Annual report - State Board of Health, State of Florida

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STATE BOARD
OF
HEALTH

1956

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FLORIDA

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State Board of Health
State <4 7tvde

1956

The following statistical reports will be published separately:
SUPPLEMENTAL I FLORIDA VITAL STATISTICS, 1956
SUPPLEMENTAL II FLORIDA MORBIDITY STATISTICS, 1956

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

C.7-

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, 1956.

Sincerely yours,

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

May 1, 1957
Jacksonville, Florida

His Excellency, LEROY COLuNS
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, 1956,
to December 31, 1956, inclusive.

Respectfully submitted,

HERBERT L. BRYANS, M.D.
President

May 1, 1957
Pensacola, Florida

Members of the
FLORIDA STATE BOARD OF HEALTH

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

CHARLES J. COLLINS, M.D.
Orlando

T. M. CUMBIE, Ph. G.
Quincy

CARL C. MENDOZA, M.D.
Jacksonville

F. P. MEYER, SR., D.D.S.
St. Petersburg

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
December 31, 1956

DIRECTORS

State Health Officer ...--...-.... -Wilson T. Sowder, M.D., M.P.H.
Bureau of Finance and Accounts-- .---.. Fred B. Ragland, B.S.
Personnel Supervisor_--- ---Paul T. Baker
Purchasing Agent-_ ------ G. Wilson Baltzell, B.S.
Bureau of Vital Statistics -...-.--....Everett H. Williams, Jr., M.S., Hyg.
Bureau of Local Health Service ...----- George A. Dame, M.D.
Division of Public Health Nursing ---. Ruth E. Mettinger, R.N.
Field Advisory Staff and Field Training -George A. Dame, M.D., Acting
Bureau of Preventable Diseases .....----- Clarence M. Sharp, M.D.
Division of Industrial Hygiene_ ____ John M. McDonald, M.D.
Division of Tuberculosis Control ...--- Clarence M. Sharp, M.D.
Division of Venereal Disease Control .. John H. Ackerman, M.D., M.P.H.
Division of Veterinary Public Health ......James E. Scatterday, D.V.M., M.P.H.
Bureau of Special Health Services_ ...._.. Lorenzo L. Parks, M.D., M.P.H.
Division of Hospitals and Nursing Homes.-Lorenzo L. Parks, M.D., M.P.H.
Acting
Division of Chronic Diseases ..--.----. Lorenzo L. Parks, M.D., M.P.H.
Acting
Division of Nutrition___-_ ... Lorenzo L. Parks, M.D., M.P.H.
Acting

Bureau of Laboratories ......-- Albert V. Hardy, M.D., Dr.P.H.
Miami Regional Laboratory __._W__. Warren R. Hoffert, Ph.D.
Orlando Regional Laboratory-------Max T. Trainer, M.S.
Pensacola Regional Laboratory ....-. Emory D. Lord, Jr., B.S.
Tallahassee Regional Laboratory_ ..__ Robert A. Graves, M.S.
Tampa Regional Laboratory..-_ ._. ... H. D. Venters, B.S.
West Palm Beach Regional Laboratory-Lorraine Carson
Bureau of Maternal and Child Health ....__ Ralph W. McComas, M.D., M.P.H.
Bureau of Mental Health -. ...... W. Laney Whitehurst M.D., M.P.H.
Bureau of Dental Health.__ _... Floyd H. DeCamp, D.D.S.
Bureau of Entomology -----......- --_John A. Mulrennan, Sr., B.S.A.
Bureau of Sanitary Engineering. -------. David B. Lee, M.S., Engineering
Bureau of Narcotics.-.. ...-....-............. Frank S. Castor, Ph.G.
Division of Health Information_ ..._..... Elizabeth Reed, R.N., B.S.

COUNTY HEALTH OFFICERS

(As of December 31,1956)

Alachua .-_...-....__--....Edward G. Byrne, M.D., M.P.H.
Baker-Nassau ._______ ..-----.---. Frank J. DiTraglia, M.D.
Bay --. ____ -----...._. .__--- Albert F. Ullman, M.D.
Bradford-Clay-Unoin ___._ ..A. Y. Covington, M.D., M.P.H.
Brevard-Osceola __._......James F. 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 ...... ... Harold F. Bonifield, M.D., M.P.H.
Collier-Lee_.___.-- ..M.... 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 --._ -....Patrick H. Smith, M.D.
Duval -___ __ __ __Tho ..Thomas E. Morgan, M.D., M.P.H.
Escambia -__ ------.....John C. McSween, M.D.
Flagler-Putnam___ __ ----....Norman B. Edgerton, M.D., M.P.H.
Franklin-Gulf-Wakulla..---...--....----Warren T. Weathington, M.D., M.P.H.
Gadsden-Liberty_ ... .....___.. ---...Wayne Yeager, 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__......__..George A. Dame, M.D., Acting
Lake .... ___. ...... __......J. Basil Hall, M.D., M.P.H.
Leon ------...... --Joseph M. Bistowish, M.D., M.P.H.
Manatee ....--------- ..__..Charles W. Long, Jr., M.D.
Marion- ...-----. -. ..._ Luther A. Brendle, M.D., M.P.H.
Monroe -.Charles W. Morrison, M.D.
Okaloosa-Santa Rosa _--_ Edwin H. Miller, 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__ ._-----___...... -------Bertram R. Provost, M.D.
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 O8ARD MEMBERS

TABLE OF CONTENTS

Page

General Summary (including Scholarship Program) .--.---------- 1

Division of Health Information ...-.----.-.- ....---- --... --------. 8

Bureau of Local Health Service (including Division of
Public Health Nursing) -.. ----------.... ....-_ 13

Bureau of Vital Statistics __. -----------------....--..--.. 53

Bureau of Maternal and Child Health ------- ..........------...... 62

Bureau of Preventable Diseases (including Epidemiology,
Division of Industrial Hygiene, Division of Tubercu-
losis Control, Division of Venereal Disease, Division
of Veterinary Public Health) ------------ -- --.---------- 69

Bureau of Laboratories -------------__--- --- 106

Bureau of Special Health Services, (including Division of
Hospitals and Nursing Homes, Division of Chronic
Diseases, Heart, Cancer, Diabetes, Division of Nutri-
tion) _--.--...-.......--..-..........-- -- .._ 125

Bureau of Sanitary Engineering ----------------------- 140

Bureau of Narcotics ..-----._---.---- -------.... .-------..... 184

Bureau of Dental Health .---......------__._.__ ---.. --..-.-- 188

Bureau of Entomology (including Entomological Research
Center) .---_...... -----.... ------------..----... 195

Bureau of Mental Health (including Council on Training
and Research in Mental Health) ...._-----.._ --..------......--- 207

Bureau of Finance and Accounts (including Personnel,
Purchasing) -----. --.------ .--------...-.-__ ......... 217

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

The year 1956 was one of reorganization and continued growth for
the State Board of Health. For the purpose of effecting more logical
units of administration, the responsibilities of two of the principal
bureaus was redefined and a Bureau of Special Health Services was
created. The Field Advisory Staff was returned to the Bureau of
Local Health Service. The Bureau of Tuberculosis Control was com-
bined with the Bureau of Preventable Diseases, with the Epidem-
ologist serving as Assistant Director. Included in this bureau are
Epidemiology, the Divisions of Venereal Disease Control, Tuberculosis
Control, Veterinary Public Health and Industrial Hygiene. The Bureau
of Special Health Services includes the Divisions of Hospitals & Nurs-
ing Homes, Chronic Diseases, Nutrition and Civil Defense. The Divi-
sion of Hospitals is charged with the responsibility of administering
the new program, "Hospital Service for the Indigent," together with
the licensure of hospitals and nursing homes.
The Bureau of Laboratories was reorganized to effect a cooperative
program with the State Tuberculosis Board. Through this program
the laboratories of the four State Tuberculosis Hospitals and the Dist-
rict Laboratories of the State Board of Health have been integrated
and are operating under the supervision of the Director of the Bureau
of Laboratories. Because of the growth and increasing importance of
research in Florida's public health program, it was considered ad-
visable to designate a coordinator of research. The Director of the
Bureau of Laboratories was given this responsibility.
Under the authority of the 1955 Act creating the State Personnel
Board, the Merit System Council employed the Public Administration
Service of Chicago to prepare a classification plan and pay schedule
for all state departments which would be included under the reorgan-
ized Merit System. The initial reclassification plan and pay schedule
proposed by the Public Administration Service for the employees of
the State Board of Health and the County Health Departments created
many problems and adversely affected employee morale. A presenta-
tion of factual data pointing out the many injustices and problems that
would be created by the adoption of these recommendations, may
lead to a more satisfactory plan during the coming year.
The Hospital Service Plan for the Indigent sick created by the 1955
Legislature went into effect January 1, 1956. Because of the small
initial state appropriation for the program, only 24 counties elected
to establish a Hospital Care Program for their indigent under the
provisions of the program. During the year, however, a special
session of the Legislature authorized the State Welfare Department
to establish a state-wide Hospital Care Program for public welfare

2 ANNUAL REPORT, 1956

recipients, and to administer the program under the provisions of the
1955 law creating "Hospital Service for the Indigent." Thus, the State
Board of Health and its affiliated county health departments became
responsible for the medical administration of the State Welfare De-
partment's Hospital Care Program. This has made emergency hospital
care available in all counties for that portion of our indigent popula-
tion who are recipients of state welfare assistance.

The mental health program has been reorganized, strengthened
and further developed. The training program of the Council on Train-
ing and Research in Mental Health was well utilized with the excep-
tion of funds available for internships in clinical psychology. The 14
child guidance and mental health clinics are inadequately staffed;
however, they were strengthened to the extent possible from available
funds. The number of rural counties served by full-time mental
health workers grew to 13. Through a program developed with the
State Hospital at Chattahoochee, county health officers and public
health nurses have been making scheduled two-day visits to the State
Hospital. During these visits they learn of the facilities of the hospital
and how they may best help the professional staff of the hospital in
preparing patients for admission and assisting discharged patients
upon their return to the community.

During the year considerable time has been devoted to the develop-
ment of a master plan to guide future construction of the Board's cent-
ral headquarters in Jacksonville. Detailed architectural plans were
prepared for the first unit of construction, which will be financed from
$450,000 appropriated by the 1955 Legislature for this purpose. Archi-
tecturally, this new unit will be a continuation of the district labora-
tory building completed in 1955. Plans were also developed for the
construction of a district laboratory building in Orlando, to be financed
from a $75,000 state appropriation and a $75,000 Federal Hill-Burton
grant.

The construction of seven modern new health centers was completed
during the year, all of which were financed from county and federal
matching funds under the provisions of the Federal Hill-Burton Hospi-
tal and Health Center Construction Program. The significant acceler-
ation in health center construction under the Hill-Burton Program
can best be appreciated by comparing the five health centers com-
pleted during the entire previous eight years of the program with
seven new projects completed this year and the 15 health centers and
auxiliary health centers which were under construction or in the
planning stage at the close of the year.

GENERAL SUMMARY 3

Projects Completed Prior to 1956
FEDERAL TOTAL
FACILITY LOCATION GRANT COST
Okaloosa Health Center Crestview $ 24,930.32 $ 38,354.34
Wakulla Health Center Crawfordville 59,437.40 99,062.34
Holmes Health Center Bonifay 26,387.51 40,596.17
Dade Health Clinic Miami 16,666.53 47,618.65
Polk Health Center Winter Haven 40,749.68 102,109.87
Total $ 168,171.44 $ 327,741.37
Projects Completed During 1956
Broward Health Center Ft. Lauderdale 43,076.92 123,678.77
Manatee Health Center Bradenton 26,954.94 67,917.65
Alachua Health Center Gainesville 102,000.00 185,454.55
Pahokee Health Center Pahokee 8,945.30 25,558.00
Jackson Health Center Marianna 56,875.00 87,500.00
Belle Glade Health Center Belle Glade 11,093.87 31,696.76
Nassau Health Center Fernandina Beach 23,824.58 52,943.52
Total $ 272,770.61 $ 574,749.25
The fifteen projects which were under construction or in the plan-
ning stage at the close of the year represent a construction program
totaling an estimated $1,592,991.00.
Articles by the State Health Officer:
Sowder, W. T. and Rogers, W. D. Future of Mental Health in
Florida. J. Florida M. A. 43:151-156, Aug. 1956.
Sowder, W. T. and Bond, J. O. Problems Associated with the
Increasing Ratio of Male over Female Mortality. J. Am. Geria-
trics Soc., 4:956-962, Oct. 1956.

SCHOLARSHIPS FOR PROFESSIONAL EDUCATION
The State Board of Health is now administering four distinct scho-
larship programs for professional education. Ten scholarships for the
study of medicine are awarded each year upon the recommendation
of a scholarship committee consisting of the deans of Florida's two
medical schools and five physicians, designated by the President of
the Florida Medical Association. Ten scholarships for the study of
dentistry are awarded each year upon the advice of the State Board of
Dental Examiners. Upon the recommendations of the Florida Council
on Training and Research in Mental Health, scholarships, or stipends,
may be awarded each year for the training of five residents in psychi-
atry, six interns in clinical psychology, five psychiatric nurses and
thirteen psychiatric social workers. These three scholarship programs
were created by the 1955 Legislature.
The fourth is an older program which was created with the passage
of the Federal Social Security Act in 1935. Through this program
federal funds are utilized to provide stipends to employees of the
State Board of Health and its affiliated county health departments for
specialized professional training. Great emphasis has been placed
for many years on the training of the Board's permanent professional
employees.

4 ANNUAL REPORT, 1956

SCHOLARSHIPS AWARDED IN 1956

MEDICAL
Charles L. Anderson Haines City Marvin G. Mayo .....-- Lynn Haven
William H. Hubbard -_ Jacksonville Luther C. McRae, Jr. .-__ Gainesville
James A. Johnson -_-_ Miami Charles T. Ozaki .......__ Belle Glade
Richard F. Kuhn -_ Miami Hoke H. Shirley, Jr. Pompano Beach
James M. Marlowe --.-- Jacksonville Arthur W. Sweat __........._ Dunedin

DENTAL
William G. Boyd, Jr. -._ Jacksonville Harry Gruen _----___-_ Miami
George E. Carver .--__ .- Live Oak Wade B. Hammer .-------- Lakeland
Thomas M. Darden ..____ ... Miami Henry J. Johnson _-_. St. Petersburg
Joe H. Dowdy .------- High Springs David C. McCoy Pahokee
Alfred J. Phillips __... St. Petersburg Richard R. Souviron .------... Miami
Raymond E. Rogers -___-- Pensacola Donald Spence --- ---- Pensacola
NOTE: This includes two 1955 dental scholarships which were awarded in 1956.

MENTAL HEALTH
Residents in Psychiatry Resident in Child Psychiatry
Irwin S. Jacobs, M.D.
Raymond R. Killinger, Jr., M.D. Ernest O. Herreid, Jr., M.D.
Morton S. Notarius, M.D.
Gregory G. Young, M.D.
Psychiatric Nursing
Barbara J. Swain, R.N., Chattahoochee
Margaret Pearson, R.N. .- --_. Miami Nancy F. Dodge, R.N._ St. Petersburg
Psychiatric Social Work
Arthur W. Bothmann --- St. Petersburg Naomi Knapper __---__ --- Sarasota
Lillian Craigo ---..------ Ruskin Donald E. Steiss -...._ -._.. Tampa
David N. Hanson, Jr. -- Ft. Lauderdale Martha Watkins __-___ ------ Sebring
Candace Keogh _____ Jacksonville
NOTE: No scholarships were awarded in 1956 to interns in clinical psychology.

PUBLIC HEALTH PERSONNEL
W. C. Ballard, M.D.--.__--.. -Health Officer _...... Pinellas County
John S. Neill, M.D.____..._. Health Officer ._ __...-. Manatee County
Johnson L. Turnage, M.D._Health Officer_ ...--- ---Okaloosa-Santa Rosa
J. Dillard Workman, M.D. Health Officer --____. Bur. of Local Health Service
Margaret Avant ___... ... Public Health Nurse -_ Hillsborough
Edna Dayson .--____- .. Public Health Nurse -- Dade
Mertie A. LeClaire ____.... Public Health Nurse. -Clay
Ophelia J. Wright_ __-- -- Public Health Nurse-. Manatee
William H. Braatz._._____ Sanitarian._---------- Monroe
William J. Clarke Sanitarian -----------. Collier
Jerome N. Conger -__ Sanitarian ------ ------Palm Beach
Leon W. Sheumaker Sanitarian------------ Leon
Mary E. Quaw -....-____- .- Health Educator -_.__. Bur. of Dental Health
William N. Beck, Jr.-.._-- -- Biologist --- ----- Bur. of Sanitary Eng.
Robert N. Thorner ......-------.. Statistician----..----... Bureau of Vital Statistics

GENERAL SUMMARY 5

ACTIVITIES OF THE BOARD
The Board re-elected Dr. Herbert L. Bryans as its President at the
annual meeting in February. Six meetings were held during the year.
The date and place of each meeting and the business transacted were
as follows:
February 14 Jacksonville
1. In connection with new law governing the State Merit System,
the Board went on record urging the retention of existing sick
leave policy, the privilege of fixing entrance salaries above
the minimum where suitable persons cannot be found to ac-
cept positions at the minimum, and the retention of the privi-
leges of giving salary increases in multiples of $5.00 per month
rather than having specific steps of a stipulated amount.
2. Adopted policy requiring new employees to have chest X-rays.
3. Adopted rules and regulations for the operation of the indigent
hospitalization program.
4. Appointed Dr. J. A. Long of Palatka, negro physician, as con-
sultant to the State Board of Health with the advisory committee
on indigent hospitalization.
5. Adopted revised rules and regulations for the control of com-
municable diseases.
6. Approved the appointment of Dr. W. Laney Whitehurst as
Director of the Bureau of Mental Health.
7. Agreed to waiving vital statistics fees for certain classes of ap-
plicants.
8. Amended the formula for allocating funds to county health de-
partments.
9. Approved the sending of a telegram to certain congressmen
urging the appropriation of funds for the National Institute of
Dental Health.

April 8 Vero Beach
1. Approved a reorganization of the State Board of Health creating
a Bureau of Special Health Services and assigning divisions and
programs between this new bureau and the Bureau of Prevent-
able Diseases.
2. Approved the appointment of Dr. C. M. Sharp as Director of
the Bureau of Preventable Diseases, and Dr. L. L. Parks as
Director of the Bureau of Special Health Services.

6 ANNUAL REPORT, 1956

3. Approved certain persons for postgraduate training for the
academic year 1956-1957.
4. Approved certain changes in the sanitary code.

May 13 Miami Beach
1. Authorized the State Health Officer to expend $4300 for costs
involved in the closing of Second Street at the State Board of
Health headquarters in Jacksonville.
2. Authorized the State Board of Health to purchase the Clark
property and the Susie Hill property on the lot adjacent to the
headquarters at the State Board of Health.
3. Made minor changes in the policy on fluoridation providing for
the addition of somewhat less fluorides to public water supplies
during the summer months than during the winter months.
4. Approved a letter presented by the State Heath Officer which
would be signed by the Health Officer and addressed to the
Merit System Director urging certain changes in the proposed
regulations of the Florida Merit System.
5. Agreed to accept the recommendations made by the Medical
Scholarship Committee for the awarding of ten medical scholar-
ships for the coming academic year 1956-1957.

August 5 Jacksonville
1. Agreed to a transfer of the State Board of Health Building in
Palm Beach County to the Board of County Commissioners of
Palm Beach County with the understanding that a new build-
ing would be built by them for the County Health Department.
2. Received the State Auditor's report and discussed it with the
State Health Officer and Director of Finance and Accounts.
3. Reaffirmed its previous stand protesting a proposed new Merit
System regulation and authorized the State Health Officer to
appeal to the personnel board if necessary.
4. Received a report from David Lee, Director of the Bureau of
Sanitary Engineering, to the effect that plans are under way
which will solve the water supply program in the Cocoa Beach
area.
5. Approved proposed rules and regulations submitted by the State
Barbers Commission.
6. Adopted certain revisions to the rules and regulations pertaining
to the indigent hospitalization program.

GENERAL SUMMARY 7

7. Adopted a resolution authorizing the attorney to proceed with
condemnation proceedings on property owned by Susie Hill
near State Board of Health headquarters in Jacksonville.

September 30 Jacksonville
1. Adopted a proposed budget for the biennium 1957-1959 after
presentation by State Health Officer, Bureau and Division
Directors.
2. Adopted revised rules and regulations on structural pest control.
3. Adopted an amendment to the rules and regulations pertaining
to the indigent hospitalization program.
4. Authorized disposal of certain records in the Bureau of Finance
and Accounts.
5. Approved the appointment of Dr. A. V. Hardy as Research Co-
ordinator of the State Board of Health.

December 2 Jacksonville
1. Approved 13 recommendations prepared by Bureau and Di-
vision Directors, County Health Officers, other staff members,
and the State Health Officer, for submission to the Merit Sys-
tem Council. These recommendations urged certain changes
to the proposals made by the Public Administration Service
of Chicago.
2. Received a report from Miss Ruth Mettinger, Dr. R. W. Mc-
Comas and Mrs. Ethel Kirkland, on the midwife program in the
state and discussed the program.
3. Approved rules and regulations for beauty culture schools sub-
mitted by the State Board of Beauty Culture.
4. Approved certain changes in rules and regulations submitted by
the Barbers Sanitary Commission.
5. Authorized the State Health Officer to purchase the Susie Hill
property for $7700.
6. Approved the abolition of the Field Advisory Staff and the trans-
fer of the staff and functions to the Bureau of Local Health
Services.

8 ANNUAL REPORT, 1956

DIVISION OF HEALTH INFORMATION
ELIZABETH REED, R.N., B.S.,
Director

There appears to be a more intensified and mature approach to
health education these days. The former is epitomized by the numer-
ous requests for assistance with health education programs throughout
the state, and for speakers on health subjects. Due to the size of the
staff, only a small number of these requests can be met. However,
six counties now employ health educators on the local level and this
helps the situation somewhat. It is hoped that during the coming
year one or two more county health departments will consider the
employment of full-time health educators. District health educators
to serve the smaller counties might also do much to relieve the prob-
lem.
The mature approach is felt in the more thoughful requests for
materials and a greater understanding of the tremendous role health
education plays in public health programs, especially so in the chronic
diseases which are receiving so much attention of late.

ART WORK
The staff artist completed the following: bulletin board displays, 4;
charts, including large display sizes, 30; cover designs, 7; graphs, in-
cluding poster sizes both line and bar types, 14; illustrations, in five
types of media, 40; layouts, 50; letterheads, 4; maps, 2; photo illustra-
tions and cropping, 7.
At the request of Hillsborough County Health Department, full
page layouts were planned for this county's annual report. These
included tables, pie charts, bar graphs and a map.

AUDIO- VISUAL AIDS
In 1956 the Audio-Visual Aids Library again showed a marked in-
crease over 1955 in all phases of activity, with the exception of total
number of persons in combined audiences. This showed less than
one per cent decrease. The greatest increase was reflected in the
number of aids circulated, which amounted to 34 per cent. This, of
course, is the true indication of the increased work load.
Number of bookings processed 3,875 ( 8 per cent increase)
Number of times all aids were used 5,128 (34 per cent increase)
Number of persons in combined
audiences 662,092 (Less than 1 per cent
decrease)
Number of aids no report received 151
Number of aids returned Not used 474

HEALTH INFORMATION

There was an increase in the number of aids other than 16mm
motion pictures that were circulated. Silent film-strips were used
most frequently in this group.
Eleven films were booked for telecast use and a report was received
on eight. The total combined estimated audiences for these were
1,915,000. Forty-four radio transcription discs were broadcast once
each to a total combined estimated audience of 1,767,169. The numb-
er of discs used increased 38 per cent. One hundred and eleven 35mm
tuberculosis x-ray trailers were booked. The library received a re-
port on 65 which were shown approximately 1542 times to an estimat-
ed audience of 349,413. Estimated number of persons reached by all
Audio-Visual aids totaled over 5 million.
Projection equipment loaned for use by persons outside the library
totaled 335 pieces, an increase of 32 per cent. Requests for audio-
visual aids were received from all 67 counties. Twelve prints of
motion pictures were removed from the Library because they were
either obsolete or damaged. Ten titles (15 prints) of motion pictures
were placed on loan in the Library by other agencies. Three new
pieces of projection equipment were acquired: projectograph, sound
motion picture projector and slide projector.
During the year a new system of handling activity reports on films
on loan to the Library from other agencies was established. Formerly,
reports were given them once a month, now only three times a year.
A new method of posting and a new reporting form was devised to
speed circulation. A full-time clerk was added to the staff. A new
catalog was printed and distributed during the summer and fall
months.
During the summer the Library inaugurated a system of distribu-
tion of discussion guides on a limited scale. This has proved most
successful. It is felt that the use of these guides will enhance the
effectiveness of the materials presented Much time is spent now
by the librarian in helping individuals plan programs, make tape
recordings, etc.... The Library was closed as usual during the month
of July for cleaning, repairing, removing and processing of films.

EXHIBITS CONSULTANT
The exhibits consultant maintained a steady output of work during
the year ranging from talks to groups on exhibits and layout, assistance
with orientation programs, consultations regarding displays, photogra-
phy and the completion of a series of slides on hookworms. He com-
pleted approximately two hundred signs from name plates to ten foot
banners; nearly one hundred illustrations, posters, charts, etc.; and
worked with the various bureaus, health departments and other agen-
cies in putting on twenty-five exhibits throughout the state.

10 ANNUAL REPORT, 1956

HEALTH NOTES
The number of people desiring to regularly receive Florida Health
Notes continues to grow. The circulation list is approximately 14,000
now in spite of the fact that the mailing list was "cleared" in 1956 by
the use of return post cards if the subscriber still wished to receive
this publication. A 65 per cent return of these cards is another indi-
cation of interest, as were the more than 1500 comments received.
During 1956 the following subjects were treated in Health Notes:
fluoridation; nursing homes; public health nuisances; health careers;
hospital service for the poor; simplified annual report; Entomological
Research Center, cancer, tuberculosis and clean water-clean air.

LIBRARY
BARBARA J. BECKNER, B.A., M.S.L.S.
Librarian

Circulation for 1956 was as follows: Books, regular loan, 1123;
indefinite loan, 1552; periodicals, 6685; pamphlets and reprints, 233,
making a total of 9593. The Library borrowed from the National
Library of Medicine 16 microfilms and bought 21 photostats. Inter-
library loans from other libraries were 43 and the Library loaned 30
items to other libraries.
A total of 1350 reference questions were answered and approximate-
ly 35 bibliographies were prepared. From October to December a
record was kept of the reference work done for private physicians,
State Board of Health and county health department employees and
others. Under reference work taking 1-5 minutes the figures were:
private physicians, 69; public health personnel, 197; others, 54. Refer-
ence work requiring more than five minutes to answer: private physi-
cians, 26; public health personnel, 52; others, 32. This reveals that
many people outside State Board of Health and county health depart-
ment employees rely on this Library.
With the assistance of a part-time cataloger the Library was able
to catch up with some of the backlog of books that had accumulated
in the attic. By next year the Library hopes to be able to catalog all
books within a week of their arrival. Books cataloged in 1956, 840;
bound journals processed, 214; total volumes added, 1054; new pamph-
lets added, 508; total number of books and journals withdrawn, 320.
The cataloger also cooperated with the Division of Heart Disease
Control in setting up their Mobile Library of Books on the Heart.
The Library offered to the University of Florida and the University
of Miami some journals to which it no longer subscribed. Since the
Library is cramped for space it is glad to give them to libraries that
can use them. Two hundred and seventy-seven items were shipped.

HEALTH INFORMATION 11

Special emphasis was placed this year on publicizing the Library's
services. A new publication called Recent and Readable designed
to stimulate interest in reading by State Board of Health and county
health department employees was started. Recommendations by State
Board of Health and county health department personnel of articles
and books are listed each month. A short paragraph accompanies
each recommendation telling why it is worth reading. Material about
all fields of public health is included and the subject matter is varied
from issue to issue.
A leaflet describing the Library's services was prepared and dis-
tributed to all county health departments. The Florida Medical
Association mailed copies to their members. Copies were also sent
to all hospital administrators. Quite a good response was received
from physicians.
Since a great deal of material is sent through the mails the Library
bought padded mailing envelopes which can be used several times
for sending books and journals to out-of-town users. Return mailing
labels are also sent with each package. This boosts circulation since
people are more prone to borrow books if packaging and labeling for
return are facilitated.
The Library received some additional funds for binding during
1956. It has the problem of more journals than money to bind them,
with consequent loss of single issues.

PAMPHLETS
The requests for pamphlets constitute a never-ending stream. Ap-
proximately 200,000 were distributed in 1956. There are now six
pamphlets in Spanish which are proving to be very popular in the
southern part of the state.
There was an increase in the number of pamphlets requested on
Accidental Poisoning. A new small flyer entitled, When You Are
Asked to Go to the Clinic Please Do!, proved to answer a need
with over 10,000 distributed to county health departments. Other
popular subjects were rabies, preparing your child for school, nutrition
and mental health.

PRESS SECRETARY
During the year the press secretary wrote routine news releases
which averaged more than one per week. These routine releases go to
all papers in the state, and radio and TV stations. Some were originat-
ed by the secretary, others were assignments. Numerous special
releases were written, often as many as three a day when a special
meeting was in session, or for such events as special emphasis on
polio immunization.
Every effort has been made to maintain good working relations with
the press and wire services locally and throughout the state. This has

12 ANNUAL REPORT, 1956

been done by cooperation with editors and reporters, assisting in
covering meetings when asked and making every effort to secure
information when requested. The State Board of Health has an
excellent reputation newspaper-wise and enjoys unusually good press
relations.
The press secretary has assisted in writing several issues of Florida
Health Notes, with particular responsibility assigned for four issues.
She was also responsible for the State Board of Health house organ,
The Intelligencer, which comes out five times a year. In the field of
photography, the press secretary took several hundred pictures for
Health Notes and for news releases, exhibits, mats and pamphlets.
In addition to many small meetings and seminars, the press sec-
retary handled publicity and pictures for seven larger meetings and
conventions. These were Health Officers' Conference, Tri-State
Obstetric-Pediatric seminar, Florida Heart Association, Florida State
Pharmaceutical Association, Florida Public Health Association,
Gastro-intestinal Diseases Seminar and Cardiovascular Diseases
Seminar.
Other duties of the press secretary have included special work on
talks, radio scripts, pamphlets and reports. Instruction on how to
prepare news releases and on press relations have been given to
groups attending orientation courses and sanitarian short courses.
OTHER ACTIVITIES
There was a surfeit of foreign visitors in 1956. There were 36
From 18 different countries who visited the central office, the county
health departments, or both, for varying periods. The amount of
time, energy and cost to the State Board of Health to handle this
many visitors is incalculable.
Seven orientation programs were held of which three were for
special groups. A total of 135 persons attended. This activity is
mne that consumes a great deal of time particularly in arranging the
programs and caring for out-of-town visitors This division makes
innumerable contacts with schools, particularly faculty groups in
planning health education activities Liaison with voluntary health
agencies is maintained.... Numerous invitations to professional meet-
ings are received with at least one meeting non-attended for every
mne where a staff member is present .... Many talks and appearances
were made by the director before community committees and civic
groups.
Our greatest lacks remain the same: Use of TV and radio, and
adequate office and storage space.
Articles by staff members:
Reed, Elizabeth. The Cobblers' Children. Am. J. Nursing. 56:895-96,
July 1956
Reed, Elizabeth. "Grass Roots Approach". Bull. Nat. Tuberculosis A.
42:29-30, Feb. 1956

LOCAL HEALTH SERVICE 13

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

There have been no significant changes in the organization of the
county health units. There was a total of 1145 employees on the
payrolls of the county health departments at the end of the calendar
year. Generally, morale is high; however, the implications of the
proposed changes in the Florida Merit System has caused consid-
erable concern at all levels. On November 19-20 the directors of
the county health departments met in Jacksonville to consider changes
proposed by the Public Administration Service of Chicago and a
series of recommendations and counter-proposals were submitted to
the State Health Officer for presentation to the Merit System Coun-
cil. Following this the Public Administration Service modified the
proposed plan to meet some but not all of the recommendations of
the State Board of Health.
There has been a considerable increase in funds available to county
health departments. A total of $5,116,117.00 was budgeted during
the past year. County appropriations alone totaled $3,377,339.00. The
increasing willingness of county commissions and other local appro-
priating bodies to support the health departments is most heartening.
One of the outstanding accomplishments during the year has been
the dedication of a number of new health department buildings and
health centers. In addition, a number of other counties are engaged
in the initial planning stages of still more facilities. This matter will
be dealt with in detail under the reports from the several counties.
Training activities have been conducted at approximately the same
level as the past years.
Dr. John W. McClane, Director of the Nassau-Baker County Health
Unit, passed away on May 3, 1956. Dr. McClane had a long and
successful career in public health, having served with the United
States Public Health Service from 1932 until 1945, when he became
director of the Nassau and Baker County Health Departments with
headquarters at Fernandina Beach. Dr. McClane was born in
Benkelman, Nebraska on September 2, 1889. He received his medical
training at Loyola School of Medicine in Chicago. He was a member
of the Florida Public Health Association, the American Public Health
Association, the Florida Medical Association and the American Medi-
cal Association. At the time of his death he was Secretary-Treasurer
of the Nassau County Medical Society, an office he had held since
1950.
The annual Health Officers Conference was held in Jacksonville

14 ANNUAL REPORT, 1956

on February 13-14-15 and the following officers were elected for
the coming year: Dr. Thomas E. Morgan, Chairman; Dr. William
C. Ballard, Vice-Chairman; Dr. Henry I. Langston, Secretary. The
following Chairmen of Committees were appointed: Dr. Edward
G. Byrne, State-Local Relations; Dr. N. B. Edgerton, Preventable
Diseases; Dr. Wayne Yeager, Maternal and Child Health; Dr. Joseph
M. Bistowish, Records; Dr. Merwin E. Buchwald, Environmental Sani-
tation; Dr. R. N. Nelson, Public Health Nursing; Dr. J. Basil Hall,
Special Health Services; Dr. John C. McSween, Mental Hygiene.
The following is a resume of some of the more interesting and
significant developments reported by the county health departments.
Unfortunately, lack of space does not permit a complete report.

Lee: Dr. Buchwald
"One of the most important accomplishments of the year in Lee
County has been the beginning of construction of the City of Fort
Myers' sewer system and sewage treatment plant. Contracts amount-
ing to $1,700,000 were let in January and March. The treatment
plant is scheduled to be completed in March 1957, and the collec-
tion system virtually completed by December 1957. Planning of the
project was materially assisted by the Caloosahatchee River Pol-
lution Survey carried out by the Lee County Health Department
in 1953-54, during which a total of 264 samples were collected by
health department sanitarians.
A Poison Control Center has been established at Lee Memorial
Hospital in Fort Myers. The center is a cooperative effort on the
part of local physicians, the hospital, the State Board of Health and
the county health department. Public health nurses make follow-
up field visits in all reported cases of accidental poisoning, in order
to check for existing and potential hazards, and to give instructions
on poisoning prevention."

Collier: Dr. Buchwald
"An increase of approximately 20 per cent in appropriations from
the Collier County Board of Commissioners has permitted the em-
ployment of a part-time clerk and the leasing of additional space
for the Naples branch office.
The Collier County Board of Commissioners has budgeted $24,000
toward the construction of an auxiliary health center in Immokalee.
The Florida Development Commission has recommended a grant
of $12,400 in Hill-Burton funds for the project, estimated to cost
about $35,000.
Collier County has received a special grant of $12,200 per year
for five years from the U.S. Children's Bureau, to carry out an im-

LOCAL HEALTH SERVICE

proved maternal and child health program for migrant agricultural
workers in the Immokalee area. The project is designed to develop
and evaluate new approaches to this serious problem. Funds are
provided to employ one additional public health nurse and a part-
time clerk, to employ private physicians for clinics, to pay the rent
for a temporary health center building pending the construction of
the new building, and to provide necessary transportation of patients
to clinics. The consultant services of a nutritionist, health educator
and a medical social worker will be shared with Palm Beach County.
The Collier County project is part of a larger one which includes
Palm Beach County and is under the over-all direction of the Bu-
reau of Maternal and Child Health.
Another notable accomplishment has been the initiation of a mental
health program. A well-trained psychiatric social worker has been
employed as mental health worker with funds supplied by the Bu-
reau of Mental Health. A very successful Mental Health Institute
for Educators was held in November, and future institutes for parents
and for educators are planned."

Volusia: Dr. Higgins
"A goal in public health nursing has been reached in a demonstra-
tion area in the Halifax area in regards to an integrated nursing
service. Public health nursing services here include a bedside care
program plus the activities of the generalized public health nursing
program. This program, carried out by seven nurses, a senior nurse
and supervisor, appears to be a rewarding work experience for the
staff as well as avoiding duplication and a more economical service
to the community.
Dr. Graham N. Charles, dentist in charge of the dental clinic for
under-privileged children in Volusia County, has started work in the
newly established clinic in Daytona Beach. Dental surveys and health
education programs are included in this service.
During the past year the Mental Health Division has been cooperat-
ing with the United States Public Health Service in exploring (under
Dr. William Hollister's direction) the possibilities of developing an
effective epidemiological reporting procedure based on the Public
Schools' Annual Report of Exceptional Children (Blue List). Out
of this study, an IBM Card System may be developed to replace the
Blue List and, in general, to provide an adequate instrument in a
system of reporting incidence of mental illness in the community."

Broward: Dr. Hughes
Broward County has noted increased activity in providing sani-
tary sewer installations in several of the land developments in the
county areas. The City of Ft. Lauderdale has approved a multi-

16 ANNUAL REPORT, 1956

million dollar revenue bond issue for sanitary sewer facilities in two
large areas. Closer cooperation between the health department and
the county and city authorities has been achieved in approving proper
sanitary waste facilities for new developments in critical areas.
The County Commission approved expenditures for the provision
of a Mobile Health Unit. This unit, worth $12,000 is a 40 foot
clinic on wheels capable of serving as a small clinic building. It is
air-conditioned, has its own electrical generator, heating equipment
and radio-phone. All the western areas of the county will be served
on schedule. It will also be available for special surveys and proj-
ects."

Seminole: Dr. Bird
"We were able to secure an increase of over 33 per cent in total
funds from the County Commissioners. Because of this increase we
have added a full-time public health nurse, a full-time sanitarian,
and a part-time clerk, making a 50 per cent increase in our per-
sonnel."

Aluchua: Dr. Byrne
"For the past year the Alachua County Health Department has
been most proud of its new home-the Frank M. Hall Health Center,
named in memory of the department's immediate past director. The
building was occupied in May, 1956 and dedicated on June 24, 1956.
Other significant activities of the year include: (1) increased bud-
get appropriations from the county which has enabled the depart-
ment to increase the nursing, clerical, and sanitation staffs: (2) gen-
eral increase in salaries; (3) the local Child Care Center law be-
came effective; (4) extension of the city sewer lines to suburban
areas; and (5) completed plans for special mental health classes
for expectant mothers by the nursing staff."

Monroe: Dr. Hill
"In the early fall of 1955 a group of local citizens, acting as repre-
sentatives of organizations within the community, met at the Sue
M. Moore School to discuss the formation of a Health Council. As
a result, early in 1956 the Marathon Health Council was organized.
During the year, the council was active in the following projects:
(1) Helped set up an adequate disaster medical unit to cover Mara-
thon in case of hurricane, explosion, water contamination or epi-
demic. Working with the health council is the entire Marathon
Ambulance Corps of trained personnel. (2) Helped form a health
council in the colored area. Known as the Marathon Beach Subdivision
Health Council, it has been active in removing health hazards from
this section of town. (3) Worked with the Monroe County Society

LOCAL HEALTH SERVICE 17

for the Prevention of Cruelty to Animals; removed 28 stray female
dogs. (4) Arrangements were made with a Homestead veterinarian
to come to town, and with health council members assisting, all resi-
dent dogs were inoculated for rabies in August. (5) Worked with
the Monroe County Health Department to remove open garbage
pits; was active in securing a sanitary land fill through the Monroe
County Commissioners. (6) Had mosquito breeding water holes
filled by owners of the land. Overflowing cesspools have been
drained and cleaned, clogged pipes cleaned and burning of garbage
has been stopped."

Gulf: Dr. Weathington
"In Gulf County, under provisions of a special act of the 1955
Legislature, as approved by a county-wide referendum, the county
appropriated $45,000 for health center construction. Together with
50 per cent matching Hill-Burton funds, this will be used to con-
struct, in Port St. Joe, 'The Albert L. Ward Memorial Health Center'
at a cost not to exceed $50,000, and in Wewahitchka, 'The Thomas
Meriwether Memorial Health Center' at a cost not to exceed $40,000."

Franklin: Dr. Weathington
The City of Apalachicola appropriated $18,000 and the County
Commissioners, $6,000 and this, together with 65 per cent matching
Hill-Burton funds, is to be used to construct a $68,000 health center
in Apalachicola. This center will house the seafood laboratory, as
well as clinics and offices of the health department."

Flagler: Dr. Edgerton
"For the first time since the health unit was organized the mobile
dental unit from the Bureau of Dental Health did extractions and
fillings on indigent school children; volunteers screened eyes of all
white school children; and the Country Club instituted a plan for
dental bills for indigent children.
An increased appropriation by the County Commissioners enabled
us to move into more convenient offices, and to employ our clerk
full time rather than part time."

Sarasota: Dr. Wright
"The County Commission adopted a set of subdivision regulations.
One of these regulations made it mandatory that all subdivision plats
be submitted to the county health department for review and recom-
mendations before the plat is submitted to the Commission for ap-
proval and recording. In going over these plats we cooperate very
closely with the county road engineer in working out the drainage
for the subdivisions. This contact with the subdivider has at least

18 ANNUAL REPORT, 1956

given us a chance to talk about public sewer systems, and in one
instance, we have actually gotten a public sewer system and sewage
plant built in a new subdivision.
Recently the County Commissioners amended the county build-
ing regulations so that the building department will not issue a
building permit for any building or additions unless the health de-
partment has first approved the water supply and the sewage dis-
posal."

St. Lucie: Dr. Miller
"We feel that a great advance has been made in St. Lucie County
by the combining of the county health department and the city health
department of Fort Pierce. By this procedure we have eliminated
duplications of work and will be able to render the city all of those
services available through the county health department more effi-
cLently and at less cost to the city. This has brought the admin-
istration of public health activities in this county under the control
of the Florida State Board of Health for the first time since the
establishment of this unit. One of our first major steps was the
enactment of up-to-date food and milk ordinances."

Indian River: Dr. Miller
"A new negro health center was opened in Gifford in September.
This was made possible chiefly through the untiring efforts of our
head nurse, Mrs. Alice Helleso. The use of the building was do-
nated by a local citizen, and other local citizens, business people,
and members of the Ministerial Association donated monies, furni-
ture, equipment, and time to make this clinic possible. It is staffed
by one of our public heath nurses with local Red Cross aides assist-
ing."

Walton: Dr. Nelson
"This health department has been instrumental in getting defi-
nite steps taken for sewer extensions and treatment plant for De-
Funiak Springs in 1956. Sewer accommodations are limited and
sewage has never had any type treatment.
We have about one-third of the county's entire population within
the city limits. They were extended to take care of the area that
had become thickly populated with residences and business estab-
lishments and to these areas, a safe public water supply has been
extended."

Polk: Dr. Nayfield
"Much progress in public health has been made in Polk County
in 1956: Construction was begun on the new Lakeland district of-

LOCAL HEALTH SERVICE 19

fice which will be completed early in 1957. The Board of Public
Instruction of Polk County signed an agreement to transfer the school
nurses to the county health department and contribute financially to
this program. A school health council was organized to be the ad-
visory body for this program. An assistant health officer and a public
health dentist were added to our staff as well as several nurses, one
sanitarian and two clerks."

Baker and Nassau: Dr. DiTraglia
"In October, we instituted both in Nassau and Baker Counties a
complete school health program. This was accomplished in co-
operation with the Board of Public Instruction. In both counties we
now have very active well baby clinics, maternity clinics and health
instruction classes.
Another outstanding achievement in our counties has been the
successful and well received mental health program.
The Fernandina Beach extension sewer lines and disposal plant
is now an accomplished fact and plans for further extension are in
progress.
Since October 1956 in our counties we have pooled all our per-
sonnel for the purpose of attending all civic meetings and have
talked to these groups regarding public health programs. We found
that this has afforded an opportunity to convey an idea of our work
to the entire community."

Citrus: Dr. Bonifield
"The Health Department has continued its growth and effective-
ness for a small county. Housing facilities for the department have
been improved by a complete remodeling, including air condition-
ing. Health programs have continued and a successful mass TB
survey was conducted with approximately one-half of the available
population x-rayed.
Three major sanitation projects were started in 1956; however,
only one was completed. A sludge drying bed in Crystal River was
installed by the Council of the City of Crystal River. The Board of
County Commissioners authorized a preliminary survey and study
for a water district in the Homosassa River area. At present the
survey has been completed and ways and means of financing are
now being considered. Much work has been done in Inverness to
arouse interest in the city fathers and the citizens to get action on
the sewage condition in the city. The engineers' survey has been
completed, and financing is now being studied for a sewerage treat-
ment plant."

20 ANNUAL REPORT, 1956

Pinellas: Dr. Provost
"The trend of public health was never more evident than when
viewing the field of public health nursing and medical care in Pinel-
las County in 1956. A general medical clinic for colored indigents
in the St. Petersburg area has been successfully operating since Oc-
tober 1955. This clinic is a result of the combined services of the
welfare agency, hospital interne training program, and the health
department--housing and nursing services being provided by the
health department.
Arrangements and agreements were completed between Mound
Park Hospital, County Welfare Department, and the health depart-
ment for transfer of the maternity clinic from its location in the
health department building in St. Petersburg to the Out-Patient
Department of Mound Park Hospital. This clinic is staffed by pub-
lic health nurses; Mound Park Hospital furnishes the housing, equip-
ment and interne staff; County Welfare provides a social worker
for screening of patients, drugs, and expense covering diagnosite
service.
The service begun last year on follow-up of patients released
from the mental hospitals has been met without encountering too
much difficulty. Our public health nurses are endeavoring to pre-
pare themselves for this program by participating in a nine-month
in-service education program in mental health, one afternoon each
month. They also sponsored a one-day seminar in September with
a psychiatrist from Chattahoochee leading the discussion.
St. Petersburg is moving along rapidly in the construction of its
$14,000,000 sanitary sewerage system. Treasure Island, Long Key,
Clearwater, and Cross State Development Company awarded large
contracts for sanitary sewerage improvements. Safety Harbor, Ken-
neth City, and St. Petersburg placed new sewage treatment plants
in operation.
The Pinellas County Commissioners placed in operation the first
phase of a county garbage disposal program, a sanitary land fill in
central Pinellas County.
Sixty members of the Pinellas County Dental Society volunteered
their time to do the dental inspections on 19,041 elementary school
children."

Hillsborough: Dr. Chappell
"For several years we have had numerous complaints from house-
wives and others about sour and off-flavor milk bought from grocery
stores and particularly super-markets which have large milk cases.
We worked constantly not only with the stores, but also with the
dairies, to date their milk containers and see to it that milk was

LOCAL HEALTH SERVICE 21

not left in the store or restaurant longer than five days. We con-
tinued to receive complaints, with the stores and dairies blaming
each other. In one month during the summer we found nearly
1000 cartons of milk from six to fourteen days old in the stores
and the practice continued.
An ordinance was passed by the city in August 'requiring all bot-
tles, cans, packages and other containers enclosing milk, buttermilk
or other milk drinks, except when delivered to private residences,
to be plainly labeled or marked with the date the milk was pro-
cessed or pasteurized; prohibiting the sale of any milk, buttermilk
or other milk drinks which are six days or more old from the date
of processing or pasteurizing.' The date can be in code. The pen-
alty for violation of this ordinance can be quite severe, depending
upon the judge, and following one violation and conviction we had
no further trouble during the year."

Jackson: Dr. Langston
"The staff of the Jackson County Health Department moved into
new quarters in 1956. The new building costing $87,500 was con-
structed under the Hill-Burton Act. It is located adjacent to the
Jackson County Hospital in Marianna. The building was dedicated
October 3 by Doctor W. T. Sowder, State Health Officer, U.S. Sena-
tor Spessard Holland, State Senator John Rawls and State Represen-
tative John Shipp. This is considered the most noteworthy achieve-
ment of the year.

Calhoun: Dr. Langston
"The contract for construction of new quarters for the Calhoun
County Health Department was awarded Ralph E. Neel Construc-
tion Company of Bonifay, Florida, August 14, 1956. The new build-
ing containing 3,000 square feet floor space costing $64,000 will
be completed approximately March 1, 1957. The building is approxi-
mately 80 per cent complete at this time. It is located in the busi-
ness district of Blountstown-just north of the Court House."

Palm Beach: Dr. Brumback
"During 1956 two much-needed public health centers were com-
pleted, one in Belle Glade and the other in Pahokee. These were
constructed with the aid of Hill-Burton funds, and funds contributed
by the cities and Palm Beach County.
A project for the study of health services to migratory agricul-
tural workers was approved by the U.S. Children' Bureau. This
study, being conducted under the supervision of the Bureau of
Maternal and Child Health, includes migrant groups in Collier and
Palm Beach Counties. The purpose of the study, which will be

22 ANNUAL REPORT, 1956

conducted over a period of five years, is to find ways of provid-
ing more effective health services to migrants. A team will be used
consisting of public health nurses, a health educator, a medical
social worker, a nutritionist and a liaison worker.
The first year of a tuberculin testing program, conducted among
children in the first grade and kindergarten, was completed in May,
1956. The second year of this program was started in the fall of
1956 and included not only kindergarten and first grade children,
but also second graders who had negative tests during the first year."

Manatee: Dr. Long
"County health department staff members held a series of educa-
tional classes for Spanish-speaking migrant laborers. Lessons in
health and sanitation were given by an interpreter with encourag-
ing results. Several excellent new labor camps have recently been
completed in the county and a more extensive educational program
is being planned using a variety of visual aids.
A rabies control program was set up through the coordinated
efforts of the County Impounding Officer, local veterinarians, and
county health department personnel. Clinics were set up to aid in
inoculating and licensing of all dogs who had been in the county
over 30 days. Through the cooperation of the County Superin-
tendent of Schools, schedules and notices were sent home with school
children. WTRL, local radio station, gave free spot announcements.
What started as a small sanitation and intestinal parasite program,
sponsored by the county health department has grown into a co-
operative community project to improve housing, environmental sani-
tation and community welfare. A team composed of the director,
health educator, a sanitarian, and a public health nurse initiated the
project in the negro sections of Palmetto to combat insanitary con-
ditions conducive to infection with intestinal parasites."

Clay: Dr. Covington
"(1) Secured increased appropriation from Clay County Com-
missioners which enabled us to employ an additional sanitarian
and nurse, both badly needed for some time. (2) Through help
of volunteer lay workers, a reference library consisting of several
hundred volumes has been completed, including binding and in-
dexing. Information on all subjects can now be readily located and
utilized and is very helpful to our staff and others in the community.
(3) an auxiliary nursing health center building, a project initiated
by and built by labor, money and materials of the citizens of Middle-
burg and surrounding area, was finished and utilized to fullest ex-
tent by our health department this year. The nurse in that area

LOCAL HEALTH SERVICE 23

is assisted in clinics by a volunteer lay individual, and hundreds of
citizens of all ages in the northwestern border of Clay County re-
ceived services for the first time-a wonderful example of community
effort."

Bradford: Dr. Covington
"(1) Was successful in having the outside of health center build-
ing completely repainted. This was badly needed after twelve years
of use. (2) Present splendid relations between health department
staff and the local physicians and community were augmented by
the opening of the new Bradford County Hospital, the county's
participation in the state indigent hospitalization program and the
appointment of the health officer to the attending hospital staff by the
request of local physicians.
Approximately 36 per cent of the population 0-19 years of age of
the tri-county rural area consisting of Bradford, Clay and Union have
received two or more doses of polio vaccine. This was due to the
cooperative effort of the local physicians and the health department
staff."

TABLE 1
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

'3 rt aSs oa
,.3 ,m pq o .0UU U U U

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service 233 270 61 149 236 1,153 14 1,408 56 198 18 0 470 195 125 158 101
2. Field and Office Visits...... 253 290 63 276 257 1,343 14 1,563 61 346 18 0 1,170 395 241 201 189
3. Hookworm Treament Given ... 220 247 452 161 43 97 254 131 73 39 29 1,163 21 179 125 110 301
TYPE OF IMMUNIZATION
4. Smallpox -----.... ..... 698 161 1,250 296 219 2,224 85 134 86 206 93 422 15,916 207 72 1,546 3,698
5. Diphtheria .. 1,540 350 2,355 686 665 2,604 147 188 145 232 334 2,307 9,995 454 241 3,394 5,125
6. Whooping Cough ........... 1,356 350 2,373 686 637 2,559 150 158 141 208 290 2,307 9,992 300 237 3,246 4,153
7. Tetanus ...- ......- ..... 1,990 350 3,291 801 675 3,640 159 236 363 254 334 2,877 10,124 520 378 4,155 6,021
8. Poliomyelitis -...----------..... 11,636 854 6,921 1,550 5,639 9,824 1,416 662 725 2,988 775 4,878 37,479 1,553 604 5,530 22,738
9. Typhoid ... ------------ 1,962 778 6,493 144 34 283 281 29 287 8 5 2,670 785 45 666 674 6,840
10. Rabies-Humans um- 12 0 0 1 0 8 0 0 0 0 0 3 4 0 0 12 0
11. Rabies-Animals .......... 2,159 105 0 0 0 1 18 0 60 119 0 0 0 0 0 202 0
B. VENEREAL DISEASE
CONTROL
1. Admissions to Service .....--. 1,096 2 148 50 90 852 20 2 4 87 27 19 3,067 7 4 5,224 2,563
2. Not Infected ...-.......... .. .. 42 2 59 17 72 135 16 0 1 10 4 1 4,774 2 1 3,013 739
3. Treated in Clinic- --....... 870 4 87 33 57 751 1 1 1 14 4 47 1,741 5 4 2,210 1,321
4. Treated by Priv. Physician.. 0 0 0 0 3 0 1 0 0 4 5 0 0 1 2 36 4
5. Ret. to Treatment in
this Clinic _..._...... 95 0 1 12 4 17 1 3 0 5 0 15 157 1 2 224 65
6. Ret. to Treatment to Priv.
Physician ....__.._........ .. 0 0 0 0 0 2 0 1 0 1 0 0 0 0 0 4 0
7. Epidemiologic Treatment
Contact of: .....--...--- ...- 192 0 17 1 11 43 0 0 0 15 1 0 564 1 0 832 817
8. Patients Interviewed..-. 816 1 50 58 27 427 1 0 1 16 10 45 1,361 3 7 1,270 820
9. Contacts Obtained -.. 360 1 66 47 42 160 1 0 0 5 5 15 1,820 1 5 1,814 953
10. ERFs Closed ..........- .. 428 1 106 21 105 325 0 1 0 48 14 17 2,503 6 5 2,311 1,090
11. Field and Office Visits .. 1,734 27 304 124 245 2,689 21 13 9 199 35 83 9,334 26 20 10,681 1,840
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case
Active ....-....-....-..... 45 9 18 13 20 85 3 13 5 12 10 16 620 5 2 119 157
2. Adm. to Service-Case
Inactive .- ..-.......... 76 4 115 44 46 238 14 5 11 13 12 27 780 2 4 297 284
3. Adm. to Service-Contacts &
Suspects -...... -........... 239 33 163 139 98 563 39 19 58 43 86 66 4,640 15 1 472 740

z1

z

0

i--
(D
C0
0Y)

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

a a B -

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service---- 14 4 319 92 4 31 0 274 1 33 139 1,252 8 24 88 183 6
2. Field and Office Visits .-___ 25 5 319 122 6 48 0 280 1 34 181 1,646 9 31 75 157 6
3. Hookworm Treatments Given. 3 100 79 265 15 276 767 257 12 164 31 476 435 26 206 90 46
TYPE OF IMMUNIZATION
4. Smallpox _. ....... .... 106 316 1,888 18 14 306 73 140 40 177 127 4,157 172 235 387 441 53
5. Diphtheria ...... 143 241 2,110 195 78 376 400 410 170 136 701 4,835 949 549 2,236 597 108
6. Whooping Cough_-----. 149 229 2,110 195 77 376 400 306 167 103 681 3,159 804 556 1,315 531 108
7. Tetanus ---------.... ----------- 208 662 3,946 237 85 618 1,020 454 178 309 790 5,207 1,024 667 3,679 914 154
8. Poliomyelitis ...............-- 445 1,209 5,447 452 35 1,710 1,034 1,141 292 987 1,656 17,067 2,071 3,036 6,915 848 389
9. Typhoid _.--.--- 21 864 2,332 85 5 951 122 41 16 136 123 243 188 248 2,132 53 87
10. Rabies-Humans -.........-..- 0 0 2 0 1 0 28 0 0 0 1 2 0 0 0 0 2
11. Rabies-Animals .-. 0 0 133 0 37 0 0 0 0 0 1 0 0 0 0 315 5
B. VENEREAL DISEASE
CONTROL
1. Admissions to Service___- 17 16 285 1 0 26 39 43 13 11 85 2,008 7 58 74 105 7
2. Not Infected -...--...-- 0 2 104 0 0 2 0 2 4 3 70 1,617 0 1 0 5 2
3. Treated in Clinic .... ... 15 9 180 2 0 20 72 11 8 5 66 1,063 5 48 74 47 9
4. Treated by Priv. Physician .... 2 1 0 0 0 0 1 0 0 3 7 0 2 2 5 1 -3
5. Ret. to Treatment in
this Clinic _........-...____ 1 0 25 0 0 5 10 0 0 0 5 71 0 13 0 0 0 1
6. Ret. to Treatment to
Private Physician ....... 0 0 0 0 1 0 0 0 0 3 2 0 0 0 0 0
7. Epidemiologic Treatment
Contact of: ..........----- -----.. 0 1 59 0 0 2 2 1 0 0 19 276 0 9 8 26 0
8. Patients Interviewed ......... 9 6 56 2 0 4 11 19 5 3 56 1,538 6 56 65 51 0
9. Contacts Obtained ..__ 7 1 51 0 0 1 0 10 2 3 43 1,397 2 34 27 47 0
10. ERFs Closed O_ ---- __ 0 5 86 0 0 1 9 9 5 2 38 1,584 2 16 16 54 5
11. Field and Office Visits- ... 23 35 547 2 0 34 95 40 15 18 110 8,839 9 112 228 191 34 -
C. TUBERCULOSIS CONTROL C)
1. Admission to Service-Case
Active 2 8 16 0 3 7 13 11 7 4 13 324 4 8 36 5 3
2. Adm. to Service-Case
Inactive ....-.---- 3 10 36 8 4 12 6. 8 5 6 29 693 9 38 88 12 0
3. Adm. to Service Contacts &
Suspects -. ....... 11 28 209 13 6 49 9 79 13 13 136 3,345 54 311 58 18 9 9 1
%Ci

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

5,l
0 0
J l I jJ I i a I a 'U
.0 3 s4 6 .
;4___0_0__0 p4 P4

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service--- ---- 119 159 243 75 6 257 358 450 69 329 320 83 13 383 8 320 407
2. Field and Office Visits 249 211 348 77 10 276 540 561 84 400 578 89 13 579 12 585 673
3. Hookworm Treatments Given 79 89 182 96 353 126 262 171 4 9 444 152 9 319 171 40 509
TYPE OF IMMUNIZATIONS
4. Smallpox --------------- 35 921 1,325 98 49 186 607 613 361 595 1,134 587 1 5,215 124 3,999 92
5. Diphtheria 176 1,198 859 332 176 771 809 249 731 510 3,237 2,169 12 5,104 221 4,757 192
6. Whooping Cogh--------- 176 547 859 330 175 584 723 251 521 483 3,241 1,788 12 4,125 201 3,736 179
7. Tetanus ---------- --- 176 1,613 2,156 889 243 842 1,057 359 845 811 3,282 2,706 13 6,411 232 7,962 192
8. Poliomyelitis --------------.. 2,763 2,328 5,221 1,947 725 1,178 6,107 4,122 2,012 3,010 2,286 13,458 276 12,189 1,972 10,369 4,141
9. Typhoid -------11 790 1,626 467 238 884 173 3,392 423 916 3,985 935 3 3,624 64 757 124
10. Rabies-Humans 0 0 3 1 1 0 0 0 0 14 2 0 0 0 0 0 2
11. Rabies-Animals --------....... 0 0 0 0 0 0 0 185 175 0 125 0 0 0 978
B. VENEREAL DISEASE
CONTROL
1. Admissions to Service..----- ... 17 199 1,992 80 2 30 484 730 26 154 9 121 14 261 53 831 111
2. Not Infected ----------- 3 36 132 44 0 0 138 177 0 36 0 1 0 61 8 75 69
3. Treated in Clinic ------ 5 138 1,153 11 2 21 195 417 22 54 5 120 13 141 36 571 23
4. Treated by Priv. Physician..... 6 1 0 0 0 0 2 3 0 1 3 2 0 9 1 4 10
5. Ret. to Treatment in this
Clinic 0.-.....--P....- 9 9 95 0 0 2 87 16 5 5 2 10 0 4 5 66 0
6. Ret. to Treatment to Priv.
Physician -i..-__ --.. .. 3 0 0 0 0 0 1 1 0 1 0 1 0 1 0 5 0
7. Epidemiologic Treatment
Contact of: 0 18 329 12 0 13 34 70 1 58 0 33 3 25 8 187 7
8. Patients Interviewed---- ... 0 86 93 9 1 31 70 608 22 108 12 101 4 63 30 271 71
9. Contacts Obtained -...... 0 101 157 7 0 16 83 329 17 39 0 66 4 81 24 328 14
10. ERFs Closed ._ 13 145 260 18 0 21 191 430 15 51 6 53 3 280 14 704 39
11. Field and Office Visits .... 37 373 3,502 99 1 60 902 1,826 53 500 32 131 26 1,153 89 2,233 170
C. TUBERCULOSIS CONTROL
1. Admissions to Service-Case
Active ..........---------------. 37 24 43 9 1 10 44 15 11 24 13 9 3 260 13 173 31
2. Adm. to Service-Case
Inactive -......_ _.... 59 42 100 15 4 24 45 56 7 17 34 13 6 535 15 309 27
3. Adm. to Service-Contacts 73 138 128 52 829 36 1,063 194
Suspects ......_ __rie s__W --- 167 179 240 65 23 144 89 85 8 73 138 128 52 829 36 1,063 194

z
z
C
1t

0
t--

M

01
CD
Oc
CTD

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

S0

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service ..--...------- 287 270
2. Field and Office Visits..._... 508 364
3. Hookworm Treatments Given .... 224 486
TYPE OF IMMUNIZATION
4. Smallpox .-.._... _....---- ------- 1,070 2,529
5. Diphtheria --------------.------ 1,825 3,673
6. Whooping Cough ----- ---- 1,807 3,568
7. Tetanus ..--------- -..... ------------ 1,875 3,809
8. Poliomyelitis ..--...-----.--------..----. 0,252 22,491
9. Typhoid ---... -------------------_ .. 121 272
10. Rabies-Humans ------------ 0 0
11. Rabies-Animals -- -.--. 5 0
B. VENEREAL DISEASE
CONTROL
1. Admissions to Service ........------.. --- 1,329 837
2. Not Infected--....------------- -- 444 148
3. Treated in Clinic --.......--.. ------ 469 462
4. Treated by Priv. Physician ..__-.-----.. 109 20
5. Ret. to Treatment in this
Clinic ...--..-.----- ..14 57
6. Ret. to Treatment to Priv.
Physician --.........----------- 14 3
7. Epidomiologic Treatment
Contact of: -...........------------------- 103 134
8. Patients Interviewed---...-.......-------- 139 212
9. Contacts Obtained.-----...........------.. .. 150 373
10. ERFs Closed -.. ----.......-----------.. 974 695
11. Field and Office Visits --..._......_.- 5,384 2,628
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case
Active ...............------------...---. ---- 125 143
2. Adm. to Service-Case
Inactive ...--.---....... ..--- --------- 304 132
3. Adm. to Service-Contacts &
Suspects ------------------------- 1,320 288

a 0

I s

r Im 0 C
13 ii 0a
Iq i Li E >|
CC M C M O M tl p ? ; -

9
24
37
338
1,185
924
1,471
2,856
215
0
0

64
0
61
0
2
0
1
16
4
3
73

10
31
45

6 40
18 54
1 146
33 40
90 738
87 666
159 947
732 4,635
48 262
0 0
0 0

228 55
0 27
227 27
0 1
2 17
0 0
1 8
203 22
22 23
5 21
348 79

9 9
22 13
75 42

105
147
43
459
542
534
630
70
52
5
0

473
245
226
6
0
0
7
232
114
44
673

49
63
169

274 79 39
49 16 7
163 47 50
9 4 0
6 5 2
0 0 1
43 7 1
64 42 4
111 28 5
270 23 2
836 120 73

25 3 14
28 9 20
148 46 174

67
105
186
428
499
424
699
1,143
534
0
0

51
55
64
78
189
96
200
613
148
0
ni

35 3
2 0
20 4
3 0
0 0
0 0
12 0
30 0
26 0
16 0
93 16

15 4
26 2
24 12

158
301
61
682
617
548
873
13,830
306
0
0

103
17
58
2
6
1
8
106
50
130
480

92
192

77 345
84 345
40 532
51 841
336 1,179
337 1,141
403 1,385
744 4,344
398 62
0 0
0 0

44 26
1 0
29 22
0 0
2 1
0 0
20 9
17 18
7 13
16 17
54 55

0 9
11 41
51! 35

1 13,057
1 17,798 t.-
12 12,271
83 59,169
51 78,975
55 70,016
147 100,548
34 26,567
71 50,942
1 117
0 4,887 3
t-n

22 24,782
0 12,436
28 13,605
0 276 -
1 1,153
0 46 C)
5 4,054
13 9,498 r
14 9,126
4 13,276 <
38 59,853

2 2,845
2 5,143
1 17,829 t
__4

2
1
5
5

2,5

- -

-

I '

,

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

I Id

4. No. of Persons X-rayed-
Miniature Films
5. No. of Persons X-rayed-
Large Films ....-...-.........
6. Tuberculin Test -...............
7. Field Visits ---------..........
8. Office Visits .......
9. Cases Hospitalized .---...
D. MATERNITY SERVICE
1.-2. Patients Admitted to
Maternity Medical Service..
3. Visits by Antepartum Cases
to Medical Conferences .
4. Patients Admitted to
Maternity Nursing Service ....
5. Field Nursing Visits .....- .
6. Office Nursing Visits .....
7. Patients given Postpartum
Medical Examination ....
8. Number of Midwife Meetings.
9. Visits for Midwife Supervision
10. No. of Midwife Deliveries
Supervised by health dept.
personnel -..... ..............
11. No. of Individuals Enrolled in
Classes for Expectant Mothers
E. CHILD HEALTH SERVICES
2.-3. Adm. to Well Child
Medical Service Infants.._
1.-b. Adm. to Well Child
Medical Service 1-4 .._
1.-c. Adm. to Well Child
Medical Service 5 over ....
4. Visits to Well Child Medical
Conference: Infants ___
1-4 ....__ _
5-over .. ...

21,118
850
146
581
44
26

464
927
481
1,124
1,707
172
6
20

2 0
297 0

993 65
224 302
325 480
1,290 159
349 802
627 1,437

0
626
134
96
359
14

182
525
161
206
581
26
0
6

0
0

89
15
3
182
23
8

2,355 13,381 29,4091

104
224
117
575
77
2
0
46

0
0

95
112
124
165
152
231

1,070
661
2,573
1,267
58

360
729
355
631
1,691
138
18
88

26
2

515
15
4
1,329
37
6

2,784
82
18
169
59
3

95
248
123
351
290
7
3
20

0
72
9
112
83
4

39
55
76
46
203
9
0
9

0
0

11
3
3
13
4
1

3,187
102
67
204
121
10

243
256
316
563
391
30
10
58

0
0

66
63
45
85
65
47

0
34
28
43
97
2

49
123
46
63
176
17
4
52

0
0

46
29
115
55
36
125

33,079
1,989
380
1,715
2,679
31

51
150
435
723
236
7
1
3

12,085
1,347
270 0
2,409
547
62 O

540
800
659
1,465 .
1,822 C1
147
1
57

0 2
0 134

331
2
4
882
3
4

Zx,
z:

i

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

4. No. of Persons X-rayed-
Miniature Films ___---- 1,071 1,421 7,432 465 1 3,270 1,659 20 0 2,254 0 88,013 0 3,717 0 1,912 0
5. No. of Persons X-rayed
Large Films -------- 75 77 205 12 28 115 76 84 37 59 127 1,304 165 151 245 40 20
6. Tuberculin Test ----.-------.. 0 16 86 4 3 322 32 307 1 24 505 711 19 24 59 348 4
7. Field Visits ----20 40 567 16 16 93 47 104 41 68 185 3,435 142 165 228 42 21 0
8. Office Visits ----_ 14 68 258 18 7 151 67 102 30 41 145 3,979 102 40 105 36 15
9. Cases Hospitalized --....... 2 4 14 0 1 6 7 8 4 3 22 76 4 4 23 5 3 Q
D. MATERNITY SERVICE
1.-2. Patients Admitted to
Maternity Medical Service..- 85 8 402 7 11 17 68 44 49 29 19 1,716 28 0 255 46 14
3. Visits by Antepartum Cases
to Medical Conferences --- 124 23 878 18 28 23 92 118 125 47 35 6,162 59 0 214 125 23 1
4. Patients Admitted to
Maternity Nursing Service _. 37 11 631 26 2 23 107 46 1 22 7 2,147 33 95 594 61 16 l
5. Field Nursing Visits ----....._ 41 8 565 217 2 52 305 92 0 66 7 4,107 44 171 884 62 21
6. Office Nursing Visits -- ... 145 19 1,013 12 1 27 311 152 4 50 2 7,950 68 141 990 172 24
7. Patients given Postpartum
Medical Examinations....-- 3 0 75 3 0 4 25 19 0 12 0 794 9 7 58 7 0
8. Number of Midwife Meetings.. 9 0 10 0 0 0 5 0 0 2 0 1 0 1 17 3 0o
9. Visits for Midwife Supervision 3 1 147 0 0 14 22 7 2 5 10 29 22 20 178 17 5
10. No. of Midwife Deliveries
Supervised by health dept.
personnel ...d.----.-. ....---- 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 5 /
11. No. of Individuals Enrolled in
Classes for Expectant Mothers 40 0 0 0 0 0 0 0 0 0 0 77 0 0 0 O 0 M
E. CHILD HEALTH SERVICES
2.-3. Adm. to Well Child <
Medical Service Infants- 137 4 153 0 1 8 9 17 12 22 24 2,345 104 0 35 49 8 1
l.-b. Adm. to Well Child
Medical Service 1-4 -_ 69 5 84 0 0 8 9 0 9 2 18 3,864 42 0 4 8 5
l.-c. Adm. to Well Child
Medical Service 5 over _. 8 4 235 0 0 5 0 2 3 0 4 3,411 2 0 73 1 4 J
4. Visits to Well Child Medical
Conference: Infants __. 167 6 203 0 1 11 9 23 19 22 24 4,998 156 0 40 84 12
1-4 ..--- 106 7 111 0 0 8 3 0 13 2 19 8,737 57 0 5 8 8
5-over 19 4 240 0 0 0 2 7 0 4 6,491_ 3 0 73 1 7 t3
CD

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

S 0
0 ; 0 0 0

4. No. of Persons X-rayed-
Miniature Films ....--......-... 3,800
5. No. of Persons X-rayed
Large Films .......--- -------- 321
6. Tuberculin Test .--...............-. 51
7. Field Visits -.......----------........ 583
8. Office Visits ____..-....... .. 100
9. Cases Hospitalized ..--.. ..... 24
D. MATERNITY SERVICE
1.-2. Patients Admitted to
Maternity Medical Service- 141
3. Visits by Antepartum Cases
to Medical Conferences ... .. 277
4. Patients Admitted to
Maternity Nursing Service ... 293
5. Field Nursing Visits ..--.......... 655
6. Office Nursing Visits--............ 109
7. Patients given Postpartum
Medical Examinations-.......... 42
8. Number of Midwife Meetings.. 0
9. Visits for Midwife Supervision 28
10. No. of Midwife Deliveries
Supervised by health dept.
personnel ...--...._. ___. -- 0
11. No. of Individuals Enrolled in
Classes for Expectant Mothers 0
E. CHILD HEALTH SERVICES
2.-3. Adm. to Well Child
Medical Service Infants.... 48
1.-b. Adm. to Well Child
Medical Service 1-4 .- 10
1.-c. Adm. to Well Child
Medical Service 5 over .... 2
4. Visits to Well Child Medical
Conference: Infants ... 63
1-4 __ 11
5-over -- ---- 5

0
258
184
295
505
17

98
215
323
558
509
55
1
8

0
0

29,755
1,061
168
728
582
33

171
485
372
760
8
41
12
71

2,218
88
40
139
34
2

78
194
81
41
174
4
0
5

57 202 13 93
8 86 0 10
44 109 5 2
61 216 14 93
9 124 0 25
47 141 5 4

12,852
617
209
443
96
11

139
424
161
288
463
51
7
2

0 0
0 115

0
750
34
375
53
12

0
0
137
307
2
0
2
29

0
0

45 5E
4 7
2 33
47 57
4 72
3 40

6,175
128
36
261
233
20

51
123
105
120
198
15
7
9

0 0
0 24

0
1,308
51
292
144
10

33
46
59
53
109
6
0
5

0 0
0 39

46 117 151
53 428 60
0 438 222
86 447 96
221 2,749 62
4,031 223

0 282
0 287
0 392
0 422
0 469
0 552

2,912
258
57
89
185
5

91
234
100
221
366
36
0
9

12,543
1,345
9,652
2,381
1,577
79

549
1,393
473
1,023
1,138
144
30
19

405
6
8
488
25
19

z>

0
163
51 tn
540
278
17 O

91-3
15
51
48
62 C1

4
2

0
0

0
0
0
0
0
0

1 1

I

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

T
S0s

I 4 i I I |

4. No. of Persons X-rayed-
Miniature Films 131,83 27,894
5. No. of Persons X-rayed
Large Films ....- ... 4,746 1,536
6. Tuberculin Test ....__ .298 318
7. Field Visits ...-- ....... .. 1,314 1,559
8. Office Visits-- -- __ 5,853 712
9. Cases Hospitalized ----- ---- 77 49
D. MATERNITY SERVICE
1.-2. Patients Admitted to
Maternity Medical Service ..... 397 782
3. Visits by Antepartum Cases
to Medical Conferences 1,353 1,911
4. Patients Admitted to
Maternity Nursing Service -... 424 764
5. Field Nursing Visits .... ... 1,012l 1,607
6. Office'Nursing Visits ...____ 548 2,298;
7. Patients given Postpartum
Medical Examinations ------- 273 243.
8. Number of Midwife Meetings O0 10
9. Visits for Midwife Supervision 24 27
10. No. of Midwife Deliveries
Supervised by health dept.
personnel .........------------- 0! 21
11. No. of Individuals Enrolled in
Classes for Expectant Mothers.- 14 0
E. CHILD HEALTH SERVICES
2.-3. Adm. to Well Child
Medical Service Infants .. 999 744
1.-b. Adm. to Well Child
Medical Service 1-4 .- ... 1,018 112
1-c. Adm. to Well Child
Medical Service 5 over 535 34
4. Visits to Well Child Medical
Conferences: Infants .... 1,522 1,258'
1-4 ........ .... .. 1,759 213
5-over __ ----...........__.. 733 100

5,964
866
35
244
80
11

81 174
2581 524
2321 208
286 280
408 7291
231 0
12 0
20' 6

0 0
25 0

25 18
38 0
21 0
51 251
44 0
24 0

5 71 1
5 217 1
9 74 4;
3i 319 9(
71 232 1I
0 34
0! 0
1 0 1

5 01
0 94

33 39
3 74
33 55
33 48
35 86
341 70

81 1 4
83 1 64
30 128 68
)2 237 103
85 111 159
28 01
1 01 1
88 38 1

1 01 0
0 0

0 4 32
0 3 261
0 11 16
0 4 48
0 3 32
0 11 44

26,813
1,178
590
1,461
693
45

82
392
248
586
408
50
2
52

24 63 145
12 43 277
6 33 292
33 98 37E
15 92 704
6 861 538

1,092
54
7
35
59
1

70
246
60
150
25
20
6
13

0
0

25
5
4
25
6
5

77
32
41
98
39
45

0 580,179
37 33,868 I
0 20,435
27 32,529 Q
25 40,091
3 1,675 (

50 12,993
55 35,683 l
89 16,662
145 34,324
178 39,881
30 3,907
3 254
24 1,758

1 48 C/
0 906 T

20 14,561
15 9,855 (
29 8,146
28 26,014
26 25,472
63 18,416

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

41 SS l 1l 1 U 14

___ _________ __u -. a _

6 Admissions to Nursing Service
Infants ....... 526 101 129 247 266 709 24 29 48 155 97 96 4,178 2 92 871 877
1-4 .---_...._ 845 350 111 634 562 59 54 84 105 185 79 175 3,193 13 187 1,093 242
5-over ... 915 179 462 345 658 7,085 121 239 47 637 65 6014,860 13 137 907 1,174
7. Field Nursing Visits-Infants.- 1,014 195 325 945 512 1,886 25 51 74 275 73 185 8,141 8 140 1,306 1,790
1-4 ... 1,477 699 259 1,792 957 206 58 149 182 414 43 200 5,431 13 237 1,876 407
5-over 1,309 318 643 936 310 1,869 146 277 66 423 78 62 5,027 23 284 1,502 906
8. Office Nursing Visits-Infants. 446 11 189 66 124 1,622 3 31 1 141 119 56 7,022 0 66 925 1,718
1-4 ... 230 37 56 104 169 76 15 45 11 132 105 48 7,159 1 54 670 108
5-over 509 101 2,562 119 638 7,300 93 210 5 763 50 1555,384 5 89 463 2,314
9. Nurse-Teacher Conference
5-over 698 152 1,026 128 514 2,035 76 184 62 529 139 016,479 76 146 3,240 1,583
F. SCHOOL HEALTH
1. Pupils Examined by physician
with parent present ........-- 379 124 316 250 304 919 46 210 109 269 76 141 4,688 2 42 1,281 52
(b) Referred for Further
Diagnosis ...-.. __. 163 26 7 35 24 195 0 93 15 34 4 57 0 0 8 398 5
(c) Completed Referrals ... 348 6 1 14 6 14 0 39 0 9 0 20 0 0 7 158 11
2. Pupils examined by physician
with parent not present 222 193 623 43 168 3,935 8 192 341 96 23 45716,672 1,195 193 17 6
(b) Referred for Further
Diagnosis .............. 47 12 61 3 20 750 0 23 40 6 14 113 0 86 50 2 3
(c) Completed Referrals _---_ 69 6 0 1 1 55 0 3 2 4 0 19 0 12 11 29 0
3. Screening by other health de-
partment personnel VisuaL_ 160 767 2,970 137 5720,733 47 16 219 311 353 5928,015 10 14 14,970 3,336
(b) Referred for further
diagnosis ...--........-- 113 36 571 38 18 2,233 29 2 36 42 37 20 3,918 1 79 591 465
(c) Completed Referrals .. 105 17 135 19 8 580 29 0 5 21 2 9 508 1 20 327 168
4. Screening by other health de-
partment personnel-Audio-
meter Testing 357 324 1,780 0 5 133 0 12 1 1 1 021,810 1 19 35 1,968
(b) Referred for further
diagnosis 245 1 155 0 0 49 0 0 1 2 0 0 863 1 7 1 77
(c) Completed referrals 184 1 13 0 0 12 0 0 1 34 0 0 0 1 0 73
G. DENTAL HEALTH
1. Adm. for Dental Treatment
(a) Maternity Patients ......-- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5

CI
lvv

C"
r

t0
O

t-J

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

0 0 0 0 m 1

6. Admissions to Nursing Service
Infants _-
1-4 .
5-over
7. Field Nursing Visits-Infants-
1-4
5-over
8. Office Nursing Visits-Infants
1-4
5-over
9. Nurse-Teacher Conference
5-over

F. SCHOOL HEALTH
1. Pupils Examined by physician
with parent present ---
(b) Referred for Further
Diagnosis ---------
(c) Completed Referrals _
2. Pupils examined by physician
with parent not present -
(b) Referred for Further
Diagnosis o....
(c) Completed Referrals ..
3. Screening by other health de-
partments personnel Visual.
(b) Referred for further
diagnosis ...........
(c) Completed Referrals -
4. Screening by other health de-
partment personnel-Audio-
meter Testing
(b) Referred for further
diagnosis --
(c) Completed referrals --
G. DENTAL HEALTH
1. Adm. for Dental Treatment
(a) Maternity Patients

92
65
143
53
53
64
156
134
275
32

82
2
0
80
11
0
450
1
2

33
35
0

0

590
1,053
459
728
1,627
394
253
321
930
773

355
9
6
646
60
2
1,241
358
34

340
10
1

n1 0 1

63
132.
22
237
460
59
7
33
1
15

137
14
1
580
63
2
202
19
0

0
0
0

0
2
36
0
2
25
0
0
27
43

103
3
3
176
5
7
4
4
2

0
0
0

32
71
135
61
135
223
26
88
383
638

121
30
2
189
11
2
374
83
21

O 0

44
15
8
140
302
235
70
97
203
400

566
19
3
608
14
1
41
5
1

0
0
0

0

41 0
53 25
139 56
63 0
59 5
70 11
23 0
4 20
96 35
321 78

155 140
13 6
11 1
2,047 306
209 0
80 0
1,891 96
23 4
57 4

1 0
0 0
0 0

0 0

45
44
60
115
110
18
17
38
11

266
2

395
50
45
783
183
6

0
0
0

0

31
127
2
8
21
132

222
89
0
600
63
1
106
17
6

9
0
0

0

3,135 34
5,077 43
8,172 54
3,146 33
2,819 72
5,040 58
5,761 16
9,864 4
10,007 52
5,193 169

2,598 317
705 28
41 0
6,550 202
2,039 7
157 0
35,376 0
2,425 0
681 0

36,291 0
5,453 0
78 0

241 0

106
101
237
213
153
265
88
78
206
10

250
3
0
36
0
0
1,574
177
27

960
41
S 1

255
322
342
316
474
353
103
43
202
116

109
49
41
6
4
2
131
63
12

1
0
0

129
66
64
225
72
55
162
62
36
8

47
1
1
25
11
0
78
7
5

918
25
1

n

43
92
92 1
96
169 0
167
25
31
33
31

49 '
0
0
204
0

11

0

O~
0

0 CA
C
(r

01 0

.
_

,

1 0

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

o0
> 0

z 010 P

6. Admissions to Nursing Service
Infants 312 331 397 34 50 137 104 154 89 97 137 104 11 274 120 536 58
1-4 -.. 476 507 448 80 33 36 64 244 333 93 371 108 15 420 278 141 150
5-over 720 619 484 196 10 17 895 400 116 577 829 334 104 1,373 167 1,723 740
7. Field Nursing Visits-Infants 595 687 897 33 67 420 185 296 326 131 191 100 19 568 255 1,222 47
1-4 682 886 953 70 82 101 90 497 849 97 548 170 16 1,066 579 333 124
5-over 854 438 816 184 40 62 480 736 228 272 992 299 91 1,468 106 2,251 557
8. Office Nursing Visits-Infants 86 90 31 10 47 50 44 5 46 182 173 90 2 70 213 316 49
1-4 141 104 9 24 9 4 5 2 215 120 909 50 1 659 315 254 124
5-over 456 440 63 154 2 88 635 94 87 1,578 2,206 389 33 4,034 372 5,816 1,375
9. Nurse-Teacher Conference
5-over 375 4 358 82 75 101 959 1,076 2 1,115 416 132 31 2,444 300 1,508 633
F. SCHOOL HEALTH
1. Pupils Examined by physician
with parent present ..-__ 513 240 262 157 47 6 192 62 92 60 82 367 24 330 128 79 169
(b) Referred for Further
Diagnosis 0 65 25 13 6 3 2 0 0 22 9 17 0 82 14 4 26
(c) Completed Referrals 0 0 0 3 0 0 1 0 0 21 0 0 0 3 2 6 0
2. Pupils examined by physician
with parent not present __. 26 336 25 649 159 8 205 539 38 432 2,986 189 119 70 125 472 337
(b) Referred for Further
Diagnosis ... ---------. 1 89 5 93 0 0 112 0 1 61 6 5 2 8 10 19 104
(c) Completed Referrals ____. 0 0 0 0 0 0 21 0 0 8 0 2 0 1 0 11 0
3. Screening by other health de-
partment personnel VisuaL 1,833 411 2,838 1,745 100 157 2,285 292 202 2,323 2 1,537 44 5,698 71 5,462 882
(b) Referred for further
diagnosis ----- 269 98 315 131 0 15 147 50 0 333 2 137 8 246 21 472 182
(c) Completed Referrals -_ 69 0 124 12 0 2 67 19 0 139 0 21 5 193 7 285 69
4. Screening by other health de-
partment personnel-Audio
meter Testing ------ 12 0 1,921 1,248 59 0 909 28 306 60 0 12 0 4,197 50 1,173 4
(b) Referred for further
diagnosis ---.. 8 21 132 20 4 0 43 2 1 4 2 0 0 403 3 99 4
(c) Completed referrals 4 0 53 0 0 0 8 1 1 1 0 0 0 89 0 83 0
G. DENTAL HEALTH
1. Adm. for Dental Treatment
(a) Maternity Patients .___ 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0

z

O

Cn
0

C)

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

6. Admissions to Nursing Service
Infants ------------
1-4 .---........---.. --.. --
5-over --------
7. Field Nursing Visits-Infants --.--
1-4 ..........
5-over _......
8. Office Nursing Visits-Infants --------
1-4 ..........
5-over .......
9. Nurse-Teacher Conference
5-over
F. SCHOOL HEALTH
1. Pupils Examined by physician
with parent present --...----..- .-- -
(b) Referred for Further
Diagnosis -.........---------
(c) Completed Referrals .... .....
2 Pupils examined by physician
with parent not present _-----
(b) Referred for Further
Diagnosis ..--..--_..------- ..
(c) Completed Referrals ...--........
3. Screening by other health de-
partment personnel Visual --.......
(b) Referred for further
diagnosis -... --------------
(c) Completed Referrals ...-- .......
4. Screening by other health de-
partment personnel-Audio-
meter Testing --.......................
(b) Referred for further
diagnosis .-----------... --......... .--
(c) Completed Referrals ._-_. ...
G. DENTAL HEALTH
1. Adm. for Dental Treatment
(a) Maternity Patients -.......--

878
1,635
3,239
1,474
1,637
5,127
1,883
2,728
5,042
5,622

7,9
1,0(
3'
9,8
2,2
7
48,5'
1,9'
1,38

32,21
41
21

962
332
594
1,574
1,100
1,107
1,364
544
1,194
1,490

48 204 200
65 34 14
79 12 0
76 416 242
27 21 24
06 10 0

75 2,079 255
70 209 6
82 44 2

85 97 0
53 11 0
64 3 0

01 8 0

[3 90
r9 958 1
8 293
38 177 1
30 1,462 2
13 65
11 22
73 559
33 705

10 58
26 18
5 9
)6 279
36 57
13 29
37 4,212
18 479
27 328

0 4,054
0 93
0 20

0: 4

222
242
115
256
373
166
180
135
135
182

88
37
0
216
70
0
987
94
27

594
62
7

0

62 112
32 122
62 100
110 133
81 256
145 244
82 100
63 122
34 179
30 5

0 81
1 3
0 2
0 54
0 2
1 1
37 23
12 9
2 0

25 0
5 0
0 0

0 0

269
268
1,158
558
521
710
62
265
1,302
1,003

632
11
3
54
14
13
5,567
254
66

4,773
43
4

6

38 19,817
16 23,685
13 56,614 -4
14 35,113
)5 36,018 O
38 44,649
10 24,991
35 27,138
)9 112,358
52 55,260

54 27,891
0 3,575 >
0 1,200
38 56,754

0 6,770
0 1,440

34 205,064
14 17,349
2 5,807
<
0 117,242
0 8,430 t-
0 945

0 0 50 C
Cn

0 0

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

C3 3

3

(b) 1-4 ........----............. 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 0 0
(c) 5-over -.--_ ---- ....... 3,067 0 0 0 0 121 0 4 0 0 0 0 924 0 0 393 188
2. Topical Fluoride Applications
(b) 1-4 _..__..-----------------... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(c) 5-over ---.--................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. No. of Children Screened-
Dentist ------ ------ 3,287 0 0 0 0 6,565 0 27 0 156 22 0 0 0 0 3,014 600
(b) Others ...----._--.......---.. 0 106 755 214 3,560 3,691 0 329 263 44 32 0 6,585 0 0 81 1,168
4. Referrals of Children Screened-
Dentist -------------.. 24 0 0 0 0 3,264 0 21 0 78 0 0 0 0 0 5,578 39
(b) Others ----.- 0 0 175 2 2,868 1,741 0 84 22 5 20 0 464 0 0 325 627
5. No. of Children who Com-
pleted Referrals Dentist 24 0 0 0 0 606 0 32 0 2 0 0 0 0 0 523 21 .3
(b) Others -_.._....... 0 0 0 0 0 68 0 36 4 0 0 0 207 0 0 83 178
H. CHRONIC DISEASES
1. Adm. to Cancer Service .. 121 8 131 48 33 121 13 32 14 28 32 42 19 12 1 7 283
2. Field Visits-Cancer ....------. 8 13 100 178 40 263 18 61 32 71 93 52 121 27 0 19 567 C
3. Office Visits-Cancer -..-.. 200 5 451 72 42 515 7 34 9 26 49 42 0 15 2 0 492 01
4. Adm. to Crippled Children
Service ...--_ ......... 75 19 93 70 50 109 14 33 27 37 34 8 14 7 17 44 17
5. Field Visits-Crippled Children 162 9 224 550 91 308 38 66 44 102 62 20 10 10 46 82 487
6. Office Visits-Crippled
Children ..... --------...........-.. 154 4 32 82 102 47 3 54 15 53 30 7 1 1 24 15 23
7 Adm. to Diabetes Service .. 4 8 3 23 21 36 7 6 10 9 14 3 1 1 6 6 69
8. Field Visits-Diabetes ._..... 5 1 8 34 41 284 2 12 31 17 37 8 7 2 8 11 519
9. Office Visits-Diabetes --__. 5 26 5 26 104 135 7 35 12 8 75 3 0 0 86 3 3
10. Admissions to Heart Disease
Control ....__......-- --... ... 1 0 9 29 7 31 2 3 8 5 5 3 14 4 0 8 146
11.Field Visits-Heart Disease -... 2 0 11 84 1 108 1 4 13 16 7 6 40 7 0 14 2,056
12. Office Visits-Heart Disease.... 0 0 29 122 6 119 1 0 21 3 2 3 4 0 0 1 497
J. MENTAL HEALTH
1. Admission to Service ..._........ 10 19 1 0 31 13 0 24 0 29 47 1 272 35 4 10 257
3. Cases Closed .......-0......... 0 1 0 0 1 0 0 6 0 15 5 0 219 5 0 0 206
4. Testing -------- ---- ..... 0 16 0 0 0 8 0 1 0 1 1 0 80 0 0 0 256
5. Counselling -------...... ... 3 5 0 0 9 8 0 45 0 38 43 0 0 33 4 0 3
6. Local Therapy _--..... _.------... 0 0 0 0 5 0 1 0 0 3 0 793 0 0 0 72
7. Referred for further Service.... 41 2 2 0 29 91 0 2 0 4 12 1 33 1 0 12 40

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

(b) 1-4 ................. 0 0 0 0 0 0 0 0 0 0 0 0 19 0 0 0 0 0
(c) 5-over ...........-....... 56 0 0 0 0 0 0 1 0 0 917 0 2 0 0 0
2. Topical Fluoride Applications
(b) 1-4 ..-------.............-----------. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(c) 5-over ---- -.. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. No. of Children Screened- 0
Dentist) .. .. ..........- 0333 0 0 0 0 0 0 0 0 0 0 0 0 21 0 0 0 0 0
(b) Others -.._ .-...._..... 2 0 1,308 0 0 0 0 3 0 0 918 7033 0 0 0 70 0
1. Referrals of Children Screened-
Dentist ..---...........--- 250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(b) Others .....------- 0 916 0 0 0 0 2 0 16 0 1,880 0 10 0 30 0
5. No. of Children who Com-
pleted Referrals Dentist 0 0 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0
(b) Others ._..--.......-..-- 0 0 0 0 0 0 0 0 0 10 0 217 0 5 0 0 0
H. CHRONIC DISEASES tl
1. Adm. to Cancer Service -.... 3 26 32 17 0 31 16 21 4 8 18 713 59 33 34 5 7
2. Field Visits-Cancer ....... 5 37 151 37 0 118 5 12 12 21 42 908 34 84 69 18 8
3. Office Visits-Cancer ..... 0 42 24 13 0 47 51 16 9 5 9 1,775 73 35 6 1 1
4. Adm. to Crippled Children
Service .-............. 7 33 99 15 4 33 15 26 6 20 13 663 32 66 107 20 13 -
5. Field Visits-Crippled Children 36 8 233 35 6 146 70 29 8 28 31 992 75 233 74 56 76
6. Office Visits-Crippled
Children ...... 0 96 81 0 5 25 9 8 7 2 4 109 18 48 243 19 15
7 Adm. to Diabetes Service -..... 3 18 25 4 3 17 12 9 12 3 21 431 29 30 8 19 7 /fl
8. Field Visits-Diabetes ....... 3 28 27 30 0 62 0 3 3 5 10 1,261 35 134 5 20 10
9 Office Visits-Diabetes __ 4 128 81 0 6 39 60 7 58 4 102 4,461 174 91 29 92 61 L
10. Admissions to Heart Disease
Control --...---......-------....-- 0 21 104 11 5 68 18 2 4 0 3 113 5 4 0 0 9
11.Field Visits-Heart Disease __. 0 7 817 13 9 29 2 10 2 0 2 1,414 3 6 1 0 4 <
12. Office Visits-Heart Disease_ 0 48 154 134 2 235 56 1 39 0 4 15 12 0 1 0 8
J. MENTAL HEALTH
1. Admission to Service .._. 17 3 11 0 1 4 3 24 1 0 0 394 0 4 0 3 1
3. Cases Closed -...... 0 1 3 0 0 0 0 3 0 0 0 428 0 0 0 0 0
4. Testing __. ..... ...... ._ 13 0 2 0 0 0 0 0 0 0 0 401 0 0 0 0 0
5. Counselling -__ 1 1 14 0 0 0 6 25 0 0 0 1,044 0 5 0 0 0
6. Local Therapy ..---. 1 0 0 0 0 0 2 1 0 0 0 94 0 0 0 0 0
7. Referred for further Service .. 1 3 6 0 1 3 2 2 0O 0 0 104 0 9 0 2 O c

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

0 '

Q s.. >a ,r z
Cs M M 0 0I
_____ __ __ zL 0 0 0 61P4

(b) 1-4 --------- 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 5 0
(c) 5-over 0 0 0 0 0 0 88 1 0 0 0 0 0 914 0 2,057 2
2. Topical Fluoride Applications
(b) 1-4 -0..................------ ------ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(c) 5-over .. ....... ...... ... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. No. of Children Screened-
Dentist ......_.... 0 0 0 281 1 0 0 00 0 606 0 15,542 3 738 1
(b) Others ...... .442 0 5 0 6688 16 0 1,109 49 0 0 161 0 6,264 175
4. Referrals of Children Screened-
Dentist _... ..... 0 0 0 0 211 1 0 0 0 0 0 408 0 8,467 3 362 1
(b) Others ----- 2 253 0 2 0 0 173 13 0 406 0 0 0 35 0 1,374 36
5. No. of Children who Com-
pleted Referrals Dentist .. 0 0 91 0 0 0 0 0 0 0 0 0 0 828 2 1,222 1
(b) Others 2 0 0 0 0 0 118 3 0 51 0 0 0 1 0 473 2
H. CHRONIC DISEASES
1. Adm. to Cancer Service -..... 24 55 77 8 21 35 48 10 10 35 64 22 6 72 8 119 85
2. Field Visits-Cancer ..-...... 35 190 20 8 4 83 101 3 9 120 109 31 10 33 12 132 69
3. Office Visits-Cancer ......... 3 29 247 4 21 34 11 32 11 59 48 13 0 665 7 680 50
4. Adm. to Crippled Children
Service -------- 66 29 175 19 27 35 77 71 17 28 20 40 22 92 32 50 72
5. Field Visits-Crippled Children 210 48 630 9 27 123 187 230 34 53 49 104 59 155 89 225 144
6. Office Visits-Crippled
Children ........_._... ----_ .... 21 41 792 15 14 23 22 8 8 62 3 17 10 32 31 60 208
7 Adm. to Diabetes Service -.. 25 12 23 7 7 8 60 19 18 13 19 30 8 36 19 32 26
8. Field Visits-Diabetes --------.. 63 39 7 0 4 23 179 77 39 52 110 18 14 34 22 148 8
9. Office Visits-Diabetes -.... 5 152 188 17 46 114 24 32 30 69 110 145 19 198 80 40 43
10. Admissions to Heart Disease
Control ...._.... _________... 1 3 2 1 15 0 6 1 4 8 25 2 4 6 1 9 18
11.Field Visits-Heart Disease .... 1 3 3 1 3 0 19 15 7 23 38 3 4 11 1 19 32
12. Office Visits-Heart Disease.... 0 10 0 0 93 0 0 0 0 7 19 2 0 3 1 3 29
J. MENTAL HEALTH
1. Admission to Service .......... 3 0 289 2 1 2 8 3 6 3 30 4 1 255 12 22 9
3. Cases Closed __.. .. 0 0 245 1 0 1 0 0 6 1 3 0 1 325 0 115 0
4. Testing ..-.... 0 0 1.5 0 0 0 3 0 0 0 20 0 0 405 0 0 0
5. Counselling -----...... --- 0 0 466 1 0 3 5 1 0 1 19 0 0 79 0 0 2
6. Local Therapy .-_---- 0 0 361 0 0 0 1 0 0 0 0 1 0 520 0 0 0
7. Referred for further Service- 2 0 4 0 0 0 f1 2 1 6 1 31 6 0 20 19 12 8

Cbi

t--

t-l

itn

cT

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

-0

(b) 1-4 ------------------------------ 69 4 0 0 0 0 0 0 0 0 0 0 0 0 0 129
(c) 5-over ----- 629 224 0 0 0 16 164 0 0 125 0 45 149 0 0 10,087
2. Topical Fluoride Applications
(b) 1-4 --------------------- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(c) 5-over ..... -------.------ ---.0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 8
3. No. of Children Screened-
Dentist ......--.....--------------------- 30,591 11,190 0 0 0 4 125 0 0 0 0 1,790 0 0 0 95,797
(b) Others -------------------- ---- -- 0 25 0 27 235 0 1,287 0 0 0 4 130 19 0 46,814
4. Referrals of Children Screened-
Dentist ------------ -- 9,548 6,169 0 0 0 13 35 0 0 0 0 1,211 0 0 0 35,683
(b Others ]----- -- 0 0 0 0 27 42 0 248 0 0 0 1 0 7 0 11,806
5. No. of Children
pleted Referrals Dentist 4,368 209 0 0 8 14 36 0 0 95 0 136 0 0 0 8,241
(b) Others 0 1..--.._.... 69 4 0 0 0 9 0 9 0 0 0 0 0 0 1,491

H. CHRONIC DISEASES
1. Adm. to Cancer Service 6...2. 304 354 27 13 44 66 16 40 13 20 7 98 11 8 18 3,71087
2. Field Visits-Cancer ----- ...-... 133 200 84 54 57 124 22 67 16 72 8 126 10 6 50 5,222
3. Office Visits-Cancer 513 1,211 9 6 26 32 6 38 3 23 6 175 6 9 32 8,077
4. Adm. to Crippled Children
Service .....--------------- ......... 15 52 61 35 52 56 35 49 31 19 29 85 26 58 20 3,493
5. Field Visits-Crippled Children Screened-.. 31 129 152 199 59 163 104 127 84 83 57 265 50 99 62 8,487

6. Office Visits-Crippled
Childrentist --.-------------........ -- .- 7 25 11 17 24 26 7 37 2 133 0 36 20 6 81 23 3,158
7. Adm. to Diabetes Service ........-...... 35 130 3 7 9 21 4 19 5 15 8 95 9 18 5 11,623 3
8. Field Visits-Diabetes No... .. ....... 75 380 31 12 19 54 4 22 3 32 12 717 69 48 9 4,987
9. Office Visits-Diabetes -. 4220 112 6 7 50 23 0 12 13 60 68 298 24 104 18 8,459
10. Admission to Heart Disease
Control ...........Cancer Service ............. 48 14 2 1 3 1 0 13 1 1 0 8 41 15 9 905
11. Field Visits-Heart Disease .. 100 18 4 6 1 5 0 11 2 0 0 129 3 9 6 5,066
12 Office Visits-Heart Disease 77 16 1 0 13 0 0 11 0 1 0 5 75 7 10 1,900
Adm. to CrippHEALTed Children
1. Admission to Service 541 237 17 45 3 78 7 0 3 14 0 434 0 3 2 2,766
3. Cases Closed -Crippled Children 3 219 0 25 0 41 0 0 0 0 0 25 0 0 0 1,944
4. Testingsits-Crippled........................ 68 05 10 0 0 53 0 0 0 3 0 63 0 0 1,974
5. Counselling ............-------....... 97 251 15 70 0 145 1 07 0 9 O 100 0 0 0 2,552
6. Local Therapy ____...... ... ... 15 0 0 0 0 6 0 0 0 0 0 32 0 0 0 1,908
7. Referred for further Service _..__ 2 54 1 15 2 32 4 0 0 11 0 2 0 4 0 485 C
1 -----------------------------------------+-------------I----- WQ

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

8 Family Conferences ...-- .. 13
9. Conferences-Other Agencies. 1
K. MISCELLANEOUS
1. Adm. to Morbidity Service.... 476
2. Field & Office Visits-
Morbidity ------- 7 741
3. General Medical Examinations 400
4. Health Cards Issued .---.......-- 2,627
5. Visits in the Interest of
Vital Statistics .-..........--.- 6
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service .- .. 4
2. Visits to Nursing Homes-..-. 70
P. SANITATION
1. Approved Water Supplies In-
stalled, Private & Semi-Public 4
2. Approved Water Supplies In-
stalled, New Public Water
Connections -----.-..---__ 8
3. New Specification Privies
Installed _..-. .....- 64
4. Percolation Water Table or
Soil Log Test __.___... ..... 1,036
5. Subdivision Analysis ...._.. 2
6. Pollution Survey _--_ 6
7. New Specification Septic
Tanks Installed .--...--........ 622
8. Rabies-Number of Animal
Bites Investigated ..... 230
9. Field Visits for Rabies
Investigation ...__ ........-..... 71
10. Complaints Investigated ..-..- 378
11. Nuisances Corrected -..... 151
12.-19. Field Visits ___. -......-- 5,492

13
8

I -

1_il
Ms Q M M M a ) i U

0
0

170
360
102
327
60

52 8 0 31 0 27 78
24 0 0 50 0 38 147

01 4 6 0 1
4 1 10
369

2

2
2
14
1
0
50
20
35
64
42
177

231 357

24
2
307
S149
187
5,811
526
1,116
1,179
560
10,770

6 0 0
0 2 0
16 260 18
0 1 4
0 0 0
53 77 223
0 77 23
1 116 34
27 35 51
24 7 14
641 584 654

1 2,182 13
0 23 115

91
382
1,937
9,700
86

7 18
0 5

0 1 90 01 0 22
0 131 730 1 0 204

11

10
0
0
214
17
159
2,513
7,653
6,020
3,716
27,772

253

72 1,174
14 8
1,324 81
20 74
0 25
1,053 2,650
789 671
358 1,993
1,909 1,461
839 1,069
7,402 14,259

Iz
Iz

80 t-~
113

327 rJ
2,992 't
570
7,646
17
3

8 ,
89
Cn
571 )

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

I .0
Ia 8
.0) I a 12 I 0
E 'a
'5 8 .2O 8
O~~~ 0 0 rooem m

8 Family Conferences -- .......-
9. Conferences-Other Agencies-.
K. MISCELLANEOUS
1. Adm. to Morbidity Service__
2. Field & Office Visits-
Morbidity ----.......---
3. General Medical Examinations
4. Health Cards Issued -...
5. Visits in the Interest of
Vital Statistics .
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service --
2. Visits to Nursing Homes--
P. SANITATION
1. Approved Water Supplies In-
stalled, Private & Semi-Public
2. Approved Water Supplies In-
stalled, New Public Water
Connections -___
3. New Specification Privies
Installed ...----__- _. _
4. Percolation Water Table or
Soil Log Test --____- __
5. Subdivision Analysis ....___._
6. Pollution Survey _._ ____
7. New Specification Septic
Tanks Installed
8. Rabies-Number of Animal
Bites Investigated _
9. Field Visits for Babies
Investigation __-. __-_--
10. Complaints Investigated _
11. Nuisances Corrected .__.
12.-19. Field Visits -____

4 11 28
5 3 9

46
407
44
773
218

0
0

148
483
21
125
10

0 0 0 0
0 0 0 0

63

329
110
232
7
45
116
14
34
96
221
887

4

0
8
0
0
0
96
1
1
6
8
903

1 17 6 5
0 11 0 95

0 0 240
0 0 154

2 0 30
2 0 353

2 132 69

01 31
1 3

10
24
304
251
4

1

0
1
7
0
0
12
7
3
38
27
175

0 3 8
0 0 0

0 1
0 16

13
27
0
851
9

S 3
0 26

15

20
5
198
17
2
338
6
3
40
58
660

52
O
134
34 >
5

oM

0
0

20
0 x

0
0

2
2
2
0
0
42

' '

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

3 10 0 e3
5 s 5 a a a

s a z_ o 0 o e p

8. Family Conferences __...._
9. Conferences-Other Agencies..
K. MISCELLANEOUS
1. Adm. to Morbidity Service.---
2. Field & Office Visits-
Morbidity ----------------------....
3. General Medical Examinations
4. Health Cards Issued -.........
5. Visits in the Interest of
Vital Statistics ---....... ....
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service ..-...._.
2. Visits to Nursing Homes....
P. SANITATION
1. Approved Water Supplies In-
stalled, Private & Semi-Public
2. Approved Water Supplies In-
stalled, New Public Water
Connections -. .
3. New Specification Privies
Installed -. Wate .....
4. Percolation Water Table or
Soil Log Test ----... --__
5. Subdivision Analysis ._.........
6. Pollution Survey -------........ ..
7. New Specification Septic
Tanks Installed -.......... .....
8. Rabies-Number of Animal
Bites Investigated ...............-
9. Field Visits for Rabies
Investigation ........_.. _-..
10. Complaints Investigated .._...
11. Nuisances Corrected __...
12.-19. Field Visits .._..__.. ..

2 0 4 2
0 0 30 3

10 5 3
17 9 22

23 13 8

2 6
1 0
63 95
5 5
1 0
682 948
37 59
97 155
200 144
109 44
1,735 1,806

49
261
208
795
18

1
2

0

0
4
3
2
0
27
25
53
25
21
1,208

0 4
1 0

4
11
1
283
20

47
548
82
168
4

0
0

0

0
0
7
4
0
0
1
1
4
3
129

1 3 2
4 33 10

0

0
0
10
0
0
31
8
21
29
6
503

1 52

4 32 9
4 25 4

118
270
75
638
66

0
0

13

2
0
66
7
1
165
19
0
43
7
415

873
1,816

103
232
128
1,368
7

1 29
6 99

2

1
0
1
0
0
9
10
15
4
2
138

610

967
0
1,394
111
0
2,342
387
222
2,666
1,047
19,098

8 27
44 94

2

0
1
227
36
5
2,050
130
33
724
320
16,358

z

30
7

326
985
39
3,996
19

t-
0
4

56 I
105 'T
4
2,171 0
74 -
9--

7
27
CO
6

1
2
90
0
1
77
8
37
43
38
440

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

0 .0
2B
P4 ( n W V3 En"
1, a IJI |II
__ _____i^_______-_h^^__ II I__-

8. Family Conferences ----..--------- .
9. Conferences-Other Agencies .--......
K. MISCELLANEOUS
1. Adm. to Morbidity Service -- --.
2. Field & Office Visits-
Morbidity .--.....---------......---.--- -
3. General Medical Examinations ..- -----
4. Health Cards Issued ...-......-. .....
5. Visits in the Interest of
Vital Statistics
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service ---......-....-- ....
2. Visits to Nursing Homes .....-.... .....
P. SANITATION
1. Approved Water Supplies In-
stalled, Private & Semi-Public _--..
2. Approved Water Supplies In-
stalled, New Public Water
Connections .------_--...--.
3. New Specification Privies
Installed ........-.............. .
4. Percolation Water Table or
Soil Log Test .--_ -.....-.......--. --
5. Subdivision Analysis ..... -
6. Pollution Survey -....... ...- ....
7. New Specification Septic
Tanks Installed .---.....--.............
8. Rabies-Number of Animal
Bites Investigated .---...... .........---
9. Field Visits for Rabies
Investigation --.........-..... ..
10. Complaints Investigated ..._.........
11. Nuisances Corrected .-......---------
12.-19. Field Visits ..- -...-...........

7 228 18 169 2 51
91 12 296 1 56

474
1,323
22
244
209

46 16 4
630 110 12

3 0
13 12
2,009 272
33 30
9 25
4,208 1,277
210 209
290 385
1,111 450
542 295
17,247 5,141

25

8
7
129
16
2
131
7
5
98
13
450

0
0
0
660
17

4
22

183
787
186
1,775
112

9
58

0
0

71 11
74 11

451 7 366 25 3

132 3
0 0
456 110
24 6
0 42
477 50
26 14
49 16
89 42
54 15
1,576 548

3 12
0 10

84
203
45
329
8

17 2 0
9 3 13
447 14 18
13 2 0
1 0 0
373 24 43
51 8 8
112 73 1
177 53 16
66 56 12
938 917 423

1 0
7 0

2 16

74
2
28
8
0
112
13
24
38
12
517

0 1,044 0
0 404 0

182
1,618
423
2,196
92

0 18
0 263

20

2 18
26 1
0 409
0 57
0 42
30 1,457
2 207
0 305
23 370
5 131
1,168 2,705

0 0
0 0

1

0
3
2
0
0
12
2
11
37
8
270

5 5,485
6 1 3,595

23 8,468
2{ 35,036
11V 14,028 Q
477 137,821
4 1,997

I 399
S 3,188

2,986
I~3
4,727
S 828 t)
S15,177 M
1 1,381
S 633
24 36,836
17 9,104
S22,513
64 24,269
44 13,742
7 216,152
___ ____ tP_
C.'s

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

R. PROTECTION OF FOOD |
AND MILK
1. Food-handling Establishments 7 I
Admitted to Service .._ 130 37 219 76 104 1,094 21 64 23 93 26 51 5,567 16 10 679 545
2. Field Visits to Food-
handling Establishments ___ 2,637 642 1,285 757 284 2,183 299 324 188 792 39 395 32,171 69 115 1,840 2,290 O
3. Number of Food-handlers' 1
Certificates Awarded _._ ... 43 0 0 0 0 26 0 0 0 0 0 0 3,349 0 0 0 0
4. Dairy Farms Admitted to
Service 48 3 5 4 4 1 12 7 2 6 0 7 80 4 0 0 109
5. Field Visits to Dairy Farms-_I 276 28 84 54 33 2 251 90 4 70 0 50 1,496 29 0 0 905
6. Milk & Milk Products Plants
Admitted to Service--.........-... 4 0 13 1 1 4 0 0 0 5 0 4 95 5 0 0 5
Products Plants --------. ---- (-
7. Field Visits to Milk & Milk 116 0 42 24 5 15 0 1 0 24 0 24 3,626 5 0 0 171
8. Cows Tuberculin Tested .. 1,220 0 187 0 0 0 167 1 0 4 0 0 5,873 110 0 0 4,217 "'
9. Cows Bangs Tested---.....__--- 196 34 154 103 0 0 332 0 0 4 0 328 0 0 0 0 3,713 OC
10. Dairy Farms under Mastitis
Control Program ._.... _......... 82 0 10 0 0 0 0 0 1 4 0 0 0 0 0 0 60
V. HEALTH INFORMATION I
1. Meetings Attended ........_--. 1301 48 27 56 84 131 32 78 27 184 69 9 944 23 14 188 210
2. Lectures and Motion Picture I
Showings ..-.................I 1311 461 103 39 96 122 36 60 16 45 64 6 1,298 32 14 107 196
4. Radio & Television Programs 9 01 0 0 4 1 2 1 0 0 11 0 30 0 0 0 3
5. News Articles Published .-- 12 19 1 34 2 290 0 25 10 84 11 0 88 6 26 0 29
6. Exhibits Displayed 4 Oi 0 1 0 0 0 0 4 8 0 0 2 0 0 4 1
X LABORATORY
1.-21. Specimens Examined 15,614! 1,608 9,236 1,631 8,460 8,004 1,207 2,840 958 2,012 1,691 2,787 8,047 2,622 1,351 21370 26,221

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

i i 5)
ri 0 5)

R. PROTECTION OF FOOD
AND MILK
1. Food-handling Establishments
Admitted to Service .-....._._.... 8 1 40 76 4 24 113 44 32 70 12 291 2,736 51 78 115 65 4
2. Field Visits to Food- i
handling Establishments 46 288 259 165 54 857 346 170 153 75 502 18,281 468 138 529 508 38
3. Number of Food-handlers' I
Certificates Awarded ___ 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0
4. Dairy Farms Admitted to
Service _~.-.._-.....I. 1 0 8 1 8 1 1 5 5 0 3 99 26 13 38 9 22
5. Field Visits to Dairy Farms-- 1 0 181 14 67 11 5 114 46 0 22 2,816 261 56 271 213 493
6. Milk & Milk Products Plants
Admitted to Service_ 0 0 2 0 1 0 1 0 0 0 3 38 0 4 3 4 0
7. Field Visits to Milk & Milk I
Products Plants ------_.. _... 2 0 41 7 2 0 1 1 2 0 3 993 1 10 29 6 0
8. Cows Tuberculin Tested _. 250 0 424 0 0 0 0 417 0 0 0 16,183 618 0 28 556 762
9. Cows Bangs Tested...-...-........ 250 0 486 0 0 41 0 0 0 0 01 2,258 604 0 0 1,351 766 )
10. Dairy Farms under Mastitis
Control Program -..... ....... 0 0 0 0 0 0 0 0 0 0 0 99 0 0 0 3 0 j
V. HEALTH INFORMATION
1. Meetings Attended -....-......._ 34 7 181 3 6 21 30 113 7 5 23 583 1 17 18 62 8 <
2. Lectures and Motion Picture
Showings ----- 5 46 103 9 1 137 11 78 2 2 31 455 36 16 35 111 7
4. Radio & Television Programs- 0 0 1 0 0 105 0 0 0 0 4 0 1 1 0 0 C
5. News Articles Published..-__ 3 10 19 0 8 4 4 50 9 1 12 44 22 28 1 16 0
6. Exhibits Displayed ..----- 4 0 1 0 0 201 2 0 0 0 0 1 0 20' 0 0 0
X LABORATORY
1.-21. Specimens Examined ---- 1,066 973 5,005 794 442 1,649 1,82713,120 1,028 764 3,040 120,595 3,061 3,858 5,280 1,319 630
--------------------------------!---* ---------- ---- ---- ----

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

I I Z

0 0 T o 0 a 0.C.
a a a a a 0 a (5 0 Pk P C

R. PROTECTION OF FOOD
AND MILK
1. Food-handling Establishments -
Admitted to Service ....... 134 27E 172 89 9 37 231 3j 14E 12' 43 110 34 447 3E 621 180
2. Field Visits to Food-
handling Establishments ...- 41- 746 1,107 182 91 325 703 402 34( 50 271 44E 65 2,81, 341 1,956 795 O
3. Number of Food-handlers'
Certificates Awarded -...- 0 C ( 0 0
4. Dairy Farms Admitted to 10
Service -1 2 1 11 28 1 1] 41 10 -
5. Field Visits to Dairy Farms...n 22 34 156 15 1 306 138 21 21 3 10 51 429 135 -
6. Milk & Milk Products Plants
Admitted to Service ...... .. 4 4 1 1 4 ( 2 28 1
7. Field Visits to Milk & Milk CO
Products Plants ....-..- ... 41 13 1 1 12 8( 4 1 1,143 1
8. Cows Tuberculin Tested .... 731 323 1,657 1E ( 684 2,593 241 141 S ( 24 ( 3,904 1,176 n
9. Cows Bangs Tested --.___--..... 288 54 7,122 15 ( 1,219 56 39 ( 68 213 566 CD
10. Dairy Farms under Mastitis
Control Program -------- C ( ( 0 0
V. HEALTH INFORAMTION
1. Meetings Attended ...._.... 20 6E 60 5M 1 12( 332 E 3 262 15 2 8' 4f 270 27
2. Lectures and Motion Picture
Showings -- 72 25 33 5C 1 7f 318 25( 3C 29f 27, 1 I 627 2( 514 1,990
4. Radio & Television Programs.. 1 2 10 C 2 1 4 0
5. News Articles Published .----- 11 5 4 1 64 351 4 2 5 9 3
6. Exhibits Displayed _..........- 0 0 ( 4 41 ( 2( 21 0 1 2 0
X. LABORATORY
1.-21. Specimens Examined ..__ 2,842 7,429 22,261 2,594 819 1,755 13,526 4,54 894 5,76' 3,011 3,121 37S 12,367 2,47( 36,051 3,356

TABLE 1 (continued)
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1956

| s
u I & 0

R. PROTECTION OF FOOD
AND MILK
1. Food-handling Establishments
Admitted to Service .--- -- .. 2,395 872 69 184 53 217 107 52 64 84 18 1,026 25 127 65 20,608
2. Field Visits to Food-
handling Establishments -.....---.... 10,385 4,227 130 862 190 997 385 307 647 253 63 5,708 206 353 399 105,809 1
3. Number of Food-handlers'
Certificates Awarded 0 -----...... 0 0 0 0 1 0 0 0 0 1 0 2 0 0 0 3,430 1
4. Dairy Farms Admitted to
Service ------------------------------....... ... 42 45 8 7 28 10 8 7 11 2 3 29 0 16 19 929
5. Field Visits to Dairy Farms -... 677 544 45 43 242 129 22 100 157 7 42 327 0 192 210 12,263
6. Milk & Milk Products Plants
Admitted to Service .- __-. 64 14 0 5 0 4 2 0 0 2 0 26 0 2 1 385 -
7. Field Visits to Milk & Milk
Products Plants --............._.... 650 58 6 24 0 51 7 0 0 56 0 176 0 33 1 7,734
8. Cows Tuberculin Tested -.....--_ 6,203 4,856 0 235 510 100 0 267 289 44 0 515 0 541 401 56,692
9. Cows Bangs Tested ................. 1,768 460 0 226 900 100 0 340 317 46 0 271 0 541 401 26,605 /2
10. Dairy Farms under Mastitis
Control Program ..------ -------- 42 48 0 0 0 0 0 7 0 0 0 0 0 16 0 375 I
V. HEALTH INFORMATION
1. Meetings Attended .-..................- 842 204 50 24 46 224 26 6 30 46 18 96 0 35 66,612 <
2. Lectures and Motion Pictures
Showings ----....-....----------- 773 378 13 15 40 346 42 51 53 94 15 101 1 21 20 10,070
4. Radio & Television Programs 54 1 25 3 80 18 0 0 0 1 0 0 0 28 3 447
5. News Articles Published ........- 289 41 15 2 5 143 0 9 0 8 10 17 12 41 2 2,098 l
6. Exhibits Displayed ....... 12 9 1 0 8 19 0 0 0 1 0 1 0 74 0 469
X. LABORATORY
1.-21. Specimens Examined ...__. 34,365 13,796 2,804 4,607 3,166 6,901 1,882 2,286 2,172 1,271 911 5,685 1,309 2,879 1,902 559,255
1----------------!------------------------- Spcien

48 ANNUAL REPORT, 1956

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

This division continues to support the work of the bureaus, divis-
ions and county health units, thus avoiding a duplication of effort.
Leadership in the community by the public health nurse has been
a big factor in stimulating local support and in many county units
the staff has increased. However, an increase of approximately four
per cent does not meet the demands of a growing population and
the introduction of new services.

IN-SERVICE EDUCATION
A. In-service study groups: Much progress has been made in the
in-service study program. Growth in the majority of the classes
is evidence that a more purposeful and permanent type of planning
has been done. This year study was focused on interpersonal rela-
tionships and emotional health.
One of the outstanding features of the program was a three-day
workshop in leadership training held at the University of Florida.
A total of fifty public health and hospital nurses participated in
the workshop. Representatives from the field of mental health were
secured as resource persons.
B. TB Hospital exchange visits: These visits have continued with
thirty-five public health nurses visiting the hospitals and twenty of
the hospital nurses spending from one to two days in the county
health units.
C. State Hospital visits: The 48-hour visit to the State Mental
Hospital has been accepted with enthusiasm. Fifty-one public health
nurses, seventeen health officers, all staff members of the Division
of Public Health Nursing, Bureau of Mental Health, and the Di-
vision of Health Information have attended. The brief orientation
program has given the health department personnel a much better
understanding of the treatment and facilities used for mentally ill
patients. It has also assisted the public health nurse to perform
a more comprehensive follow-up program on patients referred to the
health department by the social service department of the hospital.
D. Institutes-workshops-seminars-etc.: A two-day school health
conference in Tallahassee was attended by all personnel of this divis-
ion; one consultant remained for a week to serve as a resource person.
At the request of one of the district nurses' associations, this division
in cooperation with the Bureau of Preventable Diseases, planned an
institute on the Communicable Disease Center for the northwestern
section of the state. Two representatives from the U. S. Public Health
Service were resource persons.

LOCAL HEALTH SERVICE 49

A consultant attended a two-weeks workshop in Nashville, Ten-
nessee, on child development and behavior.
E. Advanced education: Four public health nurses were granted
scholarships in 1956 for the year's program of study in public health.
(See scholarships awarded under General Summary).
Through extension work many nurses accepted responsibility for
their own education. Local organizations such as the Cancer So-
ciety and TB Association have given scholarships for short courses
at the University of North Carolina and New York University-Belle-
vue Rehabilitation Center, New York.
One consultant attended a three-day workshop on mental health
in Chicago following the biennial convention of the American Nurses'
Association.
F. In-service training: Eight nurses employed in the county units,
who had no previous formal training or experience in public health,
were sent to the training center in Gainesville.

CONSULTANT FIELD SERVICE
It has been most difficult to fill the many requests for consultant
nursing services. One consultant resigned in the fall of 1955 and
her replacement was not secured until August 1956. The new con-
sultant was given an orientation for approximately two months,
which included institutes, workshops, conferences, etc.
Public health nursing consultants have served primarily those coun-
ties where nurses are employed who have not had previous public
health nursing training or experience, and lack local nursing super-
vision.
To render consultant service in a generalized public health nursing
program with any continuity and carry 20 to 22 counties is a difficult
assignment.
Assistance was given in developing programs for career day in the
junior and senior high schools, and acting as resource persons in
nursing.
Surveys were made of the nursing activities and facilities available
in two counties. They showed the work accomplished and work that
could not be carried on due to the limited nursing staff. In one
county the survey assisted in acquiring new offices.
A. Nursing home program: This program continues to require
considerable work. Each consultant has the responsibility for the
nursing homes in her area. A one-day meeting preceding the an-
nual convention of the Florida Public Health Association was held
for health department personnel in connection with the nursing home
program.

50 ANNUAL REPORT, 1956

B. Civil defense: Two classes of four hours each were taught by
one consultant. Those in attendance were registered nurses, prac-
tical nurses, nurses' aides, orderlies and x-ray technicians.
C. Migrant program: This division has participated in securing
of personnel for the migratory labor project in West Palm Beach and
Collier County. Three program-planning meetings were attended.

FIELD EXPERIENCE
At the request of the USPHS arrangements were made to provide
experience for four foreign students. Three from the Philippine Is-
lands, and one from Bolivia, who was the director of the division of
public health nursing for the country.
Field experience was also provided for four students from the Uni-
versity of North Carolina, two from Peabody College and two from
Vanderbilt University.
Four county health units provided field experience for a total of
eighteen Florida State University students. Four of these students,
upon graduation, were employed by three health departments.
Two conferences were held, one in Gainesville and one in Tallahas-
see, with the representative from the Nursing Accrediting Service of
the National League for Nursing, to plan future field experience for
students from the two state universities.
Dade County Health Department has given field experience to
University of Miami students.

MIDWIFERY
The process of licensing 299 midwives was done through this di-
vision. Most of the yearly activities in the midwife program were
centered around the new manual. Emphasis has been on interpret-
ing the changes in its content and assisting the midwives in con-
verting their equipment to meet the new standards.
Thirty-three counties were visited by the nurse-midwife consultant
during 1956. Revisits to ten counties were made for the purpose
of following through on educational activities started on previous
visits.
Three classes in mother and baby care were taught in two counties
by the midwife consultant. These were co-sponsored by local chapters
of the American Red Cross and the county health departments. Forty-
five mothers completed these courses and received certificates from
the American Red Cross.

Assistance was also given at the Alachua County Health Depart-
ment with American and foreign students assigned to the agency for
additional experience in public health.

LOCAL HEALTH SERVICE 51

IN-SERVICE TRAINING PROGRAM
GEORGE W. GEHRES, B.S., M.P.H,.
Coordinator

Late in 1955 plans were made to train sanitarians in Jacksonville.
The format of the general instruction which they receive during the
the twelve weeks period is as follows:

Rather than spend the entire period at the Training Center, the
last four weeks are devoted to internships in selected counties. During
this internship period each of the trainees is assigned to a large county
health department for two weeks. The other two weeks the trainees
are assigned to medium and small county health departments.
During 1956 two classes of sanitarians (totaling 16) completed the
twelve week training program. The four week internships were in
the following counties: Dade, Palm Beach, Lee-Collier, Pinellas, Polk,
Levy, Lake, Seminole and Orange.

One staff member from the Field Advisory Staff, a sanitarian con-
sultant, was assigned to supervise the training activities for the sani-
tarians. A total of twenty-five field visits were made by the sani-
tation consultants to the county health departments where the sani-
tarian trainees were interning.

This training is designed for sanitarians employed in county health
departments who have not had any specialized training. In addition
to the regular classes, several who were on a standby basis in the
central office were trained for limited periods.

The program for nurse training operated during 1956 as it has
in past years. Eight nurse trainees completed eight weeks field ex-
perience in public health nursing in Alachua County. Currently four
health officers are taking post-graduate work in public health and
will return to their respective posts in June 1957. (See "Recipient of
Scholarships" under General Summary.)

On December 2. 1956 the Field Advisory Staff became an integral
part of the Bureau of Local Health Service. The position of Director,
Field Advisory Staff, will in the future be known as that of As-
sistant Director, Bureau of Local Health Service. The field con-
sultants will continue to be called the field advisory staff, although
they will be under the direct supervision of the Bureau of Local
Health Service. In November 1956 Dr. Charles J. Mathes re-
signed as Director of Field Advisory Staff. Responsibility for the
licensing of Nursing Homes and Hospitals was transferred to the new
Bureau of Special Health Services on July 1, 1956.

52 ANNUAL REPORT, 1956

The activities of the Field Advisory Staff are summarized in the
following table:

Type Visits Persons Served

Counties Number Old Em New Em- Health
Consultant Visited Visits Routine Request ployees ployees Officer Group Other

Health Officer 27 28 23 5 28 8 22 11
Sanitation 48 142 128 14 130 25 90 10 74
Record 65 171 126 45 149 33 57 3
Total 341 277 64 307 169 13 85

VITAL STATISTICS 53

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 1956 in greater detail is presented in Supplements 1 and
2 of this report under the titles Florida Vital Statistics, 1956 and
Florida Morbidity Statistics, 1956.

POPULATION
The population of the state was estimated to be 3,875,700 as of
July 1, 1956. Of this figure 3,143,000 were white and 732,700 were
non-white.
This population estimate was made by the Bureau of Economic
and Business Research of the University of Florida. The methods
used in making these estimates were approved by the Population
Committee of the Florida Development Commission. The director
of the Bureau of Vital Statistics is a member of this committee. One
of the objectives of this committee was to obtain population esti-
mates which would be accepted and used by all state agencies and
also by private business organizations.

BIRTHS
The number of births to Florida residents reached a new high with
a total of 96,969, an increase of 8.7 per cent over the previous year.
While the total birth rate of 24.8 per 100,000 population was higher
than the previous year's rate of 24.5, it was still slightly below the
estimated national birth rate of 24.9. White births totaled 69,557
and non-white births 27,412.
The white rate of 21.9 changed only fractionally from the previous
year's rate of 22.0. The non-white birth rate increased consider-
ably (7.8 per cent) from 34.5 in 1955 to 37.2 in 1956.
The figures in Table 3 show the upward trend in births and birth
rates during the years 1931-1956.

DEATHS
The 36,876 resident deaths that occurred in Florida in 1956 rep-
resent an increase of 11.8 per cent over the total deaths for the
previous year. Of these deaths, 28,500 were white and 8,376 non-
white.

54 ANNUAL REPORT, 1956

The total death rate as well as the white and non-white death
rates showed an increase over the previous year. The total rate rose
to 9.4 in 1956 from 9.1 in 1955, the white rate increased to 9.0 from
8.8, and the non-white rate became 11.3 in 1956 compared with 10.4
in 1955. The national death rate for 1956 was 9.4.
Crude death rates for the three leading causes of death showed an
increase over the previous year. Diseases of the heart with a rate
of 324.6 was 2.7 per cent higher than the rate of 316.1 in 1955. The
cancer death rate climbed to 146.4 from the previous rate of
142.9 per 100,000 population, and the crude death rate for cere-
bral vascular disease increased to 111.1 in 1956 from 107.7 in 1955.
The tuberculosis death rate, still on the decline, fell to 6.6 in 1956
from the previous year's rate of 7.7 per 100,000 population. The
syphilis death rate increased slightly to 3.2 in 1956 from 2.8 in 1955.
Tuberculosis and syphilis are the two most frequently fatal of the
infectious diseases.
The trend in resident death rates for the twenty-six year period
1931-1956 is shown in Table 3.

MARRIAGE AND DIVORCE
Marriages occurring in Florida increased by 6.3 per cent to reach
a total of 31,666. There were 25,148 white marriages, an increase
of 6.2 per cent, and 6,518 non-white marriages, an increase of 6.5
per cent.
The crude total marriage rate was 8.1 per 1,000 population, and
the white and non-white crude marriage rates were 7.9 and 8.9
respectively.
Divorces and annulments totaled 20,245, an increase of 2.5 per
cent over the previous year. The divorce and annulment rate per
1,000 population in 1956 was 5.3. Divorce and annulment rates are
not available by race.

ACTIVITIES
A major change in the operations of this bureau resulted from the
expansion of the IBM tabulating unit. Alphabetic key-punches and
verifiers, an accounting machine, a collator, and a reproducer were
added to the equipment of this unit. The following operations have
been transferred and are now being processed by the machine tabu-
lating unit: indexing of birth, death, marriage and divorce records;
preparation of monthly lists of deceased persons for each county
and city supervisor of voting registration; property and equipment
inventory formerly handled by the Bureau of Finance and Accounts;
and the registration of medical practitioners, formerly handled by
the Bureau of Narcotics. The latter will permit the tabulation of

VITAL STATISTICS 55

data for each type of practitioner by age, race, sex, and geographic
location.
Late in 1955 the bureau started a register of all persons injected
with the new Salk poliomyelitis vaccine. A punched-card was pre-
pared for each of the 1,006,203 injections reported to the State Board
of Health during the year. In addition to the register of names, the
system provides considerable statistical data.
In addition to the previously mentioned new procedures, the rou-
tine work load of the office has continued to increase. The number
of paid requests for certified copies increased 9.7 per cent. A total
of $134,084.69 in fees was collected. There were 186,384 new cur-
rent certificates filed for an increase of 8 per cent. There was a
22.5 per cent increase in the number of new birth certificates pro-
cessed for children who were adopted.
A consolidated Vital Statistics Scoreboard is shown as Table 8.
Counties are listed in order of rank showing their relative efficiency
in birth and death registration. It is gratifying to note the improve-
ment which has taken place in some counties. On the other hand,
it is discouraging that the state average has shown little change. It
is hoped that the local health departments 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.

Articles by staff members:
Williams, E. H., Thorner, R. M., Ehrmann, W., Illegitimacy in Flor-
ida. Eugenics Quarterly, 219-227, 'ec., 1956.
Thorner, R. M., Williams, E. H., Neonatal Mortality in Florida; A
Statistical Analysis, J. Florida M.A. Part I: Birthweight, Race and
Sex 42:926-930, May, 1956. Part II: Place of Birth and Attend-
ance by Midwife or Physician, 42:1017-1021, June 1956. Part
III: Cause of Death, 43:160-164, Aug., 1956.
Thorner, R. M., A Follow-up Study of Reported Cases of Polio-
myelitis, Florida, 1954. J. Florida M.A. 42-563-566, Jan. 1956.

56 ANNUAL REPORT, 1956

TABLE 2

ACTIVITIES OF THE BUREAU OF VITAL STATISTICS
DURING THE YEARS 1955 AND 1956

Per cent
Activity 1955 1956 change

Current certificates filed 172,609 186,384 + 8.0
Delayed birth certificates filed -- 3,552 4,202 + 18.3
Amended certificates filed for adoptions 2,451 3,002 + 22.5
Amended certificates filed for legitimations
and corrections of parentage -... 616 743 + 20.6
Requests for certifications
Fee paid ...........----. ----.. 82,600 90,600 + 9.7
Free -- ------- ------------ 14,953 14,877 0.5
Photostats made .--......----...-- 92,044 96,359 + 4.7
Birth registration cards made ---- ------26,812 29,683 + 10.7
Fees collected and transmitted to
State Treasurer ___ ........ $122,272.24 $134,084.69 + 9.7

TABLE 3

RESIDENT BIRTHS AND DEATHS WITH RATES PER 1,000
POPULATION, FLORIDA, 1931 1956

YEAR POPULATION BIRTHS BIRTH RATE DEATHS DEATH RATE
1956* 3,886,600 96,969 25.0 36,876 9.5
1955 3,643,562 89,112 24.5 33,295 9.1
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
*1956 data based upon preliminary totals.

TABLE 4
DEATHS AND DEATH RATES, BY CAUSE, BY RACE, FLORIDA, 1956 (PRELIMINARY)
CAUSE OF DEATH Deaths Rate Per 100,000 Population
(Numbers in parentheses refer to the International List of Causes of Death) Total White Colored Total White Colored
ALL CAUSES ---- 36,876 28,500 8,376 9.5* 9.0* 11.4*
Tuberculosis of respiratory system (001-008) ....--- ------. --------------------.. 232 151 81. 6.0 4.8 11.0
Tuberculosis, other forms (010-019 _---------------------------- 12 6 6 .3 .2 .8
Syphilis and its sequelae (020-029) .-------------- -------------- ---- -------- 126 65 61 3.3 2.1 8.3
Typhoid Fever (040) ------------------------------------------------------------------------------------ ----- 1
Dysentery, all forms (045-048) ------- -.....----.-.------------------ 15 3 12 .4 .1 1.6
Diphtheria (055) ....--------------- ----------------..----- --2 1 1 .1 .1
Meningococcal infections (057) ... ------------ -- ----- ----19 14 5 .5 .4 .7
Acute Poliomyelitis (080) 8 5 3 .2 .2 .4
Acute Infectious Encephalitis (082) -- --- -------------- --- 13 10 3 .3 .3 .4
Measles (085) ...-- ----------...-..--......---- ------ 8 6 2 .2 .2 .3
Typhus and other rickettsial diseases (100-108) -.------------------------- ------ -------- 0 0 0 --
All other diseases classified as infective and parasitic (030 to 138 with exception of above causes 151 77 74 3.9 2.4 10.1
Malignant Neoplasms, including neoplasams of Lymphatic and Haematopoietic tissues (140-205) 5,694 4,814 880 146.5 152.7 120.0
Diabetes Mellitus (260) .....-- -- --.....------ -- --------------------------- 545 413 132 14.0 13.1 18.0
Anemias (290-293) ..----------------- ------- -------- 70 44 26 1.8 1.4 3.5
Major Cardiovascular-Renal disease .- ......---......-------------------- 18,874 15,441 3,433 485.6 489.7 468.2
Cerebral vascular disease (330-334)---------------------- 4,371 3,319 1,052 112.5 105.3 143.5
Rheumatic fever (400-402)-------- ----------------------- 15 7 8 .4 .2 1.1
Diseases of the heart ........------------------- ---..---.......------ 12,789 10,820 1,969 329.1 343.1 268.5
Chronic rheumatic heart disease (410-416) ...... ---- -_ .- ---416 356 60 10.7 11.3 8.2
Arteriosclerotic heart disease, coronary disease (420) __------------- ---------- 9,267 8,329 938 238.4 264.1 127.9
Nonrheumatic chronic endocarditis & Myocardial
degeneration (421, 422) od--- -- ---------- i 979 757 222 25.2 24.0 30.3
Hypertension with heart disease (440-443) --_ ---- ----------- -- 1,449 870 579 37.3 27.6 79.0 Cr
Other diseases of heart (430-434) ---_ .---------------- 678 508 170 17.4 16.1 23.2
Hypertension without heart disease (444-447) ..----- .. ..------------- ------- 293 204 89 7.5 6.5 12.1
General arteriosclerosis (450) ........... -------------------...........----------......590 499 91 15.2 15.8 12.4
Other circulatory disease (451-468) .---..-..-..-...... ..........------- ----- 441 373 68 11.3 11.8 9.3
Chronic and unspecified nephritis (592-594) ...-----------....-.- -------375 219 156 9.6 6.9 21.3
Influenza (480-483) ......---------------.-------------- -----. ..------------ 79 28 51 2.0 .9 7.0
Pneumonia (490-493) -.........--------- ----- -----981 581 400 25.2 18.4 54.5
Ulcer of stomach and duodenum (540-541) ----------------- --231 184 47 5.9 5.8 6.4
Intestinal obstruction and hernia (560, 561, 570) --------------- ---------------- 243 163 80 6.3 5.2 10.9 Cl
Gastritis, duodenitis, enteritis & colitis, except diarrhea of the newborn (543, 571, 572) .---- 277 120 157 7.1 3.8 21.4
Cirrhosis of liver (581) ..-.-- -----------.-----_----. ---- 415 348 67 10.7 11.0 9.1
Acute nephritis and nephrosis (590, 591) _.......-.......-.. -- ......... ---- 54 29 25 1.4 .9 3.4
Complications of pregnancy, childbirth and the puerperium (640-652, 660, 670-689) 64 25 39 .7** .4"* 1.4**
Congenital malformations (750-759) --__.-------___ ... ------- 431 332 99 11.1 10.5 13.5
Birth injuries, postnatal asphyxia & Atelectasis (760-762) .- ----------_____ 775 482 293 19.9 15.3 40.0 -I
Infection of the newborn (763-768) --------.------..... -.-------------.... 144 60 84 3.7 1.9 11.5
Other diseases peculiar to early infancy, and immaturity unqualified (769-776) -..-.......-. 921 505 416 23.7 16.0 56.7
Symptoms, senility, and ill-defined causes (780-795)--------. ----------- 724 425 299 18.6 13.5 40.8 H-
All other diseases (residual) ---------- ----------.......... .--- 2,327 1,736 591 59.9 55.1 80.6 H
Motor vehicle accidents (810-835) ---------------- ------------- 1,133 875 258 29.2 27.7 35.2
All other accidents (800-802, 840-962) -----......---------------- 1,416 981 435 36.4 31.1 59.3
Suicide and self-inflicted injury (963, 970-979) ---------- --_ --------------- 476 456 20 12.2 14.5 2.7 Cl)
Homicide and operations of war (964, 965, 980-999) --------. 415 119 296 10.7 3.8 40.4
Infant Mortality (deaths under one year of age) -..--.....- ___ ... -.. 3,147 1,679 1,468 32.5** 24.1'* 53.6*
*Rate per 1,000 population.
"*Rate per 1,000 live births. CD
***Rate less than 0.05. 1

58 ANNUAL REPORT, 1956

TABLE 5
ESTIMATED POPULATION AND PRELIMINARY TOTALS OF BIRTHS,
DEATHS, AND INFANTS DEATHS BY COLOR, FLORIDA, 1956

Total

STATE... 3,886,600 96,969

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.

65,900 1,809
7,200 208
57,200 1,900
12,000 343
53,500 1,509
205,100 5,013
7,300 181
5,100 88
6,200 150
17,400 545
12,900 321
19,500 595
757,700 17,746
9,500 192
3,900 107
400,100 11,133
152,700 5,122
4,800 131
5,400 126
43,500 1,083
2,900 64
2,800 52
9,400 277
8,600 260
12,000 228
6,600 197
8,700 204
16,300 440
332,600 8,091
12,300 221
17,100 467
36,500 863
9,200 334
3,000 53
46,600 1,055
36,700 852
62,400 1,780
9,400 247
2,400 85
15,000 425
46,000 996
45,900 1,152
10,500 268
40,200 1,335
15,600 467
51,100 1,744
4,400 110
196,700 4,919
13,700 283
173,400 3,882
26,800 538
235,700 3,875
164,500 4,160
30,900 840
32,500 717
29,800 785
23,200 678
44,400 953
36,400 979
10,800 276
14,600 358
12,800 343
7,900 105
91,900 1,982
4,700 126
14,500 343
10,300 258

. BIRTHS DEATHS INFANT DEATHS
4TI B

White

69,557
1,170
139
1,582
227
1,213
3,159
140
72
99
453
240
351
13,414
120
88
7,985
3,850
58
94
292
53
28
197
115
190
115
110
303
6,485
208
291
552
86
46
672
607
1,003
134
61
167
644
577
150
1,187
319
1,626
79
3,836
226
2,525
437
2,987
3,073
461
448
387
593
739
524
157
241
243
65
1,339
81
279
165

,olored

27,412
639
69
318
116
296
1,854
41
16
51
92
81
244
4,332
72
19
3,148
1,272
73
32
791
11
24
80
145
38
82
94
137
1,606
13
176
311
248
7
383
245
777
113
24
258
352
575
118
148
148
118
31
1,083
57
1,357
101
888
1,087
379
269
398
85
214
455
119
117
100
40
643
45
64
93

Total White Colored

36,876 28,500 8,376
540 298 242
59 38 21
338 264 '74
126 89 37
420 333 87
1,735 1,310 425
69 64 5
92 79 13
101 75 26
136 109 27
93 52 41
233 128 105
6,904 5,894 1,010
110 82 28
40 30 10
3,234 2,138 1,096
1,106 754 325
52 27 25
68 42 26
352 115 237
33 27 6
17 8 9
50 31 19
82 48 34
107 101 6
64 38 26
84 66 18
194 144 50
3,054 2,487 567
108 100 8
175 135 40
313 201 112
100 41 59
26 23 3
526 404 122
368 281 87
449 212 237
110 60 50
30 24 6
148 62 86
587 492 95
477 278 199
109 74 35
299 234 65
123 83 40
222 201 21
55 39 16
1,690 1,414 276
204 186 18
1,805 1,282 523
324 293 31
3,712 3,449 263
1,427 1,109 318
334 196 138
322 226 96
275 179 96
143 119 24
544 477 67
353 189 164
123 82 41
180 122 58
113 62 51
44 33 11
1,273 1,035 238
41 27 14
143 122 21
108 83, 25

Total White

3,147 1,6791

colored

1,468
32
5
19
2
17
133
3
1
4
3
12
12
260
5
1
109
68
3
3
65
0
1
6
5
0
6
5
9
84
1
11
10
6
0
15
17
39
8
1
11
19
20
9
12
2
4
6
40
1
112
3
50
43
22
12
34
6
11
20
10
2
5
0
24
3
3
3

_j

, ,

VITAL STATISTICS

TABLE 6
PRELIMINARY TOTALS OF RESIDENT DEATHS FROM
SELECTED CAUSES, FLORIDA, 1956

^ Cardio-Vascular-Renal Dis.

TATE..... 64 244 126 15 5,694 545 70 1,060 4,371 12,789 375 1,339 133
STATE...-..- 164 244 1126 15 8 5,694 5451 70 1,060 4,371 12,789, 375 1,339 1,133 1,416

Alachua ...- 2 2 2 0 0 73 6 0 29
Baker .- 0 1 1 0 0 2 0 0 2
Bay 0. 2 0 0 1 38 4 1 13
Bradford-. 2 2 0 0 0 17 2 1 3
Brevard-.... 3 0 0 0 0 63 11 0 14
Broward 4 4 3 5 1 307 32 4 59
Calhoun 0 1 0 0 0 10 1 0 2
Charlotte- 0 0 1 0 0 20 0 0 4
Citrus ....-... 0 0 0 0 0 17 3 0 3
Clay- 0 1 1 0 0 19 2 0 5
Collier ..-. 0 0 0 0 0 11 0 0 3
Columbia 1 0 2 0 0 24 1 0 18
Dade ....... 5 49 35 0 1 1,227 117 17 173
DeSoto -..... 0 0 0 0 0 15 3 0 5
Dixie ....0.. 1 0 0 0 3 0 0 6
Duval...... 6 41 22 2 1 472 57 3 103
Escambia 7 9 3 0 2 131 15 1 44
Flagler 0 0 1 0 0 8 0 2
Franklin ....-. 0 1 0 0 0 7 1 0 1
Gadsden.... 1 3 1 1 0 39 1 1 23
Gilchrist...... 0 0 0 0 0 8 0 0 4
Glades ...-- 0 0 0 0 0 1 0 0 1
Gulf .....0... 0 0 0 0 5 0 0 1
Hamilton 0 1 0 0 0 7 1 0 5
Hardee ......... 1 2 1 0 0 19 0 0 0
Hendry 0 1 0 0 0 11 0 0 4
Hernando 0 1 1 1 0 7 b 0 2
Highlands.. 1 4 2 0 0 28 2 0 6
Hillsborough 1 28 4 0 0 527 59 5 62
Holmes 0 0 0 0 0 15 1 0 5
Indian River 0 0 1 0 0 25 1 0 4
Jackson 1 3 1 0 0 43 3 0 10
Jefferson.....1 1 0 0 0 10 0 0 5
Lafayette .. 0 0 0 0 0 4 1 0 0
Lake ... 0 2 2 1 0 81 5 2 16
Lee .......... 1 1 2 0 0 50 7 0 13
Leon 0 2 0 0 0 47 6 1 20
Levy .. 0 0 0 0 0 17 0 0 2
Liberty .-.. 0 0 0 0 0 1 1 0 4
Madison .... 0 1 0 0 0 19 6 0 5
Manatee...... 0 3 4 1 0 79 10 1 20
Marion......... 1 3 2 0 0 59 8 1 15
Martin..--.... 0 1 0 0 0 18 1 0 3
Monroe......... 0 1 0 0 0 46 6 1 6
Nassau ....... 1 2 1 0 0 12 0 0 4
Okaloosa ......0 1 0 0 0 18 0 0 5
Okeechobee. 1 0 0 0 0 8 0 0 7
Orange......... 1 15 3 0 0 243 24 3 41
Osceola .... 0 0 1 0 0 28 3 2 2
Palm Beach.. 3 7 2 3 2 273 24 5 43
Pasco ......-- 1 1 1 0 0 69 7 0 3
Pinellas .....- 6 15 10 0 0 641 54 6 77
Polk ............. 2 8 7 0 0 206 18 6 42
Putnam.. 2 1 0 0 0 38 1 3 11
St. Johns......- 1 1 1 0 0 38 5 3 6
St. Lucie..... 0 1 1 0 36 1 0 8
Santa Rosa .. O 0 0 0 0 20 0 0 12
Sarasota..... 0 4 0 0 0 96 5 0 9
Seminole ...... 1 4 3 0 0 45 7 1 10
Sumter..... 1 1 0 0 0 19 2 0 5
Suwannee..... 1 1 1 0 0 27 2 0 6
Taylor...........1 1 1 0 0 12 0 0 3
Union............0 1 0 0 0 2 2 0 0
Volusia......... 2 5 2 0 0 119 16 2 35
Wakulla........ 0 0 0 0 8 0 0 1
Walton. 2 3 0 0 0 14 0 0 3
Washington.0 1 0 0 0 12 0 0 21

89
8
38
8
40
174
10
11
21
19
11
36
611
14
4
418
145
4
7
47
7
0
5
11
14
5
5
16
297
18
19
53
18
4
55
51
64
20
3
23
72
75
19
45
10
19
5
230
36
213
38
505
171
33
37
36
16
62
44
25
32
14
7
162
6
38
18

lIncludes all vascular lesions affecting the central nervous system.

153
23
85
51
132
563
19
35
30
47
18
66
2,481
41
16
1,029
316
11
25
103
6
6
13
27
43
20
24
62
981
28
72
81
32
11
204
121
122
33
12
38
229
161
30
85
39
49
12
659
78
658
120
1,536
514
90
101
94
41
233
120
31
54
38
18
535
7
47
33

,

60 ANNUAL REPORT, 1956

TABLE 7
PRELIMINARY TOTALS OF MARRIAGES BY COLOR, DIVORCES, AND
ANNULMENTS FOR FLORIDA, AND EACH COUNTY, 1956

COUNTY MARRIAGES Divorces Annulments
Total White Colored
STATE .-..-------------..--. 31,666 25,148 6,518 20,100 145
Alachua 434 278 156 188 0
Baker ----.-- 35 29 6 508 0
Bay ------- 424 336 88 160 0
Bradford 63 38 25 510 4
Brevard --.... .. ..----- 423 335 88 513 2
Broward ..---- 1,883 1,450 433 787 2
Calhoun -... -.. ... .27 20 7 49 0
Charlotte .---....___ 72 66 6 24 0
Citrus -- 87 61 26 54 0
Clay -- 82 71 11 64 1
Collier -- ..... ..... 148 133 15 16 0
Columbia ---...- ...- 134 82 52 71 0
Dade ---7,430 6,445 985 4,991 43
DeSoto.----- ------- 92 77 15 17 0
Dixie ------- 28 24 4 13 0
Duval .... 1,986 1,527 459 837 4
Escambia ._ _962 781 181 900 10
Flagler ....... 43 21 22 287 1
Franklin ..........- --------- 57 48 9 22 0
Gadsden_ 181 69 112 68 0
Gilchrist 50 39 11 8 0
Glades_ ----- 24 16 8 4 0
Gulf -------- 71 50 21 30 0
Hamilton_- 48 33 15 31 0
Hardee__ 156 135 21 322 3
Hendry -- 138 100 38 26 0
Hemando -____ .-........... 130 111 19 33 0
Highlands .........---- -----. 156 111 45 163 0
Hillsborough -- 2,884 2,404 480 1,410 9
Holmes --- 51 46 5 47 0
Indian River- 195 129 66 32 0
Jackson............ ... 165 106 59 89 0
Jefferson .------------------. 54 24 30 7 1
Lafayette -- 11 9 2 3 0
Lake .....------ 378 254 124 459 2
Lee .... .........-------- 317 242 75 119 0
Leon -............------ 415 237 178 286 4
Levy 75 41 34 31 0
Liberty ..._-.... --. ----- 10 9 1 23 0
Madison ..----. 57 45 12 37 0
Manatee -------- 441 356 85 71 0
Marion ...-----------.......- 342 205 137 184 1
Martin------ 117 84 33 19 0
Monroe .---....----------- 456 388 68 304 3
Nassau .......--.......----- 62 54 8 16 0
Okaloosa --- --. 265 239 26 188 4
Okeechobee-- -- 51 34 17 15 0
Orange .--.......---------. 1,586 1,282 304 392 4
Osceola -.._._- 191 142 49 16 0
Palm Beach ....._... ---...- 1,543 1,090 453 646 5
Pasco _.......... ------------- 315 261 54 102 0
Pinellas ---__ --- 1,988 1,732 256 738 5
Polk ..........------......... -- 1,463 1,170 293 1,228 15
Putnam _..-....--. 197 114 83 702 1
St. Johns. .--...- 201 145 58 670 11
St. Lucie ----- 322 174 148 136 0
Santa Rosa- -- -- 126 115 11 99 1
Sarasota ---- 464 393 71 197 1
Seminole --- ---. 322 196 126 203 0
Sumter .----- 112 76 36 77 3
Suwannee ---- 117 84 33 60 1
Taylor-- ---- 77 56 21 19 0
Union ... ---- 43 30 13 302 2
Volusia --- 720 571 149 425 2
Wakulla .... ---- 41 19 22 0 0
Walton ------------- 67 58 .9 36 0
Washington ...........--- ---- 61 48 13 16 0

VITAL STATISTICS 61

TABLE 8
VITAL STATISTICS SCOREBOARD
Based on Promptness and Completeness of Certificates
Filed in 1956
Percent of Percent of Percent of
Certificates Complete Monthly Total Score Change
COUNTIES Rank Filed on Time Certificates Reports (Maximum from 1955
Submitted Equals 500) TotalScore
Births Deaths Births Deaths on Time
Wakulla 1 100 100 100 100 100 500 + 5
Sarasota .--- 2 100 100 99 98 100 497 + 2
Hillsborough_ 3 96 99 100 100 100 495 + 7
Orange- 4 99 99 99 98 100 495 +21
Baker 5 99 95 100 100 100 494 + 7
Hernando... 6 97 97 99 100 100 493 2
Okeechobee 7 98 98 98 98 100 492 2
Volusia.. 8 96 97 99 99 100 491 + 2
Dade ---- 9 94 96 100 100 100 490 1
Escambia -. 10 93 98 99 99 100 489 2
Martin ... 11 100 98 99 100 92 489 + 6
Citrus .... 12 88 100 97 99 100 484 +12
Polk ---.... 13 91 97 99 97 100 484 1
Franklin...... 14 92 98 96 97 100 483 3
Jefferson .. 15 88 98 98 99 100 483 +15
Monroe -... 16 97 90 98 97 100 482 +16
Charlotte......- 17 86 98 97 99 100 480 7
St. Lucie ........ 18 92 94 98 96 100 480 0
Broward..... 19 86 96 98 98 100 478 + 3
Gilchrist.-....... 20 88 94 96 100 100 478 +26
Bay ...... 21 87 94 98 98 100 477 + 1
Hardee .. -- 22 95 96 96 98 92 477 + 9
Pinellas...... 23 91 93 99 100 92 475 +47
Marion -... 24 84 97 97 96 100 474 -10
Indian River.. 25 82 95 97 99 100 473 +84
State ...... 88 95 98 99 92 472 + 3
Gulf ............. 26 94 87 93 98 100 472 +10
Gadsden... 27 83 90 99 99 100 471 +22
Madison-...... 28 88 100 95 96 92 471 -12
Duval 29 77 98 96 98 100 469 2
Levy.-....--....... 30 88 85 100 96 100 469 + 3
Seminole....... 31 99 99 97 99 75 469 + 2
Collier-- ........ 32 90 95 99 99 83 466 -12
Holmes......- 33 94 90 95 94 92 465 + 8
Nassau---.... 34 97 96 99 98 75 465 +21
Palm Beach.... 35 71 96 99 99 100 465 -11
Putnam -.....36 89 81 97 97 100 464 +14
Suwannee--... 37 94 99 99 97 75 464 + 2
St. Johns ........ 38 90 93 99 98 83 463 6
Washington... 39 85 87 95 95 100 462 4
Alachua-...... 40 81 82 99 96 100 458 +47
Liberty....... 41 100 85 81 100 92 458 +31
Walton....... 42 92 83 100 100 83 458 -11
Brevard-..... 43 88 89 98 99 83 457 -24
Highlands-.... 44 74 93 99 99 92 457 -14
Lee .......... 45 64 97 99 97 100 457 2
Lake ...----. 46 83 79 97 97 100 456 1
Leon----....... 47 81 88 98 97 92 456 +11
Manatee--..... 48 94 99 97 98 67 455 -36
Calhoun -.. 49 85 83 94 92 100 454 + 5
Clay---...........- 50 81 85 98 98 92 454 -12
Dixie ............ 51 69 100 95 97 92 453 -5
Santa Rosa..... 52 90 94 96 98 75 453 -25
Bradford...53 97 97 96 94 67 451 + 4
DeSoto --.. 54 100 100 98 94 58 450 -27
Union-........55 84 86 91 96 92 449 +23
Osceola-..-.. 56 87 96 99 99 67 448 -19
Lafayette -... 57 60 94 100 100 92 446 + 4
Jackson.. 58 80 73 96 96 100 445 +14
Sumter ...... 59 74 71 99 99 100 443 -28
Flagler---..- 60 99 89 94 91 67 440 +21
Hendry .......... 61 64 78 97 100 100 439 +16
Taylor ....... 62 57 92 96 98 92 435 -10
Pasco ........63 75 92 95 93 75 430 -14
Hamilton. 64 56 73 98 98 100 425 2
Okaloosa.. 65 77 84 98 96 58 413 -28
Glades ... 66 25 100 75 100 100 400 -24
Columbia ----. 67 35 69 98 99 58 359 +19

62 ANNUAL REPORT, 1956

BUREAU OF MATERNAL AND CHILD HEALTH
R. W. McCOMAS, M.D., M.P.H., Director
E. L. FLEMMING, Ed.D., Clinical Psychologist
EARL LOMON KOOS, Ph.D., Social Scientist

The Bureau of Maternal and Child Health and the Bureau of
Mental Health are now completely separated. A new director of
the latter bureau was appointed in February 1956 relieving the di-
rector of this bureau of further administrative responsibility for that
program.
One full-time Consultant on Child Growth and Development, a
clinical psychologist, was added to the staff in September 1956. Also
added was a social scientist who is part-time Consultant on Family
Life. For the first time in recent years, funds became available to
fill the position of School Health Consultant and plans were made
to add this person to the staff on January 1, 1957; however, the ap-
plicant failed to accept the position. Other plans for filling it have
been made which it is hoped will materialize during the current
fiscal year.
The study project on Health Services for Migrant Agricultural
Workers terminated in 1956. A full report on activities relating to
migrants appears in another section of this report.

MATERNAL HEALTH
The maternal death rate rose by 3 per cent over the previous year.
This is the first time in nineteen years that the steady drop in the
maternal death rate has reversed itself. Preliminary tabulations show
a total of 64 maternal deaths with a rate of 6.6 per 10,000 live births.
In 1955, there were 57 maternal deaths with a rate of 6.4 per 10,000
live births. There have been no significant changes in the relative
importance of the reported causes of maternal death. The number
of practicing midwives has been reduced and their supervision, if
anything, has been improved.
This bureau is jointly responsible for supervision of the midwifery
program, but the specific activities of the Nurse-Midwife Teacher
will be reported by the Division of Public Health Nursing elsewhere
in this volume. There was a sharp reduction in the number of mid-
wives licensed: from 345 in 1955 to 299 during 1956. Nine new mid-
wives were licensed for areas where there was definite need for their
services and 10 were retired during the year. Late in 1956 at the
request of the Governor, the midwife program was reviewed and
a report prepared recommending certain steps that would improve
maternity services for low-income families. It is hoped that the
Hospital Program for the Indigent will secure more adequate funds

MATERNAL AND CHILD HEALTH

FIG. I
RESIDENT MATERNAL DEATH RATES
(PER 1.000 UVE BIRTHS) BY RACE
FLORIDA 1933 1956

IS

t

0. to

-J

for the next biennium and that the Act can be interpreted to pro-
vide for both normal and abnormal obstetrical cases. This would
do much to improve maternity services in areas served by hospitals
and thereby reduce the necessity for midwives in those areas.
There has been continued emphasis on the development of low-
cost maternity plans and the interest in this program continues to
increase. There has been some tendency during the year to increase

64 ANNUAL REPORT, 1956

hospital charges and in some areas private physicians have volun-
teered to provide prenatal services.
A review of maternal deaths continues to reveal that at least half
of them are preventable, emphasizing the need for careful medical
review of these deaths, education of the public, and better maternity
services. The special form developed by this bureau for use in
studying social and economic factors related to maternal mortality
was not accepted by the maternal and child health committee of
the Health Officers Conference in 1956. It was felt that the form
was too long and would require too much time on the part of both
public health physicians and nurses. The proposed form has been
modified and it is hoped that it will be possible to present it for
further discussion at the next conference.
The Annual Tri-State Obstetric and Pediatric Seminar was held in
Daytona Beach on September 10-11-12. There was a record attend-
ance with increased participation from the states involved-South
Carolina, Georgia and Florida. Attending the Seminar were 254 phy-

FIG. 2
RESIDENT INFANT DEATH RATES
IPER 1.000 LIVE BIRTHS) BY RACE
FLORIDA 1933 1956
120

105

90

60 NON-WHITE
TOTAL
S45

WHITE
zmn

1945
YEAR

MATERNAL AND CHILD HEALTH 65

sicians, 88 nurses and three others making a total of 345 persons who
came from the following states: Florida 258, Georgia 45, South Caro-
lina 27, and 15 from other states. The Seminar is sponsored by the
Bureaus of Maternal and Child Health of the three State Health De-
partments and the Maternal Welfare Committees of the three State
Medical Associations. The program was well received and another
Seminar is being planned for 1957.

CHILD HEALTH
The number of births reached a record high of 96,969 this year
according to preliminary figures. The infant mortality rate increased
in 1956 as compared with the preceding year. The provisional rate
of 32.5 per 1,000 live births represents an increase of 9.4 per cent
over 1955. At this time there has been no opportunity to study the
probable causes for this increase; however, this will be done in the
very near future.
At the time of the Annual Report last year, Salk vaccine was a
major concern because the demand for it exceeded the supply. At
this time vaccine is plentiful and the chief concern is with public
apathy concerning its use. Local health departments, assisted by
the State Board of Health, are engaged in a campaign urging the
public to have their children vaccinated before the onset of the
polio season.
There was an increase in the number of premature infants cared
for at the Premature Demonstration Center, Jackson Memorial Hos-
pital, Miami under the special project grant from the U.S. Children's
Bureau. The annual report of the Center is not available at this
time, but a preliminary report from the Dade County Health De-
partment indicates that 261 patients were admitted and cared for
under this program. Of this number 83 were white and 178 were
non-white, and they came from Dade, Palm Beach, Broward and
Monroe Counties.
Special equipment in the form of both standard and specialized
incubators has been distributed to hospitals in various parts of the
state to provide better services for premature infants. This equip-
ment was placed in the hospitals on indefinite loan from the county
health departments.
In July 1956 the U. S. Children's Bureau announced that addi-
tional monies were available to the state for the purpose of strength-
ening School Health Programs and providing certain health services
for mentally retarded children. In addition a fixed sum was avail-
able for special projects for retarded children. The increased funds
under the regular state formula were utilized to provide additional
staff for the Bureau of Maternal and Child Health and to establish
four positions in selected child guidance clinics for increasing their

66 ANNUAL REPORT, 1956

services to retarded children. These positions were either clinical
psychologists or psychiatric social workers at the clinics in Escambia,
Orange, Sarasota-Manatee, and Palm Beach Counties. Considerable
time has been spent during the past few months negotiating with
the Children's Bureau for a special project grant for retarded children
without success to date.
The Consultant in Child Growth and Development was employed
to explore ways of helping parents and other individuals concerned
with children understand the normal growth process and the in-
herent problems within this process.
In the initial phases of this program, it was necessary to contact
people in health and education, discussing with them their felt needs
in the understanding of the "normal child." These groups indicated
a need for more formal training in a workshop experience in Child
Growth and Development, in techniques of counseling or interview-
ing, and simple diagnostic procedures which would allow them to
differentiate between those problems which are a part of the normal
growth process and those which are the result of some traumatic
experience.
Several different types of workshop experiences have been tried
out. In one workshop parents in a single school met with the con-
sultants for a series of two-hour sessions according to the age group
of their children. Before the discussion began the parents were
asked to indicate a behavioral problem within their child for which
they had considered referral to a child guidance clinic for assistance.
At the completion of the session the parents were asked to indicate
whether or not the problem still seemed to require outside assistance
or if it fell within normal growth limits. Of a total of 167 parents,
33 indicated behavioral problems in their children which seriously
concerned them. Of these 33 only two indicated, at the completion
of the workshop, that they still felt a need for outside professional
help. This indicated a rather marked attitudinal shift within the
parents as their understanding of the behavioral problems associated
with the growth process increased. While this program has not been
in effect long enough to have any measurable results, it would appear
that parents and professionals in health and education have a tre-
mendous need for understanding normalcy and that as their under-
standing increases, their tension about their children's behavior de-
creases.
During this time meetings have been held with personnel of ten
different health departments outlining the proposed program and
exploring their felt needs for in-service training in the areas pre-
viously mentioned. As a result of these contacts, workshops have
been scheduled in four different health departments within the state.
In addition, the program has included a regularly scheduled tele-

MATERNAL AND CHILD HEALTH

vision show focusing entirely upon the child and how he grows,
which has been presented through the courtesy of WMBR-TV in
Jacksonville. The excellent response to this program certainly leads
to speculation as to the great potential of television as a health educa-
tion medium.

SCHOOL HEALTH
During 1956 the School Health Program in Florida received a
tremendous boost because of two developments. First, many schools
had the experience of having, for the first time for a whole school
year, a school health coordinator appointed from the faculty. This
is a requirement as set forth in the "Standards of Accreditation of
Florida Schools, adopted April 20, 1954."
Early in the year a statewide conference was held at Florida State
University in Tallahassee bringing together appropriate persons from
the State Board of Health, the State Department of Education, Florida
State University and the public schools. This conference was held
jointly with a summer course for school health coordinators at Florida
State University. Much time was given to discussion of the roles
and responsibilities of school health coordinators in addition to ways
and means of improving School Health Programs at the local level.
Later in the summer a similar conference was held for negroes at
Florida A & M University. Second, concurrently with these con-
ferences, plans were developed by the Consultant on Health, Phy-
sical Education and Recreation, State Department of Education, for
bringing a nationally known health educator into the state for the
current school year to work with the school health coordinators in
planning School Health Programs at the local level. This effort
was assisted by financial grants from several voluntary health agen-
cies as well as a grant from the Bureau of Maternal and Child Health
of the State Board of Health. The services of Dr. George T. Staf-
ford of the University of Illinois were secured and he started his
work in September and is currently holding a series of school health
"clinics" throughout the state.
During the year special equipment in the form of audiometers and
illuminated Snellen charts has been distributed to county health de-
partments for use in the School Health Program. This equipment
was purchased with funds from the U. S. Children's Bureau.

HEALTH SERVICES FOR MIGRATORY
AGRICULTURAL WORKERS
As previously indicated the special study project on Health Services
for Migratory Agricultural Workers terminated on June 30, 1956. The
two full-time persons employed on this project were transferred to
other programs. The report has been completed and is now be-
ing printed and will be available for distribution early in 1957. As

68 ANNUAL REPORT, 1956

a result of the study project, and of the 1954 Washington Confer-
ence on Migrants, a second conference relating specifically to the
health problems of migrants was held in West Palm Beach in April.
This conference was attended by representatives of health depart-
ments and their local units from New York to Florida. Several per-
sons representing other migrants streams and from the Federal serv-
ices were also in attendance.
In the summer of 1956 the State Board of Health received a grant
of $54,900 annually for a period of five years from the Children's
Bureau for the purpose of developing a health service project for
migrants in the Belle Glade-Pahokee area of Palm Beach County
and the Immokalee area of Collier County. This provides for the
employment of additional physicians and public health nurses in
these two areas; also a medical social consultant, a health educator,
a nutritionist and a health aide. Selected nursing districts have been
designated and the project team will focus its attention on devel-
oping better and more effective methods of providing health serv-
ices to negro migrants. The project team is now complete with
the exception of a nutritionist and over the past several months
organizational and planning meetings have been held to plan the
project.
The Governor's Advisory Committee on Migrant Labor held a
series of hearings about the state early in the year and has recently
completed its recommendations to him.
Late in the year the Governor appointed a Committee on Chil-
dren's Institutions, of which the director of this bureau is a member,
to advise the Cabinet concerning the state's responsibilities in this
area and to do the necessary studies to develop plans for these in-
stitutions in the future. The committee has held two meetings and
plans to have other meetings in the several institutions to be studied.
The committee will report directly to the Governor and the Cabinet
with the exception of its legislative recommendations which will
channel through the Florida Children's Commission.

PREVENTABLE DISEASES

BUREAU OF PREVENTABLE DISEASES
C. M. SHARP, M.D., Director
JAMES O. BOND, M.D., M.P.H., Epidemiologist

EPIDEMIOLOGY
Services in epidemiology in 1956 were carried out by one physi-
cian epidemiologist and two clerical staff members, under the di-
rect supervision of the director of the bureau.
Early in 1956 the new Rules and Regulations for Control of Com-
municable Diseases were adopted and distributed throughout the
state. These revised and replaced the old Chapter 34 of the Sani-
tary Code. One important change in reporting of diseases was
made, affecting the reported numbers of certain diseases, to be noted
later. Measles, whooping cough, streptococcal infections, influenza,
chickenpox, mumps and hookworm reports were required by number
of cases only, rather than by individual names of cases. Increased
total numbers of such cases reported were expected as a result of
this change.

POLIOMYELITIS
Poliomyelitis continued to receive the major amount of effort and
interest in the control of communicable diseases. Total reported
cases fell from 466 in 1955 to 364 in 1956; a 22 per cent reduction.
The rate of paralytic polio per 100,000 population dropped to 2.7
from 3.6 in the preceding year. The large number of Salk vaccine
immunizations undoubtedly played a role in this reduction, but the
exact magnitude of the effect is unknown. Under the Federal Polio-
myelitis Assistance Act of 1955, 1,335,552 cc of vaccine had been
distributed to Florida counties as of December 31, 1956. Adding the
315,000 cc of vaccine used in the National Foundation for Infantile
Paralysis program of 1955, the distribution of Salk vaccine by in-
jection number and age is given in Table 9. It is seen from this
that at least 575,222 children under 20 had received one or more
injections by the end of 1956. This is 45.9 per cent of the estimated
eligible population. 178,798 or 14.3 per cent were known to have
received the completed series of three injections. An additional
unknown number of injections of commercial vaccine were given to
individuals under 20, but the number is estimated to be relatively
small.
The surveillance for safety of the vaccine was continued as a
part of the National Surveillance Program. Table 10 shows that 83
cases of poliomyelitis were reported in 1956 following Salk vaccine
immunization. No correlation of these cases was found with pa-
ralysis and site of inoculation, manufacture or lot number. It was

70 ANNUAL REPORT, 1956

again concluded that Salk vaccine is as safe as any other biological
used in communicable disease control.
It is of interest to note in Table 10 that no paralytic cases occurred
following a full course of three injections. A special study was made
during the three-month summer period to obtain more exact rates
of paralytic polio for the vaccinated and unvaccinated population.
The results, as shown in Table 11, indicate a definite protective ef-
fect of vaccination, which increases with the number of injections
given. These data must be taken with some reservation because of
inherent difficulties in obtaining accurate and complete reporting
and estimating the population at risk.
Difficulties in diagnosis were well illustrated by 30-day follow-
up reports received from county health officers which indicated the
clinical diagnosis of nine cases reported in vaccinated children were
changed to "not polio." This was 10 per cent of the total 92 original
cases reported in vaccinated children. The Virology Laboratory of
the State Board of Health was able to isolate polio virus from only
9 of the 42 stool specimens submitted from these children, and in
only 21 of 45 blood specimens submitted were polio antibodies of
significant titer found. It was of considerable interest that 11 of
20 blood specimens had significant titers of antibody against mumps,
indicating the possibility of a recent infection. A critical review of
all the evidence would undoubtedly further decrease the number of
cases of poliomyelitis occurring in vaccinated children. However,
the same criterion should also be applied to the cases occurring in
unvaccinated children, and this was not possible due to lack of labora-
tory specimens.

OTHER ROUTINE MORBIDITY SURVEILLANCE
Although total cases of typhoid fever remained essentially unchanged
(Table 13), new interest in typhoid was stimulated by a program of
phage typing all known typhoid carriers. Of the 92 known carriers,
35 were phage typed during 1956 by the Communicable Disease
Center, Enteric Disease Laboratory, Chamblee, Georgia. It is hoped
the remainder will be typed in 1957. The number of individual
phage type reports obtained on carriers is as follows: A 3, B1 2,
Cl 4, Dl 2, El 6, Fl 1, F2 1, N 3, Degraded Vi 8,
W form 2, Type 34 1, Type 38 1, Untypable 2, D Group
Utrecht IX 1. This phage typing information was used during the
year to show that there was no association between an outbreak
of several cases of typhoid in one small rural area.
Increased reported cases of mumps, measles, and influenza were
noted, but due to the change in reporting as described above, these
increases probably do not reflect true increased numbers of cases
of this magnitude. Despite the change in reporting, numbers of
reported cases of whooping cough and streptococcal infections fell

PREVENTABLE DISEASES 71

from 1955 and this undoubtedly indicates true decreases in actual
cases. Increased reports of Salmonellosis and bacillary dysentery
were largely due to efforts of the epidemiology staff in getting posi-
tive laboratory reports recorded in the morbidity statistics. The
downward trend in reported cases of infectious hepatitis, which be-
gan in 1955, continued through 1956.
Other routinely reported diseases showed no essential changes.
All eleven reported malaria cases were of foreign origin. Tetanus
and meningitis remain the leading causes of death from communi-
cable diseases in Florida, other than tuberculosis, venereal disease
and pneumonia. Although several deaths are reported each year
as due to encephalitis, these are not laboratory confirmed cases of
the known viral encephalitides.

SPECIAL INVESTIGATIONS AND UNUSUAL
OUTBREAKS OF DISEASE
During January and February, nine infant diarrhea deaths occurred
in the Belle Glade area in Florida, and 13 cases of amoebic dysen-
tery were reported by local physicians. A special investigation was
made in an attempt to determine whether there was any association
between the cases and deaths, as well as the general pattern of en-
teric disease in this area at that time. It was concluded that there
was an unusual amount of amoebic dysentery, particularly for chil-
dren, in the area but no common source or carrier was found. En-
teric disease in this significant farm labor area presents a problem
of inter-state importance since both the migrants and the raw vege-
tables they harvest are widely distributed over the northern states.
In the spring, the Leon County Health Department reported an
outbreak of an unusual exanthematous disease in school children.
The subsequent investigation showed this to be Erythema infectiosum,
or Fifth Disease. Distribution of this information to other health
officers in Florida resulted in the observation of a similar outbreak
in Okaloosa county.
In April 1956, the Charlotte County Health Department notified
the bureau of an outbreak of an unusual neurological disease. A
preliminary investigation revealed the symptomatology to be remark-
ably similar to that observed in the Tallahassee outbreak in 1954.
The illness was characterized by rather abrupt onset of headache,
myalgia of the cervical, thoracic and spinal musculature, incoordi-
nation, and disturbance of mood and mentation. A total of 144
cases were found or reported over an interval of three months. The
disease was again selective in severity for adult white females. Upon
invitation, this outbreak was intensively studied by the U. S. Public
Health Service Epidemic Intelligence Service. Despite an exhaus-
tive search, no laboratory evidence of an infectious agent was un-
covered in either the Florida State Board of Health or the USPHS

72 ANNUAL REPORT, 1956

Virology laboratories. An interesting clue of unknown etiologic im-
portance was found in the epidemiologic investigation by the nutri-
tionist from the Division of Nutrition. Of twenty-three patients with
the illness interviewed, only three received the recommended Vita-
min C allowance in their daily diet. None of the twenty-three re-
ceived the recommended amount of Thiamine. No epidemiologic
associations were found with water, milk, food or drug injection,
contact with animals or insects, nor were especial occupational or
environmental risks demonstrated. The tendency of this disease to
invoke emotional disturbances during a prolonged convalescence is
perhaps its most baffling and important aspect, meriting further care-
ful studies.
During the summer of 1956 a special survey for tuberculin sen-
sitivity was made at the Florida Farm Colony in Gainesville. The
major purpose was to evaluate the sensitivity of the patch test, using
the intra-dermal Mantoux with intermediate strength PPD as a refer-
ence standard. 83.9 per cent agreement between the two methods
was found. Of those tested where disagreement was found, 14.5 per
cent were Mantoux positive and patch negative. This apparent de-
creased sensitivity of the patch test varied directly with age. 5.8
per cent of the 5-14 age children had "false" negative patch tests,
compared with 31.0 per cent of the over 25 age group. Since in addi-
tion, 23 per cent of the original patch tests applied were accidentally
lost by the children, it was concluded that the patch test is not as
accurate or practical as the intradermal Mantoux for testing tuber-
culin sensitivity in Florida school children.
In the fall a special study to evaluate the effectiveness of a new
adenovirus vaccine was instituted in cooperation with the Bureau of
Laboratories. 117 volunteers were recruited from the central offices
of the State Board of Health and half were given an injection of the
new vaccine, the other half receiving a harmless placebo. The occur-
rence of upper respiratory illness, including extensive virological and
bacteriological studies by the laboratory, is being recorded over the
winter months, in order to evaluate the effectiveness of the vaccine
in preventing upper respiratory illness.

EPIDEMIOLOGIC STUDIES IN NON-COMMUNICABLE
DISEASE
Under a grant from the National Heart Institute, the Epidemi-
ologist and State Health Officer were responsible in 1956 for direct-
ing a study of the epidemiologic factors associated with the increas-
ing ratios of male vs female mortality. A research committee rep-
resenting vital statistics, psychology, sociology and epidemiology de-
veloped an interview format designed to determine any differences
that might exist in parental attitudes towards boys and girls which
might later affect their morbidity and mortality. Families of boy-

PREVENTABLE DISEASES 73

girl twins born in Florida in 1949, 1950 and 1951 are being studied.
This study is in process, and incomplete data preclude any conclu-
sions at this time.
The epidemiology of accidental poisoning in children was the sub-
ject of considerable time and activity by the staff in 1956. In co-
operation with the Florida Pediatric Society, The Florida Chapter of
the American Academy of Pediatrics and the County Health Depart-
ments, assistance was given toward establishing a statewide network
of Poison Control Centers in 15 strategically located cities through-
out the State. The pediatricians in each city established a treatment
center in the accident room of a hospital, centered around a file of
1500 common household products and their poisonous ingredients.
This file was prepared and distributed to the centers by Dr. Robert
Grayson, a Miami pediatrician, and his local committee. Cases of
poisoning seen in the centers are referred to county health depart-
ments for follow-up home visits. All data regarding the case is
recorded on forms prepared by the epidemiology staff. This in-
formation on these forms is coded and tabulated, and used as a basis
for preventive programs. The first tabulation for the 267 forms re-
ceived during 1956, from all the centers in operation is shown in
Table 4. The accumulation of this epidemiologic information on
accidental poisoning in children will be used to aid in the pre-
vention of such accidents, and it is hoped, will serve as a stimulus
for interest in general accident prevention activities.

Articles by staff members:
Bond, J. 0. The Effect of Vinegar on the Growth of Enteric Bac-
teria in Evaporated Milk Mixtures. J. Pediat. 49: 708-715, Dec.
1956.
Bond, J. O. "Tallahassee-Punta Gorda Encephalomyelitis." Electro-
lyte 2:10, Oct. 1956.

TABLE 9

REPORTED INJECTIONS OF SALK VACCINE FROM FEDERAL OR NFIP SOURCES

FLORIDA, APRIL 1955 THROUGH DECEMBER 1956

NUMBERS OF POPULATION VACCINATED IPER CENT OF POPULATION VACCINATED

Population

406,761
370,907
277,315
199,386
1,254,369
1,054,145
2,308,514

1 or More 1 or More
Injections 3 Injections 2 Injections 1 Inj. Only Injections 3 Injections 2 Injections

177,735
267,947
100,672
28,868
575,222
30,400
605,622

42,692
96,461
35,072
4,573
178,798
3,631
182,429

116,173
124,792
57,265
18,900
317,130
19,843
336,973

18,870
46,694
8,335
5,395
79,294
6,926
86,220

1 Inj. Only

Age.

0-4
5-9.
10-14
15-19
Under 20
20-40.
Under 40

PREVENTABLE DISEASES 75

TABLE 10

REPORTED CASES OF POLIOMYELITIS IN VACCINATED
CHILDREN FLORIDA, 1956

Vaccination Onset Less Than 30 Days Onset Over 30 Days
Received After Inoculation After Inoculation Totalso

Non- Non- Non-
Par. Par. Uns. Tot. Par. Par. Uns. Tot. Par. Par. Uns. Tot.

1 3 6 1 10 2 3 .. 5 6 13 2 21
2. 2 4 .-- 6 4 19 2 25 9 32 4 45
3, 0 2 .... 2 0 3 1 4 0 9 5 14
Unk. .. -- .. --- -- 3 3

Total 5 12 1 18 6 25 3 34 15 54 14 83

*Total includes 31 cases with interval between inoculation and onset unknown

TABLE 11

REPORTED CASES OF POLIOMYELITIS UNDER AGE 20 IN FLORIDA,
JUNE 1, 1956 TO SEPTEMBER 1, 1956 BY VACCINATION
STATUS BY PARALYTIC STATUS

Average Population CASES Rates per 100,000
Vaccination Status At Risk Par. Non- Uns.
Par. Tot. Par. Tot.

One inoculation 91,605 3 5 .... 8* 3.3 8.7
Two inoculations 269,806 2 18 1 21 0.7 7.8
Three inoculations 73,566 0 4 4 -. 5.4
Total vaccinated. 434,977 5 27 1 33 1.1 7.6
Total unvaccinated. 819,392 38 34 13 85 4.6 10.4
Grand Total 1,254,369 43 61 14 118 3.4 9.4

*Includes five cases with onset thirty days or less after vaccination.

TABLE 12

REPORTED CASES OF ACCIDENTAL POISONING, FLORIDA 1956

Type of Poison

Race and External Internal Cleaning Petro- Turpen- Cosme- Insecti- Rodenti- Herbi- Poison
Sex Total Unknown Medicine Medicine Agent leum tine tics cide cide cide Plant Other

267 12 12 100 30 50 5 2 38 1 1 12 4
Unk..... __..._.......... 11 5 2 4
W-M..--..---.. --.....-.. 101 6 4 31 12 17 2 20 1 6 2
W-F--- .. .._ 112 4 3 60 7 14 2 2 13 5 2
C-M--- .. ... 22 1 1 2 3 9 1 4 1
C-F ..._---------. ....... 21 1 4 2 6 6 1 1

Age....---.-. ..-..
0-4..--- .....--- ....... 208 5 5 75 24 44 4 2 34 1 1 9 4
5-9 ------------------- 5 2 1 1 1
10-14----- ------..... -----........--- 1 1
15-19 ..--.- .. --. ........- 8 1 1 5 1
20+ ---- ......- 36 6 4 17 4 1 2 2
Unk... ............ 9 3 4 2

C',

M

0

cr)

Co
mI

PREVENTABLE DISEASES

TABLE 13

CASES OF CERTAIN REPORTABLE DISEASES, FLORIDA, 1946-1956

DISEASE 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956

Anthrax..--------..... ..------- 0 0 0 0 0 5 0 1 0 0 0
Brucellosis ....---- 81 67 74 86 36 10 10 10 9 12 12
Cancer ------........ 1,041 1,025 1,880 4,394 5,090 5,057 5,333 5,717 5,640 5,852 6,591
Chancroid ------- --- 818 745 388 343 248 317 462 328 344 388 273
Chickenpox--...... -. 959 1,969 1,402 2,841 1,945 2,603 1,261 1,900 2,144 3,241 2,256
Dengue Fever-.... ----. 1 0 1 0 0 1 0 2 0 0 0
Diarrhea of Newborn------- 51 67 191 134 113 60 143 96 106 158 288
Diphtheria_ ---- 361 283 327 206 97 66 82 114 114 99 102
Dysentery, Amebic..--- 79 59 153 135 113 88 161 177 102 144 139
Dystentery, Bacillary----- 450 164 219* 77 50 47 235 53 48 68 83
Encephalitis, Viral_..--- 14 4 5 10 9 17 12 9 13 19 15
German Measles.------------ 153 64 56 43 45 214 304 305 126 190 205
Gonorrhea....-----.. .--. 18,548 20,160 18,820 15,388 14,185 12,709 11,809 11,459 11,841 12,146 10,991
Granuloloma Inguinale--- 257 271 773 827 446 417 233 109 71 69 73
Hansen's Disease .._.-------- 8 2 11 0 3 2 2 1 2 2 2
Hepatitis, Infectious.---.....- 32 24 66 4 27 46 236 301 303 262 152
Hookworm.... ---------- 3,805 4,605 5,008 6,636 10,051 6,561 6,611 4,206 4,772 3,551 2,659
Influenza-------- --- 227 1,083 366 258 235 584 218 1,406 279 157 219
Leptospirosis ---------- 0 0 0 0 1 0 0 1 1 1 1 0
Lymphopathia Venerea-- 176 216 197 127 34 40 120 96 55 51 55
Malaria ---------- --503 135 111 43 7 23 50 19 11 13 11
Measles------- ---- 3,491 1,315 4,802 3,753 2,499 2,431 4,072 1,316 10,766 1,495 5,186
Meningococcal Infections 77 49 48 41 53 92 88 102 96 88 69
Mumps--- ... ----- 1,592 914 1,329 1,791 1,452 2,101 1,985 1,112 1,516 1,933 4,353
Ophthalmia Neonatorum- 20 30 26 11 22 14 20 7 17 16 22
Pneumonia------------ 772 663 551 686 624 727 707 959 747 731 695
Poliomyelitis ---- 577 111 285 282 471 362 663 733 1,777 466 364
Rabies, Animal ----- 59 438 332 75 38 11 20 58 84 77 62
Ringworm of the Scalp.-- 1 6 6 50 103 196 167
Rocky Mt. Spotted Fever- 0 2 0 0 0 2 2 0 2 1 0
Salmonellosis*O------- 105 132 135 150 39 120 78 91 63 223 156
Scarlet Fever*"" --* 413 441 485 384 277 456 460 592 632 726 647
Syphilis----- ---- 16,067 16,653 15,395 12,363 10,738 9,445 10,824 6,722 6,894 5,541 7,182
Tetanus---------- 40 27 73 71 43 34 46 44 59 53 47
Trachoma------- ------- 0 0 0 1 0 1 1 0 1 0
Tuberculosis------ 2,437 4,335 3,313 3,198 2,337 2,590 2,603 2,424 2,461 2,253 2,453
Tularemia.----------- 7 8 19 29 18 6 18 7 3 5 2
Typhoid Fever------------- 66 66 103 51 30 23 36 41 31 56 60
Typhus Fever.------ 397 340 166 123 34 20 11 10 5 11 6
Whooping Cough- 1,029 1,861 731 191 471 920 291 209 339 1,080 547

*Includes other and unspecified.
0"Includes Paratyphoid Fever.
*0"Includes Streptococcal Infection.

78 ANNUAL REPORT, 1956

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

LABORATORY
Air pollution contaminants, their collection and subsequent analy-
sis, have been the major problem throughout the year. In the case
of fluoride contaminants alone, 104 determinations have been made.
In addition, a large number of field tests were made; for example,
air temperatures, humidity and sulfur dioxide levels were checked.
Industrial occupational health studies, surveys and routine analyses
have been conducted consistent with available time. In basic occu-
pational health practice, 277 chemical analyses were made of which
160 were for determination of lead in blood or urine. To this should
be added 43 control determinations to provide accuracy of analysis.
One study of special interest was done to estimate whether an ex-
posure to dichlorobenzene was hazardous to employees of the State
Plant Board.

AIR POLLUTION
The 1955 air pollution study around the phosphate processing
plants in Polk County was continued. As before, air samples were
taken in the vicinity of the plants, checking for the presence of fluo-
rine compounds and sulfur dioxide. It became apparent that unless
this procedure could be undertaken on a larger scale the study would
be unduly prolonged. Because of public pressure for immediate ac-
tion, it was decided to take samples directly from the plant stacks.
In this way it was possible to get reasonably accurate information
about the amount of fluorine discharged by each company. By the
end of the year, stack sampling had been carried out in four plants.
Many difficulties were encountered in this sampling. In some
cases the work had to be repeated because of variations in plant
processes. In other cases sampling points were difficult of access.
In addition, the chemical analysis for fluorine compounds is a tedious
and complicated procedure requiring much more time than taking
an air sample.
During the course of this study it became apparent that another
potential source of air pollution was present, namely, the products
of combustion of fuel oil. Large quantities of fuel oil are burned
in drying phosphate rock and concentrating phosphoric acid. It is
possible that these partially burned products of combustion are the
cause of the eye and throat irritation complained of by nearby resi-
dents. The possible effects of these pollutants as well as the po-
tential air pollution from rock drying plants remain to be investi-
gated.

PREVENTABLE DISEASES

On the basis of information obtained so far, it can be said that at
least partial control of the emission of fluorine compounds has been
attained. Also because of the rapid increase in commercial uses for
fluorine, several plants are now recovering it in substantial amounts
for sale. This recovery may be expected to increase, thereby re-
ducing air pollution from this source.

EDUCATION
The director was appointed Visiting Assistant Professor of Preven-
tive Medicine at the University of Miami School of Medicine. Two
lectures were given to junior medical students.

CONSULTATION SERVICES
Among the increased numbers of consultation services rendered
were several of special interest. Requests for assistance came from
Gadsden County about a rendering plant; Polk County: cypress knee
plant; Seminole County: concrete block plant; Duval County: oil
recovery plant; Hillsborough County, on potential contamination of
processed citrus peel by insecticides; Bay County: odor and discolora-
tion in water; Palm Beach County: use of parathion on lawns; Brow-
ard, Dade and Pinellas counties: malathion spraying for Mediter-
ranean Fruit Fly.
Assistance was given to the Jacksonville City Health Department
in setting up a study on the sanitary conditions in barber shops, and
also in an investigation into the odors arising from shell molding.

SPECIAL STUDIES
At the request of the Atomic Energy Commission and the Public
Health Service, the Division operated a monitoring station for de-
tecting air-borne radiation. A large volume air sampler was kept
in operation for 24 hours a day for about six months. Beta activity
readings were made on each filter using a Geiger Muller Survey
Meter, before forwarding to the central office. Adhesive plastic
film was also exposed every day. Changing films and filters, and
making reports required about one man-hour per day.

PERSONNEL
Mr. R. B. Hull joined the staff as industrial hygiene chemist on
March 1. He attended a two weeks training course for chemists at
the Occupational Field Headquarters of the Public Health Service
in Cincinnati. Because of illness, Mr. R. L. Hebblethwaite left the
Division in August for prolonged hospital treatment, and had not
returned by the end of the year.

80 ANNUAL REPORT, 1956

COOPERATION WITH THE FLORIDA
INDUSTRIAL COMMISSION
Further assistance was rendered to the Florida Industrial Com-
mission in the revision of their regulations for the control and pre-
vention of occupational diseases in industry. At the request of the
Commission, a study was made in a small electric utility powered
by diesel engines in order to determine whether or not the opera-
tion of the engines caused the formation of carbon monoxide in toxic
amounts in the engine room. Help was also asked in the preven-
tion of cement dermatitis.

MISCELLANEOUS ACTIVITIES
Because of the growing interest in air pollution, the director joined
the Air Pollution Control Association and attended its annual meet-
ing in Buffalo. The director and chemist also attended the Ameri-
can Conference of Governmental Industrial Hygienists' annual meet-
ing in Philadelphia.
Two meetings of the Legislative Committee on Air Pollution were
attended. The director attended the annual Sanitary Engineering
Conference in Gainesville and also was present at a meeting in
Cincinnati on Administration of Air Pollution Programs. He took
part in the Southern Regional Education Board meeting in St. Peters-
burg to discuss the industrial applications of nuclear energy. No
pollen counting was done, but the mold study was carried on for
the first four months of the year.
Requests for information about the Florida climate continued to
increase. A total of 107 letters were answered on subjects ranging
from pollen counts to the effect of the climate on arthritis and other
chronic ailments.

Articles by staff members:
McDonald, J. M.: Industrial Hygiene in Florida. Natl. Eclectic
Medical Quarterly. 47: 7-8, March 1956.

PREVENTABLE DISEASES

SUMMARY OF

TABLE 14
INDUSTRIAL HYGIENE ACTIVITIES

1956
Number of industrial establishments given service ._.--. -----------.---- -- 88
Number of workers affected by services...----....---------------. 2869
Number of other places and areas visited.....------... .---.----------..... 23

Number of field visits made:
Planned or self-initiated_ ..... 47
Requests and complaints. ---.... 8
Agency referrals- .---_... ------ 38
Plant Environmental No. o
Services: Visits
Routine inspection ------ 18
Industrial hygiene survey- 16
Technical study of hazards---- 32
Consultation only -.-.---. 12
Follow-up on recommendations 14
All other_ --- ---------- 24
Total ----. 116
Other Technical Investigations:
Air pollution -------- 11
Radiation surveys (non-indust) 4
Non-occupational problems 9-- 9
Total _-------- 24

Occupational disease reports ..--.- 3
Revisits ...-....---------------------- 32
Total .---------.... 128
f Environmental
Recommendations:
Number made .----...------------ 9
Number complied with .-------. 3
Field Determinations:
Atmospheric contaminants -- ... 47
Radiation monitoring -- 2
Total ....------. 49
Laboratory Analyses:
Routine --....----------- --- 13
Air pollution .------------- ------ 104
Biological -- ----------- 160
Total _......-- -- 277

Occupational diseases investigated 13
Occupational diseases reported .--. 827

RELATED ACTIVITIES
Office consultation services and inquiries handled --...-...----------- ---- 96
Lectures given .----.... 9 Demonstrations ..------ 4 Attendance ...------.....241
Meetings attended .- 16

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

The year 1956 has been a year of great change in the field of tuber-
culosis control. The impact of a situation in which there were ade-
quate hospital beds for treatment of the disease and the develop-
ment and extensive usage of anti-tuberculosis drugs made itself felt
in decreased hospital stay for many patients in most of our hos-
pitals. The availability of drugs for the outpatient treatment of
patients after discharge has probably gone a long way toward pre-
venting reactivation of this relapsing disease.
As an example, the preliminary analysis of the central tuberculosis
case register from July, 1955 through December, 1956 indicates that

82 ANNUAL REPORT, 1956

2467 patients were discharged from our state tuberculosis hospitals,
which is approximately 30 per cent more rapid turnover of patients
leaving with advice than any similar period. On the other hand,
there have been fewer relapses of patients after discharge. Of the
2467 patients discharged in the period mentioned above, only 6.7
per cent have shown reactivation according to the central case register.
If, however, we consider that 107 of the 167 patients showing re-
activation of their disease were discharged from the hospital against
medical advice, and consider only the 60 patients given medical
discharges, we arrive at the rather startling fact that in this 18 month
period only 2.5 per cent of the discharged patients who have been
followed by this office showed evidence of reactivation. One must
consider, however, that for the last six months of 1956 follow-up
information is rather meager, since there is usually a six months period
before information is received on discharged patients. So, in reality,
the above figures would represent a period of approximately twelve
months. (See Table 21).
The above facts, together with the slowly decreasing number of
cases being found in surveys accounts for the vacant beds in our
hospitals. As a result of these vacancies the Budget Commission ap-
propriated $80,000 with which to accelerate case-finding activities.
Two more mobile X-ray units with generators were purchased and
the older equipment renovated, giving a total of six units for state-
wide chest X-ray surveys.
With the stepping up of X-ray survey activities there has been
an increase in case finding and hospital admissions, and it is esti-
mated that by July 1957 there will again be waiting lists for Flor-
ida's tuberculosis hospitals due to surveys now being conducted in
large population areas in south Florida.

MORTALITY
Table 15 reveals the death rate for tuberculosis for certain years,
going back to 1920. The death rate from the disease decreased from
7.7 per 100,000 in 1955 to 6.3 in 1956. It is particularly gratifying
to note that the death rate continues to drop very rapidly in the
negro group from 14.6 per 100,000 in 1955 to 11.9 in 1956. The
reason for this is the rapid and satisfactory manner in which the
tuberculosis process responds to drug therapy in the negro race and
the availability of adequate beds for treatment. We still predict
that by 1963 the death rate for both races should be about the same
if the rate of decrease continues as it has over the past four years.
When one considers the year 1948 (before drugs were generally
available to most patients) there was a death rate of 27.8 per 100,000,
and compare it with the death rate of 6.3 for 1956, one can see that
the death rate since 1948 has declined 77.3 per cent. This is indeed
good news.

PREVENTABLE DISEASES 83

MORBIDITY
The true picture of the tuberculosis problem cannot be told by de-
clining death rates alone. The disease is still with us as shown in
Table 16. In this table we have combined the decrease in mor-
bidity with the decrease in mortality for the years 1948-1956. Here
we have a different story. The morbidity rate has declined from
128.0 per 100,000 to 63.3, or 50.5 per cent.
The number and percentage of reported cases for 1955 and 1956
is shown in Table 17. It will be noted that the number of newly
reported cases increased because of the increase in survey activity.
2453 cases were reported in 1956 as against 2253 in 1955.
The increase in cases reported for 1956 over 1955 does not re-
flect a real increase in cases, but rather an increase in case finding
activities which we feel will in the future decrease more rapidly
and permanently as larger segments of the population are examined
by X-ray surveys.
There was a decided improvement in the number of far advanced
cases, reported, and we still find the highest incidence in the age
group over 45, which includes approximately 50 per cent of the tuber-
culosis problem in white males alone.
Another very encouraging feature noted in Table 17 is that the
number of cases first reported by death certificate decreased from
72 in 1955 to 59 in 1956, a decrease to 2.4 per cent of all reported
cases as against 3.2 per cent in 1955. This has always provided a
very valuable epidemiological index.

CASE FINDING
The major portion of the activity of this division can be attributed
to mass community-wide chest X-ray surveys. Due to the availability
of additional personnel and equipment, as well as to the improve-
ment in the technique of community organization, we have seen
the total number of persons examined by X-ray surveys increase from
559,555 films in 1955 to a total of 742,652 films in 1956. This in-
crease can be wholly attributed to activities of the units of this di-
vision since several thousand less films were made by local units;
units operated by the division increased by 194,225 the number of
persons examined.
Not only have more people been examined, but a larger percent-
age of the population has been examined, and a more productive
group has been reached. For instance, in 1956, 42 per cent of the
population was examined by the state units in communities where
X-ray surveys were conducted as compared to only 31 per cent in
1955. In addition 85 per cent of those with suspicious films has
had follow-up X-rays along with clinical study as compared to 82

84 ANNUAL REPORT, 1956

per cent in 1955. As a result 669 new significant cases of tuberculosis
were uncovered directly as a result of surveys, and at least an equal
number indirectly from contact examinations. Also, 605 old cases
were again brought under follow up. Of the new cases found 172
were considered to be minimal, 348 moderately advanced and 117
far advanced. Of the total cases demonstrated 475 were considered
active cases. Hospitalization was recommended on the majority of
the active cases. Of the old cases again brought under follow up 59
were considered to have reactivated, requiring hospitalization.
In spite of the increase in cases found the new case rate per 100,000
decreased from 105.4 in 1955 to 90.7 in 1956 due to the fact that
more people were examined.
As a direct result of the surveys a total of 335 persons were given
hospitalization, or about one for every 2000 persons examined. If,
however, the active cases found are considered, one active case for
every 1500 persons X-rayed was discovered, and there was approxi-
mately one case of active and inactive disease uncovered for each
1000 persons X-rayed.
A large amount of pathology other than tuberculosis continues to
be found as a significant by-product of tuberculosis case finding. Such
conditions as heart disease, tumors and other pathology are shown
in Table 18.
We cannot give enough credit to the invaluable assistance given
by the local tuberculosis associations in organizing these surveys.
They have not only spearheaded the organization of communities,
creating the awareness of the need for X-ray examination of pre-
sumably well population groups, but they have greatly assisted finan-
cially by providing volunteer workers to assist in registering the in-
dividuals receiving X-ray examinations, and by paying for the pub-
licity used in the surveys as well as for the negative report cards
sent to each individual X-rayed.

CONSULTATION AND DIAGNOSTIC CLINICS
An analysis of the 14 x 17 inch diagnostic and consultation X-rays
(Table 19) shows an increase of 605 in the total films taken. A
total of 4631 films were interpreted as showing tuberculous pathology
in 1956 as against 3642 in 1955.
When one considers these interpretations by activity there were
1142 "probably active" or active cases in 1956 as compared with 766
in 1955. This accounts to a large degree for the fact that the hos-
pitals are rapidly filling to normal capacity.

CENTRAL TUBERCULOSIS CASE REGISTER
As usual a great part of the activity of this division is taken up
by compiling case records in a central tuberculosis case register.

PREVENTABLE DISEASES

Table 20 shows comparison of the cases in the register for the past
five years. Of the 3875 active cases in the register 2022 are hos-
pitalized as against 1853 who reside at home. Many of these active
cases residing at home are on drugs and are considered active cases
because of so-called "healed" cavities; but it is distressing to learn
that in spite of empty beds in our tuberculosis hospitals 394 patients
reside at home with positive sputum.
Table 21 shows the number of active cases at home with positive
sputum by counties. In reviewing this table there has been very
little change over 1955. It is hoped that the local health authori-
ties will see that positive sputum cases now at home are soon hos-
pitalized. In addition, there are still 32 per cent of the cases on,
the register whose sputum is undetermined, which indicates rather
poor follow up by the local health departments.
In regard to patients, who have relapsed after discharge from the
hospital, an individual study is being made to determine the num-
ber who have shown relapse where no information is available on
the register.

ACTIVITIES IN LOCAL HEALTH UNITS
As a result of the development of outpatient chemotherapy along
with the continuing mounting backlog of tuberculous patients, there
has been a proportionate increase in the activities of local health
units. This year there has been a total of 2845 active cases admitted
to service in local health departments and an additional 5143 in-
active cases who must be followed up, many of whom are on out-
patient chemotherapy. Also admitted to service were 17,829 con-
tacts and suspects.
Of the total cases admitted to hospitals 1675 were admitted through
local health departments, or approximately 90 per cent of all ad-
missions.

TUBERCULOSIS HOSPITALS
The number of empty beds in tuberculosis hospitals has gradually
decreased over the past few months. There are approximately 100
more patients in the hospitals as of February 25, 1957 as compared
with the same date in 1956. If case finding of tuberculosis continues
at the current rate there would seem to be little reason why all
of the tuberculosis hospitals should not be filled to capacity. If the
394 positive sputum cases at home were hospitalized we would again
have a waiting list.
There is little justification at this time for the rumour which ad-
vocates closing one of these hospitals. Tuberculosis still it, and will
continue to be for some time to come, our principal public health
problem.

86 ANNUAL REPORT, 1956

TABLE 15

DEATHS FROM TUBERCULOSIS (ALL FORMS) AND DEATH RATES
PER 100,000 POPULATION BY COLOR,
Florida, Selected Years

TOTAL WHITE COLORED
YEAR
Deaths Rate Deaths Rate Deaths Rate

1956*.....-...... 244 6.3 157 5.0 87 11.9
1955..... ... 281 7.7 175 6.0 106 14.6
1954 283 8.1 159 5.7 124 18.1
1953 303 9.7 171 6.9 132 20.7
1952 501 16.7 250 10.5 251 40.0
1951 518 17.9 279 12.2 239 38.7
1950 .- -- 522 18.7 254 11.6 268 44.1
1945 708 31.1 339 19.7 369 66.2
1940 .. 973 50.8 375 26.8 598 115.6
1935 ..---- 908 56.0 395 34.3 513 109.4
1930 ------1,015 68.6 432 41.3 583 134.0
1925 999 80.8 426 50.0 573 148.7
1920------ 1,016 102.3 423 64.3 593 176.8

*Preliminary
Note: Deaths and rates, 1930, 1925 and 1920 are by place of occurance. Other years
by place of residence.

TABLE 16

TUBERCULOSIS CASES REPORTED, CASE RATES,
DEATHS, & DEATH RATES
FLORIDA, 1948-1956

Year Cases Reported Case Rate Deaths Death Rate

1948
1949
1950
1951
1952
1953
1954
1955
1956

3,313
3,198
2,337
2,520
2,603
2,424
2,461
2,253
2,453

128.0
118.7
83.5
86.8
86.5
77.9
70.6
61.4
63.3

PREVENTABLE DISEASES 87

TABLE 17

NUMBER AND PERCENTAGE OF REPORTED TUBERCULOSIS CASES BY
STAGE OF DISEASE, RACE AND SEX, AGE AND SOURCE OF REPORT.
FLORIDA 1955 AND 1956

1955 1956
Stage of Disease, Race and Sex, Age
and Source of Report Cases Percent Cases Percent

TOTAL CASES ........- ..............- 2,253 100.0 2,453 100.0

STAGE OF DISEASE.
Primary .......-..-_.. .... 41 1.8 73 3.0
Minimal--------- --- -_--- 396 17.6 348 14.2
Moderately Advanced-.._ .............. 853 37.8 993 40.5
Far Advanced .-..... .... 657 29.2 634 25.8
Non-Pulmonary_ 51 2.3 59 2.4
Unknown-.---..... -- .......- 255 11.3 346 14.1

RACE AND SEX
White Male...-_.........- 1,035 45.9 1,124 45.8
White Female .. --- ----__ 544 24.2 570 23.2
Colored Male -....._...._.._. .... 424 18.8 447 18.2
Colored Female----- 240 10.7 266 10.9
Unknown .....__............... ---- 10 0.4 46 1.9

AGE
Under 5 ........ .... ....... 58 2.6 57 2.3
5-14 ---...........___...._.. __.....-... 28 1.2 50 2.0
15-24-........--_.__.....-....-..-.. .. 168 7.5 164 6.7
25-44...--------. .. ----....... ----... -- 834 37.0 871 35.5
45-64 ......- ... ---...__ 779 34.6 844 34.4
65 Plus.--.-- --.--...... ........... 341 15.1 400 16.3
Unknown--- -. ------------. 45 2.0 67 2.8

SOURCE OF REPORT
Health Department ---------------------- 1,507 66.9 1,677 68.4
Sanatoria .--.-- .......- -- _...._ 249 11.0 322 13.1
Private Physicians -..-..-.. ..... 56 2.5 42 1.7
General Hospitals --...-......----- 17 .8 23 .9
Out-of-State----....-- -..._ ........_---- --. 141 6.3 151 6.2
Death Certificates_- -......---. .... 72 3.2 59 2.4
Veterans Hospitals ...------._-..---- -------_. 183 8.1 150 6.1
Florida State Prisons.-------......._ ----..------... 18 .8 24 1.0
Florida State Hospitals ..-__-----------------.. 5 .2 1 .0
U. S. Recruiting Stations-___... ------------_. 5 .2 4 .2

TABLE 18
RESULTS OF 70mm X-RAY SCREENINGS AND 14" X 17" FOLLOW-UP
FILMS ACCORDING TO RACE AND SEX, AGE, AND COUNTY, FLORIDA, 1956
70mm X-RAYS 14-in. x 17-in. X-RAY FOLLOW-UP FILMS ALL FILMS
Film Impressions FINDINGS NEW CASES FOUND
By Stage By Activity

AGE, AND COUNTY & '
d a Ql l >f |
0 o a a 0 :& '0 4 a a
P4 Pk 0 Och 1-0 Pk4, Z On Z 0 r- U 0
GRAND TOTAL ....-.-. 742,652 30.9 8,2027,969J726,481 6,126 75.5 669 605 348 1,198 970 2,336 172 348 117 32 475 194 335 90.7 59 3,107 704 ,356
MASS SURVEY X-RAY SCREENINGS WITH 14 X 17 FOLLOW-UP
SUB-TOTAL ......... 422,406 42.4 4,403 4,096 413,907 3,723 84.6 410 275 198 622 720 1,498 86 251 57 16 271 139 185 97.1 4511,634 430 ,654
RACE AND SEX
White Male_.._.... 158,853 42.1 2,308 1,6551154,890 974 82.5 170 88 57 271 122 266 40 102 21 7 99 71 58 142.1 25 482 235 1,209
White Female 183,789 47.4 1,488 1,467 180,834 728 84.2 103 52 35 201 96 241 30 61 7 5 52 51 28 76.0 3 553 133 982
Colored Male- ..... 35,885 31.5 332 453 35,100 221 79.2 53 34 24 44 12 54 10 34 7 2 44 9 30 169.9 15 244 37 216
Colored Female -...- 37,443 31.5 235 487 36,721 157 74.1 24 12 10 22 16 73 4 13 5 2 18 6 13 72.7 2 338 20 151
Unknown .......... 6,436 ..... 40 34 6,362 25 83.3 5 2 __._ 7 2 9 3 2 .... 3 2 1 92.3 -... 17 2 22
AGE (e)
15-24 .. 95,908 53.9 222 207 95,479 149 78.8 16 4 8 18 10 93 1 9 4 2 15 1 13 19.4 1 64 11 150
25-34_ 77,774 37.9 296 199 77,279 194 80.8 41 15 11 30 20 77 13 18 8 2 33 8 26 63.6 1 42 25 162
35-44 _- 77,291 38.4 487 346 76,458 333 87.6 58 33 14 71 38 119 14 36 5 3 40 18 24 94.1 8 111 41 265v
45-54_ .... 63,979 39.3 670 664 62,645 390 83.9 76 36 21 98 39 120 13 45 12 6 45 31 28 156.9 11 269 72 421
55-64--....--...-. -----. 49,638 41.1 914 861 47,863 428 81.7 79 46 33 104 58 108 18 52 7 2 44 35 25 239.9 16 368 85 512
65 and over -.._..--- 46,343 36.0 1,675 1,710 42,958 552 79.1 78 48 38 207 74 107 25 47 5 1 36 42 13 298.5 8 733 1781,006
Unknown ......... ..... 11,473 ....-... 139 109 11,225 59 83.1 7 6 1 17 9 19 ....- 6 1.... 3 4 1 81.8 47 15 64
COUNTY
Alachua .... ...- 15,529 33.0 99 207 15,223 88 88.9 9 12 4 28 4 31 4 1 3 1 6 3 9 ...... 4 57 24 154
Baker. -- -- 1,329 25.8 7 16 1,306 5 71.4 1 ... 1 3 ----.....- 1 1 .. 1 ---.. 8 2 9
Bradford ----- 2,269 26.4 12 21 2,236 10 83.3 3 1 .__ 1 4 1 .._ 2 1 -... 3_ 2 ... 12 ... 10
Brevard__ 13,313 34.8 68 91 13,154 45 66.2 10 9 ... 8 8 10 .... 9 1 5 5 6 .-...- 1 33 11 55
Charlotte .. ------------ 1,524 41.8 11 11 1,502 7 63.6 0 2 1 3 1 _---------.. ..... .- -...-..... -- ...... 4 .-..-- 10
Citrus --------- 1,920 43.3 9 18 1,893 8 88.9 1 2 -.... 3 1 I .__ 1_. 1 --- .-.....- 9 2 10
Clay ..._.._ 3,048 24.5 20 54 2,974 15 75.0 3 1 2 4 1 4 1 2 ..- 3 2 1 25 1 32
Columbia__ ... 3,183 22.8 24 45 3,114 21 87.5 3 2 2 8 2 4 -- 3 .- 2 1 2 ....__ 17 6 30
Duval __84,994 29.7 1,115 620 83,259 1,036 92.9 177 48 64 244 147 356 45 110 15 7 110 67 53 ---.. 7 250 79 535
Flagler ...______ 1,066 31.1 4 8 1,054 0 -- -- - -- -- -.......... 1 ------ 7
Franklin 1,416 36.7 5 10 1,401 4 80.0 3 -- ----. -- 2 1 2 1 --------------- 6. 4
Gadsden_______ --.. 7,417 23.8 36 73 7,308 15 41.7 3 4 1 3 2 2 1 1 1 .... 1 2 1 40.4 2 29 3 44
Gilchrist -----...... 464 22.4 5 5 454 3 60.0 .... 1 2 --.. ------- --- -....--.- --.... -. --- -- -- 3-. 4
Gulf--___- ..... 3,255 48.4 10 28 3,217 8 80.0 1 2 1 3 1 _1_ _- 1 ----.. 1 1 30.7 1 15 1 15
Hamilton__ .._. 1,649 26.8 14 18 1,617 9 64.3 3 3 1 1 1 __ 1 2 2 1 1 181.9 1 8 4 7
Hemando -.... 2,248 36.1 29 20 2,199 23 79.3 6 2 ... 6 4 5 1 4 1 .- 4 2 2 266.9 7 2 17
Indian River ..... 3,706 30.3 18 54 3,634 13 72.2 2 1 1 51 2 22 2 2 -.. 54.0 36 ------ 23

TABLE 18 (continued)
RESULTS OF 70mm X-RAY SCREENINGS AND 14" X 17" FOLLOW-UP
FILMS ACCORDING TO RACE AND SEX, AGE, AND COUNTY, FLORIDA, 1956
70mm X-RAYS 14-in. x 17-in. X- AY FOLLOW-UP FILMS ALL FILMS
Film Impressions FINDINGS NEW CASES FOUND
1 By Stage By Activity
RACE AND SEX .
AGE, AND COUNTY o4 a a.9Q'E>
Jeerso 1,906 29.0 1 6 23 77 66, -I ... 1 a -a' -uO i-- -1 9 10

Leon... 19,896 44.6 229 206 19461 165 72:1 14 12-11 25-8 95-4-7 1 2 9 5-8-70:4 11 80 29 122
Levy 2215 33.0 22 2 2 1 8 0 3
0 ~ W a > E o

Jefferson ------------------- 1,906 29.0 623 1,877 4 66.7 1 -. 13 -- 11
Leon --------------19,896 44.8 229 206 19,461 165 72.1 14 12 11 2 9 4 7 1 2 9 5 8 70.4 11 80 29 122
Levy 2,215 33.0 22 29 2,164 18 81.8 3 2 ___ 1 1 1 1 2 1 135.4- 10 3 20
Liberty 422 24.6 1 5 416 0 ----- 1 1 3
Madison 3,216 30.0 19 45 3,152 15 78.9 33 1 4 2 -1 3 3 93.3 1 25 2 22
Manatee 12,749 38.8 78 171 12,500 70 89.7 14 4 1 27 8 3 9 2 8 6 4 109.8 78 5 115
Marion--- --------- 11,134 33.9 45 135 10,954 33 73.3 4 4 3 13 4 --- 4 3 35.9 1 53 4 91
Martin ------ 2,869 38.2 21 33 2,815 12 57.1 3 -.. 1 3 2 1 3 3104.6 15 2 19
Nassau ---- 4,865 43.6 39 37 4,789 29 74.4 2 5 2 10 1 1 2 41.1 3 17 10 20
Okeechobee 1,339 42.6 12 20 1,307 10 83.3 2 1 1 1 1 1 --------- 1 1 1 149.4 --.. 12 12
Osceola ......-- 2,702 27.6 17 47 2,638 13 76.5 3 2 1 4 2 1 --. 1 2 111.0 24 6 21
Pinellas --.-.. 119,057 70.6 1,8361,250 115,971 1,618 88.1 55 87 72 7 472 85 2 38 15 55 55 46.2 .436 169 722
Putnam .....--.... 5,109 23.1 28 51 5,030 17 60.7 4 4 2 3 .. 2 1 1 4 2 78.3 24 5 25
St. Johns.- 8,940 38.5 78 80 8,782 62 79.5 9 20 4 1 1 1 7 1 5 4 2 100.7 3 40 2 51
St. Lucie 9,260 43.5 75 111 9,074 49 65.3 12 5 3 1 1 7 4 6 6 4 129.6 1 66 1 63
Sarasota ..------ 15,786 49.7 95 175 15,516 89 93.7 15 14 7 3 1 2 11 2 9 6 7 95.0 2 87 15 108
Taylor-... --- 3,514 38.4 21 2 3,465 17 81.0 1 2 1 .. 1 1 --- 28.52 16 3 18
Union 999 17.7 7 12 980 5 71.4 .__ 2 1 1 8 5
Volusia .. ---- 24,894 379 242 266 24,386 150 62.0 37 8 7 4 14 4 14 16 5 2 16 21 9 148.6 2 82 29 197
Wakulla ---------. 1,086 32.3 3 12 1,071 0 -- --. --- ----- -- -- -- 6 6
Florida A&M Univ.. 2,818 100.0 4 12 2,802 3 75.0 1 -- 1 1 1 35.5 7 6
Florida State Univ.. 6,885 98.6 6 16 6,863 6 100.0 1 2 -- 1 1 --- 1 14.5 6 1 10
University of Florida-- 12,415100.0 33 33 12,349 28 84.8 2 10.... 4 1 1 1 1 .-- 1 1 116.11 8 8 21
OTHER X-RAY SCREENINGS
SUB TOTAL --. 320,246 17.2 3,79 3,87 312,574 2,403 64.8 259 330 150 576250 838i 86 9760 16 204 55 150 82.3 14 1,473 2742,702
Broward Health Dept..- 28,617 19.7 371 39 27,854 196 52.8 18 7 15 37 44 75 9 2 15 3 8 62.9 ..- 296 125
Dade Health Dept..._- 19,217 3. 635 27 18,306 518 81.6 33 60 212 69 144 12 10 11 28 5 21 171.7 179 1 292
Dade TBC Ass'n.------ 64,480 12. 427 651 63,402 300 70.3 37 64 .I 101 50 48 8 25 4- 37 20 57.4 8 192 6 495
Duval Medical Center 5,394 1. 89 13 5,173 FOILOW-UP NO t A AI AB 65 60
Jacksonville Health D... 29,332 18. 590 30 28,442 531 90.0 36 40 12 78 41 324 5 12 1 5 36 36 122.7 157 1 211
Escambia Health Dept.- 11,19 10. 7 9 11,021 68 87.2 12 8 4 8 11 25 2 4 3 9 3 9 107.2 32 66
Hillsborough Health D.. 86,083 36. 1,04 1,15 83,893 460 44.2 78 131 89 86 12 64 4 24 1 4 55 23 34 90. 5 328 10 808
Orange Health Dept. 20,76 14. 26 35 20,149 91 34.3 6 3 13 15 42 1 1 3 1 6 -- 3 28.9 102 21 241
Palm Beach Health D. 12,41 10. 82 13 12,201 64 78.0 14 820 3 5 8 6 10 112. 1 32 1 101
Pinellas Health Dept.-. 11,237 6. 7 136 11,025 71 93.4 5 5 9 9 1 42 .. 4 1 544. -.. 36 1 99
Polk Health Dept..... ... 31,509 27.1 146 255 31,108 104 71.2. 20 4 6 13 7 54 11 1 6 14 4 63. .. 54 1 204
(a) Excludes unsatisfactory films. Distribution by age, race and sex based on a 10% sample of films.
(b) Based on estimated 1956 population 15 years and over in area surveyed.
(c) Counties without follow-up excluded from totals.
(d) Rate per 100,000 satisfactory 70mm. films. Totals exclude counties without follow-up.
(e) Age, race and sex for 1,618 follow-up films in Pinellas County not available.

90 ANNUAL REPORT, 1956

TABLE 19

FINDINGS OF CLINICS AND CONSULTATION (14 X 17) CHEST
X-RAYS INTERPRETED IN 1956 BY SUBMITTING FACILITY, REASON FOR
TAKING FILM, RACE AND SEX, AGE AND ACTIVITY. FLORIDA

Tuberculosis Pathology by Stage I Non-
Tuberculosis Unknown
Pathology
Submitting Facility, Reason for .&, ,'
Taking Film, Race, Sex and Age 1 '
and Tuberculosis by Activity a 0

c 2S0 U Q 0(2 1:t P4

TOTAL -- ___.. 20,399 12.567 4,631 1,210 2,235 354 681 151 312 636 926 1,062 265

FACILITY SUBMITTING FILM
Diagnostic X-ray Clinic.......--- 6,163 2,847 2,078 462 1,035 172 352 57 139 258 356 437 48
_County Health Department. 10,838 6,825 2,286 694 1,027 156 316 93 157 348 494 531 197
Private Physician-..-......... 205 126 22 4 11 5 2 -- 6 7 16 25 3
General Hospital..__ ..... 487 410 8 1 3 1 2 1 3 9 33 20 4
State Prisons ............ 2,614 2,299 224 41 155 20 8 -..- 4 13 24 41 9
Florida Farm Colony ..-_.._--. 57 41 3 1 2 _.. 3 .. .. 1 5 4
Other-___ ... .... 35 19 10 7 2 .... 1 ... .... 1 2 3

REASON FOR TAKING FILM
Mass Survey Follow-Up _....... 2,374 929 354 106 212 25 10 1 129 277 319 344 22
Known Case Follow Up -........ 4,114 30 3,908 1,025 1,857 270 645 111 4 44 14 80 34
Suspect Follow-up......... 1,913 1,116 124 30 51 28 9 6 66 113 187 260 47
Contact of Case.. 3,792 3,402 73 13 20 6 5 29 47 34 66 107 63
Possible Source Case _......... 65 58 3 ........ 2 ... 1 2 -..... 1 1
School Employee ... --..---- 347 328 1 1 .... _... .. ... 7 3 4 4
Food Handler, etc._-- ......-- 2,160 1,999 23 9 13 1 .. .- 15 35 35 29 24
Military Examination ..._-_- 67 59 1 .. 1 -- ...- ... 1 .. 4 2
Prenatal ------ 132 114 11 2 5 .. 4 1 1 2 2 1
Medical Personnel .~.... 284 269 3 2 1 _-- 1 8 1 2
Other ..._...._..... 5,151 4,263 130 22 74 24 6 4 50 121 292 230 65

RACE AND SEX
White Male...----- --... --... -- 7,761 4,478 1,848 452 992 167 204 33 133 302 420 482 98
White Female .._.. .....-.. 6,736 4,547 1,137 400 491 60 156 30 102 261 273 333 83
Colored Male _._---.....-- 3.199 1,819 971 188 490 87 161 45 53 46 136 137 37
Colored Female -...--. ---... 2,546 1,607 662 166 255 38 160 43 22 20 91 98 46
Unknown... -------- --......---. 157 116 13 4 7 2 -- 2 7 6 12 1

AGE
Under 5 --- .......___.. ... 247 114 59 4 ~.55 15 1 4 28 26
5-14....--....---....----- 1,472 1,205 103 11 2 ... 2 88 37 12 22 73 20
15-24--..........----. -- --- -- 2,828 2,434 231 72 87 15 49 8 28 13 40 60 22
25-44....------------.-...... 7,336 4,947 1,711 524 700 113 374 57 140 167 243 71
45-64---------....~..... -----.. 5,802 2,780 1,841 470 995 148 228 .- 106 268 332 389 88
65 and over.... -..-.--.--- -- 2,381 825 665 126 439 73 27 66 193 345 248 39
Unknown--.--... ------..--... 333 262 21 3 12 5 1 -.. 3 9 16 21 1

ACTIVITY
Active..-- ...-------. -__---- ..... 591 25 243 228 19 76
Probably Active .-- --- ....-. -- --..... 551 72 382 60 18 19
Inactive----- -----......... ._.._. ..... 293 202 47 5 15 24 -
Probably Inactive .----. -- 3,196 911 1,563 61 629 32 ....

PREVENTABLE DISEASES

TABLE 20

COMPARISON OF TUBERCULOSIS CASE REGISTER STATISTICS,
FLORIDA, 1952-1956

Tuberculosis Cases by Number of Cases Percent Distribution
Activity, Location
nStatustm 1952 1953 1954 1955 1956 1952 L953 1954 1955 1956

TOTAL CASES IN I
REGISTER ............ 11,172 11,608 11,009 10,821 11,893 1. 1000 100. 100.
Active Pulmonary
Tuberculosis........--. 3,976 4,024 3,735 3,631 3,875 35.6 34.7 34.0 33.5 32.6
Questionably Active
Tuberculosis....-...1-..--- 1,253 1,150 1,028 768 688 11.2 9.9 9.3 7.1 5.8
Inactive Pulmonary
Tuberculosis---.....-.. .. 5,846 6,281 6,075 6,209 7.048 52.3 54.1 55.2 57.4 59.2
Primary Active
Tuberculosis .._...... ... 63 79 107 163 ...... 0.5 0.7 1.0 1.4
Non-Pulmonary
Tuberculosis ..---.._ ------ 97 90 92 106 119 0.9 0.8 0.8 1.0 1.0

ACTIVE PULMONARY
TUBERCULOSIS .---------3,976 4,024 3,735 3,631 3,875 100. 100 0. 10. 00. 100.
Hospitalized ----.. 2,038 2,115 2,150 1,979 2,022 51.3 52.6 57.6 54.5 52.2
At Home-........----......-. 1,938 1,909 1,585 1,652 1,853 48.7 47.4 42.4 45.5 47.8

ACTIVE PULMONARY
CASES AT HOME---.......... 1,938 1,909 1,585 1,652 1,853 100. 100. 100. 100. 100.
Positive Sputum-- ............. 987 865 424 328 394 50.9 45.3 26.7 20.0 21.3
Negative Sputum._....... 608 781 633 769 856 31.4 40.9 39.9 46.4 46.2
Undetermined Sputum.---- 343 263 528 555 603 17.7 13.8 33.4 33.6 32.5

	Front Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Official staff Florida state board...
	County health officers
	Organizational chart
	Table of Contents
	General summary
	Division of health information
	Bureau of local health service...
	Bureau of vital statistics
	Bureau of maternal and child...
	Bureau of preventable diseases
	Bureau of laboratories
	Bureau of special health servi...
	Bureau of sanitary engineering
	Bureau of narcotics
	Bureau of dental health
	Bureau of entomology
	Bureau of mental health
	Bureau of finance and accounts

MILLISECOND	CLASS.METHOD	MESSAGE
0	sobekcm_page_globals.constructor
0	sobekcm_page_globals.constructor	Application State validated or built
0	sobekcm_database.verify_item_lookup_object
0	sobekcm_page_globals.constructor	Navigation Object created from URI query string
0	sobekcm_database.verify_item_lookup_object
0	sobekcm_page_globals.display_item	Retrieving item or group information
0	sobekcm_page_globals.get_entire_collection_hierarchy	Retrieving hierarchy information
0	sobekcm_assistant.get_entire_collection_hierarchy
0	cached_data_manager.retrieve_item_aggregation
0	cached_data_manager.retrieve_item_aggregation	Found item aggregation on local cache
0	item_aggregation_builder.get_item_aggregation	Found 'all' item aggregation in cache
0	system.web.ui.page.page_load (ufdc.page_load)
0	sobekcm_page_globals.constructor.on_page_load
0	html_echo_mainwriter.add_style_references	Adding style references to HTML
0	html_echo_mainwriter.add_text_to_page	Reading the text from the file and echoing back to the output stream
48	html_echo_mainwriter.add_text_to_page	Finished reading and writing the file