4 ...... ... 4 6. .. 1....... 2 ..... ... .. ... ... .....
Pa.lmBeah....... 10... 12... 20.... 1.......4 1 1 ................... ........ 3
Pasco. .......... ... ...... ... .. ... .0 ........ .....................
Pinellas........ ... ..... .. ... 2. ......... .. ........ ...... ... ... 3
Polk.............. 63 1 ... 3 .8 24 1.. .. .. 1 ...... .......... ... 2 1 ...
Putnami ........... 4.. .......... 1. ........... 1 41 ..... ...... 1............ ... .... .
St. Johns......... 2 ................ .............................. ..... .... .... ...
St.Lucie ........ 2 ........... ..10 1 ...... ... .. .. .................................
SataRosa.......... ........ 3 ... 2 ......... .. ... ...
Sarasota...................4 2 3..........1... 1.................... .. ..............
Seminole.......... 4.. ......... 2 1 1 .. 1 1 ........... .......................
Sumter............. ...... .1.....1..... ............ ... ... 1.... ..... ... ... ... .
Suwannee ......... ....... 1 9 ... 10 ... ...... ...... ..1... ... ... ... ... .. .. .. ... ...
Taylor............................1 2................................. .............1.
Union............ .. ... ... ... ..... .. .......... ......... .. .......4............
Volusia........... 45..... 3... 2 8 1... ... ... .. 1... .1. ..... ..... ............ ....
Walton.......... ...... ... ... .. ... 5............... 1...... 1 ... 1 .. .... .
Washington ................ ...... ...... ....... ... .. ............... ...... ........
W ashington ....../. ... ... ... ... ... 1... ... .... ... ... ... ... ... ... 1... ... ... ... .. ... ..l:II1 1 I

TABLE 27

CUMULATIVE TOTAL OF ADDITIONAL ANIMAL DISEASES REPORTED BY
VETERINARIANS, 1954, YEAR 1954

2 Alachua.......................... ... ...... ...... ... ...
I I JS I-
COUNTY *

IWl So l A El
5' oS 0 u S Slo M Mi

Bayl hu. ................... ........ .. .. .. . 1 ... .. 1 .. 2 . 4 ... ...
Bry....rd......................... ..... ... .. ...... .. .. 2 ... .. ....
Brad ford.......................... .. . ....... ... .. .. ... 2 ..... .. ... .. 2 ... ... ... .. ...... .. .. .
Brevard......................... .... .. .... ..... ...... ....... .... ..... 1...................... .........
BrCalhounward................................:. ................. ... ..................... .....
Calhounollier .................... ..... ... .. 2... ....... ............... .....................
DadCollier............................ ................... ....1... ........ ... 3 .......1 ........ ......
Dade ............................. ... ... ... ... ..... 1 57 ... .... 18 .... ... 5. ... .. 631 .... 1 33 ... 1... ... 5 ... ... ..... .. ... 2 ......
Duval ..................................... ....... ... 6 ....... 19.......... ...... 15 1 3... ... 1 .......0 ...... 1 2 ... 20
Escambia ......................... ... ..... 3 .. 5 8 .......... .. 17 ... ... 4 .... .... .. ... .
Gadsden............................. .. .................. ...... .. 5 .. .... .. 1... ... 6 1... 1.....4 ... .......
Gilchrist ........................ ............. ... ... ... .. .. ... .. .. ......... 1. .. .. .......... .. ....... .........
Hardee ................... ...... ... .. ... .. .. .. .. .. ... .. .... ... ... .. ... ...... ... .....
Hillsborough................ ......... ............ ... 69 ... .. 7 .3 .. ... .. .. .. .. .. 3 ... ... ... 1...
Holmes.......................... .... ..... ........... ... ... ... .. ... ... ... ... . ... ... .
Indian River ................................ .................... ... ... ...... ... ....... ... ... ... ... ..............
Jackson.... ...................... ..... 3......... ..... ..... .. .............. .... .... ..... 15 .
Jefferson ......................... .................. 5 ......
Lake............................ .... ..... ......... ............ ........ .. ... 1 7 ... .... .. ... 1... .. ...........
Lee................... .... ... ...... .. ... ... 36 ... ... ... .... ... ... ... 53 ... ... 5 ... 8. .. ... ......
Leon. ............................ .. .... ... ... ... ... ... ... ... ... 9 .. .. ...... 7 ... 8 .. .....
Levy ......................... ...... .. .... .......... .. ...... .. ... .. .. .. .. 1..
Liberty........................... ..... ... 1... ... ... .. ............ .. ....... ... ... ......... ..... 1 ... .. ..
Marion. ................ ....... ... ..... ..... ... ..... ... .. .. 1 ... ... .. . .. .. .. ... .
M artin .................. ....... ... .... 7 ....... .. .. ... 1 ... ... .. ... ... ... .. ... .. ... ... .... ...
M onroe .......................... ... ... ... ... ... .. .. ..1... .. .. ... ...
Oklaloosa............................ .... .. ...... ... .. ..... ......... ... 2......... ......
Orange........................... ... ... .... .......... .. .... .... .... .. ... .. .. .. . ... ... ... ...... ... ...... ... ... .. 1 1....
Palm Beach. ..................... .. 1 ............ ... .. 2 ... 2 ... ... 2 ...... ... .. ... ...... 1...... .... .. ...1 .
Pinellas.......................... .............. ........... ... ........... ... 8 ...... 3.............
Polk ..................................... .... ...1........... ..6 1... .. ... 2... ... ... .... ..
Putnam ........................................ .................. ... ......... .....
Sarasota .......................... ... ... .... .. ....... ... ... ... .. ... .. ... ........
Putnam .......................... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ...

Suwannee......................... .. .. . . .. .. .. ............. ................. ... 1..
Taylor ........... ........................... .. .. . ... ..... .. .. .. 1 ..... ......... .. .. 1. .. 2 ...
Walton.............. ............. .... ..... ........ ... 10 ............ 16 ...
TOTAL.......................... 11 5 35002 l 1 9200 15 176 1 6 1 22 10 3284 25 1 85 6 12 1 1 91i66 5 8 6 1" 11 120

PREVENTABLE DISEASES 89

TABLE 28

LABORATORY CONFIRMED ANIMAL RABIES CASES
BY COUNTIES AND SPECIES, 1954

SPECIES OF ANIMAL
COUNTY __TOTAL
Dog Cat Cattle Horse Raccoon Skunk Fox Bat

Bay.......... ........ ....... 2 ....... ....... ....... 1 ....... 3
B row ard.............. 4 ...... ... .. ....... ....... .. ..... 4
Calhoun.............. ....... 1 ....... ............. ..... 3 ....... 4
Citrus................ ... ... ....... .......... ..... ..... ....... ....... 1 1
Collier ................ 1 .......................... ... ........... 1
Duval ................ ............. .... ... ..... 5 ........ .............. 5
Gadsden .............. ....... ....... 1 ............... ...... 1.......... 2
Hendry ............... ....... ..... ... .... ... 1 ................... ..... 1
Hernando... ................ .............. ....... 1
H ighlands........... ........ ....... ....... ... 1 ....... ....... ........ 1
H illsborough .......... 3 ....... ....... ...... ....... ....... ....... ....... 3
Holmes............... ....... 1 ................... .1 ...... 2
Jackson.............. 2 2 11 .............. ...... 8 ....... 23
Lee.................. 3 1 ....... ....... ....... ........ ...... 4
Levy ................. 1 ....... ....... ....... .............. 1 ....... 2
Liberty. 1 1
Liberty ............ ....... ....... .. ..... ...... ....... 1
Nassau ............. ....... ...... .............. 3 ...... ........... 3
Okaloosa .................... 1 ....... ....... .... .......................
Orangeosa............... 2 .. .......... ................... .............. 5
Orange ............... 2 ......... ............ .. ................. 2
Osceola....... ....... ..... ..... ...... 1 .. .............. 2
Pasco ................ 2 1 1....... ........................ ....... 3
Putnam.............. 21 ... ...... .. ....... 1 ....... ................ .
Putnam n .............. 1....... ........... .. .... ........... ....... 1
Voluann. ............. ........ .. ... ....... .. ...................... 1
Walton ............... ........ ......1. .. ..... ... ........ 1 ......... 1
W ashington........... 1 2 2 ................ ....... 2 .... 7
TOTALS......... 23 11 16 1 16 2 19 1 89

90 ANNUAL REPORT, 1954

BUREAU OF TUBERCULOSIS CONTROL
C. M. SHARP, M.D., Director

In spite of the rather drastic curtailment of funds during the past
fiscal year, brought about by a reduction in Federal funds, the activities
of this bureau have resulted in continued progress in the fight against
tuberculosis.
It is evident, however, with the rapid growth of population in the state
that it is absolutely necessary that sufficient funds be appropriated to
operate this bureau in an adequate manner, since it is felt that through the
activities in case finding of the county health departments, in conjunc-
tion with this bureau, the majority of tuberculosis cases are admitted to
our state tuberculosis hospitals.
With the marked revolution in the treatment of tuberculosis brought
about by new drugs and a more rapid turnover of patients who are to
continue drug therapy on the outside, it is obvious that the activities of
this bureau as well as the county health departments need to be stepped
up to find the unknown cases, and to care adequately for those dis-
charged cases who will need more intensive follow up and supervision
of drug therapy administration.

MORTALITY
The status of tuberculosis as a leading cause of death has changed
greatly. In 1953, for the first time in the history of the bureau, tubercu-
losis was not listed among the first ten causes of death.
There was a phenomenal decrease in the mortality rate between 1952
and 1953 when the accelerated treatment program first went into
effect. During 1954 there was still a very significant drop in the number
of deaths from tuberculosis, and in the death rate for both white and
colored. There were 277 total tuberculosis deaths in 1954 with a rate
of 8.0 (provisional) per 100,000, a decrease from the 303 deaths for the
previous year.
The number of white persons dying of tuberculosis decreased from
171 in 1953 to 157 in 1954, with a death rate of 5.6.
The number of colored persons dying from tuberculosis continues to
decrease rapidly with 120 deaths in 1954 compared with 132 deaths in
1953, with a resulting death rate of 17.5. (Table 29).

CASE FINDING
A comparison of the number of cases of tuberculosis reported in 1954
and 1953 shows that there has been a slight increase in the number of

TUBERCULOSIS CONTROL

cases. In 1953 there were 2424 cases reported, whereas in 1954, 2461
cases were reported. If, however, one takes into account that there has
been between a five and six per cent increase in the population in
Florida, then one cannot say that there has been an increase in the
case reporting rate. This actually means there probably has been ap-
proximately a 5 per cent decrease in the reported case rate when com-
pared with 1953.
The distribution of the cases by stage (Table 30) shows that there has
been an overall increase in total cases reported, with an increase pro-
portionately larger in the moderately advanced cases.
One significant finding observed is that there has been an 86 per cent
increase in the number of cases of active primary tuberculosis reported
between 1953 and 1954. This, of course, may not be significant since so
few cases are involved, but it should be pointed out that 41 active cases
of primary tuberculosis were reported in 1954 as against 22 in 1953.
It is still rather important that approximately 50 per cent of all cases
of tuberculosis reported were in the age group over 45, and over 15 per
cent were in the age group over 65, confirming previous observations of
a swing toward the older age groups. (Table 30)
It should be noted that 61 or 2.5 per cent of all cases reported were
reported first by death certificate. This is, however, an improvement
over the 1953 figure which showed 72 cases. We received 15 reports
from death certificates from the State Hospital in Chattahoochee, or
25 per cent of the total reported first by death certificate.

CENTRAL TUBERCULOSIS CASE REGISTER
As usual, a great deal of time and effort is spent by the central office
staff of this bureau on the central tuberculosis case register from which
a large volume of valuable information can be obtained. (Tables 31
and 32.)
Due to the closing of many cases from the register because of the
termination of the period of follow up prescribed, the total number of
cases in the register which we consider necessary to be followed is 11,009,
a decrease of approximately 600 cases over 1953.
There were 2115 cases hospitalized in 1953 as against 2150 in 1954.
The number of active cases residing at home has shown a decrease from
1909 in 1953 to 1585 in 1954.
One of the most marked improvements between the two years has
been the number of positive sputum cases at home. In 1953 there were
865 positive sputum cases at home whereas in 1954 this number had
decreased over 50 per cent to a total of 424. In addition, the number of
questionably active cases decreased from 1150 in 1953 to 1028 in 1954.

	Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Official staff Florida state board...
	County health officers
	Florida state board of health
	Table of Contents
	General summary
	Finance and accounts
	Vital statistics
	Local health services
	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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